The URL can be used to link to this page

133 Marchmont Dr Lot 18 .. DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street - Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account M 990005640 Tax PIN:EH#: 5789-88-5675 Billed To: Todd Halver Subdivision Info: Marchmont Lot# 18 Reference Name: SYSTEM EXPANSION tocationiAddr ss:- 133°Mh'rchmont Drive-27006 Proposed Facility: Residence Property Size: 2.7 Acres Site Type: ❑New ❑Repair %Expansion ATC Number: 5742 **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 l l 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 l #People ? Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats ' Square Footage(or Dimensions of Facility) Lot Size Type of Water Supply: I.County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD) 8d Tank Size / AL.Pump Tank GAL. Trench Width 19 Max.Trench Depth Rock Depth Linear Ft. /Dd LR *P4 Site Modifications/Conditions/Other: G tm&fir 1 h Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m. a day of installation. Telephone#(336)751-8760. i� yr��•� I I O arc Environmental Health Specialist Date: 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 OPERATION PERMIT Account #: 990005640 Tax PINIEH#: 5789-88-5675 Billed To: Todd Halver Subdivision Info: Marchmont Lot# 18 Reference Name: LocationlAddress: 133 Marchmont Drive-27006 Proposed Facility: Residence Property Size: 2.7 Acres ATtw*48vt4r*ThViiNuance 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. 1 ,a System Type: S.T.Manufacturers Tank Date Tank Size Pump Tank Size System Installed By: pis (dCKhOe E.H.Specialist: �OLate: V120 ;W1 GPS Coordinate: r� dr TO ' n meg'3 '`'�•G . r V 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 IMPROVEMENT PERMIT Account #: 990005640 Tax PIN/EH#: 5789-88-5675 Billed To: Todd Halver Subdivision Info: Marchmont Lot# 18 Address: P.O. Box 116 Location/Address: 133 Marchmont Drive-27006 City: Advance Property Size: 2.7 Acres Reference Name: Proposed Facility: Residence **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 I 1 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: Qf5 Years ❑No Expiration Residential Specifications: #Bedrooms f #Bathrooms_#PeopleBasement❑ Basement plumbing❑ _ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):�—TQ_ Type of Water Supply: Acounty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: System Type LTAR Initial WID Repair Site Plan Environmental Health Specialist Date i.p.11-06 "• V' ATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Environmental Health FEB 2 B 2011 P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 Application For: Site Evaluation/Improvement Permit Authoriz4i2n To Construct ATC EB th Type of Application: New System Repair to Existing System xpansion/Modification of Existing S st acility ***IMPORTANT***THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1 i APPLICANT INFORMATION 1110 Name to be Billed'C o d A +a Iy e r Contact Person�r CL 4 G kyvt 71�Iv Billing AddressHome Phone V City/State/ZIP V A--h C e t N C 21 O O L Business Phone ry (A Name on Permit/ATC if Different than Above S�• Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facilq Corners Fla NOTE: A survey plat or site plan must accompany this application. Included Site P Plat(to scale) (Permit is valid� 6 ons with site plan,no expiration with complete p at. Owner's Namey e r Phone Number Owner's Address City/Stat /Zip Property Address Ci %,(X^ N C 77O OA Lot Size Tax Subdivision Narneff ap licableSection/Lot# S Directions To Site: Ole—O C N +, If the answer to any of the following questions is`ryes",suppbftingdociinientation must be attached. Are there any existing wastewater systems on the site? W No Does the site contain jurisdictional wetlands? Yes 40 Are there any easements or right-of-ways on the site? Yes Is the site subject to approval by another public agency? Yes Will wastewater other than domestic sewage be generated? Yes go IF RESIDENCE FILL OUT THE BOX BELOW. r* + WWO.6r(. #People T� #Bedrooms _(_ #Bathr oma Garden Tub/Whirlpool Yes Basement: Yes Basement Plumbing: Yes o IF NON-RESIDENCE FILL OUT THE BOX BELOW Tqe 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: Convention Accepted Innovative Alternative Other Water Supply Type: r ounty/City Wate 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)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 Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and Hiles. I understand that I am responsible for the proper identification and labeling of property lines and comers and loc � d a in or staking the house/facility location,proposed well location and the location of any other amenities. � Site Revisit Charge Pr erty owner's or owner's legal representative signature 242-1111 Client Notification Date: Date EHS: Sign given Yes No Account# I Revised 11/06 Invoice# DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990005640 Tax PIN/EH#: 5789-88-5675 Billed To: Todd Halver Subdivision Info: Marchmont Lot# 18 Reference Name: Location/Address: 133 Marchmont D ive- 7006 Proposed Facility: Residence Property Size: 2.7 Acres Date Evaluated: Water Supply: On-Site Well Community Public X Evaluation By: Auger Boring �� Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % • HORIZON I DEPTH Texture group c3( Consistence Structure for 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 L « RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE ? SITE CLASSIFICATION: Jos EVALUATION BY: LONG-TERM ACCEPTANCE RATE:, OTHER(S)PRESENT: REMARKS: �1 /n LEGEND Landscap Poe sition .� 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 1Y1Q1St . 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 lyotes 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 Iansurface to free water or inches from land surface to soil colors with chroma 2 or less Classification-S(suitable),P (provisionally suitable),U(unsuitable) TTAR -T.nno_tPrm arrenfan P rAti-- aallAaV/ft) T!`7Tr%ACInC in__.:__� DAVIE COUNTY HEALTH DEPARTMENT ' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION "NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.19968) Permit Number Name - - Date G/ I Y Location `-- — Subdivision Name Lot No. I Sec. or Block No. Lot Size- �VT744 House Mobile Home _ Business _— Speculation No. Bedrooms — No. Baths No. in Family Garbage Disposal YES ❑ NO ❑ Specifications for System: Auto Dish Washer YES NO ❑ �� f31A Auto Wash Machine YES EDNO -E] C � Type Water Supply "This permit Void if sewage system described below is not installed within 36 months from date of issue. 1 f - I V I Improvements permit by `Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by 1�0U,S(Z� Certificate of Completion ;-Date 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PE MIT AND CERTIFICATE OF COMPLETION NOTE: Issued in Compliance with G.S. dYi�/1 19hapter 130 Article 13c Sewage Treatment and Di pos I u es/(, 0 CAC 10A .1934-.1968) Permit, Number Name " ' �`. < Date 3 Location Subdivision Name .) Lot No. v Sec. or Block No. Lot Size ��'' _ House Mobile Home _ Business Speculation No. Bedrooms — _ No. Baths No. in Family _ Garbage Disposal YES Q NO ❑ Specifications for System: _ Auto Dish Washer YES NO ❑ L�� Auto Wash Machine YES [t] NO -E] vd Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. -,, > Improvements permit by- *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by I 1 Certificate of Completion _ _ T 0. � .-Date 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period,of time. • ` ° ' APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT ` Davie County Health Department Z' Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT,BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. _ ( Home Phone Q9 ta) 9 45 S653 1. Permit Requested By Business Phone C-211) 799 310 2. Address 26 �a x 64 u,ilu, /Ir AL0, n70.',1_A 3. Property Owner if Different than Above Address 4. Permit To: a) Install ✓ Alter Repair b) Privy Conventional Other Type Ground Absorp ' n c) Sub-Division MArAthe .,;Sec. Lot NO.- 5. System used to serve what type facility: House ✓Mobile Home Business IndustryOther b) Number of people a 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions 44 X CID 1 8 PZ05 Bed Rooms 3 Bath Rooms a/a Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes urinals o garbage disposal lavatory showers -2 washing machine / dishwasher sinks f 8. a) Type water supply: Public ✓ Private Community b) Has the water supply system been approved? Yeses No 9. a) Property Dimensions 2�'7 dqcrc s b) Land area designated to building site S c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? This is to certify that the information is correct to the best of my knowledge. � a/3/gsK:,, / L'2� - Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: �►ro Nej P�pry x��m G-�1 � _ 11m�. ��.. � e��_2c.� m o•�-� ��r l��-�lc p(o, �.. ( L44, r 6 j P'j (( W UYl L� F`� i'�' 1"SSS N Cj r ►V►621 ( 70 1 Twv �Aa�S �A ©7"/�J L�un�Nt9nQ S \ DCHD(6-82) - • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION J Name. �� Date Address Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position � � S S ( PSlJ ( P.S� PS PS 2) Soil Texture (12-36 in.) Sandy, S S Loamy, Clayey, (note 2:1 Clay) PS PS U U 3) Soil Structure (12-36 in.) S S Clayey Soils P PS PS PS U U 4) Soil Depth (inches) S S P PS PS PS U U 5) Soil Drainage: Internal S S P PS PS U U External S S PS PS PS U U U 6) Restrictive Horizons 7) Available Space S S PS PS PS PS U U U U 8) Other (Specify) S S S S PS PS PS PS U U�"' U . U 9) Site Classification z RJ, U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: �° 7 Described by_-� ' �� Title Date SITE DIAGRAM DCHD(6-82)