Loading...
300 Lutz Ln (2)Perrnittee's DAVIE COUNTY HEALTH DEPARTMENT ,-.-emy/jr- Environmental Health Section PROPERTY INFORMATION ! �1C� �� P.O. Box 848 Directions to property: Mocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION " AUTHORIZATION NO: 002707 A Road Name:30D Lo Z GAZip: 2 t r. **NOTE** This Authorization for Wastewater System Construction MUST 13E ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits, This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Articlf I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) % �' ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. -E-•NVIR N HAL H SPECIALIST DA E ISS�JED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS_ # BATHS _2-- # OCCUPANTS _ GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT ^� # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY �� DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ✓,� ROCK DEPTH 2 LINEAR FT. OTHER 7 CASTCJ,f % yj t.UN '~'"'Ar4 s REQUIRED SITE MODIFICATIONS/CONDITIONS: ' `� �" �TM 1=-1:- Lk IcS OymT oF Q A:lCZOA Y 1 IMPRO EMENT PERMIT LAYOUT As stated in�tSmsNC�C 18A.1969(5 c;o be used .accepted SV. MAtaahu to FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: '`&,zq ME C iT _LP 1�1 i I zs �- AUTHORIZATION NO.. OPERATION PE BY: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT E SYSTEM DE IBED ABOVE HAS BEEN I WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVENPERIOD OF TIME. DClloazrortRevrsea,:57V ) 2-17-5 It & COMPLIANCE CBE TAKEN AS A Permit ke's DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION P.O. Box 848 Directions to property:t 1� ,r�r, # Mocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - - AUTHORIZATION NO: 002707 A Road Name:.S 0 L.•LY1 , tJZi **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article"l I of G.S. Chapter 130A, Wastewater Systems, Section.] 900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION t -«►. fv'^ �. .- U �h,^ IS VALID FOR A PERIOD OF FIVE YEARS. ',- ENVl; f ItN A EAL H SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE 1'k) KC # BEDROOMS ,, _ # BATHS _,�_ # OCCUPANTS -/� - GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No i27�1 c� LOT SIZE TYPE WATER SUPPLY I"`II^-L-�^ DESIGN WASTEWATER FLOW (GPD)-"-kPO NEW SITE REPAIR SITE ✓� SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH M- ' ROCK DEPTH 12," LINEAR FT. ��00 l r• : l�. a1J`> cxX< . k''tr. LL1, X 5 �., Ar :�aA Y REQUIRED SITE MODIFICATIONS/CONDITIONS: C IMPRO EMENT PERMIT LAYOUT 11V i ptl�:nluu r, 11 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. 1 OPERATION PERMIT I SYSTEM INSTALLED BY: C e T J c9 a AUTHORIZATION NO. 27077 OPERATION PE BY: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT E SYSTEM DE IBED ABOVE HAS.BEEN INS D COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN A E TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD OM (Revised) ML7 l 1 � ?�NUoiCe #1V .5 ?V/ DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION 1 APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME k)AV,) L- [-,)r2- PHONE NUMBER ADDRESS SUBDIVISION NAME LOT # DIRECTIONS TO SITE DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS -3 NUMBER PEOPLE SERVED TYPE WATER SUPPLY w L=ZS SPECIFY PROBLEM OCCURRING '-�C-406 7A "Je DATE REQUESTED INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges Incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1193 �, - q n :.,.p� ��� }� � ���� � � � .� Po � G� . �� E � +'� �.�(pi 4a A�46^,� .� �H. �y ���£Yy , mR. � �C ,y9,� � ��� � b ",9" �^ ` � � � .5 a 4 . �`�:$'.+N�„�,� ,� �yr 1" tF" T� ~����'�" � � i � ,d ��� �°`�,�a��y t,� ��" ��. ���s� ��,.. �_� � _ � � ��` 7 m� �c ����"� � J S � - .� u .y�ffi n S �;: � l� � Y � }� re, � i �E+� r i� , s+" A'� � ��. �` �: � k,..+?� . `�� � R dr `rv a q �'° k � '� �'P, �:,�� � � Y ,'!" �'' . I � � ��'� � � �'� � �' ������"' �� � � ��.'� �� = ������y y�� s � Ia � ry,� '- � ,� 'f� ��s s� � �� .,p '��� �,a- . '�*"�^:�€h � 7 ♦ . �a �' ��sro��d. � � a ^ � � �a� � _' � � < �w�.,,� ` ' �A � k� � . �� �.. �," ��`..��a 3� �. a d� T4y^�* . � ,���� �'�� . ��a p�" �t,�,�Ax . � * .� �� '� `�'. � � y � ' `=� 1k'`., ° �, t� � .�..� �, d. „� .� tx , ,��"� ,�s; a'in. . q m, �" �...i . �i ^ ' ' rr�.`�"�. ��`,,�.� �� �, �x �5,€ .� '�"ro. ?g �a�.�.; '��i���a �"�:„.s �'" � "��& . I , -�`^� ,� � � � t - � - . w. � r� � "" � a a,� q�. �. " " � 9a� x `S'� F . . �, �' .. "� �'r� �i��p � �� r . � j� t € � 'S "� "�' k ,.d ,r i �. '��. .� �.� � �. �� _ � ��" � � �,r�, �,��,. �� i �'�' ���` 8 � � � ��� �; � `� � � � � " � ���'�,����" � ����� �� �� �_ �'�„�� � � j � � �����,�Q��+ ���� � ���, � � �a,y� � �� �" ��� , �.�`s' �Od,��'�:�"��''�� '� � �.a���1" 1 "�;"� 3 �.� ��. :��y'�ay$ { 6 .: &'u,m� i i �. �NP�`s�t�.. ! �_ � �� ��.,.�� � � �F �:.E ��i4� R,�� �. S °a � �„w a� ?�&.T'.��v�.'#� � �."Y f"�> � �° "`�Y�'-�T �..a'� s, '�4 '� S�� �. �� .��,,. w�, �.� �� a �. '"�"� .�r`� 4"��"` �,ro �a . ��� ,��" � . "� '� '�"""��'� '�i 5 � �' ���'�s�°`� „ � � .. � ,� � „�y *��, � 2���a , �. F„� ��,;� "�`��'� � � . s' ..�� . � �.��yy,��. �. �„�,,� "�,� � ��,' ��� � s a + m�9 i �'�� °a ' ri'�,P:' �: ��� �� � . �, �c ��*.���, �� �� � '�a� ' �� � �a h s ����'s� ,a t' t �.�``'`�Q�x w �"� . �� �' ��� � ��`�" �� cs. F� �`�,, �' "'. � '�" �` v� s . � 3 � � a��„e�'a��° ,:e � -. �� � � �'"a .. a� �y�g �: � t�ym�a "' � ��` ��"'��V �i �� �n 9�. ���uy°�s { � re, � �3F��+ y, �� � � a� �� "� �� �r,t � �re�.«���� ��m� � . .� '"",� .� '�` ��n�t E �� w ��i� �P a� � "�* � a��,, �t.���' �i', � �`".,F.*�, ' �� ���� a , � = n � a �� a .w -� s�ti. -�_ s � ^� � � � �r� ,,�,�+�' ,��`� ��� �. u � �..,y p ��"" �d.,� ,�,°� ��. � � .ay �'�'�",�� �������. 3w�'�*,'�w'�-. a o �: �t � � ���.ict="-��'.� � � ����� ,� � s�� � °��"�� � � * � h���E°�" �' ^"v � I � y�_.'"'�� ��� �y��,:�'"� �"����k� ' � ��� "'��"� �.�: � �' �� __; �i.F� � � � ��5� � �� � ,�� �a ��� s�r ���� �: � a ;� ' � i � � � �` � ,�� � ' { � � ��m. �� �� i ��„ ' i, . � ���" � ���`�"{�� ��,�� �. ��� E � �.� ��li � „m, ���g��� �i a�� I � �A� '.-�, �',w;. �� g, IM��!�f-gI`, . i'� : :� eiah.a 7�� •»�'. " ���4... '&°����r,� ,� �°�. �� — �:�z �j����,�� .,,a 9. � . r . , � �, � �," ' 7 / �^��" .. '�. . � � ��—� � , � t � ' t' S ��� � �„ ,� '��,a t �' ��,�� � � � a�� d� �.e ����'`< +�.. „y� � � a��'�' ��'� c �.� �g ! �"�i�i�.w :� � +� � � �_: �. .� ` � �q ,�';p'" ��, ;°� �+ °� . �;> � g s..r � ,�"a� .,rv �" . � � ' i��.$ �~ ,� n�g�� q� ; f��� ' ��z db�.: � � �t } ��g� 4 . '1'i PeM .,i'�� 0 . I �s A � � N�. ..� � i.. _ � '�„ ., #�' C A a�.. 4^ . ��•,� �^-1"y 3 ¢�^ .�` . . .. �^ ' �4�� � .P� �'Y�' �k.:. �y�y��.' . C �w„�� �' , ���P I -0 � -::� '�# . � 'ea""�. . �+'� � � � x x- ��.,�e � � � � ..� . ..a. . x 'f . u ,s� � . � � � � �, � � 3 "?; �� „ �� �� d@ ��� �'`jrt'� �...� �, � ����"J� �. % p ,c � �,' 4 �° �, ,��%q�'� ��{ , � ��.- �� ��_ �. � "����' � �.s���. ��`��.^" � � ,. � �e �-;� �; � ° �'��i.�M���" .¢, , �� ����'�r _. � :�� . I .� w a<.p �,. a��. �. � . � i� �.�'�� .�rj���, �, ° �� s� �"1�� , � �d� _ ���'.•4 a a� '+i� � �•j��.$- . �: �yT . � � � � ����� � � �� �� ; �� . .."�, � .,�.� ��°,: � . a`;„��.�. : ���� ��i a;r�, � + rv �4 ' u �gi!h� -� �yy � ' °' .. ; • �. " ' �� m�,.� ��- �t :�'�. ��,�; ti .,,�' ��,��..'.. ��I E �- >-' ` < � -.�A�,� � ^` �� �g 'i�h g �NI ���. �'�� a�`��"a � �� � � . .. � 4Pt �� t � ,� � � ,�' �� �I s*�+ .h ' � � ' S" � a°.s��.:",�.�°.�' S.� - ��'p�" �.� - i �c L 4q � . WR`... 7 � ". �� ��� � ���� � ��� ���� � � I �°���.: �' y�'� � ��i ,„ �� � �� � f��� .� �.���,� � � .� ��� � �k� � ���`� �� � �� � `� ? ',�'� .��. � � ��,, ,,��..� �� i� � - � ��.. � ���� r �� i��,;"� � �r � �� �� � F � I I ., �. �� � � � �:: :, ,; � y; f i � � �y` r � ; : rr � . � v t,�'�°�, .� y -F i ' `i ��. i � ;���� �fi.�=� ���� � � x��. "��.: x .. � ��� Ed'� �"w� �;i� �� � y c���._ � F��F � I 4 3 � � � i s �� � ��� �� B �p�n 1� �� A . .< T3,y 1' �. ��S �� � k11 � � � ������'��� U�i � g�": � . . } ... ' m � � ��a� � � �, �� A "?�� . � P 4 ii� 1 g �" I G i� Wi r� ��"''� ��.«� a ��`� � � r � � � �" ,� . � ��t r � ���" d�+'u ���i �v pxf pC iJ . S F rT+.�`�'S� Y � a ,} . � 9y A W,� �' %� �'� . � u ��1 �k `�4`'F' ,3 d.�� .$" 't ., . � .e`;� " w- �� .� , li � j � . " i}. ... . s. ., . ��� .��.�+had��Q�����.d�� APPLICANT INFORMATION Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION On -Site Well Community Auger Boring / Pit ////(4/_/� Public Cut FACTORS 1 .2 3 4 5 6 7 Landscape position �. Slope % 2. HORIZON I DEPTH Texture group,1 Consistence S Structure itt Mineralogy HORIZON II DEPTH - Z Texture group Consistence Structure Mineralogy HORIZON III DEPTH 2 Texture groupr Consistence Structure ' Mineralogy HORIZON IV DEPTH Texture group Consistence r Structure Mineralogy SOIL WETNESS «— RESTRICTIVE HORIZON SAPROLITE ._ CLASSIFICATION LONG-TERM ACCEPTANCE RATE . 'Z -..1 SITE CLASSIFICATION: � � ' EVALUATION BY: V i LONG-TERM ACCEPTANCE RATE ! OTHER(S) PRESENT. REMARKS S�t� �O — tip-.t� 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 VFR -Very friable FR - Friable FI 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 aStructure 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) LTAR - Long -tern acceptance rate - gal/day/ft2 DCHD 05105 (Revised) ■■■ecce■■■■ee■■■cc■se■ee■■■■ee■e�■ee■■■sc■s■■■■■■■ecce■■■■■eee■■■ ■■■c■■■■■Ices■■■■■c■■c■■■■■■c■■■■■■■■■■■c■■■■■c■■■■■■■■■c■■■■■■■■■ see■e■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■c■■■■■■■■■■■■■v■■■■■epi■■■■■■■■■■■■■■■■ ■■c■ccs■■■■■■■■■■■■■■■■■■■■■c■■■■■■■■':�+e■u�uuc■■■■■■e■■e■■■■■■c■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■C!!1n■■■■■■��7■■■■■■■■■■■■■■■■■■e■■e■ ■■■■■■ ■■■■■■ ■■■■■■ 120ME5:■ PI■■■■O ■■■■■■ ■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■,�■■■I■■■■■■ice■n■■■■e■■■■■■■■■■c■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■