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153 Blaise Church Rd (2)DAYIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900477 Tax PIN/EH M 5729-75-6528 Billed To: American Best Homes Subdivision Info: Reference Name: Jimmy Chilton Location/Address: 601N.-27028 Proposed Facility: Business Property Size: ATC Number: 2116 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 #People #Bedrooms #Baths Dishwasher: 13 Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: 0 Commercial Specification: Facility Type �Y #People s� #People/Shift _� #Seats Industrial Waste: El Lot Size 1`Iic Type Water Supply eb Design Wastewater Flow (GPD) %6S� Site: NewZj Repair El System Specifications: Tank Size/APO GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width �� Rock Depth /0 Linear Ft-�W t IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " 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.**** Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900477 Tax PIN/EH #: 5729-75-6528 Billed To: American Best Homes Subdivision Info: Reference Name: Jimmy Chilton Location/Address: 601N.-27028 Proposed Facility: Business Property Size: ATC Number: 2116 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 Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWAT CONSTRUUC)TION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: �� r Date: G? 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. I P t—t:2 Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) a ,ggAPPUCA170N FOR SITE EVAUlAMON/IMPROVEMENT PERMIT a ,0" Davie County Health Department 0 Environmental fleaRfi SeWOH ^� P.O. Box 848x210 Hospital Street Wp ' ' Mookaville, NC 27028 !As 1999 (336)751-8760 ENVIRONMENTAL HEALTH 7 *#*IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL 117FORMATION I3 PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. flame to be Billed �Y„� } �aiv�mtS Contact Person Mr•,�y C.��fON ' Hailing Address �COv Same Phare City/State/LIP A Q r CL'hw • bi 1 "t`'1 Business Phone �Lo (03 '.S S L4 (o Z. flame on Pe==t/ATC if Different than Above N � l�(1 � �i,� /� r' Hailing Add :-ess f ^. City/state/Lip GAG %i �r Uj✓r 3. AM: ation for:'Site Evaluation mprovmement Permit/ATC�%e� ❑Boot l 1 4. system to service: u Horse 11 Mobile HomeBusiness 0 Industry 0 Other s. If Residence: /►People • Bedrooms • Bathrooms 0 Dishwasher 0 Oasbage Disposal 0 washing Machine 0 Basement/Plumbing O Basement/go Plumbing 6. If Business/Industry/other: specify type a rx4_S / People cJ # Sinks a • Commodes # Showers C) # Urinals O * water Coolers IF FOODSERVICE: IF Seats Estimated stater Usage (gallons per day) 7. TVIm of water supply: County/City ❑ Well ❑ Community e. Da you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes /?lo If yes, wt at type? NO r`""'. AIWORTANT'*• CLIENTS AfUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED DEWW. Eithe a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions., Tax O` ice PIN. # 9 Property Address: Road Name City/Zip If in a Subdivision provide information, as follows: Name: WRITE DUMMONS (from Mocksville) to PROPERTY: F Section: % Block: �a Lot: 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 information submitted In this application Is falsified or changed I, also, understand that I ons nponsible for all ch ges Incurred from this application. I, hereby, give consent to the Authorized Representative or the Davie County Health Department to enter upon above described property located in Davie County and owned by to co_a,duct all testing procedures as necessary to determine the site snitability. �4TIr 3 H - G11:11 SIGNATURE 115 AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of thk-MM-1300" wi so 01 aperCy lines and dimensions, structures, setbacks, and septic locations). V1 Z L� h7 I.2 8 1999 Revised DCHD (07198) Account No. Invoice No. 40 w DAVIE COUNTY HEALTH DEPARTMENT `� • " Environmental Health Section Soil/Site Evaluation APPLICANT'S NAME Ael'-Z�/1 44 PROPOSED FACILITY QA?(?0 Ci° SUBDIVISION Water Supply: On -Site Well Community Evaluation By: Auger Boring I/ Pit SECTION LOT DATE EVALUATED PROPERTY SIZE <& !Z, � ROAD NAME �O/N/ Public r� Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH ' ` 'Ter 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 r SITE CLASSIFICATION: EVALUATION BY: ��4j LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: yl X ` 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 DCHD (01-90) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■SSSS■■O■■■■eM■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■M■■■N■■■■■■■e■■O■■■■■■■■■■■■■ SSSS■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■M■■■■■ ■■■■M■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ i ■■■■■ ■NEEM ■MENS ■■■■■ MENS■ ■M■■■ ■■■■■ ■■■■■ MENS■ ■■■■■ ■■■■■ ■■■■■ MEMS■ ■■■■■■ ■■N■■■ ■■MONS ■■N■■■ ■■■■■■ ■■MONS ■■■■■■ ■MEMS■ ■■■NM■ ■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■MONS ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■e■■■■■■■e■■■■SSSS■■ ■■■■■■■■■■■■■See■■■See■■■■ ■■■■■ ■■M■■ MENS■ ME No ■■ ■MEMO■■■ ■■■■■■■M ■■■■■■■■ ■■■■NEEM NEEM■■■■ ■■■■■ NOME■ ■■■■■ ■ i ■ No ME DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION P.O. BOX 848 MOCKSVILLE, N.C. 27028 336-751-8760 April 19,1999 American Best Homes P.O. Box 242 Siler City, N.C. 27344 Attention: Jimmy Chilton Re: Site Evaluation/601 N . Tax PIN # 5729-75-6528 Dear Sirs: As requested, a representative from this office visited the aforementioned site on March 31, 1999. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. Before a representative of this office can issue an Improvement Permit/Authorization to Construct the site needs to be cleared and the structure clearly marked. Contact this office when this has been completed. If you have any questions, feel free to contact this office at 336-751-8760. Sin cerely, Robert B. Hall, Jr., R.S. Environmental Health Section