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210 Ginny Lane Lot 12DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003170 Billed To: John Bishop Reference Name: John Bishop Proposed Facility: Residence ATC Number: 4502 Tax PIN/EH #: 5862-73-7441 Subdivision Info: Springdale Lot # 12 Location/Address: Ginny Lane -27006 Property Size: 0.98 acres 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/Amhorization 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: / YGt' Date: 1121VOI,0-6 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. � N fl 1rs O.. s it, Ctlu 1S6�S � 1 t� Cd�lck� I ly , . I pfk�gl -ra�J l< 1 t l QRS Septic Syster4 Installed By: 74 yx 1 (-�.1.� Environmental Health Specialist's Signature: ate: L/ r DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003170 Tax PIN/EH #: 5862-73-7441 Billed To: John Bishop Subdivision Info: Springdale Lot # 12 Reference Name: John Bishop Location/Address: Ginny Lane -27006 Proposed Facility: Residence Property Size: 0.98 acres ATC Number: 4502 **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 cS #Baths Dishwasher: e Garbage Disposal: ❑ Washing Machine: 91Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply 1-d' Design Wastewater Flow (GPD) \J79!9 Site: New Repair ❑ System Specifications: Tank Sizo� GAL. Pump Tank GAL. Trench Width �� Rock Depth 49 Linear Ftcj�� Other: As stated in 15A NCACAs stated in 15A NCAC 18A.1969(5�. Required Site Modifications/Conditions: sc . t��etamc m��i�o bm IMPROVEMENT/OPERATION PERMIT LA ( OR��UE V_ [ FILTER RISER(S) IF 6 " BELOW FINISHED GRAD ****NOTI E: Contact a representativ fthe Davie Coun Health Department for final inspection of this system between'8• a to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. n the day of instal ation. Telephone # is (336)751-8760.**** 6°mss ' 1� I Environmental Health Specialist's Signature: ��//Y� Date: i bCHD 05/99 (Revised) Hug 22 06 01:30p ^., AP -Al `1 Name to be Bill Billing Address City'lStatclilp_ riavie county envhealth 336 751 8788 p.1 ION FOR. SITE EVALUATION/IM'PROVEMbNT PERMIT & ATC Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksvllle, NC 27028 (336)7151-8760/ Fax9319')751-8796 Evaluation in'pmvem Penrd[ _ A[�" utherization To Coh uct(„ITC C: Bob v� Name on Pnrntit/ATC if Di�orerrt � [ramal is v: Street Address, 1.e Subdivision Name Directions To Site - any this apphcanon. plan, no expiration TILE REQUIRED Phone s PhorY�- o"Z=x%17/ lZ' 737ylo'1 Date House/Facility ComersPlugged N -CS f If the answer to any of the following q.,esti is "yes”, supporting documentation anus be attadied. Are there any existing wastewater systems on the site? Eyes MKQ Does the site containjurisdic clonal wetlands? C", .3 5,4, Are there say easemenu w right-of-ways on the site? CYcs fa1Qo Is the site subject to approval by anotherpublic agency? DYcs (;?d, IF RESIDENCE FILL OUT TH3 BOX BELOW __ - #Penpk__ NBcdwoms ___ #Bathroom<- - Garden Tub/Whirlpool ❑UNo asement: ❑YeYes. Bs DNo Btucment Phtm ing: D. Type of Facility/BusinessTotal Square Foo:ageof Building_ #People # Sinks # Commod w A Showers _ 4 Urinals Estimated Water Usage (gallon: perday) __._(Attach documentation of similar facility water consumption) FOODSERVICE. ONLY: $Sears Type syste inquested: tgeonvention'ol DAccepted ❑innovative CAlutrnative CUrher_ Water Supply Typo: ql ounty/City Weser 0 New Well ❑Existing Well ] Community Well Do you anticipate additions or expanx one of the facility this system is intended to serve? C Yes 1. < / lfyes, what t1pe9 This is to certify that the information provided on pais application is true and correct W die best of my knowledge. I understand that any pennii(s) or ATC(s) issued hereaf er are subject to suspension or revocation if die site is altered, the intended use changes, or if the information submitted in this appL ration is folsified or changed. Fwavmlonrl that lam responsiblefor all chargee oicurmd from this application. I hereby grain:'igbt of entry) to !heyAutltorized Representative ofthe Davie County Health Departmeatta conduct%ieCnxcsa d "Peet"' dctcrmme eempl's sac • 'N split to ltjytv,a, ��s� above described property located in Davie County and owned by KLl� ['rerty owawtr's legal i pi<-esentadvc st'�a/ ` Site Revisit Charge Date(s): Client Notification Date: EHS: Sign given 7Y'es DNo } f Account it 8170. Revised Revised 2/06 Invoice # ;7/D 9T �-9 /®/ APPLICANT INFORMATION Account #: 990003170 Billed To: John Bishop Reference Name: John Bishop Proposed Facility: Residence COUNTY HEALTH DEPARTMENT vironmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5862-73-7441 Subdivision Info:$Qh Aql�, te4 4112- Location/Address: 1ILLocation/Address: Ginny Lane -27006 •operty Size: 0.98 acres Date Evaluated: Evaluation By: Auger Boring_ Pit Cut FACTORS 1r 2 3 4 5 6 7 Landscape position ,..; . Slo e.% , .... ._ „., r.. •HORIZON I DEPTH f Texture groupdC Consistence Structure Mineralogy' HORIZON H DEPTH,., `,t Texturegroup Consistence . f. ,,.. Structure Mineralogy HORIZON IH DEPTH ' ' ' Texture group Consistence Structure _ Mineralogy.. HORIZON IV DEPTH Texture group Consistence Structure Mineralogyr .. SOIL WETNESS RESTRICTIVE HORIZON Azlel SAPROLITE _ CLASSIFICATION LONG-TERM ACCEPTANCE RATE ,SITE CLASSIFICATIO N: - EVALUATION BY: LONG-TERM ACCEPTANCE RATE' O THER(S) PRESENT' REMARKS;.` LEGEND Limdac Vie -Position R - Ridge S - Shoulder I.- Linear slope .: FS -Foot slope ' ,. ; N -Nose slope CG- Concave slope 'CV - Convex slope• 1 T - Terrace FP - Flood plain H - Head'slope TeStnrC. , . . , . , '• ' '.S -Sand ' . LS'-.Loamyrsand ' SL - Sandy loam ; . L Loam SI - Silt SICL - Silty clay loam ' SII. - Silty loam - CL - Clay loam SCL Sandy clay loam , SC Sandy clay SIC - Silty clay C - Clay n CONSISTENCE Mme.., ; ry. , able FL - Firm „ VFI Very, firm EFI - Extremely firm , VFR Ve fnable FRi Friy sticky' ` , Very y NS No - n sticky • •;SS•—Slighti S Sticky VS = Ye Stick NP - Non plastic., ' SP - Slightly plastic P - Plastic VP _Nery'plastic , Structure iSSingle gram' .. .Massive CR -Crumb•...'. GR-'Granulaz ABK Angular blocky SBK - Subangular blocky PL -PlatyPR-Prsc .` - - Mineralogyt ' - Horizon 1Yutes n dp fixed 1qq � th - In incE Tr Restrictive horizon- Thickness and inches from land Depth of fill - In inches ` ,...,.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(provisionallysuitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05105 (Revised) ■■■OOOO■■O■OO■OO■■ ■■■■■■■■■■■■■■■■O■ ■■■■■■■■■■e■■■■■■■ ■■■■■■■■■■■■S■■O■■ ■S■■■■■e■■■■■■■■OS ■■See■■Se■S■EN■EEO ■N■■N■■S■■■N■■■■■■ ■■■■■■■■N■■■■e■■S■ ■OSN■■e■■E■e■■O■■■ ■NON■ ■■■■■ ME ii E MEMO ■E■■ ■■■E ONES ■■■ Address Iv DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Date Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 Topography/ Landscape Position d) 5) 6) 8) 9) S S S S T\ i PS PS PS U Address Iv DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Date Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 Topography/ Landscape Position d) 5) 6) 8) 9) S S S S i PS PS PS U U U U !) Soil Texture (12-36 in.) Sandy, cnz:> S S S Loamy, Clayey, (note 2:1 Clay) PS PS PS PS U U U U 1) Soil Structure (12-36 in.) ® S S S Clayey Soils PS PS PS PS U U U U Soil Depth (inches) Z5> S S S PS PS PS PS U U U U Soil Drainage: Internal C�j S S S PS PS PS PS U U U U External -CR> S S S PS PS PS PS U U U U Restrictive Horizons Available Space S S S S PS PS PS U U U U Other (Specify) S S S S PS PS PS PS U U U U Site Classification U—UNSUITABLE—SUITABLE PS—Provisionally Suitable Recommendations/Comments: Described by ftJ un Title SITE DIAGRA 1 1CHD (6-e2) Dated Z —4-3— M 1 DavieCounty Health De partment Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville,'NC 27628 (336)751-8760/ Fax (336)751-8786 _ Improvement Permit September 11,2006 Mr. J. Bishop Inc. 243 Bonldn Lake Road Mocksville, NC 27028 Re: Ginny Lane, Lot #12 Tax PIN# 5862737441 Dear Mr. Bishop, This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans or the intended use change. System To Serve:--h—l—Wastewater Design Flow(GPD) ',,?4J Valid: ZYears ❑No Expiration System Type: ❑Conventional PrA"ccepted ❑Innovative ❑Alternative ❑Other Site Modifications/Permit Conditions: As. �tstateed Sd InSstems�nay 15A NCAC aj1aEtA.1909(5) �o use Site Plan t fy� Pop pq 1 E&iromnentaf Health Specialist Date i.p.letter 7/06