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552 Frank Short RdDAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001421 Tax PIN/EH #: 5757-56-8168 Billed To: Thomas Poplin Subdivision Info: Reference Name: Location/Address: Frank Short Rd -27028 Proposed Facility: Residence Property Size: 2.085 acres **NOTE iiss Ll b prove8m8ent/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 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 y4/' #People #Bedrooms !L1 #Baths Dishwasher:;;�Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrriaall Waste: ❑ Lot Size Type Water Supply /� Design Wastewater Flow (GPD) Site: New Repair El 42 System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width �-?AL Rock Depth Linear Ft.,,/00 Other: c��t��f" �C`� D �' '�Ol�/��i / ""Ir 5F ell Required Site Modifications/Conditions: 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.**** Environmental Health Specialist's Signature: Date: Zd (� DCHD 05/99 (Revised) DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001421 Tax PIN/EH #: 5757-56-8168 Billed To: Thomas Poplin Subdivision Info: Reference Name: Location/Address: Frank Short Rd -27028 Proposed Facility: Residence Property Size: 2.085 acres ATC Number: 2588 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 CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. , Environmental Health Specialist's Signature: 666 Date: A6 ;2. Q� CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NOWAY betaken as a guarantee that the system will function satisfactorily f�� given period of time. �f fl� t fn 10C / a�r S 11� F Septic System Installed By: Environmental Health Specialist's Signature : en G Date: DCHD 05/99 (Revised) APPUCATION FOR SITE EVAUTATION/IMPROVEMENT PERMIT do ATC F ' j ;`-� �" [E Davie County Health Department D �S Envirunmentml Hen/& Section '� eta P.O. Box 868/210 Hospital Street SEP 2 6 S 14ackoville, NC 27028 �uU� (336)751-8760 ***nWCRTAN"** THIS APPLICATION C71WWT BZ VA0=6SZD =388 ALL TU ReQUIRZD Zti1'ORi uov I8 PROVIDED. Refer to the Itili'ORMRTim SULLETin for instructions. I 1. llama to be Billed -lac, (Y`P._S � (�n(��iYa �nP��f1 Contact Pos.oa Cr l/miling Address 1 0 ��.� n \L � : Tor Nions .3 2- - 7S) '1212 city/statemp Sr) r) C\�Sv�\\�' , �� 70c1 c� -s ailMWns, Z. lone on parait/AIC it Different than P&ove flailing Address City//tate/sip _ a. Application ror: 0 Site Rvaluattion 15 improvement Permit/ATC \. Both a. systes to services O Hou@e d3' Lle Home 0 Business O Industry 0 Other s. If Residence: i People � s Bedrooms i Bathrooms c� dishwasher 0 Garbage Disposal \Q/ftabing Haobine 0 aaseaant/Plumbing 0 saseaant/No, Plumbing 6. If Business/lEndustry/other: Specify type f People f @inks i Commodes i showers i urinals I water coolers IT 1=82MICe: ii seats estimated Water Usage (gallons per day) 7. Type of water s '8 supply: 0 county/City '11611 ❑ community 0. Do you anticipate additions or expansions of the facWty this system Is Intended to serve? 940 Ilya, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED I BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client witli THIS APPLICATION. Property Dimensions: ol. 0 g15 c', c r P— S 5G Tax Office PIN: s�^7 �-7 41§ Property Address: Road Name rc-ctc)V- � t'� Vc) CitympM), i,\Io— , cg -70r � s it In a Subdivision provide information, as follows: Name: Sections Block: Lot: WRITE DIRECTIONS (from Mockniile) to PROPERTY: (nc)\ --0(4�� 1 e � � Date Property Flagged: / This is to certify that the Intbrmation provided is correct to the bat of my knowledge. I understand that any permit(s) Issued hereafter are subject to suspension or revocation, If the site plans or intended ase change, or If the information submitted In this application Is falsified or changed 1, also, understand that I am responsible for all charges incurredftom this applicadon. I, hereby, give consent to the Authorized Representative of the Da��Coes ty H De crimen( to enter upon above described property located In Davie County and owned by, to conduct all testing procedures as necessary to determine the site suitabW . (y o DATE / ' 626 _CFD SIGNATURE s� MM AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge IDate(s)s Client Notification Date: 1 ERS: Account No. 02 Invoice No. ��✓ C/oj� v 880 Z ,� deo■ VL mt, 'ell 99 �9 CD LO s DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001421 Tax PIN/EH #: 5757-56-8168 Billed To: Thomas Poplin Subdivision Info: Reference Name: Location/Address: Frank Short Rd -27028 Proposed Facility: Residence Property Size: 2.085 acres Date Evaluated:-,29��r% Water Supply: On -Site Well I / Community Public Evaluation By: Auger Boring V Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH `1F Texture group C Consistence ,<'i Structure f� 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: LONG-TERM ACCEPTANCE RATE: REMARKS: 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 FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic 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 Mineralogy 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 - gal/day/ft2 DCHD 05/99 (Revised) ■■ME■■E■■MMM■■ ■M■■M■■EM■■MM■ ■M■■■■■EM■E■E■ ■M■M■E■■MMM■ME ■■M■■EM■E■■■E■ ■■M■E■■MMM■■■■ ■EM■M■■M■M■■■■ ■E■■■■M■■M■■M■ ■EM■■■E■■■■M■■ ■■■MMM■M■■■M■■ ■E■■MM■E■■EM■■ ■■M■■■■M■■M■■c ■■ME■■■E■■■EM■ ■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■ ■■■■M■■■M■■■M■ EMOMEMEMMM■■■■ mom iii iii ■■■ ■■■■O- ■ENOMONE■ ■■■ME■■■■ ■■MMS■■■■ ■ ■ ■■M■O■ ■EN■■■ ■■N■■■ ■■ME■■ ■■MONS ■OM■■■ ■EM■■■ ■EMM■■ ■■■NE■ ■E■■E■ ■E■■E■ ■■N■E■ ■■■■E■ ■■MMM■ ■■M■■■ ■■■■■■ ■■■E■■ ■■■N■■ ■■■■■■ ■E■E■ ■E■■■ ■MO■■ ■E■E■ ■E■E■ ■E■■■ ■■■■■ ■■■■ ■N■■ ■EN■■ ■MMM■ ■M■N■ ■■E■■ MESON ■■E■■ U■M■■ ■■■■■■■■■■■■■■■tri■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■Mee■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■Mee■■■■■■■■■ ■■■■■■■■■eee■■■ecce■■■■Mee■■Mee■ e■■■Mee■■■■■EM■E■■■■■■■■■M■■e■■■ ■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■ ■■■M■M■■M■■■M■■ ■■MEM■M■■■■■■e■ ■MEN MMM■SNow amM■■■■■■■■■■ft■■■■ ■■■■M■■■cue■■■■■■■■■■■■■■■it■■■■ ■■Mee■■■■��■■■M■■■■■■■■■■■Mit■■■■ EMEMMEEMMEMEMOMMEMMEMMEM ■■MMM■■M�i■MMc■■■■■■eee■■■■■■■M■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■M■■■■■■■■Mee■�■■MM■■■■■M■■■■■ ■■■■■MMM■■■■■■ ■■CR■■■■■■■■■■■ ■M■■■■■■■ecce■■■■C■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■eee■■■■■M■�;MM�■■■■■■■■■■Mee■■ ■N■SS■E■■E■MO■ ■■■■M■■E■■E■■E■ Mee■■■■■■■■■■■■■■■■MMM■M■■■■■■■ ■■■■■■■■Mee■■■■Mee■■■M■M■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■E■■M■■M■ME■ ■■EME■EM■MMEM■ ■■MME■OMMEMEM■ ■■E■M■■MEMEMM■ ■E■■EM■M■MM■■■ ■■MM■MMEM■O■M■ ■EN■NOM■O■■NN■ ■MM■E■M■■■■■■■ ■MEMM■M■■MEMM■ ■EMMEME■OM■■E■ ■E■■MMM■■M■ME■ ■MMM■■M■■MEME■ ■■■M■■■■■ME■■■ ■E■■M■ME■■EE■■ ■E■■MOMEMMOM■■ ■EM■■■■M■M■E■■ ■EM■OMMOM■■MM■ ■■■■■MMM■ME■ ■■■■■■M■■MM■ ■MO■■■■MMM■■ ■M■■■■■MMM■■ ■M■■M■■M■M■■ ■O■■■M■M■■M■ ■■■■OMM■M■M■ ■E■■OM■■M■M■ ■■■M■■■M■■E■ ■■■M■ME■■M■MM■ ■M■■MMM■■EMME■ ■M■■MMM■■■■MM■ ■■■■MMM■MMM■M■ ■■■■E■E■■■M■M■ ■EE■■■■MMM■■■■ ■■■■■■■■■M■■■■ ■M■■■■■MMM■M■■ ■■M■■■■■■■■■M■ ■M■■■MMM■■■■M■ ■■■M■■■■MMM■■■ ■■MM■■■e■■■M■■ ■M■MM■■■M■M■■■ ■■■■■EM■■■■M■■ ■■ ■ NONE SEEN ■■M■ ■■E■ ■O■■ ■■■■ MEMO MEMO■■ ■■■■■ ■■■■■■■■■■■M■■ ■■■■MMM■■■■■■■