857 Howardtown Circlef
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
1�(U l# rloOOCCONIN,
Account #: 990003915 Tax PIN/EH #: 5860-06-0726
Billed To: Long Builders, Inc. Subdivision Info:
Reference Name:}�/rLL�Q l�o{�� �� Location/Address: Howardtown Circle -27028
ATC Number: 4347
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 CONSTRU OWN IS VALID FOR A PERIOD OF /FIVE YEARS.
Environmental Health Specialist's Signature: A& Date: c�%?_- A6
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 I 1 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.
Q
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
N
f
DAME COUNTY HEALTH DEPARTMENT
�• Environmental Health Section
• - P. O. Box 848/210 Hospital Street
Mocksville, NC 27028 �nD
(336)751-8760 IN
IMPROVEMENT/OPERATION PERMIT
Account #: 990003915 Tax PIN/EH #: 5860-06-0726
Billed To: Long Builders, Inc. Subdivision Info:
Reference Name: Location/Address: Howardtown Circle -27028
Proposed Facility: Residence Property Size: 2.99 Acres
**NOTE * This Improvemeent/Operation Permit DOES NOT authorize the construction of a 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 -19 #Bedrooms _ #Bathse°1
Dishwasher Garbage Disposal; Washing Machine: ❑ Basement w/Plumbing: O'� Basement/No Plumbing: 13
CommerciaiSpecification: FacilityType #People #People/Shift #Seats Industrial Waste: 11
Lot Size Type Water Supply Design Wastewater Flow (GPD)Site: New e Repair
System Specifications: Tank Size GAL. Pump Tan)�T31JPGAL. Trench Width-,� Rock Depth Linear Ft.g5�7
Other:
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT
FINISHED GRADE. ****NOTICE: Cont,
system between 8:3 a.m. to 9:30 a.ny ,OC
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
TER RISER(S) IF 6 " BELOW
i Department for final inspection of this
e7eepFone # is (336)751-8760.****
WAY,
-+f Mar 16.06 11:28a davie county envhealth 336 751 8786
P-2
"� MAR � 7 2006
4i t
EVALUATIONAMP ROVEMENT PERMIT & ATC
County Health Department
vironmentat Health : pecdon
I Boz 8M10 Hospital Street
i MocksMe.lNC;270? B
To Consttuc[ ATC) n Both
r�l'LICAMN CANNOT BB PROCESSED V.: LESS ALL OF TM: REQUIRED
IS PROVIDED. Refer to the INFORMATION BULLET N for instructions.
Name to be Billed Zodv5l�'y� ��. Contact Person ii�iU �dW
Billing Address D 1;�� Lvrd '? /?e�. H -tore Phone �, j„�G - SL • .
City/State,W /.N&/ 14- - Bu iness Phone ,Q pZ'Y�o% <</
Name on Petmit/ATC if Different than Above
Mailing Address City/St ate/Zip
YKUYEXTY MUHMNIIUN
NO'T'E: A storey plat or site plan stmt accompany this application
(Permit is valid for 60 months with site plan, no expiration with tplete p t
Street Address dra.+�0^r tnjuls City /�' Tax PIN#,%l�',D6 —07"
Subdivision Name j&WSectionaot# Lqt :zc -VAW
Directions To Site 4aA _ _ ! 7R_ d +' "i�o�`—�—Zi
..f .sa./.. o+✓ iu2'' e95f t 7k sew- /— ,ra A�,
-vt, TX 0--' vt O.iry
Date House/Facility Corners Flagged
If the answer to any of the following questions is "yes", supporting doctmtet zitiop must be attached.
Are there any existing wastm-Ater system on the site? Gy es,
DoQl�jp
Does the site contain jurisdictional wetlands? DY.-s�to ,�et
Are there any easements or ti;ht.of-ways on the site? es DNo �' S6t s/ .f v�l� ✓
Is the tate subject to approval by another public agency? OY cs &No
Will wastewater other than dimestic sewage be generated9 oY es81`lo
BOX BELOW
# People# Bedrooms I, # Bathroom. oX �2 GardLtt Tub/Whirlpool HYes ONo
Basement: Vies ❑No Bastanent Plumbing: A- ONo
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 dommentation of similar facility water consumption)
FOODSERVICF. ONLY: # Seats
Type systetnrequested: OConventioual t7Accepted Olnnovative OAlutnstive
Water Supply Type: a C".ty/City Water O New Well OE dsting Well C Ctmununity Well
Do you anticipate additions or expansions of the facility this system is inte tded to serve? O Yes i�lo
If yes, wbat type? .—
This is to certify that the infomtation provided on this, application is true a td correct to the best of my knowledge. 1 understand that
any penniKs) or ATC(s) issued bere:.fter are subject to suspension or rave ration if the site is altered, the intended use changes, or if
the information submitted in this application is falsified or changed 1 tuwerswul duct ! am responsible for all charges incurred
from this application. I hereby grave right of entry to the Autfiorized Rep: esentative of the Davie County Health Department to
conduct necessary inspections to ' det�IMMypmpl' with applicable la -vs and rules on the shove described property located in
Davie County and owned by CAC 911=
Prop wner's or owner's legal repres tative signature
3 iG oL
Date
Sign given OYes GNo
Revised 2106
Site Revisit Charge
Date(s):_
Client Notification Date:
EHS:
Account #
Imola #
Feb 17 06 09:09p Becker Pblo & Video
r
Davie County Health Department
.Environmental Health Section
P.O. Box $481210 Hospital Street
Mocksville, NC 27028
(336)751-87601 Fax (336)751-8786
February 03, 2006
Stc-ven Beck -cc
106 Grand Avenue
Abenleen, NJ 07747
Re: Acres: 2.99+
Howardtown Circle
Tax PIN#: 5860-06-0726
Dcar Mr. Becker,
As requested, a representative from this office visited the above site February 01, 2006 to
perform a site evaIuation.. Based on the information provided on theApplication fur Site
Evaluation and after the evaluation was completed, the site was found to be provisionally
suitable for the installation of an on-site sewage disposal system.
This Improvement Permit DOES NOT authorize the construction of a wastewater system.
An Authorization To Construct a wastewater system must be obtained from flus office prior to
the construction/installation of a wastewater system or the issuance of a building perm,it(in
eompli-,mce with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement
Permit is subject to revocation if site plans or the intended use change.
Jmprovement Permit
System To Serve: lit Wastewater Design Flow:_
System Type: k6onWntional ' (Accepted i Ilnnovative IAtternative
System Location: &4re%Ua'l�r' f= i�./C�1 Valid:
Site Modifications/Pemzit Conditions. 4, 5-AA-0,J'lAcYctfrr•
Environmentrl 111tJ� h Speci;ilist --' 1')ata ,
ps-i.p,lotter 2106
nNo Expiration
r
m
v
LD
Q-
M
0
N 29'-25'-47" E
100.76'
HOWARD TOWN
CIRCLE 60' R/W
(public)
point at Intersection of
Pollard Lane &
Howard Town Cir.
THIS MAP IS SUBJECT TO ANY
EASEMENTS OR RIGHTS–OF–WAY OF
RECORD PRIOR TO THE DATE OF
THIS MAP WHETHER VISIBLE OR NOT
TITLE SEARCH NOT PROVIDED.
\
Now or Formerly
George Marshall S 28'-57'-34" W \
DB 81 Pg 183 53.12'
DB 621 Pg 251
N 28'-56'-08" E
S 6S, 116.91' (total)
28g \2811
rpm E?s
N 22'-30'-32" E
115.47'
— 9.ui,.Pf.990 Ac.+/– —
/ N 86'-31'-09" W 574.45'
/ Now or Formerly
George Carter
Now or Formerly
Christopher Marsl
DB 413 Pg 445
T �6'�
o
3 3.10' s.
existin existing 18'
building access & utility
Ieasement
I uj
I
Now or Formerly
<v James Smith o
'n DB 168 Pg 472 `n
io
o
DB 212 Pg 583 N 13'-55'-36" E I
78.12' 176.05' I
/ N 83'-35'-20" W
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Jan 10 06 11:55a davie county envhealth 336 751 8786 p.2
b JZO� Ye / 4/) 7'
'
APPLICATION 1011 SITU EVALUATION/iMPI;OVEAIFM I'Ct1b1IT & ATC )
Davie County Health Denaltment V
Environmental Health .5ection �-
• P.O. Box 848/210 Hospital Stre� III l,�ti n
Mockaville, NC _7028 11
(336) 751-876(
***Il•1PORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED \� V
INFORISATION IS PROVIDE). Refer to the INFOIMATZDN BULLETIN for instructions.
1. Name to be Billed �!JPpr��-- Contact Person
Mailing Address W -CL. pa)-eJltl-e- Noms Pbone — `,� •t.: `•..� (' , %, ;� , J . _
City/state/ZIP
Business Phone
•
•
2. Name oa Permit/ASC if Different than Above
'r
Mailing Address/ — Ciky/:tate/Zip
1. Application For: A Site Evaluation E3 Improvement Permit/ATC ❑ Both
4. System to Serviee:Ag Hours ❑ Mobile Home ❑ Bus iness ❑ Industry ❑ Other
r
5. Type ayaten requeatedsCc.oventionai 13conventional modified 13innovative t3acCepted
S. If Residence: a peop:.e i Bedrooms • Bathrooms ".2)• s
Ainhwastier ❑Garbage Dis,osal Mashing Machi sement/Plumbing ❑aasesientmo Plumbing D
7. If Huolnesa/Zaduatzy /others varify type _ I People 3 SinksWa
I Commodos t Shovers 7 i urinals R Nater Coolers Cy V
IF FOODSERVICE: 0 Seats . Estimated dater Usage (gallons per day) tIAN
S. Type of water supply:)Ctt1_Aty/City 13 Iti all ❑ Community "'06
1. Do you anticipate additions or expansions of the facility this ii -item 3s intended to serve? ❑ Yes AO DA It
If Yes, nitat type? ��ECou'N
I*••m11,ORTAN7—*CLID7SAIUSTCOAfPLETETHE RC(IUMED PROPERTY INGORMATION REQUESTED
L1Bt.OlV. Either aPL.AToeSiTEPLAN AWSTUESUDAHMDbl*the Went with THIS APPLICATION.
Property Dimensions: -"-% T WRITE DIRECTIONS (from Mocicsvillr) to PROPERTY..'
Tax Office rIN: it (o 0 CQSZ a_ a t V� I S O PC
Property Address: Road Namc HOW4,4 / 40—JAnn' CIQrr JiCKAJXtrc�_ 10 W✓1
CItymp AJ kmt:� A_ fT b Q�%tT x i r
If in a Subdivision provide IpTorntition, as follows:�� P �QQi
Name.• — •�
Section: Block: Lot: Date home corners flagged:
_ 471
It MOMealTis-f
Ts� 0-ree r
00IQvita Ba410h
33le'lGS=7��(c
Phis Is to certify that the inforinatiou provided is correct to tate best of hay knowledge. I understzind that any permits)
issued hereafter aro subject to suspension or revocation, if the site plan: or intended use change, or if the Information
submitted III this applieatiom Is fahlficd or changed. 1, also, understand (list 1 ant responsible jar all charges incurred from
(bis application. 1, hereby, .give consent to the Authorized Represcntatire of the Davie Cpunly health Departilicut p �( (�
to enter upon above described propt-ty located in Davie County and at-ned by e —r►� I�C� x1 e, P@NQ it1� �'� 4Jt �NLCsId'
to conduct a31 t img procedures as necessary to determine the site suit: bid' y. � j
DATE I SICNATURE
THIS AREA AIAY BE USED FOR DRAWING YOUR SITE PL 1`I (h� cede all of the Coi[awing: 3sUmg and proposed
property lines and dimensions, structures, setbacks, and septic locatio s).
Side Rcvlsit Charge
Datc(s):
Clicut Notification Date:
EHS•
Sign given Account No.�
Revised DCIID (05/03 Invoice No.
DAVIE COUNTY HEALTH DEPARTMENT
• ' Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990003861 Tax PIN/EH #: 5860-06-0726
Billed To: Steven Becker Subdivision Info:
Reference Name: Steve Location/Address: Howardtown Circle -470P6
Proposed Facility: Residence Property Size: 2.99 Acres Date Evaluated: 6 !10
Water Supply:
Evaluation By:
On -Site Well / Community
Auger Boring Pit
Public
Cut
FACTORS
1
2
3
4
5
6 7
Landscape position
L--
,[„
T7 --
Slope %
4
lr
1��
a-
z
HORIZON I DEPTH
1,
Texture group
«',�
S
4-
C4
_ry
Consistence
Structure
Mineralogy
u�1
r�<
^-----�
.-i
/
HORIZON II DEPTH
Texture group
-
Consistence
,�•77
Structure
/
Mineralogy
HORIZON III DEPTH
f
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
-
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: 6'%I GQ4-` G C/YlC /%C'/� EVALUATION BY-,
LONG-TERM ACCEPTANCE RATE. 0THER(S) PRESENT:
'REMARKS < e
LEGEKD
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
NS - Non sticky SS - Slightly sticky S - Sticky VS =Very Sticky
NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic
aStructure
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
Ltotes
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 05105 (Revised)
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PcB2
Davie County Health Department
Environmental Health Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax (336)751-8786
February 03, 2006
Steven Becker
106 Grand Avenue
Abenleen, NJ 07747
Re: Acres: 2.99+
Howardtown Circle
Tax PIN#: 5860-06-0726
Dear Mr. Becker,
As requested, a representative from this office visited the above site February 01, 2006 to
perform a site evaluation. Based on the information provided on the Application for Site
Evaluation and after the evaluation was completed, the site was found to be provisionally
suitable for the installation of an on-site sewage disposal system.
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 or the intended use change.
Improvement Permit
System To Serve; k4oc Wastewater Design Flow: / (.
System Type: ]'Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other
j j�
System Location: &ar eleyalee •t- idd Valid: M Years ❑No Expiration
Site Modifications/Permit Conditions: �� Y 5�-41.0'j�c ,� u Dnp
Environmental
ps-i.p.letter 2/06
Specialist
d
Date