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301 Hanes TrailDAVIE COUNTY HEALTH DEPARTMENT�Z 4 `03 FCO - Environmental Health Section ' P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002560 Tax PIN/EH #: 5863-16-4711MT Billed To: Marty Tharpe Subdivision Info: Reference Name: Location/Address: 301 Hanes Trail -27006 Proposed Facility: Plane Hanger Property Size: see map .ATC Number: 3343 **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 •e— #People #Bedrooms #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type—44A1,4/1#People #People/Shift -- . #Seats eW Industrial Waste: ❑ Lot Size Type Water Supply _kd ljj Design Wastewater Flow (GPD) IRP Site: New 00"Repair ❑ System Specifications: Tank Size GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width<7A6 f� Rock Depth,2/f Linear Ft.z;j2_ 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.**** r Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002560 Tax PIN/EH #: 5863-16-4711MT Billed To: Marty Tharpe Subdivision Info: Reference Name: Location/Address: 301 Hanes Trail -27006 Proposed Facility: Plane Hanger Property Size: see map ATC Number: 3343 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: A�62/ 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 WA be taken as a guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: !'.9W S`, %C Environmental Health Specialist's Signature: .� VG�� Date:" DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION /IMPROVEMENT PERMI Davie County Health Department 6�0 EnvifonmentaiHealth Section 10 P.O. Box 848/210 Hospital Street `002 Mocksville, NC .27028° (336) 751-8160' ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUI INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Contact Person K SCK- S4--L,� Mailing Address/)� N Home Phone City/State/ZIP 4du A-r—C-t (^- Z7d 0 �o Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑Site Evaluation 0 Improvement Permit/ATC Cy'Both 4. System to service: ❑ House ❑ Mobile Home ❑ Business ❑ Industry 2/'Other S. If Residence: i People # Bedrooms # Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type c2 # People # Sinks 7— # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 100 7. Type of Water supply: P County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 9190 If yes, what type? "IMPORTANT' CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions:...ZX�. �.� ►rN' �'7 WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # di � �o r'J'7 % / m� a � Ti' X• %✓ 'V� Li i �, C -L0 Property Address: Road Name'l O I T City/Zip ul1.w 1'7001� ON I'ZA / ,tej dn.. If in a Subdivision provide information, as follows: ��_tw hi. 931..6-5 Trzz n Name: i �2 Section: Block: Lot: Date Property Flagged: oZ 0— C3 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 p� to conduct all testing procedures as necessary to determine the site S79 bili/ty. DATE L'2,— 3 0 17 '�- SIGNATURE T� THIS 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). Site Revisit Charge Date(s): Client Notification Date: � EHS: Account No. o; -S L ° / Invoice No. v / / I i S7['CK -344 r VAI 238 eros 312 „p x , 301 171 J92 ----------- 158., 2 1,2 L 1, 0"'159 , 214 138136 t 1366 , Y 1.89 ',.' 3,5 .- 1446 245 14. 1 4_1 48 1513 526 fs32 1549 ----- 1565 1572 -- ' w 85 423 4,8 • t 1590 —_ '159 r 1604 — DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002560 Tax PIN/EH #: 5863-16-4711 Billed To: Marty Tharpe Subdivision Info: Reference Name: Location/Address: 301 Hanes Trail -27006 Proposed Facility: Plane Hanger Property Size: see map Date Evaluated: Water Supply: Evaluation By: On -Site Well je!f Community 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 Structure 1 S' 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: 6QS LONG-TERM ACCEPTANCE RATE: rX 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)