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187 Kennen Krest Rd /1UTHOR .�,' Ell DAVIE COUNT�7HEA r ' Permittee's \ ,.y , 1 T T T 1 P, Name• ail ll - Environmental 8 PAT Directions to Property: P,Q Bo ealth S��t�o MENT ; y: 'a- x 848 n �; Mock'Wille,Nc 2 pR 'r?fc/ ne# 7 28 OPE - AvT1ro 634-8760 SubdivisizZZ: on ' T NrO PMAT10 RtzA Na N * NOTE t�sAutho . Sys Ti WAgR OR Section: me; e o issuance okOp for W NSTRte UCTTO ( ast cOmPliane wl�When appy g Pe z• Tax Cons N T Office pIN Lot; cle 11 of S BuddgPe ns F° AuU�ti°p MUST . Road # Chapter 1304 nth Num BE ISS Name; , Wastet�•aterS s bersho� ythe Da NEgL Y term S )--pre ed un SPECI�IST. ,c *** .ection 1�Seip' pt ,to the Da'T iroM�en� g DA T ISSUEp; Ti age Treatmept and le CO ty Bul d g h��aon Prior Vf1L�F0 ATIpNF D"SPOsal SYstert>s 4ons R A pE�ODORO ASTEWA .' I'EARSR CUIVSTRU CTION E f✓."S �.rr�ii.» D�*ir'f'=c fs fiN��'��ctyil-c:i*ik �"Y"'J'14. iac:..v. 'C 1c,:rri '�i"L ..7 � ,v,i.... _+.v. .y.i:..h Tt,--; .� q/.i'°'R*�^YY}:C.' . i ,h r i 5' • 'G .., r:. DAME COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Pemitte�' '"` Name: ,. r �.• � Subdivision Name: <� , Directions to property: �''r; , ' rte`, s: Section: Lot: � IMPROVEMENT' NT PERMIT Tax Office PIN:# t Road Name: **NOTES*This Improvement Permit DOES NOT authorize the construction or installation 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) 1 ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS zV, #OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No 1,4 LOT SIZE L TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) NEW SrrEy REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE /dnp GAL. PUMP TANK /DDd GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT.6 d D OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: Y4—: IMPROVEMENT PERMIT LAYOUT y , 4-1"' **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)6348760. OPERATION PERMIT tlfi7lk SQ IJ.�o�f�`l IZ SYSTEM INSTALLED BY: Lit T AUTHORIZATION NO. OPERATION PERMIT BY. DATE: r C,/ . **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. DCHD 05/96(Revised) •- "" ' DAVIE COUNTY HEALTH DEPARTMENT ki IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Pe" ttee'�"`'°" Name: A7 �' Subdivision Name: w Directions to property: .�` f : r' Section: Lot: IMPROVEMENT PERMIT Tax Office PIN:# Road Name: "4e} r. p �t" `' **NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system.An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the constructionlmstallation 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) ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE 4 PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE 1_ #BEDROOMS �� #BATHS i.0 C.�#OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE J TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) NEW SITEy REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE Z&OP GAL. PUMP TANK Z,:2L GAL. TRENCH WIDTH �5� ROCK DEPTH LINEAR FT. A OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT p:U .'- **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 t S VI T),I' SYSTEM INSTALLED BY: '`X t _ 1 f �� AUTHORIZATION NO. ' `y OPERATION PERMIT BY',_,- �i"C 1T /-� �-1" DATE: r F ; **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. DCHD 05/96(Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC Davie County Health Department Environmental Health Section { P.O. Box 848 Mocksville,NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed miken// Contact Person OIl /I'1 e i o / Mailing Address /IIP p f� Home Phone:179—p—?`L 9 City/State/Zip (� .2. O Business Phone 2. Name on Permit/ATC if Different than Above ` Mailing Address City/State/Zip 3. Application For: [t-rSite Evaluation [ ]Improvement Permit&ATC [ti/Both 4. System to Serve: [douse [ ]Mobile Home [ ]Business [ ]Industry [ ]Other 5. If Residence: #People--Z— #Bedrooms –3 #Bathrooms Z S [Kishwasher[gdarbage Disposal [`TWashing Machine [ ]Basement/Plumbing [ ]Basement/No Plumbing , 6. If Business/Other: Specify type #People #Sinks #Commodes #Showers #Urinals #Water Coolers If Foodservice:#Seats Estimated Water Usage(gallons per day) 7. Type of water supply: [bounty/City [ ]Well [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [40 If yes,what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT***A2MMOF THE PROPERTY MUST BE t= SP- R R LT SUBMITTED WITHrAPPLICATION. i Property Dimensions: / /X 2 y X /SOX 260 ;WRITE DIRECTIONS(fromksville)TO PROPERTY: Tax Office PIN: # 58 H Z - 17 - q776 ; j . 6 T rm%n tor% `� --VU1'11 Property Address: Road Name_&anen Kl-e r Rd Lff FL G a(A QA 1- 2 d . City/Zip j&kSd/LLL•',. AIC 2,702-9` ; a t A t _ Ctf $1`D� S �G1/1 T(hZA/ If in Subdivision provide information,as follows: _ fT L07" 15 -0,61 7�P_ A21 A n r Name: ; Section: Lot#: ; 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 I am responsible for all charges incurred from this application. I, 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 41e(4 2077s to ind t esting procedures as necessary to determine the site suitability. DATE 6�/5, f7 SIGNATURE Revised DCHD(06-96) THIS AREA MAY $E USED FOR DRAWING YOUR SITE PLAN: I APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE Davie County Health Department DEC .. Environmental Health Section P. O. Box 665 �► Mocksville, NC 27028 ENVIRONAIENTRL QAVIE tour 1. Application/Permit Requested By �� r PAI nr's G Mailing Address l 3 .51 /U c- YWY MI AJ Home Phone 9 9 4 'X 3 S-3 C Business Phone b Ss' 2. Name on Permit if Different than Above 3. Application for: Mr6eneral Evaluation ❑Septic Tank Installation Permit 4. System to Serve: ❑ House ❑ Mobile Home ❑ Place of Public Assembly ° ❑ Business ❑ Industry ❑ Other ❑ Unknown ' 5. If house, mobile home: Subdivision Section Lot # / ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing } No. of Bedrooms ❑ Washing Machine No.of Bathrooms ❑ Dishwasher dd Dwelling Dimensions ❑ Garbage Disposal is 6. If business, industry, place of public assembly,other: Specify type No. of People Served No. of Sinks No.of Commodes No. of Urinals I. No.of Lavatories No. of Water Coolers r. No. of Showers Water Usage Figures is 7. Type of water supply: ❑ Public ❑ Private ❑ Community 6. Property Dimensions G/ , W Sewage Disposal Contractor 9.`Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No i If yes, what type? ! i. I. t ° 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvementd Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. 'l PROPERTY INFORMATION REQUIRED: Directions to Property: Tax Office PIN # SR2- y�,/- 977 (o F2aYy� y �►� Fr4a s+nhf�i'� Road Name t l�cPf,) -, AR-iUe— �w S"� NoY Box // (if available) Sr; / Y-7( /ems d,1 City 7rY1 o c Ic sv(,('Ile-- ; /gide v44, `��u L- � 0�^J 18�' �µ t-1 r i i This is to certify that the information provided is correct to the best of my knowledgJaunderstand I am responsible for all charges I incurred from this application. DATE SIG&A4rURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PRPPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. 2. 1 DO NOT OWN the property. If you checked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of a ie Count Health D part to enter upon above described property located in Davie County and owned by � V1 I n t-- to conduct all testing procedures as necessary to determinesaid it" suitabili for a ground absorption sewage treatment and disposal system. 12 - t- g ;5-' c DATE SIGNATURE DCHD(1/93) i 1013.80 `wa 101.$3 115 97 � H� .206 147.9 -�- o 371.25 5.58 Ac. 410 707.52 \ m t iB 98 (3.5 Ac) 0.6 Ac}rnP 5.10,AC 1u59.96 379,C�- (TR 3)t 99 �` (2.84 Ac) 1.6 Ac) 44 Ac, 4o87.90 I A Ln 93 _ m 4' 7.29_ACS F+ 2g594 �r 229 594 t 2 AC 229 w292.78 450 w 495 j q 1 574.50 1.75 Ac 124 , \ -, - 3 1.77_Ac 3 N�2.20SAc o ..� 125 ,� I_� N901 3A �`� .4 Ac s � s � � A co (342 '" -4 ro 200 12927243.58.69 97 300 N n h f}•7 ;� I0�1.4 t Ac. U I Ac. r4 4C�hh�o. ,330 G aEgA�c 1,943 4 2')3.6 a 556 i N �I ;.15Ac 9.44 A0 C? ms 0 2.69Ac 294.73�;a.58 � 0 - 556 255 64 v co 133 © cD 1.12sac. 103 F 85 N x' 26016 (6.2 Ac) o1.44lc-3 X1.32$25 ti 260 10;5 :04.01 . \ g 1 i �, 20 2 2 �` 54 �' .933 Ac 10 A c 173 Ac X1.33 si �'�6 (0.25 Ac) i " 300 _ 2\g2pN124.60 �, 1 .973 Ac ++� -- - - 396 t 1 3c�, �?8 v0 360 I AC z50 1.1 AC 170 \ (i) 261 107 b-1 70 5 170 .50 N 61 . N O Ul ��i ��05 � 8� N 81 X79 W 4 75 '08Ac� c, - oIAc "�IAc o X53 �' e� 104.02 � 1 01.39Ac 50 A5. c� a 74 254 360 05.7 1 62 X53 x,108 N 1(x.4 4 Ac � o(IS) 50 � Ipg2 o ro 35 415~ U t�zj�L}p`G� 2 2 (395459 8g 0 C8 01 300 �Ac o -\ 120 "'� ��-'-----�- �(20) 360 O 317.14 2.309AC s� 2 I2 AC 62 (775.50) 677.14 g93 (� 299' `�21q 265."0 G(]A.6'2%0 ' 13v 19 `as ? A 6p30 cNi \ o 0 I l 0 0 in o rn� 3.08 Ac o 36.2 Ac) ° Pt. of 127 �� 472. 0 s iv 077 Ac t'' w 3po 111 61:-6 o 3 72 0 391.12 N 112 v (7) 0 \ (2) 117 w 134.40 Ac Cil30;71 \ CP =$) "'- 426.21 - 116so� Q 113 �1 CO Pt. of 127 j p (3) C-0 i 15 114 ���Qg) 253 y _ (�}} (5) (LOT 59) f �`��' a 3 79.3 379.39 (2$2 .Ac ) -- 762.30 - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation ��t l J QA NAME ' DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE i ( re6-4- .04 Water Supply: On-Site Well _ Community Public - Evaluation By: Auger Boring Pit Cut FACTORS 1 1 2 3 4 Landscape position L- i- 1 L Sloe z HORIZON I DEPTH Z .. <' Texture group /-I)- Consistence Structure Mineralogy HORIZON II DEPTH Texture group C 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 4,ls- els LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: ted_ ��1P4 EVALUATED BY: 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-Sandyloam L-Loam SI-Silt SICL-Silty :lay loam• SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Vc.cy 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 3C-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(01-901 ■■■■■■■■e■■■■■■■■e■■■■■■■e■■■■■■ ■■■■■ME■I■I■■■■.■■.M■Ee■■■■E.■■■ ■■■■.■■■■■■■.■■■■■■EE■■e.E■■E■■■■.■■■■M..■ ■ M■M■■M.■E■■■.■.■■■.■■ ■■.■■■■■■■■■■■.■■°■■■■■■.■■■■°■■■■.■■■■■■■M■■M■■■O■.■.■■MMMMM■■■■■ ■■■■■■■■■■■■■■■■■■■■SSM■■■■■■■■■■E■■■■■■■■■■■■■■■■■■■MMM■■..■■■■.■ ■■■.■°■°.■■■■■...■..■..°■■■■■.■■■..■■M■M■MMC■■■■■■M■o■■■■E■.■■■■■■ ■■■■..■■■■■■■..■..■■■■■.■■■■.■■.M■■■■M■■■. ■■■■■■■. ■■■M■■■..■■.. ■°■■°■■■■°■■°■■■■■■■■■■■■■■°°■.°..■■■■■■■■■■■■■■■■■_ ■■■■■■O■■O■■■ ■■■■■°.■■■■■■.■°.■°■■■■■■■..■..■U■■■■MMMMM■MM■MM■■ ■.■■■■OM■■MMM■ MMENEOMMMOOMMEMEEMEMEMMMMEEMEMMMMEEMMEMIMMCCCCC iiil MMMM MMMMEMMM ■■■■■■■■■■■■■■■■■.■■■■■.■■■M■..■■.■M■■.C■■■■■■■I■■■■CMM■■C■■■M■■.■ ■■■.■■■■■.■■■■■■■■■■■■■■■■■■■■■■■■■■..■■■■...IIml MI C■■MC..MOMMEMMM ■■M■MCC ■■°■■■■°■■■■■.■e■■■■■■E.■■■.■■.■■■M..■■■mmmmmommommmmommmmmmmmmmmmmmmmmmmmommomm .M. ■■■■■■■.■■■■■■■■■■■■■■■■■■...■■■M■■■■■OM■■MMOS■■e ■■ ■■■MMM■■.■M■■■■■ ■■■■■■■E■■■E■■E■■■■■■■■■■■■■.■■w■■■■..■■.....MM.....■.■■■■■■.■■■ ■O■..■■■...■■■■.■■■.■■.■■■M■■.■ ■■.■■MMYO■MSM■MM■■■■■O■■M■■■■■■ ■.°■■■■■°.■■■■°■.■■■E■■■■.■■■■■■■■■■M■■■■.E.■..i■.■■■.■■.■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■M■.■■■■■■■ ■■I■■E.■■■■■■.■■.■ MEMOOMMEEMOOMMEMEMEMEEMMMEMEMEMMOMICCC■iMMEEMMMMOMMMMMOM m=CCCCC=■� ■■■■■■M■■■■■■MM■■■■■■■..■■■■■■■■■■ .■ME■E■■■■nM■■M■OMM■■■ ■■O■■ ■ ■■■■°■■■■EE■■■■■■EEE■■..■■E■ee■■e.E■■■■■■■■■■■M■■■■. 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Nealtfr Department i acrd Nome Aeaff Oyefley 210 HOSPITAL STREET/P.O. BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634-5985 E March 22, 1996 i Mr. J.W. Phipps, 1351 NC Highway -801 N Advance, N.C. 27006 Re: Site Evaluation/Ridgeway Drive Tar, PIN 5842-74-9776 Dear Mr. Phipps: As requested, a representative from this office. visited the aforementioned site on March 20, 1996. Based upon the information provided on the application for a site evaluation and after an evaluation was completed, the site was found to be provisionally suitable for the installation o£.an oversized-modified on-site sewage system. If you have any questions, please feel free to contact this office. Sin erely, Robert B. Hall, Jr., R.S. Environmental Health Section Enclosure