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460 Redland Rd ;- „ � ,. , ,, . �:., : . _ . . - . . . - r. .. .. �� ,. , . f, t .. . , : � PermitteA's f f /,J D.VIE COUNTY HEALTH DEPARTMENT N a m e'.• '��f�� ' `� J� Ft'� �'' �r�y ��✓E n v i r o n m e n t a l H e a l t h S e c t i o n P R O P E R T Y I N F O R M A T I O N ` � c"_: " P.O. Box 848 Diryc6ons to property: � 5 r) �� Q Mocksville,NC 27028 Subdivision Name: f f/ /f Phone#:336-751-8760 Y� rrrr, 1�1 L-r�:� �G / (`}Q �r��/<<�-:%' Section: LoL• j ,� AUTHORIZATION FOR �� ! �� r /1 �j //G✓fil /�f7�''!��!.(�' �'ASTEWATER Tax Of�ce PIN:# `�= Q O�� ,FS�SYSTF.M CONSTRUCTION �l�rC� �/� r I � ,�/l AUTHORIZATION NO: 1� Road Name:�` �'� �' "�/ . Zip:�~ �� **NOT'E**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior ro issuance of any Building Permits.This Forn�/Authorization Number should be presented ro the Davie County Building Inspections Office when applying for Building Permits. (ln compli,ance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) %; .� l`.�,.-,r`,'L" ,'%' .r,,,,i*�� l�/�!�'� //, ***NOTIC�***TH1S AUTHORIZATION FOR WASTEWATER CONSTRUCTION •-y-�!"i'� ��`/�"��'�" �/ /��i� /C/ IS VALID FOR A PERIOD OF FIVE YEARS. ENViRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLF/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No G�'�i.(' /+ j LOT SIZE � TYPE WATER SUPPLY ( � DESIGN WASTEWATER FLOW(GPD) / � �NEW SITE REPAIR SITE �^'"'" �x;31,'�5 � / �� 7�, SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH J[� ROCK DEPTH / LINEAR�� ` �Uw D�� /�J�-�'o�« ��I, 1�,,,` ��`� oTxER r , �� QUIRED SITE MODIFICATIONS/CONDITIONS: IIVIPROVEMENT PERMIT LAYOUT ` � -�... 14l�� U�UG � �. �� ,: � /��. �`' � -. .�' So ' 'v � �, , ,� � � _.�,,,.� � ,�Y.�i 3� � �u � , —_._� o � v� —� �5� �p.� � / ,�,f � �1 � v � � � z ; o t R � � � c - s � � _ _____ �� .� 1 JO r i �-e w �� '' � �, -- -----._-- —.j . , � =- r� _��P -� `' � --- ` QU`r '�, � t FOR FIIVAL INSPECI'ION OF T[IIS SYSTEM PLEASE CALL BEI'WEEN 830-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760. OPERATION PERMIT �; /Q� � J I [�/ SYSTEM INSTALLED BY: (/►'CO �G..� / O� �� v p :; , r-- --�_ � �,�� t C � n� • v � � «� � � � � AUTHORIZATION NO.��RATION PER11[IT BY: � DATE: �� G —�� **THE ISSUANCE OF THIS OPERATION PERMTT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 1 I OF G.S.CHAPTER 130A,SECfION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WII.L FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. nctin o�,oz cxe��ua� '� �7 /T�X� � b `� . ' • ! '�...-»i ".�! ��.�r,."�.� .s�ti-:lr. , • ```L1 `_ F �_l^i"_ . � ( P a .�y:-: 7 i "�'L �, ..q�.. ..� r.._. •- ii�y' " � .. .. . i�Y+1 . ..� ; .. ._ ... � w. 1 ..-'. a.•' .�...�. 'k..�,..�.. S"�� .', . 4:' `� F � � . 'S.,. . . .. � �n�A�. �1 /l / e " cc �'s� I 1�„} DAVIE COUNTY HEALTH DEPARTMENT � � � . . — =Nam�,�~'� � `' � t' `A r ` �'� �� '� ��'%� ��s'"Environmental Health Section PROPERTY INFORMATION - 4 � "' � ; , _ P.O. Box 848 Dirgctions to ro ert : !�, `�y' L�� P P Y Mocksville,NC 27028 Subdivision Name ( J �/��] �r / Phone#�336-751-8760 ' ,r'! r",- / /It.l(= f /� -__` 4':`� /'�/,.-�1<`c1., � ` � Section: Lot: • ' %' f AUTHORIZATION FOR ' WASTEWATER �� '�r '� �7 �j /!��•l f�r�'i�L�{'� SYSTF,M CONSTRUCTION Tax Office PIN:# - - AUTHORIZATION NO: �Q��$ 1��/ Road N�e:`'��" `'��Zip: .?�� -� **NOT'E**This Authorization for Wastewater System Construction MUST BE ISSUEDby the Davie County Environmental Health Section prior to issuance of any Building Permits.This Fom�/Authorization Number should be presented to the Davie County Building Inspections Office when applyina for Building Permits. (ln compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) � �,,,._.!`'` �.;,% �, �;%. - ` ,/'***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ."'�'✓"' �-'��'�' - -=�r I` /�✓ �� t/ IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS� #BATHS #OCCUPANTS GARBAGE DISPOSAL:Ycs or No COMMERCIAL SPECIF[CATION: FACILITY TYPE #PEOPLE #PEOPLEISHIFT #SEATS INDUSTRIAL WASTE:Yes or No �O( �•, i LOT SIZE ' TYPE WATER SUPPLY'�v DESIGN WASTEWATER FLOW(GPD) / G �NEW SITE REPAIR SITE •"'" � C—x;3�,'�•5 �� ,� SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH�� ROCK DEPTH /�LINEAR FF�� L g r I�0'r ��.1 OT}iER � � J C!��'d�e ♦`�. �� V 7 . , QUIRED SITE MODIFICATIONS/CONDITIONS: - IMPROVEMENT P�MIT LAYOUT G L� � 4 � y�: . �'i�ll4� .. . . .. ��r,` '•. . �if �,��4 . , . .. . , .(, -v S� ' � � � �—\i� "Y �y• y°3' ��r� � �tt � . ` � . �5� s/n� � r` � , � �� z .. _ o � � � y � �. _V J� � "'� �. ` _,.—. �� ' .`,�,< .� , , _ I �tiucw �' �/ '" � � � � --�..._. _..,.� ' -- - �\ �u f� ;;. � ,.,( J �.i � �,_ . . �L�� _ �� Q_ � FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 830-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760. OPERATION PERMIT �_�� / = �� SYSTEM INSTALLED BY: � / `�� /(/ �O ; � _ � o�, � ; � � J . tL----------_ y . C,�,._. ,t— x , �� s �- ' . rd � P. \� ' � � �s s ` U v U V `R�i: � 0 � _ <.,e � �s cd . T � 1 AUTHORIZATION NO.�OPERATION PER10iIT BY: � � DATE: l V �(.� I r� ,. .. . - r,-. '•THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WTfH 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 SATISFACfORILY FOIt ANY GIVEN PERIOD OF TIME. ncxn ozoz cx��s�a� � �;�� `ti `77 r� � 5� � �G -�� j :'` ' DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) NAME � �CJ f �� -e�/ PHONE NUMBER 3 �5 ADDRESS �� G F � � cho�' �Q� SUBDIVISION NAME LOT # DIRECTIONS TO SITE � �� -- L'/� /�P��-c� K o� �C� [� / O�! � J u� � .�-Q-�`�.� ��M �a�. �� a� �-- DATE SYSTEM INSTALLEp � � � � NAME SYSTEM INSTALLED UNDER � TYPE FACILITY u NUMBER BEDROOMS 3 �d d NUMBER PEOPLE SERVED 3 TYPE WATER SUPPLY C. U SPECIFY PROBLEM OCCURRING /�G�' �`�t '�/� DATE REQUESTED ( ��v r � INFORMATION TAKEN BY This is to c�rtify that th�information provided ie eoneet to the best of my knowledpe,and I underaWnd I am nsponsib e aryes incurcsd from this application. SIGNATURE OF OWNER OR AUTHORIZED A ��/ Rw.1�93 DAVIE COUNTY HEALTH DEPARTMENT � ' � Environmental Health Section � Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION . .� C�'��v (�D �'.��<<.M�O /�� ,� b� ��n � � �Ua � Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit ✓ Cut FACTORS 1 2 3 4 5 6 7 Landsca e sition L Slope% HORIZON I DEPTH — Texture rou G Consistence � Structure Mineralo HORIZON II DEPTH Texture rou Consistence ' Structure Mineralo HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZAN IV DEPTH - Texture rou Consistence Structure � Mineralo � SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: �� EVALUATION BY: � � �LONG-TERM ACCEPTANCE RATE: • �� OTHER(S)PRESENT: ,.��Gr�N � REMARKS: . LEGEND �, n s pe 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 Tgxtur� � 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 oN�Y�• .rrc . � VFR-Very friable FR-Friable FT-Firm VFI-Very firm EFI-Extremely firm I�e.t . � � NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic - ' S r, ,r SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogv ' 1:1,2:1,Mixed � 1Yn..LeS Horizon depth-In inches Depth of fill-In inches Restrictive horizon-Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) Soil wemess-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-gaUday/ft2 , DCHD OS/OS(Revised)