Loading...
143 Springwood Trail Lot 3 DAVIE COUNTY HEALTH DEPARTMENT /4/11e Y Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001893 Tax PIN/EH#: 5843-53-3627 Billed To: Fred Throckmorton Subdivision Info: Potters Ridge Lot#3 Reference Name: Location/Address: Spring Wood Trail-27028 Proposed Facility: Residence Property Size: see map **NOTEq* ThMis frmprovement/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 r #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 c-S''f�l`� Type Water Supply 06 Design Wastewater Flow(GPD)<.?6L7) Site: New, Repair❑ System Specifications: Tank Size/ GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft-Tad 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.**** r mod s Environmental Health Specialist's Signature:^ Date: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001893 Tax PIN/EH#: 5843-53-3627 Billed To: Fred Throckmorton Subdivision Info: Potters Ridge Lot#3 Reference Name: Location/Address: Spring Wood Trail-27028 Proposed Facility: Residence Property Size: see map ATC Number: 2965 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 CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: /6 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. �� ua�= L��C��f� 70� A3 �s �r 400SIL -�- � AT-5 3 Z,,�- Septic System Installed By: Environmental Health Specialist's Signature: Date: i DCHD 05/99(Revised) ck 5PI , TION FOR SITE EVALUATION/IMPROVEMENT PER411T&ATC r� Davie County Health Department AUGEnvironmental Health Sedion AUG 2 3 2001 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 EtdVIRDECOUNTYEALTH (336)751-8760 VIE ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED., Refer to the I/NFOORMATION BULLETIN for instructions. 1. . Name to be Billed / �L i'7 d Contact Person�/ 6Q/`�tL ��p` �j) / Mailing Address �/ j cP1 -C�f l� (� Home Phone 4lJ � / CJ City/State/ZIP Z�xlh q�rj/"l a /�� Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/state/Zip 3. Application For: Improvement Permit/ATC E01 Both 4. system to service: House ❑ Mobile Ho usiness ❑ Industry ther s. if Residence: # People �c10Co�� # Bedrooms # Bathrooms Dishwasher FI Garbage Disposal X Washing Machine Basement/Plumbing ❑ Basement/No Plumbing �.1�IC1 Business/Industry/Other: Specify type # People # Sinks yy�V1 .'.11ff#,��Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: 90. County/City ❑ Well ❑ Community e. 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 REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION. Property Dimensions:a3//45(Rx 0-1/x(�3Ox c�0 l WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: it 5$ 43 53 36 o 158 -40 f�nRmiNCYTON ROAD Property Address: Road Name /l7 U / l ' 7� On I n e y 1 Le— Pn l9 D C city/zip moCk5V IL( E, e- --fron- aae road �SPL;aod (� �p �L If in a Subdivision provide information,as follows: c n �e- 1e cl 5t Rp*e f s Name: P hGs e L - POTTER '6 R o G L k Section: Block: Lot: 1/ Date Property Flagged: Y2Y 7Mx m4P C-5 - 570 03 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 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 suitability. 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 Date(s): Client Notification Date: EHS: Account No. t T3 Revised DCHD(07/99) Invoice No. _ y���.��� l�y h ^/ � �P it • _ '�, fr ![ c ...1'y//y��`' lr 0 W -33 t cr7s w•r m rr,a.A' ;o .•.°' .'� 't?S-Wj-MAL1�. uoe ,J pr,, `� nvvl m� soh ,.'� / 71'32'S3'N' 1326.14' '_ �n7s•,oi re.tlr h m`t' p o •� FROM THE CENTERLINE _ I W aL ,p / INTERSECTION OF ^' 1 i t oz•3 � �'1 ,�h SR 1431 AND SR 1410 �, IJ0.3 ,'i !� h 5 1U'31'OC'w 30.06' �'i: r' o N Ab. N y �- ---- 1— ,f (Io ^ `8O f l<<f ROAD I I 1 9 m ' � - — '----'---------------- _ of tri,I tti sl r5.010 a _ �" m 5.232 cc. s rr., � 43y Ar rr ,-,1r• I �N SOLD s> 4, I .( s60. 1 �$30 , 868 . 3 039.3 pc 3/' ' I PROPOSED n O 2•E JOLS rr /'O6� i 20-F T. n ^ ^i Z•�' S>a 1", m 3: S B6.24:33'E 50.00' O X32• s lurvrr /r 209.09' 8 8 E .�rt A rK O 8 - �_ G6rAK! n, N . , 7TATr U rO' 5.100$30 ,090 3ac. } ,. 287.(5' 0 ,0 9 0 . 3 `y(>tAKAY� N'7 y N 89.18,52•W 6.5•,'D,.W � ;;r,W' ...6613 2E3,3 vl I CAL M A riD, W/7woro ,r ® �l1 X52• a ` r� r,Trrsr t/1•o S93•E h /i• aA 9/>a6 Ire.17' •h.1A C \ 41..� �,• O C ,ti° °8.n W 33'' re'• I MW TN rA.ea 1, I. 1 5 87.53'03'E 302.13' ,F $ '$ Jg F• e,,. I�e,r3N II PRNp1fa''.m cF rr py t ac. g s �; n La O u ri n Ngol9 , 00 . teS 5.995 ac. w r�Ar rcwr,l $35, 370 . W 5.255 ac. �, �'.--" s i�3'• � `rN m I .._...-e.R/ zg9p'1 10 IP ! ir�cipFo �' g 5.274 ac. N N _ $31, 116 . s7 \ q6W " L ! E u 11 \• z w ;,T 1!L 3N S 89'58'47'W 490.76- N V J _ NS 83'44'30•W 633.08' 5.098 ac. ^' lyt W $30 , 078 . 5.132 ac. L_ — $30 , 278 , _ -- - r _.�j l� PC • C5 343.34' ._— - � /` rpond! A. C4 iA S g3 44.30.00 ` aC Owner5: 4T I.7 83.44'30'00 / TEMPORARY T Ct.L-DE-SAC FIl c,aulu �� APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT �r�✓ Davie County Health Department Environmental Health Section P. O. Box 665 !)D Mocksville, NC 27028 1. Application/Permit Requested By W J/,LZ-,J� W iir�4,1J �a. C i'Jki c ku !�r Mailing Address Ri Z Py of 3 9 5 rnQ ];su /Jc AIC 2 7 0 2g Home Phone ��,� —3 2 S',/ Business Phone 7 O-0,T F c m 70 q-C 7'1-2 o// 2. Name on Permit if Different than Above TX 1,�4 c A Iry s 3. Application/Permit for: General Evaluation ❑ Septic Tank Installation 4. System to Serve: ❑ House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ IndustryPr�er� ;�I DCt Other-7 30'95 ❑ Unknown �-r' )JL, 5. If house, mobile home: Subdivision /O/�'c/ �",c�� Section �# ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms ❑ Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public ❑ Private ❑ Community 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes, what type? *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: / sR (zc1, !^e .� � on, �tt�MlVlOj}6n �� -�Etrak`1 54f p ` 9 /, , r►�i�e a �• L�6 d This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fand ECK ONE: 9--1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. ked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative of the Davie County Health Department to enter upon above described cated in Davie County and owned by cJ-c� A-al 4- Tom.�cn =<e '�Ja�.d all testing procedures as necessary to determine said site's suitability for-la ground absorption sewage treatment al system. DATE SIGNATLIRE DCHD(12-90) ' '• DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section / Soil/Site Evaluation f / NAME DATE EVALUATEDl,� lQ� ADDRESS PROPERTY SIZE PROPOSED FACIILTY ",axl r LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Slope % — HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH e Texture group (If 1 61 ell Consistence Structure shi s Mineralogy HORIZON III DEPTH Texture grOu2 Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION / LONG-TERM ACCEPTANCE RATEE�_ E SITE CLASSIFICATION: A!r EVALUATED BY: /l/ 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 Mineraloity 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(01-901 .................................................................. ................................ ................................ ................................ ................................ .................................................................. CCCCCCCCCCCCCCCCCCCCCusiiiiiiiiiCCCCCCCC�■CCCCCCCCC=CCCCCCCCCe=. CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC�CCCCCCCCCCCCCC■iiiiiiiiiC'i.=iii �CCCCCCCCCCCCCCCCC::CCC:CCCCCCCCCCCCCCC�CC■CCCCCCCCCCC■ ■■■■■■■■■..■■■■/i■.■■■■.■■..■..■ ....■.......MI■■■...■■.■.■....■■ ■■■■....■■■■■.■.N■...■■■.■■■■■■■■■■■■■■■.■■.. ■■M■MM■EMME■■M■■■. ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ME■■■EE ..■■■■N■■■■■■..■.■■■...■ ■.....■..■■....■....■■....■■.......... .■■■■■.■■ MEMO■■■. MMEME■M■ mommm.....................■......■■■....... E.�EEE■■■ MIMMME■CME■M■MME ...................................... ..... . ..... ........ CCCCCCCCCCCCCCCCCCCCCCCC�:CCCCC"CGCG :CCCCCCC'C CCCCCME MEMEMEN ............i..........E■..EEEM.CCMMM.C■■M■MEN MMMMMMMMMM■ MMMM ...................................... . MEMO MOMME■EMEMEC■■■■ ::::::CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC:.0 MMMMMMMMMMMMNMM :::::CCCCCCCCCCCCCCCCCCCCCCCCCC"=:�=CC' CCC' CCCmom MOOMMMME CCC'.CCCCCCCCC. ::::CCCCCCCCCCCCCC::CCCCCCCCCCCC�:CC ME::.. . CCMMMMNM�MMMMMM■ MM ::::::: ■..C.........................MEMEMME ��...■ . .. OMMEMNEMMM0 CME ..................................... . . �.■. MONOMER■.■■E ...............................lEO■.N�■C■CCM.■ECC■ MMMMMM ■■.....E..EOEEE.......■.■.N....■.....E.. CnCCCCCCCCCC■CCCCCCCCCC ■......N............■..■ ...■.....EENN ......■■............ ............................■M■■■■ME■E■.■■■■■ .................N..........H■■■■E■E■�.M■..■E■E.■■EEE■E.NM.■■M■■ moon .................................................................. ■.■.M===MM i�ii�iiii/iiiiiGiiiii/MMM..■ ■/Eire■■■.■■■.■■■.■.■■■■■■.■■■■■■■ i Dan? County Ylealtii Department and Horne NealtFr Ayenty 210 HOSPITAL STREET/P.O, BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634-5985 August 11, 19973 J. C. Hutchins c/o William W. Spillman, Jr. Rt. 2, Box 395 Mocksville, NC 27028 Re: Site Evaluation Dear Mr. Hutchins: As requested, a representative from this office visited the aforementioned site on August 10, 1993. Based upon the information provided on the application for a site evaluation and after an evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr. , R. S. Environmental Health Section RH/wd Enclosure cc: George Wilson DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001893 Tax PIN/EH#: 5843-53-3627 Billed To: Fred Throckmorton Subdivision Info: Potters Ridge Lot#3 Reference.Name: Location/Address: Spring Wood Trail-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: 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 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 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)