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115 Princeton Ct Lot 2 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section / D ' 13--a P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990001307 Tax PIN/EH M 5860-81-3295.2 Billed To: William Joyner Subdivision Info: Princeton Court Lot#2 Reference Name: Location/Address: Princeton Court-27006 Proposed Facility: Residence Property Size: 122'x 250' **NOTE*Viisgmpro 5em09ent/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 H 00SE #People #Bedrooms —`� #Baths-2 Dishwasher: 2"� Garbage Disposal: 100' Washing Machine: e Basement w/Plumbing: ❑ Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: Lot Size 122' >caSO Type Water SupplL —0W Design Wastewater Flow(GPD) 3(pO Site: New�Repair System Specifications: Tank Size 1CCOGAL. Pump Tank GAL. Trench Widthl&.0 of Rock Depth 2 Linear Ft-V Other: '�t�TQIBt)TtoJ EJIC , 6��fi4U- L-i 3-S 11 O..C. M nJ . Required Site Modifications/Conditions: 44ST4Lj— Da CPN T-0QZ_<< S dPE 14ox V� t o or-e CW- I IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6 11 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 p.m.on the day of installation. Telephone#is(336)751-8760.**** I 00` I OC7' I SDI Ll Q 1 o� Environmental Health Specialist's Signature: Date: eD 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 #: 990001307 Tax PIN/EH#: 5860-81-3295.2 Billed To: William Joyner Subdivision Info: Princeton Court Lot#2 Reference Name: Location/Address: Princeton Court-27006 Proposed Facility: Residence Property Size: 122'x 250' ATC Number: 2509 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 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CON ON I ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatu Date: bj6p CERTIFI E OF COMPLETION **NOTE** The issuance of this Certificate of C pl ion hall indicate the system described on Improvement/Operation Permit has been installed in compliance vAth Arti le 1 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NCWAY e t en as a guarantee that the system will function satisfactorily for any given period of time. X Lit3 ,J p•r Z; s V, Septic System Installed By: C- Environmental Health Specialist's Signa e: Date: t D UW DCHD 05/99(Revised) - F7DAVIE 1-� `�APPLICATION FOR SITE EVALUATION/IMPROVEME.NT PERMIT&ATC Davie County Health Department 2 7 2000Environmental Health Sertfon P.O. Box 848/210 Hospital Street Mockaville, NC 27028 NMENTAL HEALTH(336)751-8760 COUNTY ***IMP0RTANT*** THIS APPLICATION CANNOT BE FROCESSLD UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Ta to the INFORMATION BULLETIN for instructions. 1. Name to be Billed z6l'/!I'o[.?% a Zlifs, e- Contact Person Hailing Address Home PhonsJ?3�-- City/stats/ZIP b/ Bwiasss Phons3�� b �i� Z4.2 g 2. Name on Permit/ATC if Different than Above Mailing Address City/state/Zip 3. Application For: 0 Site Evaluation ct]110provement Permit/ATC 0 Both 4. system to service: dl--douse ❑ Mobile Home 0 Business 0 Industry 0 Other s. If Residence: # People # Bedrooms _ # Bathrooms &'Dishwasher dl-Gisbage Disposal R-WhUng Machine U Basssent/Ploabing D Basement/no Plumbing 6. If Business/Industry/Other: specify type # People # Sinks # Commodes # shovers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system Is intended to serve? 0 Yes A"*— If yes,what type? ***IMPORTANT"**CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: / /� �U WRITE DIRECTIONS(from M'ocWlle)to PROPERTY: Tax Office PIN: # Property Address: Road Name 0r I�'►c e 11`0 '1 �a,D`— W'C//AJ42Ce-- Yf i�eE � CityrLip ,catl'?nC e- If In a Subdivision provide Information,as follows: 011166Name: Section: Block: Lot: 2 Date Property Flagged: 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 incurredfrom 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 to conduct all testing procedures as necessary to determine the site suitability. DATE / r SIGNATURE T THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS• Account No. c>-7 Revised DCHD(07/99) Invoice No. . o W N PRINCETON CT. I- SITE -' a m PRINCETON COURT ORNATZER RD. LOCATION MAP S 85044'15"E 122.23' ' I m I , I I � 4 I � ' I '$ ' 000 I W E 0 W ' 35.23 ' _ W l� PROPOSED L� 28.00' S HOUSE o - o N I , 28.00' <p :r \\\\\ C A/ N a� SITE PLAN ONLY �N ..-...°�, ''': z o?.oF s..l��I. :ti I N 1 THIS WAS MAPPED FROM A DEED OR ; •z:Qe N ! SEAL = RECORD PLAT AND NOT FROM A SURVE`� : o 2 BY M E. _ L-2 0 IT 890 Z:�_ . ti ti /� 2 SUR.... � N ' ''''// 9�CiHIA�RO`\�\\\\\\\\\ I I l aro 40 0 40 80 120 _ I , I ' GRAPHIC SCALE FEET I , I � ' ' FOR GLORY BUILDERS INC. I 122 29' SCALE TOWNSHIP COUNTY STATE DATE,s SHADY GROVE DAME N. C. 7-21-00 N 8TH 2'18"W LOT 2 PRINCETON COURT. HOWARD SURVEYING JOB NO. JOHN RICHARD HOWARD PLS 0065 P.O. BOX 276 ADVANCE, N.C. (336) 998-5396 4 • .,t PLICATION-FO TE EVALUATIONAMPROVEMENT PERMIT&ATC (C 0 1 ( 1;. Lavie County Health Department NEnvironmental Health Section J. 2 1999 P.O.Box 848 Mocksville,NC 27028 ENYIR0111.01TAL 11EALTi1 (704) 634-8760 I1 aE Ct'd1,1JY ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed Gi2 A.{ lon ?%S Contact Person Mailing Address 10*7D 't?o� Home Phone 54 /v/.— City/State/Zip A Q%/4 Am c' Tom, C`, Z.7 U U G Business Phone :5A �L 2. Name on Permit/ATC if Different than Above .9rJL Mailing Address .514 11" G. City/State/Zip 3. Application For: [Site Evaluation [ ]Improvement Permit&ATC [ ]Both 4. System to Serve: P4 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?[ J Yes [ J No If yes,what type? L11111-It A 1'1_:tl OR S1111- 1'L•tN PROPERTY INFORMATION REQUIRED:***IMPORTANT***•A FEAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: �� 4a>5��"2�1 WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: #-5-66 0 - - $r ; 0. S /15'R Property Address: Road 1 ame R 4 G ?ihlur c=' /7.a _ A3 A L iiiVo,t r le c&eJ4 citymp 4,0 VA Nc r �, �'. 70y ' 1t/b,r51-A cl 4,1 Z ZCr.r-- If in Subdivision provide information,as follow s �� �o�. �J fl c.�,� �a �c� G.i rt'_ S 7' Si/' C, Name Section: Lot#• � i 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 to conduct all testing procedures as necessary to determine the site suitability. DATE 7- / Z SIGNATURE Revised DCHD(06-96) / THIS AICEA MA11 BE 11SEU FUI: U1?A111IN(j I101IR SITE PLAN: I rl/(/ J/0 ---------- arcel 65 - - James Mayhew D.B. 071-392 S 85°37'40"E 1599' 150' 150' 150' I 150' 150' ^' i 17 rt88 N 19 20 21 22 I :r 150' 150' 150' 150' 150, �)TT 1)Ll l/�)T T(' ooI ( 0 I l ) pro;,oso erel i we r isc _ T _ • L J -11 ILi DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account M 989900111 Tax PIN/EH M 5860-81-3295.02 Billed To: Gray Potts Subdivision Info: Princeton Lot#2 Reference Name: Gray or Betty Potts Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: 150 x 251 Date Evaluated: Water Supply: On-Site Well Community Public L� Evaluation By: Auger Boring Pitpi Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope% HORIZON I DEPTH Texture group rC1__ S71 6 Consistence Structure Mineralogy HORIZON II DEPTH Texture groupC G Consistence i Structure s v Mineralogy TI_7 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: PJ(' 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 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 05/99(Revised)