Loading...
373 Michaels Road Lot 23-*r�, -r r - �C � rr r - +r�•-.� + �y.�,,..yvi,ly�'�yl,`�.�-.i-_rr^,.+.._ t �•...e' L " �� �•� i �`�Crt;�f��.O�f t 66 � n � -L-l.a i n s � Z ✓aro `. DAVIE COUNTY HEALTH DEPARTMENT Y RO-YEMENT AND OPERATION PERMITS PROPERTYTNFORMA ON Pe " • (Name � � Subdivision Name: 40 Directions .to.peSection: Lot: l II MOVEM ENT y/ ''•' i s :& °l4 yip PERMIT Tax Office PIN:# Road Name• C **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An 4 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) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER &VIRONMENTAL HEALTH S T DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE 402%1 # BEDROOMS �_ # BATHS --.? # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL, SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY_ DESIGN WASTEWATER FLOW (GPD) NEW SITEy REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZEZM ?/ ' GAL. PUMP TANK GAL. TRENCH WIDTH � ROCK DEPTH � LINEAR FT. moa 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 PERMTf 'C hQ , •D c Sad Pkv 0 90 �0 AUTHORIZATION NO. /.� 9� OPERATION PERMIT BY: L 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 TIME. DCHD 05/96 (Revised .: � J�.C',('�,�.ttt''�� � �kt�, � n � .. .: rh �c-�-4 `y�t•�.�r � Y/.Xo AUTHORIZATION NO: 7 V 6 DAVIE COUNTY HEALTH DEPARTMENT J Environmental Health Section PROPERTY INFORMATION Permits 's` ,,* ,p P.O. Box 848 Name: fir' k ~�'`��`}` Mocksville, NC 27028 `�f �� �' Phone #: 704-634-8760 Directions to p]ropperty:jl r'�/ <_`r' �"_'� - .�` l ' ` I dy—"Js -k AUTHORIZATION FOR ' �D WASTEWATER . ,^ SYSTEM CONSTRUCTION Subdivision Name: wt Section: Lot: t� Tax Office PIN::j# �'---ia FITP -Road Name/ C' r% �-5 **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) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. MENTAL HEALTH SMCIALIST DATE ISSUED APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC Davie. County Health Department FIM Environmental Health SectionP.O. Box 848 Mocksville, NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS -70 THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billedo, u� Contact Persono Mailing Address PO 738 Home Phone 33 & City/State/Zip lS�,J0 E -f- G 0? --70 Business Phone 336 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: [ ] Site Evaluation [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: [ ] House [ }'Mobile Home [ ] Business [ ] Industry [ ] Oth r 5. If Res' ence: # People # Bedrooms # Bathrooms [ Dishwasher [ ] Garbage Disposal asking Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 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: [ ounty/City [ ] Well [ ] Community 8. Doou anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [ 7�0 y P If yes, what type? EZTHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***4y14XT OF THE PROPERTY MUST BE 3� xlpp/ SUBMITTED WITH THIS APPLICATION. Property Dimensions: i WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: #15-7qlo - 2,0 _ 01 U/' Property Address: Road lame city/zip If in Subdivision provide information, as follows: Name: Section: Lot #: ' 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 'Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by P,66f k, ) •� t c duct all testing ocedu es as ne s to determine the site suitability. p t DATE , 3 " - �o SIGNATURE 94 Revised DCHD (06-96) THIS AY' :A ,1tAy 13E USED FOR DRAWING YOUR SITE PLAN: C t, i i e : 0 F N!OTr C j � �,` F •'.- - - ii - i ; _,; ;,il lois to �� ,vr�vu u'� cf k 1/ All utilitiCs tc u in F u i r) All lots It WVQ c¢mr niFnmr ! ,*il- Iota '.0 I c+l� ALL ; i i °) r i �; ).Total suL� �i I w 3) All lots n' all hz", a minimum c i 0 { r� a � 9) AvcrogO lot siza 33509 a4ua q Jr I o S o io) No USGS monumerta within o o I r `c t) 36 Lots in sut>diviaicn I t r Z UJ _ ri O'1t� ZF t t4 1 t°oi'os"E _ , Tax Lot 16 i 00.00' ' i C10.00, _� 3 200.09' Tax Map M-5 - -- F 289. 4' r� "o ri z S 44-27'0�2— 05 20.23' .� o� Shec .419 Ac. +;' _ in S+ i.78' Ac. -, - 3/4"EIP uj 0 0 —_. --- _.. ^ ;'(bent) M a, :rAT=i�6 ' N Si 0 0 �! 3 Leveloper: L 4�) P,oger P. Spilln 3• 7 _ UI y E3ox 7.,3 8 F i APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER Davie County Health Department Environmental Health Section D JUL 2 1 1995 r t P. O. Box 665 j/ Mocksville, NC 27028 EWH co 1. Application/Permit Requested By lcoh7SO '_avrrn See— C. i't yi ce- / M In 2 Mailing Address Home Phone b -�' J 33 Business Phone u 7 sZ `✓-S 2. Name on Permit if Different than Above 3. Application for: General Evaluation C3Septic Tank Installation Permit 4. System to Serve: ®f'/House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown i 5. If house, mobile home: Subdivision "–`'� 'T�' G�B� Section _,� Lot # 6. W No. of People No. of Bedrooms No. of Bathrooms ��- Dwelling Dimensions If business, industry, place of public assembly, other: Specify type _ 7 /Bao s�;>✓� ❑ Basement/Plumbing ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ .Garbage Disposal No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ublic ❑ Private ❑ Community 8. Property Dimensions 10 O ,;',QOF Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes "0 If yes, what type? 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: �©/ 50.x[ S 9'� % G J This is to certify that the information provided is correct to the best of my knowledge, incurred thi a�plication. DATE Qoo I understand I am responsible for all charges SIGNATURE *' CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED �ROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representativ of the Dewe Co my Health �artment to enter upon above described property located in Davie County and owned by .;�5 ej /corm, Set UA0'— k)14. to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. Ap 5 DATE DCHD (1193) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ADDRESS PROPOSED FACIILTY DATE EVALUATED PROPERTY SIZE LOCATION OF SITE���re s Water Supply: On -Site Well _ Community Public f� Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position /1 G Slope Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH �- Texture groupG 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: REMARKS: DCHD (01-901 EVALUATED BY: Ila !Z 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 SILL -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 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 ■EE■ SEEN ■ES■