Loading...
1626 Hwy 601S• DAVIE COUNTY ENVIRONMENTAL HEALTH 011110 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax 4 (336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990000811 Tax PINIEH #: 5747-02-6382-B Billed To: P.D. Allen Subdivision Info: Reference Name: LocationiAddress: 1628 US Highway 601 S-27028 Proposed Facility. Business Property Size: 1.40 Acres ATC Number: 5108 Site Type: XNew ❑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 # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility TypeaLAI People_ # Seats l' Square Footage(or Dime sio sof Facility) ? /cSC� Lot Size I . i Glc_ Type of Water Supply: 'bounty/City ❑ Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) _Tank Size A )W GAL. Pump Tank AaGAL. 2/ t i Trench Width � Max. Trench Depth Rock Depth Linear Ft. 160. Site Modifications/Conditions/Other: �edweovt 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. VI/ �P. (C�->;;'I Environmental Health Specialist Date Cd DCHD 11/06 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH • P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/Fax #(336)753-1680 Account #: 990000811 Billed To: P.D. Allen Reference Name: Proposed Facility: Business OPERATION PERMIT Tax PINIEH #: 5747-02-6382-B Subdivision Info: 1,78 LocationrAddress: 41SUS Highway 601 S-27028 Property Size: 1.40 Acres ATC Number: 5108 **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. System Type: S.T. Manufacturer Tank Date�3A�`-Tank Size %OO( Pump Tank Size E.H. Specialist: Ald System Installed BY xWe—�hZU/d GPS Coordinate: DCHD 11/06 (Revised) 0 Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680 IMPROVEMENT PERMIT Account #: 990000811 Tax PIN/EH #: 5747-02-6382 Billed To: P.D. Allen Subdivision Info: Address: 204 Bean Road Location/Address: Hwy. 601 S.-27028 City: Mocksville Property Size: 1.40 Ac. Reference Name: P.D. Allen Proposed Facility: Business **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: ❑New ❑Repair ❑Expansion Permit Valid for: X5 Years ❑No Expiration Residential Specifications: # Bedrooms # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type b ens' ~itl�ople #Seats Square Footage(or DimNX Facility) Design Flow(GPD): ©(::) Type of Water Supply: aCounty/City ❑ Well ❑ CommunityWell Site Modifications/Permit Conditions: Site Plan System Type LTAR Initial Repair 3 Environmental Health Specialist i.p. 11-06 Date @W200 Aug 12 10 11:56a Information Services 3367531680 p.1 v LI ` FOR SITE EVALUATION/IMPROVEMENT PEI MIT & ATC Davie County Environmental Health 2o�Q P.O. Box 848/210 Hospital Street C P�G 6 Mocksville, NC 27028 't t� (336)753-6780/ Fax (336)753-1680 teaion lid Sit tion/Improvement Permit ❑, Authorization To Construct( ATC) ❑ Both Et eiil�Ap GNew System ❑Repair to Existing System ❑Expansion/Modification of Exi ting System or Facility ** *L1IPORTAN * • THIS APPLICATION CAN7VOT BE PROCESSED UNLESS ALL OF THE QUIRED INFORIVIAT12-1 IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. Name Vrm k Contact Person j �tet1 Arl ss r 01 S. Home Phone City/Statc/ZIP SU.` a IJC, Business Phone — LbOO Name on Permit/ TC if D Arent than Above Mailing Address City/State/Zip PRnpF.Rlry IR CIRMATTnN T -T ­ /P„-;i;t. NOTE: A survey Aat or site plan must accompany this application. Included: C Site Plan ❑Plat(to (Permit is vl lid for 60 months with site plan, no expiration with complete plat.) tale) i Owner's Name Phone Numbe Owner's Address City/State/Zip Property Addr o ___jCity no Lot Size I I 11ixPIN# — Z Subdivision Nam if applicable) Section/Lot# Directions To Sit p\ Md, e ecai If the answer to an �if Are there any e. isting Does the site fain Are there any a senients the following questions is "Yes",supporting documentation must be attached: wastewater systems on the site? _Yes zpo jurisdictional wetlands? _Yes Flo or right-of-ways on the site? 2SCes _No Is the site subj-tIl``t��o Will wastewater other approval by another public agcr:cy? _ Yes o than domestic sewage be generated? , Yes�o IF RESIDENICW FILL OUT THE BOX BELOW # People I # Bedrooms # Bathrooms Garden Tu 'hirlpool DYes CNo Basement: ❑Yes No Basement Plumbing: DYes 7No IF NON-RES11 ENCE FILL OUT THE BOX BELOW Type of Facility siness 'Q• ,.;-Total Square Footage of Building 9 # People # Sinks # Commodes /1 # Showers!_ # Urinals D F_ Estimated Water isage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE D NLY: # Seats Type system reque: ❑Conventional DAccepted GInnovative ❑Alternative ❑Other Water Supply Typ : County/City Water C New Well ' ❑Existing Well ❑ Comm nity Well Do you anticipate d ditions or expansions of the facility this system is intended to serve? J Yes o If yes, whatty Pe?. This is to certify th t the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) TC(s) issued hereafter are subject to suspension or revocation if the site is alterec, the intended use ebanges, or if the i rmation submitted in this application is falsified or changed. I hereby grant right i f entry to the Authorized Representative of Aq Davie County Health Department to conduct necessary inspections to determine c mpliance with applicable laws and rules. I u erstand that I am responsible for the proper identification and labeling of property ines and comers and Ing [lag�y(r staking the houseifacility location, proposed well location and the location of a y other amenities. 144 Property owner' (s o—w� Y U ner'slegal presentative signature Site Ilevisit Charge 11-1 Client EHS:_ Sign given DYes Revised 11/06 00) • ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION Account #: 990000811 Billed To: P.D. Allen Reference Name: P.D. Allen Proposed Facility: Business PROPERTY INFORMATION Tax PIN/EH #: 5747-02-6382 Subdivision Info: Location/Address: Hwy. 601 S.-27028 Property Size: 1.40 Ac. Date Evaluated: F��P> Water Supply: On -Site Well Community !2t Public Evaluation By: Auger Boring of Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % 0 HORIZON I DEPTH Texture groupt' Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: . EVALUATION BY: OTHER(S) PRESENT: 07,11.li i AU 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 Moist VFR - Very friable FR - Friable FI'- Firm VFI - Very firm EFI - Extremely firm _Tet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic 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 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) T TAR - T 0h Parcel #: K5090A001104 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bili Search Sales Search Q Viers Property Record for this Parcel View Man for this Parcel View Tax Bill Information Parcel #: K5090A001104 Account #: 82513196 Owner Information Building: Tax Codes BXF• ALLEN P D& ALLEN ERICKA B Land: ADVLTAX - COUNTY T Market: 1628 HIGHWAY 601 SOUTH assessed: FIREADVLTAX - FIRE TAX Deferred: MOCKSVILLE NC 27028 Property Information Township Land (Units/Type): 1.400 AC JERUSALEM [Address: 1628 S US HWY 601 Deed Information Local Zoning Date: 10/1999 Book: 00316 Page: 0928 Plat Book: Page: Legal Description PIN 1.40 AC HWY 601 5747026382 Property Values Building: 178,7701 BXF• 27,2201 Land: 51 84 Market: 257 83 assessed: 257 83 Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00316 0928 10 1999 WDualifiied Vacant 35,000 View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oP.1r� °o'��-: Davie County Web Site All Information on this site is prepared for the Inventory of real property found within Davie County. All data is compiled from recorded deeds, plats, and other public records and data. Users of this data are hereby notified that the aforementioned public Information sources should be consulted for verification of the information. All Information contained herein was created for the Davie County's Internal use. Davie County, its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or implied, in fact or In law, including without limitation the implied warranties of merchantability and fitness for a particular use. If you have any questions about the data displayed on this website please contact the Davie County Tax Office at (336) 753-6120. 1.5.9 http://maps.daviecountync.gov/itsnet/View.aspx?prid=1473942 7/14/2016