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107 North Hemingway Court Lot 23✓. • •y P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/Fax #(336)753-1680 REPAIR OPERATION PERMIT Account #: 990005811 Tax PIN/EH #: H8060A0023 Billet: To: Ter1y5Carlton Subdivision info: Covington Creek II Lot # 23 Reference Name: REPAIR PERMIT LocationiAddiess: 107 N.Hemingway Court -27006 Proposed Facility: Residental Repair Proper#y Size: 0.60 Acre **NOTE** The issuance of this Operation Pen -nit shall indicate the system described on the ATC. has been installed ATCTIti#MjgA ijqncj5S,6t Article I I 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. Svstem Tvoe: S.T. ManufacturerOff— IOL, Tank Date Tank Size Pump Tank Size System Installed By: JJl,h&� Mt n E.H. Specialist: ate: Z i GPS Coordinate: i DCHD 1 1/06 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 • (336)753-6780 / Fax # (336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005811 Tax PINfEH #: H8060A0023 Billed To: Terry Carlton Subdivision Info: Covington Creek II Lot # 23 Reference Name: REPAIR PERMIT LocationiAddress: 107 N.Hemingway Court -27006 Proposed Facility: Residental Repair Prop% j ❑QM i fi@pair C]Expansion AMMT iFhis5 thorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 1 I of G.S. Chapter 130A Wastewater Systems, Section. 1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use chance. Residential Specifications: # Bedrooms—L— # Bathrooms .5 # People BasementD Basement plumbing. -- Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Lot Size Type of Water Supply: XCounty/City DWell OCommunity Well System Specifications: Design Wastewater Flow (GPD) ELOTank Siz*'��AL. Pump Tank � GAL. 360Trench Width � Max. Trench Depth :_ Rocckk DeepthA,2A Linear Ft. 2 1 0 Site Modifications/Conditions/Other: .. Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 – 9:30a.m. on the day of installation. Teleuhone # (336)751-8760. l lif III-.� T I 1-- , I I I 11 A 1 I 3',RX RA Al eye,/' . w v 1t Environmental Health Specialist ., Date: DCHD 11/06 (Revised) I DAVIE COUNTY HEALTH DEPARTMENT �// 00 ` Environmental Health Section Z's P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Z kLE IMPROVEMENT/OPERATION PERMIT Account #: 989900317 Tax PIN/EH #: 5789-24-4344.23 Billed To: Glory Home Builders Subdivision Info: Covington Creek Sec.2 Lot # 23 Reference Name: Bill Joyner Location/Address: N. Hemingway Court -27008 Proposed Facility: Residence Property Size: 118'X 270' **NAi* Nis Tmpro38 veement/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 I I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION 1F SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type yAo0c c #People #Bedrooms 3 #Baths Z - Dishwasher: O Garbage Disposal: 02" Washing Machine: 0" Basement w/Plumbing: 0 Basement/No Plumbing: 0 Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 13 Lot Size Type Water Supply LpjlDesign Wastewater Flow (GPD) 3(oC) Site: New 0'-- Repair O System Specifications: Tank Size ��GAL. Pump Tank GAL. Trench Width -s(; Rock Depth Linear Ft.3Uc Other: �I S-ri2� g��Tto-�(� ►JST4Ll I�ccS , !] .0 . W�1►J Required Site Modifications/Conditions: �� o� Np,�S;;, �tJ Cly Pi2vP• 1�r5 IMPROVEMENT/OPERATION PERMIT LAVOL T - APPROVED EFFLUENT FILTER. RMER(S) IF 6 ~ BELOW FINISHED GRADE. ****"TICE: Contact a representative of the Davie County Health Department for'final inspection of this l,ystem 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 ( 6)751-8760.**** D �F aPP/1vx.. ,!PZC % -bpI \/�:r 1dMjA.,, Environmental Health Specialist's Signature: I (Revised) Date: 41/iIsle o Q -I>V-T r, JST 3C ;, c, �_ Mu J3✓� PR ts� To �A ��' .J ►J 1 ,J � SYST��- N J Date: 41/iIsle o P?ob0Aon-7,3 6'U0 DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME 61k I jPHONE NUMBER ADDRESS ItlaUALi SUBDIVISION NAME &VIM&AJ AA-<& -ru)o LOT # DIRECTIONS TO SITE 06I10 14W L41 Q6 Aidd&x 41 n�i Ie5 ��11i 1 a�'lI S'�hoa . 110 �i,�u�n fo �Ck--ba- 2�>�Jb DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY ��� NUMBER BEDROOMS NUMBER PEOPLE SERVED �r TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING Awl DATE REQUESTED INFORMATION TAKEN BY This is to oerfify that the information provided is correct to the best of my knowledge. and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev.t/83 < < : Ora 2 -2 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 8481210 Hospital Street Mocksville, NC 27028 (336)751-5760 Account #: 989900317 Tax PIN/EH #: 5789-24-4344.23 Billed To: Glory Home Builders Subdivision Info: Covington Creek Sec.2 Lot # 23 Reference Name: Bill Joyner Location/Address: N. Hemingway Court -27006 Proposed Facility: Residence Property Size: 118'X 270' ATC Number: 2382 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 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEW NS IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa Date: CERTIFICATE OF COMPLETION **!VOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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 will function satisfactorily for any given period of time. TIC M V) Tb �Al. 1 a pwek L4 J: Septic System Installed By: I TI Environmental Health Specialist's Signature: te: 00 DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & A Davie County Health Department Environmental Health Se"b r°" MR 4 2000 � P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 ENVIRONMENTAL HEALTH __ DAVIE COV-, ***IMPORTANT'*** THIS APPLICATION CANNOT BE PROCESSED UNLESS INFORMATION IS PR//OVV-IDED. Refer to the INFORMATION BULLETIN fo instructions. 1 . Name to be Billed (�y�p /0-4�('m /� / �j �Contact Person Mailing Address [) 3 / l_ �/1�P/ �ro✓e Q*rti ^� Home Phone City/State/ZIP �tO�y� /y? D ,11} 1/ ��cl 7V �inesa Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation r`+� � �Improvement Permit/ATC II Both 4. System to service: House 11 Mobile Home I I Business I I Industry I I Other 5. If Residence: • People P # Bedrooms _,-) r Bathrooms t4 Dishwasher Ilt,"rbage Disposal N"Washing Machine II Basement/Plumbing II Basement/No Plumbing 6. If Business/Industry/Other; Specify type Y People d Sinks i Commodes # Showers tl Urinals tl Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of Water supply: 1`t County/City II Well II Community B. Do you anticipate additions or expansions of the facility this system is intended to serve? I I Yes -r•I-Nvv- If yes, what type`' ***IAIPORT.4NT*** CLIENTS 11USTCObfPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AIUST BESUB.1fITTED by the client with THIS APPLICATION. Property Dimensions: 1�/ r 6 ?� � 70 Tax Office PIN: Property Address: Road Name R L City/ZiP JV 1 k -7 c- e If in a Subdivision provide information, as follows: Name: !i i% ,' Y► 9 4 Cr c°e k Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: ep, 17 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 that l am responsible for all charges incurred from this application. 1, hereby, give consent to the Authorized Representative of the Davif County I ealtil Department to enter upon above described property located in Davie County and owned by V- 11I /r/.. , . to conduct all testing procedures as necessary to determine the site suitability. DATE � — ` � - _ ' )� 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). i Revised DCHD (07/99) :i Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. Invoice No. LOT 4-'. MAP H-6 N/F ALAN BAILEY D6 167. Pr, 901 inn"': I{ r-4 i 20. 15' 50.11' 132.00" -� WTO � i �rN A• n - Cc, ' i i,, ,1 to 1 ^' �r; t 'fir '�+' � ;s, � � { � •. � � f; fi 1 N , rte,•, � i Ir�1ti I ' A ,/1 I fuel r 1 — I v %/�N L 54 CT .14 —L74- L 4 L A N , a4 'N l . i 14 ci r ALM r 0' rnrn co a cr' 302.+]1 S oat cn ct 36;.93' i - Y 31' 'G /� 50 IVY i r� �rJ1 T l lam^ cU Ic -j J O Z ` +i �p� n� ��r7 �/Iy�•J� YL 1 -1 f; _Irr O J C r�'fs 31:3 47' 20 IA u 1 ; Q .n r . / t'-. i `? S *• <_ _ _ .2 44 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 , FA ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE RE UIRED INFORMATION IS PROVIDED. 1. Name to be Billed— � b r,n E Contact Person �I Mailing Address �L� T 1 X d Home Phone y77tz City/State/Zip �c;� 706 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: Vite Evaluation [ 1 Improvement Permit & ATC ���,,,,[��1 Both 4. System to Serve: [ ] House [ -] Mobile Home [ ] Business [ ] Industry [ ] Other-�,b�C� /0+ ut< I yiSiy'v 5. If Residence: # People # Bedrooms # Bathrooms I I Dishwasher [ ] Garbage Disposal [ ] Washing Machine [ I Basement/Plumbing [ I Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: Lec"'O'unty/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ I Yes If yes, what type? 1plapmp- PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A FLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: ,>nr+ D''t fvt� Ct _ im«-e WRITE DIRECTIONS (from Mocksvillle) TO PROPERTY Tax Office PIN: # s 789 - _— - y 3 y -- 21 =ST 1ki K LL's" d CI fit, L L` Property Address: Road Name^o,e( m t — •� �ti t Ide o ? City/Zip .�5�/) Z ?0'0 _C1L�GS.S . C""m lid If in Subdivision provide information, as follows: Name: b ) / ,nr4drll reek �rcracSzd ;. Section: Lot #: P– A%_ .)c ' This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsifie, changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Author Represenjative of the Davie County Health Department to enter upon above described property located in Davie County and ov Revised DCHD (06-96) SIGNATU all testing proce�ws as necessary to determine the site suitability. rirr �r r.t 1111 W IVJ1) 1OI, Dim it, Ix(i ►/0Iik : I II Iv_ i'<: N E T— ? PC 1 %0, r DAV IE COUNTY HEALTH DEPARTMENT ` Environmental Health Section SECTION LOT -4 Soil/Site Evaluation APPLICANT'S NAME PROPOSED FACILITY fT! SUBDIVISION Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit I DATE EVALUATED �'- PROPERTY SIZE ROAD NAME 2:ffaZ_ Public Cut L.� FACTORS I 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence r Structure f ,t Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE I, SITE CLASSIFICATION: f LONG-TERM ACCEPTANCE RATE: — , 1Z REMARKS: DCHn (Or -9% EVALUATION BY: tC� OTHER(S) PRESENT: 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 Tsxtv 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 EF1- 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 AB - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineral= 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) i; AR - Long-term acceptance rate - gal/dayfflQ