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279 Pepperstone Dr Lot 24 ` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001594 Tax PIN/EH#: 5820-75-6412 Billed To: NC Dream Builders Subdivision Info: Pepperstone Lot#24 Reference Name: Location/Address: Danner Road-27028 Proposed Facility: Residence Property Size: see map ATC Number. 2725 - 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 Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 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. _ e v� Septic System Installed By: Environmental Health Specialist's Signature:. Date: � ��- DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT to Environmental Health Section / P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT ,;2-2 q loop e r Account #: 990001594 Tax PIN/EH M 5820-75-6412 Billed To: NC Dream Builders Subdivision Info: Pepperstone Lot#24 Reference Name: Location/Address: Danner Road-27028 Proposed Facility: Residence Property Size: see map **NOT>:**lliisgin rovement/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 - " #People #Bedrooms --F #Baths –I— Dishwasher: Dishwasher: ;�/ Garbage Disposal: ❑ Washing Machine:901, Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seeats Industrial Waste: ❑ Lot Size Type Water Supply C a Design Wastewater Flow(GPD) (.�d Site: New M Repair❑ System Specifications: Tank Size`P) GAL. Pump Tank GAL. Trench Widthls�,/"'Rock Depth 14 Linear Ft.,74/ Other: Required Site Modifications/Conditions: 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 installation. Telephone#is(336)751-8760.**** Environmental Health Specialist's Signature: Date: !,f �f DCHD 05/99(Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT J &JD Davie County Health Department r1 r Environmental Health Section r~g P.O. Box`848/210 Hospital Street Mocksville, NC 27028 INVfRON (336)751-8760 DAV/,r TANRPALTH ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION .IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Nam e to be Billed �j} Q�� �'LContact Pe son-JM Mailing Address LV. �Q/flj tC S� Q/i , ai /h Ale �/�/_ Home Phone �--7 '7 Q �j City/State/ZIP S Al 1 �� 7C 0i z Business Phone / /- /1 S / r2 2. Name on Permit/ATC if Different than Above Mailing Address City/state/Zip 3. Application For: ❑ Site Evaluation improvement Permit/ATC ❑ Both 4. System to Service: X House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other ! ? l S. If Residence: # People # Bedrooms J # Bathrooms _ Dishwasher 11 Garbage Disposal -Washing Machine ❑ Basement/Plumbing O Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: PK County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes 4WNo If yes,what type? ***IMPORTANT***CLIE TS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: WRITE DIRECTIONS(from Mocksville)to PItOI'ERTI': Tax Office PIN: # _ 2 D — '76- - r% �L/A- Property Address: Road Name City/Zip If in a Subdivision provide information,as follows: Name: ' Section: 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 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 to conduct all testing procedures as necessary to determine the site suita DATE SIGNATOR /tom THIS AREA MAY BE USED FOR DRAWING YOUR SITE P (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic ocations). Site Revisit Charge Date(s): Client Notification Date: EHS• s 3� Account No. Revised DCHD(07/99) 2Z 33 Invoice No. Z-C) 0 �� ZY DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation NAME „SCI DATE EVALUATED ADDRESS PROPERTY SIZE �OAG� PROPOSED FACIILTY —cf��2, T LOCATION OF SITE 0,2122,LY/_ Water Supply: / On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position G G Slope HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH elkf' p/' Texture group Consistence Structure S6.e 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 y SITE CLASSIFICATION: -49 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 Mineraloju 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 watef 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 _.. ._ .. .......a. ur Inc wLrASNA OF DEEDS. R tS 11AViE COIN(TY BOARD OF C01ifO55i0gERS FOR RflWRDf1C IN . UJATM FVff HEREBY NOTED THAT SUCH.APPF^ft FOR RFOORDAm" DOES NOT THE OFFICE OF THE REG6TER OF DEEDS OF DAME COUNTY. E WRRTm FtEPOFtT ON INCLUDE APPROVAL TO INSTALL AND VnUZE SMttTARY FArKnXS A= .S Gf'J i DOES R INCLUDE FOR TM CONSTRUCWH OR OCCUPANCY ' .12 DATELUI►E COUP(TY PI/NRRNG - -- DAVE OF BU&r4NGS OR COLMY Cila1C , r' PROPERTY LINE CURVE DATA K LOT CURVE RADIUS I LENGTH I CHORD DCARING ~r. 12 C12 792.531 20.00' 20.00' N 80.24152" C 26 C13 719.131 4.27' 4.27 N 78951'42" C 25 C14 719.13' 140.22' 140.00' N 85.371050 E 24 Cis 719.13' 62.76' 62.741 S 86.1744" E ;URVE DATA 24 C16 55.00' 43.36' 42.251 N 61'12132" W CURVE f 4 23 C17 55.00' 35.301 34.70' S 20.14108" C 0 • 16'30'48" 22 cis 55.00' 42.12' 41.09' N 20'05117" E R • 689.13' 21 CIO 55.001 111.81' 93.53' N 78.44115" W T ■ 100.00' 20 C20 30.00' 36.22' 34.061 S 56-04157i"T L 198.61' ?9 z 6 0.TY 96.2P 96.271 S 80'233335"°W P EP P E 28 C23 377.63' 99.34' 99.05' S 024461220 E 27 C24 317.631 83.94' 83.69' S 02.4418" Cl N/A C25 417.231 55.04' 55.00' S 85.54'071 E 27 C26 417.23' 112.50' 112.16' S 82.35138" W C26 SIGN s'6j'4),°OM PAUL G. HENDRICKS SOEQ�,mant �6 •86, �° �)�) DECDTAX LBOOK 362 P GE 0 6.01 MAP 3 PROPERTY LINE TANGENT DATA CL oto x 70 SC 22o at 190 LINE DIRECTION DISTANCE L7 N 21.41103" E 43.4 23' MSC N 15239, L2 N 34.01126" W 0.691 TELEPI O S BEING TAX 1 <o_ '+� L%� Z �e0'Oo'75.54°p° C RECORDED IN N 7941'29" C 0' C1A < Z 23'2.41` ���� Z v o 24 0`` D JA a 0 7�gY u 5 0369` 103i•SO, 0 0 f r �s 26 >_ ; 5 0 / 23 99.15, b00 °��10 x 70 SE _ - cis C14 C?5-_._.{\s (x;RVts f 4 n �1 N 88709'05" E PA JFt.AENT � 741.36' 2O C21 95.69` 111:001- C19 i <? (p \ #m� o� �� � S s� 22,E°3 . J� o Zo m ' 7,9 J N JO� 01, O (p \.