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P0481 Daye Ln DAVIE COUNTY HEALTH DEPARTMENT 44 Ab IMPROVEMENT PERMIT and OPERATION PERMIT .,�� . . IMPROVEMENT PERMIT PERMIT O/4 **NOTES* This improvement permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater f-f-76 system. AN AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the td9b 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) NAME PROPERTY ADDRESS �-�'l- DATE LOCATION SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE: # BEDROOMS : # BATHS t OCCUPANTS GARBAGE DISPOSAL: Yes/No COMMERCIAL SPECIFICATION: FACILITY TYPE �j # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE TYPE TYPE WATER SUPPLY C d DESIGN WASTEWATER FLOW (GPD) `-V6d NEW SITE L,- REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE /,IJAA)GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. J e&9 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. y 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:x-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY � irjz �, VC�Gffirt/Y1. t 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 136A, SECTION .1900 'SEW 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 Davie County Health Department %44 ENVIRONMENTAL HEALTH SECTION •36� P.O. Box 665 "pop Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.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 � Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when a lying for Building Permits.*** NATE D D!U DATE �lp�� AUTHORIZATION�?NU�9ER � NAME ON IMPROVEMENT PERMIT (If different than above) E. SITE LOCATIDrI COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM 1 ***NOTICE*** THIS AUTHORIZATION FO WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. t \ F1 _ ENVIRONMENTAL HEALTH SPECIALIST DATE DCHD 10/95 APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC `• °' Davie County Health Department Environmental Health Section ENLESS P.O. Box 848AUG 2 7 1996 Mocksville, NC 27028(704) 634-8760flttlDAYIE tOUNl YNE�FIi ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed t, Contact Person Mailing Address / Home Phone C� City/State/Zip G Business Phone 7 g QZ./hd 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: [ ] Site Evaluation l mprovement Permit&ATC [of-Both 4. System to Serve: [Kffo-u dr Mobile Home [ ]Business [ ]Industry [ ] Other 5. If Resi ence: #People #Bedrooms _ #Bathrooms [Arishwasher[ ]Garbage Disposal [ Washing 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 [I No If yes,what type? PROPERTY INFORMATION REQUIRED:***IMPORTANT***A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: goo //D,X 30d#WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: #_V6, 2—- Ll _ HI Q -/0? Ifrerrt Address: Road Name DWI,aL A City/Zip 0-( 1C�A.— If in Subdivision provide information,as follows: Name: ; 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 Department to enter upon above described property located in Davie County and owned by to conduct all to ng D—rkvdures as necessary to determine the site suitability. DATE SIGNATURE Revised DCHD(06-96) �r \y gj�[ 11Y 1 rl , 14. '191°' • ::y.. rlc � '�' �+ `,�' , � r tw too rppy�- t. r wr 7Y:¢�~,p rF rs F y I �F{1�"�y.' ��• ' �'T.� '��13� • • �. '. � .. s •,, .yak , • '.gra r ' a ' M w1✓r." ' Q ^ +. _ �• Q ��p•�' mo nl • l�. M1i + '• 4 w f�'. . l y � r r • "t • e ��` � '� ' {'� • F ., ,�.• J� ✓�'' ' 1, "p�G( " ,. ,r 3. x � •.s i r- � la'cl � I ,✓�<• iR • .�. '/pis n. ;l � ,� M1,p•��.,1 to 00 � /�`� r .'N� y c � 7%/ � ' 'i J 'T'•j�� ejly• .�I•Y I �, ,y4'� �YCµ"^ r ,'%' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED T ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By: Auger Boring L/ Pit Cut FACTORS 1 2 3 4 Landscape position 4- Slope Slo a % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH :<T 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 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 SILL-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-Nonplastic SP-Slightly plastic P-Plastic VP-Very plastic acture 'ingle grain M-Massive CR-Crumb GR Granular ABK-Angular blocky Subangular blocky PL-Platy PR-Prismatic iralofity 2:1, Mixed �n depth - In inches f fill - In inches ive horizon - Thickness and inches from land surface e - S(suitable), U(unsuitable) tness - Inches from land surface to free water' or inches from land surface to soil colors oma 2 or less -ation - S(suitable), PS(provisionally suitable), U(unsuitable) Long-term acceptance rate - gal/day/ft2 ■.■■■.■■■■.■.■■■..■..■./.■...■....a.■.en■■.■.e .e■.■■■. ■■..e■■■■■ ■■■..■..■■.m..■■■■■....■■.......■.■..... ■.■.Noe■ ■.■o■■■.■■■■■■■ ■.■■■e■..■■.■.N■■■■■■..■.■■■.....■ .e■■O.N■.■■■ue.OE.■■■■.■ENNEN ■.■.■.■.eON.■.■■.■.■■■■...■e■..■■■C■■■■N■.■.■■■■■■.. 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