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300 Campground Rd (2), � DAVIE COUNTY HEALTH DEPARTMENT yy�/'��—�d Environmental Health Section � P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-87G0 IMPROVEMENT/OPERATION PERMIT Account #: 990001134 Tax PIN/EH #: 4797-41-4609 Billed To: Wolgang Brodauf Subdivision Info: Reference Name: Herb Brodauf Location/Address: Campground Road-27028 Proposed Facility: Horse Bam Property Size: 8.941 Acres **N()TE*'� Thi b�mprovement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALTTHORIZATION 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 #Baths _� Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement wlPlumbing: ❑ Basement/No Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 0 Lot Size Type Water Supply �/ Design Wastewater Flow (GPD) ,/� D Site: New � Repair ❑ System Specifications: Tank Size � GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width ���Rock Depth ��Linear Ft. �OO � 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 8:30 a.m. to 930 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** S%�s�v d��BT � �fI w ��' �� Environmental Health SpecialisYs Signature: /�/� Date: �'�% �� DCHD OS/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001134 Tax PIN/EH #: 4797-41-4609 Bilied To: Wolgang Brodauf Reference Name: Herb Brodauf Proposed Facility: Horse Barn ATC Number: 2397 Subdivision Info: Location/Address: Campground Road-27028 Property Size: 8.941 Acres AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his Authorization for Wastewater System Construction MLJST 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 WASTEWATE ONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: � -�. � Date: �/��`'� .7 j Gr�' CERTIFICATE OF COMPLETION **NOTE** T'he issuance ofthis Certificate of Completion shall indicate the system described on ImprovemenUOperation 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: Environmental Health Specialist's Signature : DCHD OS/99 (Revised) Date: ����.� �� Please complete the highlighted area(s) and return. � � � l5 U U TION FOR SiTE EVAWAT10Nf IMPROVEMEM PERMiT & ATC Oavie County Hea{th Department �� z� 2�00 Environmenta/ Hea/th Se�ion P.O. Box 848/210 Hospital Street Mocksville, NC 2702B ENUIROPdi;1ENTAl NFAI (336) ?51-8?60 DAVIE CQUN?Y ***II�ORTANT*** THIS APPLICAT20N CANNOT HE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. /. ,� Y�i i y d �, u,. � v� i 1. Na�mo to be Hillad Mailinq Addrees 3B0 Citylstatolzzp �i Y.` e,/YG.Z�62.� 2. Namo on Pormit/ATC i! Diiferent than Above Mailiny J►d�dresa Contact Pareon Home Phone /0 / — J T� ' ���� Huainesa Phone !�/ rp6 � �� / �� � CitylState/2ip 3. Application For: �3ite Evaluation ❑ Improvement Permit/ATC ❑ Both ;. syst� to sez„i�a: ❑ House ❑ Mobile Home ❑ Business O Indus�ry � Other oY1' i'�' � � �- s. ' if Residence: II People � Bedrooms � t Bathrooms �o � (l DishMaaher II Garbage Diepoaal ll Washinq Machine 11 Haaement/?lumbing 11 HaeementlNo Plumbing 6. It Businase/Induatry/Othor: 8pecily type / Commodee � Showers � Urinala � Peopls � 3inka / Water Coolera IF FOODSERVICE: # Seats Estimated Water Usaqe (qallone per day) 7. Z��e of water supply: � County/City �Rell � Community 8. Do you anticipate additions or ezpaosions of the facility this system is iatended to serve? Q Yes No Iiyes, what type? ***/h��'�!�?'AN..T***�:.9�;�.':�..J�Ti:�ri►iri.�ic�i'iiE REQUIREDPROPERTYIN['ORMATtON�iF.n�IFSTFn nGi.uN'. Eit6er a YLAT or SiTE PLAN htIIST BESU�MI7TED by the clieat with THIS APPLICATION. PropertyDimeasions: 62�"i2'��L'--- ����-1 � � �t rr# �} 7 i�d Tax Ofiice P1N: ,_ _ _ _ Property Address: Road Name _�� k�r � c�tyiz�����, e, �G�6�� If ia a Subdivision provide information, as fo{lows: Name: Section: Block: Lot: WRITE DIRECTIONS (from MocicSville) to PROPERTY: � •�fl �r/�/✓� z�r-,e�, vL �/62 ��%f� � �� � CO- (,tws B-Lr.uO ol � � B—� GR��(d�-�y � � � D D _� Date Property Flagged: �f�o�6�00 This is to certify that the information provided is correct to the best of my knowledge. I understand that aay permit(s) issued hereafter are subject to suspensioa or revocatioa, if the site plaas or intended use change, or if the information submitted in this applicatioa is falsiGed ar changed l, also, rrnderstand that I am responsible jor al! charges incurred jrom tbls applicatlon. I, hereby, give conseat to the Authorized Representative of the Davie County �iealth Department to enter upon above described property located io Davie County and owned to coaduct all testing procedures as aecessary to determiue t6e site suitab' � i'if� i G � �%/ �� SIGNATURE THIS AREA MAY BE USED FOR DRAWIl�iG YOUR SITE PI.AN (I de all of t6e following: E=isting and proposed property tines aad dimensions, structures, setbacks, and septic locations). Site Revisit Charge � Date(s): I Client Notification Date: I EH5: Revised DCHD (07/99) Ac¢ount No. � Invoice No. 0 . . . .� � � ' DAVIE COUNTY HEALTH DEPART'MENT Environmental Health Section Soi]/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001134 Tax PIN/EH #: 4797-41-4609 Billed To: Wolgang Brodauf Subdivision Info: Reference Name: Herb Brodauf Location/Address: Campground Road-27028 Proposed Facility: Horse Bam Property Size: 8.941 Acres Date Evaluated: ���6'lX� Water Supply: On-Site Well �/ Community, Evaluation By: Auger Boring l� Pit i ex�ure Texture gro� �.__......_..,... SITE CLASSIFICATION: IIVHLUHl1V1V ISI: Public Cut LONG-TERM ACCEPTANCE RATE: � OTHER(S) PRESENT: REMARKS: 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 Wet NS - Non sticky NP - Non plastic FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm SS - Slightly sticky S- Sticky VS - Very Sticky 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 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 - gaUday/ft2 DCHD OS/99 (Revised) ■■■■ ■��■ ■��■ ■■�■ ■■�■ ■■�■ ■■■■ ■ :: ■��■��■�■��■�■��■�����■■�����■ ■■�■■■���■����■���������■■��■■ ■��������■�������■���■����■■ ■����■���■�■�■��■�■■■���■■�■ ■■■���■■���■�■�\■��■■■■����■■■ ■�■■�■■���0■���■■■�■■���■��■■■ ■■■��■���■����■��■��■��■�■�\�■ ■���������■■�■�■■�■��■��■■���■ ■�■��s�■■s■��e�■■����■�����■�■ ■■■����■�■�■����■����■���■�■�■ ■■�����■�■�■�■�o�t���v■��■�■� ■�■■■��■���■■��■■��■��■�■■■■ ■■�������■��■����■��■��■�■t■■■ ■�■�■����■��■■�■�■���■�■�����■ ■■■���■��■�■����■�■��■����■��■ ■���������■■��■■��������■�■■�■ ■■��■��■�■t�■�■■■��■��■����■�■ ■■��■����■��■�■■■�■■■�■■■■�■■■ ■■���■����■����■■■■���■■���■ ■■■�■�■�■�������■■■�■■�■■��■ ■�■���■���■■■�■�■■�■�■��■����■ ■������■�■��■�■����■�■��■■���■ ■■�■■����■��■�■■���■■���■■�■�■ ■���■■����■���■■�■�■��■�■■�■�■ ■���■���■�■■■ ■■��■�■��■■■■ ■�■��■�■■�■■■ ■�■■■��■�■��■ ■���■����■■�■ ■■■■■■���■■�■ ■■���■��■�■■■ ■�����■�■�■■■ ■������■■��■■ ■�■■■■�■�■��■ ............. ............. ■■���■■■ ■����■■■ ■�����■■ ■■�e���■ ■�■■���■ ■■�■���■ ■�■�■��■ ■�■���■■ ■�■���■■ ■■■��■■■ ■�����■■ ■������■ ■������■ ■■�����■ ■■�����■ ■■��■■�■ ■����■■■ ■�����■■ ■■ ■�■■■ ■�■■■ ■���■ ■��■■ ■�■�■ ■■�■ ■■�■ i ■ ■■ ■■�■����■�■■�■�■�■■�■■��■■■■ ■■�����■�����■���■■����■���■ ■■��■■���■��■���■��■�������■ ■■���■�■�■��■�■■■��■�■�■ ■�■ ■��■�■■�■��■�■�■■�■■��■��■■■ ■�■��■■��■��■■�■■■���■�■���■ ■����■■��■�����■■����■�■�■�■ ■■���■■��■���■��■����������■ ■■�■■�■■�■■O�■■�■■■����■���■ ■■���■■���■��■��■�■��■�����■ ■■��■�■■■�■�e■■��■■■��■■���■ ■■�■■■��■��■��■�■■�■���■���■ ■���■■��■��■��■�■■�■����■��■ ■�■��■��■■��■����■■�■■���■�■ ■�■��■■■�■�■■�■■��■�■����■■■ ■�■��■■��■��■�■■�������■�■■■ ■■■■��■■t■■�■�■■■�����■■��■■ ■■�■■■■��■e�■��■■��■��■■���■ ■■��■�■■�■■����■���■■������■ ■��■■■���■■■■■��■■��■■���■�■ ■���■■��■�■�����■■■��■���■�■ ■���■■■���■■��■�■■��■�■■■��■ ■�■■�■��■■�■�■■�����■■��■■�■ ■■■■�■���■�■��■���■■■■��■■�■ ■��■��■����■■�■■����■■■��■■■ ■■�■��■��■�■■���■�■�■�■��■�■ ■��■■�■■�■��■��������������■ ■���■����■■�■■�■���������■�■ ■�■�■��■■�■�■■��■��■�����■■■ ■�■��■�■�����■■��■■■■■�■���■ ■�■■�■�■■�■■�■■��■�■■■■■■��■ ■�■■�■����■���■��■■■�������■ ■��■■■■����■■�■■��■�■■�■�■■■ ■���■��■■���■���■■■■������■■ ■�■�■■�■■�■��■■�■■�■�■■■■��■ ............................ ............................ ............................ ■■�■■�■■�■��■■ ■■��■�■■�■��■■ ■■��■■�■�■���■ ■■■��■�■■���■ ■�■����■��■■ ■�■■ ■�■���■ v■�■�■■��■■�■ ■■o■��■����',�■ ��■����■■�����■ L=�iiii�����■ ■■��■��■■■��■ ■���■■wr�■■■�■ ■�■■ n�■■■�■ ■�■■ �:�■�■�■ ■��������■�■■ ■�����■��■��■ ■��■��■��■�■■ ■�■ ■■■■■■ ■����■ ■■■��■ ■����■ ■�■��■ ■����■ ■■ ■■ . ■������■■ ■■■■����■ ■��■■■��■ ■���■■■�■ ■���■■■�■ ■�������■ ■�����■�■ ■■■■����■ ■■�■■■��■ ■■��■■��■ ■���■■■�■ ■■�����■■ ►�����■■■■