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146 Rabbit Field Lane Lot 411-7 AUTH . ORIZATION NO: 0 6 8 6 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPEZY INFORMAL Penni'tteels--- P.O. Box 848 Name-�- Mocksville, NC 27028 Subdivision Name: Phone #: 704-634-8760 Directions to property: Section: Lot: 14 AUTHORIZATION FOR Tax Offic WASTEWATER SYSTEM CONSTRUCTION e PIN:# Road Name: Vl-S)�Vr-,�s-�,,� Zip: **NOTE** This Authorization for WastewaterkSystem Construction MUST BE ISSUED by the Davie County Environmental Health Section pr�or 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 co�npliance with Article 11 ofG.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. ENVIRONMENTAL HEALTH DATE ISSUED Ifl o� 61a �/x 0 DAVIE COUNTY HEALTH DEPARTMENT do - IMPROVEMENTS PERMIT AN6,CERTIFICATE OF COMPLETION /0:0o *NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a sanitary Sewage Systems Permit Number Name 0 Date Y3 L4 N2 780-�7 Location Q S d- 7iv i s LL ub on Name —Lot No. Sec. or Block No. Lot Size !3 House Mobile Home Business -- Industry_ No. Bedrooms No. Baths No. in Family Public Assembly ------Other Garbage Disposal YES 0 NO [3 Specifications for System: Auto,Dish Washer YES C3 NO C:1 x Auto Wash Ma,;hine YES g NO Type Water Supply Lf *This'permit Void if sewage system described below is not installed within 5 years from date of issue. This Permit is subject to revocation if site plans or the intended use change. J 61� Fin Improveme,nts permit by *Contact a representative of the Davie County Health Department for final inspection of this systern between 8:30-9:30 A.M., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985. B Certificate of Completion Date *The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERmr welt, Davie County Health Department Environmental Health Section P. 0. Box 848 FEB 7 1997 Mocksville, NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED-UNEESS # Commodes If Foodservice: 7. Type of water supply: # Showers # Urinals # Seats Estimated Water Usage (gallons per day) El County/City' I - 0 -'Well # Water Coolers 8. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? Q Community C3 Ye s 9 -No PROPERTY INFORMATION REQUIRED: ***IMPORTANT*** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: AL i -.- Tax Office PIN: # Property Address: Road Name 6,-M Pdl City/Zip If in Subdivision provide information, as follows: Name: A) /k'7� Section: Lot #: WRITE DIRECTIONS (from Mocksville) TO PROPERTY: 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. 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 J—,o to conduct all testing procedures as necessary to determine the site suitability. DATE 9-1 — 5 — �'Z SIGNATURE Revised DCHD (06-96) ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed JVX J &d�� ContactPerson Mailing Address 33,9 Home Phone 719 �E City/State/Zip 1 hi ",/ 9 1 IV /?/0 4� Business Phone 74�� 7 Y' 'Al k 2. Name on Permit/ATC if Different than Above - 44 Mailing Address .7<9 7-5- 6veg1A)i- [),s- City/State/Zip )e a,1'3 t1la, 3. Application For: Y�S-ite Evaluation 0 Improvement Permit & ATC El Both 4. System to Serve: Or -"House El Mobile Home El Business El Industry 0 Other 5. If Residence: # People -4- # Bedrooms # Bathrooms 5"Dishwasher U'Garbage Disposal 13'-W-ashing Machine EY'Basement/Plumbing El Basement/No Plumbing 6. If Business/Other: Specify type # People # Sinks # Commodes If Foodservice: 7. Type of water supply: # Showers # Urinals # Seats Estimated Water Usage (gallons per day) El County/City' I - 0 -'Well # Water Coolers 8. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? Q Community C3 Ye s 9 -No PROPERTY INFORMATION REQUIRED: ***IMPORTANT*** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: AL i -.- Tax Office PIN: # Property Address: Road Name 6,-M Pdl City/Zip If in Subdivision provide information, as follows: Name: A) /k'7� Section: Lot #: WRITE DIRECTIONS (from Mocksville) TO PROPERTY: 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. 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 J—,o to conduct all testing procedures as necessary to determine the site suitability. DATE 9-1 — 5 — �'Z SIGNATURE Revised DCHD (06-96) 7 7 . . . . . . X DAVIE-CO TY HEALTH'DEPARTMENT INFORMA IMPROVEMENT AND OPERATION PERmrrs PROP TION Subdivision Name: Nlr�e` 9ktion: 6n IMPROVEMENT Tax Office PIN:# Road Name: 4ip: **NOTE** This Improvement Permit DOES NOT authorize ft construction or installation of aseptic tank system or anywastewater system. . 1� An AUTHORIZATIONTOR WASTEWATER�SYSTEM CONSTRVCrION must be obtained from,this Depwu=t-priorto the issuance of a building permit. construction/installailon of a system or the, sterns), N compliance with'Article I I of G.S. Chabter 130A. Wastewater Systems, Section. 1900 Treatment and Disposal Sy Sewage ***NOTICE*** TEIIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTMATER SYSTEM CONTRACTOR MUST SEE TEIIS PERMIT BEFORE E]�� HEAtrH S&40� D'ATOSSUED INSTALLING THE SYSTENL RESIDENTIAL SPECIFICATION': BVIIDING TYPtIA� # BEDROOMS MO #BATHS 73 # E b SPOSAL(74or Ro OCCUPANTS GARBk.G I COMMERCIAL SPECIFICATION: 'FAcuxrY TYPE # PEOPLE # PEOPLEISHIFT'—� #SEATS. INDUSTRIAL WASTE: Yes'or No TYPE WATER SUPPLY DESIGNVASTEWATER FLOW (GP6).3 jA NEW SITE REPAIR SITE LoTsrzES-A, SYSTEM SPECIFICATIONS: TANK SEZEW��—GAL. PUMPTANk—GAL. TRENCHWIDTH ROCK'DEPTH W LINEXRF300 REQUIRED SITE MODIFICATIONS)CONDITIONS: "CONTACT A REPRESENTATF�h OF THE DAVIE,COLUM HEALTH DEPARTMENT FOR FINAL INSPEC'TION OF THIS SYS. TEM BETWEEN 8:30 - 9:30 A.M. OR 1:0b -'1:30 P.M. ON Tiffl DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. 9-9 lf! �!s� �' I ..s..�..�. vim. -r,• ..�.-� a�- b I 9 css s�1 I n � Co 7 � J 9.2 0 .22'N L 9 Fn n oo�Y n 1 L I � 1 IASNCTO 'M r(:NII K"SSW A r1.dM �rilDa�J .[am "Jr1Vw .ntm aY •t-`. . . A DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION UL LOT Soil/Site Evaluation APPLICANT'S NAME PROPOSED FACILITY SUBDIVISION DATEEVALUATED PROPERTY SIZE 1A ROAD NAME 1�4�0 Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS I 3 4 5 6 7 Landscape position -5 Slope % N2 HORIZON I DEPTH Texture group Q! I Consistence V__T_ Structure Mineralogy HORIZON 11 DEPTH 4�0' 42 Texture group C—, Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S _15 RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: C:�' LONG-TERM ACCEPTANCE RATE: 03 REMARKS: DCHD (0 1 -90) 5; � �>% ; �-� \ � \' LEGEND EVALUATION BY: ("�� OTHER(S) PRESENT: 1W cz, -0 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 Sl - Silt SICL - Silty clay 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/ft2 Ems MEN on No ME MMEMMEMEMMEMEMENN MEEMMEMMEMOMMEMME MEMMEMEMMEMMEMMEM MMEMMEMEMMEMEMEMM MEMEMEMEMEMEMEMEM MOMMEMOMMEMEMEMEN MMEEMMEMMEMENMEME MMENMEMEMMEMMEMEM MENEM MENEM MEMO MENNEN M ME No so M mommomm MEMMUME EMMOMME MEMMEME EMMEMME MMEMMEM MEMMEME monsoon mmommom MEMMEME