The URL can be used to link to this page

206 Indian Hills RdDAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Account #: 990002387 Billed To: Twin Lakes Avbnics Reference Name: P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5769-80-2954 Subdivision Info: Location/Address: 206 Indian Hills Drive -27006 Proposed Facility: Residence Property Size: 83 acres ATC Number: 3231 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 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWAT R C9PNSTRUI TION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date:'�� 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 I 1 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. one r� Septic System Installed By: Environmental Health Specialist's DCHD 05/99 (Revised) 0 Date: 9 — 9 — DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990002387 Billed To: Twin Lakes A%,l nics Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5769-80-2954 Subdivision Info: P40 9-19-07-- Location/Address: -1q.oz Location/Address: 206 Indian Hills Drive -27006 Property Size: 83 acres ATC Number: 3231 **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 #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility TypeV R_#People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply �� Design Wastewater Flow (GPD) Site: NeY421"Repair ❑ System Specifications: Tank Size "GAL. Pump Tank GAL. Trench Width �? Rock Depth � / Linear Ft.,&o � Other: Required Site Modifications/Conditions: 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.**** 0'r Environmental Health ?� Specialist's Signature: Date: DCHD 05/99 (Revised) � n APPLICATION FOR SITE EVALUATION/IAIPROVEM1IENT PERAi1T & f r t y Davie County Health Department / S Environmental Health Section P.O. Box 848/210 Hospital Street �•L� Mocksville, NC 27028 LtA(336) 751-8760 FJ232::-� D ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL IRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed ica.,t, A✓ao a ie -T Contact Person tZab bz e-�7�pf �F Mailing Address ao 6 -7-AJ 1; (W ffi Home Phone 94 8 City/State/ZIP Ax JOAae. , /Vc— '. 1 UD c Business Phone g7 6102 y 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: 0 Site Evaluation 0 Improvement Permit/ATC Both 4. System to Service: 0 House 0 Mobile Home Business 0 Industry 0 Other S. If Residence: # People # Bedrooms II Dishwasher 1.1 Garbage Disposal II Washing Machine 6, If Business/Industry/Other: Specify type # Bathrooms II Basement/Plumbing II Basement/No Plumbing # People - 41 # Sinks 2 N Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Typo of water supply: El-C-ounty/City 0 Well a Do you anticipate additions or expansions of the facility this system is intended to serve? 9 1fycs, what type? -_A."k -'0s-�Gc-3/ tAx.aVee. 4 SAgwo-C 17 Community Fifes 11 No ***13fP0R7AN7'*** CLIENTS IIIUS7'COAf1'LL,TIi TILE REQUIRED PROPERTY INFORMATION REQUESTED IIELOW. Either a PLAT or SITE. PLAN MUSTBr, SUBA117TF.D by the client with THIS APPLICATION. Property Dimensions: �'� %aCerS WRITE DIRECCIONS (frons Moclisville) to I'ROI'E'RTY: Tax Oil -ice PIN: # S-96980-29551" 61( `ro AAu we c— le - o rd Iork B>xb,I Property Address: Road Name aO6 Yt'jX. t,+J %t A s QA _4,prm_ JF4; (e-. -7_-A ,,j &_f:r City/Zip _ AXjo S ce. At c 97001 9:115 KA ccA6Tcu._'r.'u1) AA If in a Subdivision provide information, as follows: aOO yo( Nanlc: otj —r 4c- Ywzo Lai -S Ay o F't Section: Block: Lot: Date Properly Flagged: 2�23—�2- 'I'liis is to certify that the information provided is correct to the best of my knowledge. I understand that any permil(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 that I am responsible for all charges incurred from 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 by to conduct all testing procedures as necessary to determine the site suitability. �j DATE,, �"02�� SIGNATURE THIS AREA MAY 13E USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations)., Revised DCHD (07/99) Site Revisit Charge Dalc(s): Client Notification Date: CHS: Account No. Invoice No. Vww 1 . 51 5 1248 261 ` l , b 206 62 232202 158 I 4--♦ I , ' 13 --- 4 � o:�, ;,. 42 ---4 10 38 I 286 r. 455 269 : 1 3 1005 41 2U___ ; 3 � , loo mr �OW,", , , i - r , , I -- =--�-- Y 135 84 uwl �y) to.w 101 8.73 a. AM DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990002387 Billed To: Twin Lakes Avonics Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: PROPERTY INFORMATION Tax PIN/EH #: 5769-80-2954 Subdivision Info: Location/Address: 206 Indian Hills Drive -27006 Property Size: 83 acres Date Evaluated: 7-Je vf%y On -Site Well Community Auger Boring Pit Public Cut - FACTORS 1 2 3 4 5 6 7 Landscape position ,L Sloe % HORIZON.1 DEPTH Texture group Consistence Structure Mineralogy HORIZON lI DEPTH Texture group' Consistence / Structure S. Mineralogy/ 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 r SITE CLASSIFICATION:'S LONG-TERM ACCEPTANCE RATE: ' REMARKS: EVALUATION BY: 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 Moist 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 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) LIAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/99 (Revised) ■ ■ ■ i MENNENMENNEN'i::::: N MEME:::::NEN EM:::: ■■■■■■■■■■■■■■.■■■■..■■.■■.■.■■.■e.■■..■■.■..■■■■■■.■.■■■■.■■■■ ii ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■ ■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■U ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■e■■■■■■e■ ■■ ■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■eee■ ■■■■■■■■■■■■■■■■ ■■■■e■■■.ee■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■e■■■■■■ ■■■■■■■■■■■■■■■■ ■.■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■..■■■■■■■.■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■.■■ ■■■■e■■■■■■■■■■■ ■■■■■■■■■■■.■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■.■■■■■■ ■■■■■■■■■■■■■■e■ ■■■■■■■■■■■■ ■■■■■■■■■■■■ ■■■■■■■■■■■■ ■■■e■■■■■■■■