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226 Merry Lane Lot 9 DAVIE COUNTY HEALTH DEPARTMENT /6/ Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksviille,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900051 Tax PIN/EH#: 5788-06-6008.09 Billed To: Haven Home Construction Subdivision Info: Merrybrook Acres Lot#9 Reference Name: Sharon Vogler Location/Address: Merry Lane-27006 Proposed Facility: Residence Property Size: 5.7 Acres ATC Number: 2241 **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 IV- #People #Bedrooms �_T #Baths Dishwasher: ;!r 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 1�76 Design Wastewater Flow(GPD) `!d a Site: New©Repair❑ System Specifications: Tank Size/b&GAL. Pump Tank GAL. Trench Width ~Rock Depth Linear Ft.17ed Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISERS) 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.**** /57 Environmental Health Specialist's Signature: Q ,i'� l Date: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900051 Tax PIN/EH#: 5788-06-6008.09 Billed To: Haven Home Construction Subdivision Info: Merrybrook Acres Lot#9 Reference Name: Sharon Vogler Location/Address: Merry Lane-27006 Proposed Facility: Residence Property Size: 5.7 Acres ATC Number: 2241 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: 0 'd 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.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. Septic System Installed By: Environmental Health Specialist's Signature: Y y Date: 9::ry O� DCHD 05/99(Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMlT&ATC Q Davie County Health Department D Environmenta/Heal&S&Won P.O. Box 849/210 Hospital Street NOV 1 1999 l Mockaville, HC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BR PRO=SMM UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the XMrORMATION BULLETIN for instructions. 1. Mama to be Billed 1 Mccntaot Parson is XX.�UT l �1 n(G Mailing Address _R^K 1Q4 QC) - Eome Phone Li City/stat./Z2p n ; L"Y' c97l0C)Lr Business phone gctz — cons 2. Mame on Permit/ATC it Different than Above Mailing Address City/State/Sip 3. Application For: 6�Site Evaluation [improvement Permit/ATC 0130th s. system to service: R Bouse U Mobile Home 11 Business 11 Indtistry 0 Other s. If Residence: # People 4 # Bedrooms _ # Bathrooms Dishnasher ❑ Garbage Disposal 'Z Washing Machine ❑ aasemsnt/Plumbing 9 Basemsnt/Mo Plumbing 6. if Business/Industry/other: specify type # People # Sinks # Commodes # shovers # Urinals # water coolers iF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) z. Typo of water supply: County/City 0 Well. 0 Community a. Do you anticipate additions or expansions of the facility this system Is intended to serve? O Yes 81o If yes,what type? ***IMPORTANT***CLIENTS MAST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. �t Property Dimensions: 7 c. DIRECTIONS(from Mocknille)to PROPERTY: ,09 I Tax Office PIN. # :5 7 g� - bto- to0o -Sc) ( 'S --R+ Property Address: Road Name LOT C1 "t-m-1 6-y-- — Lor 9 cityalir"ar�ce. IJC a7ob� oYl If in a Subdivision provide Information,as follows: Name: N=-�kroor-Acre-S Section: Block: Lot: Date Property Flagged: 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 we 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. 1,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 I•�o�! 19 9 SIGNATURE i THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Exis g and proposed property lines and dimensions, structures, setbacks, and septic locstions). �ILs�Ip�;f �'n��!7«/f%n✓ C(.. ��i ly/�i i.� ��� Site Revisit Charge Date(s)' / Client Notification Date: EHS: J Account No. y�( Revised DCHD(07/99) Invoice No. Q y '00.56 !(it R'thoni J Mur el�n0 J" ' 0 8 50.4b2 X68-227 - 375 q. 330' !75.67• 167 q- 31 63j-9� u,• N ! 30• Q• 3 3>_2 T O`C Z f ! r+C obcee al Q .en v b MI s s Oovd �o5y /'`f►' I p 266 5.775 AC ti _30S-.30' 10B'f9-t38 13 reb b( b N " � •/f�i1 /e i. 1 `W b A� Y. 20 d wo.- o f J r n-'o^ /o a n s f ^.a ^ Sr• 00 C 6736 a 6.703 4C. s « 6. A 3Cr f V Sr °o A. _ ,• 389 Aso• 1co f r C' • w /\ 3/i.Jc' I tI' P iNv" ,ls� C '»w, yn 36/_.33626. eC.v.4•9A�.fF y jdw.)r7..S� 6 e ! t _sp78 ee...+ 36. s- 'o cN, �.. N77 .z3•..7 E �� a1 � - ,a 1 - 1' 'b • o-• -'o'E q ! i 1 �_.. mob `s`w `• `. -sl 77. 6`020 `7 Y ro _e I �s s za n 6.665 ACRES : '° 'n u. w be'• 3� ~•O -- ----- -. n^ 3 a by eO'e 26 339•V - e�'S0f.9i' -333.if' '•O / O ( � b 6244 ACRES 0 2 `M�/2pcz t;6�w ( "S-17r. raa se OD AC 5SAC. 6.408 A le ( Z JomBs R rKps I 749.36 • '' 3. H ei 6 � • ie 5.010 ACRES "77•-sT-1s'C— 5 75S A0.'ES ' i ' •..� •��' � - � .. 5 bo '- �'� oe. = _ f Mer +� 1.003 ACa`g4 5,�� �• ONNEF \ - .o,� �`• ,c. \ yr moo. •r ,\ ` �` ti• Fallon Sca Z A b�rye J6•7. 9�.7r.. 20Cte r .j- 2 b. $• ?•� r cc.. Ia •pe 1!642• /to �',.=, ?,'J,. x 32.46 x3'-39-ss 207.76 !COW 12.36 19'-39'-27' „_tel ZB V6/2'-13:Xi w �� X00. 6I-11'.W. �_ 189-24 _r _ OI. MO'Y Ann 807'7d1 fC 0099.- s- 60.10' << 60 s0' 17416 n 9 r2.40•: \\ - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME N�tz'X-� �r DATE EVALUATED ADDRESS A CMS PROPERTY SIZE PROPOSED FACIILTY N- C' `�s Q LOCATION OF SITE Water Supply: On-Site Well Community Public Y Evaluation By:C.",_%,.Auger Boring V-1 Pit Cut FACTORS 1 2 3 4 Landscape position -S -S Sloe % S • 77 TTT' f J ° HORIZON I DEPTH Texture group S C S L S C .S C Consistence FIs F T } Structure Mineralogy HORIZON II DEPTH Texture group C C. C Consistence Structure k -S 131c SS SB k Mineralogy HORIZON III DEPTH Texture grou2 Consistence Structure Mineralogy HORIZON IV DEPTH Texturegroup Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON — - SAPROLITE - CLASSIFICATION 5 �5 tD s P LONG-TERM ACCEPTANCE RATE .3S- SITE CLASSIFICATION: P 5 EVALUATED BY: LONG-TERM ACCEPTANCE RATE: 3s- O _ OT,pHE'R(S))PPRESENT: NO1 REMARKS: � � C9-� s � S — !sk—�s=-'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 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 i ■/.■...i:/!!'a■ice.\\\'.'iii:�\11/t.r...■13C.■./■►\■�.r■!tf■fC■■.■...■..■ ■■■ ■ .■■ ■MUMuca■■.. ■■■■■■■.■.ti■■.■.........■...■.....t■.■■■ ■ONO..�mom�MEMO �■■■■..�■■.■N.■■■■■...■■■■■■■■.■.■■.■■.■.■.■■■■■ on ME C:C:CCC:::C::::::::CC:C:C:CCC:��::C::C::C::::�C:CC:C:::C MCCCC■M.CCM■C■� M���������■�������■C�CL% rC�CC.CCC�■CCCCC■.CCCCCC CCCCCCCC:CCC:'::CC':C000:CCCCCCC::C' =CCCCCCCCCCCCCCC■riia■■■■■.■■.■■.■■.■..■■.■■■■■■■■■■.■■■■■■■■■■.■ nommonimmommom CCCCCCCCI::----: ........................ ....................................... ................................................................ H:::::: .E:::: MENNEN MENNEN MENNEN CCCCCCCC�3CCCCCC"MMMMCC ................................ .............................. ................................................................ . .............................................................. . .............................................................. ................................ .............................. ..._./.......................................................... ■....■...............i...■...■■t■■..t....■/......■■■...■■..■■..■ ...■.....■C....■■■.■■.■.■■■■.■■..■.............................. ...................................... ....t.■../......t..t.t.■. ■..■■■.■■..■.■■■■■■■/.■■.■.■■..■u.■./.■.■■.t/..■...t..■■.■■tti■ ■■t■■.■tt■tt.....■■■..■tt......■ ■.■t.■..■■.■.■■■■■.■.■■.■■■■■■ ■■.......■...■..■..■..■■■..■■.■■■■.■■/■..■./t/..//..tt.t/.t■.t■■ ■...■.■■t...■■■......■■■.■■■■■■■■■.■.■ttt.■.■■...■./../.■.■■..■■ ■......../....■.//...■.■.//■■/t.■■■■.■/■..■/t■.....■■.■tt....■/■ ■...■.■■t.■..■■...■■.■■...■■■■./■■■■.t.■■.........■■■./.■....■■■ ■..■■/■/...■.■..■■.■t../■■.t■■..■■.■■/.....■■■../■....■t■■■.■■.■ ■.■■...■■■■.....■■tt.■■■....■■t..■.tt.■...■....t.../....../..■.■ ■■■■.■..■.■........t■■■■■■■■■■■■ ■■■■■■...■■■t....■t.■.■■■■.■.■ ■/■//..///■■.■..■./....//i..■■.■�■■■■■■/.■..■....■.t■.....■t■■■ ■..■■■■■■.■.■■.■..■■■■.■■■.■■u.■■..■■.■t■..t..■.....■...■t..■■■ ■■ ■.■ ■■.■■..■.■■.■......■■.■■■t..■.■■...■.■..■....t.■■..■■■■ • 15 � L5 � V L5 L APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMI D iQtJ Davie County Health Department tttt _ tt Environmental Health Section �^ E3 P. O. Box 665 f p Mocksville, NC 27028 CCI Y� 1. Application/Permit Requested By Tnn �' u sa•-� 'Iti 2�� Mailing Address ak�J Pw— -3o--�)— 1 1 nckS U 1 VL-e— 9-7021? Home Phone g 6 g 4 '1 Business Phoneg9g 6 5 5 1,xe 2. Name on Permit if Different than Above pa 5`,aP�`'*f 3. Application/Permit for: Sept��Installa�tio��> 4. System to Serve: `House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industrynn ElOther ❑ Unknown 5. ouse mobile home: Subdivision me.�i B P. & Acres Section Lot # P<Basement/Plumbing No. of People 15 ❑ Basement/No Plumbing No. of Bedrooms 4 Washing Machine 2 No. of Bathrooms Jyi 0-X' 4 Z g Dishwasher Dwelling Dimensions 00 ❑ Garbage Disposal 6. If business, industry, place of public assemb y, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ublic ElPrivate ❑ Community 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes XNo If yes, what type? 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: ., n,+tb (11..o c*s J 1 I,Iz. O, 8o 1 4(. 4 �o leaf- (go 1 N 0,e�) o c�b�. - a a rrt.%I-eo nl c I tn,v,tL A,06Ld 4oe CrIl sold- -This is is to certify that the information provided is correc to a best of my knowled e, and I understan am responsible for all charges incurr d from this application. ATE SIGNAT R CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Fand ECK ONE: ❑ 1. I OWN the property. 2. I DO NOT OWN the property. ked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative the Davie County Health Department to enter upon above described cated in Davie County and owned by �� �QTov>P�r,��_ all testing procedures as necessary t got2rmine aid site's suitabili for a gro rption sewage treatment al system. - 3-9/ I I k-i��2d DATE SIGNXtURE DCHD(12.90) • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section c p Soil/Site Evaluation NAME ��� � � DATE EVALUATED I - to - 91 ADDRESS A` a PROPERTY SIZE QNr � PROPOSED FACIILTY oy s Q LOCATION OF SITE Water Supply: On-Site Well Community Public—Y, Evaluation By:C't_.V.Auger Boring Pit Cut FACTORS 1 2 34 Landscape position S S Slope % S • /h -JS T)T' g J 6 HORIZON I DEPTH � �� �� Texture group C S C Consistence Structure C K R G Q Mineralogy •l HORIZON II DEPTH 3 Q, a'' 6 '' Texture groupC C C Consistence Structure k 131c S13 SB k Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON — - SAPROLITE — - CLASSIFICATION S to s F> LONG-TERM ACCEPTANCE RATE ,3s- b 35 5- Ws L4u SITE CLASSIFICATION: P S EVALUATED BY: LONG-TERM ACCEPTANCE RATE: .3 S " l O OTHER(S) PRESENT: c" 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 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 Mineraloity 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 ■■■!.!.■■■.!!■!.!■■■■!■■■■!■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ !.!■u■■ ■.■■■■!m.■■■■.■■.lSME:�E■■■■t�Oa■■!.■v■■..■!■■.■u■!■■.■■ !!.■!■■■mi!■■■■.ltc.■.■■■.■■.■■■■!■■■■!■.o■■■■■■■■!■!■■!.■■■■!.■■■■ ■!!..■.■!!.■■.l.mo■...■■.!!■!!■■!■■comms■■.■■■■■■■■.■■■.■■■■■■■■■■■ ■!■■.■..1.■■.11OaRR■!.■■!.■.■■■.!ommmumam■■■■■■■■!.■■.■■..■■.■.■■■ ■■■■■■■■■■■■■■munm■■■!■■.■!.■■■lM•aE■!��!■!■■■■■■!!■■■■.!■■■!■.■■■ ■mmmmmmmm�mmmmmmammmm■mmmmmsmmm!■immmmmmmmmmmmmmmmmmmmmmmmmommmmm ■■■■.!■■..M.■.■....■■. .■.■u■■■...■■■.■■■.■...■!■■■■..■.■■■■■■.!■ mmmmmmm iimmi=i■iimmiii immiiiiiiiiiimMMIMMMMMMMMI OMMMMMMMmmmii'iiimiiiiiii ■■■.■■■.■..■■■..........■...■ .■■■■.■■V.r■.■■■■■.■■■■■■■■■.■■■■.!■ ■■!!.■.■!.!■■■■.■..■■.....l.■■!! 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