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278 Pepperstone Dr Lot 21. DAVIE COUNTY HEALTH DEPARTMENT /r/ -Y dam 1100 Environmental Health Section ° P. O. Boz 848/210 Hospital Street MockrAlle, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900478 Tax PIN/EH #: 5820-75-6142 Billed To: Jimmie Caudle Subdivision Info: Pepperston Acres Sec.1 Lot # 21 Reference Name: Jim Caudle Location/Address: Pepperstone Drive -27028 Proposed Facility: Residence Property Size: 100 x 270 **NOTEQ* Tlii sgmprov ement/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 CCTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type HQ V5 #People #Bedrooms #Baths Z Dishwasher: IP""'Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Suppl4DPtJ f Design Wastewater Flow (GPD) :5gt2 Site: New 0lRepair ❑ System Specifications: Tank SizeAL. Pump Tank GAL. Trench Width7tX Rock Depth le' Linear Ft. �' Other: 2 a1S'i�1�a-� �c7yCt:,S, ��ST��- L,.�ts,S �l a•G rK•�.J. Required Site Modifications/Conditions: )N�ST41 — 0"-)C�.JTOc�Q, 1G.:�� �� 0W "o ja; ! o 00-- 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 a.m. or 1:00 p.m. to 1:30 p.m. on the day of insta lation. Telephone # is (336)751-8760.**** W 1-7)()C.> �P 7 - LA -SC 1-0-T #{ 20 Environmental Health Specialist's Signature:C7-�-�-Date: R DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900478 Tax PIN/EH #: 5820-75-6142 Billed To: Jimmie Caudle Subdivision Info: Pepperston Acres Sec.1 Lot # 21 Reference Name: Jim Caudle Location/Address: Pepperstone Drive -27028 Proposed Facility: Residence Property Size: 100 x 270 ATC Number: 2297 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 Fonm/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 Tre ent and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CO CT N I ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signator : Date: o9A, 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. , % V)t 1 Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) FI[ �— APPS �FOR SITE EVALUATION/IMPROVEMENT PERMIT a ATC uNno� 31AII Davie County Health Department H11d3H 1d1N IM081AN3 Environmental Meath Sm fon fJAN 0 2000 .O. Box 848/210 Hospital street 00T 0 � Nd(' Mocksville, NC 27028 111111111NTAL HEALTH (336) 751-8760 MG INFOamicon I8 PRWXDED. Rohr to the Mr==XOH BULLETIN for instructions. I. Name to be Billed --�! Contact Verson wiling Address /� Ease s'baz►e _ 9a city/state/222 /circyzA.9-�D� � Business Mme — Z • items on perait/ATC it Di!lerent than Above C+�' Nailing Address city/stay/alp s. Application For: 0 Sita Evaluation 0 Improvement Permit/DTC Both e• system to service: E'House 0 Mobile Home 0 Business 0 Industry 0 Other _ S. IP Residence: ! People ! Bedrooms � - I? !Bathrooms = oi•h�nshes o Garbage ai pe•d ff"Washing Machine O sasenent/aivnbing o aa.denthto plumbing 6. z! swine••/:nawtry/other: ap.oity type ! Deopl• — ! sinks ! Commodes ! shower• ! urinal• ! Water Coolers _ it FOODSE MCE : # Sean Estimated hater Osage (gallons, per acyl 7. Type o! Water supply: ff County/City 0 well 0 Community e . Do you anticipate additions or expansions of the facWty this system Is intended to serve? 0 Yes 131�0 If yes, what type? ***IMPORTANT*** CLIENTS MW CIOMPLETETHE REQI/IRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN RWTBESUBAHTrED by the client With THIS APPWCATION. Property Dimensions: _ %400 DC' O WRrM DIREC171ONS (from Mocl aville) to PROPERTY: Tax Office PIN: # s go2d - Al 7;1s L/SPL Property Address: Road Name o VV Clty/Zip If in a Subdivision provide information, as follows: Name: �� e S0A ,e Section: _ 7 Block: Lot:. LDate Property Planed: 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, anderztand that I an responslbk for all charges Incurred from this appUcadon. I, hereby, give consent to the Authorized Representative of thety Hpa es rtment to enter upon above described property located bt Davie County and owned by to conduct all testing procedures as necessary to determine the site snitch ty. ' 6 DATE J—JO-06 % / / SIGNATURE THIS AREA MAY BE USED I Property Imes and dimensions, Revised DCHD (07/99) X�OUR SM icks, and sei AN Udciude all of the following: Existing and proposed locations). Site Revisit charge Date(•): Client Notification Date: I EHS: Account No. Invoice Na ` �� • �fo�a��s�� � o2J DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME Annz ADDRESS PROPOSED FACIILTY DATE EVALUATED �'L PROPERTY SIZE LOCATION OF SITE Water Supply: On -Site Well Community Public l� Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position .Cr .G Sloe Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH r Texture groupC' Consistence Structure ie A' Mineralogy i HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 77 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: 9 REMARKS: DCHD(01-901 EVALUATED BY: OTHER(S) PRESENT: 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 28 C23 377. .,.— 27 C24 317.63' 83.84' N/A C25 417.2Y 55.04' 27 C26 417.23' 112.50' _ S Q PAUL G. HENDRICK If Gx 50 sl GN?s 860 TAX LOT # e 7� DEED BOOK 3 3 62 PAGE O 6 50�p G x 7 2� LINE Ll 1 � � 152 .351 cp 1 � (p�e s 7504'oo,� o z o.oa o o� � =: + 2�' � o X24 O`• 00 k - 1 0 6S. 0o c14 cis C% °110x70 SL - J �_ ` 230 73 CURVE i 4 l• _ 20' PA,VEM�Nt 95.69+ - � U <? - A `p o s IM `° s° �D 1p o a_ o v ° 18 'o rw o o_ kLv1 0 ��y) A 70.00 11,.96' 112.00 112 00+ EDITH BROWN RUMMAGE'_ TAX LOT 0 74 MAP G-3 09, Totoi DEED BOOK 047 PAGE 206 RAPHIC SCALE 100 200 goo GENERAL NOTES: s LOTS SERVED BY: • PRIVATE INDIVIDUA 6 NO DRIVEWAYS SH Oft A STREET RIGH 0 ZONED R -A 9 2675 LINEAR PEET DAVIE COUNTY HEALTH DEPARTMENTI-Vy'aQ'a� 1100 Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 989900478 Tax PIN/EH M 5820-75-6142 Billed To: Jimmie Caudle Subdivision Info: Pepperston Acres Sec.1 Lot#21 Reference Name: Jim Caudle Location/Address: Pepperstone Drive-27028 Proposed Facility: Residence Property Size: 100 x 270 **NO " Vi bfinpro?eme TE* nt/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 H0056"'— #People #Bedrooms 3 #Baths 7:2- Dishwasher: Dishwasher: P"" Garbage Disposal: ❑ Washing Machine: Ir Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 13Lot Size Type Water SupplA--!?4 Design Wastewater Flow(GPD)�t2 L Site: New Repair❑ System Specifications: Tank SizetOCCbAL. Pump Tank GAL. Trench Width7tX Rock Depth le' Linear Ft. 2!�� 1 Other: IanTLk� L.-,-a .S �l�•C. rw�.J. Required Site Modifications/Conditions: lt�'I"Al_�- �� C-a.�1•iOJQ, 1C,r�-� �' F�6-� 0,L-r,-g. ld Z5-Z%- IMPROVEMENT/OPERATION iZ%-IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6 K 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 a.m.or 1:00 p.m.to 1:30 p.m.on the day of insta lation. Telephone#is(336)751-8760.**** 2 �►I � y 1-7 100 LAs w�„J, �•c! 1 JA ,w Environmental Health Specialist's Signature: Date: R DCHD 05/99(Revised) DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900478 Tax PIN/EH#: 5820-75-6142 Billed To: Jimmie Caudle Subdivision Info: Pepperston Acres Sec.1 Lot#21 Reference Name: Jim Caudle Location/Address: Pepperstone Drive-27028 Proposed Facility: Residence Property Size: 100 x 270 ATC Number. 2297 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 Tr ent and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CO CT N I ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa Date: m/94" 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 arantee that the system will function satisfactorily for any given period of time. , zlz 1=2� Septic System Installed By: AO"i Environmental Health Specialist's Signature: ate: 710 DCHD 05/99(Revised) IIpPr� FOR SITE EVAWATION/IMPROVEMENT PERMIT 6C ATC AM=31AVO IK L`'-i� Davie County Health DepartmentH 1d1N11N081AN3 Envimnme ta/hWfh Sayan JAN 1 Q 2000 .0. Box 868/210 Hospital street OOOZ 0 Ndr Moakaviile, MC 27028 ENVIRON ENTAL HEALTH (336)751-8760 p ** I8 APPLICATION CRIMM SA' BROCa883D MWSS AIS. UIRZD INrORt+ 210H I8 PROVID$D. Rater to the IN101tI+1 2100 SMUTIN for instructions. 1. Nans to be shied {G Contact Verson WALUinq Address I e,,O Av,, d noes: shone 4t9� City/state/1523, &kwlI tzTA n 42-OA 7r suainess Phan a (?=��3 2. Nar on 3,erait/ATC it Di::,rent than Above Idiliuq Address Cit:/state/sip 3. Application ror: 0 Site =valuation 0 Improvement Permit/ATC WSoth a. system to services 80House 0 Mobile Home 0 Business 0 Industry 0 Other c� s. It Residence: # People # Bedrooms _ # Bathrooms Dishwasher O Garbage DisposalQf siraainq 112duns a sa..eent/3,1n binq 0 sa..wenuNo Plumbing 6. it swinese/2ndustry/otters speoity type t People + $sults # C000des # showers # Drinals # later Coolers Ir 1=81IAVRCi: # seats satimated Nater Usage (osuc+s 3,•r day) 7. Type of Water Supply: ff county/Cit, 0 Well 0 commial tyy e. Do you anticipate additions or eipalulow of the facility this system Is intended to serve? 0 Yes 81N0 If yes,ghat type? •**IMPORTANT'**CLIENTSMMCOMPMMTHE REQEUMPROPERTYINFORMATION REQUF.STED BELOW. Either a PLAT or SITE PLAN UMBESUBM 77ED by the client with THIS APPW CATION. Property Dimensions: 1DD ,9C WRITE DIRECTIONS(from Moclwlile)to PROPERTY: Tai 08ice PIN: # -5 gid -7-4/- 6//4/ 6161 Al -7;.0L v. � /s y► L/��j►�/i Property Address: Road Name &VO ►�d ,cfi �l'�dld�1��Ta yr �li CityrLip aS .0 If in a Subdivision provide Information,as follows: Name: PeVlple ksyleA e V iv Section: 7 Block: Lot: Date Property Flared: This Is to certity that the Information provided is correct to the but 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 U the luformadon submitted In this oppilation Is falsilied or changed. I,also,understand tint 1 an responsiblefor all charges lncamrd from this appUcadom I,hereby,give consent to the Authorized Representative of thety Hal apartment to enter upon above described property located in Davie County and awned by b to conduct A eating procedures as necessary to determine the site sultab ty. h DATE I `— d SIGNATURE J Atv�, A�4 THIS AREA MAY BE USED FfG OUR SITE kAN clads all of the toUowing: Esisting and proposed property lines and dimensions, cks, and sep c locations). Site Revisit Charge Client Nottilation Date: ERS: Account No. Revised DCHD(07/99) Invoice No. <�� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME an�z DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY /' sP LOCATION OF SITE f�Jtiwf r Water Supply: On-Site Well Community Public l� Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Sloe Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH r Texture group 17C' Consistence rl Structure Mineralogy / HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION PET I LONG-TERM ACCEPTANCE RATE 2 f SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: D y 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-Finn 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 MineraloMineralory 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 28 C23 377. -- 27 77._- 27 C24 317.63' 83.84' N/A C25 41722 55.04' 27 C26 417.25' 112.50' _ _ 8 Q 4 PAUL G. HCNDRICKS 6 50Gx 50 Stew ?s 0 TAX 86, e 77 DEED BOOK PAGE O L3G6.01 MAP 3 �P 0 x 1 22p 8' LINE Ll L2 tD O 152 3s, � q va"' 28 S 7's. 4b � al `� °! 0 2 3 o �� 26 . • of ; :k _ . . O _ C14 C15� ,,_� J .(110 x 70 SE 230 73' CURVE f 4 1 - ` 20) Pp�VEt'hE'NT _C21 95 .691 -- V 00� C18 i fir' 0 1M ee e.,41 o m o o ° 18 0 10 1 0IS O-Is � n 70.00 176 .36� 115.3? 1 111.96, 112.00 112•°Ot EDITH BROWN RUMMAGE I6, TAX LOT f 74 MAP G-3 0w -Totol DEED BOOK 047 PAGE 206 GENERAL NOTES: LOTSRAPHIC SCALE 0 PRIVATE RINDDIV DUA 100 200 soo 6 NO DRIVEWAYS SH OR A STREET RIGH 6 ZONED R-A 9 2675 LINEAR PEET