The URL can be used to link to this page

241 River Road Lot 5IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street p �w P.O. Box 848 Mocksville NC 27028 For Office Use Only *CDP File Number 197477-1 County ID N umber: 5881048834 Evaluated For. NEW Township: Phone. 336-753-6780 Fax. 336-753-1680 PERMIT VALID UNTIL: 10/25/2020 *NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit. Applicant: Peggy King Address: 241 River Road CRY: Advance State/Zip: NC Phone #: (336) 998-2559 ldress/Road #: River RD Advance Structure: # of Bedrooms: # of People: *Water Supply: NC 27006 SINGLE FAMILY 4 PUBLIC 27006 Property Owner: Peggy King Address: 241 River Road City: Advance State/Zip: NC 27006 Phone #: (336) 998-2559 Subdivision: Greenwood Lakes n: Provisionally Suitable Saprolite System? OYes @No Design Flow: 4 8 0 Soil Application Rate: 0 a 7 5 *System Classification/Description: TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25% REDUCTION Phase: 1 Lot: 5 Directions Hwy 158 right on Hwy 801 Left on Underpass Rd. left on River Rd in curve Minimum Trench Depth: 2 4 Inches Maximum Trench Depth: 3 6 Inches Septic Tank: 1 0 0 0 Gallons 1 -Piece: OYes ®No Pump Required: OYes O No ®May Be Required Pump Tank: 1 0 0 0 Gallons 1 -Piece: OYes OQ No Repair System Required: 0Yes ONO ONO, but has Available Space Repair System *Site Classification: Provisionally Suitable Soil Application Rate: 0 _ 2 7 5 *System Classification/Description: TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25% REDUCTION Minimum Trench Depth: 2 4 Inches Maximum Trench Depth: 3 6 Inches Pump Required: OYes O No Q Maybe Required Pagel of 3 CDP File Number 197477-1 County ID Number: 5881048834 "Site Modifications ❑ Open Fill Sheet No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department *Permit Conditions The issuance of this permit by the Health Department in noway guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. I Site Plan The Mprovement Permit shall be valid for 5years from date of issue with a site plan (means a drawing not necessarily drawn to scale that shows the existing and proposed property lines with dimensions, the location of the facility and appurtenances, the site forthe proposed Wastewater system, and the location of water supplies and surface waters). Plat The Improvement Permit shag be valid without expiration with plat (means a property surveyed prepared by a registered land surveyor. drawn to a scale of one inch equals no morethan 60 feel, that Includes: the specific location of the proposed facility and appurtenances, the site for the proposed Wastewater system, and the location of water supplies and surface waters. Plat also means, for subdivision tots approved by the local planning authority and recorded with the county register of deeds, a copy of the recorded subdivlslons plat that Is accompanied by a site plan that is drawn to scale). The Department and Local Health Department may Impose conditions on the Issuance and may revoke the permits for failure of the system to satisfy the conditions, the rules, or this article. This permit is subject to revocation If the site plan, plat, or Intended use changes (NCG,S 130A-335(1)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, Installation, operation, maintenancA monitoring, reporting, and repair (.1938(b)� Applicant/Legal Reps. Signature Required? OYes ONo Applicant/Legal Reps. Signature: Date: / / `Issued 13y: 2140 - Nations, Robert Date of Issue: 1 0 / a 5 / a 0 1 5 : OValid without Expiration? Authorized State Agent 0Create CA? QHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Improvement Permit CDP File Number: 197477 -1 County File Number: 5881048834 Date: / / Q Inch Scale: QBlock QN/A III V II Ii. i I� O E i � I I I III I I- ------ --- .... ..... . . . . . . . . . . . . ........... . ......... .. .. - II S IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksviile NC 27028 CDP File Number: 197477-1 County File Number: 5881048834 Date: i0/Is 12e15 Click belowto import an image from an external location: Drawing Type: Improvement Permit RECEIv t L-;. SEP 1 g 2015 Fig viv-A- STH //�J,'► ° I CATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & T Dam. ul ATC Davie County Environmental Health gec� P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/ Fax (336) 753-1680 Application For: X Site Evaluation/Improvement Permit E Authorization To Construct(ATC) E Both Type of Application: %New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1Nr(3RMA 1 ION Name to be Billed /y- t ,v G Contact Person , P I_, 6 6 y fCf 1Ve- BitlingAddress ,41LL4 s N l? /R IR n _ Home Phone City/State/ZIP eg (2 N/4 ,t/__ e 1 Ale-- a rj /1 z,�6_Business Phone Name on Permit/ATC if Different than Above Mailing Address City/State/Zip INFORMATION "Date House/Facility Corners NOTE: A survey plat or site plan'must accompany this application. Included: [I Site Plan KPlat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) /�. Owner's Name /= C �v'G Phone Number (33ta%991f- 53- Owner's Address ^h!( /a? / V tZ� J) . City/State/Zipo4,C21/,ytiNC/ -�. iL r aoz r Property Addresses - ,R 1 V �L Q R t City 0 q V4 .�/ C -- �. Lot Size r. U 3�i�} G R t= Tax PIN v'"-8 8' O �l �' (F Subdivision Name(ifa 'icable) /_hiVWout7 J-;r9C)5Section/1-ot# L0 -r r- l` ea Directions To Site: ir-YI Cnz.L .+,v t./nl0 i=n bvz-e A> r-2 . If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes vqo Does the site contain jurisdictional wetlands? Eyes C�vo Are there any easements or right of--wa..,,v1's on the site? OYes NIo Is the site subject to approval by anothc't public agency? ❑Yes INo Will wastewater other than domestic sewage be generated? ❑ Yes VNo IF RESIDENCE FILL OUT THE BOX BELOW # People (�- # BedroomsLam, # Bathrooms _ Garden Tub/WhirlpoolyYes ❑No Basement: }?Yes ❑No Basement Plumbing:�lYes ❑No IJP►`CI]`►I� I� �[.`ll1Dl►Y� *91NW41 ul : 6) � 3Zweli./ Type 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: Conventional EAccepted ❑Innovative --[Alternative uOther Water Supply Type: County/City Water a New Well 7Existing Well 11 Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? a Yes If yes, what type? J( No 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 rules. 1 understand that I am responsible for the proper identification and labeling of property lines and comers and locatin d flagging or staking theJ ase/facility location, proposed well location and the location of any other amenities. ' Site Revisit Charge Property owne s o Kowpt is legal representative signatur� Date(s): 9 - /4p -. :2 p/,S- Client Notification Date: Date EHS: LOT . 3 AREA = 1.243 ACRES r 6 LOT 5 AREA = 1.036 ACRES RECEIVED SEP 1 ?015 DG HEA^.LTH LEG 0 = IF • = N PIP = P DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Q �N i ar A", cd3�e Water Supply: On -Site Well Community Public "y Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L t_ Slope % HORIZON I DEPTH Texture group L L<C c- C,l Consistence Structure MineralogyF HORIZON H DEPTH Texture group Consistence Structure 6 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 • 1 p. 7' 1 • k 771 i 4— SITE CLASSIFICATION: 0 / 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 CONSISTENCE 1Y dq 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 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 - Lona -term acceptance rate - eal/dav/ft2 nrun nvnc tD.— .-AN