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154 Calvin Lane Section C Lot 18 AAUTHOrtI7ATION NO: 1747 DAVIE COUNTY HEALTH DEPARTMENT CL . ,Environmental Health Section PROPERTY INFORMATION Permittee's P.O. Box 848 Name:�� —'�ILI-fin Mocksville, NC 27028 Subdivision Name: c�-� -751-8760 Directions to property: l^i� IS 7 tl �b��^�V Phone # 336 Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# -7 c, SYSTEM CONSTRUCTION Road Name: �C : ,t.n� ST— 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/AuthorizationNumber should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliancewith Article 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. TH SPECIALIST - DAYT 1 UED a r_ % DAVIE JOUNTY HEALTH DEPARTMENT IM ROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Subdivision Name: T Directions to property: - t 1 t E �i r +" �� ` i Section: Lot: UvIPROVE)4ENT PE" Tax Office PIN:# Road Name: it rt 6 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) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE ` 11 th PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAgHEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE r F # BEDROOMS , # BATHS L— # OCCUPANTS r GARBAGE DISPOSAL: Yes ork-q_�) COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No f LOT SIZE �>C �WPE WATER SUPPLY )�TY DESIGN WASTEWATER FLOW (GPD) - [ 0 NEW SITE v.""e REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE L Odl0 GAL. PUMP TANK GAL. TRENCH WIDTH _�& ROCK DEPTH I Z LINEAR FT. 3"' OTHER i D15- // rt5L2r D d 7y X REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT L. -CJ% o, T _ O �G I'1 X v N **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: To L_rt-%2& It)flI Y2_1, ®� . AUTHORIZATION NO. / OPERATION PERMIT BY: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIB A OVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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 WELL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) APPUCATION FOR SITE EVAWAMON/IMPROVEMENT PERMIT do ATC Davie County Health Department Environmental Healib SmWon P.O. Box 848/210 Hospital Street OGT 1, 3 �g98 Mookoville, NC 27028 (336) 751-8760 E1IYIIl IEOCOUfdT HEALTH ***nWORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Contact Person Nailing Address S o 4T Rome ph C/—o? city/state/zip ,y4 & Business Phone 2. Name on Pe=It/ASC if Different than Above Mailing Address City/State/Sip 3. Application For: U Site Evaluation 0 Improvement Permit/ATC 194oth 4. system to service: 0 House ®'Mobile Home 0 Business 0 Industry 0 Other a. If Residence: i People i Bedrooms 9 Bathrooms 0 Dishwasher O Garbage Disposal wwaashing Machine I] Basement/Plumbing 0 Basement/No Plumbing 6. if Business/Indnstry/other: Specify type ! Commodes t Shovers f people • sinks # Urinals i Nater Coolers Ir rOODSERVICE: fi Seats �� Estimated Nater Usage (gallons per day) 7. Type of Nater supply: id" County/City 0 Well 0 Com=nity e. Do you anticipate additions or expansions of the facility this system is Intended to serve! 0 Yes 0 No If yes, what type' ***1MP0RTAN7*** CLIENTS DIUSTCOA(PLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN d1UST BESURUITTED by the client with THIS APPLICATION. Property Dimensions: Lin pI2�X. Tax Office PIN: dd0 DIRECTIONS (from Moc Ile) to PROPERTY: Property Address: Road Name_ 6 2 City/Zip /I/ 1(►C yi & If in a Subdivision pro de information, as follows: Name: Section: lock: Lot: � Date Property Flagged: ! a / — 16 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 lnformation submitted in this application is falsified or changed. 1, aLw, understand that l ars reVornible for all charges incurred fronr this application. I, hereby, give" consent to the Authorized Representative of the Da C ty Health Deptwent to enter upon above described property located in Davie County and owned by ., to conduct all testing procedures as necessary to determine the site suitabilih'. DATE /0 3 l tai SIGNATURE &Lud -24�/ 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). Revised DCHD (07198) Account No. 'g 0 a Invoice No. 36 s ♦ i� i Date Property Flagged: ! a / — 16 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 lnformation submitted in this application is falsified or changed. 1, aLw, understand that l ars reVornible for all charges incurred fronr this application. I, hereby, give" consent to the Authorized Representative of the Da C ty Health Deptwent to enter upon above described property located in Davie County and owned by ., to conduct all testing procedures as necessary to determine the site suitabilih'. DATE /0 3 l tai SIGNATURE &Lud -24�/ 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). Revised DCHD (07198) Account No. 'g 0 a Invoice No. 36 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION C LOT 187A Soil/Site Evaluation APPLICANT'S NAME Okf,� 'fi <:SPI 1 LA4AAJ DATE EVALUATED ) t I4'"l E PROPOSED FACILITY K. I'FO�Me PROPERTY SIZE ,t`i0 , q�D 4 SUBDIVISION �I o AY Ac¢�S ROAD NAME Po&erj S' Water Supply: On -Site Well Community Public V Evaluation By: Auger Boring Pit ✓ Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % c HORIZON I DEPTH Texture groupL Consistence r 5 Structure Mineralogy HORIZON II DEPTH -1 Texture group C Consistence v` Structure iL Mineralogy1 1 HORIZON III DEPTH -"3 2 U - Texture groupGk Consistence S Structure c Mineralogy; HORIZON IV DEPTH Texture group Consistence Structure G 1j Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: Ps LONG-TERM ACCEPTANCE RATE: �• REMARKS: LEGEND Landscape Position EVALUATION BY: \ �" OTHER(S) PRESENT: 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 (O1-90) ■ ■ ■ i ■■M■■ ■■NE■ ■■NE■ ■■■E■ ■EN■■ ■EN■■ ■■N■■ ■■■M■ SEMEN MENNEN MENNEN MEMENE MENNEN MEMN■N MEMN■N MENNEN MEEMEM NEEMEM MENNEN M■N■■N ■■■mm■ mmm■mm m■mm■m MENNEN NEENME M■N■■N MENNEN MENNEN NEENNE MEMN■N MEMENE MENNEN EMM■NS MENEM MENEME MENNEN MENNEN ■■■■■■ ■■■■■■ MONS■■ ■■M■EM■ ■■MEMS■ ■■EMEM■ ■■■mmom ■■■■ME■ ■M■■ME■ MMEMMEM ■■■M■■■NE■■■MEN■ ' ■■MEM■■ ■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■ ■■ ■ ■■ ■■■ ■■■ ■ ■ ■ ■ ■■■■■ ■ ■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■ ■ ■■ ■ ■ ■ ■■■ ■■■ ■ ■ ■■ ■ ■■■■ ■ ■ ■ ■■■■■■■■■■■■■■■■■■■■■■■■■ N■MM■ ■M■M■■M■■■MNEWSMEN m■mmmi■mmEEMEEMMEMENNEEMEM ■M■■■.■MEN■E■M■M■1U■N■■MME MMENEVEMMMEMMEMEEMEEMEM ■■■■■,■■■■■■■NMN■■■■■■■NE■ H■mm■mmMEMN■NMEMN■N� ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■E■■■■E■E■■■■■■■■ ■■■■■'■■E■■■■■■■■UMME■■■■ ■■■ENS■■■■SEEN■■■■■■■NMN■■ ■■■■■■E■■■■■■■■■■■■■EEM■■ ■■■■■■■■■■■NMN■■■■MEE■■■■ ■■■■■■■M■■■■NEM■■■■■■■■■■■NMN■■■■■■� ■■■■■■■■■m■■■■E■■E■■■■M■■■■■■■■■■EMS ■■■■■■■■■■■■■■■■■E■■■■■■N■■■■■■■■ENS ■■■■■■■M■■■■■MME■■■■■■ ■■■■■EEE■■■ ■■■■I■IE��■It■tl`v��iji�!�■■�i�i■■■■■II■■■■ MEMEMEMMEM ■E■■E■E■■■ MEMO■■■■■■ ■M■■E■EM■■ ■E■■■ME■■■ ■■■■mons■■ ■E■■■MEM■■ ■E■■EMM■■E MENEMEMENE MEEMEM■MME MENMEMEMNE EMEMMEMMEM MEMMEMENEM MENEMEMOME MEMMEMMEEM MEMEEMEMEM MENEEMENEM MEMEMENMEM MEEMMENNEM MMEMEM■EEM NEEMMENEEM ENNEMEMENE UNEMENEEME ■■MME■■■■■ MEMMENNEME ■■■■mmmm■■ ENEEMENNEE m■■■mm■mm■ MMENEEMEEM MEMENNEMEM EMMENNEMEM NEENNNEMEM mommommmom ■E■■■■ME■■ MEMEMENNOM EMEEMEMEME EMEMEMMEME EMEEMENNNE NEEMEEMENE EMENNEEMEM ■■■■■■■EE■ ■■■■NEEM■■ ■E■■■■■N■■ ■■■N■■■■■■ ■■■■■■■■■■ ■■■■■EN■■■ ■■NOMMEN■■ ■■■■■■■■■■ ■■■■■■■■■■ ■■NEEM■■■■ ■■■■ME■■■■ ■■■■EON■■■ ■■■M■■■■■■ ■■M■■■■E■■ ■■■■■■■E■■ ■■■NEEM■■■ ■■■■■■■M■■ ■EE■■■■■■■ ■■■■E■■N■■ NEEM■■■■■■ ■■■■N■■■■■ ■EM■E■■■■■ ■■■■■■■■■■ ■■NE■■■E■■ ■■■MEM■■E■ ■■