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129 Cornwallis Drive Lot 33 DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section P. O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 98§900025 Tax PIN/EH #: 5831-98-8223.33 Billed To: Dick Anderson Construction Subdivision Info: Pudding Ridge Lot#33 Reference Name: Location/Address: Cornwallis Drive-27028 Proposed Facility: Residence Property Size: 1.113 ATC Number: 4514 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 CONSTR TI IS IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ( Date: l� -757e k ld�faCERTIFICATE 9F COMPLETION f� ? � �O ;, **NOTE** The issuance of this Certificate of Completion`shalndicate t sys�er?�'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 that the system will function satisfactorily for any given period of time. Ia a A or ro 15' C p �1` 1lCh G8 O y w«I► a (,Grlag C'uYh w� 5 nbJo ��5 joSeptic System Installed By: Environmental Health Specialist's Signature: /[ li /l/ �• n 5 Date. DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT '• -' Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900025 Tax PIN/EH#: 5831-98-8223.33 Billed To: Dick Anderson Construction Subdivision Info: Pudding Ridge Lot#33 Reference Name: Location/Address: Cornwallis Drive-27028 Proposed Facility: Residence Property Size: 1.113 ATC Number: 4514 **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 IN'T'ENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. M —9 Residential Specification: Building Type #People #Bedroomsy #Baths Dishwasher:Z Garbage Disposal Washing Machine: 12rBasement w/Plumbing: Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift /v#Seats Industrial Waste: ❑ Lot Size �j ', Type Water Supply GO Design Wastewater Flow(GPD) Site: New M Repair❑ J� System Specifications: Tank Sizf/�GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft. G D Other: As stated in 1.5A NCAC 18A.1969(5) Required Site Modifications/Conditions: accepted Systems may also be used 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.**** 1� Environmental Health Specialist's Signature: GDate: DCHD 05/99(Revised) 336 996 7279 p' 1 Dick Anderson tQQ p.s APPUC4MON FOR Sf7£tIIAtItaT10N/MUMM81MY PEM27 Sr ATC, Davie County Heatth Depaft=t ' • _ , F�vimtumenta/Health SeIaau P.O. BOX 848/210 Eospital Streat �J I,S ,� MoCksvi7la, 14C 27028 (336)751-0760 :. i C�, 2 Q ••*�reaez�rr►•e rlsxs nr=zuasraar cAramr As�.gnceas�,v ass , z= a::QUZ= C _00 ; 1*06f"0t""M IS PRt7VIDM 2--f= to the nWORiIMM BII6t:$TISt _or inatimationa. ✓1. naso &Dbo rAZA—rmy .�-'71alling Ammav 7-2.9 w�ii sa j HAVe,-j IAMFS Name:kor 3310 z1'av; t o`u;; 'LTH /cscr/Siaw/12s _t Lt4 N C ?--lots3�uinsss Paooa 3'SCP 99$ 0419 _9 ✓2. Rasa oo ft=Lt/A=It altarwt taco al,vr. rALU g Ad4m&m CLCr/staee/Zlp �. (�� .�r3. Ayp1Si' rima razz IKSS�ta er&U f1tigm 13 Mwp=avu==t P—m;t;/A4"r. i? 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I st: tc hurtc arras BA=ed: a TM it to CCrGf7 chit the tnfarW2UOR provided is correct to the tteit Oftny�natTICdSG I wmtcrstand t�rat ant'ecru ii{s) hsned hermit r are subject to aaspeosios cr resorntioa,if tAe site plays or inleided use chant,or Kite,Worntnt,oa sufanitleJ it thts appl6atio-is fatsif'ad or Ctsss=nd.I,dm,a�rdasfarrdrharlaat rr�.arca7+fefora!!cl,.^.�.s ir,cwrfrrrlrom tirtr applteatlon. I,hereby,girc cmnseut to the Authorized Rcpracntattrc of ilee Date Carroty health artmen to enter upon atwre Itactibed proputykeated in Davie Cowdy and omred by taeonduetaltgteStlaEpr�edaresasneces;arytmdetecnunethtsitesaiia tY -- -MCNATURS UMV& ' TIUSAItSJiMAYBEVSHDFORWAT,7NGYOURS11 MAN(Include allofthe foRowiag:Fsi4kigandprupcsed ptopertylloesaaddfinc=!ans,strueta—.seM=lo;,And septtctomdons). SiteR"i,It Charge Datc(s): Cticnt NiotiGcatton Dz:_:r__,______ j j 88Sc •. � Sign sI*� /_a Axtonstxa. 99oa� Revised DCFiD(85f8.7 IerwlooDta.•, ! DAVIE COUNTY HEALTH DEPARTMENT Environmental HNlth Section Soil/Site Evaluation NAME y^�(' DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well ✓ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Slope Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH G Texture group Consistence Structure .e, 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: EVALUATED BY: LONG-TERM ACC PT NCE RATE: OTHERS PRESENT: REMARKS: p /- o �O�'� - 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 3C-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 X F SY%s? aFP �k Yr vx, x all i yY5 d 4 f' ryb. i F,� �� ®! �� =� C _Y.� h. nt � � �� ,� - �.. !�; • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900025 Tax PIN/EH#: 5831-98-8223.33 Billed To: Dick Anderson Construction Subdivision Info: Pudding Ridge Lot#33 Reference Name: Location/Address: Cornwallis Drive-27028 Proposed Facility: Residence Property Size: 1.113 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% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON 1I DEPTH Texture group Consistence Structure 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 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 lYQteS 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 05105(Revised)