Loading...
107 West Knoll Brook Drive Lot 12DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900323 Tax PIN/EH #: 5749-43-8747 Billed To: Vogler's Construction, Inc. Subdivision Info: Meadowridge Lot # 12 Reference Name: Elaine/Richard Shelton Location/Address: Sain Road -27028 Proposed Facility: Residence Property Size: see map OT> N rIs p 2864 ovem Op septic Ys Y * * N * * is m rovement/ eration Permit DOES NOT authorize the construction of a s tic tanks tem or an 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 #People_ #Bedrooms _ #Baths 127 Dishwasher: Garbage Disposal: Washing Machine:'Ca""."Basement w/Plumbing-J2'' Basement/No Plumbing: 13 Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: CI Lot Size �` �'� G Type Water Supply Design Wastewater Flow (GPD) Site: Newer Repair 0 System Specifications: Tank Size GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width Rock Depth J� Linear Ft., -5W 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.**** Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900323 Tax PIN/EH #: 5749-43-8747 Billed To: Vogler's Construction, Inc. Subdivision Info: Meadowridge Lot # 12 Reference Name: Elaine/Richard Shelton Location/Address: Sain Road -27028 Proposed Facility: Residence Property Size: see map ATC Number: 2864 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 C NSTRUCTION IS VALID FOR A PERIOD OF FyIGVE YEARS. Environmental Health Specialist's Signature: Date: A - ( a/ 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. b I 30' T �60 Septic System Installed By: Gov Environmental Health Specialist's Signature: „06;zl Date:,, //% DCHD 05/99 (Revised) t ; s • • • APPUCATION FOR SITE EVALUATION IMPROVBIENT PERMIT 7 LS Davie County Health Department Entrironmenta/Hea/tfiSec on MAY 1 �qql P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ' xr*;,p;�PdENTAIHEALTH ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PR VIDED. Refer to the INFORMATION BULLETIN for Anstructio4s. I _ t 1 - - % / -/- 1 . - 1. Name to be Billed Mailing Address � Contact Person Home Phone City/state/ZIP Hd a a::4'edf .9C Q��` 06L Business Phone 1 R rG _1'3 y -3 2. Name on Permit/ATC if Different than Above ,C, 1 / Q {�� t (�`(1QQ /( Q,n Mailing Address ? City ///St ate/Zip 3. Application For: 0 Site Evaluation Er-, rovement Permit/ATC ❑ Both 4. system to service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms `f # Bathrooms 4T'5ishxasher O-aa—rbage Disposal Washing Machine �ement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers IF FOODSERVICE: # Seats # Urinals # People # Sinks # Water Coolers Estimated Water Usage .(gallons per day) 7. Type of water supply: County/City ❑ Well 8. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? ❑ Community ❑ Yes ell o ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 3,6C �( Tax Office PIN: # r Property Address: Road Name City/Zip If in a Subdivision provid information, as follows: Name: !Z %� - --L— Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: .O w �? 0 S ler-34—d;, l✓l—.Ar -5 Date Property Flagged: C/ 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 IIealth ep. Mien 5/�� to enter upon above described property located in Davie County and owned by�9%- �- �r J _ to conduct all testing procedures as necessary to determine the site suitability. DATE (J I t 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). Site Revisit Charge Datc(s): Client Notification Date: EHS: q Y-11 Account No. �3 Revised DCHD (07/99) Invoice No. Z 3 Z O F • APPLICAl10N FUII 811E EVALUATION/IMPROVEMENT PERMIT sit ATC Davie County Health Department D V L5 Environmental Mealdr SeWon • P.O. Box 848/210 Hospital Street JUL 1 1999 Ilockaville, MC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCBSSSD UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Mass to be Billed KE N nl E T N L - Fo STE R . Contact Person KE N as T H �. • FOSTE 2 !sailing Addressl �8G (o I Yl a PL.E TR�� L q,,ic some phone 704 -54(o--7-7 � S City/State/LIP t4t0CKSv11Lt N •C .27OZe Business Phone 33CD-iZ3-8850 Z. Mame on Psrdit/ATC if Different than Above Malting Address City/State/Lip r. Application For: Pt Site Evaluation 0 Improvement Permit/ATC 0 Both s. system to service: fd House ❑ mobile Home O Business 0 Indus try 13 other / s. It Residence: T People / # Bedrooms 3- / i Bathrooms [YDishwasher D Garbage Disposal B !lashing Machine 0 Basement/Plumbing 0 Basement/no Plumbing 6. if Business/Industry/other: Specify type f people # sinks • ea®oaea e# Showers f Urinals i water Coolers IF rOODSERVICS: p Seats _ / Estimated Nater Usage (gallons per day) 7. Type of water supply: 11 County/City 0 well 0 Coz='1n4 ty s. Do you anticipate additions or expansions of the facility this system Is intended to serve! 0 Yes 0 No If yes, what type! ***IMPDRTANT*** CLIENTS MUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN DUST BESUBIIIITTED by the client with THIS APPLICATION. Property Dimensions: I G UK 57 1175 X %9 9 WRITE DIRECTIONS (from MocksAlle) to PROPERTY: Tai Me PIN: # 5!4-9 - 43- S`I98 C- 4.5T ONy 5 �1 S R Property Address: Road Name �S A d -4 R a r-., City/ZipNioCKSy'11e OL -1 07's If In a Subdivision provide information, as follows: Name: MEA3oWRt.DGC- �P+�PoSED� Section: Block: Lot: I Z TO n0,1 0 RaO-o ( s R 1(,43) rU-P VJ R1GN7 OP Sn.►•.1 - APP0..or. 0.5 M1LC- -TU S (Te, n r.1 1k\ L %A T Date Property Flagged: 6, . a 8 - 94 This Is to certify that the information provided is correct to the best or my knowledge. 1 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 ani responsible for all charges incurred from this appliaadon. I, hereby, give consent to the Authorized Representative or the Davie County Health Departmer-d to enter upon above described property located in Davie County and owned by IfENA)-57 - L. FVS-r R, to conduct all testing procedures as necessary to determine the site suitability. DATE (a -Z8 -1991 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). Revised DCHD (07/98) Account No. 45� Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900654 Tax PIN/EH #: 5749-43-5798.12 Billed To: Kenneth Foster Subdivision Info: Meadowridge Lot # 12 Reference Name: Kenneth Foster Location/Address: Sain Road -27028 Proposed Facility: Residence Property Size: 2.29 Acres Date Evaluated: Water Supply: Evaluation By On -Site Well Community Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L ps Slope % <R 23D 420 11,20 HORIZON I DEPTH 2 -1 Texture group Consistence - Structure k Mineralogy1: HORIZON II DEPTH —Z(v 12r Texture group Consistence i Structure Mineralogy; HORIZON III DEPTH -'3 - Z- Texture groupf Consistence Structure 5 Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION RT�—__Q_s LONG-TERM ACCEPTANCE RATE I ------ $6— SITE CLASSIFICATION: P- LONG-TERM ACCEPTANCE RATE: C>• REMARKS: r �"kt �''� ca.')< LEGEND Landscaue Position EVALUATION BY: fir"" OTHER(S) PRESENT: 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 05/99 (Revised) MEAD 0 W RIDGE DRIVE SMN ROAD Q? WIST /— — — — — — — — — — — — — — — — — — — — — — SITE /S 01053 33"E 169.40' — _ _ _ LOCATION MAP I - / - - - - - - I - - - - - - - - - - - - - - 1 _ _ I 2 D -' — — -1 — 0,_�INgGE EASEMENT S 1 29 2 "W — � I I 1 \ ? 190 ♦ \ 1 II —,` \ dao I � N I 1 ~ \ 02 W 35.50• I 12 \ \ PROPOSED N 1 $ HOUSE , I 2.33' 3.78' 35 I � ri / 2.00.- .50' N y $8.87'78' I 8 GARAGE I --------------, 24.83' / 1 I I / 1 , / , 1 / I Z 1� / OD P.B. 7 PG. 130 1 / 1 0o No7o1 "w 17x.37'-----_- �N, , SITE PLAN ONLY I _ —P..•••"..... THIS WAS MAPPED FROM A DEED OR —�oQQOFEss��+';,9;, RECORD PLAT AND NOT FROM A SURVEY I _ SEAL ` BY ME I - 35.50' - ' f c- L-2890 o Q: z N .......... . � �. Ql J3 30 0 30 60 90 GRAPHIC SCALE - FEET oR VOGLERS CONSTRUCTION, INC. SCALE I TOWNSHIP I COUNTY I STATE DATE,s 1 " = 30' 1 MOCKSVILLE I DAME N. C. 5-30-01 LOT 12 MEADOW RIDGE SECT 1 P.B. 7 PG. 130 HOWARD SURVEYING JOHN RICHARD HOWARD PLS P.O. BOX 276 ADVANCE, N.C. (336) 998-5396 JOB NO.