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118 Tara Ct Lot 10 /got DAVIE COUNTY HEALTH DEPARTMENT V/// Ied Environmental Health Section P.O.Bog 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001505 Tax PIN/EH#: 7922-7843-7679.10 Billed To: Edmond Rycroft Subdivision Info: Meadowwood Lot#10 Reference Name: Fleetwood Location/Address: Junction Road-27028 Proposed Facility: Residence Property Size: 16/10 acre ATC Number: 2645 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 CONSST>RUCTION 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 the system will function satisfactorily for any given period of time. r 17 UL � 7 ystem Installed By: �v")") Environmental Health Specialist's Signature: Date: 2 DCHD 05/99(Revised) • DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001505 Tax PIN/EH#: 7922-7843-7679.10 Billed To: Edmond Rycroft Subdivision Info: Meadowwood Lot#10 Reference Name: Fleetwood Location/Address: Junction Road-27028 Proposed Facility: Residence Property Size: 16/10 acre ATC Number. 2645 **NOTE** This Improvement/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 c-Z — #Bedrooms Ij #Baths Dishwasher: V1 Garbage Disposal: ❑ Washing Machine:l21 Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �' Type Water Supply _ Design Wastewater Flow(GPD) Site: New Repair❑ System Specifications: Tank Size GAL. Pump Tank,,&eXAL. Trench Width Rock Depth Linear FL-MO Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)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 a day of installation. Telephone#is(336)751-8760.**** � �pl�4 Environmental Health Specialist's Signature: Date: 111---2?_0 � DCHD 05/99(Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Health Department D C LK l� L5 U l5 EnvironmenlaiHealdi Section _V5 P.O. Box 848/210 Hospital Street NOV 2 1 7 no Mocksville, NC 27028 (336)751-8760 ENVIRONMENTAL HEALTH ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE lwo INFORMATION IS PROVIDED. Refer to the IN-�F'rOP1/4kTION BULLETIN for instructions. 1. Name to b0 Billed — !✓� A 11/ Contact Person /N�P//al Mailing Address S tl =/IhCG Home Phone City/State/ZIP lVid e &f i/, 11P Business Phone 2. Name on Permit/ATC if Different ^� Mailing Address / City/State/Zip 3. Application For ❑ Site Evaluation Improvement Permit/ATC ❑ Both 4. System to Service: ❑ House Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms �Dlahwaaher ❑ Garbage Disposal Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. Bins/Indus Other: Specify e # People # Sinks �Y/ P Y tYP P # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ounty/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? -21'Yes ❑No If yes,what type? go S Sr b /y d f- � S _(p �S 1 ***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: ! 61,04-C'/i-tom WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # 7? 2--7,F`/3-7 7 cl Property Address: Road Name I o✓ n� — 1 r``"� City/Zip /71-0 C1ICS U,//c. If in a Subdivision provide information,as follows: Sx� Name: �}'1 e-a- Section: Block: Lot: 1 Date Property Flagged: 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 to conduct all testing procedures as necessary to determine the site suitability. / DATE SIGNATURE 7� �t THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS• Account No. Revised DCHD 07/99 Invoice No. ` �` Ar•NUtAlION FOR SITE EVAUlA11ON/IMPROVEMENT PHIMIi&A r f� ri. Davie County Health Department -�-- Envifonmentat Health Section P.O. Box 818/210 Hospital Street JUN -d 4 1999 Mockaville, HC 27028 (336)751-8760 ENVIRONMENTALITH1rEATH ***ZHPORTAHT*** THIS APPLICATION CANNOT RE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INWRMATION BULLETIN for instructions. l, hams to be Billed _ MLn Ark�)• 70V�-t Contact Person ✓ /�� - / Nailing Address _ 1��5 w l� �!'�_ some mme City/state/Lip �y V�t /�/L► Business Phons Z. Name on Peradt/ATC if Different than Above Nailing Address /� City/State/Lip S. Application For: t+l'Site Evaluation 0 Improvement Permit/ATC 0 Both 4. system to service: VHouse oY 0 Mobile Home 0 Business 0 Industry 0 other a. If Residence: /�t► People _ _ ! Bedrooms 3 # Bathrooms 21 Ir Dishwasher W13arbage Disposal Ir1/Nashing Machine 0 Basement/Plumbing 0 Basement/No Plumbing 6. If Business/industry/other: Specify type f People / sinks / Ca®odes f Showers urinals i Nater Coolers IF FOODSERVICE: 11 Seats Estimated Water Usage (gallons per day) 7. Type of water supply: l9'6ounty/City 0 well 0 Community e. Do you anticipate additions or expansions of the facility this system is intended to serve! 0 Yes "-0-- If yes,what type! ***IMPORTANT"**CLIENTS MUST COAIPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AIUST RESUBMITTED by the client with THIS APPLICATION. Property Dimensions: a-GY't- 4— WRITE DIRECTIONS(from Mocknille)to PROPERTY: Tax Office PIN: #.'7 J'Z'�� `T $431-7G -71 •10 �.z � W- -y: LAPT �r- Property Address: Road Name zr,.t"10 .. - Gr ,.d. Yh. �� u►-� `> -. City/ZipMagi"y% Z.7o4 -6-Pl If In a Subdivision provide information,as follows: Name: CL Section: Block: Lot: AO Date Property Flagged: S a� °`P - �s:A<-wl� oc- This Is to certify that the lurormatlon provided Is correct to the best of my knowledge. I understand that any permit($) Issued hereafter are subject to suspension or revocation,if the site plans or intended use change,or if the lurormatlon submitted In this application Is falsUkd or changed. I,also,understand Kiat I ars revons9le for all charges Incumd f loom this appikation. 1,hereby,give consent to the Authorized Representative of the Davie Pounly Health Department to enter upon above described property located In Davie County and owned by' vr+ w -� to conduct all testing procedures as necessary to determine the site suitability. •�— �o � /� („� �,� DATE C As 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. Revised DCHD(07/98) Invoice No. �3 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900606 Tax PIN/EH#: 7922-7843-7679.10 Billed To: Mel Jones Subdivision Info: Junction Acres Lot#10 Reference Name: Mel Jones Location/Address: Junction Road-27028 Proposed Facility: Residence Property Size: 1 Acre Date Evaluated: Water Supply: On-Site Well Community Public 1/ Evaluation By: Auger Boring Pit L---- Cut FACTORS 1 2 3 4 5 6 7 Landscape sition Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 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 ,-Z SITE CLASSIFICATION: V �v� C EVALUATION BY: .:z; LONG-TERM ACCEPTANCE RATE: L j �� ��''� 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 Mineraley 1:1,2:1, By 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 (Revised 05/99) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■t■ ■■■■t■■■■t■■■■■■tees■■■■t■■■■■t■ ■■tt■t■■eels■■■■■t■■■■tt■■■■■■■t■■■■tttet■■tt■■■■■t■■■■t■te■■■■■■■ ■■t■■t■■ecce■■■tt■■■■■■■■■■■■■■■■t■■■■■t■■■■t■■■■t■■■■■■■■■■t■■■t■ ■■■■■■■t■■■t■■■■■■■■■■■■■■■■t■■■■■■■t■■t■■tt■■■■t■t■ttt■■■■ttt■tt■ ■■■■■■■■■■■ee■t■t■■tt■■t■se■■■tt�■ttt■■■ttt■ttt■tttt■t■t■■tee■tt■ ■■■■tt■■■■■■■■■■t■■■■■tit■■■■■■■■■■■■■■■■■■■■tt■■■t■t■■■■■■■t■■■■■ ■■■■■■■■■t■■■t■■■■■t■■■■■■■■■tet■■■■t■■■■■■■■■ttt■t■■■■t■■■■■■■■■■ ■■tt■■■■■t■■■■■■■■■■tt■■■■■■■tt■■t■■■■■t■■ttt■tt■■■■ttt■t■■■■t■■t■ ■■ttttttt■tett■■■ttt■■t■■tt■■tt■�i■■■■ttt■■te■ttttt■t■■■tttte■tte■ ■■■■■■■■■■■■■■■■■t■■■■■■■■■■■■t■■■■■t■■■t■■■tttt■■tt■■■t■■■■■tit■■ ■■■■■■■t■■tt■■■■■e■■■■ttt■■■■■■■■■■t■■■■tt■tttt■t■tti■■■ttt■■■■■■■ ■■■■■e■e■■■■tt■■t■■■■■■■■tI■■1_�1�7�[►Liiil/G■■■■t■■■■■tt■■■■■■■■t■■■■■■■ ■■■■■t■■■■■■tttttt■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■t■■■t■■■■■■tt■■■■■■■■■■■■■■■■■t■■ttttt■■ttt■■■■■■■ttttttt■■■ ■■■■■■■■tttttt■■■■■■t■■■i.�■■■t■■■■■■■■■■■■■■■t■■tttttt■■■■■■■■■■■ ■■■■■■■■■■■ttt■■■ttt■■tt■■►■■■■■■t■■tttt■■t■t■■ettt■t■■■tttt■t■■t■ ■■tttt■ttt■t■t■�■■■tt■tt■■■■t■�� ■■■■tt■■■tt■■■■tt■■■t■■■■■■e■tt■ ■■■■■■t■■flet■t■■■■■■■■■ti►�■tet■■■■G'7■\1■■■■■t■\■e■■e■■■t■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■t■■t■■■■1i■i■■■■■■■I�■e1■■■■■■e►\■tett■■■■■■■■■■■■■ ■■■t■t■tt■t■■tt■ttet■■tt■tt■eel■■■■■■■■�t■■tt■■►�ett■■■et■■ti■t■t■■ ■■■■■■tt■■t■■t■■■■■■t■■■t■■■■■■■■■■■■tt■t■■■■■■■►�■t■■■■tt■etttttt■ ■■■■■■t■■t■tt■■t■■■■e■t■t■■t■t■►\ ■■■■■ttt\1■■■■■■r■■e■■■■■■■■■■■■■ ■■■■tt■■t■■tt■■■t■■■■t■■■■t■■■■t�■tt■■t■■eel■■tt►�■■■ttttt■tttttt■ ■■t■■■■■■t■■■t■t■■ttettt■tet■■tt■t■tt■■ttt■te■■■te►�t■■tt■■tt■t■tt■ ■■t■■t■■■tttttt■■■■t■■t■■■■■■t■■■■��■■ttt■■tt■■■■■\�■■■■r■■s■■t■■■■ ■ttt■■■t■■■t■■■ttt■■■tttttt■■■■■�■■■r►�t■■■■t■tt■■t■rttttr■t■■i■t■ ■■■■■■■■■■■■fire ■ ■.■■.■■■■■■■■■■■■■■■■■■■■■t■tettet■tt■■■■■■t■tt■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■t■■■■■t■■■tttttt■tttttt■■■■tt■■■■ ■■■tt■■■t■■■tit■■t■■■■■■■■■■■■■■■■■■■t■■■t■■■■■■t■tt■t■■■■■■■t■■■■ ■■■■t■■■■■■■■■■■t■■■■■t■■■■■■■■e■■■■t■■■■t■tt■■■t■■■tt■■■ttttt■■■■