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208 Crescent Dr
Account #: 990003601 Billed To: Richard Daywalt Reference Name: Proposed Facility Residence ATC Number: 4065 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (33G)751-8760 i � S�l+'� Tax PIN/EH #: 5708-20-2953 Subdivision Info: Location/Address: Crescent Drive-27028 Property Size: 32 acres 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: �/��S CERTII ICATE OF COMPLETION _-__ ,. _. —_ _ � „� l - : 1 o d o' �F- r`�` � **NOTE** The issuance ofthis Certifica�Ee ofCompletion shall indicate the sy tem described on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S. Chapter 1 OA, Section .1900 "Sewage Treatment and Disposal Systems," but shall in N� WAY be taken as a guarantee t at the system will function satisfactorily for any given period of time. � � � ` � w oac9 �.^�^2. S�►edg �� �000 - '�1�-IICG � - - - , - - - - �ra "'�r �� `7s +- 11•0� � c1•�w�w ��411 -ZSG�. lad • (,v�e �2-2TCj+. Id� , �.r�. N3 -2.r�1. -�a. �t� �tvti1 f . ---�. ,� ao � rool � ## 3 .�,�� _ toa� .�} � lna� .ti{ 1 � O � x . � ��i.� ��..�, ^ ._ ^ .— � ._ .; Septic System Installed By� �,k.,� �o�a�C.i�at � � Environmental Health SpecialisYs Signature . Date: y` � Ll - �� DCHD OS/99 (Revised) • , DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section � P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (33C,)751-87C>0 IMPROVEMENT/OPERATION PERMIT Account #: 990003601 Tax PIN/EH #: 5708-20-2953 Billed To: Richard Daywalt Reference Name: Proposed Facility Residence ATC Number: 4065 Subdivision Info: Location/Address: Crescent Drive-27028 Property Size: 32 acres **NOTE** This ImprovemenUOperation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATtON 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 w/Plumbing: ❑ Basement/No Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: � Lot Size 3 Z/� Type Water Supply ��/l Design Wastewater Flow (GPD) ��� Site: New 1Q Repair ❑ System Specifications: Tank Siz%�%GAL. Pump Tank GAL. Trench Width��Rock Depth �� Linear Ft.�� Other: Required Site Modifications/Conditions: 11�1PROVEh9ENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF C, `° BELOW FINISHED GRADE. ****NOTICE: ntact a representative ofthe Davie County Health Deparhnent for final inspection ofthis system between 8:30 a.m. to 9:30 a.r�. b�:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (33G)751-87G0.**** Environmental Health Specialist's Signature: DCHD OS/99 (Revised) � �y� Z , g. 0 7 - �'-: y�,r � �ur �;�-� �-/ ,�,., ,,.,�w�- — w6d/ �-- �,l,:.�f�=.- Ga.�,r �",, � �s- � �„ Date: � �r � APPUCATION FOR SITC EVALUAT(ON/IhfPIi0VEh1[M PER6i1T & ' Davie County Health Department Environmenta/Hea/th Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-6760 � � ls � V � APR 2 6 2005 ENVIRONME�JTN. NEAl1H DAVIE COUPdTY ***IMPORTANl*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to tho INFORMATION i3ULLETIN for in;tstructions. 1. Namo to be IIilled Mailing Addrean City/State/ZIP � /}; U % ) � 'Cl Fi ,i- � / _ , i...r . �• Contact Peraon �� liome Phone� �) ��i v�0� � Huainesa Phono���d�� (,/>�l- ���.�.! � 2. Name on Permit/ATC if DifEercnt than Above Mailing Address City/State/Zip 3. Application For: j�l SitQ Evaluation ❑ Improvement Permit/ATC �Both 4. Syatem to service:-� House ❑ Mobile Home ❑ Buainess � Industry ❑ Other 5. Tj�pe syatem requested: � Conventional ❑ conventional modified ❑ innovativo 6. If Residence: 8 Paople ,� # F3edrooms � # I3aLhrooma .�. �(gDiahwashar �Garbago Diaposal [�Waahing Machine �Ha3ement/Plumbing �Dasemont/No Plumbing 7. If IIusinena/Induatry /Other: verify type # Paople tk Sink� # Coauaodea� � Showera IF FOODSERVICE: �� Seatu � Urinaln # Wator Coolora Eatimated Wator Uaaga (qailonn por day) 8. Typo of water eupplys � County/City �� Well O Community 9. no you anticipate additions or expansions of tl�e facility tliis system is itttended to serve? � Yes �1 No If ��cs, �vI�at typc? ***I/IIPORTi1NT"°** CLIGNTS �11UST COAIPLETL• 'I'IIC IlCQUII�CD 1'ROP�RTY IIYrORD9A'I'lON 12CQUGS'fGD 6GLO1V. Cithcr a PLAT ar SITI; PLAN hIUST Bli SIIIIAIlTfLD by ll�c clicnt �vitl� TIIIS APPLICATION. I'roperty Dinicnsions: �-2 � Tax Officc PIN: # .S '7D��4�c1.�-� Property Address: Road Namc �/`f� 5'� P�� �G1. City/Zip � .�,(�t� � /'�/� � 7�Oa� If in a Subdivisiol� providc iiiformation, as folIotivs: Namc: Scction: Blocic: Lot: 1VRIT[: DIRCCTIONS (frum Modcsvillc) to PROPCK'fl': � cJ �� c�.r i� I���ll ti':` P���a�,lti�u� � P �� �`i �/�c� v.' �= /�'�e^�r�e� ci� �/ 7'' �, �-/'(�s'('�i�",�" ��'.��%� � /,i �i'�"f�'«!� �`�i���, � i�9�% G- �x,���0 �✓ ''Li'y�!%� Datc liomc corncrs flaggcd: �—.� � ��S Tliis is to certify tliat tlie information pi•ovided is correct to tlic best of tny l:�iotivledge. I understand tliat any pcl•ii�it(s) issucd I�crcaftcr are subjcct to suspcnsion or rcvocation, if tIic sitc plans or ii�lcndcd usc changc, or if tlic infornialion submitted in tliis application is falsified or clianged. I, nlso, rurdersta�lrl tlrat I nni res1�oirsiLle jur a!! clra�se�s iuctrrred fi•unr tlris npplicatio�r. I, l�crcby, givc conscnt lo tlic Autl�oriud Rcprescutativc of tIic Davic Cow�ty I7c:i1(h llcpartmcut to cntcr upon 1boti�c dcscribcd propert}' IOC1fC(I lll D:lvic Couirty and o�vncd by to conduct all tcsiing pt•occdures as ncccss:ii•�� to cJctcrmiiu tlic sitc suita r't�� DAT� , � '' D� SIGNATUI2� C�G .EI.CG ��- �Q� � l.F' , � TIIIS AIZ�A MAY B� US�D rOR DRAWING YOUR SIT� PLAN (Includc all of tlic follo���iiig: Lxistiug aud proposcd property lincs and dimcnsions, structures, sctbadcs, and septic locations). �b�L� V� �' .� �o Yv�>`�� �� L—Ci�� s,sn s���n ��`�t:?� i�i ^��7 9y�- �/�0 Rcviscc! 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' xt�'�'2c r�, kf� : � �� '�' P� 8..:�-� 11�` �ti 1 �. . .` ' � �� . . + ,� � �w,�h ���, . � ��� � +�: g �� ��'� �� .„ �'�* �,-��. x ..���ti"�� �� �� '�`•'K&�� ��� � ..�...,.xi,.�:.._ �...^;.,n {:�'�1°��� 1'� � r '� "�;��," � ..:, � ;«'�.�. �. . �. ,. � . , '. .. .✓ . . . . .,. .� ..� s ' ' � � DAVI� COUNTY HEALTH DEPARTIVI�NT � ' Environmental Health Section - ��' Soil/Site Evaluation APPI,ICANT INFORMATION Account #: 990003601 Billed To: Richard Daywalt Reference Name: Proposed Facility: Residence PROPERTY INFORMATION Tax PIN/EH #: 5708-20-2953 S�'bdivision Info: �.ocation/Address: Crescent Drive-2702 � Property Size: 32 acres Date Evaluated: � � Water Supply: On-Site Well V Community Public Evaluation By: Auger Boring ✓ Pit Cut ' % FACTORS osition I Texture group Consistence Structure Mineralogy HORIZON II DEPTH Tcxture groi Consistence Swcture III DEPTH 7 exture gro� Consistence Structure HORIZON IV I Texture group Consistence Swcturc Mineralogy SOIL WETNES RESTRICTIVE SAPROLITE TERM ACCGPT SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: c L r ��� '� 00�� ���----- i��, '�- ---_— �E��)����� ���---� ��.�----_ ���----- ��----- f'��:l�L����� �rl�----- ���0---- �i �l.��----- ��----- ��-�''E-'l'J����� EVALUATION BY: OTHER(S) PRESENT: LEGEND � Landscapc 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 oi VFR - Very friable FR - Friable FI - Firm VFI - Vcry firm EFI - Extremely firm Wet NS - Non sticky SS - Slighdy sticky S- Sticky VS - Very Sticky � NP - Non plastic SP - Slightly plastic P- Plastic VP - Very plastic � , tr cturc 'SC - Single grain M- Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralog,,y 1:1, 2:1, Mixed te 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 DCI-ID OS/99 (Rcviscd) .........................................................�........ ................................�....................... .... ... ................................ .......................... . ... ...........................................................■C. ... ............................................................ ■ . . ....■...................................................■.■. .C� ...........................................................� . .....................................................■..■..■ .. ............................................................ ................................�...................s�'CC�' B� ................................ ................... . . .o.......................................................... � . ............................................................ ............................................................. . ......�......................�............................... . ...... ...................... .............................. .. . �������������������������������������������������e���������■ ■■ ■ ■���������n�����������■��������■ ■��������������t��������■ ■ ■��������������������������������i���������������■��������■ ■ ■���������������������������������������������������������� ■ ■�� ■����������������������������������������������������������■ ■ iiiiiiiiiiiiiiiiiiiioiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii� ■ii ■�������������������e��������������������������������������� ■�■ ■���������������������������������������������������������■ ■■ ■ CC:CC:CC::C:::::CCC:C::C::::::::�:::::C:::::::::::::::::�:. 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