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110 Oak Leaf Ct Lot 12 AM . DAVIE COUNTY HEALTH DEPARTMENT �•c— I /3- ° d Environmental Health Section P.O.Boa 848/210 Hospital Street '. Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 989900063 Tax PIN/EH M 5708-06-7210.12 Billed To: Larry McDaniel Subdivision Info: Oak Crest Sec.2 Lot#12 Reference Name: Janice McDaniel Location/Address: Davie Academy Road-27028 Proposed Facility: Residence Property Size: See Map ATC Number: 2535 **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 1-bose #People_ #Bedrooms 3 #Baths -2— Dishwasher: U!r Garbage Disposal: ❑ Washing Machine: ® Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size NOL& Type Water Supply l�013wDesign Wastewater Flow(GPD) Site: New l3d""Repair❑ System Specifications: Tank SizeWDIIAL. Pump Tank GAL. Trench Widt Rock Depth Linear Ft. Other: `1 Required Site Modifications/Conditions: ,s -)Wu va CiDI1 SOS v� ' �� Q O Off- 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.bn the day of installation. Telephone#is(336)751-8760.**** fl mss' Z C, C`i a5� SW / Q Environmental Health Specialists Signature: _ ate: C� DCHD 05/99(Revised) -46 • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section I P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900063 Tax PIN/EH#: 5708-06-7210.12 Billed To: Larry McDaniel Subdivision Info: Oak Crest Sec.2 Lot#12 Reference Name: Janice McDaniel Location/Address: Davie Academy Road-27028 Proposed Facility: Residence Property Size: See Map ATC Number: 2535 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 Tr ent and Disposal Systems). THIS AUTHORIZATION FOR WAS O N IS ALID FOR A PERIOD OF FIVE 7ARS. Environmental Health Specialist's Sign tore: ate: on 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. t to y Cao' a C72 C I FSo '\ r ,J SP,�� lo' To -'NL To F4 Septic System Installed By: Environmental Health Specialist's Signature: te: DCHD 05/99(Revised) APPUCATION FOR SITE EVALUATION/MPROVEb1ENT PERM&ATC Davie County Health Deparbnent D ` Ablofiatmaenrnf H"Iffi Sesdlart P.O. Bos 848/210 Hospital Street AUG 2 2 2000 oo Mocksville, HC 27028 (336)751-8760 ENVIRONMENTAL HEALTH DAVIE COUNTY ***ZtdQO MUM*** T3118 71>?>?LICUICH CAM= SII PF==8SD U10JOB ALL TIM RZQUIRZD IMrOR�1TION 18 PROVII)IM. Rabe to the rAf*MTZOIN BU=TIM for iastrnotiOns. , 1. s..a to be PilledJ=i ne, M-CDO'n if-! S c,. contact veto" 2 r� Millsig Address name MGM ; 3(0- qG$— 4(y L city/state/sw MOC LVI ilc'_ ML. 27102 sualows vbone 55(0- 151-0)02.2•. Z. w.. on Per it/Aze Le D"Zovent than abo.e l...nt rN 1111.e_ a Y Q Q, &A;p dihzD UN4 24 nq aaasese_QX S �1 Citi/state/sip No( Ski i 1 I e 41C..'MQ2 3. Applioaticaa rot: CI Site Rvaluatioa Improvesient vesmit/M 0 Both s. srstas to service: House O Mobile Hoare 0 Business 0 Iadustry 0 Othes S. Z! Residence: t# people 3 Bedrooms 5 0 Bathroosis r IxnisLxasbes 0 Garbage Disposal xft"np ltaobiae O assesunt/PimiAiaq 0 aaasmaot/:to al:aibiaQ 6. zt suainess/zednstrt/otber: speoilr type f People 0 steaks t# carodes i sho"MM t usinale a water coolers Ir ra0D82MCZ: # Seats sstiwated water Usage (4aume per day) t 7. 2%M of Mater supply: Ae"tr/city 0 well 0 COMMMity s. Do you anticipate additions or espauioos of the facihty this system Is intended to serve? 0 Yes 0 No If yes,what type? ***IMPORTANT***CiJENTS MWrCOMPLEWTHE REQUIRED PROPERTY INFORMATION REQULWO BELAW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: see below WRFM DIRECTIONS(fres MwJwAk)to PROPERTY: Tax Office PIN: # �.� �38 f),n#-F`1N- ap -'1 a 10 . �z- Property Address: Road NMs Oaq 1vr1 V ve citymp t NC, fi V t If in a Subdivision provide Informadon,as follows: Na : Cx�S� me4 • mhn b2 M-1 �2 Section Block: Lots Date Property Flagged: This is to cerft that the information provided is correct to the best of my knowledge. I understand that any permlt(s) issued hereafter are subject to suspension or revocadon,U the site plans or Intended we change,or if the information submitted In this application Is hisi&d or changed 1,also,undenund Ant I am responsible for aU cbayts inc mel front Ab apppcadoa. I,hereby,give consent to the Authorized Representative of the Davie Coonly13e lth Depar ef to ester upon above described property located In Davie County and owned by t ,I/I G. to conduct all tesdag procedure as necessary to determine the site saitabWty. SIGN ATURA: THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed Property Ilan and dimoulons, stracturM setbacks, and septic krcatioss). k Site Revisit Charge c/1 rn s i OY1S Date(s): Client NoMendon Date: ERS: ILA 13�con- Account Nn(,3a Revisal DCHD(07/99) Invoice Na J0C Davie♦coder. y is subject to oil easements,right-of-wayti / SR 1W isments,if any,as the some may appear of I IRS I No tW got Ice of the Register of Deeds,Clark of Court, I W 'az office or which may have been acquired by iV This survey In subject to any facts that may �8 1 3 j full and accurate title search,NOT fumished 7br "OAK CREST I I "OAK CREST' W 0 ring and any aecomparryinq - Phase II r '� Phase II Sere umished to the person(*)named PB 7 O PG 121 ? PB 7 O PG 121 I CL 3@orations or use by others I ss authorized by eying Co. I rip rdation. -- 1/2"EIR N 23°54'23"W 192.35' 1/2" EIR Io+ ' I5'Utility icaxmant (NC ( Typical Vicinity Map ' y I 0 1 declare that Q ' 9 U o I we surveys` th# pro hown;on o o 0 1 2 � this plat ;G7:`y ¢:tip "OAK CRESP' tVto a '.,2 1 '2. / Phase II ( I 3 Proposed 0.690 Acres +/— V , PB 7 O PG 121 3 I P �_ '( o J c House polo '�.ryrp08�R���P N a_ u7 I !� "OAK CREST" (O Ito ase I o O to ^ PS 7h0 PG 82 ss.00• I I I ,O'z 70' —. — — Sight Easement - - — s'Negative Control Comer Access Easement 1/2"EIR 1/2"EIR 116.82' S 24.30'58"E S 22.26.21"E '-- 1/2"EIR 35.69' Survey for: LEGEND Larry K. McDaniel lay ki-c! 93ne : Davie Academy Road Pips CI.-Center Line Rebar EP-Edge of Pavement Lot 12 FC-Face of Curb nument PP-Power Pok ht Pde S.R. 1 143 .et t/r' ii—ho Noe "OAK CREST' Phase II ccesa CF{RChoM Dietanee Plat Book 7 0 Page 121 Concrete Ptpe, SE/�SPar Easement — ---� /- y P Metal tope OB—Deal cook 0.690 Acres + b coordinate computation p1 Pips PB-Pae Book 60' Public R/W 20'+/— Pavement SCALE TOWNSHIP COUNTY STATE Ba"%da ry' —pceAC'atch m 1" = 40' Calahan Davie North Carolina F .ties S-5 er t�e BoC- ad[ori Curb 0 40 80 120 s,wL,, Stone Land Surveying Company MT,MS1 George PLS L-3182 MAPPED: � \ 113 Drumm Lane Phone(336)998-4733 SALE — FEET GRS Mocksville,N.C. 27028 h • APPUCATION FOR SITE EVAWATION/IMPROVEMENT PERMIT&ATC IE 0 v E • Davie County Health Department D ti Environmental Health Secdon SEP 2 1999 P.O. Box 848/210 Hospital Street — Mocksville, NC 27026 (336)751-8760 ***II!lPORZUM** THIS APPLICATION CANNOT BS PROCICBSED UNLESS ALL TIM REQUIRED n=RMATION 18 PROVIDED. Refer to the IMRMATION BULLETIN for instructions. I.. liana to be Billed (k LS I n(,. Contact Person Mailing Address 1531 Nose Phone 33U- qqS-• 4(0oc city/st.ate/z2v Mocsyi llf- NG 21022 Business Phone 3f)(D- g022 s. (Tame on Perait/ASC it Different than Ilbova 141 aq P&C 1 a rU i Wailing Address 2 1 ox s l- . City/stats/aip J 3. Application For: Site 3valuation 0 Improvement Permit/ATC 0 Both e. systen to services House 0 Mobile Home 0 Business 0 Industry 0 Other s. If Residence: # People # Bedrooms ,. # Bathrooms r XDishvasher 0 Garbage Disposal /yfashina machine Cl aaseaant/Pluabiag 0 Sasesrant/Ho Plumbing 6. if Business/Industry/Other: specify type_ # People # sinks # Commodes # shomme # Urinals # ?eater Coolers I! >!'OODSERVICS: # Seats Estimated Nater Usage (gallons per day) 7. Type of water supply: County/City 0 Nell 0 Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes 0 No Hyea,what type? ***IMPORTANT"'**CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST RESUR W7M by the client with THIS APPLICATION. Property Dimensions: See b2�a W WRITE DIRECTIONS(from Moekaville)to PROPERTY: Tax Office PIN% # ►?-38 P,r#-P1N- 0(V - 'l a10 DA Property Address: Road NVe 1L �O U l e . City/Zip - NCi ON i Hin a Subdivision provide information,as follows: lJ �.Y CSYL� �0� Gl�JOV Name: l ,Ul LJI T 4 -fC�(``�'�15 d Section: Block: Lot: �^ Date Property Flagged: This is to certify that the information provided Is correct to the beat of my knowledge. I understand that any permit(s) Issued herafter 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 Health Department to enter upon above described property located in Davie County and owned by LQt r rr Mx za'n i el Su l l der S In C. to conduct all testing procedures as necessary to determine the site mai DATE Q " n�" q -i SIGNATURE —✓ . THIS AREA MAY BE USED FOR DRAWING YOUR STTE PLAN elude all of e f g: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Oji rn�s t ors Date(a): Client Notification Date: EHS: Account No. Revised DCHD(07/99) Invoice No. f"' t• �• Y y . Tax Lot 38 6.4 Acres +/— Angie Iron Stake Found .-Total 30.00 35x•34 N 363402 2�• ��oab. 100.00 1/2" EIR 00 M N ►7 ~ 30,000 SF + N 30,000 SF + a� �^ V h �• 14 30,000 Sr + o 30,000 SF + W 4, o g N 336 w N N i. 53.00' 39.53' ~ 18 23.72 23.72' 13 �O 30,000 SF + �`` 30,000 SF + `O /2" EIP $ V` r° ent N 18.40'28"W 172.68' 15.00' N 23.5423"W 192.35' c 12 g 30,000 SF + Q t 'X30,000 SF + IoW N � � (n y2► 35.69 1/2" EIR _ �.�. 116.8 N 102.50 30.54' S'22°6 1"E S2302 •• +' IRS 30.02' `_ .............. — 291.95' p 96. Davie .Academy 1 RR Spike Found n. .` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900063 Tax PIN/EH#: 5708-06-7210.12 Billed To: Larry McDaniel Subdivision Info: Oak Crest Sec.2 Lot#12 Reference Name: Janice McDaniel Location/Address: Davie Academy Road 27028X1 Proposed Facility: Residence Property Size: See Map Date Evaluated: �6 �C Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH T6" Texture group Consistence =C__ / 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 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 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 05/99(Revised)