Loading...
122 Matthias Court Lot 1501 • DAVIE COUNTY ENVIRONMENTAL HEALTH 1(J`yl P.O. Box 848/210 Hospital Strut - - Mocksville, NC 27028 (336)753-6780/Fax #(336)753-1680 OPERATION PERMIT Account #: 990005465 Tax PIN/EH #: 5749-53-8619.15 Billed To: Buck Horn Construction Subdivision Info: The Oaks at McAllister Park Lot # 15 Address: 1268 Hauser Rd. Location/Address: Matthias Lane -27028 �- City: Lewsiville Property Size: .873 acres Reference Name: buck Horn Proposed Facility: Residence pec 0 Soya **NOTE** The issuance 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. � O � / �!1 System Type: S.T. Manufacturer Tank Date 0(`Tank Sizea- Pump Tank Size iG4p �- p System Installed By: O E.H. Specialist: Date: Cs Y\ + tt" -%�e `% 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 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005465 Tax PINIEH #: 5749-53-8619.15 Billed To: Buck Horn Construction Subdivision Into: The Oaks at McAllister Park Lot # 15 Reference Name: buck Horn LocationfAddress: Matthias Lane -27028 Proposed Facility: Residence Property Size: .873 acres Site Type: ❑New ❑Repair ❑Expansion ATC Number: 5069 **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 11 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 3 # Bathrooms c- # People I Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size 6 � Q U 7 S Type of Water Supply: Er ounty/City ❑ Well ❑ Community Well System Specifications: Design Wastewater Flow (GPD)3 0 Tank Size GAL. Pump Tank_ Z� _ Trench Width 0 0 Max. Trench Depth f'r " Rock Depth Linear Site Modifications/Conditions/Other: As stated in 15A NCAC 18A.1969(5) a GAL. Contact the avie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telephone ne # (336)751-8760. 5"..e P c_ Ca ►� 1 Tar�t� � �rvt u-s�1""_Gk P 1a'-A1v Environmental Health Specialist / Dater Q DCHD 11/06 (Revised) Vr � a � 6E F --I An _jri 1 1a'-A1v Environmental Health Specialist / Dater Q DCHD 11/06 (Revised) Vr 04/05/2010 15:50 3369462433 BUCK HORN PAGE 01/01 r`•' '�" �- �.- S 8700 0S"E 111.5 I I I 1 I I I I . I � I I I l I I ' I � I 14 15 Ni 0 I * I I I z I 1 I I 1 o d_ I � 2 i38' slow- PROPOSED 0.00 I _ ()► 1 � Sic _ I I .b0' 9 47.93' CAIiAGI 251457 I14M - 24.00' I •I 1 ' 10_ORAINAGE ae l Tum EmEMENT _ _ ^ r' ^8' SIDEMAI K EASEMENT .r 132' N 88'55838' 94.95 2�s1, 6 +--N AQ'1n 1r, McAWSTER PARk P.B. 8 PG. 252- 0 I J 17.32' MATTHIAS COURT APP�LI,� TE EVALUATION/IMPROVEMENT PERMIT & ATC avie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 36)753-6780/ Fax (336)753-1680 Applied ion Fo`�T�v`alcl mprovement Permit Authorization To Construct (ATC) ❑ Both Type of pplication: System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMP ANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. A PPT IC A \TT TNFCIR 1\4 A TTC11vT Name 15A 4Gni`OVA Address I d,Gaq .4Ztsen 2 City/State/ZIP Lf w ,ti C 9 7 P 23 Name on Permit/ATC if Different than Above Mailing Address Contact Person Home Phone Business Phone '42(o Off 3 C PROPERTY INFORMATION •y` % 10 *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 m nths with site plan, no expiration with complete plat.) Owner's Name �2A ni n/ Phone Number 4 6:a vZ D g- 3 Owner's Address /9(osr e11L Rd City/State/Zi tPA.LA3U1 t A/C- a70 i3 Property Addressl,*/5" /n ,4 ff ) F} S C7— City In D C465 w J _ "t -L Lot Size r 873 40re5 Tax PIN# 5 53 - 19Glq Subdivision Name(if applicable) -7—h e_ 040 Section/Lot# f .- Directious To Site: /_5-9 Ftp% -/0 " * ?4rlty lYlYlcdln -` �r If the ans er to any of the following questions is "Yes",supporting documentation must be attached: Are there any existing wastewater systems on the site? _Yes 1�_No Does the site contain jurisdictional wetlands? _Yes kNo Are there any easements or right-of-ways on the site? _Yes kNo Is the site subject to approval by another public agency? _Yes KNo Will wastewater other than domestic sewaae be venerated? Yes MNo IF RESIDENCE FILL OUT THE BOX BELOW # People a— # Bedrooms . -3— # Bathrooms Garden Tub/Whirlpool Ves ❑No Basement: ❑Yes RNo Basement Plumbing: ❑Yes XNo IF NON -RESIDENCE FILL OUT THE BOX BELOW 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 ❑Accepted ❑Innovative ❑Alternative �9`6ther Water Supply Type�VCounty/City Water ❑ 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 rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and ing sta ' g the house/facility location, proposed well location and the location of any other amenities. Site Revisit Charge Property er's or owner's legal representative signature t [ _ Date(s): T Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account # 64t$ 9 Revised 11/06 Invoice # 7Z &I ION F TE EVALUATIONAMPROVEMENT PERMIT & ATC Q 2pQ6 avie County Environmental Health f±Ov P.O. Box 848/210 Hospital Street Mocksville, NC 27028 �nv�RONh� (336)751-8760/ Fax (336)751-8786 Applic do Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both Type o Application: view System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed Cc'C'_'3Y''✓�/l�j .3.`-k�,Cn, n� Contact Person Billing Address Pt►!•''� -;2,&V0 Home Phone City/State/ZIP cS ' t'S't- !% 1 -2-c �40 Business Phone .3Y,�= - _`i >J-1--3 (C'c// Name on Permit/ATC if Different than Above Mailing Address Y1CVY�K1 Y 11N1'U1CV1A11U1N -Late House/Facility Uorners rugged NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan*lat(to scale) (Permit is alid for 60 months w'th site p n, no expiration with complete plat.) Owner's Name .a / 1'G , rl %5 Phone Number Owner's Address ,5 tk✓ ,--' City/State/Zip X zAs i1 r ae- XJ3' 7G3 Property Address c' Ci� Lot Size Tax PIN# 5 7 —, Subdivision Name(if applicable) O/ZC`Nl Section/Lot# Directions To Site: /5. %i2i� /l1 �iGYC9,f ZT/tf rn'N4 yr?� t 7R` 6- ,, �l � 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 -lfFN6' Does the site contain jurisdictional wetlands? ❑Yes ©'No Are there any easements or right-of-ways on the site? Dyes S -No Is the site subject to approval by another public agency? Dyes CiNo Will wastewater other than domestic sewage be generated? Dyes U90 IF RESIDENCE FILL OUT THE BOX BELOW # People 1—? # Bedrooms # Bathrooms a Garden Tub/Whirlpool es ❑No Basement: ❑Yes ❑No%,' 4 Basement Plumbing: C s No kj ./J IF NON -RESIDENCE FILL OUT THE BOX BELOW 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: onventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: County/City Water ❑ 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 rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging or aking the louse/facility location, proposed well location and the location of any other amenities. Site Revisit Charge Property owner's or er's legal representative signature Dt Date Sign given Dyes ❑No Revised 11/06 a e(s). Client Notification Date: EHS: Account # Invoice # ` DAVIE COUNTY HEALTH DEPARTMENT " Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account M 990004186 Tax PIN/EH M 5749-53-8619.15 Billed To: Cool Spring Builders, Inc. Subdivision Info: Black Forest Lot # 15 Reference Name: Michael Moorefield Location/Address: Sain Road -27028 Proposed Facility: Residence Property Size: see map Date Evaluated: 3 eZ�3d% Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit_ Public Cut FACTORS 13 & Wo 01361 4 5 6 7 Landscape position f_ L Sloe % HORIZON I DEPTH Texture group " Consistence Structure L Mineralogy HORIZON H DEPTH Z 7-30 Texture group!� Consistence Structure n / Mineralogy '50-6-1 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 2 ©•Z�S �, 2 SITE CLASSIFICATION: S LONG-TERM ACCEPTANCE RATE. •2�� 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 I&A = 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 L010 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 05105 (Revised) y Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990004186 Tax PIN/EH #: 5749-53-8619.15 Billed To: Cool Spring Builders, Inc. Subdivision Info: The Oaks at McAllister Park Lot # 15 Address: PO Box 2040 Location/Address: Sain Road -27028 City: Advance _ Property Size: see map Reference Name: Michael Moorefield 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 11 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: i0'NVew ❑Repair ❑Expansion, I Permit Valid for: ❑5 Years o Expiration Residential Specifications: # Bedrooms '7 # Bathrooms S # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): 'w Type of Water Supply./!�County/City ❑Well ❑CommunityWell Site Modification /Pe m't Conditions: oat r, k C C) J IcT,6d Site Plan Initial 10.-00 Environmental Health Specialist i.p.11-06 V 01 *4 I W 1TIAL t LTAR ©. J 0 -Z - 25- '5"T , Date C. f 1 Date C. f