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206 Ginny Lane Lot 13DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003170: Tax PIN/EH #: 55862-73-7441.13 Billed To: John Bishop Subdivision Info: Springdale Lot # 13 Reference Name: Location/Address: Ginny Lane -27006 Proposed Facility: Residence Property Size: 0.852 ac ATC Number: 4503 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 I 1 of: G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FORA PERIOD OF F VE YEARS. Environmental Health Specialist's Signature: Date: i **NOTE** CERTIFICATE T& issuance of this Certificate of Completion shall indicate the has been installed in compliance with Article 11 of G.S. Chapter Disposal Systems," but shall in NO WAY be taken as a given period of time. �1-ler It`��� •iA�J 1z C9 -12) Septic System Installed By: Health Specialist's DCHD 05/99 (Revised) .112 described on Im-provement/Operation Permit Section .1900 "Sewage Treatment and ystem will function satisfactorily for any I �C �—)oos Fri s Date DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION N i k V) Z /A-, -Q ins �C�Co i C5 I`nn y ?j r (S— tG Water Supply: On -Site Well Community! Public ✓� Evaluation By: Auger Boring Pit Cut FACTORS 1 2 i 3 4 ', 5; 6 7 _ Landscape position L :.' Slope % . . HORIZON I DEPTH • D- i j Texture group Consistence : •. _ .. Structure _ Mineralogy. HORIZON II DEPTH ., . Texture group�. _ Consistence Structure Mineralogy- _.. i HORIZON III DEPTH : Texture group Consistence , Structure i - Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy -SOIL WETNESS • ; . RESTRICTIVE HORIZON SAPROLITE , CLASSIFICATION LONG-TERM ACCEPTANCE RATE • 7 SITE CLASS ... n IFICATION. ' Ps .-..-c..' _;-;-EVALUATIONBY.. , ���NyJ -/' ^� LONG-TERM ACCEPTANCE'RATE r d-7 J� .. OTHER(S) PRESENT:�Idi PU/✓�O4iLUt�C7 REMARKS: f i LEGEND I- Landscape Position R - Ridge ;_ , S - Shoulder ' L = Lineaz•slope FS !: Foot slope. N Nose slope CC - Concave sloe '--CV - Convex sloe — p p T - Terace - FP'= Flood plain ' H -Head slope, "' - .. Texture ._ .. . SI S -Sand LS -Loamy sand.: . SL L - Loam. -Sandy loam � -Silt SICL -Silty clay loam , - : SIL - Silty loam' , CL - Clay loam SCL = Sandy clay loam " SC - Sandy clay, ' ,SIC -Silty clay .. C _Clay . CONSISTF-NCF. , VFR -Very friable FR - Friable FI'- Firm VFI - Very firm .. EM -Extremely firm } BSlightly sticky %S - Sticky VS Ver Sticky NP - Non plastic SP - Slightly -plastic lYPlasticP Plastic r VP -Very plastic . r ' SC - Single`grain MMassive', _ ,CRw Crumb . 71GR - Granular ' .ABK 7 Angular blocky SBK -Subangular blocky PL - Platy PR Prismatic , Mineralogy 1:1, 2:1, Mixed r Horizon depth -In inches Depth of fi- 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 chrom'a 2 or less j Classification - S(suitable), PS(provisionally. suitable), U(unsuitable) LTAR - Long -tern acceptance rate - gal/day/ft2 I DCHD 05105 (Revised) ■■■■■■ ■■■■■■ ■■■■■■ ■■■■■■ No ■ ■ ■ ■■.t■ mmilm ■■■■■ ■■■■■ Account #: Billed To: 990003170 John Bishop Reference Name: Proposed Facility: Residence ATC Number: 4503 DAVIIE COUNTY ]HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 55862-73-7441.13 Subdivision Info: Springdale Lot# 13 Location/Address: Ginny Lane -27006 Property Size: 0.852 ac AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Constructionl 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: Date: Z / CERTIFICATE pL PL TION 13-------------- (KGs+' �j.J **NOTE** -I�ie issuance of this Certificate of Completion shall indi has been installed in compliance with Article 11 of G.S. Disposal Systems," but shall in NO WAY be taken as a given period of time. the 4fft described pImrovement/Operation Permit pter IfQ4, Section .1900 "Sewage Treatment and Xe th a system will function satisfactorily for any F'rWi,JT Septic System Installed By:4X► LLCK Health Specialist's Signature DCHD 05/99 (Revised) Date Account #:990003170 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 I IMPROVEMENT/OPERATION PERMIT i Tax PIN/EH #: 55862-73-7441.13. Billed To: John Bishop (Subdivision Info: Springdale Lot # 13 Reference Name: Location/Address: Ginny Lane -27006 Proposed Facility: Residence Property Size: 0.852 ac ATC Number: 4503 **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 r/ #Pe Iple #Bedrooms #Baths oL Dishwasher: Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type /{ #People_ #People/Shift #Seats Industrial Waste: ❑ Lot Size � Type Water Supply Design Wastewater Flow (GPD) 'Z�Y6 Site: New Repair ❑ �q/1 System Specifications: Tank Size `fi'{T GAL. Pump Tank GAL. Trench Widthz� Rock DepthiOC Linear F�e6 Other: 15 :rn:,.n .n 15^ -NCA(' IRA iArV14r1 may Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) 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.**** Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: i Aug 22 06 01t30p AEal4k D AUG 2 2 2008 nppltcation F 17 davie county envheallth '336 751 8'766 P.1 )N COR. SITE EVALUATIONAM PROVEMENTPERMIT & ATC Davie County Health Department Environmental Health Section P.O- Bos 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/Fa 336)751-8786 ermit iluatiott Improvement PtWorindoi To Construct(ATC) CBoth Cr1F'NOTBE PROCESSED UNLESS ALL OF THE he INFORMATION lguLLE'rIN for iaeo tions. Name to be Billed e f_n,t Billing Address bl4� RcnYj� City/State?ZI(r��t_Bnsiness Cuntact Persony� Il'onie Phone j - Phot=jy,�_ Name on Permit/,ATC if Dijjere it -.hart Above_ I—_ Mailing Address.,__^_—.City/StateiziP PROPERTY INFORMATION j NOTE: A survey'plat or site plan urn itaccompany this application (Permit is vali f 0 monthr. with site plan, no expiration with co!'aplem plat.) r ^ Street Address_ny��) r...�"._ CitY.yfy02i�_'Cax YliV#/�0�. Subdivision Neme _Section/Lot# �..��Lot Size �] III"' Directions To Site 1�' VJ . no_�Z n.n Da T...t Yrs . rv%A�n�..-- M c:�_.�tSt:CLi._�-__1::r.:FiT''w)-le.l✓.1"--�Qr..S.aL1.�t'.r� �fiq¢r--`J------- Date HauselFaciliry Comers•Plugg:d -d--- If the answer m any of the following cl iesti is nation must be attached. Are Mere any existing wasiev.ater systems on the site? [:,I CPS 0d' Qo Does the site containjurMia Tonal wedands? CY'va 0`4 Are dare any easements at right-of-ways on the site? CY'cY wo. Is the site subject to approval by another public agency? Oyes QXO Will watttnvatm other than deraesdc anwage be gancram ? OYea Wo IF RESIDENCE FILL OUT TH'3 BOX BELOW # People #Bedrooms # Bathrooms _ — Ctarden Tub/Whirlpool LIYes I'!No Basement: OYes ONo Basemen Plumbing: OYas ONo 1F NON -RESIDENCE FILL ULT THE BOX BELOW Type of Facility/Business Total Square Foo:age of Building __ # People # Sinks # Commodes # Showera 1 # Urinals Estimated Water Usage (gallons pr.r day} .___(Attach documentation of simi lar facility water consumption) FOODSERVICE OATLY:#_S_ea:s Type syslemnqueste��d://Weonvenlion:d OAccepted 31nnuvetivelCAllomative C(kher_ Water Supply Typo: yrcounty/City Astar 0 New Well 1Ofixisting Well D Community Well Do you anticipate additions or expane ans of the facility this system is intended to aervi3O L Yes V4. ! If yes, what q PC? This is to certify that the information provided on this application is 4ue etnl correct to the beat of my knowledge. 1 understand teat any perinit(s) or A'TC(s) issued hcreaf er are subject to suspensian or revocation if the site is altered, the intended use changes, or if E:a information submitted in this apph ;ad on is falsified or changed. If undemaand char Tom responsiblejor all Charges incurred from this application I hereby grant: tght of entry to the Authorized Representative of the Davie County Health Deparhneut to conduct nocnaary inspc<tinns determine compl'a eo • th appi ble 1;y�aa�nd rules an the above described property located m Da, ie.�Cei n y and owned by �_ lClliea/ /� rn*-l.Y!' ,ja�(f"�Q Site Revisit Charge I' arty owner's nrawe is egall preaentafivesignall _ 1 Datc(s):__ D��/ Client Nmdtcation Date: nHS: L7� f +J 7 Sign given DYes ONo I AeuaunH! �__ Revised 2/06 I/VI I Invoice I a DAVIE COUNTY HEALTH DEPARTMENT F Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPE TION PERMIT Account#: 990003617 Tax PIN/EH M 5862-73-5471 Billed To: Martin Lee Locklear jSubdivision Info: Springdale Lot # 13 Reference Name: Location/Address: Ginny Lane -27006 Proposed Facility Residence Property Size: see map ATC Number: 4076 **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 _ 3 #Bedrooms #Baths Dishwasher: Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑, Basement/No Plumbing: ❑ Commercial Specification: Facility Type /� #People #People/Shift #Seats Industrial Waster 13Lot Size Type Water Supply C 1p Design Wastewater Flow (GPD)36/0 Site. New ❑ Repair ❑ System Specifications: Tank Siz91-00OGAL. Pump Tank _GAL. Trench Width ��'Rock Depth J2 Linear Ft.,_�O Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYO - P ROVI FINISHEDGRADE. ****NOTICE: Contactarepr ta've fthe system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:3 the IF ,D EFFLUENT FILTER RISER(S) IF 6 " BELOW Davie County Health Department for final inspection of this day of installation. Telephone # is (336)751-8760.**** 161, ljo Pl''v pr .)J` vt Health Specialist's Signature: Date: �-/ D DCHD 05/99 (Revised) ATC Number: 4076 I 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 CONS RUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ✓��Oy Date: sic—a 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: DCHD 05/99 (Revised) Date: i DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC, 27028 (336)751-8760 Account #: 990003617 Tax PIN/EH #: 5862-73-5471 Billed To: Martin Lee Locklear Subdivision Info: Springdale Lot # 13 Reference Name: Location/Address: Ginny Lane -27006 Proposed Facility Residence Property Size: see map ATC Number: 4076 I 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 CONS RUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ✓��Oy Date: sic—a 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: DCHD 05/99 (Revised) Date: APPLICATION FOR SITE EVALUATIONJIMPIiOVEM1tENT PERM C Davie County Health Department D E17viroiimental.HeaitliSectioiI MAY - 6' 2005 P.O. Box 848/210 Hospital Street, Mocksville, NC 27028 (33 6) 751=67 60 ENVIRONMENTAL NEAUN DAVIECOUNTy ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALLTHEREQUIRED INFORMATION IS PROVIDED. Refer to the/1aINFORMATION BULLETIN for instructions. 1. Name to be Billad -moy a"�(-) 6 (Ll ey- I Contact Person I%I0r 111i 1 jXQ.1rt0.—IP�{� . Mailing Address I .lO�f7�7� -'Home Phone ��.//U city/State/ZIP - IV[rm1/e , N(/. 2 L Business .Phone 2. Name on Permit/ATC if Different than Above Mailing Address/Zip 3. Application For�ite Evaluation ovement Permit/ATC - ❑ Both - �4. System to Services House ❑ Mobile Home ❑ Business- ❑ Industry ❑ Other S. Typo eys tem requested: Conventional ❑ conventional modified ❑ innovative 6. If Residence: #Pe pla A Bedrooms _ _ M Bathrooms 2 - PRiahPRi ahwasher wanher ❑Garbage Disposal AWaahing Machine ❑Basement/Plumbing ❑Dasomont/No Plumbing 7. If busineae/Industry /Other: -verify type N People t) Sinks R Commodes• - R Showers R Urinals - tl Water Coolers IF FOODSERVICE: -8 Seats EstimatedWaterUsage (gallons per day) 8. Type of water supply: A County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility Ibis System is intended to serve? ❑ Yes XNo If yes, what type? ***IAfPORTANT*** CLIENTS AIUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AIUST BES(JBAIITPED by the client witlm THIS APPLICATION. Properly Dimensions: tX' `5` 2-Z0�VRITE DIRECTIONS (from Mocksville) to PROPER'T'Y:, Tax Office PIN: iE �(o Z� 3 llic) I � Property Address: Road Namc ( (�� � � &; on � line u r n on Clot don city/zip PTL ance. TW, -EL n o0o rid le -1 lyn hz If in a Subdivision provide information, as to] lows:�97)��(�1 (A PA +0 �, 6(f —%6 . Name: t �� f \ (-)a 60)� l L/T �� n Section: Block: Lot:_ Date home corners flagged: i This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits) 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, rn derslald that I am responsible for all chases incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County IIcalth epaar6pent to enter upon above described properly located in Davie County and owned by IA to conduct all testing jprocedures is necessary to determine the site suitabil/itty. DATE . \ I �_ _D l SIGNATURI TIIIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed nronertv lines and dimensions. structures, setbacks, and septic locations). 944,46 418.4`,4 N a CO 2A p.w h 418.44' aro _ erY a 41� 8D �_ �❑ 1 Act 1� g 4t8,44 3 r, $ 52 O1J /7 31733 735.77 /. o l] 547.31 (g24 it 54780 42r�Ac Ll PIN, a. °S 83.21 — 1362.90 1432,20) c_ 50 cS' MAN �: 5D294 oQ�' 1438.80 c- 34.45ACR - % q, ti 4; (1.55Ac)� �� ��.b� •.�. '"' R/W UTILITY EASEIAEINT NEAL S. CORDON , SR. PLAT SK.4 PG.163 LEGEND * : EXISTING IRON P`IN 0 a NEW IRON PIN SPRING OY G1 ROL FARM 100 50- W may{Rt kyr z ✓. r.t n .�pj! i' �.�'�. i7iI4E.fV ' p� ._.pG 175 o= 175.0 525.0.0 TO1'at_ t O. 804 AC. a.So4F dry. 2.362 ACRE - - N 86042-i. 39° W }"' S'42`'39":1F' k :. 440.76 �f :. coulBE.1.G' STREET) 5 �C1.QU arc 6 .�` . , 7. �9' c It . ."" x.04' s 1.806 ACRE Sao �C� _ C ��, co e� �43F9 . w civ �." 0 2 O 15 �`co !4 �. �� o N o a M 0 0 O z .. 0 z 0.972 ACRE 150_ o z O 937 AC- 0.852 AC. _ - - 01 AC. z 1.012 AC. 316.86_-- ____--- EASEh1EN TOTAL 10� UTIl.1TY _—r1p47.91 151.58_--- 000 1 54 UTILITY EASEIAEINT NEAL S. CORDON , SR. PLAT SK.4 PG.163 LEGEND * : EXISTING IRON P`IN 0 a NEW IRON PIN SPRING OY G1 ROL FARM 100 50- N O" .. ACRE`' o >~ N M1 m. `.39.° W ! 76 t q 1 r7 _� )6' ACRE o ; GEORGE RIDDLE. ' a i DB•44 P(;. 321 N ID a N O CD O y 1 I 150_.00 _ J — — CONTROL CORNER TILITY EASEMENT I 1 PRI NGDALE• SUBDIVISION SH.E.ET OWNER � DEVELOPER', GILBERT.- L.ROGER, ROUTE 3 MOCKSVILLE N C:: ; FARMi4d'F6V CO .TWSP.vDAVIE NORTH'- CAROLINA ` . Y'. . T ��' �Q 0: •: lOt . - 20Q .30Q m� . �, • F f Av y. .. .. • �. �.Y nC{nLA'e. �.rf �. ....� J la SY���.0 �.r��Y'.Si A, t DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Qn Name Ge OW+ 6�1�= Date Address Lot: FACTr1RS ARFA i AREA 2 X13 AREA 3 AREA 4 Topography/ Landscape Position 2) 3) d) 5) 6) 8) 9) S S S PS PS PS PS U U U U Soil Texture (12-36 in.) Sandy, C:9> S S S Loamy, Clayey, (note 2:1 Clay) PS PS PS PS U U U U Soil Structure (12-36 in.) S S S Clayey Soils PS I PS PS PS U U U U Soil Depth (inches) S S S PS PS PS PS U, U U U Soil Drainage: Internal Atf5� S S S PS PS PS PS U U U U External S S S PS PS PS PS U U U U Restrictive Horizons Available Space S S S S E PS PS PS U U U U Other (Specify) S PS S PS S PS S PS U U U U Site Classification U—UNSUITABLE S—SUITA PS—Provisionally Suitable Recommendations/ Comments: Described by 1ltn ctlj, 01CTitle SITE DIAGRAM , Z16 11b' DCHD (6-62) Date 8,-Z s/ i `. Davie County Nea, IDeppartment and Noire NealtFi ,�fyeney 210 HOSPITAL STREET P.O. B0%885 MOCKSVILLE. N.C.!, 27028 PHONE: (704) 634.5985 - March 6, 1989 I Boger Realty Rt.2, Box 382 Mocksville, NC 27028 Re: Site Evaluation Springdale Lots 11, 12, & 13 Dear Mr. Boger: In August, 1985, this office evaluated lots 11, 12, and 131n Springdale. On that date each lot was classified provisionally suitable for a septic tank system. Before any permits are issued an application for each lot must be filled out and house location staked off. I I If you have any questions feel freejto call. -Sincerely, Robert B.I Hall, Jr., R.S. Environmental Health Section RH/wd I DAVIL COUNTY I-I1;ALTI1 DI;I'ARTMENT .. l Environmental Health Section SOD/Site Evaluation APPLICANT INTORMATION PROPERTY INFORMATION Account M 990003617 Tax PIN/EH #: 5862-73-5471 Billed To: Martin Lee Locklear i Subdivision Info: Springdale Lot # 13 Reference Name:; Ldcation/Addressi Ginny Lane -27006 Proposed Faqility, Residence Property Size: see map . Date Evaluated: - Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS I 2 3 4 5 G .7 .. Landscape position Sloe % i HORIZON 1 DEPTH Texture group 'Consistence Structure Mineralogy HORIZON 11 DEPTH, Texture group Consistence - ... Stricture Mineralogy HORIZON III DEPTH Texture group Consistence Stricture Mineralogy IIORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS: RESTRICTIVE HORIZON SAPROLITB CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: 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 L$ -Loamy sand SL - Sandy loam L - Loam SI - Silt SICL - Silty clay loam SIC- Silty loam CL -CI ay loam SCL -Sandy clay loam SC =Sandy clay SIC - Silty clay C - Clay . CONSISTENCE Mo st VFR -Vcry friable FR - Friable FI -Firm VFI - Veryfirm EC7 - ExtrcmelY' 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 Mineralopp L' 1, 2:I, Mixed Notes Horizon depth - In inches ' Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Sa rolite - S suitable), U(unsuitable) P ( I Soil wetness Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(sui(able), PS(provisionallysuitable), U(unsuitablc) LTAR - Long-term acceptance rate - gal/day/ft2 /<r9 In n, "in Pernuttee'S kk ly,I DAVIE COUNTY HEALTH DEPARTMENT Natne�r Environmental Health Section PROPERTY INFORMATION `(✓ 1 P.O. Box 848 r Directions'[o proRerty((: � G �d 1 Mocksville, NC 27028 Subdivision Name:: i/ Phone #: 336-751-8760 Section: � Lot: , I l ,.\ J/ ' U HORIZATIONWASTEWATER FOR �n /� -, 2 �� 7/ U d VLA 01A � * "I WASTEWATER Tax Office PIN -ft G(! J SYSTEM CONSTRUCTION ou, - AUTHORIZATION NO: 003019 A .. oad Name:_ Zip 766 **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 Fonn/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) ENVIRONMENTAL HEALTH SPECIALIST 3_e)y_lb ***NOTICE***THtI"SfV�A{LID OR ATION FOR WSTEWATER /PERIOZDOFA FIVE YEARS. DATE ISSUED (1 Si v 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 L LOT SIZE v • TYPE WATER SUPPLY �D DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE F r. o SYSTEM SPECIFICATIONS: TANK SIZE - X 5GAL! PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT � Gti V�Ki71 io� r�,�, 11 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30.9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. E OPERATION PERMIT SYSTEM INSTALLED BY: to, lie, AUTHORIZATION NO.Jd'331PERATION PERMIT BY: ,Ch l OL —.4 t� **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I 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. DCHD02(02(rtvns0 ACC t-#)eiULi ZnJ \ •`Peffeesrl•�// ' � DAVIE COUNTY HEALTH DEPARTMENT m 0" Environmental Health Section ' PROPERTY INFORMATION P Q. Box 848 D�ekoproperty: ' �- 4 �� Mocksville. NC 27028 Subdivision Name: {�tk�w{1 llG(.�1.JCfGi 4 �V Phone #: 336-751-8760 / -, Section: t Lot: H tORIZATION FOR -73 r- ll� �C) U� FJY'I �ip WASTEWATER i�l _ - SYSTEM CONSTRUCTION Tax Office�PIN:# d AUTHORIZATIONNO: 003019 A R?N•ame7l/lil(� Ali Zip/600 **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building PermitsJbis Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I I 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 TI X I'%-•ry- r ���t yi J' `i) ; t/�r/ RESIDENTIAL SPECIFICATION: BUILDING TYPE �# BEDROOMS 3 # BATHS _2i__# OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL( SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZEy • U TYPE WATER SUPPLY 60 DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE i ,�t� -. SYSTEM SPECIFICATIONS: TANK SIZE r k`SGAL!PUMPj TANK —AdGAL. TRENCH WIDTH , ROCK DEPTH. f ���j !TT LINEAR Fr. i "REQUIRED SITE MODIFICATIONS/CONDITIONS: - f. IMPROVEMENT PERMIT LAYOUT 1. S J . `i A rI4 0 �I e C Cl VN CJ o ,9 i i d FOR FINAL INSPECnON OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT _ v SYSTEM INSTALLED BY: G , ti. I �U r II / C AUTHORIZATION NO. 3 1 (,RATION PERMIT BY: �" �i _ DATE: _ l / **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 NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. ' DCHD6'd62(Re,1,M)... 'Iii .t 1T