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234 Potters Ridge Dr Lot 5 IZATION NO: Q 5 2 2 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permitte 's ! P.O.Box 848 Q Name: i 1 p�=H j� �� Mocksville,NC 27028 Subdivision Name: {{ Phone#:704-634-8760 Directions to property: 5 w �•4 tib Section: Lot: AUTHORIZATION FOR _ �` � t�►tvcyN ��" C,'r,ti WASTEWATER Tax Office PIN:#- `93 SYSTEM CONSTRUCTION VA- ' ` a 4s ;, -� i �,, a Road Name-'�W; V t, t ZiAl 0 **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***TIM AUTHORIZATION FOR WASTEWATER CONSTRUCTION I IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Permitee,s Name: 4-.' 1 ',;" . 1 t r. >. Subdivision Name. Directions to property:' i" Section: Lot: /~ IMPROVEMENT PERMIT Tax Office PIN:# '� °t t; ,. '.� �.. . �,R ' , Road Name. 13, ,A Az r Zip:- f 't **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 constiuction/mstallation 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) ***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. RESIDENTIAL SPECIFICATION:BUILDING TYPE (4tl #BEDROOMS #BATHS-D-4,1—#OCCUPANTS GARBAGE DISPOSAL Yes r No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT STYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITE (� � � u OU t SYSTEM SPECIFICATIONS: TANK SIZE L t - GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH�� LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT :AYOUT **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: L A AUTHORIZATION NO.65�--12 OPERATION PERMIT BY: P�O 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. DCHD 05/96(Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERN ITT& ATC Davie County Health Department Environmental Health Section IL P.O.Box 848 Mocksville,NC 27028 OCT - 1 (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCES ED UN ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed _t� t tr`flT j7 t L LA 2 e) Contact Person Mailing Address o S Home Phoney 7 L (• r City/State/Zip C L Lr-Y-%- a 5 N C- 2 "7 47 1 -1- Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation Improvement Permit&ATC ❑ Both 4. System to Serve: ld House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People 3 # Bedrooms 3 # Bathrooms RDishwasher U Garbage Disposal Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage(gallons per day) 7. Type of water supply: County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes (➢--'-No If yes,what type? PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. SLG° n L Property Dimension s S S. -7 1 X Lj o q, o I X -3 4 2, 2 7-)� I WRITE DIRECTIONS(from 1 Mocksville)TO PROPERTY: Tax Office PIN: # 5 4 3 - 6-3 - 2 2 C 3 L L( b Lei S i 7-t Property Address: Road Name I�c�T'TL=/L$ L/a.�L-~ 1 1 F A/L",, �'C r'b ,-• IZ D City/Zip //h 0 CX S %J I L L` W L ?--7 0 2 1 -T-0 ?/N Lf 0, LLLr 1L If in Subdivision provide information,as follows: 1 1 To ?o i 1 c-r-5 Name: "PIC,—17-01L S IZ t13 1 I Section: Lot #: S 1 1 This is to certify that the information provided is correct to the best of my knowledge.I understand that any permit(s)issued hereafter are subject to suspension or revocation,if the site plans or intended use change,or if the information submitted in this application is falsified or changed.I,also,understand that I am responsible for all charges incurred from this application.I,hereby,give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by lT) t t_t-A/L-12 _ to conduct all testing procedures as necessary to determine the site suitability. nn DATE �6 j ' L SIGNATURE � ky 4atX C=y Revised DCHD(06-96) { DAVIE COUNTY HEALTH DEPARTMENT ` - - Environmental Health Section Soil/Site Evaluation NAME 9 �Xi3he - DATE EVALUATED ADDRESS �- 3 � PP,$RTY SIZE 6 PROPOSED FACIILTYLOCATION OF ITE -P 1 G-� Water Supply: On-Site Well }— Community Public Evaluation By:�,��AugerBoring V Pit �/ Cut FACTORS 1 2 3 4 Landscape position .-.S' Slope Z O`PI-° `o7 HORIZON I DEPTH =!`' ,Ila Texture group Consistence 1=I Structure Mineralogy HORIZON II DEPTH Texture group <° Consistence =� Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S IS s� RESTRICTIVE HORIZON — SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 'J' EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: V.1 C{.�-� �.<�?� �� _- 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 r:lay loam, SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR--Vcry 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 ■....■.■......■■..■.■....■...■.....r�wnw■....nws�.E■■.M�■Irl..■...■ ■■■■■■■■■■■■■■..■■■�1��■jai■■.....M■u.■■■■■■ ■■■■■.■■■■■■■■■■■■ ONE ■.■.■....■■I.■■.......■............../1........■■...■■. ■■..■■■..■I. ■..■...0..11.■■■.■�!1l�"`+tl101i■./�.C�!■..i.l'1........■■..■.■.■■■.....■...■ ■..■...■../1■...■........■..IJII[I�III ■r(/■..■■.■■.■I■....■■■..■..■■■■■ .....■...�i.■..........M...a.�....M.i■.■..■..■.■ ■■.■.■0■M.0■0■■ IMM ■.......■.■I...■...■■....■.OO■■.■....I■■...................�.■■.ENO ■■■■....■■■1■0.■..■ ..■■■M■M■M■Irw�■■!■.■.. ■■■... ■■■■■■■.■■■■■■■■■ �iiiiii�iii�iiiiii��iiiiiii�iiiiii�iiiiiii�iii''■ii■�iiiiii� ■...■..■■■....■......■...Gi/.■...■..... 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L ---------------- ---1-- �C; Flo Ir:.r-r.J• 3 S.232 J s p 6 c 5.0 0 ac. ..OE PROPOSE[$ 8. ' SOLD 20-FT.per. I7 • "•'/' '2 `I m094,33 E soon o o e3¢• m fe 08 be> � � � w 8:, 8 �•E r ,0 5.070 aa. w $OLD 267.05 .� ., ► • +v � AJr 0'A r iva H as•I s's2ti1 26'�a $3 0,0 9 0. * t i ~g. . -n Al' pr �Z\ � m 4 o S 1= �h �i. \ ufaU�m SOLD ��K.. m 3o•q�, y r\�\— a 0 87'35Lt3•E s•rfr rs•� o, 4J� EJ.C]er�T 307 13' q• . IIl W ,$ C J aC7Y M'■ i .. $29, 500. } 5�' L Q�,lre� �. 6.995 oc. �C!�, r �1 S $35, 370. Co 5.255 ac. t N SOLD c' 5.274 ac. 4�. • j s a�5a 4J rY 19RJ8 ,°, 'I N M 5.098 ac. » S 83''►4 N 63308 1 SOLD ro � $30,078. cr4 � D 5.132 ac_ $30, 278. Doed•� 4TI.Ta• C4 Cs 343.54 --- ._ •-1-�� \ • 1 S a•4�3C`Y < 5 33.41"3ABY PC .,/- OfrRCrs: 3 .S+v t N ..•sk.•-r•R;•.,,.• -'••---«r _ ':—r'. '• 'y-- ...F-..'. "t".,r"'-S'O.sT�ST�"^' '°'e'-r, , •.,-..�..-•t._. ..:'cs'^3^4 al