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115 Tara Ct Lot 1 . DAVIE COUNTY HEALTH DEPARTMENT /D//7/0 d Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001425 Tax PIN/EH#: 7922-7843-7679.01 Billed To: Fleetwood Mobile Homes Subdivision Info: Meadow Wood Lot#1 Reference Name: Bill Martin Location/Address: Junction Road-27028 Proposed Facility: RESIDENCE Property Size: 1 ACRE+ **NOTIJ� iIss&provemennt/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 #Bedrooms �,,? #Baths_ --2- Dishwasher: Dishwasher: 1210, Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size /t/C Type Water Supply C Design Wastewater Flow(GPD) Z/10 Site: New ErRepair❑ System Specifications: Tank Size IM GAL. Pump Tank GAL. Trench WidthZ4� "Rock Depth -9 Linear Ft. Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPR90,VED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representa ' oft a) County Health Department for final inspection of this system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m. �. n y of installation. Telephone#is(336)751-8760.**** _J e J r�C`f Pd !� �i Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) lot DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Bog 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account M 990001425 Tax PIN/EH#: 7922-7843-7679.01 Billed To: Fleetwood Mobile Homes Subdivision Info: Meadow Wood Lot#1 Reference Name: Bill Martin Location/Address: Junction Road-27028 Proposed Facility: RESIDENCE Property Size: 1 ACRE+ ATC Number: 2586 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 WASTEWATER NSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: t Date: o�/r 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 tha em will function satisfactorily for any given period of time. f J'C L-4s-7- `-n t, o f"efi� 1 Z'� Ad 6a,(11 pt s. /fid e•v� Septic System Installed By:(�1� 1 S& ! Environmental Health Specialist's Signature: Lvw Date: I'd rf y'� ✓ DCHD 05/99(Revised) APPUCAHON FOR SITE EVAUJAMON/IMPROVEMFM PERMIT do ATC Davie County Health Department D . Environments/Health SbWan SEP 2 8 2000 P.O. Bo: 646/210 Hospital Strut b1oohsviile, HC 27026 (896)751-6760 ***nV0RTANT*** THIS "nICKTION calwo? He PROC USED UNLe88 AM THS RZQUIRZD nVOR10TION iS PROVIDZD. Refer to the nUVR10TION BU=TIN for Lnssttractions. ara. 1. Nto be billed �e7 SOD >1* 4 contact Verson �i�f/ /��.�/�•c� ltailimq Address os lP�ql Voce Phone Z Vueiness a. 36- 7.5" -1933 Z. wase an Permit/USC i! Different than Above Hailiaq address City/s to/ LP 3. Applioation tor: 0 site evaluation �-U Improvemaat Vermitl= 13 Both e. bysten to servioei O House ` 'Mobil* some O Business 0 Industry O Other 5. It Residence: f people I Bedrooms # Bathrooms +Z. ishw caber S-oa age Disposal LD-962iing Nsehlae [I Vasemut/Vlunbinq O sasment/wo Plumbing 6. I9 business/Zn&wtrr/Others speoifr type I.People I sinks ! commodes f showers i Oriman I hater Coolers I! 3=8&MCZ: # seats estimated Nater Usage trazons per da:r) 7. Type of water supply: L-B' ounty/City 0 Well a Community e. Do you anticipate additions or expansions of the facWty this system Is Intended to serve? O Ya LJ3Xc If yes,what type? ***IMPORTANT***CUENTS UMT COMPLEMTHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESI/BhBIM by the client with THIS APPUCATION. Property Dimensions: )-4- r-r--m-3 WRITE DIRECTIONS(from Mociaviile)two PROPERTY: Ta:O®ce PIN: 6 -7 c'! 1- 7S Y3.7477. d t o /' C- 4 Property Address: Road Name_ l�,r.�l� o., � • !�-st City/Zip 2--7°t� mac_ l� IlXe1— U In a Subdivision provide Information,as follows: Names �+ Section: Blocks Lot: Date Property egged: l Z" This Is to certify that the Inlbrmadon provided Is correct to the but of my knowledge. I understand that any permits) Issued bereaner are subject to suspension or revocation,if the site plans or Intended no change,or If the Information submitted In this application Is folsilied or changed. 1,also,understand that I am responsible for all charges inc)rmd from this applicadom %hereby,ghro consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all 7), procceedures as secasary to determine the site suitabMly.DATE 0 k SIGNATURE 4 �S1 4a5\4-1/'n o THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Fadsting and proposed property Tina and dlmendons, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: ERS: Account No. 1. Revised DCHD(07/99) Invoice No. w APPLI(A110N FOR SITE EVALVA111ON/IMPROVEMENT PERMIT do A y s '~ Davie County Health Department Envfrvamenfal Health S&Won P.O. Box 848/210 Hospital street _ 4 1999 Mockaville, NC 27028 (336)751-8760 ENVIRONMENTAL HEALTH DAVIE COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. Nam 1. to be Billed / i t-,� A� . dQAA Contact Person -30-y QQ -t / Mailing Address __ L� Wt-11� ��t�Dp_ Home Phone �`� nf. 1��G�1<<O City/state/ZIP _ � �/� L9, Business Phone L Z. Name on Pe=lt/ATC if Different than Above Hailing Address _ City/state/Lip 3. Application For: "Site Evaluation rovement Permit/ATC 0 Both 4. system to service: 9"House or [I"Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: II People _ # Bedrooms 3 / Bathrooms 21 UYDishwasher W16a bage Disposal "ashing Machine O Basement/Plumbing D nasement/No Plumbing 6. If Business/industry/other: Specify type f People sinks # Co®odes t showers f urinals Nater Coolers IF FOODSERVICE: / Seats Estimated hater Usage (gallon per day) 7. Type of water supply: Lel'County/City 0 Well ❑ Co==mity s. Do you anticipate additions or expansions of the facility this system is Intended to serve! 0 Yes wlq-o If yes,what type' *••IMPORTANT•"k CLIENTS AIUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBAIITTED by the client with THIS APPLICATION. Pruperty Dimensions: L o-crt-- 4— WRITE DIRECTIONS(from Mocisville)to PROPERTY: Tax Office PIN: # Q z�� `I 7 G Z 9•01 •T r-.z � W- TT UFT Property Address: Road Name City/Zip m4 %a -10/V C 2-704 -�e Fw- J"'.L If in a Subdivision provide iuformationn,,as follows: Name: Section: Block: Lot: L Date Property Flagged: S�� t s:�c.wl bahce- This is to certify that the information provided Is correct to the best of my knowledge. 1 understand that any permits) Issued hereafter are subject to suspension or revocation,if the site plans or intended use change,or if the iurormation submitted in this application is falsified or changed. I,also,understand that I am responsiblefor all charges Incurred from this application. i,hereby,give consent to the Authorized Representative of the Davie ouuty Health Department to enter upon above described property located in Davie County and owned by �nyxA 'D"Ie „ to conduct all testing procedures as necessary to determine the site suitability. UVm DATE �9 Z SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Includ all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Account No. 646 6 Revised DCHD(07/98) Invoice No. 1�3 DAVIE COUNTY HEALTH DEPARTMENT i� Environmental Health Section _ SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900606 Tax PIN/EH#: 7922-7843-7679.01 Billed To: Mel Jones Subdivision Info: Junction Acres Lot#1 Reference Name: Mel Jones Location/Address: Junction Road-27028 Proposed Facility: Residence Property Size: 1 Acre Date Evaluated: a Water Supply: On-Site Well Community / Publicy Evaluation By: Auger Boring Pity Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slo % Ay HORIZON I DEPTH Texture group / Consistence Structure Mineralogy HORIZON II DEPTH '24", Texture group 6 r L Consistence r {' Structure AA e Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 73 LONG-TERM ACCEPTANCE RATE I SITE CLASSIFICATION:_ EVALUATION BY: LONG-TERM ACCEPTANCE RATE: / n OTHER(S)PRESS/ENT: REMARKS: ! 2G4//r1fG e' s'�'�D " 1"��,•! �/q�C - 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 T xe ture 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 MineralQU 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 PCH1) (Revised 05/99) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■e■e■e■■■e■■nee■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■e■/■■ ■■■■■■■■■/■fiii�iii��iiiwi��iiiiiiiiiiiii�f�■■■■■■■■■e■■■■■■■■■■■■■■ ■■■■/■■■■■■i■■■■e■ENE■E■eEEENEE■EE■■/■■■■■■■■■■■■■■■■■■/■■■■■■■/■■■ ■■■■■■■■■■■i■E■■■e■■■■■ca■■■■■acre■■■■■E■E■■■■►�■e/■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■i■■■■■■e■■■■■s■EE■E■etc■■■■■■r_■■■■aE■■■■E■N■E■■N■E■■E■■■ ■e■■e■■ee■■i■■■■e■■■■■■■e■■tee■■■■■■e■/■■■/■/■■aa/■■■/■■■e■■■■■■/■■ ■■■■■■■■■■■�■■■■■■■■■■■■■■n■■■■/■■■■■■/NOON■■■■■■a■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■�iiniiiiiGiii/i��ini�CC:.�C�CC:':��C�C�/■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e.I,11!X71.■e■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■/■■■■/E/■//■/■■/■■/E■ci■Gi��l■■//E■■/■/■/■■//■/NOON■■■/■■■///////■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■e■ee■e■e■■■e■ee■e■eee■e/e■ecce■■■e��e■eee■■eee■e■e■■e■■■e■ee■e■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■/■/■/■■■■■■■■■■/■■■/■■■/■//■■■NOON■/e■■■■■■■■■■■■■■■■■■■e/e/■ ■■■■■■■■■■■Nee■■eeeeee■■ee■■■eee■■■■e■e■eee■eee■eeee■e■e■e■e■e■e■■ ■//■■E■■EEE■E■■■■E■■E■■E■■■■■■■E■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■/■■■/■■■■■■■■■■■■■■■■■■■■■E■■■■E■■■■E■■■■■■■/■■■■■■■/■■■/E■E■■/e■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�■■■■■■■■■■■■■■■■■■■■■■■■■■■■NONE ■EN■■N■OOO■■■■■N■N■■O■■N■■■■NON■ ■■O■EN■■E■■■■■N■O■■EON■E■■■■■■N■ ■■■■■■■■■■■■■■■■■■■■■■■■■■eO■■■■■E■■■■E■O■O■■OO■/E■■EE■O■E■eE/MEMO