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165 Redfield Rd •3, .W 0`4 #i �`K+t'!YPa., ''i7.-+.xtr Hva -n.. -,fn "�-a,.i f ,,•-:W- .r` . w.:4[ ', . ,. � t.-_,,. ., -ew. -, .,.t,.. �" DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT PERMIT **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) 0 PROPERTY ADDRESS �C� C'-�c�.&�. ! DATE LOCATION d SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yeso COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE # PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE XNe TYPE WATER SUPPLY k,„L DESIGN WASTEWATER FLOW (GPD) 7,4d NEW SITE I-,-'REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE&Q GAL. PUMP TANK{ A)GAL. TRENCH WIDTH :'?/ ROCK DEPTH 1,2� LINEAR FT. � OTHER XOYfrS r REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. Al �y 1= W IMPROVE T PERMI BY **CONTACT A REPRESENT, IVE OF THE DAVIE COIN) HEALTH RTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8e30-9:30 A.M. OR 1: 1:30 P.M. ON THE DA OF I A�,t<ATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT S EM INSTRLLED BYL�� $t•L AUTHORIZATION NO. �_ OPERATION PERMIT BY C./ 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 10/95 ' Davie County Health Department ENVIRONMENTAL HEALTH SECTION P.D. Box 665 Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) ***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 applyi ng for Building Permits.*** NAME / i�'/�!f /O i! DATE /��,�„ AUTHDRI NATION MMR N2 N2 0262. MOE ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM e **WICE*#* THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR PERIOD OF FIVE (5) YEARS. . ENVI AL-HEALTH CIALIST DATE ; DCHD 10/95 � a 16 s ..-. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE T O lti ✓ Davie County Health Department Environmental Health Section ' P. o. Box 665 JAN 1 6 1996 Mocksville, NC 27028 ��ryry Ti11 , 1, Application/Permit Requested By ` Ai5fs Mailing Addressy �Ar F� Home Phone C- � b ),;1-- Business Phone 9 )b 74,to 17�G� 2.<Name on Permit if Different than Above ` 3: Application for: ❑General Evaluation Septic Tank Installation Permit 4: System to Serve: I"House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # E. ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms Elwashing Machine No. of Bathrooms VDishwasher ' �� Dwelling Dimensions Q.Garbage Disposal 6. If business, industry,place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures f, 7. Type of water supply: ❑ Public 2-Private ❑ Community.' `C 8. Property Dimensions O r ��e3 S Sewage Disposal Contractor a: 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 0-'No I t. If yes, what type? f 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to i. revocation, if site plans or the intended use change. Effective October 1, 1989. �. PROPERTY INFORMATION REQUIRED: Directions to Property: Tax Office PIN // x ��PP Road Namei;��; Box # (if available) i City FA �•�{ b� �6L�L-u��r,{1�. �bA� � r r..Z '�.�Zra �e�-� oJ �h�'J•.,l t= �of1 A4 �72d�r,,ILT',� �, 5 �..� keq-4 -;S;) `tJdBo..�� 6ke-�+ N 'T i w l This is to certify th t the information provided is correct to the best of knowledge, and I understand am responsible for all charges incurred fro Sthi�plication. DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: W41 I OWN the property. ❑ 2. 1 DO NOT OWN the property. } If you checked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative f tDa ie my Health Department to enter upon above described property located in Davie County and owned by r :ar to conduct testyig procedures as necessary to determine said i e's sui bili for a groutd a orption sewage treatment and dispo sy f 6 175 5- ; DATE SIGNATURE i. e DCHD(1193) r, ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS PROPERTY SIZE C PROPOSED FACIILTY LOCATION OF SITE Jac Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit - Cut FACTORS 1 2 3 4 Landscape position —727— 7 Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Y— Texture group. Consistence Structure C Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESSJ. RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION T7_1_ 775 LONG-TERM ACCEPTANCE RATE (, SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: L OTHER(S) PRESENT: REMARKS: LEGEND Landscape Position Q� R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope (5' 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 ;lay loam• SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-V=:!.-y 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 ■■■.■■■■■■■.■■■.■■■■■■■■■■■■.■■■■■■.■■.■. ■■■■■■■I■■■■■■■■ N■■■�■ iiiiiiiiiiiiiiiiil��iiiiiii'iiii■■iiiiiiiiiiii'i'i=i�i'iiiiiiiiiiiii mom NMI M'=mom .OPENS ■■■■■■■■■■■■■■■■.■■■■■■■■■■r1■■W■■■■N.SM...MM■■■..■..■eeN.■■■N■■ ■..■■■.....■■■..■■■■■■...■.■.■■.■■■■■■■■..■.■■■IJ ■ ■■■■■■■■■■■■■■ ■.■■.■■■■..■■■■■■■■■...■.■■■■■■■■■■■�■Ne■■�.....■ ■.ON.�MONSOO■■� ■■■■...■.■....■.....■.■..■■■..■■■■ ■ ■■■■■. ■■■H■■■■■■■ ■ ■MENS ■■■■NM■■■N.■■■.SM...■■eS.■■..■■N.■ ■■■..S■..■HOee�O�■■..e�■■IMMIN ■■.■■■■N■.0......■.■■..■....■■M�.....HH.�:�'�N��■ NNE ■■■.■■■■■...■.■■■■.M.N.■■■..■...■MN■■■■■■■■■'■=■.MEE MEMM■MNMEN MEN MONSON ..■. ................................................= C MIMEME MEMEMMC :::0 MEMNON .....................u.■■MM■■.■�■■■■H■■NNMHHN■■■■■■ MEN■■■N. 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H ■►�■ mom MONSOON ■■O. ....eN..NN■eeee.lN■►■e ■■ ■ ■ .N ■ ■........E■i■...■EI/......■■■■ME..O■ ■ u■ `M■ ■■■■E ■■.■■■■■■■■N■■■■■t■■■■■■■■N■.I/■■■,N■■N N ■Eli. ■■ ■.■.■■■■■.■■■■■■■■►/■■■■■■■■■I■■MINE ■ ■■■■■■■■■■ MARIMMEMMUMMERMAINMEMENNO ■MME■■ ■�.■.■■■■.■■■■■■ ■■I■■■■■.■N ` ■ SN■ ■ ONN■■■ ■ONSON ■EEMHENNIN■SSONCN■UMMH■ �■■ ■ No ■NMMEMHMM■M■E■ EMMENOMMENNOMENS so mom No MEMAIMMEMEMAMEMEM .......N■■■■■■■■■■■■■■■■■■■■■■■ NM■MM■■M■■■■■n■■■■MMMMMMMMM■■■ ...................................... .......................... .................................................................. ■■..■MN■■■■N■.■■M■■■M■■M■.■N■O■.■■■M.NH■■..NNNNN■■HEM■...NNN■MN■ ■.■■...■..■...■......■■.■.■.■■ ■E■...■■E..■..■■■■..■■...■.■.E■■ Davie County Nealtk Department and Nome Nealtfr Oyency - 210 HOSPITAL STREET I P.O. BOX 665 MoCKSVILLE.N.C. 27028 PHONE:(704) 634-5985 March 20, 1996 Michael Poe 4750 Country Boy Ln. Clemmons, KC 27012 Re: Site Evaluation Redfield Road/10.3 acre tract Dear Mr. Poe: On March 14, 1996, this office evaluated a 10.3 acre tract .on Redfield Road in Davie County. The soil conditions on said tract are classified from provisionally suitable to unsuitable for the installation of septic tank systems. There are also several springs that would prevent the installation of septic tank systems. Topography also presents some problems due to the complex slopes and gullies that exist on the property. The only area that is acceptable for the installation of'septic. drain fields appears to be under Duke Power's right-of-way. In order for this office to issue a permit using this right-of-way, an easement must be granted by Duke Power for the proposed installation. This must be done in writing and submitted to this office before any permit is issued. 1 If you have questions, feel free to call. { Sincerely, Robert B. Hall, Jr. , R.S. Environmental Health Section t RH/wd x Enclosure cc: Sam Simmons/Duke Power s� j . • Dake Power Company (919)835-6769 461 Winston Road P.O.Box 829 Elkin,N.C.28621 05 DUKE POWER Duke Power Company Rights of Way and Properties Management Elkin, NC March 27, 1996 RE: 1I94 Idols Tap to Mitchell River Tie Duke Power Company does not object to the installation of sewer drain lines on our transmission rights of way, as long the County Inspector sends a letter to Duke Power Company stating that the only option the property owner has is to install their drain lines on our rights of way. Duke Power Company shall not be held liable for. any damage to these septic tank lines by our personnel and/or equipment. Also, all grading shall be at least 20 feet from each structure. Enclosed is our Rights of Way Restriction Sheet for your reference. Thank you for contacting Duke Power Company prior to your construction. If you have any questions, please call me at 526-2574. If you agree to follow these restrictions, please sig his form: Mike Poe Sincerely, Sam Simmons R/W Specialist, Jonesville 910-526-2574