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2057 Hwy 601SPerinittee's ~`'�1 j i�;c7i^t'E N,� DAVIE COUNTY HEALTH DEPARTMENT .— �- Name: Environmental Health Section PROPERTY INFORMATION C/ul ", V, P.O. Box 848 O'f Directions to property: Mocksville, NC 27028 Subdivision Name: Lt C. Phone Phone #: 336-751-8760 Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# JASYSTEM CONSTRUCTION AUTHORIZATION NO Z t Road _m ( a e ,'"t=Y .13 wtf'4) f **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmentale�alplseFtion prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County"Bu (riding In' sKections Office when applying for Building Permits. (Incompliance ith.Article,l 1 of U -S --Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) s , J***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION i / f'' 7FF— �,A IS VALID FOR A PERIOD OF FIVE YEARS. ENViRONMF� At, H T SPECIIST D RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS -,a-# BATHS .Z # OCCUPANTS \5 -'GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or Ho- LOT SIZE �09, E WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) _ NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZEGA MP TANK GAL. TRENCH WIDTH ROCK DEPTH J.INEAR FT. , OTHER E ��5 L'{ IQ/J A0 --C- Q-ti!I� gn O �=-Wc loj , Sre f REQUIRED SITE MODIFICATIONS/CONDITION$ IMPROVEMENT PERMIT LAYOUT, 7,51 sTA►TI- iw.ta� FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - A. . O THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT RA fj L / M) L� p SYSTEM IN TA LE j�)`� 1` i r )o' OFF 2700 WC, 111EP-P 5D' 12� I;Dose G ' FQ.�T ootu qab AUTHORIZATION NO. `a9A OPERATION PERMIT BY: I DATE: 27/n V **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE TE ESCRIBED AVE 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. DCHD 02102 (Revixa))q Ml t X3777, _ .1. /1 vo ice-ff 37 �' J Pet Ni Directions to property:: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION . P.O. Box 848 Mocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - - Q 2 619. A w� . 17? -AUTHORIZATION NO Road Vame j"NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmentalealpi!section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County' Bu ding Inspections Office when applying for Building Permits. t (In compliance with Article` 11 of 6.5. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) IL ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. %`'ENVIRON ETA HEALTH SPECIALIST D TE i SUED RESIDENTIAL SPECIFICATION: BUILDING TYPE BEDROOMS � # BATHS 2 # OCCUPANTS _J GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No i LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) 3 / NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAtr RUMP TANK GAL. TRENCH WIDTH & ROCK DEPTH LINEAR FT. OTHER I !.� } 1 t7 I6 J % 11(, �G•1-LJ 0 REOUIRED SITE MODIFICATIONS/CONDITIONS U( -F f tC Int LP V oT l" f c • IMPROVEMENT PERMIT LAYOUTMW, IC i E7 1-W , j- LA r. • FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWkEN 8:30 - :3 M. THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT A ,�M I LLQ SYSTEM IN ALE IZ (((CCC t Fe o r 7 AUTHORIZATION NO.OPERATION PERMIT BY: 7 DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE TE ESCRIBED AB VE 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. ' ,. ncHnovox seal , __ ff77Z- i tJ0%Ci' mv;d fil or, DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) PHONE NUMBER�/ �y %'�/� ADDRESS Z05✓�'l q US 11 W � 661 cJ f�6 kSl;df—SUBDIVISION NAME 40 ° _ � 2/ / LOT # DIRECTIONS TO SITE Ie0l twine DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER A44 TYPE FACILITY A -e— NUMBER BEDROOMS �3 NUMBER PEOPLE SERVED TYPE WATER SUPPLY Al SUre, SPECIFY PROBLEM OCCURRING -A%Die / (mD -4Q.r I DATE REQUESTEINFORMATION 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 i 3 .. g AZA �pg. o dMi t �ya'4 ''ky'•'�� e� -" .,� �' � a w^^ s d ` RA �r�ya- � � � � �` ��,4 � *`•' `-$� �5 .r aux �4 r .�: ( ��, J y is �� _ �, e xi r +Aqt e . y'.y!� `� "��' $ 3Y .'ti'±^'si $ +� � :N� '!r •" 6�: m. * iimzn DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: Billed To:, Reference Name: 1�/1 Proposed Facility: PROPERTY INFORMATION Tax PIN/EH #: Subdivision Info: Location/Address: ,207 Wk 01 C Property Size: Date Evaluated: ? Water Supply: On -Site Well Community Public Evaluation By: Auger Boring ✓ Pit Cut FACTORS .1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH - TexturegroupG Consistence Structure _ Mineralogyi HORIZON III DEPTH ! Texture grou- - - 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: EVALUATION BY: OTHER(S) PRESENT: . REMARKS: 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 ois VFR - Very friable I 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 I �E �� CCC::::CC::::CC:C::::::::■■::C:::::::C::::::CC:::CC:CCC:CC ...... . ....................................................... 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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=1472231 8/3/2016