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106 West Chinaberry Court Lot 25AU ' a ANION NO. O 9 5 O. DAVIE COUNTY HEALTH DEPARTMENT e pe Environmental Health Section PROPERTY INFORMATION P.O.;Box 848{ n \- Nara Mocksville, NC 27028 Subdivision Name:.D�t111 11(ZD� ' /� Phone #: 704-634-8760 Directs to property. tan S �� 6e. Section: L Lot: �s AUTHORIZATION FOR ' WASTEWATER SYSTEM CONSTRUCTION Tax Office PIN:#J147 - - ?`ll . Road Name: �R 8 P. �. Zip: **NOTV-** This AuthorizatioH for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental ijealth Section prior to issuance'of any Building Permits. This Fpnn/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 Systemon. s; Section Sewage Treatment isposa atment and Dl Systems) ,R ''***NOTICE*** THIS AUTHORIZATION FOR WASTEjVATER CONSTRUCTION A CNS i4 a� i4e 1) Tti7:n �' 1 t IS VALID FOR A PERIOD OF FIVE TkEARS ENVIRONMENTAL HEALTH SPECIALIST;,: DATE ISSUED DAVIE COUNTY HEALTH DEPARTMENT � 1?`a IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION _Name. �A®1 1 \�' (j R` �1p YMI Subdivision N`a"mee 50VAX 62� Db Directions to property: �� i s _ �` � » Section: f!_ Lot: � PERMIT Tax Office PIN:#I7 Road Name. N. �� Zip:i0�f **NOTE** This ImprovementPermit DOES NOT authorize the constmctioa or installation 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:9. Chapter 130A, Wastewater Systems,. Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED - SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. - .. RESIDENTIAL SPECIFICATION:•BUII,DING TYPE VivhQ #BEDROOMS --.�J_ # BATHS A # OCCUPANTS GARBAGE DISPOSAL: Yes or r No v; COMMERCIAL SPECIFICATION: FACI.IT'Y TYPE�, .# PEOPLE _ # PEOPLEISHIFr # SEATS ',,INDUSTRIAL WAST&„Yes or No 00 , LOT SIZE IM k TYPE WATER' ( SUPPLY \A - DESIGN WASTEWATER FLOW (GPD) 60 NEW SITE REPAIR SITE :,.SYSTEM SPECIFICATIONS: TANK SIZE IDQp•' GAL. PUMP TANK GAL. - TRENCH WIDTH ROCK DEPTH I �" LINEAR Fr..7 d� 1 OTHER' - •s - . REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT' 001. - -4a - .. 001 + s F �lpusa; **CONTACT A REPRESENTATIVE OF THE DAA COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEENS:30 - 9:30 A.M. OR 1:00 -130 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 6348760. - OPERATION PERMIT \ `, " SYSTEM INSTALLED BY. f AUTHORIZATION NO.�./ OPERATION PERMIT BY; Q,� �' DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE t 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 05/96 (Revised) z ti _ APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department DIf �, Q Environmental Health Section P.O. Box 848 L = 91997 Mocksville, NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed 11JMce Contact Person Mailing Address Lq a & s /Q' Home Phone !We -9,7 5 7 City/State/Zip kk t�S Business Phone �1I0 7 `i 4 �— , 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: K/ ite Evaluation [ ] Improvement Permit & ATC oth 4. System to Serve: [vJ House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People # Bedrooms _ # Bathrooms !a- [pMishwasher [ ] Garbage Disposal [{/f Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes j # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [1106ounty/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes ]dNo If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** AOF THE PROPERTY MUST BE I SUBMITTED WITH APPLICATION. Property Dimensions: 1 Ida 'Yz e 1 WRITE DIRECTIONS (from1 kocckksville) TO PROPERTY: Tax Office PIN: Property Address: Road Name L'///Ije g) �tl tT�t1— p _JS�n %� �d j� lLF li�� % S / city/Zip If in Subdivision provide information, as follows: w �� A Name: SD Y 6 /i l- i Section: Lot#: S ; 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 7l o / 7Q /Wd-& zS Trto c duc�all testing proc s Vecessary to determine the site suitability. DATESIGNATURE Revised DC (06-96) AREA BE USED FOR DRAWING YOUR SITE PLAN: bRif Ve WAy ( J� v J s-� ee°/� APPLICATION FOR SITE EVALUATION/IMPROVEMENTS P • . 4', Davie County Health, Department Environmental Health Section FEB 2 8 1996 v P. O. Box 665 Mocksville, NC 27028 o 1, Application/Permit Requested ByT. KNte Swicegood agent AAA Kt. /MAD. Rod Wboduiand ' 300 ,South Matin StAeet 704-634-1010 Mailing Address Home Phone MOCKSUILLE, N: C. 27028 Business Phone 704-634-2222 Name on Permit if. Different than Above Application for: General Evaluation ID Septic Tank Installation Permit 4. System to Serve: {v7 House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown .. 2 -49XP&L- , 5. If house, mobile home: Subdivision SOUTH AR- Section Lot # r - ❑ Basement/Plumbing ' No. of People 3/4 ❑ Basement/No Plumbing No. of Bedrooms 3 91 Washing Machine No. of Bathrooms 2 Q Dishwasher. Dwelling Dimensions' 1300 SQ. Ueet + ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No, of People Served No. of Sinks No. of Commodes N No. of Urinals No. of Lavatories A No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: D Public ❑ Private ❑ Community 8. Property Dimensions See attached map Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑e No If yes, what type? 'NOTE: Improvements Permits shall be valid from hate issued. Improvements' Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. " Directions to Property: PROPERTY INFORMATION REQUIRED: r, Tax Office PIN: N 577 PROPERTY AbbRESS, as follows: Road Name: South AJCbbA - city:. Mocuyttue, N. C. SUBMIT A PLAT WITH THIS APPLICATION. - - Revisions effective October 1, 1995. This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. FebtuaAy 26, 1996 T. Kyte Sw.ceegood, agent 60A "od--l2d-A�j ' DATE a - CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1 ❑ 1. 1 OWN the property. EJ 2. 1 DO NOT OWN the property.: If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized represent ive o th p vie C�un y Heal D artment to enter upon above described property located in Davie County and owned by � ft ' Kod? Woo�a�� to.conduct all testing procedures as necessary to determine said site's suitability for a ground absor tion sewage treatment and disposal system. T. y sego d Febhuahy 26, 7996 DATE AT E Lot ' -�•' DAVIE COUNTY HEALTH DEPARTMENT Lot 1 - Environmental Health Section Soil/Site Evaluation NAME ADDRESS PROPOSED FACIILTY \1 cs Q DATE EVALUATED PROPERTY SIZE �r X1.67 X I -DO LOCATION OF SITE Water Supply: On -Site Well Comm" .t Public Evaluation By:Z rL Auger Boring Pit V Cut FACTORS 1 2 3 4 Landscape position Slope Z 45 o' C HORIZON I DEPTH 't Texture group l_ Consistence Structure Mineralogy\ HORIZON II DEPTH Texture rou Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S RESTRICTIVE HORIZON — ^ SAPROLITE CLASSIFICATION —T. _S1 i LONG-TERM ACCEPTANCE RATE f SITE CLASSIFICATION:y '� ` EVALUATED BY: q n LONG-TER]]yy�Q�Q��CC��EPT CE RATE: 14 OTHER(S) PRESENT: -- 0 6N¢ REMARKS:._519�_ 10*14 i-1 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 <Aay 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/f(2 DCHD (01-901