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125 Tutterow RdPermittee's DAVIE COUNTY HEALTH DEPARTMENT Name: _I"ln �Iis� Environmental Health Section PROPERTY INFORMATION P.O. Box 848 Directions to property: L D!j L'4 Ur).,-6��U Mocksville, NC 27028 Subdivision Name: 1 Phone #: 336-751-8760 pz. bl� [Int. t `DEI �"1ot""� Section: AUTHORIZATION FOR 6 L'J O� am- WASTEWATER Tax Office PIN:#_ SYSTEM CONSTRUCTION AUTHORIZATION NO: 002858 A Lot: Road Name: 6iS �T�{}¢ rtml Zip: 0 2� **NOTE** 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 bavie County Building Inspections Office when applying for Building Permits. (In compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION z4kIS VALID FOR A PERIOD OF FIVE YEARS. _ L!�Xg — AL 6F,44TWSPEC. ALIST DATE ISSUED „,IPerniittee's DAVIE COUNTY HEALTH DEPARTMENT Nam �i111 l� Environmental Health Section PROPERTY INFORMATION ' f ) P.O. Box 848 Directions to property: �f `1 C (U56Z'1 a Mocksville NC 27028 Subdivision Name: Phone #: 336-751-8760 } (; ►� I I,1 I Ole / h ot'.e't Section: Lot: f `4 AUTHORIZATION FOR WASTEWATER Tax Office PIN:# - - SYSTEM CONSTRUCTION AUTHORIZATION NO: 00285°1P A Road Name: �`-r�,�i r t~)J Zip:,),)0A **NOTE** 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. (In compliance with Article „tl of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) / ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION 0 C 5” JF— 0� IS VALID FOR A PERIOD OF FIVE YEARS. N IRONMENTAL T SPE IALIST !DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE 3 # BEDROOMS —� # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes o No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT/ # SEATS INDUSTRIAL WASTE: Yes No LOT SIZE TYPE WATER SUPPLY � DESIGN WASTEWATER FLOW (GPD) 1 D� NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH N LINEAR FT. ,aao ,A s4sI REQUIRED SITE MODIFICATIONS/CONDITIONS: 11 VA � 1 oo : (d �1 is ]1T , i 1,) /� 1}Yti w t 0" A 1 Com- 6' d 1'). 1 I , 11 4PROVE AENT PERMIT LAYOUTilot 6t Y1Cj w Q (W-.4 50 M' n �`r, ,Q jLiS},nq Zu w Ail BM6*"art" thLs$...�' nDi. b PE he bd ow 3t," 1 j sty, nw 11 Io il-ft 0* JQt�:1�Q S:G-oy �� 5.1.-o�-ant, C , c5v11d Zu -� pi P, °6 AUTHORI2 ATION NO. SD OPERATION PE IT BY: [i 1 DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE rL FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. PE PBAM"-- — ._. _, _ SYST3E NSTALLED j sty, nw 11 Io il-ft C> 00 S"p (1�lll Ione c5v11d Zu -� pi P, p! AUTHORI2 ATION NO. SD OPERATION PE IT BY: [i 1 DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUAR E THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 07J02 (Revised) '�" a?a8� J.otice-0 T go 1?4tee's DAVIE COUNTY HEALTH DEPARTMENT Name: X11 )1 ! ��:�' Environmental Health Section ! i P.O. Box 848 PROPERTY INFORMATION Directions to property: I f j '` '_ 1 U Mocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 1 . i (: t ., i a 1 �s ► -2, •I L:.I" • , Section: AUTHORIZATION FOR /All A WASTEWATER ` SYSTEM CONSTRUCTION Tax Office PIN:#_ AUTHORIZATION NO: Q U Z 0 ',,) ' A Road Name: 1 7i , f{: Lot: **NOTE** 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. (In compliance with Article J.1, of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) �_' ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION --j.I ilff / ,` f .._�/ r/.:.,`j 4 � T:. " c�_I_,`/ IS VALID FOR A PERIOD OF FIVE YEARS. —ENVIRONMENTAL HEALTFISPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE F # BEDROOMS �_ # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes o No COMMERCIAL SPECIFICATION: ,FACILITY TYPE # PEOPLE # PEOPLE/SHIFT / # SEATS INDUSTRIAL WASTE: Yes o No LOT SIZE TYPE WATER SUPPLY 1 t t 0l - • DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE / (� / SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH :2. ! h1 ROCK DEPTH LINEAR FT. REQUIRED SITE MODIFICATIONS/CONDITIONS: I 1 t5 t J C1 �� )i i �, i, (, ('i 1 j 1 I 'C i i t,ld 1' h LA � i / � I PROVE ENT PERMIT LAYOUT Ll -i iu (• '( ! 1[:� (;'y'� I plc' L Ua. f l l ,1 r t v6 4r, N PERMIT --- _. _ _ ,_••- — SYS1;E iNSTALLED B ��1i Y17 43 f'1j�{ 1) f' i l N. >. , C11 %-1;1` n ,�., (()) T-1 ro IN I w � �i�.v�l/ .�U'�i C+}.'(nsi'e•,� iii' , AUTHO h` rrxT� v j (M Ct+ ci V� c-0 A ANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ART CLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARA E THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. 1 ,�.li t �1 i�i_f. FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751 -8760. -OPERATIC N PERMIT --- _. _ _ ,_••- — SYS1;E iNSTALLED B ��1i Y17 43 f'1j�{ 1) f' i r C11 , AUTHO TION NO. OPERATION PE IT BY: 11 ( L i I �./1 DATE: •._� I v j "THE ISS ANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ART CLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARA E THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02/02 (Revised) "` Pe>nuttee's / DAVIE COUNTY HEALTH DEPARTMENT t i Environmental Health Section PROPERTY INFORMATION r P.O. Box 848 Directions to property: ! t ' f Mocksville, NC 27028 Subdivision Name: i l Phone #: 336-751-8760 Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# - - SYSTEM CONSTRUCTION AUTHORIZATION NO: 0 0 2 8 51 A Road Name: i 7,! i I Zip: **NOTE** 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 Pen -nits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTALtHEAI)TWSPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes o No l 1 LOT SIZE TYPE WATER SUPPLY i'� 1 i DESIGN WASTEWATER FLOW (GPD) �7 / NEW SITE REPAIR SITE J / SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH 1� LINEAR FT. REQUIRED SITE MODIFICATIONS/CONDITIONS: �� t i', • �; / i r t h r t i 11 1PROVEIENT PERMIT LAYOUT (! (;1 , l i i I 1, + + ` j _..`' . It, h— 1 -etI0lt PERMIT 1 –• 1 SYSTEM INSTALLED ) +•Z , + �. ( It;'J .2L j fi r jj r.. 1, 17/ >k N� 7- AUTHORI TION NO. ,/ =� OPERATION PERM ITIT B / l •' f -i l J t DATE: -; **THE ISSI ANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTI 4 GUARANTJE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. C.,, FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:36A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. s PER'A•TIO PERMIT 1 –• 1 SYSTEM INSTALLED Y (� fi r jj r.. 1, 17/ >k N� 7- AUTHORI TION NO. ,/ =� OPERATION PERM ITIT B / l •' f -i l J t DATE: -; **THE ISSI ANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTI LE I 1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTJE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02/02 (Revised)' _ ��D . I J!i10 we -�/ t.; (�% rTd" 6411, c-) l6 %w_.011 vv S-4 �lC� W &J -44A, azz Ay.t,vw DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) 7ri-8'30 NAME �-VN/V 170SS PHONE NUMBER 7r/ 71 ADDRESS mss%/%%a SUBDIVISION NAME �1i✓lt /? l ?�70 za�' %% LOT # / DIRECTIONS TO SITE 4V 60SJ �--4�d - �i(0k DATE SYSTEM INSTALLED 6_0k� NAME SYSTEM INSTALLED UNDER TYPE FACILITY IU e. NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED TYPE WATER SUPPLY (OU -Y SPECIFY PROBLEM OCCURRING Q(aa�--406 llzek— 6 fu � , tlae' ?, 7 - I W 6 ,)- 10 A 7 A/0 DATE REQUESTED �' -S'd� INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge, arddthat I understand 14") responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1193 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION Llan D05 -s q5 q tnAcl," M'h nloe.![SvaLt NC- -MA z,We�� , ` Water Supply: On -Site Wells yid 10 flof c Community Evaluation By: Auger Boring Pit 3 l4 PROPERTY INFORMATION &q tv - 0 -rd lv�-j hot uS2 W_ cp be ki rC( E x ),-my- Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % 2 r HORIZON I DEPTH - Texture groupL Consistence P JCrA1<iiJP Structure r AA Mineralogy HORIZON H DEPTH Texture group Consistence ZS SP ri c sf' M Structure S Mineralogy HORIZON III DEPTH (7 y Texture group Consistence 5 500 Structure 5 Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS , RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 1 LONG-TERM ACCEPTANCE RATE 1 O S SITE CLASSIFICATION: EVALUATION BY: J. AlPAdv LONG-TERM ACCEPTANCE RATE: o •.;?' OTHER(S) PRESENT: SkurvL4r a REMARKS: LEGEND Landscape 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 Texture 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 Moist 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 Mineralogy 1:1, 2:1, Mixed 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 05/05 (Revised) ��e��■■��■��a�� ■��■��o��■■e��■��■��■ ■��■��■�■��■��■ ■��■��■ ■��■�■��■o��■��■�■��■ ■��■��■��■�■��s��■�■��■�■��■��■■��■■ ■��■��■��■��■��■��t■ ■��■��■��■■��■��■��■��■ ��■��■��■��e��■■��■��■��■��■�� ■�■��■s��■��■��■�� ■��■��■��■■��■�■��■��■ ■��■��■�■�■��■ ■��■��■��■ ■��■��■�■��■�■��■��■��■�■��■�� ■��■��■��■��■��■��■��■��■��■�� ■��■��■��■��■�� ■��■��■��■��■��■�� ■��■��o��■��■��■�■��■��■��■■�■■��■ ■��■��■�■��■■��s��■�� ■��■��■��■��■■��■ ■■��■��o��■ ■��■■�■��■�■��■��:,�i��■��■��■�■ ■��■■��■��■��■�■ ��■��s��■��s��,��■��■��■��■�i��s��■ ■��■��■��cc�■��■��,�■�■■ ■��■��■��■��■��Il�i��i�ii��i�ii::i]��■■�i��■ ■��■\��■��■■11��■■��■��I��■ ■��■��■��■��11��■��■�■��1��■■ ■��■��0��■■■11 ■■■■��■��■��■��:�� ■��■��11��■��■��'��■ ■��■��■��■��■��11��■��■i■��,��■ ■��■��■��■��11��■��■��\��■��1�� ■��i��■■■�■��11��■��\■��■��I��■ ■��■��77��11��■��1��■ ��■��■��■��■��■��tl�■11��■��■��■�■��11��■ ■��■��■��■a��■■�■�■��■■■��■��■ ■��■��■■��■��a��e��t�■��s�■■��■��■�� ■��■��■�a��:sr�■�� ■��■�■��■��■��■��i�� ■��►`��a��ll��■■�■��■��■��i��/'��■ ■�■��■��■��■��rw��■�■��■■��it��■ ■��\��\��i��■■�11��■�■��■��■��■��■��■I��■ ■��■��■�■��■��0��■��1��/�1��■��■tii7�l�■�■ ■��l��■�■��II/��■�■��■�■��li��!��■ ��■�■��\�i�■��■��■■�■��■■Y��.fl!l�■��I�Gl�I��■ ��\��■ ■�■��■ ■�� ►�!4!w■��■ ■��■ I!�'��I�� ' ■��■��■■��%r�l■�:►�,�RH��'G�i/v�ll�� ■�■��■��■��■��■��C�■�Ilr■��l:i'nl■��■ ■��■��7��11��■��r`��l��■ /��■��■�V/�■��■1��■��F_51�1��■ ■��■��■��■�'�l��01��■■��1�7�11��■ ■��■■��■■��1��■■��1��■��;��J�11�11�� e■��■�n��t:Si��1■��e��(r��I�i1r�11�� ■�■■��s��f��■��■■■■��r■ ■�1�'�'��■■��■■��■11��11��■ ■�■■��■��■■��I1►1��■��■�■��I■��11��■ ��■��■��i�■��i��■��■��■��i�r��i�� ■■��■I�.��Rl�l��■��■��«��■��■■��I�►�E�11�� I�l\�I�I��■��f/I�Rtn��■��■��I/!1\ii1�� I�:�1��1��■�■��■��l�!�L■��■��■��1�l��11�■■ ■��I�C1��1�■��■��■��/��\�J■��■��■��■Il��rl 1�� ■��C�C��I/��■■'/��ii��11\��111■F'I IS�� ■��■��r.��i��■�■■ ■■�■��■��r�i��■��r►��it��■ ��■■c��i��■�■��■��i��:��:��•�.��c��■ ��e��■��■i��i��i��■t��c��■ ��o��cc��i��s��■��iZ��■ ��■��■■��■��■��■��■■��i��■ ��■��■��■��i��■��■■��■�■�ii-.��■�� ■�■��■�i:::��■�■��■■��■�■��■s�i�■■��■�� ■��■��■�i■�■■��■�■��■ -:�..........��i�■�� ■��■�i��■■��s�■��'i■��■iii�i■��■��!��i��■ ■��■��■��■��■��■�■��■��i��■ ■��■��i■��■��■■■�■�■�■��■��■��i�� ■��■��■■��■��■��■�■��i�� ■��i��■��■��■��t�� ■��■��i��■e��■��■��■��■��i��i��■ ■■��e��i��■��■��■�■��■��■��■��■�� .■■■■■�...■...�......■..........■�....■........■■....■.....�.■..�■■■ ...... .......:.................. ................s........�....�... ■■■■■■■■■■■■■.�■■■....■■..■...■■■....■..■■...■...■■■....e■■.�....�..■ ■■.■.....■■■■■■...,....................■..■......■.......�■■��■.■�■.. ..................►.........................................��...�.■. ■■■■■■■.■■..■..■■.�....■■■■.■...■..■■.■..■.........■■....■..��■..■.■ ..................�.........................................��...... ■��■��■■■.■■.■■..■■■■■■■■��u�e�� Ci��i��t��■�� /��i��/�//// ��■�__��n��i��n�� ,��■_��.��a��r��ai��■��■�a�� ■��■��■��rs�•�'u�a��L��:a�!��t��■��■ GoMAPS - Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping System aV/ Click Here To Start Over Quick Search: (County ID c t ''} f Active Layer. ❑� Else Map 77Ps GIS A. PARCELS (Map Tips Available) Map Layers i Results i ONEAL J VN HENRY 11 x68 'OWk OFF HWY 64 125 r ra No a r " A/ y�9 0 561 t' nr 42 30815 5 rro 51 1N�� v 4 a "�* t J4, 2676 .1(200). 1216. I t x202& http://maps.co.davie.nc.usIGoMaps/map/Index.cfm?mainmapservice=gomaps&CFID=4129... 5/5/2008 �ioMAPS - Davie County NC Public Access Davie County, NC - GIS/Mapping System Page 1 of 1 Click Here To Start Over Quick Search: (County ID c • Active Layer. ❑UseP4ap Tps GIS SQL ti's ' :14" PARCELS (Map Tips Available) V 1 .._..a Map Layers I Results { http://maps.co. davie.nc.usIGoMapslmap/Index.cfm?mainmapservice=gomaps&CFID=4129... 5/5/2008