Loading...
113 Longwood Drive Lot 15• DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002162 Tax PIN/EH #: 5861-58-6346 Billed To: Bob Cope & Son Construction Subdivision Info: Redland Lot # 15 Reference Name: Location/Address: Longwood Drive -27006 Proposed Facility: Residence Property Size: 0.79 acres ATC Number: 3321 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 WASTEW ON 13.11 N IS ALID FOR A PERIVOFIVEARS. Environmental Health Specialist's Signature Date: 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. o� w' Lei r &OnLt 2 4' Wt.`foa- �l Septic System Installed By: �� Environmental Health Specialist's Signatur 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 IMPROVEMENT/OPERATION PERMIT Account #: 990002162 Billed To: Bob Cope & Son Construction Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-58-6346 Subdivision Info: Redland Lot # 15 Location/Address: Longwood Drive -27006 Property Size: 0.79 acres ATC Number: 3321 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 #People #Bedrooms _� #Baths 3 Dishwasher: 121"" Garbage Disposal: Ls Washing Machine: 2" Basement w/Plumbing: 00*' Basement/No Plumbing: 13 Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 11 Lot Size 0.361ACPES Type Water Supply 20"aYDesign Wastewater Flow (GPD) T190 Site: New Repair System Specifications: Tank Size IOCO GAL. Pump Tank GAL. Other P��crlo.j st?Si>� /9.i2D Trench Width Reelr-Beptis Linear Ft. 2 ccc) �'Xu> Required Site Modifications/Conditions: �EO- St u(T: 000 -c -C (IF 3'=`�"� aO�=Mti� +� . k�=�n to r�f-� e2QC. L1,%J qS IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISERS) IF 6 "BELOW FINISHED G _ADE. ****NOTICE: Contact a representative of the Davie CountyHealth Department for final inspection of this system betwee 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installati n. Telephone # is (336)751-8760.**** r c� Z t/ P �\ Di211i� I ��, Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: i O 2— NOY APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT AT a t Davie County Health Department DF,VIEC EnvironmentaiHealth Section ENVIRON„1` qui HED,CiH Y P.O. Box 848/210 Hospital Street - Mocksville, NC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PRRnjOVID/E/D.. Refertothe INFORMATION BULLETIN for instructions. 1. Name to be Billed Contact Person Mailing Address City/State/ZIP �O d'�g 11615141:9 C' ek",,re� V, C, �VWCI 2. Name on Permit/ATC if Different than Above Mailing Address Home Phone Business Phone City/State/Zip 3. Application For: 9 -Site Evaluation • ❑ Improvement Permit/ATC ll_ Both 4. System to service: &( House ❑ Mobile Home ❑ Business ❑ Industry IJ Other 5. If Residence: # People /Vl+ # Bedrooms # Bathrooms 3 17 DishxasherItVGarbage Disposal . A Washing Machine ItYBasement/Plumbing 1.1 Basement/Ho 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: County/City ❑ Well LI Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 14-IQo If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Eithcr a PLAT or SITE PLAN MUST RESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 0,'7q Tax Office PIN: # J 3yV Property Address: Road Name City/Zip��r Z?% If in a Subdivision provide information, as follows: Name: Rd t� a Section: Block: Lot: 1� WRITE DIRECTIONS (from Mocksville) to PROPERTY: 1 Lo -24 Date Property Flaggcd: A106 l� This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits) 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 ant responsible for all charges incurred fron this application. I, hereby, give consent to the Authorized Representative of the Davic 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 suit ility. DATE �5 -� 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). „lo g ) 9" -e.. r J Revised DCHD (07/99) /7�Z1 Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. "- `Z— Invoice No. API'UCRIION FOR SITE EVALUAIION/IMPROVEMENT PERMIT & ATC Davie County Health Department •,,,,, Environmental Health Section P.O. Box 848/210 Hospital Street Mockeville, NC 27028 (336)751-8760 ***IIPORTANV** THIS APPLICATION CANNOT BE PROCaSSED UNLESS ALL INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for .1 _1 " / . I I_ , 1. Name to be Billed Mailing Address City/8tata/SID 2. Name on permit/ATC if Different than Above Contact person W t' Boma phone /G_ 4, Business phone JUN i REbUIRED rucLIVIVItc' '�'I�FNTA► u� 1 e /IUM}' ivy Nailing Address City/State/Sip 3. Application For: Er / Site Evaluation D Improvement Permit/ATC ❑ Both 4. System to Services ffeilouse 0 Mobile Home 0 Business 0 Industry 0 Other 5. If Residence: 1 People 1 Bedrooms 1 Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Mashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Others Specify type I People ! Sinks 1 Commodes i Showers # Urinals 0 Mater Coolers IF rOODSERVICE: (i Seats Estimated Nater Usage (gallons per day) 7. Type of water supply: 9-County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system 6 intended to serve? 0 Yes 0 No If yes, what type? 11"IMPORTANTP" CLIENTS M11ST CUMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBM17TED by the client with THIS APPLICATION. Property Dimensions: Ae r�5 4 -- Tax Office PIN: # Property Address: Road Name City/Zip �IlAved AJ -(f �L-?et If in a Subdivision provide Information, as follows: Name: P 6�R /. Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: U : "v4- T vi1�13 7rM- D-7-1,91 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 nee 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 appUcatlon. 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 snitalRlllty. DATE — y D� SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includ all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). u Revised DCIID (07/99) Site Revisit Charge I Date(s): I Client Notification Date: I EIIS: Account No. 3 Invoice No. '�L`t / DAVIE COUNTY HEALTH DEPARTMENT 'r+h Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.15 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 15 Reference Name: Location/Address: US Highway 158-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH D Texture group 0— Consistence Consistence : S Structure Mineralogy HORIZON II DEPTH S n 11 ^ O Texture group Consistence ' S Structure 3k Mineralogy I HORIZON III DEPTH 3D 1 Texture groupCa; Consistence Structure L Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATIONLj! LONG-TERM ACCEPTANCE RATE EIV.�r SITE CLASSIFICATION: �Q4� / EVALUATION BY: LONG-TERM ACCEPTANCE RATE: ©' 3J OTHER(S) PRESENT: REMARKS: 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 05/99 (Revised) 30 Alk' :;Oo I V-/*) t(25 .0000. OP At (60 � a C a s °�� �,..-1 10 x 70'------10. Sigh t Easem en t \1 10, Public Utilities Easement L4�) 30,605 sq. ft. 0.703 Ac. t � to 3 0 13 s x 3.1 718 sq. ft. - - 0.728 Ac.f i 10' Landscape P Easement 000 �6 15 I () 30, 701 sq. f{, 0.705 Ac.t 10' Landscape Easement -� tubi �$ 10'x70' Sight Easement 168� 0.71 000wl� 000, 0000 Certificate of Ownei We the undersigned