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229 Berry Ln (3) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990003838 Tax PIN/EH#: 5718-30-2966 Billed To: R. Brad Hess Subdivision Info: Reference Name: Brad Hess Location/Address: 229 Berry Lane-27028 Pro osed Facility: ATC Number: 4298 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 CONSSTRUCTTION IS VALID FOR A PERIOD OF FIVE YEARS. X�L/iEnvironmental Health Specialist's Signature: Date: 1—/7-zX 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. a, �L)t L] "AWW) —A4f�Af'IvDfd%eptic System Installed By: A .*... Environmental Health Specialist's Signature: )Date: .212-0 1 CQ DCHD 05/99(Revised) . DAVIE COUNTY HEALTH DEPARTMENT Z` Environmental Health Section P.O.Boa 848/210 Hospital Street u Mocksville,NC 27028 D (336)751-8760 IMPROVEMENT/OPERATION PERMIT JAS' 2006 Account M 990003838 Tax PIN/EH#: 5718-30-29 AhEC 1j, H�4l1 Nry H Billed To: R. Brad Hess Subdivision Info: Reference Name: Brad Hess Location/Address: 229 Berry Lane-27028 Proposed Facility: Property Size: 24.29 Acres **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 1�—P #Baths Dishwasher: 0 Garbage Disposal: 121"' Washing Machine:Z' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste:❑ Lot Size Type Water Supply �Vt f( Design Wastewater Flow(GPD) C3 �tY Site: New Repair❑ System Specifications: Tank Size,/PQ GAL. Pump Tank GAL. Trench Width"W Rock Depth rLinear Ft. Other: Required Site Modifications/Conditions: 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.m.on the day of installation. Telephone#is(336)751-8760.**** Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) APPLICATION FOR SITE EVALUATION/I41PROVEMENT PERL Davie County Health Department Environmental HealthSectionP.O. Box 848/210 Hospital Street Mocksvi.11a, NC 27028 2006 (336)751-8760 ***XIIPORTANT*** TRIS APPLICATION CANNOT BE PROCESSED UNLELLALL TlYtlJ}t INFORZ.MTION IS PROVID,EDD. Refer to the INFORMATION BULLETIN for i`� 1. Name .Lo be Dilled � �" it:-A'� '�r S 5 Contact Person �✓7Z Mailing Address _-G, 3 0 7 t:L iG ) :Z q 11, Home Phone City/State/zIP 5f��-1y ,�z� ►J e S1-1-7 Dusinoaa Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: -❑ Site Evaluation El Improvement Permit/ATC th A. System to Service: 121 Houne ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. Typo system requested: 13"Conventional ❑ convontional modified ❑ innovative Maccepted 6. If .Residence: ti People ,,�,// _ fl Bedrooms 3 11 Bathrooms l2blahwasher ErGarbago Disposal Lgniashing Machine Mas amen t/Plumbing ❑Daaement/Ito Plumbing 7. If Business/Industry /Other: verify type 0 People ti Sinks I Commodoa U Showers ti Urinals ti Water Coolers IF FOODSERVICE: tl Seats Estimated Water Usage (gallons par day) 8. Type of water supply: ❑ County/City 03/well ❑ Community 9. Do you anticipate additions or eSp:lnSiolls Of the facility this systelll is iItended to serve? ❑Yes 1;31NO If ycs,what type? ***I/1fP0RT11NT***CLIENTS MUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED III;LOIV. ritlier n PLAT or SITE PLAN.1fU.ST BESUIIM=ED by the client with THIS APPLICATION. P1.opert3,1)iulcllsions:a`/. ,4 1VRITE DIRECTIONS(fromMoclaville)to PROPERTY:' T:lx orree r1N: # .:E:7 21262 6 AX.y Ile, 'X�>, PropertyMdress: Road Namc 2D °! CitylZip /�JGC,�s✓��_ /rl�(.= l='i.��sT i iG-��% ct/..A1e1-/ i5 If in a Subdivision provide information,as follows: b ; .��1,✓t: �,F� tom''% �'� Namc: Section: Blocla Lot: Date home corners flagged: �o� 'ZU-09 'I'llis is to certify that the information provided is correct to file best of my knowledge. I unclerstand thatany pernlit(s) issued hereafter arc subject to suspension or revocation,if the site plans or intended use change,or if the illfornlalion submitted in this application is falsified or changed. I,also,understand that f ans responsible for all charges incurred from this application. I,hereby,give consent to the Authorized Representative of the Dais County IIcalth Depart) lent (o enter upon above described property located in Davie County and owned.by 1> E i3c��rA %4 � �goye q to conduct all testing procedures as necessary to determine the site suitabilit M'I'E �� - /C ' G S SIGNtI'I'URE TIIIS AREA MAY BE USED FOR DMM'ING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Datc(s): Client Notification Date: EMS: Sign given .Account No. (-3a 39 Revised DC1ID(05/03 Invoice No. �:� �_.-- ,�i, ��fg moi!' • �G N7il?1?J38 �••, . � ew S � � y_ zG�'� ,S;ars�"'�.��y��f : ,,f' i .,` , 1� , 9 , -lea � � `''� ..... � �•!� 1 `�` °� �'� � � � r MUCK: Lot: Date llonlc corners flagged:_ /a .'' This is to certify flint file information provided is correct to the best of my knowledge. I understand that any permits) issupd hereafter are subject to suspension or revocation,if the site plans or intended use change,or it file information submitted in flus applicatioll is falsified or changed. I, also,understand thatl am respousiblefor all cha ges incurredfrom this application. I,hereby, give consent to the Authorized Representative of the Dnp ie Colmty Heal ill Depart( gent to cnfcr upon above described property located in Davic County and owncd.by t F't3c.��►a t � ee'C�-/ to conduct all testing procedures as uccessary to determine the site suitabilil}� DATE �� - /G - f: S SIGNA'T'URE TIIIS AREA MAYBE USED FOR DIULIVINC YOUR SITE PLAN(Inchutn all r n-C following: Existing and proposed 7 tt �IF1 R j s r Site Revisit Charge Va cut Notificatiou Date: w4 A BERRY LN n , , ,� .ACCOUlit N0. s g38 __ fllv0ice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003838 Tax PIN/EH#: 5718-30-2966 Billed To: R. Brad Hess Subdivision Info: Reference Name: Brad Hess Location/Address: 229 Berry Lane-27028 Proposed Facility: Property Size: 24.29 Acres Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slo % HORIZON I DEPTH 6 Texture groupS Consistence Structure r Mineralogy HORIZON II DEPTH j �y Texture groupG Consistence _ f 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: 75 EVALUATION BY: LONG-TERM ACCEPTANCE RATE: I OTHER(S)PRESENT. REMARKS 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 3Y&I 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) LIAR-Long-term acceptance rate-gal/day/ft2 DCHD 05105(Revised) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ immom MEN 10 10 111111111 ■■■■■■■■■■■■■■■■■■■■r■.■■■■■.... _ ■ase■■■■■■s■■■■■■■■■■■■e■■■s■■■■ MEMNONiMENNENMEMNONMEMNON ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■a■■■■■e■■■e■■■■■■■MEN