Loading...
199 Lakewood Dr (2) DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT 'IMPROVEMENT PERMIT **NOTE** This improvement permit DOES NOT authorize the construction or installation 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 13OA, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) NAME � t�1� �• S AVt%T4)PROPERTY ADDRESS --- I-QkwoOcL- )Or. ? DATE LOCATION SUBDIVISIONNAS LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE M, %# BEDROOMS _3— # BATHS # OCCUPANTS GARBAGE DISPOSAL: Ye No COMMERCIAL. SPECIFICATIOW4XILITY TYPE � c # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: ,Yes/No iA LOT SIZE `TYPE WAT ERSUPPLY. DESIGN WASTEWATER FLOW (GPD) ,-36&) NEW SITE ✓ REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE16bo GAL. *PUMP TAME( GAL. TRE' WIDTH 3 ROCK DEPTH I�` LINEAR FT.^,,1��1 OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR`WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. y r pp 101 f � , } IMPROVEMENPERMIT 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:; HE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY � r FVpN �66 AUTHORIZATION NO. OPERATION PERMIT BY ` DATE **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 13OA, SECTION .1900 -SEWAGE TREATMENT AND DISPOSAL SYSTEMS-, BUT SHALL. IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FICTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. \ DCHD 10/95 ` t_� - ,� Davie County Health Department ENVIRONMENTAL HEALTH SECTION rr P.D. Box 665• Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) ***This Authorization For Wastewater System Construction must be issued by the Davie County Environ e,n�l-/Hg�h Section prior to issuance of any Building Permits. This For,/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits.*** p NAME Ke N W S�A t%t� DATE �� —9 ' , AUiHi1RIZATION NUMBER N2 j U 9 2 NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION A V Q W o o . CDKNTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM ***NOTICE*** ' IS AUTHORIZATION FOR 4ASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. ENVIRNJI�NTAL HEALTH SPECIALIST DATE' t DCHD: 10/95 ' ' ' APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER Davie County Health Department Environmental Health Section . P. O. Box 665 NoV 2 8199 S, Mocksville, NC 27028 1. Application/Permit Requested By Mailing Address /99 4:7,kewwd Or. Home Phone 33 7� JBusiness Phone l 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation Septic Tank Installation Permit 4. System to Serve: ❑ House Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms k Washing Machine No. of Bathrooms Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type i' No. of People Served No. of Sinks No. of Commodes No. of Urinals ? No. of Lavatories No. of Water Coolers i No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public );Q Private ❑ Community €' 8. Property Dimensions Q e-V Sewage Disposal Contractor f: 9. bo you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes No !i If yes, what type? "> t � "NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. PROPERTY INFORMATION REQUIRED: {. Directions to Property: (00/ S fo �c4 to oad U/j Tax Office PI/N•• # g2 -lle,2 '7 i CIOW55 Prow, Deoclt-mw Takert 1�1' ✓ road Name 9 I jr� 0 �Qkewcoe( - pa55 PjrtC_ �0 Se5 O A Box # (if available) ` I 4 ( 1-q ke wood Dr) city /??o r_ks v,'lle z: o fo f ke I-d to-k to be oln r19kt, 1/7 tol This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges 1. incurred from this application. , 95 DATE SI NATURE a CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY [and ECK ONE: 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. ked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative,9f the Da i Count He alt 4e ment to enter upon above described cated in Davie County and owned by o all testing procedures as necessary to determine said site's suitabi'y for a ground absorption sewage treatment al system. DATE SIGNATURE F, h' DCHD(1/93) f�f 7_Kx 7117 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME 2 0�+ �� 5 p X11 [l3. N DATE EVALUATED ��, " 1-I I�S ADDRESS S A t`^a PROPERTY SIZE PROPOSED FACIILTYLOCATION OF SITE tl�_ w 0 a a p Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe Z HORIZON I DEPTH Texture group Consistence Structure rfz- Mineralogy HORIZON II DEPTH n Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS -ss SS RESTRICTIVE HORIZON -- SAPROLITE _ CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: R-5 EVALUATED BY: aC �• LONG-TERM ACCEPTANCE RATE: L4 OTHER(S) PRESENT: '�� t,V30 REMARKS: 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 r;lay loam, SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-V-..-.-y 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 3C--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(01-901 ■■■■■■■■■■■■■■/■■■■■■■■■■■■■/NOON/■■■■■■■■/■■■■■■�■■■■■■■■ NOON■■■ ■■■■■■■■■■■■■■/■■■■■■■■�■■■■/■■■■■■■�■■■■■/NOON■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■/ice■■■/■■■■■■■NOON■■■/■■\C��■■■■■■■■■■■■■■■■■ ■■■■■■■■■/■■NOON■■IG%■■■■■■■■■■■■■■■■■■■■■/ NOON\►��/■_■■■■■■■■■■■■ ■■■■■■■■■■NN■■■■■■■■r�_Y■■.►�■■i���a�■■■■■■■ ■■■ ■ ■■■ Il■■■■■ ■■ ■■■■■■■■■■■■■■■■■■■/■■►�■N�1\N■/1►1■■�/■■■■■�■■■� ■ �■■/�■r/■■■■Nm■/ ■■■■■■■■■■■■■■■■■■■■■■■/■■■■■■■�■■■■■■■■■■■■■■■■■■■■Ori■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�■���'■■■■■■■■■■■■■■ ■■■■■■■■\■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■H■■■ ■l'■■N2N0■■■■ ■■■■N■■■ MEMOMME [am MEN ■■■■■■■■■■■■■■■■■I.■■/:H■■■■■■■■.��■■N■■■■■■■■■■ NOON ■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■�uear��nnr�v�aa■■■t/■��ue■��e■■� �ii i■_■■■e■■■■■■■� ■■■■■■■■■■■■■■■■■■■■■■■■■��■■tit♦J���i���■■■ ■■■�■■■ ■■ ���■■ NOON■■■ ■■/■■■N■N■■■■■�■/�/_!_�C:ii�ia/NOON■■■■l1■■/■�/.■/■ ■�■■�■■■■ �■■■■■■■ ■■■■■■■■■�r•_:.�■■■ee■H■■■■■■■a■�■■e■N■■eNH�i■N■■■■■■C■■■■■■■■ ■■■ H■■■■■■■Ht/! ■�■■■■■■■■J���iii�/■■ll■■■■ �■■■H�■■■■N■N■■ MEMO ■■■■■■■/iii/■■■■■►1■■■■■■■■■►\■■■■■11�■■\I■■■■■�■ ■■ �■■■■■■� :::::::::::::::::C::::=m: ::n_ : :�CC : ........................■...1■...■.. .. .. ■... .a■ ON ....._ ■■■■■■ NOON■■ NOON■■ ■Y■■■N NOON NOON■ N■Olson MUMMEM NOON■■ . MEMO ■■■■■■■■■■■■■■■■■■/ ■■■■aN■■■■■■ ■,�i■■■ ■ ■■ ■N■■ ■■ ■■■■N■N■■■■HH■■■■�i■■O■■■■muH■�■\H■ NO ■■■■N�■■ moomm ■■■■/■■■■■■■■■■■■■s■■►�■■■■■■►�■ ■OM ■ ■■■ ■■NN■■N■■■■■ ■HNHN\''� ■■■ ■►■INE ► NOON ■IIII■N■ ■N■N■■■■■_■■'■I�iH■ INSWER'i�■■■=■■m ■■ ■\ ■■ ■H■■■I■ ■■■■■■■■■ NOON■■■NN■ ■■■ ■ ■■■ ■■ ■■ NOON■■ EMMEMN mummom MONEMEM 001 ■■■■■■■■N■■■■m■mt■n■■■ommommom�p � H■■■■■■■■■■ NOON■N■ NOON ■ .�■ H■■■■■■■N■ :EN 0 Cii�■�iiiiii■��ii�il:nC'�ii 'C■ :: ■■i ='■■■�'0 NOON.■■ N■■ ■■■■■■N■■■■NNIN■11'i■■Nil N■ . Nor H ■ ■■■..■■.■■■■■■■■■■■■■■■■■■�i■■�>` S■■1l ■� ■ ■■■ ■NN■■ ■■■■■■■■N■■■N■aN■■■N■■■■■■��■■■■■■■■■H ■1 ' ■NC■=■■N ■■■N■■■.■■■■■■■■■■■■■■■■N■1�■■■■■ ■N■ ■■1 ■■■H■ .1■■ OMER NONE pm:man ��► ����['.'�`V���Hl� l�.■u�■� /i1'� �u '��ii'ii��'■1' ■■■[ANO !��■■■�.���e�=►l� Nl■�NNrY�I■■N■■N + / ■NN ■�■■H■ NONE \E■N ■■r ■ . N=NH■■■■■■N■ ■ ■■■■■► ■ MEN■■Oon ■■■ No ■■■■■■■■■■■■ mom■■\ ■ ■O►_q■N N■ ■■ ■H■■■ EMEN women=iiiiii'■■"■iii■iiiiiiiii/iiii iiii'■IZiiiiiiiiiiiiiiiiiiiiiiii=i loss ■■■■■■■■■■/■■■■■■■■N■■■H■■■■■ ■ ■NON■■■■■■■■■■■■■■■■■■■■