The URL can be used to link to this page

217 Cornwallis Drive Lot 28 DAVIE COUNTY HEALTH DEPARTMENT pey- Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900323 Tax PIN/EH#: 5831-97-9267 Billed To: Vogler's Construction, Inc. Subdivision Info: Pudding Ridge Lot#28 Reference Name: Dick Vogler Location/Address: Corvallis Drive-27028 Proposed Facility: Residence Property Size: see map ATC Number: 2613 **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 /T[ #People #Bedrooms—tz _ #Baths _ Dishwasher: Garbage Disposal: C?"'- Washing Machine: 121o" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow(GPD) _?,� (Z Site: New Repair❑ System Specifications: Tank Size,,,�2p GAL. Pump Tank GAL. Trench Width—V"* Rock Depth_,!ter/Linear F 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.**** i 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 #: 989900323 Tax PIN/EH#: 5831-97-9267 Billed To: Voglees Construction, Inc. Subdivision Info: Pudding Ridge Lot#28 Reference Name: Dick Vogler Location/Address: Corwallis Drive-27028 Proposed Facility: Residence Property Size: see map ATC Number: 2613 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 CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate ofComplet' indicate the tem described on Improvement/Operation Permit has been installed in compliance with ' e 11 of apter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO AY en as aguaranfee that the system will function satisfactorily for any given period of time. o 110 Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC —��'� Davie County Health Department P�DGT I, �I Enyinonmental Health Section 1 8 2000 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ENVIRONMENTAL HEALTH (336)751-8760 DAVIE COUNTY ***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 (/' ' Contact Person Mailing Address M Home Phone City/State/ZIP Business Phone 2. Name on Permit/ATC if Diffe nt than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation mprovement Permit/ATC ❑ Both 4. System to Service: Ouse ❑`Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms _ # Bathrooms fishxasher fYGarbage Disposal _[, asking Machine O Basement/Plumbing ❑ 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: WCounty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 4TNo If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MU ST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: ��e �rf T T/�CDIRECTIONS(from Moc yille)to PROPERTY: Tax Office PIN: # 5 _ 6 U Property Address: Road Name /ve— Ad'a` LV' 4 V [ty Ip �l2 If in a Subdivision provide information,as follows: �---- Name: (o 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 1 am responsible for all charges incurred from this application. I,hereby,give consent to the Authorized Representative of the Davie County Health Dep. nent to enter upon above described property located in Davie County and owned by _ to conduct all testing procedures as necessary to determine the site suitabili DATE d SIGNATURE THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN(Include all of the followi g: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): �d Client Notification Date: EHS: 7 Y9 9 Account No. Z 3 Revised DCHD(07/99) Invoice No. g� PUDDING RIDGE RD N O K O � 29 SITE m /a 235�O LOCATION MAP N co g9°0,,38" w Vl?i \ , o S c A, i \ GARAGEc P• ' ESS/ O . pF y . SEAL 19< •� \ op = o = e• k� — `' L-2890 Q•::C PROPOSED Oy'9'L Jo a� ^ \ �•'' HOUSE Yb %i y •'•�SUFN •' Ov`� \� 0� � v`�\ SITE PLAN ONLY %� �� ``��, THIS WAS MAPPED FROM A DEED OR �1�z RECORD PLAT AND NOT FROM A SURVEY �s oo BY M E. \ S 40 0 40 80 120 \ \ GRAPHIC SCALE — FEET MAP FOR VOGLER'S CONSTRUCTION, INC. SCALE TOWNSHIP COUNTY STATE DATE,s 1" = 40' FARMINGTON DAVIE N. C. 10-17-00 \ LOT 28 PUDDING RIDGE SUBDIVISION P.B. 6 PG.88 \ HOWARD SURVEYING JOB NO. JOHN RICHARD HOWARD PLS 0098 P.O. BOX 276 ADVANCE, N.C. (336) 998-5396 . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ��t9 L° DATE EVALUATED 7�z�� ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well �l Community Public Evaluation By: Auger Boring Pit _� Cut FACTORS 1 2 3 4 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 2414 Texture group t— Cl Consistence Structure L Mineralogyl 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 3 SITE CLASSIFICATION: EVALUATED BY: �^ LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: � T r l✓ 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 - gal/day/ft2 DCHD(01-901