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142 Pardue LoopCONSTRUCTION Tax Office PIN:# - - AUTHORIZATION NO: 002009 A Road Name: Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Fom-dAuthorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ENVIRONMENTAL HEALTH SPECIALIST ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION /. // _4c/ IS VALID FOR A PERIOD OF FIVE YEARS. DATE ISSUED 7"�p�� RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOM # BATHS -�_ # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No Q (/."r`7 4 .1616 LOT SIZE I TYPE WATER SUPPLY © DESIGN WASTEWATER FLOW (GPD) / °�� / NEW SITE REPAIR SITE Imo — �AI � I I ,r l SYSTEM SPECIFICATIONS: TANK SIZEL QQ/✓ GAL.' PUMP ANK GAL. TRENCH WIDTH ROCK DEPTH % LINEAR FT. If REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT r / Ul FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. 1 OPERATION PERMIT ` � t N Ise p -box faxG�k SYSTEM INSTALLEb lie AUTHORIZATION NO. OPERATION PERMIT BY: DATE:' **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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. DCHD 02/02 (Revised)''f t �` I 44� ��a l c c Co I Z� i l�pol Permietee's - DAVIE COUNTY HEALTH DEPARTMENT IMme: "-' l i G J 1 ' ` �� f1�-i_j Environmental Health Section PROPERTY INFORMATION 1�b P.O. Box 848 Directions to property: Mocksville, NC 27028 Subdivision Name: J c ij+ / t & Phone #: 336-751-8760 t V 4� oc.c r(� I - �� r Section: Lot: I c (p t I AUTHORIZATION FOR 1A WASTEWATER CONSTRUCTION Tax Office PIN:# - - AUTHORIZATION NO: 002009 A Road Name: Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Fom-dAuthorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ENVIRONMENTAL HEALTH SPECIALIST ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION /. // _4c/ IS VALID FOR A PERIOD OF FIVE YEARS. DATE ISSUED 7"�p�� RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOM # BATHS -�_ # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No Q (/."r`7 4 .1616 LOT SIZE I TYPE WATER SUPPLY © DESIGN WASTEWATER FLOW (GPD) / °�� / NEW SITE REPAIR SITE Imo — �AI � I I ,r l SYSTEM SPECIFICATIONS: TANK SIZEL QQ/✓ GAL.' PUMP ANK GAL. TRENCH WIDTH ROCK DEPTH % LINEAR FT. If REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT r / Ul FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. 1 OPERATION PERMIT ` � t N Ise p -box faxG�k SYSTEM INSTALLEb lie AUTHORIZATION NO. OPERATION PERMIT BY: DATE:' **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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. DCHD 02/02 (Revised)''f t �` I 44� ��a l c c Co I Z� i l�pol .• PermRee s ," DAVIE COUNTY HEALTH DEPARTMENT NArne: �� C '^ ` r i' ► Environmental Health Section PROPERTY INFORMATION t- P.O. Box 848 Directions to property: r MoAsville NC 27028 Subdivision Name: Phone #: 336-751-8760 w �, . F : < < �� , h Section:_ 144 AU R'AOSTEWATOFR OR SYSTEM CONSTRUCTION Tax Office PIN:#_ AUTHORIZATION NO: 0 0 2 n g A Road Name: Lot: Zip: **NOTE** 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 Office when applying for Building Pen -nits. (In compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ' a ENVIRONMEN-I AL HEAL I H SPECIALIS I _ ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. DATE ISSUED /, �Q;^ t 5 til c / T' RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE 1 ( TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) / }, NEW SITE REPAIR SITE L,--- SYSTEM J -- SYSTEM SPECIFICATIONS: TANK SIZEtG 0 P TANK'S✓1J ► GAL. TRENCH WIDTH li ROCK DEPTH I . LINEAR FC. , GAL. PUM REQUIRED SITE MODIFICATIONS/CONDITIONS: 11 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. u OPERATION PERMIT ,ry�� g SYSTEM INSTAL ED n r n� 5 a v I _ _i7 AUTHORIZATION NO. OPERATION PERMIT BY: % (/6/A 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 FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02/02 (Revised)) • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION cvf c. &bJ5ji0t_4j Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit PROPERTY INFORMATION 7 �r' v Gt o__4 XOY A,�QcL.,c.e j /SIC -D 7d 6 Public I --- Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % y HORIZON I DEPTH 07 q Texture groupC 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 •?'l SITE CLASSIFICATION: V LONG-TERM ACCEPTANCE RATE: �• 7� REMARKS: LEGEND EVALUATION BY: !1 6 A,,V-id,;, 1 OTHER(S) PRESENT: dc— /1 Sy`d4J 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 Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm 3YCt NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic 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 05/05 (Revised)