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229 Oak Tree Drive Lot 9-10AUTHORIZATION NO. Q 5 8 3 - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section -PROPERTY-INFORMATION Permittee'.s / / P.O. Box 848 Name: Mocksville, NC 27028 Subdivision Name: / �% Phone #: 704-634-8760 C'.9�C,} Directions to property: %�/✓�3` , !..Ve- Section: Lot: U AUTHORIZATION FOR �q WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION ff `' 7 Road Name: d n k/a t1 CL- Ryezip: 'A l ega? **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. ENVIRONMENTAL HERLTH SPECIALIST DATE ISSUED wompgrf DAVIE COUNTY -'HEALTH DEPARTMENT/•.w . Il4IPROVE�j'�` AND OPERATION PERMITS PROPERTY INFORMATION '•aIt„ Subdivision Name: AO- . —6 . - si �) ection , to roverty.: � ',IVg :+��'s1�'t' " �,� Section: Lot: IlVIPROVEIIIIIVT PERMIT.Tax Office PIN:', Road Name:* ame Al kla Yl d- &@dip A .-law . **NOTE** This Improvement Permit DOES NOT authorize the constriction 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 constractiontinstallation of a system or the issuance of a building permit (Incompliance with Article. l l of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) r ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE �r •FLANS OR TIS INTENDEDUSE CHANGE. YOUR WASTEWATER r —Tq.M0NMENTAti SPECIALIST . DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE '. INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS Z # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT . # SEATS INDUSTRIAL WASTE: Yes or No r LOT 'Em.� � TYPE WATER SUPPLY y ' 'DESIGN WASTEWATER FLOW (GPD) NEW SITE V REP.4IIt SITE 1' - SYSTEM SPECIFICATIONS: TANK SUE ® GAL: PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR Ff..1 Od { OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC ©�.-F- Davie County Health Department 7 Environmental Health Section P. O. Box 848 Mocksville, NC 27028 C��2 (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE RE UIRED INFORMATION IS PROVIDED. Name to be Billed Contact Person Mailing AddressU Home Phone City/State/Zip i J c�51/, �l� , 4 2 % D Business Phone 2. Name on Permit/ATC if Different than Above 3. Mailing Address Application For: City/State/Zip ❑ Site Evaluation Improvement Permit & ATC ❑ Both 4. System to Serve: ❑ House �obile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: -17 # People # Bedrooms # Bathrooms ❑ Dishwasher ❑ Garbage Disposal GY'<ashing Machine ❑ Basement/Plumbing ❑I 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: ;1-'County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: 1 WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: # ��! �l -,� - ®� 1 Duk/ g I 1 Property Address: Road Name G{71 C� !7 lie- - �>7L 1 r ' / City/Zip D SV/�l� , /YC 1 If in Subdivision provide information, as follows: ` YS �%�hi - :/ %t % 1 / G 167 Section: Lot #: 1 1 1 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. II, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County I and owned by as necessary to determine the site suitability. DATE SIGNATURE Revised DCHD (06-96) conduct all testing procedures APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE T �, • q7 • 1]f2 Davie County Health Department , G Environmental Health Section Se P. O. Box 665, Mocksville, NC 27028 1. Application/Permit Requested B Mailing Address U Y Home Phone / Wi—i.�..,-'1(�,,L- . Business Phone77 ,2. Name on Permit if Different than Above I 3. Application for: ❑ General Evaluation C . eptic Tank Installation Permit 4. System to Serve: ❑ House obile Home ❑ Place of Public Assembly E ❑ Business ❑ ustry ❑ Other ❑ Unknown %d If house, mobile home: Subdivision (�.,R_�L�.n�.�L'� k o • Section Lot #'o No. of People No. of Bedrooms - No. of Bathrooms J- Dwelling Dimensions 11.9-16 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Sinks No. of Uri Ials No. of Lavatories No. of Showers 7. Type of water supply: kublic 8. Property Dimensions No. of Wa�er Coolers. Water Usage Figures ❑ Private Sewage Disposal Contractoi 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? ❑ Basement/Plumbing ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal ❑ Yes ❑ No ❑ 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 Octob�ler 1, 1989. Directions to Property: J34D CG This is to certify that the information provided is incurred from this appliic�ation. / /7-�(n DATE to the best of my knowledge, and I understand 1 am responsible for all charges I SIGNATURE I i CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. D,;� I DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the own person person authorized by the owner: I hereby give consent to the authorized representative 9fA Davie C u ty H Department to enter upon above described property located in Davie County and owned by , to conduct all testing procedures as necessary to deter -mine said site's suitability for a ground absorption sewage treatment and disposal system. 6'/q -Q &AyXJ DATE fy F� /� G 1 r .c c -, n1vt ) I A -J,0 f U,( -k , -1 [1z)"O2t-P DCHD (193) 01- A. Cl J (104 ) Colo I 2w 7� (106) 1 �i 4 ._---OAKLAND HEIGHTS"- r SECTION --NO. R- P. BA PAGE 15.1 , ' z w 200 _ 0 00) - Jz- cl J , X (102) _ o I1` A. Cl J (104 ) Colo I 2w 7� (106) 1 �i 4 ._---OAKLAND HEIGHTS"- r SECTION --NO. R- P. BA PAGE 15.1 , ' ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section �� D Soil/Site Evaluation / NAME v"! / DATE EVALUATED ADDRESS PROPERTY SIZE II PROPOSED FACIILTY L�4 LOCATION OF SITE p t Water Supply: Evaluation By: On -Site Well _ Auger Boring 1Z Community Pit 1 Public LJ Cut 1 -- FACTORS 1 2 3 1 1 4 Landscape position I Slope Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH +- + I Texture group�- Consistence 1 Structure Mineralogy1 HORIZON III DEPTH I Texture groupi Consistence I Structure I MineralogyI HORIZON IV DEPTH 1 Texture groupI Consistence I Structure I MineralogyI SOIL WETNESS I RESTRICTIVE HORIZON I SAPROLITE CLASSIFICATION I LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: L OTHER(S) P ESENT: REMARKS: LEGEND Landscape Position R -Ridge S -Shoulder L -Linear slope FS-Footslope 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-Silt-v ;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 kBK-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 DCHD (01-901 Davie County Health Department and Come Heafth Agency Environmenta(Heafth Section P.O. BOX 848 / 210 HOSPITAL STREET COURIER #09-4-06 MOCKSVILLE, N.C. 27028 . PHONE: (704) 634-8760 June 26, 199E -Wa Swicegood 11 & Assoc. Attn: Sharon Cohen 300 S. Main St. Mocksville, NC 27028 Re: Site Evaluation OaklandlHeights II -Lot 10 Tax PIN: #4798-95-8784 Dear Realtor: As requested, a representative from this office visited the aforementioned site on June 25, 1996. Rased upon the information provided on the application for site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, Robert P. Hall, Jr., R.S. Environmental) Health Section RH/wd Enclosure(s) v'i 0 DAVIE COUNTY HEALTH DEPARTMENT R IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION f *NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a Sanitary Sewage Systems Permit Number Name ;' 1� ��,��� Q.� Date 3 ` I � ' 9� .w; N2 7480 �i Location V -D Subdivision Name O ��% ��- \i ���G Lot No. Sec. or Block No. Lot Size 2-c" 22! House Mobile Home _� Business _— Industry No. Bedrooms .No. Baths No. in Family — Public Assembly Other Garbage Disposal YES ❑ NO EEr Specifications for System: Auto Dish Washer YES ❑ NO v❑ Auto Wash Ma^kine YES ® NO ❑ r _ �, Type Water Supply — o IrA *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 Improvements permit by 21 *Contact a representative of the Davie County Health Department for final inspection of this system 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. Final Installation Diagram: J 1: System Installed by b Certificate of Completion Date 7, / '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 EVALUATION/IMPROVEMENTS PERMIT 10'.00 i Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 j"' f - 1994 I.--- --_-_------ 1. Application/Permit Requested By Oam,4 �Q Mailing Address ouc l „� U I Home Phone`/ -Z � Business Phone 2. Name on Permit if Different than Above I 3. Application for: ❑ General Evaluation (Septic Tank Installation Permit 4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry//JJ E)Other ❑ Unknown 5. If house, mobile home: Subdivision �akIr_�C� 8z 1'19 Section Lot # ❑ Basement/Plumbing No. of People 3 ❑ Basement/No Plumbing No. of Bedrooms [Mashing Machine No. of Bathrooms ® , ❑ Dishwasher Dwelling Dimensions 1t—n (�� I ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type I No. of People Served 13 No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers 7'L ��- No. of Showers Water Usage Figures �O 7. Type of water supply: Public\ El Private ❑Community 8. Property Dimensions Sewage Disposal Contractor���e 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes C 9 No If yes, what type? '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. j I i Directions to Property: a oANI� ill 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. kafc,fl -51 DATE I SIGNATURE I CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: V1. I OWN the property. I ❑ 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 liereby 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 to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD (1193) `DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation j NAME9- ADDRESS Spm. PROPOSED FACIILTY 1-1 o v s -Q- Water Supply: On -Site Well Evaluation By:C E - Auger Boring DATE EVALUATED (� y PROPERTY SIZES LOCATION OF SITE Community Public Pit Cut FACTORS 1 2 3 1 4 Landscape position .S S S —S Slope Z c)- b0 o- Q) -i EQ, HORIZON I DEPTH G "' t� `' 1,t- Texture group C L Z' L- C L- L. Consistence :�: `F r� Structure V- C P_ Mineralogy► 1 t J `. - HORIZON II DEPTH Ti:3 `' Texture groupz Consistence Structure v_ i3k < Mineralogy VIN HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH I Texture group Consistence Structure I Mineralogy SOIL WETNESS 5 <5 5s is S RESTRICTIVE HORIZON SAPROLITE - 1� CLASSIFICATION LONG-TERM ACCEPTANCE RATE ,L1 �1 I SITE CLASSIFICATION: ' S EVALUATED BY: Cjy�r LONG-TERM ACCEPTA CE RATE: 1 L_� OTHER(S) PRESENT: REMARKS: 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 clay 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 -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 sur ace 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 I i Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD(01-901