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129 Somerset Ct, Lot 3 r'�r.!r��.- �f :.;i `'n':tt 1 o♦ .,^+ �fv, `<<: .ss - F,r' ."j -� -- ,-, _.1,n .. .i:`.%:* , AUTHORIZATION No. 1079- DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permitt6 " P.O.Box 848 Name: LAM �6 �. Mocksville,NC 27028 Subdivision Name: 0-0 ' Phone#:704-634-8760 , Directions to property: [ 1fl (4 i ' C Section: Lot: r �,r AUTHORIZATION FOR WASTEWATER ax 0"1 SYSTEM CONSTRUCTION �a9 , **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 Pen-nits. i (�comPli compliance with 11 of G.S.Chapter 130A,Wastewater Systems,Sec' n.1900 Sewage Treat ment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. EWIR ME(i urfi S IALIST. DATt ISS ED V DAVIE COUNTY HEALTH DEPARTMENT � ' .� - IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Pem tte �S ? Name: �Ct �` Subdivision Name: L1 `'L'0 Directions to property: V Section: � Lot: � f" IMPROVEMENT �p f PERMIT "7 p **NOTE**This Improvement Permit DOES NOT authorizd4the construction or installation of a septic tank system or any wastewater system.An AUTHORIZATION FOR`WASTEWATER SY'STEM CONSTRUCTION must be obtained from this Department prior to the construction/mstallation of a system or the issuanof a building permit. (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ****NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL^. EALTH SPEQ DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE j INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE Q) #BEDROOMS 5 #BATHS 7—#OCCUPANTS GARBAGE DISPOSAL es No . COMMERCIALT SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT` #SEATS INDUSTRIAL WASTE:Yes or No � . LOT SIZE ICWME WATER SUPPLY CO DESIGN WASTEWATER FLOW(GPD) NEW SITE_ REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE ��O GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. OTHER ' I�1Ss'�►�^ TI D lox REQUIRED SITE MODIFICATIONS/CONDITIONS: � 5�AU_ or,) CL-,-)30a, SN IMPROVEMENT PERMIT LAYOUT a° 0 Novs; 40 F&IJT r 72! **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY EALT DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON T E DA OF IN TELEPHONE#IS(704)634-8760. OPERATION PERMIT SYS M INSTALLED BY: 6 AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **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 05/96(Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT &ATC Davie County Health Department 9 A15L Environmental Health Section '� P.O. Box 848 D Mocksville,NC 27028 SEP 2 51997 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED /J{r THE REQUIRED INFORMATION IS PROVIDED. (' 1. Name to be Billed Contact Person C ` J��✓.' Mailing Address P C). ile Z30c) Home Phone glo- 417-7Z- City/State/Zip 1772City/State/Zip ad 4"Jec- Business Phone 9/0 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: [ ]S' Evaluation Improvement Permit&ATC [ ]Both 4. System to Serve: [ House [ ]Mobile Home [ ]Business [ ]Industry [ ]Other 5. If Residence: #People #Bedrooms _ #Bathrooms-,2- [ shwasher[ Garbage Disposal [�hing 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 [ ]Well [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes 11'rx/o If yes,what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT**EXT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: # 51111 77- - 5 33 Property Address: Road I�1ame .�o s,.f p �c£-A C i city/zip �n�U i0a L E /A14f, 2'7—t)61 ; If in Subdivisi741�ovv rovide information,as follows: Name: n C L ' Section: Lot#: ' 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 Departmynt to ent;r upon above described property located in Davie County and owned 55 by %[1 �J� to co ct al ting procedures as ne ary to d me the site suitability. DATE •2- SIGNATURE Revised DCHD(06-96) THIS AREA AIA J BE USEb FOR I)RAW I NG YOUR SITE PLAN: . r. i w i0 4 OD .F Ytz t FC t fiS' �•'r Yf 1� i l � - 7 l -� - w J SI dAGI. 4T W 21 ryT E T 1 T'. ,Q�"W OEM 14 102 . r :. YI to 3lop 145 : a � ��YZ „ a 144 t > �i 1 tam 47 10.0 31 1 � �y" Ott• stay' a?: '' - `� + l �`/►� � � 4 a i.� 1� � 1},. k"I �if t�a 6 '�. Y Jt� '}i Nj /•. �` l � `,i (�,.. '" � �1'�� t F f �1 '�• 1; fakl � I K a 1 i; 1 4 y N 133 YL ti �1 + 1 2 <9n A� l`R '} r�a' ;•tal rho- 4 t 1-. 5• � e .,'f r k P- �fi �#` '�, 1 � Y •� t A.i G E, t ',�1k a �� Y•f( h tY y' a •111.`'�'i /� / � y);vti �i i n,•(k F y 3a t. a.4 ti A ., . DAVIE COUNTY HEALTH DEPARTMENT - -• . Environmental Health Section Soil/Site Evaluation / NAME DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY 44� LOCATION OF SITE Water Supply: On-Site Well _ Community Public Evaluation By: Auger Boring Pit,l/ Cut r FACTORS 1 2 3 4 Landscape position Sloe % ' HORIZON I DEPTH � N Texture group Consistence Structure Mineralogy HORIZON II DEPTH 41 g;.,// " 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: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S7Shoulder 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 r;lay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Vc.-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/ftz DCHD(01-901 ■■■■■■■■■■■■■■.■■■■■■■■.■■■■■■■■■■■■■■.■ SSSS■.//./.....■ ■ ■..D■ ■■■■■■■■■■■■■.■.■■■■■.■■■■■...■..■■■■..See■■■■.■■.■ ■■■■.■e■■■..■ ■/■/.■..■■■■..■■.■...■■■■■.■■■.■...■■....■■■■■....■.�.■■/■./■.MOSS ■■■■■■■■■■■■■■■■■■■■■■.■.■■ ■■■■■.■■.■■■■■■.■.■�■■■■ ■■■■.■■.■■■.■ ■■■■■■■.■■■■.■■■■■■■■■...■■■■■■■..■■■e..■ ... ■ ■ MMO SOON■■ ■■ ■■■■■■■.■■■■■■■SSSS.../...■■■■.■■/......■SENE SInS�SN■ES■M■ON■Nm.■ ■■.■■■■■■■■■■.■■■■■■■■■■■■■■■■■m MEMO■..■■■■■./....■■■.■eN■■Me.■ ■■■■■■■.■■.■.■■■■■■■■■■■■■■■■■■■air■■■.oNMM.■■■■ ■ _■..■■..■■■..■■■ ■■.■■■■/■/■.■■.■■■.■...■/...■■■.1't.■�■MEM MMIMMM■■■ ■■■■■_■■■■■.■■I ■■../.MOSS■e■■■/■■■■N■■e.■M■e■.■Iil■ ■ ■Mee■■ ..■N■■■■■.. ■ e■.■■ ■■■■.■.■..■.■■■■■.■.......■..NM■SNS■...■O■■eeH■sSOO�N■■■■S■■�■■_■ ■■.■.■../....■.....M/■/e///...■■r.■/.a■■■■■■.■■N■■N.■ ./.■■.■. 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