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114 Norma Lane Lot 32AUTHORIZATION NO: 0 8 7 4 !' DAME'COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permittee: s,/9 P.O. Box 848 Name: > Mocksville, NC 27028 Subdivision Name: i-1 6—/' Phone #: 704-634-8760 Directions to property:�r, ^� .� �_, Section: Lot: '. AUTHORIZATION FOR c WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION .,. Road Xme- Q �'•Zip: AV66(0 **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 Pen -nits. (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-HEALT ECIALIST DATE ISSUED ¢�_y + --A ° D OUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Perna Name Subdivision Name •'`"r.+.r /�' plrectilins'to property: Section:' Lot: ^ PERMIT Tax Office PIN:# Eon- s Road Name: d Zip: **NOTE** This Improvement Permit DOES NOT authorize the constt fiction or installation of a septic tank system or any: wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Departmentprior to the Y } constcuctionhnnstallation of a system or the issuance of a building pemut (Incompliance ;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 f EWIRONMENTACHEALTHNECLALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THLS PERMIT'BEFORE . INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUIL:DING'TYPE # BEDROOMS _� # BATHS o #_ OCCUPANTS _GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION:• FACILITY TYPE #PEOPLE # PEOPT E/SHIFf # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE � LTYPE WATER SUPPLY _DESIGN WASTEWATER FLOW (GPD) �y� NEW SITE (/ REPAIR S1T A.• % ✓' / SYSTEM SPECIFICATIONS: TANK SIZE /DOS GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH %� LINEAR FT•�� OTHER 24%4C REQUIRED SITE MODIFICATIONS/CONDITIONS: **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 , �- SYSTEM INSTALLED BY: ' . w-Nr.+t».a.+vw ...- sfu: :e.„:.��-.sx7.4v,4,.,,, i... .,}.6r,-'--;�.:.Y'-rw.cc a+.• 1s.. .. . r .._ , -:r. ,. ,., v. ,... . - „ , , AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **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 05196 (Revised) VIEtOUNTY HEALTH DEPARTMENT . r IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Permittee,'s, ' Name: Subdivision Name: Directions to property: Section: +: Lot: IMPROVEMENT - PERNIIT Tax Office PIN:#'�,�.; Ro"ad Dame: , ''rr i t s ;_ t . Zip: s 'rid* **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 ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE _ & # BEDROOMS 7 # BATHS _ V # OCCUPANTS —/-- GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE /f ? / TYPE WATER SUPPLY _ DESIGN WASTEWATER FLOW (GPD) NEW SITE L, REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZEL,n GAL. PUMP TANK GAL. TRENCH WIDTH T4"` ROCK DEPTH e LINEAR FT J r. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT i i - 1 "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 SYSTEM INSTALLED BY: a Y AUTHORIZATION NO. OPERATION PERMIT BY: DATE: "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) r, APPLICATION FOR BITE EVALUATIONAMPROVEMENT PE Davie County Health Department 0 Environmental Health Section D P.O. Box 848 MAY 9 1997 Mocksville, NC 27028 (704)634-8760 M I ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed- j<.,l�N 6,2,a7 Mailing Address 49- D LL- Z" U City/State/Zip1W'111A1-1,/'//e' 2. Name on Permit/ATC if Different than Above Contact Person �� C"v✓�� Home Phone Business Phone 7ya -S-il 91 Mailing Address City/State/Zip 3. Application For: Kte Evaluation t,4 Improvement Permit & ATC [ ] Both 4. System to Serve: ]House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People # Bedrooms- # Bathrooms!Zp, Dishwasher [ ] Garbage Disposal 14 Washing Machine [ ] Basement/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: [County/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes It/I leo If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** SOF THE PROPERTY MUST BE SUBMITTEDWITH Property Dimensions: �� x �l3 WRITE DIRECTIONS (from ocksville) TO PROPERTY: Tax Office PIN: #�o� a -� / - g / .,/ Property Address: Road Name NDrmO- G -n / 7az/o � ,f o/-7 Wnacllee' nl./ --h -c-,City/Zip Advolve, t„Cff If in Subdivision provide information, as follows: Name: 1'E'fL c�lLCJ • ''ate "�" 0M 0-t� L r Section: <5W 3 n Lot #: �� inn n ar oN WIC, 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 by. DATE 5 Revised DCHD (06-96) THIS AREA AIAY BE USED FOR DIZAIVINC7 YOUR SITE PLAN: 'i' as necessary to determine the site suitability. rA co W N I. I Q C. C N Z t Q � J P .4- 169 ( SEC. 3 ) 17 < N (17) N - O = Z 16 (16) N - 15 (15) N 0 14 _N (14) - N � 1 8 0 4 U 12 166.75 11 100 10 P 8.4,16 9 (12) (I I) * (SEC. 3 ) 129 129 RENEE DR. 135 125 9 I I (8) „B„ (29) N MAP G- 7 b(� 06Z, - 7 8" 1 81.68 A„ 170.3 32 223.06 "q.. 33 23 0 47 (4 0) (30) (39) - =- S 18 1. 8 8 PB- 4- 169 (SEC. 3) 24 1 40.6 BROOKH I LL CT. (31) A as 182.39 — 30 (38) N (37) (32) 0 227.75 165 134.75 27 129 129 1 82.90 28 29 26 0 (34) (35) (36) (33) 18 3.47 135 4 U 12 166.75 11 100 10 P 8.4,16 9 (12) (I I) * (SEC. 3 ) 129 129 RENEE DR. 135 125 9 I I (8) „B„ APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMI M W Davie County Health Department D V 15 Environmental Health Section P. O. Box 848 14AR 1 01997 f� \ 1 Mocksville, NC 27028 A 1(i (704) 634-8760 n f ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSE ALL THE REQUIRED INFORMATION IS PROVIDED. Sw r/,� / /1. Name to be Billed V �'a�` Contact Person Mcla- Mailing Address R21 (ad Home Phone City/State/Zip ls c,rUV/ 11 �. AIC C Of 70 — — Business Phone 01 2. Name on Permit/ATC if Different than Above UI CVe� ` - �4r/,Cer Mailing Address 07w3 os (w s City/State/Zip /,ILC ✓/'Af" NC 3. Application For: ❑ Site Evaluation /N Improvement Permit & ATC &,z- 51 Both 4. System to Serve: ip House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People �_ # Bedrooms 3 ? # Bathrooms PDishwasher ❑ Garbage Disposal Washing Machine ❑ Basement/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: P 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: ��D X �8 ,9D X 116 x lga•Ct0 1 WRITE DIRECTIONS (from 1 Mocksville) TO PROPERTY. Tax Office PIN: # Property Address: Road Name /J f 3a' / `10Inu f,•Ew &WG1Ale 1 1t/te fief# City/Zip Adyarxt NC V4 61 1 2�' dh- If in Subdivision provide information, as follows: 1 Name: WOOD u 1 5ee sm'' cod GraU 1 Section: Lot #: . 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 by as necessary to determine the site suitability. DATE r5—/O— / / SIGNATURE Revised DCHD (06-96) 6 conduct all testing procedures H-) Z " ► 8 1. 8 8 PB- 4 - 169 �� + 65 -� (SEC. 3 } �. i 6 24 140. 6 BROOKH I LL. 7. (i6) N - ( 31) • = — it tt 3! ► 6 " ?a 30 182.39 - 15 Ln — — 25 (1 5) N o 0 2) 0 227.75 165 X 3 4. 7527 134.752-7 12 9 129 29. 162.90 2g !4 26 (34) (35) (3 G) o N (14) N 1 8 0 18 3.47 135 129 129 RENEE DR. 125 13 140 12- 166.75 t 100 10 135 125 1 — OD rn � PB.4,169 I (8) (1 3) (12) CD (I I) (SEC. j ( - - - (10) tN2 (9) o N -- — — N "A" 140.4 I 158. 23 "A" I 'T 12-5.36 (7) x- 109.95 150 134 95 130 130 P. B. 4 -167 0 0 - (4) - (S EC, ) o - (6) o - APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT (D Davie County Health Department be Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 9"98- S`SO 1. Permit Requested By ��' �Gl� F- Business Phone -7 -7 5Z7� 2. Address f-7-'�� 3. Property Owner if Different than Above - -- -- -- -- Address 4. Permit To: a) Install Alter Repair b) Privy Conventi Other Type Ground Absorption 3�- c) Sub -Division �� , Sec. Lot No. �3 . 5. System used to serve what type facility: H useJZ Mobile Home Business IndustryOther b) Number of people VI'CI J7`' L®� 6. a) If house or mobile home, state size of home and number of rooms. House Dimension Bed Rooms Bath Rooms 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 lavatory — dishwasher urinals garbage disposal showers washing machine sinks 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions / /D I X b) Land area designated to building site c) Sewage Disposal Contractor 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 knowledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to prop DCHD (6-82) (r? Low 33 C a OD Lc- L= '(-v - -7 \-� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION_ LOT 3Z Soil/Site Evaluation le -e,&o.G APPLICANT'S NAME DATE EVALUATED PROPOSED FACILITY A/ PROPERTY SIZE SUBDIVISION '640 U/ey ROAD NAME Water Supply: On -Site Well Community Public Evaluation By: Auger Boring 11� Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH 1.� �• y Texture group Illy 4:� Consistence Structure Mineralogy` HORIZON II DEPTH Texture groupC' C' 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 7-3 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: PC -�� 0" Z EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: e---4 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 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 DCHD (01-90) ■E■■■ ■E■■■ ■ ■■ ■ ■ ■■ ■■■EMM■■ME■MEM■■■ ■EMM■■■M■■MEM■■E■ ■■E■■■ME■■EM■■M■■ ■M■MEME■EMEMEMEM■ ■E■EME■EME■MEM■■■ ■■M■■■EM■■ME■■■M■ ■■E■■M■M■M■■EME■■ ■ME■■M■■EM■MEM■■■ ■EME■MEMEMEMEMME■ ■EM■■■EM■■ME■■ME■ ■MEMEMEMEM■■EM■■■ ■M■MEM■■EM■■EM■■■ ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■EM■■HE■■■■■■■ ■EM■■MEM■ME■EM■ ■■■M■EM■MM■■EE■ ■■REME■■ME■E■E■ ■RAMMEMM■MM■MM■ HIIU■■MM■■MM■M■■ IIAM■■■M■■MM■■E■ ■■■M■ ■ME■M■■■ ■E■E■ ■E■EMEM■ SERE■■■E■ME■■M■ MEM■■■E■■■MM■M■ ■E■■EM■■ME■E■M■ ■■E■■■■M■ME■■M■ ■EMEMMEMMEMMEM■ ■■■■■ME■■■M■EE■ ■M■MMU■M■■MOU ■E■■■ ■■■■■■ ■EME■■ME■■M■■M■ ■EMEM■■MMEMEME■ ■■■■ME■■■E■EM■■ ■EMM■■■E■■E■■■■ ■E■■■ME■■M■■EM■ ■EMEMMEMEMEMEM■ ■EM■EU■M■■E■■■ ■E■■■ ■■■■■■■■ ■■■■■■M■■■M■M■■ ■■■■MEM■EM■EME■ ■EMMEMEMEMEMME■ ■■EM■■■E■■E■EM■ ■■■■■MM■■■■■■E■ ■ME■EM■MM■■M■■■ ■EME■UM■■■■EM■ MEMOS ■■EMME■■ ■■PEm:am:m\■■■■ ■.W■■MMEM■M:■EM ■M■■MM■■E■■E■■ ■ME■EM■MEME■EMM■MME■ ■MMM■■■■M■■M■MMM■M■■ ■■M■■ME■■MEM■M■■E■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■ ■ MEMO ■EME■E■ ■EMEMM■ ■■■EME■ ■EMEME■ ■ME■■M■ ■E■M■M■ ■■■ME■■ ■E■MM■■ ■ ��xiriP (1�uun#� �ett�#I# �P;1ttZ#mEn# ttn� �IItttE �PM�#� �1�Entg P. O. BOX 665 (Alarksbille, �Karth ( aralinit 27028 OFFICE OF THE DIRECTOR October 13, 1986 Mr. Gerald Marion Route 4, Box 174 Advance, NC 27006 Mr. Marion: On October 8, 1986 this office reevaluated Lot 32 in Woodlee to determine it's suitability for a septic tank system installation. Based on the limited amount of provisionally suitable soil on said lot this office must limit any proposed residence to two (2) bedrooms. The system must be installed in the elevated area in the front portion of the lot. Due to the difference in elevation a pump may need to be used. It is imperative that this office meet with the prospective buyer of the lot in order to describe the above mentioned conditions. If you have any questions, feel free to call this office. Sincerely, Q. AYW- ? . R.j Robert B. Hall, Jr. R. S. Environmental Health RBHJR:sg TELEPHONE (7041 834-5985 APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section R 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone !gi k' 5S-041 1. Permit Requested By 02Aj.0 AIQ 121 aAj Business Phone '773 -4 ' 2. Address !!V- aX / "7 4 �-,�(CE . Al C • L7 Q0 6 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair b) Privy Conventional- they Type Ground Absorption c) Sub -Division Sec. Lot No. 2 �+ 5. System used to serve what type facility: House Mobile Home Business IndustryOther b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms Bath Rooms 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 urinals lavatory showers dishwasher sinks garbage disposal washing machine 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions b) Land area designated to building site c) Sewage Disposal Contractor 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 o my knowledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD (6-82) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 /n1 SOIL/SITE EVALUATION Name Lr-t.A a IckI(har, i w� ��i - SSv �`,�• Date 11- z-2,43 -�. a 1'7q 773 -So37 w. -JL , Address �—� Lot Size l �d �Y) g2 yl 27gz G GAr..TnRc ARFA 1 ARFA ? AREA 3 AREA 4 W. Topography/ Landscape Position S S S S PS PS U U !) Soil Texture (12-36 in.) Sandy, Loamy, Clayey, (note 2:1 Clay) S S C� S PS S U U 6D U 1) Soil Structure (12-36 in.) Clayey Soils S eft7> S ® S PS S U U 6--�) U Soil Depth (inches) S <fgs> 3Z S ® S /LPS o�� S U u u i) Soil Drainage: Internal � � PS /05�> U U 4�0-D U External S S ® PS U U U i) Restrictive Horizons raY7 w c` h e14 ') Available Space S S. S PS S S) Other (Specify) S PS S PS S PS S PS U U U U 1) Site Classification U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/ Comments: %// cc -anal eae/u�d4'P t'�u�""-p f•�` `�G -�z � ,�'��'y� •//1`111 uvw a k,4;..1 Z.. - ✓ :i ..r/u-aD-6,/rrc. % - -Z 4o Ccs„ f ?14L fCi /-.7e° ,-/ Described by Title , Date SITE DIAGRAM D HD (6-82) S�op� pavie fanuntg Aeul#4 Pepartmen# ttnb Xvme Xez&4 �genrg P. O. BOX 665 Avrksbille, Yarth (garolina z7IIz8 OFFICE OF THE DIRECTOR December 21, 1983 Mr. Gerald Marion Route #4, Box -.174 Advance, North Carolina 27006 RE: Lot #32, Woodlee Subdivision Davie County Mr. Marion: TELEPHONE (7041 694-5985 Upon your request, a soil/site evaluation was conducted at the aforementioned property on November 22, 1983 by representatives of this office. Due to the soil condition and severe problems caused by the landscape position we felt the need to consult our state Soil Specialist. On December 20, 1983 the state Soil Spec- ialist conducted further evaluations at the site. In summary please note below the findings of said evaluation. 1. Topography/landscape position is -unsuitable. 2. There is a shallow soil condition which would require the system to be installed very shallow (these would require more space than a normal system). 3. The entire lot would have to be ditched and drained in order to collect surface water and water that would move through the soils and get into the septic tank lines. Therefore, due to the poor landscape position and poor soil conditions at deeper depths and lack of space, this lot is class- ified unsuitable for a ground absorption sewage treatment and disposal system. Please advise should my office be of further assistance concerning this matter. Sincerely, J e Mando, R.S. jh Env. Health Coordinator Enc. i OPERATION PERMIT Ty Davie County Health Department 210 Hospital Street i. P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Andrea J. Smalt/Jane Whitlock Address: 1459 Old Mountain Road city Statesville State/Zip: NC 28677 Phone#: (336)971-7732 - Address/Road #: 114 Norma Lane Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 3 # of People: *Water Supply: PUBLIC *IP Issued by. *CA issued by: 2140- Nations, Robert r *CDP File Number 219650-1 5862683758 County ID Number_ Evaluated For: EXPANSION `Township; �roperty owner: Andrea J. Smalt/Jane Whitlock Address: 1459 Old Mountain Road City Statesville State/Zip: NC 28677 \Zhone #: (336) 971-7732 ierty Location & Site Information Subdivision: Woodlee Design Flow: 3 6 0 Soil Application Rate: 0 - a 7 5 Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: Phase: Lot: 32 Directions Hwy 801 North right o Woodlee Dr left on Renee Drive and right on Norma Lane *System Class ifiication/Description: TYPE 11 A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) SaproliteSystem? QYes QNo *Distribution Type: GRAVITY -SERIAL Pump Required? QYes (E)No "Pre -Treatment: Drain field 4 3 6 Sq. ft. a 1 0 6 n• 9 Inches O.C. Feet O.C. 3 Qlnches Feet inches Minimum Trench Depth: 3 6 Minimum Soil Cover. a 4 Maximum Trench Depth: 3 6 Maximum Soil Cover: a 4 Inches *System Type: INFILTRATOR QUICK 4 STANDARD Installer: Randy Miller Certification #: 1128 * EH S: 2140 - Nations, Robert Date: 0 6/ a 9/ a 0 1 6 Inches Approval Status Inches ® Approved E3 Disapproved Inches ,/ CDP File Number 219650 -1 I I County ID Number: 5862683758 septic TanK Manufacturer Let. STB: Long: Gallons: Installer: Date: j El j Certification 4: No (Min.6in.) 0 No 0 *EH S: *Filter Brand: El Yes 1:1 N o ST Marker: ❑ Yes 0 No Date: Reinforced Tank: ❑ Yes ❑ No Approval Status Vent Hole El Yes 1:1 No El Approve d 0 Disapproved, Piece Tank: El Yes 0 No Manufacturer. PT: Gallons: Date: RiserSealed El Yes RiserHeight: El Yes nforced Tank: 0 Yes 1 Piece Tank: M Yes Pump Tank Pipe Size: inch diameter Pipe Length: feet *Schedule: Pressure Rated ❑ Yes El No Approved fittings ❑ Yes El No Installer. Certification 9: *EH S: Date: Date: Approval Status 0 Approved 0, Disapproved prove Pump Type: Installer. Dosing Volume: Gal Certification 9: Draw Down: Inches 'EHS: "Chan: El No 0 No (Min.6in.) 0 No 0 No Pipe Size: inch diameter Pipe Length: feet *Schedule: Pressure Rated ❑ Yes El No Approved fittings ❑ Yes El No Installer. Certification 9: *EH S: Date: Date: Approval Status 0 Approved 0, Disapproved prove Pump Type: Installer. Dosing Volume: Gal Certification 9: Draw Down: Inches 'EHS: "Chan: Date: Valves Accessible 13 Yes 1:1 No Flow Adjustment Valve El Yes 1:1 N o Check -valve n Yes El NO Approval Status PVC Unions 0 Yes El No El Appro I ved [I bisapproved Vent Hole El Yes 1:1 No Anti -siphon Hole El Yes 0 No GDP File Number 219650 -1 NEMA 4X Box or Equivalent Box 12 inches Above Grade Box Adj. To Pump Tank Conduit Sealed Pump Manually Operable *Activation Method: County ID Number: 5862683758 Approval Status Alarm Audible El Yes ❑ No Approved ❑ Disapproved Alarm Visible ❑ Yes ❑ No 2140 - Nations, Robert *Operation Permit completed by; Authorized State Owner/Applicant Signature: Date of Issue: 0 6/ 2 9 / 2 0 1 6 This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for Sewage Treatment and Disposal, 15A NCAC 18A .1900 et. Seq., and all conditions of the Improvement Permit and Construction Authorization. This property is served by a TYPE Ilk sewage septic system. Rule .1961 requires that a Type TYPE II A septic system meet the following criteria: Minimum System Review By The Local Health Department: NIA Management Entity: OWNER Minimum System Inspection/Maintenance Frequency ByCertified Operator: NIA Reporting Frequency By Certified Operator: NIA Rule .1961 requires that a Type IV and V septic systems designed fora homethusiness owner must maintain a valid contract with a public management entitywith a certified operatoror a private certified operator forthe life of the septic system. Rule .1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid contract with a public management entity with a certified operator for the life of the septic system. Rule. 1961 (2) (e) requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the system owner and certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibilities of the owner and systems operator, provisions that the contract shall be in effect for as long as the system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Electric Equipment Yes ❑ No Installer. ❑ Yes ❑ No Certification #: ❑ Yes ❑ No ❑ Yes ❑ No "EH S: ❑ Yes ❑ No Date: Approval Status Alarm Audible El Yes ❑ No Approved ❑ Disapproved Alarm Visible ❑ Yes ❑ No 2140 - Nations, Robert *Operation Permit completed by; Authorized State Owner/Applicant Signature: Date of Issue: 0 6/ 2 9 / 2 0 1 6 This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for Sewage Treatment and Disposal, 15A NCAC 18A .1900 et. Seq., and all conditions of the Improvement Permit and Construction Authorization. This property is served by a TYPE Ilk sewage septic system. Rule .1961 requires that a Type TYPE II A septic system meet the following criteria: Minimum System Review By The Local Health Department: NIA Management Entity: OWNER Minimum System Inspection/Maintenance Frequency ByCertified Operator: NIA Reporting Frequency By Certified Operator: NIA Rule .1961 requires that a Type IV and V septic systems designed fora homethusiness owner must maintain a valid contract with a public management entitywith a certified operatoror a private certified operator forthe life of the septic system. Rule .1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid contract with a public management entity with a certified operator for the life of the septic system. Rule. 1961 (2) (e) requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the system owner and certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibilities of the owner and systems operator, provisions that the contract shall be in effect for as long as the system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Operation Permit A n r CDP File Number: 219650 -A County File Number: U62683758 Date: / / Olnch Scale: OBlock O N/A _ i r I ___ i i `1 . ' C5 V` w�.. rte. _ If I1.I 1 if=s 5 I I Ii —� a a. -c"j CJS LU ; a I f 1 e a i 1 lftlft it IF ' F i ki HEALTH DEPARTMENT RELEASE Davie County Health Department tr 210 Hospital Street ,�. ,».-✓- P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Andrea J. Smalt/Jane Whitlock Address: 1459 Old Mountain Road City: Statesville State2ip: NC 28677 Phone #: (336) 971-7732 r For Office Use Only *CDP File Number 219650 -1 5862683758 County ID Number: valuated For. EXPANSION PERMIT VALID 0 6/ a a/ a 0 1 6 I IA11r11 Property Owner: Andrea J. Smalt/Jane Whitlock Address: 1459 Old Mountain Road City: Statesville State[Zip: NC 28677 `Phone M (336) 971-7732 '-- Property Location & Site Information Address 114 Norma Lane Subdivision: Woodlee Road # Advance NC 27006 Township: Directions Hwy 801 North right o Woodlee Dr left on Renee Drive and right on Norma Lane *Structure: SINGLE FAMILY # of Bedrooms: 3 - # of People: *Water Supply: PUBLIC Basement: R Yes F]No 'Proposed Improvement: Phase: Lot: 32 Type of Business: Total sq. Footage: No. Of Employees: This release in no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site will continue to function for any period of time. Applicant/Legal Reps. Signature Required? OYes ONo Applicant/LegaHl ps. Signature; *Date: / *Issued By: 2140 -Nations, Robert *Date of Issue: 0 6/ a a l a 0 1 6 Authorized State Agent: **Site Plan/Drawing attached.** O Hand Drawing 01mport Drawing Drawing Type: HEALTH DEPARTMENT RELEASE Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Health Department Release CDP File Numl;e'r: 219650 - 1 . County File Number: 5862683758 Date: 0 6/ 2 a/ a 0 1 6 Olnch Scale: OBlock = ft. O N/A rage z or z 1) V �n I 01-- - - -;LL Ej l it rage z or z ' CONSTRUCTION For Office use Only AUTHORIZATION RILE *CDP File Number 219650-1 Davie County Health DepartmW County ID Number: 5862683758 210 Hospital StreetDeter r, Evaluated For: EXPANSION .��,. P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 6/ a 1/ a 0 a 1 Applicant: Andrea J. SmalUJane Whitlock Address: 1459 Old Mountain Road City: Statesville State/Zip: NC 28677 Phone #: (336) 971-7732 Address/Road #: 114 Norma Lane Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 3 # of People: "Water Supply: PUBLIC Subdivision: Woodlee Property Owner: Andrea J. SmalUJane Whitlock Address: 1459 Old Mountain Road City: Statesville StatefZip: NC 28677 Phone #: (336) 971-7732 Phase: Lot: 32 Directions Hwy 801 North right o Woodlee Dr left on Renee Drive and right on Norma Lane System Specifications TYPE 11 A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: Minimum Trench Depth: a 4 Site Classification: Provisionally Suitable @No Inches Saprolite System? OYes @No Minimum Snit Cover. 1 a Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 2 7 5 Maximum Soil Cover. a 4 Inches "System Classification/Description: 'Distribution Type: GRAVITY -SERIAL TYPE 11 A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons 'Proposed System: 25% REDUCTION 1 -Piece: Oyes @No Pump Required: OYes QNo OMay Be Required Nitrification Field 4 3 6 Sq. ft. Pump Tank: Gallons No. Drain Lines 1 1 -Piece: OYes ONo Total Trench Length: 1 0 9 ft GPM—vs— ft. TDH Trench Spacing:9 8Feet O.C. g Inches O.C. — Dosing Volume: _ Gallons Trench Width: — 3 Q Inches Feet Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS -I OTS -II Septic Tank Installer Grade Level Required: 01 Oil 0111 OIV Donn 1 of Z CDP File Number 219650 - 1 County ID Number: 5862683758 ❑ Open Pump System Sheet Repair System Required:@Yes ONo ONO, but has Available Space /Repair System Trench Spacing: 9 Onches 0. *Site Classification: Provisionally Suitable — Feet O.C. Design Flow: Trench Width: 0 Inches 3 3 6 0 ,_ _ _ Feet Aggregate Depth: Soil Application Rate: 0 a 7 5 inches Minimum Trench Depth: a 4 *System Classification/Description: Inches TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS, Minimum Soil Cover. 1 a Inches Maximum Trench Depth: 3 6 *Proposed System: 25%REDUCTION Inches Maximum Soil Cover: a 4 Nitrification Field 1 3 0 9 Inches S. ft q No. Drain Lines 3 *Distribution Type: GRAVITY -SERIAL Total Trench Length: 3 a 7 Pump Required: OYes ONo OMay Be Required \ Pre Treatment: ONSF OTS -1 OTS -II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of this permit bythe Health Department in no wayguarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. ; This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the improvement Permit, not to exceed five years, and may be Issued at the sametime the Improvement Permit Issued (NCGS 130A -336(b)} If the installation has not been completed during the period of validity of the Construction Permit, the information submitted in the application for a permit or Construction Authorization is found to have been Incorrect, falsified or changed, or the site is altered, the permit or Construction Authorization shall become Invalid, and may be suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, installation, operation, maintenance, monitoring, reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature: Date: _ / *Issued By: 2140 -Nations, Robert Date of Issue:. 0 6/ a 1/ a 0 1 6 Authorized State Agent: Malfunction Log OYes (DI -land Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Construction Authorization CDP File Number: 219650 -1 County File Number: 5862683758 Date: 0 6/.2 1/.2 0 1 6 0Inch Scale: QBlock ON/A 7-1 iESI Ll I j I I_►� �I {f r I x i -- - ---- ---- -- ...... II �! I ; I I ! i i CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 CDP File Number: 219650-1 County File Number: 62683758 Date: .0.6 / a 1 1 a 0 1 6 Click below to import an Image from an external location: Drawing Type: Construction Authorization c., 9 I UECEWR CATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC Davie County Environmental Health ✓ P.O. Box 8481210 Hospital Street ' Mocksvilltq NC 27028 (336)753-6780/ Fax (336) 753-1680 Application For: i"1 Site Evaluation/Improvement Permit I Authorization To Construct(ATC) ' I Both Type of Application: =!New System ClRcpair to Existing System XExpansion/Modification of Existing System or Facility ***IMPORTANP" THIS APPLICATION C� NNOTBEPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. Name to be Billed Are there any existing wastewater systems on the site? Xcs ONo Contact Person. Billing Address t Are there any easements or right-of-ways on the site? 3 Y Home Phone City/State/ZIP %)tt?;jU Will wastewater other than domestic sewage be generated? kir Business Phone Name on Permit/ATC if Different than Above,Sj M?,� Mailing Address City/State/Zip PKUPEK"1Y INF0KMA770N *Date House/Facility Corners Flag e� d NOTE: A survey plat or site plan must accompany this application. Included: I I Site Plan F-Plat(to scale) (Permit is ali for 60 months y+ith site plan, no expiration with complete plat.) Owner's Name Cc T ` A-V' ^Phon Number Owner's AddressCity/S te/ ip Property Address _ Cit i ir., i Lot Size Hrix I Y) X 1 IrA Pk;ljax PIN# 6A b Subdivision Name{if applicable Section/Lot# Directions To Site: _ Qc_ e6?d iP�_4z) L- Uri ene, i At_ If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? Xcs ONo Does the site contain jurisdictional wetlands? F Ycsw,-Po Are there any easements or right-of-ways on the site? U YesgNo Is the site subject to approval by another public agency? _i Yesrlo Will wastewater other than domestic sewage be generated? .I Yes LAO # People # Bedrooms !-,0_ # Bathrooms o_ Garden Tub/Whirlpool -';Yes �]No Basement:,KYes LiNo Basement Plumbing: ::'-Yes )4No If: NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building _# People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: Xonveritional ;.'Accepted :Jlnnovative i?Altemative i'Othcr Water Supply Type: U'C.ormty/City Water t New Well f iFxisting Well :_ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? 1_ Yes 1A If ves, what hype? This is to certify that the information provided on this application is true and correct to the test of my knowledge. 1 understand that any permit(s) or ATQs) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules understand that 1 r. � : sponsible for the proper identification and labeling of properly lints and comers and iu nd tl in pr staking the Yt 3:'e/facility location, proposed well location and the location of any other amenities- 'IT menities_ ff 4�" PQI /ia'W&s or owner's legal representative signature Sitc Revisit Charge 06:00 PM EDT Date(s): Client Notification Date: Date EHS: (.f we Sign given Yes ONo Account M Revised 11106 Invoice # XTHG RATION No- 0 74 ' DAVIE COUNTY HEALTH DEPARTMENT * - � Environmental Health Section PROPERTY INFORMATION Per m►ttet; ? P.O. Box 848 Name: i -� �., h MocksviUe, NC 27028 Subdivision Name:Pho Directions to property: Lsne #: 10"34-8760 Sectiom —Lot.. AUTHORIZATION FOR WASTEWATER SYSTEl41 tANSUCfIt7N Tax Office PIN:#� "NOTE" This Auduvization for Wastewater System Consmiction MUST BE ISSUED by the Davie County Environmental Heallh Section primo to issuance of any Building Permits. This FornVAuthaization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits (In compliance with Article I I of G.S. Chapter 130A. Wastewater Syg=. Section .1900 Sewage Treatment and Disposal Systems) r _ 'NOTICE*" IM AUTHORI7ATION FOR WASTEWATER ISYAUDFORAPERIODOFi'IVEYEARS. I'A"EALTRItECIALIST DATEISSUED RESIDENrIIAL SPEMCATK)N: BUlli & TYPE.�l — tI BEDROOMS „t BATHS 1 t OCCUPANTS �_ GARBAOB DISPOSAL Yrs a No COMMERCIAL. SPEC FICAATION: FACMITY TYPE # PEOPLE t PEOPLFISI S SEATS INDUSTRIAL WASTE: Ya tr No LOT SIIE,&&1TYPE WATER SUFMY jQj_ DESION WASTEWATER FLOW (OPD) _ I" NEW SrM_✓R►EPAm srjy SYSTEM S1SCMCATIONS: TANK S2E,,L&A-L0AL PUMP TANK GAL. TRENCH WIDTH ROCK D1M / --.9 L D AR FT. /f✓d / oT1D2t �'tL/ `4 Q1'r C REQUntED SITS MODUnCATIONSICONDiRONS: } D&ROVEMENTPERWTLAYOUT r- t$ we 11 "*CONTACT A REMESENTATWE OF THE DAVIS COUNTY HEALTH DEPARTMFNr FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN LM- 9:30 A.M OR IV -1:30 P.M.ON THEDAY OF LNSTAU ATION.TaJTHONB# IS M4) 634.8760. OPERATION PERMIT SYSTEM INSTALLED BY: t t AUTHORIZATION NO. OPERATION PF]tmrr BY: DATE: **THE LSSUANCIi OFTHIS OPERATION PERMITSHALLINDICATE THATTHE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMKiANCE WITH AR7XU I i OF O.S CRAr=130A. SEC110N .1900 -nWAGB TRF.ATMENTAND DISPOSAL SYSTEMS .BtTf SHALL IN NO WAY BETAIMN AS A GUARANTEE THAT TM SYSTEM W[I.I. FUNMN SATISFACTORILY FOR ANY GIM PERIOD OF TM DCI1D05N(Rev1t4 ' APPLICATION FOR SITE EVALUATIONQ]►iPROVEIIENT Davie Count} Health Department Gnvironn►ental Health Section P.O. Box 848 Mocksville, NC 27028 i7(MI 634-R76n ****MIPORTANT**** 1A( 9 1397 I THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFOR1lIATION IS PROVIDED. 1. Name lobe Billed Contact Person Mailing Address 13o' 7 %--- Home Phone ' / i` City/State/Zip ' "t Business Phone 2. Name on Perinit/ATC it Different than Above Mailing Address Cit}•/State/Zip 3. Application For: 10's ite Evaluation M Improvement Permit & ATC i ] Both 4. System to Serve: ('] House ( ) Mobile Home [ ] Business [ J Industry ( I Other 5. If Residence. # People / # Bedrooms_2. 3i Bathrooms j.Dishwasher [ j Garbage Disposal (; `R'ashing Machine ( ] Bascment/Plumbine [ I Basement/No Plumbing ` 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Fater Cooler-, If Foodservice: # Seats _ Estimated Water Usage (gallons per day) 7. Type of water supply: (,l County/City f ] Well (] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [p rNo If yes, what type? EITIMIi et PLAT OR SITE PLAN PROPERTY INFOR]NIATION REQUIRED:*** IMPORTANT *** XT. PAT,OF THE PROPERTY MUST BE /,rlq-AS SUBMITTED WTTHTiocksville) I;.SAPPLICATION. Property Dimensions: mj 16 WRITE DIRECTIONS (ftromTO PROPERTY - Tax Office PIN: ROPERTY:TaxOfficePIN: #_%2La--2,7 / . n Property Address: Road Name Alf D/ M% G✓" �f Cit}•lZip i�.-cvC1,r?CC, tyc r��i' ] �.�`r F:'. -r'f fn 1'/,_: If in Subdivision rovide information, as follows; � ��1, � , /-- � S��e r t- A- / Iz r- Name:G_.:CL r ; Section: Lot #: :3 11 t 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 suspcnsion 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. 1, 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 n , by ��r •ii rr lG�'. / z' �-.,A:aconduci all le ti nto ores as necessary to determine the site suitability. DATE 5�! }f�/ SIGNATURE r� Revised DOW (M-46) THIS AREA AGt1J BE USED FOR I)PLAWI,N6 YOUR SITE 1'LIN: VUL 4iXl.f,4 r{(.�[ to \7 i �1,J, LL - r Pe�� 0� Sc 3 i a 32 33 17 23 X (4 0) r (17 ) .. _. _ o t3,�i PB 4 - 169 (SECS IG 24 BROOKH I LL CT. (16) A 30 15� (25 27 - 28 - ( 3,i) RENEE DR . 12- •13 1I1109 P84,)6(4 r; Appraisal Card 6/2/2016 12:56:17 PM AMPSON ANDREA R ReWnVAppeal Notes: Parts: C7•100 -AO -025 14 NORMA INPIAT: 0004/169 UNIQ ID 2479 2521230 1)119-P9 ID NO: 5862683758 COUNTY TAX (100), FIRE TAX (100) CARD NO. 1 of 1 ,;IYean 2013 Tax Yeer: 2036 LOT 32 WOODLEE SECTION THREE 1.000 LT SRC inspectionked b 19 on OS ll 2008 03301 CRFFKWOOD ESTATES TW -03 Cl- FR -15 EX- AT. LAST ACTION 20120329 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE —dation - 3 EH. BASE -nda 0.16000 ontinuous FooNn 5. Area RATE RCN EYB AVB REDENCE TO MARKET boSystem - 4 01 O1 1 522 111 77.70 il97 199 199 %GOOD EPR. BVILDIN6 VALUE -GRD 100 60od EPR. OB/XF VALUE - CARD 1,36or 8. TYPE: Single Family Residential Single Family Resldenbal Walk - 10 ARKET LAND VALUE - CARD 30,00num Nn 1 Sidl 29. STYLE: 1 - 1.0 Story TAL MARXET VALUE - CARD 131,g Structure - 03 TAL APPRAISED VALUE - CARD 131,96,torCom g Cover - 03 ositbn Shi le 3.0 TAL APPRAISED VALUE - PARCEL 131,96r Walk ConstruRbn - 5q TAL PRESENT USE VALUE- PARClL Sheetrock20.0r Floor Cover- OB [n)r TAL VAIN DEFlRRED- PARCEL VM I lAmfrbte Fbar Cover-14TAL 6. TAXABLE VALUE -PARCEL 131,96t fuel -04----30-------+ 0.0q PRIOR ILDING VALUE 101,05gType-10 k 1. I B U O II 4.0 I I I i BXF VALUE DVALUE 1,46z,, 30,nd10oninq Type - 03 2 I 2 RESENT USE VAWE4.0 EFERRED VALUEomVNalh AL VALUE 13351d. oms I 1 I 12.00CI 7 I I I 2 S-OLL-O I +•---•--30------•+ PERMIT 1 3 CODE DATE NOTE NUMBER AMOUNT-OLL-O+-11--+ oomsS-OLL-O OUT: WTRSHD: raB. SALES DATA +-------- - -41-------- • •+ FF. INT VALU! 100.00 IBAS I LDINGADJUSTMENTS I S I RD AT! DIED INDICATE AVG 1.000 I + S - + 00 AG R TYPE A. PRICE Sh"i"n' e Dal n FACTOR 4 1.05 I I PTO 1)499 65 ] 00 WO Q 1 11700 Ita Size 1.060 I I I 193 16 3 199 WO U V 800 TOTAL ADJUSTMENT FACTOR 1.11 2 1 2 TOTAILQUALITY INDEX 11 B I S S t i I +s-+ I I I S HEATED AREA 1,853 NOTES I +-_--21-----+ +•11--+ 3 +-B•-+ SUBAREA UNIT ORIO eH ANN DEP OB/XF DEP TYPE GS AREA % RPL CS OD ESCR OrN OUN TN PRICE COND 0 AYB EVB RATE ND Co- VAL 1, 10 10 8570 30 ON PAVING 5 1 4. 1 _ 199 199 5 2 4 lu 30 02 598 ENCE PVC 5 25.0 00 00 5 7 87 Owner: SAMPSON ANDREA R Parcel: C7 -100 -AO -025 http.//maps.daviecountyric.gav//ITSNettAppraisalCard.aspx?parcel=C710OA0025 1/1 .... Andrea Smalts 114 Norma Lane Advance, NC 27006 117 Eaglewood Dr. Lewisville,•NC 27023. .......... a' ".r.c .. 336-546-6700 ....... � 182'-0" . Scale: , N. ..... ................ . . . .. OD ... ......... . ............. .... - - : 93'- - ..... - - .. _..._..- - ... 0 95'-63/16". ._..------------• .lam :... ............... N � ..:.. .. .:. .. .:. .. ..... ..: .... ..._._..._.. .. .. .. .. : _ . ... ................. .._....... ... .. .... .........__ - ... .. _.__....___..... nub Fame Health (�genq P. O. BOX 665 Alarksirille, �Karth ( arulinu 27028 OFFICE OF THE DIRECTOR October 13, 1986 Mr. Gerald Marion Route 4, Box 174 Advance, NC 27006 Mr. Marion: On October 8, 1986 this offie reevaluated Lot 32 in oodlee to determine it's suitability for a s - stallation. Based on the limited amount of provisionally suitable soil on said lot this office must limit any proposed residence to two (2) bedrooms. The system must be installed in the elevated area in the front portion of the lot. Due to the difference in elevation a pump may need to be used. It is imperative that this office meet with the prospective buyer of the lot in order to describe the above mentioned conditions. If you have any questions, feel free to call this office. Sincerely, i&&&Z� Q. ai�Ct.L�. Q, q.j . Robert B. Hall, Jr. R. S. Environmental Health RBHJR:sg TELEPHONE (7041 634.5985 I N 39 i 14 i? r"a 50IPGp Ell 32 nou. tA Mo u �► N 8 v s a 135 a 3� 3 o I— yoe .co B3. L/J / J t-, . C / - Y. O / V �3 �/ � y 9 ' w — STL • �t 7 - �,-