Loading...
180 Princeton Ct Lot 10 L, . DAVIE COUNTY HEALTH DEPARTMENT • ,/� r�� / Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990001261 Tax PIN/EH M 5860-81-3295.10 Billed To: Stone Hinge LLC Subdivision Info: Princeton Lot#10 Reference Name: Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: see map **NOTEC*This pr em9ent/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 SPIE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People�_ #Bedrooms #Baths Dishwasher: Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: Cl"� Basement/No Plumbing: ❑ Commercial)Specification: Facility Type #People #People/Shift #Seats Industrial alrial Waste: ❑ Lot Size -10 0 Ap&�>ype Water SupplyCX0W Design Wastewater Flow(GPD) 060 Site: New to Repair❑ •r System Specifications: Tank Size 10W GAL. Pump Tank GAL. Trench Width � Rock Depth L Linear Ft. Other: _ _ I'Mi 10 1aST4LL' `o Required Site Modifications/Conditions: 1C) Ow— W IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 11 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.**** � J ` • f r- Environmental Uo P�?e Health Specialist's Sign e: O Ij DCHD 05/99(Revised) SrAr G:t_-o�Stc ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (3 6)751-8760 { Account #: 990001261 Tax PIN/EH#: 5860-81 11115.10 Billed To: Stone Hinge LLC division Info: Prince(o Lot#10 Reference Name: Location a ttore Road-27006 Proposed Facility: Residence Property Size: see p ATC Number: 2899 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 WASTEWA NS N IS ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa re: Date: iAlo� CE TE OF COMPLETION **Nd'TE** The issuance of this Certificate of mp ion s 1 ' dicate the system described on Improvement/Operation Permit 00® has been installed in compliance with is I 1 o Chapter 130A,Section.1900"Sewage Treatment and to Disposal Systems,"but shall in NO WA be t as antee that th will function satisfactorily for any given period of time. �i SQe txT O `l4&raV jj�o��� 6. I=, S` Z �i.•1�2.5 � to c�.S�.� 24P� SCs' P,4-ri a UP -Sig IoZ s-`4,, b�.,-e iZ-t R8 iVt; d v r3 PLA CZ'-91 W -L)P Z Septic System Installed By: Environmental Health Specialist's Signature: ate 02-- DCHD 05/99(Revised) o` Parcel bJ K o James / U B 071 Mayhew92 o /!� j �ry • " v + ---a oQ m o 231-02' 0 '16 30 . S 83'51'3,5"E 1548.89' 2 300.16' 118.11' t �u Z z � N 10 W _ � W 0 1.906 Acres -►�j Ln ° 1.86 Acres o �' 2 m Z m j I 149 1- Ft. r � - z z 209.01' ---Z4=��: 298.69' 1 1 a.04' 1 8 .44'15-V 89°06'50"w' 0 Princeton C o u i, t. i 209.01\ � ��� . J 14.274 Acres i N 85°44'15"'N ------------- 150.00' 300.00' 25.0 'ti 47005'05'tiY �a ��\ O N0 �7 ti A 00 to z �A 3 y approx. ocatiori O ca in pond j y (li to /-�`\ CD d - V, N CO �, n I C`: -r , _ r an I- a _ C-4 n ui Y n d j1.7 7 1 Acre:, 1.073 Acres o n 1.833 Acres y 150. 5. 300.15 07' 300.1 ' 2 .8.03' N 87°32'15"W 1616.4 1' Pareei 63 Ricnard Dewy Robertson G.B. 162-130 Q =ENV1R0i'J-.',,'.MTAL TION FOR SITE EVALUATION/IMPROVEMENT PERI IIT&ATC Davie County Health Department Environmental Health Section ) P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 HEALTH ?M '6RTAIVT***..THIS. APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. I c / 1. Name to be Billed ��n e f�uC� L Contact Person Mailing Address Q '00, /n C c��Q 1.�1`t�y. Home Phone �S� tc�ft City/State/ZIP ,41-"kj off!/I C A)L 70, Business Phone 9r `j 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: u Site Evaluation improvement Permit/ATC ❑ Both 4. System to seryice: House ❑ Mobile Home ❑ Business ❑ Industry I I Other 5. If Residence: q # People # Bedrooms 3 # Bathrooms W Dishwasher ❑ Garbage Disposal .-'Washing Machine H'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 H Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes f3W-0— If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # ZT&C0 - - 3a5. � I ��1,.-,tee �• Property Address: Road.Name 9-d• ^�/ Re/n C City/zip�Q..�c�on CC .N_C . t / 1 I 5 0•, k 7` , If in a Subdivision provide information,as follows: Name: �i�`Ir� c e `k n Cv'e " Section: Block: Lot: �O Date Property Flagged: or. -1 -01 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 tun responsible for all charges incurred from this application. I, hereby,give consent to the Authorized Representative of the Davie County Hcalth 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 suitab' ity. DATE © SIGNATURE THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN(Include ll 9he following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge 7 Datc(s): Client Notification Date: EHS: 6 Account No. Revised DCHD(07/99) 2 ✓ Invoice No. 0 Concrete Slabs•Footings•Driveways �,,:.• •Pavers•Retaining Walls Z13� Williams Construction Co., Inc. ��� 's��,•lo Chris Rozina Zty Health Department cental Health Section' P.O.Boa 1686 Mobile(336)399-9441 "• Clemmons,NC 27012 Fax(336)998-7138 R O. Box 848 n Office(336)998-9900 Nextel 11 + 10 Hospital Street williamsmst.com chris@williamsenst.com --------.--_ __- - .-„ourler# : 09-40-06 Mocksville, NC 27028 ' Plione:(336)-753-6780 Fae:(336)-753-1680 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement Remodeling Reconnection Name: of I1/alt I�. tY GSC e Phone Number-(= (Home) Mailing Address: 176 lei t r.Le}e.. Z}. (3 35 5-/93 Z (Work) AAoc.lcsut 1h � NC Detailed Directions To Site: /S 8 LoQ s /la-le . Turd llumaee _Qe� • bo eLpPrax���n-�e�y +Kr ��S . Lem rimht on Rimm-efea L14E J ou Q o C4. ti ov. t S .6 't'_u k. Property Address: /To Pi Ne oa t Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: 41,1114M 'e. Type Of Facility: 701,111-le It~r St.l-dr- . .Date System Installed(Month/Date/Year): 3 11 T/2d6 Z Number Of Bedrooms: 'y Number Of People:_ Is The Facility Currently Vacant? Yes No If Yes,For How Long? Any Known Problems? Yes If Yes,Explain: Please Fill In The Following Information About The NEW Facility: Type OfFacilityc t o, a Toe I Number Of Bedrooms:_Number of People e� Requested By:, od Date Requested: Z/p (Signature) . For Environmental Health Office Use On .x 4D Approve Disapproved r h/” Col e�f 5►�`J� C ents: Td� �..Cv✓ti- Environmental Health Specialist Date: l' r *The signing of this form by the Environmental Health 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 ti1 me. Payment: Cash Check Mcwey-Qr-Eer #—L(b Amou t:$ /00-00 DatID Paid By: n 1d;I I i A-t— 4; < Received Account#:_ 3(p Invoice#: LIGATION-1 6 _ LrE EVALUATIONAMPROVEMENT PERMIT&ATC avie County Health Department Environmental Health Section ,. A 12 1%9 P.O.Box 848 Mocksville,NC 27028 EIIIJI ll:tl:l(x'.il lra>`III;LII1 (704) 634-8760 D�t�fi ,Iy ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. L1. Name to be Billed GRA looZ-1 -5 Contact Person S Mailing Address /0'7n s i?0111 Home Phone :5 .71 City/State/Zip .4/�p%/4 wee Tr, <2 . M 2 U U G Business Phone :5 �L 2. Name on Permit/ATC if Different than Above S.9r1L Mailing Address `,-?,4, / L- City/State/Zip 3. Application For. [site Evaluation [ ]Improvement Permit&,ATC [ ]Both 4. System to Serve: //__House [ ]Mobile Home [ ]Business [ ]Industry [ ]Other 5. If Residence: #People #Bedrooms #Bathrooms [ 1 Dishwasher[ ]Garbage Disposal [ ]Washing Machine [ ]Basement/Plumbing [ ]Basement/No Plumbing 6. If Business/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 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [ ]No If yes,what type? L11111-4%' -t PLA I OR S 1 I L PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT***,AnAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: �� �6 ,WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: # -5-660 -- g - 5r Property Address: Road ame .R 4 L ?�u c /?D 113 A C 7lzVo t e4 ZfV city/zip A a N&a Ale ,V. '700 ' zllb l-A ci % Cez.w,ad?Z&-A— If in Subdivision provide information,as follows-r1i S' 7' S Name: — ; Section: Lot#: i 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 7- / Z '' � SIGNATURE Revised DCHD(06-96) 7-11I8 AREA %1411 BE 11SEU f'Ol: D1{AIPIN(7 !0111% SITE IILA N: r ; v P6 I o / Parcel 65 F James Mayhew r D.B. 071-392 Lp cp �o "S I CL -� °ov~ 1.02' 150.08"ti S 83051'35"E0 150.08` 150.08' 150.08:`- . w Ln vq Z o O �- Q�71 � CD 11 )� m �O p 1�0 W N U' I d N p d Z O. Q JJ 7, (n cD VV lam: i. V) N 55°36'35"E 25.00' !y 209.01' ��� �s 148.69' 1" EP 499.94' ---/-N 5-944'15"W P ° 1'Sr3:'E 31.62' — j� a N 84°14'50"W' O 1 Y• `'1(1(,n�.' N 14.10'2� 31. 2' �o`� <70 0- r N 85 1 A Ilk � � 150.00' t' N 4700,5'V-65.00, d) CIC I o� >� mow w W x -� ° p OD Z LO u7 1 (In�3 (n V)o o Y f 0 7 �, :� Lo `S • I N d) J � o U 150.07' 258.03' 150 150.07' N 87032'15' r::F:i 63 ► DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account M 989900111 Tax PIN/EH#: 5860-81-3295.10 Billed To: Gray Potts Subdivision Info: Princeton Lot#10 Reference Name: Gray or Betty Potts Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: 150 x 281 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 Slope% HORIZON I DEPTH - 0 Texture group Consistence Structure Mineralogy I HORIZON II DEPTH Texture groupC G Consistence : S Structure k Mineralogy ; HORIZON III DEPTH O Texture group C-+—W G4- Consistence G,` StructureRSV- Mineralogy HORIZON IV DEPTH Texture group Consistence T SP Structure fY� Mineralogy - SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE S CLASSIFICATION S LONG-TERM ACCEPTANCE RATE Z2. 3 SITE CLASSIFICATION: L'S EVALUATION BY: V �LGt vu`i° LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: �ori+L" eL �'Lj (.l Q �y tombW !.J/ LOT#// 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) AD P-LIGATION-FO �5 TE EVALUATIONAMPROVEMENT PERMIT&ATC �6 [ � avie County Health Department D y Environmental Health Section G� 1999 P.O.Box 848 74- 2 Mocksville NC 27028 EKVlR0tJt1E1'IIAL 11AI (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed C _7.S Contact Person Mailing Address /Q3'7n tJ�nc29 4 Home Phone :5,4 .71 City/State/Zip .4/7%14 w�T, 0 , Z 700 G Business Phone :5/Fl WL 2. Name on Permit/ATC if Different than Above �9istL Mailing Address S14,w 6-- City/State/Zip 3. Application For: [,%4.Site Evaluation [ ]Improvement Permit&ATC [ ]Both 4. System to Serve: Pq House [ ]Mobile Home [ ]Business [ ]Industry [ ]Other 5. If Residence: #People #Bedrooms #Bathrooms [ ]Dishwasher[ ]Garbage Disposal [ ]Washing Machine [ ]Basement/Plumbing [ ]Basement/No Plumbing 6. If Business/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 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [ ]No If yes,what type? EITtll.k •1 I'l_41 OR 51TL PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT**cA P'L`AT OF THE PROPERTY MUST BE LSUBMITTED WITH THIS APPLICATION. Property Dimensions: Ce;-- PZA /-Z';)WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: # S 66 O - 0 1—-— 5� 1�5 /�P. L S? -71) Property Address: Road I�7ame R 4 G aA t?�i�'loyl r le city/zip 4,0 VA Ale C it/, C'• ; 7003 /1lb el-A v /= CPI 494 7 If in Subdivision provide information,as follows:p/��yj�� �� Io,9-2�:) v /i -E'_ S7- S'/AD 4.;- Name: Name: f4 G /JL,4 7 ; Section: Lot#: L-l7T*t 1 D 6A) A4F�,J 1V4& m Wo-R L L.o[ tin — 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 '7- / Z ;2�z SIGNATURE Revised DCHD(06-96) THIS AREA VA11 13E 11SEb FOR DR,tivINC, 1/0111: SITE PLAN-'(1 r ovo roc r, uovie county onn no 9por min I a Parcel 65 I James Mayhew o D.B. 071-392 1 ^ oS NN o 2,31'(.0��5 2' zO _ 150.08' 150 8�'oNW N 150.08' too S 83°155101' 3.058"E 0 Ln Lq o 0N Co Lti C,4 C- ri , C6 u, V 0)U7 W UO O d V N 55036'35"E 25.00' �y 209.01' --s 1�� 148.69' E � 499.94' Q — N 5°44'15"W _ P' 20 1'Sf3"E 31.62' — ° , j) , N 84 140" �•�`?l��� n�. e 1 N 4 10' 0 2 31. 2' O 1' A N 85° •1 S-- A ?4 150.00' N 47°05'85"W5.00' :yam G i0 LO N N ° r N00 CO � O n d •. " U dz 150.07' l.•�l' 150.07' 258.03' 150 _ N 87°32'15` F'C)rC9i 63