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3305 Hwy 801SAccount M 990000961 Billed To: Mike Wall Reference Name: Proposed Facility: Residence ATC Number: 2812 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5788-244685.01 Subdivision Info: Markland Lot # 1 Location/Address: Highway 801-27006 Property Size: .69 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 WASTEWATER S UCTION IS VALID FO A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date:�� CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completionindicate the system described on Improvement/Operation Permit has been installed in compliance with Article 1 of G.S. Chapter 130A Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be a guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: —,-7 f Environmental Health Specialist's Signature : �L� Date: V,- �< DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section- • P. O. Boz 848/210 Hospital Street /o/ Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990000961 Tax PIN/EH M 5788-24-4685.01 Billed To: Mike Wall Subdivision Info: Markland Lot # 1 Reference Name: Location/Address: Highway 801-27006 Proposed Facility: Residence Property Size: .69 acres , -ATC Nu��p1bg: 2812 **NOTE** Thls mprovement/Operation Permit DOES NOT authorize the construction 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). 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 &I r4 #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 Imo--- Design Wastewater Flow (GPD) t--TKI) Site: New 0`7 Repair ❑ System Specifications: Tank Size/ pV_ GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width�IF � Rock Depth J7 Linear Ft. IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date: 'Vd "d! DCHD 05/99 (Revised) CAU WY6J )&-4oJY CATION FOR SITE EVALUATION/IMPROVEMENT PERMIT &ATC Davie County Health Department APR 2 5 21 Enwronmenta/ Heaft Secftw P.O. Box 848/210 Hospital Street ENVIRONMENTAL HEALTH Mocksville, NC 27028 nev1G MINTY (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. f j 1. Name to be BilledJ Contact Person 72itj evC. Mailing Address L(�.Z 3 tJ��k 103",4 ZJV Home Phone :E 7 — 4�G/ Z' "S, 49 City/State/ZIP S cJ AIG Z Y/ 2 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/state/Zip 3. Application For: ❑ Site Evaluation Ximprovament Permit/ATC ❑ Both 4. system to Service: ❑ House N Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms , # Bathrooms a t�shwasher I:1 Garbage Disposal P/Waahing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # People # Sinks # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats. Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes �No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # b} � GILLCIl�e S WRITE DIRECTIONS (from �F/ --y Mocl sville) to PROPERTY: �< �` D 27' �� CY Property Address: Road Name f{rc,/� �y City/Zip A 2,Ce— If in a Subdivision �provide information,asfollows: Name: i K bo tt� Section: Block: Lot: _ Date Property Flagged: Z S--- e) 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 1 am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie Co my Health Department to enter upon above described property located in Davie County and owned by Mal, >' uon q to conduct all testing procedures as necessary to determine the site suitability. DATE `ti• Z S - (Z� SIGNATURE TIIIS AREA MAY BE 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 Date(s): Client Notification Date: EHS: Account No. 7docs 6 Invoice No. APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department 3 2a�0 F Please complete the highlighted area(s�-and Environmental Hea/tfi S& ion MM return. --T� P.O. Box 848/210 Hospital Street -- Mocksville, NC 27028 ENVIRONMENTAL HEAT (336) 751-8760 DAVIE COIL ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PPROOVIDED.n Refer to the IINFORMATION BULLETIN for instructions. 1. Name to be Billed ///�� / / (+r���ff[ �JG�////�/���i9N� Contact Person Mailing Address c���) �7 !�U[_ /�/�/y,�� Home Phone City/state/ZIP Adz -1 i/ eel Business PhoneG - 2. No -e on ceraitiXXC if Different than Above Mailing Address City/State/Zip 3. Application For: 04ite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. system to Service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: # People # Bedrooms # Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of Water supply: *fCounty/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes VNo If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED RL [ O'W E;!hc z AT 6 T O■mn RT ♦ wr , �• "iiSc;:iBiiiit � cu by the client wi[i[ i tfiS At`i'i,l(.:A't IUN. ..cx. vT.�.xc....rai�iria/.St Property Dimensions: p3 , /�/ 19 cdr t 4 b P �"P /, �- . " 44-; flax Office PIN: _ ._.___ #, � U, ,� --'SSG S.�G11) Property Address: Road Name;Q/ —� r�� /ion Citymp A21, /i gAlCe , /116 a -26W4 If in a Subdivision provide information, as follows: Name: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Z-5,/-9 ,5 7� Q,,1 Z/V , 4# 7/6la �7 - � L e Xi N3 j�tl r - 2- %e r 74 Ta A, / f -/7- 6-C tl6 bra/ TPD�/r,� Section: Block: Lot: f Date Property. Flaggedi t 2V29 t/ �0� � •t 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 change(L I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Die County Health Department to enter upon above described property located in Davie County and owned by -//,'� AX -1,1.4 2%94) Ad to conduct all testing procedures as necessary to determine the site suitability. DATE SIGNATURE �� 2%aA&L,—Z THIS AREA MAY BE 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 Date(s): { Client Notification Date: EHS• Account No. Invoice No. 1,13 5 �d i i GK 3 d Ou ai Iia i 2:1 M to 4 � 8.:6 A c } 4 �) 21 56.94 Acco 1.6 ' 1.0 LO 'F 56 (3'6Ac t,Ac TO (. 1-3.8 A c .• }� H ,5 5Ac. 1 454.64 A. tq 0 F '� "�• ` f r �i)�r ` �_ ` EIC• - t ;' f} ♦ , 1313 tt 0 6364( 517 311 14. n ,>'1 `�` �_ c) U 4 ,Ac 55 A IM 626.44 ,�_..,,,., 136 � . • v a, ti <. ti M s' ry� 2.92.A- . I rr t t 423-711 I.1ffi 26.01 17.031 AG, �> `.' Q 2 'gyp « ...,_,4 4334 T c� "c�,' ' ))/y CY 13.677 A c. - ;2 6 •• • _ I, Y �4 t l'144 A OD 0226 g 19 ; * "s i u./ 8c •A� r '•� 43-01 66 10.505 Ac. �� ' ��f N m �; YA oK 4 0 + r) 750:56 gQ� ` DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation 'APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001043 Tax PIN/EH #: 5788-24-4685.01 Billed To: Richard Markland Subdivision Info: Reference Name: Richard Markland Location/Address: Todd Road -27006 Proposed Facility: Residence Property Size: 2.14 Acres Date Evaluated: Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture groupL G Consistence Structure Mineralogy HORIZON II DEPTH " u Texture groupC Consistence -E 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: a LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: 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 ■ No No No on ■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■e■■■■Nee■■■■■Nee■■■■■■■■e■■s■■e■ ■■■e■■■ecce■■■■■s■■■■■■■■■■■E■■e■■■■■e■■■a■■s ■■■■■e■■■■■■■■NOON■■e■■■■e■■■e■■■■■■■■■Nee■■■ ■■e■■s■■■■■■■■ENE■■■■■■■■■�■■e■■■■■■E■eE■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ENE■■■■■■■a■■■■ ■■■■■■■■■■■E■■■■e■■■■■■■■■ NOON■■■e■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■e■■e■■■eeeee■■e■■■■ ■■■■■e■■■■■■eNee■ ■■■■■■■■■■■■■■■■■■e■■■■e■■■■■■■■■■■■■Nee■■■■■ on MEMNON MEEMME iMEMNON MEMEMEMEMMEM0 ■■■■■■■■■■■■■■eee■e■■■e■■■ee■■■■■■■■■eeeee■■■ ■e■■■■■■e■■■■■■■se■ee■■Nee■■■■■■■■■■Nee■■■■■■ ■Nee■■■■■■■eNee■■■■■■■■■e■ NOON■■■■e■■■■■e■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■Nee■■■■■e■eee■Nee■e■■Ee■ee■■■■■■■■■■■■■ee■e■ ■■■■■■■■e■eNee■Nee■■■■■■■■■■■■■■■■■e■■■e■■■■■ Nee■■■■■■■■Nee■■■■■■■■eee■■■■■■■■■■■■■■■■■e■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■NNE■■■■■■■■eee■■ ■eee■■e■■■■e■■e■■e■e■■■■■■�e■■■■■■e■■■e■■e■■ ■■■■■■■■■■■■■■■■■eee■e■■■r�r�■■■■■■■■e■■e■e■■■■ ■■■■■■■■■■■■■■■■■■■Nee■■■Y■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■M■■■■■■■■■■■■■■■■■■■■■■s■■■■■■■■■■■■■Nee■■■ ■■e■■■■■■■■■■■■Nee■■■■■■■■■■■■NeeNee■■■■■■■e■ ■■■■■■■■■■■■■■■■■■■■■■eee■■■■■■■■■Nee■■■eNee■ ■■■■■eee■e■■■■■■■■■■ee■ee■■Nee■■■■■■■■e■■■■■■ ■■■■■■■■■■■■e■■e■■■e■■■■■e�■■■■■■■eNee■■e■■■ ■■■■■■■■■■■M■■■■■■■■■■■■E■ ■■M■M■■■■■■■■■■■■ ■eEEe■MeeeeeE■■■Nee■se■■eNee■■■■■■e■■■■■■■■■■ ■■■■e■■■■E■■e■■■■Nee■■■■■■■■■■■■■■eNee■■Ee■■■ ■e■■■■■■■■■e■■■■■■■■Nee■■ee■e■e■■■■■Nee■■eee■ ■■NE■■■■■■■NE■■■■■■■■■■■■Nee■■e■■■■■■■■■■■■■■ ■■N■ NONE NONE NONE NONE ■MM■ MEMO MEMO ■ DAME COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION P. 0. Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NC 27028 Phone #: (336)751`-8760 ' April 4, 2000 Mr. Richard Markland 3155 N.C. Hwy. 801 S. Advance, NC 27006 Re: Site Evaluations — 3 Sites Todd Road Tax Office PIN: #5788-24-4685 Dear Client(s): As requested, a representative from this office visited the aforementioned sites on April 4, 2000. Based upon the information provided on the Application(s) for Site Evaluation(s) and after evaluations were completed, sites 1, 2 and 3 were found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked on each site. If you have any questions, please feel free to contact this office. Sincerely, Agr*ere g-�4�A. Robert B. Hall, Jr., R.S. Environmental Health Specialist RH/mp Enclosure(s)