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P0121 Michaels Rd r', .,:;_rte -; '1 a. - . ._�_� lw,..;! .j -�. t .r .:5. ` y j i' ��:.; ,_..•- DAVIE COUNTY HEALTH DEPARTMENT ' IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT PERMIT **NOTE** This improvement permit DOES NOT authorize the construction or installation 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) NAME /A(�P � i�1f1i✓ PROPERTY ADDRESS 7'1'IICf�/`�£�5� TOt- DATEf LOCATION �.�Q�t �0� / i/j /�E/s �//-' f�t/Y`<y /Y/.�✓ �I�` fl �ilT! �� � SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS--? # BATHS # OCCUPANTS GARBAGE DISPOSAL: Ye � COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No r LOT SIZE TYPE WATER SUPPLY tVo DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TAM( GAL. TRENCH WIDTH 3F ROCK DEPTH LINEAR FT.--? OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. J ' �d w IMPROVEMENT PERMIT BY **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. i OPERATION PERMIT SYSTEM INSTALL BY AUTHORIZATION 'NO. OPERATION PERMIT BY 14JAII DATE **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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 FICTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. / DCHD 10/95 w ".'�T�"v ne «.^..iw^`�`r'x..-�'::t �:J 4.a a r jf 'a' cfyA, �t"''x: Y ,.+ ..,. .;r•. ;., yi' _Ivey' Davie County Health Department ENVIRONMENTAL HEALTH SECTION P.O. Box 665 , Mocksville, N.C. 27028 a - AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) ***This Authorization For Wastewater.System Construction must be issued by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections i Office when applying for Building Permits.*** 7 �J AUTHORIZATION NUMBER NAME J DATE /ol/�fT��s N° 0 1 ?,. 4 N2 NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM- f}{NOTICE*ff THIS AUTHORIZATION FOR WAS TER SYSTEM CONSTRUCTION IS VALID F A PERIOD OF FIVE (b) YEARS. ENVIRONMENTAL HEALTH WMALIST DATE DCHD 10/95 t - . . ... APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERM V15 f Davie County Health Department D v - Environmental Health Section P. O. Box 665 DEC 1 4 1995 Mocksville, NC 27028 - 4 1 -- P� 1. Application/Permit Requested By z2 1 Q 17&42ff Mailing Address 0 Home Phone.0 Wee m tra e o rT/ Business Phone T " o� J 5 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation ' at-e'ptic Tank Installation Permit 4. System to Serve: ❑ House C8/'Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision "yo Section Lot # ❑ Basement/Plumbing No. of People 1� ❑ Basement/No Plumbing No. of Bedrooms O'Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Seared No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ublic ❑ Private ❑ Community 8. Property Dimensions pG V-t- 1 15 Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes Er No If yes, what type? "NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: s its t-4Y This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. /2 DATE SIG AT RE CONSENT FOR SITE EVALUATION TO BED NE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. [R-� I DO NOT OWN the property. If you checked Box#2,the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative f the Davie Cou Health Department to ente pon above described property located in Davie County and owned by e ' to conduct all testing procedures as necessary to determine aid site's suitability for a ground absorption sewage treatment and disposal system. ) � 7, --9� DATE SIGNATURE DCHD(1/93) i -- lT•' - �p�blr. rl Siy y, 1623.G— Ad. 623. co Ad N o ,. .60 r.YyPt� t _ �• � � � � N e __ P/0 16 0 Ac) M N 9 Ad \ ti 483,78 460 I\ 3 Ac 16 o a 1?5.5 Ac SEE MAP M-5-7 A i 204.6 2376 '. 6568 (29 Ac) � 12 16 21 Ac m � o 13 ° 2.5 Ac , Ac) 2609. OI 17.51..-Ac 7.,;,. '� 1901. , O.S Xi. Ac) / t N (14,,$ Ac14 ) SEE MAP 5-10 --�__ 46- G114 NGE 6-GRANGE R AVENU+= SWICEGOOD STREETi � r 4Y •��`/ �t` 31•�p� fir; 4 �. A1/ W .LO. ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation / NAME i/` DATE EVALUATEDA ADDRESS PROPERTY SIZE l� PROPOSED FACIILTY ,,CIS i/�Yj LOCATION OF SITE �'"hv S Water Supply: On-Site Well _ Community Public [1) Evaluation By: Auger Boring Pit Cut FACTORS 1 1 2 3 4 Landscape position Slope Z <- HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH a'" _410 Al 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: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: 7 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<:lay loam- SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Vc-y friable FR-Friable FI-Finn 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 .3C-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 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 DCHD(01-901 ■■■■■■■■■■i■■■■�■■\1.■■■■/■■■■■■■■■■■..■■■■■■■■■■■�■■■■■■.■ ■rev■�■ ■■■■■■■■■■■ieeee■■■1■■■H■/■■/■■■.■■N■■■■■_/■■■■. ■.■■■■■.■■.■■■ ■ ■■■■■■■■■Eli■■■■■■■t1■■Ne■■■eee■■■�■■■■■N.■ ■■■■■.■../■■■■■//■■.■.■ ■■■■a■/eee■��■/■/■11■i.■MM.■MMMMM■/■/■■■..■■■/■■.■/■■■.//.■//■//./■ ■■■■11Ni\1 ■■/./�1■■■l.■■■■■.■■■C■■■■■■■■■■■■■■■NOON.■■■.M■.■■/■■■W■■■■ ■■■■111,,lililleee■ell■■11■■e■MMM/M■/M■.■.■■■./■.■■■■■■ .■/■MMH�■■■II/■/■■ ■.■■Ilf■■11■■■■■1�■■■i..■.//■.■/■■■.■■■/ EN ■■/■■ ■■. ■ ■■■ ■■%./■H on ■■/■. ■■■■■/■.11■■■I■OOM■eM■Orr\■1■■� ■■■■■■■■.■■.....■■■■%■ .■..memo■ ■.■■//■/■■■.■I■M■■I■.■.■..■■.■■..■.■/■■■/■■■■■.■■ ■.� Nmmeeme■■■e■mN ■/■.■■■\\■.■■.I■m■llemmeeeeeeeeeeeme■_./.■■..■�■�■I..■■■■■■�.�■■■//� ■.■■nM/Me►.■MII/■II■MMNMMN.M.■■■M�/M■NMM■H►.e■MHMeeeM■e.eMMM ■■■ ■■.■■n■.■■►■■■IMM�I■MMMNM■■/■■.■.■ ■■■■■■■M�.�M■ ■■■/■.■■■■■■■■/■■■ ■■■■■.■■■■■■■nl■■■■■■■■H■■/■■/■■■■■■■■■■/i■/■■■■■ .ME e■■�■.■■■■MONSOON Hoomm � ■■.■■■■.■/■/■■■■■.■■■■.■■■■■■//■■■■/■■/■■■ MEMNON ■■■■..I �0 MIN E■■■NM■� .................I.O.MH■MMOM■M■■�■O/■mmmuiuuHM■.Mie ■m■momeM ■■■/■■/■■/■■\■■.■l�■■■■■■■■M■/■■■ MEIMMeMMEMM■ ■■N■■■■ M■N■■N/■ ■■■ H.■■■■.■N■11■■■■■■■■..■/■■■■■//■■/■■■ummom MOON NOME ■OM. ■■.■.■.■\■■■11■■■■■■■■eM■/e■e■IeO■�■■■■■■■■ ■ ■■ ■�■m■mm■■i ■.■./MN■i/■M■►�i■NIIM■e■e■■ee■//■H1r ■ .■■ ■ ■ ■■■ ■■mmom MEMO■■M■M■■M■MM■M I■■M■ H■■.■■ un IN �N ■■ a■e■ ■.■■MNe■■eMeeel•ee■le■■eeem■ee.eme//■m no i/NI►., I ■■■ oe■ ■■N■mM ME mom�iMMMMMMWIMMM■iiil�i■MOMS �'immos ' n i ii ■ Ml�No 0 MEN: ■■■■■■■MMMMMI■M■■I■MEN=■■ ONE■►.■■■ONE ■ No MOONSOMENS mom MENNEN ■■■■■■.■.■MNNI■MN�I■MO■MMm■Hm■//■N■ H ■N ■■■■■■.N ■■■■■■■■MM■MMMI.MM■IMMMMMMM■■■■m1/■ ■ Ne ■ ■■ .M■Oe NE ////■■/■N■eN■11■.■le/■■■■■■■■I�M■■�=M�e■ ON .■■OM�O■ iiiiii■i�iiiii::iii�l:iiil��H.M. om . e�■■N�■=■e■M■■�I� NH■EN ■ ■. 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