Loading...
245 Juney Beauchamp RdDAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 • (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990001857 Billed To: Susan & Mike Heaggans Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-45-4851 Subdivision Info: Location/Address: Juney Beauchamp Road -27006 Property Size: 1.81 acres **NOTES* rll sfmprovement/Operation Permit DOES NOT authorize the construction of a 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 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 BEFOREINSTALLING NSTALLING SYSTEM. Residential Specification: Building Type H(71S` #People � T #Bedrooms #Baths 2 - Dishwasher: Dishwasher: ef" Garbage Disposal: ❑ Commercial Specification: Facility Type Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 1.61 Type Water SupplyC,B tAny Design Wastewater Flow (GPD)LLQ 7-60 Site: New ❑ Repair to � System Specifications: Tank Size ICM GAL. Pump Tank GAL. Trench Width Rock Depth 2 Linear Ft.qcd Other: 3 S-� ► > > a.J �X�-S 1, I�4tL t. L i.S , ©. �' . ►J . Required Site Modifications/Conditions: I Vab L r=te 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 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.**** to o FQoR U ►J 401 nvironmental Health Specialist's Signa Date: WEU— �% 1 .1, 1 n � v DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001857 Billed To: Susan & Mike Heaggans Reference Name: Proposed Facility: Residence ATC Number. 2934 Tax PIN/EH #: 5861-45-4851 Subdivision Info: Location/Address: Juney Beauchamp Road -27006 Property Size: 1.81 acres 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 FOR WASTEWATER COZ1�5z//111 D FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: O Ir 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 ken as a guarantee that the system will function satisfactorily for any given period of time. F Z4011'i LL� Septic System Installed By: Environmental Health Specialist's Signature: Date: 0 2 DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 JUL 2 72001 ***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 la -=X) $ Contact Person .�_j� ^QrA1ip Mailing Address J C�� I Gln Home Phone D� — OL I p - 14 City/State/ZIP 1-7 13 Business Phone 49- 2 2- 2. 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC Z -Both 4. System to Service: JZ House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. I£ Residence: # People _— # Bedrooms q— # Bathrooms dishwasher N Garbage Disposal Washing Machine 6. If Business/Industry/Other: Specify type # Commodes # Showers O Basement/Plumbing ❑ Basement/No Plumbing # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes W90 If yes, what type? ***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: I ,'3Adle--S WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # 51 (el- y' 5- 17 Property Address: Road Name 1 �` VL �`� �� c)" S -u ,e4 Qeo(1Ckamp City/zip. Nyanov_ agQaa CJ+ Sti-otkS 4nraue. �0h 1s If in a Subdivision provide information, as follows: O DOyi 2 Name: ufn� 6 %�i-s �o�� 30 �� i �� U3 DO (IntL Section: Block: Lot: Date Property Flagged: I so 10 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 D le CountyXfalt 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 17-2,1-0/ SIGNATURE . 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). tv� Lr -`T— - (A&� -&- �.I S Yin OLP-> - OL wc,3 D -Y Tbu o a-15(-�-. Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS• . <3 51 Account No. l Invoice No. IS Ya-", A-r- C) 0) t� E700000066 o (1.81 A) DULIN JEWEL 4851 3c� LO � o (426) 03 A) F 0710 E700000044 0 CO J �1 4649 i BLACKWELL WILBUR CLAY C` (405) rn. 77— E700000045 (1.76A) 4554 -Q DULIN JEWEL cq I P 0. (365) 452.20 DAVIECOUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION l *MOTE: Issued in Compliance with G.S. of North CarolinaChapter 130 Article 13c • Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name 2n "1, Lim/ Date �' INK" ` .�. 4a98 Location l� gJ''x`'.�f �/L/©o.�Sr ' o'/%� /1� s/`%'o%'�- /tel %�li •� Subdivision Name, Lot No. Sec. or Block No. Lot Size IZ�2 House Mobile Home Business Speculation No. Bedrooms_ No. Baths No. in Family__ Garbage Disposal YES .0 NO p Specifica ions- #or ystem: Auto Dish Washer YES NO ❑ Auto Wash Machine YES NO p Type Water Supply I?� _ 41� *This permit Void if sewage system described below is not installed within 36 months from date of issue. 4 Improvements permit by *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by Certificate of Completion 'Date i%o? - *The signing of this certificate shall indicate that the system described above has been installed in compliance with. the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. �. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990001857 Billed To: Susan & Mike Heaggans Reference Name:: Proposed Facility: 'Ikesidence Property Size: Water Supply: Evaluation By: PROPERTY INFORMATION Tax PIN/EH #: 5861-45-4851 Subdivision Info: Location/Address: Juney Beauchamp Road -27006 1.81 acres Date Evaluated: On -Site Well Community. Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON lI DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND Landscape Position EVALUATION BY: OTHER(S) PRESENT: 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 Moist 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 Mineralogy 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 DCHD 05/99 (Revised)