2245 Farmington Rd..i►...•►._ ,,,,
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P9 w4ab
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990001420 Tax PIN/EH #: 5843-52-7662
Billed To: Franklin Godfrey Subdivision Info:
Reference Name: Chad Godfrey Location/Address: Farmington Rd -27028
rroposed raciiity: Residence Property Size: see map
ATC Number: 2582
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST 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 CONS �VAFOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signa re: ate:
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Cor
has been installed in compliance with
Disposal Systems," but shall in NO W.
given period of time.
Septic System Installed By:
Environmental Health Specialist's Signature
DCHD 05/99 (Revised)
1 indicate the system described on Improvement/Operation Permit
G.S. Chapter 130A, Section .1900 "Sewage Treatment and
as alguarantee that the system will function satisfactorily for any
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Date:
DAVIE COUNTY HEALTH DEPARTMENT
• ' Environmental Health Section
P. O. Boa 848/210 Hospital Street-
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990001420
Billed To: Franklin Godfrey
Reference Name: Chad Godfrey
Proposed Facility: Residence
Tax PIN/EH #: 5843-52-7662
Subdivision Info:
Location/Address: Farmington Rd -27028
Property Size: see map
**NOTE* * 'I i bfmprovem2ent/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 1 l 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 M- lAblr< #People 3 #Bedrooms #Baths 2
Dishwasher: Garbage Disposal: ❑ Washing Machine: a Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #Peeople #People/Shift #S'ateaElts Industrial Waste:
Lot Size t' Type Water SuppleOC #P / Design Wastewater Flow (GPD) �G� Site: New Repair ❑
l f/ 0 '
System Specifications: Tank Size GAL. Pump Tank GAL. Trench Widt Rock Depth /Z Linear Ft. �0
Other: Di-SjQWD 0,3 byX , j + '
TAU.- LI��S � D•Q µti .
Required Site Modifications/Conditions: RMP 51 off- j-ka;E , II& 16, Orr p2d. 061c;, 1rJ<TAii, C -A U
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) 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.****
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Environmental Health Specialist's Signature: Date: QLo 2A
DCHD 05/99 (Revised) I
APPUCATION FOR SITE EVAUJAT10N/IMPROVEMENT PERMIT & ATC
Davie County Health Department
• Envlronmanbal Healdim Seatfon
P.O. Box 848/210 Hospital Street ! SEP l J?(�
Mooksville, He 27028
(336)731-6760
In2MMION
HPORTA1W** THIS APPLICATION CXlQ= BN PM=S8RD UNIMS8 ALT. TSE `IOZQUIRBD '� d.4..�
IS PROVIDED. Rater to the 11=10021011 BULLETIN for instructions.
1. Ma's to be silted Contact Derwen eQ'1ox:o adle-
Wilingaddress 7:6r- am* Dhone
city/stat./s:2 KY' Q1 103 •(sins• mmme _95(o — •i(oR - 65248
Z. Man• on grit/ATC it Different than Above
Mailing address
S. Application For: O Site •valuation
e. Bytes to servioe: O House Mobile Homo
S. It Residuice: i People
City /state nip
Improvement Permit/=C O Both
O Business O Industry O Other
Bedrooms 3 r Bathrooms a
'A Di•hwsaber O Oarbaga Disposal )Nabbing Machin O aasseent/Plumbing 0 Sa••ment/no Dlumbing
6. It suaine•s/industry/otber: specify type i People i sinks 3
! commodes I showers i Urinals i Water coolers
it 1=811MCM: II Seats Zatimated Water Usage (gallons per day)
7. Type of water supply: X county/City O well O Community
e. Do you anticipate additions or expansions of the facility this system Is intended to serve? O Yet No
Dyes, what type?
***IMPORTANT*** CLIENTS MUST COMPLMTHE REQUIRED PROPERTY INFORMATION REQUESTED
� BEIDW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions:
Tax 0111ce PIN: -7(P ('0 �-
Property Address: RoadName
Citylzip
U in a Subdivision provide Information, as follows:
Name:
Section: Block: lAt:
WRITE DIRECTIONS (from Moclovllle) to PROPERTY:
d' '(lob) (1
nn
0
Date Property Flagged: AU
This Is to certify that the Information provided Is correct to the best of my knowledge. I understand that any permit(s)
Issued hereafter are subject to suspension or revocation, If the site plans or Intended we change, or if the information
submitted in this application is fabitied or changed 1, also, understand that I am responsible for all charges incurred from
this applicadom 1, 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
to conduct all testing procedures as necessary to determine the site
THIS AREA MAY BE USED FOR DRAWING YOUR SITE #LAN (Include all of the foliowl : Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Revised DCHD (07/99)
:�- 7-
Site Revbit Charge
IDate(s):
I Client NotiHcstion Date:
I EHS:
Account No.
Invoice No. t�
Davie County NeaAk Deyrtment
and Nah7e Nealtlf .fyency
210 HOSPITAL STREET / P.O. BOX 665
MoCKSVILLE. N.C. 27028
PHONE: (704) 634-5985
August 15, 1996
Steven Loftin
190 Matt James Ct.
Lewisville, NC 27023
Re: Site Evaluation
Farmington Rd.
Tax PIN: #5843-52-7662
Dear Mr. Loftin:
As requested, a representative from this office visited the aforementioned
site on August 14, 1996. Based upon the information provided on the
application for site evaluation and after the evaluation was completed, the
site was found to be provisionally suitable for the installation of an on-site
sewage disposal system.
If you have any questions, please feel free to contact this office.
Sincerely,
Robert B. ?Mall, jr., R.S.
Environmental Health Section
KBH/wd
Enclosure(s)
DAVIE COUNTY HEALTH DEPARTMENT
Elivironmental, Health Section
Soil/Site Evaluation /
DATE EVALUATED
PROPERTY SM %S";O-G
LOCATION OF SITE i�
DRESS
.OPOSED FACIILTY' 4!ir4,ee
Water Supply:
on -Site Well _
Community
F jblic
:valuation By:
'Auger Boring t/
Pit
It
FACTORS 1 2 4
Landscape position
Sloe %.
HORIZON I DEPTH do.
Texture; group
v.7T'g i's-•er. c 2 • • '
Structure
Mineralogy
HORIZON II DEPTH ^
Texture group
Consistence r
Sciucture ' l
Mineralogy
HORIZON III DEPTH
Texture rou
Consistence
Structure
Minera-logy
HORIZON IV DEPTH
Texture'group
Consistence
Structure
Mineralogy
SOIL uETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE' RATE
SITE CLASSIPIC,ATION: _
[ANG-TE.RM ACCEPTANCE RATE'
REMARKS: ,
un in. _e..+
EVALUATED BYt ��`
OTHER(S) PRENI?l+ T;
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 -Loath SI -S 1t
SICL-Silty ;ley loan- • 'SIL-Sitty loam CL -Clay loam SCL-;andy clay'loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR- V ---y friable FR -Friable FI -Firm VFl-Very firm I RI -Extremely firm
NS -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky
NIS -Non plastic SP=Slightly plastic P -Plastic VP -Very l lastic
Structure
,XC Single grain M -Massive CR -Crumb GR -Granular
SBK-:-Subangular blocky PL -Platy PR -Prismatic
Mineralo¢v
1:1.'2:1, Mixed
Notes
).SK -Angular blocky
IIorizon 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 3u --face to soil colors
with 'chroma 2 or less
Classification - S(suitable), PS(provisionally suitable). U(unsuitable)
LTAR - Long-term acceptance.rate - gal/day/fez
M.B. BROCK
DB 13 P 417
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KUHN C.ONS TR. UCT_ION S
'f.Q9f2 WA All/rnr'o- n
0.020 ACRES IN HIGHWAY
^
MAINTAINED
RI-GHT-OF-'WAY
S87'00'00'E
881,78'
LOT 2
T_
87ti0 p0 W 328.22'
M�
29,484 ACRES ���
(TOTAL)
'f
311.78'. -
0 ri.N
o 4
'? c 'LOT 3
co
(TOTAL) ail,
..
f
oNB7'00'00'W 328.70
v
JAMES M. !k RACHi:I ORDC
�
DAB 109 P 714
0.075 ACRES IN HIGHWAY
!,83'45'02wµ'
MAINTAINED RIGHT-OF-WAY
ti
,984.37'
n 1rn%/rk/ nnC'n Aor-n -'CnD
KUHN C.ONS TR. UCT_ION S
'f.Q9f2 WA All/rnr'o- n