Loading...
232 Beauchamp Rd Lot 2 Z^ECJT,ION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Environmental Health �Otl; P.O.Box 848/2 10Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 Application For:()Site Evaluation/Improvement Permit O Authorization To Construct(ATC) OBoth Type of Application:ONew System ORepair 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 William E.Hartington,III "Tripp" Contact Person David Holeman Address 232 Beauchamp Road Home Phone (704)309-2557 City/State/ZIP Advance,NC 27006 Business Phone (704)309-2557 Email tharrington3@idoud.com Name on Permit/ATC if Different than Above David Holeman Mailing Address 408 Woodlark Court City/State/Zip Indian Trail,NC 28079 PROPERTY INFORMATION *Date House/Facility Corners Flagged 02/28/2016 NOTE: A survey plat or site plan must accompany this application. Included:OSite PlanOPlat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name William E.Harrington,III&Julie Meyer Hartington Phone Number(336)577-8000 Owner's Address 232 Beauchamp Road City/State/Zip Advance,INC 27006 Property Address 232 Beauchamp Road City Advance,NC 27006 Lot Size 2.324AC Tax PIN#8364 54t1O5� �9 Subdivision Name(if applicable)Lot(house not Within subdivision Section/Lot#F6-000-00.021.04 l Directions To Site: Take Bermuda Run Exit(180A)going S.on Hwy 801 to Hillcrest.From Hillcrest take rt.on Mocks Church Rwd and then left onto Beauchamp Rd.House appmx.1/2 mile down on left. Specify Problem Occurring: Construct accessory building with one 1/2 bath+wet bar. IF RESIDENCE FILL OUT THE BOX BELOW tiV" #People 4 #Bedrooms o #Bathrooms 1n Garden Tub/WhirlpoolOYes ONo Basement:OYes ONo Basement Plumbing:()Yes 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 documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested:OConventional OAccepted OInnovative OAltemative OOther Water Supply Type:OCounty/City Water ONew Well OExisting Well OCommunity Well Do you anticipate additions or expansions of the facility this system is intended to serve?OYes ONo 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 comers and locating and flagging or staking the house/facility location,proposed well location and the location of any other amenities. Site Revisit Charge Date(s): Client Notification Date: EHS: Property owner's or owner's legal representative signature 03/01/2016 Date v Sign given OYesCNo Account# Revised 11/06 Invoice# Davie County,NC Tax Parcel Report Thursday, October 13, 2016 f^� 24 249 y, yi l +, q ' z � 247----0 244 J 232 239.--.t5 _ 219 n .X �--- 114 i C i 231-- 1 234 5' 223 X 1-1�98ERTDn� LAQUfNTADR 218 — — -----215 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: F80000002104 Township: Shady Grove NCPIN Number: 5870548919 Municipality: Account Number: 8300337 Census Tract: 37059-803 Listed Owner 1: HARRINGTON WILLIAM EUGENE III Voting Precinct: EAST SHADY GROVE Mailing Address 1: 232 BEAUCHAMP ROAD Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code: 27006-0000 Voluntary Ag.District: No Legal Description: LOT 2 2.324AC MOCK S/D Fire Response District: ADVANCE Assessed Acreage: 2.12 Elementary School Zone: SHADY GROVE Deed Date: 5/2011 Middle School Zone: WILLIAM ELLIS Deed Book/Page: 008590036 Soil Types: GnB2 Plat Book: 0009 Flood Zone: Plat Page: 333 Watershed Overlay: DAVIE COUNTY Building Value: 355070.00 Outbuilding&Extra 18700.00 Freatures Value: Land Value: 45880.00 Total Market Value: 419650.00 Total Assessed Value: 419650.00 161 l data is provided as Is without warranty or guarantee of any idnd either expressed or Implied Including but not limited to the Davie County, Implied warraties of merchantability or fitness for a particular use.All users of Davie Countys GIS website shall hold harmless the County of Davie,North Carolina,Its agents,consu brats,contractors or employees from any and all claims or causes of action due to N`"!� or arising out of the use or Inability to use the GIS data provided by this website. Ct7NSTRUCTION For office use only AUTHORIZATION *CDP File Number 200518-1 Davie County Health Department County ID Number. 58705489169 210 Hospital Street Evaluated For. NEW P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax:336-753-1680 0 3 / 3 1 / a 0 a 1 FApplicant: William E. Harrington 111 'Tripp" rAddress: erty Owner: V�Iliam E. Harrington III "Tripp" Address: 232 Beauchamp Rd 232 Beauchamp Rd City: Advance City: Advance State2ip: NC 27006 State2ip: NC 27006 Phone#: (704)309-2557 Phone#: (704)309-2557 Property Location & Site Information Address/Road#: Subdivision: Alan Mock s/d Phase: Lot: 2 232 Beauchamp Road Advance NC 27006 Directions Structure: SINGLE FAMILY Hwy 64 east, Left on Cornatzer Road then left on Beauchamp rd.on the right. #of Bedrooms: #of People: 'Water Supply: PUBLIC System Specifications Minimum Trench Depth: a 4 rDesign ssification: Provisionally Suitable Inches System? OYes CNo Minimum Soil Cover. 1 a Inches low: 1 0 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 2 7 5 Maximum Soil Cover: a 4 Inches 'System Classification/Description: 'Distribution Type: GRAVITY-SERIAL TYPE 11 A CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 Gallons 'Proposed System: 25%REDUCTION 1-Piece: OYes ®No Pump Required: OYes @No OMay Be Required Nitrification Field 3 6 4 Sq. ft. Pump Tank: Gallons No. Drain Lines 1 1-Piece: OYes ONo Total Trench Length: 9 1 ft GPM—vs— ft. TDH Trench Spacing: _ 90IInches C.0 Dosing Volume: _ Gallons Trench Width: 3 @Inches — Feet Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS-I OTS-II Septic Tank Installer Grade Level Required: O I OII O III O IV Dann 1 ^F1 CDP Fite Number 200518 - 1 County.ID Number. 58705489169 ❑ Open Pump System Sheet Repair System Required:OYes ONo ONo, but has Available Space rDesign System Trench Spacing: 9 Inches O.C. ification: Provisionally Suitable — E03 Feet O.C. Trench Width: Inches w: 1 0 0 , 3 _ @ Feet SoilAggregate Depth: inches Application Rate: 0 - a 7 5 Minimum Trench Depth: a � Inches *System Classification/Description: TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover 1 2 Inches *Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: a 4 Nitrification Field 3 6 4 5q. Inches ft. . No. Drain Lines *Distribution Type: GRAVITY-SERIAL 1 Total Trench Length: g 1 ft Pump Required: Oyes @No OMay Be Required Pre Treatment: ONSF OTS-1 OTS-11 *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. 'Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. ; This Authorization for Wastewater System Construction shall bevalid for a person equal to the period of validity of the Improvement Permit,not to exceed five years,and may be Issued atthe sametime the Improvement Permit Issued(NCGS 130A-336(b)}If the installation has not been completed during the period of validity of the Construction Permit,the Information submitted In the application for a permit or Construction Authorization is found to have been Incorrect,falsified or changed,or the site is altered,the permit or Construction Authorization shall become Invalid,and may be suspended or revoked(.1937(8)).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,Installation,operation,maintenance,monitoring,reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature: Date: *Issued By: 2140-Nations,Robert Date of Issue: . 0 3 / 3 1 / 2 0 1 6 Authorized State Agent: Malfunction Log Oyes ®Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: 58705489169 Mocksville NC 27028 Date: 0 3 31 / .1 0 1 6 Q Inch Drawing Drawing Type: Construction Authorization Scale: , OBlock QN/A ti + Q 1 I CONSTRUCTION AUTHORIZATION ' Davie County Health Department 210 Hospital Street CDP File Number: P.O.Box 848 58705489169 Mocksville NC 27028 County File Number: Date: .0.3 / 3 1 / 2 0 1 6 Click below to Import an Image from an external location: Drawing Type:Construction Authorization i IMPROVEMENT PERMIT Far office Use 'CDP File Number 200518-1 ;. "t• Davie County Health Department 210 Hospital Street County ID Number.58705489169 P.O. Box 848 Evaluated For. NEW Mocksville NC 27028 Township: Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID UNTIL: 3/31/2021 *NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit. Applicant: William E. Harrington III "Tripp" Property Owner. William E. Harrington III "Tripp" Address: 232 Beauchamp Rd Address: 232 Beauchamp Rd City: Advance CRY: Advance State/Zip: NC 27006 State/Zip: NC 27006 Phone#: (704)309-2557 Phone#: (704)309-2557 Property Location & Site Information Address/Road#: - Subdivision: Alan Mock s/d Phase: Lot: 2 232 Beauchamp Road Advance NC 27006 Directions Structure: SINGLE FAMILY Hwy 64 east, Left on Cornatzer Road then left on #of Bedrooms: Beauchamp rd. on the right. #of People: *Water Supply: PUBLIC System Specifications rSaprolfte System iiicatson: Provisionally Suitable Minimum Trench Depth: a 4 Inches ystem? QYes QNo Maximum Trench Depth: 3 6 Inches Design Flow: 1 0 0 Septic Tank: 1 0 0 0 Gallons Soil Application Rate: 0 . a 7 5 1-Piece: QYes @No *System Classification/Description: Pump Required: QYes QNo OMay Be Required TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR Pump Tank: Gallons LESS) *Proposed System: 25%REDUCTION 1-Piece: QYes QNo Repair System Required:@Yes ONO ONO, but has Available Space Repair System *Site Classification: Provisionally Suitable Minimum Trench Depth: 2 4 Inches Soil Application Rate: 0 a 7 5 Maximum Trench Depth: 3 6 Inches *System Classification/Description: Pump Required: QYes QNo Q May be Required TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25%REDUCTION Pagel of 3 CDP File Number 200518 - 1 County ID Number;.58705489169 *Site Modifications ❑ Open Fill Sheet No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of this permit bythe Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. Site Plan The Improvement Permit shall be valid for s years from date of Issue with a site pian(means a drawing not necessarily drawn to scale that shows the existing and proposed property lines with dimensions,the location of the facility and appurtenances,the Q site for the proposed Wastewater system,and the location of water supplies and surface waters). Plat The Improvement Permit shall be valid without expiration with plat(means a property surveyed prepared by a registered land surveyor,drawn to a scale of one inch equals no more than 60 feet,that Includes:the specific location of the proposed facility and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters. Plat also means,for subdivision lots approved by the local planning authority and recorded with the county register of deeds,a copy of the recorded subdivisions plat that is accompanied by a site plan that Is drawn to scale). The Department and Local Health Department may impose conditions on the Issuance and may revoke the permits for failure of the system to satisfy the conditions,the rules,or this article.This permit Is subject to revocation If the site plan,plat,or intended use changes(NCGS 130A335(t)).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,installation,operation,maintenance,monitoring, reporting,and repair(.1938(b)} Applicant/Legal Reps.Signature Required? Oyes ONO Applicant/Legal Reps.Signature; Date: 'Issued By: 2149'Nations,Robert Date of Issue: 0 3 / 3 1 / a 0 1 6 AOValid without Expiration? Authorized State Agen O Create CA? @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT • Davie County Health Department CDP File Number: 200518 - 1 210 Hospital Street Count File Number: 58705489169 P.O.Box 848 y Mocksville NC 27028 Date: Olnch Drawing Drawing Type: Improvement Permit Scale: , OBlock ON/ACal ll Tr w 1 y xl _ �sU_U I I ^--- ^ -It^ IMPROVEMENT PERMIT Davie County Health Department 210 Hospital street CDP File Number: 200518 - 1 P.O.Box$48 5$705489169 Mocksville NC 27028 County File Number: Date: 0.,3,1 ,3-,l.,/ 2 0 1 6 Click below to Import an Image from an external location:Drawing Type: Improvement Permit DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (3369;;;ubdivision 1-8786 � (/ Account #: 990002258 PIN/EH#: 5870-65-2977.02 Billed To: Distinctive Properties LLC Info: 23Z Bpa/A�� � Reference Name: Location/Address: Beauchamp Rd-27006 Proposed Facility: Residence Property Size: 2.324 Acres ATC Number: 4862 **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 betaken as a guarantee that the system will function n satisfactorily for agiven period of Mime. _ O �. System Type:--� S.T:Manufacturer Gey Tank Date-74Tank Size_ Pump Tank Size S stem Installed By: A—'J/ Xlle/.H.Specialist � Date: h4r Alat -�� o ro .... Or�cr zr,✓ n('.Hl) 11/06(RPvisarl)