Loading...
114 Irishman Place Lot 30Account #: 989900050 Billed To: Wayne James Reference Name: Wayne James Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section y.pU P. O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: 5789.73-7100 Subdivision Info: Shamrock Acres Lot # 30 Location/Address:, Irishman Place -27028 Property Size: 1 Acne **NOTE**'ftii sK-prov ment/Operation Permit DOES NOT authorize the construction 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 I 1 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 n/#People #Bedrooms --S2 #Baths o2, Dishwasher: Pf Garbage Disposal: CT� Washing Machine: IY Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size_ Type Water Supply Design Wastewater Flow (GPD) Kn 0 Site: New 0' ❑ System Specifications: Tank Size/000 GAL. Pump Tank _GAL. Trench Width�6"Rock Depth 162Linear Ft. 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 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.**** D Environmental Health Specialist's Signature:aC���Y/�A • _ "ky-- Date: 14 :,%3 "77 DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900050 Tax PIN/EH #: 5789-73-7100 Billed To: Wayne James Subdivision Info: Shamrock Acres Lot # 30 Reference Name: Wayne James Location/Address: Irishman Place -27028 Proposed Facility: Residence Property Size: 1 Acre ATC Number: 2279 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 Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA7 CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: — " Date: 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. to f>lzoar >; 4 tstd S 30' Septic System Installed By:� Environmental Health Specialist's Signa e : Date: DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMFNF PERMR 8, AT D 6 Q d l5 D Davie County Health Department Environmental Maglo Secllop P.O, Bos 860/210 Hospital etseet DEC 17 1999 Mookaville, NC 27028 (336)751-8760 r falling Address 3. Application Tor: l7 Site Evaluation 6• oy■tee to servloe: Ouse 0 Mobile Home a. If Residence: 6 People 11 Dishwasher D Garbage Disposal City/ataGlily "mprovement Permit/ATC O Both O Business O Industry O Other I, Bedrooms IT s Bathrooms O IIasbiog Huhins 6. x! Dnsineee/Industry/other, apeoify type It C000des 6 showers O fauensnt/pluabing n suernt/Ito plwsbiag 6 people 6 sinka I Urinals It later Coolers It rOODSIUMCE: # Seats Estimated Water Usage (gallons par day) 7. Type of water supply: O County/City O Well e. Do you anticipate additions or expansions of the facility this system is Intended to serve? Ilya, what type? O Community O Yee ONO ***IMPORTANT***CLIENTSMWCVMPLETETHE REgUIREDPROPERTV INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST RESUBM77ED by the client with THIS APPLICATION. Property Dimensions: ! 17CA�— Tax Office PRN: N 5? — 9-3 - 9?49 p Property Address: Road Name T/1:5(Muv pore City/Zlp It in a Subdivision provide Infonrmadm4 as follows: Name: Til Ar.?s r !( Ac24 SeedOnt - Block: Lot: 3 y WRITE DIREenoN8 (from MockrAlle) to PROPERTY: 6!z£ o," 990/ /6 fr.o��f ow'& 7"� r a A+ 6N R 7. JAt-65' Date Property Flagged: ./2 This is to certify that the Information provided Is correct to the best of my knowledge. 1 understand that any permits) Issued hereafter are subJect to suspension or revocation, if the site plans or Intended use change, or if The larormation submitted in this application 1s faisined or changed. I, also, understand that I am responsible for all charges incurred from this applicadon. 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 toting procedures as necessary to determine the site suitabWly. DATE_ /Z — /?- 9 % SIGNATURE &/?" gq�i THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the toll6 ng: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge Dete(s)t Notificaation Date: Account No. �JSO Invoice No. _ /l2% THIS APPLICATION CAMW Bic FF=5S= UNLL88 ALL tnvi D VIE C', ***IeiPOItTAN?*** OUNTY RIIQUIRLD INPORMATSON 28 PROVIDED, Aeler to the IN1iORDATiORI BULLETIN for instructions. I. Mame to be Billed N£ /✓/ C.UN/ wailing Address L6 RO f13 / •. Contact p.r.m City/8tate/sxp//fleC-lCSYr�%/r7, /l/C woes phone 336 7,76,20 7S/ - Z/Vis an.iweapbon. 2. woes on perait/ASG It Different than Above falling Address 3. Application Tor: l7 Site Evaluation 6• oy■tee to servloe: Ouse 0 Mobile Home a. If Residence: 6 People 11 Dishwasher D Garbage Disposal City/ataGlily "mprovement Permit/ATC O Both O Business O Industry O Other I, Bedrooms IT s Bathrooms O IIasbiog Huhins 6. x! Dnsineee/Industry/other, apeoify type It C000des 6 showers O fauensnt/pluabing n suernt/Ito plwsbiag 6 people 6 sinka I Urinals It later Coolers It rOODSIUMCE: # Seats Estimated Water Usage (gallons par day) 7. Type of water supply: O County/City O Well e. Do you anticipate additions or expansions of the facility this system is Intended to serve? Ilya, what type? O Community O Yee ONO ***IMPORTANT***CLIENTSMWCVMPLETETHE REgUIREDPROPERTV INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST RESUBM77ED by the client with THIS APPLICATION. Property Dimensions: ! 17CA�— Tax Office PRN: N 5? — 9-3 - 9?49 p Property Address: Road Name T/1:5(Muv pore City/Zlp It in a Subdivision provide Infonrmadm4 as follows: Name: Til Ar.?s r !( Ac24 SeedOnt - Block: Lot: 3 y WRITE DIREenoN8 (from MockrAlle) to PROPERTY: 6!z£ o," 990/ /6 fr.o��f ow'& 7"� r a A+ 6N R 7. JAt-65' Date Property Flagged: ./2 This is to certify that the Information provided Is correct to the best of my knowledge. 1 understand that any permits) Issued hereafter are subJect to suspension or revocation, if the site plans or Intended use change, or if The larormation submitted in this application 1s faisined or changed. I, also, understand that I am responsible for all charges incurred from this applicadon. 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 toting procedures as necessary to determine the site suitabWly. DATE_ /Z — /?- 9 % SIGNATURE &/?" gq�i THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the toll6 ng: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge Dete(s)t Notificaation Date: Account No. �JSO Invoice No. _ /l2% i�-C)T ff Li af 0134 oc o ---- q -_L__-- I IRISHMAN PLA CE 'SOT #9 JA ------------- CONTROL CHORD TANGENT CHORD BRG CORNER 98.36 50.47 118.31 61.42 S 50-36'04' W S 22*04'57' w Lrl CD CD OT 267.37 152-15 N 35*00'1 C* E ru C; 'T LOT #31 LOT 30 CU '7'E EASEMENTS V. 71 NLr) LOT #8 Li DISTANCE ON -W 0 V 97.29 1 v 148.51 1 08.10 83.30'57• 1 125.00 �u z IS 83- 80.00 1 57' ORES ro 'u Lo 205,00 LOT J rn 00 W CD &, ON :OJRO� J7 0.709 AC. cn LOT #32 " 2 c:) CORNER 0.884 AC. cs .9 Q. 63 99 LOT 16 0.696 AC. ✓ LOT J5 7'8 AC. D LOT #4 0.755 AC. q 00 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ADDRESS �i o.-ri-1zDC�2 79111Wo PROPOSED FACIILTY 0�d DATE EVALUATED PROPERTY SIZE hG LOCATION OF SITE Water Supply: On -Site Well Community Public tl__� , Evaluation By: Auger Boring Pit Cut - FACTORS 1 2 3 4 Landscape position Slope Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH i J_ Texture group Consistence Structure ,S x Mineralogy/ • ` HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE i SITE CLASSIFICATION: 9C EVALUATED BY: ` LANG -TERM ACCEPTANCE RATE: / 7 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 <;lay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay 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/fl2 . DCHD(01-901