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2057 Davie Academy Rd' . . a Account #: 990Q02196 Billed To: Andy Bowles Reference Name: �roposed Facility: Residence ATC Number: 3093 p� tf _ 'j- u2 0 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocicsville, NC 27028 (33G)751-87G0 Tax PIN/EH #: 570432-8001 Subdivision Info: Location/Address: Davie Academy Road-27028 rroaenv size: -i u acres AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MiJST 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 WASTEWAT C NSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: vU �� Date: ��"/ 1% `� a� CERTIITCATE OF COMPLETION ,**NOTE** The issuance ofthis Certificate of Completion shall indicate the system described on ImprovemendOperation Permit �� has been installed in compliance with Arti of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO W Y be taken a uarantee 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) �� /��X� 2 ��°�4 Date: ,`--�� %' � ' DAVIE COUNTY HEALTH DEPARTMENT . ' Environmental Health Section /, � • � •� P. O. Boa 848/210 Hospital Street ��t � � � — � � , ' Mocksville, NC 27028 ' (336)75]-8760 Account #: 990002186 Billed To: Andy Bowles Reference Name: Proposed Facility: Residence IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: 5704-32-8001 Subdivision Info: Location/Address: Davie Academy Road-27028 Property Size: 10 acres **NOTE*��iiblmprov�emendOperation Permit DOES NOT authorize the construction ofa 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 PERNIIT 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 �7 #People � #Bedrooms �i� #Baths � � Dishwasher:� Garbage Disposal: ❑ Washing Machine� Basement w/Plumbing: � BasementlNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply _ �� Design Wastewater Flow (GPD) l�� Site: New� Repair ❑ System Specifications: Tank Size,/� GAL. Pump Tank Other: Required Site Modifications/Conditions: �� !/ , / GAL. Trench Width � Rock Depth J� Linear Ft � I1VIPROVEMENT/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 830 a.m. to 9:30 a.m. or 1:00 p.m. to 130 p.m. on the day of installation. Telephone # is (336)751-87G0.**** � .�Environmental Health Specialist's Signature: , Date: ��"� �`� 2� DCHD OS/99 (Revised) � IN FOR S17E EVALUATION/IMPR6VEMENT PERA9IT & ATC Davie County Health Department � Environment.�/Hea/th Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ***IMPORTANT*** TH2S APPLICATION CANNOT BE PROCESSED UNLESS AI,L THE REQUIRED INFOi2I�,TION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed �d�V ��L Jes Contact Person f/`,/f/L�y � ��/ b� Mailing Address �� i- L+ /�e C /T' �l�. �� Home Phone �9 � - zGa � � /� City/State/ZZP �% � C � LI � l� C° �_` . � T d v��' Business Phone 3 yl'� �/ %/� 2. Name on Permi.t/ATC if Different than Above Mailing Address City/State/2ip 3. Application For: ❑,Site Evaluation ❑ Improvement Permit/ATC I�oth � a. system to service: �, House . ❑ Mobile Home ❑ Business � Industry ❑ Other 5. If Residence: # People � # Bedrooms �_ # Bathrooms � i:l DishWasher ❑ Garbaqe Disposal CI Washing Machine ❑ Basement/Plumbing f.l Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers H Urinals # Water Coolers IF FOODSERVICE : # Seats Estimated Water Usage (gallons per aay) 7. Type of water supply: ❑ County/City ,J�"Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? If ycs, wl��st type? ❑ Yes !�'No **'�IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIKL'D PROPERi'Y IN['ORMATION REQUESTED B�LOW. Either a PLAT or SITE PLAN MUST BESUBMI7TED by the client witti THIS APPLICATION. Property Dimensions: ( � ae�S Tax Oftice PIl�1: X# � 7 L� �7' ,�,� (') � Property Address: Road Name �R v� P f�cc�e/yt Y/ld. c�ryiz�� If in a Subdivision provide information, as follows: l�lame: Sectioe�: Rlock: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: !O 7 �.�J e,5 i� 7''c0 D4 vr E /�c ^ Q�tiy ,� ✓ ., � �1 ��_ D /U /�� . .�-�� ,'s ��-T �� /, . Date Property Flagged: � � � � �� This is to certify that the information provided is correct to ti�e best of my knowledge. I understand that any permit(s) issucd hcrcaftcr are subject to suspension or revocation, if the sitc plans or intended use change, or if the information submitted in tf�is applic�tion is falsified or changed. I, also, rrndersta�td tltat I nm respo�rsible for all c%arges incuired from this application. I, here�y, give consent to the Authorized Representative of the Davie County�Health Department to enter upon above deseribed property located in Davie County and owned by to conduct all tcsting pro�ed�res as necessary to determine tbe sit� suitability. DATE 3—/l ^ 0 0'l SIGNATZJR� THIS ARGA MAY BE USGD FOR DRAWING YOUR SIT� PLAN (Include all of tlie following: Existing and proposed property lines and dimensions, structures, setbacks, And se�tic locations). Revised DCHD (07/99) �, Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. � � � � Invoice lYo. ��`� �� . � � �� '�- �A � � / S'�'„ '�2' Y / \ , /� � // CRESCEPR� �MO � \ � � � � � � � \ � � � �� / � \ y NO SCALE \ R � �� / VICINITY MAP F s , A,.�f� r r o�,�'� � l 9'9��c�. � � F � � �� ROBERT A. WALKER �� <q�� D.B. 97, PG. 204 � �F / � � f � �9�� / 1 `�✓� �'�. � � F / �- w � C:J / � � 0 1 ROBERT A. WALKER, w � �c S YL VIA T�. McDANIEL;TR US TEES � �, � "�-<� '�s .ti � ?' f3�, 204-, PG. 871 f694�f8. � �1 F +,�. 204, PG. 876 F / � . � . / s S�� j JO- � � - ,�� l�� - - � ' F � 3 . c s 6\s��6 /b 4)��S- o�e I91 � �� . '`6 F j� � ° :�. S C�� 6*. , � A � \ 1 c�6, : � �{.� L` . �09 I61 F . � � �� • ` � �� o� . • �+ Qo , � �� , j . . �� l� �' 6 �tF� S� Q� � N r 9 , � l�93 � >I N V � r � � o � � V, pN � � , b � Z � . � � � � �, �. .�, y AREA= 10. 152 A C. '� �� 1 . � � ►�," INCLUDES S.R. 1 143 & S.R. t 157 R/W's � � � �. � � � o � �0 �� N A�� r ��. N W � � V O � N W 82,09�26• E o N �� ' ? GF"Pr L. lurTEPOu CERTIFY Tr ` !.iNDER N �) � M� i�tF�ECtIou ar�P �UPEpvt�Ior� rt, MaP �29.59 ,, F, � ��7 �� Yl..� I�PNYlJ (F[)(''I HIV F1.l'J/-1L F I EL ll �l, C.7 � � ap-�,�-oo• u � n MAUE 6` �J'T ROW `I_ YE'iIN C�MPANI `` ` 363.00 � � _ _ _ — -�,�E +. �,. �,�' �,. � � — — — — i .Q`�, G� 4 4�'' ---�� - �- - - --=-- -- --- — I �}_ �ODc� YE�:IONAL AND ;UFVErDF �L_�`:2� � � "Y' � � � ' yPI5NER � p� �• `� 0�`, � S �. � yVILLIA 8�F•pG gg I �1� �;�. ``,,;tasya�d�pe TL'TTEROW St1RVEYING COMPANY D.B. ' � �,�, `.a,°�,,:: �. F11:(1 ��s, � i �� ,o�,,� ;'�/��. 1 �'� �0�_�TH SALI '-F�Uf'Y' ';T, . C` - '�,�,'•..y: MC�� ,� LLE, N C,. c� i�,= � - I • � - _ - �� '��;�i 751 -5r" ln � � °'='�� _ .: .�:o{< �--`' ,�. '�4 '.�;` , {,,v� J`�;4 , i<< , f� �. o�p�rr � .. „ `�,, ��xae�;q��,'v^n�M LEGEND PLAT pF SURVEY F'OR� ;�, p.�,P.= PLACED IRON PIN C�OLDA I�. DA YGTA � T L T ! �'v = R/R SPKIE i ��,� - p�K NAIL i Revis�oHs ,�� _ , _� OR NAIL W/ CAP sc�� wPanvEn er, nw,� er, � �'< � �,.L.ii;T'EF'.�W � - STONE � , APRIL- 10-�'C!OC1 FI�E NA►E� r!Ar'--VAI�L i��1 = NCGS GR�D MONUMENT BEitvc. t o.i 5� a� ��F THE �;n�.�sa r c,u��a,u� � ��-�P��r� -- - UNMARKED POINT � - — _ � _--� _ _�=�� -- ��'�� D,aB� i08 Nr�r, rvo�� rw�, !N TF-±� �a�ar,A�N ?�-wH��F� IiiU 5�� i) 0�� ( '�^�_-- -----J TH �'AROUNA L _ - - - ------� DRAl11NG ti1MBER� SCALE IN F�ET --- -�---�- TAx MAP REF.: ,J -�', PARCtL 4 �� i)6i��0-_� I APPLTCANT INFORMATION Accour�t �: 990002196 Bilfed To: Andy Bowles Reference Name: Prqposed Facility: Residence DAVIE COUNTY HEALTH DEPART'MENT Environmental Health Section Soil/Site Evaluation Property Size PROPERTY INFORMATION Tax PIN/EH #: 570432-8001 Subdivision Info: Location/Address: Davie Academy Road-27028 10acres DateEvaluated:� ly-Do Water Supply: On-Site Well Community Evaluation By: Auger Boring Pit icn�uic Kivu� 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 SWcture Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION i �wT� TT.•T] 1 R A/�/�T.•M• A AT/�T n w mr. SITE CLASSIFICATION: � LONG-TERM ACCEPTANCE RATE: ' REMARKS: Public !� 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 frm 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)