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241 Willow Creek Ln , , DAVIE COUNTY HEALTH DEPARTMENT �!/���� � � Environmental Health Section � � ' l ,j.�� P.O.Boz 848/210 Hospital Street � /��v Mocksville,NC 27028 � (336)7S1-87G0 IMPROVEMENT/OPERATION PERMIT Account #: 990000828 Tax PIN/EH#: 5820-81-6412 Billed To: Maribel Wall Subdivision Info: Reference Name: Maribel Wall Location/Address: Willow Creek Lane-27028 Proposed Facility: Residence Property Size: 5 Acres ATC Number: 2227 **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 .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: B� Basement w/Plumbing: � Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size ` nG Type Water Supply Ul,�l/ Design Wastewater Flow(GPD) J�,�i G� Site: New�Repair❑ System Specifications: Tank Size�GAL. Pump Tank GAL. Trench Widtl�<� Rock Depth� Linear Ft�'/, Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 "BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m.to 930 a.m.or 1:00 p.m.to 130 p.m.on the day of installation. Telephone#is(336)751-8760.**** F `j Environmental Health Specialist's Signature: �� Date: ,L�—�'�� � DCHD OS/99(Revised) � , , + DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section r.o.Bog sasmo xo�p,t��sa�c Mocksville,NC 27028 (336)751-8760 Account #: 990000828 Tax PIN/EH#: 5820-81-6412 Billed To: Maribel Wall Subdivision Info: Reference Name: Maribel Wall Location/Address: Wiilow Creek Lan�27028 Proposed Facility: Residence Property Size: 5 Acres ATC Number: 2227 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLJST 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 WASTEWAT R O TRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: Date: �/ ��� ` � 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.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. 15� ���� � Septic System Installed By: �dz�- Environmental Health SpecialisYs Signature: Date: j 1�-3�D `�� DCHD OS/99(Revised) . ,.,;,..� *�t APPLICATION F08 SITE�VA!l����'�'�;����P��91E�lEIJT��MR&AT � � C D �I � • ' Davle Goun�y Hesith�3epar�ment � Env�Itvnmenta/Hea/tfi Seclfon p.0. Box 848/210 Hoipital BtxNt ��T � � ��9� . Mock�vill�, tiC 29028 � • (936)751-9760 EPIUIR�tdh;cP!TAi HEALTH �q���F ;, 11niTv ***Ii�ARTAN?t** T8I8 71ppLIC11TICN C�II�TD10? 8� pROCaBB�D UNLa88 71LL THa RaQOIRaD =2tP0�+D►TION i8 gRCViDB�D. R�for to th� =N�'ORM�lTI01t BULL�T221 !or iastruatioaa. � i. x.■. to e. siii.a �Ct'.�i��d� �tk".cl/ (I�'JA-th�s coAc.oe r+r.on .�.3G� 9 -.SGd 1t.sls,nq �dds... o�3�i/ .f1 ��'�P/� �!•_'rras �� • aa.. �'hoa. e /�i�4/�/� � citir�■e.a�::a ,�/�.P�r�-i ont�t �/C ��s3 St sa,sa... at�a. Z. N�w oA �zsit/�TC i! Di!l�s�►t than �boro� lfailiaq �ddr��• City/Yl�b/:ip s. Appiicatioa lors @'81� =valnatioa �=mprov�at p�rait/71TC f�'8oth a. nr•tr.� �.o �.�,rio., � Hon�� �obil� 8om� � 8nait►�s• [] iaduttry � Oth�r s. i! t�sid�ao�s ! P�opl� i 8�dsooms � f Hathrooms .� 0 Di�hnu!►�r O Oarbaq� Ditpo�al �I�uhinQ ltaohia� 0 saa��ranb/Olu�bi�►q 0 suaant/tio almebiaq t. ss su.�a.�•Jzaansts�r/otl�r� �p.oity typ. i n+apl• i siak• � Coaod�� f ibo�nr� � �Triaal� + Nat.�r Cool�x� tt 1'OODBSRtttC=: � S�ats �stimztad ttabar Osaq� ��ioas r.� a.�� �. Typ. o! Mati.z •upply: o couAty/city �x•11 a commuaiCy e. �o yon snN¢Ip�te addiNon�or espawion�oi the iscWtq thb mtem b fntended to Krve? 0 Yes �io U ya,wb�t typei ***1MPORT.lIVT�'*;CI.IENI'3 ML�STCIOMPLETETHE REQi1IRED PROPERTY INFORMATION REQUF.STED 6ELAW. Eft6et a P[.AT or SITE PLAN MUST BE SUBMITTED b the t{ltnt Mitb TNIS A!'PLICATION. Pcnperty Dlmewlanet � A"C��'S WRTfE OIRECf10N8(icnm Mak:v[Ile)to PROPERTYs Ta:Odice PIN: # ri��� �f �� �'�'��: �w� �o� n l. -�i C a4 n�a I 1,�_ Pcoperty Addras: Rosd N�me �i�,nw C Re e I� `n • �"t,�►2 n I "�� n •-, C,�n� ���( . ' CttylZip �O C�Lc,�����2, (��L ����., f n n !'11ct;h C�u �„��l '� ' � a�oy� , If lo s Sabdiv4ion pravide inform�tion,u iollmv�s tw�vv�e�Q�c��-e �.r„ ��a�t' D� Namet �V+ ��a w C�2�P (� � � • ������ � S�cHon: Bloc{ct Lots D�ta Property Fls�eds �0 ��a q � 'T61e b to certity th�t the lalorm�Hon provided b correct to the bat oi my knmvtedga I anderihnd t6at�ny pecmit(�) is�aed henAfler sre�nbjeet to tospen�ton or revocAHon,it t6e eite glans ar inteaded uee c6�a��,ar 1�the InformaHou �abmltted in thb appltcaHon it fal�ttted oe chan�ed. l,also,anderstaad Qiat I am ruponsl6le jor o11 cl�aigu lncarred fi+one tbJs applkadon. 1,bereby,Qive conuat to tbe Aathorried Repraenbtive ot the D�vie Coanty Ha t6 Deparkment to enter npon sbave dattibed propetty located In Davie Connty�►nd awne�l by �'!a�z.��/�• ��� to con�laet sU taNn�pcoc�daca�s ue¢eaary to�etermiue t6e tite�It�bWty. DATE ���/'i I9�j SIGNATURE � � GU 4t-�lL., THiS AREA MAY 8E U5ED FOR DRARRNG YOi1R$11E Pi.AN(taclade�ll of t6�e foQm�v[n�: EsiatinQ and pcopaed property Uaa and dimewion�, �trocta �etbaciu, �ud septi�loc�tion�). � 8ite Revistt Char�e � ��,,j S I �� 5�I � rU'� i.. .. Client NoHBcallon Dmte: a� y � Eas: � AccoontNa �� Reviaed DCHD(07/99) �' ���`��W�- Involce Na D 2 9 t,c.���w�d 2 �'"� � 5 ' (�� �° 'sk � . -�,�..e �`� Pa'`� - . s�e.e S"�c.�C.� (n°��s ,..,, D, - l..t' �- �`'`,�-e�-�-� , :t.�- s� z i/2" dR N 12•00'00"f s31.06' IRS N 12 0'0 'DO"f 403.95'Tofal J68.95' t/2" �R �� W I���W C re e k La n e 50' Private Perpetual Nonexclusive Easement Ref: DB 188 � PG 279 /' N 76•40'Q8"W � N,,,v.o�,ny�,,, 156.37' � � IRS Parcei 2 �w» L , Parce{ 1 � �f2'� EIR N'" N 68 59'02"W f Part of 7ax Lot 49.08 108.J}' Port of Tax Lot 49.08 � � 5.002 Acros +/— 5.003 Acros +/— iR5 � �N 89•37'05"W 602.02'Totol � µ'"�Dp°'�'L"' �3 B9°0530"W 150.32' � IRS Wright � r'�''�gf•S�`;� 783.98� t '�,,�.'���,, s oo,✓�'"' '� � '� / f� .Mr � �.�ss 5�8•g6� 5 / �� Tax Lot 49.04 d p� Tax Map G-4 t/2" EIR i n/f Gray A. Laymon and wife Betty J. Laymon / DB 168 O PG 591 OB 316 O PG 664 Tie LSne / N 89•37'OS'^N f � 98.01' ��Z�� OR Tie line � D�LZJ�LSZO�IZ O� ��e t----N 89•22'20"W 24.94' / 2�� x Z���� Maribel �Q. Wall (f ormeTly Maribel Q 1RON SFIAFT �� / Pro�nerty ..�,. �a Pa�m«�t � Porcei 1' d Q�rE . � � Being Part of Tox lot 49.08, Tox Map G-4 Oeed Book 188'O Pcqe 591 i�O"O' � " ' . Dsed BoOk 316 O Poqe 565 ���� , � - 5.003 Aeres �/�by coordinote computation ,aoi, �Po.t . , '� - � DAVIE COUNTY HEALTH DEPARTMENT - • Y Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000828 Tax PIN/EH#: 5820-81-6412 Biiled To: Maribel Wall Subdivision Info: Reference Name: Maribel Wall Location/Address: Willow Creek Lane-27028 Proposed Facility: Residence Property Size: 5 Acres Date Evaluated: /f��l�'� Water Supply: On-Site Well L/ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca osition Slo % HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH }Q'• G '' Texture rou G' 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 i 1 � SITE CLASSIFICATION: � EVALUATION 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-Tenace 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-Granulaz ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineraloev 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) ■�■�■���■�■�■��■�■����■■��■■■■���■��■■■■����■���■��■�■■�����■■��■■ ■■���■�����■■�����■�����■���■�■��■■�■��■■��■■��■■�������■��■�■���■ ■������■��■■�■■■���■��������■�■��■����■■��■��■��■��■■■��������■■ ■■����■������■��■��■�■���������■ ■���������������■���■����■ ■���■ ■����■��■��■�■o�■�■��■�����e■�■��■�■■������■��■■e�■�eo■�■■�■�■��■■ 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