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5032 Hwy 601N (2)DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ' P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT(OPERATION PERMIT Account #: 990001425 Tax PIN/EH M 5749-45-2783 Billed To: Fleetwood Mobile Homes Subdivision Info: Reference Name: Location/Address: Hwy 601 K-27028 Proposed Facility: Residence Property Size: see map q�� 11p bQr. 2902 **NO I1J*this lm 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 -IA -0 M 1A #People #Bedrooms __-'S #Baths 2 Dishwasher: �" Garbage Disposal: 0 Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: 13 Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: Lot Sizc�OlS A_ 'Irype Water Supplyk)mts-- Design Wastewater Flow (GPD) _'Z.�pO Site: New M/ Repair System Specifications: Tank Size ��('AL. Pump Tank GAL. TrenchWidth -_I� Rock Depth /,? -Linear Ft. 1 �� Other: ���1 q/ 1 1O� )��S Ir MLL Ll&�-� TOL, r©.L, MI4. Required Site Modifications/Conditions: �, % 1 LIQ `= VZO 100 t 0 IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROYYENT-FILi R. RISER(S) IF 6 " BELOW FINISHED GRADE. ***"#ATIETE-:-Conta a representative of the Davie County Health Department for final inspection of this 'systepi :30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. T lephone # is (336)751-8760.**** T N 4r�Ito � x,2 � s� n 1CO' -mo.3 el®J tS. 1 V 'j)Jiz To c_AZ%Q-T APReQx . Cav '1 is/ o r r x J 11 i Environmental Health Specialist's Signature: / ate: & b a/ 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 #: 990001425 Tax PIN/EH #: 5749-45-2783 Billed To: Fleetwood Mobile Homes Subdivision Info: Reference Name: Proposed Facility: Residence ATC Number: 2902 Location/Address: Hwy 601 N.-27028 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 .19 0 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEW N IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatur A Date: 6AZI / 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. NST AT � oa 8 _V7 LS T Septic System Installed By: Environmental Health Specialist's Signatur te: DCHD 05/99 (Revised) A APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & AT /� Davie County Health Department i.J E C is a V E Envifonmenta/Health Section P.O. Box 848/210 Hospital Street JUN �^ Mocksville, NC 27028 (336)751-8760 THIS OT BE SSED UNLESS A" INFORMATION IS*PROVIDED. Refer Ntootthe I INFORMATION BULLETIN forinstructions H i. Name to be Billed F /' Mailing Address City/State/ZIPm 2 Name on Permit/ATC if Different than Above v lq r(e- Person Home Phone Business PhoneSb)gSI-1833 Mailing Address (QUI fV)[(.(,) r 1joCCV LUES qty/state/zip 3. Application For: Site Evaluation provementtPPeCrmit/ATC ❑ Both 4. 3y t6m to Service: ❑ House VMobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms )(Dishwasher ❑ Garbage Disposal +Washing Machine ❑ Basement/Plumbing CJ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7.r Type of water supply: ❑ County/City ell ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes V10 If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client *ith THIS APPLICATION. (.- Properly Dimensions: TaxO N: # 74C1 450-N3 Property Address: Road Nam,,�efl wy & 1 &0 City/Zip 0 1 oa-y.L NC If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: NorA on ti �N � Aw Hw�� a 0-� v Lk (0 r\ IeR w Date Property Flagged: 6 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. 1, hereby, give consent to the Authorized Representative of the DA ie County H Ith Department to enter upon above described property located in Davie County and owned by (� rr(e< R tjly�n r)- to conduct all testing procedures as necessary to determine the site suitability. DATE D �� I `O SIGNATU , THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inc de all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). c. `� I Site Revisit Charge C'/ O V 0 ;y Revised DCHD (07/99) PA o 0 JUN 2 1 2001 ENVIRONMENTAL HEALTH OAVIE MINTY Da tc(s): Client Notification Date: EHS: Account No. Invoice No. n� m DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiySite Evaluation APPLICANT INFORMATION Account #: 990001425 Billed To: Fleetwood Mobile Homes Reference Name: Proposed Facility: Residence Property Size: PROPERTY INFORMATION Tax PIN/EH #: 5749-45-2783 Subdivision Info: Location/Address: Hwy 601 N.-27028 n see map Date Evaluated: ` 1 Water Supply: On -Site Well Community ' Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L Slope % b - HORIZON I DEPTH Texture groupSGI� Consistence CMZ Structure tc I Mineralogy HORIZON II DEPTH 2 • 6QJ ;Z4 1 L — Texture groupG Consistence (' S Structure 15; it MineralogyMin Mr ,� HORIZON III DEPTH 3S - 4 Z Texture group Consistence ' - : S r S Structure ; S Mineralo- HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS :7�- RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE c) SITE CLASSIFICATION: 23 LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: �a�LJ%� 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) ■ i ■■ ■■■■■■■■■■■■a■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■eee■■■■■■■■■■■■■■■ ■■■■■■■e■■■■se■■■e■e■■■■■■■■■■■■■■e■■■e■■■e■■ee■■■■■■■■■■e■■■■■■ ■■■■■■■■■■■■■■e■■■■eee■■■■■■■■■■■■■■■■■■■■■■■e■■e■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■e■■■eee■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■eee■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■eee■■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■a■■s■■■s■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■1'.CiiCi��iiiiii��====�i_i�iiiiiw!'■■■■■■■■■■■■■■■■■■■■■ MEMNONMENEIRM iiiiiii'Imummo 'i■■NNEN m olsomMENNENiiiiii ■■■ee■eee■■■11■■■■■■■■e■■s■■■■■■■■v�■u■■■■e�■11■■s■■■■e■■■■■■■■■■■■ ■■■e■■■■■■■■11■■■■■■■■■■■■■■■■■ee■■■■■■■■■■epi■■■■■■■■■■■■■e■■■■■■ ■■■■■■■■■■■■�i■■■■■■■■■■■■■■■■■■■■■�:�■■■■■■.lees■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■flee■■■■■■■■■■■■■■■�■■■■■■■■■e:\■�■ee■■ecce■■■■■■■■■■■ ■■■es■■■■e■■■�■■■■■■■■■■■■■■■e■eiiiiiiie�■�Itrle■■■■■■s■■■e■■■■■■■■ ■■■■■■■■■■■■■I■■■■■■■■■■■■■■■■! 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All data is compiled from recorded deeds, plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be consulted for verification of the information. All information contained herein was created for the Davie County's internal use. Davie County, its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or implied, in fact or in law, including without limitation the implied warranties of merchantability and fitness for a particular use. If you have any questions about the data displayed on this website please contact the Davie County Tax Office at (336) 753-6120. 1.5.9 http://maps.daviecountync.gov/itsnet/View.aspx?prid=1480160 8/17/2016