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1292 Baltimore Rd (2) i---! Pelrnittee' DAVIE COUNTY HEALTH DEPARTMENT ' "Name 's u `. t Environmental Health Section PROPERTY INFORMATION K P.O.Box 848 Directions to property: !� � �— `--/6 Mocksville,NC 27028 Su Phone#:336-751-8760 j� G t 5,j r ection: Lot: AUTHORIZATION FOR �!!)r Gf int �['y�► CGv 1;,etj WASTEWATER Tax OfOc PIN:# 5 19 ^0_ ic 3 _„�i 111? SYSTEM CONSTRUCTION `a� AUTHORIZATION NO: 002820 A Road Name: rL1Gy- Z' iiJ .Zip: x�(�+a`� **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 I 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. ENVIRONMENT?��*LFSTTDATE 1 UED RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS .-•+' #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT ,1 #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE �' C. TYPE WATER SUPPLY C k` DESIGN WASTEWATER FLOW(GPD) �Gy NEW SITE r REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE /0o GA PUMP TANK GAL. TRENCH WIDTH 3(l ` ROCK DEPTH / /LINEAR FT.3)-7 r OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT jG W tv uta; e 61 VIA y�C- FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760. OPERATION PETIT , G C' SYSTEM INSTALLED BY. A4, U q4 , To (Irty tet„ AUTHORIZATION NO. OPERATION PERMIT BY: / EAKEN **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED 1N C WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT ANDDISPOSAL SYSTEMS",BUT SHALL IN NO WA1� E S A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. 1 \DCHD 02/02(Revised) ,P€tmi DAVIE COUNTY HEALTH DEPART ENT//�{ Environmental Health SecHaP 4 a 0 A-PROPERTY INFORMATION -- P.O. Box 848 k,Directions'to property: R� <?"" r L /b Mocksville,NC 27028 Subdiuisiea-Aiame: �),l yo00ootL) C)' Phone#:336-751-8760 P:ro •E et lon: Lot: ` t r AUTHORIZATION FOR r/� Ar'1 ( C II WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION t,(9-- 1: AUTHORIZATION NO: 002820 A ; Road Name: (�� 11"ti'e+'`d atd�zip: **NOTE**This Authorization for Wastewater System Construction MUS'f 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.]900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION 11171.7 IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE IS ( ED rt��-e RESIDENTIAL SPECIFICATION:BUILDING TYPE ��#BEDROOMS 3L #BATHS I#OCCUPANTS J GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE & C1' TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) 360 NEW SITE REPAIR SITE ✓ SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK J I R-GAL. TRENCH WIDTH 36 t` ROCK DEPTH/;LINEAR FT.317 r OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT rr a CA i Cci 1 �1U f O� fNh, �`4 '~ ��y �.C.L4 P4 515+tA - - FOR FINAL INSPECTION OF,THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#,IS(336)751-8760. r OPERATION PER IT p v'� SYSTEM INSTALLED BY: Iy U- V�''' t 14 OL 0,61 Ik ray. " •\ 9 G � �a g. i 4 kDt . AUTHORIZATION NO. OPERATION PERMIT BY: vflll 411 0/1110th (. I CA **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN/LIvIP�tA1�ICE 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 02102(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) NAME 1 f GLV I S PHONE NUMBER dhp - 10 ADDRESSMa PX� ;hW 7U Ed . SUBDIVISION NAME _/A LOT # � z DIRECTIONS TO SITE DATE SYSTEM INSTALLED ? NAME SYSTEM INSTALLED UNDER ? iil-1 lousn u-s i er TYPE FACILITY SQA NUMBER BEDROOMS NUMBER,PEOPLE SERVED TYPE WATER SUPPLY•&& SPECIFY PROBLEM OCCUR IING Iri1a at2 / Svr Lri c(-AD Cau. DATE REQUESTED 7 INFORMATION=AKENY This is to certify that the information provided is correct to the best of my knowledge,and that I under d 1 am responsible fo 11 charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev.1193 • GoMaps GIS Page 1 of 6 - - —12634, a a P �a V• ti r _ 12924- 108,4 _mss OOrJ3R 131$a�- 1 r � http://maps.co.davie.nc.us/GoMaps/map/map.cfin?CFID=2527&CFTOKEN=48631937 10/31/2007 Reports Page 1 of 1 Davie County, NC Tax Parcel Report J D ut f� O 3 O 357 P ' 10 504 1. ,� lE CA�DEN_CI o ^fit •� N J 4 y 1318 -WARNING:THIS IS NOT A SURVEY!* Monday, 11/5/2007 Parcel Number: 70000006804 This map is prepared for the Inventory ofPIN Number: 5860832141 real property found within this r%v�F Jurisdiction, and is compiled from [Account Number: 00082527106 recorded deeds, plats,and other public (, Listed Owner #1: SINK TRAVIS J records and data. Users of this map are o U N� Listed Owner#2: INK KATHERINE 5 hereby notified that the aforementioned Mailin Address 1: 1292 BALTIMORE F public primary Information sources should be consulted for verification of the IMalling Address 2: Information contained on this map.The it DVANCE County and mapping company assume no tate: NC legal responsibility for the Information contained on this map. L Code: LOT I Legal Description: LOT CHRIS K Notes: I POHNSON PRO [Acreage: .00100000 Deed Date: 20061020 Deed Book and Page: 06840875 Plat Book: 008 Plat Page: 197 Buildin Value: 125700 ruttures ng and Extra Features Value: Land Value: 3950 otal Market Value: 169650 otal Assessed Value: 169650 http://maps.co.davie.ne.us/GoMaps/reports/report.cfin?CFID=2527&CFTOKEN=48631937 11/5/2007 n . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION 0-7 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca a position �-- Slope% HORIZON I DEPTH Q Texture group c Consistence Structure Mineralogy 5 E HORIZON H DEPTH Texture group Consistence Structure 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 SITE CLASSIFICATION: ��, ✓t-� `�O EVALUATION BY: r LONG-TERM ACCEPTANCE RATE: -s OTHER(S)PRESENT: REMARKS: 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 Wd 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 Mineral= 1:1,2:1,Mixed Notes Horizon depth-In inches Depth of fill 1 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 05/05 (Revisedl