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140 Idlewild Rd Lot 7 Y DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Moeksville,NC 27028 (336)751-8760 Account #: 990003354 Tax PIN/EH#: 5862-35-7132 Billed To: H&V Construction Subdivision Info: Idlewild Lot#7 Reference Name: Eddie Hubbard Location/Address: 140 Idlewild Road-27006 Pro osed Facility: Residence Prope[Ly Size: See Map ATC Number: 4232 accepted SystemsNmay 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 CO ON V ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature. Date: Oho 3 15tdrooifls CERTIFICATE OF COMPLETION **NO E** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 3 has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and 163 Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. 137' \ 13, 4 �l�•91� �Y� y-Z'Z A Septic System Installed By: G�AM1S &�t C T Environmental Health Specialist's Signature: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P.O.Boa 848/210 Hospital Street ' Mocksville,NC 27028 J r I (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003354 Tax PIN/EH#: 5862-35-7132 Billed To: H&V Construction Subdivision Info: Idlewild Lot#7 Reference Name: Eddie Hubbard Location/Address: 140 Idlewild Road-27006 Proposed Facility: Residence Property Size: See Map **NOT�9*Th s Improvemeent/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. •SDisResidential Specification: Building Type I4VL)Z>F- #People 2- #Bedrooms 3 #Baths 2-,S- Dishwasher: hwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size©.•738!! r'7 'ype Water Supply CWA)tesign Wastewater Flow(GPD) Site: New Repair❑ System Specifications: Tank Size ICOD GAL. Pump Tank GAL. Trench Width : '.' Rock Depth IZ' Linear Ft.--30Z>1 Other. I 1P�l�TlO►� � ac stated iystemsNmaCalso be used ' � accepted S y Required SiteModifl - ir�n�ir�—�: _� CIS w�--Zkir 16 O �t-P LjAe IMPROVEMENT/OPERATION PERMIT LAYOUT- ABED EFFLUE T FILTER RISERS)IF 6"BELOW FINISHED GRADE. ****NOTICE: Corttart-a-representative of the Davie County Health Department for final inspection of this system between 8:30 a.m.to-9-36'j"m.or 1:00 p.m.to 1:30 p.m.on the day of install ition. Telephone#is(336)751-8760.**** �— f�'x I ., Imo, �Z f Qp, M 19 to LI <7 �- MPJ S' Y E FRONT Environmental Health Specialist's Signature. k4te: 'I Z-•7 DLO DCHD 05/99(Revised) . lug 9b r APPLICATION FOR SITE EVALUATION/IMPROVEME © AAf=&BAWCE Davie County Health Department Environmental Health Section APR 2 4 2006 P.O. Box 848/210 Hospital Street Mocksville,NC 27028 ENVIRONMENTAL HEALTH (336)751-8760/Fax (336)751-8786 DAVIECOUNTY Application For: ❑ Site Evaluation/Improvement Permit ❑ Authorization 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 �(4- V 6--9 wS'r/,g a c—rt cy w contactPerson Billing Address .�//O c/o tre gj) &L z AVL Phone 336- 399' 144 City/State/ZIP_GtJt N5 N—5��� GG1C. zT,�r, Business Phone 3>6——72.s—I Name on Permit/ATC if Different than Above 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 wit complete plat.) Street Address r d ,L Dec 4y/LA i�c� City—Al Tax PIN# S9'&Z 3S 713 Subdivision Name 1 aLcwi t-D Section/Lot# `7 Lot Size_t5'JO 20/`, h ad' 2y��yrZv -1'71 Directions To Site: o/ /u 6 2 ,t_.e�_ 4 p , f � W;�,1,-N 11z-Zt Tn hCG 1 c. f j /V j-0 Date House/Facility Corners Flagged 4. 2/1 0 6 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? Dyes RNo Does the site contain jurisdictional wetlands? Dyes IkNo Are there any easements or right-of-ways on the site? Dyes PKo Is the site subject to approval by another public agency? Dyes i Mo Will wastewater other than domestic sewage be generated? ❑Yes pPdo IF RESIDENCE FILL OUT THE BOX BELOW #People --Z_ #Bedrooms 3 #Bathrooms z �_ Garden Tub/Whirlpool ❑Yes o Basement: ❑Yes IKo Basement Plumbing: ❑Yes aKo IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business — Total Square Footage of Building #People #Sinks #Commodes. ---3F!, #Showers #Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested: V<onventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: (iYCounty/City Water ❑New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes PJ No 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 bye} G�— � Site Revisit Charge Property owner's or owner's legal representative signature Date(s): • f Client Notification Date: Date EHS: Sign given Dyes ❑No Account# Revised 2/06 Invoice# • 9. tDLt�•w QLD St,�,Ct D�v.S t w . `\ % 1 -. ., . dor '4yAj i-- .0-7103 a �. ��. � v )% r C 6350-7 5�•h'. ` M -75-1 75t Lot liar of 04 161439 aavl•eaunes snvneeten 336 731 6766 0.2 1. 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' CDatihDDo4auDate i apt �cCoiatYe• da.,+nnm wn 10.4 £I£t IZt9££ w w w A2H H!f 9G:10 t0—*I—JBS ` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003354 Tax PIN/EH M 5862-34-9883.07 Billed To: H&V Construction Subdivision Info: Idlewild Lot#07 Reference Name: Location/Address: Gordon Drive-27006 Proposed Facility: Residence Property Size: see map 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 Sloe% HORIZON I DEPTH Texture group Consistence Lr Structure Mineralogy HORIZON II DEPTH D - Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group . Consistence kT Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: i 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-Sanoy 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)