Loading...
126 Southern Magnolia Dr Lots 3 & 4 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 OPERATION PERMIT. Account #: 990005974 Tax PINIEH#: G910OA004 Billed To: Seth &Jessie Carter Subdivision:Info- Wagnolia Acres Lot#"4, . Reference Name: Location/Address: Southern Magnolia Drive-27006 Proposed Facility: Guest House property Size: 1,527 Acres ATC Number: 5997 **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_ Tank Date Tank Size /000 Pump Tank Size Bedrooms: ' System Installed By:gnCn m an t' f Installei#. Date: GPS Coordinate: a a� - yd) \X1 n Environmental Health Specialist Date: t DCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street. Mocksville,NC 27028. (336)753-6780/Fax#(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005974 '.' Taz PlN/EH#: G910OA004 Billed To: Seth &Jessie Carter ':Suladivisionanfo: ,:Magnolia Acres Lot#4 Reference Name: ;. Location/Address: Southern Magnolia Drive-27006 Proposed Facility: Guest House Property Sizer 1.527 Acres ATC Number: 5997 Site Type: ANew ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior tq 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 N subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms _#Bathrooms 1 #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size . Type of Water Supply: ❑County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD) Tank Size l DD GAL.Pump Tank / GAL. Trench Width Max.Trench Depth_ Rock Depth Linear Ft. OeO` a 67,6 Site Mo c i Contact the Davie Countynvironmental He 1 Section for final inspection of this system between 8:30=9:30a.m.on the day of installation. Telephone#(336)751-8760. Li g I � API 79�a IL-1 ' Environmental Health Specialist I Date: I I DCHD 11/06(Revised) Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT Account #: 990005974 Tax PIN/EH#: G910OA004 Billed To:,'Seth &Jessie Carter Subdivision Info: Magnolia Acres Lot#4 Address: 126 Southern M49no14Drive Location/Address: Southern Magnolia Drive-27006 City: Advance Property Size: 1.527 Acres Reference Name: Proposed Facility: Quest House 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: %New DRepair DExpansion Permit Valid for: R5 Years DNo Expiration Residential Specifications: #Bedrooms _#Bathrooms _#People Basement0 Basement plumbing Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): ,Qyp Type of Water Supply: PGCounty/City DWell OCommunity Well Site Modifications/Permit Conditions: System Type LTAR Initial o P64ACm -Repair I asojo Site Plan tc yo t lc(6c tjn �i yl pol -f V [' °e _s Environmental Health Specialist ('Itedl Date ( i.p.11-06 / Wfildreo ea eP e$n OJW • 'APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC 906 Davie County Environmental Health 0 ` P.O.Bog 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 Application For: ite Ev tion/Improvement Permit ❑Authorization To Construct(ATC) ❑ Both Type of Application: UWw System ❑Repair to Existiniz System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT"**THIS APPLICATION CANNOT BEPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name Contact Person c---,o,, .S IJA , Address _S Home Phone City/State/ZIP ni-- e­ -�,--7o o to Business Phone 3 3 t- 3 Email Name on PermitIATC if Different than Above Mailing Address j2.'5- -7 lJ 5 tAk1,V 6 y IAA City/State/Zip t!?j 0 5., , G•z7vZ PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE:_ A survey plat or site plan must accompany this application. Included: ite Plan ❑Plat(to scale) j (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name' 5 44-J- Phone Number Owner's Address)Z C. 5 , }-[,.._ yn r./ 0-T City/State/Zip A-.4,,, _ ,j_ c_.. z.-7 v a c. Property Address Lot Size /. S-2:-7 /+,,, s Tax PIN# & 7 10 o Ad 04 Subdivision Name(if applicable) /t'7-S o J;_ A,_-,- S Section/Lot# 3 Directions To ite: &'0 / 1-, If the answer to any of the followin questions is"Yes",supporting documentation must be attached: Are there any existing wastewater systems on the site? Yes _No Does the site contain jurisdictional wetlands? Yes jzNo Are there any easements or right-of-ways on the site? ,Yes No Is the site subject to approval by another public agency? _Yes 4,,t44o Will wastewater other than domestic sewage be generated? Yes✓Nlo TF RF,SIAF.NCF FIT J,OT JT THF,BOX BFLOW #People #Bedrooms J #Bathrooms 1.S� Garden Tub/Whirlpool ❑Yes o Basement: ayes ❑No Basement Plumbing: Lames ❑No TF.NON-RF,STDENCE FIT.T.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: onventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: County/City.Water ❑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 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,propose well location and the location of any other amenities. Site Revisit Charge Pr ertyowner' r o is legal representative signature Date(s): Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# Revised 11/06 Invoice# �,��� r. -....f..,. _. .tet.` ,. '•Y•�Y. .v.t ,�iti � - ,._ •�• ..:tea.+•a..f.u,-� ` .. r .Y c••.•.�, �,. :J! •t;t _ +t ( > :..�:r J.�„„„o, ,"�":r�i?',fy/rrj� IFi =et•� c � _ rJ,i,r � '• - .,.i:M1 T):._Y. a '.T-�� -^^•.+.....- _� AP, t SEJ� J 7'kss rar 04AMA � 50 t tt i zclip Afagn,oZ�icx. ,; r.. 4 - ... S 86048'29"1` I'a t ,i t �` j)tt(i`'Ut�E tt:^vPrr ,{ liD(AJC SE�9CK aQ' lJfiJitp tic r � I 09) , Am • �• z Q � mI f� � foot.. • o ., use '� • C'ovt Qd i CCIAC&, f ' � � — �.��� P�7iD � up•�f 30A' R.. PODL jr f - r $UIW(N6 SECBwck.. Per ;' O s ► �'^I C�' �.-..__...,._ - ___ .. ��__ ...._. -.•8�-----�1� Rp._,._d 149.51' `S 89°21'28"W 147•96 N 86"47'41"W 1 • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990005974 Tax PIN/EH#: G910OA004 Billed To: Seth &Jessie Carter Subdivision Info: Magnolia Acres Lot#4 Reference Name: Location/Address: Southern Magnolia Drive-27006 Proposed Facility: Guest House Property Size: 1.527 Acres Date Evaluated: /q N Z Water Supply: On-Site Well Community Public k Evaluation By: Auger Boring X Pit Cut FACTORS 1 2. 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH r)- -(, Texture group St L ISCL Consistence I-Q_ Structure VUL6 Mineralogy HORIZON II DEPTH - Texture group C Consistence Structure L S Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION I Q LONG-TERM ACCEPTANCE RATE cc 3 SITE CLASSIFICATION: j. EVALUATION BY: LONG-TERM ACCEPTANCE RATE. OTHER(S)PRESENT: (-OVA 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 NlQist 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 Tues 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) ■■■■■■e■■■■ei■■■■■■■■i■■■■■i■■■■�i■■iesi■■i■ii■ee■■eeee■e■■■■■e■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■s■■■►��..:■1■s■■■■■■■■■■■■■■■■■■■-set■■■■■■s■■■■■■■■■■■■■■■s■■■e ■■Gi■=Yiiiiii.:.Gi::CCC--�----------------------- ■■■■■■MEN Now li■ ■■■■■■■e■e■■■■■■■■■■■■■■■■■■e■■■■ ■■■■■■■■■■■■11.r/�Jilti■e■Ili1`iyi,sill■■■eYe■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■I■■■■■■■■I[IR�\�■■■■■■iii■■Y!i!!i raiGsGiiCC==�■■■■■■■■■■■■■■■■■■■■ ■■■■I■■■fiw�!\\ilY■■■■■■■■■■■■■■■■■�1\ll;l�l■11■■■e■■il■■e■■■e■■■■■■■■■■■■■ ■■■■ire■■Ilii:�!!■■■■■■■■■■■e■■■■■■■■\�■■■■■■■■■il■■■■■■■■■■■■■■■■■■■■ ■se■i�■■■11■lee■■■■■■■■■e■e■■ee■■eee■■■■eee■■■■■il■■■e■■e■■■■■e■■■ee■■ ■■7�� '■■■11■1ON0IN■■■■■■■ONO■■■■■■■■■■■■■■■■■■■■■il■■■■■■■■■■■■■■e■■■■■ ■cryil■■■i■11■IN!"UNUN■Mono■MESON■■■■■ ■■■■■■■■■■■■I■■■■■■■■■■■■■■■■■■■■ t�l!■■1■■■i■11■1■■■■e■ee■■■■■■e■■e■■■■■■■■■■i■e■e■■■lee■e■■e■■■■■■ee■■■s■ ■call■■■l■Ilc■■■e=====s■■■■■■■■■■■■■■■■■■■■■■■■s■l■■■■ss■■■■■■■■s■s■s■ ■:�■1■■■■■r�i1ei11■■■eel/■■liiiiiin�J■■e■■■■■■■■■■■11■■■■■■■■■■■■■■■■■■■■ ■tUNION■■■Iii11■■11■ONE■I■■■■■A■■, ■■i/■■■■■■■■■s■■■■■1■■■■■■■■■■■■■■■■■■■■ ■%INME■■■■■■■■11■■■■ rAVU111■■1■■■■n■■■e■e■e■e■1■ee■eeeeeeee■e■■■■■■ ■&Ltil■■■■■■■■■11■■■n■1■■■■11 U0/I■■■1■■■■IJ■■■s■■■s■■■t■DCI■■■■■■■■■■■■■■■s■ ■&NulMEN■■■■■■11■OWN milm■■um=====J■M■■■■■■C■■■■■leu■■■■■■■■■■■■■■e■■■ ■.■it■■■■■■■■■11■■���■1■■■■■■e■■■■■■ ■■■■■esse■e■lrarse■e■e■■■■■■■■■■■■■ ■P_Jil■■■■■■■■■11■■,■■I■■■■■■s■■■■■■!1■■■■■e■s■e■e■1■e■■■■■■■■■■■■■■■■■■ Elk Milo■■■■P_.i11■■■■■I/■■■■■■■■■■■■i■1!■■■■■e■■■■■I■EON MEN■■■■■■■■■■■■■ ■G�lil■■■■■li■■■Y■■■■■I/■■■■■■■■■■■■CnllL1111'■■■■■■■■■■I■■■■■■■■■■■■■■■■■■e■ ■RWIll■■ONO INN■■■■■■■■I■■■■■■■■■■■■■\IMnaa■e■■■■■■■I■■■OMENS■■■■■■■■■■■■ spail■■■■■li■■■■■■■e■i■■■■■■■■■■ee■■e�■a■e■e■e■s■i■■i■■■■■■■■■■■■■■s■■ iiiiiiiiiiiil ' iiiiiiiiiiiii"iiimisiiiiiivl�l ■■Iilil��\■■■■■■■11■■■■■■■■eee■■■■■■■■■■■■]1117■■■■■I■■■■■e■■■■■■■■■■■■■■ ■■■il■■■■\`!!!!iJe■■■■■■■■■■■■■■■■ecce■■■■!■■■e■■lice■■■■■■■■■■■■■■■■■ ■■■il■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ILS?!11■■■i<:I■■■■■■■■■■■■■■■■■■■■ ■■■it■■■■■e■■■i■■■■■■■■■■■■■■■■■■r� ■■■i1■■■■1111■■■■■■■ese■■■■■■■s■■■■■ ■■■il■e■■■■■■■■e■■■■■■■■■■eee■■■ese■■■11■li►1■111='��■■■■■■■■■e■■■■■■■■■■■ ■■■il■e■■■■■s■■■■■■■■■■■■■■■■■■■1111■■■■■■■el�c�e■es■■■■■■■■■■■■■■■■■■ ■■■�:::■.■■r■■■s■■■■■■■■si■■■■■■■■■■�!■■e■■■.:::mss■■e■■s■■■■■■■■■e■■■ ■■■■■■■■■■■i�►���e►�■■■■e■■e■■■■ee■■1�:�1i�■e■■■e■■■■e■e■■eee■■■■■ee■e■s■ ■■■■■■■■e■■se■■■■■se■■i■■■■■e■■■■■■■■e■■ei■■■■■■■eee■■■■se■■■■eee■ ■■eee■■■■■■■■■■■■■■■■■■■■■■■■■■■1�■■■■■■■■i■■e■■e■■■■■■■s■■■■■■■■■ ■ee■ie■■■e■■■e■■e■ecce■■■■ee■i■■e■■e■■■■e■i■i■■■■■■■■■■ecce■■■■■■■ ■e■■■■e■■■ee■■ei■■■■ee■■e■eee■■■■■■■■e■■■■■e■■i■■■■■e■■ei■■e■■■■e■ ■■■e■■■■eee■■■■■■■■■e■■■■e■■■■■■■■■■■■■■■■ee■e■■■■■■■ee■e■■■e■■s■■ ■■■■■■■■■■■■s■■■■■■■■■■■■■■■■■■■111■■■s■■■■■■■■■■■s■■■■■s■■■s■■■■■■ DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section SECTION--/-LOT Soil/Site Evaluation APPLICANT'S NAME -f//�/I� DATE EVALUATEDD �r PROPOSED FACILITY PROPERTY SIZE SUBDIVISION ��i�GJ�/>r� � AC ROAD NAME Water Supply: On-Site Well Community Public L� Evaluation By: Auger Boring Pity Cut FACTORS 1 2 3 4 5 6 7 Landscape position L. Slope% HORIZON I DEPTH Texture groupL L Consistence Structure Mineralogy HORIZON II DEPTH Texture groupG Consistence i Structure ,t/l 5WC Mineralogy . '/ A. 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 c 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 CONSISTENCE oist 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 tructure 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) LTAR-Long-term acceptance rate-gal/day/t2 DCHD(01-90) Davie County Health Department 18 j�` Environmental Health Section P.O. BOX 848 -L 210 Hospital Street Q U Courier# : 09-40-06 Mocksville, NC 27028 Phone:(336)-753-67.80 Fax:(336)-751-8786 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement Remodeling Reconnection by Name: L l _l'Xhone Number (Home) Mailing Address: 12 5 v S /�wY Z `/ 3 �'�`� r" Z��1, (Work) 1`7 IV-C- 2_7�-z S, Email e-- Detailed Detailed Directions To Site: '-j Property Address: j 2 (.. S d 1 _ /"1— , �• v Please Fill In The Following Information.About The EXISTING Facility: f Name System Installed Under:5), Type Of Facility: e O • �L -— - Date System.Installed(Month/Date/Year): z /�g Number Of Bedrooms:Number Of People: Is The Facility Currently Vacant? Yes (�If Yes,For How Long? Any.Known Problems? Yes No If Yes,Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: "' ' L ^ Number Of Bedrooms: 0 Number of People Requested By: Date Requested: 2- ( ature) For Environmental Health Office Use Only pproved Disapproved Comments: Al ✓1CLL1 � jVG / �O U rI Ci G�'7�dYI Environmental Health Specialist Date: 1 Z *The signing of this form by the Environmental He6fh Staff is in no way intended,nor should be taken as a guarantee (extended or limited)that the on-site wastewater system will function"properly for any given period of time. Payment: Cash Check Money Order # Amount:$ Date: Paid By: Received By: 414 4 1114-1Z/ Account#: Invoice#: