Loading...
240 Crosswind Dr Lot 44 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section 4�! P.O.Boz 848/210 Hospital Street J Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001602 Tax PIN/EH#: 5880-91-8106 Billed To: Nicholas Dudley Subdivision Info: Marchmont Acres Lot#44 Reference Name: Location/Address: Crosswind Drive-27006 Proposed Facility: Residence Property Size: see map ATC Number. 2740 **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 I 1 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_ -�e' #Baths Dishwasher:e Garbage Disposal: E7'— Washing Machine: 2'�' Basement w/Plumbing: ❑ Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size /S,9L/ Type Water Supply Design Wastewater Flow(GPD) 70ey Site: New;B""'Repair❑ System Specifications: Tank SizVoMP GAL. Pump Tank_GAL. Trench Width 3(o Rock Depth�_ Linear Ft.� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6°f 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 9:3 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-860.**** Are [� � �Z- �Q6) 10 Environmental Health Specialist's Signature: Date: 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 #: 990001602 Tax PIN/EH#: 5880-91-8106 Billed To: Nicholas Dudley Subdivision Info: Marchmont Acres Lot#44 Reference Name: Location/Address: Crosswind Drive-27006 Proposed Facility: Residence Property Size: see map ATC Number: 2740 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 WASTEWATE N U TION IS VAL D 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 bedp instplIed J I compliance with Article 1 I of G.S.Chapter 130A,Section.1900"Sewage Treatment and Dispos4l Sys ems,' but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given p iod f tim ,r 1.5 IfiP ell Septic System Installed By: Environmental Health Specialist's Signature: Date: T 'ez DCHD 05/99(Revised) APPLICATION FOR SITE EVALUATION/IAIPROVEAIENT PERAIiT&ATCKDAflE Q U 15 Davie County Health Department Environmental Health Section p P.O. Box 848/210 Hospital Street/ 1`� D 2 3 •��� Mocksville, NC 27028 / (J (336)751-8760 , ;; ,',EN?A' .i (H C00 y ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed /11 C�61.,s 4I • b�01I�e X Contact Person A//G/C Z4& Mailing Address S-/4/ a1r'4'Au,r'y RIAS _ Home Phone 7122- 93/ City/State/ZIP C IP mmo h r � / C- Z7 0 �- Business Phone 7/O !97 3 V 2. Name on Permit/ATC if Different than Above Mailing Address cit //y ��/State/zip 3. Application For: ❑ Site Evaluation vol"mprovement Permit/ATC ❑ Both 4. System to Service: LY House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People Z- 3 # Bedrooms # Bathrooms ,sem LJ Dishwasher Lf Garbage Disposal H Washing Machine ❑ Basement/Plumbing O Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: a County/City ❑ Well ❑ Community s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes 8-<O If yes,what type? ***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # 529011 % t OU Nw y Iry fo 'yu Y 4701, Gu 4-64f4 oh .00/ Property Address: Road Name 2-�O C►^a s s wi►.r( Df Ve t tyo c e , 75,.,, /crit or) Feep/e.r 6,eel< City/Zip AdJ�,hct R.I. 70—",7L -0'1 /f1Ja�c�,u.n.� . <:-'-tyle Code 3/3/ If in a Subdivision provide information,as follows: (4114e s une A AIV �Ae Name: Aot rc,4m a n4 6'a -/0 eld W /'0'lor Ckl`.de—SCLC_ roeer-11 on 'R�h Section: Block: Lot: Date Property 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 responsiblefor all charges incurred froln this application. I,hereby,give consent to the Authorized Representative of the Davie/C County Health Department to enter upon above described property located in Davie County and owned by /�-4c d/t v Z. Z44 y to conduct all testing procedures as necessary to determine the site suitability. DATE oz/J 310/ SIGNATURE LC 01 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 (;. Datc(s): Client Notification Date: 4 EHS: Account No. � Revised DCHD(07/99) Invoice No. V • DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section. R O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name -� Date c� Address S A9 Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S _ PS PS-1 U U U 2) Soil Texture (12-36 in.) Sandy, — S PS Loamy, Clayey, (note 2:1 Clay) L PS ' 'II— U 3) Soil Structure (12-36 in.) SS Clayey Soils PS PS PS75' PS U U 4) Soil Depth (inches) /�5—� PS S PSS l_�S/ U U --.0 U 5) Soil Drainage: Internal S S S—, PS PS External S PS' PSS, LF- U- U 6) Restrictive Horizons 7) Available Space S ! S r S PS —PS PS U U U U 8) Other (Specify) S S S S PS PS PS P U 9) Site Classification r Z� U—UNSUITABLE S— PS—Provisionally Suitable Recommendations/Comments: 2 Described by Title > Date - _ SITE DIAGRAM - F 3 3 DCHD(6-82) APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department V Environmental Health Section /�� ``(�� •�� DECEIVED MAR P. 0. Box 665 199 b� Mocksville, NC 27028 V 1 . Application/Permit Requested By ::5. e-1=ED w1LS0r Mailing Address CD�O 4 Pb 1- (A�r-t eVP-C-L-E- _,/ • � 1 (L Z7O0 Home Phone 919 qaZ " 3�5Z4 Business Phone 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: C) General Evaluation } S/Tank Installation 5. System to Serve: House J Mobile Home l� 0 Business Industry Ot�ther 0 Unknown 6. If house, mobile home: Subdivision a4fC4190rdT Sec. Lot# No. of People - T Dwelling Dimensions No. of Bedrooms )�-Basement/Plumbing No. of Bathrooms 3 Basement/No Plumbing Washing Machine Dishwasher �( Garbage Disposai 7. If business, industry, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers S. Type of water supply: 0 Public 0 Private Community 9. Property Dimensions ' r Q 10. Sewage Disposal Contractor 11 . Do you anticipate additions/expansions of the facility this system is intended to serve? Yes No If yes, what type? *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application . 3- 77.7# s�Ja04.55d-I— Q� nrDate L06 Signature � Pe� C�'ee� - aa.t-cAvmct �: �. . cio:55wl nac ►�r: Directions to Property : -C'cy-y,,- co(-t roaok -to DCHD (10-89) • DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION SITE EVALUATION CONSENT FORM 1. Complete the form below and return to the Davie County Health Department. 2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin." NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO: Davie County Health Department, Environmental Health Section, P. O. Box 665, Mocksville, N.C. 27028 Davie County Health Department Environmental Health Section Site Evaluation Consent Form LOCATION OF PROPERTY: DATE RECEIVED ^ O fua_ A_t , (office use only) y no 1. 1 am the owner of the above described property. yes no 2. 1 am not the owner of the above described property, however, I certify that I have consent from , owner to obtain a owner's name site evaluation by the Davie County Health Department for the purpose of determining the suitability for a ground absorption sewage treatment and disposal system. ye no 3. 1 hereby give consent to the authorized representative of the Davie County Health Department to enter upon the above described property and conduct all testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE 4. 1 hereby authorize the Davie County Health Department to release site evaluationlts from the above described property to the following: TOwner only Owners designated representative —Anyone requesting results — Only those listed below DATE SIGNATURE DCHD(11/84) - t. r. _ ..- -- . ,. , .. .. , G _: ,... -r::L. _=fir :J- .➢ .y- r' v sem.'T'X COURSE BEARING DISTANCE COUF SE 11XARlN0` 1MANCE ' L-1 S 65°42'5911E 71.83' L-12 S 79'42'OW"- 49.3f' L-2 S 81°29'56"E 64.29', L-13 N 07Q38105"E: \ L-3 N 64a54'56"t 43.3$'' L-14 S 68"+L '4 "E ` .$8Y L-4 S 52047'49"E 44.08" L-15 S 7545'32"E 28.95` ff \ L-5 S 60°41'44"E 37,79' 1-1.6 S OV7V9"-E ` 262.41' MABEL H. BAILEY L-6 S 17"44'08"E 25.29 L-17 S 56918'54"E 41.99 LOCATION IiAAP TAYLOR F. BAILEY L-7 N 83058'20"E 44.31`i L-18 N 26'57'WE 20.58' D.B. 65 PG. 377 L-8 N 75008'1 9"E 31.36'; L-19 S 8eST 1_3"E 21.63' L-9 S 05014'37"W 49.56' L-20 $ 72*30'1414E 50.17` `,c•\ L-10 S 67°41'32"E 32.92" L-21 N 83°59'1 VE .' 47.53' ' L-11 N 68046"19"E 55.37" CENTER OF S6,9 CRF INON FDUND L- �:7��6„£ L-3 L-+ EK I S pR4RER7Y i h ' � LINE ' ryp� L-2 L-5 f� PHILIP 0. ESPY \ ' � L-a- s 44l,.E 253.00 D.B. 163 PG. 145 L:19 kph' L-1/1 L-13 •�` —t>I L—Zt j • L-10 ao REEK 17 —1$ ON FLOOD HAZARD AREA �'\ VNf Ir r ; 4� JOHN L. BUFORD RM Four D.B. 144 PG. 574 0 ` A', 13.4144 ACRES+— -- � a PK NAB. IRON FUM ! IN FLOOR of 500 "t l • ! THOMAS K. & NANCY L. RIDEN PAGOQA 7Tool. y �0 Ory . , S V ry HARVEY J. YOUNG D.B. 138 PG. 658 ' /ip IRO�N \ IA 1S3 e` \' •IC 20, N Fo M ,/ Z \ SSS FqS LAKE l � � �MFM °�• '`' ,` - � o DAVID W. POWELL ,o �! W E g D.B. 133 PG. 385 \ Nft i/ RR SPIKE •. ' 100 0 100 IMMO 200 - 300 , GRAPHIC SCALE •- FEETMAP / I JOHN RICHARD HOWARD certify that tdi this map was drown from on actualFbADA p -/" field survey under my direction arld tv. supervision. that the ratio of BFJ� 1” •:1tD' t Ni -: • ' precision is 1 Coq R REGWER£D LAND SURVEYOR L-2890 � P.O. BOX Z78-�N.G. Apr 20 02 11:07a Dudley 336-712-1053 p. 2 April 20,2002 To Whom It May Concern: I am requesting a.modification to my septic system permit for Lot 44 of Marchmont Acres to allow the use of the chamber system,also know as the Infiltrator System. Gary Swan will install the system. Thank you, Nicholas L. Dudley 712-9341 (home) 712-1053 (fax)