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327 Colin Creek Trail' • `. ' DAVIE COLINTY HEALTH DEPARTMENT / — Environmental Health Section � Account #: 990002710 Billed To: Sherry Duncan Reference Name: Freddie Key Kesiaence ATC Number: 3482 P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (33G)751-87G0 S?�-� �-�� 3Z Tax PIN/EH #� - - 434 Subdivision Info: Location/Address: Chestnut Trail-27006 5ize: 50 acres AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MiJST BE ISSLIED by the Davie County Environmental Health Section prior to issuance of any building permit(s). T'his 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 CO S RUCTION IS VALID FOR A PERIOD OF FI YEARS. Environmental Health Specialist's Signature: Date: ��1 C�� CERTIFICATE OF COMPLETION **NOTE** 'I'he issuance of this Certificate of Completion shall indicate the system described on ; has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will given period of time. Environmental Hea ion Permit and ly for any %�' '� 1� DCHD OS/99 (Revised) t'- DAVIE COiJNTY HEALTH DEPARTMENT �`L lP -�� - a.3 . ` , , ' ` Environmental Health Section f� �,� j� � �-�-`� ��-s � P. O. Box 848/210 Hospital Street ' . . . Mocksville, NC 27028 (336)7S]-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002710 Billed To: Sherry Duncan ;- Reference Name: Freddie Key Proposed Facility: Residence S7 b�- o� = c� s z Tax PIN/EH #: Subdivision Info: Location/Address: Chestnut Trail-27006 Property Size: 50 acres ATC Number: 3482 **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 I5 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 � Dishwashe • Garbage Disposal: ❑ Washing Machine;,�Basement w/Plumbing: � Basement/No Plumbing: O Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply�� Design Wastewater Flow (GPD) SS� Site: New Y Repair ❑ � System Specifications: Tank Size��(� GAL. Pump Tank GAL. Trench WidthC��Rock Depth �� Linear Ft.� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FiLTER. RISER(S) IF 6" BELOW F(NISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis 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 � �✓ Date: ��i'�/� DCHD OS/99 (Revised) �"t' � � � ..�� 35�� .,. � 21-2003 Qr��50� CARD SPECIALIS S-RES _-, 336 ?18 2253 P.01i01 ••�• •. � ��,��r o v�e Cou ty env ea t � 336 951 87�� P,� �..* . � � � �/�� 5 �m� ��-.��,��- . . �'�l �,y'6 � C.�ke l� ,�6 • �'4 %�PC1q1T10N fOR SITE EVAI.L'ATION/IMPROYEMWT PERMIT & ATC � . �� } • �� a-' �t �� .� ��vis County Neatth Department �/ � � �� fnrrmnmrnto/Hea�th Secdan � / � F.O. eoz ��B/210 Ho�yital Screut �- �� , HockOVillc, NC 27028 � 1 3 �� ' . � µ (136I7S2-B7G0 �,(� I �c� •��IXPORTJ.NT��• T1118 AYPL:GTZQY CANNOT D!'. pROCtSSXD Qx7I�S$9 ALL 1iIL' REQUZRE� INpOAKAiZOR I9 DAOVIDED. Rof4s to the INi'ORilxTZON HVLbt:ZN for i:�crueeionc. �. Nam! CO be elllca � rNi2ing .Wer��■ .r esey/euc./air�i( )//[J7d%i�� „� :. Ka.. en o.nnfc/�rc !f Ditt.ceny ch: �i Nall[ng adLcota F��._L Got.e�cG Perfon � �ji ' t(ome FEm� O 3�' A�sin�v r�oM (! �'� _ CSCy/8W[e/Z1p � .� .��• +PPlic�[!oo fore tte Lv�l� 7;mprovemer[ P�rmit/aTC tioth �---- .�4. fy�een en e.evse�� .lfeeae yloLi2e Nomc Hueiaes In udtry O:her n —��.. .�5. II Raaidar.a�; • Peop2o � � BeJroom � � BaCErooma �� at�h.�sh�r CaeDp�� DSfposa] �.YU�1n7 Micnt ��s nt/Dlaatilnp Bas�ernt/N� 73aab1M Yi. SL W�inu�/SwA�.cry(OCh�r• fp.etLy tyy• / V�OPl• _�., s 9inra �_ • � _ __. � Gawmadw �� f S�ev.e. .._� II Vrin�i� ..� Y �at�r Cbo�•e. ..'_ r� fOODSERViC�� 8eate __ . M_ Saitmatsd knter UBiqC fg111ana por dar) ��. iyy� oL w�eaY a�pply: coupty/Clty tvell ��, Da yuu xnticiprte additiotu or apaaaionc oY !he f�cility tbit:y�ten�� In fndecl tu acrvc': ye Ilyes, wltot typc? Commuaity Vo QNL' � / � �� "`lMPOhTdN1w'•CL1E\TS�R/STCOMPLETCTIIC R6QU/RCOPAOPCI�TrINi"ORMATION[tEQUES'�GU � LLCLOW_ Blrhe� a i'LAT er 51T1; PLnN MUSi'AE.YUBMITlRO hy tlit c�ienl wit4'fNLS APP[,1CATION. � v� Froperty Dimenrloer: �� a WR17L D112ECTlONS (�rn �Totksril(c) t PROCENTY: ,,,jaxOfficcl'IK: N �7 J"i� � /� 4�perlyAddress: RoadNtme��u.�'� .� ��._ �(Z�� Ciiy2ip � -•'--• �' tt� ` � �t� i.(i-�. � r � If in r 5uDdiritloA proride infurmali0n. �s WIIoMt: �iR ,(�� (T�� Name: 5a�iee: Eloe�:: 4er. --- -__--- �9elc Iwinc eurncrs 'CA�s t� to ccrtit',y tl�ai IAe lnlorm�liun provided is rn��ett la 1)�c bosf of niy �now�edrr. I w�derst�uid cU�t �ay ��er�uil(s) i:suc0 6creiher u� �u�jeel !n iuspen►lon or ra�•acativn, il !he slte plan� ur intcndcd wc ehantr, er it th¢ iuturu�xtiuu ScbmillrA in thit npplle�Go.� is Colsitkd or chsnred. ], nlrA, N�+��•PJbtAlill�nll r� inrY��iG1C f'�r a/I ri•wrgrr inci�rrrd f ewr this np�Nlcalfo��. I, Gcretry, gire eonfent to Ihe Autuori:eJ Repreftnl4livs of tlu Duvie Cnun�y Ilc.+llh Dtps+rtmen! tu tulor upun abave de�crlbtd properly locott� :u D��ie Cvuury and s�vned Dr , tn can0tK1 !p t Iln� pr eclurtf at neee�cary �� detennipt thc aitc suit ' � DATE__y�/ _"�� ___.. K1G�A'CURE � / i'Hi5 AliEn MnY RB IJSED YUx bxAwIivC YOUR 5rc L rLA1v (lnctuUc atl u�c foltorviug: �xistiug and propuscJ �Dptf�f IUltf f1Ud I�nii n s ructure.� utback�, �rtd seplSe ►aerlions). ri�%�„'^�'��,(,�� .�v�p� T,� J�� . S�taRrtvi<i:C:Lar�e ��k bt�ora. �� -� � Look� ,n�«t,r._ �. �1.�� RQJ 1 151� @� ��S �� 0. C7ic�tt Nnt�fica�iu�� A:�tc: � c�.r5v�a . � I �r ,q, � �� r�trs: '� � QS � ' •ti � 'i��'"� Ja-la �� - s-I}Q. �� e.�' S(gn givcn_ .t f a _ Q� (ti1 ��*.,•,,.,,".Q- � . Aetounl No. �� `.. O . � �.� � Yv�� Rcviset! DCItD(07t99) ��Q �l-1�g5 �5�� 3 � e,� WtS� �Da,. o�..�o �,.�� ,,,�o;��no_ ��. :� ou c�oasz_.� ��.�.-�- ,r,st,�.- U�,a, -i'b . �� Jou 4�1rr�r /�-:� �� n „.�.., `° .,.... ,-,...-1 . � � �TOTAL P.01 c,��_a-� !�� . � � � �� Q�� .' .• � �� .. + � � ��.� ��.��-��. .�. � �� L� � r � ��`� � � � ,✓c , �....�L�,� . , .� �� .� ��5� � �� (,.� - S �l�- � �� ,� o� - -��,�� ; � �/ (�/p v4�'' � • � . � � . ,.''. y APPLICANT INFORMATION Account #: 990002710 Billed To: Sherry Duncan Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation Property Size PROPERTY INFORMATION Tax PIN/EH #: 5768-23-0434 Subdivision Info: Location/Address: Chestnut Trail-27006 50 acres Date Evaluated: c�� -Q� Water Supply: On-Site Well // Community Public _ Evaluation By: Auger Boring � Pit Cut HORIZON I DEPTH Texture group 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 SITE CLASSIFICATION: � LONG-TERM ACCEPTANCE RATE: — S� REMARKS: EVALUATION BY: OTHER(S) PRESENT: 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 frm EFT - 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 Mineraloev 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 - gallday/ft2 DCHD OS/99 (Revised) � ■ ■ ■ �: ■� ■■ ■■ ■■ 0■ ■�■■ ■�■■ ■■�■ ■��■ ■��■ ■■■■ ■�■■ ■��■ ■��■ ■��■ ■�■ ■ ■��■ ■�■�■ ■��■ ■��■ ■■■�■ ■��■ ■\��■ 61\1■�■ ■ ll��■ ■�/� ■��■ 1�f�■ t��■ ■�\■ ■��► ■��■ ■��■ ■��■ ■■�■ ■��■ ■��■ �� ■�\■ ■��■ ■■�■ ■��■ ■��■ ■�■■ ■ ■ ■ ■��■�■■ ■��■ ■�■��■ ■�■��■ ■��■ ■■��■ ■��■ ■��■ ■■��■ ■��■ ■��■�■ ■■��■ ■��■�■■ ��■■ ■■��■ ■■��■� ��!��■ ■��■��i ��■ ■��■ ■��■�■■ ■��■�■ ■\��■■ ■��/■ ■��■��■ ■��■ ■��■■ ■��■ ■��■ ■��1\■ ■��\1� ■■\■��■ ■��,� ■ ■�■ ■■■ ■�■ ■■■ ■�■ ■�■ ■ ■ ■ ■ "��` � t , � , �` . �� C�� °��'a�� a m �:....�....,...�,,_.�.�.�,W,��.,.�..._�, .w,.., ., �,.«.:�., .,. H m..__ w„�.�,��..��„ �«._ .,.. �...��. � ENVIRONMENTAL HEALTH SECTION P. 0. Box 848/210 Hospital Street Courier #09-40-06 ..� , .,__ .. , Mocksville, NC 27028 , _� . � � � � _ ,Phone �# � {336)751 87,60 . � ,; May 1, 2003 • Sherry Duncan 5013 Meadow Hill Court Winston-Salem, NC 27106 Re: Site Evaluation/ Chestnut Trail Tax Office Pin : # 5768-23-0434 Dear Client(s): As requested, a representative from this office visited the aforementioned site on April 30, 2003. 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/Authorrzation to Constrzrct 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, �4�� i• Robert B. Hall, Jr., R.S. Environmental Health Specialist RH/df -