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118 Princeton Ct Lot 16 DAVIE COUNTY HEALTH DEPARTMENT 17 Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 989900204 Tax PIN/EH#: 5860-91-0349 Billed To: J. D. Crews Homebuilder Subdivision Info: Princeton Lot#16 Reference Name: Location/Address: Princeton Court-27006 Proposed Facility: Residence Property Size: see map **NO T>✓* iIsgmprove6ment/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 OOL #People #Bedrooms _ #Baths 'z Dishwasher: C' Garbage Disposal: 0 Washing Machine: 0"' Basement w/Plumbing: ❑ Basement/No Plumbing: El Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: El Lot Size I?S�x 245 Type Water SupplyC00rJTY Design Wastewater Flow(GPD) Site: New lz� Repair 0 System Specifications: Tank Size I=GAL. Pump Tank GAL. Trench Width t Rock Depth 1,7 Linear Ft.-:560 Other: 1 J)15`Q1SOT,©0 l3ox,, Ie Ae,rALL L-1, LC-S 46.0-. &,4'1 - Required Site Modifications/Conditions: 5' e4-, �69,t- FEx.P k), ex &P 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 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.**** o X 1.I RV-Ck L-tr j Le- Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT 1 Environmental Health Section P.O.Boa 8481210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900204 Tax PIN/EH M 5860-91-0349 Billed To: J. D. Crews Homebuilder Subdivision Info: Princeton Lot#16 Reference Name: Location/Address: Princeton Court-27006 Proposed Facility: Residence Property Size: see map ATC Number: 2768 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 I of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewa a Treatment d Disposal Systems). THIS AUTHORIZATION FOR WASTE W ON / TIO AL OR A PERIOD OF F YEARS. Environmental Health Specialist's Signator e: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation 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. CJ R� u 4(p c, Septic System Installed By: rn ony ,Sam ML, Environmental Health Specialist's Signature: Dat 3 DCHD 05/99(Revised) APPLICATION FOO SITE EVAWAXION/INPROVIMEMi PER IL Aim... ., Dame County Health Department D • Envl/»nmental Meath sectlon P.O. Box 848/210 Hospital Street Hookswille, NC 27028 MAR (336)751-8750 ***IMP MTANT**i THIS APPLICATXotq CANNOT Zig PJWCMSSLD WCUMMS ALL .R It INFORMATION IS PROVIDED. Refer to the INSONWION BULLS i 1. Nage to be Billed .JD Gki:\tj� -- 1JQkdGiQ1&!I-6EP- Cot tact ]person C R ce-)�'J s Hailing Address No l G I-m O RF Sam phone 3310- 4L-'7 c1ty/state/z10 1A D C K-S ( L i Business phone 2. Name on 7Pei=:Lt/ATC if Different than Above Halling Address city/state/Lip 3. Application For: U Site EvalUation lY improv"Mut Permit/l1TC ❑ Both 4. system to service: VHouse 0 Mobile Hama ❑ Business 0 Industry ❑ Other a. If Residence: # People # Bedrooms - -39 Bathrooms � VDishrasher 0 Wtsba" Disposal S Washing Haahine 0 Basaeent/Plumbing O Dasement/Wo Piweeing b. if Business/Industry/other: apeaify type # People # Sings t CaOODdes # shovers t# urluals Nater Coolers IF FOODSERVICE: I Seats f, Estitcated Nater Usage (gallons per day) M 7. Type of Water supply: County/City 11 Well ❑ Coomusity a. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes SIN If yea,what type' *'*IMPORTANT***CLIENTS AIUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Eitber a PLAT or SITE PLAN MUST BESUBNIITTED by the extent with THIS APPUCAT10N. Property Dimensions: 1o25 X Z4S4 /7-5X 2.4'/ WRITE DIRECTIONS(from Mociuville)to PROPERTY: Tai Office PIN: 0 5860 -9/-0349 W� l.9�3—Z cm T O i✓ SALTi mom Property Address: Road Name kINCETor/ &-r. ebA-b— P&7hcc-7yN_C[ ot,� � lir City/Zip /b VArJ-CrT AIC-1 IS in a Subdivisim provide information,as follows: Name: PP- N CL�orJ CO u.2T Section: Block: Let: to Date Property Flagged: 2 0 This is to certify that the Isrormation provides)Is correct to the best of my knowiedge. I understand that any permits) issued hereafter are subject to suspension or revocation,if the site plant or Intended use change,or if the information submitted in this application is ftlsified or changed. I,also,undarstand that I am raponsible for all charges lncunw4from thls.ayI,tsereby,&`•'e coamt-to the-Aa*#ftr1--.d-Representative of the Dais County health,Mpiritneat to eater upon above described property located in Davie County and awned by to conduct ail testing procedures as necessary to determine the site suitabii1t. DATE 3" Z SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property tines and dimensions, structures, setbacks, and septic locations). iasn� ' s I K �> yy' , s Account No. a Revised DCHD(07/96) Invoice No. n y bICATION-FO".—Lavie TE EVALUATIONAMPROVEMENT PERMIT&ATC (C; 0 r _ County Health Department D Environmental Health Section 2 P.O.Box 848 74- A Mocksville NC 27028 EWYIR0111.1EMAL 11EALIH (704)634-8760 UVIE CGIPMY ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed, C-V'r?A-4 Pc,, Contact Person Mailing Address /J37n rJ i, •4 c s '?O r Home Phone City/StateMp .4 Q k j4 A✓r r C-' , . Z200 G Business Phone :5A 10fL 2. Name on Permit/ATC if Different than Above �9rtL Mailing Address L- ` City/State/Zip 3. Application For: [Site Evaluation [ ]Improvement Permit&ATC [ ]Both 4. System to Serve: PJ House [ ]Mobile Home [ J 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:[ 1 County/City [ J Well [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [ ]No If yes,what type? EZT11E1: A PLA"I OR' SITE PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT**CAM1AT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: � � �� �6Ts/�z�[WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: # 5'66 O - g/ ---�L 5� i _ o. Property Address: Road Mame R A L /7 0 A L?ziylo le v,14 city/zip A A/-/C c' /l/• ; -700 lik,,r4-A ci % C'-4-'e 7 Zcre- If in Subdivision provide information,as follows: T S L:- Name: ,Name: 5�- G-' AL 4 '7 ; Section: Lot#: �? (L.Or lip 0Z /Jew M-Ac) 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 AfiEA AIAIJ 19E IISEb f01t bIIAIVINC I10111,' SITE PLAN.(1- r i Filed for regi ity that the subdivision plat shorn hereon has Certificate of Approval bytJ�p p(�.n. .amply with the county Subdivision Regulations, Board DEPARTMENT OF TRANSPORTATION Planning ann I ng Board and that I t has been approved for UOplerroodSubdhrbtoa - ---- —'--.. .tion of such variances. if any, as noted In the a DovN 'd Pion, Board fwWy approved the Tiny for DIVISION OF HIGHWAYS the offlce of the Register of Deeds. It Is hereby YaIn Plat dcow h approval for recordation does not Include PROPOSED SUBDIVISIOINROAD $tall and utlllie sanitary facilities nor does It CONSTRUCnONSTANDARDS CERDF)cAt1ON nI for the construction or occupancy of pulldings Date moil—n'fib'panning BOORT Filing Fee paid APPROVED .— DWRICT ENGINEER .._... _—___-- Director, e County DaviPlanning DepartmDATE yent - Parcel 65 James Mayhew D.B. 071-392 ---------- 3 -_----- S 83051'35"E 1548.89' 1- 150.08' 150.08' 150.08' 150.08' "control come ' 50.08' 150.08' l i 112.18' 5.04' z o`� LU 0 1aJ W point � 4 W n r / 16 I W01 \� ° ..-. .,.,,• min m 'n is I V O N CD a O O •�- nT O N o p x u7 r�8) point z z o o N tS a) e u; - /Y Z Z O r4 N p Z Z point d '7 � ti t 48.69' 150.00' 150.00' 150 00' ( 1 pint 150.00' 150.J 7'56 1150.00' S 85°44'15"E 1048.69'—•--� Providence C o Ll r t ,���.�,� 60 ' public • S 85°44'15"E 1050.00--to. l ' 150.00 Z$ ` 150.00' 150.00' 150.00' 150.0 ' t 50.00' j t2 t �.. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account M 989900111 Tax PIN/EH#: 5860-81-3295.16 Billed To: Gray Potts Subdivision Info: Princeton Lot#16 Reference Name: Gray or Betty Potts Location/Address: Baltimore Road-270 Proposed Facility: Residence Property Size: 150 x 270 Date Evaluated: Iia- Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L Slope% 3 HORIZON I DEPTH Texture group Consistence Structure lL Mineralogyt:I HORIZON II DEPTH q — )q Texture group G Consistence Structure Mineralogy 1 : HORIZON III DEPTH -3 Texture group C 4 Consistence S P S Structure y_ Mineralogy1 HORIZON IV DEPTH Texture group Consistence S Structure Mineralogy ' SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION P LONG-TERM ACCEPTANCE RATE Q. SITE CLASSIFICATION: `S EVALUATION BY: LONG-TERM ACCEPTANCE RATE: t ) OTHER(S)PRESENT: REMARKS: 1 14) -24 4*-Some 9WJ4- 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) DAVIE COUNTY HEALTH DEPARTMENT _ Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900111 Tax PIN/EH#: 5860-81-3295.16 Billed To: Gray Potts Subdivision Info: Princeton Lot#16 Reference Name: Gray or Betty Potts Location/Address: Baltimore Road-2700 Proposed Facility: Residence Property Size: 150 x 270 Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L Slope% 3 HORIZON I DEPTH Texture group C L G f^ Consistence Structure l� Mineralogy1 I ; HORIZON II DEPTH - ) Texture groupG Consistence Structure v— Mineralogy1 HORIZON III DEPTH -3 lo' Texture group C 4 Consistence 6:7r SS Structure C Mineralogy. l HORIZON IV DEPTH Texture group Consistence S Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION P �S LONG-TERM ACCEPTANCE RATE Q. SITE CLASSIFICATION: es EVALUATION BY: V Clf� 1) J4N^ LONG-TERM ACCEPTANCE RATE:—C) �) OTHER(S)PRESENT: REMARKS: 1 ' -,741t"-some, &Ci-'- 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 ist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EF1-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 Mineralog 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) z of^Y=! _ c . r +' ' "•' J`' �' _, S �" "-r-a!^ S..r;;: �e# � 'K Jr 1 � � t d Jr._i J x ..r., .f.. :.v j�;4 •`7. "-�ti'* e� s... s F ``� ar' :.rH. � , t 5 Point� W W p � S O7�Tp�l.OiEr.. { L d 1 `n W 'n `, tom•. x 1 1 b O 1 4 0 15 106 d to } 1 N N °N N � N t'oE Z N 3111 49 Sq. Ft,.,�^<Np r;st> > �L$tr•<-r'?� 31149 Sq. Ft. 31149 Sq. Ft. 31149 Sq. Ft. Z Z point, Y ' 31149 Sq. Ft. 31149 Sq. Ft. ; S 0002'30"V l ' r, ij, 3 a point 02°06'25" Y 298 69' 1 18.04' 1 119.81, 1 121.67' 1 123.61' 1 125.65' 1 141.22' M : S 8504415"E 1048.69' °Prin,ceton Court1050 41� 60 ' public R5.44'15"E 1050.00' ---� I 300.00' 116.92' 118.61' 120.38' 12223' 121.87' �• ° ( ►/�� approx. ocatiorf I n i pond tn N � C ((Ij C6 } o U cli (p _ I n \ V 0 I J 1.833 Acres 50347 sq. Ft. 50347 Sq. Ft. 30347 Sq. Ft. 30347 Sq. Ft. 30347 Sq. Ft-3 M 122.2 ' 9' 126.51' 3.16 120.44 ' EIP� I tv 300.15' 116.9'' 118.67' I I N 87°32'15"W 1616.41' "control comer' -- i ('�