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206 Calvin Lane Section C Lot 12Ar'.,,r k, "'�`.w4...sji.r�i.`..Y of +'r...�..Ti1_iti .',.y,..v..:�� _..,�:....at '��..br .. .l.t —`•,. . sa .�v 'ts..�.xry .., ,�{..,'_ .,YJr,�.-/.., .. `. ., ..r-`.,,-. .. . .... AUTHORIZATION NO: DAVIE Ct OUNTY HEALTH LT DEPARTMENT/ �2 Environmental Health Section PROPERTY INFORMATION Permit tee's P.O. Box 848 Name:Mocksville, NC 27028 Subdivision Name: L/L��' �l JJ� Phone # 336-751-8760 Directions to property: Section: Lot: AUTHORIZATION FOR J WASTEWATER Tax Office PIN:# 5 ��/7? SYSTEM CONSTRUCTION t_ - C, Road Name: cJYzip: L w I� **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 IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONKIEHEALTH SPECITMST DATE ISSUED -- . .„ 1741 DAVIE COUNTY HEALTH DEPARTMENT \i. IMPROVEMENT AND OPERATION PERMITS PROPERTY IJNFORIVIATION Pe ittee's t 1�! r < f OL Name, `+� i .� i 1L� Y'4+� �/ Subdivision Name: Directions to property: !,/..'+��' �_ -t Section: Lot: IMPROVEMENT PERMIT Tax Office PIN:# Road Name: I T Zip: _ / k.i. 6 **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) fe4f,liATTI'.T,Y,tle TTTTC� TTn➢RTT 70 0TM TT`1"rV TA TTLVR7A/'� A TTAAT TV CTTL' .. /^•i, -.�-awaaa.a. as ,�i...a .. PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE ii INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE I V` E1 # BEDROOMS # BATHS An # OCCUPANTS GARBAGE DISPOSAL: Yes 4_40 COMMERCIAL SPECIFICATION: FACILITY TYPE l # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE ���'� qu'IYPE WATER SUPPLY(., �,'DESIGN WASTEWATER FLOW (GPD) NEW SITE �/ REPAIR SITE I) )/ SYSTEM SPECIFICATIONS: TANK SIZE L QeGAL..PUMP TANK GAL. TRENCH WIDTH`�-XO ROCK DEPTH LINEAR FT. OTHER i �T� l�t�tC?N 31WC4 REQUIRED SITE MODIFICATIONS/CONDITIONS: I'`� nl-L (�� C rr -TOLAA 14. o 'Q� �1�� `o -o • L 1��� `FL J , ow IMPROVEMENT PERMIT LAYOUT 5 LI o _ 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. I OPERATION PERMIT SYSTEM INSTALLED O)A 4W, c AUTHORIZATION NO. 7qjOPERATION PERMIT BY: 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) APPUCATION FOR SITE EVAWATION/IMPROVEMENT PERMIT do ATC Davie County Health Depatiment 7OCT EnvirOMenfal Health �On 3 (998P.O. Box 848/210 Hospital Street Mockaville, HC 27028 (336)751-8760 ENVIRONMENTAL HEALTH ***IWpRrA?rZ*#t THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed ! 4-) er t- J J 1 01 PV7 Contact Person `� / Nailing Address / Bome Phone 7 City/State/ZIP 11 , , 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 doth ®' 4. system to service: I] House Motibile Home 0 Business D Industry 0 Other s. If Residence: # People # Bedrooms # Bathrooms _ 0 Dishwasher O Garbage Disposal WVI;hing NACha.ns O Basement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/other: Specify type # People # Sims # Commodes # Shavers # Urinals # Rater Coolers IP FOODSERV'ICB: # Seats Ratimated Nater Usage (gallons per day) 7. Type of Nater supply: County/City 0 Nell 0 Com iunity 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 COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AIUST BESURUITTED by the client with THIS APPLICATION. Property Dimensions: 144X oda Tai Office PIN: #z Property Address: Road Name � 0 Ls G i City/Zip /C S,Yt e— If in a Subdivision pro de information, as follows: Name: J Section: lock: Lot: DIRECTIONS (from Moc Ile) to PROPERTY: 91-9— Tax /`9 t y/ i Date Property Flagged: This is to certify that the information provided is correct to the best or 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 Inrormation submitted in this applicatloskirfalsifled or changed. I, also, understand that l am responsible for all charges incurred from this application. 1, hereby, glye consent to the Authorized Representative of the Da C ty Health Depa meat ; to enter upon above described property located in Davie County and owned b? _r(7i? h' v�+ i� i �1-1'l�� 11 to conduct all testing procedures as necessary to determine the site sultabillhy. DATE\ �p'� V 43 l k SIGNATURE J,I THIS'AREA 1HAY BE:USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property,linea And dimensions, structures, setbacks,Apo septic locations). S� Account No. Ao 1l Invoice No. �d DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION C-1 J Soil/Site Evaluation APPLICANT'S NAME—�`��Lt^"^ DATE EVALUATED (117314123 PROPOSED FACILITY, 1 M • e,//.��,.��� PROPERTY SIZE 1 e� x33 SUBDIVISION .�-t-t ,Qg4Y f- af4ROAD NAME a65V3 f�t' Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Sloe % o �� HORIZON I DEPTH Texture group1- Consistence Structure Clk MineralogyI : " HORIZON II DEPTH vt Is -71.. Texture groupG t Consistence ; Structure k Mineralogy`► HORIZON III DEPTH Texture group Consistence Tr j Structure ([ Sg14- rr-, Mineralo HORIZON IV DEPTH Texture group Consistence sp Structure (10- Mineralo Mineralogy : v ; SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 1 6,4 1 ©. D C SITE CLASSIFICATION: 1 J EVALUATION BY: T LONG-TERM ACCEPTANCE RATE. (9-4 OTHER(S) PRES$NT:, REMARKS: DCHD (01-90) 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 ■ ■ ■ ■■■■■■i■■■■■■■■■■I ■■■■■■i■■■■■■■■■■ ■■■■■■i■■■■■■■■■■■ ■■■■■■i■■■■■■■■■■■ ■■■■■■i■■■■■■■■■■■ ■■■■■■i■■■■■■■■■■■ ■■■■■■i■■■■■■■■■■■ MEMO MENNENEMEMINiMMEMEM ■■ i ■ i ■■■ h_:."IM: ■wimad .:::: WOMEN ■mM■■ LWAMME AMMON ISA.■■ ■ENEM ■m■■■ ■■■M■■MM■MMM■M■■■■■ ■E■E■■EME■OM■M■■ME■ ■■■M■MEME■■MEME■ME■ ■■■EM■OMMEM■■ME■■E■ ■■■M■■MM■M■■MMM■■M■ ■■■E■■ME■■■■EMMEM■■ HEINMEME MENNENMEMMEM ■■■■■i■■■■■■■E■■ ■■■■■IME■■■■■■■■ ■■■■■i■■■E■■■■E■ ■■M■■i■■■■■■■■■■ ■■i■■t■i■■■■■■■■■■ ■■irnmi■■■■■■■■■■ ■■i■■■i■■■■■M■■■■ ::A■■i■■■■■■■■■■ ■■■■Mi■■■■■■■■■■