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448 Howardtown Rd
'.««:'-anroT'r J 'L.�y.r,Fn7•.�"r a,y. a,.. ,v s.::� ..:t;t^;i=t: �.. .r-ii 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) NAMEA l PROPERTY ADDRESS J dt/rIZ'/J`7�6J�/�,�."a��� DATE LOCATION f✓�Ji�l/flv�.�YOGu,r/ �� SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE z� # BEDROOMS # BATHS # OCCUPANTS, GARBAGE DISPOSAL: Yes/6 COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE c TYPE WATER SUPPLY �� DESIGN ISTPWATER FLOW (GPD) �l� NEW SITE _ REP AIR SITE SYSTEM SPECIFICATIONS: TANK SIZE/�/ GAL. PUMP TAIL( GAL. TRENCH WIDTH 31,E ROCK DEPTH ��� LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MAST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. IMPROVEMENT PERMIT BY **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # I5 (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY 1to-Q S kvi.N ISA ' fvr.N Jad' E v a' AUTHORIZATION NO. OPERATION PERMIIT BY Q 9, DATED **THE ISSUANCE OF.THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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.10/95 i .,{�,'z -i �bpr +y ^��4,' �,`, •`. �y +*l r•;: z 3' +''_ 4 .':rd ..;K.• v,•_•ti,--:� T - \?.• ,.�.; .•: ' A Davie County Health Department • "`, i , ENVIRONMENTAL HEALTH SECTION tf P.O. Bob 665 Mocksville,,1C. 27028 'AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION ,(Issued in compliance with Article 11 of S.S. Chapter 130A, 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 Number should be presented to the Davie County Building Inspections Office when applying for Building Permits.*** AUTHORIZATION NUMBER NAGE AvI1144 r "D DATE N2 o U a0 I NAME ON IMPROVEMENT SPE/RMIT 11f d_iiff�erent than above) SITE LOCATION COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT.WASTEWATER SYSTEM ***NOTICES THIS AUTHORIZATION OR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. 104 ENVI AL TH SPECIALIST DATE DCHD 10/95 s APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PEF 11 Ole a SCr C u 1 I Davie County Health Department Environmental Health Section j u ecLa v 4 t,k i P. O. Box 665 FEB 2 6 1996 ' Mocksville, NC 27028 1. Application/Permit Requested By 064,1 J!:1 Jr /-3-7-e ISI-o wit ``•i Mailing Address I -rai'f 4C t_i=N 93, - Home Phone A r 6 .w C. ;L Business Phone ,i 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation tic Tank Installation Permit 4. System to Serve: ❑ House Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown j 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People v' ❑ Basement/No Plumbing No. of Bedrooms O'�shing Machine No. of Bathrooms a� ❑ Dishwasher Dwelling Dimensions fT 70 ❑ 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: RrPublic ❑ Private ❑ Community 8. Property Dimensions J AG Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ET Yes ❑ No If yes, what type? Do k h1 E w t ct Gtar..c *NOTE: Improvements Permits shall be valid from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. -16t, PROPERT11 IN OW ATION RE UIREb: Directions to Property: Wh Tax Off ice PIN: # _s-X ti 1 ./ ♦•�7-SS 'Rd , PROPERTY AbbRESS, as follows: lS� C q S4- +0 1 Jowcr 4owrl C-i-,-cr Road Name: City: A/r_ oZ7oeiC v �owa. -1 a���,� £ ©^ '��h SUBMIT A PLAT WITH THIS APPLICATION. Zr: Ck 4,0 Revisions effective October 1, 1995. i i 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. i DATE SIGNATURE r CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. 2. 1 DO NOT O ]dereibed If you checked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the I hereby give consent to the authorized representative of the Davie County Health Department to enter upon property located in Davie County and owned byr �/fr1 to conduct all testing procedures as necessary to determine said site's suit ility for a ground absorption se and disposal system. DATE SIGNATURE DCHD(1/93) c \\ �i co � 5 , 0 6276 ! v" f d. "+^286:36M � 2 112. ` - :.: X300.71 y . -- — - --— I 627.66 112 ,'�• � w- 1 6 3 35 p 1 I, I Ac. (OX3�6 y YE .. �g 4 580.80 60 44Ac� y mi { '� 424.62 a"Se.' 46 4193;- 1170 m.. t : 70a'• `T`. ,� �� ,K "]O/ — 383.78 i 26 605.2 1.03A0I�- 9.56 Ac M !846.25_ 399. h I (y.. LC3ACP- �5) 106.04 1s 8.56 AC Y c � Q NN< I ` �:... 4398`3 2 8544C) 60(4) 1060 m 38I6Ac 444Ac e� �'' � ; '� s.56�a."'�• °` 06.07: ^'"f •{rya • tAcco 89 ��,,� Cpl ' ( O� 10 t g� 9.31 AC a G r -•' (3)N>� •s2 a6 210m. E t> 00 4 i DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation NAME ��G(/7J DATE EVALUATED ADDRESS PROPERTY SIZE Z tAe_ PROPOSED FACIILTY LOCATION OF SITE � d �dLyyJ Water Supply: On-Site Well _ Community Public Evaluation By: Auger Boring t/ Pit Cut FACTORS 1 2 3 4 Landscape position L .L- 1. Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group G G Consistence r Structure Je7j,J-1 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: In 7 EVALUATED 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 -;lay loam. SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Ve.-y 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 3C--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 ■■■.■./■■■■■■■■■...■■.■........■ ■■..■..■■■■■■■■■■■.■■.■■.■■■■■■■ ■■■■■■■■■.■..■eM■■MM■EMM■■MM.MM■MM■■■!!!■.!■■■!!■■■_:■■■■!!!■■!■■■ ■■■■■■■■■■■.■...■■..■■■.■■■■■..■ .�.■.■■■..■■■■.■■ MMM■■■M■■■.■■■ ■.■■■.■■■.■.....■■...■■■■■■ ■..■■■■..■■...■..■■ ■..■ MEMO on no ■MM■MMM■■MMMMEMMMMMMMMMM..MM.EM■MMEM■■■■ M■■ ■ = M■■ EMEM■■M! ■■ m MEMO MEN ■M■■M■■.■■.■MMM■■■■MM■■M.■MMM■MMMMME■..■M■■MM■■MM ■■M■MMEEE■■■E.■■ ME OEM ■■MMM..MMM■.EM■MM■■■■MEMMM■MMM■■■MMMMMM■lEMM■EN■MMM MMlM■MEMM EM■ ■..EMEMM■MEM.■.■.MEMMNM..MMMMMMM■MNMMMMOM■■■::•MMM■ M■E■M■■■MEM NOME MEMMEM ■■.■MMM■■■..■■.MEEEMME■MMMMMMMMMMMMMMMM■M ■MM■MM: �■ M■':M■ MM■MMMa MOMM MEN ■..■■■MMMM■MMMMM■MM.■■M■MMMMMMMM�iMMMMMME.MMM■M�■MMMN■M■MCMMOMMEM ■EMEMM.a NOON E■MEMM ■ MM■EM ■■MMMMM ■■■...■.■.MMMMMMMMMMMMMM:■.M■QMH ■ NOON ■ ■ MMMa■■■■■MO: ::::::::::::::::::::::::;,::::OMNI : :a :a:::: � .a'l9:u :::::' ■■■MMMM■■■M■MMMMMM■■M■■!��l:MMMMMM■MMMM ■ 00 CUNNEEN ■ "" """ ........................��.......g..■.. ■ ■■CMENEMMMMM■ so Immummom ■M ..MM.M:CMMNNMMMNMMM::iNN■MM ■■■■■.■..■.■....■■...■..■MM.M■.. 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