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188 Calvin Lane Section C Lot 14.. : P'�L W ..I s { f:,. '! ; '^e�1. ;a 1. ..Jy,; , . ,- n , ' '7 ., y ;t .. . 9 ., r;J':.y '-f •r .o , . ". `...,,.; i-u .._ ..cy-. ._ .. Al,THOR,ZATION NO:DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P OPERTY INFORMATION Permittees'P.O. Box 848 Name: G -� LI_ AN � Mocksville, NC 27028 Subdivision Name: 14DLI AV k—kc I Ole, 7 f, ����� Phone # 336-751-8760 (� Directions to property:—�=�'�,-=�� Section: � Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SWf (4/ - SYSTEM CONSTRUCTION Road Name: �!�j n% �T Zip: (':)2'9 **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) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION s 11 iqhv IS VALID FOR A PERIOD OF FIVE YEARS. VIR0NMtT4T-At71fIfALTIi SO ,. LIST DAT ISSUED a ' 7 4 Z DAVIE C OUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS 4OPERTY INFORMATION Perritt e's Name:: �� f 't t .'�'1 ; 1LL ANA Subdivision Name:14 Ll Directions to property: '' - r Section: -.-" Lot: IMPROVEMENT PERMITTax Office PINjj:# r Road Name:' i ;� 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 l l of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) j ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE it /,t ;`,' PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONME TAL �IEALTH SPECIALIST DA ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE _1V10 # BEDROOMS -5 #BATHS 2 # OCCUPANTS GARBAGE DISPOSAL: Yes 4SO COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No t LOT SIZE I C d )f STYPE WATER SUPPLY 1 !V t 1 DESIGN WASTEWATER FLOW (GPD) NEW SITE V REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH X., ROCK DEPTH &I LINEAR Fr. ,-= OTHER T? DX�S REQUIRED SITE MODIFICATIONS/CONDITIONS: � TALt 014 ar tylz -,P 10' &rrr FQ9 L1 ^I L Fic?2)SLf'S IMPROVEMENT PERMIT LAYOUT -Race, t,.trJ 40' ls� ST ki `.� T .4 "*CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR J:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. OPERATION PERMIT O f SYSTEM INSTALLED BY: Nor,, C 1 _ O^ ff AUTHORIZATION NO. OPERATION PERMIT BY: , DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYS ESCRIBED 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 EVAUTATION/IMPROVEMENT PERMIT do ATC � Davie County Health Department L5 ll Environmental Healfh Section P.O. Box 848/210 Hospital Street OCT 13 1998 Mockaville, NC 27028 (336) 7S1-8760 ENVIROIdMEPdTA1 HEALTH nmr rni]PITV f ***nV0A7ANT*** THIS APPLICATION CANIM BN PJW=S= UNLESS ALL THE REQOIREO - INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. i. Dame to be Billed 16, SK, 4,41 �i P contact Person (y Mailing Address 7Q� Home Phone City/state/ZIP /� �('1 i A Vi //-P & C, ;/�(\ Business Phone 2. name on Permit/ATC if Different than Above )!ailing Address city/state/Zip , 3. Application For: U Site Evaluation 0 Improvement Permit/ATC Doth 4. System to service: 0 House &i;obile Homo 0 Business 0 Industry ❑ other a. If Residence: # People _ # Bedrooms # Bathrooms 0 Dishwasher 0 Garbage Disposal ashing Machine 0 Basement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/other: specify type f People # Sinha # commodes # showers ; Urinals i Nater coolers IF FOODSERVICE: If Seats _� Estimated stater Usage (gallons per day) 7. Type of water supply: lt<f 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 .F. yes, what type? ***IMPDRTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either s PLAT or SITE PLAN MUST BESURM11TED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: d Property Address: R+ C to PROPERTY: If in a Subdivision pro de information, as follows: Name: Section: lack: Lot: / Date Property Flagged: 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 Kiat l am responsible for aft charges Lrcurred from this application. I, hereby, give consent to the Authorized Representative of the DAoyaty Health Depa ment to enter upon above described property located in Davie County and owned by � (ca �j�; r`��ti�.� y� to conduct all testing procedures as necessary to determine the site suitability. DATE�V�' r SIGNATURE-- 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). nP� Revised DCHD (07/98) f (koly- I-Jfl Account No. ego d Invoice No. 561 ` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION G LOT` Soil/Site Evaluation APPLICANT'S NAMEDATE EVALUATED �, O PROPOSED FACILITY 1 " �' t c`�"� PROPERTY SIZE SUBDIVISION t16 LVQ�� Water Supply: On -Site Well Community Evaluation By: Auger Boring .01" Pit ROAD NAME _ H 02rcrA Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % p HORIZON I DEPTH - 0 -to Texture grou 1-5�4,f Consistence 1 S Gc Structure GL CL- Mineralogy1:1 HORIZON II DEPTH Texture groupC G Consistence rr 5 Structure 5 011 �k Mineralogy HORIZON III DEPTH 7 2 . so Texture group C } Consistence -r S f 5SSV Structure k Mineralogy1 I 1 f HORIZON IV DEPTH W4 -S Texture group Consistence Structure k Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE SIZE C:LASSIFIC:ATIUN: 1 LONG-TERM ACCEPTANCE RATE: D 3� REMARKS: LEGEND DCHD (O1-90) Landscaae 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 ■■ NOON■■■■■■■■■■■■t■■■■■■■■■■■■■ ■■■■■■■■■■NOON■■■■■i■■■■■■■■■■c■■■■■■■■■■ ■■■■■■■■■■NOON■■■■■i■■■■■■■�■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■I■■■�iiiiiii iiiiiiil■■ ■■■■■■■■■■■NOON■■■■I■■■■■■■■■YGi�■i■■■■■■■ mom E■ ■E■ ■■■■ ■■■■ ■■E■ NONE MEMO ■■■■ ONES ■■■■ ■■■■ ■■■■ MEMO NONE MEMO MEMO ■■■■ MEMO MEMO NONE ■■■■ OMEN MEMO MEMO MEMO NONE MEMOS ■■■■■ ■■■■■ ■■■E■ ■E■■■ ■E■E■ ■■■■■ ■■■E■ ■■■E■ ■■NE■ SOMME ■■NE■ ■ ■ NONE ■NO■ ■ ii ME No ME No ■■ no •'¢ APPLICATION FOR SITE EVAWATION/IMPROVEMEIIR PERMIT di ATC Davie County Health Department '\ • • \ Environmental Health Section AVd,5" P.O. Box 848/210 Hospital street �ck Ile, NC 27028 �896)7S1-8760 1� ***IMPORTANT*** THIS APPLICATI CANNOT DE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer' to the INFORMATION BULLETIN for instructions. 1. Name to be Billed 111k Q Contact Person •[' (� Nailing Address11,146 _ Home Phone / City/state/ZIP 2. Name on Permit/ATC if Different than Above Business Phone Mailing Address City/state/Zip 3. Application For: U Site Evaluation 0 Improvement Permit/ATC Oth s. system to service: IJ House ®'Mobile Home ❑ Business 0 Industry ❑ Other s. If Residence: # People # Bedrooms 2 # Bathrooms 0 Dishwasher 0 Garbage Disposal wv"—hing Machine O Basement/Plumbing O Basement/No Plumbing 6. If Business/Industry/other: Specify type # People # Sinks # Commodes # Showers # Urinals # pater Coolers IF FOODSERVICE: # Seats Estimated water Usage (gallons per day) Type e of water supply: �� /' 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 MUST COHPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: — M0 X oS 607'- 2 Tax Office PIN: # Property Address: Road Name City/Zip (1C S L 9/ p' 2%6 ll If in a Subdivision pro rms i de infoon, as follows: av Name: � a. e Section: B '!zi / lock: Lot: WRITE DIRECTIONS (from Hoc l� Ile) to PROPERTY: �Q f te,,- 1n L e f-7'-- Date Property Flagged: 10-13-96 This is to certify that the Information provided h correct to the best of my knowledge. I understand that any permit($) 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, aLw, understand that I am responsible for a/t charges incurred from this applica3tion. I, hereby, give consent to the Authorized Representative of the D --"C d ty Heplth Depa menu to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. 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). Account No. Revised DCHD (07/98) Invoice No.