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139 Irishman Place Lot 20DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street ' • Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000736 Billed To: Butch Harter Reference Name: Nancy Harter Proposed Facility: Residence Tax PIN/EH #: Subdivision Info: Location/Address: Property Size: 5789-73-8542 Shamrock Acres Lot # 20 Irishman Place -27006 100' x 30V ATC Number. 2194 **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 H #People -? #Bedrooms ,? #Baths.` Dishwasher: Zr Garbage Disposal: ❑ Commercial Specification: Facility Type Washing Machine: Or Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ #People #People/Shift #Seats Industrial Waste: ❑ Lot Size AXIOM Type Water Supply Design Wastewater Flow (GPD) Site: New M`� Repair ❑ System Specifications: Tank Size GAL. Pump Tank _GAL. Trench Width 3lv Rock Depth Linear Fto1lJD� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) FF 6 " 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.**** � d ��� d V9� Y01^ � o�� y � � �,1�� r - Environmental Health Specialist's Signature: O�� � Date: DCHD 05/99 (Revised) Account #: Billed To: Reference Name: Proposed Facility: 990000736 Butch Harter Nancy Harter Residence ATC Number: 2194 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: Subdivision Info: Location/Address: Property Size: 5789-73-8542 Shamrock Acres Lot # 20 Irishman Place -27006 1 00' x 300' AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION 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. ital Health Specialist's Signature: "d Q • � Date: lelllloy 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. tBpr tS 10 Safi N��s 5O/4L Ar in/Sp Septic System Installed By: A!;aj Environmental Health Specialist's Signature Date: Z t/ DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION �w�0-cx�tc .�CR�S c,or 2a Water Supply: On -Site Well Community Public YCOG Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5• 6 r 7. Landscape position !� L, Slope% HORIZON I DEPTH Texture group Consistence. Structure Mineralogy HORIZON H DEPTH Texture group. Consistence :. Structure Mineralogy HORIZON IH DEPTH ' Texture group Consistence r Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE .... CLASSIFICATION . LONG-TERM ACCEPTANCE RATE ©• SITE CLASSIFICATION -- EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:. . , REMARKS: i LEGENDLandscape %itiond , R - RidgeS -Shoulder L -Linear slope FS -:Foot slope . , l . 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 ]oacn SCL - Sandy clay loam SC -Sandy clay . SIC 'Silty clay C -Clay -CONSIST N ' . 111415! _ i. .. friable FR - Friable FI _ VFR Very: Firm ; , " VFI -Very firm EFI - Extremely firm . - NS - Non sticky; SS - Shghtly'sticky S - Sticky . ' VS - Very Sticky ; NP -Nan plastic SP -Slightly plastic' c P - Plastic. - ,. VP - Very plastiStructure , SC - Single grain .. M - Massive CR -Crumb ._:- . GR -Granular ABK - Angular blocky - SBK - Subangular blocky • y PL'- Plat PR -Prismatic , Mineraloev ;. 1:1,2 :l,Mixed .; . Not Horizon depth - In inches _ Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) -, • .'. ..... Boil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 of less 'Classification - S`(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05105 (Revised) ■OOOO■ ■OO■O■ ■■O■■■ ■OOOOOO■ ■■OOOOO■ OOOOOOO■ ii■ ii Permm s Jl DAVIE COUNTY HEALTH DEPARTMENT Namelnl Environmental Health Section PROPERTY INFORMATION L/ P.O. Box 848 !1", - o Direendfis toproperty:/.?`�' f�71 ),i �`� Mocksville,NC27028 Subdivision Name /gid%�t �"te'% ✓ Phone #:336-7518760 7V96 /l 70" Section:_ Lo[:_ AUTHORIZATION FOR WASTEWATER: TaxOfficePIN:# .SYSTEM CONSTRUCTION - AUTHORIZATION NO: 002620 A RoadName;:Z— i ShitiYaAMi Zip:��Ddb **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 fog Building Permits. (In compliance with Article1 o df G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) r^ ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION �✓ `'f-'���'!'- /��.-���,�// ;i .�_,.. IS VALID FOR A PERIOD OF FIVE YEARS. 'ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE —.1y-1 # BEDROOMS —# BATHS =t-, # OCCUPANTS -.?--GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION:. FACILITY TYPE # PEOPLE `J # PEOPLE/SHIFT / # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) 3 (� ONEW SITE REPAIR SITE _ SYSTEM SPECIFICATIONS: TANK SIZEGAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTHte LINEAR FT�,�,�j OTHER. - REQUIRED SITE MODIFICATIONS/CONDITIONS: 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. OPERATION PERMIT SYSTEM INSTALLED By, " AUTHORIZATION NOW OPERATION PERMIT BY: � � - DATE: V _ "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 TREATMENTAND DISPOSAL SYSTEMS", BUT SHALL IN NOWAY BETAKEN ASA GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GW EN PERIOD OF TIME. - DCHD 07/W(R.W d) .. Din Je q �]' DAVIE COUNTY HEALTH DEPARTMENT - /aq�h Environmental Health Section PROPERTY INFORMATION 's e P.O. Box 848 , `..,. I to propertyc r Mocksvillb, NC'27,028 Subdivision Name: )i ::� l,: • Y! /lg(p? Phone #: 336-751-8760 ....1. ... ...II AUTHORIZATION NO: 0026120 A f Road Nat Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Building Permits. Chapter 130A. Wastewater Systems, Sec66n.1900 Sewage Treatment and Disposal Systems) - ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. DATE ISSUED TYPE # BEDROOMS #BATHS #OCCUPANTS_ GARBAGE DISPOSAL: Yes or No �.J 1 TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No I; �(- DESIGN WASTEWATER FLOW ( PIJ) J-3 (l dNEW SITE REPAIR SITE V y� I /�� GAL.,PUMP TANK GAL. TRENCHWIDTH ROCK DEPTI-16 AR,FC�nx�.Y `.r NS: r � r /r S� M PLEASE CALL ETWEEN 8:30 - 9:30 A.M. bN THE DAY OF STALLATION. TELEPHONE # IS (336) 751-8760. 1 SYSTEM INSTALLED BY: / Y FI�i � �7 , �' TION PERMIT BY: • (� - i ( z DATE: '�(+/� , PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE ECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT�.SHALL IN NO WAY BETAKEN ASA_ FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. **OTE**This Authorization for Waste to issuance of any Building Office when applying for Buil (In compliance with Arit ticle I I of G.S. ENVIRONMENTAL HEALTH SPECIALIST RESIDENTIAL SPECIFICATION: BUILDING r ,- COMMERCIAL SPECIFICATION: FACILITY LOT SIZE TYPE WATER SUPPLY SYSTEM SPECIFICATIONS: TANK SIZE -OTHER ' REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT r J FOR FINAL INSPECTION OF THIS SYS OPERATION PERMIT I a AUTHORIZATION NO ��• � �' OPERA ••THE ISSUANCE OF THIS OPERATION WITH ARTICLE 11 OF G.S. CHAPTER 130A, S GUARANTEE THAT THE SYSTEM WILL DQiD 02102 (RerisM) F) L L Permittee'; , DAYIE COUNTY HEALTH DEPARTMENT N e:.� I��t^ Environmental Health Section PROPERTY INFORMATION P.O. Box 848 r /� £iUl ' to Directions to property: /� ` Mocksville, NC 27028 Subdivision Name: >E KA (Ot1A kr . I U(,fLCE l C�-S), V 1010 �tV`N4Cl<Phone#:336-751-8760 i Section: Lot: l� / � ('• AUTHORIZATION FOR ^. ae�, [4 0•) V, AZ 'J L. WASTEWATER Tax Office PIN:# - - SYSTEM CONSTRUCTION '11 AUTHORIZATIONNO: 002740 A Road Name: '�� ILlS1.1LAAZipr(i'�]i(n **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 bavie County Building Inspections Office when applying for Building Permits. Stn compliance .ih Article 1 I yf G apter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER IS VALID FOR A PERIOD OF FIVE YEARS. DA RESIDENTIAL SPECIFICATION: BUILDING TYPE ` EDROOMS ,_ # BATHS Z #OCCUPANTS _ GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT7" # SEATS _ INDUSTRIAL: WASTE: Yes orNo LOT SIZE TYPE WATER SUPPLY`%/ DESIGN WASTEWATER FLOW(GPDI-��-�"'��' �f� NEW SITE REPAIR SITE ✓ SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK ff IWGAL. TRENCH WIDTHI/ ROCK DEPTH N A LINEAR Fr." OTHER REQUIRED SITE MODIFICATIONS/ CONDITIONS:. IMPROVEMENT PERMIT LAYOUT �2Z kms) �3 IZl r vj I Nt,�l D �•� 31 ,(t VbL� ' " �" •i s W U M Its' 30� II - 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. II OPERATION PERMIT, SYSTEM INSTALLED BY: 1—KLW R CFa•�LlJ WITH Mgm 6P01bA 14 -STt> d4j cbr!> P64 -rz k �s�� 1 t o���t_, , olt3 nk,-rc DRIZATION NO. MOA OPERATION PERMIT BY: DATE: d / ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THO TEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE ARTICLE I I OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02 M2 (Revi�W) Eetnu'��DAV}IE' COUNTY HEALTH DEPARTMENT wp Ij#tire � � ��{�i Environmental Health Section PROPERTY INFORMATION P.O. Box 848 �p Directions to prop rjy: Mocksville, NC 27028 Subdivision Name: h�kk%`t% a[ = Y. tL({tlC,,L.1—k� ti•N.,C>.Phone#:336-751-8760 r V' r Section: Lot: AUTHORIZATION FOR i WASTEWATER,'. Tax Office PIN:# - - SYSTEM CONSTRUCTION ,,�}} AUTHORIZATION NO: 002940 A Road Name: + � J `�4AA)ip. **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Perrits. This Fonn/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 1 I of GS.-Cl>apter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) I i , ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONM NTALt,HEAI'TH SPECIALIST DATE ISS ED RESIDENTIAL SPECIFICATION: BUILDING TYPEll)-..YLBEDROOMS # 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/r t�M}�DESIGN WASTEWATER FLOW (GPD)`�^"NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK L A-iUGAL. TRENCH WIDTH ROCK DEPTH N ri LINEAR IT. - - - ,.. ' OTHER i REQUIRED SITE MODIFICATIONS/CONDITIONS: T) IMPROVEMENT PERMIT LAYOUT: y Iii,.-- �>--=_ T" __ I �� ',+���`Tvnt-✓� �- �� 3u`d) IIFOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M.ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. II OPERATION PERMIT - - SYSTEM INSTALLED BY: 1—KA Jk —T A , k ' i ql { AS vI G< H. s - r- PvP'°ttiJk Shcoffl'aat_� {o/13 I�r� AUTHORIZATION NO. `TVA OPERATION PERMIT BY: DATE: J D !�THE,ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT TH •S EM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NOWAY BE TAKEN ASA GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. I)CIT�MV2 (Revised) : - „..,,, ,: .,.- v. a.vutvrY nEALTHDEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 — = (336)751-8760 O� � IMPROVEMENT/OPERATION PERMIT Account #: 990000736 Tax PIN/EH #: 5789-7S 8542 Billed To: Butch Harter Subdivision Info: _ Shamrock Acres Lot # 20 Reference Name: Nancy Harter Location/Address: Irishman PlacaL27006 Proposed Facility Residence Property Size: 100'x 300' h ATC Number: 2194 **NOTE** This Improvement/Operation. Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCT ION must be obtained from this Department prior to the construction/insta]]ation of a system or the issuance of a building permit tai(in ed from 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 /7( —_� #People3#Bedrooms :.� #Baths e9 Dishwasher: Zr Garbage Disposal: ❑ Washing Machine: 2r Basement w/Plumbin : ❑ g Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People_ #PeopleJShift #Seats Industrial Waste: ❑ Lot Size _&MOS Type Water Supply,'_ Design Wastewater FlowGPD(Z ( ) Site: New Repair ❑ System Specifications:- Tank Size GAL; Pump Tank GAL, Trench Width -/o Rock Depth Linear Ftao,: r Other: Required Site Modifications/Conditions: IMPROVFMFNT/nnsn m.... PROVED FINISHED GRADE. * Y NOTICE: Contact a representative of the Davie Cour y Health Department ffiefor final 6 inspection BELOW **** 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. Teleph# is (3751-8760. ofthis �uf Di” **** O � Silo IJ tl�/o 0 �� ✓ � 49 r- �7 Srd Environmental Health Specialist's Signature: Date: ,o CHD 05199 (Revised) y i Account #: 990000736 Billed To: Butch Harter Reference Name: Nancy Harter Proposed Facility: Residence ATC Number. 2194 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Seclion P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5789-73-8542 Subdivision Info:' Shamrock Acres Lot # 20 Location/Address: Irishman Place -27006 Property Size: 100' x 300' B 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 WASTEWATE kCO`N4S/TRQUCTTI /ON -Is VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: dU GSW v5 r' 2eG�� �Jf >- Dat e: 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. l l 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. Nco� �TA•JK- �bk(o- Ip Septic System Installed By: Environmental Health Specialist's Signature DCHD 05/99 (Revised) AD �S ro k/8 k Date: Narneg: ce's?s • i DAVIE COUNTY HEA1:1'H DEPARTMENT Name���t�1 Environmental Ilealth Section PROPERTY INFORMATION - _ . R„� �S4,,;; q � Directions� to property: P.0 (� i ��' �tock,s ills. N(97U'K Subdm,mn Name: l.VN..�, ,I'honc !;. 336-751-)i760 n Section. l,'t At I HORIZ: VllO\ FOR - -- - - '-� i 1 � t�� � ��Ik,.t�� •1 L- P V"I ,%N %I[, R SV•,41I NI ( ONSTRI'('IIO,V Tax OIIIe7. PIN.tO - AUTHORIZATION NO: 002740 A Road Name- i 1 /ip: **NOTE** This Authorization fur VV'a�17w;urrSc,tem C�nl,lrucliun MI iST BI. LSSCi:D by the Davie Qxnuv Environmental Health Section prior to issuance of anc PCn111,. Thi, Nt,11Nr ,hould lie presented It' 111C 1)alic Count, Building Inspections I Office when applcin_ IhI BmIJm_ I'rnnu, (Incompliance with Amide I I )rt G,$"_Giaptu 110A, NL,Icu:ner SN uem,. Section .19(X) Sewage Treatment and Disposal Syslemzl l:***THISAUTIIORIZATION FOR VVAS'fl•:WATER IS VALID FOR A PERIODOF FIVE YEARS. DA RESIDENTIAL SPECIFICATION: BUILDING TYPE �IA�BEDROOMS ,� a BATHS 2— 8 OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE A PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY' .� DESIGN WASTEWATER FLOW (GPDI"� NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK INGAL. TRENCH WIDTH ROCK DEPTH N A LINEAR FT.%, REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT G 22 J, /f I� 3 y T IS I �/t1VafLI D 4 s 67 11 FOR FINAL INSPEC[ION 01: THIS SYSTEM PLEASE CALL nLTwFFN 8 Y) 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPIIONI[ a IS 13361 7s I-8760_ 11 OPERATION PERMIT �---/� SYSTEM INSTALLED BY: Aoa 940uk)-�j 6o, cy-, L4 Sri--) eta Cim�) AUTHORIZATION NO, AVA OPERATION PERMIT BY: A DATE: j b "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT TllTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE i l 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. Fermittec s DAVIE COUNTY HEALTH DEPARTMENT Naive' �!G'%�%� y�j�Y1 Environmental health Section PROPERTY INFORMATION - P.O. Bos N 1 S/",[[/ Directions to P roperiy Vtoc4.�� Ille. AC '7tLg Subdivision Name _ �/ AUTHORIZATION NO: 007620 A I'hun,• 4760 Section. %I I lIORIz:NIION FUR %% %SI FFN A I ER Tax Office PIN:# SN'SFF:NI CONSI'RUCFION 1o3q Road Name; Lot: **NOTE** This Authorization for Wastewater S% stein Construction MUST BE ISSUED by the Davie (Cnunh L11\ immnlental Health Section prior to issuance of any Building Permits, lhrs Form/Authorlinuon Number should be presented io the Uuvic (Counts Building Inspections Office when applying for Building Pemut,. (In compliance with Article 11 cif G.S. Chapter 130A. Wuaewatu Sc*Irm�. Section 1900 Sewage Treatment and Di.posal Sy stems) t ***NO"Il('F*** TIIIS AUTHORIZATION FOR "''AS'l EkV', I SR CONSTRUCTION IS \ \LID FOR A PERIOD OF FIVE, Y'F::\K5. F.NVIRON'MENT AL HEALTH SPECIALIS IDATI ISSL'lll RESIDENTIAL SPECIFICATION: BUILDING TYPE _ k # BEDROOM # BATHS �S # OCCUPANTS �� GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE of PEOPLE # PEOPLE/SHIFT/ # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) 3 r� dNEW SITE /' � REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH(Z_ LINEAR FT,�4% REQUIRED SITE MODIFICATIONS/CONDITIONSS -- IMPROVEMENT PERMIT LAYOUT /.i POR FIN AI. INSMA-110x 01= THIS s1 S'i l,N1 Pi LASE CAI.I_ 13GI WEEN &311 �) 311 A AL ON I IIE DAY OF INSTALLAI [ON. I FLEPHONE N IS 0336) 7S 1-8760. I OPERATION PERMIT SP5T1{M INSTALLED BY, i4 1 / r AUTHORIZATION NO OPERATION PERMIT BY: tom" Tf DATE:i, '-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. -UMAK. h. mu Uavid [•Jtoddard ■ 04 10 0401p frOurr ielion SoMwe • V � J,ON Pltonr. (sJG) - 758- 6i80 W No. 004 ZZD 10,NU. Ui4 r. L r. UUI 3387531680 D 'e tyHealth Department Health Section P.O. Sox 848 AIHFAl1H 0 Hospiw Sona ENvOUA E ourm Courier f : 09-40-M 1&dmvMc. NC 27048 ON -SM Wll,.4['EWATE.It•C]MMCATION)FORDWELLXNG (Check Ae) Beplaeement Remodeling Reconnection. dba� s s� y ag^ o tr/ (Atemq Ass Please MIM, Ike ibpowingWormodon About TheZD"/M FacUlbt lamosystem ImudledUmdew TypvOrPaeidty: l/ice. Dam SyaleminetalledO&AddDeklYear)• N»berOMedreoms: 'F NomberOfPeople:� /Is I -be F> city G mzW)-VwnM7© �AnyBnownrcoblems7 Ya IpYea-Eaprsin: ' Please )MR 7n*AvFoAOIRIVE WbrMationAlmutx'hc1VEWPAcMlty ",1ypeOfPaeiUry: J, )e Humber OfTae&vo=.—Y—„,XMborofpeoplo:—� n Eor73uviroam al Health Office Use O — caJ.a.arr Approved ” Iriagw m'ed ar f ti Ufa /f\ CLA e D i✓. _ _A-- Bnviranmenteilioahh 'r The signing af8ils haWbyihe RoviKM'aenial}ieallh Sluff is in Lv way tritcnded. nor should be Mien is A guarantee (sxtendcd or limned) 1patihe on-site wastewetersyseemWill function Ptnperly ft any Swan period of limo. paymcm. cab Gieck Macey Orecr i, Ataou:at;l; Pate: . I **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 bavie County Building Inspections Office when applying for Building Permits. (In compliance with AnieJe I I ooffGG,S;Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) 3-d7 _1a IIS AUTHORIZATION FOR WASTEWATER 1S VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED - i ti 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 DESIGN WASTEWATER OW (GPD) / Sa NEW SITE REPAIR SITE tJ SYSTEM SPECIFICATIONS: TANK SIZE - V 'GAIL�. PUM TANK AL. BENCH WIDTH �' ROCK DEPTH LINEAReFT, /,/(U !l/ OTHER t �'(j ra Cl c 1 Oki REQUIRED SITE MODIFICATIONS/CONDMONS: IMPROVEMENT PERMIT LAYOUT. �QOr � A ridd i;/u.✓ lJ�s�•/D/v�>r-�/1-to � L., %[4//rrF INS -/o Q.(1t1d FOR FINAL INSPECr10N OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT / SYSTEM INSTALLED BY: ITY�Lotel i a -4,q. y PT P*e_ y p X", r AUTHORIZATION NO.," 3d I r OPERATION PERMIT BY:. CQ DATE: ZS" **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DqSCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I l OF G.S.CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NOWAY BETAKEN ASA GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD02102(P*i� ) Perrtuttee' �L�( 4v G fa �/C0� ' •r' DAVIE COUNTY HEALTH DEPARTMENT - Name:,—'� + Environmental Health Section PROPERTY INFORMATION ,J \ __ g(� DU'�[cbucaSto iop/e{rty. 1L% P.O. Box Bas j L Subdivision Name: f.0 Llb �P� 7�p5 / C(tY F Mocksvllle NC 27028 ICN Phone #: 336-751-8760 Section: Lot U 1-/b5kewi rug _ ) OR V �%� r'✓ISNstrF:�I "1eU WASTEWATER SYSTEM CONSTRUCTION A I"��f`�` 7Y ah s-._.. Tax Office PIN:# / %OU(o Road ame: Zip: AUTHORIZATION NO: 003098�..7ri�ltn•u.� **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 bavie County Building Inspections Office when applying for Building Permits. (In compliance with AnieJe I I ooffGG,S;Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) 3-d7 _1a IIS AUTHORIZATION FOR WASTEWATER 1S VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED - i ti 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 DESIGN WASTEWATER OW (GPD) / Sa NEW SITE REPAIR SITE tJ SYSTEM SPECIFICATIONS: TANK SIZE - V 'GAIL�. PUM TANK AL. BENCH WIDTH �' ROCK DEPTH LINEAReFT, /,/(U !l/ OTHER t �'(j ra Cl c 1 Oki REQUIRED SITE MODIFICATIONS/CONDMONS: IMPROVEMENT PERMIT LAYOUT. �QOr � A ridd i;/u.✓ lJ�s�•/D/v�>r-�/1-to � L., %[4//rrF INS -/o Q.(1t1d FOR FINAL INSPECr10N OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT / SYSTEM INSTALLED BY: ITY�Lotel i a -4,q. y PT P*e_ y p X", r AUTHORIZATION NO.," 3d I r OPERATION PERMIT BY:. CQ DATE: ZS" **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DqSCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I l OF G.S.CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NOWAY BETAKEN ASA GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD02102(P*i� ) _?1 ,! WL n"�..t icy .S!'W''j "':..... 4 f.w^hdrY, %Yp. .. .: �b . _� -r -..__ . •y%p'v 3�s dGk PerDShees] / DAVIE COUNTY HEALTH DEPARTMENT a t �j�f�-`f .Irl C/<�h Environmental Health Section PROPERTY INFORMATION —�� �N'�*Y g �T� roperty: P.O. Box 848 Mocksville, NC 27028 Subdivision Name: d Vl1 /C * �Y�ta eI ( { uG-I✓-v �b SPC-;i�,• jl Phone#:336-751-8760 I ' �'• �Y Section: Lot: �r / 1j, -t !A grmdl PUC ^- f AUTHORIZATION FOR /�-/+/.g/i pole.-' -1(,-WASTEWATER 003Q18 A SYSTEM CONSTRUCTION !rf/-ted' % G>7 (___ Tax Office PIN:# - - i lr1�4!rNfr�" f Dame: � %�ll AUTHORIZATION -- NO: Roa Zi p:, **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Dlavie 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) //IS AUTHORIZATION FOR WASTEWATER CONSTRUCTIOr 6"'�-1 3 - 16 ***NOTICE*** THIS IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED JW RESIDENTIAL SPECIFICATION: BUILDING TYPE._�f # BEDROOMS � # BATHS! � �# OCCUPANTSGARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE - - # PEOPLE A PEOPLFISHIFC # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE G / TYPE WATER SUPPLY A( DESIGN WASTEWATER FLOW ((//(�GPD) NEW SITE RE AIR SITE ✓�(J� ,.J �SYSTEM SPECIFICATIONS: TANK SIZE GAL 'P�TANK � 'I RENCH WIDTH — ROCK DEPTH LINEAR Fr. ! / U O/ �.. OTHER�!0 I( "4(Af I .(i Yl REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT 66r •fE�r -to 0' N.P w e.1 –_ I 0 4'r ld II FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:36,1M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751.8760. II OPERATION PERMIT _ll" SYSTEM INSTALLED BY: ✓cj (6 C I _ _ I --A Nve AUTHORIZATIONNO. 3V1 OPERATIONPERMrr BY: LiSJOCIA) IA/C/.t1106rlj DATE: 25_ **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THESYST�CRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I l 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. DCHD 02102 (Revised) CIO/ - ^ow7m sO 3JYlw°, � eR! �Q V `�•2!/ O -YI ✓ay.t � � �° _ ` �'�TF� r +�' 'OOJ (-OY3J ��� t� X� —�„ O�, r'` �J- L �,t,,�`9 � .ter+�� <t•: ��'! p 954-6 R+" 7 44 zi 6� v S � a'° ate,' <'.''." •• / `"`':.r. APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC ti Davie County Health Department 6 D Env/ronmentatmealthSection P.O. Boz 868/210 Hospital street SEP 2 11999 Mockeviile, NC 27028 (336)751-8760 ENVIRpOAVMENTALtiEALTH •**IMPCRV NT*** THIS APPLICATION CANNOT BB PRO SMS UNLESS AIS. THS REQUIRED INVORIaTION IS PROM=.�_Refer t0 the INFORMATION BULLETIN for instructions. 1ve . Nato be Billed 13U of / (Ai(V/' contact person Sri NvC-r wiling adds *@ 21•I I D.i71: �-+' IZc� nos. aeon. `/-1 la /O city/state/ala VGi v:Lt (, Z7d0 o aoeiness atone zs cl z. Neva on pes.it/arcif Different than, above /VA ✓!ey o,✓le✓ Wiling adds... _ 5A fM't� city/state/zip 3. Application ror: 0 Site Evaluation Fl im��provement permit/ATC Both 4. areae to service, 3401use 0 Mobile Home D Business 0 Industry O Other 5. If Res Oe: i People # Bedrooms # Bathrooms -� Diehruher 0 Gasbag. Disposal a Iftdbine D sasaeant/Plumbing 0 nese t/ao al:mbing 6. If Bwiness/Industry/others spealry type # People # Oinks # commodes # Showers # Drinals i water Coolers Ir FOODSERVICE: # Seats Estimated Nater Usage (gallons per day) 7. Type of water supply: t3-Coynty/City 0 Well D community s. Do you anticipate additions or expansions of the facWty thin system Is Intended to serve? 0 Ya H If yes, what type? ""IMPORTANT"* CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with TIM APPLICATION. Property Dimensions: /©!9 ' X 301) t f Tax Ogice PIN: #57 Sq ��-73 — [/Z Property Address: RosdName 11v'IS1iwiR•-, ce, �iQ�C:,�_Iq_�OCIry/ZIp�dVANLE 2700 1 ' ' If In a Subdivision provide Information, as follows: SI,A�YoaK. Atre.f Name: �i ,, ! WRITE DIRECTIONS (from Mocksvllle) to PROPERTY: &N Eas4- Tl, Ccwige3zZe r' "I -11Z 1D / T�L �e0al�s Creek Section( Block- Lot: �_ Date Property Flagged: q—Z0 —%r•1 This Is to certify that the information provided Is correct to the best of my knowledge. I understand that any permit(s) based hereafter are subject to suspension or revocation, if the site plans or Intended me change, or if the Information submitted In thb applleadon b fablfted or changed. 1, 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 n n4 b Wta,A to conduct all testing procedures as necessary to determine the site suitabWly. I DATEyI moll- W SIGNATURE / '-) A / � THIS AREA MAY BE USED properly lines and dbneus Revised DCHD (07199) to 0 NG YOUR SITE PLAN (Include all of the following: Existing and proposed setbacks, and septic locations). 30 O Site Revisit Charge Date(s): Notification Date: Account No J6 Invoice No. I DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ADDRESS aC� 1 f CJ2R o PROPOSED FACIILTY lod DATE EVALUATEDhlG9 G5 PROPERTY SIZE LOCATION OF SITE Water Supply: On -Site Well Community Public L� Evaluation By: Auger Boring Pit C711- Cut FACTORS 1 2 3 4 Landscape position I2 Slope R HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure 5b k !�l ,6 Mineralo / /.V 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 i V I i SITE CLASSIFICATION: -a LONG-TERM ACCEPTANCE RATE: REMARKS: - DCHD(01-901 EVALUATED BY: /vas 0 OTHER(S) PRESENT: 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-.Vc.-y friable FR -Friable FI -Finn 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 Mineralo¢y 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