182 S Angell Rd lot 1 , �;-.-+ t.',. F .>«t;..,,t�;,4.3a «.av::w -.{ .� t. . -`Tr1"t`Y, y 4 .i ,., r N* • .i`. r ^� '� .s- - - —
AUTHORIZATION NO: 1165' DAVIE COUNTY HEALTH DEIVARTMENT
*' t Environmental Health Section PROPERTY INFORMATIOI
riiiee.: P.O.Box 848
' Permittee s• � 1
Name. 1-V P.O.
VD�1 rJSo� Mocksville,NC 27028 Subdivision Name: 0 t`LAf7p 5
Phone k 704-634-8760
Directions to prop
erty: ";= '1 Section: Lot:
+A AUTHORIZATION FOR
�Yt� a 1.41 Tta2r� hJ O� WASTEWATER Tax Office PIN:# - -
SYSTEM CONSTRUCTION
AW(wt t_ yr1 Road Name:,'n
A)f-:i:LL 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 Permits.
(In 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 DAT
i
116 Z5 DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Pertnrt�e`,{
Name: 1-1 r1Subdivision Name: 0 1 t.-L A CO`..5
Directions to property: Section: Lot:
";S ry / IMPROVEMENT
1%aN, 1. 1 Y + ►1)2r4 C�,) PERMIT Tax Office PIN:#
- -
Road Name:!5,A4--,Lt. Zip
_ 1
**NOTE**This Improvement Permit DOES NOT authorize the construction or installation 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. : ay
(In compliance with Article I 1 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) 6
f' e�
***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
��:�- �, /;r 1�; ( ✓ PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER
SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED INSTALLING THE SYSTEM.
r ,
RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS #OCCUPANTS_ GARBAGE DISPOSAL:Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT ' #SEATS INDUSTRIAL WASTE:Yes or No
LOT SIZE ! TYPE WATER SUPPLY : DESIGN WASTEWATER FLOW(GPD)� NEW SITE REPAIR SITE V
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. .TRENCH WIDTH ROCK DEPTH 12- LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
c�rJTP�C:ToR,,
G XfST►a5 � - 5 j A.Q'S-1�.lb ���H���
1�� (.icr5T�r5� it
SIT
�e�a i
Dem:
"CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(704)634-8760.
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 T rvm.
DCHD 05/96(Revised)
' 5 DAVIE COUNTY HEALTH DEPARTMENT
Permittee ,r
y IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Name: }' , t+ttv
� =-' �1 i nS";�""') Subdivision Name:
Directions to property: l`" '` t�' Section: Lot:
' IMPROVEMENT
i4't^• ,.1 w.tt �tl' t;'�r� ,1 c. �� PERMIT Tax Office PIN:#
.. jj i i ��;f e L Road Name:` L
Zip:
**NOTE**This Improvement Permit DOES NOT authorize the construction or'installation 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)
s
***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE '
INSTALLING THE SYSTEM.
_ e
{
RESIDENTIAL SPECIFICATION:BUILDING TYPE _ #BEDROOMS _#BATHS - #OCCUPANTS " GARBAGE DISPOSAL:Yes or No k1
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No
u7Gc.c.. �'_n
LOT SIZE ' ' TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH Z t LINEAR FT. I r70 s
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT '
+1 CArr."I+1
l Xi5T,r7tr - - - - 5 j AQ I"1�3� lelJY`t�t',►J
1�J� t �c�S•t�ac� ti
XX „r
�J.5;
�C..J-r �.
"CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(704)6348760.
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
.r
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.
DCHD 05/96(Revised) i
m .APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMITt�
�c Davis County Health Department � , N
n
✓,. Environmental Health Sectio
P. 0. Box 665
Mockoville, NC 27028
1 . Application/Permit Requested�By
Mailing Address
Home Phone j( o2- / / Business Phone �� cif
2. Name on Permit if Different than Above
3. Property Owner if Different than Above
4. Application/Permit For: General Evaluation S/Tank Installation
5. System to Serve: House J Mobile Home usiness
Industry u Other Unknown
YL
6. If house, mobile home: .Subdivision / Sec. Lotw/rW
No. of People Dwelling Dimensions
No. of Bedrooms J Basement/Plumbing
No. of Bathrooms Basement/No Plumbing
0 Washing Machine F Dishwasher 0 Garbage D:ispusal
7. If business, industry, other: Specify type
No. of People Served No. of Sinks
No. of Commodes No. of Urinals
No. of Lavatories No. of Water Coolers
No. of Showers
8. Type of water supply : Public 0 Private Q Community
9. Property Dimensions
10. Sewage Disposdl Contractor
11 . Do you anticipate additions/expansions of the facility this system is
intended to serve? 0 Yes No
If yes, what type?
*NOTE: Improvements Permits shall be valid for a period of 5
years from date issued. Improvements Permits are subject
to revocation, if site plans or the intended use change.
Effective October 1, 1989.
This is to certify that the information provided is correct to the
best of my knowledge, and I understand I am responsible for all
charges incurred from this application. "I?I
Daye Signature
Directions to Property:
• . , � . • ,dot-/
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
/ Soil/Site Evaluation f
NAME Lam!/'�1��/� DATE EVALUATED
ADDRESS PROPERTY SIZE
PROPOSED FACIILTY LOCATION OF SITE
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit !,-' Cut
FACTORS I 2 3 4
Landscape position L L 1-- L
Slope Z Y
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure S-
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION 795-
LONG-TERM ACCEPTANCE RATE Qom^ y7 1 7
SITE CLASSIFICATION: D `J. EVALUATED 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
Mineralogy
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(01-901
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