Loading...
282 Walt Wilson Road Lot 3DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002978 Billed To: New Millenium Builders Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5746-39-7888 Subdivision Info: Walt Wilson Estates Lot # 3 Location/Address: Walt Wilson Road -27028 Property Size: 1.674 acres ATC Number: 3617 **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 /7 #People #Bedrooms_ #Baths Dishwasher Garbage Disposal: ❑ Washing Machine 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) Site: Nev/ Repair ❑ System Specifications: Tank Size,/ jam GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width Rock Depth/ 74 Linear Ft,=� 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 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 Mociksville, NC 27028 (336)751-8760 Account #: 990002978 Billed To: New Millenium Builders Reference Name: Proposed Facility: Residence ATC Number: 3617 Tax PIN/EH #: 5746-39-7888 Subdivision Info: Walt Wilson Estates Lot # 3 Location/Address: Walt Wilson Road -27028 Property Size: 1.674 acres 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 WASTEWATERN UCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: �` /`'AQ--ol? 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. r F Septic System Installed By: / e' Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department EflVrOnmenta/Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 E V E 4 \:l E NOV 7 2003 EIMRONMENTAL HEALTH DAVIECOUNTY ` ***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 -&W M`,VOMI 'AMI � 1 (� Contact Person t"1�T��&JL� 1A -W+' .^te/n Mailing Address 1l f] _4 e+,�7�SV Y �r .— C bn--w come Phone c3& - -7?8 —gRIF R City/State/ZIP ` 1����'p ���� Business Phone 3_3(a r --1^7R— 2. Name on Permit/ATC if Different than Above 1� 1 L LnoY-A g� Mailing Address4gz, b3AL WILSyg City/State/Zip MC)ek5y I(�e, IVC✓ 5?2-7CL28' 3. Application For: Site Evaluation Improvement Permit/ATC ❑ Both 4. system to Service: House ❑ Mobile Hone ❑ Business ❑ Industry ❑ Other 5. Type system requested: A Conventional ❑ conventional modified ❑ innovative 6. If Residence: It People # Bedrooms _ # Bathrooms _ �Ipishwasher ❑Garbage Disposal Dashing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals R It Water Coolers IF FOODSERVICE:; # Seats Estimated Water Usage (gallons per day) 8. Type of water supply: )[ County/City ❑ Well ❑ Community 9. Do you anticipate akiditions or expansions of the facility this system is intended to serve? ❑ Yes >(No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 3q2. y, C7 Tax Office PIN: # I & 3A Property Address: Road Name U RL -r- L,3 \L -G 11fSf City/zip Modes,^J,& /lie- 2 7OZ9 If in a Subdivision provide information, as follows: Name: LOW w� O� 1� c4AR'> Section: Block: Lot: WRITE DIRECTIONS (from Moc(sville) to PROPERTY: t 2 O 15 +o ',� � +vw c,•r�—�v� I— Date home corners flagged: %/� �%'U 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 aui responsible for all charges incurred fi•oar 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 testing procedures as necessary to determine the site suitability. ,n DATE // 10 7/&3 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). Sign given Revised DCHD (05/03 �t Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. a 7 72 Invoice No. –� �� ai (trod '4�' zc� UNE(typlcal) \ n � P.B. B 5 Pg. W LOT # 1v R R troat 4?.. r c (1.686 AC.) \ v........ (tract 5) ; koko\� 30 0\ w...(,• �^�0°' AS \ �$ \........................................... R O O z Y cL a- LOT #2 (1.662 AC.) 0 c tl') er 0 i L)` (7) c) o N Cu 1g2 \ 0 z R/R \. � ......... (trout e) ... ...... 6 � �0 00 •\ \ �� (tn;c of ....... . LOT #3 d `r (1.674 AC.) �N LJ ko p j 0 oa '� A •� c�� o �CD 00 '10 -' RSR\ . z W 62 20 — o LOT #4 � m s� 00 +• 't ?) 'D CD (1.649 AC.) eco\� ....... (tr.. ?) ....� >. ' ro� W N w w -* 1 '�° • (troat 12) Yo u1491 Z CL z v ° \ �\ _ P LO W 62�� abs LOT #5 W M0 \ 62 (1.808 AC.) ro "'o. M fz) Cu CD z ----82.27 s — — — — — 197.73 293.00 N 87.49112' V N 87'49'12' W N 0 I, hereby certify that the Davie County Hoc Department has evaluated the subdivision entttled : W. WILSON ACRES with respect to criteria and conditions estc by state law or promulgated thereunder or some Is found to comply with such criteric conditions EXCEPT an eet forth In ouch ev For detaile of this evaluation and for innttr' ese the written report on file at sold depc IMPORTANT NOTICE THIS CERTIFICATE DOEc CONSTfTUTE A PERMTr OR APPROVAL OF INC LOTS IN SAID SUBDIVISION FOR INSTAL AT101 SEWAGE FACILITIES. DATE DAViE COUNTY HEALTH OFT CUMFiCAT: OF APPROVAL BY DAViE CO. CC I, Cori Boon Chairman of the Davle County Board of Comleelonery oertN.y that Bold board has opproved this r entfUs,d : W. WILSON ACRES on this the day of ,1997. CHAIRMAN, DAVIE COUNTY BOARD OF COMIS< ,AN 12 097 D Being Iota 3, 7, 12 and a portion of lot 1 of 'WALT WILSON ESTATE' recorded In P.B. 5 Pg. O = existing iron s'.:� • — new Iron set or P/K nail set in center H- — unmarked point in centef of road R/R — existing - " Rood spike !n center of rc No N.C.G.S. monument within 2000' MINIMUM SETBACK UNES: Front — 40' Rear = 30' APPLICATION FOR SITE EVALUATIONAMPROVEMENT J Davie County Health Department r Environmental Health Section P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 M ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCES THE REQUIRED INFORMATION IS PROVIDED. ALL 1. Name to be Billed W i t,..t_t At4 L POL Au D Contact Person lx) i i -!—( AM iL. Qts l,&j&ID Mailing Address &fjO G-� 5(EL4— E 1% Home Phone (© -- 4;,5-1 — of 1 %! City/State/Zip &r {t✓ S i �f? i NIT, AIM Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: [54 Site Evaluation City/State/Zip [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: M House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People_„ # Bedrooms _ # Bathrooms _ [q Dishwasher [)q Garbage Disposal �2 [A Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [County/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes If yes, what type? [X No PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** SOF THE PROPERTY MUST BE SUBMITTED WITHS APPLICATION. Property Dimensions: Aeo(r [t % 6 Ac12.� ; WRITE DIRECTIONS (from ocksville) TO PROPERTY: Tax O*ff1`!'e-PK- # -,s--7 4,( � -19_ - s-7ro! %20 t�.A Property Address: Road Name W/\ t_T W ( LS C>0 {? D• 17' -PD MU hi I -D, A4.1 o WA t- V W u -so PJ city/Zip -J- If If in Subdivision provide information, as follows: QLOIrG�-CY S Ci 9�i i�ii� Name: t JA u-r�/�% 11 50� ��S i 1�TCS i P 1 ep fz' f �C) 0 Section: Lot #: S ;AN K 1"(--1-. W 1 t_t_ rL AG LOT trO e PEe t<- -r -t ---S -t- L-rteS-t- RX A--tS--cf7 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 from 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 9c2L..AQ,2b P -A /t,(I=�_to conduct all testing procedures as necessary to determine the site suitability. DATE A — t l— !R % SIGNATURE , c!i , � �✓uc a f P�, �,�� PO E-A&IJO Revised DCHD (06-96) THIS AREA h1AJ 13E USED FOR DRAWINCI YOUR SITE PLAN: DoT 0 n- A \ API- ;ox l.66f7 WALT L�5-r,�tl✓s `� �11i, i �oo- J_art 4 t i rAovtiL-f -revs-" 'Ir WA(- r WiLSotJ \ (SR IS 0,T) \ � I DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME W C� DATE EVALUATED I e r PROPOSED FACIIL`IT^Y C�� PROPERTY SIZE ``� • b� C��� SUBDIVISION ROAD NAME Water Supply: On -Site Well Community Evaluation By: Auger Boring ✓ Pit Public FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % O ­5se' HORIZON I DEPTH Q_ Texture group GL (ZA _ Consistence Structure "CZ Mineralogy HORIZON II DEPTH Texture group C, Consistence Structure S Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS S RESTRICTIVE HORIZON — SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE ► 4 t `c SITE CLASSIFICATION: Qt } LONG-TERM ACCEPTANCE RATE: 1 4 REMARKS: DCHD (01.90) N A Landscape Position LEGEND EVALUATION BY: OTHER(S) PRESENT: W6Ns 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 ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ MEMO■■■ ■■M■E■■ ■■■ME■■ ■E■ME■■ ■E■E■E■ ■EM■■■■ ■M■■ME■ ■■■■E■■ ■■E■ SEEM ■OE■ SEEM ■M■■ ■ i MEMO ■■■■ MEMO NOME MEMO ■■ ■ ■ ■■■■■■E■■■■■■ ■■■■■E■■■■■■■ ■■■■■ ■■■■■■ CO■■■ ■E■■■■ 220■_! ESE■■■■ limmome■■■■■■■ ■■a■■o■■■■■■a ■■■■■■■►M■■■■ .�■■■mwa■■■■ ■■■A■ ■i■■■■ ■■■CEUMAK■ME■ ■■■■:I■■■II■■■■ ■ENVEMO■■■■■ ■ommmamME■EM■ ■■■■■E■■EM■■■ ■EM■O■ ■■■■O■ ■■ME■■ ■EME■■ ■E■■E■ ■■■■M■ ■■ME■P, ■■■■■m ■ ■■■■■■ ■E■■O■ ■MM■■■ ■■■EM■ ■E■■M■ ■EME■■ ■EEE■■ ■■■■■■ ■ ■ ■ ■■■MEM■ ■■E■■M■ ■E■■ME■ ■EM■■■■ ■E■EEM■ ■■M■■E■ ■■M■■E■ ■ ■■■■■■■■■■■■■■ ■■■■■■■■E■■■■■ ■■MEMS■■■■M■■■ ■■■■■■■■■■■■E■ ■■■■■■■■■■■■E■ ■■■■■■E■■■■■■■ ■■M■■E■■■■■M■■ ■MMES■■■■■■E■■ ■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■ ■■■■■■■E■■■■■■ ■■■■■■■■E■■■■■ ■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■ ■M■■■■■■■■E■E■ ■■E■■■■■■■■■■■ ■■■ME■■■■■■E■■ ■■■■■■■■■■■■■■ ■EM■E■M■M■M■■■ CSEMMEM■■■E■■■ on ■■EEME■■ ■■■ME■■■ ■■ ■EM■ No OMEN ■E■■MEM■ ■■MEMME■ ■■MEM■■■ ■■■MEM■■ ■E■■■ME■ ■EM■■M■■ ■EE■■EM■ MEMO ■ME■ ■E■■ SEEN ■OE■ SEEM ■E■■