The URL can be used to link to this page

112 Stepping Stones Ln • � DAVIE COUNTY HEALTH DEPARTMENT � �� , + Environmental Health Section `� �' � P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-87G0 IMPROVEMENT/OPERATION PERMIT � Account #: 990001374 Tax PIN/EH#: 5767-37-8$31 Billed To: Josephine Poplin Subdivision Info: Reference Name: Josephine Poplin Location/Address: Stepping Stone Lane-27028 Proposed Facility: Residence Property Size: see map **NOTE*'�Tfii b�mprove�ment/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AiTTHORIZATION 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 #People�_ #Bedrooms � #Baths o_ Dishwasher:� Garbage Disposal: ❑ Washing Machine� Basement w/Plumbing: ❑ Basement/No Plumbing: O Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply� Design Wastewater Flow(GPD) .�� Site: Newl'� Repair❑ /, , �` / System Specifications: Tank Size�GAL. Pump Tank GAL. Trench Width�l� Rock DepthJ� Linear F� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6`�BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection ofthis system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30`Ip.m.on the day of installation. Telephone#is(336)751-8760.**** �� ,��?�� 5�� su r`t�`' �� ,v� �� c �� bl ?� �l'�' �'� ,�, r �� °� .� . Environmental Health Specialist's Signature: ��1'�G2%f� Date: �'��/ DCHD OS/99(Revised) r � T � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mceksville,NC 27028 (336)751-8760 Account #: 990001374 Tax PIN/EH#: 5767-37-8831 Billed To: Josephine Poplin Subdivision Info: Reference Name: Josephine Poplin Location/Address: Stepping Stone Lane-27028 Proposed Facility: Residence Property Size: see map ATC Number: 2667 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSLJED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authori2ation 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 Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. �" � p _ " � Environmental Health Specialist's Signature:___ ___�/�f�/ Date:_� �S � CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis 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 Treahnent 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. � -.� � � �O�3 x�8��'L � � . � i Septic System Installed By: Environmental Health Specialist's Signature:��a(� Date: �c `/�"� � ' DCHD OS/99(Revised) - . _�!� � C��'}�l-�l� �e �t�°/r}�r`��;�-L- i� �� • l g � .�,� ��r'� � �� 7 � a 1.� � C : r'` ��APPUCATION FOR SITE E1(AWATION/IMPROVEMENT PERMff A�C �� . Davie County Health Department �S �� ,��' Environmenta/Hea/thSertion � Z � ��1 ' ,��,, � .O. Box 848/210 Hos ital Street � � p ,n l (��,� /1� Mocksnille, NC 27028 ��v U1 �� (336)751-8760 I ***II�ORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS AI.L THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BtJI�LETiN for instructions. -.,._. . � a. 1. Name to be Billed ��1 � i �d ��. Contact Person Mailing Addreaa Home Phone �f � / M (� City/State/ZIP a a � , ��u ,re��Phona t�(�� I�I _ �.J� 2. Name on Parmit/ATC if Di!larent th�AbQ�� /'D " / V Mailinq Address ��!N CiLy/State/Zip 3. Appiication For: fJ Site Enaluation � Improvement Permit/ATC Both a. syar.� to se�.�: ❑ House tobile Home O Business ❑ Industry ❑ Other s. If Residence: � People � � Bedrooms � f Bathroom,s �. ❑ Dishwaaher O Garbage Disposal �Paa2�inq Machino ❑ HaaQmeat/Plt�biag ❑ Haaemeat/No Plumbinq 6. I! Huaineas/Induatry/Other: Specify type � Yeople � Sinke � Commodea � Shovera � Urinala 11 Water Coolera IF EOODSERVICE: # Seats EstiID�ted Water Usage (gallone per day) 7. Type of water supply: ❑ Co13Aty/City �l ❑ COTM*++�*+�ty a. Do you anticipate additions or eapansions of the facility this system is intended to serve? ❑Yes � If yes,a�hat type? ***IMPORTANT***CLIENTS MUST COMPLETETHE REQIlIRED PROPERTY 1NFORMATION REQUESTED BELOW. Either a P]LAT or SITE PLAN MI/ST.sE SUBMI?TED by t6e client with THIS APPLICATION. Property Dimensions: ��e �°�IP WRITE DIRECTiOhi�rirom iviocksville)to PROP�RTY: � Taa Office PIN: # S—] LP�—�� - �� ` �t`� �IJ(� �� " `�Ll1t�� ,1� � ) �� -urn o n �r�e �2c� � n ' � Pro Address: Road Name � (,I, ' �City/Zip � �r �� I� �'n �II x. If in a Subdivision provide information,as follovrs: �,��._��Irl1 D{n �J1C.,a1��CI ��'�i� `n • � Name: SecNon: Block: Lot: Date Property Flagged: � a'� ' � � This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issaed hereafter are subject to suspension or revocation,if the site plans or intended ase change,or if the informaHon sabmitted in this apptication is falsitied or changed. I,also,understand that I ane resporrsible for all charges incurred from this appllcation. I,hereby,give consent to the Authorized Representative of the vie County th De artment to enter upon a6ove described property located in Davie Connty and owned by . to conduct all tes ng pr edures as necessary to determine the site suitability. _ DATE �� SIGNATURE 1 THIS AREA MAY BE USED FOR DRAWING YOUR SITE P nclude all of the following: Eristing and proposed property lines and dimensions, structures, setbacks, and septic locations). . Site Revisit Charge Date(s): Client Notiticatlon Date: y?`� E�• `�... 1�� Accoant Na �� . Revised DCIiID(07/99) Invoice I � � � �-�-- �� -� /� a�`_� oco O� �/� � ►'�•�Irl�Ll.. `Y�-t I JON(V J: GO E� BLE � I _ � � S03�42�-45�� W --+- ( ( �EEo s��.ez'i 665.41� nbi� at� �I bent oxle I I � 1 M �� ( N � PiARCEL 22 I PARCEL 'rJ .0�8 AC ES 3 LIZZIE Ol.A � MATTI E HAIR `'''°�ew 'p H. JORDAN I 0. B. 65 - 5 �'''a '� D.8. 84-397 ( � I _ i r� o' S o� ' � I . �I `3Se d+�A• Z J .,3 , �� , 939 �3p,, ; �ron SO4° 30�W-t iron plocad ' �/' h'� between I 39.41� o�_ - -- - I '`�'�� C1�lEJ Ack and tree ( DEED 13�.3') � _ ACRES ��, - ,� by d. m.d. ) � � �,� �� Inew ��n �� ' �y � � S See Deed Book 159-280 �'� ,��/ ' 'F� �' �� Z I M � \ � i °' ^i _ ` y ' [..J O �` Q� �t 825 �,8, � a _ i Sp3 , f o N 180 , 55 tro RO �o'E _ 5.Q00 ACRES� - '� = „�n ` I �u�d I , �"CEL 20 � . - �� -E EVERHART � �` I�J7- 727 � N � M N _ F— N N — O c�v \_. — N — o' � � m Q � � �\ � ' � � 4F,�\ 3 � o � �ron �_ �-O fa� _i found . N 1 t�5 � 342. g8 ' � '� 5`30��E � o� � ��e.os''� S � �° 55'- 30,� w � � � � �24. 59� � � � ' o Us 0 � NpN � � J �a p 2 . I4p q ES ~ � ' �R g 0 � � � �' � � � bY a.m_d.� I I Q +- cn r+i z " I �I a �o - �,I I � � _ r.. : _ _- - -- _ _ � '.� - .'��`, ., ' DAVIE COUNTY HEALTH DEPARTMENT ' Environmentcal Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001374 Tax PIN/EH#: 5767-37-8831 Billed To: Josephine Poplin Subdivision Info: Reference Name: Jospehine Poplin LocationlAddress: Stepping Stone Lane-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: /�'�—�"'�/v Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition .0 � Slo % HORIZON I DEPTH �` n�' Texture rou Consistence SWcture Mineralo HORIZON II DEPTH '' " Texture rou • Consistence Structure 5t ?�L Er Mineralo � HORIZON III DEPT'H Texture rou Consistence Structure Mineralo � HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON � SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: 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-Sil[ 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-Slighdy sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic tructure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangulaz blocky PL-Platy PR-Prismatic Mineraloev 1:1,2:1,Mixed otes Horizon depth-In inches Depth of fi11-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-gaUday/ft2 ' DC�ID OS/99(Revised)