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517 Angell Rd DAVIE COUNTY HEALTH DEPARTMENT �./ --- -' ' Environmental Health Section �4�I � '�3-G�J P.O.Boa 848/210 Hospital Street `�:(�D Mocksville,NC 27028 (336)751-87G0 IMPROVEMENT/OPERATION PERMIT Account #: 990000867 Tax PIN/EH#: 5840-17-7655 Billed To: Wayne Hutchins Subdivision Info: Reference Name: Wayne Hutchins Location/Address: Angell Road-27028 Proposed Facitity: Residence Property Size: 150x259x151x2��� **N�*-Ttilb�mprov�me nt/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater . system. An ALJTHORIZATION 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 PERNIIT 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 /I��S� #People�` #Bedrooms � #Baths � Dishwasher: � Garbage Disposal: ❑ Washing Machine: d Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size ��y� Type Water Supply G�/l� Design Wastewater Flow(GPD) ��� Site: New�Repair❑ System Specifications: Tank Size%j�Da GAL. Pump Tank GAL. Trench Width�l r�Rock Depth��7�� Linear Ft. C�� Other: _`,�rS��f 1��. V�i�,� ' ����18� Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLiJENT FILTER RISER(S)IF 6 K BELOW FINISHED GRADE. ****NOTiCE: Contact a representative ofthe Davie County Health Deparhnent for final inspection ofthis system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.o a of installation. Telephone#is(336)751-87G0.**** A ,S"��'�'d,n � �e►�hc�S S�� w��r ,� �� w��� � Environmental Health S ecialisYs Si ature: ��;(i1 �'�l-J�- Date: �c2 � P � I DCHD OS/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-87G0 Account #: 990000867 Tax PIN/EH#: 5840-17-7555 Billed To: Wayne Hutchins Subdivision Info: Reference Name: Wayne Hutchins Location/Address: Angell Road-27028 Proposed Facility: Residence Property Size: 150x259x151x.2��' ATC Number: 2276 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 C NSTRUCTION IS VALI�R A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: � Date: !� ��U`��l" CERTIFICATE OF COMPLETION **NOTE** T'he issuance ofthis Certificate ofCompletion 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. r • D � 30���k�� , �,�KK' Septic System Installed By: %�%�G'/�- Environmental Health Specialist's Signature: Date: � � < `��� DCHD OS/99(Revised) A PLICATI N FOR SITE EVAWATION/IMPROV�JNENT PEHMtT&ATC � �"`�`--�� O ``' �4=� _ s . � � �/��' c � �, Davie County Hesith Department ��-� `� � � � Env�►ro�mente/Hea/tfi Sealfon - �Q� 1 6 I,� � �y r p o. �o: e4e/2io �o.�.ta st�..t _ �'�'� ' � � ��/ l�ock�vill�, NC 2?028 � .�Tii(I�'0;,'11.NiA! !� ('1 ' �� �� �� I336�751-8760 ,_ �1YlE�htf�� `-�it� •**Zl�04tTAHTR�* T�IS 71ppI+ICl1'riGN GNN� SS pROCC98SD UNL�88 71LL T�S RaQUIRbD =tt�RrAT=ON i8 pAOV=DED. R�lwc tio th INy'ORMI�TION BULI.� I2i tor iastruatioas. � 1. 1�aa. tio b. sill.a �' l%.:�•S "'kJl en nf.r.,�n ,_��!� i�-o," ��'�t- l��`�`'�s ita3cYinq �dds��• � ` �C�D��..7 I7 ���',Z��p� -•Q� _. ! _ Cit7/Ytab/ti0 _T °� �fnai• p'hoa� '�/ ~ � � s�l) Z. Mw on �ssit/�'PC i! Di!l�synt thia �bo�►� 1hi1�pQ �dar��• City/�tab/iip a. 71pp11aatioA toss it� nstion � Improv�t p�rait/1►sC 0 Hotb �. e�.c.. to s.s.io.� ona� 0 M�obii� 8om� 0 8niia��s 0 =nduatsy O Oth�r s. z! idaaa�: � p�opl• � f Badrooma � � 8athrooms � Di�hMul�r o wsbaq. ai.po.a 9a'�a�s�saQ xaohsa. sa..a.�t/aim�� o su.■.at/eio piu.bsaq � � 6. sr swta.••/In�u•trY/otA.rr �oily typ. � P�opl• � asafc• �, � Coaod�� f iho�zs � Usiaal� � ltabr Cool�r� IZ' 1'0�8ZRYIQ: � 8�its =ttimstt�d 1litsr OtiQ t4ul�s � �ill 7. �p� a! wa�r �upply: 0 Couaty/City �'1��11 ❑ Caaa�uaity e. Do yon and¢Ipate sddiHon�or es�psndonr oithe iscWty thb tyttem b intended to�erve? 0 Ya �O U ya,what typeT .__ — --...._.. ""'IMPORTAIV7Y'*"CLiENi��MUST CbMPIETETHE REQUIRED PROPERTY INFORMATION REQUESfED BELOW. Either s P[.AT or SITE PLAN MUST BESUBMITTED b t6e eUent w�lt 11f13 APPWCATION. `` / ����. �jL �- I�'�j!' `` y Property Dimen�iowt ��x�`���/`��/Y�� WRITE DIREG710N8(from Maksville)to PROPERTYs Ta:081cePINs # -=�� � .� ,�u--� ��� �d �/�c��� �.-L/ ���1 ,PY�,� Pcoperty Addreu: Ro�d N�me n _ � n� � l-o�f� � � � � p �1 � �// � �. /� � CI 21 ✓ DL. S�/, P � �����. ��'h , v���✓� �'�r�e�� r r If tn�Subdivbioa prwide iniorm�don,�u folimv�s D� �?��`��;,��. /� Dl-1�7`O� . N�mes n ,� G.Y �A,•>.P�S�-�/yt�%�� N�'��, . ,--, &cHon: Blocks � Loh Date Property Ft��ed: i �'�' /(G �! / T61s b to cerHh►that the InfbrmaHon pt�o�vided b con�ect to t6e bat oimy Icno�►ledga I anderatand t6at any permit(f) lasaed 6eceafter are�abJect to�wpewlon or revoc�Hon,lt the dte pl�w or�ntended m�e c6wn�e,or if t6e InformsNon �abmitted in t6b�pplicstton V filsifial or chan�ed. l,also,und�tstand t1ia�I am ruponst6la jor all cborgu lr�cumd froni tlils opppcodo». I,6ereby,�ive con�ent to the Aat6orisisd Repneuntative o?t6o�Dsvie Cawty Halt6 DepaMment to enter apon�bove dacttb�d property{ocated in Davie County�ad awned try to eondact ap taHn�peocedora a�aee�A►tA�•e�•�!•�•+�•_��!:��•���;!;� n��_ 1 )— 1 G�-- g I SIGNATURE CG � � TH1S AREA MAY BE USE�U 1+'OR DRAWING YOUR$1TL PI.AN(Inciade a f t6e iolla�rin�s E�tinQ�ad prnpa�et� property Una and dimen�ioa, �tructara, utb�¢kt, tnd�epNe IocaHow). 8tte Revbit C6ae�e Date(�): .� Cltent NoHBcaHon D�te: � � � EA3: I � Acconnt Na _�� Revlaed DCHD(07/99) Invotce Na //� n � � � 7 7 7 9 ��'ia36�' r41 �-��i : i:�V%.`,^.K,y�� ' ' f :b4�t;��',''7•^�� � f � � �� This map is for PERC TEST and BUILDING PERMIT purpose only. The Davie County Tax Administrator's Office assumes no liability forany information contained on this m . n 4 COUNTY-ID:F50000001104 ' I October 26,199911:38 AM � Parcel Identification Number i 5840-17-7655 �' � `� �' � DAVIE COUNTY HEALTFI DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 9900Q0867 Tax PIN/EH#: 5840-17-7655 Billed To: Wayne Hutchins Subdivision Info: Reference Name: Wayne Hutchins Location/Address: Angell Road-27028 /� Proposed Facility: Residence Property Size: 150x259x151x Date Evaluated: /�^�� �7 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring t� Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition Slo % L HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH '• �d� Texture rou Consistence � , Structure � ( ' Mineralo HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON � SAPROLITE CLASSIFICATION ,E, LONG-TERM ACCEPTANCE RATE 2 'Z SITE CLASSIFICATION: w d� �`'y'�16���C fCf9iv EVALUATION BY: G LONG-TERM ACCEPTANCE RATE: � OTHER(S)PRESENT: � / a c, REMARKS: � P-,��Y • lp -- !CS� . � i CvU � l�✓��'7��- LEGEND Landscaae Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Tenace 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 tructure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineraloev 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-gaUday/ft2 DCI-ID OS/99(Revised) ■■�■����■■���■■�■■�■�■�■■■��■�■■��■■�■■��■■��■■■■�■���������■�■�■■ ■������������■���■��■���■���■■■�■■■����������■■���■■��������■■��■■ ■�■���■�■����■�■�■�■■��■■■�■���■��■��■�■■■���■�■�■■��������■���■ ■■��■■��■■��������■��■�■���■■■�■ ■�■�■■���■������■��������■ ■�■�■ ■�����■■��■��■■oo�e■■�■■o�����■�■���■■■����■����■��s�0■����������■ ■■������■■�■���■��■�■■���■�■■■�����■■���■�■��■■�■�■��■■■■��■■�■�■■ ■���■����■�■�■��■�■■��■�■��■�■���■�■■�■���■��v���■��■■�■���■��■��■ ■��■■■■■■■���■■�■�■■�■��■■�■�����■�■■�■���■■�e■��■��es�■�■�������■ ■�����■■■■■���■�■��■■�■��■��■����■����■�����■�■��■��■■■■������■�■■ ■■�■�■■�����■■��■��■�■��■■�■�����■��■�■���■����■�■s�■�■■o�����■��■ 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