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1688 County Line Rd� � DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990000865 Billed To: Sonya Spry Reference Name: Sonya Spry Proposed Facility: Residence IMPROVEMENT/OPERATION PERMIT P�/�,�2�i Tax PIN/EH #: 5800-07'-7621 Subdivision Info: Location/Address: Courrty Line Road-28634 Property Size: 2.558 Acres ATC Number: 2258 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALJTHORIZATION 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 %J'% }� #People � #Bedrooms � #Baths -2 Dishwasher: � Garbage Disposal: ❑ Commercial Specification: Facility Type Washing Machine: L1 Basement w/Plumbing: ❑ Basement/No Plumbing: 0 #People #People/Shift #Seats Industrial Waste: ❑ Lot Size _ fi�� Type Water Supply �� Design Wastewater Flow (GPD) � Site: New � Repair ❑ System Specifications: Tank Size��}6D GAL. Pump Tank Other: Required Site Modifications/Conditions: !i GAL. Trench Width'?�� Rock Depth � Linear Ft� _ ___ 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.**** ti n- ��` ', � V�G � �`�,`� � j�� , � � ��D� r� � /" �� ,��' L/ ��,� Q� h ��� u,�`��` ��r�' ���` 4 � P�� �' s�' � ��'�� s�`� �, s-� �� v _d o� Environmental Health Specialist's Signature: �� G+' ` . Date: �/ —� ��(t DCHD OS/99 (Revised) � Account #: 990000865 Billed To: Sonya Spry Reference Name: Sonya Spry Proposed Facility: Residence ATC Number: 2258 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5800-07-7621 Subdivision Info: Location/Address: Courrty Line Road-28634 Property Size: 2.558 Acres 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 WASTEW R CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: � � Date: �� �� ��� CERTIFICATE OF COMPLETION **NOTE** T'he issuance of this Certificate of Completion shall indicate the system described on ImprovemenbOperation 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 eiven neriod of time. .� Septic System Installed By: Environmental Health Specialist's Signature : DCHD OS/99 (Revised) Date: �j � — �� - (�C7 , � . 1. Z. APPLlCAT10N FOR SRE kIIAWATION/IMPROVEMEM PERMR & Davte County Health Department EnwironmentaJ Hea/tfi Sectfon P.O. 8ox 8�8/210 �ospital 8txa�t Mock�vill�, NC 27028 �• 1336)751-9760 r �C�G�M� � NOV I 51999 *** I3�OATAHT� *� THZS ]IppI+iC1►'rIO2t GHtfOZ A� PROCC88�D VNLa88 ALL TH� REQOSRED =NrOR�ATtON =8 pROVIDED. A�lor to th� IN�'ORMIITION SULLBTIN for instruatioas. � Mas. to b. ssll.e 2. Y' co�,t.oc �.s.o�s t1 0. �.U'1 Z �� �...1t�Q I l:� so.. �. - 5 ���.�.w�==p �in�,on�. Nc a�c��- �.�... �..�33�-��i-350'1 /35D� 1tw oa �sait/USC i! Di!l�swti! t�a:► 7►bo�� l�ailiaq �ddt��• Cil.y/Ytat�/fip �. I►pplia�►tion lor: � Sit� svalustioa ��mprov�at p�rmit/7►TC �{ Hoth �• M� � s•Mo•� 0 Bon�� � Mobil� �oms 0 Susia��� U=adustsy 0 Oth�r a. I! �sid�aa�s � P�opl� � i H�drooms �� � Bsthzooms � �oi.b«ub.r o ws�aq. ai.po•a 'R Ka.hioQ fhohsa• o sa,.�rnt/alvabsn� o sa..a�at/210 pluabsmq 6. I! awia���/InQu�tn/OtMre tp�oity typ� t�apl� f Biak� � Coaiwd�� i Ybo�nr� � oriaa.l� • ltat�r Cool�s� =t TOODStRVICs: � S�atia i�timu�d Kat�r O�aq� l�oA• ��yt �. Typ� o! Kawr �uppiy: Coun City 0 R�11 0 Co�muaity e. Do yoo aaHcipate addiHow or ezp�ndon� of the tncWty t6b ty�tem b intended to iervc? V yes, wb�t typeT ❑ Ya � No ***IMPORTANT"** CLIENTB MUSTCY?MPLF.TETNE REQUlRED PROPERTY 11VFORMATION REQUESTED BEWW. �ither � PLAT or SITE 1'LAN MLZST'BESUBM1TlED by the clleat �viW 1'N[3 APPLICATION. ���: ; :;:��:.;:�� a . � � � Q.CX e S T�:081ce PINt � 5�DD - D'7 -� t� a i Property Addras: Rad Name City2lp RYYnOn ��, i�iC 7�(Q�- U in �t Subdlvillon pravlde Intormadon, �u folimve: N�mes Secdout Biockt Lroh WRCt� DIRECflONB (tcom Ma{�svtlle) to PROPERTY: �e�t h�, (Qy- -fn �e�w�d �oad, l. � .a �• .1' �' � ��' i`� /. .i I ' � .s . �.L � . � � � � � r � � ..1�1. � �_I /� I � � I.� l! . �a � • � � � � � � ` � � t� � � � �+� -� � / T6is b to cerHf'y t6at the InformaHon pravided b corrcet to t6e be�t of my IcnmvledQa I anderrtsnd tbst aay permit(�) iuoed 6enARer are �ablc�t to �wpewlon or revocAdon, i[ t6e dte pl�nt or tntead�d aae eh�n�e, or 1[ the inform�Non �abmitted tn t6b sppltcaHou b t�lsilied or chw�ed. l, also, understand fJiat I am ruponsl6le jo� aU cbarges lncamd froni tlils applk4do». I, hereby, �ive eouseot to the Aatho� RepseunhtEve of the vle Cawty Hailt6 Departmeat to enter apon sbove dacNbed property Iocatal in Davie Coanty snd owaed bY to condnet aq taHn� procednra u neeeaary to determiue t6e dte taitabWty. DA'TB �Bv'. {J. Iq'q� $IGNATURE 7i�13 AREA MAY HE USED FOR DRAWING YOUR S1TL PI.AN (Inclade sll of t6e follm�ringi EiistinQ and prnpa�ed property Una and dimen�low, �tructnra, �etbac{u, �nd tepNc locstion�). ' 8ite Ravbit CLar�e Cltent NotiAcaHon Date: Efl3: Reviaed DCBD (07/99) Accoant Na ��� Invotce Na �� / Gg ��E' ? �3s ��s�• NOTE : TMIS PLAT IS SUBJECT TO ANY EASELENTS. AGNEEI�EN75. OR RIGHTS OF WAY OF RECORD YRIOR TO THE DATE OF TNIS PL�T. TNIB SUIIK7 IS EWJ[CT TO ANT //1CT3 TNAT IMY SC D16CL06ED BT �/ULL AND /1CQIR�TE TITIE SEMICM. 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CY PoMt NIP �N wyro�n�Plae�d �� �� Pil - Prep�rtr L1�• R- Rodlu� C A- ContrWbd A�ew CM - Cherd Dlatano� � _ R�hdore�d M�P • �pip� �� -�� °� CCP- Com�+9abd Pkstk Rw -�� B°�1` -F- 100 ywr Flood Boundory �_�� F�at X F� �d W� Sw�r .• � .� � :• I�����������-- 7������\��--- Parcel 3g Randy G. Vaughn D.B. 158 - 885 Plat tor Sonya Diane Spry / Portion oi Deed Book 42 - 512 � Port of Porcel 48, Davie County Tax Mop F-1 ,�g� r� � Ta�wr+s�xv �unn suh a�� Q°��a��o`i91�� �" � 60' Caiohan pavla Ncrth CoroMa 08-14-t p.an �� C. Roy Catea p8' ��` 119 Depot Street '� N0. yppp� Mockaville. NC i7028 Zµ p�� � Phone (704) 63s-3735 2825L-g 0 APPLICANT INFORMATION Account #: 990000865 Billed To: Sonya Spry Reference Name: Sonya Spry Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5800-07-7621 Subdivision Info: Location/Address: County Line Road-28634 Property Size: 2.558 Acres Date Evaluated: //^/8� Water Supply: On-Site Well Community Evaluation By: Auger Boring C/ Pit 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 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: f1 l LONG-TERM ACCEPTANCE RA' REMARKS: Public t/ Cut EVALUATION BY: OTHER(S) PRESENT: 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 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 tructure 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 - gaUday/ft2 DCHD OS/99 (Revised) ■ ■ ii ii ■■ ■■ ■■■�■ ■�0�■ ■■��■ ■■��■ s■s■■ ■�■�■ ■���■ ■�■�■ ■■■�■ ■■��■ ■�■o■ ■��■■ ■�■�����■■��■■��■�■ ■����■�■■���■�■��■■ ■��■■■■�■�■�■�■■�■■ ■��■■�■�■����■�■��■ ■■■���■�■■�■�■��■�■ ■�■���■��■�■������■ ■�■■��■■�■�■■�����■ ■■�■�■�■�■�■■�■�■■■ ■■■■����■■��■����■■ ■��■■���■���■����■■ ■��■■���■�■���■■�■■ ■■��■�■�����������■ ■■■�■�■■�■�■■■��e�■ ■�■����■����■���■�■ ■■�■�■�■���■■�■�■�■ ■■�■■��■■�■■■�■�■■� ■■�■■■�■��■�■■■�■■■ ■��■■■�■e■��■�■�■�■ ■�■�■�■■■��■ ■�■�■ ■■■��■ ■�■�■��■■■��■ ■�■�■��■■■■�■ ■��■�■�■■■■�■ ■��■�■�■■�■s■ ■■�■�a■�����■ ■��■■�■�■�■�■ ■�■�■�■���■�■ ■■■���■��■�■■ ■�■����■�■��■ ■�■■��■ve���■ ■■■N■�■�■��■ ■■���■����■■■ ■��■■■■�■�■�■ ■■�■��■�■���■ ■��■��■�■���■ ■�■�■�■�����■ ■�■�■�■����■■ ■�■�■�■��■�■■ ■■■■�■�■�■■�■ ■����■�■�■��■ ■■�����■■���■ ■■�■�■��■�■�■ i ■■ ■■ ■■ ■■ ■■ ���� ■��■■ ■��■■ ■���■ ■���■ ■■��■ iii�■ ■■�� ■ ■��■ ■■■■ ■�■■�■ ■���■■ ■��■■■ ■■■■■■ ■■■■■■ �■■■■ ■��■ ■��■ ■��■ ■■■■ ■■ ■■■■■■■�■■�■�■■ ■■■�■���■■����■ ■�■■■■��■■�■��■ ■�■���■■�■■���■ ■�■■��■■■�■���■ ■�■■������■���■ ■�t�■������■■�■ ■��■�����■■���■ ■��������■■■�■■ ■■�■■�����■■��■ ■■■����t���■■�■ ■■■■■���■■�■�■■ ■■■■■■■������■■ ■��■■�■■�■�■■��■�����■�■■■���■■ ■���■�■����■■��■■����■■■■■�■�■■ ■�■■■■�■��■�■���■��■��■�■■■■■■■ ■�■�■■■■■■■�■■�■■�t��■��■■■��■■ ■����■�■�����■■�■■■���■����■■■■ ■�■■�■�■■���■■■������t■����■■�■ ■��■�■■�■■�■■��■■�����■�■��■■�■ ■■�■■�■■����■■�■■�■��■■■■■���■■ ■■■■������■�■��■���■■■■■■�����■ �::���■■��■■■��■■��■■■■ ■�■�■��■��■��■�■■■�■�■■ ■�■�■��■����■■�■■��■�■■ ■���■��■■■�■�■■�■■����■ ■■������■■������■■■���■ ■■�������■��������■■■�■ iiiii��iiiiii�iiiiii�i ��!==:e���■■■■�■■�����■ ■�■�■��■��■��■�■■����■■ ��■■■■����■■�■■�■�����■ ��■��■�■■��■��■��■■�■�■ ■■■�����■■■■■�■■��■�■■■ ■■■■��■��■■�■������■�■■ ■■■■■�■���n�■■�■■����■■ ■�����■■�■i:L7■�■■�����■ ■��■��■■�■a�l���■��■��■ ■�■■����■■■■����■■■■��■ ■���■■�■■��■��■�����■�■ ■�■�����■■�■�����■■■��■ ■■���■■��■�■■��■�����■■ ■■�■��■�■���■��■■����!■ ■■■■��■��■�■■��■��■■�■■ ■�■■���■���■■■�■■��■■■■ ■■�■��■������■��s�����■ ■��������■■■�■��■■■■��■ ■�■�■��■��■■■■■��■�■■t■ ■����■�■■■■■�■■��■�■■�■ ■��■■■�■��■���■�■■■�■�■ ■����■�����■���■■����■■ ■■�■�■ ■����■ ■����■ ■■�■�■ ■��■�■ ■■■��■ ■■■■■■ ■■■■■■ ■■■■■■ ■■ ii