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118 Idlewild Rd Lot 3 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990003354 Tax PIN/EH#: 5862-44-1832 Billed To: H&V Construction Subdivision Info: Idlewild Lot#3 Reference Name: Eddie Hubbard Location/Address: 118 Idlewild Road-27006 Proposed Facility: Residence Property Size: 3/4 acre **NOTE *This Improvement/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 914pos= #People #Bedrooms 3 #Baths Z Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size©:M AC4agS Type Water Supply Design Wastewater Flow(GPD) G-41U Site: New 25""Repair❑ System Specifications: Tank Size 1000GAL. Pump Tank GAL. Trench Width � Rock Depth (1" Linear Ft.�''C7 As stated in 15A NCAC 18A.1969(5) Other: 3 1DVSMIl fi oO 71&Ne_S accepted Systems may also be used Required Site Modifications/Conditions: f),.y GQT ftjQ, VA�_- �j © rtpy�, art kp f)1F Fkp.t_1.3; 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.**** AA �� b S 120 X „xl2' UZI nvironmental Health Specialist's Signature: Date: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksviille,NC 27028 (336)751-8760 Account #: 990003354 Tax PIN/EH#: 5862-44-1832 Billed To: H&V Construction Subdivision Info: Idlewild Lot#3 Reference Name: Eddie Hubbard Location/Address: 118 Idlewild Road-27006 Proposed Facility: Residence Property Size: 3/4 acre As stated in 15A NCAC 18A.1969(5) ATC Number: 4343 accepted Systems may also be used 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 WASTE W ON UCS IPC_A ID FOR A PERIOD OF IVE YEARS. Environmental Health Specialist's Signatur : Date: CERTIFICE F COMPLETION *,WTE** The issuance of this Certificate of Com etio sh I in irate the system described on Improvement/Operation Permit has been installed in compliance with icl 11 fS. .Chapter 130A,Section.1900"Sewage Treatment and %'9 Disposal Systems,"but shall in NO Vx Y tak - (�,fi guarantee that the system will function satisfactorily for any given period of time. �Q �q r1 e9 S�jt�• -r�P� 11- TaJI; TEATC 4-17 T Septic System Installed B 4 Environmental Health Specialist's Signature: i Dater _ DCHD 05/99(Revised) AI)PLICATION-EQR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section D P.O.Box 848/210 Hospital Street r�AR 2Q06 Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 plicatior#h�8g� gA vv provement Permit OAuthorization To Construct(ATC) ❑ Both IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed CO Contact Person Ebble K'[� Billing Address -7-110 G(o ve-R .AAZ_v_w 241/&f- 1=Phone 3 3c-s 94- t X79 City/State/ZIP 1 t/e. Z 7/y3 Business Phone 3 36- 7zs-/2S"y Name on Permit/ATC if Different than Above 'gym C- Mailing Address City/State/Zip PROPERTY INFORMATION NOTE: A survey plat or site plan must accompany this application. (Permit is valid for 60 months with site plan,no expiration with complete plat.) Street Address /18 Mo(ewtLD R-D City_ _;,q VBG' N-G TaxPIN# 5862-141- az- Subdivision Name ,��L w r t, Section/Lot# 3 Lot Sizes A1C. 'f- Directions To Site: /58 &r,,4ST 4-itl`AN 4 e-l^T e-K i?AkeX*-yb R.P. /P-r epAJ !g.0 n4!!ej 1- EJ'e'-;� .i.� =b t-,&-ry ,L.D Date House/Facility Corners Flagged 3- a 1. O!t? If the answer to any of the following questions is"yes",supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes PNo Does the site contain jurisdictional wetlands? Dyes Cho Are there any easements or right-of-ways on the site? ❑Yes PNo Is the site subject to approval by another public agency? ❑Yes BNo Will wastewater other than domestic sewage be generated? El Yes RNo IF RESIDENCE FILL OUT THE BOX BELOW #People / #Bedrooms 3 #Bathrooms Z Garden Tub/Whirlpool X8 es ❑No Basement:: ❑Y�o Basement Plumbing: ❑Yes FNo IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY:: #Seats Type system requested: m1Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: 9 County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes "o If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed. I understand that I am responsible for all charges incurred from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules on the above described property located in Davie County and owned by (•f+V C,9 S-rRt e fr4 e1t. e--LZ— 67 z� "moo Site Revisit Charge Property owner's or owner's legal representative signature Date(s): 3 , Client Notification Date: Date EHS: Sign given Dyes ❑No Account# y�✓ Revised 2/06 Invoice# 3, s 114P al 04 161-13a eavla aaun6a anveaaitn 336 751 6766 P.2 APPUMM no AM•iglL'R7O7y6t7gYdlpjr MALAR l lAr i . 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FpIItYtwhtt61Qed6rdmltl jallrtrda7out7itila7er�uaUefirtlP liftrtpltOtleftbdpojtCt)baled (qq �l+eattOoDarkGaulDaltl,Dq�irwee �6 bdldupaOuAfalP�ln,narscc:ttlr7hddav�elhesketuBaC9U��'�'_ � rD�s�uretiwceammrvxD�iwLvc�oalm=t9caypAal��ntrl,acl.�7 r�;,,�,� • $11eRitIA1Cl�rte Dim: ' CGatitaUOoWuDtte � 1 apk kcooalf, 3 A..�.a nnln su7t .. 10'd 21211Z49££ w + w ASH WW 90:10 t0-6,1-jas DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account M 990003354 Tax PIN/EH#: 5862-34-9883.03 Billed To: H&V Construction Subdivision Info: Idlewild Lot#03 Reference Name: Location/Address: Gordon Drive-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: 1 2- Water Supply: On-Site Well Community Public Evaluation By: Auger Boring I Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH ) 0 Texture group GL. Consistence Structure ` SEA Mineralogy i HORIZON II DEPTH Ll Texture group en— Consistence rrssv Structure �k Mineralogy . HORIZON III DEPTH 2 Texture group Consistence Structure k Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION es LONG-TERM ACCEPTANCE RATE 7 SITE CLASSIFICATION: EVALUATION BY: `''� LONG-TERM ACCEPTANCE RATE: � !�'� OTHER(S)PRESENT: REMARKS: N04R:T2 K V—X X15 1$"+- its Cl?`Z S CC 1Y 'rL3iQ v (qj ct)-r 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) M b r � � � 1 . plat Book _ F7kp I�. f i Y4 , i � . ` OMINQt 0'wNER II .. FOX �ADO � SUBDI VI,s10N � PL. B�'f. 4, PG. 134 � � � I . J ZONEp R-20 hlARY HENI�RIX 1 � 1 � D.B. 46 � � � � • � � I � , , PG. 483 ! 25 � � � � � r � i z4 � z� i � i i , z,� , � ► , � + � � � .�� � zo � � � � _____�__� �Xo�� � ! + , , � � �9 , >a � _ � ' � � f ==�� r 4a, �z s e a so� e tei 4. � rornu+ I i :.:.�ti�R z,e. 3s ( LARRY G. lIF. S T 18b. gg ex:s•:aU I D. B. 20 , PG. 793 °° ' _ _ ��N — L — � _ _ � 4 ,� ,.-----_--- P38 99 _ � - � O N� � ��I'Rw� % 0� CVN`�Ol Y N •�vrL � � .� LJkN;'.. � N (y - -- -- _•,_ ,._, ,... i.�T 8 �= � e ` ► — ` 0.738 AiCRES �p�'-► LAT � � o�f ` � ; 4.738 AiCRES ' � C.�IESTER c � ,�; � LOT 6 �• � ;, O �� r%��ti7 T� S � �/ 0.%3�J ACRESf,L�,4'Ap � I o D. B. 204, �'C. 7'99 � 6,. �. ti� :�°' 2m°' N r�ii `'�t. *ats' �' `� !? f `� I.OT `.� � / � � �`�t�' i� 1.222 ACR�S � i -..---,�_,,__� w � �� i c5` "' � _. �� bC � ` � � S N ,. � '0 LOT 9 B.�'TTY li'. MARKLIN�'.�'" N o.�21 aCRES _ o �' o � D.B. 204. PC. 796 x N � �-. �� �'� �' LOT 4 0 � �, � id�`�' � ,172 AGRES � � � ~ ' — �" '" -- — -- _. /�, �►� � � � ►•� �t � q g, , w � s �`�+ w � Ji f � � Z 1.�� � 0 ..� ti Q �_ � �a 1a?39� 1� LILLIE D. 1P,I'�T � `- 0.734 ACRES . w:� L0� t1 � � �� i O U D. B. 185, PC. 8 0 1 � ry � 0.702 acRE.s 1 I.OT 3 ^� � 'J . � �, . 8 �� � 0.738 ACRES �..,, t� � Ex��-�*�G ; EXiSrikG ��� $ gS•29'OQ' . � � —� _, — ' — — � — E'"" . �Ro►+ �v � W� a S 8S 29' OQ' .--- N d5' Z9` Op' �y �� 2{0. 63 � I 7 N 8<•48' �� ' If � •< . � 3t' 29 j N eb� ��• v 64.9's ,- lOT 12 � � c� p4 � W� 4.7� 1 ACRES � � I.OT 2 � � �5� ° I LEST�R N, HILT4N = �. o.ssa ACRES ,� Y o a !/' B• s.2► PV. 450 � t^ 32G 60 322. 9� � ZONED R—�Q �� `S �' � ��� i � _�__ +--_� 85'24'00' V j � ' -�LOT '13 � , � r -------- -----� � 0:70fi ACRES o =. �OT � � ACRES � � 0.703 + �,,,��.. �..�.. � _ � s MG�TwrE'�{Ct�g �� � 0'� 1�T � N i� L---- ------------- ��--J v� � w � ,... .r � ' »""`N eS'24'OQ' y 32'.18 ' —•. ._ _ s NE�AT+� A.S�E�� FL�E�E� TL a M L,vf. �� -+--N 83'29' 00' If 2 — � �T •• •• ••� b, Rr . E. + � ?C` pAVEO 4i R S� f� C. ` „'ru'� w � � su�.. � r ..,r�..�, �.. . . . '�."�"'r'��— iN _ �O; • j!i . , �Yr��.� � • . . b 4 ti .�� r. �...�... � .� �+� w .. .�.��. � � �.r� � � .�� � � � .. .�w�. � � �..�..L. .� o� Z ` + , . - _ �. : . GORDOIV D 1 �f48� _ _ l ' M o° RIP1r (S.R. � . R�« ,�Nr � �° . �o• w+. �,, �,�b ��. _. - � r+oar►+ u�ouw► a� �wwsPo��no+� N OF NI�;MWAY$ PROPOSED SU80MSK1N RfLM1 ��' ��`"^" r W F�,� �Htir r � Z,., t J ��� o j►