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115 Valley Oaks Drive Lot 23ID oO Permittee?s )�r'_ C�'�t r''�1V�IE COUNTY HEALTH DEPARTMENT Name:- ;- ° ��(_. A, :lEnvironmental Health Section PROPERTY INFORMATION /oe% � �3 ,,� P.O. Box 848 Directions to property: �'✓)� Mocksville, NC 27028 Subdivision Name: \/!,CL.- Phone #: 336-751-8760 �-. / Section: Lot: AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Tax Office PIN:# AUTHORIZATION NO: 0027 6i 5 A Road Name, � "�"t Zip: � **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 1 j of G4. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) "7-\ ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ' 1 IS VALID FOR A PERIOD OF FIVE YEARS. SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS _.]� # BATHS 43 # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY -��` `DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH Q 6 LINEAR FT. OTHER A�PTy,= t— ) �� c1�uc' I� � C ill , �L�I rjt� t I )&I F �..•i34'Jy%L-vt REQUIRED SITE MODIFICATIONS/CONDITIONS: )I ..Ip I d o"F r N: E- Qct kcp `" cf-r IMPROVEMENT PERMIT LAYOUT _j.. 1Z -J-c> C I SL J t "I L 0,-) 6:1 d OPERA' FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. l VV"C1^ Sk c` Fc6"U"� SYSTEM INSTALLED BY: C jj Ch V% �Ct, Q c NO. OPERATION PERMIT BY: ;pr4cDATE: 21 ip T y -/a -- o7 "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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. �% !- , DCHD 02/02 (Revised) o / Permittees �-""' �' DE COUNTY HEALTH DEPARTMENT !iIL �/�i� t I� Environmental Health Section PROPERTY INFQRMATION " lsiiate==--• I!/�f`�� P.O. Box 848 ) I/ Directions to property: (� �i) t Mocksville, NC 27028 Subdivision Name:41-11 VAL L - L Lr ly4,Z 5 fes:, Phone #: 336-751-8760 . / Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# - - SYSTEM CONSTRUCTION AUTHORIZATION NO: 002765 A Road Name: Zip: 7 <' Lr' **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with, Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION 0 IS VALID FOR A PERIOD OF FIVE YEARS. NT&�IEALTqSPEC�IA IST DA EIS QED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS _ # BATHS \'31 # OCCUPANTS ZI GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY 1A DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE V j I SYSTEM SPECIFICATIONS: TANK SIZE -----GAL. PUMP TANK GAL. TRENCH WIDTH " 1 ROCK DEPTH IJ I LINEAR OTHER �Ll t�k� .— i� �4_1�U✓� Y�r^ ,1�L7 I�tJA t 1 t�G1 F -L avf �nL1/ REQUIRED SITE MODIFICATIONS/CONDITIONS: )4o ---p �t U� t r L""• IMPROVEMENT PERMIT LAYOUT v.1v' w c,�r' ;:.. �;, �''i,.>a MLS -'t ?,Al+✓'1' t t � cttcavt`1 A a-JG1 r.1yv1i FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATIOMPERMIT-- 10 �O I AUTHORIZATION NO. -- -- ED BY: U � � -AA l t OPERATION PERMIT BY: C `— " DATE: 41-10-0-1 **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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 ,,Frrr��UNCTION S/ATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02/02 (Revised) 60 204 a II r 44 E a 41� 63 '� r gii Jv r � s m i 828_ WWII 77 r s yt l i k x, kr m. v n` .. �,' . ay *WPI .. rl- Ow I ( , 1 =_ 92e m 6 d e ;4 8 54 ., a4 � 8 xi l3 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION Water Supply: Evaluation By: On -Site Well Community Auger Boring Pit PROPERTY INFORMATION f -S ro4ttG'7 7,9 o? Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position' Sloe % HORIZON I DEPTH Texture group Consistence S Structure Mineralogy HORIZON H DEPTH Texture group Consistence Structure j Mineralogy HORIZON III DEPTH ' Texture groupS Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: M14 a uTf.11 . EVALUATION BY: OTHER(S) PRESENT: 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 NA M, 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 Nom 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) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MENNENiiiiiiiiiiiir�ii ■■■■■■■■■■■■iil■■■■■■■■iii.::i�iiiir�i�rrinn!■■■■■■/■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■rill'11■■■■■■■■■■/■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ NAME AI)I)RFSS IIS DIRECTIONS TO L DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) WaAetz 21 (9 72-y--als-9 PHONE NUMBER �I(IfV SUBDIVISION NAME Va �(PP� Da4-5 r DATE SYSTEM INSTALLED VU 61P NAME SYSTEM INSTALLED UNDER WAleE,# Lkyaq&-9 TYPE FACILITY e- NUMBER BEDROOMS 1-2 NUMBER PEOPLE SERVED TYPE WATER SUPPLY 6 SPECIFY PROBLEM OCCURRING t VAIA (�S h4n1(-uUn i/ -c _ aMt eco,( iivd Uji A waje'� . DATE REQU FORMATION TAKEN BY This Is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1/93 i •'�T'� � r. '� $.Mtn., l I �r- "Contact arepresentative of the Davie County Health Department -for -final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-59 5. -Final Installation Diagram:ystem Installed by //l/A Certificate of Completion Date�'`��'�_ "The signing of this certificate shall indicate that the system described above has been installed in compliance with- thestandards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued _in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and -Disposal Rules (10 NCAC 10A .1934-.1968) Permit -Number Name - ! r ` _ Date ' `= Location ► ,' �� — Subdivision Name Lot No. '" Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms No. Baths _ No. in Family _ Garbage Disposal YES ❑ NO ❑ Specifications for System: Auto Dish Washer YES ❑ NO ❑ , f - _ Auto Wash Machine YES ❑ NO ❑ Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. i i Improvements permit by *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-59 5. Final Installation Diagram: m Installed by Certificate of Completion /f/ Date %� = *The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 7 SOIL/SITE EVALUATION Name— Date ✓a/" Ss Address Lot Size FACTORS AREA 1 AREA 2 AREA 3 APPA A 1) Topography/ Landscape Position PS S � S PS S PS U U ?) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) AD S PS S PS PS U U U U i) Soil Structure (12-36 in.) S S Clayey Soils (:V) C PSS PS PS U ""L�j�� U U I) Soil Depth (inches) -&�) S PS S PS ��> U U U U i) Soil Drainage: Internal S S S PS S PS U U External PS S PS U S PS U 1) Restrictive Horizons Available Space S S S PS S PS U '[T U U 1) Other (Specify) S PS S PS S PS S PS U U U U 1) Site Classification ,� t, . U—UNSUITABLE S—SUITABLE PS—Provisionali Suit Recommendations/ Comments: p y Described by Title `s/✓ Date SITE DIAGRAM Qa DCHD 16-82) DvA DAVIE COUNTY HEALTH DEPARTMENT Z ►7vc'�' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. Permit Number N° 2826 Subdivision Name Lot No. Sec. or Block No. Lot Size— House !� Mobile Home _ Business Speculation No. Bedrooms No. Baths __ No. in Family Garbage Disposal YES C❑ NO Specifications for System: Auto Dish Washer YES NO �� Auto Wash Machine YES NO -❑ Type Water Supply *This permit Void if sewage system described below is not installed within 36//months from date of issue. K77" Improvements permit by Q1 *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: � v System Installed by © V OIL— \ W Certificate of Completion Date 11-0 Al 'The signing of this certificate shall indicate that the system described a ove has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. DAVIy COUFTY HEALTH DEPART_iEPIT ENVIROV1.1ENTAL HEALTH SECTIOU SOIL/SITE EVALUATIOr ADDRESS DATE LOCATIO14 v LOT SIZE TOPOGRAPHY: SOIL TE,tTURE a a. SOIL STRUCTURE: DEPTH: RESTRICTIVE HORIZOUS: PERCOLATION FATE: Presoak Turk & time Drop Time Pate/iii%. Inch 1. 2. 3. *** CLASSIFICATIOTI°Suitable Provisionally Suitable Unsuitable C01RIEUTS e SAFITARIAH SITE DIAGF,APi APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT.. Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. 1. Permit Reqy-e§ted Bu 2. Address ' 3. Property Owner if Different than Above Address 4. Permit To: a) Insta111GAlter Repair Home Phone 59F— F2 0 7 Business Phone 25,oSp a b) Privy Conventional Other Type Ground Apsorption c) Sub -Division ec. Lot No. 5. System used to serve what type acility: House Mobile Home Business IndustryOther b) Number of people /, 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms -3 Bath Rooms Den w/Closet_(0_ b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-us�ijl1g fixtures: 7 - i F LY9Sc commodes 2." Ise un Is lavatory showers Z dishwasher % sinks 8. a) Type water supply: Public- (_-"'�Private Co munity— b) Has the water supply system been approved? Yes No.. .s5" B /�Q 3--= �f/o l,zao 9. a) Property Dimensions z/b� `t b) Land area designated to building site T��diFt-�a c) Sewage Disposal Contractor garbage disposal 0 a washing machine 1 F //'If F-/dd 10. Do you anticipa//te any add' ions or expansions o the facility this sewage system, is ntendeo to serve. OF What type? _ � C ---A/ '^ a�'k "1Z Z so J /// oJi� This is to certify that the information is correct t the best of my knowledge. V 2-5 1 A4AVeN. Date Owner Signature OWNER IS SOLELY RESPONSIBLE F R COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD (6-82)