The URL can be used to link to this page

136 Irishman Place Lot 27DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 84=10 Hospital Street Mocksville, NC 27028 (336)751-8760 /5& & _L F1 <-h hj r /" P/40-6 Account #: 990000863 Tax PIN/EH #: 5789-83-0255 Billed To: Norman Buidling and Remodeling Co. Subdivision Info: Shamrock Acres Lot #27 Reference Name: Butch Harter Proposed Facility: Residence ATC Number: 2260 Location/Address: Irishman Place -27006 Property Size: 100' X 300' AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION 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 WASTEWATER -COON IS VALID FOR A PERIOD OF FIVE YEARS. dal Health Specialist's Signa i� 4 Date: �! CERTIFICATE OF COMPLETION The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 1 Iof G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NOWAY be talon als a guprantge that the system will function satisfactorily for any given period of time. I I I I Septic System Installed By: / Environmental Health Specialist's Signature: 0 Date: �� O DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT'2 Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATIONPERMI/T�/-Teisiti{wnAl/ lace Account #: 990000863 Tax PIN/EH #: 5789-'883-0255 Billed To: Norman Buidling and Remodeling Co. Subdivision Info: Shamrock Acres Lot # 27 Reference Name: Butch Harter Location/Address: Irishman Place -27006 Proposed Facility: Residence Property Size: 100' X 300' ATC Number: 2260 **NOTE** This Improvement/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 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 H D Q5( "'- #People #Bedrooms 3 #Baths 2 Dishwasher: G?r Garbage Disposal: e Washing Machine: 19�' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size •% Type Water SupplyCy- IiIT Design Wastewater Flow (GPD) �t Site: New 17 Repair ❑ System Specifications: Tank Size JOGAL. Pump Tank GAL. Trench Width c s Rock Depth )Z" Linear Ft�' other: Z 'O1STi24N) of 110 141 5T 1 aAo g 10-C. Required Site Modifications/Conditions: W%ALL n7i CoAlwoz V, S 'BFr ►�aJ3� KeeP 10' Cr -r- W. VAX 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.**** �y )L5.' Y4 ✓I 1-1 mss' AQ S �S' �z. t '° AFPo Environmental Health Specialist's Signatur Z Date: /l Z 9 DCHD 05/99 (Revised) APPLICATION FOR SITE EVA1 WITION/IMPROVEMFM PERMR & ATC RR RR RR D ' Davie County Health Department EnWronmenfe/Hea/M Section P.O. Box 846/210 Hospital StreetNOV 15 1999 Mockaville, HC 27026 (336)751-8760 ENVIRDNM DAVIE ***IMPORTANT*** THZS A"LICATION CANNOT BE PROCEHBZD UHLS88 AM THE REQ=RED Ili1 TMATIOH IS PROVMZD. Refer to the IN!'OMWXON BULLETXK for instructions. 1. Nage to be Milled Meiling AddLeee 1:� D � ! qfA so.e Bunce 334 fl -16-6 /0t city/stats/Zzr _ Adye, N z -e df e� -z-?o (O Business shone 33 ji 3g/9 3ZS 5 2. Naas on "zait/ATC if Different than above Nailing Addsese :261 City/stats/sip I. Application For: 11 Site Evaluation U-Mi�rovement permit/ATC D Both 6, ey.t.a to Berviw, 0 House O Mobilo Boma ❑ Business D Industry O Other a. If Residence: E people i Bedrooms 3 i Bathrooms Z. [Ybiehueeher D�bage Disposal p.Kashing Madams o Bueaent/nluabing 0 saaaaent/No hrl�sbing 6. It Business/Industry/Other: Specify type people ♦ siaks e cosaodes # shovers i nriaals i later coolers Ir rOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Typa of Nater supply:City D Well a Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? O Yes ldDie� oyes, what type? ***IMPORTANT*** CLIENTS MUST COMPLEWTHE REQVIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PWT or SITE PLAN MUST BESUBMITIED by the client with THIS APPLICATION. Property Dimensions: M -, U o WRITE DIRECTIONS (from Moeksville)1to PROPERTY: Tax Office PIN- 0 5:,28q8,3 -b7$5- 6q lra>t k-46nY'natZ-2r Property Address: Road City/Zip / b 1jC 4 ti!> Tit, f, ;�7,"' PeAt? 1 es C,,�ee L It in a Subdivision provide Information, asf (lowsZ��b T�L / /1/6Ii it 9A Name: Si, &M- i/o (✓� 4 ,, rt5 1_✓, stl oAatk r IG /-e Section: Block: Let. 7,-7 Date Property Flagged: 1l— l Z -I n This b to certify that the iafbrmation provided 1s correct to the but of my knowledge. I understand that any permit(s) Issued hereafter are subject to suspension or revocation, if the site plans or Intended we change, or If the Information submitted In this application is fidsiRed or changed. I, also, understand that I ane responsible for aB charges incurred from this applicadon. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter open above described properly located in Davie County and owned by to conduct all testing procedures as necessary to determine the site saitebRity. DATE SIGNATURE I I THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the foHOWIDgh Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revbk Charge Client Notification Date: Account No. t/ Invoice No. a / • �� NQS 110- ``�-�Xi'v,�y�.ty 1 17 yai Via: IP4- 06 z? 1 OSI 3 c- �"93�s• f �, ion \a � �: . • � 6 a ;>tg t �;. Jv f cYLau& SHAMROCK ACRES a� 111!Z;, , LUTA AL b'AMRA p.+a �CE 2? Pov�p AUAC OfUAD PEan.Ea carpe ROW ADVANCE AC 27.006SHADY GMT TVR?JSW (9101 940-5064 D 0 No F'Rr I I Los -& w � .• j /j(j Q ��') W ' tvrrEWW SLCff COWAar LL `yO 127 LEEN" tMe7n1 avo fl 192-561 P a•�00 t� --- Zoo 1 VIE COUNTY HEALTH DEPARTMENT DA Environmental Health Section Soil/Site Evaluation NAME D n DATE EVALUATED ADDRESS �4alk� --_P_Oje- TI `tea PROPERTY SIZE n� �/� PROPOSED FACIH.TY LOCATION OF SITE /K l7" Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit L,�-' Cut FACTORS 1 2 3 4 Landscape position Slope b HORIZON.I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH t B P Texture group Consistence Structure S Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: o REMARKS: Landscape Position EVALUATED BY:r -Lf/!t/'O i OTHER(S) PRESENT: LEGEND 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-Veryfriable FR -Friable FI -Finn 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 5C -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(01-901