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237 Crosswind Dr ayr•w'.bz, ..,y;;r- r :�tzi,_„I ra _ ''14 .N... a ;sr.';;+. _ ai�erti "•; rl ly :; t S � � -, ,,jXO . - DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT PERMIT **NOTE** This improvement perait,.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 It of G.S. Chapter 13OA, Wastewater Systems, Section .1980 Sewage Treatment and Disposal Systems) NAME PROPERTY ADDRESS .Qom- �.�a DATE LOCATION /�//fl/Y�i,'JfJ � 1 (i/�•SW, fi & SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE t BEDROOMS _�/ # BATHS -5' t OCCUPANTS -5/ GARBAGE DISPOSAL-.(q/No COMMERCIAL SPECIFICATION:"FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE ' TYPE WATER SUPPLY �40 DESIGN WASTEWATER FLOW (GPD) NEW SITE !/ REPAIR SITE SYSTEM SPECIFICATIONS: TAM( SIZE GAL. PUMP TAM( GAL. 'TRENCH WIDTH ROCK DEPTH /�9 LINEAR FT. . DO OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. IMPROVEMENT PERMIT BV `/G� 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:N-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS 1704) 634-8760. OPERATION PERMIT4 SYSTEM INSTALLED BY L� /D0 �r AUTHORIZATION N0. 3-2 2 OPERATION PERMIT BYDATE **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 13OA, 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 10/95 Davie County Health'Depariteent ENVIRONMENTAL HEALTH SECTION P.0. Box 665 . . r_ Mocksville, N.C. 27028 r AUTHORIZATION FOR WASTEWATER SYSTEM'W S RUCTION R (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) ***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/Authorizati N er ould be prps Vntdb&e Davie County Building Inspections Office when applying for Building Permits.*** ��SSiy/A� ' AUTHORIZATION NU9'BER NRME AlwA/') (�6�/I DATE .S^/.�//� � 0377 NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION IZ5716/JInD>ti/� " p9121 e S ct-e e_k Ra-- COMMENTS/CONDITIONS COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM **WICE*** THIS AUTHORIZATIONFDR S ITER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. rZ12 ENVIRMWAL WAfH SPECIALIST, DATE ,. DCHD 10/95 • :-.a ._ .>.— r PI APPLICATION FOR SITE EVALUATION/IMPROVEMENTS. P l ( U�l�® • '�� Davie County Health Department • 6D Environmental Health Section P. O. Box 665 DECG 9 1994 Mocksville, NC 27028 1. Application/Permit Requested By o 'f to 19 1p- Mailing Address CL ie1,V/-Y' ktor,tv Home Phone V L 7ao(, Business Phone -1 2. Name on Permit if Different than Above 3. Application for: So(� Va�(r General Evaluation ❑Septic Tank Installation Permit ,,, /,p� 4. System to Serve: X House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # J 1 Basement/Plumbing No. of People j ❑'Basement/No Plumbing No. of Bedrooms Washing Machine No. of Bathrooms 3 ;3'Dishwasher t Dwelling Dimensions�� I '� �Q ,Z Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: Public ❑ Private ❑ Community 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes No If yes, what type? 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: ew WVq Cd- _LL Irt4 1UIswi caea tic ,),weed CU- GRAY i"oT i S 39 — (1 l'oirr('fiN c is✓:S/TT This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. �± 41 /7-1a,,&¢y 40D�rrv�cl�- .(.CG�rtGc 1JATff SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fand ECK ONE: ❑ 1. I OWN the property. 2. 1 DO NOT OWN the property. ked Box#2,the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative of the avie County Health Department to enter upon above described cated in Davie County and owned by !� L 1 all testing procedures as necessary to determine said si e's Suitability for a ground ab orption sewage treatment al system... DATE SIG URE DCHD(1193) All, kNfl °1.88 .. �ty�� ,�1 � `I'" -+� ` �• � _ 40 ' n , 1�` 4' } ♦♦ 14� No 12 3.2 6 AC �i1 P + •' �r t, r .!► a! '. `k'� ', • err""' ,#t.,, ; xi 43 5.3 Ac . CV ` 1 r u�w• It ,yd`s' y,'n r;y„ •C.T �. •.,..t S., 12 3.52 Ac �. - 59 Ac 1 i �• i` ) w " 607.42 (5A) 39 8.71 Ac Ir 1 ] i 5 1 yp 500 N I "' 1►.:#' SLY to � �". � � •�.�. 1.Y �'� 10 A le '� . '� 8.03 5I Ac e a T •r. a Ir- Ci 1 � N�. 5.09 Ac .05It 1 (8) .. , 470. \ 10. e .l �D V 4•sc • w t----.., . 5 Ac �. 5. Ac t K 1 Y k• 14 2.63 ' _� 3.41 2.79 .Z �rw. �. �.. 1450 • w 64 � °ate .�r:. '� �•' N 1, t i• • 8, f; DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation . NAME D�`/" DATE EVALUATED ` 9 ' ADDRESS ,,c��/ PROPERTY SIZE PROPOSED FACIILTY 'Hale a LOCATION OF SITE Water Supply: On-Site Well Community Public Plz Evaluation By: Auger Boring i/ Pit Cut FACTORS 1 2 3 4 Landscape position 4 L A- Slo e Z — L HORIZON I DEPTH -t Texture group Consistence Structure Mineralogy HORIZON II DEPTH 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 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: �Q 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-Sandy loam 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-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(01-901 ■■■■.■■■/■■■...■■..■■■/.■■.■■■■■■■■■..■■t..■■■■■■.....■..■ Mii■■..■ ■/■.■■■//■■.//■■■■■■■■.■■■■■■.■■■A■NOON/....■.■■.■■.■■t.O■■.■■■.■■ ■■■■■■/.■■■■■■■■■■■■■■■.■■■■.■■■■■■■iOtO■■■.■■■.■..■..■../.■..■■■■ MOMMEM■■.■■....■■■■........■..........■■.■■.■■�...■■■�■■■■■■.■■■■■■MINN ■■ MMMMMMMMMMMMMMI ■■■■■■■■.■■■■■A.■..■■■■NA.■.■■■■ ■■■.■■■■t ■■...■■.■.■■■■■■■■ ■■■ ■■■■t■■t.■■■.■■■■■■■■■.■■■■■■■■. ..■.....■�M.....r�AAA..■....t..A. ■.....■...........■..■AAAA.■■■O.■...■.■■.■...■..■//.■ ■.■■■...■OI■ ■..■....t.....■..............■.. ■rli.■.■■■■■■A.m■■■■■■AtM■■.■■■.■ iiiiiiii'.iiaiiiiiiii'ii■iiiii�■ii��iii■ii■',iiiii �iii�iiiiiE.iiiiiii ■■■..■■....t.......■■.....■.t�>t..t.MA..=. ■MAOI;. ■■■.■■NE.■...AA.■ MMMMMMUMMMMMMMMMMMMMMMMM ME UMEMEMMMUMBEEM■EMEN."M MEAMME M■MMMMMIEMMU MMMMIMMEMEMEMEN ■.....■....■..■■■.■.....�..■■■■..■...■■■■...%■■■ . ■MMMMMMM■MMMM■ ■■■.■.■■■OMMHODEN■ENM.■■■■NM■■.■ANE■■HM ■a■MEMN B■M■MMME■M■MMM■ ■.■■■.■■OM■■MMENNNE■M■A.■■■■.■■■■..■■■ ■■ nMMMMM. ■ ■■MOMMMEMOMM■■ ■■.....■AAAA■...D....■■....t.......M■■ %MEMMO .�■.■■■■■■■■..■■ ■AA■M■■A■N■A■■H■\..■■M ■t■.■■■■A■■�:■.M11■■ ■ ■■ ■ Nt ■■■■A■ ■..■■.....■....t■.■.......■n�...�... ■r.■t.■. t■N■■■■.■■. .O■. ■...■■..■.■■E■M■.■u■■■■■■■■AAME■.■MMNN �l/ MEMO N■■■M■■■■■■M.■M■ ■....■..■■.■■M..Mu�■...■..■.■■.■..■.. ,. ■ MuuaN ■NOON. ■ ME SOONER MEN! 0 MINE MMEMOMOM ..............AAAA..\..O■.t■t■....u.�i..ft■.H .. ................ ■■■■..■■..■■■.■■.■.■■■UMMERM■■■■M■■■NERMMM.. MMM■H■.M■.■■■.■ ■■■■■uE■■■■■■■■■■■■lMMlMMMMMMM■.■■■■■■■■■■■■■■mMMMMNMMMMMMMMMMKMM■.■■■IMEMN ■■M■■■■■.■M■■■■■■ ■MOMME■ .■ MMUMN ■.N■.■■t ■■\\■■■■■■■■A■■■/■u■■■■ ■■■ ■NEMA.■MEMOMM■ MENE■ MMMMMMMmMMEMMEM MEN MMUMMUMMMMMMMEMOMMEMEMUMMA MEN MEN mommomommmmmmmommmmsmmmommmmmmmmmmrmmm m MI M MIMMMMMMMMMMMMMM ■■■.....■■.■........■t■..■i..... ■.■■■. --- ■■■■■.t.■■■t.■..■...■■■■t■■\■■■.!�■■■■■OM ■■..■.MN■t■H.■■A■■.■■■■ ........./......A■..■..t..H�.■■......... NAME ■C....■■■ ........ ■..■■..H.■.........■.... ..►�.■ri..■.■...■ AAAA==i■■■.■■..■M■■H.■■A .................... ...............■.............■.........■■...■■ ■■..■■AAA.■■.■.A.N■■ ..■.■�iG�i�� ■■■■/...■.......■....■■..■.■..■. Davie County NealtFi Department and .dome Nealti ��yency 210 HOSPITAL STREET P.O. BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704) 634.5985 December 29, 1994 Norman Adair 129 River Road Advance, NC 27006 Re: Site Evaluation Marchmont/15. 64 Acres Dear Mr. Adair: As requested, a representative from this office visited the aforementioned site on December 29, 1994. Based upon 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. If you have any questions, please feel free to contact this office. Sincerely, l )qt�� Robert B. Hall, Jr. , R.S. Environmental Health Section RH/wd Enclosure