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1302 Godbey Rdw AUTHORIZATION Y40: 12 1 1 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY Peinlitte'e;s'" ,+` y P.O. Box 848 Name: ,'- t fj.x�` Mocksville, NC 27028 Subdivision Name: ;_.•'! Phone #: 704-634-8760 Directions to property: r�/%'! '.-+ Section: AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Tax Office PIN:# -a Road Name: !'�^ **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Env to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and D ***NOTICE*** THIS AUTHORIZATION FOR W. IS VALID FOR A PERIOD OF ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED TION _ Lot: E7 W Health Section prior Building Inspections ;al Systems) WATER CONSTRUCTION YEARS. **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or y wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this D partment 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 System's, Section .1900 Sewage Treatment and Dis ' sal Systems) t -J` ***NOTICE*** THIS PERMIT IS SUBJEC TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANG . YOUR WASTEWATER yENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE Y— # BEDROOMS —'? # BATHS # OCCUPANTS COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS LOT SIZE -112 I( TYPE WATER SUPPLY —Alz-,11DESIGN WASTEWATER FLOW (GPD),,..F4_/, L NEW SYSTEM SPECIFICATIONS: TANK SIZE/--/'L"—GAL.;PUMP TANK GAL. TRENCH WIDTH /• ROCK REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT 1 foo "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHI OPERATION PERMIT SYSTEM INSTALLED BY: 11' .�3� F �5 GARBAGE DISPOSAL: Yes or No INDUSTRIAL WASTE: Yes or No REPAIR SITE ^� LINEAR FT. O� ;CTION OF THIS SYSTEM IS (704) 634-8760. AUTHORIZATION NO. OPERATION PERMIT BY: /`/— 7 I DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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. DCHD 05/96 (Revised) DAVIE COUNTY HEALTH DEPARTMENT j •j , ,a{` IMPROVEMENT AND OPERATION PERMITS PROPERTY NFORMATIQN Subdivision Name: / Pird fQns to�roperty: % -' r Section: Lot: IMPROVEMENT PERMIT Tax Office PIN:#.'t r� '`�- r 4. " � ' Road Name: ='/.# -Zip: **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or y wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this D partment 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 System's, Section .1900 Sewage Treatment and Dis ' sal Systems) t -J` ***NOTICE*** THIS PERMIT IS SUBJEC TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANG . YOUR WASTEWATER yENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE Y— # BEDROOMS —'? # BATHS # OCCUPANTS COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS LOT SIZE -112 I( TYPE WATER SUPPLY —Alz-,11DESIGN WASTEWATER FLOW (GPD),,..F4_/, L NEW SYSTEM SPECIFICATIONS: TANK SIZE/--/'L"—GAL.;PUMP TANK GAL. TRENCH WIDTH /• ROCK REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT 1 foo "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHI OPERATION PERMIT SYSTEM INSTALLED BY: 11' .�3� F �5 GARBAGE DISPOSAL: Yes or No INDUSTRIAL WASTE: Yes or No REPAIR SITE ^� LINEAR FT. O� ;CTION OF THIS SYSTEM IS (704) 634-8760. AUTHORIZATION NO. OPERATION PERMIT BY: /`/— 7 I DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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. DCHD 05/96 (Revised) APPLIC ATION FOR SITE EVALUATIONAMPROVEMENT PERM I ` Davie County Health Department r Environmental Health Section P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 t _ T ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSE NL] THE REQUIRED INFORMATION IS PROVIDED. t y r 1. Name to be Billed 64 P �"+ ,le��y� Contact Person_ Mailing Address / 1 ja l l b ro 0 X I h Home Phone �%�JL341-03 City/State/Zip �e- t) G 2-702-3 Business PhoneCY I� 76l 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: [ ] Site Evaluation City/State/Zip Improvement Permit & ATC [ ] Both 4. System to Serve: [ r]'House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People _r # Bedrooms_3 # Bathrooms 3 [,. Dishwasher [t -Garbage Disposal [ ^ashing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing C ac -e_ 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [ ] County/City [IlVell [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes P-1190 If yes, what type? E. EITHER A PLAT OR SITE PLAN INFORMATION REQUIRED: *** IMPORTANT *** SOF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: 4pPt-0 4 -Cy Q G res � WRITE DIRECTIONS (from Mocksvule) TO PROPERTY. Tax Office PIN: # t) t F - ; V 1 --,el w. n dS %� L �eo e F=-7` Property Address: Road N$me S-0�b`n�e 1�d � � 6Y1 t/CsD��y^ � � •. �� C.._/ city/zipI I� d G KS v ! (l � (Vr-02 70� e lit d C9 i= je,1 V C ►+-fen 1 . pi -op " 1�/ If in Subdivision provide information, as follows: 1� © ;61t^ +� GVH E' _ ^cy k Name: Section: Lot*: ? J _ 1E 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 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 to con sting proced s as necessary to determine the site suitability. LA / Revised DCHD (06-96) THIS AREA MAY USED FOR DRA V r oulz SITE PLAN: .7 `) 92 . 549 0.9. !09 75e _ fy P40Pc.—, ARE_ c- 194 acres ^'C --SES S.R. J50 RIGHT OF N4Y----- �fi 7f :Y/LL.::M L. SMCCT E5; 4rr J.8. 56 -�. 239 K'%%1 C36 -E-12,3 _ -ERRY c j KYR E• ;;vr� c- - - - 0-e '9l P--" 1-1,116 s sr Ac"a- E� / fd 9 •.g o ` • a 1M1 E S 17- P��N maozfE APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT S �� ' • �-21 Davie County Health Department Environmental Health Section D '4r P.O. Box 848 V?J�'le �� 2 28 � �,� �C Mocksville, NC 70 b (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be BilledF- (A A L e :6 r Mailing Address r'cc'e- Lr-, City/State/Zip 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: [Site Evaluatior 0 0 1,097 Contact Person Home Phone 0--;� L{ n 5 L, 3 Business Phone Nc�) ::I(, ` — I q Q City/State/Zip [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: [House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People # Bedroom # Bathrooms - -7--, aDishwasher k,,Garbage Disposal [VliVashing Machine [V14B asement/Plumbing [ ] 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) 7. Type of water supply: [ ] County/City [Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [Yes [No If yes, what type? X A PLAT OR PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***)&JUA-1T OF THE PROPERTY MUST BE �j' SUBMITTED WITH THIS APPLICATION. ✓f Property Dimensions: ll OOl2o�G - /?�d C'JU--O WRITE DIRECTIONS (from M'olcksville) TO PRO] Tax Office PIN: 6-8.3 D - 6 9 - �n Property Address: Road Dame `�n oA � e. u�C� .r7 City/Zilp Ic V I `it II 1 If in Subdivision provide information, as follows: Name: P r()a8 Section: Lot #: ; TY: 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 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 I _.i THIS AREA MAY BE USED FOR DRAIVINC YOUR SITE PLAN: as necessary to determine the 47'25" W 83.24 S64°46'13"W 465 79 - LEGEND- DB. 92 PG 549 109 751 N 02° 00' 00" w 1001.16 TOTAL EIP S67 -4V 57"W 611. 67 's 0 770. 16 EIP 31 198 113 758 N 1Q° 25' 521,E 1834. 4p AREA = 62.118 ACRES i TWIN HICKORY ep H E'i R Y WALK E D E 7 7 PG C7 �0, a 22 " S►NEETGUM O' . -- .a ( INCLUDES SR 1150 R/ w) HUNTING X -�—�__ / S 04048'32"E 216.97 CREEK - S 610 55'12"E /125.46 S 370 53'48"E / 268.49 k c \". S 83°18' 23"E LLJ184.52 S 69° 54"53" E 934.55 TOTAL c' 259.41 \31.38 903.17 25.99,•/ E1F 454.44 F;P clP� 31.3 -S 03°25'31w 1� - rr 965.91 TOTAL f-- S 03°23'21"W 480.43 TOTAL • �� E x1S70'G RON P1% ;-'-,ACED V -ACED IRON P IN MONUMENT UNMARKED POINT, CENTER OF CREEK OR ROAD JAMES T. WiNFREY CHAR,ES E. PIERCE C. 5 8 7 PG. 244 D. B. 114 PG. 757 ;;-HARLE- R. LEE D. B. Iic PG I DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT'S NAME Ad6t PROPOSED FACILITY 2 SUBDIVISION SECTION LOT DATE EVALUATED PROPERTY SIZE ROAD NAMEZ'1' Water Supply: On -Site Well / Community Public Evaluation By: Auger Boring t/ Pit Cut .FACTORS 1 2 3 4 5 6 7 Landscape position ,L Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence r Structure /C 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: 0 V, REMARKS: LEGEND DCHD (01-90) Landscaue Position EVALUATION BY: ,A�, OTHER(S) PRESENT: 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 ■EM■■E■E■■E■■■■■■M■ ■M■EME■E■■ME■MEM■M■ ■E■ME■EM■MME■MEM■M■ ■■■■■MEMS■■■■■■ME■■ ■■■EM■EMEMEME■E■EE■ ■■■E■■■■■■■■M■MEMO■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ MEMO ■OE■ ■■■■E■ ■■■■■■ ■E■■E■ mmmmmw ■M■M■M■■ ■MEM■ME■ ■E■E■E■■ ■EMMEME■ ■E■EM■M■ ■■MEMEM■ ■MEMEMM■ ■■MMM■■■ ■ME■EME■ ■EM■EME■ ■■■■■■M■ ■■■■■■E■ ■EM■O■ ■■■ME■ ■E■■■■ ■E■■E■ ■E■■E■ ■E■■■■ ■■■■■■ ■EMME■ ■EMEM■EMEMM■MEME■ ■OMME■■■■EMEME■■■ ■M■■■■■M■■ME■E■M■ ■■EMEME■■E■■■E■E■ ■EME■EM■ME■E■■■■■ ■E■■■E■■■■■■■■■E■ ■■MOEM■■■ME■MEME■ ■EME■■■■■MEMEM■■■ ■■■EMEM■MOMMEMME■ ■■MEM■MEMMEMEMEM■ ■E■■E■■■■MEMEMEM■ ■■■■■■MEMMEMEM■E■ ■E■■E■EMEMEMEM■■■ ■E■■MMEMEM■■ME■E■ ■■■■■ME■EM■■■M■E■ ■■■M■ME■MEME■E■M■ ■■■■■E■■EM■M■MME■ ■ME■■M■■MME■■EM■■ ■MMEMM■■■■■■■■■■■ ■■■■■■■E■M■■E■ME■ ■E■■EME■■■■EM■■■■ ■■M■■■EME■■■■■MO■ ■■■■■■MMEMEMEME■■ ■OMME■■■■ME■■■EM■ ■■■■■E■E■E■■■EMM■ ■M■MEM■■■■ME■E■M■ ■E■OOME■■■MEME■■■ ■■■■MME■MEMEMM■M■ ■EMEME■■■■■■■E■E■ ■E■EMEM■MEMEME■■■ ■E■■MEM■EM■E■E■M■ ■■■■■M■■EMEMOMME■ ■■MMMM■MMMM■■M■■■ ■E■■■■■■■■■■M■ME■ ■E■E■■E■■■■■■■■E■ ■■■■■■MMEMMMEMEM■ ■■E■■■■■■■■■■■■■■ ■E■■E■ ■EM■E■ ■E■■M■ ■■■■■■ ■E■■E■ ■EME■■ ■■MEM■ ■ME■■■ ■ } : - Davie County Heafth Department and Home Health B .fit. enc y 3; Environmenta(Health Section i P.O. BOX 848 / 210 HOSPITAL STREET COURIER #09-4-06 MOCKSVILLE, N.C. 27028 PHONE: (704) 634-8760 December 2, 1997 Eddie & herie Rector 1105 Fallbrook Ln. Lewisville, KC 27023 Re: Site Evaluation/Godbey Road Tax PIH(s): #5830-69-6718 Dear Client(s): As requested, a representative from this office visited the aforementioned site on December 1, 1997. 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 installation of an on-site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr., R.S., Environmental Health Specialist RH/wd Enclosure(s)