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137 Tara Ct Lot 2 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ' P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 . (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001667 Tax PIN/EH#: 7922-7843-7679.02 Billed To: Mitch Hall Subdivision Info: Meadowood Lot#2 Reference Name: Location/Address: Junction Road-27028 Proposed Facility: Residence Property Size: see map ATC Number: 2894 **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 THISS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type /X T/ #People Q #Bedrooms #Baths Dishwasher: Jam' Garbage Disposal: ❑ Washing Machine: 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: Newt Repair❑ System Specifications: Tank Size-`XZ) GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft.*70" 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 the day of installation. Telephone#is(336)751-8760.**** r Environmental Health Specialist's Signature: i Date: L� j6 A/ DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001667 Tax PIN/EH#: 7922-7843-7679.02 Billed To: Mitch Hall Subdivision Info: Meadowood Lot#2 Reference Name: Location/Address: Junction Road-27028 Proposed Facility: Residence Property Size: see map ATC Number: 2894 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 NS UCTION IS VALID FOR PERIOD/OFF 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. ��SP p1� r T o�ify s"a 117 Septic System Installed By: Environmental Health Specialist's Signature: z,/ Date:e�/ DCHD 05/99(Revised) A I ATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC JUN 2 2 2001 IF Davie County Health Department Environmental Health Section ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street DAVIE COUNTY Mocksville, NC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed '�'1 Contact Person V "/�i1 (' L) l Mailing Address U Home Phone osq-1-619 ) City/State/ZIP 2Ri In Business Phone00L _ 2. Name on Permit/ATC if Different than Above n/\Q Mailing Address W__im . City/State/Zip 3. Application For: ❑ Site Eval�u�nat�,op Improvement Permit/ATC ❑ Both 4. System to Service: ❑ House "X Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: # People _ # Bedrooms _ # Bathrooms "NyQ, Dishwasher ❑ Garbage Disposal Washing Machine ❑ Basement/Plumbing Cl Basement/No Plumbing 6. If Business/Industry/Other: Specify typeee # People # Sinks # Commodes A, # Showers FWD # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well ❑ CommTNo ty 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 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: pe WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # i a�-7 �3"7b� / d� oe Property Address: Road Nam L"O} a �IF`lo"� )a04& S Cly PC) City/Zip 1. If in a Subdivi sion provide information, s follows: Name: ow Section: Block: Lot: D— Date Property Flagged: c I 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 ealth 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 su' bility. DATE SIGNATU 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. o�� S m-PUt:A11ON FOR SIIE EVAIJUAHON/IMPROVEMENT PERMIT&ATC Davie County Health Department i J � Environmental Realth Section P.O. Box 848/210 Hospital street JUN — 4 1999 Mockaville, NC 27028 P 13361751-8760 ENVIRONMENTAL HEALTH )AVIE COUN ***ZMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. l. Naa+e to be Billed _ d Q�/1.tJ� Contact person S ''� 4- / Nailing Address �.Li5 W rJk -� -• home Phone 3 3 G— 4��-�� t�e City/state/LiPl If N� ?NnAOA t Business Phone �-0 �� ('��Q Z. name on Permit/ATC if Different than Above palling Address City/state/Lip 3. Application For: 9 Site Evaluation 0 Improvement Permit/ATC 11Both W'Hat/ e. system to service: ouse nr "bile Home 0 Business 0 Industry ❑ Other a. It Residence: A�li People _ / Bedrooms 3 i Bathrooms 21 i1Dishwasher Woarbags Disposal lashing Machine O Basement/Plumbing 0 Basement/No Plumbing 6, if sualness/industry/Other: Specify type / People t sinks / Cocmodes f showers f urinals / Nater Coolers IF FOODSERVICE: # Seats Estimated slater Usage (gallons per day) 7. Type of water supply: Is'County/City 0 dell 0 Comity e. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes If yes,what type? ***1UP0RTANP** CLIENTS A(USr COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUB11lIITED by the client with TIUS APPWCATION. Property Dimensions: L a.C�Y'e-- 4— WRITE DIRECTIONS(from Mockcvllle)to PROPERTY: Tax Office PIN: #17 4 z21—Z -7 )14 -74 -01 Jl r-rt-" W- TT UE-1- .Su-r,e. -u— Property Address: Road Name c7w�Gt1 City/zip I!"V%Le,Iy C 170:4 /L.L &Zt'-Ue If In a Subdivision provide lnformatlon,as follows: / Name: �Gqdvc tJ WC)C' �( io Section: Block: Lot: V_ Date Mperty Flagged: SO-4- " ' 1.k.wl This is to certify that the Information provided Is correct to the beat of my knowledge. I understand that any permil(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 1,aiw,undeWand that I am raponslblefor all eharges Incurred from this WU='1on. 1,hereby,give consent to the Authorized Representative of the Davie founty Health Department to enter upon above described property located in Davie County and owned by w1 \Lw k " to conduct all testing procedures as necessary to determine the site suitability. ,� l70 � j� t..1 �,� DATE absSIGNATURE 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. 7�3 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900606 Tax PIN/EH#: 7922-7843-7679.09 Billed To: Mel Jones Subdivision Info: Junction Acres Lot* 2— Reference Reference Name: Mel Jones Location/Address: Junction Road-2702 Proposed Facility: Residence Property Size: 1 Acre Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape sition A— L. Slo % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure ,c Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 1/9 LONG-TERM ACCEPTANCE RATE c- SITE CLASSIFICATION: r� 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 xture 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 Mineraloav 1:I,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 (Revised 05/99) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■/■■■■■■/■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MENNENMENNENMENNEN ' iiiAMWMM MENNENMENNENMEMNON ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�