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533 Gladstone RdAccount #: 990000985 Billed To: Annette Brown Reference Name: Annette Brown Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT /:9--/.2 02 y GG Tax PIN/EH #: 5736-73-2237 Subdivision Info: Location/Address: Gladstone Road -27028 Property Size: 1.01 Acre **NOTI * iIss provement/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 ,yl, #People �� #Bedrooms #Baths - Dishwasher: Garbage Disposal: ❑ Washing Machine: 2'0" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Ql Type Water Supply _ Design Wastewater Flow (GPD) Site: New C2" -'Repair ❑ System Specifications: Tank Size GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width /, Rock Depth f,, Linear Ft.,120� 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.**** C� Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) Account #: 990000985 Billed To: Annette Brown Reference Name: Annette Brown Proposed Facility: Residence ATC Number: 2332 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5736-73-2237 Subdivision Info: Location/Address: Gladstone Road -27028 Property Size: 1.01 Acre 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 WASTEWAT CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.. Environmental Health Specialist's Signature:.A Date: C1'2 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. Ch to l OA, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a gua nt hat the system will function satisfactorily for any given period of time. F Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date:—? -0 -06 Fab -09-00 11:12A CB TRIAD, REALTORS 910-998-4492 APPUGITION FOR SITE EVALVAt70N/IMPROVEMENf KRMif i ATC Darts Count HoaM Depuhnant �� E}ttdromrttertbet i AW* S*Cl/W ` _. 20 P.O. Do: 040/210 Rosaital Stssat Moeata►illa, MC 27020 P� 9 (236)731-Y760 aha T,.e• Tats AltLICPMOU CAULV' BE PSOCXSSRD tuaass ALL TtM NWIMM ZIUOR MIM 15 (7 �0=2J)=. 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APPLICANT INFORMATION Account #: 990000985 Billed To: Annette Brown Reference Name: Annette Brown Proposed Facility: Residence Water Supply: On -Site Well DAVIE COUNTY HEALTH DEPAR'T'MENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5736-73-2237 Subdivision Info: Location/Address: Gladstone Road -27028 Property Size: 1.01 Acre Date Evaluated: - av' Q� Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % << °' HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence l l Structure L 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: 4,// 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) ii No ON ■■ on ME ■■ ■■ ■ ■ ■ ■MM■■E■ ■■M■ME■ ■■MEMM■ ■E■E■■■ ■■MME■■ ■■MEMS■ ■■E■■E■ ■■■E■■■ ■U■■■■■ ■ ■■■■■ ii ■ ■ ■E■■M■ ■E■■E■ ■E■■E■ ■EEE■■ ■■■■S■ ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MESON �CMEMNON MMEMONIMMMEME mommon MEMEME ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■