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240 Leanne Ln F �, , � ' , • ;. , DAVIE COUNTY HEALTH DEPARTMENf ��� Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990003757 Tax PIN/EH#: 5822-93-5861 " Billed To: Donald Noel Subdivision Info: �� Reference Name: Location/Address: Leanne Lane-27028 Proposed Facility Residence Property Size: 29.664 acres ATC Number: 4256 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his Authorization for Wastewater System Construction MUST BE ISSLJED 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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: � Date: �� �s���� '� � � � rwo� CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis Certificate ofCompletion shall indicate the system described on ImprovemenUOperation Permit has been installed in compliance wit ter OA,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken as a guarante �t the system will function satisfactorily for any given period of time. �' ,�D� �'� �:�✓n��r ,o � �� Septic System Installed By: (/�� �(��� Environmental Health Specialist's Signature: (/V Date: �-�Z'�� DC�ID OS/99(Revised) , r � '. DAVIE COUNTY HEALTH DEPARTMENT �,/� , �' � Environmental Health Section � z � S �� �-` `: . , P.O.Boa 848/210 Hospital Street ' ' Mocksville,NC 27028 (336)751-87G0 IMPROVEMENT/OPERATION PERMIT Account #: 990003757 Tax PIN/EH#: 5822-93-5861 Billed To: Donald Noel Subdivision Info: Reference Name: Location/Address: Leanne Lane-27028 Proposed Facility Residence Property Size: 29.664 acres ATC Number: 4256 **NOTE**This ImprovemenUO�ration Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHOId,�ZATION 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 l l of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). TffiS PERMIT LS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE YOUR WASTEWATER SYSFEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE INSTALLING SYSTENL / Residential Specification: Building Type #People_� #Bedrooms�� #Baths���_ Dishwasher. Garbage Disposal;❑ Washing Machine� Basement w/Plumbing:❑ Basement/No Plumbing� � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste:❑ Lot Size Type Water Supply li�/e// Design Wastewater Flow(GPD) �/$!� Site: New� Repair❑ „ ,, J System Specifications: Tank Siz�� GAL. Pump Tank GAL. Trench Widtt�_ Rock Depth� Linear Ft:� Other: Require�Site Modifications/Conditions: INIPROVEMENT/OPERATiON PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF'6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Depariment for final inspection ofthis system between 8:30 am.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.**** I 1� I � , �... / Environmental Health Specialist's Signature: /r Date: �S '� DCHD OS/99(Revised) (� � � l�� �c--c�-s�� ` �G . ,FC�' V��C,. /k�K�S �a�~� G' a � _ a�7 a ag �3at� L i,v�.� ,�r�' or �F«;��raR ST��'�'..� ��r�na�'�2.� � �1�� ,�t2� �3" �C�t: h�D r�✓� �o �o� i�-voXES � ��AinaC�Zs• L_���� . # 5���R3 �x ����� r��s aa. ��� � /o�' '' � 90°EL ��a« � L.R. �F/�o �a`f" �a �R „ _ : D-ao�c 75''�" -ro L��. ,. 53'i," =a �R• ' ` ,a-aax ��� ,� �,�. ���K� " , .. „ �s � R��� ��a„ � -ra L�r�. car�N� �o �. �o,�,v�r2 ,, , �. ; �„w 3a � s- � ra�a �°� � ` � �s7',�� �� _ �r5•—� � �3Y Jo� : � �. � �5��� 1a -a ��� �30` : �3 Y.�k ��� �� � • - /� ��L� �,��/�E Loc.�WfY ' _ - �` �o , �� •' �'or � � " . . ,, , O'�.�a -s � s- � � , �� A . ; , , � � � � � � , 1 �� �Qi�' AI 1 L(C�l'(!UN FOR S17C CVi1LUATlON/Ihi1'liOVCAiFM I'I:Rd11L •, � : ; Davie County Health Department ° � • :► EnvironmentalNeatfh section $EP � 2 � P.O. Box Q4Q/210 Ho�piL•al Straat Mocksvil],e, NC 2702a � i` (336)7�51-8760 G'�ECOU�fi��� ***Sl'IPORTANT*** TIiI5 APPLICriTION CANNOT BE PROCESSED UNL�SS ALL THE RLQUITi�D INFORZ•I1ITION IS PROVIDLD. Refer to the INFOR2dATI0N I3ULLETIN for inutructiona. l. Namo Cu bc Dilled I Contact I�cruon " l ldailing Addra�u L�II�3 OL.1� f�.U� ��I E lsomo Pliono ��c,P ���,f—�Cpls�� Cily/StaLo/ZIP ��iV�/ �/�,/.� . /U C. . IIunino�a I�hono J3cP"'�lo�"�t�(O� 2. Namc on PermiC/ATC SE Diiforont t21an Abovo 23ailing Addraaa City/Stato/Zi� � ' �. 7lpplication For: �SiLc �valuation Improv mcnt PermiL/11TC ❑ Doth a. syacem eo servica: Gd Iioune ❑ 2dobile Homc � I3u�ine3� ❑ InduuL-ry ❑ OLher 5. Typo u}•aL•om requnated: 6d ConvenBional ❑ convnntional modificd ❑ innovaCivo paCCepted �7( G. If .Reaidenco: It People �._ tt Eiedrooms � � i1 Da1:2irooma �C o� UDi�hwaahor ❑Carba�o Diaposal l�dWaa2iing 24achinn ❑Ba�emenb/Plun�ing �Uaaement/tto P1wnUing 7. IL• DuninoDa/Induul•ry /Othur: verity typa If Pcopla IF Sinku � Commodoa !1 Showora �F Urinala !f 1•7aCor Coolara II' r00D��ItVIC�: ►E SeaLa � EnL•ima�cd WaLer Uuage (qallon� per day) 0. Typo of wator auppiy: ❑ Counly/C�.�y [�d' i�lell ❑ Cotntnuniry 9. no you anticipatn additiona or cxpat�sions of tlic tacili(y tLis s}�slcu�is intcucicd to scr��c? ��'cs [�No If�•cs,tivliat typc? -- ���;x.� U /�/'1 L '�� � ***li1f1'OltTilN7'"**CLIEN7'S�ifUST COAI!'LETt TIIL RGQUIRED PROPCIi7'Y INl�URi�•1ATlON ItLQULS�rLu i31iL01�'. Iiitl�cr a PI,AT or SI'i'C PLAIY hIU.STl1F.SUltdfl7'T1iA by tlu clicnt �vith TlIIS AI'PLICA'I'10N. I'roperl}'lliuict�sions: �, [��Q� f�/;�� 1YKIT�DIRGCfI01�'S(fruin 11•Iocl:svi(Ic)to P1tOP1:(i'f'1':' • 'rax ocrcc I'tN: �����-��'� $�� 1_l�f'_( C��� N� /� I'roperty Addc•css: Road Namc c'�f��i(/��� ��f�7� � ��.(�S(f�t'.l�E���� Cily/'Lip_ �Y'f(C1//11E _�1��. �)'�')/LE 7(� �FT O�tl711 If iti a Sttbdi��isioii pro��idc iiiforrnation,as follotivs: ���,{�� �/l/� L�/cS7� ���� Nati�c: O� /`r/�'f�T, Scclioii: I3locic: Lots llatc I�omc cor»cts ll;��gcd: c�a 't'liis is to ccc•til'y tliat tl�c ii�foi•�natioi�provicJcd is corrcct to il�c besi of ii�}�I:notivledgc. T uiidci•staud tt�:it at�y j�cr�iiii(s) issucd I�crca!(cr are subjcct to suspcnsioti oi•rcvocation,if tl�c sitc plans or intcnJcd usc cl�:u�gc,ur if tl�c iiiforivalioi� subniitfcd iu fl�is applic�tiou is falsificd or cl�an�cd. I,also, rutrlcrs�ulrrl t/1at 1 rrur resporrsiLlc�fnr n!!clurrgcs i�rcrrrrrd fi•uur 11ris npplica�io�r. I,I�crcbp,giti�c conscnc to tl�c Autl�orizcJ Rcprescut:ititi�c of thc Da Cocuity�IIcal li llcpartmcnt to cnicr upon abovc dcscribcd property�localcd in D:�vic Couuty:111 lY»cd y_�J✓�{-�� �1� to conduc( all tcstitig proccdut•cs as iicccss:ii•y lo dctct'11liJll`tI1C Sl 5Ui�AliIIlI �. D,l't'� � SIGNA.l.0 ; �: ' TIIIS AR�A 11�A1'B�US�D rOR llI�11VING YOUR SITL PLAN(Includc all of tDc follotiti�il�g: Lxistinb�nd proposcQ property tiucs ai�d diinensious, structures, setbacics, anJ septic locatians). � GC/ ' Si(c ltcvisit Cliar�;c � ��� Datc(s): . Clicnt NotiGcatiou Datc: � (9'`-' � � LI�IS: �S �r� 'Q'�� �� . . Sign Givcn • ,�lccount No. d' �� � ltc��iscd llCIIll( 5/03 _ - * ,� Li��oicc Na. �� �� . � �� o��-. _' ,� _ ,��..�-_ �,,�,�.r_ ^� \�� � � � — � � � � _ � � � q� _ � � \ � , � � / � � — \ � � �, � � m \ i � `�,r� � � � � �"� � a � � ' ' :;`/ �$ � � - � � �, � � : . . ,� � �. ��� � _ _ � ` \ �� � �� , �� � ��: � ��b�' �� � � 9 � (16.6A).` � �'� � 5816 � 9 ,y 9.664A ' 5861 t m � � w ;�9 \ � ; � � , 16.098A �3�2�� 7355 . �A9� �� ' ..r�`S �� ' �s.�aza � � "�� 7924 � u . � 1Y' w�.� l� � � . �. . . � . . •• � ' DAVIE COUNTY HEALTH DEPARTMENT . , � '•'y ' Environmental Health Section � Soil/Site Evaluation � APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003757 Tax PIN/EH#: 5822-93-5861 Billed To: Donald Noel Subdivision Info: Reference Name: Location/Address: Leanne Lane-2702 �t Proposed Facility: Residence Property Size: 29.664 acres Date Evaluated: J" � J Water Supply: On-Site Well f Community Public Evaluation By: Auger Boring_(� Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e sition ` Slo % HORIZON I DEPTH � </ � Texture rou - . Consistence �/ l` Structure ' Mineralo - � - HORIZON II DEPTH � « Texture rou �. Consistence Structure " / C Mineralo � � HORIZON III DEPTH Texture rou - Consistence Structure � Mineralo HORIZON IV DEPTH Texture rou � Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON . SAPROLITE . ,. CLASSIFICATION LONG-TERM ACCEPTANCE RATE P � SITE CLASSIFICATION: EVALUATION BY: ����'i(1/ . . LONG-TERM ACCEPTANCE RATE: ��� . OTH�R(S)PRESENT: REMARKS• L� � / s�" ��7u�-S LEGEND - Landscane 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 . � � . 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 ' CONSI�TENCE MQ1S� VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-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 �.tr13Gt13T� ` SC-Single grain M-Massive CR-Crumb GR-Granulaz .� ABK-Angulaz blocky SBK=Subangular blocky PL-Platy PR-Prismatic - � ` Mineraloe.-.�' ' , 1:1,2:1,Mixed lYQt€� 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-gaUday/ft2 I, DCHD OS/OS(Revised) J � � ' . '`. • � � , . � 2 � � �/ � � • _ Q C n � � � 0 = � � � J J � . . � �.�TN�R � Q . . � . . � �4 . . � � � � . �. . . . . . . ^� . . . . � 6fo . . � /. . � . . . . � � . /� . - . . �` � . W � . . . �//. . . � .. .. � . . . . . � . . . . �.: � . . � . � . � � � � � � � . � . .. . C � � . � � . U � G .� �� z �Q � �' _ :G� . �;�� � cl� S� �� � rW, ; � •� .!4 ' V a � g� 2 � W $". � �� � � Z � � � Q J . . . 'w . � \ . . . � . � `6p� � �' Q W W S�" � ' (� �� Q � � w � � cn 0° . � . � � � � � � �N � � .. f, rei � . . � '. . .. . . . � v � .. . . � �.. . . � � � . W � � .....� � � •� � � .�, I � _.� ,_,_.._ _ .__.._._.. , . s..� W N� L.�L -- �\ � . � ' . . � � '. ' . � � M � � . N s N O . . . - . . . H . � :9L• .. . . . . . . . . . . . W . . . .. J r,.,, � . � � �`° � �� _ ' �-s a, r--'-- �� . . .. . . NY-lVon piasu� .,. ....b.._� r--. � tructure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangulaz 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-gaUday/ft2 DCHD(01-90) � • . ✓ , ' . . . � `r • � � � ��� i a �r�� ��;*Y'��`� ` ` � �* � e ."�r" � . .z�l' �^s�z�,m.z-�""�"�"`�< ��7 �e � �,�i+'�� � w � �� � ` ' ,:;�.: �'���I�r'C�UI�'Tl��I�I�T�����'i��TRRfii�NT���� i� ;��� x �`��� �� Environmental Health Section P. O. Box 848/210 Hospitai Street Courier 09-40-06 Mocksville, NC 27028 . .�T.�.^^�.�.-g^.�...�..e�e�.s.......�•.,•w �«wK,*}�-k,.� +-�».+�a.,.a,..�s+n�ym'�r"'•"r'S w*^'- , �!- �� �;����x�a�, ,; , � ��� �(336)751 8760 ��� >, xs „ � � , ������.��������� � . -° lro ���. a rr.'� $��g � f g 4 r�*° ' d { k�*rk�$`�,� s .r � : t�a� '� �. �s.F r m � � �� fi . � % £ .M ! '.� » . � f t {�` h ^,� X,wL . � � �.F y . ` � L � 1 ! ��� �' �.v� ��v�h^ ,r � ; t�.�i � ,* �� - �u.��1,.�w`2Jh�w.3.t�&:miR;t.......�. ..ai r....�:.:..��..,x......u�.ax.a3�.,��.�.:,:"�.....a::�.y,z:�:RY`:t.�«c:.f�i�;::.:.,•s,�.:La....::..,.,...�.....h.4�....�w..6.,_w..`w�+ '' �i 5��5mwS.e"G' $� September 28,2005 . J Donald Noel 3113 Old Highway 421 E. Yadkinville,NC 27055 Re: Site Evaluation/ Leanne Lane Tax Office PIN: #5822-93-5861 � Dear Client(s): - , As requested, a representative from our office visited the aforementioned site on September 28,2005. Based on the information provided on the Application for Site Evaluation and after an evaluation was completed on the site,it was found to be provisionally suitable for the installation of an on-site sewage system. Before and Improvement/Authorization to Construct can be issued the appropriate . application must be filled out and the house/mobile home location staked off. If you have any questions,please feel free to contact this office. Sincerely, . ��'�`����• Robert B.Hall,Jr.,R.S. Environmental Health Specialist RBH/dlf