Loading...
135 Howell Rd Lot 4 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002745 Tax PIN/EH#: 5822-62-1818.04CH Billed To: Clayton Homes Subdivision Info: Asr4 5&&x e&"4 La OL 4 Reference Name: Location/Address: Howell Road-27028 Proposed Facility: Residence Property Size: see map ATC Number: 3458 **NOTE** This 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 ` #People/ #Bedrooms S? #Baths 2— Dishwasher:. Garbage Disposal: ❑ Washing Machine 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 Size�GAL. Pump Tank GAL. Trench Width Rock Depth/2 Linear Ft,.-�� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)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: DCHD 05/99(Revised) V DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990002745 Tax PIN/EH#: 5822-62-1818.04CH Billed To: Clayton Homes Subdivision Info: rywin is"X 83 W4% Lot"& Reference Name: Location/Address: Howell Road-27028 Proposed Facility: Residence Property Size: see map ATC Number: 3458 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 CONS VCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: / Date: d 3 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 guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: � Environmental Health Specialist's Signature: Date: DCH)05/99(Revised) 111 f1N�31At10 H111f3H 1tl1N3WN081AN3 APPLICATION FOR SITE EVALUATION/IM PROVEN!ENT PERMIT AT Davie County Health Department MAY 1 2 2003 B=ftnmentaiHeaitii Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 Q (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL -THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. ,,,A�1l 1. Name to be Billed �Oh NJ Via V'-- -S Contact Person (3k v-, J "A-- Mailing Address 32.16 &tf l r Sd lr\� glome Phone 336 -J"sJI_ Vy City/State/ZIP -S ne- . '-� o3� I 5- Business Phone 33(0' �O� f� `!1, 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: S Improvement Permit/ATC Both 4. system to service: ouse bile Home Business *� Industry Other 5. If Residence: # People # Bedrooms # Bathrooms Diahwashe Garbage Disposal Washing Machine Basement lumbing 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 a. Do you anticipate additions or expansions of the facility this system is intended to serve? Yes No If yes,what type? ***IMPORTANT"CLIENTS MUST COMPLETE THE REQUIRLD PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: r WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # to 661 � �� Qi O h Property Address: Road Name • C h r'e.h RSI LP_F i o city/zip w.a V': rl�,a 2g �I�y...L l^1 r d 01 rsf I o If in a Subdivision provide information,as follows: 40V^- Name: MaAki _&t4JC E44--Od Section: Block: Lot: _ Date home corners flagged: 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 from this application. I,hereby,give consent to the Authorized Representative of the Davie County IIealth 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 suitability. DATE 3 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 Date(s): Client Notification Date: s Sep EHS: 5 Sign given � �o��y Account No. q Revised DCHD(07/99) Invoice No. APPLICATION FOR SiTE EVAIJUAMONi1MPROVEMENT PEBMR B ATC Davie CountyHeaith De ailment NOV 17 1999 ; `! Envi dmmental HMO Saffon � ��..6�•'� �0,�1 P.O. Box 848/210.Hospital Street 1 Mockaville, VC 27028 LWVikik,;,L111;t.11 ALM (336)751-8760 i1HV1E coin'TY ***IHPCIItTIIM** 2818 AIVLICtiZZ= CMM? BB p'ROCB;BMM muzos ALL TU REQUIRED INrOIMTIOH YS PROVIDED. pRotor to/the ZHIO/MMION SMUTIH for i1nstructiions. sU ZA 1. Sum to be lied �✓•Y !J. BetzJc �S�ra�t Contact 9"80011 r i S U'lr 0 CC. ki bvtnl teailinQ :address roo/ /.?,c CA y7Qzd so.. sstona 3.36— 46$^tf6�� H/C Z7o; cit►/etae./s=s �Z 8U l_ /uoc.Ed�./�ci�Gnttain.as sboaoa _ 336— d-7R" N 8N O 2. Zwk on ss llsa ss Different thaq abo e ,�. oyP--rl/c inq�addLyj. '�e�� c�+��•• � clti7c/ocstal:ip �h .` /r �C� Z'/ L� 3. X►sitc Fsvalnation O Improvement gersait/ASC O Both a. fret..► to sertrioet HOU116/ Mobile Some 17 Business 0 industry i] Other s. I! Residences a Veople I Bedrooms T or 3 e Bathrooms O Dishwasher O Garbage Disposal O weebiaq Nadhina O aueeant/21—d"na D aassamt/Ho Pluablag f. Ie atuiaess/Indttstrr/athert specify' type f "to s finks I Canum"a i showers i Urinal• I hater Coolers i* rOODUMCit # seats Zstissted Water Usage 49allons per earl 1. Type of water supply: County/City O-v,' well O Community e. Do you anticipate addition or expansions of the deility this system is intended to serve? O Yes ANo U yes,what type? ***IMPORTANT"**CLiEN•I•S Mt7lSTC1DNUMTHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT orSITEPLAN MUST BE SUBMITTED by the cUeut with TN14 APP1-1C-a.Tinu. , Property Dimensionst .�Gc. _/'�,�?�� ',V' 'TZ:;MW1IGNS(nem Mockwille)to PROPERTYs Tax Office PIN: fl •' . t- d s a e0 V1 jQ� C4.t c Z Aw. Property Address Road Name U�✓ U In a Subdivision provide Information,as follows: 61 l/Z}w� Names � �' &ew'-,w f�L fA.11 Secdoas Bloclu Loh Date Property Ilaggeds J e �,•.•tel' This Is to certify that the Information provided Is correct to the but of my lmowledge. I understand that any permits) issued hereafter are subject to suspension or revocation,If the site plans or Intended ase cbsnge,or If the information submitted In this application Is Milled or changed 11 pilo,understand 40 1 out rtspoinAk for an charge incurred fi om this applicadoa. I,hereby,give consent to the Authorized Representative of the Davie County Health Deps to to enter upon above described property located in Davie County and awned by to conduct all testing procedures u necessary to determine the sitesal blli i a E / ty. Z ID l f P '�� SIGNATURE15e THIS AREA MAY BE USED FOR DRAWING YOUR KIM PLAN(include all of the following: sttdug and proposed property line and dimensions, structure, setbacin, and septie locations). Site Revisit Charge Please complete the highlighted area(s)and Datc(s)s return. Client Noddestion Date: EBS: Account Na Revised DCHD(07199) Invoice No. f 0 X3 S 84.25'45' E 446.69' -- ---------- I" Square Iron 343.10' �N - 48. 2• `A .2 /ry61 7.,26 sq.ft 2 Xt 0.1636 acre n tA f4 /b I 6 it 56.227 sq.tt o 'L 1.2909 acres FBD40 PG 376 �� S 862421 E 0 370.42' io 5 � 1.3456 ocm 1 20 58,615 sq.ft. S 8624'21' E $ n 427.01' 1 WILL DB N 84.03'3' w 7,0 sq.ft. _ ?o .310 acres h 5.3�. O94.8,2. ipike = N 42,560 sq.ft 0.9770 acres � O 2 m S 0-2r �° o � 4w S emu I t rN f b ^b O t ° [] 250.00• E � r 57,4bE sq.R �\ 1.3198 acres \ `y 49,499 s l� 1.1363 a LBGZKD s \ W � F1,19 PUT �\ 224.64' 7--= BOOK a IPAGE Z KM BOOK ,DOME UERmN1 UMM U �e bi?PROPEM �T�` !� ICENTERLINE k. MOy' RIGM of WAY \ u .RS t�q EATON CHURCH ROAD �, Spike WSNED FWGR EEEVAMON SR 1415 �•. \ t P ( DU5ThIG RON Foum \ \ P ( NEW IRON SEI ) on ( NO UONUNENuwm SET ) GS CONTROL MONUMENT STwz PK NAIL NAIL SEI " ER ''A METER PRELIMINARY PLA TWO FOP R .v wv c "• DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000872 Tax PIN/EH#: 5822-62-1818.04 Billed To: Grady Beck Subdivision Info: Mary Beck Estates Lot#4 Reference Name: Grady Beck, Executor Location/Address: Howell Road-27028 Proposed Facility: Residence Property Size: 1.31 Acre Date Evaluated: )1.-91 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit ✓ Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence / / Structure 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 C < SITE CLASSIFICATION: 9l EVALUATION BY: 6� 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 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 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)