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130 Macy Langston Ln _.__ a.,..... ^iso-^-rW-9--r.n"y,r-{a...iJ+r-rn:5ry-rr xv-w.�;�,rY�',.P"..`7`_.....w-+.mss-.'%•-•-w+-.-.r-•�r;.•'h1.�-r—v�:.-,...y.,..ww.yygvo`Y'.."'r,wr+wr�^w,-:.mom.ttsw"^'w ' DAVIE .COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION Q'�Cab�-`� *NOTE:Issued in ompliance With Article II of G.S.Chapter 130a j Sanitary Sewage Systems ^^ Permit Number Name o_a�..Vis_ aSc � �1 1 Date —3 NO 70.73 LocationTO Subdivision Name Lot No. Sec. or Block No. Lot Size �'`' C, .vp House w`;Mobile Home Business. Speculation No. Bedrooms No:Baths No. in`Family Garbage Disposal, YES ❑ NO ❑ , S ecificatiens for S ste Auto Dish Washer ,` :`YES O NO;❑, Auto Wash Ma thine YES• NO:,:❑ tf • ' �a � �-�� Type Water Supply __— a *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 plans or the intended use change. Odd - Improvements,permit by(;N — *Contact a representative of the Davie County-Health-Department 161 final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telepho a umber Q n allation Diagram: S t m Insta ed by Final I st g �— Zo Certificate of Completion 4Date '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. APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&AT v Davie County Health Department Environmental Health S&Won SEP 2 3 IM P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760VIDAVE COUNT HEALTH ***I1W0RTANT*** THIS APPLICATION CANNOT EE PROCESSED UNLESS ALL THE REQUIRED INMRIMTION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. / 1. Name to be Billed ��Q /)'J 1 i WL- Contact Berson � &d,,-Anc Mailing Address / o m.¢G i' L,4r1/c s A*/ L.¢fr/G Some Phone q f 2 -2 S-.3 2 City/state/ZIP mOGIks U: IV e. 270 Business Phone 9�-.2%� 2. Name on Permit/ATC if Different than Above Mailing Address City/state/21p 3. Application For: ❑ Site Evaluation +Improvement Permit/ATC PJB Both 4. system to Service: ❑ House ❑ Mobile Home JS Business ❑ Industry ❑ Other 7 S. If Residence: # People # Bedrooms # Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine I ElBasement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type /YIACVLr s A o d # People # sinks # Commodes �_ # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: It County/City ❑ well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? N Yes ❑No If yes,what type? s r /�!:R X/ o ***IMPORTANT'**CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUB�IIITTED by the client with THIS APPI AVATR AD r. Property Dimensions: 2 a U.4 / WRITE DIRECTIONS(from Mocksviile)to PROPERTY: Tax Office PIN: # Sg�L'2 "l7— g`S/ -,do No r A o�a (cot Au/so d Property Address: Road Name1y1V j, ,Ve cA�vlV City/Zip M,99L d f 1E .2710-2e' 0k) 6 to rE yo a c e 7< 7'to If in a Subdivision provide information,as follows: MAC Z,'&/ ,SIS oIP /Sf IF Name: Qu.`/d`"�S o w R,�g >s oh/ /ftAcr -"A11.t1✓ Section: Block: Lot: Date Property Flagged: 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. 1,also,understand that I am responsible for all charges incurred from this application. I,hereby,give consent to the Authorized Representative of the Davie alrtment to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determinethe site suitab* ity. � DATE � /'� SIGNATURE 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). Account No. Zeti:sm'.DCH (07/98) Invoice No. .x N 470 5f 28"E 50.00 NIP ON -b p r .00 s TODD L. HOWARD slro •Se F\ \� J;; APPROXIMATE LOCATION OF PROPOSED DWELLING y�rF A �O O Qp PARKING NIP J0C2 9 P APPROXIMATE BLDG. LOCATION NIP AREA 2.000 ACRES G �'S4o 9S O� 0• o / 20 (� WOODS-7 2s 00 / 5 /• O��LF EIP TODD L. HOWARD 6All TODD L. HOWARD V DB. 162 PG. 321 ZONED RA oe• �ti�; ZONED RA APPLICATION FOR SITE EVALUATIOWIMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section �F , pV(ED P. O. Box 665 f.:: Mocksville, NC 27028 MAR 1 9 1993 1. Application/Permit Requested By o Mailing Addressx-) 3 196,x -2 2/ Home Phone(9 iQ,/ Business Phone r2 D 1!Z L S 9fS` 2. Name on Permit if Different than Above -,L h/ 9-�dd 3. Application/Permit for: ❑ General Evaluation peptic Tank Installation 4. System to Serve: ❑ House ❑ Mobile Home ❑ Place of Public Assembly mousiness ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms ❑ Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type ,);1/q a/�/ e, f�o n No. of People Served Z No. of Sinks No. of Commodes Z No. of Urinals No. of Lavatories f No. of Water Coolers No. of Showers 7 Water Usage Figures 7. Type of water supply: Public ❑ Private ❑ Community 8. Property Dimensions r2 42C&PS Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes tl t o 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: C/ O i, O o K�� _ ��// a f"(/Ls yJ ASS LA,�' c �/ Sb� o o/- �,L,i� ctl� w N�lz ��/ ,!✓� d �?iylc7� >v rJ p a- td 1 // S a- o 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 Fand ECK ONE: ❑ 1. 1 OWN the property. �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 representatives o the D ie County H alth Department to enter upon above described cated in Davie County and owned by 7o I cJ }h all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment al system. 3-i9_ y 3 . DTE SIGNATURE DCHD(12-90) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME n"I- e rw-o N s DATE EVALUATED ADDRESS S A 'iM a PROPERTY SIZE PROPOSED FACIILTY " - rte LOCATION OF SITE C 1 iy Water Supply: On-Site Well Community Public Evaluation By:0£L- Auger Boring l,--- Pit Cut FACTORS 1 2 3 4 Landscape position S S s Slope Z -/-9-1T- 1S-�o 9-150 k-)60- HORIZON I DEPTH 4P'' fl- -2.` ).a .k Texture group C L C L L L- Consistence Structure Mineralogy HORIZON II DEPTH 4 0L iv 6" SIb Texture groupG G Consistence Structure Mineralogy ) ',� ► t ;I ; I HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S S S RESTRICTIVE HORIZON — SAPROLITE — CLASSIFICATION y LONG-TERM ACCEPTANCE RATE 14 1 SITE CLASSIFICATION: (R, 5 EVALUATED BY: l LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: %_% ` `` d' 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(01-901 ■■■■■■.n■■■.■...■■...■■.■■.■■.. ■■■.■.■.....■■■■.w.■.■.■...■_■■■ ■.■www■■■.■■wwww■■.■■.w■■ww■■■■■.■■■■.■■■.■■■■.■■■■■■■■■w....■w..■ UIMEMEME ■■MONS ■■■■■■ ■■■■■■ ■■■■■■ ■■■■■■ ■.■■■■ ■■■■■■ ................................................. .. .... ....... ::CMM:CC: ::M::::E:C:':::� ...................................■.■■■■■■■.■■.�■■..■w■■■.■■ .■.■ ::'::::::C::NNEN 0 ■■■..... ■■■■■■■■■�vr.�.■..■■.t■E�a�uw.ww■wt■..■■w■ww...■■■■.w■�.w■■■ ■■■■.■. ■■■�■■.■.i■ ■■w..,■.■�:r■■■■1' E:iia.��!■■■■■w■w.ww.w. ■■�■■ ■■■.■■■w ■■■ ON ......■..■....■.■■.■��.■..1V►�J.1.!■■.■■■II... ..■.■■■■■■■■■■■■■ ■■■ ■■■■■■■■■■■■■■■■■■■�i■■■■�■■■■■■■■■■■■■■Ori..■.■■....■.■...■■.■....■ iiiiiiiiiiiiiiiiiiiii:��wiiiiiiriiiii�::�w■..■■..■■■w■..■■.■■■e■..■ ■■■■w.■■■■w■■■■■■■.■..■■■.■■r:'■■■.■■■■...■...........■■.■■■■■■■■■■