Loading...
170 Webb Way � DAVIE COUNTY HEALTH DEPARTMENT �/ V� � .• � � Environmental Health Section ` P.O.Boz 848/210 Hospital Street . Mceksville,NC 27028 (336)751-87(►0 IMPROVEMENT/OPERATION PERMIT Account #: 990001578 Tax PIN/EH#: 5872-12-2923.02 Billed To: Wayne Webb Subdivision Info: Reference Name: Location/Address: 170 Webb Way-27006 Proposed Facility: Business Property Size: see map **N(3"I'E�*�i�b�mprovem�t/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALTTHORIZATION 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� Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type J��d f#People� #People/Shift #Seats Industrial Waste: ❑ Lot Size ��� Type Water Supply�_ Design Wastewater Flow(GPD)�� Site: New� Repair❑ System Specifications: Tank Size,�j,�GAL. Pump Tank GAL. Trench Width�� Rock Depth�JLinear Ft��` Other: �� Required Site Modifications/Conditions: I1�1PROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF 6 "BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe 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 130 p.m.on the day of installation. Telephone#is(33(►)751-87G0.**** � `� G�`/.�Lf r"!N C� 'E. f � . l I�eY �ij,G' �u i�C►�Jlc�j' lSf7 �/� �,�/fj ll�r o`�`� �y S �G�,�( r� -�'� d � � S� � , �� �' � �= Environmental Health Specialist's Signature: Date:___�"6� � � DCHD OS/99(Revised) , 1 `, • , DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/Z10 Hospital Street Mocksville,NC 27028 (33G)751-87G0 Account #: 990001578 Tax PIN/EH #: 5872-12-2923.02 Billed To: Wayne Webb Subdivision Info: Reference Name: Location/Address: 170 Webb Way-27006 Pro osed Facilit : Business Pro ert Size: see ma ATC Number: 335� AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his Authorization for Wastewater System Construction MLJST 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 Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ,�G.1�'�/ Date: �"��? CERTIITCATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on ImprovemendOperation 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. � � � Septic System Installed By: - Environmental Health Specialist's Signature: Date: 2� � DCHD OS/99(Revised) �� ..� ' • , ,�/ v�� f APPUCATION FOR SITE EVALUATION/IMPROVER4EM PER69IT&A � �� ��v� Davie County Health Department �0 � � Environmenta/Hea/th Section r� � P.O. Box 848/210 Hospital Street t� Mocksville, NC 27028 ., (336)751-8760 F�, ���? �jR�NM ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE • �'ij� INFORI�.TION IS PROVIDED. Refer to the INFOF2MATION BULLETIN for instructi ri .� � l' r- /- /�--�� '/'/ / 1. Name to be Billed �,�l�� ] /��—'� `�(/L=r%5� Contact Person ��J✓'�L� /� Ma.iling Address / Q —/ p �L��/ � /�/ Home Phone ��� .�� / �� City/State/ZIP /",Q G�,$'L//�-,���� Business Phone ��7� '� �Z L 2. Name on Permit/ATC if Different than Above �� `j 9 � - S�/ `�_3 Mailinq Address City/State/Zip 3. Application For: �site Evaluation Improvement Permi.t/ATC Both a. system to senrice: ❑ House ❑ Mobile Fiome Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms t,l q Bathrooms �J "/ � •�`�. IJ Dishxasher ❑ Garbage Disposal f:l Washing Mactu.ne CI Basement/Plumbing II Basement/No Plumbing 6. If Business/Industry/Other: Specify type l�//✓��,�/OG✓/v # People � # Sinks _� # Commodas '�'�_ # Showers # Urinals # Water Coolers �_ IF FOODSERVICE: # Seats Estimated Water Usage (gallons per dayj 7. Type of water supply: f�' County/City ❑ Well ❑ Community s. Do you anticipatc additions or cxpansions of thc facility this systcm is intcndcd to scrvc? cs� � ' � If ycs,what typc? MtiI , ,�/, �QG _ ***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROP�RTY INrORMA'I'ION R�QUGSTGll BELOW. Either a PLAT or S1TE PLAN MUST BESUBMI77'ED by tl�c clicnt with T[I1S APl'L1CA170N. Property Dimcnsions: �s/���s �VRITI,DIRGCTIONS(from Mocicsvilie)to PI�OPI:R'1'1': ,t Tax Oflicc PIN: #_ Jf �����2. /i2�-��t Q � ���� �.��/ �r L.�l._-�� Property Address: Road Namc f� ���� l,vf� ' `^J ��( ..���-��i.�ls����J City/Zip�.� l/�i�C,�'— �c-�_ Ifin a Subdivision providc information,as follows: Name: �� Section: Block: Lot: Datc Property Flaggcd: �Z -ZY —OZ— This is to certify that the information provided is correct to thc best of my knowledge. I undcrstand that any permit(s) issucd hcrcaftcr are subject to suspension or revocation,if tl�c sitc plans or intendcd usc changc,or if thc information submitted in this application is falsified or changed. I, also,u�rde�sta�rd tltnt I ant respo�rsible for a!!c/iarges incr�rred from 16is opplication. I, I�creby,givc consent to the Authorized Representative of the D v.�.�ounty Hcalt�j Dc�� rtmcnt to cntcr upon above described property located in Davic County and owncd by ��c��n�' �,c./�1�� to conduct all tcsting proccdures as necessary to detcrmine thc sitc sui ability. DA'CE_ /����J 2r SIGNATUR� / THIS AREA MAY I3E USED FOR DRAWING YOUR SITE PLAN(Includc all of tt�c following: �xisting and proposcd property lines and dimensions, structures, setbacks, and septic locations). Sitc Rcvisit Cl�argc Datc(s): Clicnt Notification Datc: EHS: Account No. � -��� Reviscd DCHD(07/99) Invoicc No. 3-�--� S . • S�c e���. ��„ -, ��u .�� �� Raw S ��2a s �g vvN � 3°f� � ��'�<D� N S �2• 56��• ?S4 �,. , � �C� k 1� �c.r 2�s6�3�a, f ` . °op, S�' q e a c'� f � Ge ' � .,�h a � ip . 4 ,� � A ��,a f ' ' O ^ '�' �' ��� \ �"O�� � 'p� i - r�r�- . • `'o r 0 8 �� R � '1 � >:. ' , Q� )6 QS9.�I �i,7� AqR�/V o2 \�� �C �2fit„ �\S\ . ..:',�,.,f " �4' A��q C NE1y \��'� '`.� 2b 5). . I� ia� so• r�koa �� u q �• �\1��� pk� S 85'SS�G`�4� u R%R N �� � �`r'�,lNFN7 � �Z�ti��� °j'� I ��„9��9��� S ,�9$ 1�J4.1� SPiKE N / � �2 �J-. ���:r.� � `�F�!\ j8,1 c r o � �� �� ,RpN zo. �9sr,��� ���' ����F;4Fw N 66•a�5 � ` �8 �b Fk's7�',� �C � °'ti9�3� P�� �\n, �'1 � ` � �•� �`•', . t : � � t.�� �. S 6�. -. � �ron �aund / S 2 .� 6 � ` v i4e� �5 j` \ ��``` `8 j9, � . :PJ7 / S• � .�.� c�9 , sa' P P _ BEARINGS �o n,c 8p49'ol� � �. �,�, � Ro os�o v�� �R�,� Ic� 'V •� � �/+R M iNC N 41'07'44• E.'���''��� 1q � sEMEn�r EARING D►�CE �'�'�, � / • )'46'S2" W � pROPO o � / / 96.02 �.���„ ���` ^ 2'12 � C ,�f 20' SEWER � � '�S� ��46��J2�� W ZG.3O tI� O '+.�� EASMENT � 1 •J`..oj "18'19" E 294.86 'S4'S8" E ���o��,G`� c��'\•\�St��� � � N 41'07'44' E 0 � �� �2 ro c�a 13.50 100,27 � �a 'S4'S8" E 167.89 � � � 9� '27'32" E t 68.92 �p {` a g ,`.�C �/ �Rorr Exist�Nc - of 03'18" E 13.07 � � �yG� .�. .o 03'16" .2 � � oP E 82.49 � � � / � $ �c�' ' `'3 2S'S6" E 59.58 ���'��� PR0=0SeU . �� �3'19" E � u� �/ 20' sEwER--_._ � / N 44 32'Gil' E 9°� ��t � 2�o D��O 2 � 23.00 0 ... �'�7C FASr�IEY7 �,- / iSl. �j` 1� � �t. 't�'1 � - • E�(ISTtVC lRON / `Z`� S� ��0� � ;. �23�3�' �' �t,�A ���° P�A Z ��.33 �j Jg��' ��'�•� .I1�,��J t.?.5" /' S r� t� � iren jUr.a S �0 �p,'� � . � 1 0: ?� N ,���G ���'� ;;o� OWNER _______ � ,.,5,. . j ���' �'�� � ����� 1�'�� ��°�� S � 3 o�°cP I�iAYl ' � '� a WE88 H i r p� f��n d a G j � ��� u�� P�.gA of � U.S. i�ri� �' � C� � p � � o,.o� AD'lANCE� .A�Q���i r31 ' �� � O 1 � � � ?,21��',�� - ;J� . 4°aR�a� (33fi� "��. ` �� / �. `oa , � � 1 � � G •O � � � �S/p''•.,/L� titi � � �.��r' gti �� . .� � �r 1 � � .��- s -�• � MOCKSVIL; �<-� � �h .� 1 � ` � 6> ��oN �� �- DAVIE CO 27 � f n"�urked point S �.A s , cn-0 1 '9 U N TY, Q•,�a B@k �1 :~ O , Cfl � 1 �J�• ' � DATE: SL7. N��'O. � Q,� ' � . e �, ..�• •Qe,.° 1 �,, � N 1 � 1"��' d 1 � 1 ���,,,. .± ., � DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section SECTION LOT � Soil/Site Evaluation APPLICANT'S NAME � � ��� DATE EVALUATED /-� � '1J�� PROPOSED FACILITY PROPERTY SIZE ,� ��l� SUBDIVISION ROAD NAME �i° �6 � 1�1��l . Water Supply: On-Site Well Community Public J� Evaluation By: Auger Boring Pit Cut1� FACTORS 1 2 3 4 5 6 7 Landsca e osition Slo e% HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH � d"� .�) '� Texture rou ' Consistence -� � !�/' Structure /C Mineralo y. HORIZON III DEPTH 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: �d � 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 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 Mineraloev 1:1,2:1,Mixed Notes Horizon depth-In inches Depth of fill-In inches Restrictive horizon-T'hickness 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 DCHD(Ol•90) .