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275 Cornwallis Drive Lot 26 ` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900628 Tax PIN/EH#: 584-10-64637-26 Billed To: James Brown Subdivision Info: Pudding Ridge 1/A Lot#26 Reference Name: Jimmy Brown Location/Address: Cornwallis Drive-27028 Proposed Facility: Residence Property Size: 180 X 180 ATC Number: 2069 **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 C joo #People 1-4 #Bedrooms a> #Baths 2•S" Dishwasher: [2( Garbage Disposal: ❑ Washing Machine: Off"" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 1W Y-7�� Type Water Supply Design Wastewater Flow(GPD) O0 Site: New le Repair❑ System Specifications: Tank SizelOWGAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft._qOO Other: 3-pleoQ �fxC�S `�3�1t�U. 1�,.�ES�I C• M�.J . Required Site Modifications/Conditions: � - 0-1 ca ROC Ll•-� -0-1 CPF t - S0 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(3(336)751-8760.**** Pr��7 X Z �oca-t►o.J 5�llu�• cum Environmental Health Specialist's Signature: ate: DCHD 05/99(Revised) • � u�6 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900628 Tax PIN/EH#: 584-10-64637-26 Billed To: James Brown Subdivision Info: Pudding Ridge 1/A Lot#26 Reference Name: Jimmy Brown Location/Address: Cornwallis Drive-27028 Proposed Facility: Residence Property Size: 180 X 180 ATC Number: 2069 **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 constructionfinstallation 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 l �J #People #Bedrooms #Baths2' Dishwasher: 12"'� Garbage Disposal: ❑ Washing Machine: 0""" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �&�� Type Water Supply Design Wastewater Flow(GPD) Site: New Repair❑ 11 of I System Specifications: Tank Size 101ruAL. Pump Tank GAL. Trench WidKh Rock Depth J�L Linear Ft.yOD Other: Required Site Modifications/Conditions: *'�Cl lr 613 Cc,JTooz rofthis IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF 6 "BELFINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspectio system between 8:30 a.m�to 9:3301:q.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.**** *LNc A Ltr-AE To Lam►-1�TN = loa' t_qIla .. 1O 5.0 #'� e I Z S5 0 io' i �2 I Environmental Health Specialist's Signature: ate: J� DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900628 Tax PIN/EH#: 58410-64637-26 Billed To: James Brown Subdivision Info: Pudding Ridge 1/A Lot#26 Reference Name: Jimmy Brown Location/Address: Comwallis Drive-27028 Proposed Facility: Residence Property Size: 180 X 180 ATC Number: 2069 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 Sewa reatment and Disposal Systems). THIS AUTHORIZATION FOR WAS CTIO IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa V Date: 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. Chapt r 139A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO W hat the system will function satisfactorily for any given period of time. i A5 a �i Septic System Installed B Se :p y y IJAJ Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number: 139817 - 1 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: 07 / 17 / a 6 1 4 Olnch Drawing Drawing Type: Construction Authorization Scale: . OON/Ak �G ?� 0 O r rd A G t t ' APPLICATION FOR SITE EVAWAHON/IMPROVEMENT PERMIT&Al@ O IE Davie County Health Depardnent D Environmental Heaft Suction P.O. Box 848/210 Hospital Street r.1 Z 1999 Mockaville, NC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.1. Name to be Billed r. •%C'CAZ�l (� Contact person -Z-ny a(I aw l Nailing Address 1r1�\\__1.1�t,J }� "C� 1�`l�r Some Phone City/state/zIP �10e1tSV�l�2 Ne Z7�Z.$1 ` Business Phoma\Oy-92q-Z143 ' _ y2=pg5q P. Name on Permit/ATC if Different than Above t�gtica t1rc� W&V& UA Gi`C Ck-, Nailing Address City/State/Zip 3. Arnplication For: U Sits rr�l.usij,�.,n Q�":....._.»._ ..._:.t c^��..�WO 46C 0 Both --:---.._..� eiYS'-M to service: X Xonse ❑ Mobile Home 0 Business ❑ Industry. 0 Other ^t. If Residence: # People L' # Bedrooms ._ # Bathrooms 2.12 PIDishwasher 0 garbage Disposal dwashing Machine 0 Basement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/other: Specify type # People # sinks # Commodes # showers # Urinals # Nater Coolers Ir FOODSERVICE: (( Seats Estimated Nater Usage (gallons per day) 7. Type of water supply: County/City 0 Well 0 Community e. Do you anticipate additions or expansions of the facility this system is Intended to serve? 0 Yes No If yes,what type? ***IM1VRTAN7'***CLIE14TS AlUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. 1 Property Dimeoslens: mc; " 180 . _ _ WRl"I'At DMI?r"ONS Mt-dovAl.)•_PoOog� .; Tax Office PIN: # Z t. Property Address: Road Name 225 CorrmyaW-S Jb #be City/Zip If in a Subdivision provide information,as follows: Name: /;Putl8±22ha Section: �. _ Block: Q Lot: 20 Date Property Flagged: lo- -°S`� 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 responsiblefor 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 y-:0A Gr e, to conduct all testing procedures as necessary to determine the site suitability. DATE � R� ..............,sn �� — • VaVIrA•VrL' t/—�" THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed properly lines laud dimensions, `structures, setbacks, and septic locations). Account No. ReAsed DCHD(07/98) Invoice No. _ �_ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME V /°�e DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By: Auger Boring PitCut FACTORS 1 3 4 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH r Texture group Consistence r- 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: ,I e LONG-TERM ACCEPTANCE R E: -� OTHER(S) PRESENT: REMARKS: A !� 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 watet 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 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900628 Tax PIN/EH#: 5841-06-4637 Billed To: James Brown Subdivision Info: Pudding Ridge 1 Lot#26 Reference Name: Jimmy Brown Location/Address: 2251 Cornwallis Drive-27028 Proposed Facility: Residence Property Size: 180 X 180 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 grou2 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: 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 of 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 bCHb 07evised 05/99) a OP 'weak �ou5� SO � 2,y 2D. a �5 y -ZS' Cl i Cctii`51Wa��i,S •L�r►V� 225 Gare W alis�rivt,