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1680 Deadmon Rd. . _ . . . . �� . . . _ -�� , - ' � _ . , . . -. , � � � . , . .. � ' . � // ' . . . .� . .. vi �. ♦ ,� ' �'Y a.. .'. �` I r . - .. "Y . . , i.5. . � . -.. � � x� AUTxoxizATiorr No: Q 7 � � DAVIE COUNTY HEALTH DEPARTMENT •� ,f r'�� � , � ;..:. .. �., �'• Environmental Health Section PROPERTY INFORMATION Permitt�e's�--��' .yj P.O. Box 848 J�` Name: �=.����%'' Mocksville, NC 27028 , Subdivision Name: b -� �!`�.�.7,� �? Phone #: 704-634-8760 Directions to properfy: ���� r�-...- Section: Lot: AUTHORIZATION FOR / ) �� �,E;,,,�-.,,� �..�._,,,, WASTEWATER Tax Office PIN:# �rl��)- !n � - � � 'n � SYSTEM CONSTRUCTION Road Name: ��/i �YYI D n! ��ip: _�, r� � **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Pernuts. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Pernuts. � (In compliance with Article ll of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ��,�' ;J ,1 ('� ***NOT'ICE*** TFIIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION r`" J' -�t ,I t, ; f� 7 rJc'',�,`� /��}. /�r IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEAL�"H SPECIALIST DATE ISSUED . . . .,,.,. �' , . �.;�5 . . .. .. . . ... . .. . . . �a �.. .., i. ..,��... ,,�..:.-,., `. . . ,. ' . '; �, . -`_ I , ;. L Y^ DAVIE.COUF `� �v �`, . F�' NTY HEALTH DEP` RTMENT - f "`}'� - _ ' "�. � ' . -; �" ' IMPROVEMENT AND OPERATIO PERMITS PROPERTY INFORMATION � �, 17 • Permitte�c���s. �: �: / .. ,r� / �Name ` .:,��t1,�?i) / �?�?_lE��'.. r - , " . �- . �y "7"`� < : ? t %� f r�... Directions_to properfy: <--` �" •.—% ��t--�- � '� ! C w�.- -. ,,..t... -. � _,. ' �" � �.� E � -.- Subdivision Name: Section: Lot: IMPROVEMENT : � PERNIIT Tax Office PIN:# � �`=� �t _ � - ' : - �� `' �`'�T i Road Name: t=�`� C? �?l'1:'} � t� y�� .�,Zip; {`i f''' `->, �;' **NOTE** This Improvement Pernut DOFS NOT authorize the construction or installadon of a septic tank system or any wastewater system. An p AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTIQN must be obtained from this Department prior to the construction/installation of a system or the issuance of a buildirfg peimit. ' - (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** TFIIS PERMIT IS SUBJECT TO REVOCATION IF SITE �` 1 {';; �',�• <<, ;' `� ,,.�';-" 1 s ji�;�_ PLANS OR Tf� IIV'I'ENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THI.S PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE �+� # BEDROOMS "�` # BATHS i� # OCCUPANTS � GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLFJSHIFf # SEATS INDUSTRIAL WASTE: Yes or No i LOT SIZE��`% �,�" TYPE WATER SUPPLY � DESIGN WASTEWATER FLOW (GPD) `:�G .-% NEW SITE L� REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE � I� GAL. PUMP TANK GAL. TRENCH WIDTH -.�/� � ROCK DEPTH � LINEAR Ff. '=��t 0� REQUIRED SITE MODIFICATIONS/CONDITIONS: 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: �eo�S ��5 � �� �N�L" .t°$ 4� r �� LL N t� Up i c�Pi.c;-�-L� �lT ra�P�C �, � �Q ( � AUTHORIZATION NO. ��� � OP TYi���' 0 Y: DATE: I� **THE ISSUANCE OF THIS OPERATION �L IND CATE THAT THE S S DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SE 1900 " WAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WII.L FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD OS/96 (Revised) ci. O � N a � � 0 � a C � � � � 5' � �o 0 � a c � � �" 't7 'U �n � z � 'j �3 "O � � � � � � �' cp a `G 0 `G � � G � a �• a � � c� � � ro y � z ,� o. 0 0 � y � � n a � � z 0 � � � !� -� a � Q y ' � 1 � y � O o � �- r � ' � Z -� -- Q -------� � �+' ` ?i o y rn � �� (� i �, d � � A � � o� o, N -� y ° � z °z �/' � O v� .. � � �o i A :'� � �� ��� � • . � � � 0 � � 0 z � � � v * � iF � O H � z H * �a C „ti �' r � y �O Cy H � x� �� b � �� C H y O t� z � � � ., 0 � � � � y `�J � ao � � � a � CD � a 0 � o � � m � � � � � c � � w "� �• 0 a 0 r� o o� �� � N M co � P: G O ^• � � x O � O � c � �' � � O s a. 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'—I �- i � -� - I 1 ' _�_ I . _ � .__ '- I � -,'- L .- _ _ I - - - i- � -- -- - � - _ - — —�� � I — � I � , I � I i I --- -�-- i -I_ ,___ _�_r -- -- ---- - , ' � , ' � ' I � I ! �, ', �� � � � ' � ! i �-.t-��- -�-i �- � -�-.- -. • .� >� DAVIE COUNTY HEALTH DEPARTMENT -„ � Environmental Health Section SECTION LOT SoiUSite Evaluation APPLICANT'S NAME l�,���Le'i" DATE EVALUATED �`�1`"�� PROPOSED FACILITY ld' PROPERTY SIZE /�'''� � SUBDIVISION ROAD NAME �� � Water Supply: Evaluation By: FACTORS Landscape position Slope % 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 On-Site Well Community Auger Boring �� Pit SOIL WETNESS RESTRICTIVE HORIZON CLASSIFICATION � 1 0 � Public �� Cut 3 4 5 6 7 SITE CLASSIFICATION: iJ� EVALUATION BY: ��a; /� �T 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 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 - Subangulaz blocky PL - Platy PR - Prismatic Mineraloev 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restric[ive 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 - gaUday/ft2 DCHD (01-90) ■■■■ ■��■ ■��■ ■■�■ ■■■■ ■■■■ ■■�■ ■����■ ■■��■■ ■■■■■■ ■����■ ■�■■�■ ■�■■�■ ■�■��■ ■�■■�■ ■■���■ ■���■ ■���■ ■■■�■ ■■��■ ■■■■■ ■���■ ■■��■■���■■�■ ■�■■■■��■■�■■ ■■■■ ■■■■�■■ ■�■■ ■■■�■■■ ■�■■■��■■��■■ ■�■���■■■�■�■ ■■■■■�■■�■��■ ■��■�����■■■■ ■�■��■■■��■�■ ■■���■■��■�■■ ■■■�����■��■ ■■�■ ■�����■ ■■■■■■�■����■ ■�■�■����■■■■ ■■■���■■����■ ■������■■�■■■ 11��/■�rir.:.'��■ ■Ir■�■■��■■��i\ ■I���■■��■■■■Il �I���■■�■■■�■1� �I���■��■■■■11 �I■�■■ ■■■�■1� 11��■■��■■�■��1 11����■■■■■■■l! 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