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1617 Peoples Creek Rd Lot 5 vxa DAVIE COUNTY HEALTH DEPARTMENT -r4 IMPROVEMENT PERMIT and OPERATION PERMIT �qS A ' IMPROVEMENT PERMIT` •A�� MH **NTE** This improvement permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater Cd�0 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.r (In compliance with Article 11 of B.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ; C q NAME e/fflr-�f r•/flh/P PROPERTY ADDRESS E d 0 < C-J::ee L PA DATE LOCATION own S �� .G ��/ /lvl7 /�eo�0les c� SUBDIVISION NAME �/77tI�Y/y/'r i� /7'C LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS -�/ # BATHS : # OCCURAMJTS J GARBAGE DISPOSAL: tjpNo COMMERCIAL. SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE 1,.'7f9C TYPE WATER SUPPLY �L_ DESIGN WASTEWATER FLOW (GPD) -I' W NEW SITE A-"' REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIIE,/�i�GAL. PUMP TANK GAL. TRENCH WIDTH ,3L ROCK DEPTH 1j_� LINEAR FT. 5"dam OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. 3 t , . i IMPROVEMENT PERMIT BY **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 R.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. e OPERATION PERMIT SYSTEM INSTALLED BY Y. AUTHORIZATION NO. OPERATION PERMIT BY C� �.C' 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 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS', BUT SHALL. IN NOWAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 10/95 Davie County Health Department ENVIRONMENTAL HEALTH SECTION / AA P.O. Box 665 ` Mocksville, V.C. 27828 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 138A, Wastewater Systems) ***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 byrgsaBte 2/ p/`pa �ugy�rl�l tjng Inspections. Office when applying for Building Permits.*** l��,, `! /�� !,,,,�� J/ dl�S''IV,y Ill en SAN t l AUTHORIZATION NUMBER NAME 1�'J/- �I//i°Ica/, .fl7o��rL��/� DATE /��- '(,�'g S' No €J � NAME ON IMPROVEMENT PERMIT (If different than above) 1/ . �,qr/�1— •./DC'S ` r r. SITE LOCATION COMKNT5/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM ***NUTICE*ff THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE.(5) YEARS. ENVIRON ENTAL HEALTH SPECIALIST DATE DCHD 10/95 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMI =C'-E;P Davie County Health Department Environmental Health Section P.O..Box 665Mocksville, NC 27028 1. A lication/Permit Re nested B v� I�S '� Y Mailing Address f\ \(�-,C W, 4 0 3 6 J— Home Phone Business Phone 01g do— `115 (gc-- 2. Name on Permit if Different than Above 3. Application/Permit for: eneral Evaluation ❑ Septic Tank Installation 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 0•'(Nashing Machine No. of Bathrooms C}-Dishwasher Dwelling Dimensions ®-Grarbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No.of Lavatories No.of Water Coolers No. of ShowersWater Usage Figures 7. Type of water supply: 2-Au//blic ❑ Private ❑ Community 8. Property Dimensions 3 `l a � Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 04-<O If yes,what type? '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. Directions to Property: ,p c -------------- This is to certify that the information provided is correct to the best f my knowledge, and I understand I am responsible for all charges incurred from this application. /- Qs- s� S DATE � �Q SIGNATURE, CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fand ECK ONE: ❑ 1. I WN the property. L� I _DO NOT OWN the property. ked Box#2,the rest of this form MU T be completed by the owner or a person authorized by the owner: ve consent to the authorized representative of the Davie Coun eat De rtment to enter upon above described cated in Davie County and owned by , all testing procedures as necessary to determi aid site's suitability for ground absorption sewage treatment al system. n DATE SIG ATU DCHD(12.90) - ` DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section t Soil/Site Evaluation l NAME DATE EVALUATED ADDRESS PROPERTY SIZE ��C PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By: Auger Boring 11 / Pit Cut FACTORS 1 2 3 4 Landscape position L Slope 112- HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group 14- Consistence f _ / Structure 5161r / 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: EVALUATED BY: Ali LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: 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-Vary 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(01-901 ■■.■■.■■■.MUNE■//■/■■■■■■.■.■■■■.■■.■■/■■ UNUM ■■■■.■■■ MUNE■EN■■ ■■■■..■■■■Mee■■■■.■E■e.E■■■.■■.■.■ ■■■E■■.■■E■■■E■■■■■■■■■.■■.■■■.� ■■■■■■■■.■■■■..■■■.■■■■■■.■■■■■■.■�.■■■■■■■■■H■■■..C■■■■■■.■..■■■ ■■■.■.■uEN■■M■■■./■■■■M■.■.■.■■�■.■■■■....�e■■■■E■.■■■E■■.■.. ■■■ ..................■............................... ............... ■iiiiiiiiiiiiiiiiiiiiiiiiiiiiei.■iiiiiiiiiii:■iiiiiiiiiiiiiiiiiii iiiiiiiiiiiiiiii�i■iiiiii�.iiiii■iiiiiii■iiiiiiiiiii=iiii■isiiiioi MEMNON e==iiiiiii■=iiiiiii. ii■■ilii■MISiiiiiiiElsol■�■Iiiiiiol■�■iiiiii�iiiiii■�=iiiiiii�■�i ....................... mmommomi MEME.EME UNUM MM ■ ME ■ ME MENU.■. 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Coun� NeallFr Department and .dome NeallFi �,yencw 210 HOSPITAL STREET/P.O. BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634.5985 c, February 14, 1995 Charles R. Jones 10 Old Dominion Rd. Wellsville, PA 17365 Re: Site Evaluation March Ferry Acres/Sec. 1-Lot 5 Dear Mr. Jones: As requested, a representative from this office visited the aforementioned site on February 3, 1995. Based upon 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. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr. , R.S. Environmental Health Section RH/wd Enclosure cc: Gray Potts/Hubbard Realty