Loading...
138 East Knoll Brook Drive Lot 10+" DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900204 Tax PIN/EH #: 5749-53-1472 Billed To: J. D. Crews Homebuilder Reference Name: Proposed Facility Residence ATC Number: 3951 Subdivision Info: Meadowridge one Lot # 10 Location/Address: E. Knoll Brook Drive -27208 Property Size: see map 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. age Tre ent and Disposal Systems). THIS AUTHORIZATION FOR WASTE R CTIO IS ALI PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatur : Date: 1 cc) 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. g� Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 'k -19b - C/%a DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section , � � 0-5'' P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900204 Tax PIN/EH #: 5749-53-1472 Billed To: J. D. Crews Homebuilder Subdivision Info: Meadowridge one Lot # 10 Reference Name: Location/Address: E. Knoll Brook Drive -27208 Proposed Facility Residence Property Size: see map ATC Number: 3951 **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 I 1 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 000SC #People I #Bedrooms 3 #Baths �Z— Dishwasher: 13" Garbage Disposal: d Washing Machine: d Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Typenn #People #People/Shift 2� #Seats Industrial Waste: ❑ Lot Size I--18AC(ZeS Type Water Supply W__ J Design Wastewater Flow (GPD) Site: New EfRepair ❑ System Specifications: Tank Size ICCO GAL. Pump Tank GAL. Trench Width -AoIl Rock Depth 17�' Linear Ft. Other: R S Required Site Modifications/Conditions: Sie t.L �� �� �` � `�� oA:r- �z 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.in n the day of installation. Telephone # is (336)751-8760.**** �I 3&0 I ._ ►,, 1p0` \ 1L - -MIJJ• ' A Environmental Health Specialist's DCHD 05/99 (Revised) 146 � .vJ v► _. .W�Vi 1 (Pup) =Coy rpy 1 I ,o I V f ��•• M ISD.► V S .L6 dQ4 M into -t0 S /y (pup) smw f6l 'Z �r moo' gwr z s '�4 tot • V4 n 2 N ..��r' �r • rr,,.r—r+���—'�—.rte • ` ,.,� r r,..r+ —ww— • • w 'mow—ww w�— www ww,w••w w_ hoz e� ew` 14 41 5624 t :A 2.37 2.94A 73279378 _ PLICAT! Q 3 2p t� J R SITE EVALUATION/IMPROVEMENT PERMIT & ATC vie County Health Department virwmeatal Health Section .O. ox 848/210 Hospital Street ocksville, NC 27028 (336)751-8760 * * * IMM2 NT THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFO N IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. �(D n '' nn -- Sxrry Ck,-a vs 1. Name to be Billed J `✓ � R�-k�s r�CJYY�ccI3(toLD 1�•$ Contact Person Mailing Address q01 Home Phone q92-76/9 City/State/ZIP NG -L'702-0 Business Phone `fc1Z-76/8 ar- c1q0=7c1Sf, 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: ❑ Site Evaluation City/State/Zip V0,14rovement Permit/ATC ❑ Both 4. System to Service: M House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: # People # Bedrooms 3 # Bathrooms Z l�f Dishwasher 4Y Garbage Disposal H�Washing Machine ❑Basement/Plumbing f] 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 s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Q'No 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: 1410 X & (D 1 )G 13 5')( 55WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # S'7q'7S3 /q -7Z Hwy /S9 E71si - Rtct kT ea S;Ai n! 2ow.4 Property Address: Road Name E. Kwyi-i, 2312,;DK bp-. FZ', &wr t N i U McA,4ow Rl dq g p e iyC City/zip /�OGkS ✓%ttE,�1G Z7oza If in a Subdivision provide information, as follows: Name: MarADDW Q-- j jE dr od Aews ]" kap uG GjeDoi< DQ, / o'r /0 o rJ ! `! j i' S� e NIOA/ '/0X o p� Section: / Block: Lot: /O Date Property Flagged: /Z - 3 D - O ce 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 fur all charges incurred from this application. 1, 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 A-.Y'yj— to conduct all testing procedures as necessary to determine the site suitability. DATE /� 3 0' 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). Revised DCHD (07/99) I=. YVJO%-L, QV-10wo- Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. �� % jr� d a o y� Invoice No. 5"S / APPUlA110N FOR SIZE EVALUAiIUN/INPflOVEJMENT PERMIT 8 ATC 2 a Davie County Health Deparbnent D L� ' Environmental Health Swffon P.O. Bos 848/210 Hospital Street JUL I1999 Mocksville, HC 27029 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BS PROCESSED UNLESS ALL *HZ- REQTJIRED INFORMATION Is PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. name to be Billed K E N nl E T N Contact persaa KE /J �.1� T H FOSTE 12 Mailing Address t ��8dL (o YYI a PuE acme phone 704 - 54<o- i -72� 8 City/State/Lip _ _ 1`�OCKS�/ 1 �-�� , n1 •�- • -27028 susiness Phone 33Co -"i Z3-SSSO Z. Name on ,emit/ATC If Different than Above Nailing Address City/State/Lip !. Application for: IttSite Evaluation 0 Improvement Permit/ATC 0 Both s. System to service: td/House 0 Mobile Homs 0 Business 0 Industry 0 Other S. it Residence: / People ; Bedrooms , �" y • Bathrooms Z U Dishwasher 0 Garbage Disposal "as Machine 0 Bascomt/Pimbing 0 Basement/No plumbing 6. If Business/industry/other: specify type 4 People f Sinks i Cwsaodiss / shovers 4 Urinals # Nater Coolers IP IWDSERVICE: # Seats__ Estimated Nater Osage (gallons per day) 7. Type of water supply: D"County/City 0 Well 0 community s. Do you anticipate additions or expansions of the facility this system Is intended to serve! 0 Yes 0 No If yes, what type' ***IMP0RTANT***CLIENTsAtusTCODIPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN UUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: J 3 5 X 5 5 2 X 13 s X s s-2 WRITE DIRECTIONS (from MockrAlle) to PROPERTY: Tax Office PIN: # 5 -7 49 - 43- 15 -7 9 6 Property Address: Road Name 5 A 1" Q A o City/ZipTiccKs,J .11S 9107,0 If in a Subdivision provide information, as follows: Name: iYIEAOCW{2lDGE CProPosED� Section: Block: Lot: ) 0 1 -AST K $ TO 5, *N, t 0 Racy o (s R 1 b 47;s) Tu R h1 R1GN'T ON SA,, --1 _ APPatcx 0,ea MtLO Tv S QTc n til R S L %A T Date Property Flagged: 6.018 -9f This is to certify that the information provided is correct to the best or my knowledge. I understand that any permit(s) Issued hereafter are subject to suspension or revocation, if the site pians 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 front this application. i, hereby, give consent to the Authorized Representative of the Davie County Health Departmel-t to enter upon above described property located in Davie County and owned by 11'�T/!Ne7W L. -FAST E R _ to conduct all testing procedures as necessary to determine the site suitability. 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). Revised DCHD (07/98) Account No. �5 Invoice No. / �� _ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900654 Tax PIN/EH #: 5749-43-5798.10 Billed To: Kenneth Foster Subdivision Info: Meadowridge Lot # 10 Reference Name: Kenneth Foster Location/Address: Sain Road -27028 Proposed Facility: Residence Property Size: 1.71 Acres Date Evaluated: S bI h-9 Water Supply: Evaluation By: On -Site Well Auger Boring Community Pit ✓ Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % HORIZON I DEPTH - / 2 Texture groupL' L Consistence S Structure L MineralogyI' HORIZON II DEPTH I Z Texture group C UV C Consistence S Structure Mineralogys HORIZON III DEPTH1.7-10 Texture group Consistence P Structure S Mineralogy HORIZON IV DEPTH Ito Texture group Consistence ! S Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE S CLASSIFICATION LONG-TERM ACCEPTANCE RATE 3 b SITE CLASSIFICATION: 1 s LONG-TERM ACCEPTANCE RATE: ' s REMARKS: LEGEND Landscape Position EVALUATION BY: s, Lrf-aY`^ OTHER(S) PRESENT: 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)