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464 Brushy Mountain Trail �, •�, DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section �� /� � P.O.Boz 848/210 Hospital Street Mceksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000829 Tax PIN/EH#: 5870-18-1357 Billed To: Matthew McKnight Subdivision Info: Reference Name: Matthew McKnight Location/Address: Brushy Mountain Trail-27006 Proposed Facility: Residence Property Size: 5.055 Acres ATC Number: 2230 **NOTE** This ImprovemendOperation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AiTTHOWZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Deparhnent 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). THLS 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 S ecification: Buildin T e / p g yp ,��Jllf C #People�_ #Bedrooms�� #Baths o�. S Dishwasher: Y-� Garbage Disposal: ❑ Washing Machine: � Basement w/Plumbing: ❑ Basement/No Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ , Lot Size �� Type Water Supply �i°// Design Wastewater Flow(GPD) �� Site: New Repair❑ System Specifications: Tank Size�GAL. Pump Tank GAL. Trench Width��Rock Depth�� Linear Ft.�� Other: (l�u�l GC"css� �/.t�G'�� `� `�LXt_� Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 830 a.m.to 9:30 a.m. or 1:00 p.m.t 1: 0 p. .o the day of installation. Telephone#is(336)751-87G0.**** Environmental Health SpecialisYs Signature: � > � �- Date:��"�9 DCHD OS/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Heaith Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (33G)751-8760 Account #: 990000829 Tax PIN/EH#: 5870-18-1357 Billed To: Matthew McKnight Subdivision info: Reference Name: Matthew McKnight Location/Address: Brushy Mountain Trail-27006 Proposed Facility: Residence Property Size: 5.055 Acres ATC Number: 2230 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLJST 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 CONSTRUCTION IS VALID FOR A PERIOD OF 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 ImprovemendOperation 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. X��,� � ��X� _�-�-�-- I F � Septic System Installed By: Environmental Health Specialist's Signature: 6� � � �, Date:OZ',��('!� DCHD OS/99(Revised) C�v;,,��*�, i � at►Nut;t►I IUN Da le County ealth Department p�MtT&AT � � � � ��k � .� Environmenta/Kea/thSea6►on � � � S'.�' ,(� p� I P.O. Box 818/210 8oapital 8tra�t \.�h� Mockavilla, t� 27028 � • � � 5 1999 (336)7g1-8760 � .,.�� u� ***2l�ORTANT*�* THI$ APpLICATION GNNOT Eb' PROCd'SSSD UNLa88 ALL Ha QtLxR�D0UN1Y INH'ORMATION t8 PRCV2DED. Re�ar to !he ZNH'O�+JATIO�N BULL�Ti�t tor atioas. � 1, ltas� !o b� sill�d /�"/l1 ��/[L�cr/ -.�"/ `l7i��i� Conlaot �raoa _i!�,�� GYy'� ��s1�'t•r��`/�' G►% 1dRilis�4 Addr�� 2/T/�!'1�o� �� Ra� pbost� ��fo �—�Z�� J r.�t�/stat./s=r f�i/c�t�I C'_P , yL. Z 7d0(n su.ia�aa reon. . S� `�"90� �SG/.� 2. Nas� oa P�sait/I►TC i! Di!l�ra►t lhat► f►bow 1fai11nQ lldds��• Citiy/Sla��/sip . a. !►pplioation ror: Sits avaluation 0 Improv�t p�zmit/ATC ❑ Hoth 4. s�.r�ua co e.�.so.: ouso 0 M�obile Hoaue ❑ Business � =adustsy O Oth�r s. s� Residaama: � Peopla � � Bedrooms .� � Batbrooms _<� GYbi�hras�r O Garbaq� Dispoad as1�9 Msahi� 0 Saf�nt/plvabiaq 0 Sas�ntllio pinsbiaQ 6. 2! suaia��/Is�dustsy/Oth�r: 8p�oi�Y tYP� f P�oPl� � Binkt � Coaod�t # 8hox�r� # tTriaal� � Kat�r Cool�r� I!' 8'a0D8ERYIC�: � 8sata Estimatad 1Pa�c Oaaq� to•uoa. ra= e�) ,. �. or ��►�= s�iy: a co,�ty/city c�.ii a co�ty e. Do yon anHcip�te addlHons or e�ansIons of the facWty tWs aystem!s intended to aerveT � � � / / . /�� ,f� /� � u yes,wlwt type? a 0'� s� l��9 7�h r'o�vj-� i v? 7�h r� .�'"'� �c�'r� _ ***IMPORTANT�'**CLIENTS M[IST G�DMPLETETHE REQUIRF.D PROPERTY INFORMATION REQUE3TED BEIAW. EIWer s PLAT or 31TE PLAN MIIST BES M11TED by tbe tltart �aiW TH13 APPIICATION. j�- . . Property Dimeaslons: � �� dfl WRITE DIREC`110N3(trom MockavWe)to PROPERTY: F��-uJt�' /� Tai Ofire pI1V: #� .�"�r7o- /8- /3 b'rJ l`r"�a,=,z. /�2'�� s v�!�� . �e�`�� l.� Property Addres�: Road Name��ks�u YVI�•�i�a.l� �o ��/�i�iv:�cv ICa'`�.� c�� :�.�es- � City/Zip �tu rr�..�._ Zzo d 4 �„ ��.c j Li� ./t�i�t�, ��. ��.,� If in a Sabdivlsioa pravtde informaHon,as follawa: Q�'�'�-�/e� �oaC� , ��os S i n�c��s c�f'�� 6� Name: <�!?o��r �' �iZ�J_ � `!'�`r>ll �t/ �aL O u ' o .S�f"� Section: Block: Lot: Date ProI�erty FIaB�edt �/�- ,/� ` �� Thia i�to cerNfy t6at the lnformaHoa provided is correct to t6e beet of my knawledge. I anderstand thst any permit(s) iasoed 6ereaRer are enbject to sa�penston or revocadon,if the slte plans o�Intended os�ch�nge,or if t6e informadon aabmttted in thts applicallon ts fal�ified or chenged. I,also,anderatand tbm I ant nsponslblc jor a►l cba�ges tncurred frotn tbJs appllceHon. I,hereby,give consent to the Aat6ortiecl RepresentaHve of t6e Davie C ty Ha�lth Deps�� to enter apon�bove deacrlbed prnperty located in Davie Coanty aad owned by ��Su�v,, v,,c; to condact all teaHng procedarea ts neceassry to dehrmine t6e aite�nlbbWty. DATE r - _ ^�d�—�IGNATURE � �� .-�=r � THI3 AREA MAY BE USED FOR DRAWING YOUR S1TE PLAN(Inclade all of We follo�ving: FaiaHng and propoeed property Ilnes and d[meastons, etractarea, eetbacka, snd�epNc locatlona� Site Rtvbtt Chuge Dste(a): Client NodHwNon Date: EAS: � Accoant Na �� Revised DCHD(07/99) Involce Na 0�� , � �� r i � � i � i i � , BETTY SUE CORNATZER TUCKER , 0.8.208,PG.155 � � � , , , � � � � � . � � �s000 � � � Hor�•a•w —► .. wr. �a000 $� soo.00 rmu `» Fo � 0 t aREq= 5.055 qCqES = � �C �° N � A N N V ^+ \ v w. \v o U \ o a, £ � 2 � � � .►- 5 07•41'04'E N1P. 500.06 , , BEfTY SUE CORNATZER TUCKER T U1"T n R 9AA PG 155 12�1- • �� '_,�_,,, > DAVIE COUNTY HEALTH DEPART'MENT Environmental Health Section Soi�/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000829 Tax PIN/EH#: 5870-18-1357 Billed To: Matthew McKnight Subdivision Info: Reference Name: Matthew McKnight Location/Address: Brushy Mountain Trail-27006 Proposed Facility: Residence Property Size: 5.055 Acres Date Evaluated: �//�,//r'� 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 L L Slo e% HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH �� Texture rou Consistence f Structure �9 ( �i/ Mineralo r�_' " ` HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE _._. CLASSIFICATION LONG-TERM ACCEPTANCE RATE , SITE CLASSIFICATION: OP C EVALUATION BY: / u LONG-TERM ACCEPTANCE RATE: ! OTHER(S)PRESENT: REMARKS: (�'(,�-PI S�`��M 6�7� ��- r" LEGEND Landscane 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 s[icky 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 Mineraloav 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 DCHD OS/99(Revised)