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494 Fred Bahnson Drsc, , DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028-4t- (336)751-8760 7028�J � '! (336)751-8760 14q`1 Account #: 990001277 Tax PIN/EH #: 5873-60-2472 Billed To: Bleeker Strand Subdivision Info: q�tt Reference Name: Location/Address: Fred Bahnson Drive -27006 ATC Number: 4144 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: Date: , 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 NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT t - Environmental Health Section ' P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001277 Tax PIN/EH #: 5873-60-2472 Billed To: Bleeker Strand Subdivision Info: Reference Name: Location/Address: Fred Bahnson Drive -27006 Proposed Facility Residence Property Size: see map ATC NuMber: 4144 **NOTE** This Improvement/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 H #People _ #Bedrooms �f #Baths —,2_ Dishwasher; Garbage Disposal: 0 Washing Machine: 0"' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type / #People #People/Shift #Seeaats Industrial Waste: ❑ Lot Size Type Water Supply A/�� Design Wastewater Flow (GPD) �ly r/ Site: New e Repair ❑ System Specifications: Tank SizeGAL. Pump Tank GAL. TrenchWidth Rock Depth ��Linear F6, l V Other: As stated in 15A Kr -AC 18A.1969(5) ECCUPi U tiM-1 else be . a 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: DCHD 05/99 (Revised) y '. ZO'd Jul DN as Olt6Yio aavl• oountlll dnvhaalOh 336 751 APPUCAYIOA FOR SIR tVAI1.11T1 W M WVtAtFIYT PElhltn Davie County Health Department 1'gYIhOA/leaflbisi hgdEll 8irtxJorr M/oka9i11s, PIC 27078 (336)191-8790 p--1 C;VECOj U _ t% 2005 ATC K�(Tf! P*AXWtaR!iWI! &a 1=s AiAl�U"MCLIF C. 044 Ad =04108841 f711 IS ALL ?$a ASpVSsaD) 2MMAITC10 Ia 311MM21119. Attar to the 2MIp0OMTS0tt al)S.b>!L'= tot tyiCc sonata. 4-- Par.1 to Do 5111e4 E-1i,;r,�tf 9 t (�Q�"f f� L.CUL aae Platen. �aalller A".. 3_Fy4C1 '-� tier/►t.►el►s►. Y�v+fLt tUL '17pay ,wabwo.t .a 49Cy'Q941) ?. Now as ►mea/a/C it Mlowals eats rover galling tatraea _....._.__,_ ._..----�- _ _ _. "sr/staleflip v.t. aapllesaiaa Mr. Walk, rvslsatioa O Saeprovenank Oatstlt/ATC 9o11h --T. systea to mar -los. IQ Rota it D leobila lbez 0 D 'Saatt Q a'ruaiaa`ry W40t It f"Qdo\O-jr "Vy?-Ne, "-f. 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J `�o -24 z2 �t?L1L �1ri a —1ijaSk- frt y e e-A'A- U1MpelrtyAdhhMt laasdNstnsS A1�/Aij�rrl v.rl �dn1 I�kartL, TU C414 A � VF1,Y1 C 1�� =0 1*t 't_''� Lbu 10i a Subdivision provide httormallt o, lu !►!Jowl: _tQJr !�) n i, �S t'L i(. �lR_� �! c 3 -------------- Faust (� ►�rv� a a_ ) Acellon: Week: Lob Alper botue toroera nagged: This to to amrilly that Ilia inibimation provided 0 armee to tip bon atnv knotvlcdga f wnderala,ld tlioI any parndt(a) blued hereafter an luoj&tl to luponk.n or nvareCOM It the Alto plan er Intesdsd aro Ntuhaq ar U tir Ishrohadoa ra"'•ptt d to tl:la rq p tai:'Go I: 6'allied or ehwM94 y, alev, tutderatrxd rhn/ go mairoadWibt, all drrrlartnerwidAwa dub aMleriaba. Llwoby. Sivr egnmu to the Authorized Representative of tlW Dario Comply Itt_ftb Drpartntettl to tater upon above destribod property looawd In Davie Comity, and owned by h1 t r is a w S3XO ,,e,C _ I: grads— all letili j praioatUwo as utrteemry to dotortedne the tits suitpblitty. Its GNATI)AS�1 -7 It 105- THM Ai U MAY DZ UAW MADRAWING YOUR SITE PLAN (I :olvda elf *CID* Csi..73rinS: 2trlslatS and preperal FW" uu rad dlmsndoal, Ilra/tur;e, I410eCM, and roptic IocaUoe). site ltovhu Charge Carat fretitleation Balm zinc Ill$A leve Aasarhy)yo. /2--7-7 AavleadMID (eW^.a Invoice No. tri > OL62OV69££ S-13NN3A-3QISN3A1N Wd 9Z:Z0 S00Z-80--inr • '� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001277 Tax PIN/EH #: 5873-60-2472 Billed To: Bleeker Strand Subdivision Info: Reference Name: Location/Address: Fred Bahnson Drive- 7006 Proposed Facility: Residence Property Size: see map Date Evaluated: l Water Supply: On -Site Well (/ Community Public Evaluation By: Auger Boring LZ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % 1 HORIZON I DEPTH Texture group Consistence ✓7T Structure (� r Mineralogy HORIZON II DEPTH Texture groupG Consistence Structure 1 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 r _. SITE CLASSIFICATION: lh� LONG-TERM ACCEPTANCE RATE: r 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 a'I41St VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm 33.s' �t 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 lYQtes 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 05105 (Revised) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■/■■■■■/■■■■■'19111►J■■/■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■