Loading...
363 Harvest Way (2)OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336.753-1680 Applicant: David Morris Address: 148 No Creek Rd City: Mocksville State2ip: NC 27028 Phone #: (336) 391-1774 Address/Road #: Harvest Way Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 3 # of People: 'Water Supply: PUBLIC ("P'roperty Owner. David Morris Address: 148 No Creek Rd city: Mocksville State/Zip: NC Phone #: (336) 391-1774 27028 Iertv Location & Site Information Subdivision: Phase: Lot: Directions Hwy 158 toward Advance, left at Country Lane, quick left on Harvest way 'System Classification/Description: 'iP Issued by. TYPE 11 A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPO OR LESS) 'CA issued by: 2140 -Nations, Robert SaproliteSystem? QYes ONo Design Flow: 3 6 0 'Distribution Type: GRAVITY -SERIAL Pump Required? QYes QNo Soil Application Rate: 0 _ 3 *Pre Treatment: 1 Drain field Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: 1 2 0 0 Sq. ft. 3 3 0 0 It. 9 Inches O.C. (J)Feet O.C. 3 Inches (r Feet inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. 2, 4 Inches Maximum Trench Depth: 'S ' 6 Inches Maximum Soil Cover. a 4 Inches 'System Type: INFILTRATOR OUICK4 STANDARD Installer Brian McDaniel Certification #: *EH S: 21140 -Nations, Robert Date: 0 3/ 0 9/ 2 0 1 5 ®A .... ...... CDP File Number 187515 - I • Electric Equipment County ID Number: L040'001201 NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer: Box 12 inches Above Grade ❑ Yes ❑ No Certification #: Box Adj. To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No *EHS: Pump Manually Operable ❑ Yes ❑ No '*Activation Method: Date: AlarmAudifate El Yes ❑ Nb ,Approval Stafus CIi�ApPro r+ed❑ .bisapproved Alarm Visible ❑ Yes ❑ Na 2140 - Nations, Robert *Operation Permit completed by Authorized State Agent: Date of issue: 0 3 1 0 9/ 2 0 1-5 Owner/Applicant Signature; This system has been installed in compliance wth applicable NC General Statutes: Article 11, Chapter 130A, Rules for .Sewage Treatment and Disposal, 1 5 NCAC 18A .1900 e#. Seq., and all conditions of the Improvement Permit and Construction Authorization. This property is sen+ed by a 1YPE ltA Sewage Sepc System Rule .1961 requires that a Type TYPE 11 A, septic system meet the following criteria: Minimum System Review By The Local Health Department: NIA Management Entity: OWNER Minimum System InspectionlMaintenance Frequency By Certified Operator. NIA Reporting Frequency By Certified Operator. N!A with a p public 961 manag met euires that a nt tywith a certiIV and V fied Operatortor aprivate cert i'ed opesiness owner must maintain a valid contract rator for the fife of the septic system. Rule .1961 requires that Type VI septic systems designed fora homelbusiness owner must maintain a valid contract with a public management entity with a certified operator for the Iiie of the septic system . Rule. 1961,(2) (e) requires a contract shall be executed between the system owner and a management entky prior to the issuance of an Operation Permit for a system_ required to be'maintsined by a public or private management entity, un, s'the system ownerand certified operator are the same. The contract shall require,specific requirements for maintenance and operation, responsibilities of the owner and systems, operator, provisions that the contract shall be in effect for as long as the system is in use, and otherrequirements forthe;continued proper perfom►ance of the'system. K shall also be a condion of ,the Operation Pem+it that-subsequentowners of the systems execute such a contract. ®Hand Drawing Olmport Drawing Site Plan/Drawing attached. Address/Road #: Harvest Way Mocksville Structure: # of Bedrooms: # of People: NC 27028 SINGLE FAMILY 3 "Water Supply: PUBLIC Subdivision: Phase: Lot: Directions Hwy 158 toward Advance, left at Country Lane, quick left on Harvest way system Specifications Trench Depth: a 4 Inchesn: \ Site Classification: CONSTRUCTION For Office Use Only Saprolite System? AUTHORIZATION Minimum Soil Cover *CDP File Number 187515.1 •°"�'`�` Davie County Health Department Maximum Trench Depth: County ID Number. L50000001201 Soil Application Rate: 210 Hospital, StreetEvaluated Maximum Soil Cover: For. NEW "System Classification/Description: P.O. Box'848 GRAVITY - SERIAL Township: 1 0 0 0 Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 "Proposed System: 25% REDUCTION 0 1/ 0 a/ a 0 a 0 Applicant: David Morris Property Owner. David Morris Address: 148 No Creek Rd Address: 148 No Creek Rd City: Mocksville City: Mocksville State/Zip: NC 27028 State/Zip: NC 27028 Phone #: (336) 391-174 11 -7GI Phone #: (336) 391 1'7? Address/Road #: Harvest Way Mocksville Structure: # of Bedrooms: # of People: NC 27028 SINGLE FAMILY 3 "Water Supply: PUBLIC Subdivision: Phase: Lot: Directions Hwy 158 toward Advance, left at Country Lane, quick left on Harvest way system Specifications P ann I of Z Trench Depth: a 4 Inchesn: \ Site Classification: Provisionally Suitable Saprolite System? OYes @No Minimum Soil Cover 1 a Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 - 3 Maximum Soil Cover: a 4 Inches "System Classification/Description: "Distribution Type: GRAVITY - SERIAL TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank; 1 0 0 0 _ Gallons "Proposed System: 25% REDUCTION 1 -Piece: QYes QNo Pump Required. OYes @No OMay Be Required Nitrification Field 1 a 0 0 Sq. ft. PumpTank: Gallons No. Drain Lines 3 1 -Piece: OYes ONo Total Trench Length: 3 0 0 ft GPM vs— ft. TDH Trench Spacing: — 9 . Inches O.C. @Feet O.C. Dosing Volume: _ Gallons Trench Width: 3Feet Inches _ Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSFOTS-) OTS -11 SepticTenkInstaller Grade .Level Required:'01 0I1 OIII OIV P ann I of Z CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type:, Construction Authorization CDP File Number: 187515 - 1 County File Number: L50000001201 Date: 01 / 0,2 / 2015 Q Inch Scale: QBlock ON/A APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC RECEIVED Davie County, Environmental Health PAID P.0'. Box 848/210 Hospital Street Date: 1 L Mocksville,`NC 27028 --rI) y!►y-- - Date: 12llg jig Receivedby:676780/ F 3367531680 13•Mt}cheU Application For: ❑ Site Evaluation/Improvement Permit Authorization To Construct (ATC) ❑ Both Type of Application: ❑New 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 V Address -14Q A10e2, City/State/ZIP JL Email Name on Permit/ATC if Different than Above Address PROPERTY INFORMATION Contact Person Home Phone h- - Business Phone *Date House/Facility Corners Flagged ' ` ' - . ' NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months ith site plan, no expiration with complete plat.) Owner's Name ( Phone Number 130q -I :) C4 Owner's Address City/State/Zior-t?(,Aka V�- Property Address CityAAQe--N q11 Lot Size 1(,�,eS.--TAX PIN# Subdivision Name(if applicable) Section/Lot# Directions To Site: Z c�,C- 1 So� n,.. "aqvQ UA\1 r Uti�V+ Specify Problem IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms � # Bathrooms Z Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes no Basement Plumbing: ❑Yes^o 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 addition or, qxpansions of th facility this system is intende&Krve? Yes ❑ 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 DpAie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I unders d that I am Jesponsible for the proper identification and labeling of property lines and corners and locating and flagging or stakin the 119W44ility to sed well location and the location of any other amenities. I V Prope owner's or er's legal representative signature Site Revisit Charge Date(s): Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account # 1 �/ Revised 11/06 Invoice # • Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 /Fax (336)753-1680_ IMPROVEMENT PERMIT Account M 990005754 Tax PIN/EH M h50000001201 Billed To: David.Morris Subdivision Info: Address: 2358 Hwy 158 Location/Address: Harvest Way -27028 City: Mocksville Property Size:' 10.75 Acres Reference Name: Proposed Facility: Resident **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: PNew ❑Repair ❑Expansion Permit Valid for: El5 Years ❑No Expiration Residential Specifications: # Bedrooms'_ # Bathrooms 3 # People !!!� Basement ❑'Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): LKQ Type of Water Supply: XCounty/City ❑ Well ❑CommunityWell Site Modifications/Permit Conditions: As stated in 15A 'NCAC 18A.1969(5)ep#ostr� limo ' isa a uscct Site Plan Initial Environmental Health Specialist i.p.l 1-06 LTAR C . fo-F 7 - r I ► pass ble ore JOU Id r45s ��2 J �0 . - ZJN� 14A � � Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680. IMPROVEMENT PERMIT Account ,#: 990005754 Tax PIN/EH #: 1150000001201 Billed To: David Morris Subdivision Info: Address: 2358 Hwy 158 Location/Address: Harvest Way -27028 City: Mocksville Property Size: 10.75 Acres Reference Name: Proposed Facility: Resident **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 1 I 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: New ❑Repair ❑Expansion Permit Valid for: El5 Years ❑No Expiration Residential Specifications: # Bedrooms # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design } low(GPD): Type of Water Supply: XCounty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: As, stated in 15A NCAC 18A.1959i5i --ueeeptea-Synrnis-may also De use i.p. 11-06 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health p P.O. Boz 848/210 Hospital Street q Mocksville, NC 27028 JUN , (336)753-6780/ Fax (336)753-1680 &Jay d ?0 p Application For: V /iteEvaluation/Improvement Permit ❑Authorization To Construct (ATC) Type of Application: ❑New System ❑Repair to Existing System OExpansion/Modification of Existing Sys i` ac ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION.BULLETIN for instructions. APPT,TC;ANT INFORMATION Name t)8U1 6 M uX15 Address Z3 S '- City/State/ZIP Nloc l?-,& -k Email Name on PermitIATC if Different than Above Mailing Address Contact Personc�J AA V%/-r!;�f Home Phone 7 T �-3 C(1 111 2� U Z Business Phone PROPERTY INFORMATION G '=- %—N -&Date House/Facility Comers Flagged NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is alid or 60 months with si lan, no \\expiration with complete plat.) Owner's Name i , - I �q� v �2���`� 6� � R�f Phone Number Owner's Address City/State/Zip t)taS g �,Q Property Address City Lot Size �t7 ,"�� Tau PIN# /ZO / Subdivision Name(if applicable) Section/Lt# Directions To Site: I5Z /5 A) Q OA) 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 _io Does the site contain jurisdictional wetlands? Yes No Are there any easements or right-of-ways on the site? 4Yes No Is the site subject to approval by another public agency? _Yes /No Will wastewater other than domestic sewage be generated? Yes No TF RESIDENCR FTT.L 01 JT THF, BOX # People _16�_ # Bedrooms Basement: ❑Yes FM�n_ Basement .C1W # Bathrooms _ %� Garden Tub/Whirlpool ❑Yes ❑No ❑Yes L Na- TENON-RESIDF.NCE FTI,L, OUT THF. ROX.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: onventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type :t<oun Xity. 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? ._ _....... , 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) is ed hereafter are sub' ct to suspension or revocation if the site is altered, the intended use changes, or if the inform tion submitte this appli a sified or changed. I hereby grant right of entry to the Authorized Representative of the Da 'e County He Deent to conduct necessary inspections to determine compliance with applicable laws and rules. I unders d a"eit t-i�40.P.3a onsi for the proper identification and labeling of property lines and comers and locating and flagging or stake e. -!h o proposed well location and the location of any other amenities. L^- - Site Revisit Charge Prop wner's or o s legal reiVesentative signature Date(s): �^ Client Notification Date: ate EHS: 76q Sign given ❑Yes ❑No Account # Revised 11/06 Invoice # 6 [4119 GoMAPS - Davie County NC Public Access A 1 x o �; f s� .0 '? _ _ COUNTKY-LN� -• - j j I r �1 t xt z i ;, M �7 •'1, P u 1 II 't MO KC SVILLE Oo241f1' ***WARNING: THIS IS NOT A SURVEY!*** This map is prepared for the inventory of real property found within this jurisdiction, and is compiled from recorded deeds, plats, and other public records and data. Users of this map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on this map. The �f County and mapping company assume no legal responsibility for the information contained on this map. WATERSHED—STRUCTURES i WATER BODIES COUNTY—BOUNDARY t .:. STREETS RAILROAD CENTERLINE PARCELS CITY—LIMITS BERMUDARUN COOLEEMEE DAVIE COUNTY htOCKSVILLE nccounties DAVIE <all other values> Monday, June 18 2012 APPLICANT INFORMATION Account #: 990005754 Billed To: David Morris Reference Name: Proposed Facility: Resident Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: h50000001201 Subdivision Info: Location/Address: Harvest Way -27028 Property Size: 1075 Acres Date Evaluated: On -Site Well Community Auger Boring Pit Public A " Cut • 0®®�®00 ToLandscape position HORIZON I DEPTH r Ej A fi���[�7s':F e group Consistence .Texture • DEPTH MOMso����s��� Texture group r l701P sr. �- Consistence Mineralogy HORIZON III DEPTH group Consistence HORIZON groupTexture Texture �■�®��■owe Comistence Mineralogy SOIL WETNESS KM 0 5 IQ I WE@ 1 to)• RaiSAPROLITE -5�-®�� CLASSIFICATION SITE CLASSIFICATION: EVALUATION BY:`tecoA&LwaA4 LONG-TERM ACCEPTANCE RATE: -� OTHER(S) PRESENT - REMARKS: 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 LAS - 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 D�Qist 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 Limos Horizon depth - In incles 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)