The URL can be used to link to this page

673 Joe RdAccount #: 989900617 Billed To: Joshua Hilton Reference Name: Hubert Stewart Proposed Facility: Residence ATC Number: 2080 f4V 7 -,O -'?f DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5767-43-2971 Subdivision Info: Location/Address: Joe Road -27028 Property Size: 200 X 300 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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FORWASTE R C CTION I ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Si ature: L Date: 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," buthallin` O WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. 11 11 8 go .1 I-lo0sa- u Septic System Installed By: — Environmental Health Specialist's Signature DCHD 05/99 (Revised) Account M, 989900617 Billed To: Joshua Hilton Reference Name: Hubert Stewart Proposed Facility: Residence DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Moclksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Tax PIN/EH M 5767-43-2971 Subdivision Info: Location/Address: Joe Road -27028 Property Size: 200 X► 300 ATC Number: 2080 **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',, l I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and -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 t #People #Bedrooms #Baths .2 Dishwasher: �II Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply �L _,Design Wastewater Flow (GPD) 3t,00 Site: New Repair ❑ System Specifications: Tank Size jp�O GAL. Pump Tank GAL. Trench Width , Rock Depth IZ Linear Ft 3S& Other: t Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FII TE RISER(S) IF'6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** .O Iz- \A1 $O� For �? C' oga 6 7 Environmental Health Special DCHD 05/99 (Revised) VAL)05 Co'="3T � � l = APS o k_01*`�'� Signature: V I APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & AE— .1 O Davie County Health Department Eciyirwnmenta/ Health Section P.O. Box 848/210 Hospital Street Mockeville, NC 27028 (336)751-8760 ***7MP0RTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED,.,, Refer �tJo/It_he INFORMATION BULLETIN for instructions. 1. Name to be Billed Tm`k .A1}0, /Tilkoy Contact person gubid 7i4e1 c ' Mailing Address —a 1) bCML r79b� Some Phone 99% /►— 97).Q City/state/ZiP De�sJ) )1�. NL mac__/�nnpZ� Business Phone 5.4A 2. Name on Permit/ATC if Different than Above{ -o Mailing Address 5k4 City/state/zip ,5144 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC Both 4. System to service: 19 House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence;: # People # Bedrooms j� # Bathrooms Dishwasher ❑ Garbage Disposal )(washing Machine ❑ Basement/Plumbing ❑ Sassmant/No Plumbing 6. Sf Business/industry/Other: specify type # People # sinks # Commodes # showers IF FOODSERVICE # Seats # Urinals # Water Coolers Estimated Water Usage (gallons per day) 7. Type of Mater supply: ❑ County/City Well a. Do you anticipate additions or expansions of the facility this system Is intended to serve? If yes, what type? ❑ Community ❑ Yes )0io ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Elther a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # 767 - y3 -2 9 7/ Property Address: Road Name :.k! city/zip Mo6k5u; he, '27p- 'A If in a Subdivision provide information, as follows: Name: Section: ! Block: Lot: WRITE DIRECTIONS (from MockwUle) to PROPERTY: c)V Co `4 9 AD J—CC RoQ& iYir �jt'S on 1p+Pf . j c,e s� ager' Vou C'laJs �a Cr e2K . && wi 1! toe /ho,rkem Call Cm4ycF R-lSnn 7dr gtc\Ai+vcrg1 rn7-D 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 ownedAiy to conduct all testing procedures as necessary to determine the site suitab 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: EHS• Revised DCHI? (0'1/99) Account No. UJ Invoice No. 45k M A-pQb�e� F a tie. i d DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900617 Billed To: Joshua Hilton Reference Name: Hubert Stewart Proposed Facility: Residence PROPERTY INFORMATION Tax PIN/EH #: 5767-43-2971 Subdivision Info: Location/Address: Joe Road -27028 Property Size: 200 X 300 Date Evaluated: aJ' Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % G HORIZON I DEPTH 0-V Texture group L St, I L Consistence Fr s S $ 5f Structure 00 - Mineralogy HORIZON II DEPTH Texture group Sc - c - Consistence Consistence Fr S -' S Structure Slut .6612 - Mineralogy 1 ' 1 HORIZON III DEPTH- 3 -3 Texture groupC_ t . S G+ c Consistence SS P fy- Structure S361<)L Mineralogy HORIZON IV DEPTH -U + Texture group121 Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION I PE LONG-TERM ACCEPTANCE RATE I�. SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: O• '!>� REMARKS: Ao-5 g� %I t LEGEND EVALUATION BY:c�'►4►1 OTHER(S) PRESENT: Landscape sition 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 xtur 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 moist VFR - Very friable FR - Friable F1= Firm VFI - Very firm EFI - Extremely firm 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 - Angularblocky SBK - Subangular blocky PL - Platy PR - Prismatic Mine 1:1, 2:1, Mixed Notes Horizon depth - In inches 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 1IED (Revised 05/99) ■■M■■M■■ ■■M■■EM■ ■■■M■■M■ ■■AMMME■ ON-EMEM■■ ■.■■N■■■ ■■■NI■SN ■ENNINN■ ■■■■I■■■ SEEN NONE MEMO NONE no ■ i ■ ■ ■■MNEME■■■ ■EMEMEMMENMEEMME■ MEMO ........................ ■■■■Ilr.EEME■ENM■M■ MEMO i ■ ■■ NONE MEMO NONE NONE MEMO ■ ■■■■■NN■■■■ ■EON■■■■■O■ ■■■.■■■MMS■ ■SSE■S■■■■■ ■■■.■■■■N■■ ■N■.■■■■■E■ ■■■ESEM■■.■ ■■■.■■■■.■■ ■■■■■■■■E■■ ■■MO■M■M.M■ ■ES.■ME.■.■ ■S■.■M■■■S■ ■■E.■S■■■■■ ■■■■■■■■■N■ i ■ NONE ■EN■■■ ■E■■E■ ■■■■E■ s■■■O■ ......NINEEMS■■ ■■■■■■NIMEME■■■ E■■■■■RIMEME.■■ S.■■■■ll5.■■■.■ m■■■■.li■■■■■■. W■■■■■NIMMEM■■■ ■S■■■■NI.■■■■■■ ■■■■ENNIMM.■■M■ i:iiiiWMMMm■S■ ■■.M■■■■M■■.■■ ■N■ ■■ EMENIMMEMM ■MO■l.■■■■ ■■■■IO■■.■ ■■e■■■■eNN■■■■e■iiiil�iiiii UMENEiiMENNENMENINME ■ ■ ■■■■■■■■E■I.E■■■ ■■■M■■■■■■1■M■■■ ■■■■■■■■■■I.■■■■ ■■.■■■■■■■I.■■■■ ■■■■■■■■■■IN■■■■ ■E■ES■..■■I■E.■■