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167 Pepperstone Dr Lot 36 ,.;,�f; «,.. ,r".F�a•}.>tt� ♦- � �`,��`S 3 �'f Y.w:; .:�rro'- ri.. 4 a t .-r•f:.�,.,y a,.,,e-w.s.;y..P.;*}. .«.�: .--�.;i-e�•'r.r.- ..,.,+. ,- ,.•:..- i A tl-lOmZATION NO: 15 3 6A DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permittee s- P.O.Box 848 . Name: L► Mocksville,NC 2702E Subdivi ion Name: Phone# 336-751-8760 •; Directions to property: Section: Lot: �.-- (� r^ AUTHORIZATION FOR WASTEWATER Tax Office PIN:#fezo SYSTEM CONSTRUCTION �TO,�t: t' 's►. Road Name: "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 1 of S.Chapter 130A,Wastewater Systems,Section:1900 Sewage Treatment and Disposal,Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION h� IS VALID FOR A PERIOD OF FIVE YEARS. , L HEALTH SPE I LIST DATE SSU D t 'Y�j9 TAT <i f _� _ - v..- --i ., •ir- i-7. ..{app .-,,, y, ,..F,_ . _ .:.- - f --, . .g�, ��;�� �►+_, i v ��6A DAVIE COUNTY HEALTH DEPARTMENT -,r, IMPROVEMENT AND OPERATION PERMITS` PROPERTY INFORMATION Permittee=s NaFtt : t1 j { Vl }'' CrY'r_,s ] Subdivision Name. .. Directions to property: A�_�r� t�.4 �1�-' Section: Lot: IMPROVEMENT. -,, - -1� '-.-����. •� PERMIT Tax Office PIN:#` - f .r� t_� t' �C C L.. �'�^�►- Road Name: [L :.! 'Zip: **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. (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATTON IF SITE PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER �-.r. - ; SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE ENVIR AL HEALTH SPEZ IALISTI DATE SSU D T . c.....-- INSTALLING THE SYSTEM.. RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS�7�#OCCUPANTS GARBAGE DISPOSAL:Yes.ghNtj COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE' TYPE WATER SUPPLY �v DESIGN WASTEWATER FLOW(GPD NEW SITE REPAIR SITE+ � SYSTEM SPECIFICATIONS: TANK SIZE t L' ? GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. OTHER 2 TCrt Q t ISI 110 a YVX4LM-5 i -1 / REQUIRED SITE MODIFICATIONS/CONDITIONS: I���LL ON CTI t0(�i 4� � D�F.��� �./D Rd odsf IMPROVEMENT PERMrrLAYOUTI*APPROVED EFF'LUEUT FILTER& +QISER(S) IF 6" DELOV FIRISRED GRADE* Lj �IooSG • S loti .• �o'M,a 10 -10 **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(;84}(, 4.8 9ZX3L�X7Z}rX3i I�3b)751-f17b© OPERATION PERMIT KU SYSTEM INSTALLEDBY: � ar g� Cb p AUTHORIZATION N0. �OPE K N PERMIT B DATE: **THE ISSUANCE OF THIS OPERATION _Tr SHALL DIC THAT THE SYS M SCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S.CHAPTER 1 -SECTION 00" AGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM FUN S CTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96(Revised) APPUI Al10N FOR SITE EYALUAIION/IMPROVEMENT PERMIT& Davie County Health Department Envlmamenfal Healfft SeWon P.O. Box 848/210 Hospital street �t� Hooksville, NC 27028 AM 2 3 IM (336)751-8760 ' IAA ***nWORTANT*** THIS APPLICATION CANNOT BE PROCESSED MUZS3 M Lm01ffMNTY INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed k4:-7 r Contact person Mailing Address o6a 7-16Bowe Phone �� Idle city/state/LIPd C/'�S /// /Y easiness phone d Z. Name on Permit/ASC if Different than Above Nailing Address City/state/Lip !. Application For: U Site Evaluation 0 Improvement Permit/ATC e8oth a. system to service: 110'House 0 Mobile Home 0 Business 0 Industry 0 Other a. Iff Residence: # People # Bedrooms # Bathrooms fs Dishwasher 0 Garbage Disposal 6 hashing Machine 0 Basement/Plvsbing 0 Basement/No Plaubing 6. If Business/Industry/other: Specify type # People # Sinks # Casaodes # Showers # Urinals # Nater Coolers IF FOODSERVICE: 11 Seats Estimated Rater Usage (gallons per day) 7. Type of water supply: Wgunty/City 0 Well 0 Community 9. Do you anticipate additions or expansions of the facility this system Is Intended to serve! 0 Yes "o If yes,what type' e'"IfflURTANTA"CLIENTS AIUSTCOAWLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: Add/),e 96 WRITE DIRECTIONS(from Mocksville)to PROPERTY, Tax Office PIN: # jJ-7 'D �P Property Address: Road Name Lar IW City/Zip :alk IC <7,11'1' ,1 ah 4 If in a Subdivision provide information,as follows: Name: *A6 P �he Section: —L_ 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 penult(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 regponsiblefor 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 _ to conduct all testing procedures as necessary to determine the site suitability. rN A DATE `7 �v� 3 SIGNATURE THIS AREA MAYBE USED FOR DRAWING YOUR SITE P (include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Account NO. 2 3 Revised DCHD(07/98) Invoice No. ` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME 1_'A DATE EVALUATED ADDRESS PROPERTY SIZE l/G PROPOSED FACIILTY LOCATION OF SITE �� 1Jit/Gi Water Supply: On-Site Well Community Public L� Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupC 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 �f SITE CLASSIFICATION: /✓�� EVALUATED 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(01-901 rk S11BON610N ElY1TT11D PEPPE1t5TtkrE ACRES ' MTT7H ERi'YYI HAS BEEN Fr-�r.:U TO C01P1.Y-��iYGJ���OO^^^''' CRnENA AND CONDITIONS ESTABLM ED BY STATE LAM OR 9UB014TSIOM FtFf-IAATIONS FOR lifflE COUWY. D THElvalJOADM AMD THEStlIE IS FOU00 TO COMPLY WMI SUCH WJFTH CAROCNO, AND THAT nED NS PLAT He OWN APP"OBY THE C6 o CONOI7Xm6'E)M"T'AS F0100,N SUCH EYPA-UA OK FOR DANE COUNTY BOARD OF COM ISSIONM FOR NECCOROM IN 10 C7 IM EW"ATEN mo FSR LUMOMs SEF THE W TEN RF:1'W ON THE OFFICE OF THE REs;/s OR OF DEEDS OF DONE COUNTY. 0 Ca SW �,�. ca 9 ; .5 4 T §ffO:TICE M : TM COMnCAN DGS'', 5 DAZE � � / DARE COUNTY CLEW ,E COUNTY W.&TH OFFICM l 166.19' p _ ey•32'or' e s 8ro6'1T' a s a Z024o: �R---ROAD / ' 4�� 140.42'— — _ 78.76' 87.42_ 2.7 SO, , Ja 66.16' 115.46' 81•J2b4" C• 401, /.0�"�1" �a 15' 11►i►1►y C - - N 661 91�, e. c4J 8 WH►mM► / ,oit � (A-A ^ 4) m ID / ; 00 ��s O O 1:6chi civ O h k0)p� O OID r` 41 G Tr. N O cv 0 54.52' N 119.80' k6ry90 1,8 5 \ 115.11' ~ 40 G 115.481 �0\ Bp\ 01g S 80.29'59" 97.07' C 100.00' ==i� 0 G u Cb u \ I^ cv to m z cv ' ^ ILJ \ 'J z o J it m w 10.07, r I O C4 oT h \ pEppERsTo 115—ea,QN �s 115_0p, 7x•03'04„ e SRI V c3 _ C4 — 1rs`oo, 21.98, ( P(AdLIC / CURVE • 2 78.9e� 0 — , c h �1 a c7co c OS m 3 ,O w04 o 3 1 3� r o-R�' S 86• v1 I0 0 n 0 � L o ® h oo 3 3 co i� cv m _ - U) ` h 0 h o o �D v- 10 w ei 11 cn (v> ►� m {• !o °' ?1p O, N HA N 1,•1p'OO„ _ „8.221 N 83.54'00" 109.89' 256.37' W 19.9x, N 7g1 O9 8, W N 6� pe, 0` YHIC SCALE r-ATHERINE BAKER 73 6.26, I,1, 3 16, 1950�g 4l'29N IN JII