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146 Rocky Hill Trail (2)IMPROVEMENT PERMIT a, ' DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION 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) PROPERTY ADDRESS M0 m *- : '/L'7 DATE f , LOCATION l`i �"" i C- �br SUBDIVISION NAME LOT NUMBER��, �t SEC./BLOCK NUMBER i RESIDENTAL SPECIFICATION: BUILDING TYPE � BEDR60MS--:7 # BATHS r . # OCCUPANTS GARBAGE DISPOSAL: Yes/No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE TYPE WATER SUPPLY AUe// DESIGN WASTEWATER FLOW (GPD) NEW SITE //-"REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ��' ROCK DEPTH XJ ' LINEAR FT. OTHER 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. IMPROVEMENT PERMIT BY //,15W **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY AUTHORIZATION N0. OPERATION PERMIT BY 4/ 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 Departments C' ENVIRONMENTAL HEALTH SECTION P.O. Box 665 Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) �X u :1714 /o-q-%� w b� ° t0i ***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 applying for Building Permits.*** NAME � U DATE/� AUTHORIZATION NUl'R NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION COMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM APPLICATION FOR SITE EVALUATION/IMPROVEMENTS P Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By Mailing Address eo �6 91( Home Phone - /UV-//n//1nyt /c,X /7 / Business Phone 2. Name on Permit if Different than Above 3. Application for: ❑ General Evaluation Septic Tank Installation Permit 4. System to Serve: ❑ House �_ _� 21 Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry N Y ❑ Other ❑ Unknown( -4,1 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People �- ❑ Basement/No Plumbing , No. of Bedrooms ❑ Washing Machine No. of Bathrooms ❑ Dishwasher, Dwelling Dimensions ❑ Garbage Disposal l / 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 a � Qr 7. Type of water supply: ❑11LLPubbllliic El Private ❑ Community 4, £- `�j"(5LCT_ 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes KNo If yes, what type? *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: PROPERTY INFOrUNIATION REQUIRED: q.q k4'� Tax Office PIN ,� O©r% Road 'Name f- U Wv L Lk' � Dox # (if available) u City This is -to certify that the ir'rformation provided is correct to the incurred from this application. M/_s/'q(o -Z DATE -Z) knowledge, grrV undersl#rV I am responsible for all charges CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1. 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 of the Davie unty Health Department to enter upon above described property located in Davie County and owned by Iq to conduct all testing procedures as necessary to determine i rte's suitabr a g�nd absorption sewage treatment and disposal system. // DATE DCHD (1193) IGNA tt" -- I ww� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME i �� DATE EVALUATED "L' �� I ADDRESS PROPERTY SIZE�� PROPOSED FACIILTY/� LOCATION OF SITE Water Supply: On -Site Well ti' _ Community Public, Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L, .-- Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH /o % -� Texture group Consistence Structure 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 tf , , SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD (01-901 EVALUATED BY: AL& OTHER(S) PRESENT: LEGEND Landscape Position R -Ridge S -Shoulder L -Linear slope FS-Footslope N -Nose slope CC -Concave slope CV -Convex slope T -Terrace FP -Flood plain H -Head slope 'r__t. ._ 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- Vl---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 ,3C --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 ■��■��■��■��/�� ■■ ■/��N��n�� u�� ■��■�� u�/ ��r� ��/�� ■��■��■��\�� ........................................�=C:C�.:��..��........... ............................................. . . ............... ............................................ ..�.... ............. ■��H��■■�� ■�� ■��i��■\�� v �� 5■� �� ■��..■■ ��n�■� �� N��■�� a��■ ■■��■��■�� ■ ■ ■ ■ ��■�� ...........................C........... ..us�. �.a ....�.....�.. ........................... ........... ... .. ...�.... ..... .. ................�......... ........... .. .�. . ... ..�.�._...... ::C:::::::::::..,*�..............._...... �.._� •=�C:� . . .. . s�a��n��■ �� n�i�i� ��■��r��i��■��u�■��■��i�� ■��■�■��:.■�r�� u■��w�u��u�� ■��■�■��■■��I/��I1�� !■�� N �� i��■��r��■��■�■�i��i�� i�uua��u�� ■�■��r��■��v� ■ �� ■ ■��■��a�� ■ �■�� u��r��■■ �■�i�� ■ �s� �■��i� n�■� ..................■.�......�■......■_.....■■.■■C��■�.■C■.�.._..�■ ■��■��ii�N��r��■�� ■ �� ■ ■ ��n�■��'�rHht/��l��H��N�u��N�� ■��■��'�� N� ��n�� ■��M�� N��W�� ■��■��■��i��M/i�� u� ��\�� Sn��N�� 1��1/��■�� ■�� ..................�,.....►................. ...':� �. .......■C ■■��■��■��w��■��u�■�� u� �� ■ n�� N��n��%��■�� N� ��C��■��■�� ■�� i�■��I��u �N� � N�� ■�� ■�N■��■��■�A��I��\�� ■ �� ■�� v��v�NN�l��/�■��H��N��C �■�� ■��■��■��i�� N�� ■ ■ �� ■��i��■��■��u��■��5� ■ �� ■�� e��u��■�� =�t �� ■��■�� ■�� ■ �� _�� ■�■��u��u�■��u■� ��U■� �u ■ �� _ ■�■�� ■ �� u�= �� u ■ �u� �� iiiiiiiiiiiiiiii�iiiiii'ui'i'��i=n�i � �� ' ��u�� i�iN�� W�IIli1 �Il� �� ■ �� Uu��sn��n � iii��n�� u�� -,. ;, � �� ii u��ii ��iii'iiiuw'i�i��■�ii��i� � �� ■�v��q ��:■�■ ��■��/��u��u��u�� ■ ��■�� ■�� vn ■ �� ■�v��■■■�� U�� N�� ........■ �.�....�..��..�.■., . ■ ■■■■■.�� ........... ... .... .. .. ...; 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