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2986 Hwy 801S- DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street PC, Z S'- Z_- Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002364 Billed To: Amanda Steelman Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5788-28-2505 Subdivision Info:& Location/Address: Highway 801 S-27006 Property Size: 2.100 acres ATC Number: 3217 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People #Bedrooms - #Baths_ Dishwasher: Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow (GPD) -!�& Site: New Repair ❑ System Specifications: Tank Size/&,D GAL. Pump Tank Other: Required Site Modifications/Conditions: IOU GAL. Trench Width' Rock Depth Linear Ft.%W IMPROVEMENT/OPERATION PERMIT LA�6ttT" :FFLUENT FILTER. RISER(S) IF 6 " BELOW FINISIIED GRADE. ****NOTICE: Contact a representative of the Davie Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. o p.m. on a tallatjo elephone # is (33C►)751-8760.**** A�o0 n ei�jai- Environmental Health Specialist's Signature: i Date: DCHD 05/99 (Revised) • • ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002364 Tax PIN/EH #: 5788-28-2505 Billed To: Amanda Steelman Subdivision Info: Reference Name: Nroposea Facility: Resfaence ATC Number: 3217 Location/Address: Highway 801 S-27006 size: Z.1 uu acres AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATE N T:FnIS VALID FOj RIOD OF FIVE YEARS. Environmental Health Specialists Signature: Jrl Date: —12 —172— CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. (eld E=- F 5? ec : Septic System Installed B V[J p oar P Y Y Environmental Health Specialist's Signature: �Tj�'/ Date: DCHD 05/99 (Revised) P ON FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC D /� Davie County Health Department L5 M li? Environmental Health Section P.O. Box 848/210 Hospital Street `+NL Mocksville, NC 27028 (336) 751-8760 fNVIRnAt- -APPLICATION ,.._ - APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED � INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.U c 1. Name to be Billed ,1 m Q 1'l G( 6( S+l_e I man Contact Person (� 1 I Y 1G. n C1C( fcc I ro � Mailing Address) 4-o R i ye-ry i r u� l h h -I S . t) r _ Home Phone 61 � - 61 ? -Z City/State/ZIP /\ d VQ n C P, _ WC_ a% 0 D(P Business Phone qj-0 ` -7 2. Name on Permit/ATC if Different than Above Mailing Address City/s to/Zip 3. Application For: IiYSite Evaluation Improvement Permit/ATC CI Both 4. system to Service: ❑ House R"'Robile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People _ # Bedrooms # Bathrooms_ IYDishwasher 11 Garbage Disposal L14ashing Machine CI Basement/Plumbing I -.I Basement/No Plumbing 6 If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: iI Seats Estimated Water Usage (gallons per day) 7 Typo of water supply: V6ounty/City ❑ Well ❑ Community o. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes rj No If yes, what type? **IMPORTAN7'*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED IELOW. Either a PLAT or SITE PLAN MUST BESUBMI7TED by the client with THIS APPLICATION. _,�?t bo Properly Dimensions: q uWr%Q GGA C, tr e Tax Office PIN: # Property Address: Road Name Hwy 9w ( — s City/Zip A V a in Le IVC, a7�u If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIREMONS (from Mocksville) to PROPERTY: / -f•--i o n I l' a h 15 TT' Dale Property Flagged: / This is to certify that the information provided is correct to the best of my knowledge. 1 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 ant 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 conduct all testing procedures as necessary to determine the site suitability. DATE rl - J I - D-z� SIGNATURE / vyv_.vvt Ot, ) THIS AREA MAY 13E USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge Dalc(s): Client Notification Date: EHS: Account No. '3— (�_v Invoice No. o � 7 _ F NEW RON AREA= 1.389 AC. TAKEN FROM D.B. 207. PG. 874 $ Bl•3U.yo .. NEW � IRD,� IN 81 KON 1, STOC BRENDA' 8 pG. 567 10 PERSIMMON TREE ..t+l. 1 p'��Z�ZPvS� 1 TUCKER h1ATT1E B' PG. 131 �N 1).'g. 114, �tl 10' EXISTING ` DRIVE — �> 10' NEW PROPS c�58 i NEW EASEMENT ZO?a nu34 E 'DD IRON LINE BEARING DISTANT L1 N 08'18'49' W 15.7 L2 N 8t'41'11• E 68.8: L3 N 80'25'04' E 37.9 L4 N 80'25'04" E 18.3: x W p e o N N o co pN O r---- N NEW I OD I t 96.01 IRON NEW IPON V I Jp I r5 0 �1 v9 fn I I W v in '^ AREA= 0.622 AC. J. TAKEN FROM 1 I D.B. 114. PG. 831 j,. ohi;U IRON ExSrtING IRON 164.64 S $4. OO• V � I _� 1 JERRY w. STOCKON KAE STOCKON � I D.B. 81, PG. 540 i LINE BEARING DISTANT L1 N 08'18'49' W 15.7 L2 N 8t'41'11• E 68.8: L3 N 80'25'04' E 37.9 L4 N 80'25'04" E 18.3: Z N 9E �8 (`dEL'L9) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990002364 Billed To: Amanda Steelman Reference Name: Proposed Facility: Residence Water Supply: Evaluation By Property Size: PROPERTY INFORMATION Tax PIN/EH #: 5788-28-2505 Subdivision Info: Location/Address: Highway 801 S-27006 2.100 acres Date Evaluated: On -Site Well Community Auger Boring_ _ Pit Public !� Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % % HORIZON I DEPTH 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 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: U� LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY:W—& OTHER(S) PRESENT: 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 - 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 - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - 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 05/99 (Revised) ■ ■ i i ME ■■■■ NONE OMEN NONE NONE ■■■■ Enos ■MO■ ■■■■ MENS i i ■ 0 ■ ■E■■■M■■■■M■M■ M■■■■M■ ■■■■■■■■■■■■■■ NOON■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■M■■■M■M■■■■ NOON■■■ ■■■■■■■M■■■e■■ ■■■■■M■ ■■■■E■E■■■■■E■■N■■■NOON NOON■■■MM■■■M■■■■■■■■s■ ■■■B■■■MM■■■■■ ■■■■MM■ ■■■Mva■■■N■■■■■■Nee■■■■ i■■■■e�■■MOS■■N�eS■■■M■ iMMMBMN■■■■OM■■ ■OMM■■■ i■■■■■■■■■Nee■■■MMMsn■■■ i■■■■■SNB■■■MM■■■■■■■■■■ ■■■■MM■■■■■■M■■■■■■ ■■■■MMM■■■■■MMM■■■■ ■M■■MEMS■■■■M■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■M■■■■B■MN■■■■■■NO■ ■E■■■■■■■M■■■■■B■■■ ■■■■■■■■■■■■■■■"■■ MONO■ ■E■■■ ■■ ■ ■ ■■■■■■■■■■■■■■■ ■■■■■■■N■■■■■■■ ■■■■■■■■■M■■■■■ ■■■■■■■■■■■■■■■ ■■M■■■■■■■M■M■■ ■■■■■■■■■M■BM■■ ■■■■■■B■■■■■■■■ ■■M■■■■■■M■■BB■ ■■■■■■■E■■■■N■■ ■■■■■N■■■■■■OS■ ■■■■M■■■■■■■■■■ ■■■■■■■■■E■■■E■ ■■■M■■■■■O■■■E■ ■■■■■■■E■■■■■■■ ■E■■■■■■■■■■■■■ ■■M■■■B■■■■■■M■ ■ME■■E■■■■MMEM■ ■19MMM■M■■■MM■■■ ■a■■MMNB■■■M■M■ ■WMMMMMBM■■■■■■ ■OM■■MNMB■■■■■■ ■E■■■■E■EE■■■■■ ■■■MM■■■EEE■■■■ MEEME■U■■EM■■I 11■■■■■ ■■■■■■ 11■E■E■E■■E■■■E■ ■i■B■■E■■■■MEMO■ ■■■■■■MBs■■■ ■■■■■■■■■■■■ ■■■E■■■M■■E■ ■■■E■■■■■■M■ ■B■■M■■■■■■■ ■■■MMBMMEMOM ■B■■■■■■■■■■ ■■M■■■■■■B■■ ■■E■■■■EM■■■ ■MME■■■■■■■■ ■■EE■■■■M■■■ ■■■■■■■■■■■■ ■■■■B■■■■■■■ ■■■■■B■EMEM■ ■■■■■■■MMM■■ NONE NOON MEMO Boom seen ■■B■ ■■M■ ■■MMMEMOMM■ ■Mss■■■■M■■ ■■■■■■MEMO■ ■■■■■■■MOM■ ■■■■■■■MMM■ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990001433 Billed To: `Benjamin Steele Reference Name: Sheryl Steele Proposed Facility: Residence PROPERTY INFORMATION Tax PIN/EH #: 5777-43-5858 Subdivision Info: Location/Address: 257 Lois Lane -2702 Property Size: see map Date Evaluated: __L2P_' IcD tD " Water Supply: On -Site Well Community Public Evaluation By: Auger Boring_ Pit Cut HORIZON I DEPTH SITE CLASSIFICATION:? LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: OTHER(S) PRESENT:C� 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 Mois 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 - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - 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 05/99 (Revised) HORIZON I DEPTH Consistence �I•WAR ar�®a���� ME EMM Mineralogy HORIZON 11 DEPTH INA ConsistenceTexture Consistence MineralogyMineralogy Texture group Consistence SOIL WETNESS CLASSIFICATION SITE CLASSIFICATION:? LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: OTHER(S) PRESENT:C� 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 Mois 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 - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - 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 05/99 (Revised)