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312 Michaels Road Lot 4''Yd } F.P-r- », . �.�'/� .n. (�.1? ''� r"iT p47-`�'�'la.j hwL , _' c,f ,J.::.vz t~•;:of'1���=wy�;3'Ql..�:;��y'-''�. `•.r'c"f'�$`�7S'.`i+T^+o+rte! ty PerAittge's : f . DAVIE COUNTY HEALTH DEPARTMENT` Name:' LIrl 4 el6ratte Environmental Health Section'. PROPERTY INFORMATION j P.O. Box 848 Direction's to property: t r f���J?�fS Mocksville, NC 27028Subdivision'Name: AGI' _ Phone #: 336-751-8760 Section: Lot: 41 —mat i AUTHORIZATION FOR ; !r wr,t r� oc&1 WASTEWATER Tax'Office PIN:# S'1 Flo SYSTEM CONSTRUCTION AUTHORIZATION NO: 00343.2 . A Road Name':)'NlL[1w Le Zip: 2.7624" **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 io the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I Fof G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION 1111cloi Dwgjw..:.��� IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEA TH SPECIALIST.-DAT� ISSUED N. 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 QU I� DESIGN WASTEWATER FLOW (GPDki(O� NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE&IS AL. PUMP TANK 4i 4GAL. TRENCH WIDTH .7(n % ROCK DEPTH IVIZ- LINEAR FT. FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336i 751-8760 OPERA711ON PERMIT I qt �o� SYSTEM INSTALLED BY: �5c AUTHORIZATION N030zA OPERATION PERMIT BY: DATE: "TIE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DES IBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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. 'v DMD 0202ft1h.,a) �O G NrT�- 4q�aoay A1'>d.4 /i� rq..s s N ttee's r % DAVIE COUNTY HEALTH DEPARTMENT Name:Environmental Health Section PROPERTY INFORMATION r - P.O. Box 848 Directions to property: *J1 i t ` ! ' Mocksville, NC 27028 Subdivision Name: ` 1 f 1. —41 '•J Phone #: 336-751-8760 Section: 1:6t: AUTHORIZATION FOR WASTEWATER, 1 SYSTEM CONSTRUCTION Tax Office PIN* -5 7 r «,'- AUTHORIZATION NO: ® Q 3 0 32 A Road Name: -)M (.t if Su. I i f Zip: **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 C IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED lr RESIDENTIAL SPECIFICATION: BUILDING TYPE -SL # 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 t C DESIGN WASTEWATER FLOW (GPD). n NEW SITE REPAIR SITE i SYSTEM SPECIFICATIONS: TANK SIZE ��' ' �' i, "tAL. PUMP TANK "'�/ GAL. TRENCH WIDTH `� r, ROCK DEPTH / i LINEAR FT. REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT i J _ ' 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 T k c ~ , 1t 1mk SYSTEM INSTALLED BY: AUTHORIZATION NO.3103 • i OPERATION PERMIT BY -/,;70/0 DATE **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DES IBED 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. ncHn ozoi (rtevlsed) 'VX tr AXTHORIZATION NQ: ' DAVIE COUNTY HEALTH DEPARTMENT 14 rL ` Environmental Health Section PROPERTY INFORMATION' Permktee's �.�., P.O. Box 848 ,� Name:a-x -- L, -'�«3�1e' Mocksville, NC 27028 Subdivision Name: 1-I. 1 . yy ��� l Phone #: 704-634-8760 Directions to property: aL� tf -,'. (s. Section: Lot: .t�Z9-� AUTHORIZATION FOR C `e) ! 4 WASTEWATER �. { C-�D SYSTEM CONSTRUCTION Tax Office PIN:# f As --T -17`aly t~ Road Name: Zip: l G 71�f **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 (3:S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) I"� r , -, �� -- ,,, / Jj i- "� ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION A-1- IS VALID FOR A PERIOD OF FIVE YEARS. HEALTH'SPECIALIST DATE ISSUED RESIDENTIAL_....... _. _.. _ .. ... _. SPECIFICATION: BUILDING TYPE K # BEDROOMS = # BATHS `� # OCCUPANTS GARBAGE DISPOSAL: Yes o`r No \ COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE pl~ �--'�TYPE WATER SUPPLY�O"') DESIGN WASTEWATER FLOW (GPD) G O NEW SITE ✓ !REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE j GAI . PUMP TANK GAL. TRENCH WIDTH _' Ca' ROCK DEPTH 1 LINEAR FT. ? OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS:�*�--('���° t_.� 1i)1 �1 ��`'} �1�.};?k�► ��{ �C-] C'S PROVEMENT PERMIT LAYOUT gg 1 tlil i ^ ,r r Ll f V "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT aA SYSTEM INSTALLED BY: 1" It AUTHORIZATION NO. f " OPERATION PERMIT BY: ,. �7 y a,..... C - F 4- DATE: 1 d 1 �1 / a (I i�---L-1- U ( ) **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. DCHD 05/96 (Revised) -k "fi AUTHORIZATION N?: DAVIE COUNTY HEALTH DEPARTMENT N 1377 Environmental Health Section PROPERTY INFORMATION Permiitee's �'' < 1 P.O. Box 848 Viso Name: [.Q'` �'- /�}ti1�^' Mocksville, NC 27028 Subdivision Name: ALI-1 E AoEL�-rs Phone #: 704-634-8760 K - Directions to property: AL"l-q (n-'! Section: Lot: g-y� t, AUTHORIZATIONWASTEWATER OR ('titC:�i i �Ct. ► , i<J �► t!! ! + SYSTEM CONSTRUCTION Tax Office PINq:# - 1 "T T-aw Road Name: iIn AF-ull, A Zip: 7 7 , **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 VALID FOR A PERIOD OF FIVE YEARS. `ENVII�3N T- IA HEALTH SPECIALIST DALE ISSUED %A L? . f' r° DAVIE COUNTY HEALTH DEPARTMENT -°'1377 IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION 5, Zt'� Directions to property:! L, ` t'� # �' - �,- r, G-1 Subdivision Name: 7SI)t_U L A,J tYS>'iy Section: Lot: - Z IMPROVEMENT 08 PERMIT Tax Office PIN:#"_ Road Name: � `�.1 f A L-1 t, e, zip: **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. (In compliance with Article 11 of G.S. 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 `"ENVIRO ENTAL HEALTIi'SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE " # BEDROOMS S # BATHS —2--# OCCUPANTS GARBAGE DISPOSAL: Yes r No COMMERCIAL SPECIFICATION: FACILITY TYPE LOT qq LOT SIZE I 7TYPE WATER SUPPL���"AJly # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No DESIGN WASTEWATER FLOW (GPD)'2V0 NEW SITE ✓REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE'yWGAL. PUMP TANK GAL. TRENCH WIDTH %t� , ROCK DEPTH 17— LINEAR FT. OTHER - REQUIRED SITE MODIFICATIONS/CONDITIONS: � - ;" cytj Cx I o . I G { 1 fl�T M � ��D I JD LTC 02V. wt,3% IMPROVEMENT PERMIT LAYOUT **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT AUTHORIZATION NO. ! Z"72 OPERATION PERMIT BY: SYSTEM INSTALLED BY: A V' 1' r- —L"Ute t= 4.1-3 r )ATE: / **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. DCHD 05/96 (Revised) t o P ' 't : e APPLICATION FOR SITE EVALUATIONAMPROVEMENT ****IMPORTANT**** Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 THIS APPLICATION CANNOT BE PROCES THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed Par4-X' Contact Person po�prI Mailing Address -'t 1 0— —1,3 Home Phone a V f a -T 4-1 City/State/Zip C001.�ff NG a:9u al0 ( Business Phone � --.-o5 I 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: [ ] Site Evaluation mprovement Permit & ATC 4. System to Serve: 5. If Residence: ] House [4Vlobile Home [ ] Business [ ] Industry [ ] Other [ ] Both # People_ _ # Bedrooms # Bathrooms 2-1 [ Dishwasher [ ] Garbage Disposal [ L*ashing Machine [ ] 1iasement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [ ti County/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [ %]-lo If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT **'AG1A3' OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. 1 Property Dimensions: �1-W X' �� , WRITE DIRECTIONS (from Mocksville) TO PROPER Tax Office PIN: # -�_- COT( S Property Address: Road Name M.L� � � �t1�� ma y --o4- A,W � � m W rxy- City/ZillI V�p O� U 1�� E ���c�gi P -"t If in Subdivision provide information, as follows: Name.- ff_ Section: Lot #: i� ' 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 �Ucltall ter upon abo descr• ed property located in Davie County and owned byhi 00 to c testing pr edure ecessary to determine the site suitability. DATE V SIGNATURE Revised DCHD (06-96) THIS AREA MAY $E USEb FOR bRA1VINC7 YOUR SITE PLAN: i777""7 7 C C C (HERE GIVE NAGE W TjT7_,_' CJ7 THE OFFICER SIGNING Ti+._ CERTIFICATE PASSED UPON) Is eertlt tee e of DEPUTY—ASS ISIAI; - F1 led for registroi Ion at - — i G __ — - I in Plat Book page __ . Register ol, Deeds I Filing Fee Paid I DEPUTY—ASSISTANT Stone Z Tax Lot 42 --A co Tax Map L Carol Jean A. Evens Vi DB 114 0 PG 457 0 C)O, DO 106.00' 72' 0 0 O 0 z Tax Lot 41 Tax Map L-5 Chores Eubie Evans, j a/w Carol Jean Nexon( Dr' 86 �' PG 349 2 3' 10 4, c� -7 r�) 0 Z, 7 _ a" c' /'A APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMI Davie County Health Department Environmental Health Section JUL 2 1 1995 �r t P. O. Box 665 / Mocksville, NC 27028 1. Application/Permit Requested By r o'"1 O --avyn SerJae— C- -,&— 64f' Pi / Mailing Address�+' Home Phone to �g 33 �o Business Phone 2. Name on Permit if Different than Above 3. Application for: �/ General Evaluation El Septic Tank Installation Permit 4. System to Serve: ®'House ❑ Mobile Home ❑ Place of Public Assembly, ❑ Business ❑ Industry ❑ Other A ❑ Unknown g:vf �s 5. If house, mobile home: Subdivision Y' Q� tyB� Section Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms ❑ Washing Machine No. of Bathrooms ��- DOS ❑ Dishwasher Dwelling Dimensions %DO IF �g ■ .Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ublic ❑ Private 8. Property Dimensions ,Id U �� s/ ,�Q©F S we age Disposal Contractoi 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? ❑ Yes "o ❑ Community 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: -A- .C4U,& z5 ✓`� r This is to certify that the information provided is correct to the best of my knowledge, incurred from IN plication. 2 DATE I understand I am responsible for all charges SIGNATURE' CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED FYROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MU T be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representativ of the D�we Co my Health �artment to enter upon above described property located in Davie County and owned by is t v %e'nl e✓'v; i I he . to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. 2,Z5�-,/'� 5 DATE DCHD*(1193) w w - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation �c DATE EVALUATED c� .�6 4S_� NAME ADDRESS PROPOSED FACIILTY mgr Water Supply: On -Site Well PROPERTY SIZE LOCATION OF SITE Community Public C/ Evaluation By: Auger Boring Pit Ems_ Cut FACTORS 1 2 3 4 Landscape position Sloe Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupC Consistence Structure S' /G Mineralogy e-.� HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 1 75 - LONG -TERM ACCEPTANCE RATE SITE CLASSIFICATION: ff LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD (01-901 EVALUATED BY: A7 // 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- Vl�-y 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 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 watet' 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