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808 Sain Rd
_ � y. �++ �,�, � ` .: , � ,. . . , � � i�,,.��� 1 � �'��-(� Permittee' .- .,, D�1V E COUNTY HEALTH DEPARTMENT l�ame; s�,""��,Y, ��L4����G�� Environmental Health Section PROPERTY INFORMATION P.O.Box 848 ��� (� Directions to ro e ��W� ��� ,�� " h4ocksville,NC 27028 Subdivision Name: _ 1��"� P P rtY� ��!� �� Phone#:336-751-8760 Section: Lot: AUTHORIZATION FOR R'ASTEWATER Tax Office PIN:# SYSTF,M CONSTRUCTION ,, . O Q 2 71$ r� U ,�J ►�,`�,.., ;�--, ALTTHORIZATION NO: A Road Name�=:�7r'.?�A� Z�p: .� ���j **NOTE**This Authorization for Wastewater System Conswction 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 appl mg or Buifcl'ingPermits. (ln compliance wjth Articl��11 of G.S.Chapte�130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) l // ,r'� .�-' / ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION � �� � �' I* .� ��n IS VAL[D FOR A PERIOD OF FIVE YEARS. ENVIRQ �`����LTH, PE fAL ST DA E ISS ED RESIDENT'IAL SPECIFICATION:BUILDING TYPE�or1s�#BEllROOMS�#BATHS_;�#OCCUPANTS�GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILTI'Y TYPE #PEOPLE #PEOPLF/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE �•���PE WATER SUPPLY�f T� DESIGN WASTEWATER FLOW(GPD) (�`� NEW SITE REPAIR SITE ✓ �� t SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH 3� ROCK DEPTH �? • LINEAR FT.� OTHER ��rt.11� ��'A �C��t/C��[� S��t"Tl�.� REQUIRED SITE MODIFICATIONS/CONDTfIONS:_1�t�%� � � , G�� F�►�.��� � �.+s-�%� I b� �'� ��• �-�"�d IMPROVEMENT PERMIT LAYOUT �,}V� � � �r a �s _� '" -�__.. J tq �7 _k � o � � a �` � � N�� � � � • � � v ,v�.------- � \ ��v , ,�...._,_,.�. � � ����T � �-x'����U �_-�--...p. � � r ��.) � � - / �-1��St ; .P�+��`.,� � I�' �� � ' � �� FOR FINAL INSPECI'ION OF THI S L BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760. OPERATION PERMIT � S�I��M� ^�,1•�r 1 SYSTEM INSTALLED BY: VV�� V -r � � s � � �� � ���� s � , ►5 ,� �.�..p,�-� ��� � � i �`I�"> � , . 17 _- 1�o,��� � AUTHORIZATION NO. ��t� A OPERATION PERMIT BY: DATE: *�THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE YS R ED BO AS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S.CHAP'TER 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. . �o���,�� �LC l� 07D�v ` - - .l�J�- � �3792 ;i � �, - ' � —_ „-.r.n_ � ;i e . - i. /. _ . . :� r, ' �,,. `+1 � �-L`.��-1 � '1 `' (� N��t:1,�._J�.�`{ !��'�Lf�t111�'--A�I� COn N pmHEAH aH DEP nRTMENT PROPERTY IIVFORMATION J� ' P.O. BOX 848 ��/ /� . � Directi}'`s'to property: ! �t'}� <<`� �� � hlocksville,NC 27028 Subdivision Name: i�Y)�O� ��,� ' �� Phone#:336-751-8760 � Section: Lot: AUTHORIZATION FOR �- . • , WASTEWATER Tax Office PIN:# - SYSTF.M CONSTRUCTION ----�y, � oo�� �� .-� AUTHORIZATION NO: A Road Name:�-=��?���� �� Zip: � i:�'�� **NOT'E**This Authorization for Wastewater System Construction MUST BE ISSUED�iy the Davie Countv Environmental Health Section prior to issuance of any Buildin�e Permits.This Forni/Authorization Number should be presented to the Davie County Building Inspections Office when appl ing or Builc7irtg..Permits. . (In compliance iith Artid�.I1 of G.S.Chapter;130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ; �;��� ^ ' " / ***NOTICE***TH1S AUTHORIZATION FOR WASTEWATER CONSTRUCTION �.,-" I . �,' r' �.,� IS VALID FOR A PERIOD OF FIVE YEARS. ENVIROjY�E� �, TH�PEC��ST DA E 1SSCIED RESIDENTIAL SPECIFICATION:BUILDING TYPE,1�,�e�#BEllROOMS�#BATHS�#OCCUPANTS�GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILI7'Y TYPE #PEOPLE #PEOPLFJSHIFT #SEATS INDUSTRIAL WASTE:Yes or No f�� C�f�, LOT SIZE �•�� TYPE WATER SUPPLY��r� DESIGN WASTEWATER FLOW(GPD) f�v NEW SITE REPAIR S1TE ✓ � / SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH �Lo ROCK DEPTH_L� LINEAR FT. � OTHER i t�v�`"( /L11� �?O �C!ILIL��� 5�IS(c.'J�� REQUIRED SITE MOD[F[CATIONS/CONDITIONS: 1�t.l=� � � ' d�� �y\��� � �-l'-�� I t�1 �='f`� �`''�?�. L 1.-,c� IMPROVEMENT PERMIT LAYOUT ��� � '''s"^ � ` ,. �, •1 0 � �� .�C � _. . €.:, ' J k t A `� ' CI p n , � � , tJ t.v) I '��f=Y � �v�' y � � . • .,_.._ f - � tv� �'' �. � ., _ ��"�.JT . �-x'���^�U . . � �-..-----� � , � � � � � �,�'.� i�� , � � _ � -,. �-�vvSt ' r�%.' ���.M� . . � . .f����t{M ' f � . . .Pt4��,,c ' / ,4 A a.-�. . ' .�Z�' � za' ' � , � �� FOR FINAL INSPEGTION OF THIS Mi�. L BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760. C' OPERATION PERMIT '- �� S�I��M r,•1 SYSTEM INSTALLYED BY: � �v/�� - � � � � � t� U� �n �., , � � � � MAP �S �5 � v _�� �._ � �> �-�o�s� AUTHORIZATION NO. ���OPERATION PERMIT BY: � DATE: _ '+THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE YS IBED BO AS BEEN INSTALLED IN COMPLIANCE � WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION..1900"SEWAGE' AT'MENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORIL,'FOR ANY GIVEN.PERIOD OF TIME. � �o���,�� �e��� o�o� � � ���� �l �'79z . � DAVIE COUNTY HEALTH DEPARTMENT � Environmental Heaith Section Soil/Site Evaluation ' '' APPLICANT INFORMATIO PROPERTY INFORMATION ��� �.°-�t���ll�-�� - �� �,.�,� ;�`� ` . ��.��� ��� Water Supply: On-Site Well Community Public `�'� Evaluation By: Auger Boring Pit �"�- Cut FACTORS 1 2 3 4 5 6 7 . Landsca e sition Slope% _ , .. . , HORIZON I DEPTH c9 - 5 '; Texture rou � , Consistence , Structure S Mineralo �. . - HORIZON II DEPTH . Texture rou , � • Consistence �.- . Structure • Mineralo HORIZON III DEPTH Texture rou r Consistence Structure + - Mineralo . HORIZON IV DEPTH � � Texture rou Consistence ' ` ' Structure - Mineralo � ' SOIL WETNESS ^- RESTRICTIVE HORIZON -" __.- ` SAAROLITE !'-" , r CLASSIFICATION ' LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY�� �t�r4 � LONG-TERM ACCEPTANCE RATE: A OTHER(S)PRESENT: �4O� �l�L��� _ . . : . REMARKS: . _ LEGEND L�ndscape Position • . ; � R-Ridge S-Shoulder 1:-Lineaz slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-F1ood plain H-Head slope Tgxturg - 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 .ON4I4T ,N . . MoiSt _ VFR-Very friable FR-Friable FT-Firm VFI-Very firm I 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 ,�tLll�lit� � . SC-Single grain M-Massive ' CR-Crumb GR-Granulaz ABK-Angular blocky ' � SBK-Subangulaz blocky PL-Platy PR-Prismatic Mineralogv. � 1:1,2:1,Mixed '. LYntes , ' � 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-gaUday/ft2 DCHD OS/OS(Revised) ■■�■���■�■s■�e■■���■����■■��■■�■�■■■����■�■■■■��■��■■��■�■��■■■��■ ■�.o�■■o■■.■s■■■�■o�■■o�■��■■■�■ ■��■�■■e■■■��■■������■����■s■��■ ■��■��■�■■s■�■���■�■■e��e�■�■■e■��■���o�■a�■��■�soo■�v■�■�■sv��■■ ■��■■■s�■eo■o��■■■�����■■�■■�■■■�■�■�■o��■■■■a■�■■■�■��■■■�■�■��■■ ■�■�■■��s��■■■�■�■■�■■�■■■■■■�■■�■���■�■�s������■■■�■■■■�■�■�■�■e■ e.�■s�■�■�■.�■���■■■■■voso■■■��■o■■■■o�■v■oo��o��■���■�■■�■��■�■■■ ■���■■s�■�o■�����■■■�■■�■■■�■�■■■■■��■�■�����sea■■���e�e■■eee■�e■■ ■■■■■eev�■■s�■���■�■�■■■■�■�■��■■■■■os�ae�■��o■■■■■��■�■■■■���e■�■ ■■�v�■■sv■�■��■■�■�■��■�■�■���■■■■�■■�■a�■��■■■�■■�■�■�■��■�■�e��■ 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