The URL can be used to link to this page

1657 County Line Rd , DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005208 Tax PIN/EH#: 4890-97-5147-HK Billed To: Hilda Keaton Subdivision Info: Reference Name: Location/Address: 1657 County Line Road-28634 Proposed Facility: Residence Property Size: 13 Acres ATC Number: 4940 Site Type: ❑New ❑Repair OExpansion **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--I#Bathrooms #People BasementO Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size 0.0G A�)C Type of Water Supply: DCounty/City ell ❑Community Well System Specifications: Design Wastewater Flow(GPD)r�� TankSize GAL.Pump Tank4 GAL. Trench Width M x.Tr Uch 3_ c t� Linear Ft. Site Modifications/Conditions/Other: u ,eptvd Syttems may alt;3 b2 usa Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.rp.on the day of installation. Telephone#(336)751-8760. 4(b'rAj S�Pfii C_ Aov,k any a 5 S hoUJ In Ilk 10, 11 Environmental Health Specialist Date: ` DCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account #: 990005208 Tax PIN/EH#: 4890-97-5147-HK Billed To: Hilda Keaton Subdivision Info: Reference Name: Location/Address: 1657 County Line Road-28634 Proposed Facility: Residence Property Size: 13 Acres ATC Number: 4940 **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. System Type: S.T.Manufacturer Tank Date Tank Size Pump Tank Size System Installed By: E.H.Specialist: Date: DCHD 11/06(Revised) r Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990005208 Tax PIN/EH#: 4890-97-5147-HK Billed To: Hilda Keaton Subdivision Info: Address: 1651 County Line Rd. Location/Address: 1657 County Line Road-28634 City: Harmony Property Size: 13 Acres Reference Name: 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: ew ❑Repair ❑Expansion Permit Valid for: Years ❑No Expiration Residential Specifications: #Bedrooms #Bathrooms 9—#People ')�Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply: ❑County/City ❑Well ❑Community Well Site Modifications/Permit Conditions: A? stated in 155 NCAC 1pi 1!De9Trl a.. Q16 oms may 8I:a bQ used System Type - LTAR Initial aC. Repair Site Man V a >•- soo � 3 V ( YI l� f i Enviro ealth Specialist Date i.p.11-06 . , oot& WHENAoh APPLI SITE EVALUATIONAMPROVEMENT PERMIT & ATC QDavie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 _ DEC 2 (336)751-8760/Fax(336)751-8786 App tcatio For: ion/I ment Permit ❑ Authorization To Construct(ATC) oth Typ of Ap icgTM�" _Dlh' em ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility *** TANT***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 f Contact Person Billing Address Home Phone q12-516 City/State/ZIP . , a ,?6 3 Business Phone q0q , Z1660 Name on Permit/ATC if Different than Above Mailing Address City/State/Zip / PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is'.va id for 60 months with site plan,no expira ion th complete plat.) Owner's Name eCI� Phone Number9� Owner's Address I L 49 0A a t1 L.� City/State/Zip PQrmontf N e. a2863V PropertyAddress ; City /-/4ymdnc AL--c. Lot Size J Tax PIN# 495A-g7- 5/x/7 Subdivision Name(if applicable) Secti ot# Directions To Site: ire M i a0 e h ,4,ev If the answer to any of the following questions is"yes",supporting docuilientation.must be attached. Are there any existing wastewater systems on the site? ❑Yes 2f4o Does the site contain jurisdictional wetlands? ❑Yes Ao Are there any easements or right-of-ways on the site? ❑Yes Ao Is the site subject to approval by another public agency? ❑Yes NO Will wastewater other than domestic sewage be generated? ❑Yes 2No IF RESIDENCE FILL OUT THE BOX BELOW #People —A #Bedrooms Q _ #Bathrooms _ Garden Tub/Whirlpool.R'1'es ❑No Basement: ❑Yes J0Mo Basement Plumbing: ❑Yes ,?'No 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 ;dt Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 0"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 staking the house/facility location,proposed well location and the location of any other amenities. Site Revisit Charge Property owner's or owner's legal representative signature ' Date(s):_ /a. a 9•Ds Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# Z Revised 11/06 Invoice# / � S`1 h. L ,Sh 12 � w 1�. J l 4/ o GoMAPS -Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping System Click Here To Start Over Quick search:(county ID or Owner Ni A[tive Layer. ❑� Use Map Tops Ei 6 ® PARCELS(Map TipS Available) ,!✓ M. Addre TU%UE MARY REEVES 24Bg! 216080061401 2.11 AC 622 SR 169 1613; 16570 I 186 l 167% It 65 4 18400 1621 N � l 18404 18070_ 1 118* i 1592 / V / I � 1\ 1571y � -i588a l � 5 o1Hifl ,�E��PRO j \ http://maps.co.davic.nc.us/GoMaps/map/Index.cfm?mai=apservice=gomaps&CFID=41... 12/30/2008 • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990005208 Tax PIN/EH#: 4890-97-5147-HK Billed To: Hilda Keaton Subdivision Info: Reference Name: Location/Address: 1657 County Line Road-28634 Proposed Facility: Residence Property Size: 13 Acres Date Evaluated: Water Supply: On-Site Well Community. Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Lands cape position Slope% if HORIZON I DEPTH Texture group C_ Consistence �r Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION PS LONG-TERM ACCEPTANCE RATE /1:1'71-1 p. 0,17 SITE CLASSIFICATION: EVALUATION BY: A& LONG-TERM ACCEPTANCE RATE: �� OTHERS)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. Mont 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 lYQtes 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 05/05(Revised) i r ■■■■■■■■■e■■■■e■■■Ile■a■■■■■■■s■■■e■■■■■e■■■■■■■1?rG■■e■■■■e■■■■■■■■■■ s■■■■■■■/■■■■■■■■■r■■■rc�■■■■■■■�■■■n■■■■■/■■/■■■Irl{■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■11■i■■■■■■■■■■■■■■■■■■■IIIJ�■■Illi■■■■■■■■■■■■■■/■■■ ■■///■■//■/■/■■■■/■/■■■■■//■■/■■■■/■■/■■//�■■ell{'■■■//■■■■■■■■■■■■■■ ■■■■■■■ecce■■■e■■■■■■■■■■■■■■■■■■■■■■■r��.�■■■ereu■■ee■■■■■■■■e■■■e■■ ■eco■■■■■■■■■■■■■■■■■■■■■�►�■esee■■■■■■■■■e■■■■■e■■■■e■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■11■7r�111.1/.i■■111■■■■■■■■■■■■■■■■■■/■■■ ■/■//■/■■/■■■■■■■■■■■■■/■■/■��■■L:1�5►:■■■�/■Y■■1;11■■■■■■■■■■/■■/■■/■/■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■�/■■■■■1i■■■■■■■■III■■■■/■■■■■■■■/■■■■■■■■ e��■■Imo%��MENNENMENNEN MENNENM'IMMEMMEMNON MEMNON ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■ee■■■■■e■ee■■■■■eee■ecce■■■■ee■■■eee■ee■■e■■■■■e■e■■■■■e■■