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201 Cornwallis Drive Lot 29 DAVIE COUNTY HEALTH DEPARTMENT + Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900323 Tax PIN/EH#: 5831-97-9435.29 Billed To: Vogler's Construction, Inc. Subdivision Inf�Pudding Ridge Lot#29 Reference Name: Dick Vogler Location/Address: Cornwallis Drive-27006 Proposed Facility: Residence Property Size: 200 X 235 ATC Number: 2395 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 CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: �L'�"{" Date: -'7-1 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. 1 ' v � Septic System Installed By: (/t/ Environmental Health Specialist's Signature: Date: ��`( _ DCHD 05/99(Revised) 1 CAROLINASURVEYOR.COM � DONALD J. MOORE, P.L.S. c� PH: 336.998.0100. FAX:336.998.4998- `� LAND PLANNING •SUBDIVISION DESIGN •SURVEYING • r - a • P.O. BOX 2281 ADVANCE, NORTH CAROLINA 27006 � DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900323 Tax PIN/EH#: 5831-97-9435.29 Billed To: Vogler's Construction, Inc. Subdivision Info: Pudding Ridge Lot#29 Reference Name: Dick Vogler Location/Address: Cornwallis Drive-27006 Proposed Facility: Residence Property Size: 200 X 235 **NOTES* ,Isblemprovement/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. i Residential Specification: Building Type #People #Bedrooms ",,� #Baths _ Dishwasher: Id Garbage Disposal: ❑ Washing Machine: d Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial C3l Waste: al Lot Size Type Water Supply Design Wastewater Flow(GPD) �G�J Site: New 0 Repair❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width jr Rock Depth Linear Ft Other: Required Site Modifications/Conditions: 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.**** Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) APPUCATION FOR SITE EVAUTATiON/IMPROVEMENT PERMIT a AlM @ 15 D W L5 Davie County Health Department D P.O. ox 848/2110 Hospi street APR 2 d 2030 Moc koville, NC 27028 (336)751-8760 ***IH80RTANT*** THIS APPLICATION CAMOT OT BZ PROC OSZD UMSS ALL Tax REQUIRM INFORMATION 18 P ED. Refer to the IN> P&MIGH BULI.ICTIH for instructions. 1. Name to be Billed V cA Contact person F cJ Nailing Address x41 � noes phone -3 "/ S-Q_ 0 7 city/state/sip ��t� /(oc ata 9s Bneineas phone Z. Neaa on pernit/ATC it Different than Above Nailing Address City/state/Zip 3. Application for: O Site =valuation G-21irovemeat permit/ATC 0 Both a. system to service: aH6'use 0 Mobile Boma 0 Business 0 Industry O Other s. If Residence: # Peopli a Bedrooms a Bathrooms ! _ Wiishwisher O Oarbeye Disposal aching Machine O Basement/pluabing O sasesiant/No plumbing 6. it Businees/Zadustry/others specify typo # people # stake # Commodes # showers # Urinals # Mater coolers i! TOODS&RVICZ: # Seats / Zatimated Nater Usage tgauous per day) 7. Type of water supply: 9-County/City 0 Well 0 Community a. Do you anticipate additions or expansions of the facility this system Is Intended to serve? O Yes D.#w_�_ If yes,what type? ***IMPORTANT"**CUENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MULWT BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: y -) 35 WRITE DIRECTIONS(from ModwAl�e))to PROPERTY: Tax Office PIN: # j�S l ' 7— 9 73 f��1/z '�°� �`''` leo- C2 Property Address: Road Name Lc! l� ✓ z.}� / (�-�� '" •U City/Zip 'm: - AnG U in a 3a "'ou provide Information,as follows: lb �/1/�� 1 f j k;dkName: t �a �. u'y eCf r � S� Section: . Block: Lot: g Date Property Flagged: a .� This Is to certify that the information provided is correct to the best of my knowledge. I enders mad 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 falslfied or changed I,also,understand that I ant rMonsible for all charges Incurred front this appUcadon. I,hereby,give consent to the Authorized Representative of the Davi oa ty Health"rtmen to eater upon above described property located in Davie County and owned by f < to conduct all testing procedures as necessary to determine the site suitability. DATEZC) SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property Uses and dhmensions, structures, setbacks, and septic locations). �`q G l L Site Revisit Charge Y 1 ' Date(s): Client Notification Date: EHS: Account No. v �� Revised DCHD(07/99) Invoice No. • w. moi. ,�' �• -�•• ��' .� • F r l fib• 'f- 4• � _^+• tl � 5��, — � "�• �, • I1 R s r } �. •. • M K L ;- _� _ :� •�.. ,fie; '' ,..�- " ,P ,�� ^i a�' {' • V;Osll .;rs` aA,;.• X11`.' {' :f�•'l/. �!' = '. "a:' :,,,w... � •� ✓e•�� + 1A fes. ,�Si'. 1 �I Il�,'� � - ppp 4 ' DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation NAME L//--�'tIL�P DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 3 4 Landscape Position "All 2P Sloe 7. /11 HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II 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: /_�> EVALUATED BY: LONG-TERM ACCEPTANCE RATE- OTHERS) PRESENT: REMARKS: a �L EGEND 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(01-901