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171 Tara Ct Lot 4 DAVIE COUNTY HEALTH DEPARTMENT �d- 10 '/7- o Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001425 Tax PIN/EH#: 7922-7843-7679.04 Billed To: Fleetwood Mobile Homes Subdivision Info: Meadow Wood Lot#4 Reference Name: Bill Martin Location/Address: Junction Road-27028 Proposed Facility: Residence Property Size: 1acre+ ATC Number: 2585 **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 /z�y�// #People #Bedrooms #Baths Dishwasher: 0 Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #SSeaathts Industrial Waste: ❑ Lot Size /1/9 G Type Water Supply _ Design Wastewater Flow(GPD) d(/ Site: New, Repair❑ System Specifications: Tank Size/ GAL. Pump Tank GAL. Trench Width Rock Dept h�� Linear Ft.�� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 G°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.**** Environmental Health Specialist's Signature: �' ✓G� Date: DCHD 05/99(Revised) ld 1010(,w DAVIE COUNTY HEALTH DEPARTMENT _ Environmental Health Section P.O.Bog 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001425 Tax PIN/EH#: 7922-7843-7679.04 Billed To: Fleetwood Mobile Homes Subdivision Info: Meadow Wood Lot#4 Reference Name: Bill Martin Location/Address: Junction Road-27028 Proposed Facility: Residence Property Size: 1acre+ ATC Number: 2585 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 WASTE WATE O STRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: `��v 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. `c�o',� %Gx,: `— `l.�ir N67- Gv*'LPI,.L'rcf 4,'r' �.istcrt�1 ?o V- b A- GU-7 Septic System Installed By: Environmental Health Specialist's Signature: D te: o l DCHD 05/99(Revised) APPLICATION FOR SIZE EVAUTAT10N/IMPROVEMENT PFRMR a ATC Davie County Health Department Environments/fleadth Secfon P.O. Box 648/210 Hospital Street Hootsville, NC 27028 (336)751-9760 #**IWORTAM** THIS APPLICATION GIQ M H8 VF4=888D UNLE88 ALL TER REQunum n=RMATION IS I?ROV"IDED. Rales to the IN VRMATiON BULLETIN !or instructions. 1 1. Mans to be Killed _I��e �c9c�cl' � / -� Caa►laoL 96sson Bailing m&eee 1-7 L ti am* geese Citr/state/s2p Business Phone _3 /q 32 2. name on aosaitATC it Di!lerent than above Melling Addroae City/state/sin a. Application For: 0 Site Evaluation 0 Improvement Petah/ATC O Both e. stat.n to servioes O House 0 Mobile Hosts 0 Business O Industry O other S. If Residence: # People + Bedrooms # Bathrooms 0 Dishwasber O Garbage Disposal O lheb" fteabina O Buement/Pluebing 0 Baeesent/No plumbing 6. 29 Bneineee/Iaduetrr/Others apeaily type # people # sinks # COmmOdee # showers # Orinala # water Coolers It 1=SERVICE: I seats Estimated Nater Usage tgauuse Pei dar) 7. Type of Mater supply: O County/City 0 well 0 Community 8. Do you anticipate additions or expansions of the facility this system Is intended to serve! 0 Ya 0 No if yes,what type! ***IMPORTANT"**CUENTS MUST COMPIETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN.musr29SEWWT=by the client with THIS APPUCATION. Property Dimension: ) ax--,� WRITE DIRECTIONS(from Moeksvflle)to PROPERTY: Tax OMce PIN: # -71q;k--k" -7b Y 3 - 7 677. oJ Property Address: Road Name J L-c n�- .��✓ i n-�- - n QQ City/Zip P110 C(< S O�A l e )--7°'-r U In a Subdivision provide Infbrmatlon,a follows: Name: 4/2�i eaJaL-) L-) O o e� c Section: Block: Lot: Date Property Flagged: ( � �� _o 0 This Is to certify that the lufbrmation provided Is correct to the but 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 faisilied or changed I,also,understand that I am raponslb/e for all charges lncarred from this applicadom %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 saltabWty. DATE I��I O SIGNATURE �� -C V✓V�� THIS AREA MAY BE USED FOR DRAWENG YOUR SI'M PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic location). Site Revisit Charge Date(s): Client Notification Date: EAS: Account No. ( ZS Revised DCHD(07/99) Invoice No. j 7 8=-7 ju•t•ui:A11UN F Davie County Health Department PEIIMIT do AT D I5 Environmental Health SeWan JUN - 4 1999 n P.O. Box 848/210 Hospital Street Mockoville, NC 27028 / (336)751-9760 ENVIRONMENTAL HEALTH DAVIE COUNTY ***nV0RTAltT*** THIS APPLICATION eANMW HE PROCESSED t)NLESS ALL THE REQUIRED IHWRTrMATIOH IS PROVIDED. Refer to the INFORMATION BUWZTIH for instructions. Mane to be Billed / < too Contact Person Sowvv`'P 16iling Address _I P9 W i kc an'.1=�—. moms Phone 3 36— 4 00--61 <<o Ci1� r�ty/state/Zip _ I IC ,Bs,L$ Business Phone _ 10IlT" ,Z- — n� t. Name on Permit/ATC it Different than Above Hailing Address _-/ City/state/Lip a ` J. Application For: Site Evaluation ❑ Improvement Peimit/ATC ❑ Both 4. system to service: I"House or W-Mobile Home 0 Business 0 Industry ❑ Other S. It Residence: ��/ People tl Bedrooms 3 i Bathrooms 1 W'ishwasher Q'Oarbage Disposal W'Uashing Machine U Basement/Plumbing O Basement/No Pluabing S. it Business/industry/other: specify type / People # sinks # Coamodes # showers # urinals # Nater Coolers IP FOODSERVICE: i Seats Estimated Nater usage (gallons per day) 7. Type of water supply: 9-16ounty/City ❑ well ❑ Community e. Do you anticipate additions or expansions of the facility ibis system Is intended to serve! 0 Yes t If yes,what type' "'IMPORTANT""CLIENTS A(UST C0A(PLETE TH6 REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN dIUST BESUBAIITTED by the clleat wltb THIS APPLICATION. Property Dimensions: a-GV`t_- 4- WRITE DIREC'T'IONS(from MocksKile)to PROPERTY: Tai Office PIN: # 4 Z�Z Z $X317 G 711 •01 S t-,-L� W- 1 6 ET J r' J-:�-- Properly Address: Mad Name �w�i'�l oma- .. - ar .,�. rh. le- u,.- `R+ City/Zipf!1&4cs vi L A)(_;.704 36e Fw4_ 1��,`�•�-�- l.0 �u.. - S�u.0 It in a Subdivision provide information,as follows: Name: n►� --�trtS �v�v �Uoa4f tM Section: Block: Lot: Date Property Planed: s: - J�wi This is to certify that the information provided is correct to the best of riry knowledge. I understand that any permits) issued hereafter are subject to suspension or revocation,if the site plans or intended use change,or if the information submitted in this application Is falsified or changed. 1,also,andastand that I am reronslble for all eharges Incurred front this appYeadlon. 1,hereby,give consent to the Authorized Representative of the Davie ouaty Health Department to enter upon above described property located in Davie County and owned by w+ ��y to contact all testing procedures as necessary to determine the site suitability. ted--- —o C' ��• W i�Se-� DATE a/$ SIGNATURE ve .11 THIS AREA MAY BE USED FOR DRAWING YOUR SITE PIAN(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. �� • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation A.PPLICA.NT INFORMATION PROPERTY INFORMATION r`'e� Account #: 989900606 Tax PIN/EH#: 7922-7843-7679.07 ��— Billed To: Mel Jones Subdivision Info: y 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 Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope% G 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 SITE CLASSIFICATION: 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 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 truct re SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralos=v 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 bC1ib (Revised 05/99) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MESONS MENNEN SEEMENsommusmom1\mMENNEN MENNEN MENNEN