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451 Howardtown CircleAccount #: 990001409 Billed To: Billy Allen Reference Name: Proposed Facility: Residence ATC Number: 2573 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 9900 -EH -01409 Subdivision Info: 451 Location/Address: Howardtown Circle -451 Property Size: see map 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 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. r Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) lac 110 gpM Date: /6 - - � v Account #: 990001409 Billed To: Billy Allen Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: 9900 -EH -01409 Subdivision Info: Location/Address: Howardtown Circle -451 Property Size: see map **NOTir** Tliisbgmprov5ement/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 #People #Bedrooms k,7 #Baths_ Dishwasher: 2T" Garbage Disposal: ❑ Washing Machine: 2r" Basement w/Plumbing: ❑ Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply// Design Wastewater Flow (GPD) Site: New 121, Repair ❑ System Specifications: Tank Size GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width 16- Rock Depth Z l Linear Ft -120 / IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) IF 6 K 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 9:3 :00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature:Z�/4z Date: DCHD 05/99 (Revised) w NAM_ ADDRE; �'7 06 -�� _ b /V D i (7, c-'/4 DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) l I--�--e-� PHONE NUMBER_ 7` wcw•C� 7�vw iJ c'C' L --c-- SUBDIVISION NAh LOT # DIRECTIONS TO It DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER �►._I TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING DATE REQUESTED INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT ' Rev. 1/93 • rF Biu *4a�,; w ` y �' fi ' fi t Yi'1..� .. i ti,. s i F r. f , — .5 p r S�tF,y`y:1ia3 't ._. .' _ . '...., DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION * NOTE: Issued in Compliance With Article II of G.,^ Chapter 130a XSanary Sewage System �%f� hwlA/ Permit Number Name e OC sri Date �- 9- N0 7 6 0 3 Location Subdivision Name / Lot No. Sec. or Block No. Lot Size— House Mobile Home — Business -_ Industry No. Bedrooms No. Baths —4-1— No. in Family c— Public Assembly Other Garbage Disposal YES p NO Specifications for System: r7 Auto Dish Washer YES ❑ NO �� Auto Wash Ma^hine YES p NO Type Water Supply *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plan or the intended use change. ,Soar// y0a� Improvements permit by *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by Certificate of Completion Date *The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. g x 1 u 1 +- DA VIE COUNTY HEALTH DEPARTMENT r IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 0` * NOTE. Issued in Compliance With Article II of G.S. Chapter 130a _ Sanitary Sew ge SystemsPerm-it Numb . Name -&&4/ -�� F 7r sv1�e- Date �" 9- 9 N2 1 76 0 Location Subdivision Name Lot No. Sec. or Block No. Lot Size L House Mobile Home _T Business _- Industry No. Bedrooms No. Baths _- No. in Family 0— Public Assembly Other Garbage Disposal YES ❑ NO Specifications for System:,, Auto Dish Washer YES ❑ NO •� /�� _ Auto Wash Ma^hine YES ❑ NO Type Water Supply 'This permit Void if sewage system de bed below is not installed within 5 years fror mate of is§ue. This permit✓ts subject to revocation if site planor the n ded use change. : ,.It �he '� t Impro is permit by *Contact a representative of the Davie County Health Dep rtment for final inspection of this sy" st?3m between 8:30-9:30 A.M., x 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. T lephone Number: 704634-5985. . ..Final Installation Diagram:. � �Wtkm Insta "I--t7-7-C— Certificate of Completion Date The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. . APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department n Wig Environmental Health Section P. O. Box 665 J U N u $ 1994 Mocksville, NC 27028 1. Application/Permit Requested By Mailing Address / eZ %3 -[ Zo �7 Home Phone /%% 1�• _:Z 7 D.. -f- k Business Phone 2. Name on Permit if Different than Above 3. Application for: General Evaluation Tank Installation Permit U1 4. System to Serve: M House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If house, mobile home: Subdivision No. of People No. of Bedrooms 2 No. of Bathrooms Dwelling Dimensions 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures 7. Type of water supply: ❑ Public 0? -Private 8. Property Dimensions 3 Qom✓ Sewage Disposal Contractor ❑ Place of Public Assembly ❑ Unknown Section Lot # ❑ Basement/Plumbing ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes I"No If yes, what type? ❑ Community 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: H&zo aa,L / 07v -.-A- 1 �-•-� oma. 06",� 4e- o •�W• Iva, oma--. X19 �7* This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: L1'1. I OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative ofAhe Davie County He It Department to enter upon above described property located in Davie County and owned by IT Y&& to conduct all testing procedures as necessary to determi6e said site's stability for a ground absorption sewage treatment and disposal system. / �2 !Z2 4F DATE SIGNATURE DCHD (1/93) - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ADDRESS PROPOSED FACIILTY 14Aa-e?s­� DATE EVALUATED PROPERTY SIZE fege'/ -/ LOCATION OF SITE /►�GVG�/'�� �Du/� Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position 4 L .4— LSloe Slope% HORIZON I DEPTH i' 6ef �1 Texture groupr SG Consistence Structure Mineralogy HORIZON II DEPTH Texture group C CG Consistence AE5'`' Structure 516 /G IrAI 01k lyblt Mineralogy r i 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: DCHD(01-901 EVALUATED BY:�1� 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 r:lay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay I 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 ........................... ....................�........■.....■EMMEMMOMMOM .. ■■■■■■■■■■■■■■■■■■■/■.■■.■■■■■■■■■■■■.■■ ■■■■O■■■ ■■■■■■■■■■NO■■ .................................................... ......... ... ................................ ......... ...................... ■.■■■■■■■■■.■■■■■■/■■.N■■..1'1■■■■■.■■/■.■■■■■■■till■■■■ ■■■■.■■■■■�■ ■■■■.■■■■../■.■■N■■■■■.■■■■■■■■■■■■■■■.■■■■.■ .■■!■■■■.■■■■■■■■■ ■■■■■■■■■■■■■■■■■■.■.■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■M■■■■MM■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■ ■■■■■NNMMMM■MMMMMMM■MNM■ ■■■■■■■■■■■■■■■■■■/■.■■■■■■■.■■■■■■■■■!■■■■■■■■■■■■■■■■M■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■.■■■■■■■■It■■■■■■■■■■■■■■■■■■■ MO MME■MEMMME■EM■ .......■../■N■■■■■■..■■■■■■■■.■■■■N/■N ■■MOMME�u■MEM■ MM■■■EM■ ...................................... 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