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329 Hobson Drive Lot 4**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) '7 ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION I IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED A AUfHQRIZATION NO. 0 8 7 8 DAVIE COUNTY HEALTH DEPARTMENT Job, 06 k=; ` Environmental Health Section PROPERTY INFORMATION Permi'tt6es ` Name-: �-'° -'� '° P.O. Box 848 — Mocksville, NC 27028 Subdivision Name: Directions to property: ���`-' " i Phone #: 704-634-8760 Section: Lot: AUTHORIZATION FOR WASTEWATER // ter/ Tax Office PIN:# = . ?46- t IOeD SYSTEM CONSTRUCTION Road Name: n , . c) zip:-�7 oa4 **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) '7 ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION I IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED R.4 .� " ►, DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTYI' INFORMATION a Name 7- - ti ` �';�s s , t; �.; Subdivision Name: t Directions to property: Section: Lot: l' IMPROVEMENT PERMIT Tax Office PIN:# �A 3�'' raJ� _ 3D Road Name: Zip::-, **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) ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYP� 01'.lq # BEDROOMS # BATHS # OCCUPANTS ,1�_ GARBAGE DISPOSAL: Yes oi:p COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE Q � X 6, TYPE WATER SUPPLY`P M DESIGN WASTEWATER FLOW (GPD) NEW SITE / REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZd 0 ©C1 GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH (� (f LINEAR FT. d D ) OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT n ON **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: k✓- �Z L�-�f� ])=HvAk�g AUTHORIZATION NO. __(28�?OPERATION PERMIT BY: woell 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) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC Davie County Health Department- Environmental - - Environmental Health Section L L/ \\ P.O. Box 848 RN Mocksville, NC 27028 MAY _ 91997 . (704) 634-8760 I ****IMPC9RTANT**** THIS APPLICATION CANNOT BE PROC THE REQUIRED INFORMATION IS PROVIDED. i 1. Name tote Billed hheH SZIn Rrl Contact Person ' Mailing Address Q I#ome Phone 29751 . City/State/Zip �& + - a Zo F Business Phone g 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip + 3. Application For: ]Site Evaluation [ ] Improvement Permit &.ATC ' [ ] Both PP L P 4. System to Serve: [ ]House [ obile Home [ ]Business [ ]Industry [ ]Other 5. If Resider. ce: # People_ # Bedrooms # Bathrooms_2 ]Dishwasher [ ]Garbage Disposal [ ] Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing i 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers l' If Foodservice: # Seats,.EstimatZ'ell ter Usage (gallons pet'day) 7. Type of water supply: [ ]County/City [ ] Community 8." `Do you ar ticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [ ] No If yes, what type? ' - EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:*** IMPORTANT *** A.D=OF THE PROPERTY MUST BE y SUBMITTED WITH Tim APPLICATION. i Y Pro pert ;Dimensions: ��S /� 2 WRITE DIRECTIONS (fromVcksville) TO PROPERTY: Tax Office PIN: #� -ff,,jj - �� v ��� So tt i� &NPS_/ J.71 6/) Property Address: Rold Name G ' City/Zip C/ISO�%� i r If in Subdivision provide information, as follows: Name Section: _ Lot #: �. y, �i q , This is to certify that the.information provided is correct to the best of my knowledge. I understand that any permit(s) issued 'r--eafter are subject to�suspension or revocation, if the site plans or intended use change, or if the information submitted in this applicatiot. is 'sifted or changed. I, also, understand that I am responsible for all charges irrurred 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 to conduct ll testi procedaas cessary to determine the site suitability. DATEcZ SIGNATURE I Revised DCHD X06-96) THIS AREA MAY BE USED FOR DlaW I NCS YOUR SITE PLAN: a APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC Davie County Health Department- Environmental - - Environmental Health Section L L/ \\ P.O. Box 848 RN Mocksville, NC 27028 MAY _ 91997 . (704) 634-8760 I ****IMPC9RTANT**** THIS APPLICATION CANNOT BE PROC THE REQUIRED INFORMATION IS PROVIDED. i 1. Name tote Billed hheH SZIn Rrl Contact Person ' Mailing Address Q I#ome Phone 29751 . City/State/Zip �& + - a Zo F Business Phone g 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip + 3. Application For: ]Site Evaluation [ ] Improvement Permit &.ATC ' [ ] Both PP L P 4. System to Serve: [ ]House [ obile Home [ ]Business [ ]Industry [ ]Other 5. If Resider. ce: # People_ # Bedrooms # Bathrooms_2 ]Dishwasher [ ]Garbage Disposal [ ] Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing i 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers l' If Foodservice: # Seats,.EstimatZ'ell ter Usage (gallons pet'day) 7. Type of water supply: [ ]County/City [ ] Community 8." `Do you ar ticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [ ] No If yes, what type? ' - EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:*** IMPORTANT *** A.D=OF THE PROPERTY MUST BE y SUBMITTED WITH Tim APPLICATION. i Y Pro pert ;Dimensions: ��S /� 2 WRITE DIRECTIONS (fromVcksville) TO PROPERTY: Tax Office PIN: #� -ff,,jj - �� v ��� So tt i� &NPS_/ J.71 6/) Property Address: Rold Name G ' City/Zip C/ISO�%� i r If in Subdivision provide information, as follows: Name Section: _ Lot #: �. y, �i q , This is to certify that the.information provided is correct to the best of my knowledge. I understand that any permit(s) issued 'r--eafter are subject to�suspension or revocation, if the site plans or intended use change, or if the information submitted in this applicatiot. is 'sifted or changed. I, also, understand that I am responsible for all charges irrurred 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 to conduct ll testi procedaas cessary to determine the site suitability. DATEcZ SIGNATURE I Revised DCHD X06-96) THIS AREA MAY BE USED FOR DlaW I NCS YOUR SITE PLAN: F • 4 � V I •� s e r t r e' O� 4 o t �► ._ av��s ,.I N.'u �I Q�rN 4eN • � • � • � ` is l� .� �' j � d+ �• ; l w .fir♦ tt • lO G � w I Y 79♦ rt � Z s,- O � ( ' '� .. O"• � 3b h s X37 ge SO 31 tAl v s t1y s Cr k • ab a f®r OX O 1 , •`� O a �• s Q r� N " v v I 10 1 I; ee+mJ tAat tbb �Gyl : n s UysA Q t �. me) (deed deaeriPtion \ .S".S' e f ` \ d rx 3C� ure aseaieu13te6 ham- '�► a.�` ��1 /�'°�J•, .�.� i 3 4, -,own im broken tines A� ook Pie----% I • ' a rdance wft% G. S. 47a0 Seat this Lf—doy of DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT'S NAME 5 C? PROPOSED FACILITY SUBDIVISION ` , DATE EVALUATED SECTION LOT L4 5- 3 0- q1 PROPERTY SIZE X nL,-i: d ROAD NAMEC]�p5 C -5"L,3 4� Water Supply: On -Site Well ✓ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position S Slope % - HORIZON I DEPTH to, Texture group Consistence =ate Structure Mineralogy "VA HORIZON II DEPTH `? w Texture groupC Consistence F` Structure Mineralogy, ) HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON -- SAPROLITE — — CLASSIFICATION . S. ,S LONG-TERM ACCEPTANCE RATE y %14 SITE CLASSIFICATION: Q '� LONG-TERM ACCEPTANCE RATE: JA EVALUATION BY: OTHER(S) PRESENT: REMARKS: S ;at sa� - V \ � �' - A o'' LEGEND Landscaue 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) ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■ ■■■■■■■■■■■RI■//ll■■SII■■!■A ■■■■■■■■■■%■■■:1\\'Mil\■■�i}I� ■■M■■■■■■N/.■■ll■■►a\ ■i1f■■■fl ■■■■■■■■■■■■■■■■■■■■ 1111■■ ■■■■■■■■■■■■■■■■■■■■■■iii ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■ ■■MNO■ ■MMN■■ MONS■■ ■■■N■■ ■■MNO■ ■■MM■■ ■M■M■■ ■■M■■■ ■■MN■■ ■ ■ ■ ■■M■MM■M■■■■ ■M■■■■■M■M■■ ■■MMM■M■■■M■ ■■■■■M■MM■■■ ■■M■MM■M■■M■ ■■M■M■■M■■■■ ■■■■■■■MM■N■ ■■■■■M■M■■■■ ■■MN■■■■MM■■ ■■■■MOMM■■M■ ■■■M■■NM■M■■ ■■M■■■M■M■■■ ■■■■M■M■■■■■ ■M■■■M■■M■M■ ■■■■M■■M■■■■ ■■■M■■■M■■■■ i ■ ■OM■■N■ ■■M■M■■ ■■M■M■■ ■■■■■■■ ■■M■■M■