Loading...
227 Old March Rd Lot 49 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Strut — - Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 OPERATION PERMIT Account M 989900025 Tax PIN/EH M 5789-77-4010 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#49 Reference Name: LocationiAddress: 227 Old March Road-27006 Proposed Facility: Residence Property Size: ATC Number: 5085 **NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC 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. C' System Type: S.T.Manufacturer Tank Date Tank Size Pump Tank Size System Installed By: Ili 4 44 ie E.H.Specialist: ate:_ � l� 1V�dre � coo ac� � T6 ��� l,� �✓'.�� /�� � t 3 S.. •� v C If. c � DCHD 11/06(R vised) 410 ? 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 #: 989900025 Tax PIN/EH#: 5789-77-4010 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods. Lot#49 Reference Name: LocationiAddress: 227 Old March Road-27006 Proposed Facility: Residence Property Size: ATC Number: 5085 Site Type: ew ❑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 L.J #People Basement3'] asement plumbing R— Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size Q- Type of Water Supply: B ounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD)3(oto Tank Size 1)0 —tJAL.Pump Tank GAL. � d Trench Width 3�1 Max.Trench Depth 3 G 41RockDepth I a- Linear Ft. �3 b As stated in 15A NCAC 18A.1969(5) Site Modifications/Conditions/Other: asseptod System-- rnav ai4n he [IsE hContact 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. (� 0A ep to n►1' — , if 0'8 Environmental Health Specialist Date: 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 #: 989900025 Tax PIN/EH#: 5789-77-4010 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#49 Address: .225 Wing Haven Lane Location/Address: 227 Old March Road-27006 City: Mocksville Property Size: 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. f Permit Type: R<ew ❑Repair ❑Expansion Permit Valid for: Years ❑No Expiration Residential Specifications: #Bedrooms #Bathrooms �!.- #People BasementCgasement plumbing Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):3' Type of Water Supply: 96unty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: As stater! in 15A NCAC 18A.1969(5� ♦J t'd-SSystems-Tiady d1SV LOU U c� S stem Type LTAR Initial ? NNI Repair Ce npQ Site Plan V► 'L` O c� (, 4k n � tz �r M Hb� Environmental Health Specialist Date i.p.11-06 K11AY C E O V E APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIDavie County Eavir omental Health 1 4 2010 P.O.Bax sallalo Hospital street Mocksville,NC 2)M // (336y7Si-67801 Fax(336)753-1680 Q�MRONMENTAL HEALTH Apptication For. 114c aluationArnprovement Permit C Authorization To ConshW(ATC) t DAVIE COUNTY Type of Application: =Jew System =1Repair to Existing System OExpansim Modification of Existing system or Facility ••9IMPORTAN70•0 THIS APPLICATION CANNOT85PROCESS£D UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Ria to the INFORMATION BULLETIN for insUvctior& APPLICANT INFORMATION Name to be Billed lic:4 A}4d6RSa o Contact Pelson Billing Address e v J 4) LAas Home Phone A4 I.- D& D218 Business Phone 3. ia T15 22-72 Name on Pett =ATC ifDiTereid thats Above Mailing Address City/StatdZip PROPERTY INFORMATION "Date HousdFa ffi Coursers Fl ed NOTE: A survey plat ar site plan mist accompany this application. Included:IS Site Plan I-Mat(toscale) owner'sName b����is valid for 60 morahs with site plan expiraaon with wr>pktc ply Phone Nttntl�er 33 99$7L7q Owner's Address =17 t 6 i Citymi-e Z Atoe1XVt We- Property Address city *d 0A t 2 o.e.. Lot Size &*Qui, At Tax PINK 4C7.0 V721 401a Subdivision Name(if applicable) W til Directions To Site; O If the answerto any of the fotlov iog questions is"yes".supporting dommentation must be attached Are there any adsting wastewater systems an the site? 3Yes MSO Does the site contain jurisdictional wetlands? tlYes M40 Are there any easements or right-of-ways on the site? UYes Wo Is the site subject to approval by another public agency? Oyes Will wastewater other than domestic sewage be enerated? f_I Yes WK IF RESIDENCE FILL OUT THE BOX BELOW N People�_ #Bedrooms T M Bathrooms Z.V Garden Tub/Whirlpool es -No Basemen lies LINO Basement m : Vfcs 13No IF NON RESIDENCE FILL OUT THE BOX BEW W Type of Facility/Business Total Square Footage of Building N People k Sinks 6 Cottnnodcs g Showers 0 Urinals Estimated Wen Usage(gallons per day) (Attach documentation of similar facility,water constmnption) FOODSERVICE ONLY: A Scats Type system requested: UeSaventional BAccepted Elnmovative OAlterntttive OOdter Water Supply TypeSKoumy/City Water .No.%v well •'IEtrisring well J Community Well Do you anticipate additions or expansions of the faeility this system is intended to serve7 L'Yes If yes,what type? This is to a:r*That tie information provided on Misapplication is true and correct to the best of ray knowledge. I understand that any permit(s)or ATC(s)issued here l erare subject to suspension or revocation if the site is altered,the intended use c ungm or if the information submitted in this application is falsified or changed. I hereby grunt right ofentry to the Authorized Representative of the Davie County Health Department w conduct necessary inspections to determine compliance with applicable laws and rules. I understand that 1 am responsible for the proper identification and labeling of property tines and corners and Ioca�nRgrjd f 'n m o hoosr/faeility 1 on.proposed well location and the location of any other tunenidcs. Property owner's or owriies legal representative signature Site Revisit Chargee (7 Client Chew � Notification Date: Daft EHS: Sign given OYes DNo Account a f9 Q0 d l Revised 11.106 Invoice A 5 ` d d00:Z0 60 ZL AyaW r- a 9k0Pb11 �.�.,..•..mss.•..i. uAW,►•,,,, z tet....... P..d�• L y•�. .ti..':}lL AF70 A-a It.rl w rnr r.l-P...tr.r..• � U-5 31 � f.:G Lot 011 ' .... >* J , .s• 1,i ' t.r wic ! ,r n 4 I r'1 i• l ,;P , • r.i.'�.i}.S. PLAT MAP Of PHASE 31 i% ;wl.•t� ��' n 7„ �•� k ar n MARCHWOOD 1'1'/'t /,t DICK ANDERSON CONST. CO. 80 WAC WAU UN •31. ,' ' 1-711 f ,• ` �� tOv,O a.. ,' ` �)Lt $MACY OROrt TOWNSHIP .� )• DAVIE COUNTY.MoRTN CAROLINA t •,� �' .�,�� �) � ' ./' TA%MAP REfa O-S.PARCEL 13.09 w7c►cnRusRr-S-:oa+ I.. y,,�,,_ •1' ) ' � m'�•• •� Aattrra sn P,�,w a. �•� �,...�.IR7T.^ �" 11 4 :' ` ru main 311Wrnxt tommir .)-)..w+t Pw«M.Y•�+.+-� `C , I •%, • ` 1O).R.71 a m t)M{i,LR y.,.1Ir.t.R w.1.11.r• \1L ) UI.YIt :m fe t lL ,a t!1 71L r.tsYt.u� wy�nM+�u �ItlK I.RL) tv .i .E M1�P of WO. ^.f P`:[wK• K•MtK lOw"r :.)rw airy �•+Pt 7)49 Y .a. M Pw•.[! LL7 0 04 O EA O N ' O3 ,r t l 4 15; t i V' IAOl� - � ; • � I i t i s r • ii s t �iCIL 'Ac8Ef46,--1) q-q Z•d db0:Z0 60 U ALM �,. APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT& O Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 MAY 5 2042 (336)751-8760 ENV! ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS AL EALTH INFORMATION IS PROVIDED. Refer tof the INFORMATION BULLETIN for instrucnt3.o 1. Name to be Billed _-0J61e 4oU4t2�d A 1A, "L 10AJS7 -�-Z r_ Contact Person 1)10e lyAJa!jl 7.G) Mailing Address vZ a _� C(/l.tl G //-A,45;; Z,0 Home Phone '7 � -7 7 City/State/ZIP I��GS✓/c-z _ �(/,�. 70� Business Phone ��- 7-17 `% 2. Name on Permit/ATC if Different than Above Mailing Address Ci Statepylye T A IIz((�/1t�Vj 3. Application For: X Site Evaluation Improvement Permit/ATC n Both 4. System to Service: 'House ❑ Mobile Home D Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms -2)— # Bathrooms of /-I'- Ll ,/LI Dishwasher LI Garbage Disposal LI Washing Machine LI Basement/Plumbing II Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well ❑ Community Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No �./ If yes,what type? ***IMPORTANT'CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQU TED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. TH!S I Property Dimensions: '7-0 WRITE DIRECTIONS(from Mocksville)to MtOPERIT: y Tax Office PIN: # 5'7 0 9^7 9-58 5). 1/7 nn Property Address: Road Name 06!Q /1?A2cay 4 /-0 /�moC�cs✓icc f � �d"a'UCc �.dw y / City/zip 40VL7.tucz . 7.7006 LFA,– oAU "e4 If in a Subdivision provide information,as follows: ,TO oo o 5 o.y 2;r-- Name: MAALP c t bQ191 Section: ""IA Block:N/►9. Lot: 9 Date Property Flagged: AwV 6 714 This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) 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 am responsible for all charges incurred froru this application. I,hereby,give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suita DATE SIGNATURE •/ /`)_ � 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). Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. 7 Doo 5- Revised Revised DCHD(07/99) Invoice No. ' 0 -0 • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900025 Tax PIN/EH#: 5789-79-5851.49 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#49 Reference Name: Location/Address: Old March Road-2700/9 Proposed Facility: Residence Property Size: see map Date Evaluated: O Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit j/' Cut FACTORS 12 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture group SL Consistence Structure 41( Mineralogy 5 '' r/` HORIZON II DEPTH Texture group Consistence i Structure /C 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 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 Mois 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 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) LTAR-Long-term acceptance rate-gal/day/ft2 DCHD 05/99(Revised)