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251 Lakewood Dr t � � �5, . .:.. �. DAVIE COUNTY HEALTH DEPARTMENT � � Environmental Health Section P.O.Boz 848/Z10 Hospital Street Mocksville,NC 27028 ' (336)751-8760 Account #: 990003898 Tax PIN/EH#: 5737-82-7027 Billed To: Jessi Andrade Subdivision Info: ��, Reference Name: Jessi Location/Address: Lakewood�esa-27028 Pro osed Facilit : Residence ATC Number: 4345 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 Build�ng 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 CON TRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature:_ Date: ��!/ �� Q � CERTIFICATE OF COMPLETION (D �0 '� **NOTE**, The issuance ofthis °'�etion shall indicate the system described on Improvement/Operation Permit has been in ' comp iance wi icle 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Dispo yst ' ut shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any giv period i ti � �� 4 '2 C� �RS � �, �J `y ��,�tlJla � S � , Wq.�� T � �� Y' ..------� � , q � c�� 1�d . � � ,� �_ � 3 �c� 7 �---� �-�� 3�j.S' ��(� �i�fl �� ,�t�,�,�p�-� Septic System Installed By: � � �� Environmental Health SpecialisYs Signature: Date: � ��' fl7 DCHD OS/99(Revised) , 3±� . � � DAVIE COUNTY HEALTH DEPARTMENT � Environmental HeQlth Section � � ' P.O.Boa 848/210 Hospital Street ' �� , W' Mocksville,NC 27028 ��° (336)751-87G0 3 I3'� IMPROVEMENT/OPERATION PERMIT Account #: 990003898 Tax PIN/EH#: 5737-82-7027 Billed To: Jessi Andrade Subdivision Info: Reference Name: Jessi Location/Address: Lakewood Road-27028 Proposed Facility: Residence Property Size: 2.157 acres **NOTE�*-This Improvemei�dOperation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALJTHORIZATION 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 CONTRACT R MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People � #Bedrooms v #Baths �S Dishwasher:� Garbage Disposal�Washing Machine� Basement w/Plumbing: ❑ BasementJNo Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: � � / ,,,�� Lot Size ��G Type Water Supply ��( Design Wastewater Flow(GPD)� Site: New� "Repair� �1 System Specifications: Tank Size fJfit'S GAL. Pump Tank GAL. Trench Width� Rock Depth� Linear Ft�� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis 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)751-87G0.**** � / Environmental Health Specialist's Signature: � Date: �`J�� DCHD OS/99(Revised) � , e , .. . _ _ _ _ _ ___ _ _ _ _ _ _ _ _ _ _ Davie County Health Department Environmental Health Section ': P.O.'Box 848/210 Hospital Street Mocksville,NC 27028 ' _ ___ __ __ (33�751-8760/Fax(336)751-8786 ' March 17,2006 Ms. Jessi Andrade 225 Lakewood Drive Mocksville,NC 27028 Re: Lakewood Drive Tax Pin#: 5737-82-7027 Dear Ms. Andrade � As requested, a representative from this office visited the above site March 15,2006, to perform a site evaluation. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans or the intended use change. Improvement Permit System To Serve: 1H(/(�t'C Wastewater Design Flow: ��0 System Type: �(:onventional �Accepted ❑Innovative ❑Ahernative �Other I / �' System Location: L�kr'(NUOC�- � /V� Valid: C3-S�ears �No Expiration Site Modifications/Permit Conditions: � � 6 Environmental Health Spe ialist - Date ps-i.p.letter 2/06 �. . .� b� P�e�se Call f�enr�y uiher, you a ��• ��C?z�5� o� ,.. �*:� ; • �-/e u�oulc� li l�t e f v be-�he�e �jr�s �o�e u�s�� Iv`�l' 7Z�� Mar.03 06 01:44p davie oou�ty envhealth 336 751 8786 p.! � � � � � � D APPLiCATI R SITE EVALUATION/IMP��OVEMENT PFR1UbIT&ATC . 7 2006 Davie County Health De��rtment MAR E�vtronnreRtar!Bealtb:.�ctiax ?.O.Boz 8a8IZ10 HoopiiaJ 5tccet Moc3csvilly NC M0:3 � � �jdVIRON �A�H�x (33�751-8760/Faz(33�7s�1-8786 COl1Nn or. Site EvahmtiqJfmpvvanent Pamet �Authoriut oa To ConmuU(ATt."� �oth I _ ••,IAdPORTdNi"•*TH1S APPUCA.'[ON C�NNOT BE PROCESSED I!l�Q.ESS ALL OF 7HI:REQUIRED INFORMATION 13 PROVIDFD.Jtdix to the INFaRMATt�Pl BU'LLETIN tor inrnucliams. � APPLICA�l1'II�'�OItMATION Name t I be Billed �SS�� a f�LUr c�c�b Car�tact Pcrsaq��C�� Billing Address��5 wKc.w�-oc1 �'�r Hc me phone _��ir_�S�-�dl fe City/State/2IP�s�s.:�l�_�vc" �•ln�� 8u:•inees P4one____j3 G•�+i 3&•a.�;a , Nar.x I PamiUATC if Di�'erv+�ttun Abo�e �"�P�_e�-h �y_Ly�� . �1(r�r-� Ma�ling Address ta �Y�2v��ec1 t : �z. City15t.Wlap � . � I . PR�PERTY INFURMA7'ION NaTE: %1�ucvey plat ar sits pIau r.v�sl aceompaa7 ffiis apQtiudoa �{Pcracit is valid for 60��j� thriteplan,no ezpintiw an comfaar Plat . sao�t nea,Ts: l�,��OQ(l �/'• c��e.'r�rav� �"*l 3��'�c� Su6divisian Name Sec-oa2otil Lot Size a,\S -e � Dimaan<�r •r.. r .!,� � � � � �� ? �Yte -D hl � Ct� L 0 DateHauselFaciityCornetsFltgged - —U �� K} . Kenn� tf the aNwer oo any of the boUo�+iag questians iz'Ya'.supportiag doeua�eniatio�ut be atsacbed. Arr these acty watiag wutcw�R[systans oo tbe site? OYes aN9 1Dves tLe site conhiaTeadictiaml wethDds? DYca�ji� . �thcre aey easeu�e�ta or rigl�t-af-vrays an ttx zite? GY�::f� Is the eioe urDject w appnovat try smt6er pubtic aga►c� OY�s�� Will wastewahs otLer Run doastic sew be geuermal? OY<.QNo � z�xEsmEnrcE FII.i.ou�r�r Box s�t.ow t�People tf Bedzr.ems�,� �Bathrooros� �"� G:rden'CublWhirlpoal Yes fJNo Basemei►� es UNo BasexxntPl�mobing: �u flNo ff NOIV-RESIDETCE E�,L OtT THE BOX BELOW Type of facility/Busiusa Total SQuarc Foo'sige of Buildiag !1 Pcople � #5inka I #Commod�s -.�Showos #.Uiiasls � EsGmated Wata Ussac(galtons pci day) (Attach dac.urKaqaor�of similar facility wata wasucnption) � FC30DSERVICEOM.Y: #Sri1s �. Type sysmm eeqvesteC: OCoL.ention�! C'•Accepted Ulvnovative UAtt<�rnative COCl�ei • _ Warer Scl Q1yTy�r:r?Canntyl�City Ra►a a Newi�Vd! pF�a.is�ng Well 0 Co�euaitY Well Do you I'apaec add�aoas or up:nroat of<he tac�I:ry a�sysiaa is inaajed to s«veY U Ya B'Ko If yes,w�t type? I 7hhis u to cccoi[y Unt the iniomntiaa�.swidad on this tpylication is ttve an 9 coaea to the best of aq lawwledge: I undcistand tbat uy perm�t(s)or ATC{s)issued heraafcez ue subjeet�o susprnsion os ievae:eioa i[die siu is albeced,ihe intmded nse efange�,or if thc inCanoaaoo wbmitted in thic apptintiao is&Isifud a cha�god f uad�:ruaAd tbo!Jan mpoa.rFbleJ6ra11 c6arge�acumeC fiwn 8ru�oppticaiios:7 kr�grant:ig}st cFe�y Du the qulborit�dReprcsmtative o�the Aavie County l�calth bepac4[x+tt ta coaduct necesssry iaspatians ro dexemine carnplianee w�irh ay_plia6le la.+s aad m1a un the abuve descn�btd p�operty Joeated in DsvieCotnryandownedbY_L�i'i1Y1L-T+'1 ��1��-ti"'1 � � � �` � siie[tevisit Qurge Property b.mer s«owau's leaal eqrcesentatire si6na�uce Dam(sX 3-5r ('�� Cliorn NotifiQtion Datr. Date ` - ��--- I � Signgivco OYd�No Aecounttl Revised i 6 lavoiee# `�r�,�_iy/i--- /�-��/� i l'd �Z0�60 90 LO JeW t: � ' 25' ACCE5S EASEM�idT! � , TO SERVh::E REFAAINI�JG`� KEI�INETH M. SPILLMf;N J � � PROPER7Y. � y Cb � �� ' � � Cn N� ' � `(�" iRON \� �F n, NI W �9` E � _.__ -;-�. iFor� t� �8 � ��. �, s��=__,_.._......--------�-"'.,.�..� � � 1 � ,�,,,.o....,-...,-.r-----.'._..._._. I i ""' --�.� . � S �Qo �'fq,� 3 •g � 99.08 � _P/'� ``� 2T.• E /.'ti° d -�� 5� �A9' W NEtiY h� 89'13'03 � �� 1"''•�C O 1 c 78�� IRON <�� '� NCVJ �_ �^ � ��''`�--{� �""`� � IRON � � v� � i'_��ti ,' � ;v� EXI�TING 12' \ , �� W � ,_ n� �,., GRAVEL DRIVE � O � J;�,� f'G1/'b/ � /' . �� `\` .� . . . (4�..7 S/ . �� . . . /I . . � �l:j � � � � �' !J J � � ; NF,y �� s ��,;�:�� ! � � .t� � `� � � . � �V'i c.. � . . , � A i• __ ___ _ - � r�. e r} _�/' 7 � , �, S 1...,�. — �G �`�f, � � � . �;' ' — --- �-� — — � � - �'� 1 � �� _�1r,'ft�1'�.t�'�'.� 1'�. S`��.�.�1�� .��..�. �Jr�g �.trr. �e��G � , `� � � � \ � � 6� � -c a <' ;��,.4"��` ^ v i ^ ��c� , r` +V� f , � , {�i� � f�, �� ' � t ,� �`'�.,. '• 1" EXISIING v, ~�``r., t I ROPJ 'V 1 1~ • � a` �I�� /� �� 'l•� 1�Q.5 6 2a, W C�.1 ' ��'a� $ �� .` d . �`ti,,_ Ut ^� � , , _h��` � v ! � NryY � �. � � :r :�:�� n � � :� :�:o �J . <` � n .,�- �.; � � - �.,, ,�,�-;�� ;��- _ �., � _ a -. � ,4. ' �,- a,,. .. �. , _ _ _ _ _ � � , _ ' � � � ' `` DAVIE COUNTY HEALTH DEPARTMENT . � '' � . � Environmental Health Section � Soil/Site Evaluation � APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003898 Tax PIN/EH#: 5737-82-7027 Billed To: Jessi Andrade Subdivision Info: Reference Name: Jessi Location/Address: Lakewood Road-270 8 Proposed Facility: Residence Property Size: 2.157 acres Date Evaluated: � �o Water Supply: On-Site Well � Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 �2 3 4 5 6 7 Landsca e sition � � . Slo e % HORIZON I DEPTH ��, ,, _ . Texture rou CL �G Consistence � (�� Structure ' j' Mineralo /.� �.! HORIZON II DEPTH i� �� Texture rou C' � Consistence : . �F� � Structure �� Mineralo �;• ' - HORIZON III DEPTH � �/�ti Texture rou (� � �2 Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence � Structure . Mineralo SOIL WETNESS ' RESTRICTIVE HORIZON SAPROLITE - ' CLASSIFICATION LONG-TERM ACCEPTANCE RATE r - -' - SITE CLASSIFICATION: � EVALUATION BY: �! LONG-TERM ACCEPTANCE RATE: e ' OTHER(S)PRESENT: REMARKS: • LEGEND : ' T, n c ne Position . _ R-Ridge S -Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Tenace FP-Flood plain H-Head slope Ts�turg _ 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 DZQ1Si , VFR-Very friable FR-Friable FI-Firm VFT-Very firm EFT-Extremely firm 3�t _ • � NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly_plastic P-Plastic VP-Very plastic StT.tiCt�iiC� ' SC-Single grain , M-Massive CR-Crumb GR-Granular ABK-Angular blocky - ' SBK-Subangulaz blocky PL-Platy PR-Prismatic Mineralogv 1:1,2:1,Mixed _ lY.otr� - Horizon depth-In inches � Depth of fill-In inches Restrictive horizon-Thiclrness 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 . , Classi�cation-S(suitable),PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate-gaUday/ft2 __ DCHD OS/OS(Revised) il