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187 Serenity Hill Trail Lot 7r^" -i. i`a'"�'""_'e'*+` 4„; _ :.��, ^.: ••^,r.. .V7"y�..-;!•.^.+,yw+.. �r '✓(^ .`i^,. _ "'x'f.-v,;;-.,"L• -.-..^ •Nr.+',+.-.i._-Wr..-"�. DAVIE OUNTY ALTH'DEPARTMENT kxt�L TM PRO . MENT PERATION PERMLTS PROPERSubdivisionName �t i_,^Duechon6�property ��,r/+�'`�rr” Section �/ Lo: w t� t' `�BIPROVEMENT a. PERIVDT1 1 Tax Off, PIN:# } ce 414 Road Name. P: —4 **NOTE#* This Improvement'Pemut DOES NOT authorize the construction or, • .-:of a septic tank system or any wastewater system AW r AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be'obtained' from this Department prior to the const uctionlmstallaton of a system or the issuance:of a building pernut .1 -' .(In compliance v�nth Articled l: of G S..Chaptei 130A, Wastewater Systems, Section 1900 Sewage Treatmentand'Disposal Systems). } ,ti ►s*NOTICE THIS PERMIT LS ►ss suBjEcT.T' O:REVOCATIOr4l F SITE. 'PLANS OR THE' INTENDED -USE CHANGE: YOUR WA9nWATtR SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE ENVIRONMENTAL HEAL PECIALIST i' DATE ISSUED INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION BUILDING TYPE__ # BEDROOMS_ # BATHS_ # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL:' SPECIFICATION: FACILITY TYPE #.PEOPLE#. PEOPLE/SHIFT #SEATS : INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY • w r J DESIGN WASTEWATER FLOW (GPD)-. NEW SITE—L,_1 REPAIR SITE • SYSTEM'SPECIFICATIONS: TANK SIZE �Q�GAL: PUMP TANK GAL. TRENCH WIDTH�� ROCK DEPTH �! LINEAR FT.� REQUIRED'STIE MODIFICATIONS/CONDITIONS: i "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENTFOR.FINAL INSPECTION OF THIS•$YSTEM BETWEEN 8:30 - 9:30.A.M. OR 1:00 - 1 30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. . R APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & D R n M R t'f1Davie County Health Department Environmental Health Section The P.O. Box 848/210 Hospital Street • JUL 3 0 1998 Mocksville, NC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed e -n ne�h �-b&-V h a { � Contact Person LQ jLu � � M rn) 5 O� Orn Mailing Address 1{ 1 1�/�1 / e.� LiV0-1t l` Home Phone 9M) ~507 City/State/ZIP M 1,�n C2._ � t c �`7o o� Bu§iness Phone) -79k-5 -()g 5D 2. 'Name on Permit/ATC of Different than Above: :IG-r.Lj'1}�Q�� Uwtgra �, :57 +hare Mailing Address n I 1 � E' Q/ WEU- 1+ City/State/Zip /`- dQ6)n C.(? 2..7100 �Q 3. Application For: ❑ Site Evaluation E. Svstem to Service: House ❑ Mobile Home 5. if Residence: # People t Improvement Permit/ATC ❑ Both ❑ Business ❑ Industry ❑ Other # Bedrooms 13 # Bathrooms I'll Dishwasher ❑ Garbage Disposal�Q Washing Machine 6. If Business/Industry/Other: Specify 'type` # Commodes # Showers Basement/Plumbing ❑ Basement/No Plumbing # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City /X Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Y(No ORTANI" CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED I BELOW. Either a PLAT or SITE PLAN hIUST BE SUBMITTED by the client with THIS APPLICATION. ?r;)ij,_-iy Dimensions: I d O WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # 5��'`f� -� � o� oZ � '8*1 ?roperty Address: Road Name T1.% U2X P)MCA 4-- lk _ W City/zip Ad y !M (21 2--70O(n P-1AW- lel lr .7hJ1 If in a Subdivision provide information, as follows: 1.50.r ,Pit P–DoLd � C.. 1 � „ r Name: T � 11/ Q�i� �je.1'1L1 i�l � I S `�Pi - -- Section: Block: 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 Davie Cgunty Health Department to enter upon above described property located in Davie County and owned byw to conduct all testing procedures as necessary to determine the site suitability. , TH;S AfXA MAY BE USj.D FOR DRAWING YOUR SITE PLAN: A No. 116 Invoice No. Revised DCHD (07/98) JESSE BOYCE.JR ------------- 671.59' OF - SAND Parcel 2.01 I Tax Map A-7 Stephen W. Walker D. B. 160, 618 EIP I E1P to b Cerrecf. Th I$ Probate tee Pe 1.,• 1 Meh�rlSbere, Rglat LJ I, _ 44;u r— % 3. Parcel 2.02 `a o Tax Map A-7 r Kathy M. Walker ro CN Deed Book 179, Page 272 ;nj; g ° laJ ,v va 1 v rr 195.89' - - a `BS ,.b` L a ca N __� S 03°09' 10"W 549.7I 5' .� 5" � c�9•_ C 4j IS h CV - 0c 1�0�0• I 0�6 0'a C CY, al h � rn�ll ►06 •� �, '` '�!� N'� H a' M OO F' 00 .S0 0 � / 017 ' Z E t�9►8 _`'�- "ale•?J NIP U m 7 -- - s 5.2 76 A C, RE POINT 76.26' U m zzc.89•--- ,9 a .i,, QO 2 42°20'40"E � N c 1 •so ti�� POINT /� u r � 16. ,5 3 Opp 'S 50°59'45"E w J . C J90'�9'Jg �`'�} 8' MFM P�IOT i' 78.87' N —I ?11 � 35' driveway e°aement os 00. o 42°18'4 0"E NIP ry Un pp� . 124.22' g s 4 � z � 4 1e �,10. RES PIP 6.108 ACRE .o�� e��-,SF x.66¢6 047 ``bACRFS 00 6 I � 0 y`2°�>`' oSaF° ' 9 73 - (atL� � p NIPS P\ "7.610 A C R Fas 9es J / N\P 3.63. �b 'b, OJ N7 1'25 {� F �� po(ae 1 K �5. Po9 � pe ed gc J ' APPLICATION FOR SITE EVALUATIONAMPROVEMENT PE i n Davie County Health Departments Environmental Health Section p „ P. O. Box 848 Mocksville, NC 27028 DEC 4 19" (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCES D-I3NLES ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed c ��1� ON. fi n V% ei j.•c�X„,L, Contact Person Q4V to �'{�.►•� S Mailing Address 3 d 1 a c 3 t :- 1 r Home Phone to -1 5 cc -I -?,t! 3 City/State/Zip `),Je- n G6 N . L . Z '7 b0 6 Business Phone 4 GO e. 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: 9^ Site Evaluation City/State/Zip ❑ Improvement Permit & ATC 4. System to Serve: 9�'House ❑ Mobile Home ❑ Business 5. If Residence: # People # Bedrooms ❑ Industry ❑ Other # Bathrooms ❑ Both ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/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 'B—Well ❑ Community 8. Do ;you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH TRIS APPLICATION. Property Dimensions: �' J� P ate" t WRITE DIRECTIONS (from t Mocksville) TO PROPERTY - Tax .Pffice ROPERTY:Tax;Office PIN: # eel �'it'x )' Property Address: Road Name e r'eYl 1 �l w ( 1 0 City/Zip c% 1/� �� /I 7C�D� n d 1 If in Subdivision provide information, as follows: t Name: `?tai Yer$e n-�i�/ls t t ar l % t Section: Lot #: t 1 This is to certify that the information provided is correct to the best of my xnowleage. i unaerstana tnat any permugs) issuea nereatter 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 Davie County Health Department to enter upon above described property located in Davie County and owned by 110 a 1O AN e SCa-+� �^�r '� I'k., � to conduct all testing procedures as necessary to determinethe site suitability. / DATE I' N l � SIGNATURE �J �� df:n:� Revised DCHD (06-96) I t ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION_- LOT. Soil/Site Evaluation APPLICANT'S NAME AA) e -< DATE EVALUATED PROPOSED FACILITY SUBDIVISION tf'.,zc Water Supply: On -Site Well V,-- Community Evaluation By: Auger Boring L✓ Pit ✓ PROPERTY SIZE g�AC ROAD NAME Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % (a HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTHG Texture groupL Consistence i Structure & S •C S 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 2 SITE CLASSIFICATION: _ �' - —5 V'W ex LONG-TERM ACCEPTANCE RATE: lGC fp REMARKS: DCHD (01-90) LEG Landscape Position EVALUATION BY: OTHER(S) PRESENT: �_ /il /' `'rte l 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 ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■rte■■■■■■■■■■■■■■ MENNENMMUMME Emmons' MEMMUMMENNEN�i ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■ ■E■■ OMEN ■■ A UTAtIZATION NO: 159"' "' DAVIE I OUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permittee's ,r % P.O. Box 848 Name: Mocksville, NC 27028 Subdivision Name: Phone # 336-751-8760 Directions to property: _tea .%r . ,� f�/� Section: . Lot: - AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Tax Office INA, " - �-1� Road Name: **NOTE** This Authorization for Wastewater System Construction MUST BE IAUED 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 I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED