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108 Princeton Ct Lot 17 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street • Moclksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 989900204 Tax PIN/EH M 5860-91-1368 Billed To: J. D. Crews Homebuilder ° Subdivision Info: Princeton Court Lot#17 Reference Name: Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: see map ATC Number. 3068 **NOTE**This Improvement/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 T/ #People #Bedrooms #Baths -2— Dishwasher/. Z Garbage Disposal: ❑ Washing Machine Basement w/Plumbing;.p Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply_ Design Wastewater Flow(GPD) Cid?1 Site: New u Repair❑ System Specifications: Tank Size�(�GAL. Pump Tank GAL. Trench Widthc,"��Rock Depth 1� Linear Ftk?�e) Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISERS) 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 9:30 a.m.or 1:00 p.m.to 1:30 .m.on the day of installation. Telephone#is(336)751-8760.**** Environmental Health Specialist's Signature: Date: 352 W-,0 DCHD 05/99(Revised) • DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900204 Tax PIN/EH#: 5860-91-1368 Billed To: J. D. Crews Homebuilder Subdivision Info: Princeton Court Lot#17 Reference Name: Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: see map ATC Number. 3068 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED 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 I 1 of G.S.Chapter 130A,Wastewater Systems,S on.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA C TRU ION IeSVT R A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of o Cpl 'on shall indicate the system described on Improvement/Operation Permit has been installed in compliance wi hArti le 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO AY taken as a guarantee that the system will function satisfactorily for any given period of time. Wxy Septic System Installed By: , Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) ArrutAUION 1-011 WE EVALIlAMONJIMPROVE lENT PERMIT&ATC Davie County Health Department . EnHwAth SedbN p [ p M • P.O. sox $48/210 Hospital otree�t tloa xville, VC 27029 t99si 751-0790 FEB 2 2002 ***V"QVxAttT*** THIS APPLICaTION CURT IN FJWMSAW Maass ALL TAL HEALTH naroviaTicM is Pi MDM. Refer to the I111'OM210 f BU== for nat=0 1NTY 1. None to be Billed s;Tb CREWS SS3Ll���.k_�LCoarstet Noraott rel�RRa/ Ckeli S flailing Address go I L'LW\,o2c R� , name, a ma 33b• "/Sr 2--7 6 t R city/state/21s, oCKS V/;XQ L 2`Z sv,suess Selene 32)(Q-,2Y0-794-5- 2. 9452. Ila" on Pandt/Arc It bi=lereat than At�ows mailing Address city/state/Lilp 3. Applioattan Tor: IJ Bite Waluation "2:mproro mmt Permit/ATC 0 Both d' 4. systew to Service: House 0 Mobile Homs 0 Business 0 Xnftstry 0 other a. xf PAsideaae: # people , I Bodroc" -3 0 Bathrooms i/Didsrasher 0 Gatbage Disposal H llashiog Machine 0 Bs wout/nlmbiaq 0 Darement/wo Plumbing e. it musiness/indust r/other: fteoify type f People t sinks t c mood" f shcmers i Urinals Nater Coolers _ it r000J " iT m 0 seats Ratimated stater Osage (gallms per day) t. i`i►pe of watez supply: vcomty/Ci.ty U well 0 Community a. Do you anticipate additions or expansions of the facility this"em Is intended to serve? 0 Yes to If yea,ghat type? *"'IMPIDRrANPQ*CUIXTSAtUSTCOWLEWTill REQUIRED PROPIZRTY INFORMATION REQUESTBD BELOW. Either a PLAT or SITE PLAN MUST BESUBAfJ17'ED by the client with THIS APPMATION. Property Dimensions: Jq1 x z145'4 103 z ys WRM DIREMONS(frm Modisville)to PROPERTY: Tat 011ke PIN: 01-j 0b9,),V Tz&?-,. Property Address Road Name -PR» D 13 AL t mog-r iZd- — citymp, Ab-4 P yjcg . 0G Zooaf .l-e-Pr i7d 8--i NceM4 Gi= 1 ' Lot If in a Subdivbiitaa provide infarmatim as fidlows: 0 tj 12�-,U WT Mane: *x'1.0 C.r�t3 CepUz g Section: Block: Lot: 17 Dale Property hoed: This Is to certify that the information provided Is cornett to the best of my knowledge. I und"amd that any permit($) loved hereafter ase smhject to srspewdoe or revocation,If the site pians or Intended use cbasge,or If the Information submitted in tits application Is fabtikd or clanged. 4 dLso,xxAnweadshat 1 are mpassibkfar all ch ges Incumd frvr ls au3plte L may,Cf"toeent to IM-Autborhex!Repreoeotstive of the Davie Como Bettie Departmi"t to tater upon abort described property Ncsted in Davie Cow*and owned b? to coadad aU testing proeedurts as necessary to determine the dee rAtability. DATE 2!^ 17--t7 Z SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(hehWe sH of the folioKlag: E:Isft and prepaaed property lines and dimensions6 stractures, selbaeks, Sed septle locations). . X03 K Acemat No. gyp' a o 20 q Rewiseti WHO(07198) Q Invoice No. -77� F N 4 r_ {�iz.ac�rvl� GT bIGATI01 TE EVALUATIONAMPROVEMENT PERMIT&ATC Q F r, : avie County Health Department o Environmental Health Section M P.O.Box 848 2 ' Mocksville NC 27028 FIIYll31�EAL IJEALTN (704) 634-8760 alp ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed I � ?S Contact Person Mailing Address /Q'7n U o4.1a---12 P } Home Phone q w City/State/Zip 4 p�14.✓�. (,—* . . Z 7 U o G Business Phone :5A rr1= 2. Name on Permit/ATC if Different than Above 4Anta Mailing Address 514r7r L City/State/Zip 3. Application For: [Site Evaluation [ ]Improvement Permit&ATC [ ]Both 4. System to Serve: N House [ ]Mobile Home [ ]Business [ ]Industry [ ]Other 5. If Residence: #People #Bedrooms #Bathrooms [ ]Dishwasher[ ]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? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT**CXFI AT OF THE PROPERTY MUST BE L SUBMITTED WITH THIS APPLICATION. Property Dimensions: G �� �6T3 1�z� ' p y WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: # S"66 O - _- 9 !r i ---(J. 5 /�'P G-74 S"T -Z-o Property Address: Road lame R A L 7-11Vy e /7 4 A3 A(-Z6.V-Q.r' city/zip 4,0 VA ire C ,v. r'. ; _70c; /)/Q'C� 0 /— C-e4 X117 E df-r— If in Subdivision provide information,as follows: A-i2 0 '1'/ G.i -e S- 7- S/AD [.;— Name: — ; Section: Lot#: -_ ���LD'r 17 r9{J� f�E.� MAP) 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 fals_-fied or changed. I, also, understand that I am responsible for all charges incurred from this application. 1, 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 to conduct all testing procedures as necessary to determine the site suitability. DATE 2 / Z SIGNATURE Revised DCHD(06-96) TRIS AREA At.11f 19E IISED FOR DRAIVIA'C 1/011R SITE PLAN:( Filed for regis ty that the subdivision plat Shown hereon has :oC"-"))'Kato of APP"val try thty Planning Board mply �Itn the subdivision Regulations, DEPARTMENT OF TRANSPORTATION -- -------" -- .?loll of such variances, it any, as noted In the Planning Board and Phot 11 has been approved for The eCount' 'g BOO/d��'°WOV`d thefk?a1 plat for ttheDIVISION OF HIGHWAYS ne office of the Register of Deeds. It Is hereby*woo��� In Plat Hook h approval for recordation does not Include PROPOSED SUBDIVISIOINROAD ;.loll and utillte sanitary facilities nor does It CONSfRUCTIONSTANDARDScERI1FlGT1oN al for the construction or occupancy of DVlidings Dote amin"a^•Count' PlamAg Board Filing Fee Pala APPROVED DISTRICT ENGINEER Director, Davie County Planning Department DATE by ------ --__.— uF Parcel 65 James Mayhew D.B. 071-392 -------------- S 83°51'35"E 1548,89' 150.08' 150.08' 150.08' 150.08' W t1 50.08' o�'wn control co m e 150.08' 112.18'5.04'' Z poi ntuo' LO a? my + r Qo -rn m cr 1 17 U Po intO ' Z N Z CV Z N p Z l0 7`R` n0 ^ Z point 148.69' !� 150.00' 150.00' point 150.00' ( .00 150 �0• S 85044'15"E 1048.69'— -� 150.00' Providence Court 1050-41' 60 , public S 85"44'15"E 1050.00' - ` /* � • ZR 150.00' 150.00' "�-� 150.00' r 4�i� 13F 150.00' 150.0 )' 150.00' LO ' LO ^ ^ :n to \. I ` I I ` r ( N M.— O DAME COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account M 989900111 Tax PIN/EH M 5860-81-3295.17 Billed To: Gray Potts Subdivision Info: Princeton Lot#17 Reference Name: Gray or Betty Potts Location/Address: Baltimore Road-2700 Proposed Facility: Residence Property Size: 150 x 266 Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring + Pit t/ Cut FACTORS 12 3 4 5 6 7 Landscapeposition L L Slope% HORIZON I DEPTH c. 1/ Texture groupe/. L Consistence Structure Mineralogy HORIZON II DEPTH Texture groupG Consistence Structure oQ tai Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: �� EVALUATION BY: Aal�z 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 oiA 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-tern acceptance rate-gal/day/ft2 DCHD 05/99(Revised) T DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation •APPLICANT INFORMATION PROPERTY INFORMATION Account M 989900111 Tax PIN/EH#: 5860-81-3295.18 Billed To: Gray Potts Subdivision Info: Princeton Lot#18 Reference Name: Gray or Betty Potts Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: 150 x 262 Date Evaluated: L Water Supply: On-Site Well Community Public 4_ Evaluation By: Auger Boring Pit 4/ Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupG' Consistence r / Structure ff Mineralogy /,- HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 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-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 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 05/99(Revised) J. a r J rr r 1 r Z _ p' sn O c m0 r Baa'gums Ive � <> O 1111 Qy t a o z An ; rn { Z� M M _ 0w s pU n U x ►� 17--1 a rn o z w tri L IL `'- ' O C6 3 a _ o E..� In CL z Z > ' E �; 0 ti o o m Q U U E o x in EL o' . 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