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2295 Hwy 601SAy7COUNTY HEALTH DEPARTMENT Name: <.- L-B�`1�71�"t Environmental Health Section . PROPERTY INFORMATION _"� P.O. Box 848 Directions to property -r�+f' =9 i��! Mocksville, NC 27028 Subdivision Name: !_, f Phone # :336-751-8760 r' Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Offi e PIN: - SYSTEM CONSTRUCTION # %��/ %, AUTHORIZATION NO: 002582 A WoadName#A(V # `�" `� Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ' /� r ` ,, , �� % ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ✓ //'{ t` IS VALID FOR A PERIOD OF FIVE YEARS. I ri EN RONMENTAL HEALTH §PECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE & # BEDROO S # BATHS !V # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION:. FACILITY TYPE # PEOPLE' # PEOPLE/SHIFTt # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY Go DESIGN WASTEWATER FLOW (GPD) �+ NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTHLINEAR OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: 0 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.' 9 IOPERATION PERMIT SYSTEM INSTALLED BY: V ��. J/'/ / v' I AUTHORIZATION NO. ��ERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I 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 (Revised)/ C w _A -a 7 re / A/% �_.5Al_ �A IFJCOLfNT EALTH DEPARTMENT f�' �",r� Environmental Health Section PROPERTY INFORMATION P.O. Box 848 " Directions to property. l�gocksville, NC 27028 Subdivision Name: � 4 hone #: 3 tom. X P 36-751-8760 - Section: Lot: r' AUTHORIZATION FOR WASTEWATER / SYSTEM CONSTRUCTION QdSe: Tax Office PINN:# - )' tAUTHORIZATION NO: 002582 A #A/(,� /� Zip: " **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. " (In compliance with Article I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) " ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION t,~ie;'L f,f,„ter `(: �' •t i IS VALID FOR A PERIOD OF FIVE YEARS. WIE RONMENTAL H ALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE & # BEDROOM. S -F # BATHS 11 # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY 4fO DESIGN WASTEWATER FLOW (GPD) *' NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH \� .1 ROCK DEPTH NEAR OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT r y t ` z � a / D i `t FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.' "'' OPERATION PERMIT SYSTEM INSTALLED BY: 7 s ' i 4 , AUTHORIZATION NO.�ERATION PERMIT BY DATE: *.".THE ISSUANCE OF THIS -OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTI [,E T1 OF G.S. CHAPTER,130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NOWAY BETAKEN ASA GUARANI * 'HAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02/02 (Revised) 3 DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION R7(-Tv EMENT PERMIT (REPAIR) /fix NAME ��PHONE NUMBER ADDRESS SUBDIVISION NAME LOT # DIRECTIONS TO DATE SYSTEM INSTALLED CS NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS ---S NUMBER PEOPLE SERVED TYPE WATER SUPPLY IFY PROBLEM OCCURRING DATE REQUESTED ",�//INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge,that I unde SIGNATURE OF OWNER OR AUTHORIZED AGENT. Rev. 1193 I a i respgpsple for all ghjg ges incurred from this application. DAVIE COUNTY HEALTH DEPARTMENT z aZ. is 0o Environmental Health Section %j°� �� P. O. Boa 848/210 Hospital Street` Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002342 Tax PIN/EH #: 5746-24-9281 Billed To: Timothy Cranfill Subdivision Info: Reference Name: Location/Address: 2295 Highway 601 S-27028 Proposed Facility: Residence Property Size: 4 acres ATC lggftr:' 3204 **NOTE** is mprovement/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 "�r #Bedrooms �,? #Baths 2 Dishwasher; Garbage Disposal: ❑ Washing Machin 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 Repair ❑ System Specifications: Tank Size/ GAL. Pump Tank GAL. Trench Width (.?v/ "'Rock Depth/ Linear Ftl:rdO Other: Required Site Modifications/Conditions: 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. t of installation. Telephone # is (336)751-8760.**** r Environmental Health Specialist's Signature: _ Date: —2//Z, "o DCHD 05/99 (Revised) to • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002342 Tax PIN/EH #: 5746-24-9281 Billed To: Timothy Cranfill Subdivision Info: Reference Name: Location/Address: 2295 Highway 601 S-27028 Pro osed Facility: Residence Property Size: 4 acres ATC Number: 3204 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 WASTEWAT CONSTRUCTION IS VALI A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: 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 WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. �'cs Wt+v- Septic System Installed By: Environmental Health Specialist's Signature DCHD 05/99 (Revised) .10 1.) Date: ,L/ ,•J, APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & Davie County Health Department li t5 Environmental Health Section P.O. Box 848/210 Hospital Street JUN 2 6 2��) Mocksville, NC 27028 (336)751-876.0 ENV I R r�ME1UTA/ yE4 ECO(/ CTy ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer too the INFORMATION BULLETIN for instructions. 1. Name to be Billed 7i yW -4 (rk74h. C r A n i 1) contact Person T i rA o t h y cr a n -r i 1 1 Mailing Address 788 Q[RUrrharnp Rd Home Phone Jq6 qq8-'1003 City/State/ZIP ACJ an rt , N(, 2-700 (a Business Phone Cell 336 916 -00q (e 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For:Site Evaluation ,Rf Improvement Permit/ATC `Both 4. System to Service: AHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People 5 # Bedrooms # Bathrooms ,PeDishwasher LI Garbage Disposal kVashing Machine IJ Basement/Plumbing LI 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. 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—PJ-Nb If yes, what type? `**IMPORTANT*** CLIENTS MUST COMPLETE THE ,REQUIRED PROPERTY INFORMATION REQUESTED 3ELOW. Either a PLAT or SITE PLAN AfUST BESUBMITTED by the client with THIS APPLICATION. I �'c'c^-�¢J WRITE DIRECTIONS from Mocksville to PROPERTY: s Property Dimensions: ( ) Tax Office PIN: # Jt'% y lv a y 9 a 8 Property Address: Road Name 2ag5 S. /4,,Ihwa_ v� ; Lo+ -for home is be4ween aa95 and City/Zip Mocksville, NG- Fc �ur ch ._:1r iyo Wall 62S bten cea->L . If in a Subdivision provide information, as follows: fa 1 I 8 1 b-00 `Ilo Ti rn -For Mot" e Name:d1're-dion 7/ Section: Block: Lot: Date Property Flagged: O b �Z 6 c"'// 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 Tj mokh rami jl + Donna to conduct all testing procedures as necessary to determine the site suitability. DATE (J a 410'd SIGNATURE ,aarvrnav 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 2' Datc(s): Client Notification Date: ��.. O ! � loo EHs: 00 ii6J Account No. r Revised DCHD (07/99) Invoice No. 71 �G -� - 4- � "yam �- �/ /, ..,. ,c//.�/ ✓/��. � 6 / � ,/a's: /, / -. Y y FT 1 wv E r / post VV AM G / ♦� DRi. �� v � £ y W"Pr EE E Mal 0-W two -A tMH 05 k hl ( aa `y`Yti a g :y� =E a � a rWa s Y R E a € E€€$ 4NYR 0. € Too Int— ys 4 # e(FhCE E€fie 3 I €- OTHER€ ° �,P(�R EPS E � z� e ' .t// ✓��, / / � q �// _ an a d° r �51 �" %mJg35 RelQ $ €z�"€€€€ €€ � P Jul 5 �mfi"Y'�EIaOE! E �� ' J >t , €Y a 1€ J ,q pd, i,. ° gggg a w S / DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990002342 Billed To: Timothy Cranfill Reference Name: Proposed Facility: Residence PROPERTY INFORMATION . Wax PIN/EH #: 5746-24-9281 Subdivision Info: Location/Address: 2295 Highway 601 S-27028 Property Size: 4 acres 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 L Slope % oZ. HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH U<< Texture group Consistence Structure 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: EVALUATION BY:�� LONG-TERM ACCEPTANCE RATE: 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 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) No ME so ■■ on ■■ i■ ME M■ ■■ ■ i ■■■■■■■■■ ■■■■■■■■■ ■■■■■■■■■ ■■■NOMMEN i ■ ■ ■■■■c■■■■■ ■■■■■■■■■■ ■■■■■■■■■■■ ■■■■■M■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■c■■■■■�■■■■■■■■■■■E■■■■■■■■■■■■■■■ccs■■ ■■■■■■■■■■■■■■e■ ■NOON■■■Ns■■■■■■■■■■Ose■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ENE■■■■■■■�i■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■fl■■■■■■�■■NOON■■■■1■■■■■■■■■■■■■■■■■■■■■■ NOON■■■■■■i■■■see■■■■■■■■■■■■iM■■■■■■■■■■■■■■■■■■■M■ ■■■■■■■■■�■■■■■■■■■■NOON■■■■i■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■i■■■■■■■■■■NOON■■■■i■■■■■N■ENs■■e■■■M■■■■■ ■■■■■■■■■■i■■■■■■■■■■NOON■■■■i■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■�■■■■■ ■■NOON■■■■i■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ NOON■■■■■e■■■■■■.■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■��NOON■■■■■■■■■c■■■■■■■■■■■c■N■■■ ■■■■■■■■■■■■eee■■■■■■■c■■■■■e��e■■Oce■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■eee■■■■■■■■■■■■■■■■■■■■■■ ■■■■a■■■c■cc■c■■■■■■■eee■■■■■■■c■■■■■■■■■■■■e■a■■■ ■■■■■■■■■■■■■■■■■■c■■■■■■■■■N■■■■■■■■■■■■■■■■ecce■ ■■■■■■■■■■■■■■■■■■■■■■■■■ecce■■c■■■■eee■■■■■eeeee■ ■■■■■■■■■■■OOc■■■■■■■c■■■■■■■cc■■■■Oce■■■■■■eeeee■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■