The URL can be used to link to this page

133 Tulip Magnolia Dr Lot 19 DAVIE COUNTY HEALTH DEPARTMENT -7'd Environmental Health Section - P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001316 Tax PIN/EH#: 5880-51-5022.19 CC Billed To: Craig Carter Builders, Inc. Subdivision Info: Magnolia Acres Lot# 19 Reference Name: Location/Address: Tulip Magnolia Drive-27006 Proposed Facility Residence Property Size: see map ATC Number: 3819 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 WASTEWATER CON TRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: o[�! 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: l�(te 7- �LjO Gf Environmental Health Specialist's Signature:��'�� Date: DCHD 05/99(Revised) 4' . APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT& © C Davie County Health Department Q Environmental Health Section r P.O. Box 848/210 Hospital Street G JUL ' Mocksville, NC 27028 6 2044 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS AL EQ #1Fq(� INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for �iyn�struct1 1. Name to be Billed 6�j"-O �i` /L�✓ �C Contact Person ///y,�w��r Grc? •f Mailing Address /J .v Q -s Home Phone 3yS-3l,�7 City/State/ZIP /yp�jlNlP ,VC 09701Z Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/St to/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC Both 4. System to service:AHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. Type system requested: ❑ Conventional ❑ conventional modified innovative 6. If Residence: # People # Bedrooms � # Bathrooms Aishwasher XGarbage Disposal XWashing Machine Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) S. Type of water supply:X County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes JWNo If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE /PLAN MUSTTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: ,C( WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # O - (' f go � Property Address: Road Name ,. ,o c�;,�a �r 4�1n/�S Ceeif "A� " City/ZipDII � e 27 L�l If in a Subdivision provide information,as follows: %vim /��— �l o-� IeIZ Name: 41 '4C'adL-"'q- a /ear Section: Block: Lot: ( / Date home corners flagged: This is to certify 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 that I am responsible for all charges incurred fi orn 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 testi g procedures as necessary to determine the site suitabi 'ty DATE �r SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS: Sign given Account No. Revised DCHD(05/03 Invoice No. / ...... .:,,,.. ... t .:: 1 .. .. _. ... ..a. : -..w ,_. _ ._. ., :c,: : , ..• M1. t. _.":tom / x s s r .-- .. .: ,.....a..— ...E ,.. ,... .__. 77. - _ _ 77- DR 9 '-- Z - NE . 2 . 1.S.86 029'33"E 9.00. `CR s SITE I " DRNNAGE EAS 1 � `Z�TULIP MAGNOLIA DR � PEOPLES CREEK RD LOCATION MAP 00 : � W 19 W E 20 N tH C00 /I ` 20.00' BEAL few `-` j Z 19.34' 40. 17.00' _ . ----- _ d �' g 52.40- AR PROPOSED to HOUSE p 20.00' $2.00' r' SITE PLAN ONLY 2.00' - --------- g $ 11.67.Esz�__ THIS WAS MAPPED FROM A DEED OR $ - RECORD PLAT AND NOT FROM A SURVEY 29.67-: $ BY ME. 8 ' ; 30 zo 30 60 90 co .GRAPHIC SCALE — FEET 1 15' UnM EASEMENT L MAP AIG C CA BUILDERINC. FOR R CARTER BU DE I N 8648'06"W' 128.50' SCALE TOWNSHIP COUNTY STATE DATES 30' SHADY GROVE DAVIE N. C. 7-13-04 LOT 19 MAGNOLIA ACRES PHASE 1 P.B. 8 PG. 63 , TULP MAGNOLIA DRIVE HOWARD.SURVEYING ` HARD HOWARD LS 04 P.O. ADVANCE, N.C. (336) 998-5396 JOHN. 091 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION I LOT Soil/Site Evaluation APPLICANT'S NAME ,r12 A&P/ DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE_-�C e _*ozR4Q SUBDIVISION ROAD NAME ?.40& Water Supply: On-Site Well Community Public !/ Evaluation By: Auger Boring Pit Cut FACTORS 1 2- 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH C7 Texture groupSL' Consistence Structure Mineralogy HORIZON H DEPTH Texture group Consistence r- Structure Mineralogy HORIZON III DEPTH Texture group Consistence Q Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 9v EVALUATION BY: LONG-TERM ACCEPTANCE RATE: r 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 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 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) LTAR-Long-term acceptance rate-gaVday/ft2 DCHD(O1-90)