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199 Calvin Lane Lot 29IAUTI-1091ZATION No: 1759 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permittee'sLEP.O. Box 848 j] Name: �`. 1�'IL�Y�A� Mocksville NC 27028 Subdivision Name: Directions to property: Phone # 336-751-8760 Section: / Lot: r AUTHORIZATION FOR / / G � WASTEWATER Tax Office PIN:# 574/ 5(0- SYSTEM CONSTRUCTION Road Name: 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 I 1 of G.S.,Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION tTit,� ✓ �'" " l i ri IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONIN 1rTEALTH SPE IAL DATE IS UED DAVIE CQUNTY HEALTH DEPARTMENT T PROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Permis Subdivision Name: .lL T Directions to property: ('' Section: Lot: IMPROVEMENT PERMIT Tax Office PIN:# Road Name. Zip: C �' **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 compliancewith 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 1;'' f <? PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONME " TAL'HEALTH SPE`CIAL�iST' DATE I$'SUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. ti r ii' `ti, RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS L ' # OCCUPANTS q GARBAGE DISPOSAL: Yes No COMMERCIAL SPECIFICATION: FACILITY TY # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE VOYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE -f --"' REPAIR SITE �!I � -� SYSTEM SPECIFICATIONS: TANK SIZE �Q.GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH ) 7 LINEAR FF. OTHER ST(ZIhI-Dr�7 i� REQUIRED SITE MODIFICATIONS/CONDITIONS: 'v u" CY~ ry J" ' "�=�%i" �t �� [i • LI �v 1 Orr IMPROVEMENT PERMIT LAYOUT bop lqo I r-4 k_II "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. OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYS?tM 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) APPLICATION FOR SITE EYAWATION/IMPROVEMFM PERMIT do ATC Davie County Health Department Env/ronmenta/Hea/th SmWon P.O. Box 848/210 hospital Street Mookoville, NC 27028 1336)751-8760 OCT 13 1998 EMI ***IldCPt7RTANT*** THIS APPLICATION CAMWT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed S i i P Contact Person Mailing Address Borne phone / D C City/state/ZIP Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/state/Zip 3. Application For: U Site Evaluation 0 Improvement Permit/ATC U'�Oth 4. system to service: 0 House iki; bile Home 0 Business 0 Industry 0 Other a. If Residence: i People i Bedrooms_ i Bathrooms_ 0 Dishwasher 11 Garbage Disposal 9-1ashing Machine 0 Basement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/other: specify type i Commodes i Showers i Urinals i People i sinks i Nater Coolers ITt IWDSERVICE: d Seats Estimated hater Usage (gallons per day) � 7. Type of water supply: 9 County/City 0 Well 0 Community e. Do you anticipate additions or expansions of the facility this system is Intended to serve? 0 Yes 0 No If yes, what type? ***IMPORTANT*** CLIENTS AIUSTWMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AIUST BESUBbIITTED by the client with TINS APPLICATION. Property Dimensions: Tax 011ice PIN: # Property Address: Road Name -90 LS 613 City/Zip , M (► C S h /�e- .22 If in a Subdivision pro de information, as follows: Name•14 t Section: lock: Lot: Date Property Flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits) Issued hereafter are subject to suspension or revocation, if the site plan or Intended use change, or If the ioformation submitted In this application Is falsified or changed. 1, also, understand that 1 am raponsible for all chargesincurred from this application. I, hereby, give consent to the Authorized Representative of the DrCoduty Health Depa meat to enter upon above described property located in Davie County and owned by •7 Lo wl to conduct all testing procedures as necessary to determine the site suitability. DATE V f J " r SIGNATURE- k LX rt �K �9 . ', THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). N lei P, u� Account No.D Revised DCHD (07/98) Invoice No. 7 affasm y/ Section: lock: Lot: Date Property Flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits) Issued hereafter are subject to suspension or revocation, if the site plan or Intended use change, or If the ioformation submitted In this application Is falsified or changed. 1, also, understand that 1 am raponsible for all chargesincurred from this application. I, hereby, give consent to the Authorized Representative of the DrCoduty Health Depa meat to enter upon above described property located in Davie County and owned by •7 Lo wl to conduct all testing procedures as necessary to determine the site suitability. DATE V f J " r SIGNATURE- k LX rt �K �9 . ', THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). N lei P, u� Account No.D Revised DCHD (07/98) Invoice No. 7 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION � LOT 2-1 Soil/Site Evaluation APPLICANT'S NAME &2IU_A&J PROPOSED FACILITY N \ . Win.- SUBDIVISION .1 ov DATE EVALUATED l PROPERTY SIZE �� T V O ROAD NAME }kj&!%d S -r Water Supply: On -Site Well Community / Evaluation By: Auger Boring Pit ✓ Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position IL Sloe % o10 HORIZON I DEPTH - '7 Texture group Consistence Structure c C Mineralogy HORIZON II DEPTH -7 • 7-'-7 Texture group Consistence 5 Structure It MineralogyI , ` HORIZON III DEPTH 2 Texture group{ Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy: 1 SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 'f LONG-TERM ACCEPTANCE RATE: �• dJ REMARKS: DCHD (01-90) EVALUATION BY: _-� 4(�GI4&.1- .7- 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 - SubanQular blockv 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■■ MEMO ■M■■ ■E■■ ■■E■ ■■M■ NOUN ■■E■ ■■E■ ■■■■ OMEN ■M■■ ■■■■■■■1■Ti■�ii■iMTiiiiMiiiii ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ MEMO ■■■■■■ ■■■■■■ ■■■■■■■M■■■■■■■■■■■■ ■■■■■■■■■■■■■■E■■E■■ ■■■■M■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■ME■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■MEMO■■N■■■■EO■■ ■■■■■■■E■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■NEE■■ ■■■■■■■■■■■ ■■■■■■■■■■■ ■■■E■■■■■■■ ■■■■■■■■■■■ ■■■■■■■■■■■ ■■■■■■■■■■■ ■■■■■■■■■■■ ■EMM■■E■E■E■ ■EM■MEM■MME■ ■E■ME■■■EME■ ■■■MMM■■MEM■ ■■M■■M■■■E■■ ■M■■ME■■MEM■ ■■■■E■E■E■E■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ iiiiii■-li iiiiiiii■-i■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■ ■■■■■■ ■MNEME MENNEN 1I■■E■■ 1I■7■■■ 11HAMME ■1■■■■■ MENNE■ ■ ■ ■E■E■ ■E■E■ ■■■E■ ■■■E■ ■■NE■ ■■N■■ ■ENE■ WOMEN ■E■■■ ■■E■■ ■■M■■ ■■N■■ ■■E■■ ■■NE■ ■■■O■ ■■■■■■11 ■■I■■■■■■■■■■■■■ ■■■■■Oil■■■■I■■■■■■■■■■■■■ ■■■■■■��■■■SIS■■■■■■■■■■■■ ■■■■■■��■■■■I■■■■■� ice■■■■■ ■E■■MME N■I■■M■M■■E■E■■■ ■■IMNM■■MMMMM■■MMM■ ■■IMM■M■■MM■■M■MMM■ ■■I■■■M■■M■MM■MMMM■ ■■!■■MM■■M■M■MM■■M■ ■■I■■M■■■M■MMM■■M■■ ■■ME■■■E■■ ■EM■■EMM■■ ■EM■■■M■■■ ■EN■■M■■■■ ■E■■M■E■■■ ■E■■■ME■■■ ■■M■■■■■■■ ■■■U■■■■■ ■■■ ■■■E■ ■■■E■■■E■■ ■■■E■E■E■■ ■■■■■■■■■E ■■■■■■■■■■ ■■E■■■■■■■ ■EEE■■■E■■ ■E■■■■■■■■ ■E■■■EEE■■ ■E■■■E■■■■ ■■■■E■■■■■ ■E■■■■■■■■ ■E■■■ ■ENE■ ■