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971 Burton Rd , � ' • •- �� � DAVIE COUNTY HEALTH DEPARTMENT �� _ Environmental Health Section . P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (33G)751-8760 Account #: 990002293 Tax PIN/EH#: 5798-11-7825 Billed To: Branch River Ranch,LLC Subdivision Info: Reference Name: Location/Address: Burton Road-27006 Proposed Facility: Residence Property Size: 2 acres ATC Number: 3159 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSLJED 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 WASTEWAT CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: � .�� Date: C� ���� CERTIITCATE COMPL TION **NOTE** The issuance ofthis Certificate ofCompletion sh 11 ndicate the described on Improvement/Operation Permit has been installed in compliance with Article 11 f .S.Chapter 13 A, Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be tak s a guarant at the system will function satisfactorily for any given period of time. � "� /" d c� M �� � lo I�F� 'DL"C� , �-�o��.�' Septic System Installed By: � A1 , l� Environmental Health SpecialisYs Signature: � � Date: �� / � ��i �� DCHD OS/99(Revised) • + � DAVIE COUNTY HEALTH DEPARTMENT ��- -it7 ` ,, � • • Environmental Health Section � , . , P.O.Boa 848/210 Hospital Street ��� Mocksville,NC 27028 �,� �r _ 6 -Z . (336)751-87G0 IMPROVEMENT/OPERATION PERMIT Account #: 990002293 Tax PIN/EH#: 5798-11-7825 Bilied To: Branch River Ranch,LLC Subdivision Info: Reference Name: Location/Address: Burton Road-27006 Proposed Facility: Residence Property Size: 2 acres **N����iib�Improveme nt/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). T'HIS 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 S' #Bedrooms� #Baths� Dishwasher:� Garbage Disposal: ❑ Washing Machine:� Basement w/Plumbing: ❑ BasementlNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: � Lot Size G Type Water Supply l�/�// Design Wastewater Flow(GPD) .����Site: New� Repair❑ System Specifications: Tank Size�GAL. Pump Tank GAL. Trench Width��Rock Depth�� Linear Ft.� _ Other: �v Required Site Modifications/Conditions: ` IA'IPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S) IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for fin 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 y of installation. Telephone#is(336 51-87G0.**** C- ��� � � �Q p►,�`' ���', � � k� � ��� � 6 � �� � F � � � Environmental Health Specialist's Signature: �` ` Date: � '��1-- , DCHD OS/99(Revised) . ._. . . • .• - ' • , . APPLICATION FOR SI�E EVALUATION/IMPROVEMENT PERMIT � � � Q �/� ., V � Davie County Health Department � Envinvnmenta/Hea/th Section P.O. Box 848/210 Iiospital Street ��AY � 3 Mocksville, NC 27028 2042 (336)751-8760 �'�RONM �A� FNTq�N ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS AI,L THE RE INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed �.�(�' { Q��''rr� �yJ� � (i(�(� Contact Person �r�} '�i__ Mailinq Address / (r �drQx ,�(�(� Home Phone 336- 4 q Q- ZS 3�_ City/State/ZIP �Y��/V� �e. L[�� �y_ Business Phone -" -/�� �7'v 8� 2. Name on Pezmit/ATC if Different than Above ^ ��. � Mailing Address City/State/Zip 3. Application For: fiYSite Evaluation „�Improvement Permit/ATC 17 Bo�h a. system to sezvice: �J House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People � # Bedrooms _� # Bathrooms 3' ,V�Dishxasher IJ Garbage Disposal l�f Washing Machine ll IIasement/Plumbing I I Hasement/ido P].umbing 6. If IIusiness/Zndustsy/Other: Specify type # People A Sinks _ N Commodes # Showers # Urinals It Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of watar supply: ❑ County/City t� Well II Community s. Do you anticipate additions or expansions of thc facility tl�is systcm is intcnded to scrvc? ❑ 1'cs �'IVo If ycs,what type? ***IMPORTANT***CLIENTS MUSTCOMPLETET'IiE RLQUIRED PROI'ERTY INrORMA'tION IiLQUGS'1'l;D BELOW. Either a PLAT or SITE PLAN MUST 13ESUBMI77'ED by the client rvith THIS APPLiCATION. � ` Property Dimensions: �� X'2�G ��1.. Z'��d> WRI'fG DIRGCI'IONS(from Mocicsviilcj to PKO1'GR'1'1': Tax Office PIIY: # S79 Fl - ►1-"78 ZS ]yr,✓y b�. � Zi $01. �E,�r- o� 80� Nr,�,,� Yroperty Address: Road Namc 13N,/LTDiJ �H,D�SR►��b��h�fl2a�{ � MI t�b, �1: Dv� �F.��'r� GRf�f.vC �-.D, City/Zip ��PlvJ�2700h �T, qr1 (��23'Ur1 P�. �}'T� 6r�d4 � �J+f.,�n� " h If in a Subdivision providc information,as follows: �d ��KaKi 11��GON6tic 6�r"T� t�Q�n1G.� ��If.�./1Ar�Cc/ Name: �wt�,d'�� �S ���f Nh� DD►.� �tf�IbD�A.O Pf�$+� SrW—P {�.i�Jj.�J . Scction: Block: Lot: Datc Property rlaggcd: �-22 ��Z� This is to certify tl�at the information provided is correct to the best of my knowlcdgc. 1 undcrstand that any permit(s) issucd hereafter are subjcct to suspension or rcvocation,if tl�e site plans or intendcd usc change,or if ti�c information submitted in this application is falsitied or changed I, also,rurderstaitd thut I nm responsiGle for aR clrrrrges inrrrrrrd frnm !/ris applicatiar. I, hcreby,give consent to tlie Authorized Representative of thc Davic County I-Icallf� Dcpart���ent lo cntcr u�on above dcscribcd property locatcd in Davic County and owncd by I�JCµ �d'�,,,/L n�v�1G-i U.�_ �--- to conduct all tcstiug procedures as ncccssary to determine thc sitc suit ility. UAT� �I2�` J�2 SIGNATUI2� � � (�� ''�' M�w�.tG �Ap�, THIS ARCA MAY BE USED FOR DRAWING YOUR SITE PLAN(Includc all of tLc following: �xisting and proposcd property lincs and dimensions, structures, setbacks, and septic locations). Sitc Rcvisit Cliargc Datc(s): l��`1��,�,� S7�$�,,,,., Clicnt Notification Datc: �� �� �, .N-.� �� EHS: Aceount Na. � o� I 3 C__._ Qeviscd DCHD(07/99) I�►voicc No. �� q � i , ' � I � � � �� ' � ', � I� : I : I i �ZBL � � _ � i ` dZ � � �� 0 : � t ; _ _ _- -- - - - -- - - _ -- � " , � - DAVIE COUNTY HEALTH DEPARTMENT - ' ' . � , Environmental Health Section " ' ' ` Soil/Site Evaluation • APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002293 Tax PIN/EH#: 5798-11-7825 Billed To: Branch River Ranch,LLC Subdivision Info: Reference Name: Location/Address: Burton Road-27006 Proposed Facility: Residence Property Size: 2 acres Date Evaluated: �-Z�D Z Water Supply: On-Site Well Community Public ' Evaluatioa By: Auger Boring � Pit Cut FACTORS 1 ; �, 3 4 5 6 7 Landsca e osition �.. Slo e% HORIZON I DEPTH � � Texture rou Consistence Structure Mineralo HORIZON II DEPTH 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 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: 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-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 Structure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangulaz blocky PL-Platy PR-Prismatic Mineralo�v 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 DC�-ID OS/99(Revised) ■������■■���■�■�■������■�■���■��■��■■�■���■���■��■■■■■■�■����■V�� ■■■�����■��■■■�■��■�■■■�■��■�■����■����■������■���■��■��������■■■ ■�������■■���■������■■���■■■���■����������■����■��!■��■�/������■ ■������������■■■���■■���\■��■��■ ■������������������■����������■■ ■���■���■■���������������������■�■��■�■��■�������■■■��■■����■�■��■ ■�������■����■�■����������■■��■���������■�����■�■■���������■����■■ ■��������■■�����■��������■�■����■����■■����■�■■�■��■������■������■ 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■�����■■��������■■■�■■■���■■�■��■���■■����■■■■■■���■■������■�■■��■ ■■■■�����■■���■■■��■■�����■■���■■���■�■����■��������■■■�■■■■��■■�■ ■�■■�■����■�������■■■■���■��■�■■�����■■■■����■■�����■■■■■■■■����■ ■�����■■��■■�■■■■■■���■■■■■����■ ■■■�����■����■■�■�■■■����■��■■�■ ■��■■�������■■�■■■■■��■■■■■���■■■��■■■■���������■■���■�■��■■����■■ 12-12-202 12:d7PM FROM CRAIG CARTER BUILDER 336 9d0 2620 P. 1 , • ` , . • A ° � Craig Carter Builder, Inc. Hands�n 119 Hwy_ 801 S eui�dsr AdvanCe, North Carotina 27006 N.C. License Unlimited Nt�vember 26, 2002 � Mr. Buck Hall Davie County Health Department � Environmentai Health.Section PO Box 848 . Mocksvi{le NC 27028 .� Dear Mr. Hail, � Craig Carter Builder, Inc. is currently constructing a house for me at 971 Burto� Road in Advance. I am requesting that the septic system utilize the Infiltrator system. � � Sincerely, , � . ���2'�,(,cl �=�/��- � Mrs. Charlie Branch (336)940-2341 • Fax(336}940•2620