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301 Bamboo Ln (2)DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002541 Billed To: Frank Tharpe Reference Name: Proposed Facility: Residence IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: 5863-16-4711.FT Subdivision Info: Location/Address: Hanes Trail -27006 Property Size: see map **NOTI:ll *iisgmprove9 ent/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 / t #People #Bedrooms :9- #Baths 1-7— Dishwasher: en/ Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: X Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size All, Type Water Supply _ Design Wastewater Flow (GPD) -C 3l- Site: New 21"' Repair ❑ System Specifications: Tank Size/ 2 GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width' Rock Depth _Z2 " .r Linear Ft.SPd ! IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISERS) 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.m. on the day of installation. Telephone # is (336)751-8760.**** ,11 hy tFA zo/Wouy- Environmental Health Specialist's Signature: ` Date: _S' S' " P gn DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002541 Billed To: Frank Tharpe Reference Name: Proposed Facility: Residence ATC Number: 3397 Tax PIN/EH #: 5863-16-4711.FT Subdivision Info: Location/Address: Hanes Trail -27006 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 CONSTR/U%CTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: S�f/ Date: -2 ---Z f 0 7 � 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: " e"o r Y � *orc- Jj Q '� 20 lc� a pv' jl a Environmental Health Specialist's Signature :�! D�/lI Date: DCHD 05/99 (Revised) 1•j" ///o3 X—� S/��-� APPLICATION tOR SITE EVALUATION/iMPROvmw PERMIT & AT Davie County Health Department V" § Environmental Health Section V P.O. Box 848/210 Hospital Street' �3 Mocksville, NC 27028 aa. (336) 751-8760 FNVIR * * * IMPORTANT* * * THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL TH INFORMATION IS PROVIDED. Refer /�to the INF/O�RMATION BULLETIN for instructio 1. Name to be Billed 7 /7/%/IJiG T/f��Pc JT) Contact Person Mailing Address / 15600)" 1-19NO/A/% /.-2. Home Phone(3 30 9a V- -3,9,9,3 City/State/ZIP J4/4a/ j2 al 5AZLEM 4AC `5 l � Bus ess Phone ---�_ 2. Name on Permit/ATC if Different than Above >11 Mailing Address City/State/Zip x -417 3. Application For: Y<Xte Evaluation ❑Imp ovemement Permit/ATC p/-1 °th 4. System to Service: _ 9 House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: # People_ # Bedrooms # Bathrooms 191 0 Dishwasher V Garbage Disposal a Washing Machine fg Basement/Plumbing ❑ 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: ip County/City .2 Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ®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: e l'- WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # y- UI 3 �-7 / ;o Bd/ L. O Al �FO / -7,9 y/IDR N Property Address: Road Name #A/I E -S Za G V & LL Z� A 0 — 3 !N /-' -7-,0 City/Zip ) 0 I//9 /L/G -Z: .%&SSG 1 //d L-7 / 5 T P/4 V&D If in a Subdivision provide information, as follows: J $ 7 /3 / L Name: Section: Block: Lot: Date Property Flagged: (-Z 2a O 'Z— This 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 Count He. h tment to enter upon above described property located in Davie County and owned by Grit to conduct all testing procedures as necessary to determine the site suit bili DATE - � O�-, 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). Account No. Revised DCI�D(07/99)-------- nvoice No. g I fl�.n333i" �tt n ij Sjq�� f! Hy �, 133•; 3, & s "et 238 312 99W R � 1 1 301 ... .__ 1582 t,. e. 3 3333 +3,3 12l � F "Iqlk, 3 pa,� - — i ..,.. �•Iri �... .a` "159 1 214 138136 : 1366 1 1 1 1 1446 245 ' X91 14 1 4 48 526 632 -,-' 1549 1565 1572 —~ 423 ------ 1604,-: 1604 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002541 Tax PIN/EH #: 5863-16-4711.FT Billed To: Frank Tharpe Subdivision Info: Reference Name: Location/Address: Hanes Trail -27006 Proposed Facility: Residence Property Size: see map Date Evaluated: -D? Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texturegroup' Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure , Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 6 LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: 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) ENVIRONMENTAL HEALTH SECTION P. 0. Box 848/210 Hospital Street Courier #09-40-06 Mocksviile, NC 27028 Phone #: (336)757 8760 December 31, 2002 Frank Tharpe Sr. 131 Brooks Landing Drive Winston-Salem, NC 27106 Re: Site Evaluation/ Hanes Trail Tax Office Pin : # 5863-16-4711.FT Dear Client(s): As requested, a representative from this office visited the aforementioned site on December 30, 2002. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, the site was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr., R.S. Environmental Health Specialist RH/df