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195 Mortgage Hill Way ` . ' , DAVIE COUNTY HEALTH DEPARTMENT /��� �� Environmental Health Section ,.�� P.O.Boz 848/210 Hospital Street � Mocksville,NC 27028 (336)75]-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001040 Tax PIN/EH#: 5823-26-3173 Billed To: Carolyn Foster Subdivision Info: Reference Name: Carolyn Foster Location/Address: Mortgage Hill Way-27028 Proposed Facility: Residence Property Size: 3 Acres �* �T�G*�l�,�lbgr: 2372 N ts mprovement/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 y� #Baths�_ Dishwasher: �Garbage Disposal: 0 Washing Machine: � Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size� tR ' Type Water Supply ril/Cl� Design Wastewater Flow(GPD) ��d Site: New�Repair❑ System Specifications: Tank Siz%OD GAL. Pump Tank GAL. Trench Width�l�Rock Depth���Linear Ft. 'T�� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S) IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 8:30 a.m.to 930 a.m.or 1:00 p.m.to 130 p.m.on the day of installation. Telephone#is(336)'751-8760.**** � �D � Enviro s at e: r�i,�� Date:,f��DT'�J(� DCHD OS/99(Revised) � , DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (33G)751-8760 Account #: 990001040 Tax PIN/EH#: 5823-26-3173 Billed To: Carolyn Foster Subdivision Info: Reference Name: Carolyn Foster Location/Address: Mortgage Hill Way-27028 Proposed Facility: Residence Property Size: 3 Acres ATC Number. 2372 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 WASTEWAT CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: �U � Date: �% �y— � CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on ImprovemendOperation 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. h ����'� , 1' Septic System Installed By: � . � /� 1' �t � Environmental Health Specialist's Signature: ��j� Date: — � DCHD OS/99(Revised) � � � , APPUCATION FOR SITE EVALUATI�N/IMPiiOVEMEIJt PEdiAlR�C ATC �2 � � O'�`�' `�� �/��� Davte County H�alth Department p l� ��< <5 Gu// ���`�✓ Env�►ronmert�a�Hea/th Sea6fon ,0e���� �fi�e����'�i�����p.o. eox e�e��i�+ �o�pital Str..t MAR I 3 2000 / • Mockevili�� NC 27028 ���y.— ��(�'7 ' � (336)781-8760 � �tJVI QfJP:1�NfAl �LTH ***IlII�ORTAN?4*• THI$•71PBLICATION Ca1NNOT � P�lOC6BS�D L1NLE$8 I1LL INS'OItMATi02i IS PRCVIDED. tt�ler to th� IN�'ORMATiON BULL�TIN !or instrnatioas. ) 1. liaa. to b. sill.d � r0 O � co�,t�o! p.r,oe► lS .lP..✓lt� ��� �... r 8�. �►. ��_�C� ��'9���f� cshr/saa/sza ��(�C.�i'S V 1 � , �-(lC• auss�... at�oA. ?�,�,�.P� ���' d 7��� z. �... o� n.�c/are sr airr.:.ot s�a,a �►bo.. .SC�•z� -� �.s.1� aaesr.• cs�/naa/sir _ _ a. 1►pplioat.ion por: 0 Sit� =valuatioa 0 2mprov�m�at II�rmit/ATC .�' oth a. sY.t,.. to s•r.i.w� U Hous• �Mobila Hom� U 8usin�sa O Iadustiy D Oth�r s. I! R�aiMna�: / p�opl� ��� f SedroOms .�_ i Bathrooma r, i,]�11�h��l�r O Oasbaq� Dispo�d l�asbinq Naohia� O sas�nt/pl�sbiaq O sasraant/No pi�iaq 6. It Swisu��/Zaduatsy/Otturt 8p�oily lyp� � �opl� � 61sik� i Coamod�. i Bho�r� t Uria�l• i Nabr cooi�r� =r rooasa�vica: � s.sts aatimat�d Nat�r o� Q• ro•l�oA• r� �Y� 7. Typ� ot wat�r aupply: t�rCouaty/City N�11 0 Commuaity e. Do yoa�nHcipate eddiHon�or e�neions of the taetlity thb ryatem b intended to�erveT 0 Yes C�-Ai6 If yes,w6At typeT *""IMPORTAMI'"**CLIEN'TS MIIS7'C�UMPtETETHE REQUIRF.D PROPERTY INFORMATION REQUESTED BELOW. Either s PI.AT or 31TE 1'LAN bii/ST Bfi SUBMITTED by the elient �viW THIS APP WCATION. Property Dimensloas: �C'.��5 ' __._ WRITE D1RF.Cf10NS(ine�*Ro��.lR•�!�oAnno�o�rv; Ts:08Ice PIN: # :���,��02�''.��� CQOI '�Df,�'��'� `f A al.�j,`!!1�i II�, Property Addrea�: Rosd Name �G4�/"y�'SG' �7/����y'� D�� /V l�l'1"�'1_ � t,(f`� l�� � Ciry/Zip���"`�L;'`ll� � Cbrh e,f-S � ��+1� . � � b V In A Sabdivision pravlde InfornwNon,aa followe: f�1'�-K'��. �� 1.� � N�me: �Q� SecNoas Biceks Lot: Date Property F4�eds ,s7�� I' � This ia to certify that t6e InlormsHon prowided is correct to t6e beat ot my kamvledge. I anderstsnd t6at�ny permit(s) �saed hereaner are enbJect to�aspenalon or revocadoa�itthe eite plana or intended oae chsnge,or if the 9nformaHon aabmitted in this appilcaHon Is taL�tfied or changed. I,also,anderstond tbat I ani rtsponslb/�jor ai!cbar,�es lncurred froni tbls appllca�lon. I,6ereby,give eonaent to the Aathorized Repreaentative of t6e�e Coanty Ha�t6��ent to enter apon above descHbed pr+operty loa�ted in D�We Coaaty and owned by Q�l��r1 �?� to condnct sq tesNng procedara iu neceaaary to determine the dte�nihbWty. DATE_ ��" � I^l�� SIGNATf)RE o�� . o��(��.�u11 aiai�i+i.�i�m�+=��ua�.�ru�'t l)NCA`W1NG YOUR 31TE PI.AN(InClude sll of the fo1101►iogi Ezi3ting�Iud propoeed property lines and dimenaiona, ttractares, aetbacks, nad aepNc IocsHons). 3it�Revbtt C6arge D�te(e)s � Cllent NoHBcaHon D�te: . � � EHS: r ✓ Acconnt Na ,�! Q Revised DC�(07/99) Involce Na ��/ ,J�.------- � a MdC Mn62 ' ChA �- a MnC2 a . ��i 6�� - `,�;:,;,�r��4;�, „a t ti�, 10] J ^� � e pq� � W � � 6 4.97A ' £ 4 «Q 111.92A1 MsD 1588 � ti n 2 ,, rs 1 This map is for PERC TEST ��� � h9sC and BUILDING PERMIT purposes oniy. The Davie County 3 3 Tax Administrator's Office assumes no liability for any information contained on this map. �6 � ��5 95 MdD �3: E B COUNTY-ID:B300000043 rse.a�Ai w 14�8 March 13,2000 9:01 AM � MnB2 Parcel Identification Number 5823-26-3173 ' � •, . � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001040 Tax PIN/EH#: 5823-26-3173 Billed To: Carolyn Foster Subdivision Info: Reference Name: Carolyn Foster Location/Address: Mortgage Hill Way-27028 Proposed Facility: Residence Property Size: 3 Acres Date Evaluated: �� 3��� Water Supply: On-Site Well Community Public Evaluation By: Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition � Slo e% HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH �' � Texture rou Consistence ; Structure /" Mineralo ` � HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: ,� � EVALUATION BY: LONG-TERM ACCEPTANCE RATE: If--� 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 day 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 Mineraloev 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-gaUday/ft2 DC�ID OS/99(Revised) ■■���■����■■■■■�■�■■■������■■■��■���■�■■■�■■■�����■■�■■�■■��■�■�■■ ■�������■��■�■����■��■����■■�����■�■�■�■���■�����■�■�■■�■�■�■■��■■ ■����■■��■���■■����������■��■�■��■��■�■■��■�����■■���■����■��■��■ ■�■���■■■■����■�■■�■��■■�■��■�■■ ■��■��■���■��■■�■■��■�����■■��■■ ■�■��■■■�■■���■�o■��■�■��■�■■�■�■■■��■�■■��■■�■■��■a��■��■�■■■■�■■ ■�■��■���■■�■��■�■■��■■��■��■�■��■■��■■■■��■■�■��■■�■■■■■��������■ ■������■■■■■���■���■■■���■■���■�■■■��■�■■�■■■�■oo�■■■■■■■�■����■�■ ■��■�■■��■■■�■■■��■��■�■■�■��■����■�����■�■■��■■�■��■■■■����■■�■�■ ■��■■��e■■�■�■s■�o■��■■■■�■�����■■■■���■■�■■��■■�■.�■■■�■���■■�■�■ ■��■�■��■■���■■■���■■�����■�■■■■��■����■■■■■��■��■��■a■���■�■■■■�■ 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