The URL can be used to link to this page

142 Oak Tree Drive Lot 142-144IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 For Office Use Only *CDP File Number 219665-1 County ID Number: 4798965356 Evaluated For: NEW /Township: Phone: 336-753-6780 Fax. 336-753-1680 PERMIT VALID UNTIL 7/6/2021 *NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit. r pplicant: CMH Homes, Inc/Marcelle ddress: 3866 N. Patterson Ave AY: Winston-Salem State2ip: NC 27105 Phone #: (336) 813-6316 Pro AddresslRoad #: Oak Tree Drive Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 3 # of People: *Water Supply: PUBLIC Property owner: Gina Neely Address: 142 Oak Tree Drive city: Mocksville State/Zip: NC 27028 Phone #: (336) 428-0199 Subdivision: Oakland Heights Phase: Lot: 142 Provisionally Suitable Saprolite System? OYes @No Design Flow: 3 6 0 Soil Application Rate: 0 3 2 5 'System Classification/Description: TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25% REDUCTION Directions Hwy 64 West Left on Davie Academy Rd. right on Oakland AVe. right on Oak Tree Dr Minimum Trench Depth: a 4 Inches Maximum Trench Depth: 3 6 Inches Septic Tank: 1 0 0 0 Gallons 1 -Piece: OYes ONo Pump Required: OYes Q No O May Be Required Pump Tank: Gallons 1 -Piece: OYes ONo Repair System Required: 0 Yes ONo ONo, but has Available Space Repair System *Site Classification: Provisionally Suitable Soil Application Rate: 0 3 a 5 *System Classification/Description: TYPE II A. CONY 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 ONo O Maybe Required Pagel of 3 CDP File Number 219665 -1 County ID Number: 4798965356 *Site Modifications 0 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 bythe Health Department in no wayguarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. ; Site Plan The Improvement Permit shall be valid for 5 years from date of issue with a site plan (means a drawing not necessarily drawn to O scale that shows the existing and proposed property lines with dimensions, the location of the facility and appurtenances, the site for the proposed Wastewater system, and the location of water supplies and surface waters). Plat The Improvement Permit shall be valid without expiration with plat (means a property surveyed prepared by a registered land O surveyor, drawn to a scale of one Inch equals no more than 60 feet, 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 lots approved by the local planning authority and recorded with the county register of deeds, a copy of the recorded subdivisions platthat 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 (NCGS 130A -335(f)). 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, maintenance, monitoring, reporting, and repair (.1938(b)� Applicant/Legal Reps. Signature Required? Oyes ONo Applicant/Legal Reps. Signature: Date: / / 'Issued By: 2140 -Nations, Robert Authorized State Agent: Date of Issue: 0 7/ 0 6/ 2 0 1 6 OValid without Expiration? O Create CA? @Hand 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 Drawing Drawing Type: Improvement Permit CDP File Number: 219665 -1 County File Number: 4798965356 27028 Date: I Q Inch Scale: QBlock QN/A n--- •, -9-1 IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksviile NC 27028 CDP File Number: 219665 -1 County File Number: 4798965356 Date: 03 / 06 /2016 Click below to import an Image from an external location: Drawing Type: Improvement Permit ti APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street eVJ Mocksville, NC 27028 (336)753-6780/ Fax (336)753-1680 Application For.�'te aluation/Improvement Permit C Authorization To Construct (ATC) D Both Type of" f Applic iaTori/ew 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 CPntact Person 1 t Addressv 57Phone $ — City/Sta /Zlp116-kyp —Qa IC^i WC1 Business Phon Emai( Name on Permit/ATC if Dierent than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facili Comers Flagged o. NOTE: A survey plat or site plan must accompany this application. Included: ite Plan UPlat(to scale) (Permit is lidSor 60 mon th si a plan, no expiration with complet pat.) Owner's Name PhoneNumber Owner's Address City/State/Zip 1 Property Address O4 / n t5 7L City G !! 5 '1 Lot Size PIN# Subdivision Name(if applicahle `11, ot# Ir Directiom To Site: (��rj'�—�, �Y�t. 4— W K. ff the answer to any of the following questions is "Yes",supporting dol Are there any existing wastewater systems on the site?__ _Yes Does the site contain jurisdictional wetlands? _Yes Are there any easements or right-of-ways on the site? _Yes Is the site subject to approval by another public agency? _Yes Will wastewater other than domestic sewage be generated? Yes IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # BBthr< 7 Basement: Yes o Basement Plumbing: ❑Yes Nc IF NON -RESIDENCE FILL OUT THE BOX BELOW ation must be attached: htvre-s, Con,? WA'. � s • &MI M 7219 11 MR _ Garden Tub/Whirlpool I IYes Wo 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:)iKonventional ❑Accepted ❑Innovative DAlternative ❑Other Water Supply Type. ounty/City Water D New Well ❑Existing Well :1Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? C Yes XNO 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 ide 9fication and labeling of property lines and comers and locating and flagging or staking the ho ac location, proposed & location and the location of any other amenities. t G Site Revisit Charge roperty owner's or wn s legal represen& ti a signature Date(s): cJ I Client Notification Date: Date EHS: Sign given I Yes DNo Account #�1 Revised 11/06 Invoice # Site Plan 6 Davie County, NC \T 'I 4287 Tax Parcel Report Monday, May 16, 2016 o16 6414 941 yr 5356' �� job - -3 /� �; w "'82'17 .7. \�7 Aq 02471 N r v"vie Davie County, NC WARNING: THIS IS NOTA SURVEY o ' harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or information Parcel Number. 11120A0043 Township: Calahaln NCPIN Number. 4798965356 Municipality: Account Number: 8303133 Census Tract: 37059-801 Listed Owner 1: NEELY GINA P Voting Precinct SOUTH CALAHALN Mailing Address 1: 142 OAK TREE DRIVE Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27028 Voluntary Ag. District No Legal Description: LOT 142 OAKLAND HEIGHTS Fire Response District COUNTY LINE SECTION II Assessed Acreage: 0.45 Elementary School Zone: COOLEEMEE Deed Date: 2/2014 Middle School Zone: SOUTH DAVIE Deed Book / Page: 009500300 Soil Types: PaD,PcC2 Plat Book: 0004 Flood Zone: x Plat Page: 151 Watershed Overlay: - Building Value: 0.00 Outbuilding & Extra 0.00 Freatures Value: Land Value: 9800.00 Total Market Value: 9800.00 Total Assessed Value: 9800.00 Davie County, NC All data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold o ' harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or °� tit causes of action due to or arising out of the use or inability to use the GIS data provided by this website. ,NCDENR Division of Environmental Health On -Site Wastewater Section Soil/Site Evaluation For On -Site Wastewater System "Date:' "File #: a 1 9 6 6 5 PIN #: 4798965356 "Owner Gina Neely Proposed Facility SINGLE FAMILY Proposed Design Flow (.1949) 3 6 0 Location of Site Oak Tree Drive Property Size Water Supply PUBLIC Evaluation Method auger 3 14940 Horizon SOIL MORPHOLOGY Profile# Lan scape Depth •1941 Other Profile .1942 W et. POSSlope °�0 (IN) Matrix Color Factors Texture Structure Consistence Color .1943 Depth Zo °:o -3 -5f, .1942 W et. ,1944 Rest. Horizon .1943 Depth GPS Saprotite: (in) 5 G1• C-7 .1944 Rest. Horizon 1947 Class ENS .1947 Class EHS Profile LTAR Profile 7 ,! % Saprolite:00 LTAR .1942 Wet. GPS Copy rofile L- .1942 Wet. L .1943 Depth GPS Saprotite:(n)rit5t9 5GL.1944i 1H riZont. 12 .1944 Rest. Horizon 1947 Class EHS CoD rofile 1947 Class ENS ofile j�j 171 1 Profile LTAR 3 % Saprolite:(n) .1942 W et. GPS Copy rofile .1943 Depth ,1944 Rest. Horizon 1947 Class ENS Profile LTAR % Saprolite:00 .1942 Wet. GPS Copy rofile .1943 Depth .1944 Rest. Horizon 1947 Class ENS Profile LTAR Available Space (.1945) Other Factors(.1946) Ste Classification (.1948) Initial LTAR: . Comments: Evaluated By. Nations, Robert Repair LTAR: Others Present: % Saprolite:(in) .1942 Wet. GPS raEHS Copy ofile .1943 Depth .1944 Rest. Horizon .1947 Class Profile LTAR — Available Space (.1945) Other Factors(.1946) Ste Classification (.1948) Initial LTAR: . Comments: Evaluated By. Nations, Robert Repair LTAR: Others Present: NCDENR Division of Environmental Health on -Site Wastewater Section Date: e s / / +9 i s Soil/Site Evaluation Fie 9: 2 2 9 6 6 5 For On -Site Wastewater System PIN*: 4 7 9 8 9 6 5 3 5 6 Profile# 1940 Lan scape POS Slope % Horizon Depth (IN) SOIL MORPHOLOGY .1941 Mineralogy Matrix Matte Texture Structure Consistence Color Color Other Profile Factors % Saprolfte:(in) .1942 Wet. GPS Copy-grofil 1942 wet, GPS Ccpy Profit .1943 Depth 1943 Depth .1944 Rest. Hofton 1944 Rest. Horizon 1947 Class EHS 1947 Class ILTAR EHS NOfile LTA R Pronle " • . % Saprolde:(in) a'o Saprolite:(in) .1942 Wet, GPS Copy,.t;rofil j J .1942 Wet. GPS raEHS Gopy,Profil l� .1943 Depth .1943 Depth .1944, Rest. Horizon .1944 Rest. Horizon .1947 Class �---- EHS .1947 Class Profile LTA R Profile LTAR ab 5aprolde:(in) 1942 Wet. GPS raENS 000y -Er rofil .1943 Depth .1944 Rest. Horizon .1947 Class Profile LTAR Comments: ola Saprollte:(in) .1942 Wet. GPS Copy-grofil .1943 Depth .1944 Rest. Hofton 1947 Class EHS NOfile LTA R % Saprolde:(in) .1942 Wet, GPS Copy,.t;rofil j J .1943 Depth .1944, Rest. Horizon .1947 Class �---- EHS Profile LTA R Comments: Attach Image The "Open Drawing Form" button, opens the the drawing form. The "Import" button, attaches the drawing, or other image into the space below. Open Drawing Form Profile: X Y -- Z Profile: X Y Z Profile: X Y Z ------ ---- Profile: Q X Y Z Profile: X Y Z Profile: X Y Z Profile: X Y Z Profile: X Y Z Profile: X —y— Z Profile: Q X Y Z-. " DAVIE COUNTY HEALTH . DEPARTMENT IMPROVEMENTS -PERMIT AND, CERTIFICATE OF COMPLETION. *NOTE: Issued -in Compliance with G.S. of North Carolina 'Chapter 130 Article 13c Sewage Treatment and Disposal. Rules (10 NCAC 10A .1934-.1968) _ Permit Number Name �� .� , Date "Location �'is�/f,.�.c Subdivision Name I' Lot No, Sec. or Block No. Lot SizeHouse % , `Mobile Home _1� Business Speculation • No. Bedrooms No. Baths f/ �a No.. inFamily - Garbage Disposal YES . NO ; p''" . �i 'i Specifications' for System: • Auto Dish - YES � NOfl Auto'Wash Machine YES NO, Type -Water Supply *This permit Void if sewage system. described below is not installed within 36 months from date„ of ,issue. I APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section R 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. 1. Permit Requested By l -/n Va " L a,$ 2. Address // , "C Aj,< < 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair b) Privy Conventional Other Type Ground Absorption Home Phone '? ��g'3/ j; Business Phone c) Sub -Division Sec. Lot No. 5. System used to serve what type facility: House Mobile Home L, Business IndustryOther b) Number of people j 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions / `/ N 1� Y' Bed Rooms —9 Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes lavatory dishwasher urinals showers sinks garbage disposal washing machine 8. a) Type water supply: Public DC Private Community b) Has the water supply system been approved? Yes Ot No 9. a) Property Dimensions ) Or, 0- b) Land area designated to building site c) Sewage Disposal Contractor'o- ;e s . 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? dtn What type? This is to certify that the information is correct to the best of my knowledge. 1;7j Date Owner Si—gin-Aturi OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD (6-82) Address DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Date Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 Topography/ Landscape Position 2) 't) d) 5) 6) 8) 9) S PS S S PS S PS U U U Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) PS --<N:)PS PS U U U U Soil Structure (12-36 in.) S S S S Clayey Soils � � PS PS U U Soil Depth (inches) S S PS S PS U U U Soil Drainage: Internal PS S PS S PS S PS U U External S S S S PS PS PS PS U U U U Restrictive Horizons Available Space Ste, S S PS S PS U U U Other (Specify) S PS S PS S PS S PS Ute' U U U Site Classification 5, . U—UNSUITABLE Recommendations/ Comments: Described by _ SITE DIAGRAM �v DCHD (6-82) S—SUITABLE PS—Provisionally Suitable Title ,/2, Date A,