Loading...
214 Longwood Drive Lot 29DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section , P. O. Boz 848/210 Hospital Street • Mocksville, NC 27028 • (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900573 Billed To: Glenn Johnson Builders Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-59-5239.29GJ Subdivision Info: Redland Lot # 29 Location/Address: Longwood Drive -27006 a/V Property Size: see map ATC Number: -3391 **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 -- #Baths , Dishwasher: / Garbage Disposal:, Washing Machine: e 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 e Repair ❑ System Specifications: Tank Sizel,006 GAL. Pump Tank GAL. Trench Width "Rock Depth 19 it Linear Ft. � Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a repres ve 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 l:3.Q2.m. e day of installation. Telephone # is (336)751-8760.**** i� re ulve kn�nf r Environmental Health Specialist's Signature: e & Date: J DCHD 05/99 (Revised) a • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900573 Billed To: Glenn Johnson Builders Reference Name: Proposed Facility: Residence ATC Number: Tax PIN/EH #: 5861-59-5239.29GJ Subdivision Info: Redland Lot # 29 )-Zr Location/Address: Longwood Drive -27006 a# 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 .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONST/RUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: /�Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Com all indicate the system described on Improvement/Operation Permit has been installed in compliance Article 11 0 Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WW taken as a antee that the system will function satisfactorily for any given period of time. <\ \ iop 9 Septic System Installed By: Environmental Health Specialist's Signature: moi/ Date: ) Z ` DCHD 05/99 (Revised) I • ' APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERArd/A Davie County Health Department Environments/Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 2003 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLEQ UIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETI ALL ins _ Q // IY 1. Name to be Billed ��,��� `/��`.tS2�l 9" (�Qil5a it Contact Person �fi1 hs Mailing Address /3y,/ //n(►!E"—": 5 /: ,I Home Phone6J��7_ City/State/ZIP QhC/ ,7ZO Vj Business Phone �yl/ `S 6 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: Site Evaluation {Improvement Permit/ATC ❑ Both 4. System to Service: Ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms o7� Fl - Dishwasher ff-Garbage Disposal ['Washing Machine O Basement/Plumbing .f-1-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: B—County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes B -No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. , 1 /S- Z'e-r"e Property Dimensions: /�f,� •rf '-3� /48 leP 3(a ).StC"� WRITE DIRECTIONS (fro/JmMocksville) to PROPERTY: Tax Office_ PIN: /�� G��s7� ,L2 } ��� �y /�e)oc l� ,� �2 . Property Address: Road Name w o o W 61e. 44 L n it I e Q, 2 City/Zip If in a Subdivision provide information, as follows: Name: T ( c -14- Section: Block: Lot: Date Property Flagged: w I I/ e—t 1 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.,r DATE 1`6 1`e 3 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inclu of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS: Revised DCHD (07/99) Account No -q/ Ob S 7,9 Invoice No. 2a LU � N 48 76,62 sq. it 1.759 Ac.f_ 1 N tP .v_ ?0' Public Utilities Easement ' n CA 1�. 0 i� 15'_ 274.96' — N ai Typical Setbabcs 0 o Interior Lot N N I 49 N 33,874 sq. ft. I 30' 4` '0.778 Ac.t 3—J 15' N 86'44'41" V f 274.97' 0 W 50 37,552 sq. ft. iv 0.862 Ac.t c0 r ��.:.yyri,Y.MIi�a.�s.YiA&Yri2+.i.:i.itfitr+froiie�k: :.. ��.+�,:.���y{SjB}f.�Nf9b2SFMi'��, ,. � .•..:.'. Tf';'T.?�`.:� i co 31 1 45,789 sq. ft. � 0 1.051 Ac.f C4 J S 86'44'41" E � 357.26' o � o U � M N oq Ln .o O 10' Public Utilities iEasement �I Ir -s 0 rn o r` ,30 41,191 sq. ft. 0.946 Ac.t 6'44' 41 " 381.08' 29 44,122 sq. ft. 1.013 Ac.t S 86'44'41" E 407.75' 948 ft ! sq. v N 86'44'41" W in o I 1.040 Ac.t o 434'(Tw 274.25' tal)r- S 86'44'41" E t. o o ZCN 274.57' 158.85' ;t o rn ( o t) 36,112 1 q. ft.IN Z 0.829 Ac.t �I o I(' ) 27 4, 30,580 sq. ft. d _ I`o 0.702 Ac.t ^� N rn ° N 86'44'41" W o o f _ o CN f°- 272.93' 15' S 86'44'41" E N iv Typical Setbacks �� 238.42' 25 `D Corner Lot I 30' 45,182 sq. ft. no I NI 1.037 Ac.t ft 36,244 sq. ., r> of co �o 0.832 Ac. t � 2 6 "? �. 30' 2 10' 7 eSight �v 30,091 sq. ft. --� 0.691 Ac.f 1 25' R' 10'x70 �n g2 6 —C37 S8�— `�8 Z Sight Easement N 6 26g� 32'03"E (4) iso' P��P114.24' 83'32'03" CT�e Line 117.77 � —C35 C34___ N $'3 G3" w �� �, Bethlehe7n D h 10' Public �24� - �'2?Je co Utilities 38,496 sq. ft. '� N 83 -- yr iU'hiu �ight�" Easement p 884 Ac.f 113.84'--- 4 `Ease��ent 10'x70' Sight GN \ \\ t. Easement Cy 1_ 32,240 sq. ft. ,\ 0.740 Ac•f SEE SHEET 1 OF 2 rn APPUCAI ION FON S11 EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department UFJ EnWronmental Health SeWonP.O. Box 848/210 Hospital StreetMockaville, NC 27028(336)751-8760 ***II�ORTANT*** THIS APPLICATION CANNOT BE PROC SBBD UNLESS ALL T REbUMMD j INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for i etruatfhl y�EN J _ C1,14-4 � COUNTY 1. Nash to be Billed S� I1 E� ) w A �/ Contact Person W /"/ - Mailing Address House Phone City/state/LIP 1411,YS41111s c. C. Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address// City/state/zip 3. Application For: to Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. system to Servioei E3 !louse ❑ Mobilo Home ❑ Business ❑ Industry ❑ Other �� « 5. If Residence: 1 People I Bedrooms I Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Hashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/othert Specify type 1 Commodes 1 Showers IF FOODSERVICE: Il Seats 1 Urinals 1 People 1 Sinks 1 Water Coolers Estimated Water Usage (gallons per day) 7. Type of water supply: 9---County/City ❑ Well a. Do you anticipate additions or expansions of the facility this system is Intended to serve? If yes, what type? ❑ Community ❑ Yes ❑ No "ItIMPORTANT"* CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with TRIS APPLICATION. Property Dimensions: 5 g. yes Tax Office PIN: #_ ) — 51� - Property Address: Road Name AaL S City/Zip C�l�/dd1ee, AJ_L° , 2/ If In a Subdivision provide Information, as follows: Name: J� P ,'( /11 ", Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: -rA - D -7-/,9 l 4-X'of Date Property Flagged: This is to certify that the information provided is correct to the beat of my knowledge. I understand that any permit(s) Issued hereafter are subject to suspension or revocation, If the site plans or intended we 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 sulta Ulty. DATE — `f "L�f SIGNATURE — THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inch d all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: I EIIS: Revised DCHD (07/99) Account No. / 3 Invoice No. 1 Y DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5861-59-52329 Subdivision Info: Redland Lot # 29 Location/Address: USHighway 158-27928 see map Date Evaluated: -71 Community Evaluation By: Auger Boring Pit Public 11_� Cut FACTORS 1 2 3 4 5 6 7 Landscape position t. L Sloe % HORIZON I DEPTH - (!� �7 - Texture group1_ �i Consistence Cr SSS ' S Structure Mineralogy HORIZON II DEPTH - q Texture group Consistence `5 'STI Structure Mineralogy HORIZON III DEPTH Texturegroup f'� ,t Consistence Ft^ Structure Sg Mineralogy HORIZON IV DEPTH Texture group Consistence r Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 4 SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: 030 REMARKS: EVALUATION BY: \l= I .;-A t44" X. OTHER(S) PRESENT: 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)