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121 West Chinaberry Court Lot 18).UTHORIZI�TION NO ` ` 1 21 DAVIE COUNTY HEALTH DEPARTMENT < Environmental Health Section PROPERTY INFORMATION Permrttee's . P O. Boz 848 Name d 1. � Mocksville, NC 27028 SubdiJision Name: I" Phone #: 704-634-8760 Directions to property:.Section: Lot: AUTHORIZATION FORWASTEWATER .. SYSTEM CONSTRUCTION Tax 0fic PIN:# Road Name: AVN **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 for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section ..1900 Sewage.Treatment and Disposal Systems) . ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS YALII) FOR A PERIOD OF FIVE YEARS ' ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED }}q rI 214 DAVIE COUNTY HEALTH DEPARTMENT a Sr r IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION ,.-Penin?esu'/.J,�.i�jA7+ ' Duecfipns"to property: Subdivision Name: BUPROVEMENT Section: Lot: PERMIT Tax Offc PIN:#_471L_ - 4%_ /21 ZiD: A vez-q **NOTE** This Improvement Permit DOES NOT authorize the construction 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. (Incompliance with Article 11 of G.S. Chapter 130A, Wastewater Systems,'Section :1900 Sewage Treatment and Disposal Systems) / ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATIOP t 14L . ' , PLANS OR THE INTENDED USE CHANGE. YOUR WASTEW, SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE RESIDENTIAL SPECIFICATION: BUILDING TYPE 'f N BEDROOMS # BATHS -V # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFI' _ # SEATS _ INDUSTRIAL WASTE: Yes or No IAT SIZE 1_0J_NyTYPE WATER SUPPLY r/J e DESIGN WASTEWATER FLOW (GPD) �,GD NFw s TE ✓ REPAiR SITE SYSTEM SPECIFICATIONS: TANK SIZE 201V GAL. PUMP TANK GAL.. TRENCH WIDTH —7-"' ROCK DEFTH /a% LINEAR FT. &1'pp���� �� L REQUIRED r **CONTACTA REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM 'BETWEEN 8:30 - 9:30 A.M. OR 1.00 - 130 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634.8760. OPERATION PERMIT Ipn p N �I NI--r4�J�L7taT� 2-1� AUTHORIZATION NO. OPERATION PERMIT DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE Y M DESCRIBED AB V S BEEN INSTALLE INCOMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .5900 "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) APPtItATION FOR SITE EVALUATIONAMPROVEMENT PE Davie County Health Department D J t Environmental Health Section P.O. Box 848 FEB I Z FA Mocksville, NC 27028 (704) 634-8760 ENYI ENi 1,14 ` ' ****IMTORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL (� / THE �JREQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed lj'aAl T ohs / f�f4'W yrs �!4 'P `Contact Person !i 1 h'i g �V , /a �� ,/`fA q Mailin Address '/� Y -!Y Home Phone / ��` 3 %5 City/StateMp )11,1 Sl1i ' &� Z If Kl 47 Business Phone agp* 2- 2. Name on Permit/ATC if Different than Above Mailing Address " 3. Application For: Uq Atte Evaluation R // r ��� - [ 1}lniprovement Permit & ATC [ ] Both 4. System to Serve: [9 -House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People # Bedrooms 3 # Bathrooms_g— [`]'Dishwasher f ] Garbage Disposal VJ'Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify # Showers # Urinals # Water Coolers # People #Sinks # Commodes If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [ ] County/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?( ] Yes V414t) If yes, what type? J''! ' EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT **tom OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: 2 97" Tax Office PIN: #03�7-pp - Property Address: Road Jame GJ< T city/zip WRITE DIRECTIONS (from Mocksville) TO PROPERTY - If in Subdivision provide info ation, as follows: _ AName: da -/ti e ' Section: # Lot#: E 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 all testing Revised DCHD (06-96) - V THIS AREA MAY BE USED FOR bRAWINC1,y0UR SITE PLAN: to determine the site suitability. ��.^� �yV, / t� APPLICATION FOR SITE EVALUATIONAMPROVEMENTS P L5 OUR R j �p c ° Davie County Health Department Environmental,Health Section FEB 2 8 1996 P. O. Box 665 Mocksville, NC 27028 1.cApplication/Permit Requested By 'T. KNxe Swicegood, agent {oA Mh./MA4. Rod WoodwaAd Mailing Address 300 Sou-th.Ma,tn_ StAeex Home Phone 704-634-1010 MUCKSVILLE N. C. 27028 Business Phone 704-634-2222 2. ,Name on Permit if Different than Above 3., Application for: General Evaluation ❑ Septic Tank Installation Permit 4. System to Serve: {X7 House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown /9, 5. If house, mobile home: Subdivision Sotifff ARBOR Section 2 Lot # ❑ Basement/Plumbing No. of People 3/4 ❑ Basement/No Plumbing No. of Bedrooms 3 ® Washing Machine No. of Bathrooms Q Dishwasher Dwelling Dimensions 1300 sq. Aee-t +- ❑ Garbage Disposal 6. If business, industry, place of public assembly, other:. Specify type No. of People Served N No. of Commodes No. of Sinks No, of Urinals No. of Lavatories A No, of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: © Public ❑ Private ❑ Community .8. Property DimensionsSee attached map Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes [3xNo If yes, what type? 'NOTE: Improvements Permits shall be valid from date 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: Tax Office PIN: #-S7-y?yZ2 2 -PZ PROPERTY ADDRESS, as fottows: Road Name: South AAbbt City: 6focksv-ttte— N. C. SUPMIT 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. f-ebauahy 26, 7996 T.'Kyte Sviceegood, agent box 'ud and—Sloodwatid DATE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. E} 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 of th vie un y eal D artment to enter upon above described property located in Davie County and owned by �• ax [Coo k to conduct all testing procedures as necessary to determine said site's suitability fora ground absor tion sewage treatment and disposal system. T. 1-ebAuaAy 26, 7996 �y` d ego DATE �/ AT E ti .r DAVIE COUNTY HEALTH DEPARTMENT ��"I� Environmental Health Section Soil/Site Evaluation NAME %"�9 wee A DATE EVALUATED 1 ADDRESS PROPERTY SIZE PROPOSED FACULTY 5 LOCATION OF SITE p asr Water Supply: On -Site Well _ Community Public - Evaluation Bye. Auger Boring Pity' b- Cut FACTORS 1 2 3 4 Landscape position Slope a HORIZON I DEPTH �t Texture group Consistence F Structure Mineralogy ',l VA HORIZON II DEPTH 1' 2" Texture group C Consistence FM VIM Structure $ Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 5-5 RESTRICTIVE HORIZON — — SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE , SITE CLASSIFICATION: J . EVALUATED BY: LANG -TERM CCEPTANCE RATE: `i OTHER(S) PRESENT: No Ne REMARKS: e C V,A�9lpQ-S;� 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 - uvr�larcnt:c - 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 3C -Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky SBK-Subangular blocky PL -Platy PR -Prismatic Mi neralo¢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/ftz DCHD(01-901