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419 Elmore Rd; ;.F , , ,; : ,>. ,.;.. - h . - . � . .t , -:;,_ ,i< .•:,.:.. . � . ',..-.. ' �. .. . . .. . n-t `." . ' � , ` . . � J'. ' .. ;" . . � . , �-Sl...._.:�F . , . .. ,. : . ,8 �XO ' auTxoxir�aTiOrr No: O$$ 3 DAVIE COUNTY HEALTH DEPARTMENT %'=''' ��' � Environmental Health Section PROPERTY INFORMATION Permittee's ,� P.O. Box 848 Name:� -r!_ �:- ��...,r.�� :��-.`�,�'��Sv-�t. Mocksville, NC 27028 Subdivision Name: � Phone #: 704-634-8760 Directionstoproperty: �� `��' ��6c� `.�c�'"� Section: Lot: AUTHORIZATION FOR , �^� ti,,�,.., ^� _ � _� �=,. i� � �-� ..�c�. r.��.?��.. ��`'j..�.,�,.� WASTEWAT'ER Tax Office PIN:# �:� O a� a . SYSTEM CONSTRUCTION � Road Name: �.� �'`�� Zip: � �� **NOTE** This Authorization for Wastewater System Construction MUST BE ISSLTED by the Davie County Environmental Health Section prior to issuance of any Building Pernuts. This Fom�/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Pernuts. " (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) �� ,`,� �,�,...r f � cy ��*NuriCr:�**'1'H15 AU'1'HUKiGA'1'lUN FOR WASTEWATER CONSTRUCTION ��°�.:--< �+ -�?-•ua .,:•:_�� 1�� "'� i� IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED A �� Js r ,. . �.":. ... ..;» .. .. „ � . . . � . . . .. � , - ' r , - - ��.�. � :�i.�...� i,_.;..: .:.�.-; . .. „'... ... „ .: . ': .�.� ' . ..-,.` .. ,� . �... _ ..i"- . . . . � , - ' ' ' , �:..:, , � �µ * '� � DAVIE COUNTY HEALTH . , p vX� .. x ..�..;n --�.`- DEPARTMENT � , � ' �:- :�-- � _ ,,_-s �' IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION � �'ermittee' � _ ' Name: ' z� _ '� ' � - �'�� '<4•'.; Subdivision Name: � birections to property: � "?� � - � 1� �� `7 ,-f�``" Section: Lot: ` � IMPROVEMENT .,�� .., r•• `ti , . �41]�i PERMIT . Tax Office PIN:# �� '� � - r? � , ( r ~} � ��n � ..i � . . � � � � � _.. � . . r� .-.. Road Name '. ^> . �, �,, '^•-, `a ZlP_ .. � l � **NOT'E** This Impmvement Pernut DOFS NOT authorize the const�uction or installation of a septic tanlc system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCT'ION must be obtained from this Department prior to the . construction/installation of a system or the issuance of a building pernut. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) � A:-.a � . �-., .-,� ***NOTICE*�`* Tf�S PERMIT IS SUBJECT TO REVOCATION IF S1TE -�> >.: .'' k�`--'}- �;.," � i PLANS OR Tf� INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THI.S PERNIIT BEFORE INSTALLING TI� SYSTEM. RESIDENTIAL SPECIFICATION: BUII.DING TYPE'"'� ".�# BEDROOMS �� # BATHS ""' # OCCUPANTS � GARBAGE DISPOSAL: Yes oi,'�iryl COMMERCIAL SPECIFICATION: FACILTTY TYPE # PEOPLE # PEOPLF✓SHIFT # SEATS INDUSTRIAL WASTE: Yes or No —� � LOT SIZE � t�'� TYPE WATER SUPPLY � DESIGN WASTEWATER FLOW (GPD) ..� �''� NEW SITE �''� REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZ� '�� GAL. PUMP TANK GAL. TRENCH WIDTH J' ROCK DEPTH '�' LINEAR FT:�� ' REQUIRED SITE MODIFICATIONS/CONDTTIONS: IMPROVEMENT PERMIT LAYOUT **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. I OPERATION PERMIT SYSTEM INSTALLED BY: � /_i6-qg AUTHORIZATION NO. EI� OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAP'fER 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. DCHD OS/96 (Revised) .. u � ��` APPLICATION FOR SITE EVALUATION/IMPROVEMENT ' Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 � (704) 634-8760 �� a�� D MAY�51997 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. i'/►'� E, �CI� � �� P.hl� Y� 1L Contact Person �2 ►'Y' �i 61r ��-�1 i� C 1-� wS 1. Name to be Billed �. � rews , n pG r Mailing Address '-� o � EI m o re, R d Home Phone %�'�{ �/a '%�r �� City/State/Zip II�iO .KS V i 1 � e. � L a7Ua � Business Phone 2. Name on PermidATC if Different than Above Mailing Address 3. Application For: �( ] Site Evaluation City/State/Zip [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: 4(] House [] Mobile Home [] Business [] Industry [] Other 5. If Residence: # People� # Bedrooms� # Bathrooms �(] Dishwasher [] Garbage Disposal [X] Washing Machine [] BasementlPlumbing [] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 1 7. Type of water supply: [�Q County/City [] Well [] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [] Yes [1(] No If yes, what type? EZTHElz A PLAT OR SZTE PLrIN PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** �'�COF THE PROPERTY MUST BE �, 7(J �% Q,CJZP,o SUBMITTED WITH T APPLICATION. Property Dimensions: �'� •'4'� X�a ; WRITE DIRECTIONS (from �VIocksville) TO PROPERTY: Tax Office PIN: #.,��_ -�- � 7�3 ; l D�l� � e-{�� o n l. ; b.r�u C h Rd, . Ra�� h t Property Address: Road Name � I m o re, 110ct..� � 0 Y C� . O � City/Zip � O C K Sv \�� e. 1 V C• ; r � � S i C� 2 If in Subdivision provide information, as follows: � 1� Ci � Name: � � � Section: Lot #: ; � This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter aze subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by �� Revised DCHD (06-96) conduct all THIS �IItEA hU4� 13E USEb �OIZ bltflWlNC� JOUIt SZTE �'LtIN: as necessary to determine the site suitability. ;:: � _ ;�—'" '-��- � � � � � � . __ . _ _ . .. ; _ � �,,t � _ ,, =--- - �-�-_--��------ _ ,_..;.�. , . _ ... � �._ �.,:_�_ �� - . � . — _.. - - - _- - . - f ° " ' �` T �= ` �'Y;�S , ,. - ' pavement J - - , 1332 � - � _EA,ews D S. R. � \ W �o t,i�. ' .. FI,MORE R�A unmarked P�o1�t 9_ _ .� 0 ' � a� �� om Zo o.. w� o� DONALD A. HARRIS D.B. 152 P9. 734 MARY A. CREWs. ET AL � 6� 30 0 60 120 180 SCALE IN FEE7' c 0 O �. �y . p.�.� .. ` : . h � ro 5c KF „ ��,.,, ' F ?°�� A�o��'l��= :O�'�� F� �.9�. 'Z; ..=^,L - = : � L-2527 Q ; o: ��` 0�0 5 Li R�;Fy ' , C,�° .. ' �1 �,r °l'TU�� I, Q2ADY L TUTTEROV, CFRTIFY THP,T UNDER HY DIRECTIDN AND SUPERVISI�N, THIS MM YAS DRAVN FR�M AN ACTUAL FIELD SURYEY MADE BY MTER04 SURVEYING COHPANY. ��1 ��'��' _ ! _ �'��='— REGISTERED LAND SURVEYpR �-2527 �/ TUTTEROlY SURVEYING COMPANY 127 LIBERTY CHURCH ROAD M�CKSVILLE, N,C, 27028 C7�4> 492-5616 PLAT OF SURVEY F�R� TIM �c DENISE HENDRIX aEvtstoru �, 1� � 60' iaPamrn rn ua�v� rr� �H n,�� JANUARY 08. 1997 �T B�NG 1.707 ACRES TAKETI FROM THE IMFtY A CREIVS, Ef AL PROPERTY LYING IN iHc CL•��`_.Ytu� i0!°�-:�.`=!Y, COUNTY OF DAVIE, NOR7H CAf2pLlr:.l TAX MAP REF: D-3, a_ portion of PARCEI._ 18 '""�I"� H1OE3° - --- - 29�-2 �R i : u _ � • ' DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section SECTION LOT SoiUSite Evaluation APPLICANT'S NAME � `�`� �`�'`��9 PROPOSED FACILITY � � �=' �" � SUBDIVISION `'"�— Water Supply: On-Site Well Community. Evaluation By�St,,L Auger Boring � Pit FACTORS Slope % HORIZON I DEPTH Consistence Structure HORIZON II DEPTH Texture group Consistence Structure HORIZON III DEPTH Texture group Consistence Structure HORIZON IV DEPTH Texture group Consistence Structure SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE � � � � �— DATE EVALUATED � � �- � �� PROPERTY SIZE _ I .�b� �'�� ROAD NAME � � Public � Cut 3 4 5 6 7 LONG-TERM ACCEPTANCE RATE I �� I ��k I I I I I SITE CLASSIFICATION: �'S � EVALUATION BY: \ ��.�""' C��-�� LONG-TERM ACCEPTANCE RATE: `y OTHER(S) PRESENT: `� a� REMARKS: __��-s-�' C� — �,� � �-�a� �J�--�� '� LEGEND DCHD (01-90) 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 - Sil[y clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C- Clay Moist VFR - Very friable Wet NS - Non sticky NP - Non plastic FR - Friable FI - Firm VFI - Very firm EFI - Extremely frm 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 ■�■■�■■ ■��■■■ ■■■■■■■ ■��■ ■■■■�■■ ■■��■ ■■��■■■ ■■�■��■ ■■�■��■ ■��■ ■��■�■■ ■�■■�■■ ■■��■ ■��■��■ ■��■�■ ■■■■■■ ■■��■ ■��■�■ ■�■■■■ ■��■�■ ■■�■�■ �■�■�■ ■��■ ■■�■�■ ■��■�■ ■ ■�■■ ■��■ ■■►�■■\`\■ ■■■\\■■\\ ■■��\\�■ ■��■■■\�■ ■■■�■■�\ ■■■ ■■�■ ■��■■�■■■ ■■■■�■■�■ ■�■■�■■■■ ■��■�■ ■�■��■■■■ ■■G1�■■�■ ■■1'N■■■■ ■��■■■■�■■■■■��■��■�I■�■ ■■��■■��■�■��■■�■■■■■�1�■ ■■■�■�■■�■■�■��■■��■■�■11 ■ ■■��■�■��■■�■��■��■■■�■�1��■ ■■��■■�■��■��■■�■■■■■\I■�■ ■��■�■■■■■�■��■■��■■■■�1■■ ■■��■�■■��■�■�■�■��■■�■■l��■ ■��■■■■■■■��■■��■ ■■■■■�■■�■��■��■■s■■■��■ ■■■��■��■■��■��■■■■■�� ■��■■�■��■■�■��■��■■ � ■��■��■��■�■■■■■��■■ ■��■�■��■��■t�■��■�■■��■■ ■■■■■■■■■■■��■t■■■ ■■■��■��■��■��■��■■��■■ ■�t��■��■■�■■■■■■■■■■��■■ ■��■�■■�■■■■■�■■��■��■■ ■��■��■■�■■■ ■ ■■�■■■■■■■■�■■�■��■�■■ ■ ■■■��■��■■■■■■�■■ ■��■■�■■�■■■■■�■■■�■��■■ ■■��■�■��■��■��■��■��■��■■ ■■��■��■��■�■■■■�■�■��■■ ■��■�■■�■■��■�■■■�■■�■��■■■ ■■��■�■■■■■�■■■■�■��■ ■■■■�■■�■■■��■■��■ ■��■�■■��■��■��■��■�■ ■ ■��■�■■■■■■�■■■■■■■■■��■ ■��■■■■■■■■�■■��■��■■ ■��■■��■■■■■�■��■�■■■■■�■ ■�■■�■■�■■��■�■�■■■��■��■■■ ■��■■�■■■�■■■■■�■��■��■■■ ■��■��■■�■■■■■t�■■■ ■��■�■■■■■■■�■■■■■■��■�■ ■■■i�■■ ■■■��■ ■�■��■■ ■�■■�■■ ■■■��■■ ■�■■��■ ■■■��■■ ■��■��■ ■■��■■ ■��■■�■ ■�■■■■■ ■■��■ ■■��■ ■��■ ■��■�■ ■��■ ■■■■■■■ ■��■ ■��■ ■■■■■■■ ■■��■ ■��■ ■■�■■�■ ■■��■■ ■��■■�■ ■■��■■ ■■�■■■■ ■■�■■��■■■�■ ■■■■��■ ■■■■■■■■�■�■ ■��■■��■ ■��■■�■■■■■ ■■■■■■■■■■�■ ■■�■■■■��■�■ ■■■■■��■�■ ■■��■��■■ ■■■■■■■��■■■ �■■�■�■��■ i��■ ��■■■■■■■��■■■ ��■■■■■■■��■■■ ��■��■■ ■t�■■��►�■■ ��■■�■■��■■ ■ ��■��■■ ■i��i�■ �i�■��■