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429 Vanzant Rd • DAVIE COUNTY HEALTH DEPARTMENT � � �,. Environmental Health Section � ,�� � ' P.O.Boa 848/Z10 Hospital Street �`�/ Mceksville,NC 27028 (33()751-8760 Account #: 989900306 Tax PIN/EH#: 5709-90-7476 Billed To: Charles Lee Subdivision Info: Reference Name: Location/Address: Vanzant Road-27028 Pro osed Facilit : Residence Pro ert Size: 36.7 ATC Number: 4352 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). 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 CONSTR CTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: �riL( Date: �/��6� CERTIFICATE OF COMPLETION **1�OTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation 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,��� -- �� �9�.���� y . � � � ��� �Q\� ��'�'�� �����+�� ,�G� , �,. �As� �.�-�: ��-s,o � rp �. � Septic System Inst ed r � � ' 'rJ /. � Environmental Health Specialist's Signatur •� t • Q�O DCHD OS/99(Revised) . • � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section �, ' - P.O.Boz 848/210 Hospital Street ,�..,�� � Mocksville,NC 27028 ' (336)751-87C►0 IMPROVEMENT/OPERATION PERMIT Account #: 989900306 Tax PIN/EH#: 5709-90-7476 Biiled To: Charles Lee Subdivision Info: Reference Name: Location/Address: Vanzant Road-27028 Proposed Facility: Residence Property Size: 36.7 **NOTE�'*�TTiislmpro4ement/Operation Permit DOES NOT authorize the construction 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). 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: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply G b Design Wastewater Flow(GPD) ��o Site: New� Repair❑ � System Specifications: Tank Size�GAL. Pump Tank GAL. Trench Width ���� Rock Depth�'� Linear Ft.�� J,2, Other: As stated in accep e ystems may also be uss Required Site Modifications/Conditions: I1�IPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S) IF 6"BELOW FiNISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Departrnent 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 installation. Telephone#is(336)751-8760.**** � �. fi' �� �� , ��� �/ �/� Environmental Health Spec�alist s Signature: Date: � DCHD OS/99(Revised) . � — -i ',• . �� APPLICAT OR SITE EVALUATION/IMPROVEMENT PERMIT & A'T� � � � � Davie County Health Department � (� � Environmental Health Section P.O.Box 848/210 Hospital Street � � � 2��6 Mocksville, NC 27028 � � �'�A� (336)751-8760/Fax (336)751-8786 �A�N�N plic�t' �0���1 } ion/Improvement Pernut ❑ Authorization To Construct(ATC) �Both 0 ** RTANT***THIS APPLICATION CANNOT BE PROCESSED LTNLESS ALL OF THE REQUIRED INFORM�ITION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed C.�1 Gt.Y' �S � � Ji'+ Contact Person__��/�CS R.LPe,.Tr� Billing Address . Home Phone 3 3(p- '�-Q�-$'�3 8" City/State/ZIP 0 ' Itf OZ. Business Phone 33l0- q'�kD'?!o(o cf Name on PermidATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION NOTE: A survey plat or site plan must accompany this application. (Pernut is valid for 60 months with site plan,no expiration with complete plat.) Street Address '�o2.Q `1�Q���- IQ�, City_!�'�,OC�(SV1%�G Tax PIN# Subdivision Name� Section/Lot# Lot Size Directions To Site: � p � � . � n o A il 2 � � Date House/Facility Corners Flagged If the answer to any of the;ollowing questions is"yes",supporting documeri�ation must be attached. Are there any existing wastewater systems on the site? ❑Yes'�To Does the site contain jurisdictional wetlands? ❑Yes�No Are there any easements or right-of-ways on the site? ❑Yes�To Is the site subject to approval by another public agency? ❑Yes�o Will wastewater other than domestic sewage be generated? ❑Yes o IF RESIDENCE FILL OUT THE BOX BELOW #People �_ #Bedrooms �_ #Bathrooms � dL Garden Tub/Whirlpool es �No Basement:�es ❑No Basement Plumbing: ❑Yes �No ar�#-f'a.l IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of FacilityBusiness Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type systemrequested: �Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type:�County/City Water ❑ New Well �Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes �No If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed. I understand that I am responsible for all charges incurred from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules on the above described property located in Da��ie County and owned bY_��/Z,f...�� �/'• � ��� Site Revisit Charge Property owner's or owner's legal epresentative signature Date(s): �... �t� ��p Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# � Revised 2/06 Invoice# `i� .....�.�����I-�IUYUnt��l 1'tltMll �c AIC Qp D�vie County liea�� ��e�r�rtment �'—" , ,�• -� - E�s�iranan�rta0�e��Sec�fon a � � � � d � � Se r ��, • P.o. Box ��B/21� Hospital street ' � ��. . ��s,��.�e, N� ��oze DEC ` 4 (998 �336)751-8760 ***II�ORTRIVT*t* THI3 APPLICATION CANNOT � PROCE3SED ONLE33 ALL COUNTY INFORMATION I3 PR4VIDED. Refer -to the INFO�iMATItiti BtJLLETIN for i s ruc ons. . p� � � H���� ('rv�r�� i-rZ.Lt�r�,�r, �,�at �«, c:��.r-I�s Lee or' Lu nne��e. Nailinq Addreas �11�UG1..hZ1�./�-1 �F � 8ome phone 331e- �'}9al-S'�`�f3 Clty/8tate/ZIP YYl OG�Svi��P. t�1 C. �-7�� snssness Dhone 3 31n.- ��-1 O - %lo(oc( . Nams on IIesmit/ATC i! Diflerent thatf Abave Hailing A�dresa City/8tate/Zip i. Applicattoa Bor: �3ite Evaluation � Impravement Peanit/ATC 0 Soth 1. system to service: �Honse 0 M�obile Homn 0 Business 0 Iadustry ❑ Other s. If Reaidence: � People �_ / Bedrooms � i Bathrooms J� �-. �Dishxaaher O Oarbaqe Diaposal �Aashinq Machine 0 Hasmirs�t/Plumbinq �Basement/No Plumbing 6. i! Business/industry/Other: Specify type f Feople i Sinks f Co�odea � 8hoxers � Urinals / Rater Coolera IP FOOD3EAVICE: � 3eats Estimated iPater tlsaqe �Qaiions per aay) 7. �pe of water supplp: ❑ Conaty/City �iiell ❑ Conmunity s. Do you anticipate additiona or eipansions of t6e facjllty t6ia aystem is iotended to aervet ❑Yes �No lf yes,w6at type' "*'lMPrIRTANT'�" CLIENTS�►lUST CO�.ATP�TE THE REQUlRED PROPERTY INFORMATION REQUESTED BELOW. Ett6er s PI.AT or SITE PI.AN e�lvST BESUBMITTED by the ellent wlt6 TH1S APPLICATION. Prnperty Dime�siona: �.� Lt�i'e S /��'r� � WRITE DIR�CTIONS(from Maksvllle)to PROPERTX: - .�'70 9- 9'0-7 y7G' 7'" Ta:Office P1N: #,�, ' �OO�D� � � � _ _ ' ,� --r Prnperly Addreas: Road Name i�anzcui-{- i�" vc�f� r�nnr�X, a`'�-rn�����'��z�cnf��.--'N►n City/Zip mti�svi ��� 1�1� �`10a$ jettor� �QnzM�-��.-'A���<f �ncl.r57�-�in� ��::��::�rY�=�VY~i;.:.,:.���.��;.:�.::;,.:,�::c::.x��: .��-�e�o<�s 1 lah����k,�►�.-1at�.-- n�c+ , Name: h0[�l`�P D►1 �et-C��ft- YQ55i�L'i�7✓I[[(1_ �T_ Section: Block: Lot: Date Property Flagged: �2' `�`q.P� This t�to certifp that the ioformation prnvided is correM to the beat of my knowledga I understand that aay permit(s) issued her+eafte�Are subject to auapen�ion or revocatioo,If t6e site plans or Inteaded ase change,or i�the Informatio� submlded in t6ts applicatton is falsti�ed or chsnged I,also,understand tArat I anr responsible for a!1 cliarges tncurred from thls app/fiaotio,r. I,ber�eby,give conaent to the Authorized Repreaentative of the Dxvie County Healt6 Department to eoter upon above descr�bed property locuted in Davie County and owned b�• to coaduct ail testing procedures as neca�try to determine the�lte aitabilih. DATE r 2 � � ' � � SIGNATURE� �- THIS AREA MAY BL USED FOR DRAWING YOUR SITE PL.AN(Include all of t6e toilowlag: E�aHng and proposed property line�and dimensiona, �tructurea, eetbacic�, and aepttc locatlona). Account Na ��l0 Re�►�i�ed DCHD(07/98) Invoice No. �(D 0 , s, ' �� DAVIE COUNTY HEALTH DEPARTMENT � , . � , • Environmental Health Section sECTiorr LOT SoiUSite Evaluation APPLICANT'S NAME ��� DATE EVALUATED `�,���� PROPOSED FACILITY /"�+"' PROPERTY SIZE ���e SUBDIVISION ROAD NAME �/��Gf�'L• � 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 e% HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH �i�" �3d` Texture rou Consistence � Structure t �¢ /i 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 �02 SITE CLASSIFICATION: �) EVALUATION BY: l^Y�+�"/ LONG-TERM ACCEPTANCE RATE: o�- OTHER(S)PRESENT: REMARKS: LEGEND Landsca�e 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 tructure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangulaz blocky PL-Platy PR-Prismatic Mineralogv 1:1,2:1,Mixed otes Horizon depth-In inches Depth of fill-In inches Restrictive horizon-Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) Soil wemess-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classifica[ion-S(suitable),PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate-gal/day/ft2 DCHD(01-90) � 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S'��'Ei,� x `y, ` � � ' �+i �,-',.. ����' 4 ♦ .'�' � �..r� }#����r��t�t��= .Aw.��/ . `r � .� ���n i{� '��.r��`s�9�'r"ti,� 'w 1 " + ^�' �,y� � � � f +*+,� '�}!���_Si����'�?et��,�a �"� + �ti�ti r� 1 ��• LL •�y �ff,�� .:Y� .�tt . �. .y. ;�,xxs` z3�aw�.a,+ ..y���.F} ? ��, � �'� � i� a .� : '� �.. . . ' "�" ;�y,,_{s,ro'j 1y5,� 4; � � t +r , ��:.�.� s +/ .Re �� 4 ' ,°`5.:.. � i^A�����5.�;.{.•�4.��M"+~d.� 1..� � Y. P y' .. �� ���� ` � � .. . ; s�'� ; '.eY. fb A ¢ $ �I � • � ..t �`s.. � � ��'�` ti �,F .v "a � �:�"`.�Y � ` t '4�;t.����*�u� a. £'.d �" '�^����j..��f'a'�"++�� ��a'�h �:�. �+.�^dy ra'.�'e"��,,..: � 'y ► � ���? r Yl;i;�,� �f{�� ? ''�3'� +- ..j�i w.. ,�; ':.4"�'�?�r�� �w Y. '� . ��"'�' 7' �".^�;�i-��'.4�t M" � �..`�i� '*d -�..Y, .. ,t' t. ti ~_*` '�' n �� ��v ,.� �► . � . _ __.. . �;D�YI�COU1vTY�I�LT�i ���TM�ENf . ENVIRONMENTAL HEALTH SECTION P. 0. Box 848/210 HospitaJ Street Courier #09-40-06 Mocksviile, NC 27028 Phone #:'(336)751-876Q December 15, 1998 Charles R. Lee, Jr. 413 Vanzant Road Mocksville,NC 27028 Re: 2 Site EvaluationslVanzant Road Tax Office PIN: #5709-80-9668 (60.63 Acres) T�O�ce PIN: #5709-90-7476 (36.7 Acres) Dear Client(s): As requested, a representative from this office visited the aforementioned sites on Decemb�r 10, 1998. Based upon the information provided on the Applications for Site Evaluations and after an evaluation was completed on each site,the sites were found to be provisionally suitable for the installation of an on-site sewage system on each acreage tract. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house location staked offon each site. If you have any questions,please feel free to contact this office. Sincerely, .����2�-��ur.C��;�;�,. Robert B. Hall,Jr.,RS. Environmental Health Specialist RH/wd Enclosure(s) � � • DAVIE COUNTY HEALTH DEPARTMENT . • ' . Environmental Health Section ' - � • Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900306 Tax PIN/EH#: 5709-90-7476 Billed To: Charles Lee Subdivision Info: Reference Name: Location/Address: Vanzant Road-2702 Proposed Facility: Residence Property Size: 36.7 Date Evaluated: �"'����� Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut � FACTORS 1 2 3 4 5 6 7 Landsca e osition Slope% HORIZON I DEPTH Texture grou Consistence Structure Mineralo � HORIZON II DEPTH Texture rou Consistence Structure Mineralo HORIZON III DEPTH / �" Texture rou ' L L Consistence f � Structure ' r Mineralo / -/ HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: �� EVALUATION BY: Nd`��� LONG-TERM ACCEPTANCE RATE:_, OTHER(S)PRESENT: ,���%�/� REMARKS: LEGEND i,�ndscane P�sition 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 � 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 �ONSI�T �.N . . DIQiS� 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 StrLct�re SC -Single grain M-Massive CR-Crumb GR-Granulaz ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralo�v 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 OS/OS(Revised) ■■■�■���■�■����■�■�■■■■■■■■■■■��■��■�■■�■■�■�■�■■���■��■�■�■�■�■�■ ■��■���■■������■�■�■���■■■■■�■■■ ■■■■■■■�■■�������■■�■■���■�����■ ■■�■�■■�■■����■�■��■�����■�■��■���■■�■■�■����■■����■■�■���������■ 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■����■��■�■■■��■■■�■��■�■■����■����■����■���■�■■■���■����■■�■��■■■ ■�■�■���■■�■�■���■����■����■■■■■����■�■����������■���■����������■■ ■■������■■�■�■������■�■�■��■■�■■■■■■�■��■����■���■��■■�■��■�■����■ ■�■����■��■■�■■■■■�■����■��■■���■■�■������■�■■■��■��■■�■■■■�■����■ ■������■■�■■����■��■�����■■■����■��■■■�■�����■■■■■������■�■��■■■�■ ■���■����■��■�■�■�■■���■■■■■�■������■�■■■■��■���■■■���■■���■����■ ■��■■■■■��■�■■�■�■■�����■■■■���■ ■��■■��■������■■■�■■�����■�■■■�■ ■��■�■■■��■�����■��■�����■■�■��■■�■■�������■�■�■■■■�■���■��■�■�■■■ ■��■■■���������■■�■■■��■■��■�■■■■�■■■■�■�������■■��■����■��■■�■■■■ AUTHO'RIZATION NO: 1 9 7 � DAVIE COUNTY HEALTH DEPARTMENT � V Environmental Health Section PROPERTY INFORMATION Permittee's- P.O. Box 848 Na'm�:_��,�j��,j' Mocksville,NC 27028 Subdivision Name: Phone# 336-751-8760 Directions to property: . Section: Lot: �� AUTHORIZATION FOR WASTEWATER Tax Office PIN:##.S'�"d9- �!� -�'c�7_ SYSTF,M CONSTRUCTION � Road Name: �Zip�; **NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any BuildingPermits.This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Perrnits. (ln 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. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED _ ,. . . ; . _. .;..:. . .; , _:, ,, . . . , .. ,... � . ......: , , . . . . . . , . _ _ .., _ _ _ �_. _ . ' � . .., . . , " ��_�,� � � 9 7 ') DAVIE C�UNTY HEALTH DEPARTMENT "'�� - ` TMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Peqnittee's� ,� � �l� N�'mi�:r �-� `�����f,+��"' .�C' � Subdivision Name: ��� . Directions to property:��f 1rJ�fl,�/�`�' Section: Lot: ,� Il�IPROVEMENT i�C � �M� ��� �j F�l PERMIT Tax Office PIN:#-�'� r��. - �✓ -�d:'=> . . . � � ,r ".J�:'� ^/< �t�ff� Road Name: "'� .�./ Zlp�.��-;Y.F. **NOTE**This Impmvement Pernut DOFS NOT authorize the construction or installation of a septic tank system or any wastewater system.An AUTHORIZAT'ION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building pemut. (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ; � ***NOTICE***THIS PERNIIT IS SUBJECT TO REVOCATION IF SITE r � , r��� � i ;f , � _ /±', l� � PLANS OR THE IiVTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALTH SP CIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING TI-IE SYSTEM. �/ RESIDEIV'fIAL SPECIFICATION:BUILDING TYPE� #BEllROOMS�'�#BATHS�,�#OCCUPANTS�_GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #k'EOYLE #PEOPLFJSHIr I' #SEATS INBUSTRIAL WASTE:Yes or No LOT SIZE ��C 'i'ypE WATER SUPPLY_lQ[�L/DESIGN WASTEWATER FLOW(GPD)_��� NEW SITE v REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE /pOd GAL. PUMP TANK GAL. TRENCH WIDTH U b � ROCK DEPTH��/LINEAR Ff. � o� OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMrRovEMEtv'i'PE�uvtrrc.AYouT sAPPROVED EF'FLUEt�i't' FILTER+► �RI5ERtS� IF 6" BEL01I FIEII5HED GRADEs r v r � **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M.OR I:00-130 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS (336)751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: DATE: , •*TFIE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS 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. DCHD OS/96(Revised) Davie County"'Health Department � � � Environmental Health Section � � P.O. Box 848/210 Hospital Street Mocksville,NC 27028' (33�751-8760/Fax(336)751-8786 March 22, 2006 Mr. Charles R. Lee, Jr. 413 Vanzant Road Mocksville,NC 27028 Re: 429 Vanzant Road Tax Pin#: 5709-90-7476 Dear Mr. Lee, As requested, a representative from this office visited the above site March 20, 2006,to perform a site evaluation. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans or the intended use change. Improvement Permit System To Serve: Wastewater Design Flow: System Type: ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other System Location: Valid: ❑5 Years ❑No Expiration Site Modifications/Permit Conditions: Environmental Health Specialist Date ps-i.p.letter 2/06