Loading...
189 James Rd�ia a��1 4o: C-10 DAVIE COUNTY HEALTH DEPARTMENT ,so Ko Environmental Health Section owe- foo P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 • (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990000669 Tax PIN/EH M 5769-96-7043 Billed To: Paul Boger Subdivision Info: Reference Name: Paul Boger Sr. Location/Address: 189 James Road 27006 Proposed Facility: Residence Property Size: 1.008 Acre ATC Number: 2108 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A,, Wastewater Systems, Section .1900 Sewage Treatment an&Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type M,t> #People I #Bedrooms 2- #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water SupplyCLh� Design Wastewater Flow (GPD) Site: New Repair ❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width MV' Rock Depth _12�-" Linear Ft.Z'qO� Other: WTI C-3 -tIDV� Required Site Modifications/Conditions: W�111- ori CZIATOOP- r Io' O(F OP -d- ( tJC, t IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final u:spection of this s tem between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 in. on the day of installation. Telephone # is (336)751-8760.**** APPRoK-. 1?o' to, t,41,4, AQP. u •JL 3 N- �fo' MIS L4 "J . Environmental Health Specialist's Signat re: DCHD 05/99 (Revised) Date DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990000669 Tax PIN/EH #: 5769-96-7043 Billed To: Paul Boger Subdivision Info:, Reference Name: Paul Boger Sr. Location/Address: 189 James Road -27006 Proposed Facility: Residence Property Size: 1.008 Acre ATC Number: 2108 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WAS O $/TRUC ION IS ID FOR A PERIOD OF FIVE YEARS. 700 Environmental Health Specialist's Signa Date: 1/4 CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: Environmental Health Specialist's Signature : DCHD 05/99 (Revised) Date: l holqi APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & AT D 0 V N Davie County Health Department Environmental Hea/ffi Section 1 2 W9 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 ENVIRONMENTAL HEALTH nAwrNiRTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed 64, Mailing Address Ra. ,/3 ems' 2Z City/State/ZIP GI'�di�f �%i Ci 7 `70th (D 2. Name on Permit/ATC if Different than Above Contact Person Home Phone -79,V— 3� -- 7 Business Phone Mailing Address �e City/state/Zip 3. Application For: 9"'Site Evaluation Id improvement Permit/ATCth 4. system to service: ❑ House 2(Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People —� # Bedrooms Z # Bathrooms / ❑ Dishwasher ❑ Garbage Disposal "W shing Machina ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: C,Jf County/City ❑ Well ❑ Comm mitty e . Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes "io If yes, what type? k**IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # 7 6, 9 g G 7 0�1 3 Property Address: Road Name j' (Td ,a- 2 City/Zip fd�u qtr �_ c� �7 �, 77041ly If in a Subdivision provide information, as follows: Name: WRITE DIRECTIONS (from MockrAlle) to PROPERTY: %-ter v L-O)rt &A) 6,Lv4y Ad dd! aa6ay Aim J;_�.� A s .Poi 'to Ge I Section: Block: Lot: Date Property Flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) Issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted In this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE 7 — // 9!Z SIGNATURE Pois4/Or THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: I EHS• Revised DCHD (07/99) Account No. ��✓/ Invoice No. O J/ m�I 00.22' (pip TO EIP) PLAT B00 5 PAGE 99 z z o 138 IN,p N0. H-7-3 ANO WE. GTo $ 3 . DAVID SPACH SUSIE R. SPACH Z N Z-, DB 98 PG 487 to O �a -0w �1- 44' IP TO OLD IGLE IRON) -- r �� ,cEo 1 �R PIAT BOOK -\ PAGE 99 t37� I y TAX MAP N0. I 60 0 60 120 180 if GRAPHIC SCALE - FEET PATRICIA MILLER (PIP TO PIP) N 86'28'31"E 330.00' TOTAL 329.78' 0.998 ACRE BY COORDINATES I POWER POLE rz-m�-SHED - i O` GRAwE nanuA T_._ \ (PIP TO PIP)BLL _DG• N 8619'00"E 326.70' T POWER P (OLD ANGLE IRON 0 OA \ TO PIP) .r SHED \0 sem. 0 99 Op. 1.008 ACR J;. Y COORDINA ZOS I 3?5 93 3g6.25P01 S 74 4u MPRKEO PAGE 99 Plp'T gcoKr g j -2 , NO N,7 T AT MP PRCE\. 3NAS5 ,%A, 82 PG g19 .••CA�O` I. GRADY L. TUTTEROW CERTIFY THAT UNDER Q •.•O�ESS�0• �i!_� MY DIRECTION AND SUPERVISION THIS MAP Q. ti '9 WAS DRAWN FROM AN ACTUAL FIELD SURVEY Q C MADE TTEI WSUR NG COMPANY SEAL L-2527 OPR- LAND SURVEYOR L-2527 �9Et'' Q, �Y SUR�. \ `� �% PIP C/L CENTERLINE BRIER CRI, V I 0 , Cz TOTAL A 2.006 A;' BY COORDI':-,, f(S NOTE: AREA(S) SHOWN THE RIGHT-OF-WAY OF TUTTEROW SURVEYING 127 LIBERTY CHLIRC'. MOCKSVILLE, NC (336) 492-561 M• pe SURVEY FORPAUL F. BOGE SCALE 1 „ = 60 1 APPROVED BY G LT DATE 5-10-99 BEING A COMBINATION OF TWO TRACTS OF LAND STANDING ROGER G. BOGER (DB 186 PG 768) AND J. W. BOGER (D;` IN SHAnY r,RnvF MWNSHIP DAVIE COUNTY_ NORTH CAROLII' PARCELS 59 and 60 OF TAX MAP NO. H-7 APPLICANT INFORMATION DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ' Soil/Site Evaluation Account #: - 990000669 Billed To: Paul Boger Reference Name: Paul Boger Sr. Proposed Facility: Residence PROPERTY INFORMATION , Tax PIN/EH #: 5769-96-7043 Subdivision Info: Location/Address: 189 James Road -27006 Property Size: 1.008 Acre Date Evaluated: ZZ Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % HORIZON I DEPTHp- Texture group G1— Consistence g Structure Mineralogy1; HORIZON II DEPTH ZOO — Z Texture groupG Consistence Structure Mineralogy HORIZON III DEPTH 5 2 -- -Texture group Consistence Structure L Mineralogy HORIZON IV DEPTH Texture group Consistence Structure .". Mineralogy=< SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE .: CLASSIFICATION LONG-TERM ACCEPTANCE RATE 0. __Q::3 " SITE CLASSIFICATION: PS r LONG-TERM ACCEPTANCE RATE: - EVALUATION BY: L�0C_k444�,,P OTHER(S) PRESENT: REMARKS: _L -yr C�'f YCX PAi LEGEND Landscape Posits R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope CC'- Concave slope CV - Convex slope T - Terrace FP - Flood plain H - Head slope Texture S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL; Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE pis VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky . SBK - Subangular blocky PL - Platy PR - Prismatic Mineralaa 1:1, 2:1, Mixed Notes Horizon depth - In inches g Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD'(Revised 05/99) ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■ E■■■■M■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■M■■■■llMMM■■■■ NEEM■■■ ■■■■■■■ ■■■■■M■■■■■■■■■■ ■MEM■■■■■■■■EE■■ ■E■EEM■■EME■EEE■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■M■■■ ■E■E■■M■■■■■■EN■ ■■E■E■■UMME■■■■ ■■■■■■■ ■■■■■■■ ■■■M■■■M■M■MM■■■ ■■■■■■■■■■■■M■■■ ■MEMMM■■M■■MM■M■ ■■MMOMMENeM■■■■■ ■■■■■■■■E■■■■■E■ ■■■■■■■■■■■■■■■■ _■■■■■■■■■Nee■■■■n■■■■■■■■■■■■■reel UMMOMMiEmmonsIMMENSE MEMMME ■■■■■■■■■■■■■■■■■Ott!■■■■n■■■■■■O■�ii ■■■KIMEME■■■ ■■■n■■■■■■■ ■■■aI■■■■■■■ ME ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■MEM■M■ ■■MEMME■ ■■ ■■■■ ■■ NONE ■■■■■e■■ ■E■■E■■■ ■■■■■■■■ ■■■■■■■■ ■■MEMO■■ ■■■■■■m■ ■■O■■■■■ nrONA■■■ :i1J■■m■■■ ■■■■i■■■■■■■■■■■■ ■■■Mil■■■■M■M■■■■ ■■■■u■■■■■■■■■■■ ■■M■iN■■■■M■■■■■■ ■■M■IIMMMM■M■■■■■ ■■■■il3■■■■■■■■■■ ■■■■I ■■■■■■■■■■ ■■■■r: MMIR■■■■■■■ ■■MMEMN&■■■■E■■■ ■O■■■■■■■■■■■■■■ ■■■■■■■■■M■■■■■■ ■■M■■■■■■M■■■■■■ ■■■■■■■■■E■■■■■M ■■■■ MEMO SOON ■ ■ OMEN NOME ■ ■■■■■ME■■■■ ■■■■■■■M■■■ ■■■■■■■■■■■ ■■■■■■■■■■■ MEMO■■■■■■■ ■■■■■■■■■■■ ■■■■■■■■■■■ ■■■■■■■■■■■