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133 Somerset Ct, Lot 4 �• Y:.;...<r +-i a::,nt,,y,. a:"t t y:i ,... •f.:i'ds` ..a,..,_ ,.-<i'�.� f. .e.,:` tsa i : t°Y'n i,: .'i }'^ > Y i°`.�a;:, t-,"`"a.-'.-f�: AUTHOR17wATION No: 0979 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Perrakiee's P.O.Box 848 Name: / Mocksville,NC 27028 Subdivision Name: Directions toproperty:�f/'.?n+l'll h"e 4 4 l Phone#:704-634-8760 Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office'PIN: ,-�,��r SYSTEM CONSTRUCTION #<>s.� - - Road Name: >a9� i Zip �d **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 HEALTffSPECIALIST`. DATE ISSUED F �,.:.. �,y,.;:gbr�,b;.rM jr�.,b.",:; .. ai� + p.,.�;:a{ ' ,p .: ; .y*,�, ... {,.,r:'i..kr� .. :,.ert"i . ,k... , r ria. - r , ,;.�,s,.,•r f i DAVIE COUNTY HEALTH DEPARTMENT • '{ -�"� r IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION `Name: %CfI�I/' Subdivision Name: _��✓�"" �'' ill—rI P- Directions toert ro ,`f{i /�f, /�f � P Y:°-s Section: Lot; 74 IMPROVEMENT PERMIT Tax Office PIN:#f<- Road Name:44 j 1p: Y*NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater systemAn 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) ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALTIi SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMSC!P #BATHS , _#OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY_� DESIGN WASTEWATER FLOW(GPD)�—�2540 NEW SITE L� REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZEO!f GAL. PUMP TANK GAL. TRENCH WIDTH ` l ROCK DEPTH LINEAR FT.Jed 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: Ni LA• lee t30� 1j- ra �Jq Ljoaf A AUTHORIZATION NO. V �� 1 OPERATION PERMIT BY: DATE: N "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THA THE S M DESCRIBE ABOV HAS BEEN INSTALLS IN COMPLIANCE WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSALS S",BUT SHALL INNO 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 PERMI Q v L Davie County Health Department Environmental Health Section D ` � 'gg-� P.O. Box 848 Mocksville,NC 27028 M (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed ' (o `►d�?� Contact Person f1 Mailing Address - Home Phone ywe City/State/Zip AdVr6(-:: ' --!P--700& Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: [ ]Si Evaluation [ Improvement Permit&ATC [ ]Both 4. System to Serve: [ ouse [ ]Mobile Home [ l Business [ ]Industry [ ] ler 5. I7ashing ence: #People #Bedrooms #Bathrooms [ Dishwasher[ Garbage Disposal, [. 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 i 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [ No If yes,what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT*** F THE PROPERTY MUST BE SUBMITTED WITH T S APPLICATION. Property Dimensions: WRITE DIRECTIONS(fmm VIocksville)TO PROPERTY: Tax Office PIN: # a?/ - - 7,2- - Property Address: Road Name L,,nw0 IC + City/Zip CL I I C , /0,6: If in Subdivision provide i fo atio follows: Name: 1 j�r�Yl K ✓�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. 1, hereby, give consent to the Authorized Representative^of the Davie County Health Department to enter upon above described property located in Davie County and owned by to ndu al testing procedures as n ssary to et ine the site suitability. DATE SIGNATURE Revised DCHD(06-96) THIS AREA MAY $E USED FOR DRAWINC7 YOUR SITE PLAN: IM701 I � •�' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS PROPERTY SIZE J2P D PROPOSED FACIILTY /-4w LOCATION OF SITE Water Supply: On-Site Well _ Community Public L1__/ Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe Z HORIZON I DEPTH d' Texture group Consistence Structure Mineralogy HORIZON II DEPTH 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 Ape LONG-TERM ACCEPTANCE RATE l/ / SITE CLASSIFICATION: EVALUATED BY: A!/ LANG-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 clay loam• SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-V,---y 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 3C--Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralo¢y 1:1, 2:i, Mixed Notes Ilorizon 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 ■■■■■■■..■■■..■■.■.■■■..■■■....■ ■■■■....■■■.■■■■■■.■■■■■■■.■■■.■ ■■■■■■.■■■■■..■■■■.■.■■ecce.■■■.■■■■■■■■■.■E�■■■■■.■■..■.■■■■■■..■ ........................... 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