307 Griffith Road Lot 24AUTFip )ZATION NO: 1 3 4 2 DAVIE COUNTY HEALTH DSP tTMENT a: �"� I've
Environmental Health Section PROPERTY INFORMATION d- 0-00
Permittee -�4 P.O. Box 848
Name: .t L r ,.... ' � Mocksville, NC 27028 Subdivision Name:
Phone #: 704-634-8760{ 4�1, 1370
Directions to property: Section: Lot:
T?�q
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#.4;16 -
SYSTEM CONSTRUCTION ----J2 �.
Road Name: f 1 i' 7C? y
**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)
,T
LIST DATE ISSUED
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
IBJ%] • �' � � � J.I�Q
NW UH ra
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Q-3
= -Perini. . - r i� .I► / • _ A
W
Name:
r_
Directions to-property:�"
dry nNPPERM[T NT
! PERMTP
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Subdivision Name:
a
Section: ,� Lot:
Tax Office PIN:# - -
s • /^ w or
Road N
Q
"NOTE" This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained frori►.tliis Department prior to the
i constructioidmstallation of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S. Chapter MA, Wastewater Systems, Section .1.900 Sewage Treatment and Disposal Systems)
* **NOTICE* *THIS PERMIT IS SUBJECT TO REVOCATION SITE
'I� IN
PLANS ORTENDID USE CHANGE YOUR WASTEWATER.
ENVIRONMENTAtHEALTH AtCIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE Tim PE u*ffr BEFORE
INSTALLING THE,SYSTENL
RESIDENTIAL SPECIFICATION:BUILDING TYPE # BEDROOMS 1Y # BATHS # OCCUPANTS _,$_00" GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT S1ZE� TYPE WATER SUPPLY Id"el DESIGN WASTEWATER FLOW (GPD)_ NEW SITE_k___11REPAIR SITE
Ile
SYSTEM SPECIFICATIONS: TANK SIZE,&4_90 t�G��AL. PUMP TANK GAL. TRENCH WIDTH,7`' ROCK DEPTH)� LINEAR FT�
Y, OTHER
Aire- zDIASz Oox
-;` • _`�I UIRED SITE MODIFICATIONS/CONDITIONS:
DeROVEMENT PERMIT LAYOUT
J
�1llt�/�jR�'Qn6v�r71! /11yS
Cuf�Aea u,!JPrc�
P
41 )ve s •
s -/Ay �,� ,c
R rea r r�
jbe
N **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPA]
V BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INST
OPERATION PERMIT
K5°�
U
t b'o
I�
�1
FINAL INSPECTION OF THIS SYSTEM
NONE # IS (704) 634-8760.
,
AUTHORIZATION NO. �- n OPERATION PERMIT BY: �/ DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NOWAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PEit�AIT & ATC
Davie County Health Department
Environmental Health Section Aa 4
P.O. Box 848
Mocksville, NC 27028 WR 3
(704)634-8760
E;
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSIT-U-UNLMS4
THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billed ! t" 'y= -h{ �•s n (� Contact Person
Mailing Address s �[ (� Home Phone
Cit /State/Zi { 7 `' t'�f �' } ► z E? (i,f cJ rlc Business Phone C _ y
Y P D, O), 1�
2. Name on Permit/ATC if Different than Above rt y, =' --
Mailing Address Y", : "' City/State/Zip
3. Application For: Wii 2 Evaluation [ mprovement Permit & ATC [ ] Both
4. System to Serve: [_1 -House [ ] Mobile Home [ ] Business [ ] Industry [ ] Ot�,heer;
5. If Residence: # People ---!V # Bedrooms /# Bathrooms [✓]'Dishwasher [ ]Garbage Disposal
`[ ] Washing Machine [ ] Basement/Plumbing [.4-I`55ement/No Plumbing
6. If Business/Other: Specify type # People #Sinks # Commodes
# Showers # Urinals # Water Coolers
If Foodservice: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: [ ] County/City [ ell [ ] Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes
If yes, what type?
PROPERTY INFORMATION REQUIRED: *** IMPORTANT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: Mt//q ac lw n _ WRITE DIRECTIONS (from Mocksville) TO PROPERTY:
Tax Office PIN:
Property Address: Road i ame(.t
� IV 1
City/Zip : ; t ;" t? ; t�' tw Ci
If in Suffidivision provide information, as follows:
f
Name: I oqf?-
Section• Lot #: '
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 responsible for all charges incurred from this application. I, hereby, give consent to the Authorized
Representative of the Yvip Count
jjy
Health Department to enter upon above described property located in Davie County and owned
by ` > { Jk r- 611k1l"O-- to conduct all testing procedures as necessary to determine the site suitability.
DATE ' I 1 Y> &NATUR
Revised DCHD (06-96) , �[
THIS %,A -JAy $E USED FOR DRAIVINC YOUR SITE PLAN:
NAME
ADDRESS
PROPOSED FACIILTY
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
V'
DATE EVALUATED
c� �6
PROPERTY SIZE
LOCATION OF SITE
Water Supply:
On -Site Welly
_ Community
Public
Evaluation By:
Auger Boring
Pit LI -10,
Cut
FACTORS
1 2 3 4
Landscape position
.L
Slope
HORIZON I DEPTH
<<
Texture groupS
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: OTHER(S) PRESE T:
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 :lay loam SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR- V• --.-y 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
Mineraloiry
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
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
NAME !4t'21eS
ADDRESS
PROPOSED FACIILTY Z6
DATE EVALUATED
PROPERTY SIZE !, ri91% j
LOCATION OF SITE
Water Supply:
On -Site Well 1� _
Community_
Public
Evaluation By:
Auger Boring
Pit
Cut
FACTORS 1 2 3 4
Landscape position
Sloe R
HORIZON I DEPTH s7i
Texture group J_e
Consistence
Structure
Mineralogy
HORIZON II DEPTH /-
Texture group
Consistence
Structure Pi r
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: zz__!� EVALUATED BY: "'&'l
=tel
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD (01-901
OTHER(S) PRESENT:
LEGEND
Landscape Position
R -Ridge S -Shoulder L -Linear slope FS -Foot slope N -Nose slope
CC -Concave slone 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 ;lay loam SIL -Silty loam CL -Clay loam SCL-Sandy clay loam
SC -Sandy clay SIC -Silty clay C -Clay
CONSISTENCE
Moist
VFR- V+:. -y 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
NVMgr�R:
Davie County Health Department
N ptiv4s 22• �gg8 and Come Health Agency
�FFEG�`•33 .5.01roo Environmenta(Heaf& Section
P.O. Box 848 / 210 HoSPrTAL STREET
COURIER #09-40-06
MOCKSZLE, N.C. 27028
PHONE: (704) 634-8760
April 30, 1998
Beauchamp Building Co.
340 Spillman Rd.
Mocksville, HC 27028
Re: Septic Tank System
Riverbend Trails/Lot 24
Dear Mr. Beauchamp:
On April 27, 1998, this office met with you, David Hanes and the
prospective home owner on Lot 24 in Riverbend Trails on Griffith Road in Davie
County. The purpose of this meeting was to determine the location of the
septic tank system and drainfield.
Based on the grading work that has been done there is a limited area
available for the installation of the septic system. If a lift station is to
be avoided, it is imperative that you work very closely with this office to
ensure that adequate space is reserved for the proposed installation.
If you have questions, feel free to call this office.
Sincerely,
WW4F&.7ae��
Robert B. Hall, Jr., R.S.
Environmental Health Specialist
RH/wd
Enclosures