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123 Manchester Ln' � .- - �,� j l .fid ; Zl� /Ui�Ip%l /err• .. `�lor �/(/G�/�'Gp zZlld t� n I Permittee's `� •, �1 f DAVIE COUNTY HEALTH DEPARTMENT �"D( "Name `'� �: �'�rZ— Environmental Health Section PROPERTY INFORMATIOW2-&/07 f�.t P.O. Box 848 Directions to ro erty U M ]c 'll 27028 Subdivision Nam P P oc svr e, NC e• Phone #: 336-751-8760 Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - - AUTHORIZATION NO: 402709 A Road Name: I•,7 A=l�t`p:�;-7. c;'' .y **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This FornVAuthorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. . f la.complianceyvt .Article 11 of G.S. Chapte 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) jl f1 ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION 0 IS VALID FOR APERIOD OF FIVE YEARS. ENVIRO A HEAL SPE ELI S DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS 3 # BATHS # OCCUPANTS _ GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE' �� ^��' `�'P]'PE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH a,' ROCK DEPTH 4 LINEAR FT. REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT i to S � -r(� - I I V4 0-- v _ ST41) ii I ZS / 1 't l=,[ 1St ►�J & FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT7 r��) �n , i1 SYSTEM INSTALLED BY: -1 ti'1 L_% b A U t a Ott) "/, .&v ( ai,, . ALL s4wAI �, 6 �E' 3gz> w u NhS AUTHORIZATION NO. 2�DU OPERATION PERMIT B : DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBE ABOV S 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. DeNn 02102 (Revised) fi ee1- 0 O oto Z _,&j10 %L' 5-7 IT ! Permittee's .. J - 1 F DAVIE COUNTY HEALTH DEPARTMENT f Q� 'fA i0r/jti:,aL Environmental Health Section '�, PROPERTY INFORMATION P.O. Box 848&/d7 Directions to property: f-} l� (`t'�'�'cksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 Section: Lot: AUTHORIZATION FOR «,)�-t;:a� d,,•�� WASTEWATER Tax Office PIN:# _ Y SYSTEM CONSTRUCTION - - AUfHORI7.ATION NO: 002709 A Road Name: Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter„ 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) "�" ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ,�j ; •.-- , .'� , ;1(,r IS VALID FOR A PERIOD OF FIVE YEARS. '�_ENVIRO &N•tiAlilEALfr1 SPECiALIS DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE 110t1 `i- # BEDROOMS 5 # BATHS -# OCCUPANTS _-� GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No a n 1 ✓� LOT SIZE ' �� -"TYPE WATER SUPPLY `�� DESIGN WASTEWATER FLOW (GPD) ---K..G(2 NEW SITE REPAIR SITE SYSTEM SPEC�FICATIONS'i TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTHS ROCK DEPTH #A_ LINEAR FT. OTHER /-� I"^t' Tlr 1 L-�.-' f<j_ tk!-T 1 O -j "`� clTY.I�.i. A L71 'itt Lyt.� • 1InL �/t. REQUIRED SITE MODIFICATIONS/CONDITIONS: K ?E t�. r.I'E � J cJ`� . ' �+� l C��c?fad,. IMPROVEMENT PERMIT LAYOUT tA KJ �, �e-i► r ! a 1l ` a f E 4c' 1 'Si Ini 6 Is 11 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. 1 OPERATION PERMIT t H 17 SYSTEM INSTALLED BY: ��I ALU i2 h /4 C / S C�1I4��(t ALL AUTHORIZATION NO. 2e2EO94 OPERATION PERMIT B DATE: bb X "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SY M DESCRIBE ABOVE6S 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 07/02 (Revised) �_) eOl ly 0,/4 Z k ae 7 4- DAVIE COUNTY ENVIRONMENTAL HEALTH SECTIONS o APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME do 10 I 'i✓ 62 /11 P ONE NUMBER Picy 13 ADDRESS . �NU�2 U DIVISION NAME 1\-kaa'rAW'j61 LOT # DIRECTIONS TO SITE r �f /) Q(eyGZ'%(J� (� A) o>J7 �s Gll'C�� DATE SYSTEM IN LLED `�y NAME SYSTEM INSTALLED UNDER—O" TYPE FACILITY S NUMBER BEDROOMS V NUMBER PEOPLE SERVED TYPE -WATER SUPPLY QAV SPECIFY PROBLEM OCCURRING><%�� C. ��IS��I'Y► &d& f, la & & d6ei!—Is - 4 DATE REQUESTED INFORMATION TAKEN This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1193 i.01A A . ' >..� . DAVIE COUNTY HEALTH DEPARTMENT ^ ' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *Note: |aomyd in Compliance with G.G. of North Carolina Chapter 130—Article 13o. Permit Number Name kk.i--___-Oat» Location Subdivision Name Lot No. Sec. or Block No. Lo[ Size House Mobile Home __----_-_ Business -_-_--__ Speculation __---__-- No. Bedrooms No. Baths _--_L-___No. inFamily ---��_-_ ' Garbage Disposal YES NO [D- Specifications for System: 6L; Aub} Dish Washer YES E] m[) ,0 Auto Wash yWobhinn YES [J --~NO F-1 Typ6 VVater Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. °Contacta representative of the Davie Health Department for final inspection of this system between 8:30- 9S0 A.M. or 1:00-1:30 P.M. on day Of completion. Telephone Number: 704'834'5D85. Certificate ofCompletion` Date ` 'The signing of this certificate uhu| indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period oftime. Final Installation Diagram: Installed by --- / . ` Certificate ofCompletion` Date ` 'The signing of this certificate uhu| indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period oftime. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION &�j t6&�ga_ Water Supply: On -Site Well /Community Evaluation By: Auger Boring Pit PROPERTY INFORMATION Public Cut 1117-910 L FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % 4, HORIZON I DEPTH p - Texture group Consistence Structure Mineralogy HORIZON II DEPTH - ars Texture group 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 LONG-TERM ACCEPTANCE RATE v SITE CLASSIFICATION: '� EVALUATION BY: CI�iJ-1�� t LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: 1 f 7`5Li 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 Moist VFR -Very friable FR - Friable ' FI - Firm VFI - Very firm EFI - Extremely firm 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) LIAR - Long-term acceptance rate - gavday/ft2 DCHD 05105 (Revised) ■■tee■tMMM■ttM■■MMtMMMt/ttM■ett■■■t/Mtet■MttMMttMMM■tMMeM■Mt■MM■ ■■t■M■■■■■■tt■■t■tte■■t■■t■■■■t■■t■ttte■sttttt■Mt■■M■■t■M■■■■t■tt■ ■■■■■M■ME/■■■■■■M■M■■■M■■■■■■■■t■■■■■■■■■Me■Ott■■■tMM■■■■■■■■■■■■■ IEE■EM■■MMM■■M■■■M■■■M■■■■■■■■■■M■■■■■■■■■■■■■■■■■■■■■■■■■■■s■■■s■■ !■■MEMEMM■MM■■■■■■■■■■MMM■■■■■■■■■■■■■■■■e■■tM■M■■■■■tM■e■■M■■/■■ ■■■■■■■■■■e■M■■■■■■■MM■■■■■■■■■MMM■■■■■■■■■■■■M■■tMMMM■■■■■■MOs■■■ ■■■■M■■■MMM■■■■■■■■M■MM/■■■■■M■t■■■a..e■■�■e■t■■■■■■■■t■■/■■■■■■■■■ M■■■M■■t■■MMM■M■MM■MM■■M■t■■■■_se■■■■■■■■■e■■�■■■■■■■■■■■e■■M■■e■■■ ■■■■■■tt■e■■■■■■■■t■■■■ttttG/ttttttttttttL' f�..Cl�;�;,1%�!f 7t'■tI1■ttttt■■tt■ ■■■■■■■■■■MOMO■■■■E■E/■■■I.I■■■■■ME■■MMM■■■■r■■ft■Yili�■�;•i`�■■■■■■■■■■■ ■■■■t■■■t■■t■■■■■■■■tt■ti■■■■t■■■t■a■_■.a::e■■t■■■■■t■■■■et■■t■■■t■ ■ ■ t ■MMM t t tt tt ■ MM ■ ■ ■ t t t ■ �tt ■ t ■_■�� r - 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