Loading...
130 Pondview LnDAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003353 Tax PIN/EH #: 5862-24-7946 Billed To: Alan Cain Subdivision Info: Reference Name: Location/Address: 130 Pondview Lane -27006 Proposed Facility Shop Property Size: 1.80 acres ATC Number: 3873 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 Trea ent and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONS IS V ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 7letl 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 be taken as a guarantee that the system will function satisfactorily for any given period of time. Nol Septic System Installed By: Environmental Health Specialist's Signature DCHD 05/99 (Revised) V�12-p tyT M Date: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section L P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003353 Tax PIN/EH #: 5862-24-7946 Billed To: Alan Cain Subdivision Info: Reference Name: Location/Address: 130 Pondview Lane -27006 Proposed Facility Shop Property Size: 1.80 acres ATC Number; 3873 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 (S #People #Bedrooms A14 #Baths / Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industria11l Waste: Lot Size • �''1�-� Type Water Supply &AVDesign Wastewater Flow (GPD) �� Site: New ValRepair 13 System Specifications: Tank Size /PnAL. Pump Tank GAL. Trench Width Rock Depth Jv Linear Ft.hj Other: Required Site Modifications/Conditions: — Ka G41 -1-F "1046' hd /D I IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW FINISIIED 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.**** I IS2- se Environmental Health DCHD 05/99 (Revised) t— U- 10DI A"., it giz') Date: 1// / 104'� LL Qa APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department EnvironmentaiHeald? Section RDrZEECP.O. Box 848/210 Hospital Streetll�yMocksville, NC 27028(336)751-8760 p ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLES AL THE REQUIR INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETfor }Il tions. �E 1. Name to be Billed Contact Person / Mailing Address .n IIt ^'s Home Phone City/State/ZIP -Adm-2eecr Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For:�te Evaluation )❑�nprovement Permit/ATC ❑ Both 4. System to Service: ❑ House ❑ Mobile Home ❑ Business ❑ Industry they _410 5. Type system requested: onventional ❑ conventional modified ❑ innovative 6. If Residence: # People # Bedrooms # Bathrooms ❑Dishwasher ❑Garbage Disposal ❑Washing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals f # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 8. Type of water supply: X County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 8<0 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 Dimensio Tax Office PIN: # ,S lU �� / / cl I Property Address: Road N eam �9aAe( LA el") L-11 City/Zip AV Vic" /J e If in a Subdivision provide information, as follows: Name: WRITJ DIRECTIONS (from Mocksville) to PR PERTY• � �JLi Section: Block: Lot: Date home corners flagged: 5;�- / 1i'/` 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 front this application. I, hereby, give consent to the Authorized Representative of the Davie County Health 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 In — A, ) 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). 77-,-, •� Sign given C5 Revised DC D (05/03 Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. 3 Invoice No.� � ,,. �. �' 1.�2 ,.._�..., . . ' ' r. 3ZUb n. .-:�.. . .p�..+ •q'q�,y�;+,;a,_. :�,., ... ,. ."tiw- ,.n�.�,n�r _ a�. �I `.� � ^� 4 � ;~ � . ��r:�__«._ � 5 � � � � 352 75 � '.{2.44R} '. . . � 206 Q�, 3.14A o � d 7 y( � � 7075 �•�� �31 � � � i o � ➢ ri z I I � 10 7 0 �: o �� 20 �� .,y � N zs� ��� ,, ) � . 539 .' ��� (1 16A} 291�� �''�� � ', � �i _.�. 3.14A 7857 � '�V. - 260 (2.13A} i es --._: ��. - � 4708 5sa u � � 1(19 328 � �2�� � � I, 2 * -- � �� 474 1 � 0 `' � ( V � ' � �s ` � ; ' , 4saa I � d' 7 9 - �_ __. __ ` � �� , , , 327A 328 ' ` �� '` :�.� � � ) 2.75A i I � . . .... �. . � ) , � . �. . �. . �h�c 5.58A 89 ,A. � � �� � � 9575 ; ', � �� � " � �T �._._v_ ___ - --- � I � � �� � ����� �� o , ;i 5 ' 6f I � ...... 4 . � , . ' 720.... I \ 56 � _ _._._ r--�,.: ,'� o I _--- � 1�A�Jf__—_ O N �. I � _�t � --��—._ '- —SR t445- �139T � (845} -HftTO�}RflAC3--- -.- -. . ._ _�_._ � I � Q F� � �� � 3.35A ,� ( a..._. .�� ��35d.47 . 7.12. � j� ° � } �gg � � � _��ti zza� � �,.s ��9��� �I 1�� N � i �,`� � v, F 8271 �' 144 (12$j 692 803 -:, r .�+'"' t+``i� �� 366.87 �r �� � o i I � 327 ��87 � (i� ' �� � (�7� � - �. � � �,;. �� � . _ jJ .r r �y` ,� � .: ,x o �■ ' ^7" _ ..._.. � �.� Pi i'` '`; y-.-�`�� ,�'�""`�gq .�� � �� ' { /� n. � 52 � �9�5 � o\r1 c , � 29SS � a �/ ` � ; , ,� r..>-�^ $ T ; �` --- y � 9923 �' . � / -- -- �� '394 73 . . �� - _ f� �� na � � �4s ���./ {3.1�5� � � � N ��' C� w � � � 7.58A , / h ��,� 2745 �� �S�„. `� �� 6�92 w �� ` 41 /� DD � � .. l O l(1 ' �� � '� �� �bA ,.� F,��„�_ � ,�,� "�'�' , � �� ' �5S � � �� ��" �t a � _ �' ta2 67 3638� „ �1`��� � \''''' /� '� 'm 1�a� °� ; 1�` 'i�r 6 ! ♦. , � '€0 IZQ (2(i8F_,,,,� I . ,;.. �. ' - r- �- '�,�`,6t€448 �-- I � .� � . �. .: ^ (283j ' (315) �II f ^ a ' p 6� � �' �� � � t��J � t3.46A} C� 3492 � �I n �� _ � �� * �---�.— .�.1�12} i �➢4.,� � i (�$63 f�813 (245) �� ��.I I('i - — � � ��� � � ��1�.. � � f2.�ta,, �� � 4 4i57 ^O 3187 � � 2�'i r� � (237) : . � 2.595A �' (18.42A} � � 9015 3E794 .. . o .. � . � �� . � . w .o � . � (y .. � H {370) �a � �? lz5a} ° ` j� V�,/, ,� (3.48A) � i 1.258A i'i E<< , , r�' . ��� � '� I ` $7G0 �: �' ��'"' � ' {E.:SA} � � � ���� 2950� � ,�� 4`l5 < ��IIiO� �y'"1' ��7g� ir ,p � 325 ,�.�•w'*"'"� V �r � j . . I �, ���. j/,.��,//''\�/''� e i m . . ...'�f , ,-, . s ... .](`�/ �. ' . . 1 1.258A �" �� (q3a� � �rSi:c�y��✓ 8765 � 'l�-°� ! , __ a .�f . . � }� i ,� a �-"',^;';�5 274 _ . .Y.r, - DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION • NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a Sanitary Sewa a Systems Permit Number Names r� N a- s C1 _ Date - N2 16 9 Location 13 `� 1_' • s""i .� 2 ` b Q Cc\ 4; R� Q T� ,C .� r' 00 I Subdivision Name `' Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business -- Industry No. Bedrooms —. No. Baths — —� No. in Family — Public Assembly Other Garbage Disposal YES Q NO [E� Specifications for System: Auto Dish Washer YES ®/NO Q Auto Wash Ma:hive YES -[;/NO,, TypeSupply YP Water 'This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site`plans or the intended use change. y 0 Improvements permit by Q L Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by — •� J I Certificate of Completion Date � � A9r '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 APPLICANT INFORMATION Account #: 990003353 Billed To: Alan Cain Reference Name: Proposed Facility: Shop DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5862-24-7946 Subdivision Info: Location/Address: 130 Pondview Lane -27006 Property Size: 1.80 acres Date Evaluated: 1 jc�,p Water Supply: On -Site Well / Community Public Evaluation By: Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L. - Slope % HORIZON I DEPTH p- 1 Q- 2 Texture group 61, Consistence G -CI ' Structure Mineralogy HORIZON II DEPTH 19 Texture group C, - Consistence __ Structure c - Mineralogy"7G HORIZON III DEPTH r 3 Texture group Consistence Structure Mineralogy AL HORIZON IV DEPTH -1 Texture group Consistence SS Sim Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: 04 REMARKS: EVALUATION BY: OTHER(S) PRESENT: &i A 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 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) ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■N■■■■I■■■■■■■■■ ■■■E■■IM■■EE■■M■ ■ 1019 i«■ ■EM■■E■ ■■■MEM■ SSSS■■ SSSS■■■ SSSS■■■ SSSS■■■ See■■M■ SEEM ■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ MONOMERS ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■SSSS■■SSSS■■■ moll ■■ll ■ no ( ,� . �.� •, � �,���.�. « a � a��� ���- .: . . . r . N��a_ � � , �.t ��_ � � �< ti ;� < � ^� �� + �� �_��_ 59Q � � �^�`�� � � 10�� �� � 328 � � f ' �'�� A� � ,�.�. � ��� z� ' �� , �� t t����T � �� ��� � "' � � - � . y b, �i. �a a @ s .�.. � � fl� �('� i �t`S*„�k;.t� � '�� - . � ,i s � h�c� F �E' ml� �°��e � " ` � � �„.��.� ' , ,� "��� ����a�^�fl �i���� R' ���u 4"°����a°� �� im, -� � a . � "` ` .x.A �� . �.��"` " . 4 Y.. � ' o'. g f a y . . , , �.. ,a z '.. . M �. � ,�. m :.'�� , ' .. -`, i �. � �: A � . , . � d° ,.fl,,d.. : a , . �4 ' �m� . �, •� � ~`�� � � � � ���4 �' ;��"�»�� ���� ;� ;:� � � ���:^� �. . , ,. .� � a ���a �� ;... . � . , ,�, �. �, . . � � � . ,� . � � a � �" d.�� a _ „ _ v � � e � � , ' . � x , ' � � � ' ��' � , � 1 � � `�. x�� � ��� ��� d� ��,y.��� p � �o�� �x . . _ ,� . � . . . � . r� r� _ .. � a r � � � J.G. A . i a���gi �8�.� � �,�; ��1 9 w �arii..� �. �� . , '��. � �� . � � u. .� i � , i 5.5$A ` ��. (2.75A� � ° �, 89 �,' � � .e y 9575 ' �� °;� 2544 �s, = ry � � � �' ����� ' " �� � ' '` N' �`�m`� � '� � �,� o _ • � � ' �� ,�k i ` � p„� � � � .. � �� 4 °� m�, � � ���,�na"'� .i � '.i"�� ,��i � ��.� �� �. H � � � ,i�. T� �� n� .� � iL���.� ��§ s�" d . k� . . _ . . , � r ' �.- . ' ' � . . . "i. . _ Q 136 �� � .u � � , w ,�° � ' '» - � , �, �r,�. . ;� � ` � � `-�---� 249 � .' � � �-x'- �.--�___ 2 �, ��" � �� 920 � �� �� ,���:, , ��� P � � ,t�� r e��i���F<e 2 ���e� �5 t�r i�� _ I `� � `�� p � . a �w i <�� ,i � � u' �� � � � � � a� �� � � �� � `����� �, �,r ��'� � �,�ta " F E � ���'" v� �`�i'�r ��� # � ti a a,"' � -u _�, <��� _ _ , , ; � _ ., {$45} � �.,,,_. �� ,= a. , �� a����� �t � �� a. .' � , , ':... �� ,.�r ..: ^ .3,. - ,� `� ����� �?� . � �� d�� . �a f.�,� „� '�� s , ^-Y .gr.a���` � �. � r3.35A � � ' { z �,�� � � '� � � t � r�°.A � e��:� �`` <.'�`. �.„ A,�� ,� a A � ,a, � I 2��� m � � , �, � ,�. � � � �� � �nB � � � � � �4�.� � "��� �� "` � °� ��� � ��� � .���s M�r�2� az-�, � � ������, � � , ;� � , ��: � ��� � " a 1� Y � a , ��a m ^ .. � `� �1 . p� . r ., �. m "'. x 8 . � x '.. . � .. , � � v ti '�� o'F . - . _.. . V . �n P� °���� ��0 ,'R��� �����a ,�� ,,.—��x�. � �--A-- � � � � I� _ a a, t � . x, '� � q �G � �� � � � ��a ��� •�� �v �� ��`r � I d @�4� �w � � � �{i� �„��1�I, r+ ` , �...r r .. � ��, ek ^r4'`,� '�' "rv�iA ip� '� "4 N A ° � �?�!1�W :.}'�� . Y � « � .�ar i �. � T `� S � � � � � -0. � �rv3€ ' . r $�� `" � '�� . . . ��� aG i z , ��. � �,�k� 9 ' ��' � s ,��, •�� . ���� i� i�� � . . � ��. ���%;,,�� �� a� �_ �� �� �9�Fi _ � � �° � �,�ryy � d p ��r N �"- � . .:. . 4* ����,� i � °ul�( �I �`�- �', c . . . . w� i +� . , . t v 7 , ' i -- + , � :'i� �`�.�-m . .w���,�k 5 .:�s� �<' ._... . �i".o. ("� . 4 ai . � r- a ' . 9, � � �`^� N€ o ��'� �'� . .�.�„ �k�:.��5�*"�7 � �I i,n= '. , , �. > „ r^y :' . .��� �P a � �� 3r9 v ;�,«�� P� �C � � �ro�� i r f��,� a�.T �i . �. � � . � -a-__ ( „, :�,� �` ,.,, � 4� � — �. , , `� � � ��� '°'"°�� 185'� �� � R � � ' ----L�,� �`' � u ' �r, 1 � � �.� �� �,� � , � � � �� � � .r, �� i = . � ��� � � � �4 , � , � , � a . . � w , �� o �� • �, �° ,� � � I .. .. O . '� ''� � `�' �'tl' i a ,� �� � , *w 'k' &�., �[l� ' ,m .: , `a`-' w � v� �'�p ��V '�� y..., � . `�� � \" � ��� .� ���it `�1 .� � i #�; � � .. � . ,�:-'� e `'� "P `� �,.W I ,��� ' k; ., * � ' T � 9 � � � k ,, a '�- . o � �� � i �"��, � # 'a � , � . , ' , � 'fl y ` ' n�P a � i � ��n � � p, �" r ,t�� -.a , •�"� �. : � .�._ ��� �`��y� �"`,` :.�b x i " � , . . �� : �,� :. � " ` � . ..�' �, ,� , � a � �� ��, ,� �. i.ie a N e�'�. �� '��� �,y�,�-� � $�, � �� _ . � u�i� �' � �5� �� �.d, e �^ ,� ,�K "'+� s' � u � ° ;- a i � � . * ' �. " �� � �_ � r �;G �;. �� ;��'u� ��� � £d .p �� �"�v V �''` �' ��:: � n .�Iµ��' �� � , �,; �.. � �a�' .� �s t.� y.�r t '�.�,��° � �' ��� 150 � �. � � ,� . I � , . � ta 4.� � n "� � ��:.� . k-.. v � ' u I �s , _ � .+ � ,.�� � Y"ap���. �m � r� N ,,. : . �5d�' � �'1 -�u . , . ��P' �' °� � ��x � � V n � h' "4"`"��.��r'.� I .., � � .. <.t.� � ����<, � �� � � �,� �-- � � , � � � at ��� �,� �n °��, a ��� �, � � � � � � � _ � � � '� ,��, ���, � ''�� �. � &o °6 »i R "+ � , � g e g . , i w � y . r.' '�.$.� . . � . ' ' * '" - .` .. -- . z � � �96 4 . � . o � 4 . C�t � ..�. o . , :� �'�' � � a x.. `. C � , ^ ° a. "!p.. "8 ` �^� �` � � ��� � �' ° �"��9 �� � � �Y �. R ��� .D.e v, e:�-�� .t� �A. `��/ @"��,x a 4,e x ��n o d a a �'" � �� � . "�.J � . :..�i ,� g$ � '� . 4„'� KX ��.�� ' � .,+�"�" �� ° :A�.� I . . � s i a » � $ ��g, � < < . . t Q µ u, . ""� �'g� �s . . � �. .._r . . � m � � � � a "4' � _ , �, � �., �».: . .�^ . .. . ro . aP m_ � .. �y� a � �� _,� ..q' .^� ,� ^ _ e �,�a 5�, �.. F � �� , .. . . � . �`"� : � :�E �: . '� � :. �I, 'ah ��. . '� �� .9.; " e , !�" ��' ° . , � � � � � .. s „ �y 1. ., �. ' n , w 3 r m ffik �a� ,y� � ° _�d� �5 t � ��x � � P�e 6� ' € � '� ���nu� ` ii I ��� � .,,k " i�� ..�� :. . ( s. ��, . +�� . �, , �I� � �� ,� � "��r° .� i �afl �d i������ a� � �,�+'fi �� �w� 3�; p , ,� �� '° �&" �°� '�'� � . a � . �� �m • > . , ,r ; � ` °__�= 4 '�' i .y ��� �M�,{�{,""�" � � �� ,�� ��M2��� �'�10���r"e a„��„ �z'�w 4 � � ,�� � � �3� � �{#� ,. , �...:''"v� " � � � ��. L:, �...�. �. ....�'�i.:: :`��..a� �� . ... . b? ... �� . _.. ,� ��_,.:�„1�'1 ama#�.��:�` �I *d° � ' w. e,k.:x. .�.s.a ii . . -.__ __ - .� . � u _..1. , y .� � � � ,� ����. . ,. ` . . ;. + . 'v�.. II. —_ . � _—"- _—_