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869 Underpass Rd ' .r ` � DAVIE COUNTY HEALTH DEPARTMENT' �� _ � S_ o � ,' Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)75]-87C►0 IMPROVEMENT/OPERATION PERMIT Account #: 990000781 Tax PIN/EH#: 5880-59-6366 Billed To: Nancy H. McKnight Subdivision Info: Reference Name: Nancy McKnight Location/Address: Underpass Road-27006 Proposed Facility: Residence Property Size: 2.5 Acres ATC Number: 3647 **NOTE**This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALJTHORIZATION 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 .]900 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 � #People� #Bedrooms�,� #Baths�_ Dishwasher� Garbage Disposal: ❑ Washing Machine:� Basement w/Plumbing: ❑ BasementlNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: � Lot Size Type Water Supply`��'" /Design Wastewater Flow(GPD)� Site: Ne� Repair❑ System Specifications: Tank Size,��GAL. Pump Tank GAL. Trench Width��Rock Depth J�l�Linear Ft��d Other: Required Site Modifications/Conditions: INIPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF G"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Deparhnent for final inspection ofthis system between 8:30 a.m.to 9:30 a.m. or 1:00 p.m.to 1:30 p.m.on the day of installati_ on TP�Aphone#is(336)751-8760.**** � Environmental Health Specialist's Signature: Date:�/ '� / "�� DCHD OS/99(Revised) . ' �� ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (33G)751-87G0 Account #: 990000781 Tax PIN/EH#: 5880-59-6366 Billed To: Nancy H. McKnight Subdivision Info: Reference Name: Nancy McKnight Location/Address: Underpass Road-27006 Proposed Facility: Residence Property Size: 2.5 Acres ATC Number: 3647 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his Authorization for Wastewater System Construction MLJST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any buildirig permit(s). T'his 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 SpecialisYs Signature: Date: /` ! L�� CERTIFICATE OF COMPLETION **NOTE** T'he issuance of this Certificate of Completion shall indicate the system described on ImprovemendOperation Permit has been installed in compliance with Article 11 of G.S.Cha tion.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY uarantee that the system will function satisfactorily for any given period of time. �da�(�/��2 �� f � ,t Septic System Installed By: ��J�'1l,Yt-l„ /V/�t7f� Environmental Health Specialist's Signature: Q?5��/ Date: ` ✓ DCHD OS/99(Revised) "� =�. n�/� 4� � APPLICATION fOR SIiE EVAWATION/IMPBOVEMENT PEfi�O"!!T&ATC � � � u v � G' ��// �� Davle County Nealth[]epartment � Env�i�vnm►ental Nea�tti Se�c.�tton SEP 2 01� S p.0. 8os 8�9J�10 �o�pital �trNt � �soox.v��., Nc zZOZe � .r��'D3 �336)751 976d ,�� - _ , .� *��ZllPO�+lTA2i?R+* TAYS �pLIt�ITidN CaHN�! B� P1tOt�88�D UNI�E88 ]1I.I. T1ia ltaQUIR]ED itirOi�lTiOtt ZS pRGViD�D. A��sr to th� INa'ORMIITION B�ILLBTIN for instruatioas. � ' ., ✓ / , 1. 1[aa� !o b� �ill�d � �� t- ! ��._,^1'/CdG{�/_ � Gontaot P�r�oa G��lG' / , !"/ 1t�ilinQ �dds��sL�'� .3�✓ .C-�.��I'l�r�_ f�� toM phou� � `��-'-�.�� u ci.L7rlstaLa/ss: ,L%,/Lil/�5_l1s�/E'��_ '(.� _ o2,D�y.ia... �oa�. a. x.a. oa o.saitlLsc is asst.sa►ti tl�aa �bo,►. �/ r Cl,'/Cy�C6��j , 10ailinq �ssss City//!aw►/sip �� l�Id o a. Ap�piioatioa Tor: fdreits iealnatioa �Improv�at 8�raitl�C O Both �• M*� *A kMo•� �onsa B'�obii� Homa [3 Susia�ss [] Iadustry 0 Oth�r !t. I! R�sid�ao�a i p�opl� �,� t B�drooms �' � 8uthrooms /� Q Di�Anaal�s O Qasbaq� Dirpo��l. [�'RaaDiaq liadsi� O saa�nt/plu�biaQ O Da��nt/!to OluebiaQ i. t! �wia��r/IebualsYlotb�r� 1p�oilY l.yp� � pwpi� f siuk� i Coa�ods� i Bb�o�s� _ � �sisaal� � � 1rat�r cool•s. � It r00D8sRVICi: # B�ate � �r�imat�d 11a��r �8�aq� ��uon. p.r aaxl �. Typ� o! Mst.�r .upply: o couaty/city �•b� 0 community •. Oo yon anHclpate�ddiNau or eipantioa�oithe tacWty thb�ntem b tnteaded to�ecvs? U Ya �-Pt"io li ya,wh�t type? �*ajMPORTAMf***C4lENf8 NUST CIDMPLEIBTHE 1REQUIRED PROPERTY[NFORMATtON REQUESfED BELOW. Eithec�P[.AT ar SITC I'i.AN MUST B�S[19MITlED b t�e cilent w�it4 THIS AL'PWCATION. Pcopert�r Dlmeo�lowt � �1 ��r��'.� WRITL DIRECI'IONS([ram Mock:vllle)to PROPERTYt Taz OHice plNt # .��'� - �9'-�3 G� �� /�" � ��-�.�- � ,�rn �'o/� Propert7 Addrsat Aoaid Name �l�'��pa►� � �c��.a�,��. �c,�,.�2.� � ./��,� � � � � City21��-r-,,�.,,.�-�(.��•�.2�04� �,t��^� .of� � ,.� -,� ��,-� Ii la�Sabdtvbiou prmrtde isform�idou,�t fotlow�: �,��.n /��,�''�^� �-�<-�'1- ��--�^�� . Names ✓'-�.�J..`-.�,1 �'r.f��:�'1u�--�� • . l v DI� &cHons Btociu Lot: D�te Property Fis�eds ��' %! Thb b to e�rtlfy t6at t6e tntbrm�Hon pr�opided b eomet to the bat ot my IcnawledQa I andenbnd thst any perm{t(�) ian�d hen�fl�r are�abJat to�asp�wio�t or revoqiNon,it t6e tita plaw or latende�me e6sn�ti or If the Informallon •abmined in 16V spptlesNou i�tsbiA�d or ch�o�al l,also,anderstand tiat I ant ruponst6ia jor all c�argu lncurred jrom tA�ts appUcadoa. I,4enby��tva conseut to the Aathoctsesi RepraeobHve at the D� !e Coaaty Ae�i%"/ .�.�� to enter apon sbove dactibai p�opetty located in Il�vtc Conoty snd cnrnad by ��l-��, f�' �-� C�` . tu coadnct aU tatin� roeedura�u ne�ea�ry to detecmine the�ite�aitabUlty. _ 1 / .�, / � � ,� DATE � .-�D / J � SIGNATURE ��-��'� ff • /'.?�-1.�`�� 7 HI3 AREA MAY BE USED FOR DRAWINt3 YO[TR S1T�PI.AN([nclade�11 oi t6e iollmrina: E�HnQ snd propaed property Una snd dimen�ioni, �troctora, utbs¢{u, �rnd�epti¢loaitioni � 8[te Rivblt C�sr�a Date(�): � Client NoNOealloa Dstes i � EAS: Aceoant Na �� Revtaetl DCHD(07/99) luvotce Na �✓ . � ��..� � � �" � � /3.19 A1 7633 sz ��6P� RnD 1553 � ��,��;;u;'�;I'` 'y:� L.4:4j>�;)• ' .. "ti� v4n�. �W4,`l+ � ��::� � � � P V �� . ��6 ��7 This map is for PERC TEST and BUILDING PERMIT purposes e� only. The Davie County INDEXED ON Tax Administrator's Office assumes no liability for any 5880 bn information contained on this map � 1eg WeC ��o� 5A � 0848 �� (5.17A1 s�s COUNTY-ID:F900000002 pep 2669 September 20,1999 9:18 AM � `'� 6A �C2 Parcel Identification Number �.� . 9507 5880-59-6366 . � �' � '"r. , DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000781 Tax PIN/EH#: 5880-59-6366 Billed To: Nancy H. McKnight Subdivision Info: Reference Name: Nancy McKnight Location/Address: Underpass Road-27006 Proposed Facility: Residence Property Size: 2.5 Acres Date Evaluated: �O'�' , Water Supply: On-Site Well � / Community Public � Evaluation By: Auger Boring �,/ Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition Slo % HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH � �� _� ` Texture rou . Consistence / Structure _ , �( -b ' 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: 1� EVALUATION BY: �-C 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 Mineraloav 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 DCHD OS/99(Revised) ,\ . •� . f . _. _ . .. _._.., ...._- ,._.:, ,._: :.. . _.� , .. ..._ _ D��I� �O�URITY ii�i�LT�i 8��T�d�NT . . _ .. _ ENVIRONMENTAL HEALTH SECTION P. O. Box 848/210 Hospital Street Courier #09-40-06 Mocksvilie, NC 27028 Phone #: (336)751-8760 October 8, 1999 Ms. Nancy H. McKnight 1033 Howell Road Mocksville,NC 27028 � Re: Site Evaluation/Underpass Road Tax Office PIN: #5880-59-6366 Dear Ms. McKnight: As requested, a representative from this office visited the aforementioned site on October 8, 1999. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, the site was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions, please feel free to contact this office. Sincerely, ,/�4�t,,,tco•��,. Robert B. Hall, Jr., RS. Environmental Health Specialist RIi/mp Enclosure(s)