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125 Princeton Ct Lot 3 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001307 Tax PIN/EH#: 5860-81-3295.3 Billed To: William Joyner Builders Subdivision Info: Princeton Court Lot#3 Reference Name: Location/Address: Princeton Court-27006 Proposed Facility: Residence Property Size: 120'x 250' ATC Number: 2510 **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 �Ic)o5e- #People #Bedrooms #Baths 2.-IS Dishwasher: 3( Garbage Disposal: u Washing Machine: E Basement w/Plumbing: 2111- Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste:❑ Lot Size 20`7��0� Type Water SupplycW—fl)TYDesign Wastewater Flow(GPD) 3tOo Site: New Mee Repair❑ System Specifications: Tank Sizel 000 GAL. Pump Tank GAL. Trench Width 3(o Rock Depth 12 Linear Ft. SOO" Other: 17�'—IVA 61)-D 0,3 ?—XDx. , fT ��GT-to.J t b nA Q Ccs E� -- Required Site Modifications/Conditions: `N)Si qu-- D,3 Cb")-j7()l)Q k=f Imo`aEF 16)SZ. Vzy--P 10` vW- Fev(l ua- IIi'[PROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6 K 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.**** $D� X.12'' Zi s too I Environmental Health Specialist's Signature: Date: Z DCHD 05/99(Revised) 4 ' 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#: 5860-81-3295.3 Billed To: William Joyner Builders Subdivision Info: Princeton Court Lot#3 Reference Name: Location/Address: Princeton Court-27006 Proposed Facility: Residence Property Size: 120'x 250' ATC Number: 2510 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 CONSTRUC ON IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatur . Date: Z !2Q CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion hall i dicate the system described on Improvement/Operation Permit has been installed in compliance with ArticIp 1 of G. Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY tak as a antee that the system will function satisfactorily for any given period of time. T Septic System Installed By: G Environmental Health Specialist's Signature:_ jy�� Date: DCHD 05/99(Revised) APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&AT Davie County Health Department 2 7 Z�d� Environmental Health SftWon P.O. Box 848/210 Hospital Street Mocksville, NC 27028 DIVIRONMENTAL HEALTH (336)751-8760 L DAVIE COUNTY ***IMPORTANT*** THIS APPLICRTION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed - - - /�'G1 m /�_� .S , Contact Parson ' Hailing Address �� Hosie Phone City/stats/ZIP Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address city/state/zip 3. Application For: 0 Site Evaluation e'Improvement Permit/ATC ❑ Both 4. system to Service: 8'House 0 Mobile Home 0 Business 0 Industry ❑ Other 5. If Residence: //# People # Bedrooms # Bathrooms FT Dishwasher Gasbags Disposal U fiashing Machine Aff Basement/Plvabing O sasesent/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # showers # Urinals # Rater Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of Rater supply: County/City 0 well 0 Community a. Do you anticipate additions or expansions of the facility this system Is intended to serve? ❑Yes 61-W If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. I r Property Dimensions: �j� X ,Z�� WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Ofllce PIN: # -96 6 D' 16- 6 `o Property Address: Road Name /' ✓i C-e/0 h �� Y��t�7'i m 'r P City/Zip&va»e P .270d- If in a Subdivision provide information,as follows: Name: Ly?c cMn C-6u r k Section: Block: Lot: Date Property Flagged: 7' ,2.2 "©a 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 jmin 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 suitabil ty. DATE 7f ! -4eo4t::�7 SIGNATURE 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. 3 l Revised DCHD(07/99) Invoice No. � o 1 u W N PRINCETON CT. J m PRINCETON COURT CORNATZER RD. LOCATION MAP S 85°44'5,,E 120.38' I 1 I I I I I I 1 I I Ig 1. 1618 I ,co i$ ' W E 1 1 --- I S 1 \`�"�a��uluurrr,,,,Z � 8.33' I 38.00. wi $ - PROPosED3a' — OQ'.O� 'S HOUSE $ ? Q'cy o) _ N S = ' a SEAL _ 4 N ___— 3a.00• o 44.00• L-2690 I 33' g 38' O 0 .9 O s cli HAFk 0 �r z o SITE PLAN ONLY ' `n THIS WAS MAPPED FROM A DEED OR 1 f , RECORD PLAT AND NOT FROM A SURVEY 1N ' .,BY M E. _ ' 1 40 0 40 80 120 I I ' 1 1 1 ; GRAPHIC SCALE — FEET 1 , � 1 FOR GLORY BUILDERS INC. ' I SCALE TOWNSHIP COUNTY STATE DATES N 87�32'18"W 120.44' 1 — 40' SHADY GROVE DAVIE N. C. 7-25-00 LOT 3 PRINCETON COURT HOWARD SURVEYING JOB NO. JOHN RICHARD HOWARD PLS 0066 P.O. BOX 276 ADVANCE, N.C. (336) 998-5396 •r vPLICATION-FO „� TE EVALUATIONAMPROVEMENT PERMIT&ATC M_ ;, avie County Health Department Environmental Health Section Gj Xm P.O.Box 848 74- 2 F i j, Mocksville,NC 27028 E11ul1 11.1E1lTAL IiU ii (704) 634-8760 I11C�tf CVIIPL Y ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed C-;,?,4-i 1-90 ??S Contact Person MailingAddress �� i�=l2p�¢t s 1?dll Home Phone City/State/Zip A o iA ac c 7- C . Z 2 U a G Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address 14,w L- City/State/Zip 3. Application For: [Site Evaluation [ ]Improvement Permit&ATC [ ]Both 4. System to Serve: P'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? LI'Ltl[.:R ,1 I'L.-1 L 01%' SITL PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT***•A*FLIAT OF THE PROPERTY MUST BE Property Dimensions: 196 '' SUBMITTED WITH THIS APPLICATION. WJ66 ��zWRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: # 5'Sb O -01- 5' 0. S Property Address: Road Mame &A C 7 Wyx,4- /7 a A t7fi9?oyl City/Zip A'Q VA Nc c Al- (4. 70�' it/v, l-A CIE Com,4W 7 If in Subdivision provide information,as f ll ws �� ac.�4"� GP_ S 0 / / .i - Name: — ; Section: Lot#• 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- / 7— 'h `,� SIGNATURE Revised DCHD(06-96) THIS AREA , AIJ 13E USED FOR DR.tININ(i !J011R SITE PLAN: r r -arcel 65 /T .fomes Mayhew I D.B. 071-392 I 00 S 95°37'40"E 1599' I 150' 150' 50' 150' r--� 150' I a I 017 / 200N 19 21 22 p CD f 5p 150' 150' 150' 150' o r A t � 4 60, Y tT B LI C arap.�zeu 5,1►-- 1 1 SO' 150' r- ~l1 1 r'c - De*e, or r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900111 Tax PIN/EH#: 5860-81-3295.03 Billed To: Gray Potts Subdivision Info: Princeton Lot#3 Reference Name: Gray or Betty Potts Location/Address: Baltimore Road 27006 Proposed Facility: Residence Property Size: 150 x 255 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 Slope% 20 HORIZON I DEPTH 0-14 Texture group 64- Consistence 55 Structure Mineralogyl HORIZON II DEPTH Texture groupG Consistence Structure Mineralogy HORIZON III DEPTH Texture groupk Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy1: SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE ']gjEj I SITE CLASSIFICATION: P-S EVALUATION BY: E.LALr,94M 19 LONG-TERM ACCEPTANCE RATE: D' 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 oist 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)