Loading...
309 Will Boone Rd Permittee's � , DAVIE COUNTY HEALTH DEPARTMENT Name: ' �,� �'-��=' �, � �'i"i ��:�� Crr�:-�� �'; Environmental Health Section PROPERTY INFOR1v[ATION r _ " �� J: �1 � (i � � � c���[c.<<,. P.O. Box 848 Directions to property:' -��� � � ��� Mocksville, NC 27028 Subdivision Name: �'ti ( �' •��.�.�: �� �GG {+ -E ���i` ;,,;�j � Phone#: 336-751-8760 Section: Lot: AUTHORI7.ATION FOK ( / 3`{�j W'ASTEWATER � �+�/��_ � �..� ` � r'��y' SYSTF,M CONSTRUCTION Tax Office PIN:# I r j C1 - AUTHORIZATION NO: �Q��`�� � A �Rroad N•ame t ������''� '� � �' � ����' ��;� Zip: **NOT'E**This Authonzation for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Petmits.This Forrn/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Pennits. (ln comptiance with Article 11 of,('j.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) . i �r' f�/ .�' •^, �w,� ,,�'''.`.�'` ***NOTICE***THIS AUTHORI7.ATION FOR WASTEWATER CONSTRUCTION 'f f,,,.i�.�''•*�Q'"�«""��=-%�' (� � 1��'" (i � IS VALID FOR A PERIOD OF FIVE YEARS. �`� ENVIRONMENTAL HEALTH SPEC(ALIST DATE ISSUED L,,,� � " i 1 I 4 F:'�� � �,�r... f"""C/�' RESIDENTIAL SPECIFICATION:BUILDING TYPE� #BEllROOMS #BATHS �'��OCCUPANTS � GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFI' #SEATS INDUSTRIAL WASTE:Yes or No i�G�j-F% `� LOT SIZE� TYPE WATER SUPPLY �� DESIGN WASTEWATER FLOW(GPD) ��� NEW,SITE REPAIR SITE C/ �f�}� ( (��� ,.� � � ��� � y�/ SYSTEM SPECIFICATIONS: TANK SIZE�GAL. PUMP TANK�GAL. TRENCH WIDTH �� ROCK DEPTH LINEAR�Pf. / � �/ OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYO T � -� � U l��� �� �"`�°! Cs Y�°' �i.�I. .�G� �"- �,� (�� � `� ' ,, � � '°' °� y , * . � � b� �� ,� �,«. i���� r � 1 � , e � � � - 1 V o Y�^ `� It ,� �t' c� C� d'� � �w�'S " �,"' � ' � ` ,��5"1 f5 s �a1 ;-� .c� �,� o -�r'c �>�� � ~ �:` �� .n c� c t .C'C�� 5 l�I`��� � '' , c� r /� ,( f':.� { �t ,.� �� � . �. {„� P "� ���` . r�i"' ,� � � �,. 5\\`,� . G� �� tr ,.C � 0�1'' r { �.!�--� � �,As-�. � � t�i� L��I/ -f' f� �U�-� W � -� �, ./2��C. � /' _—�''� �ti J i C�, C.�( v�,>i�l_� ��i--- �--�- _�. N �r � ,.? ^ �.P ) �'r, � r�'� r'i F.-s y� S�1 �'y� /...-�,..--"" '�' � �' �� i ��<G it� � l��g��1 �J � ���' � . � ;,i 1 1` �� �' c_f �'�'`9 c�f'�, _.�_1� /i�i f� ��^ Gv -,' � _ '"� � � ! �� � ' �` ' � � � � � / � U � �/ J �}� l-J t�c�r. ��"� „ , �1, ,' ^ �,a �.''��� i;d� � � � 1 ,,�`��������2L1�� � � ��UW F r���'� � FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 830-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760. OPERATION PERMIT � SYSTEM INSTALLED BY: — Q ,1 �� ��� ����1 � � l� � � �5 �� , . �� �-� u � � � � ti � �,c�c�� ��.��� I � � �,- AUTHORIZATION NO. OPERA ION PERMIT BY: F�`'�� � p �u` DATE: —�� � •"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE YS DES ED AB E HA EEN INSTALLE IN COMPLIANCE WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPO AL SYSTEMS",BUT SHALL IN NO AY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTOgILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02/02(Revised) . ,. . .,. . ,_ ... + DAV# IE COUNTY HEALTH DEPARTMENT _ _ . Perniittee's�� � �" _ _„� . �_ ' ; Name: �"'j,�� ��w�' �`. + ►'��'t �'•� �"'.� - t fi,- Environmental Health Section PROPERTY IIVFORMATION �"`' P.O. Box 848 i t / / Ji' Gj ; . Directions to pr�perty: t�t-% t -� ! � 1 "'`"t ��L"'�'` �qocksville,NC 27028 Subdivision Name: �f ' � � ' Phone#: 336-751-8760 `� �� �-'.��_``:.z l� .�. S,t.,l; _' 't; :;(," � Section: ' • Lor. � AUTHORI7.ATION FOK • ,� N'ASTEWATER x �,/ F' � �� �l� ` : t ,l• SYSTF,M CONSTRUCTION Tax Office PIN:# "! � t �- ( �1 - P.;��� l��'� ��� �:� � ! J,�, AjJ.THORIZATION NO: Q Q��!� � A � C'��t c. .� ,�, i R'� c, ,,,,, ,. , oad Name: I�t 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 Pennits. (ln compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ` `' ' %" �J,, ,, �,,,;'._ . _ � � *�**NOTICE***THIS AUTHORI7.ATION FOR WASTEWATER CONSTRUCTION ,/F �'.�� s-f�''� '- --'"-=--`' �� 'j� �` j IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED GJ� L, �� y�"� � RESIDENTIAL SPECIFICATION:BUILDING TYPE�_ #BEllROOMS�#BATHS �"""�'#OCCUPANTS � GARBAGE DISPOSAL:Yes o[No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLFJSHIFI' #SEATS INDUSTRIAL WASTE:Yes or No -� �� �5 �r�d � LOT SIZE� TYPE WATER SUPPLY �U DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITE � _ � (� �J f, �� r SYSTEMSPECIFICATIONS: TANK SIZE���AL. PUMP TANK�GAL. TRENCH WID H��� ROCK DEPTH � I LIN��'Aft`Fi'.r I��r� OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT r � i t � � .�l �F°�1`� tx ��P 1� •� �3' "� :( C;, �^ J��'. �Gx ,�, C�' �y;,, �t � �' `� � i� : ,��. � � t,�« � /c:✓�v' j� � � p"� � 0(��-F� � I ,� c .,._� � ( � � � - fVU �"� _� l� * c� l, C" ( r � i� r •�'� �t�-. / x � � / �.- �;, .��` , ► ( r u C •� �,:�l.,i tf �-'`�✓ C� ` � � � �� �� � ��,, _ .�- "� .�. � � C �,,6 ^° -f" �e.` .--"'` .�_ , " �\ , cl Ut '� r f J! , � �v t, -f ��' � yY \ .!"�'" ,� _-'ll��,y` 1, --i ( Uc� t ���,c' �' l ca C: .�� c1_ 4� L'��R� r < ,��� .1, c'�--" 5 :.. f. P �r� ' � ` ' ' � � � .... '�_ ��- ,-+,. `,( . /4� �, ��.. ;.di � /,,,_.-� � i ! �.�",.- r„ [.�' ,t ' t �IT/ �' � ( 1� `14�..,rti:T�;,� � r" �� !'f- � r.,� r'� � Y r � �� �// ___-- / G( � �_,l C � � ` ��t ! � '( ' ` ( _� � ` . t 17^� 1G�� f' �/ 1;�<� � l� (,t�; � ` _ / ! / t.' d � C� t-C . � � � .� �c.: � ; L� �j t.��. C�cYch� �.� J ." ;�,r��� � �, :� � � ��{�\ �ZG i ci {,.� c L� � �-� �✓'�(1 � .. FOR FINAI:INSPEGTION nF THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760. ' OPERATION PERMIT /' ' SYSTEM INSTALLED BY: 1 t — �1 I 4 .�� � .. � ,, / . 1 I _ � a� Sfi�v� � _. �. ".' .., .. ------" �n � . '��^�.:._----_._--_,— '_ (� � � � � C • �� . ` v�' i �-�' i i� i � f '� i !� '� �i ' ` 1 l�0 < 1� (1 � �._ ��t �(� �w��,. � A � . � ... � (;a�`7� pY�v'� .�— �. AUTHORIZATION NO. OPERA ION PERMIT BY: / DATE: � "�/�rs`� � l�"�s B€ ' *'THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYS'�E ED ABO�/E HA EN 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 07/02(Revised) , Permittee's ....�: ! + V �DAVIE COUNTY HEALTH DEPARTMENT N a m e: "'L�`M �� '�-- t �`P� �� �c% �� C.�' E n v i r o n m e n t a l H e a l t h S e c t i o n PROPERTY INFORMATION � P.O. Box 848 Directions to property: ��" ��� � ��=' � � ���' Mocksville, NC 27028 Subdivision Name: .�,��A�'�S� �� rr i � J�, � ��.t � � �t<<lt „ r Phone#: 336-751-8760 Section: Lot: J � (� AUTHORIZ.ATION FOR 7 r�rl �.. �; WASTEWATER �,r 1��,-_ (�S ,,�;1� r � , r - �-��' 1�� r_k'1 Q'`�. Tax Office PIN:# - ; � SYSTFM CONSTRUCTION � �. ���— }�— �r a'� ,�, ;f{.: � �'L�,��, '�:� �.,- �"k•a'�-� '� `.� �' AUTHORIZATION NO: ����a� � t� Road Name: t Zip: "" ��� ��'�'' �'" **NOTE**This Authonzation 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 Perrnits. (ln compliance with Article 11 of G.S.Ctiapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) , ,.� y �,;�•" � `J,,.�f,�:`�� ,,..�'�,,�`,/'a�-_f'1 T•-. 1 *;�,*.�;VOTICE***THIS AUTHORI7.ATION FOR WASTEWATER CONSTRUCTION �; ,, -.�'�- - �' f�',r /��� 'r� �, �V ^ �� � �'�,� IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED �- � ��" RESIDENTIAL SPECIFICATION:BUILDING TYPE� #BEllROOMS 1 #BATHS�#OCCUPANTS > GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFI' #SEATS INDUSTRIAL WASTE:Yes or No '`�� �''� r' � �f�/ LOT SIZE �� TYPE WATER SUPPLY /Q DESIGN WASTEWATER FLOW(GPD) !��k'� NEW SITE REPAIR SITE � � F SYSTEM SPECIFICATIONS: TANK SIZE ��GAL. PUMP TANK -/ GAL. TRENCH WIDTH�f-� ROCK DEPTH � � , LINEAR FT.-�� OTHER �'� "`��'� 'f'C/�ri �-C'�F' r �..�" � ' ' � ..�r � ,e�� -t°"d ��'V�r.� ,.- t� G��i t"�'/•'f;r,�l n�� REQUIRED SITE MODIFICATIONS/CONDITIONS: U'�� (�+�"'"rG� / -(�}(+ C -!' C' � � "7 e/I'-:" -�"r'�r'c'l� IMPROVEMENT PERMIT LAYOUT �' ` ";,.! �,4^.C�`U C'✓� �–�'�}� +C. ! �r� �'- `j 'i Ci( t. j � (��Ci.W'�G° �f'- �l'�:)1 Ct C�-P � C{rnn���� \ i rj-r'i-' � i U t�� ; �r15 u d � ��v��' �j i f (;l i' t� `-�'J-�' t 6 P h ca u-E }�,a H'1 o P�� --„'-•.. �� 4� Cl "?< �I+-°! 1 v�C � ��u f��� ¢v i�� r _..._. �� �� .� w. �aF= G�. � ��; �u�'�; �,�, � o�. �r .` -� -.�` -��' '�C v� 1 ��� � -��I r5�, Y 1�-�-� �.� ,\ /`.. -c �6 'c (� I � v. � ; .1- 5r��uT4, c-c . ��� , •\ ( �� 7�i �'� �C-F IM G f�-f('i` C?T-F'C t �G�'�/( �� f � ,.. _, .._. ... + i i � / �'C' t ti^' t')u � /-r t�� j� 'r/���!C -�'- c( � _ _.. __. .._ � ! � � j ;10��,���' ` C" C` � `� �.trG,,� � ctin i ✓� `' � G} f �t iG.+ ^�j { ) � fdt>Y^� r (�-� ���-P S `f r.�' 4>r-���� � /1 1��'t J r��/,.� t' J, , — \ l.�.\\ }�4 n�,, Rl � ,..-,.--� i(� . ,.G�'�, 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. �F���49� I OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. ncHn ovoz�Re���a> -:. - , , : , . � _.. _ , . _ , "� a.-;� � ^� .(� . . . , ,. Permit�ee s � , -F-. ''DAVIE COL�NTY HEALTH DEPARTMENT . . Name;,:^-"�'''�-�-�� `�- + �'?� '�? r s -rY C---�' Environmental Health Section PROPERTY INFORMATION ' �. �.- i ,,.- r P.O. Box 848 Directions to pr`operty: �-� �- � � � � '-- Mocksville, NC 27028 Subdivision Name: f ' 7 Phone#:336-751-8760 �� � r;,�� ;:f' ; � - h; f�- !,(:•, � i l.:�r:. , c Section: Lot ' 'j ,.' AUTHORI7.ATION FOR , _ �,.�,�r . -�,:.,, ,,r': ,., r r �� �� �� r� .% ��� I'`w '"� • WASTEWATER �f���'' ���'i _ ,: ;,�i tr �. � t. .<_, , ; SYSTF,M CONSTRUCTION Tax Office PIN:# � � � �.� ��.��� �. +�'c t: ,� �����.:t� y �1 � �` �:'.A[,ITHORIZATION NO: ����^�'� A Road Name: Zip: �` � r�` ,� *"'� **NbTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior � to issuance of any Building Permits.This Fonn/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (ln compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) f � 'J ***NOTICE***THIS AUTHORI7.ATION FOR WASTEWATER CONSTRUCTION � �� ���;;s� ` •'�f,r",•'1 � ' � ���' ' ��`�,'f IS VALID FOR A PERIOD OF FIVE YEARS. ENV[RONMENTAL HEALTH SPECfAL1ST DATE ISSUED ,,,^. � O RESIDENTIAL SPECIFICATION:BUILDING TYPE� #BEllROOMS�#BATHS�#OCCUPANTS � GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFI' #SEATS INDUSTRIAL WASTE:Yes or No c' �/�/" LOT SIZE J��r�r TYPE WATER SUPPLY �� DESIGN WASTEWATER FLOW(GPD) /�/('� NEW SITE REPAIR SITE � > >� /r SYSTEM SPECIFICATIONS: TANK SIZE ��GAL. PUMP TANK��/IT I GAL. TRENCH WIDTH�l� ROCK DEPTH� LINEAR FT. -� j• - OTHER ;� � l Vf Y-CI�: •/ -!"'-t� � �,�" � 1 � � � C^t .l�t -�^y� FiY�.,r +� c� �i.�E tr f� REQUIRED SITE MODIFICATIONS/CONDITIONS: Q� ����"'�� �" 4 �1 1(� !�_f "l ��`I�' -+^t^-1 r" r;�� r � IMPROVEMENT PERMIT LAYOUT �,� 1114�rC}U.� tf .'�-f �� �C' �'� r.`r- � Cj� ii '� � t �'� Ct �/�^C`,�-(� • < �-t"yl" (i,f.•.-t' Ct fj'c.y^�.���� , f �-j t'( •� r C's 6�1 � , �"��� ��.� ,,� � , .�, y) t fj ' j �1 I t� �.,c• c: -t- ' wL� � h fc v .c� jo o iti'\GO 1°� , _ .�.^4,, r:.. ".'. ,- 4 -� � � � , '1 1� �-i��t��l •� ji�-I It�� �t G� �e..f�ja �c•' �� � � � � � � ., ,� �.:.� c r\', �'i`, ��t''1; �•.� (�-o� 4- ; }(� { 1 (r, j H - • — , .., ,� "'i �F, „F"..�.� ` ��) 1 1 ✓' { �i 1 �^e) ��,� ( �'�'F'\, _ � a.�'w.� ��, i+"`, ' ( � /�� �"�" � /t { R„� � , l�' ! ' I"" , ; t� .,v- r �^l _-) Y"' ti�i {'N ( ...�.:, � � �` /`�" _ � \ ( . _ µ.. � . �,d �� .�, =' �_{ C�Cta�� < 4� -��"�, C�� ..� {� �,..a'li !'t !'� 4 F � ' 3'/�'� ,' � -�� � .C' �)c� � /.r c^"� �� 'r L���CP r �•- c� �'3 • ,.. �, � f � �.-"/ �i�y�\'.+'�, � !"' r•� i� -` �r �.. � `� , r. t-�. � .� y � � ( �� + c -� `.� ,, jf ! ��,�....k �'f !�. -r : 4� �r°' f I l"`,i f � ,� (�1_�J Cr y'�•C.� `� r, ' S � 1 � _. ._ .. . t � \ r�,�, ✓� _--."`�' "') �(.J' FOR FiNAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 830-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760. �,;.•(�G�f� OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: DATE: *'THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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 SATISFACfORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02/02(Revised) � " __ a . , ' . . "`�� ' DAVIE COUNTY HEALTH DEPARTMENT „ ) S I � � U �� � -�- Environmental Health Section � .�� C'�� k � � P.O.Boa 848/210 Hospital Street � � � � ( � ^ �� Mocksville,NC 27028 — (33G)751-87G0 .�, .-� h ��L�� -�� � �.. i�4� 7�� s�t c��«,� S ����f.y l s�, 1�.�:�1� � • Account #: 990003971 Tax PIN/EH#: 5746-98-2399 ���( — �`!�� Bilied To: Joe and Janice Zimbardo Subdivision Info: Reference Name: Larry Davis Location/Address: Will Boone Road-27028 ATC Number: 4428 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **1VOTE** T'his Authorization for Wastewater System Construction MUST BE ISSLJED 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 WASTEWATER CONSTRUCTIQN IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: �/��/ Date: � �� ��r1 Y��' �xJL��j o c�v��S r� '� U C 1 -����� -r 5���'��c�c� C�-�.'��' C��J-t�`,i G� 1�' ,> ;� C�RTIFICATE OF COMPLETION d:s,�I�� + ��� ��-��'�� z r .�"f v��v► S'-e ��� �t�-c � **NOTE** The issuance ofthis Certificate of Completion shall indicate the system described on Improvemend�ration 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 th t the system 'll function satisfa orily or any given period of time. ��� ��. ��. C. ta. l/ �`�� . �✓�7� �- -�. �'��� �,;�, � . .�;, t��-y � `�`.`i` �z� ,�b � `- w t' `'� �i �' � � � . a�` �,��j��v�' 1�� �� � � �•.���.a � � 5 � � . � � : i � `�, ��� �� �' ` . . � , � � p�� �� s�s �oC►�-�>> �_����: ��. d��'�' � � �� �!, �� �� ,l _ .�,,ti� �� G�V 1C��. � �D C'Z41�w�2 ..�;2�.�:.�'; � �- �-o�� ��� ���� Septic System Installed By: _:... \�.- .-. . , - - r,.. . r....._ �� . . . -� .•- 1 r, Environmental Health Specialist's Signatur': i ^, t. .--` Date: I/ �l f% `"`_ �` -._.. � �,,. i DCHD OS/99(Revised) , ' �:� � ` . � � ' , ' ' �. � DAVIE COUNTY HEALTH DEPARTMENT , � Environmental Health Section '� C'� r.o.sog sasnio x�p���s��t � 1� Mocksville,NC 27028 (33G)751-87G0 • Account #: 990003971 Tax PIN/EH#: 5746-98-2399 . Billed To: Joe and Janice Zimbardo Subdivision Info: Reference Name: Larry Davis Location/Address: Will Boone Road-27028 ATC Number: 4428 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSLJED 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 WASTEWATER CONSTRUCTIQN IS VALID FOR A PERIOD OF FIVE YEARS. � Environmental Health Specialist's Signature: /�f/ Date: 3 � � a� ,� % CERTIFICATE OF COMPLETION z , ' **NOTE** 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. Q�� �2 ;."! •t b l�l _� � \`� .1� , � . ��,r _ �_ ; .;;,.��Y �f ;� ��� :� `�'� �r--�,,5 s�C��-� �-�J S� ' . � �U tGk 4 srD e�a�z .�rL�,�i - '�s . , .. �1.,�^-a-�S � .Y,�,:.;�:_ Septic System Installed By: '���:• � �� - r ,`;.- - . ..,- . Environmental Health SpecialisYs Signatur : C i'� Date: �� 2`'1 f� ��'- � ''_.- . , ., DCHD OS/99(Revised) � ' . �`Y'v� •.��.� ... °,\'; „ , . DAVIE COUNTY HEALTH DEPARTMENT ' '�' . • Environmental Health Section � _ ' P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (33G)751-87C0 IMPROVEMENT/OPERATION PERMIT . Account #: 990003971 Tax PIN/EH#: 5746-98-2399 Billed To: Joe and Janice Zimbardo Subdivision Info: Reference Name: Larry Davis Location/Address: Will Boone Road-27028 Proposed Facility: Residence Property Size: **NO���*"1��sZiiiproVetYi�nt/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 J� Dishwasher:f� Garbage Disposal� Washing Machine: Pf Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ �G Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �f�C Type Water Supply� Design Wastewater Flow(GPD) �� Site: New� Repair❑ System Specifications: Tank Size/46� GAL. Pump Tank GAL. Trench Width Cs�'�rRock Depthy�f� Linear Ft3Dll Other: As stated in 15A NCAC 18A.1969(5� Required Site Modifications/Conditions: acc� r��_,j���Fms r�aj� alse ���^ I1�IPROVEMENT/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 9:30 a.m. or 1:00 p.m.to 1:30 p.m. on the day of installation. Telephone#is(33()751-87G0.**** �a''�' . ,��► Zr��n�� J`� . , �� �� � Environmental Health Specialist's Signature: � ,��/ Date: ���CO� DCHD OS/99(Revised) � May 04 2006 9:SORM PIEDMONT TRRID HOMES 336 661 1651 p.3 , . . . . ��p6 = � � ��' � �� �. � �L�A� SITE EVALUATION/IMPROVEMENT PERMIT&ATC l�� , ,� �' ► , f � � � Davie County Health Department ,�I� ��lr�Q Environmental Neatth Section � � (- D ,�� �- � � � 2006 r:o.Boa 848(210 Hospital Sheet 1� � �, �.,I�AY .' Mocksville,NC 27028 � � . (336)751-8760!Faz(33�751-8786 �j��u� valuatio ement Percnit �Authoriration To Construct(ATC) }�Both • 11� � f S •s« +*��S pppLICAT[ON CRNIVOT BE PROCESSED UNLE5S ALL OF Tf[E REQUIRED _ ORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN foi instxuctians. APPLICANT 1NFORMATION • r I� Name to be Bi11ed�Jo� � � /e� ��nbR-�d o Contact Person . G��-'���G� Billing Address a. Home Phone S'1`— � —� ' City/5tatelZIP // b Business Phone Name on PerrnidATC zf Different than Above Mailing Address City/State/Zip � PROPERTY INE'ORMATIO�T NOTE: A survey plat or site plan must accompany ttris applicarion. {Pertnic is valid for 60 months with site pl no expization vrith co ]ete ptat.) Street Address ,��J,�l Jgpoh r 1��_City�ar�C£�,.Yl.. Tax PIN# �a�'I�fG�I S/23�J g S�s6division Name SectionlLot# ot Size Airections To S�te:��Qpn. �CJ/ t«,R..y� �tJj��� �?'i P 2 isei�f _ b� ! Date House/Facility Comers Flagged S^ — If the answec to any of the following questians is"yes',suppoiting docu�eatatio}¢�.ust be 2ttached. Are there any existing wastewater syste�on the site? ❑Yes,Q1�Io Does the site eontain jurisdicrional wdlands7 ❑Yes�o . Are thcrc any easements or right-of-ways on tLe site? ❑Yes J2'�Io Is tbe site subject to approval by anotha pvbtic agency�? ❑Yes fdNo Will wastewaur other than domestic sewage be generattd? �Yes o IF RESIDENGE OUT THE BOX BELOW _ I#1 People , #Bedrooms � #Bathrooms Garden Tub/Whirlpool OYes �TTo . Basement:❑Yes �lo BasementPlumbing: ❑Yes �Q�io IF NON-RESIDENCB FILL OUT THE BOX BELOW Type of FacilityBusiness Tota1 Square Footage ofBuilding �t PeoplC #Sinks t#Commodes #1 Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICF ONLY: #Seats Typesystemrequested:�Conventional OAccepted ❑Iimovativz OAhemative ❑6lther w'ater SupplyType�i ountylCity Water ❑New Well ❑Existing Well O Com.�nunity Wel1 Do you anticipate additions or ezpansions of the facility this system is intendcd W servc?�Yes �lo If yes,what type? This is to certify that the information provided on this applzcation is true and correci to the best of my knowledge. 1 understand that any pemiit(s)or ATC(s)issucd hereafler aze subject tn suspension ot tevocation if tfie site is altertd,the intended use changes,or if the information submitted in this application is fals�ed or changed I understand that I am responsiblefor¢!(chnrges incurred frara�his applicatinn. 1 hereby grant right of entry to the Authorized Represenutive of the Davie Co u�ry Health Department to conduct necessary i�pections to defer�e eo liance with a�P liczb laws�d mIes un the above described property{ocated in Davie County and owned by�f —}' y�/4so�[f Zsr„��Ld p • ',C'�^� ��"�""' � Site Revisit Charge Yr e s or owner's legal iepresentative signacnre Date(sy. ��(f� Client Notificatioa Date: Date • . 1:115: _ Sign givcn ❑Yes ONo �w���� l�!,/ Revised 2l06 Invaice# May 04 2006 9: 50RM PIEDMONT TRRID HOMES 336 661 1651 p.2 � : • . . � • • ' /Uv`- � J � � � � � v � � . � � . �, .s, � � � � � ¢ � � � � � � �� W �a � � C3 � . !� � � � ti � � . �-- � C._ . � � � � � � � r��� �� _ L � ,(� � ��. % �w �`� � - �� � ��� �� � � � �/� i' � . �,. �b � • . '' •' • , . � � DAVIE COUNTY HEALTH DEPARTMENT • � . ` • Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003971 Tax PIN/EH#: 5746-98-2399 Billed To: Joe and Janice Zimbardo Subdivision Info: Reference Name: Larry Davis Location/Address: Will Boone Road-27028 Proposed Facility: Residence Property Size: 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 sition Slope% HORIZON I DEPTH Texture grou Consistence Structure Mineralo HORIZON II DEPTH Texture rou Consistence Structure 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 , i.�ndscaFe Position R-Ridge S -Shoulder L-Lineaz slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope Tg�CtliL@ 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 �ON4IST .N . . , �Q1S� + VFR-Very friable FR-Friable FI-Firm VFT-Very firm EFT-Extremely firm � � � NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky � `' NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic � � S r' 'r , SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineraloev 1:1,2:1,Mixed Notes=� Horiipn depth-In inches Deptfi 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-gaUday/ft2 DCHD OS/OS(Revised) �,f' t : • ; ° � - r `�r ��eU %�U ;.��-�G��'P�'��C��c��� , � �Q � . ; � � f.� �� ��. �� . � •� . . , 1J.Nt10�3U1tla ` .'C U��. t ;, ,E-e�t, d _ � � .i�H�dln�wNo��nr� � � � . � ��iv�����t�;,< ,,�. ,�, , • APP CATiON FOti SITE EVALUATlON/IhiP130VEAfENT PEfihflT&ATC ' - �~ � � ' Davie County Heatth Department .� �QQ� 6 1 ��� Environmenta/Hea/thSection l �L`�r �w�Q1��� '� ' ,� ,��-;_ � � �; -���'�� P.O. Box 848/210 Hospital Street ,..{� `T.� � �_�`�-` � � Mocksville, NC 27028 � � �. � � � {336)751-8760 � ��\� � �--f-- L� U I' . ***ItSPORTIINT*** THIS APPLICATION CANNOT I3E PROCESSED UNLES S AL �THE I2E IRED INFORMI�TION IS PROVIDED. � the TNFORMATION BULLETIN for inatructionu. ���� s +� -rl `i�21 f�, iSlo-l��l2� 1. Nama to be Hille J �YJ. L�, ���1l17. Contact Peraon C� � ` Mailing Addre3a �" Home Phona %��'��� � City/State/ZIP ' / � � `a� Bueinena Phono [sl�2^:�l,��� Z. Nama on Pormit/ATC if Diffozent than Abovo /T����G �//'��j�K f�(� - Mailing Addreus /�()l,' /'!/�''7�v 1/7 �5� ' City/Stato/Zip /'l���L/����� C..� �.j,L��� 3. Application For: t� Site Evaluation ❑ Improvement Permit/ATC ❑ BoCh 4. syatem to servtce: I�House ❑ biobila Home ❑ BuBinesa ❑ InduBtry ❑ Other 5. Typo syatem requested: � Conventional ❑ convantional modified ❑ innovativo � 6. If Rasidence: . � Paoplo _� It nedrooms _� t1 Ba�hrooms LNDiahwashor ❑Oarbage Diaposal twlWanhing Machine ❑nasement/Plumbing ❑Daaemont/No Plumbing 7. If Dusi:ieas/Induatry /Other: verify type �# People 11 Sinka # Commodea� # Showora �{ Urinals �E Watnr Coolaro • "r' IF FOODSERVICE: �� Sea�a Estimated Wator Uaage (qallona por day) s. x�pa of water aupply: 0 County/City � Well ❑ Community s. no You unticipate additions or cxpansions of thc facrility this systcui is intcnded to scrvc? I7 Ycs O No .� If ycs,ivtiat typc? ***I111POIZTi1N7"`**CLIENTS�1IUST CO�IIPLGTE7'IiC f.GQUI1tED PROPGRTY 1Nl�ORI1'IA'170N IZCQUCS'fCU B�LOI'V. Githcr a PLAT or SIT[;PLAN hf ST BI?rSllllAllTfL•D Uy thc clicnt �vIti�TIifS APPLICtITION. Gk I'roperty Dimcnsions: �`��� �� � lYRITL•'D[RLCTIONS(from Mocics��illc)to P20PLR'1'1': - T�a orr��r�rr: �� �`7���'�'�(�a�fl2 � � ����. ��� �p�� ��.,> Property Address: Road Nan�c---����.-1�(�(��- 2� t.�� �� �i>7� ;�?"K � (�'Z i �l'..f' . c,tyiz;� ��C�C`avl t�i.,�, �`+� C�� I ��-� �;�;z. Cc:i��eQk.. z��� � L. If in a Subditi�ision providc i�iformalion,as follotivs: �-�'� ��' ����(YU. (ctci� �Jj� 7U -.�. Namc: l��r�'t.+2�L. i'V1C1�1►,� �'I�3'D�J�_ f �(�'L��,y t �3� Q/ ��( i Scction: Blodc: Lot: Datc l�omc corncrs ilaggcd: i' T�� !l C,���� =;f �,..,M...1`. •�� "/^''� / �( �w..,. �.s .,. Y�.w�.,� . 4,.._ � �L 1 / l.' �I .......�..-�"'.,.J+.""� �}:...� t... t.-.._. . {y` � ;_ . t� J Tl�is is to ccrtiCy tliat thc information pro��idcd is corrcct to tlic Lcst of my I:notivlcdgc. I undcrstand tliat any,permit(s) issucd IurcaCtcr are suUject to suspcnsion or rcvocation,if tl�c sitc plans or inlcudcd usc changc,or if thc inCortnalion submitted in tliis application is falsitied oi•cl�anged. I,nlso,«�rderslRn'r!tlint l�un respa�siLle for a!!clrm�es incrrr•rerl fi•o»t tliis rrpplicalioir. I,licrcby,givc conscnt to thc Autliorizcd Represcutativc of tl�c Davic Co}�iit I�I�alt],i�'�cp,a.� •ttncut to cntcr upon abovc dcscribcd properly'IOC1�C(� !Il D1��ic Com�ty'II11(I Oti��ncd by �?f�{af� I:JtC�I'.r�i�n to conduci all tcstii�g proccdures as►icccssa►•y'f0�(ICfCI'IIIIIIC tI1C SI�C SUIt:llilllfy. � / � r DATL , , J'�/1`1/�� SIGNATUIZ� ' f� ,,J /'' a �L it� c�'�J,���L . ; TIIIS AIt�A&IAY B�US�D rOR DRAWING YOUR SIT�1'LAN(Iiicludc all of tlic follo�v i : L�is(iug a�id proposcd property lincs and dimcnsions, structures, setbactcs, nnd scptic locations). Silc Rcvisit Chargc - . , ; Datc(s): ,�, �:1.. c(v >�^''.� � f f U J �� Clicnt 1�IotiGcation Dntc: �• `� '�` �FIS: ti , �: ..- ' � ' , �lf,. . `f . ��`.�(r.`J � 1(:`\�' ' r1` � �j� C C Sign givcn ��-�� � f, r'-Account Nu. / �/ � u�-�� � ,* � ;' ' � RCvisCJ DCIIll OS/03 , � �;! ,1'i I � � � s l ����ij� �;��� �� Iuvoicc No. � �� � � �t�. � -�--- (� il�:�? �./----- . I _._....__�_.�.`—:_-__y=� . ;, � __.. . ._ : .�� ..I - . .--��-..-��_ , _ . � . _ _'. . . . , ._' .' _' '. Taz Lot 73 08 �� _ .,'-a :-_Sy,� _..^—_. . " .'. ,'_"'._-. . .+ . � .. � ]'az Alcp;x 5 � . •. . R� . .,\ . . .. . . ;l - � - . . n/f R nald Lee Ho�ell . �-- Qub��� . • . DB 198:0 RC351 Op i. .� S�P�P_n. . • . . � . . . . I ' ' � •} .6 � (l��M ` , . . . . ��1 4 Fnd F ... ,� 'q . � . .. .I . , , - � -�''s..\\ . `� . . • . . ' i � . . . :j �. . . � �I �..� � � \ �� � . . . � . ... l! a •: ^ . .;�'.:,. ' . _ ' . : . ' ' �. ' Tz�Pt - _ , . ,.: .:.o. : .'. '_r_ ; . . _. ' . '�+- , ,. S��nE �fa: _ � ^' x-1/wL6 .. � - . . ,908.50 ��t. • `\' .�n%f�:. .On i . . zo � - . . . r ta� - - . . 4 - r - . � , .n �. q , � "fea3.fp�� ��to E �,. \ �'\ DB.45 O PG 577� . 1 F . • . � s ' �- } < i� . ,'.r i-� ,, . . . :'p. t : \ T.4 . . f . . ' .j i • 4 �T- � .. [.f. 1 � J' ��'� , . . �� �. . . J ! i '�' .3 . "` ���Paint E . ' �- . ':/'� � �� � - . . � � ti. f.� r 3%4•':flP Fnd, , .3.i'.O .t, ° �-j T ��; I 1�' � .. � �.,.` `'� R.. .. � . . . . _,. _' . :. �: , , . � � ... . -. . .: , . � .. W .' ..; �.. .. ......:. : ... . � , �� � - �'�.,::r o4on of 100 Year . -� - _���ry _ . -- a: " ..:. . .= ,...,�.. ,. . . :.� --:- � � = . �Fe+ .,v "Fbcd Hazatd Vne ai,xaled.fmm ;� �: 1� � �n • . ._ � ���,p '��. ' � . . . :a:v . _� � . ;�. `FloodJn runce`Rak'YaV;�F1PodS _.-r'.'.T� 1 .;r�� \ - �o'�� ':3 }. .'� . .�' 1, n:..i -Pc�-I umba � s�. y ��: ..'�' m ., . ... . . . _ , . . . . . 1 . � � •�Ca'mmunu ne N ..F� .� . . ' ' .. .� dY., � �,� m„� r ..1"� ' a.Y' a ,,i i" - . . ,i�r-r �/' �f`-�370308'.OtDOC:': :s` .� 1=�: c ��- ��� u ,� a c` -i`� t rv . .-t r 7', 1 '.2:�. _ . • . . , -�o� evibed:12-� 1993f. . �.. .� . �-:�.P'R � )... .t - . .. �"� �i . . ,i-. -.\�:.:- � 'y, . � �' / .. . �. .. �. . . . , i . .� . �� 3/4 AP F'nd:, . .1. ' ° , ... .��,- ..' � t,•.;. .. , '. - .� { .__:� :: .�r.: .., ' ;, r' .�,.. 1� � '� ; 5k., 4' � . _ 2 h - t�.0 . � . • ,a: '. �`;. :.� ,':,,' T,.. , . <..: v r S l't.�O ��S]X O I• .,;:,: - .�s,: w. ':. ..,.�f-�-..:�. >:,'r... .. .:.: .. .. .. . : : :!', �f .YJ. �tQ -\ - ' � 8;(C 03 ' . .•,� ✓ �. a � f _ ,. � .�. �; � L .. ` f�a' . „ .: . :. ._ .�•�'N �;:�. v�, v. ���- ��.:. ..:�' . , : . . .:..: _: i:.`'� _ . d �, �e(� ....:.. .;�.,., n , P64ltC .....,s._.�. ., . ._. . . _:.� . • .��� ' -^N :--.����•A .. � t ...56� es� .��b to u[er..,. .:�\e:$� . ����. 5-:..,�... _Pd �in:(?nek� .._::.._•:.. .,. .� •� .� •: ... . . .. ..... :::.. ^.L..t,:.,a � - 5-jy �,�... . , ^t :.. � Y.,.;. ., t „ , ., . . r .�... - Fr ama�v�ithin''S R..180- i: �J�'X � ' k.: . , - -t�..:.f _. _ :�`.� .e. � Mdasye;ot z-F� . .. . s, . , - F e - .a-•r, ��f� .7 � 4;`>'.`_ . . . t' 't k� - .� . . _ . .... . . � � . . . . . �� -� .. . � .;� ' _� Na.��. ...� ' ,: �..,� ,S h.. F' t. . � . ,!Y(Y' t' . . _ f'• e� 4.� j � ' , . .r , ,/. '�C.�` U ' .Poinifn�roel�. ;y` �t' ¢ .���'P ' �� . . �_ _ .y f,. . 1N i_: �'Pou�f B ,s. \\ .,F � F � "t ,t ..y• F s� "` � . � � 4 ,. .. . . . . �_.. �. . ;. . � ,,. '��, .�.. �.'� ..,, . . ; .� i .�.i! �7$ . . .. -. -,�•a•< x..,,.._; ..i i , r �4.. � �ti: .� . '� . t_ ' ' �'v' .'. . ?J;N _,...- . '~� �� . '..,..- ..:: 's. a. 9B: S.'7$'2.♦.. _ � ..,..,.; ' . . .......,,�q ,:. ; ,�y, �i; K ,.99- � Z35) t . -ia�, �t .�.... } w< e+ - .>1 � R ti. " �• ���: ,� •. . .�, 3 + . _ . M . . :.� � �... r : ,;,-..- �:.• � -r»u�.�.:; ::_ :. � �.;..� �:r - �-4':: _ :-M1a ' ':s'l .k_ :,� Q. � - /4 �'�,� ./.. �:* EIP 'ti��: ''��7 , �� . � • ]4'25'ti"W Fnd io- �1- r t. ,�, - e� +�.. t �.+:- ':N.. >�� .t+na ,.t• � s .„ . .. ��. . � ,.. . • -: .. . ' . �'�C 5' �{ �Y . ,� rv5:�( A ' o.tl J'4�EIP n .�s 1 � . 2 �>, /. ,Fd �C vca . : „: ... ;. . , , a ;a r.' �., :,. r' 'A 7 Y, x P 0. "! F. - h- F �� t .�k� r a•: - . i� .k-;� � � � r �. r 1 1 •F? .�� 1� �_ \ ''t 3',, t `ip X.t�. r. �r� ,:�e: u, . - `�t: �r. , . . - , „ ,y . . , . .. .� .�,. yr .r. : , , • �. _ ..,. •n .��.;, � .. �. . : . �v�� J^.�.. �:t , :,, ,:�:... ,a.4. .1.,.� � ,�.;.. �,�. � ...... ;u �}t �# .h�... .�,4 vT . ,�4,.' . . .� . ..,,�:. _ � .. t �,; �:. �.. . j ,,,.,. . , .�.,. : _ti- -. :' �..[. r'i'"830.29 � >- - 'r \ -r . ,r,�. a .r.z .t; . ` Y T tal A ��` ¢;(b73.78' � "n. �E, + "^' � c. �. . ,.'v •., "'�:�. � 'j,' _:a- ,;y` t?e.' b _ , .�:�` i� ' - i' S. � i vcT�< .�;83•42'f3' �x. -+t� � . .. ��� . .. . : .. .� „�, .. , . . '-,: � � .. , . .. . j`ir i� �. .[�x ,�....� . ._ ......� �->:.:� -� .. �..,a.t ..�' .:t � ...e i _— .�Y(�. 9.p� r.^ F �t. ."1'-.L. :L � 4� �:%� ,-�a_ •y � p. 6 ..!'� �:ai '"N. �y' _ '��,, y. j ....i� - �-- .�. i' . .:.`� ¢ .. . . . . ; _. . 'a . ; .; . ..>. -. :� ;� _ P:� ,:., 'F ,X,a �Y ,; - �, . .� . ep � - './v� Y . "P, ) �, G 1 o j• .-� . ��i - . �. .. .. _ r "'' , ' .. " e >= .. . _. . _: ;�r, � �- , .� C7anx.oc.ss.o � a z ,�. .7' .,.��=i;� i rr - "tv t,�- " .� ,,.. 3-�u' -' �..,.i .�....,.,,��� :;r ' �:: : '^.. '.. �-t ,v _��r 7 • _. . �F .,,.��;- � �� L'T ..iy:. . . � .-`� �.'i,,... .. ;r f. '.y.�.,. �.... •; ... �. . �... ,.;:- »�,* .Taa3Aa:i�S. s .�r� . .•< . .:.. .. p.. n. ..s., -.f -r:.<...,.r,4+�... :, .. . ��� .,� :- ..i �- .� .... ,;:� , _..• .�e .a., ''3 4"�P�Fnd .t i` ..Y:- _ e. q:, .,,`��� F ,p:: /. - �:�.a�,. ..-G'� ,i:. ._� r i_x-? .r -';�'� r -.: ..., , a. .. . . : .. . :�., .n�Rdberf'�Jou h:�BeQdin ton�P�.. '�F �y�.t. :�;+ :_'.. � ...;,. ... �_••� :;.`. ..x' !. F m \ !'.y:�. .. .?a. / ....,. P ,:�.9._• . ,x.��.. .. ._. . _�.:: .e_ .. ..� y .� . .F�t.�� r T i , S - �J . ._... ., . ,. ..p: .: .. .:..c., � 2 -.� �D8,1.95:;0-P,G-148 � . . � - . ��y:::... ...>,;•:_ :i. �...__��. .. ... . .. ., �..i' .. r-� _y' ' i� o '(_ x. �.� i; - _ �.?�'s � r j:. �s; MJ �.}. � .:4 R� � �_�: _ k .� � C � � . . ... �.� . ��. .. '�. • .� . �_. . �' �.�� 'r.���r a'r.�'�+�1.1.. ..::��. . ,:�'- � ..:�. .. r: . . :. . '..r._,}:.v _ O,.:m �X. `� 't'_ ' [ {" _ ',S'... #. .�. .d.. ' '4 ..:.� -p.. . ....,�r 'r ' . _. .:.. . .' . .. � _ : ' ..:.... 1.�-.. . . ��. -vk ,.•, .:-.�... ..:i. '•:"� �. �-::. �4 ] J� _1 }. �-" \� ` 4,t {�' � . -.�� 1�� I .l. O it< j` �h-, ti� � ' - i )' .J_ t'• �:'V.i� - ' � ap `(- .�C i'1� .fi }� i ,_� �T V�•j` '-+� S� .\ � � .. �.�C , ;.3'. ;y' � � � f �' _ , . � . • ' .'. :i' ���.< � -.w ��. ."� . Y.�.... N&.'� ' .:. �..... ` �. �.-.�!f .i�. 7] .�.� ..1':. :.. ., .. n.. ... �.r .:._ .. �.. .. �:: . :�_..� r•.. :.� •.�."� e w t :�. ,.�q,h ,. *- . .. .� .�-.r ... - .;.. . r,..: ,� '`r* '-E1PFnd . . ,� . . .. ' _ f :s „'" ' " w .;�. °,. . •:: F� r E`. ; , \ a ' •� . f ._� ..�-� � ..�.i ... . �4� .. C.�\. . . . �� .4. . �"'-: .. �. ... .r. . Y . . ...'. _ c . . , �'����.C.,. ....�: . �.y.:. .� ' .,. �... . . ...• :. '1 . . J • . � ` I'•i .�:d,. . I :�f' € "d � '\ y ! ,�{. t - J �' -.�; T ... . i. - . , _ ��. i\ �, .. 4 .,� .. . • . �: . \, : . . � . '� : .w„ :. . . - .;. _ . ,_ , . � . . . . : � •'_�.:«�.,a.-.<� _�_�•"'_... ��:.� _"__�..'.. _�_._ . .- • � . • .`..._.`.._�—__t._.'_ . �_ . - . _.' ' '_.._. . ...... . _ .. ,. _.. ... ._ . . ."_. " '��_ . _ . -�.,---••--__." . � i • r • I ' . � � '' � � ' � � . � � , � . �� , . ' ; • , ; � ' ' DAVI� COUNTY IILALfII D�I'AItT1VI�NT �, �, �, Environmental Health Section Soil/Site Evaluation ,�PPLICANT INFORMATION PROPI'sRT'Y INFORMATION Account #: 989900291 Tax PIN/EH#: 5746-87-7662 Billed To:. Robbis Beddington Su�division Info: � Reference Name: � Location/Address: Will Boone Road-27028 . Proposed Facility: Residence eroperty Size: see map Date Evaluated: ���'� Water Supply: On-Site Well Community Public f.�� Evaluation By: Auger Boring Pit Cut ' FACTORS 1 2 3 d 5 6 7 Landsca e osition Slo C"/n �n `� -) ►iOIZIZON I DEPTH �� �� Texwre rou , �� G' Consistence Structurc /� � Mineralo < HORIZON I[ DEPTH �i �/ Tcxture rou - Consistcncc - ?� Stnicture � , ( S Mincralo � �/ ; HORIZON ]I1 DEPTH �� � Tcxturc rou Consistcnce ' ' SWcturc Mincralo* F{ORIZON (V DEPTH • Tcxture rou Consistcnce Structurc Mincralo� SOIL WETNESS RI:STRICTIVG I-IORIZON SAPRO(.ITL CLASSIFICATION LONG-TERM ACC�PTANCE RATE � � SITE CLASSIPICATION: � EVALUATION BY: `� LONG-TLRM ACCEPTANCE RATE: � OTHER(S)PRCSENT: RLMARKS: LL��Nn � I,andscapc Position IZ-Ridge S-Shouldcr L-Linear slope FS-Foot slope N-Nose slope CC-Concave slopc CV-Convex slope T-Terracc FP-Flood plain H-Head slope Tcxturc S-Sand LS-Loatny 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 ' CONSISTENCC oi t VI'R-Very friable FR-Friable FI-Firm VFI-Very�rm �I'I-Extremely firm Wct NS-Non sticky SS-Slightly sticky S-Sticky VS-Vcry Sticky �r NP-Non plastic SP-Slightly plastic P-Plastic V('-Vcry plastic 'lructurc 'SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky . SBK-Subangular blocky PL-Platy PR-Prismatic Mineralo�y � 1:1,2:1,Mixcd � otes I-�orizon depth-In inchcs ' Dcpth oF fil]-In inchcs Restrictive liorizon-Thickness and inches from land surface t. Saprolite-S(suitable),U(unsuitable) ' � s��� Soii wetness-Inches from land surface to free water or inches from land surCace to soil colors with chroma 2 or less • Classific�tion-S(suitablc),PS(provisionally suitablc), U(unsuitablc) Rcviscc. LTAR-Long-tcrm acceptancc ratc-gal/day/ft2 � �• DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT.PERMIT(REPAIR) o. NAME � C1 � �� v1n 10 � v �C� PHONE�NUMBER �� U ��7� ADDRESS ��� W�`� � oo��.p SUBDIVISION NAME LOT " _ ' DIRECTIONS TO SITE �.Q-U` �" � � � ao -�.. ��?�, � c5 � f�4 U�^ �� . DATE SYSTEM INSTALLED � � U NAME SYSTEM INSTALLED UNDER 7 ,' M VJ �r �o TYPE FACILITY �T7v� NUMBER BEDROOMS NUMBER PEOPLE SERVED � . � TYPE WATER SUPPLY l'?� SPECIFY PROBLEM OCCURRING S� S�I�-"� S ��(1 c�c: � DATE REQUESTED. n� � G v INFORMATION TAKEN BY�n � �n �'� This is to certify that the information provided is corcect to the best of my knowledpe,and that I derstand I em responsible for all ar a ncurred m this applicatio�. SIGNATURE OF OWNER OR AUTHORIZED AGENT �' � � -� '�� � - �,.,,�3 � ;�� U�S;-� � 3 _� y_�� _ �(_ � G � � � -a� - ��,�s=0�r �( ' � ''I —v Pj �'�(f`�. � —� ^ � �(� _ - �' S�, , � � u,�C �,� uo � ��1 � �7� - �� � �- , - ..�-.�, � w,���-o - � � �� ' }���� a-J �� � ��� � �' �.� � �� ', �. � r ' � �