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183 Tara Ct Lot 6 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#: 7922-7843-7679.06 Billed To: Mitch Hall Subdivision Info: Meadowwood Lot#6 Reference Name: Location/Address: Junction Road-27028 Proposed Facility: Residence Property Size: 1.03 acres ATC Number: 2764 **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_� #Bedrooms J #Baths _ Dishwasher: 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) �5o Site: New Repair❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft. Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISERS)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: Date:A DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 - Account #: 990001667 Tax PIN/EH#: 7922-7843-7679.06 Billed To: Mitch Hall Subdivision Info: Meadowwood Lot#6 Reference Name: Location/Address: Junction Road-27028 Proposed Facility: Residence Property Size: 1.03 acres ATC Number: 2764 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 I 1 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA C NSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: - Date: l 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. 5� -6T M. lot 0r '� Septic System InstallBy: �1 Environmental Health Specialist's Signature Date: —� DCHD 05/99(Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department tR 2 5 2001 Environmental Healfh Section P.O. Box 848/210 Hospital Street �lYli2t}NMElYTAlHEA1T11 Mocksville, NC 27028 (336)751-8760 DAVIE COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN fo^r. instructions. nstt{�lruc 1ions. 1. Name to be Billedyy\ t�a l i p Contact Person \1 "1���/ 1Q`� 1`a k` � I Mailing Address �1^5^0 (a,/ 1C/� Ay C Some Phone Vi ^ City/State/ZIP V v}(S J�}n�(}Q dx o -- AA Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address \cm-"R 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 t # Bedrooms 3 # Bathrooms l Dishwasher EJ Garbage Disposal *1 Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If� Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes No If yes,what type? ***IMPORTANT***CLIENTS MUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT orSITEPLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 1 . QJ CZ CvK WRITE DIRECTIONS(from Mocksville)to PROPERTY: T Tax Office PIN: N9 -?%431'16-79 Property Address: Road Nameiy%A,6VU v I City/zip AP VOM, agog If in a Subdivision provide information, follows: Name: 4 Section: Block: Lot: - 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 respo ible for all charges incurred from this application. I,hereby,give consent to the Authorized Represe tative of the Davie unty Health Department to enter upon above described property located in Davie County owned by to conduct all testing(procedures as necessary to determine the sit sitabili DATE �J� 1 SIGNATURE 4 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. 2 `' .0 ruaAsIUN t011 1111E EVA1.JJA110N/1MPll0VEMENI PERMIT do AIG Davie County Health Deparbnent Environmenfa/Health Section D s P.O. Box 818/210 Hospital Street Monksville, INC 27028 F. - 4 1999 (336)751-8760 nn ***XW0RTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL ULNtoCOUN1Y INFORMATION 13 PROVIDED. Refer to the INFORMATION BULLETIN for instruatiozzs. name to be Billed / r n��` A • cJ ea/k l contact person Mailing Address _�.�ZS Ut1f.� �_ 1 ^" Rome phone city/state/Lip _M ,��� �� l r . Business phone t. name on Pe=lt/ATC i! Different than Above Mailing Address City/state/sip s. Application For: R Site Evaluation 0 Improvement Permit/ATC 0 Both e. system to service: tKHouse or Cf Mobile, Home 0 Business 0 Industry 0 other S. If Residence: �# People # Bedrooms 3 # Bathrooms uYDishwasher D'oarbage Disposal "ashing Machine U Basement/Plumbing O Basement/No Plumbing 6. If Business/Industry/other: specify type # people # Sinks # Commodes # showers # urinals # water Coolers Irl FOODSERVICE: (t Seats Estimated Nater Usage (gallons per day) 7. Type of water supply: R'County/City 0 well 0 Comounity s. Do you anticipate additions or expansions of the facility this system is Intended to serve! 0 Yes [I� If yes,what type! ***IMPORTANTR1*CLIENTSAIUSrCOA[PLE1ETHR REQUIREOPROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN 11IUST BESMUlITTED by the client witb THIS APPLICATION. Property Dimensions: L a-cY't- 4- WRITE DIRECTIONS(from MocksvNle)to PROPERTY: Tax Office PIN: #: q zx'J Z $101 1 4 `Z 1•©� W— -T UFT Ju*'J-r-- Property Address: Road Name zK1 -H a*-,- not .r.� City/Zip b&?�cs V t U1,c-t Al C I 'fie i=ce 1,u ,L.L S4,41A1. If in a Subdivision provide information,as fol/lows: / Name: -OV-. r-a ��vdaW woc Section: Block: Lot: —A!r � Date Property Flagged: Sam 's" - �°s: w1 brxkkoc� This is to certify that the information provided Is correct to the best of my knowledge. I understand that any permit($) issued hereafter are subject to suspension or revocation,if the site plans or intended use change,or If the information submitted in this application is falsifled or changed I,also,rtnAffmand that I am mVonsibtefvr all rbc res brcuffed from this applicadon. 1,hereby,give consent to the Authorized Representative of the Davie fpputy Health Department to enter upon above described property located in Davie County and owned by ��y to conduct all testing procedures as necessary to determine the site suitability. e � /� w �Se�.... DATE C zy 7 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. 71173 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900606 Tax PIN/EH#: 7922-7843-7679.05 Billed To: Mel Jones Subdivision Info: Junction Acres Lot#'�* 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 Sloe% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 4o r" 9,70 r Texture group Consistence Structure Mineralogyl` 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:_ 4 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 Dist 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 N-Qtes 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) ■■ecce■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■e■e■■■■e■■e■■■■■■■■ ■■■e■■■■■.�/■■/■■e■eee■■e■e■ecce■■■■■■■e■■e■■e■■■■■■■■■■/■e/ee■■■■ ■■ecce■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■/■■■■■■■■■■■ ■■■■■■■■■■■■■■ I///1ii�liiinir» mm-mm mmmiii■■mom■■■■■■■MEMO ■■/eee■■/■■//■■/e■e■■■■■■e/ee■e■ ■■////■e/■/t///t///t//■■/e/■ee■■ SEEN I