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300-302 Campground Rd 'rt., ._'v"+�; 4r..::..y,, �...-sit :.:j: ,., , ;• r, DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT PERMIT **NOTE** This improvement permit DOES NOT authorize the construction or installation 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) NAM PROPERTY ADDRESS C I.- a�6 rl7DATE LOCATION ]: 1. SUBDIVISION NAME LBT-�R SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TY ' c# BEDROOMS�,_? # BATHS .12— # OCCUPANTS GARBAGE DISPOSAL: Yes/No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZED yN� TYPE WATER SUPPLY A�111 DESIGN WASTEWATER FLOW (GPD) NEW SITE !.--"' REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE � GAL. PUMP TANK GAL., TRENCH WIDTH y'� ROCK DEPTH ,/07 LINEAR FT. D�'J OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. l ` IMPROVEMENT PERMIT BY **CONTACT A REPRESENTATIVE OFVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M. OR 1:00-1:30 P.M. THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. i OPERATION;PERMIT ` SYSTEM INSTALLED BY i II t AUTHORIZATION N0. L OPERATION PERMIT BY r� C DATE 6 **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTa4 DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 136A, SECTION .1900 -SEWAGE TREATMENTDISPOSAL SYSTEMS-, BUT SHALL IN NO WAY BE TAKEN AS A ! GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GI h PERIOD OF TIME. I DCHD 10/95 Davie.County Health Department, ENVIRONMENTAL HEALTH SECTION --,P.O. Box 665 Uv Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONISTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 13OA, Wastewater Systems) ***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 Numb r shpuld be presented to the Davie County Building Inspections Office when applying for Building Permits.*** �( AUTHORIZATION NUMBER . NAME ZIATE �� 9 g tr1 � NAME ON IMPROVEMENT PERMIT (If different than above) II SITE LOCATION A11V19 d&AA'11 COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM I **WICE*** THIS AUTHORIZATION FORWASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. ENVIRONMENTAL HEAL IALIST DATE DCHD 10/95 } / APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health DepartmentED —p n Environmental Health Section 7RE_ �E QP. O. Box 665Mocksville, NC 27028 V 3 01994 1. Application/Permit Requested By GvD G 6a h lsl � l/�' Of w Mailing Address //.3N /'� /'Nj�t Home Ph oe 6/vC ^7oi'e4°//,`1Le i e A? J/J Business Pho Tz2/- ' �;7OG 2. Name on Permit if Different than Above Aw" ` //• 3, Application for: a General Evaluation 5ii-SentirTank Inst aBa i©nP..srmit 4. System to Serve: *House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry Other ❑ Unknown 5. if house, mobile home: Subdivision S� Section Lot # rBasement/Plumbing No.of People ❑ Basement/No Plumbing No. of Bedrooms 1 Washing Machine No. of Bathrooms V• s Dishwasher /ir/i �t v-e�� 17's" Dwelling Dimensions .56X �� ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No.of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No.of Showers Water Usage Figures 7. Type of water supply: ❑ P,-u�blicc/ ZPrivate ❑ Community li 8. Property Dimensions �� 1t CZV­� J Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes No If yes, what type? "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: ! �r "L v �q_%VC1/'ti[//V!V /'O y 72 This is to certify that the information provided is correct to th st my knowI96p, and I understand I am responsible for all charges Incurred from this application. / DATE `SIGNATURE CONSENT FOR BITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fand ECK ONE: ❑ 1. I WN the property. -j 2. I DO NOT OWN the property.. ked Box #2,the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative of tt}� avie County Ith Department to enter upon above described cated in Davie County and owned by all testing procedures as necessary to determines d site' suitabilit or aground rption sewage eatment al system. DATE SIGNATURE DCHD(1193) CJ �] AVIE COUNTY HEALTH DEPARTMENT 1 O �r t Environmental Health Section Soil/Site Evaluation NAME �CI� _ [9L.L 7 DATE EVALUATED ADDRESS PROPERTY SIZE �' "Ie9 PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well t/ Community Public Evaluation By: Auger Boring !/ Pit Cut FACTORS 1 2 3 4 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group C_ Consistence Structure / !C Mineralogy •/ HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATEy SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: i / 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-Finn 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 Mineraloey 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(01-901 ■■■■■■■s■■■■■■■■■■■■■■■■■■■■■■■■■■■E■■■s■■.■E■E■■■E■E■See■ ■■■a■■■ ■■■■■...See■.■■E■.■■E■■EEE■■E■■s�■■.eE.EEE....■..■■..ESE■■■■..■■■ ■■■....■.■■■.eEE■■.■■■■■■■■ E■■■■■E■■E■■EE■■■■■ ■.■■■.■■■■.EE■E■.e ■.■■■■..■■.■■..■..■■.■■■■■■■■..e.■■...■.■■�.■.■ ■■■■■..■ ■■■■■■n■■ ■■...■■.■■■■■.■■■.■....■■■■■■.■..■■■■.tt..ttt■t■t■=■ttttt..tttttt■ ■..■.■■.■..■■....■..■■....■E■..■■■■.....■....■...e..■....■...■I■■■ ■■■■.■■■■■.!■■■■■■■.■■■■■■■■■■■■�■■■■■/■■■�■■■■■.....■■■■■■■■ ■EE ■...■■■...■■■...■..■■.......r►l��►.11■.........■.■■■■■.■.....■■ SOMEONE ■.■■....■■..■■■■.........■■cup..■ ■■■■■■. ..■.■tn■■.■e........■■.■ CCCCCCUMEMEME�EMEMn]C//,IjMMEMEMUMMEOEMCCEMEMEM iiSOSO■"OOSSi■ ■■■.■. 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Main St. Mocksville, NC 27028 Re: 3 Site Evaluations Campground Road/55.41 Acre Tract Dear Mr. Brodauf: As requested, a representative from this office visited the aforementioned sites on December 9, 1994. Based upon the information provided on the applications for site evaluations and after the evaluations were completed, three sites were found to be provisionally suitable for the installation of an on—site sewage disposal system on each site. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr. , R.S. Environmental Health Section RH/wd Enclosure i' STATEMENT DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION 210 HOSPITAL STREET P.O.BOX 665 MOCKSVILLE,NORTH CAROLINA 27028 (704)6345985 December-14, 1994 Wolfgang H. Br�odauf 1132 N. Main St. Mooresville, NC 26115 3 Site Evals. /Campground. Road — $150.00 Payment Due Within 30 Days DETACH AND MAIL WITH YOUR CHECK YOUR CANCELLED CHECK IS YOUR RECEIPT. -----------------------------------------------'-------------- 12-14-94 13 Site Evaluation @ $50 each 1 $150.00 ------------------------------------------------------------- I --------+---- -------------------- -------- ---- — — Wolfgang H. Brodauf/Campground Road i ------------------------------------------------------------- - -----=------------------------------------ -- — ----- — 1 I ------------------------------------------------------------- ----------- ----------= ---------- ---- ------ ----- - --0-- -- — ------+-------- I i —_--- ---+=-------- - ---DEC-2-x-1994-- - ---------+-------- ------------------- - - - ---------+-------- ----------F------=-- ----------------- ------------ -- --------------------------------- --- ---------------- ---- 1 ------------------------------------------------------------- 7-+-, ------------------------- ---------- -------- ---- --+--------------------------- --------- ---i--------- ------- ------------------- -----------------------i-------- 1 BALANCE DUE-- 1 $150.00 STATEMENT SAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION 210 HOSPITAL STREET P. O. BOX 665 MOCKSVILLE, NORTH CAROLINA 27028 (704) 634-5985, 8760 DATE 4-17-96 �_Wo 1 fgang $rodauf 1132 N. Alain Street Mooresville, N.C. 28115 Permit/ATC # 0144 Campground Rd. 50.00 L J DETACH AND MAIL WITH YOUR CHECK. YOUR CANCELLED CHECK IS YOUR RECEIPT. 4-17-96 Permit/ATC #0144- Campground Rd 50.00 R 2 ,519% 17�2,w BALANCE DUE — 50.00