Loading...
187 Sand Pit Road Lot 28AUTHORIZATION N(10554, DAVIE COUNTY HEALTH DEPARTMENT •-, �,,�� Environmental Health Section PROPERTY INFORMATION Perinittee's /^"� 1 P.O. Box 848 �-� Name: a Mocksville, NC 27028 Subdivision Name:,��Ii/f ^ Phone #: 704-634-8760 Directions to property:..:'., Section: /� Lot: AUTHORIZATION FORWASTEWATER // SYSTEM CONSTRUCTION Tax Office PIN:# t,5- 3. Road Name: N #b Zip: Avd'06 **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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) J f ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED t�`I DAVIE COUNTY HEALTH DEPARTMENT ROVEMENT AND OPERATION PERMITS PROPERTY INFORMATIOIcffj,� r Name: e&� WN Subdivision Name: Directions to property I '�!� f t x, s Secition: l Lot: f "' ROVEMENr � T - Tax Office PIN:#� Road Name:.: NW rrZip: r�6 **NOTE** This' Improvement Permit DOES NOT authorize the construction or installation of a 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 SewageTreatment and Disposal Systems) � ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE:INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE " INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE J! # BEDROOMS # BATHS -V- # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No p LOT SIZE A� TYPE WATER SUPPLY lVell DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZEo!!V-49 GAL. PUMP TANK - GAL. TRENCH WIDTH ROCK DEPTH /0 LINEAR FT. OTHER - REQUIRED SITE MODIFICATIONS/CONDITIONS- CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY: 4 ii .. / it AUTHORIZATION NO. (�S OPERATION PERMIT BY: �\<=� 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 NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF Taffi '' APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department Environmental Health Section P. O. Box 848 Mocksville, NC 27028 (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be BilledrT� I p I t n } L N t.t �L /��' GA P-0, Contact Person 4 Q Mailing Address :5 n,11 m qhD T -s --v Home Phone 1 C�i Qq� —,q Il City/State/Zip 1 It I)Sof llA �� �� N< Business Phone `'11D qq g , 7 % 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip WRITE DIRECTIONS (from 1 Mocksville) TO PROPERTY: 3. Application For: ❑ Site Evaluation ❑ Improvement Permit & ATC 2-1oth 1 1.— i 42m1n u 4. System to Serve: U House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms_ # Bathrooms a ishwasher ❑ Garbage Disposal 8''Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing If in Subdivision provide information, as follows: 6. If Business/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/Citye©SGV ll ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 3 -9 -0 -- If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: 1• g 7 G ae4,, d 1 WRITE DIRECTIONS (from 1 Mocksville) TO PROPERTY: Tax Office PIN: # � � � 3 - 3 S _ 3 SG S 1 1 1.— i 42m1n u Property Address: Road Name � city/zip Z70o to T If in Subdivision provide information, as follows: 1 r* 1 qadn/'Ta 2 Name: 1 A S1 1 � ` 0 G21�hH, Section: Lot #: 1 la P 1 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 from this application. I, hereby, give consent to the Authorized Rwreserli�tive of the Davie County Health Department to enter upon above described property located in Davie County and owned as necessary to determine renthe site suitabiliti DATE I 0 — % Y-- % C Revised DCHD (06-96) tj • o J to conduct all testing procedures DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation DATE EVALUATED PROPERTY SIZE LOCATION OF SITE NAME \ T it I I 1 tiIdA a-rn Q / ADDRESS PROPOSED FACIILTY Water Supply: On -Site Well �_ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L - Slo e R HORIZON I DEPTH � r� Texture group re C Consistence Structure Mineralogy HORIZON II DEPTH Texture group (1 C__C Consistence -fes Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION T LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATED BY: "Ally 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 'r -t. - S -Sand LS -Loamy sand SL -Sandy loam L -Loam SI -Silt SICL-Silty :lay loam- SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR- V ----y 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 3C --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 watet 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 f DAVIE COUNTY HEALTH DEPARTMENT�� Environmental Health Section Soil/Site Evaluation J NAME A,1 LOS DATE EVALUATED ADDRESS PROPERTY SIZE 9 PROPOSED FACIILTY LOCATION OF SITE _ 6r, Water Supply: On -Site Well 1/ _ Community Public Evaluation By: Auger Boring Pit i_� Cut FACTORS 1 2 3 4 Landscape position G Slope Z HORIZON I DEPTH j Texture group ,S Consistence Structure Mineralogy HORIZON II DEPTH Texture group 27777,1 Consistence -(v 77' - Structure l J Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S 2 LONG-TERM ACCEPTANCE RATE � SITE CLASSIFICATION:. LONG-TERM ACCEPTANCE RAT REMARKS: JG17 DCHD(01-901 EVALUATED BY: 144Z OTHER(S) PRESENT: 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 ;lay loam SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR- Vc.-y 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 3C --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 This map or drawing and any accompanying documents are furnished to the person(s) named thereon and no alterations or use by others Tax Lot 49 is permitted unless authorized by Stone Land Surveying Co. Tax Map B-7 1 Map not for recordation. David M. Hanes 1 Tax Lot 49 Tax Map B-7 David M. Hanes DB 183 O PG 694 GRAPHIC SCALE — FEET I declare that of we surveyed the this plat: - N CAp Qp15TER*-0 grty n ; LLL NOTE: This property is subject to all easements, right–of–ways, streets and assessments, if any, as the some may appear of record in the office of the Register of Deeds, Clerk of Court. Town or County Tax Office or which may have been acquired by prescriptive use. This survey Is subject to any facts that may be disclosed by a full and accurate title search. NOT furnished as of this date. NOTE: Street location not centered within recorded right of way established per Plat Book 6 0 Page 147. P-Aialp '4'. Beauc�a�p ansa' wife �c.�ie C.' .Beauc�iamp w Lot 28 ILEGEND R/W – Right–of–Way t – Center Line EIP – Existing Iron PipeCL EIR – Existing Iron Rebar –Center Line ^ 7 EP – Edge of Pavement L – Point ace of Curb – Pole IP CM – Concrete Monument - IRS – Iron Rebar Set LLpp� tu�aoawer MH – %nt Holle David M. Hanes P/L – Property Line R – Radius C A – Controlled Access CH – Chord Distance P 0 – Part of RCP – Reinforced Concrete Pipe SE – Sight Easement CMP –Corrugated Metal Pipe CPP –Corrugated Plastic Pipe PB BBkk –F– 100 year Flood Boundary –Plat _atchaNn o –0– Overhead Utilities –X– Fence an –S– ewer Una 50 0 50 100 150 GRAPHIC SCALE — FEET I declare that of we surveyed the this plat: - N CAp Qp15TER*-0 grty n ; LLL NOTE: This property is subject to all easements, right–of–ways, streets and assessments, if any, as the some may appear of record in the office of the Register of Deeds, Clerk of Court. Town or County Tax Office or which may have been acquired by prescriptive use. This survey Is subject to any facts that may be disclosed by a full and accurate title search. NOT furnished as of this date. NOTE: Street location not centered within recorded right of way established per Plat Book 6 0 Page 147. P-Aialp '4'. Beauc�a�p ansa' wife �c.�ie C.' .Beauc�iamp w Lot 28 'R/VER BEND TRA/LS" Plat Book 6 ® Page 147 Sand Pit Road 1.976 Acres +/— by computer SCALE TOWNSHIP COUNTY STATE DATE 1" = 50' Farmington Davie North Carolina 10-1-96 suRVEYED: Stone Land Surveying Company JOB NO. GRS,crewGeorge Robert Stone, RLS L-3162 S63963 MAPPED: 113 Drum Lane Phone (910) 998-4733 MAP NO. S63963 JLC\GRS Mocksville, N.C. 27028 1Q • APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT 1� J, Davie County Health Department l�� Environmental Health Section �// / P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By PAY112 /`I1 -A ANS Mailing Address 304 .�/ASE s 7"/2474.. Home Phone_�� 1912 VA All L ZU , C-, Business Phone 2. Name on Permit if Different than Above ✓t F 3. Application for: 14 General Evaluation a Septic Tank Installation Permit 4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision At/&-,- BcNy 7-/&ii/5 �Ok'000���,� Section Lot # — No. of People No. of Bedrooms No. of Bathrooms _ Dwelling Dimensions 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures ❑ Basement/Plumbing ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal 7. Type of water supply: ❑ Public ;K Private ❑ Community 8. Property Dimensions ). g.:,, Arees 1-21Al Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes, what type? *NOTE: Improvements Permits shall be valid from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: Tax Office PIN: # j,711111;iM4109NA- 1F Al. c, 8oi 7 'd YAI- vc l v4 &tz. led, PROPERTY ADDRESS, as fol lows: /-f'S r, r r i 7/1 x arJ �. J Road Name: �'c, A � t / /7 �'} /A/%L Jz 5 CL7/;7d- d 1- City: ,�ID�/,�,J'E t� r) r- /;, 5 i2. -,4t- /¢53 c.-- /471 SUBMIT A PLAT WITH THIS APPLICATION. Revisions effective October 1, 1995. This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. C// ZV ala fv,*- . I DATE SIGN TURE FtaonCONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY d ECK ONE: �I 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. ked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative of the Davie County Health Department to enter upon above described cated in Davie County and owned by all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment al system. DATE SIGNATURE DCHD (193)