The URL can be used to link to this page

127 Glasgow LnDAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street l� G Mocksville, NC 27028 (336)753-6780/Fax #(336)753-1680 OPERATION PERMIT Account #: 990002917 Tac PKIEH #: 5850-50-8242 Billed To: Jessie Hepler Subdivision Info: Reference Name: , : LocalioniAddress: Glasgow Lane -27028 Proposed Facility: Residence Properly Size: ATC Number: 5730 **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) d Tank Date//—// Tank Size oO Pump Tank Size System Installed By: Oval 6,,0 41 9 E.H. Specialist: Uu 4t e: GPS Coordinate: DCHD 11/06 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 l (336)753-6780 / Fax # (336)753-1680 4 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION I Account #: 990002917 Tax: PIN E'H #: 5850-50-8242 Billed To: Jessie Hepler Subdivision info: Reference Name: '- Location/Address: Glasgow Lane -27028 Proposed Facility: Residence Properfy'size: Site Type: ❑New ❑Repair ❑Expansion ATC(�y� �er� 5730 *NO'l l; finis Authorization to Construct (ATC) MUST At 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 2 # Bathrooms _ # PeopleBasementp-Basement plumbing.,' Non -Residential Specifications: Facility Type # People # Seats ' Square Footage(or Dimensions of Facility) Lot Size ,_ Type of Water Supply: ZCounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) 2 Tank Size WO GAL. Pump Tank GAL. Trench Width 5�Max. Trench Depth Rock Depth Linear Ft. 50015'6o Site Modifications/Conditions/Other: f/Z'Ir(6A &P k, AQ81 10 be- 3 G`i Qw7Ld/J Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the da of installation. Tele hone # (336'751-8760. Permit Type: CNlew ❑Repair ❑Expansion Permit Valid for: 45 -Years ❑No Expiration Residential Specifications: # Bedrooms Z # Bathrooms # People._ BasementP Basement pluinbingl — Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): IW'41�10 Type of Water Supply: ,County/City ❑Well ❑Community Well Site Modifications/Permit Conditions: System Tvve LTAR Initial• 2 Repair `'o Site Plan -` -- .` leop/. r c i 2' �`f 5� wet( L2wl I� Environmental Health Specialist i.p.11-o6 Date2WZQIL- R DAVIE COUNTY ENVIRONMENTAL HEALTH • t P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION j Account #: 990002917 Tax PIRI H #: 5850-50-8242 Billed To: Jessie Hepler Subdivisio:n.into: Deference Name: }'. .Location/Address: Glasgow Lane -27028 Proposed Facility: Residence Propefty'Size: Site Type: ❑New ❑Repair ❑Expansion der 5730 *NO"1'1r fihis 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 2, # Bathrooms_ # People_ BasementX-Basement plumbingk' Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size ,_ Type of Water Supply: ZCounty/City ❑ Well ❑CommunityWell System Specifications: Design Wastewater Flow (GPD) ZIKOTank Size GAL. Pump Tank GAL. Trench Width�__// Max. Trench Depth~ Rock Depth Linear Ft. '50 Site Modifications/Conditions/Other: �/Mir4 11a f 103 �u r Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760. 'fr sr 4 70' Ar 2!' �Y Environmental Health Specialist UU& Ok m1k Date: Q % 2&L DCHD 11/06 (Revised) Residential Specifications: # Bedrooms Z # Bathrooms_ # People_ BasementX-Basement plumbingk Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size �� . Type of Water Supply: ZCounty/City ❑ Well ❑CommunityWell System Specifications: Design Wastewater Flow (GPD) Tank Size GAL. Pump Tank GAL. Trench Width / Max. Trench Depth L ~ Rock Depth Linear Ft.�p�'10 Site Modifications/Conditions/Other: �/�(C� Gt��f �ou Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760. Environmental Health Specialist. DCHD 11/06 (Revised) Date: I , r Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680 IMPROVEMENT PERMIT Account #: 990002917 Tax PIN/EH #: 5850-50-8242 Billed To: Jessie Hepler Subdivision Info: Address: 127 Glasgow Lane Location/Address: Glasgow Lane -27028 City: Mocksville Property Size: 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 I . 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: IgNew ❑Repair ❑Expansion Permit Valid for: A.i Years ❑No Expiration Residential Specifications: #Bedrooms 2 #Bathrooms # People Basement;m,-Basement pluinbingL— Non-Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): -AW0�0 Type of Water Supply: XCounty/City ❑ Well ❑Community Well Site Modifications/Permit Conditions: Site Plan Ir System T e LTAR Initial • Z Re air ''p 1951 Environmental Health Specialist i.p.1 1-06 Date 117-W6 N Nov 19 10 01:46p Information Services 3367631680 p.2 � Cg Nall v CATION FOR SITE EVALUATIONIIMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 8481210 Hospital Street J A*1 u 4 ` 011: Mocksviue, NC 27028 1,1V ��l' y�9� (336)753-67801 Fax (336)'153-1680 kW' t�0 S to valuilgonllmproveinent Permit C Authorization To Construct (ATC) 0 Both BY' , p pp !stem 0Repair to Existing System OExpansion,'Modification of Existing System or Facility ., Type of Application: I ew S . I• • "IMPORTAN,"" THIS APPLICATION CAN OT BE PROCESSED UNLESS ALL OF TIIE REQLTRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. Name i �1�t' a eta Contact Person keSec� fJ2�-,t-��/ Address N _ Homc Phone 25 9 — !{(p 2!J City/State/ZIP(�1or_Y s� \1 t; L Zia 2Z5 Business Phone i Nance on PermidATC ifDoerent than Mailing Address NOTE: A survey plat or site plan must accompany this application. Included: 0 Site Plan OPlat(to scale) (Permit ii valid for 60 months th sitr Ian, no a pi Lon with complete plat) Owner's Name i�� «Se_ 777 , re V Mui , it Phone Number - q47-) Owner's Address 7 61 qscicw LN Cityistatelzip My s C Property Addressity Lot Size crc� _S Twe PIN# p Subdivision Name if applicable) S tipo n/L4'f 595V -57C -t7 Z'yZ` Directions To Sitey a , / , c( 6n =Ja r LQ k P 6 If V answer to any 6f1the following questions is "Yes",supportin octanentation must be at ached: Are there any exiiting wastewater systems on the site? LYes No Does the site contain jurisdictional wetlands? Yes No Are there any easements or right-of-ways on' the site? _Yes V_ o Is the site subject}o approval by another public agency? _Yes 2o Witt wa3v water oilier than domestic sewage begenerated? Yes two IF RESIDENCE,FI:LL OUT THE BOX BELOW # People I # Bedrooms Bathrooms �_ Garden Tub/Whirlpool Oyes o Basement: No Basement Plumbing: a. s 0No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/B siness Total Square Footage of Building # People # Sinks # Commodes r? Showers # Urinals Estimated Water 11tsage (gallons per day) (Attach documentation of similar facilitywater consumption) FOODSERVICE ONLY: # Seats Type system requested: OConventional :]Accepted Ctnnovative GAhemative 30ther Water Supply Type:County/City Water 0 New Well ! OExisting Well C Community Well , Do you anticipate aJditions or expansions of the facility this systein.is intended to serve? l7 Yes V40 Ifyes, what 1),P6? 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) odATC(s) issued hereafter aie 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 Drpartment to conduct necessary inspections to determine compliance wide applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating e d t1a irg or stn 'n the hour eility location, proposed well location and the location of any other amenities. ., tr (; Site Revisit Charge Property owner's o_rlr's legal presentative signature e7 Date(s): Date P p 9 Client Notification Date: JA Sign given ❑Yes ❑ No�Yi,.:. Accowit a / ,� Revised 11/06 •_,_ _ invoice � W A r YM. G60000( jumu Ia( inrormation visit: Davie County has compiled this ips.co.davie.nc.us/GoMaps map from various sources Implied, Implnd in factes no nlatw, ncludngwithou�, expressed or repared by: Davie County tlimitations the implied warranties of merchantability and fiitnessfor aParticular ministration Purpose. This map is not a land survey and all information shown on this map should be verified by a NC licensed (336) 753-6120 surveyor. Users are encouraged to notify the GIS Department of inconsistencies in the map so that corrections can be i made in future printings. APPLICANT INFORMATION Account #: 990002917 Billed To: Jessie Hepler Reference Name: Proposed Facility: Residence Water Supply Evaluation By: On -Site Well Auger Boring DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation ,PROPERTY INFORMATION Tax PIN/EH #: 5850-50-8242 Subdivision Info: Location/Address: Glasgow Lane -27)0288] Property Size: 10 Acres Date Evaluated: Community Pit X Public % Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % b HORIZON I DEPTH 0 -5 - Texture group Consistence Structure r Mineralogy HORIZON II DEPTH Texture group Consistence Structure Jjti 171 - Mineralogy CWd HORIZON III DEPTH Texture group Consistence Structure Axt MineralogyL°,i✓ HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: 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 W5 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 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) TTAR - T.nnv_tarm arrPntanrs+ rats. _vol/sioa"/ft7 - r . . GoMaps GIS Page 1 of 6 http://maps.co.davie.nc.us/GoMaps/map/map.cfm?CFID=4129&CFTOKEN=61640881 1/5/2011 Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680 IMPROVEMENT PERMIT Account #: 990002917 Tax PIN/EH #: 5850-50-8242 Billed To: Jessie Hepler Subdivision Info: Address: 127 Glasgow.Lane Location/Address: Glasgow Lane -27028 City: Mocksville Property Size: 10 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. Pennit Type: ❑New ❑Repair ❑Expansion Permit Valid for: 05Years ❑No Expiration Residential Specifications: # Bedrooms # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD): Site Modifications/Permit Conditions: Site Plan Type of Water Supply: ❑County/City ❑Well ❑CommunityWell System Type LTAR Initial Repair Environmental Health Specialist_ i.p. 11-06 Date I