Loading...
123-129 Deer TrailDavie County Health Department ,•'y,, r"' ENVIRONMENTAL HEALTH SECTION r P.O.Box 665 Mocksville, N.C. 27029 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) ***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.*** �+ ��� AUTHORIZATION t�IMBER NAME DATE N2 :y NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION OlAdlz COfENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM *mWICE*** THIS AUTHORIZATION F WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE DCHD 10/95 ,n Y L --XO DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT PERMIT **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 Sewage Treatment and Disposal Systems) LOCAT SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER 0 -- RESIDENTAL SPECIFICATION: BUILDING TYPE WC� # BEDROOMS C # BATHS a # OCCUPANTS �, GARBAGE DISPOSAL: Yes/0 COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE &fid GAL. PUMP TANK OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: GAL. TRENCH WIDTH ZW ROCK DEPTH /J " LINEAR FT. VDD S6' 1 ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. IMPROVEMENT IMPROVEMENT PERMIT BY **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 v /3a `D AUTHORIZATION NO. 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 TIME. DCHD 10/95 APPUCATION FOP SITE EVALLIATIOIViIMPROVEMENTS PERMIT Davie Courry Health Department Environrnental Health Section P O. Mix 665 v N 1 Mockoville, N.C. 210128 CONSTRUCTION SHALL NOT BEGIN UNTIL 1KIPR0VENIEN-TS PERMIT HAS BEEN ISSUED. • Home Phgnp � -,Y-(/604 t, 1. Permit Requested By-- 0 .__' /itkI /L -h. ---___-- -- Business Phone __ I'll 2. Addre3s c ..� ! lL�rL� .. _� /9 d 11..✓ c _ 3. Properly Owner if Different 11han Above _ 1 W�!> _. _ r..n��i�,. Adiftew 4. Permit To: a) Install-lef-After Repair.,._ b) Privy Conventional-..- Other Type__.. 3 - Ground Absorption c) Sub-Q1vision-.171171i.__+ Sec..______.._ Lot No S. System used to serve what type fa ility: House-- Mobile Home Eluaryess-___ Mdustry____ Other__. b) Numbw of people____. 8. a) It house or mobile home, state size of home and number of rooms. House Dimensions — — Bed Rooms_.i_ Bath Rooms..._ -_0__-& ._._ Den w/Closet _ b) If Business, Industry or Other, State: Numtw-r or persons served What type business, etc.._.._. Estimate amount of waste daily (2•4 7. Number and type of water -using fixtures: commodes garbage disposal lavatory !/ -- showdrs __-�/_ r_.___--. _ washing machine -kms dishwasher ._.,jam__._- sinks -_._-__-- 8. a) Type water supply: Public_._- F'rivrge_,Y._. Community_ b) Has the water supply system boen approved? Yes___ No_kef", 9. a) Property Dimensions __ _.. b) Land area designated to building sit E: -- c) Sewage Disposal -- 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What tyae? This Is to cortify that the. information is correct to the best of my knowledge. Date Owner Signature OWNER 1$ SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 says for processing Directions to properly: �~ Cab a d APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By Mailing Address 2. Name on Permit if Different than Above 3. Application for: ❑ General Evaluation 4. System to Serve: ❑ House ❑ Business ❑ Industry 5. If house, mobile home: Subdivision No. of People No. of Bedrooms No. of Bathrooms Home Phone Business Phone ❑ Septic Tank Installation Permit ❑ Mobile Home ❑ Place of Public Assembly ❑ Other ❑ Unknown Dwelling Dimensions 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Lavatories No. of Urinals No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public ❑ Private 8. Property Dimensions Sewage Disposal Contractoi 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If vas- what tvnP? Section Lot # ❑ Basement/Plumbing ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal ❑ Yes ❑ No ❑ Community 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvementg Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. PKUP1i1,ClY 1Nr'Uiti` A11UN KL'' UIRLD: Directions to Property: Tax Office PIN # _r _J S-71 Road Name JSnea,'l 2.9irc Fox # (if available) City 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. DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. I OWN the property. ❑ 2. I 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 representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD (1193) r ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME YIJI/�'n /IArir DATE EVALUATED�3/�5� ADDRESS PROPERTY SIZE PROPOSED FACIILTY A/ z LOCATION OF SITE A*0-24r- .4A Water Supply: On -Site Well _ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position 4, Slope R HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH d /' Texture groupG� Consistence r Structure -c- Mineralogy CMineralo 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: EVALUATED BY: ,Xk& LONG-TERM ACCEPTANCE RATE: ; OTHER(S) PRESENT: REMARKS: LEGEND Landscave 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- 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 DCHD (01-901 /0 LEGEND WMROW SuRyffw; EXISTING IRC!. PIN ROUIE 0 d.gNEW IRON ETOLERANCES 1ACKEN -ZC7T—,KEl FROM THE W BRACKEN 08.36 PG. 509),LYING I LARKSVIL DAVIE CO, N.C.�t� � c� I .CAI. 1--= so*wawa. x J CT r 12-1- 81 16581-2 I Davre County Xealtlr Depanbnent and Nome NealtFi .qyency 210 HOSPITAL STREET I P.O. BOX 665 MOCKSVILLE. N.C. 27028 PHONE: (704) 634-5985 December 19, 1995 Norman Dillingham 1219 Riverbend Dr. Advance, NC 27006 Re: Site Evaluation Boozie Lane/Site 2 (1/2 Acre) Dear Mr. Dillingham: As requested, a representative from this office visited the aforementioned site on December 13, 1995. Based upon the information provided on the application for site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on—site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, A 4 " V'j. /16 ed<7 4!; 7. Robert B. Hall, Jr., R. S. Environmental Health Section RH/wd Enclosure(s)