124 Oak Leaf Ct Lot 14 DAVIE COUNTY HEALTH DEPARTMENT Pu-
Environmental Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 989900063 Tax PIN/EH M 5708-06-7210.14
Billed To: Lary McDaniel Subdivision Info: Oak Crest Sec.2 Lot# 14
Reference Name: Janice McDaniel Location/Address: Davie Academy Road-27028
Proposed Facility: Residence Property Size: See Map
**NOTE**'Tliibgmproveement/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 Holst-�, #People #Bedrooms ----3 — #Baths 2
Dishwasher: 19'/' Garbage Disposal: ❑ Washing Machine: Ise" Basement w/Plumbing:.❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size () "Type Water Supply`s W_ Design Wastewater Flow(GPD) Site: New Repair❑
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System Specifications: Tank Sizelh_A AL. Pump Tank GAL. Trench Widtht Rock Depth If'
Linear Ft.
Other: )Is -LatJiIO.J
1
Required Site Modifications/Conditions: L p.l C&"j 1 --S C� Zr63a-c� 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;�jn. or 1:00 p.m.to 1:30 p.m.on the day of installar* . Telephone#is(336)751-8760.****
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Environmental Health Specialist's Signature Date: 912J610
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 #: 989900063 Tax PIN/EH#: 5708-06-7210.14
Billed To: Larry McDaniel Subdivision Info: Oak Crest Sec. 2 Lot#14
Reference Name: Janice McDaniel Location/Address: Davie Academy Road-27028
Proposed Facility: Residence Property Size: See Map
ATC Number: 2537
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 WASTEWA CO ION I ALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signatur . Date:
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.
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Septic System Installed By:
Environmental Health Specialist's Signature: Date:
DCHD 05/99(Revised)
` APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERM do ATC
Davie County Health Department `
Env,F Founts/Hes/th S'eWan EDG 2 2 2000
P.O. Bos 048/210 Hospital Street
Mookaville, MC 27029
(336)751-8760 - AVIE COUNTRY LTH
***zwcazum*** THIS APPLZCRTIOK CUMT in PROC:Bfiw MQXS8 ]ILL To RZQO M
1DT7mmZON IS PROVIDZD. Rehr to the ZHIMB►TION BIILLZTIN for
instruotious.��
1. xalme eo b. sul.d contact Pace n y1 OUn i cp2.pI V/L
Msilinq aadss* .a.. shoo.
city/saa/:u Ma Y,SV I Ile-, Mc, a-7G408 su.in..s sin. /���(0- -151 - qac- �&
s. nese on semit/uc sr/a�i�sr sent than
q wo... �1Qhhl^ ►��', I�(.�i OC�hn� �r1 G.
ULtLU hddsese X�_1 l vitt:/d�taa/spa �11 112 . IJC. c�'10
a. ]►pplioatioa tors l7 Site =valuation X zmprovesoeut Persi0 Both
a. Rete s to &*wine$ House 0 stabile eosin 0 Business 0 Zodustry 0 Other
s. u RSSideaoe: #/#``People i Bedrooms i Bathrooms
*htrYh.r 0 Oasb" Oisposal O aaeer*nt/91=biaq 0 smaew.nt/xo phab aq
.. _! Business/Iad"UT/others speoiip type i teopi* i sick*
i commodes i shower* i Urinals i water cow a s
zIr >f=SSRnCi: 6 Seats Zstimated Nater Osage (gallons per daw)
7. Type of Water SUPPLY: YCouaty/City 0 Well 0 Cosuwnity
I. Do you anticipate addidons or expansions of the facility this system is intended to serve? 0 Yes 0 No
If yes,what type?
***IMPORTANT***CLIENTS MWCOMPl.MTHE REQLQRF.D PROPERTY INFORMATION REQUESTED
BELOW. FA&w a PLAT or SITE PLAN MU8TBESUBMITTED by the dint with THIS APPLICATION.
Property Dbunsloss: SQ.,' MD WRrM DUMMIONS Mus Modu4b)is PROPERTY:
Tu Office PIN: * T- 1 1�-3Cb��(1 P5'lC,$� blp-,a�o •�`�
Property Addrm: iLoadName���'Ve- �CA�eXr ,
y
citymp 60%x,i Il e, A'1003 1 e
If In s Subdivision provide Information,as follows: r)ak .Y t'�-� r)n 7 O,I�r d loo -
Name: �`1C.YQo�� j J ACA: 'I'Y� C mile- .
Section: / Block; Lots _ Date Property Flagged:
This Is to certify that the information provided Is correct to the but of my knowledge. I understand that any permit(s)
Issued bereafter are subject to suspension or revocation,If the site plans or Intended use change,or If the information
submitted in this application Is Milled or changed, It slap,undeMend that I art rrapondble for sU cbangm kaundfrom
IAds apPllca6m Is hereby,Sive consent to the Authorized Representative of the Dav�ie, c4an ROM lkpac en4
to enter upon above described property located in Davie County and owned by.�A�.[. i ,1 -- aMers Inc.
to ended all tesdag procedures as necessary to determine the site suitability,
DATE� aa� SIGNATURE-P1 r V 1
THIS AREA MAY BE USED FOR DRAVWNG YOUR SITE PLAN(Include aU of the following: Ezkft and proposed
property Hues and dimensions, structures, setbacks, and septic locadoru).
kQ; 't�.C,�LQQ(� Site Revisit charge
Date(s):
Meat Nodfleadon Date:
EAS:
3�
Account No. (p (- 3
Revised DCHD(07/99) Invoke No.
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OAK CREST"
88.48"03•M1 '�ST 'CGlond 'Roc
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APPLICATION FOR SITE EVALUATION IMPROVEMENT PERMIT&ATC a
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` • ` Davie County Health Department
EnVM007 nenfRI MOM SeCNon SEP 2 1999
P.O. Boz 848/210 Hospital Street
Mockeville, NC 27028
(336)751-8760
Q
***I1�ORTl11tT*** THIS AIP>?LICATION CA1tItOT BE PROCE88ED t�liLE$$ ALL TAE R,EQIIIRED
INFORMATION IS PROM ZD. Refer to the nVORM 1010 BU=19W for instructions.-� n
i. slam to be Billed I Ma
contact person .,n', ,.epp�C�IJail
Hailing Address mom Phone 33�o- Opp LAU
city/state/:zp _M(x h'rw i Ile, Mr, a-70-q8 so.iness phone 3a D- 151 - q0'lel"
s. Naas on permit/ATC it,,Different than Abovs o n h h t 4 d- 11.1 0 0 I A1',�c,U Q1dQJ1/1)� 'nnc-
lalling Address 0{"JU I. l City/state/sip oc 'E' ]1 1� e-, { �V�c�"10o`�
3. Application for: �Site 3valuation 0 improvement Permit/ATC 0 Both
e. system to service: House 0 Mobile Home 0 Business 0 Industry 0 Other
S. If Residence: !#`people # Bedrooms # Bathrooms 1
Dishwasher 0 Garbage Disposal q Washing machine 0 basement/Plumbing 0 Basement/Ho plumbing
6. If Business/industry/otherI specify tno # people # sinks
# Commodes # showers # Urinals # Yater coolers
If FOODSERVICE: # Seats Estimated (tater Usage (gallons per day)
7. Type of water supply: County/City 0 Well 0 Community
9. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes 0 No
If yes,what type?
***IMPORTANT***CWENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPWCATION.
-1
Property Dimensions: SZc1� �� WRITE DIRECTIONS(from MockrAlle)to PROPERTY:
Tax O®ce PIN: NT
1� A W41'S�1C Culp`
Property Address% RoadName \{'If_ � 1 PXY\U
Citylzip �C, \I I ��Z O�� J �-C—A 6f\TCkye'2 PM0 _
If in a Subdivision provide information,as follows: ��,Y P.�„ nn a1 X� -
Name: 6aY\cn,6+ L4 �C&tm l� md-e--
Section: oZ Block: Lou 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)
tuned 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,understand that I am responsible for all charges incamd from
tills appllcadom I,hereby,give consent to the Authorized Representative of the Davie Conn Hea1W Depa ent
to enter upon above described property located In Davie County and by La YYII �C,�CI_Xl iel�U 16crs I no.
to conduct all testing procedures as necessary to determine the site tab
DATE 'c9 q I SIGNATURE G� /
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN elude all of the foAowing: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
k Qp o ( Site Revisit Charge
�'"" Date(s):
Client Notification Date:
EHS:
Account No. QK-3
Revised DCHD(07/99) Invoice No.
- 1 .9
it
Tax Lot 38
6.4 Acres +/—
Angle Iron Stake Found
4 1°{O 30•p0
I
352.3
N 36 34 o2,W 222.34.
�' .00,
,()0.00'
3 1/2" EIR
.00
►r1 N !.'�j i
tn
I �
30,000 SF + N 30,000 SF + 0�
17 k,�oh
30,000 SF + 14
30,000 SF +
34.73 .tf
A
F 19e�j, '`� rw 40'� 212•g8,
31.36'
cn cn cj 53.00' 39.53'
18 23.72 23.72' 13 0
30,000 SF + o, O � 30,000 SF +
12�� EJP � `O
snt N 18.40'28,W 172.68'
15.00' � N 23054'23'W 192.35'
� g
g ' 30,000 SF + 30,000 SF +
N
V
N
35.69 1/2" EIR
cn 50.00' 116.82'
102.50 30.54' S ~—
22°26'21"E S 2302
!. IRS 30.02' r� `--— 291.95' P 96.
1' _ _ --
_ - Davie .Academy 1
RR Spike Found
• r-.r n 4 _4_ A n
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 989900063 Tax PIN/EH#: 5708-06-7210.14
Billed To: Larry McDaniel Subdivision Info: Oak Crest Sec. 2 Lot#14
Reference Name: Janice McDaniel Location/Address: Davie Academy o d-270 8
Proposed Facility: Residence Property Size: See Map Date Evaluated: A
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit J._� Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Slope%
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group �i
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: P,L EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: i Z 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
Mineralog
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)