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734 Ridge Rd �' . 't ' DAVIE COUNTY HEALTH DEPARTMENT . . • Environmental Health Section � P.O.Boa 848/210 Hospital Street � Mocksville,NC 27028 (336)751-8760 �-^�. � �, �U / Account #: 990003819 Tax PIN/EH#: 5707-61-7704 ,' _. Billed To: Richard Allen Sub-division Info: ��� ��3 Reference Name: Location/Address: 734 Ridge Road-27028 Proposed Facility Residence Property Size: 1.048 acres ATC Number: 4277 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLJST BE ISSLIED 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: � f � accepted Systems mav also be use CERTIFICATE OF COMPLETION 2- II - 4' ; **NOTE** ' suance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been m in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems," 1 in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period oftime. /�Gr I ��, �Git,�.� li ���� � � �J��doo � �� � i _ �,V' �G �� .G� '�. ,�0 'h0 �--I � �'W/YI }� r N �..._� —1� � a � �.�� ti �--- . � Septic System Installed By: ` Environmental Health Specialist's Signature: — e: " � DCHD OS/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT �/ '�,C1� . ��; "� • Environmental Health Section 2 �� �v � P.O.Boz 848/210 Hospital Street �v`` � _ Mocksville,NC 27028 (��S� �"� �S (336)751-8760 � v- pv l �� �I IMPROVEMENT OPERATION PERMIT �e� � �� � pb� �, Account #: 990003819 Tax PIN/EH#: 5707-61-7704 Billed To: Richard Allen ` Subdivision Infa Reference Name: Location/Address: 734 Ridge Road-27028 Proposed Facility Residence Property Size: 1.048 acres ATC Number: 4277 **NOTE**This ImprovemendOperation 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 PERNIIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMTT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People ! #Bedrooms � #Baths� Dishwasher� Garbage Disposal: ❑ Washing Machine� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply L-1� Design Wastewater Flow(GPD)��1�0!/ Site: New� Repair❑ System Specifications: Tank Siz����AL. p Tank GAL. Trench Widt �l�ock Depth��Linear Ft.�� Other: �/1�f'L /� � / �- � � � � � Required Site Modifications/Conditions: 6 s state in 15A NCAC 18A.1 IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EF�L� ��. �t�.�YS �2�'S gF� ELOW FiNISHED CRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 8:30 a.m.to 9:30 a.m. r 1:00 .m.to 1:30 .m.on the da of installation. Telephone#is(33G)751-87G0.**** � ' � Environmental Health Specialist's Signature: Date: � DCHD OS/99(Revised) � . � "V � ,• ' � . ' • � E1PPLfCA71UN FOR SI7C CVALUA710N/!h(I'ItOVL•h1FM PE•R�ti11T&ATC , Davie County Health Department • EnvironmentalHealth Section P.O. Box 848/210 Hospital Street � MoCks��.iio, ��c 27028 �• . (336)751-0760 �� ***IFlPORTANT*** TIiIS APPI,ICATION CANNOT IJE PROCESSED UNL�SS ALL TFI� RL•`QUIRED INFOR2•il►TION IS PROVID�D. Refer to tho IN�'OR2dA�I0N BULLETIN Eor inutxuctiona. 1. Name Lo bc Dilled R ����.���. � e /L. Contact Pcr�on �f�� q y— � 7dailing Addro�a �. Ilomo Phono '" I��.3�v.� C n City/Statu/ZIP �l � (� Au�ino3a Phono � ' 2. Namn on Permit/ATC ii Diffcront than 7lbova�/�C%j�y'� ���./''j Mailinc� Addroa3 _� /�'(.� Q City/Stata/Zip 3. Application For: Sitc �valuation 0 Improvemen� Permit/ATC �Doth 9. syacem co sorvice: O IIouucs �2�obile Homcs ❑ Duuine3u ❑ Induatry � Other S. Typo n}•atem roquc�tod: ❑ Conventional ❑ convantional modified ❑ innovaL•ivo pacCepted 6. If• Rn�idenca: p People �_ � Bectroom� � U DaL•2iroo�na � LrlDi�liwa�hcr ❑Carba�o Disposal CJWashing 2dachino, ❑IIasement/Plun�ing ❑IIaaement/17o Plumbing 7. IE Duoineaa/induatry /Otlior: verify type � � Peop1Q f� Sinka � Cosnmodoa U Showora tF Urinala p t•7aL•or Coolora IF I'OODS�RVICE: 4E Seata Estimatcd Water Uaage (c�allona per day) II. 2ypo of rrator aupply:�Coun�y/Ci.ty L� Wel1 � Community 9. Do fou anticipatn adclitions or cxpansioi�s of tlic facility tI�is s}�stc�ii is ii�tcndcd to sci•vc? Ll 1'cs �o � If��cs,titi•hat typc? **''I�iIPOItTitNT"**CLII:NTS AlUST COAIPLET�TII� RL•QUIXED PROPCRTl'INI�ORIYIA'I70N RLQULSTI:U Itl;LO1Y. Isitltcr�PI,AT or SlTC PLAV r11U.ST BESU1J1lfI77'ED b,y tl�c clicnt ivitl�TII1S APPI,ICATJON. l� Y � � � ` 1'ro �cr(}�lliii�citsioris: \VItIT�DI1tECfIO1�S(from 11�Iodcsvillc)tu P1tOPIsIt7'1':' •r:�r orr,��PIN: fE S".'7 fl`7 co l � 'Z 0�- � `� U�s� f1 r�a� �P_ D�r� � �-�,�i"! I'ropci•ly Adc1i•ess: Road Namc 7�' y��`4���f �I��C`' ' f� T' c;cyiz,I� ���5 �r���e, ��7� `�t � �)t _" d�S If iri a Stibdi��isiolc provicic i»forniatio�i,as fallo�vs: ` Namc: �'"7`_� Scc(iot�: I31oc1:: Lot: Datc Iiomc corncrs llaggcd: 1� � � '1'his is to cci-tify tliat tIic iufoi•iiiatio�i pi•ovidcd is coi•rcct to tlic best of ii�y I.no�vledgc. I uncicrsl�t�d tIi:it any perinil(s) issttcd licrcaftcr are subjcci to suspcnsion or rcvoca�ion,if tl�c sitc plans or intendcd usc cl�augc,or if tlic informalion subu�it(cd in lBis applic;►liou is falsificd or changcd. I,also,turdcrslu�rrl tlirrt I anr respa�siLlcfnr nl!chnr��es irrcrrr•rc�l jr��uc !lris npplicnfiu�r. I,hcrcb}�,bi�•c consent to tlic Au�borizcd Rcprescntatiti�c of tl�c Da��ic Cow�ty IIcaltli Dcpartu�cnt to critcr t�po�i abovc dcscribcd property�locatcd in llavic Cou�it}'and oti�•r�cdby to conduct all tcsling proccdures as��cccssar}'l0 cICICCIl]IIIC I�IC S1lC Slli�llilLl}�. � ���� Dit'I'I; SIGNr11'URL = TIIIS AItLA 117AY BL USI:D rOR DIUIIVING YOUR SITI;PLAN(Licludc all of tlic folloti��ing: L�isling znd proposcd property lines and Jimeusious, siructures, setbacics, and septic locations). � , � Sitc IZcvisit Cliargc ' � . Datc(s): ' Clicut Notific�tiou Datc: �I�IS: Sign bivcn '• wAccounl No. � �l t � Rc�•iscd llC1ID(O5/03 Iuti•oicc No. �1� �, � r jw.��. i . w' � . , - - r�. . . '' , . . • ' 1 . M M � � �� � � � O � �� m ! � / p \ , � C � / � \ ;, � DouglQs.Eric Cdrtner & wife, / ��"� ` \ ` Jennifer Page Cartner �� � , , o � � \ l�.B. 195, Pg. 832 / � o `. \ � ' Z ; �,\ \ . � � �n S 85°SO'35'£---. . � I E: � ,�4. �, 249.11 Tolo/ i i � � 194J4' Stone F `} \ a � found i � � �� � , � � � � SURVEYOR'S NOrES � \ �• Z N N . : � \ �� W� � � 1) Thls survey Is mad� � � ^ ` (� �N • � M ✓011yt H2l9JL C7'd?JBS mor bs dlsefoasd by a � � � N y � D.g. 1 Q9, Pg. 135 : s) Thls property doss 4 \ � � , 3) Th/s property ond c g , Lo t 1 R/A. � p+ 1.048 Acres+— � �� Ths lo�a shown h�r ; \ \ ` butlding sd—baeks as G � � Sides:— Fflhen (15) fe � \ "Pro osed new Ilnss" 5) rhls lot sho/l b. a� � � \ ` ✓ P "Confro!polnl" and ulllltles sasemsnt \ �'\ �\ Rebor fd. 6) Thls lof shoq be se � aJ slone � � \ lank. � Estate � `� �) rota�a�.a !n subd � 352 \ \t ` �� 8) ToloY number ol n � f I 549 \ � 9) Averogs fot sizs: i � 594 ' ' --.,orte�tatron rr�e�� � ) \ \ 10 Aroo In smaU�sJ { � \ ; � � \ � 11) No publlthed hor \ \� \ withln Z000 /eef ol th � \• Z y�j \ N � �`� �� � � i N w .: I ` `��"� �� N o • � yI � � j � � ��2��� \ \ 1�dvid Anthony Arr-angton � D.g. 109+ Pg. 133 � �5a- � � CJ (� ���', � , � � � , � ��� � � Q � �� � � �a� M \ I , N 05•,8�5a�-E . Frank . „Contro!polnt' 70.84' , SP�k, ,o��d� � Calahall in centerbne � \ , Deed Re , � \ � T � . M , , �' . DAVIE COUNTY HEALTH DEPARTMENT � �r Environmental Health Section + � � Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003819 Tax PIN/EH#: 5707-61-7704 � Billed To: Richard Ailen Subdivision Info: Reference Name: Location/Address: 734 Ridge Road-2702 ) ---� Proposed Facility: Residence Property Size: .1.048 acres Date Evaluated: / 1%! � Water Supply: On-Site Well Community Public � Evaluation By: Auger Boring_� Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e sition Slo % HORIZON I DEPTH /. �l Texture rou � Consistence y � Structure /' / Mineralo ' l�/ HORIZON II DEPTH `� - � - Texture rou Consistence ,� Structure / / Mineralo � HORIZON III DEPTH " � Texture rou / Consistence Structure Mineralo HORIZON IV DEPTH Texture rou - ' - � Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: � EVALUATION BY:�c �i LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: LEGEND � T, n s ape Position R-Ridge S-Shoulder L-Lineaz slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope T�xtutg � 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 CONSIST�.N . . 1l�lst VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm � � 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 Mineralogv 1:1,2:1,Mixed lY4t�S Horizon depih-In inches Depth of fi11-In inches � : Restrictive horizon-Thiclrness 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-gaUday/ft2 , DCHD OS/OS(Revised) ■�■■�■��■���■�■���■�■■■■�■�■■�■■���■0���ae�■■����■■����■�■�■�■�■�■ ■��■�■■■■■■�■�■���■■■�■��■�■■�■���■���■�e��■■■��■�����■�■�■■■�■�■ ■�■■�■■�■�■�■�■�■.��■■■■�■�■■�s■ ■■�■���■�■■oo■�■■■■��■�■�■■�■�■■ ■����■■■■�■�■�����■�■��■���■�■���■■■�■■o■��■■�■■■■�■��■■■■�■�■■��■ ■��■����■�■�■���■�■������■��■���■■■■�■■��■�■�■�����■���■���■�■���■ ■�s■■�■�■�■■�■�■����■�■��■�■■■■�■����■�■■■■■■�■����■���■��■■■��■�■ ■��■■�■��■�■o����■��■������■�■�v■�■■■■■■��■■■■■■�e■■���■�■�■��■��■ ■■��■■■��■e■�■���■������■��■�■■�■�■■�■■■�■�■■■�������������■■■���■ ■■■���■�■■�����■�■����■����■�■■�■��■�■�■����■��■��■�����■�■��■���■ ■���■��■�■�■���■�■��■�■���■��■����■■■s■��■�■■�■��■■������■�■■���■ ■■��■��■��■■■�����■���■■■�■��■�■ ■■■■����■■■�■■�■■�■■�■��■����t�■ ■■■�■��■�����■�■��■■■■■�■�■■�■��■������■�������■�■■■■■�■■■■������■ ■■■■��■■■■���s��a�■■■■�■��■■■■���■■■■■�■■■�■���■�■��■■����■�■�■��■ 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