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175 Leatherwood Trail• DAVIE COUNTY HEALTH DEPARTMENT Pp 4-21- 01 Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT, / l%5 o�(�iefwoc ' 1r Account M 990000761 Billed To: Swicegood -Wall Realtors Reference Na eral atricia Martin Proposed Facility: Resi ence Tax PIN/EH #: 5769-56-8655 Subdivision Info: Location/Address: Ha Lane -2— aProperty Size: • _13x89- **NOTE**'I1iis Nprov7ement/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 #People Q #Bedrooms -- #Baths SL Dishwasher: R!r Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 1,14d Type Water Supply viVI Design Wastewater Flow (GPD) �?43 Site: New e Repair ❑ System Specifications: Tank Size /DOD GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width <-?h"* j a Rock Depth Q" Linear Ft°S/01 IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISERS) 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.**** 091111--,9141w- (119 t h c, A� Environmental Health Specialist's Signature: s ) Date: . %// d%`� DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street MocksviHe, NC 27028 (336)751-8760 Account #: 990000761 Billed To: Swicegood -Wall Realtors Reference Name: era atricia Martin Proposed Facility: Residence ATC Number: 2781 Pdga7Cq Tax PIN/EH #: 5769-56-8655 Subdivision Info: Location/Address: Harrow Lane -27006 Property Size: 13.489 acres 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 WASTEWA C NSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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 t�%system will function satisfactorily for any given period of time. a c fir) P Septic System Installed By: Alwxz Environmental Health Specialist's Signature: Date: �• ��1 DCHD 05/99 (Revised) I a CATION FOR SITE EVAWATION/IMPROVEPAENT PERMIT & ATC Davie County Health Deparbnent a4' /C/ /' 70 Envlimmental Healtfi Suction P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 nnnont�t:�fSt1Al HERI7ii . *** I*'TAis APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED I INFORMATION IS PROVIDED. Refer Re'(f�er to the INFORMATION BULLETIN for inssttr�uccti/o�ns,..I 1 1. to be Billed SWM eal rs j � 'G ( U 6M66 Naar Y 1 r l t'l Contact Person 1 Yo dl�u "Rd Hailing Address . Homo Phone City/state/SIP �85L' 'I()CI"ISV! l Q Business Phone 17 6 -�j 2. Nage on Permit/ATC if Different than Above + Ph4li, Mad C in X12 -✓1q-1) -!2q Sh4 i e.W Farm TP, Lj C R &3 Hailing Address City/state/zip =ch w_ . 1 � T- 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC Both 4. system to service: Q'House ❑ Mobile Home 0 Business ❑ Industry 0 Other s. If Residence: i People CC.) 1# Bedrooms _3 # Bathrooms O Dishwasher 0 Garbage Disposal dwashing Machine 0 Basement/Plumbing D Bas—t/No Plumbing 6. If Business/Industry/other: specify type # People i sinks / Commodes . # showers #; Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City B"Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 0 No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: C -Ad 5h \ 13-4MAO- IO• WRITE DIRECTIONS (from MockrAlle) to_PROPERTY: Tax Office PIN: # d!�65S 61r', r t Property Address: Road Name rrm) T _re, 6n L ( befo'e 4ov City/Zip I�tUUQl?l'0 tV o�7 � 40 QCY055 II�Ar� T►Ti� dirt c1live, If In a Subdivision provide Information, as follows: Qa aDW 300t-+- 4wn lek Otopeyj- q oil Nape: 1t:7"T dowel Uhyy 611. ).eR (sem- 131 Sectio Block: Lot: Date Property Flagged. 06 QI 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 D2vtcl 7)1Xol to conduct all testing procedures as necessary to determine the site suitability. &J R, DATE A4 01 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the 1 ng: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). .00, i oLi x. Revised DCHD (07/99) Site Revisit Charge Date(s): I Client Notification Date: I EHS• Account No. Invoice No. i z It t DUKE POWER CO. ,km tmw at s w D.B. 99 Pg. 405 f ' aomar` `S 99.2'5.39• E - on + / rv�_ I S 89.23'39' 1362.08: SAMUEL Q. CHAPUN moo ver imn scr �. D.B. 121 Pg. 387 x 13.489 ACRES 8 ~ T • • / !/. \\ _ 9. �a7ii AClLOS l '�' S +S .? y1 ;� n� ben en -- ac ,z:,x .Oon. @ oc (INCWO[S OUKE POMIER R/MI) \ / ww" Erre / __ .. ... _ _ _ x('13 00 16 TQTAL oar leer • ,.dc near iwd '. t ebnq� 4 �•, x s 97.39'43' Inoo •'� •• ••,• t� '. N 1 11' E os•zrts• [ � Y 1e• v.. 196.334r� 8r30'oo• .4 p '� 63 toa9� 38' A y�� +4' • ► • : Y sell iron far+d �' ::: nar rror. ,/ 62.19 Non forrW • ' + -..�«' �•• N 1708'11' E - _ 4Y w S 30' 02' Y •• +'w t�� +� 1< 124.28 _�—jam �7 p91s1 32 ?`,� 11'+, mbar /ark ' �• Mfr �'An � y S. 4751'10' V • 1 \\ " ac '_ 89.79. 44 ••,. \ tr �• S .11'37 Y,.•'.• .... �i7• \ \ iron an ' •. Q" . ow% 153.01 ••:� •• jr 6•• , \"aw` it Y ; �� %..% *• •Qr► , $ 0953 4 A.* ' �• . ' R .... ......... K~ •• ....... Lit .. .'• + .•.�.••••'' renes s� ,.• ` ;:�c JAMES E. NANCE .. `... . \..... (doee ) D.B. 137 Pg 244 0 (see also-D.B. 81 P m \ \ a g. 189 AMES E. NANCE wtFnCENTER �F \ - �Si.BSO ACREScs D.B. 137 Pg. 2439 e0' EASEMENTS \ g.\(mmts�ow"mRM � �s�>•` �o� �r� °i. o� 1 = / m nom09 4,• 4' ` \ .c$ • \ , �N G 'tis a'j► i " . ,� , ren iar.re .1 _ ' ; �• �i? S Q .. ------ 47S72 ' :.:\"• ub:r — JAMES •—N '3x'42' t..� :1.t«.w r 2'>brrdorn+e / E. NANCE l Y _ _ ( D.B. 137 Pg.. "244 L I 2lS20O TER UNE "°"a° 1`"1y I !may i (see also b.B: 81 Pg. 189 I 1 JAMES .E. NANCE ,`1 '9. ° �s ( 19ced S'C'�o�"G v r 3 Gf�¢rtOr��t, Z D.B. 137 Pg. • 247 • .' i 1 I i �Z�-Lcs' � . DUKE. POWER. CO. 774.67 AD.B. 111 P ' 'SEE .- 2E IS 1.429 ACRES IN THE DUKE POWER. INC. ( 9. 4), WAY R/W WITHIN THE 9.650 ACRE TRACT SAMUEL Q. CHAPUN I D.B. 11.1 Pg. 1 i n. P. pro INDEXE 700 to (323A) . 2F1p 7 lgz t 1709 S.08A 9102 ._ (4.91A) 1732 719 (�3.3sN 6771 173 MA (S.tw- ;: _ 2926 g 6826 H70000003$ � - _ 719 111$ 25.63A 9009 (�3.3sN 6771 111$ 25.63A 9009 - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000761 Tax PIN/EH #: 5769-56-8655 Billed To: Swicegood -Wall Realtors Subdivision Info: Reference Name: Ellen Grubb. Location/Address: Harrow Lane -27006 Proposed Facility: Residence Property Size: 13.489 acres Date Evaluated: Water Supply: On -Site Well [/ Community Public Evaluation By: Auger Boring ' j-"/ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % .16 HORIZON I DEPTH a O p Texture group Consistence Structure Mineralogy HORIZON II DEPTH 3 Texture group Consistence i Structure L / Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE . CLASSIFICATION S LONG-TERM ACCEPTANCE RATE Ll SITE CLASSIFICATION: EVALUATION 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 - 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)