Loading...
3805 Hwy 601N19 -- APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC A ' 6 201 Davie County Health Department Environments/Hes/th Section lye"Olt' P.O. Box 848/210 Hospital Street �r+ENVIRONMENTALHEALTH Mocksville, NC 27028 DAVIECOl1NN (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED U14LESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions-- _. 1. 'Name to' be Billed X Al e►7CQ t,5 00 M ,0kW P Contact Person �3 _ Mailing Address 3�I)1 � �QCcS I �'� �(,(J(/ �/��-2/� Home Phone 2/ C City/State/ZIP Wl /l'510n -'501 n � � / /� ) Business Phone 3 36. 9 �s. S 155- 2. Name on Permit/ATC if Different than Aboveewa /� n • C,,I A Mailing Address %323,2C/l lea S �..I eek •�iC w / �� City/State/Zip nrj A/i - Ja l em , R, � 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC Both 4. system to service: House ❑ Mobile Home ❑ Business p Industry I I Other 5. Iff Residence: # People% g # Bedrooms # Bathrooms ` 17 Dishwasher L) Garbage Disposal M'WashinMachine H Basement/Plumbing II Basemen L -/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # People # Sinks # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well II Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? I'.l Yes 1 No If yes, what type? k**IA11'0RTANT*** CLIENTS AIUSTCOdfPLEI'ETHE REQUIRED PROPERTY INFORNIA'I'ION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the client with THIS APPLICATION. . , _.. .ill 3 Property Dimensions:' /(p x b/�/. (9iOX `151. U7X I-" WRITE DIRECTIONS (From Alocicsville) to PROPERTY: Office PIN: # '59A01 �- 00 -39'70 AVIV l J. / tlllk -'ro m Property Address: Road Namc -Nwv � a/ N • Tz/o b f 1 dae O /1le-Pl. &5ide, city/zip moc sui of, IAC 07008 Alible ( de home'— It i s1 If in a Subdivision provide information, as follows: ely i V6 WQottb/e toJe- . Name: Section: Block: Lot: Date Property Flagged: C) S D 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 ain responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the D*c County 1-Icwth Department to enter upon above described property located in Davie County and owned by t'n7& eA to conduct all testing procedures as necessary to determine the site suitability. Kj DATE BIiS� SIGNATURE` 4� 0 61 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). Revised DCHD (07/99) Site Revisit Charge Dalc(s):_ Client Notification Date: EHS• Account No. Z Invoice No. VX oo/ �l -2/ 17::)s n ' n�'nyf of �11C•dnM 66••0 '.a { t �w 1� 08 N 060 a54.0 INS iffn 08 19 N 060 441.13 .r rn b 0 a C LESA G. DRIVER ]04- 38 PG. 146323w HARRISD8. AREA = 8.000 AC AREA= 8.000 AC. ab(INCLUDES HWY 601 R/w ) (INCLUDES NwY 601 R/W) q NrMf Ito-* a r s � p . . � cy N M _ e m • . 2 NOTE: nar iron ylstfd iron ♦ + UNMIRICED POINTS IN 'OF *told yfn, 9- 565.48 �� O+ 21 PAVED S 07. 23' 57"W " * 23' S7 W S 07. 23' � gistin0' iron HWY. 601 1x�rs. fait/iny iron KENNETH LEE FERESEE SURVEY PDR : " "•THELMA A D. PEG & HARRY- DRIVER qr..,, • DAVIE COUNTY HEALTH DEPARTMENT • - • , Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990001881 Billed To: America's Homeplac4 Reference Name: Proposed Facility: Residence Property Size: PROPERTY INFORMATION Tax PIN/EH #: 5822-00-3970 Subdivision Info: Location/Address: Highway 601 N-22028 see map Date Evaluated: a "2 2$ Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupG Consistence Structure l� Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE ,3 SITE CLASSIFICATION: l� LONG-TERM ACCEPTANCE RATE: 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 EVALUATION BY: OTHER(S) PRESENT: 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) LIAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001881 Tax PIN/EH #: 5822-00-3970 Billed To: America's Homeplace Subdivision Info: Reference Name: Location/Address: Highway 601 N-27028 Proposed Facility: Residence Property Size: see map ATC Number: 2953 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 CON TRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. 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 gu �ntee that the system will function satisfactorily for any given period of time. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 7D 76 Date: G! ��'00Z Parcel #: D30000006502 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search Q View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel #: D30000006502 Account #:8304825 Owner Information Tax Codes ADVLTAX - COUNTY T EGGDOUB TONI SUSAN 1275 WORTHINGTON LANE FIREADVLTAX - FIRE TAX REENVILLE NC 27858 53,77 Market: 266 51 Property Information Township nd (Units/Type): 7.700 AC Fddress: CLARKSVILLE 3805 N US HWY 601 Vacant Deed Information Local tonin Pate: 01/2015 Book: 2015E Page: 0124 0971 Plat Book: Page: 2001 WD Legal Description PIN 18 AC HWY 601 5822003970 Property Values Building: 182,76 BXF: 29,9801 Land: 53,77 Market: 266 51 ssessed: 266,5101 Deferred: 1988 WD Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 1 00145 0255 09 1988 WD Unqualified Vacant 0 2 00382 0971 08 2001 WD Unqualified Vacant 0 3 00383 0214 08 2001 QC Unqualified Vacant 0 4 00384 0822 10 2001 WD Unqualified Vacant 0 5 2015E 0124 01 2015 DC Unqualified Improved 0 View Prooertv Record for this Parcel View Mao for this Parcel View Tax BIII Information « Return to Basic Search Page 1 of 1 Q Davie County Web Site All information on this site is prepared for the inventory of real property found within Davie County. All data is compiled from recorded deeds, plats, and other public records and data. Users of this data are hereby notified that the aforementioned public Information sources should be consulted for verification of the information. All Information contained herein was created for the Davie County's Internal use. Davie County, Its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or Implied, in fact or in law, Including without limitation the implied warranties of merchantability and fitness for a particular use. If you have any questions about the data displayed on this website please contact the Davie County Tax Office at (336) 753-6120. 1.5.9 http://maps.daviecountync.gov/itsnet/View.aspx?prid=1449168 8/10/2016 . r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001881 Billed To: A en 's rH//ol1mepjace Reference Name: Z/tfj(�(1Upi6 b Proposed Facility: Residence 101967 d G 6�- Tax PIN/EH M 5822-00-3970 Subdivision Info: Location/Address: Highway 601 N-27028 Property Size: see map OTC ly�rmber: 2953 **NO E** is Improvement/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 Al #People _ #Bedrooms ,s-5 #Baths Dishwasher:/d Garbage Disposal: ❑ Washing Machine: 000'Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow (GPD) Site: New ❑ Repair ❑ System Specifications: Tank SizK P GAL. Pump Tank Required Site Modifications/Conditions: GAL. Trench Width,3f�� Rock Depth Linear F_/ IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date: 2 DCHD 05/99 (Revised)