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143 Calvin Lane Lot 22n,t _''+•.,-, -t '"4 .'`sz,z a tx �.,yr . .. .-.G,i:- rZ` - ..... "..;� sv '�, .: 4' aj .. . _,..- ..: ::. _.:,_ r AUTORIZATION NO: 1752 DAVIE CLUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permittee's ii P.O. Box 848 Name: +�L'r`c:�LT C i It-L,h1ls�.! Mocksville, NC 27028 Subdivision Name: Phone # 336-751-8760 Directions to property: 1U15 ZU<<`>� Section: Lot: AUTHORIZATION FOR WASTEWATER -7 1/ SYSTEM CONSTRUCTION Tax Office PIN:# Road Name: 1 i-6- c r-1 - 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 G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) f ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION j Z IS VALID FOR A PERIOD OF FIVE YEARS. :NVIRO HEALTH CLIST DATE ISSUED 2- 1752 DAVIE OUNTY HEALTH DEPARTMENT �•.. �,� IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Perth ttee, s ! r hti Name: ; '1' `7 , � Subdivision Name: Directions to property: 6'c 1=�' L: Section: Lot: ` IMPROVEMENT Tax Office PIN:# PERMIT �'£/ �� _ [> 1 r•'' Road Name r' r 1 .I Zip: 'c- A l **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 I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***Nt)TTCF,*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER isi ` A HEALTTt S IALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE ENVA2O M INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS - # OCCUPANTS --41 GARBAGE DISPOSAL: Yes or 0 COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE VCO'4 TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD). -2W NEW SITE� REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE 1000 GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH J Z LINEAR FT. OTHER STI 1J I) F E?�1[ j7� REQUIRED SITE MODIFICATIONS/CONDITIONS: �tr v� c .� a,,2,1401P 10' UFS ('¢vP. L�►. , k�x.1' ` C" (-lag IMPROVEMENT PERMIT LAYOUT 1;101 Mid. _Ix yca' **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 (336)751-8760. Ln - Nom -C-11 w - t. SYSTEM INSTALLED BY:= IS-tit��J t.� �oP� nloT A t --- N K S7r,01, AUTHORIZATION NO. OPERATION PERMIT BY: "iSKIN **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 WALL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) APPUCA110N FOR SIZE EVAUJAMON/IMPROVEMEM PERMIT do Davie County Health Department 710T 4Environmental Heafth SectionP.O. Box 848/210 Hospital StreetOCT 13 iMockeville, NC 27028 (336)751-8760 ***I11P0RTA1VT*** THIS APPLICATION CAMWr BE PROCESSED UNLESS ALL hH19-A90 INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed S 1 5071,0,.17 Contact Person �r , �j Hailing Address name phone ` / p 7 'gyp? ZS e; City/state/ZIp 2. Name on Permit/ASC if Different than Above Mailing Address 3. Application For: U Site Evaluation 4. system to service: ❑ House Cd'Mobile Home S. If Residence: # People_ 0 Dishwasher 0 Garbage Disposal Business Phone City/state/Zip -L, // 0 Improvement Permit/ATC �Oth 0 Business 0 Industry ❑ Other # Bedrooms :— Oohing Machine 6. If Business/Industry/Other: Specify type 0 Basement/Plumbing # Commodes # Shavers # Urinals # Bathrooms_ 0 Basement/No Plumbing # People # sinks # Nater Coolers IF FOODSERVICE: II Seats �� Estimated Nater Usage (gallons per day) 7. Type of water supply: W"County/City 0 well 0 community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes 0 No U yes, what type? ***IMPORTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUR{IITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # Property Address: Road Namen ) (/; it City/Zip A � U K� Yj Ve- .2)6, If in a Subdivision pro de informs ion, as follows: Name: ) 1 e Section: lock: Lot: Date Property Flagged: 1y 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 nesporsible for aU charges incurred from this applfcadon. I, hereby, give consent to the Authorized Representative of the Da County Health Depa meat�� to enter upon above described property located in Davie County and owned by i to conduct all testing procedures as necessary to determine the site sultabilihy. DATE 10 1 f 3" 9,V SIGNATURE Exi9rd �. THIS AREA MAY BE USED FOR DRAWING YOUR SIM PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Account No. Revised DCHD (07/98) U -�� ,,� Invoice No. t 1 (2 + � i DAVIE COUNTY HEALTH DEPARTMENT p Environmental Health Section SECTION LOT Z2 Soil/Site Evaluation APPLICANT'S NAME 5PILLt" .4. DATE EVALUATED PROPOSED FACILITY 40v"� PROPERTY SIZE'' D0 X 200 SUBDIVISION t-1 -pqy We11s ROAD NAME �Ic&�OA sl- Water T Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut_ FACTORS 1 2 3 4 5 6 7 Landscape position 4 - Slope % 2 HORIZON I DEPTH Texture group C I_ Consistence Structure Mineralogy P/ (; HORIZON II DEPTH - Zv C, — 3 2 - Texture Texture rou C G Consistence Jc- 5 P Structure S Mineralogy HORIZON III DEPTH 20 - Texture group 4 - Consistence r Structure Q k Mineralogy HORIZON IV DEPTH _ Texture group Consistence Structure Ck' Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: PS LONG-TERM ACCEPTANCE RATE: 0.4 REMARKS: DCHD (01-90) EVALUATION BY: �,Zpf �CAL) CA4A"^� 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 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 ■E■ ■o■ ■■■M■■ ■■■■■■ ■■■■ ■O■■ MEMO SEEN MEMO MEMO ■■E■ MEMO ■OE■ MEMO NEON ■E■■ soon ■■■■ ■■■■ ■■■■ ■■N■ NONE ■E■■MME■■E■■■M■■H ■■■EMMO■MO■M■■■■E■ ■E■■■M■■■■■■■■■■■■ ■■■■■■i��::::iiiiiiiiiiiiii ■■■■■■■■■■■■■■■■■■■■■■■■■■■ UMMEMEN MEMNONMONSON ■■■■■■■■r■■■■■■■■■■■■■■Eva!■ ■E■EEM■EN■!I ■ENEEM■■■■I ■■■■■■■■■■I ■n■■Mo■■■■' ■■■■MENS■■ ■E■■■■EN■■ 0 I■■■EM■ I■■■■E■ I■■EME■ I■■EME■ I■■EME■ I■■E■■N IMEM■■■ ■ ■■E■■NM■M■■■■■N■ ■ME■■■E■M■■■■■N■ ■■■■■■EEME■■■■■■ ■■M■■■■■■■■■■■■■ ■■M■■■EE■■■■M■■■ ■■Ee■■MM■■■E■■■■ ■■■M■■■■n■■■■■■■ ■EMEE■■■■■EE■■■■ ■EMMM■■■MMM■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■M■■■■■■ ■■■■■M■■■■M■■■■■ ■■■■■■■■■■E■■■■■ ■■■■■E■■■■■■■■■■ ■■■EEE■■E■EE■E■■ ■NEEM■■■■■■■■M■■ ■■EM■■■■■MM■■■■■ ■■EE■■■■E■■■■■E■ ■■■■■■■■EM■■■■■■ ■■■E■■■■■EE■■■■■ ■■■■■■■■■■■■■■■■ ■■■E■■■■E■■■■■■■ ■■EM■■■EME■■■■■■ ENE ■■NONE ■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■IAO■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■ ■■■■E■■M■■■■ ■MMM■■■MMM■■ ■■■■■MMM■■■■ ■■■■EME■■■E■ ■■■EMEM■■NE■ ■MEMS■■■■ME■ ■■EMEM■■EM■■ ■EM■■■MMME■■ ■M■■■■■■■■■■ ■E■E■■E■■M■■ ■■■■EM■■■■■■ ■■■E■EM■■■■■ ■OM■■EN■■■M■ ■E■■■■■■■■M■ ■MMEM■■O■■E■ ■EME■■■MEM■■ ■E■■■MEMEN■■ ■■■■■■M■■E■■ ■O■■■MEN■■M■ ■■■M■■■E■■■■