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1852 Underpass Rd (2) • , � , DAVIE COIINTY HEALTH DEPARTMENT n�����Ga Environmental Health Section ��� P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900011 Tax PIN/EH#: 5871-77-8297 Billed To: Carotina Building Systems Subdivision Info: Reference Name: Christine Dean Location/Address: Underpass Road-27006 Proposed Facility: Existing Acc. Bldg. Property Size: 15 Acres **N�""Ttii��c�ipr��tn4ent/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AiTTHORIZATION 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 PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type �'fl � #People_� #Bedrooms�ji'/�- #Baths � Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: 0 Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size � C Type Water Supply �tL Design Wastewater Flow(GPD) /�jj Site: New�' Repair❑ System Specifications: Tank Sizel�GAL. Pump Tank GAL. Trench Width _� Rock Depth� Linear Ft�DD � Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATiON PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 8:30 a.m.to 930 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-87G0.**** �� \ r' Environmental Health Specialist's Signature: � Gy ,t i Date: ��'���� DCHD OS/99(Revised) 1 1 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (33G)751-8760 Account #: 989900011 Tax PIN/EH#: 5871-77-8297 Billed To: Carolina Building Systems Subdivision Info: Reference Name: Christine Dean Location/Address: Underpass Road-27006 Proposed Facility: Existing Acc. Bldg. Property Size: 15 Acres ATC Number: 2274 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED 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 WASTEWAT CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: � J. Date: �oZ��C��� CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis Certificate of Completion shall indicate the system described on ImprovementlOperation Permit 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. �—�? . F �° � � � lrv '_ � /�� r' {� Septic System Installed By: � Environmental Health Specialist's Signature: ,Date: jf,�- 2,Z�(� DCHD OS/99(Revised) r 2 _,,,,,, , � , APPLICATION FOR S�iE EVALUATION/IMPROVEMENT PENMR&AT LS l� L5 � V L5 ' ' Davie County Health Department D E n v ironmen�I Hes/t h S e�on DEC I Q 1999 p.0. Hox 848/210 Hoepital etsa�t • Mocslcavill�, NC 27028 � • �336)751-8760 ***I1�4'ORTANT+��* THIB �1P1tLIC71TI0ti C�NNOT ]9� pROClCSB�D UNL�SS I1LL TIiS REQUIRaD IN''ORMATION I8 PROVIDED. R�fer to th� IN�'ORMAT=O�I BUI�LETIN !or inst�uationa. s. �.a. to e. s�s�.a CAROLINA BUILDING' SYSTEMS �,�t p��� DOYLE OVERCASH �asas� �aa�••. P.0. BOX 1887 �� � cit�r/ot.ti./szp SALISBURY, NC 28145 �„���, �,� 704-636-7051 z. xaa. oa, �rsit/1lsC 1! Di!l�z�at thas► ]►bo�r�r�1RISTINE OEAN K.us�r �wa=... 1852 UNDERPASS RD. �������:ip ADVANCE, NC 27006 �. l►ppiiaatioa ror: 0 Sit� tvaluation 0 Improv�nt B�rmit/ATC �{] 8oth 4. sY.t.a co s.=.so.� O 8ous• O tsobile Hom� I] Husia�ss 0 Zndustry �j p��= EXISTING ACC. BLDG. s. _! R��id�nc�: i p�opi• � Hedrooms � Bathrooms 0 Di�hKuA�s O Oasb� Dispo�al O �tashiaq thahi� 0 Sasa*ant/Oluabiaq 0 saswnt/lio alusbiaQ a. zt su.sn..•/sneu.tsg/otb.r� �p.osty �yp. EXISTING ACC. BLDG. + �1i 1 t s�� 1 / Coa�od�� 1 i Shox�r� 1 + Urinal• i 1lst�r Cool�r� =t �'OODSERVIC3: � S�ats Zstimatad 1Pat�r Osaq� f��• r•= d+►�r) �. Typ� o! xat�r supply: 0 County/City �1 iP�ll 0 Community e. Do yoa�nHcipsite addiHow or espanatoae o[the fncillty thb�yttem ta intended to�erve? 0 Yes �No vyes,w�At ry�T •*'IMPORTANT°*�'CLIENT3 MIIST C�OMPLET'ETHE REQUIRFD PROPERTY INFORMATION REQUESfED BELOW. Elt6er s PLAT or SITE PLAN MAST BES[!BM/TTED by the client �vith 7'HIS APPI.ICATION. Prnp�rty Dtmenalons: 15 AC. WR1TE DIRECftONB(from Makaville)to PROPERTY: Taz 08ice PIN: # 5871-77-8297 15g W, TO 801 T.R. GO TO UNDERPASS RD. Property Addnss: Ra�d Name �R�� i�NnERPASS RD. T.L. 100 YDS. ON -f�� L.�-F� ' Cih,��p ADVANCE V In a Sabdiviaton pravide Inform�Hon,�a follawe: N�me: N/A SecNoat Block: Lot: Date Property F1s�ed: This la to cerHfy thst the inform�Non pro�vided is correct to t6e best otmy knmvledge. I andecahnd th�B ony pera�it(a� laaaed hereAfler are eabJect to tnapeneton or revaadon,if the eite plana or lutended aa�c6ange,or i!the info�mallon aabmitted ln t6ia applicsHon is tal�ilted or changed. I,also,undiratand that I eni r�sponslb/e jor all cbarg�s iRcamd jrom tl�ls appllcodon. I,hereby,gtve conaent to t6e Aathorized RepresenMtive of the Davte Connty Hait6 Department to enter npon above deacHbed property loa�ted tn Dsvie Coanty snd o7vned by_ �NRISTINE DEAN to condact all testina proc�dnra as neceaa�ry to determine t6e� tabWty. DATE I 2 — I—I " ���� SIGNA C/(/ THI3 AAEA MAY BE U3ED FOR DRAWII�iG YOUR SI'TE PI.AN(Include�11 of the[olimvtng: Ezlsting and propoeal property Ilna and dlmensioua, etractares, �etbacks, sud aeptic locallon�). 3ite Revistt Ch�rge Date(�): C1leat NoHBcaHou D'te: EHS: Accoant Na Revised DCHD(07/99) Invoice Na ,�f � � �'L J�v� O�� M 8y- 9S"•"' �'� _ - o 'd � 0� g� SZ9 � + O r , °'�4j � �p o,��� �4'� '•�s'r �OZd-'�01 9 0 °r.�`'y �� �., ,9b S6o y c�-.y�-.ZL S �' `°•, b' 3NY M •'•, N+.i � . •.i Y� _ , x/L4 y6S �-�-- -- wo '�'�,6, � GD z s t s ���+1 �nX�* �� � .�� . •9� ;� �� . �..��;�ir'.LL $ -= �y �r �9 `�� °�q,•''+'i{ro, ' • af s9i 'Ovi° '�. � M y/ ,tp�tt,y •.G�.. i�' V`~ `,\ • �� (4� .02 C �' 4. � \ . .�`' �? �fb o` 0'� \ � � � �� ,y � � '�+�i�r 0�0 �r� V (—-"\ � , e �'� ~ yv y�r `�C , l,a p `� tiy, �i * '1t� \ rf1i ' . '' � ��d . . ��\ ��.`J 5��.ld oy��1 ,4 ! � w "`h '/ �' � � ���� � ��, � 9F �� r �� ~�' 4 r° %� �S , + �'U . * / '�`b SJ'd'J y�1 .t. ..d'a' ; .4 `C� b��+p, `Y :�.� � ,�;�� / 6�g, °� ~ �- ,.��� °r, �.y C ��� r� r� ��i , �• . �� � � � . �b ` �l��sr� �.t�..ss,2 � g Z6` �w�' �9z.�� ' �. •'s 9F 'Fb;c� ._` yw .y ,o,. . ti W M ��'d� �y, ���_.r�.2 �s s � � . ti - �a, o ��/ � r�, k.'r .� '�f:� 99�98► , / � �' 8Q .s � ��M� �� �ti•6e o�• - 'M m 0 3,1►0�£�'.69 N / /\ 3 ti0;��:S1N—3 f0- N , ' � N _ ;. o � � ,ss N7� 4�ZA�9�N \ ' .�... � • • �sp�eb ob �� ; • 4' . • u' �tir � S ••8i'.ls�6 / ��j�`.• S/ . / � ' \ N � • ,2�;�b y �&F H \ / � \ � � �so.`bs9 '8' � b� \ / 9�. � , :� O � 2;b2 '� / !/' � �' ''1o;y�sF �� e � 6 � � � � \ � �`� .�.�.�s�ss�FO�ob N> �'2FN �— — —'�.si:�'ip — — S� ��s� � C/ j , ..a� ..�:��ssH•F�,2a N �.1�ss � 'Os,y 1 b.�� Op� �/ ! � ''�s�`''� 3 ,,o. . s;98 S � � ������b�, . t£,sy Z \ � �/� �' f��' 3,Fi•'S�F�� .t •9�N \ � . �1 S �'��,b?b \ _ K2�, � --. _T , � +�' - + �'LI �l . _ . ��= � � � ��• . _. . . �: �Y . • l DAVIE COUNTY HEALTH DEPART'MENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900011 Tax PIN/EH#: 5871-77-8297 Billed To: Carolina Building Systems Subdivision Info: Reference Name: Doyle Overc�sh Location/Address: Underpass Road-27006 / Proposed Facility: Existing Acc:�ldg. Property Size: 15 Acres Date Evatuated: �'/�l � Water Supply: On-Site Well mmunity Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition Slo e% 2 HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH �' �� `� Texture rou Consistence � / SWcture /l .�/1' 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: �� � LONG-TERM ACCEPTANCE RATE: � � OTHER(S)PRESENT: 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 CONSISTENCE Moist VFR-Very 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 SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralo�v 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-gallday/ft2 DCHD OS/99(Revised) ■■��■���■������■��■����■���■�■��■���■�■��■■��■■■���■�■�■■������■�■ ■���������������■�■■�■���■����■��■■��■�����■��■���■■��■�■■■�■■■�■■ ■���■�����■■■����■�■■����■�����■�■��■��■��■������■��■■�■�■■����■■ ■■���■��■■��■■■■��■����■■����■�■ ■■�■��■���■��■��■��■����■��■■�■■ ■���■■����������■�eea�����■■��■���������■■■■����■�■e��■��■�■��■��■ ■����■■�■■�■�■��■���■��■��■■����■�■■����■■������■�■■■���■■�■���■�■ ■�■���■■������■�■��■����■�■■����■��■■■�����e■�■s�e■��e�■■������■■■ ■���■�■�■�■■��■��■�■■�■�■■■���■����■■■■��■����■■■�■��■■■■■��■���■■ ■����■■■■■■■�e■■��■�■����■■���■�■���■■■■����■��■��■��.■■�������■■■ ■���■■�����■�■������■�■■�■��■�������■�■�����■������s��■■��■�����■■ ■���■���■■���■����■�■■�■����■������■■■����■■�����■�■��■���■����■■ ■����■■■■��■���■�■��■��■�■����■■ 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