Loading...
1504 Davie Academy Rd DAVIE COUNTY ENVIRONMENTAL HEALTH 1 P.O.Box 848/210 Hospital Street Mocksville,NC 27028 • • (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account #: 990004220 Tax PIN/EH#: 5717-08-2790 Billed To: Ralph Meyer Subdivision Info: Reference Name: Location/Address: 1504 Davie Academy Road-27028 Proposed Facility: Residence Property Size: 12.055 acres ATC Number: 4598 **NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC 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. 10-3-06 System Type: A TQ w S.T.Manufacturer S u� Tank Date Tank Size ►T Pump Tank Size System Installed By: k a"-r_ E.H Specialist: A kfl . 41 r 4J .-r _gyp -F ti �p�-gw�lfi 5 �u t(c, N v s -e �6� sys p, ` EI' may' ZdG �� DCHD 11/06(Revised) . F DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street • Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004220 Tax PIN/EH#: 5717-08-2790 Billed To: Ralph Meyer Subdivision Info: Reference Name: Location/Address: 1504 Davie Academy Road-27028 Proposed Facility: Residence Property Size: 12.055 acres ATC Number: 4598 Site Type: ❑New ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms '1 #Bathrooms 41.5 #People o1-- BasementB"Basement plumbinge Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) � LotSize �� rj gtrccs5 Type of Water Supply: ❑County/City aWell ❑CommunityWell System Specifications: Design Wastewater Flow(GPD) { Tank Size t aXGAL.Pump Tank GAL. Trench Width Max.Trench Depth Rock Depth Linear Ft. As stated in 15A NC,AC 1.54.29£39(5) Site Modifications/Conditions/Other: 6!ssepted S;"tPw,c may naso bT usedd Contact the Davie County Environmental Health Section for final inspection of this system between 8:30-9:30a.m.on the day of installation. Telephone#(336)751-8760. c,k tar Nfjte6C �Ow��/ WCOP7 , 6 r Fro �as� \ 7 L�'k�h an yvaat�lca��ok 5T 7 -m 6 a r< eel( ke not t/e�rt $t-,5r-rKIc&4--f Cc / f OOJ, �GCeBUC-. bbtccS ap^c Scc�. 1 a"� co�r<�e drop W,�lt (��� i� 1 eta �K 110 -EL-�S A. b.r w` "' ZI Environmental Health Specialist Date: DCHD 11/06(Revised) • Davie County'Environmental Health ' P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751=8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990004220 Tax PIN/EH#: 5717-08-2790 Billed To: Ralph Meyer . Subdivision Info: Address: 96 Brittany Court Location/Address: 1504 Davie Academy Road-27028 City: Lakeside Park Property Size: 12.055 acres Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans,plat or the intended use change. Permit Type: . ew ❑Repair ❑Expansion Permit Valid for: Years ❑No Expiration / Residential Specifications: #Bedrooms � #Bathrooms y YJ-#People I Basementl�asement plumbing�f Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): `�y Type of Water Supply: ❑County/City B'`Vell El Community Well Site Modifications/Permit Conditions: System T e LTAR Initial cc c t _a-7 5— Re air -sp7 Site Plan �.•CQt}ir TTtG �� I0( G(1V4�t �y l \ 46 O 0 7y Environmental Health Specialist Date i.p.l l-06 < --APPL �T SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 JP� (336)751-8760/Fax(336)751-8786 Appl tion or: io rovement Permit XAuthorization To Construct(ATC) VBoth Type f App ' at' stem ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***I T***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED: Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed ;�At Pq L M E k Eft Contact Person M E Billing Address Z rZ t, A N c - Home Phone. ?.51 4 z/,—Q 4i 2 City/State/ZIP A k SJ b E. PA 0 1-!5LLL $asiuess Phone 6EL . fix, Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagge7 NOTE: A survey plat or site plan must accompany this application. Included:XSite Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name RRG.P* 4. t 74N Phone Number Owner's Address !31r.i I r-rArlG City/State/Zip Aerst-Dr Aa1e i. al'1 Property Address/:52 ¢ DAVEe- A} A aCM , City "oC k S J1...L;- Lot Size AtG R C`..a- Tax PIN# 57�7-D1�-X17 40_ Subdivision Name(if applicable) Section/Lot# Directions To Site: FQat, 1_)S 1 4. - ' >,4Vi j5 Ar AD.C^fo e b M)4.-:-c. ©#-/ -/EFT 4i?.4Vr,,- CV;-. AA1eC Ct)J- 7-W C4B&E If the answer to any of the following questions is"yes",supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes)(No Does the site contain jurisdictional wetlands? ❑Yes;KNo Are there any easements or right-of-ways on the site? ❑Yes Xlo —,Ex t,E'GT —ZA0E ALS Dr-of 4./ Rb Is the site subject to approval by another public agency? ❑Yes Wo Will wastewater other than domestic sewage be generated? ❑Yes WO IF RESIDENCE FILL OUT THE BOX BELOW #People Z #Bedrooms 4- #Bathrooms + V -a- Garden Tub/Whirlpool ❑Yes'X'No Basement: XYes ❑No Basement Plumbing: Wes ❑No -t�I�ftA 1,A i1 F,N I Ea Q ASg M ►.1 IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business !..a A RA 4 F" Total Square Footage of Building 1B44 #People O #Sinks 1 #Commodes I— #Showers 1 #Urinals O Estimated Water Usage(gallons per day) /D (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested: XConventional ❑Accepted ❑Innovative ❑Alternative ❑Other WF-tt_ "3�PktLL Water Supply Type: ❑ County/City Water ❑New Well Existing Well ❑ Community Well 30`� Ab Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes )f No If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging or stab'+ the house/facility ocation,proposed well location and the location of any other amenities. Gc� Site Revisit Charge Prop rty er's or owner's legal repre tative signature Date(s): ,/ Client Notification Date: Dat EHS: Sign given ❑Yes [34 Account# Z Revised 11/06 Invoice# �-a L— 5707 \ N� (9.44A) ISP 8039 A We C J O^ (11 .49A) S 2790 Apg (1.43A) 3454 titib �o m 2271 Q . (28.44A) �Q 7108 J" DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004220 Tax PIN/EH#: 5717-08-2790 Billed To: Ralph Meyer Subdivision Info: Reference Name: Location/Address: 1504 Davie Academy Road-27028 Proposed Facility: Residence Property Size: 12.055 acres Date Evaluated: 2 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring �� Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slo % - HORIZON I DEPTH U — - - 1 Texture groupL y Y S L Consistence JV-P P „ Structure firc,4l' e C ,.- Mineralogy j: ' ri ( HORIZON II DEPTH - 6 Texture group G ti Consistence P 41 - ; P. Valf r, f.: r Structure rr SbKa Mineralogy 1:1 1-.( : r HORIZON III DEPTH -zf 1 Sf--q Texture groupGL C Consistence Structure L Mineralogyr.y HORIZON IV DEPTH Texture group Consistence Structure Mineralogyr SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE L CLASSIFICATION �- �. .1 , LONG-TERM ACCEPTANCE RATE 6 or X7 5 SITE CLASSIFICATION: 0 . ' �.. EVALUATION BY: a U LONG-TERM ACCEPTANCE RATE: n• �7 I n`+ 1 OTHER(S)PRESENT: 0 . 5 QKI REMARKS: LEGEND i, n c ape 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-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm NS -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1,2:1,Mixed lYQtes 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 05105(Revised) 4-yk tA Z P- -P 0 o b ko Trt E:s a c W ON7n r,; `Gant VV)4/- BL), -i--, CA/LAq� FjeS-T A/C .2 2 D\) 0.1 z.S pppF0X X I terLA A/I Sri 2- 7-o ALL- O"T -7S�-ioo i�)L,\Cla E4 DE 2, Vit l J 7t2 r0 n, n -4 7=1 ZZC5 ,0lI` To all \NJ, A A 4 v /oil K. Rio14o LLs--- —to o j L-1 52- A L 1L 0 Lr A-a L 2 . qAPA4c To ilc cb A- ll 3 . A^I 1 1 Pu77 Ex% >T) a ,j o p-4.- -4 02 I Icl 4 10 X