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107 Waters Edge Trail Lot 9DAVIE COUNTY HEALTH DEPARTMENT 1 a � Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003567 Tax PIN/EH #: 5813-99-4502.09 Billed To: Todd Olson Subdivision Info: Waters Edge Lot # 09 Reference Name: Location/Address: Waters Edge Trail -27028 Proposed Facility Residence Property Size: see map ATC Number: 4042 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: CERTIFICATE OF COMPLETION Date: **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 u that the system will function satisfactorily for any given period of time. r11 - ,if ,V -,? System Installed By: �pNSP Environmental Health Specialist's Signature: -,1)"911 Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT _ Environmental Health Section Yl S • P. O. Boz 848/210 Hospital Street l Mocksville, NC 27028 (336)751-8760 0D IMPROVEMENT/OPERATION PERMIT Account #: 990003567 Tax PIN/EH #: 5813-994502.09 Billed To: Todd Olson Subdivision Info: Waters Edge Lot # 09 Reference Name: Location/Address: Waters Edge Trail -27028 Proposed Facility Residence Property Size: see map ATC Number: 4042 **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 #People_ #Bedrooms #Baths y Dishwashej,YEl"' Garbage Disposal: ❑ Washing Machirwlm� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supplyl l,�// Design Wastewater Flow (GPD) Site: New Repair ❑ System Specifications: Tank Size,"P AL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width,?' r Rock DepthLinear Ft,_ IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLU FINISHED GRADE. ****NOTICE: Contact a representative of the Da ' ou system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. ay ojinS1 iv [ITER. RISER(S) IF 6 " BELOW lth Pepephnefafor final inspection of this . Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) Rz- -A TION FOR SITE EVALUATION/IMPROVEMENT PERMIT & AT �.!S 0 �j D Davie County Health Department V APR - 6 ,! %�-� Environments/Hes/th section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 tTNIR0TJhlQphtH�`�`} (336) 751-8760 p�yILC0UTIIV PORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer Ito the INFORMATION BULLETIN for instructt�ilonns. 1. Name to be Billed I �J OIJa� Contact Person I EdAy `JCS Y1 Mailing Address /�qo t W� b,01 )� n/1' �1Home Phone �(�G— J uQC�� �! City/State/ZIP I ► �o C_I� V : `I � /J C- /`�/ D Busi e��s Phone i DI — � 1 � U 2. Name on Permit/ATC if Different than Above Mailing Address `t0 w Lf V tJ City/State/Zip-12 �i k�U Ile N c 6RI M0 3. Application For: ❑ Site Evaluation XImprovement Permit/ATC ❑ Both 4. System to Service: ❑ House XMobile Home ❑ Business ❑ Industry ❑ Other S. Type system requested:XConventional 13conventional modified 13innovative 6. If Residence: # People y� # Bedrooms 3 # Bathrooms Dishwasher []Garbage Disposal Washing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 8. Type of water supply: ❑ County/City A Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes XNo If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions:r 51 t X I 9 /X d 191 X ;�37 I WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: #f'3"7 7 � `fes©a,�vl kt? (01 !V IO YV II tis Property Address: Road Nameld`)O,+e%S 9'U City/Zipl l I�S)JiI C -r � r�ah�- OnIc�OWV14oLY1 �l • N� If in a Subdivision provide information, as follows: S On \c Name: l i �, T S ��ln �) !O Jl� d i�16►/1 '�v- O U iUC h bw Section: Block: Lot:_ Date home corners flagged: a5 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 ant responsible for all charges incurred front this application. I, hereby, give consent to the Authorized Representative off/1-1 nty Health Department to enter upon above described property located in Davie County and owneby to conduct all testing procedures as necessary to determine the site suitabilDATE '7 — /n " o�oo� SIGNATURE THIS AREA MAYBEU� R RAWING YOUR SITE PLAN (Incl a all of the following: Existing and proposed property lines and dime ons, structures, setbacks, and septic locations). 00 Sin given Revised DCHD (05/03 Datc(s): EHS: Account No. Invoice No. "17 � � j Aa I ►2-� Olsa n 19 v7,, APPLICATION FOR SITE EVALUATION/IMPROwmm PERMIT & ATC MOW Davie County Health Department D 4 Enlrironmental Health Section MAY 2 3 P.O. Box 848/210 Hospital Street 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 Mailing Address City/state/ZIP 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: Site Evaluation Contact Person If Home Phone Business Phone City/state/Zip a ❑ Improvement Permit/ATC ❑ Both 4. system to Service: ❑ House P1 bile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: //# People y s Bedrooms # Bathrooms d'Re�Dishraaher W6a .ge Disposal Washing Machine ❑ Basement/Plumbing Q Basement/No Plumbing 6. If Business/industry/Other: Specify type # People # Sinks # Commodes # showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of Nater supply: ❑ County/City "all ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # Property Address: Road Name eocicf-tel &tel /�C . City/Zip,oC.l�iSc If in a Subdivision provide information, as follows: el Name: /4 7 -XX -5 E`/� 6�E Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: 4z 4A�.� 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 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 to conduct all testing procedures as necessary to determine the site suitability. DATEG�7J SIGNATURE 00-1v THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: I EHS: Revised DCHD (07/99) Account No. Invoice No. /� 7� i^�j,- R� . A "'Z . .'� ''">"°.. �"i tP �� y�� � 1 � a�t 4 .�:. � ?I•'l l •�• �r sr7, � i .�. ;• , �'+6 r, PP,� r• �p a �Arr AW&74M +A � w ;®3"p'yy� »��+dy'a +n :fwLorp�tft,; q j�; "AN � 5� f �.y ; !�{y��t ,ry�.�,"w� ► r$ ,trp w> x '; y x •4 q��P ?•,I,��i�rt.. y`;�y ?'t.�>1!'i�`a - i:�t �.y;+., + `i�Y�7'," v `•,v •� , r ,.•e;�i�v `y� y , 3 ey .5 � •t � , is -WSW Ar % J 41� A / 3 h � l! 'mss � I �, \ �, \ , t � �\'• 1� ;. 1 71 12T 31 Jill ACRis(DIA , l / l x' 1 -'�►'R ( � I I � I i � \ \\ \ \ � J � I ' � � / I I � I I I c: , / � j � �' ,,te ,�sco►�o) ( ( i 1 I t�� 1 , � y I \ ,� � I � 1 1 '', �� � l 1 t FUTURE ,SECT/ON oX 0' �oRArrr EASF] ca+ cnoN � t 57 06' 50 1 4 i 1 \� .. 112.7150 prlvaAAccow & PuWk lltYkity Ea�N5a51 1 \ \ N 163728 + R - 300.00 ! ' • Z ! I ( / \ t 1 1 I — n, �.• DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001199 Tax PIN/EH #: 5813-99-4502.10 Billed To: Ruth Spillman Subdivision Info: Waters' Edge Lot #�tf Reference Name: Ruth Spillman Location/Address: Bowman Road -27028 Proposed Facility: Residence Property Size: 1.15 Acres Date Evaluated: Water Supply: On -Site Well L Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH ? " <� Texture group(✓ Consistence i Structureil- 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: / LIZ 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 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 05/99 (Revised) i ■ ■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ MENEM iiiiiiiMMMEME� ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■ME■■ ■■■■MM■■■MM■ME■■■ ■■■■■■■■■■■■■N■■■ ■■■MEMO■■■■E■■■■■ ■■■■■■E■■■M■■■ME■ ■■E■M■MMEMMEMEME■ ■■E■■■■E■■M■■■■■■ ■■■■■■M■■■■■MMM■■ ■■■■■■■M■M■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■E■■■E■■■■■■■ ■■M■■■■■■■■■E■■■■ ■■EMMEM■■■E■EEME■ ■■E■■E■■■ME■ENM■■ ■■■■■E■E■MEMEN■■■ ■■■EMM■E■E■■MME■■ ■E■MEMMEM■■E■MEWO ■E■EEM■■E■■MNEEME ■■E■■M■■M■E■■M■M■ ■O■■MME■O■MEM■ME■ ■U■■ NONE MEMO M■■■ ■E■ ■E■ ■■■ ■E■ i ■■■■■■■■ ■■■MEMO■ ■■■E■■■■ ■■■■■■n ■■■■■■ ■■■■■■■■ ■■■■■E■■ ■E■■■■■■ ■■■■OMEN ■■■■■■■■ ■■■■■■■■ ■■■■M■, ■■■■■■ ■■■■■■M■ NEEM■■■■ ■■■■■■■■ ■■■■■■■■ ■■■■ME■■ ■E■■■■■■ ■E■■EM" ■E■■ ■■M■ ■■■■ NONE ■■■E■ ■■■E■ ENSUE ■■■■■ ■■■E■ SENSE SOMME ■■M■■ ■■■E■ ■■NE■ ■■NE■ ■■NE■ ■■NE■ MENE■ ■EM■■ ■ENE■ ■E■E■ ■■■E■ ■OMEN ■■■M■ ■■ME■ ■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ EMEME iMEMNONMMMEME ■■■■■■■■■■M■■■M■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■