Loading...
120 Hagen Road Lot 48DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 hospital Street Mockwille, NC 27028 (336)751-8760 Account #: 990001597 Tax PIN/EH #: 5870-59-5970 Billed To: Marquis Building Subdivision Info: Windemere Fams sec 2 Lot # 48 Reference Name: Location/Address: 120 Hagen Road -27006 Proposed Facility: Residence Property Size: see map ATC Number: 2638 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 .1 90a Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WAST EW C IS AVb FOR A PERIOD O FIVE YEARS. Environmental Health Specialist's Signature Date: 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, Seco n .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY taken as a guarantee that the sy�ss em will function satisfactorily for any given perioV time.LA x Q X I?LA d O Septic System Installed By: -(Zm/� J'J rJ Environmental Health Specialist's Signature Date: Z t DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 ?d 1 o'��.Gl (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001597 Tax PIN/EH #: 5870-59-5970 Billed To: Marquis Building Subdivision Info: Windemere Fams sec 2 Lot # 48 Reference Name: Location/Address: 120 Hagen Road -27006 Proposed Facility: Residence Property Size: see map **NOTE * Theis niprovement/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 _Hol#People #Bedrooms 3 #Baths �2. 5' Dishwasher: 0"" Garbage Disposal: ❑ Washing Machine: Z� Basement w/Plumbing: ❑ Basement/No Plumbing: d Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 0. Type Water Supply CQ&ml Design Wastewater Flow (GPD) Site: New Repair ❑ . 1r N ' System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width Rock Depth /,7— Linear Ft.,�LV Other: l 'E)11�>Ta1 +IQTlo;) JP�S_J_ALL Ll ���- I O.e. KM ti . Required Site Modifications/Conditions: iJs�L�ll ©e,� i3F(-- i`%,_6Q. u -sr IMPROVEMENT/ PERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRAPt. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 00 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 1�1_ on the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: l DCHD 05/99 (Revised) Date: Q � ** TRIMS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED PROVIDED. Refer to the INFORMATION BULLETIN for instructions. CATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Envirwmenta/Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 1. \.PdSe to'be Billed Mailing Address j/A�c U rr �D,,('�L LI l�Uj/ �f City/State/ZIP awl J"C /ICY Z /tY� 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: 00Site Evaluation 4. System to service: Z"House ❑ Mobile Home 5. If Residence: # People Contact Person (?Wgpu -� tJ o IThiet Home Phone 14q —6 qq 7 �� Business Phone S* -65.4 7 City/State/Zip *Improvement Permit/ATC ❑ Business Ll Industry # Bedrooms _ Il Both (.I Other # Bathrooms Z !/ 'Z� ji�ishxasher U Garbage Disposal Washing Machine 11 Basement/Plumbing .4 easement/No Plumbing 6. I£ 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: le-1 ounty/City ❑ Well II Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? 17 Yes FKo If yes, what type? ***Ib1PORTANT*** CLIENTS MUSTCOMPLCTETIIE REQUIRED PROPERTY INFORMA'T'ION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with TI11S APPLICATION. 1 Property Dimensions: A4- 2�,Q 4 Zito fjC (Q(o' WRITE DIRECTIONS (from Mocksville) to 11ROPE'RTY: rho F'c Tax Office PIN: # S� 7p ` ,�q� �G%7� S� Property Address: Road Name ���,�1 ISD �!v-r �% �L City/Zip2W 6 �o z1N�—�-#= If in a Subdivision provide information, as follows:91=14"157 Name: 0100ekl eZ62+ti `� 'J Section: Section: Block: Lot: `f'� Date Property Flagged: © AO This is to certify that the information provided is correct to the best of my knowledge. I understand that any permil(s) issued hereafter arc 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 Wivic County caltlt Dcpartmcn( to enter upon above described property located in Davie.County and o ned by S to conduct all test'ng pr edures as necessary to determine the site s t bility. DATE 7i% SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Exist and proposed property lines and dimensions, structures, setbacks, and sep c ations). Site Revisit Charge ` Ualc(s): Client Notification Date: EHS: Es;] w Account No. ` s Revised DCHD (07/99) „Invoice No. �� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street l/ Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001261 Tax PIN/EH #: 5870-69-0403.48 Billed To: Stone Hinge LLC Subdivision Info: Windemere Farms sect 2 Lot # 48 Reference Name: Proposed Facility: Residence Location/Address: Beauchamp Rd -27006 Property Size: see map 7phslo68 **N0mprvment/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 IN'T'ENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type BO VSC #People #Bedrooms 3 #Baths 7— Dishwasher: 12"" Garbage Disposal: 12"' Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: .? AW -Type T ❑ Lot Size ype Water Supply 111J Design Wastewater Flow (GPD) Site: New 12rRepair ❑ System Specifications: Tank Siz% GAL. Pump Tank GAL. Trench Widthf Rock Depth �� Linear Ft.� r Other: -;�— T)AQ-�i 60-10-J Fi:4 & I Ae-;FAU� 1; IJ GO '0,0 , M, t J . Required Site IMPROVEMYNT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED RADE. ****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.**** A i eco Environmental Health Specialist's Signature: ate: 1 00 DCHD 05/99 (Revised) z . DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001261 Tax PIN/EH M 5870-69-0403.48 Billed To: Stone Hinge LLC Subdivision Info: Windemere Farms sect 2 Lot # 48 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: see map ATC Number: 2638 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 Treatm nt and Disposal Systems). THIS AUTHORIZATION FOR WASTEW UC—­T1UZ1S V D FO PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatu Date: bd 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: DCHD 05/99 (Revised) Date: APPUCJATION FOR SITE EVALUATIONIRIP110VEMENf PEIJMIT tic ATC Davie County Health Department' Environmenb/Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 OCT z 2000 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. Name to be Billed S:I1. %e h�g L�� Contact Person /Q c Q V 0'-( Mailing Address _So A/ _ )TI y N Home Phone City/State/ZIP -1 /9--Q �c. C .S t/ I � � / %U L Business Phone _�J o j— 15211 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation L2-�rovement Permit/ATC ❑ Both 4. system to service: Ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: C/# People Gam! # Bedrooms # Bathrooms Z' IkDD shxasher II Garbage Disposal rl Washing Machine ❑ Basement/Plumbing CI 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: ET County/City ❑ Well ❑ Community s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes C1 No If yes, what type? If yea, what type? ***1MP0RTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED I BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: v e� �7 6`y - Tax Office PIN: # — co //' G 416�J , y9/ Property Address: Road Name �4 uC) �" �I City/Zip 14141�0-1ce-/1/C'Okxjc U in a Subdivision provide information, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: 1jo&5 CNVRUI Ta eAmt 6(nW A��iiArfP %td iPOPMTv 0A LeFf. Name: yrlw(Nti7httxnS iovr, 3, Section: �� Block: Lot: = �� Date Property Flagged: -� " This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits) 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 1, also, understand that 1 am responsible for all charges Incurred front 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. DATIC _ � i) - --) w C-) BIGNATURE - : V . f . _ __ THIS AREA MAY BE USED FOR DRAWING YOUR OrM PLAN (include all of the ow gt Existing and proposed property Una and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date{s): Client Notification Date: EAS: Revised DCHD (07/99) Account No. Invoice No. 0. At, APPUCATION FOR SITE EVAUJATiON/IMPROVEMENF PERMIT & ATC Davie County Health Department EnWmnmental Heat/th Section P.O. Box 848/210 Hospital Street Mocksville, NC 21026 (336)751-8760 AUG 2 5 1999 ***IMPQRTANT*** THIS "ILICATION CUNOT Bic PWMSMW UNLESS ALL THE REQUIRED IN1rO1M11TIOH IS BROVIDeD. Refer to the 11WORMATION BULLETIN for instructions. 1. liana to be Billed WEMJ[,1 DCJfWF;A HJT COMPJWI Contact Person �►) �ZCY Nailing address _ 2431 ?-EV1JOknA RO. Boat Phone 336.116•1.008 City/State/9=P ui1N1T6A-S.A1X % ,tic, 21106 rumness Phone 336.111 0018 Z. liana on Pewit/&= ie Dieeerent than W"T* Hating address city/state/siP 3. Application rot: lite :valuation 0 Improvement Permit/ATC 0 Both fLawoo 4. system to ser-rioe: I/Houses 0 Mobile Home 0 Business 0 Industry 0 Other a. If Residence: i people t Bedrooms f Bathrooms O Dishwasber O Garbage Disposal O W"bing Machine O saseaent/Plumbing O sasesent/No Plumbing S. i! Business/industry/other: speoi:y type f Commodes I People i sinks f showers # Urinals t# later Coolers Ir TOODSERVIC3: # Seats estimated Nater Usage (gallons per day) 7. Type of Mater supply: 0 County/City O Nell O Community s. Do you anticipate addition or expandons of the facility this system is Intended to serve? 0 Yes ETNo If yes, what type? ***IMPORTANT*** CLIENTS HOST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MAST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: Sce 1172 Tai 0111ce PIN: N �D �U —6 fin-' G Property Address: Road Name �'C uG 1f �� J City/Zip If in a Subdivision provide information, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: PK0PCMTV a� Lerr. Name: IVM 7:eRV.1S ffi Section: �/ Block: Lot: _ ) Date Property Flagged: _2 AV This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit($) Issued hereafter are subject to suspension or revocation, if the site plans or Intended ase change, or if the Information submitted in this application is faisifled or changed. 1, also, understand that I ane responsible for all charges incurred frons this'appUcadom 1, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. THIS AREA MAY BE USED FOR DRAVMG YOUR SITE PLAN (include all of the Mowingt Existing and proposed property Una and dimensions, structures, setbacks, and septic location). Site Revisit Charge I Date(s): I Client Notification Date: I EAS: Account No. Revised DCHD (07/99) Invoice No. 10 C r 41 rOCK I� 9 8 I CARL D.B. 1', 262 S 85.33'08' E 261 I 2.22 ?+ 298 3kNCLE IRON FOUND 025 + 7 S 83 23'37• E 76 48 - 49 26 29 616.09 �'°' o + + �! 271 252 25 254 �� y 1� 47 2 5 56 ti 55� 206 250 56 155 1 75 272 249 «� 7 90 �, 24 20 102 va 28 `� 46 24 ,.. 20 9� 74 "1 ��- �20 �0 154 153 273 258 259 �' 27 - 140 Ise 187 jJ 186 Fly G 18" 45 2'Itel 193 15744 t 158 19 � "r y.�Q s'1. rn� 194 + = 12 D 216 244 9j 42 17_i" 2 0 43 IIZ 1 19 9 198 197 395 196 A 79 _ + G j +I � 11 _ 'IV i la \%' 10 + LL2 — 223 IB 1 Nl',1 1 Zn 26 ��' N v 80 28 ao 30 219 �1 t 126 125�$ ./7 201 e1 12� _ 70 l9 101 + + / .A7 2 123/ti� o / / 9 10�m-y / 122 All v o• �� v� 51 / p 169 8 120 168 5. 97 3109' y LLrO O 54 / S 37 . ly ' 101K- + GE OAK 38 " . V, . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Brant Godfrey Proposed Facility: Residence Property Size Water Supply: Evaluation By: 1W PROPERTY INFORMATION Tax PIN/EH #: 5870-69-0403.48 Subdivision Info: Windemere Farms Sec.2 Lot #48 Location/Address: Beauchamp Load -27006 See Map Date Evaluated: IO On -Site Well Community Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH . S Texture groupt� Consistence Structure MineralogyI HORIZON II DEPTH Texture group Consistence Structure S L MineralogyI . ; HORIZON III DEPTH Texture groupSr' 19 Consistence $ Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE o . SITE CLASSIFICATION: 0 S LONG-TERM ACCEPTANCE RATE: ©•4 REMARKS: EVALUATION BY: Ca &4 -Ad 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)