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161 Sonora Drive Lot 6DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000784 Tax PIN/EH #: 5870-24-6217 Billed To: Lori Ann Lewis Subdivision Info: La Quinta Sec.2 Lot # 6 CwmeAv41,15) Reference Name: Lori Lewis Location/Address: Sonora Drive -27006 Proposed Facility: Residence Property Size: See Map ATC Number: 2203 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type DW M ODAAC-- #People :S #Bedrooms 3 #Baths Z Dishwasher: 21"'� Garbage Disposal: ❑ Washing Machine: ET� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �11D xIOoa Type Water SupplyCodn1TY Design Wastewater Flow (GPD) 3Co0 Site: New Repair ❑ System Specifications: Tank Size VbQL'1j'AL. Pump Tank GAL. Trench Width 3& "Rock Depth Linear Ft._� Other: Z 'D+STe+ 0.3 tz�S , IrJ STp,U_ L,1 91 O.G. It Required Site Modifications/Conditions: -At—� .`1 C—V'jTdJ 2 O-1 10 oA:: PQEQ, Vt�� V -..4a - G /14. /mak IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 K BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** Qpp2ou.. gip' 1L' r. Environmental Health Specialist's DCHD 05/99 (Revised) 1 1' 'teml..j. Date: 99 w Account #: Billed To: Reference Name: Proposed Facility: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 99000p784 Tax PIN/EH #: 5870-24-6217 Lori Ann Lewis Subdivision Info: La Quinta Sec.2 Lot # 6 s! y' LoriLewis Location/Address: Sonora Drive -27006 Residence Property Size: See Map ATC Number: 2203 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatmept and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONS S V FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) APPLICATION FOR SITE EYAWATiON/111PROVEMFM PERW'& AT Davie County Health Department V Envlranmental Hwith mon SEP Z 1 1999 P.O. Boa 848/210 Hospital street Mootsvillol NC 27028 (336)751-8760 * * * nW0RTA1M * * THI8 UPLICKTi0D CMW BE pR MSZD U=88 DIS. THE REQUIRED nITORIMION IS I?ROVIDED. Rater to ti:e INVORIATION BUM STIN for instructions. i. Mama to be sand 1.zg:i Contact Domm Loy,', Lil" n Bailing Aaar.ss toSW V, 'i n kava Ml�",r(} bz:�- 4 acme shone city/state/211? V-�A��"OUJ n , IU of Vo� swim... phone I R" �XD f T C��`o (,mob a. Mama on V*suLt/A= it Ditleren: than Above Bailing Addgess _.._ CLLTistate/sip !. AMILoat.ion torr. 13 Site ZVel:tation 13 Improvemet:t hermit/DTC */Both -OoLAW e, Wide, 4: Ratan to servioes El Hotlae Mobile Home 11 Bnainess 13 Industry O Other _ 5.. It Residence: i People 3 i Bedrooms i Bathrooms a 4d OishxasMv O garbage Disposal 04tehing Bachine a assaant/plusbina 0 sasamaat/Mo alnsbiaq auainesa/sndnat y/othes: spoon: type i D•ople . i sink. i COmmodes I ahoNess i Urinals i water Coolers It 1't)t]D8&MC=: : # seats Estimated water Usage (gallons per "y) d 7.,, Type of rater supply: 0 County/CityC=tea4 1 a Community e Do you anticipate addition or expansions of the SeWty this systemserve? O Yes VNo if yes, what type? ***IMPORTANT*** 0iE1 M ME5TCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUMI M BELOW. Either a PLAT or SITX PLAN MEISTBESIJBMITTED by the etlent with TPIS APPLICATION. NW -i: �cutseny aaimenga®oss S� (os 80 , D q D $� :a�'Ss' WRITE DMECnONS (EEom M0ebv111e) 40 NVMPERTY1 Tax Office PINS . , . N J -g �� a - % a) t7 CT� & Qx0 1 bR Prig -i Ow" &-r N (,d k cdamM6� Property Address Rad Name S0 w pa t)?� eun, 1,eo n SD I So CHyaip --ft�V6 rn 0 %d Gj j2a sA- - e -h wJ 1�w an a � • T� If In a Subdivision provide loformation, as follows: V:10i on W,11 C.)Q+ tie. CRO 4V 2be 613n -}Me K'b1A, on rnvGCs chkr, • 1ti Sivp IS16, Name: _ Q LA 'Wxym are V)eA6,a.r g ", C-fO 31q m1e_, -VAer) Left on LO-Qw ol4k Dr2. -rOxn (..c1- on Sdho2m Dp_. Secdout z I- Bloclu - Lots Date Property Flagged: '?49-99 GO I/10 rx le Aeecss ern This Is to certify that to Informatloo provided Is correct to the but of my knowledge. I understand that any permits) issued hereafter are subject to suspension or revocstion, If the site plans or Intended use change, or if the Information submitted in this application Is falstlled or changed 1, also, andermid Iket I am responsible for sll ciarges incurred from this appOesdom '.D,,hereby, give consent to the Authorized Representative of the Davie County Halth Department to enter upon above described property located In Davie County and owned by Lb Ry Ann L4,wiS to conduct all testing procedures as necessary to determine the site suitability. DATE U'S'iSG`.LLi 1�'R(Ci THIS ARRA MAY BE USED FOR DRAWLNG YOUR SPCE PLAN (Lu nde all of the followings Existing and proposed property lines and dimensions, struetams, setbacks, and septic locations). Site Revisit Charge zo 1 Dete(s)t Client Notification Data X C, o Est_ a� PL -- 1� W Accr.w2 No. �, max, i51a 5q.- � x R DC®(07!99) �3 Invoice No. qqq • � LA O�UINTA CORY. \ 1 III::. \ \ I • s9s z� 4 p ZO '� q 9,c f ej0 Or'f sc ?3 DRIVE (60' 'K/W) /N CORP. RL1k1E CURVE DATA LA OLU1UTA - SEC 1 Miir 1 r P LFAT BOOK v- PAGE in —/ 0 41 tv °I �Z °I V1 O n 't SAN MARCOS DR_ 3 �o OON W IP� LA QUIN1-A - SEC. 1 MAP N J �J PLA_T ROOK 4 - PAGE 128 1 CL10L c Ja � � I r� r v � J SEC. 2 -LA---QUINTA' �%w4s' z,- W SWADY GROVE TSP.- DAVIE CO N' SCALE I'— 100' \\\\ 1 0 can K WAYNE H011TQN, A.L.S. IJOS. A. JOHNS, ,bN, Jit., P. F. I WINSTON • SALEM. N• C. r �DAVIE COUNTY HEALTH DEPARTMENT .4 Environmental Health Section * Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000784 Tax PIN/EH #: 5870-24-6217 Billed To: Lori Ann Lewis Subdivision Info: La Quinta Sec.2 Lot # 6 Reference Name: Lori Lewis Location/Address: Sonora Drive -27006 Proposed Facility: Residence Property Size: See Map Date Evaluated: toll 2 Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit +� Cut FACTORS 1 2 3 Pray-# I -rAy 6 7 Landscape,position (, L Slope % 7p qo !o HORIZON I DEPTH ` 6-1., Texture group G G G Z_ �- Consistence -r P SSS Structure C;74 C_fZ Mineralogy ; 1 t 1 1; 1 HORIZON II DEPTH Ll - 2�_ cup " 22 -1 _ 10 Texture groupG C Consistence . ; Structure S IL S8 k SG V Mineralogy /: I I: 1 1, \; HORIZON III DEPTH �'J(a Z -2 /& -24, (11-30 Texture groupG r e, Gly CFS c .� Consistence Ei SP; Structure 41S k- MineralogyI 1 HORIZON IV DEPTH i 7 - Texture rou UL Consistence $S Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE .. 0.. O, SITE CLASSIFICATION: T, EVALUATION BY: �!��jft,;1�.G1•u� LONG-TERM ACCEPTANCE RATE: d� , OTHER(S) PRESENT: REMARKS: #f V_ OP P(, 6TWX6 � Z�„ ave'k_ 0sj Sc9'EF-4c d 8PT-L) P 1 TS LEG ND 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 DCHD 05/99 (Revised) ■ ■ ■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■ ■■■■■ ■■■■■■■m■■■■ ■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■m■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■e■■U■■■■■ ■■■■■■■■■■■■ ■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■m■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■ ■■■■■ ■■■■■■■■■■■■ ■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■e■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■ ■li�irilirrriir�rirr7Grrri�rrr�Giiirirrrmrrfl■■■■■■■■■■■■■■■■■I ■■■■■■■■■■■■■■■■■■■■I■■■■■■■■■■■■■■■■■IM!■■■■■11■■■■NONE ■■■■■■■■■' ■■■■■■■■■■■■■■■■■■■■I■■m■■■■■■■■■■■■■E`fir■■■■■■Ilv�►_�7■■■■■■■■■■■■■■. 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