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125 Oak Leaf Ct Lot 17 ! 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#: 57084)6-7210.17 Billed To: Larry McDaniel Subdivision Info: Oak Crest Sec. 2 Lot#17 Reference Name: Janice McDaniel Location/Address: Davie Academy Road-27028 Proposed Facility: Residence Property Size: See Map ATC Number: 2540 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 Trea ant and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CON U IS V ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: ;� p 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. AAt)wL Joe Y.-t 7, �s iq 7' S -7 Septic System Installed B : eP Ys Y Environmental Health Specialist's Signator e: t90 DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT IP-11- /0.13 a Environmental Health Section P.O.Boz 848/210 Hospital Street MockrAlle,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900063 Tax PIN/EH#: 5708-06-7210.17 Billed To: Larry McDaniel Subdivision Info: Oak Crest Sec. 2 Lot#17 Reference Name: Janice McDaniel Location/Address: Davie Academy Road-27028 Proposed Facility: Residence Property Size: See Map ATC Number: 2540 **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 Cone #People 14 #Bedrooms 0:: #Baths 2— Dishwasher: V, Garbage Disposal: u Washing Machine: uQ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size ©gL4$WRRSType Water Supplyexo%)TV Design Wastewater Flow(GPD) D Site: New 17( Repair❑ System Specifications: Tank Size U00 GAL. Pump Tank kMO GAL. Trench Width,'—'to Rock Depth 12 Linear Ft`s Other: 3 P----.,OTio.1 Required Site Modifications/Conditions: tom'-QLL, ©-J c�70t x. y rte, F �O�of-P LA IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contaq4—re-prescptative of the Davie County Health Department for final inspection of this system between 8:30 a.m.to 9:30 a.m.or 1 p.m.to 1:30 p.m.on a day of installation. Telephone#is(336)751-876 .*�***.1 y w � � x- r x AFMnx, 2co' 1W'CCN / I Environmental Health Specialist's Signature: Date: S DCHD 05/99(Revised) • ,APPUCATiON FOR SITE EVAU ATION/IMPROVEMENT PERMIT&A ff'Z15VEK01 Davie County Health DepartmentP.O. Bos 648/210 Hospital 8trestMockaville, NC 27028(336)751-8760 ***ZMPCR?WV** THIS APPLICATION CAM= ffi YP=WSD UrII283 ALL 20.UQUIItiD� Ig"OI=TICN IS PROV=D. t�weerto the nu=mTIGN BOi.LaTIN for instructions aided . 1. sane to be L-D rr Ll M�.l ajli e I A jii'l e �J ra cootsat vacam o—n i Ce. ��Q.YIa eJ 1"414aq Adde"s 2D JSQNL f5l1 MGM Mae 3&D-Qq8- 4Lu3a csty/stat./:zV Nu YsSo d( _a N(.4 'QJQ;�% 3.3La- 1s 1- C1 Ona Z. xar on V6=Lt/Arc it Different than Aba", L.n rr Q MC)c n i P I P1 :i 1AeY_c; 1lailiW Address r ��C 51r1 city/state/asp Mo(�u*1I1,P&� NC, r97: W 3. Application tor: D Site ivaluation XImprovemeat Permit/ATC 0 Both 4. syetas to serslloes House 0 Mobile Home 0 Business 0 Industry 0 Other _S. If Residemn: # People # Bedrooms 3 # Bathrooms nssbraah.s xoarba" Disposal AI►ashin�1hoAiae O saseaent/aluebing 0 X"Suent/No slnsbis>q awiaess/Zndust:Y/otb", specify to e # secpie # auks # Caoodas # shovers # t:riaa7.s # MUM Coolers IF 1=82RVICa: d Seats Estimated Niter Usage (gallaae per day) 7. Type of water supply: xcounty/city 0 Nell 0 COMEMity a. Do you anticipate additions or expansions of the facility this system Is intended to serves 0 Yes 0 No ltyes,what type? ***IMPORTANT***CLIENTS MUST CIOMPLETE THE REOWRED PROPERTY INFORMATION REQUESTED BELOW. Either s PLAT or SITE PLAN MUST BE SUB1li 7M by the client with THIS APPLICATION. Property Dimensdons: C'�ee- be-I nuJ WRITE DIRECTIONS(from Mock ilk)to PROPERTY: Tax Office PIN: # T- � ["• v)'lo$"a-s'- 'i al .! Property Address: Roalt'Nsme��.UV\ �,C O.C��i . �0a�),1PS� AL vie.a exnd�, City/Zip I V 0CMV 1 (,e- ZCa OY�� V l G Arno cmT If in s Subdivision provide information,as follows: on Name: �� e5�" i1�h5 C�� (n► �-► SecNou: 4P Block: Lot: LDate Property Flagged: - V Tits Is to certity that the information provided Is cornet to the best of my knowledge. I understand that any permlt(s) Issued bereatter aro subject to suspension or revocation,U the site plans or intended use change,or U the Information submitted in this application is falsified or changed I,sho,andealand that I an reVond Ne for oil ckga Iacrrred front Ah appllcadon. I,bereby,give consent to the AsOorized Representative of the DavieCoon�y I De en to enter upon above described property located In Davie County and owned by I--C1 r►'�l Il`l�e 1 t� (1L KL. to conduct all testing procedures as necessary to determine the site suitability. DATE a ';� SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLANelude all of the following: Existing and proposed property tins and dimeusious, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: ERS. a3' Account No. OL -?-' Revised DCHD(07199) \off. o Invoice No. � l 0 0 i 13 �' -OW CREST . Phase Phase V: - .15 Phoae N QR Q - Oa�C , ea Court 16 1� v i a - Sa Piibt R/W 34'_i l-x Pavemer !s e µ N' �� / 1/2"EIR y 17 18 ;: fir„ �. 0.94a Acres f/ Phase'N LA ol J 125.15' S 5r'1 44"W 1/2"E1R 104.23'S 58.�1"W 1/r, 1/2"OR APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC a v *� Davie County Health Department D Environmental Health Seddon SEP 21999 ' P. . Box 848/210 Hospital Street Mockaville, NC 27028 1 7 (336)751-8760 Y" 0 ***Sj ANT*** HI PLICATION CANNOT BE F==SSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED.ED. �R/efeer� to the (�11=3 4ATION BULLETIN for instructions. 1, hams to be sillsd L...!�rrC/ /Yl.C. .0 i-ii e-' 1 )tti �ders coutsot Person "l Ce, IV�•�.bayuI Mailing Address �O1L 5�t-1 SoPhone 3 QQ8' 4� Rom 3a city/state/zIP Business Phone 331Q- -15 1- a10QQ 2. Name on Permit/ATC if Different than Above Lnv-rQ Mc-T) -n',r 1 :i I(iem Mailing Address 2za `J rig city/state/zip 3. Application For: Pite Evaluation 0 Improvement Permit/ATC 0 Both 4. systea to servios: House 0 Mobile Rome 0 Business 0 Industry 0 Other 5. If Residence: # People # Bedrooms 3 # Bathrooms a' �Dishwaandw 0 Garbage Disposal , washing umftine 0 Baaamant/Pluabing 0 Bassment/No Plumbing 6. If ausiness/Zndustry/Other: specify ( `type # People # sinks # Commodes # showers # Urinals # Rater Coolers IF FOODSERVICE: # Seats Estimated water Usage (gallons per day) 7. Type of Mater supply: XCounty/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***CLIENTS MAST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: �`ee'bo nLJ WRITE DIRECTIONS(from Mocloville)to PROPERTY: Tax Ofllce PIN: # :Er Property Address: RoaAshne o� City/Zip I V cj��1 �\e- C' pica cmQ( If in a Subdivision provide information,as follows: 1`v Name: � QS+ � Ul (nl Section: ln� 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 ase change,or if the information submitted in this application is falsified or changed 1,also,understand that 1 am responsible for all charges incurred from this applicadon. I,hereby,give consent to the Authorized Representative of the Davie County Ifeaith De rtment 1 to enter upon above described property located In Davie County and owned by LQ Y rti21 Kr- to conduct all testing procedures as necessary to determine the site suits DATE o�"�GI SIGNATURE TILS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(In ude all of the owing: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(a): Client Notification Date: EHS: Account No. Revised DCHD(07/99) �0� Invoice No. 0 0 ' Tax Lot 38 6.4 Acres 70{0l 3p•pp Angle Iron Stake Found 352,34 N 36 34. `02 Iro ab• 100.00, 1/2" EfR 3.5,00 y 30,000 SF + N 30,000 SF + g 4 30,000 SF + 14 1 30,000 SF + N �'. p, 34.73 3,r,)31 X96, 1 ` 212.9V 40 8' o� g % N3� 3 0 0 0 cn a 53.00' 18 23.72 23.72' 13 0 30,000 SF + 30,000 SF + o� r rn 12.E EJP v to ent N 18.40'280w J 72.68' 15.00' N 23.54'23'W 192.35' g � g 19 N 0 12 g 30,000 SF + O 30,000 SF + 40 0 y 35.69 1/2" E1R 116.82' _. .r--- N 102.50 �'�, 30.54' S 22�2621"E S 23028'. .r r IRS 30.02' 291.95' P 96.8! 7• Davie .Academy .R RR Spike Found DAVIE COUNTY HEALTH DEPARTMENT • w Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900063 Tax PIN/EH#: 5708-06-7210.17 Billed To: Larry McDaniel Subdivision Info: Oak Crest Sec.2 Lot#17 Reference Name: Janice McDaniel Location/Address: Davie Academy Roaq-27928 Proposed Facility: Residence Property Size: See Map Date Evaluated: 191WO Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Sloe% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON 11 DEPTH 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 .. 1 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)