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138 Pepperstone Dr Lot 5 i�x ��; y ._r.Y,. ...rr "'7` .y'r..'-7I}1n:P�)'1 .i�;�'r={(^+.14n"ri+lV �i.K+ts.n.,a.,�;-^"ry`or'rrtt::r:as+*Rpt•-c'"u^7» u•-. ti�. 'r.�='p.Ya'.i't-,�^a`1rc.lti�FsF-d'Y^a--•�''t•'+�'M��.�� AUTHORIZATION NO: j 75A DAVIE COUNTY'HEALTH DEPARTMENT . A 4 . ; . Environmental Health Section PROPERTY INFORMATION Permittee' P.O Box 848 Name: / S~Mocksville,NC 27028 Subdivision Name: Phone# 336-751-8760 ^' Directions to property: (D©� a C "titr" Section: Lot: AUTHORIZATION FOR P.,4 .41h' WASTEWATER Tax Office PIN:#y-Z— 6:5 -—� SYSTEM CONSTRUCTION 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 Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I I of G.S.Chapter 130A,Wastewater Systems,Section 1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION �y ICA- 1 �5 IS VALID FOR A PERIOD OF FIVE YEARS. ENUR&NME T H ALTH SPECIALIST DATE ISSUED !� umnON FOR SITE EVAmUATION/IMPnOvmw PEEmMR&An d Davie County Health Department Environmental Healffi S&don 0P.O. Box 848/210 Hospital Street Mocksville, NC 27028 LZN (336)751-8760 *** ** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED ION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. (' 1. Name to be Billed Contact Person E�a Nailing Address C some phone '?_b'7 City/Stats/ZIP4d-*10-010 NC. 2-)bAs-tp Business Phone 3�C0 �N�ZS rte_ 2. Nan* on Permit/ATC if Different than Above Aailing Address City/State/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: ,'louse ❑ Mobile Home ❑ Business ❑ industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms: 6IR-_ .0'Sishxasher ❑ Garbage Disposal U*ashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/industry/Other: Specify type # people # Sinks # Commodes # Showers # Urinals # Nater Coolers IF FOODSERVICE: # Seats Estimatee. Water Ussge (gallons per day) 7. Type of Nater supply: krCounty/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system Is Intended to serve? ❑Yes R<o If yes,what type? ***IMPORTANT***CLIENTS MUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. rcve--Iv Dimensions: WRITE DIRECTIONS(from Mockwille)to PROPERTY: Tax Office PIN: #-5-92,0 1 cQ Y-n, P— Property Address: Road Name 130 T City/Zip nrl D r- A- ) If in a Subdivision provide information,as follows: �1�� 4 Name: rAts 12 Section: Block: Lot: Date Proms:ty 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 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 ��.-X ' 'l to conduct all testing procedures as necessary to determine the site suitability. �— DATEla 7 SIGNATURE . THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): J Client Notification Date: ¢: EHS: Account No. Revilsed DCHD(07/99) Invoice No. ... ✓..:'fir ' � %'y .R .. •�}}aEjj Y/,"" � Y'�r� :ar-.�: ��,...Py Y .�- i .r.: ". ' ,e' .'' " .0� 1 : ,- .. -r ...,: . ..�.•1 1' -� i''i"R„c. -15 75 }Q ,oA DAVIE COUNTY HEALTH DEPARTMENT T PROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION P itte -f f A/4 Subdivision Name: :Directions to property: G�lfllt `,�' % r:,��_r Section: LoG y IMPROVEMENT PERMIT. Tax Office PIN:# �r Road Name: ��i;2.. r.4 Zip: r '') **NOTE**This Improvement Permit DOES NOT authorize the construction or installation 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. compliance compliawith Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE •; PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER E ,JRCSNM117 ALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE A #BEDROOMS Z#BATHS�—#OCCUPANTS ° GARBAGE DISPOSAL.Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE - #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) NEW SITE fir' REPAIR SITE LOT SIZFA�O SYSTEM SPECIFICATIONS: TANK SIZE/ GAL. PUMP TANK b GAL. TRENCH WIDTH� ROCK DEPTH �� LINEAR Fr OTHER - ! fip C Y Is O h 0-0”c1 REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT*APPROVED EFFLUENT FILTER* *RISER(S) IF 6" BELMJ FINISHED GRADE* . 1, 5 APEA 75 **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS 0700634;SZOOX (336)751-8760 1 OPERATION PERMIT YS M TALLED BY: 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 1 I 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 05/96(Revised) CA-1119N FOR SITE 1EVMUA110N/IMPR0VEMENT PFAMIT di ATC r Davie County Health Deparbnent ". • , Em fleealifl SWUM P.O. Box 849/210 Hospital Street PP��►► Noakaville, NC 27028 ENTAD HEAUH (336)751-6760 U�V�RONM COUNSY t* RTANT"*t THIS APPLICATION CMMT HR PRO=SSAD UWZSS ALL THE REQQJIRED INFORMATION IS PROVIDED. Refer to the n0VPM M108 BULLETIN for instructions. Ham 1. Nato be nillod `I ) CeliawS Qy1? lei[O py Contact person Nailing Address SFO/ vt Rd_ gonia ghann pct 2� City/state/ZIP 111 ocKsvi'�l� 7�C.� Business Phone 2. Name on Peadt/ATC it Different than Above Mailing Address City/state/Lip 3. Application For: U Site Evaluation 1/Impsovement Pertait/ATC ❑ Both 4. system to service: 40113e ❑ Mobile Home ❑ Business ❑ Industry 0 other S. if Residence: 8 People 8 Bedrooms .3 8 Battmooms Z-- T Dibvasrer n wrba" Disposal `f/Washing a Basement/Plumbing o Sasemeat/No Plumbing S. If Boslness/Industry/other: specify type • People * sinks t+ Gamaodes ti Shoxers tt Urinals # Water Coolers IF FOODSERVICE: tt Seats Estinated Water Usage (gallon■ per day) 7. Type of water supply /: 'h� Cannty/City 0 Well ❑ ccm=mity s. Do you anticipate additions or expansions of the facility this system is intended to serve! 0 Yes 6i�Nv If yes,what type' "IMPORTANT"'CLIENTS wST C0.A1PLETE THE `REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBAlITI'ED b the dteat witb THIS APPLICATION. Property Dimensions: /&K D X 3a I WRITE DIRECTIONS(Brom Mocksville)to PROPERTY: Tai OMce PIN: # S8 2.0 $"S -700.3 -DDS 60/ At0 if 7ra4d %I-T 04 Property Address:.. Road Name Bmea.sTo,.je-- DtZ ��N niLstZ �Q �, �1•-� pN City/zip, OCC�.S�il(�% 1�1C� - '�ePA 7t��uei Q- LO S U In a Subdivision provide information,as follows: . C,, Name: "orpPZAS7D�JA 3-9ThSection: Block: Lot.. 5 Date Property flagged: s" /3-95-- This is Is to certify that the information provided is corw.t to the best 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 ie falsified or changed. 1,also,anderstaxd that I am respmrsMkfor all choges Incumd from this appMeadlon. 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 to conduct all testing procedures as atxesury to determine the site suitability. DATE ' 13 - SIGNATURE THIS AREA MAY HE,USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property Rua and dimensions, structures, setback:, and septic locations). ov Account No. 20 1 Revised DCHD(07/98) Wvoice No. DAVIE COUNTY HEALTH DEPARTMENT t Environmental Health Section Soil/Site Evaluation NAME ,,7r•1 DATE EVALUATED l/� S'� ADDRESS PROPERTY SIZE ` Y�4C PROPOSED FACIILTY �`►'� (' LOCATION OF SITE �i�.�1�✓P Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit !/� Cut FACTORS 1 2 3 4 Landscape position & Sloe % ' HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH f Texture group Consistence Structure J 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: EVALUATED BY: Z �/,/it 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(01-901