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256 Willow Creek Ln Y.,C..,x;'✓S1 irtsAwa �~bf'rt rt% kdz 1 r sc�.- �'aXsr" q. r e� txT F. y5 t+, a� 2 fAl vXD AUTHORIZATION NO: 0593 DAVIE COUNTY HEALTH DEPARTMENT �'',i " . • Environmental Health Section PROPERTY INFORMATION Permlttee'sP.O.Box 848: Name: r CIZ, if Mocksville,NC 27028 Subdivision Name: Phone#:704-634-8760 Directions to property: / 'i�< /�"�� �f ✓/ Section: Lot: AUTHORIZATION FOR ,L WASTEWATER AGI • q d �l / .�1:iJ �� Tax Office PIN:# SYSTEM CONSTRUCTION " Road Name:-�/1 AY��?5�1Jh Z �o�19. P **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) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED r r �Lyu .=.;.,1 �� uyr Yrn�� •i.v.,Fv++Inti" ...4'3i moi? n•✓�-,c.•r•yP i)a.. � 14. ..r i it:-v. r. 1 �;/ iii_ r "'S C ,* .'.� ., C •,r<'�«�..�.,::�1„ �.-,.see'. $x.��Ta .-tx;n;-'3! a` i -.t..,��;� t,•'i;, .�'�i�^a ooA` DAVIE COUNTY HEALTH DEPARTMENT • �� IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION PeI7�nftfe� s' ;. . Name: / � fr.•,: is Subdivision Name: r Directions to property: ` Section: Lot: MEPERMIT - c` Tax Office PIN:# j - Road Name: dh a., �_`ktp I r ea F **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) r /-9 ***NOTICE***THUS PERMIT IS SUBJECT TO REVOCATION IF SITE ;l-,O � " )- % �/ff;j, �' PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THUS PERMIT BEFORE INSTALLING THE SYSTEM. i #BATHS_ _#OCCUPANTS GARBAGE DISPOSAL:Yes or No RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS ,� COMMERCIAL SPECIFICATION: FACILITY TYPE " #PEOPLE #PEOPLE/SHIFT #SEATS /INDUSTRIAL WASTE:Yes or No LOT SIZE G F� TYPE WATER SUPPLY s�! DESIGN WASTEWATER FLOW(GPD) NEW SREPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE-GAL. PUMP TANK GAL. TRENCH WIDTH,, ROCK DEPTHS LINEAR FT. MoD . OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT **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#IS(704)634-8760. OPERATION PERMIT SYSTEM INSTALLED BY: 10 C � A � 0 AUTHORIZATION NO.O JC' 3 OPERATION PERMIT BY: �u DATE:, 1y� **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM kPOD E ABOV HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT ANDSAL YSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN OF TIME. DCHD 05/96(Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC _ Davie County Health Department r '> Environmental Health Section L5 P.O.Box 848 D Mocksville,NC 27028 NOV1995 (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROC S h[UNLE7 ALL THE REQUIRED INFORMATION IS 1. Name to be Billed W a 14-e tr t2 . C a e i 6 S Contact Person S Mailing Address . 3142- (Z cl Home Phone 2 $J/— io y 2 y City/State/Zip M o ckSV: Z'7 O Z g Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: E"'Site Evaluation ❑ Improvement Permit&ATC ❑ Both 4. System to Serve: ❑ House &"Mobile Home ❑ Business ❑ Industry Cl Other 5. If Residence: # People 2_ # Bedrooms 3 _ # Bathrooms z ❑ Dishwasher ❑ Garbage Disposal UKWashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/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 O'Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes @- No If yes,what type? PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: a c re, 1 WRITE DIRECTIONS(from 1 Mocksville)TO PROPERTY: Tax Office PIN: # n 1 (a6l Aloe4h a Ca ve q Property Address: Road Name 1 r A4 oHfo city/zip i'YI o Gksv,'/1e , /VC 1 1 2 al tti e,-, 1 If in Subdivision provide information,as follows: 1 Name: 1 f- 1 Section: Lot #: 1 ><o n G P^a v / / /e-1- 61 S.ilG 0-.F- 5ro✓G raf 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 W and owned by A I+e e . Qr, b S I e-1— u t/ to conduct all testing procedures as necessary to determine the site suitability. s / DATE L - - SIGNATURE Revised DCHD(06-96) Tax Lot 4.02 I Tax Map G-4 Claude Foster D B 5� a/w Carline B. Foster DB 50 0 PG 257 I I bent) Tie Line IRS N 12000'00"E 357.83' EIR S 12"00'00"W 784.85' P Part of Tax Lot 49 _ Tax Map G-4 0 1.000 Acres o ago �y 4 N ,� Z IRS P / PP X 0 W O a: 0 J O Power Pole & Phone Pedestal 0 SP 1 1 Proposed lot for Kevin G. Wright 1 Reference Map No. S1296-3, Dated 6-26-96 Stone Land Surveying Company / 1 1 1 / t / DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section JSoil/Site Evaluation, NAME LC���'Jl//1 DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well cl_� Community Public Evaluation By: Auger Boring r/ Pit Cut FACTORS 1 2 3 4 Landscape position Slope 2 T HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Q O� Texture group C_ G Consistence r Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION J LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: A 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-V"-ry friable FR-Friable FI-Fiat► 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-Anaular 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 ■■..■■■■■■.■■■■■■.■■■■■■■■■■.■.■.■■■■■■■■ MEMO■■■MEMEMEM■■ ■NEEM■■ ■■■.■■■■■■.■....■..■■■N..■..■■■■■■n.E■■■.E■EE.■E■E..■■■....■E■E■ ■■■■E■■■EE■■E■■M■M■■■■■E.E■■■.■■ ■■E■■.M■MO.■■■..E■.■.■E■E■■EEE■■ ■■.■..■■■■.■■■■■■■■■■..■■■■■■M■■■■■■■■■■S■■■■■■■SEM■■■■■■■■■■■MEMO .......................................... ■■■EE■■.CE.......■.■■■ ............................■... ................. ■■■■■■■■N■■■■■ ■■■M■■■M.■■■■■■■■■M■■■M■■■■■M■■■ ■■■■■■■■■■■........■■■■EE■.■■M.■ .■■....■....■■.■■...■■■■■■.CM■MMM■■■EEMEEMEMMM■CM■..■...■.....■■.. ■MMM■■M■■MM■MM■■M■MMMMM■MM■ ■MME■MEMOMM■■MOOMM■ ■E..M.ME■E■M■■■M■■ ■■■■■■■■■■■e.■■■.■■■E.■■EEE■■EE■...■■■■■.■.■■■ ■.■..E■ECE.■■.■.■.■ ■E■■■■EMOM■NEEME■■M■■EEMMMEM■M■EMMM■■■■■■ ■.■ ■ ■ ■■E ■MMMM■ ■■ ■E■E■MM■MME■E.E■■■MM■■11E.■■E■..E.■■■■■■.■CMEEC .CCC.■EC■..■.E.CCM■ ■■■.■■■■■E■■■■■■.■■E■■■■■■■■■■E■■■■■■■■E■■■MM■■E. ■MMOMMMMM■M■MME■ ■■■■■■■..■■■■■■■■■■■■..■■S■■■■■■■■■■■■..ESO■ME■ ■ ■..MONSOON■M.M■■ ■.■.■..■...■.■.■.■..■■.■■M■......■.■■.■......■.C.0=.....M.....M■E■ 11111111111011■■■■■■.■■O■■.OE■■■■■■■■■■■■■■■■■■■■■■�■NO■■■..■..■ ■■■■EMC ■■■■■■■■■■■■■■■■..■■■M.E■■M■■■■EE■ ■■O■..■■■MN.■■■.MMMlMMMMMMC■■■MMEMO■ MEMOS ■ ■■.■■.■H.M■■...■■.■.■....■■■■..�■■■.■HH�■■■N■N■■E■■E■■■■ ■■■ MEMEMEN......................NSE■■■ME■■■■■...EE.E.EM..■CE.MC■■MC■E■■.■CC ■.....■■..■■.■.■..■■■..■..■■.■■■■■■..■■..■■.....� E.MEN MENMENM.■momE■ ■■■■■NEE■■■■■■■■■■■.■■.■■■■■■E.■■■■■■..E EMM■ MOMMEMMINIM ■EN ENO.■■■ ■■■■■■■■ ■MMES■E.■EMEEEEE■.■■EHEE.EE■.11■�■11..u.E.E.NNNN■.ENO C■EMM■■EN ■■■■■■■■■M■■■■■■■■■■■■■■■■■■■■■■ SEEM■MEN■■MMEMS■EM■ ■MM■■■■■ ■■.CN.....■.NEN.■E.■■■..E..E■■ENO EE■■.M■■.CCCEN■NC.C.■.■EMM■ ■O■■ ON MONSOON NONE■■ ■ONS■■N■■� ■■■■■■■■■■■■■■■■■■■■■■!■■■■■■■■N ■ ■■■■ ■ ■■■ ■■■■■■ ■E■.■OOeOEE■■O■■EM■■■■C►■OOO■MOO■= • CM ECCCOE CSE■ ■■■■..■■■.■■E■■■..E■M. 1�4N■..l■ ■ ■ ■ ■■ ■ CE■EO. ■ ■■ ..■■ ■.■..E.■■■EE..E...E■■■1�1ylIE■EE/I■.... ■■ HNCE ...E �. ■■..■.■C ■■■■■■ ■■■■■■ M■■�57. ■■.[1■■ ■■■■ MN ■ ■■■ ■M■■■■ +:■ ■■■S■■ ■■■■■■ f■■ ■ S■■7■ ' ■■■■ ■ ■ ■.EM; ■ ■■NEEM ■■OO■■....uE.■..0.�:,EN.EC.EEOEE....E ..SCCA ....■■■.■■.. ■■■■■■■■■■MMM■■■■■■►�■■■■■'�■■■%■■■■■■■■ ■NH■■ ■■M■■■■■ ................................ . 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MONSOON mom CCCNENNNE2=m mm MENEMH CSCE.■.M��C ■■■■■.■.■■■■■E■■.■�M■■■■■M■■E■■.■./■.� _ uECC■.CC■■■■ ■■■.■.■■■E..■..■■/I■■e■..■E.EO.E■O.■^■ u ■■ ■. ■■■■■■■■M■■.■■■■/NEEM.■E■.EN.E■■H■«JA ai��■■■■■C•N■ ■.■■■■■■■■■■■■.1.■■■■■■■■.■■E■■�■S�ESOC■i ■■■■■■■■■M C:�: SOME.�.:CC::CC:�ommomC:■CCC:: ■ 'ONSEREENO 0 1111■ .. � ■ .■I. ■EN■ NOE ■ ■ MENo E. ■N■■■■■■■ EMMENCC■ SCCCCCCCCCCCCC�CCCS CoCCmom CCCC �CCCNCmmCMCMAC E■■■■■■■■■/IEEE■N■■■■■■■■■■MM■■■ H■■■■■■■■■■■MM■■■■MMMMMM■MMMMM■ MMMMMMMMMMMMMMMMMMMMMMMMMM ■■■■■S■■■/.HOE■■N■■■■■■■.■■H■SNS■■■�EEEEE■SE11■...■■.■■NEN■■■■■ ■■.■....IEEEMMM.■■■■■■.■■■■..■■.■■■■■M.M■■■■■■■■■■..M.......■■■■■■ ■■■■■■■■%■.■M■.■M■.■MMM■■■■C■M■■■■■■■■■■■■■■■■■.■■■.■■EM.■■■■■■■■■ SEEM C������CH�C�CCC����CC�C■ SEEN����CC���C�C����C��C��C�C�� =C■■■.■■■..■■■■■■■■■■■■E.■■■■■■■ ■■■■■■■■■■■S■M■■■■■■.■■■■■■■■■■■ ENEE.O■E■NOMME■E■■SOME■■MEM■■N■■■■■ ■ ■■1111■■E■■■■■■■■■■■MMM■■■■ Davie County Heafth Department ` and Home Heafth Agency Environmenta(Health Section { P.O.Box 848/ 210 HosPITAL STREET I COURIER#09-40-06 MOCKsviLLE,N.C.27028 PHONE:(704)634-8760 November 211996 ti r: Walter R. Combs 342 Gladstone Rd. Mocksville,` NC 270213 k i Re: Site Evaluation/Charleston Lane C Part of Tax Lot 49/Tax Map G-4 Dear Mr. Combs: As requested, a representative from this office visited the c' aforementioned site on November 20, 1996. Based upon the information c provided on the application for site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on—site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, a Robert B. Hall, Jr. , R.S. Environmental Health Section RH/wd Enclosure(s)