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1175 Yadkin Valley Rd - �-, s,;,, ��,s ;c a» z 7t*,: kr'.x c' 4�'� �5%� r 9_,. � ' - �-uk.-: a.�"Y'�,3 't, +r .�.� ''- e°"' x a '�; ����.��� '�,��;i�. 'R :y'"�� '^a a+t �� .'" €+s r�t� �''.r s...,�.d �.."`,- c.,._� �x� .._ � �'��� � � �' � �� �� � � � ,. , '_:� $�. � � Mt Permittee � < z DA�V�=E>C��.JNT'I' HEA�,T�$ �EPAR�''1�EN�'° . - . �/ �� �, -� �i -Name �.1.�� ��N v �-� � a r} ,. . 0� � : ; i� . . � - #� ,� . . f r nv�ronmental Health Section PROPERTY'INFORMATIONI I f�3 ' � : � P O:Box 84� _ { � � -""' ' 44 � .Duectio s to'property ^���� °=-' ',!� ��`�° � 1�locksville, NC,2702& . �Subdivis�ion Name � •� �` r' g � � +�_ � : �, • r � � . - � �s.� G r"�?" ,r<'t�.���;,�, 1; �� t�°� �� �t,� Phone#: 336 751-;8760 ` , . : y � �,� . r � "� �_ �� � � h=� •.. Se�tion: Lof: `y " �. , � � , , ,= ' � , , AU.THORIZATION FOR ' ` . � � , � �, ` i , � � ._=� � rv ��V � Y *,.° ,�. �WAS EWATER .O. N #�� ���'�� ����'( �Arr� �'��:�� T_ , , _ . SYSTFM CONSTRU. TI N` Tax Oft�ce PI � i a . �.��� /'r� ' r �� , , . , � , , ° ,, . • l , i d AUTHORIZATIONuNO �:"������� .' A_ ` � • - R�ad Namey ��'S ���� Zip � � � ,. . : y £ - � ,.( .: . ��^ . . . . � . � � .- .. , .� . . . ' '� . �e. , ,w- � - - _ .. . .... .... .. �.:'. , . „_ p�..^;� �-� r ,.-,._. � ,� ,_. , . , . � . . -. ,� f ," **NOTE**This Auth�nzation;for Wastewate��System,Construction'MUST BE.ISSUED,by�the.Davie:_Countv'En'vir_oninental`Health S.echon pnqr �,,�;: , �_rt .� , Offce when aPP Yi,ng for�Building'Pennits: _ } '� , ; � , . ` p ty g � }" p to�issuance.ot an 'Buildin �Pernute�,Thiti Fonn/Authorization Numher stioul'd be resented to the Da"v�e Coun Buildin Ins ctiom„ ? `,. . ` „ � ,. , y �,'�� '(ln compliance with Art�cle�l�l�,gf G S Ghapter'1��30i�.-W�aStew,ater System�,Secfion�,1,900 Sewage Treatnient and�DiSposal Systern�) � �� •:�1 .e�: ' � .�.. -�"+'� , • . �-: : � '' ,�` ' �;,� ***NOTICF***TH1S AUTHORI7.ATION FUR WASTEWATER CONSTRUCTION� � / � � ,. , ,,r�������. ;`� ��. �� IS VALID FQR A PERIOD.OF FIVE:YEARS. �' ��� - �� �!ENVIRON'vtENTAL HEALTH°SPEt:IALIST""� DATE ISSUED ' . � � F .� �� ; �' .`� �; , i ' ' , � � - �. "� . � a ^ �-'�� � - � r-., j� , I,� ., , , e RESIDENTIAL SP.ECIFICATION BUILDtNG:TYPE ,�' y ft BET�ROOMS� � #BATHS` �: � #:OCCUP;4NTS i- GARBAGE DISPOSAL Yessor No '� = ,a• W - . . > _ , . . , , s . ,. . � „ �. . , , ; ,�- .. ,. - : , .. � . ,.. . „ , : .� _.,•.... , � < .. . _, . . , . . ,F � � � . , . . � . � , , ; � �, ., ..� . ' 2 . ; _: . . . . , ' . f .�,:. J'i.: ., ,�. ,. ..� . ,.f _. �_'. ��' . . �- , . o. . , � ,n . .. . .;,�COMMERCIdL SPECIFICATION:..FACILITY TYPE''. � :�` #PEOPLE #PEOPLE/SHIF"I'� ` ' �#SEATS` � INDUSTRIAL WASTE Yes or�No ,; >. . �� �f'��� �. �:/ � : , , � °^�- .. -. _. , _ ; , . . , . . , - � � a :w e�. , . / �. yp . � ; � ��:, �. . . . �.. G�� � �, �p. :� _wr �LOT SIZE . " .�TYPE WATER SUP.PLY _ DESIGN.WASTEWATER FLOW(GPD)- , NEW SITE REPAIR SITE „ . d,, : i � . . . � , ' • ' � ` • ��y �'�,y /.t::� � : , , . G ,, � , . .�� : ASYSTEM SPECIFICATIONS TANK SIZE _ GAL PUI41P TANK�GAL. TRENCH WIDTH � ROCK>DEPTH I� � LINEAR FT�� '� � $ ,, , _ r _ . / � � �, , .. a . . . . . , , � . ,. • .. , e: y . a `- ' : . C J <_ � OTHER '� . _ " _ . , s. � , ,� .�, . . „ , . . s, < �n :. � ,� _ . , _. ��... . ,.< , ,. :. ...... .e� J�� �,'. . �� . � .� � L"� :fl --,�� .. . . ,'- ,. . . .,.� . ' ' . - � ' .g '@ . � . / � .7,r. E ., REQUIRED SITE;MODIFICATIONS%CONDITIONS � �'�.,M ' �r� .,� ' ,.��� t ,..� ,.: : , , e , `. ; , . ,� .,,, . . , t . : . -7.., ---�-- ,- �, . . r :._ �- � ,. o v • ,.. - .,. - '' ' , ' ' ' �: � t� ` � .,� .'. .,$�. .� , . , , .. . , , ,. ..._�. . . . .. . ,' ,. .�..,:.. �. .. . ....,r�. . . .. � . .�-_ - � . r„�. � „�'IMPROVEMENT PERMIT'LAYOUT ' ,- • b��, �;�, • . �F fi ; :? .. .o� � - .. _ L,, . �� � � � ��� � � ' r , ` . �✓t� f� �'� , � , , ' . :�� - ... ." ' , .�.� ' ...-,d h ' . �i � '. ... �, . a: � '- ... ,... . . � . .. ` (((���,.., n .�.��, f .. , � , • .. �� . ., � t,'W p� •��" . .� \ � _ . " �..V . .� ' . � . i .' � t , �� 7 � ' . 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'. — _ � . http://maps.co.davie.nc.us/GoMaps/map/map.cfm?CFID=17813&CFTOKEN=49736857 10/22/2008 ' � ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION r. �,,�,t I..�.d rU�,� �� o� �, � � � Gus � l/7 5� ���,.� U� �li � �� � i� �fv� � �_ �'l� , r y ; / Water Supply: On-Site Well Community Public � Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position V Slope % I HORIZON I DEPTH — j Texture grou SG Consistence � Structure ! Mineralo � HORIZON II DEPTH Texture rou Consistence Structure I Mineralo HORIZON III DEPTH Texture rou Consistence ( I Structure � Mineralo � HORIZON IV DEPTH Texture rou Consistence � � Structure � Mineralo SOIL WETNESS RESTRICTIVE HORIZON l i SAPROL[TE � CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: � EVALUATION BY: , d G� S � 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-Tenace FP- Flood plain H-Head slope T�xtiu� 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 ! GONSISTENCE DIQ1S� 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 Mineralogv 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/OS (Revised)