Loading...
133 Hilton LnAccount #: 989900616 Billed To: Todd Miller Reference Name: Rebecca Miller Proposed Facility Residence ATC Number: 3834 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5718-22-7791.TM Subdivision Info: 133 H� (Tar. LH Location/Address: Hilton Lane -27028 Property Size: 3-5 acres AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 SewageTre finent and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA N IjC1'1 N IS ALI A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: Oq CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. Septic System Installed By: Environmental Health Specialist's Signature: ' !� DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Z Environmental Health Section � y • P. O. Boz 848/210 Hospital Street / Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 989900616 Tax PIN/EH #: 5718-22-7791.TM Billed To: Todd Miller Reference Name: Rebecca Miller Proposed Facility Residence Subdivision Info: Location/Address: Hilton Lane -27028 Property Size: ' 3-5 acres ATC Number: 3834 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People #Bedrooms --'5 #Baths �2' Dishwasher: Eg/ Garbage Disposal: ❑ Washing Machine: M Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size -�' S� �CQ$. Type Water Supply Wim, Design Wastewater Flow (GPD) '340 Site: New u Repair ❑ System Specifications: Tank Size ICCOGAL. Pump Tank GAL. Trench Width 3� Rock Depth 12 Linear Ft. gtol Other: _ Required Site Modifications/Conditions: MS LL 614 C.&` TV(1K _ 5 't7� /lett % � �`�' Rzo'",'L--1— IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** -TO 514" Environmental Health 'Pau: DCHD 05/99 (Revised) "CDS �- "CM14 1 Date: gh IN Account M 989900616 Billed To: Todd Miller Reference Name: Rebecca Miller Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Tax PIN/EH M 5718-22-7791 Subdivision Info: Location/Address: Hilton Lane -27028 Property Size: 3 - 5 Acres ATC Number: 2067 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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'andDisposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type q© ose #People :5 #Bedrooms 3 #Baths Z - S - Dishwasher: Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply INEIl. Design Wastewater Flow (GPD) �©� Site: New 13 Repair ❑ System Specifications: Tank SizekXXD GAL. Pump Tank GAL. Trench Width Rock Depth 62, so Linear Alml Other: t 'D 15T9 -A &j) -no, -3 -F� Required Site Modifications/Conditions: It -y' -TALL o rA cer,m oaf VZW Is I vi:F, NO�.�e.�Eee ���� 00-L, IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is 336)751-8760.**** w_ Tp /©o w3co'��+z ►S� tom' • '' w OLX-- too �N E ' onmental Health Spec st's Si atur : Date(P "'�` DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900616 Tax PIN/EH #: 5716-22-7791 Billed To: Todd Miller Subdivision Info: Reference Name: Rebecca Miller Location/Address: Hilton Lane -27028 Proposed Facility: Residence Property Size: 3 - 5 Acres ATC Number: 2067 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental , Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Septiqn .1900 Sewa Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTE UCTI IS`°b54bI1�OR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa e: Date: CD 199 CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: APPUCAMON FOR SITE EVAWAMON/IMPROVEMENT PERMIT do Ei Davie County Health Department D Environmental Health Section P.O. Box 848/210 Hospital Street Moakaville, MC 27028 (336)751-8760 ***nW0r%!rANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL - INFORM ! ION IS PROVI/�DED.,( Refer to the INFORMATION BULLETIN for instructions. I 1. same to be Billed ll�/ / Pdc`2�1Q /P.� Contact Person LI f�f.C', zq a�, Ay Mailing Address -% �', some Phone 33i� 771� City/State/LIP & J' (� Business Phone -356 F 0/d 1. flame on Pe=It/ATC if Different than Above Mailing Address 8. Application For: WSite Evaluation City/State/Lip Improvement Permit/ATC 4m:�. 4. System to service: House 0 Mobile Home 0 Business 0 Industry 0 other s. if Residence: # People # Bedrooms # Bathrooms n Dishwasher 0 Garbage Disposal H'Nashing Machine 0 Basement/Plumbing [Basement/No Plumbing 6. If Business/Industry/other: Specify type # People # Sims # Commodes # Shovers # Urinals # Nater Coolers IF FOODSERVICE: 11 Seats Estimated Vater �Usage (gallons per day) 7. Type of water supply: 0 County/City 4a'/Well 0 Community s. Do you anticipate additions or expansions of the facility this system Is intended to serve! 0 Yes a No If yes, what type' ***IMPORTANT'** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION RLQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESURWITF.D by Me client wlth THIS APPLICATION. Property Dimensions: 3 "Sr Tax Office PIN: # 1-7 4'�,2 — 7 7 9 Property Address: Road Name Ll,'11v" L e- Citylzip If In a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (frau: Mocksville) to PROPERTY: -J r /),V, I e CC !! yr^, jP4 ©n �' .T h/-,10 /I Gi a Pnd 04 14J" Date Property Maned: Me � 'ills is to ceilify 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 dial l ant respvwZte for all charges Incurred fi,vw 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 bl-,'I�n to conduct all testing procedures as necessary to determine the site suitability. // DATE _ (O - //. � SIGNATURE A /�/./ a— THIS AREA MAY property lines and e5�1/ Revised DCHD USED FOR. DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed Ions, structures, setbacks, and septic Imations). Al 91-D p Account No. Invoice No. A 1 DAVIE COUNTY HEALTH DEPARTMENT •' Environmental Health Section Soil/Site Evaluation APPLICANT' INFORMATION PROPERTY INFORMATION Account #:, 989900616 Tax PIN/EH #: 5718-22-7791 Billed To: Todd Miller Subdivision Info: Reference Name: Rebecca Miller Location/Address: Hilton Lane -27028 Proposed Facility: Residence Property Size: 3 - 5 Acres Date Evaluated: Water Supply: On -Site Well ✓ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 4 5 6 7 Landscape position t✓ Slope % HORIZON I DEPTH �7 .- Texture group C Consistence eS Structure E Mineralogy a. HORIZON II DEPTH 7�:k 3 Texture group t ir _t.C2, Consistence 5 ` Structure e,2 G-( Mineralo h „ t,%.,ti L HORIZON III DEPTH G - 4 k 4 Texture grow Consistence -� Structure �(L Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE . t I Q SITE CLASSIFICATION: �1S EVALUATION BY:__P LONG-TERM ACCEPTANCE RATE: �'� OTHER(S) PRESENT: 7� NgLL079L_ 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 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 Dist VFR - Very 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 SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic MineraloU 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 PCHD (Revised 05/99) ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: Billed To: Reference Name: Proposed Facility: Water Supply: Evaluation By: Property Size: On -Site Well Community Auger Boring f Pit PROPERTY INFORMATION Tax PIN/EH #: Subdivision Info: Location/Address: Date Evaluated: tP Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position I—L Slo e % 320 HORIZON I DEPTH 'q-/0 Texture group Consistence F7. s Structure ; Mineralogy' HORIZON II DEPTH l0 Texture groupS� Consistence t=` S Structure 5$l< Mineralogy Mi 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 p . SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: 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 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 Wet NS Non sticky NP - Non plastic FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm SS - Slightly sticky S - Sticky VS - Very Sticky 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 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 05/99 (Revised) C� 4.46A so (2o.9oA),s\� 9237 N Scale:l" = NRlN!lN NN• ril 06, 1999 5:05 PM