Loading...
1451 Hwy 801N (2)Account #: 990003791 Billed To: Jeff Tucker Reference Name: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5852-76-0175 Subdivision Info: A:i4 Kttiop-Wo� Location/Address:.Keapa.lU y-27006 H u%q As stated in 15A NCAC 18A.1969(5) ATC Number: 4396 accented Svstems may also be used 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 eatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEW O U ION V IL1�D FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatur Date: 610 (i 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 "Sews reatmend Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will fun ' n satisf i y for any given period of time. 110 U` QF l� VI L�tZI y�• I ��Arl:l 00lak 4 SDo C+4m6L;ilZ sw WV `T� lL �4TE 7 � Septic System Installed By: Environmental Health Specialist's Signature 1G Date: DCHD 05/99 (Revised) i 0 DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 0fd.- (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990003791 Tax PIN/EH #: 5852-76-0175 Billed To: Jeff Tucker Subdivision Info: Reference Name: Location/Address:-44eapa-Way-27006 %�'Gl/ �l�l /V' Proposed Facility: Residence Property Size: 42 acres **NOTES* Thm4er: 4396 is mprovement/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 BEFORE INSTALLING SYSTEM. Residential Specification: Building Type {-'�wsi-=7 #People #Bedrooms 4 #Baths �•� Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 42 - Type Water Supply WELL- Design Wastewater Flow (GPD) CX-> Site: New 0" Repair ❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width—Z:G Width-Z:Rock Depth Linear Ft -230-6 Other:LT11���>rt_ _ tC Required Site Modifications/Conditions: � j� Li i4ES 1 r4 YEE37 1Cd ��t+A N&&LL . I IV�TR1t-�- o&l IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISH D E. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this s tem 0 a.m. o 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** 25o glrc. 20s' 105 As stated in 15A NCAC 18A.1969(5) accepted Systems may also be used Environmental Health Specialist's DCHD 05/99 (Revised) -T,saJr, AM FLcW Olay -05-06 06:47am From -NIERS MICROARRAY CENTER 9195411506 T-550 P.002/002 F-546 No 5 05:58p davie counts envhealth 336 75 8786 p.l Pte' AI'laL[CATION AOR SITE EVALUATIt]N/IhTM:OV[OIEKT N[Rdll C Davlo County Health De,i-artlnent AIOV MmironinentatHea/Ch :Section 'Y 7 P.O. sox. 048/210 Ilospi sal Streot ! 2005 Mockavilie, NC "7028 (336) 751-8760, **+Sl'JP0RTJ1NT*** TUIS Ar -PLICATION CANNOT BE PROCE.7SED UNLESS AL INFORHATION IS PROvXnMr . Re to the SNi 07t1SAT=cSN SULLETIN Cor 9.saa true zr�tramo to las D111ad ve e� n .�ecataet Poraon M 111ng Addraaa iJ Ale_ ��toma Phones _ X336' 971 • 1) !City/Stat./zXP -__-( L 2 1 buaincan Phone Name on Parmtt/ATC it niMersant than Above . Mallile7 Addroaa Ci Cy/S:+ata/Zip f Application Por. Sibc ]:valuation Mmp-rovement Pcrmi.t/ATC ❑ Doth — •t. SyatoLn to servicoi HOUB0, ❑ Mobile iromo Inuo ---aoss a ❑ Taadui,try M other S. Typo orate= roquawtods nvantlenal ❑ conventional +n>dlfled ❑ innovative Miccepced tip If jtaaidonca: u People ,_ a Dodrooaia „� it IIsaLhroomu z doiahwashor sfa.rbaae Diiipcanl vf..shinq MaChlno ❑Lisamant/Plumbing Mnaacmont/lza Plumbing 7. 2t nuais►aa./Snduatry /Othor: ver1fy typo R People _ u sinka — B COmmedea a ahowora 0 Urins,La !! 14ator Coolora SF r0oDSEItVSCE: ti G ento Estimated Wa tar Unago Coallonn par day) Typa of water supply: ❑ Coy. nt.y/City /1K Wel._ 13 Community Do you anticipato additlona or Cxpanslons or lho racilIty this systinns is intended to serve? ❑ Yes 19LN0 irycs, trlint type? •*"I/IIP0R7 t 2--*-C-LILNTS AtUSTCOA LETliTHE RIiQUJR -9 PROPERTY INFORMATION REQUESTED nr•.r_ow. r_uhcr n rt.AT orEiTJ' fUSTOBSUJIdfITTF.n by tU 7 ellait wlth TI IIS Al'P1.ICATION. L-1-11"roperlyAiill enslous:��«'j Oftcc PIN: I iE ZW %60/7 I'ropertyAddress: Road mune _ =/-1 (��y c;lyiz;p�ay9�y�P_ 2 7w Iran a Subdivision provide hirornlnllotl, as follows: Nasnc: , -m-irr-rc a1imcTiONS (riwtu T-locicsvilic) to PRomit"t•Y: 1v06%a�v�•✓l� ,-4 ti e -d nd (77 4 Section: Itlocic:-- y�i--- _•_ Lac: etc Ilo:ttc corners (lagged: 'rias is to certiry tlial the inrcrinailou lu ovidcd is correct to the best or my I4'401vledge. I unclersinud that any perinit(s) Issued hcrcnrier arc subject to suspension or revocation, it tlsn site plans ori Mended use change, or it llsc issrorsnation subusllted ill 1111s applicatiunl is falsified or changed. I, also, itisderstruu/!/+a! I ani responsiLlojns• a/!charges issCnrresl'frasu this apptJeatlon. I, Ilereby,•glve conseill to elle Authorized RcImsmltative or nic Davic County I3calUt Departsnctit to enter upon above described properly located in Davic County and owned by to conduct all •teslin proceeddjurs as uecessnry to deterinine.the site suitabilil•,. ICNATURE TRIS ARIBA MAY 13E USED FOR DRAIVINC YOUR SI'Z'E PLAN (Inc r. all or the rollowing: Existing and proposed nroner(y lines and dimensiuus, structures, setbacks, and septic locations). Sign given /" d Revised DCIID (05/03 �Nvo 1ee#5Y35' Site Revisit Charge Da lc(s): Client Notification Dates EES: % .,Account No. ` Invoice Na. APPLICANT INFORMATION Account #: 990003791 Billed To: Jeff Tucker Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5852-76-0175 Subdivision Info: Location/Address: Keepa Way -27006 _ Property Size: 42 acres Date Evaluated: 14 9S On -Site Well Community Auger Boring Pit FACTORS 1 2 3 slope "10 HORIZON I DEPTH Texture group Consistence Structure . HORIZON H DEPTH .TI :I Texture group I Consistence .VS - 4V QV9 V `Structure h," AZ Mineralogy-. _ HORIZON III DEPTH ..` -Z '21. •S ' Texture grour, roWIM Consistence d%V, NSA .P, VW WA)SAf Structure A.. r�/\ N�- Mineralogy tJ HORIZON IV DEPTH 2X- 3 Texture group., ©NUMMEW-Em- Consistence Texture group I Consistence .VS - 4V QV9 V `Structure h," AZ Mineralogy-. _ HORIZON III DEPTH ..` -Z '21. •S ' Texture grour, Consistence d%V, NSA .P, VW WA)SAf Structure A.. r�/\ N�- Mineralogy tJ HORIZON IV DEPTH 2X- 3 Texture group., Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE _ 5 3' CLASSIFICATION P S j LONG-TERM ACCEPTANCE RATE _ p, n . SITE CLASSIFICATION:Pa' ' EVALUATION BY: -LONG- TERM ACCEPTANCE RATE: O.2 OTHER(S) PRESENT: r . 1 " 1 ^ C J REMARKS: #_ ff LEGEND Landscape Position 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 I 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 - Angular blocky SBK -Subangular blocky PL - Platy , PR - Prismatic Mineralogy 1:1, 2:1, Mixed 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) LIAR Long-term acceptance rate - gal/day/ft2 DCHD 05105 (Revised) 7i 3 �— t ` 0 Ej pC }; May -,an to j `^ G 1,:rPy � ,.Y 'i ��i{ � �� t•1�' .off r � "�3"_.` K�` � `. $, �`. � � 777 A W. P, ` � ^.� a`��� s � '� '�. �"'`• �'°�''�� � `� � its" L � �r�,�� '... � -� ME ARMS fix"' " twop, wa. sex s 41' x s m by ^tib.p5; FHIM z, $12 Owl ,pBR RE ��" .p,,p.�fiW.�"'�+ ,2 -# , 2 "" • A µ•"dae„}a Y d+.` a";,.; ,r e a«e” � ��" ��-£�`s`'u?', ��" --' '"� ffi Lir g�� � iso '�� a�f, z� �,c�.�"*�f''a?' �',+>�• ' eq? P 't�` Oft EAR# Y k t k - °[s a dr 1 $ Y,i ,fM R a M sr�"'" 35, Ajr4.�. ,. ,�x costs �" 3 t . aft #". -'' �_� NN '1.1 �,"^,ry+�'F �ssp5� , � � 'i�- � �'• a�"`�"'--� � � » ma x'�� �< v� La �P�f man C "``.fi',L 9 `'°?°d r '* ,• �" fi s `""�r y. ,�"-." C'g' `' ,k �, Nag �^. �g��. � � :�=�,'���-r 6•�jz��y,�,y' �.�� "�m�„ a� � ' , � .' ,mss' m3^ i s�� ip "°� $ saa s 3 `.ars,°,. i` q f .4 sp y �` r . HNfl a4, 15 A. ,,,t # - - .. ...or ' I l DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 /Fax: (336)751-8786 November 18, 2005 Jeff Tucker 967 Vernon Avenue Winston-Salem, NC 27106 Re: Site Evaluation - 42 Acre Tract/Keepa Way Tax PIN#: 5852760175 Dear Client: As requested, a representative from this office visited the above site November 14 and 17, 2005 to perform a site evaluation. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. It should be noted that soil conditions and facility size/location may necessitate the use of an innovative or alternative on-site sewage disposal system. Actual design of the system will be determined at the time an Improvement Permit/Authorization to Construct is requested. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct, the appropriate application must be completed and submitted to this office. The location of the facility the system is to serve must be staked off. Please have initial clearing completed prior to making this request. Enc(s) If you have any questions, feel free to contact this office at 751-8760. Sincerely, Jeff G. Beauc amp, R. . Environmental Health Section