The URL can be used to link to this page

232 Beauchamp Rd Lot 1 & 2 • 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 #: 990002258 Tax PIN/EH#: 5870-65-2977.02 Billed To: Distinctive Properties LLC Subdivision Info: Reference Name: Location/Address: Beauchamp Rd-27006 Proposed Facility: Residence Property Size: 2.324 Acres ATC Number: 4862 Site Type: QN'e"w ❑Repair ❑Expansion **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 #Bathrooms-3 #People 1�' Basement❑ Basement plumbing Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size Type of Water Supply: Bl ounty/City ❑Well ❑CommunityWell System Specifications: Design Wastewater Flow(GPD) ! - Tank Size,Size GAL.Pump Tank GAL. /r /r ;' / Trench Width 3 L Max.Trench Depth 3 U/ Rock Depth Linear Ft.� As stated in 15A NCAC 184.166ct(51 Site Modifications/Conditions/Other: aoeaotsd Systema way mi4', bo i,aa� 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. 7' Y3 , C' Q L� 001 to Environmen a ca pecia istatl4 e: \ _ led DCHD 11/06(Revised) Harrington Residence Accessory Building Site Map 3.01.2016 i r i t ' Lot 1 CD 2.966A ' 8364 1 r Owner owns lots 1.&2 f ' 302 Lot 2 ` 1 ;' Newptiv41 ft proposed New �� Septic Area .— 42x48 so d _ i J� 0 Jf �' �. 2.324A M � Proposed osed New 8919 Accessory Bldg fax c _ Fence p M * � r I y a y fF xisting ' f Septic 5 Fie3' n 2 Fence Apr ; c�� ,,P SITE EVALUATION/IMPROVEMENT PERMIT & ATC ,. Davie County Environmental Health r A� 1. 6 2008 P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 VIROt,M,EN�PL HEALTH A plication'Porn. uation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both T ication: ❑New 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 to be Billed r Contact Person Billing Address % ome Phone City/State/ZIP (/,5Business Phone � 9� 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 valid or 60 mon sth site plan,no expiration with complete plat.) Owner's Name i �� 1V Phone Number, _--3gg-3gs-y Owner's Address q / / cP City/State/Zip ,4/l �2 2,9Q,,/ Property Addres.s City. Lot Size d . C' Tax PIN# Subdivision Name(if plicable) Q / /' . IStion ot# Directions To Site: 0 &441 l� "p If the answer to any of the following questions is"yes",supporting documentation �t,be attached. Are there any existing wastewater systems on the site? []Yes E0N Does the site contain jurisdictional wetlands? ❑Yes Are there any easements or right-of-ways on the site? ❑Yes E��o Is the site subject to approval by another public agency? []Yes Will wastewater other than domestic sewage be generated? ❑YesANo IF RESIDENCE FILL OUT THE BOX BELOW #People t-- / #Bedrooms1 — #Bathrooms _ Garden Tub/Whirlpool s E1'-- No Basement: ❑Yes C3� 0 Basement Plumbing: []Yes DN-6' 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: #Sea Type system requested: onventiona Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ounty/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes o 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 undirstand 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 drstand that I a e onsible for the proper identification and labeling of property lines and corners and locating and flagging o stang the house/ acil Rylocation,proposed well location and the location of any other amenities. x Site Revisit Charge Pr perty owners r o er s legal representati a signature Date(s): Client Notification Date: e EHS: Sign given ❑Yes ❑No Account# Revised 11/06 Invoice# N1629 I I \ Rd Y i \ IL V� fcin t Ma not to scale- EPK � Z � Al : 1- /gs 65 I S, 'E � U EPK � /" �� ,EPK8 . O 3• .- -_ . . _ • � � ° 60 �v��i ��M � _ SR 1621 E P NB'1'35"E CP L4 CP Ld CP L7CP N 8.48'6"E CP \\•�� 1 8 919 SF(/NS/DE R bb CP UO •N . — J N/R �' 9,005 SF 105,10 LB CP N 9'32'33"E — • _ (INS/DE R/WJ _N/R 155 2T CP LII CP LI3 9,002 SF(lNS/DE fl N N 10'1749"8 _.._.. _ � 11,794 SF INSIDE R 307.07' CP �W —.�._ •�� 40'M.B.L. LOT 3.664 AC " 1 TOTAL AREA(TYP.) w m LOT 4 N) V 2 v Z U _ .388 Ac � LOT 3 Z N N f 2.235 Ac N N LOT 2 v m I 324 LOT 1 W rtr 2.966 Ac N ,J < ro Z 0 3 _ � M 57'31'59"W NIR1.24' I ;' 915.55' 57'31'59"W NIR 57'31'59"W OFF LINE I A 300.92' NIR 5 T31'S9"W _ 300.42' N o f� 5 300.92' MR 57.31'59"W E/p ElP 400,57' New Iran Plns set at all new caners CONTROL unless otherwise noted,, CORNER I 1'kI5 plat is 5u6iect to any�a5emmb,Agreements,or PSG DEVELOPMENT GOR, TNG. NORTH V*-of Ways of record prior to the date of this plat, DB TI3,PG 818 :I which was not vi516le at the time of the Survey. P.S.q,PG.65 d 64 Total area- 13,577 Acres LIM WLE - SPC '83 12avie Camtq Zonhq:PA LINT: LEN6fH MAMIN6 Referenced: NC Grid Rcf LI 31.59 N7147'4I"w � �I L2 30,40' N35'36'12"E Ra66it Farm,Phase II,Subdivision flat,flat Dak 06,Pq,72. 1,3 30100' N78'57'22"w SSQ 4 Dy Glzm5kl 5urveylnq Co.19ated March 18 of 1994. L4 65.44' N7'25'12"E C�l�• nI flat of Survey for John N,Naas,ctrl.Plat Doric 06,Pq,49, L5 30,03' N 79'25'2111 W Dy Qzimki 5urveyinq Co.hated July l4 of 1992. L6 110.61' N 7'25'12"E Plat of 5urveq for Alan Mock,Trustee-thanaWeraiey Pssez trust Plat Doric 06,Pq,49, L7 48.05' N81511"', Dy Ponald J e,P,L,5.l2ated November 14,2006, LB 36.51' N 9.17'42"E L9 209' N 79'25'21"w Plat of Survey for John N.Nooth,etas,Plat Donk 06,Pq.49, 92 /1 vvvv D4 Glzmskl SurveyMq Co.t7ated July l4 of 1992, UO 92.29' N 9'17'42"E III o y .w' Al q'A9'415"F APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 Application For: Site Evaluation/Improvement Permit ❑ Authorization To.Construct(ATC) ❑ Both Type of Application: ❑New 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 er � " AA✓G Name to be BilledPAIJA,� I G' .�Y i�"Tf Nj �� 11��'`�oritact Person QJ'�- /�- Billing Address J (J LL JQ Home Phone !?0!?— /S- City/State/ZIP Oa t i C-P 70 0 Business Phone l 1 .9 Q A Name on Permit/ATC if Different than Above 7 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"valid for 60 nths with site plan,no expiration with'complete plat.) Owners Name. #4 Phone u ber Owner's Address a FM City/State/Zip (JQ — -ey Property Address City Lot Size Tax P Subdivision Name(if applicable) e Mmj r&i6 Section/Lot# Z Directions To Site: ►� v 4U v/ If the answer to any of the following questions is"yes",supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes VNO Does the site contain jurisdictional wetlands? ❑Yes/No Are there any easements or right-of-ways on the site? ❑Yes VINo Is the site subject to approval by another public agency? ❑Yes ZNo Will wastewater other than domestic sewage be generated? ❑Yes No IF RESIDEN E FILL OUT THE BOX B OW #People #Bedrooms #Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes ❑No 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:, ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ❑ County/CityWater ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ 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 permits)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 stakin a house/facility to ion,proposed well location and the location of any other amenities. Site Revisit Charge Property owner's or owner's legal representative si ture Date(s): Client Notification Date: Date EHS: i Sign given ❑Yes ❑No Account# Revised 11/06 Invoice# DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLIQkCb M&N1 OP819D6fDfOg Tax PIN/EH M 5M93B9M WFORMATION Billed To: Distinctive Properties of Triad Subdivision Info: Mock/Alan Lot#2 Reference Name: Location/Address: Beauchamp Rd-27006 Q Proposed Facility: Residence Property Size: 2.324 Date Evaluated: [ 7_ Water Supply: On-Site Well Community Public ✓ Evaluation By: Auger Boring Pit V Cut FACTORS 1 2 3 4 5 6 7 Landscape position L . 1 Slope % ` HORIZON I DEPTH 6 I+e Q— Texture groupe G Consistence / r P 1,77 S tructure / le- Mineralogy L Mineralo P HORIZON II DEPTH , Texture group 571- Consistence Structure �+ Mineralogy HORIZON III DEPTH Texture group Consistence Structure a Mineralogy HORIZON IV DEPTH tr Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: • -),77 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 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 Structure SC -Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineraloev 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) LTAR-Long-term acceptance rate-gal/day/ft2 ncinc Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990005064 Tax PIN/EH#: 5870-65-2977.02 Billed To: Distinctive Properties of Triad Subdivision Info: Mock/Alan Lot#2 Address: 130 Oakhill Road Location/Address: Beauchamp Rd-27006 City: Advance - Property Size: see map 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: TIlew ❑Repair ❑Expansion`` Permit Valid for: ❑5 Years o Expiration Residential Specifications: #Bedrooms L" #Bathrooms 3 #People L+ Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply: QLounty/City ❑Well ❑Community Well Site Modifications/Permit Conditions.: As stated in 15A NCAC 18A.1969(5� System Type LTAR Initial 1 Repair r 2, Site Plan 9 6L OL '2 Environmental Health Speciali Date 2 i.p.11-06