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108 W Renee Drive Lot 36Permittees_ 1 DAVIE COUNTY HEALTH DEPARTMENT Name: " U �� �� �;�� ? Ui'� Environmental Health Section PROPERTY INFORMATION 1 11c L 1 c- C, P.O. Box 848 A i ( Directions to property: t. ` Mocksville, NC 27028 Subdivision Name: _-,Crk { -)- Phone #: 336-751-8760 1� C Section: Lot: } r 4' AUTHORIZATION FOR p� _ G I� ''� _< t'i r { 0r` (C `.. ` WASTEWATER � ��. _ Cr U 7It 7 6- SYSTEM CONSTRUCTION Tax Office PIN:# 18 AUTHORIZATION NO: 0029,05 A Road Name: ``\��=- '✓ 1 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 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ENVIRONMENTAL HEALTH SPECIALIST f._ f —do ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION /" IS VALID FOR A PERIOD OF FIVE YEARS. DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE -5 # BEDROOMS 3 # BATHS *)— # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No acf � fi ! 4 LOT SIZE TYPE WATER SUPPLY (/C) DESIGN WASTEWATER FLOW (GPD) ''R NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GA PUMP TANK GAL. TRENCH WIDTH 36 I ROCK DEPTH h-{ - LINEAR FT. 3,� 7 I OTHER A.; Eatej In l:,r 4..��;" ,_,v„eptCd SyntFtms may I'-lw bta Usk -4 REQUIRED SITE MODIFICATIONS/CONDITIONS: 4 - IMPROVEMENT PERMIT LA N J�JC� �� J ( to � 1/dif.t t1�jU,A e i °7p L7 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF OPERATION PERMIT AUTHORIZATION NO. SYSTEM INSTALLED BY: 1 rLf I I I - I II C� J TELEPHONE # IS (336) 751 S Un Cwr--C� It I, --- DATE: 3-0 "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 02102 Revised C '� ! D 3 �'- Permit&,s�� ! --, DAVIE COUNTY HEALTH DEPARTMENT N�trie: �. i c -t t'1 c.. �-+ ,) '� fy-:� Environmental Health Section PROPERTY INFORMATION � P.O. Box 848 DiD rection to property: Ii (_ j '.i' 1 Mocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 7:: ` C,-0� r .,�, � � ._ ... � G Section: .� Lot: � AUTHORIZATION FOR L WASTEWATER Tax Office PIN:#C, ) '� �' _ �r _ SYSTEM CONSTRUCTION \0 AUTHORIZATION IVO: - 0029 0 t5" A Road Name: E `ZC �� iJ rLip: **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 FormJAuthorization Number should be presented to the Davie County Building Inspections Office when applying for Building Pen -nits. (In compliance with Article I 1 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 HEALTH SPECIALIST DATE ISSUED i RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS 3 # BATHS w)- # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE �' �' �Y�PE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE I. 1 '�� % I SYSTEM SPECIFICATIONS: TANK SIZE Y i GAL PUMP TANK GAL. TRENCH WIDTH �' ROCK DEPTH LINEAR FT. G-) (-� 4 f a -t d v c �, REQUIRED SITE MODIFICATIONS/CONDITIONS: �.. ) 1 iN 1 _.. IMPROVEMENT PERMIT LAYOUT r n 4 t 1�� �, - 3 i � w FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (3 ) 751-660 OPERATION PERMIT SYSTEM INSTALLED BY: (d4J 4 �H < L h --�� - ,7 r 1 i •� ���/ —'� DATE: 13-0 AUTHORIZATION NO. OPERATION PERMIT BY: **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 02102 (Revised)/ 1( i / . 1 1 r � �' I . j A�a �/ 6 . , v, I 6 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT: AND'. CERTIFICATE, DF COMPLETION 'NOTE: issued in Compliance with G.S. of North 'Carolina Chapter, 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934'.1968) Permit Number Name l <a,77'r Z J. 7 -P b f!%1r /i' 6.; :/•. ) Date / c� ' - d � ; a 4—�- LocationE>J l;Lr,• f,•.� Subdivision Name, Lot No.� Sea or Block No. 3 Lot Size House Mobile Home _ Business Speculatiotti ` No. Bedrooms No. Baths No. in Family's _ Garbage Disposal YES. ❑ NO.,©--- Specifications for System: 10_k"-' Auto Dish Washer YES [• NO ❑ Auto Wash Machine YES O NO ❑ 2 -,r -b' Type Water Supply T; •, �- *This permit Void if sewage system described below is not installed within 36 months from date of issue. Improvements-permit.by a . t_,.�<e,..`.,,. , VI "Contact a representative of the Davie County Health Department for final: in of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number:,704-634-5985. Final Installation Diagram: System Installed by 771c Q t-1 `Lkk Certificate of Completion �� �+ r�' 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. APPLICANT INFORMATION �uJ VIA L�_ C�_a Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation Q-L& to .� PROPERTY INFORMATION �Joo� Let to �87� 76 1 G,0 efl.e-e r On -Site Well Community Public Auger Boring Pit ; Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % HORIZON I DEPTH Q — Texture groupe Consistence Structure Mineralogy HORIZON H DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: I -- LONG-TERM ACCEPTANCE RATE: �_ a_ u VMS. EVALUATION BY: ieU IJ�fict--7 OTHER(S) PRESENT: or 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 - Very friable FR - Friable FI - Firm VFI -.Very firm EFI - Extremely firm 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 DCHD 05/05 (Revised) ■■■ on ■ ■ 0 ■ ■■■■■■■■ ■■■■■■■■ ■■■■■■/■ ■■■■■■■■ ■■/■■■■■ ■■■■■■■■■■■■■■■ ■ ■ ■■■■■ ■■■■■ ■ I DAYIE COUNTY. HEALTH P'. C' I h� -;�A in'; T f , i F -Permit, Number 7, xt xt.il 4 L-bUSize,-,v HbL�66"` —4;.' Mobile 461me' BUsihes .4 eu o I No e rooms No. Baths No. in Family YES,,.E3 'NO.I.[� Specifications 'fbr System: I W, W ons -h ier YES NO -�-AW.Dis..:Wish' .,Auto Wash.Madhine" `---YES-'- Typb:Water Sup m T,� *This 7ermit Void if sewage system describedbelow is'not ,installed within months from date te of issue..' 1A tom:j tIA -0 J VU. improvements -permit :,6i-IZ, *Contact .a' representative of the Davie ...County H4th Department -;fort final ainspecton of this system between : 30 y b: 1. 3k A.M.4 or :00 -,1:80`P.--M..Ibh-;da of completion".'* Telephope�Nun ber x704 634-5985 -j v Lu t., Final Installati'dri bl.!; L Cl'� r ebb L ---j rtificate, of Completion yv� b 4:te -A V i, titA -th6L,the-�syste �m,�d6sceib6d::'4bo'v'e'�h'-d*§�"b-'ie,'�e"6,,�:'ih'st-dII6,d.:.ih-.�.dbi,�61j'a�"n�"c�e wfth,,.i,-,, .:!'.The, signing of. this. certif iccate-shalli-,ihdicaf&� -."'b-rlh+i-6.*.th"6;:above- regulation the tan, ;�itds set I ,but shall':in NO way be+taken„as avguarantee that the system wl'IJ:;function im-e.. satis 9cto any given period wT 5.5 4F Location . . . . . . . . . , i F -Permit, Number 7, xt xt.il 4 L-bUSize,-,v HbL�66"` —4;.' Mobile 461me' BUsihes .4 eu o I No e rooms No. Baths No. in Family YES,,.E3 'NO.I.[� Specifications 'fbr System: I W, W ons -h ier YES NO -�-AW.Dis..:Wish' .,Auto Wash.Madhine" `---YES-'- Typb:Water Sup m T,� *This 7ermit Void if sewage system describedbelow is'not ,installed within months from date te of issue..' 1A tom:j tIA -0 J VU. improvements -permit :,6i-IZ, *Contact .a' representative of the Davie ...County H4th Department -;fort final ainspecton of this system between : 30 y b: 1. 3k A.M.4 or :00 -,1:80`P.--M..Ibh-;da of completion".'* Telephope�Nun ber x704 634-5985 -j v Lu t., Final Installati'dri bl.!; L Cl'� r ebb L ---j rtificate, of Completion yv� b 4:te -A V i, titA -th6L,the-�syste �m,�d6sceib6d::'4bo'v'e'�h'-d*§�"b-'ie,'�e"6,,�:'ih'st-dII6,d.:.ih-.�.dbi,�61j'a�"n�"c�e wfth,,.i,-,, .:!'.The, signing of. this. certif iccate-shalli-,ihdicaf&� -."'b-rlh+i-6.*.th"6;:above- regulation the tan, ;�itds set I ,but shall':in NO way be+taken„as avguarantee that the system wl'IJ:;function im-e.. satis 9cto any given period APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. 1. Permit Requested By 2. Address ? 78S' 3. Property Owner if Different than Above Ar1rIrPQQ 2,7017- 3. 7c/2 Home Phone— Business Phone 4. Permit To: a) Install ' Alter Repair b) Privy Conventional � Other Type Ground Absorption c) Sub -Division wcoa Irc Sec. Lot No. -3 6 5. System used to serve what type facility: House '-- Mobile Home Business IndustryOther b) Number of people SPL` 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms 3 Bath Rooms Z Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes Z- urinals garbage disposal lavatory Z showers Z washing machine r dishwasher sinks 3 8. a) Type water supply: Public. Private Community b) Has the water supply system been approved? Yeses No 9. a) Property Dimensions )A° r x t Ili X ) �a I ,•� b) Land area designated to building site _ c) Sewage Disposal Contractor r 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? This is to certify that the information is correct to the best of my knowledge. Date V Owner Signat OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: w El l ( - ---------- DCHD (6-82) DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name C fez /TED H:/I �,it3a:lout) Date _ /- ° 7 - ffZ' N2 4154 Location Snl Subdivision Name. Lot No. �G Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms -3 No. Baths Z' No. in Family_ Garbage Disposal YES ❑ NO p- Specifications for System: la" Com• Auto Dish Washer YES NO2,,,b Auto Wash Machine YES [� NO ❑ 72,,,bX 3'Y t�� Type Water Supply Cy.7t;— _ "This permit Void if sewage system described below is not installed within 36 months from date of issue. Improvements permit by Pa' T '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 day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by 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 satisfactoCily for any given period of time. 12 A ,Bailie (lnuntg Pealth Pepar#men# 2tnb P>rme pealth '�Benru P. O. BOX 665 90cl;sbille, �qurth (garolina 27028 OFFICE OF THE DIRECTOR TELEPHONE 1704) 634.5985 March 11, 1987 Ray Carter, Jr. 8788 Center Grove Church Rd. Clemmons, NC 27012 To Whom It May Concern: The septic system for lot 36 of Woodlee went in on March 20, 1986. The system was approved at that time. Sincerely, ��f/�21 rte• �b�-�� �2 •i �/•�•� .u,i Robert B. Hall, Jr., R. S. Environmental Health