The URL can be used to link to this page

339 Fred Lanier RdAccount #: 990004437 Billed To: Willie Studevent Reference Name: Proposed Facility: Residence ATC Number: 4767 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax #(336)751-8786 OPERATION PERMIT Tax PIN/EH #: 5709-97-5242 Subdivision Info: Location/Address: Fred Lanier Road -27028 Property Size: 27 Acres **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. I e System Type: S.T. Manufacturer S 047'-- Tank Date Tank Size_Z Pump Tank Size A ,6q -- System — System Installed By: L jf E.H. Specialist://,, � x1h -,�,dVIANate: 3 /d DCHD 11/06 (Revised) ' • 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 #: 990004437 Tax PIN/EH M 5709-97-5242 Billed To: Willie Studevent Subdivision Info: Reference Name: Location/Address: Fred Lanier Road -27028 Proposed Facility: Residence Property Size: 27 Acres ATC Number: 4767 Site Type;4<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. 5Residential Specifications: # Bedrooms # Bathrooms7t 1 5�# People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size �� ► Type of Water SupplV11'C'ounty/City []Well ❑CommunityWell 41 System Specifications: Design Wastewater Flow (GPD) oank Size kxT) AL. Pump Tank GAL. Trench Width Max. Trench Depth 4 Rock Depth Z Linear Ft. 7Gi� Site Modifications/Conditions/¢tller: Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on they nstallation. Telephone # (336)751-8760. J� NCM Environmental Health Sp DCHD 11/06 (Revised) Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account M 990004437 Tax PIN/EH #: 5709-97-5242 Billed To: Willie Studevent Subdivision Info: Address: 339 Fred Lanier Road Location/Address: Fred Lanier Road -27028 City: Mocksville Property Size: 27 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. PermitType: ;Xew ❑Repair ❑Expansion Permit Valid for:,ZfYears ❑No Expiration Residential Specifications: # Bedrooms . # Bathrooms 2•#People � Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People .# Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):,5- &0 Type of Water Supply: ''County/City ❑Well ❑Community Well Site Modifications/Permit Conditions: S s em Te'yp LTAR Initial S)Y 0.7i Repair Environmental Health Specialist EVALUATION/IMPROVEMENT PERMIT %36)751-8760/ e County Environmental Health O. Box 848/210 Hospital Street ��p 2 2�� Mocksville, NC 27028 Fax (336)751-8786 & AT Applica on Fdr--G ,lSt' '� �s htat m -ovement Permit ❑ Authorization To Construct(ATC) Both Type of pplication: System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** 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 W,' `l� R; d kJe- eJ Contact Person Billing Address 33 ` �� _ / Home Phone ��-f City/State/ZIP r �; ` < VA F Business Phone Name on Permit/ATC if Different than Above Mailing Address Ci PROPERTY INFORMATION *Date House/Facility Corners NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name lAgm e- Phone Number Owner's Address &,r -d 4gd e,— &Z City/State/Zip Property Address City Lot Size 2�%�C• Tax PIN#��rt'7� J'1 Subdivision Name(if applicable) Sec ot# Directions To Site: (dt,t/. f-rol ti;/_A n.�! DMZ urfy 0/l/�r�.. 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;&o Are there any easements or right-of-ways on the site? ❑ Yes 110 Is the site subject to approval by another public agency? ❑Yes,gNo Will wastewater other than domestic sewage be Renerated? ❑Yes ❑No IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms ---,; # Bathrooms Garden Tub/Whirlpool ❑Yes X0 Basement: []Yes ❑No Basement Plumbing: ❑Yes ❑No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested:. Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other. Water Supply Type: County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? 410 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 Vorking the house/facility location, proposed well location and the location of any other amenities. -, 7�o, �/,' Site Revisit Charge Property owner's or owner's legal representativ sign ture Date(s): ,q IW6? Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account # Revised 11/06 Invoice # GoMAPS - Davie County NC Public Access Davie County, NC - GIS/Mannina Svstem Q p,9� fi A. W ;0, Click Here To Start Over Active Layer. r- Use Map Hips PARCELS (Map Tips Available) Page 1 of 1 Quick Search: (County ID c GIS Map Layers I Results I �O NO 5108-9 7- 5-aZ http://maps.co.davie.nc.usIGoMapslmap/Index. cfm?maimnapservice=gomaps&CFID=412... 9/12/2007 GoMAPS - Davie County NC Public Access Davie County, NC - GIS/Mapping System Page 1 of 1 Y4%.0V34,7X* Click Here To Start Over Quick Search:(County ID c if J1106�1 I'h ',-Uve Layer. F Use.,Vap Tips GIs 0 LE7 ED 4 .1 " I PARCELS (Map Tips Available) Map Layers I Results I http://maps.co.davie.nc-usIGoMapslmapllndex.cfm?mainmapservice--gomaps&CFID=412 9/ 12/2007 GoMAPS - Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping System 4a636 Click Here To Start Over Quick Search: (County ID c f - x�ctiwe Layer. F tdse ^tap lips GIs ErlPARCELS {Map Tips NS,ailable} ciao Lavers I Results I C 52 http://maps.co.davie.nc.usIGoMapslmap/Index.cf n?mainmapservice=gomaps&CFID=412... 9/12/2007 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLIC ccouriN O Tax PIN/EH #: 57a' INFORMATION Billed To: Willie Studevent Subdivision Info: Reference Name: Location/Address: Fred Lanier Road -2702 Proposed Facility: Residence Property Size: 27 Acres Date Evaluated: Water Supply: Evaluation By: On -Site Well Community Auger Boring Pit ' Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position i L I Slope % 1---> T -„ HORIZON I DEPTH 0. O- 0 0 -Cp Q. l Texture group •► Gi, Consistence Gr.."IP `WS Structure 1c S. C Mineralogy 9��: HORIZON H DEPTH 2 - Z -,Z Texture group C_ _ _ Consistence qcr _ - Structure Mineralo, HORIZON III DEPTH - Texture group i7OCA4—S: C,.,( Consistence Structure Mineralogy HORIZON IV DEPTH Texture group$' Consistence Structure Mineralogy SOIL WETNESS 0- -- RESTRICTIVE HORIZON Z30�4 SAPROLITE CLASSIFICATION (� LONG-TERM ACCEPTANCE RATE Lo SITE CLASSIFICATION: 1 S LONG-TERM ACCEPTANCE RATE: REMARKS: ()j )AZSZ 4 CAL " 1+. X LEGEND EVALUATION BY:l(�` OTHER(S) PRESENT: 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. Yet 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 Mineraloev 11::1 ,, 2:1, Mixed +: A _ R 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 05/05 (Revised) ■■tttttttt■■t■■ttttt/■■tt■■■■■■■�■■■/t■■ttttt■■■■t■■t■t■■■t■■■tt■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■t■■■t■■■■ttt■■■■■■t■ttt■t/■■■ttt■■■tt■■■tt■t■■■■ ■■■■■■■■■■■■e■■s■■■■■■■■■■■eee■■■■■■■■■te■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■t■■t■■tt■■■■■■■■■t■■■■■■GI■■t�'��Iltttt■!■t■■■■■t■■■■■■■■■■■■■■■ ■■ecce■e■■■■■■■■■■■■■■■■■■■e■■■■■■��■■■■■■��■■■■■■■■■■■e■■■■■ee■■e■ ■■■■t■t■■/■■■t■■■■■t■■tt■t/■'■%!■ttt■■■ttt■■i]■■■■■t■■t■■■■■t■■■■■■ ■■■■■■t\■t■■t■■■■■■■At■AIC;■/�■■■■■■■■■■■■■■■/■■■■■■■■■■■■■■■■■■ttt■ ■■■■■■■■■►1■!■■■■■■■■/!■ttt!■■■■■■t■■■tri■t■■t■■■It■■■!■/■tt■■■■■■t■ ■■■■■■ ■■\■■■ ■■■■■■� ■■■■■■ ■■■■■■ ■■t!t■■s■/■■■■tt■t►�!t!/t!t//ttt■nt■■t■!!■■rlttrltlttt■tt■■■■t■■■!! ■■■■■■■■■■■■■■■■■tt■t■■■■■■■■■erg■■■■■e.■c��■■■■■■■e■■■e■■■■s■e■■e■■ ■■t■■■t■■■■tt!■■t■■■■tt■■t■t�:!►�t�t■■!W�■t■/t■t■■■tt■■/tt■■t■■■tt■ ■■■■■■■■■■■■!■■■■■■■■■■ ■■■■■/■■f1■■��■■■■■■■■e■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■cilli![SII■■�■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■ ■e■■■ee■■■eee■■■■■■■■■■■■/1■■I■■■I ■■■■■e■■■■■■■■■■■■■■■■■ecce■■■■■ ■■■■■■■■■/■■ttt/■■tttttt�:'.!::CC%`Jtttt■■■■■■■tt■■tt■■■t■■■■■■/■■■■■