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198 Cedar Creek RdAccount #: 990000877 Billed To: Candace Link Reference Name: Candace Link Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street � /-� G o ��'�� � Mocksville, NC 27028 ` C/ 3 � % �--- (336)7S]-8760 �/ ��g7�- U �' . � c�-�T�� � ,�,�� � � IMPROVEMENT/OPERATION PERMIT � o - � —`' " Tax PIN/EH #: 9� c�`�"` �o _3,_0� Subdivision Info: Location/Address: Cedar Creek Road-27028 Property Size: 5 Acres ATC Number: 2268 **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 �t9 c.25� #People �_ #Bedrooms �_ #Baths Dishwasher: � Garbage Disposal: �' Washing Machine: �� Basement w/Plumbing: � Basement/No Plumbing: 0� Commercial Specification: Facility Type #People #People/Shift #Seats Lot Size (� �.�5 Type Water Supplyj.JE�-� Design Wastewater Flow (GPD) �- ".�- Industrial Waste: ❑ Site: New ��Repair ❑ System Specifications: Tank Size��GAL. Pump Tank GAL. Trench Width��� Rock Depth IZ�� Linear Ft.�;�p� Other: 2'�D1STiZ-i gc)T�o•J �'lx��-i-'-� . I,J.SjL�L.L �i�..�S 710 . C.. , Required Site Modifications/Conditions: �r.1�',4L.� v� �►Jzo��(2, I�i--� 1� �� No��-. K�-�i� ��� �Q'^�— �J�LI___ IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF G" BELOW FINISHED GRADE. ****NOTtCE: Contact a representative ofthe Davie County Health Department for final inspection ofthis 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,**** AP� ►4o'T� FEnx.� c.o?.r�:� g�,�.?o�c.; . 2�0' /Sc�'x3c,...uiz�� /S�� i l�n �1'0, , �� �so • M►,�. Environmental Health Specialist's Signature: DCHD OS/99 (Revised) � ����,oc�'�rfCa �'wC�i 'r{p ��� ��iS�'C^�-- � 13n CNC� ��=� �`� � � 'T�1k LOC�.`rl.t� �tJ�= �a� �I��� ��� Date: /21314� T �G� r Account #: 990000877 Billed To: Candace Link Reference Name: Candace Link Proposed Facility: Residence ATC Number: 2268 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5841-09-2687 Subdivision Info: Location/Address: Cedar Creek Road-27028 Property Size: 5 Acres AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his Authorization for Wastewater System Construction MLJST BE ISSLJED 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 WASTEWATER CONSTRUCTION IS VA D FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: _ �._- Date: � 9 CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on ImprovemendOperation 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. , , � � �To � -�--D �JP��IL 1� ��S � �s�r qT- 1� — (�, x — ►�csr- Cc�n,PL.�:T�` p,�,T �t��P—�c..T�fl� , � � Septic System Installed By: Environmental Health Specialist's Signature : (MM L� DCHD OS/99 (Revised) _ ---�-----AP - TION FOR SITE EVAUlAT10N/IMPROVEMENT PEAMIT & ATC �� . � (� � [� � �V] [� Davte County Health Department n � _ „ /f f � Envfronnrwnta/ He�/th Secdon � . �J Ou,[ fI NOV 2 2(999 ° p.o. �ock viiie Ncp 2� 8��� � ,� � (336)?51-8T60 � ��� � L�1/Y� �1��'G , tv R nie�r � i � � *** ** THI Ap�I+ICATION C�INNOT � PROG�88�D VNI,�88 ALL T� ItEQLTIR�D , � IN8'OR�ATION =S BRCVtDE15'. Refar to th� =NTORbAT=ON BnIS.�TiN for iastruatioas . � 1, liar to b� sill�d Cosstaet P�r�oa 1t.sliaq 71aar•,. _/�ri.lJ� (� r�r,//"�'r ("/t�c° � ae�. rhoa�. �''`/ U�( H'i � Lo cst�r/eat.�a:p � �C�.�cS L'I ��c° , tU �' ,� �/1.� R' swsa.., �. _ %�� R - ���iU X l05 � -� a��o P .�k 2. 11aa� on P�uit/�1TC i! Di!l�synt thaa ]lbow lisiliuQ 7�ddr�i• 3. J►pplication ror: �it� avaluatioa 4. sy.t..: to s.�.o.: �' Hons• 0 Mobile Home s. i! assidon�: � psopia �_ city/stat�/sip ❑ improv�at B�rmit/11TC Both 0 Husia�ss �=adustry 0 Oth�r t Bedrooms �_ t Bstisrooms � Di�hrul�r O Carbaq� Di�po�d 9�ashiaq Ifsahia� 0 sasu�a!/Dlvabiaq ��ud�atMo plisbi:►q 6. I! suai���/Industsy/Ot2►�r: Bp�ai=Y tYP� ��aPl� f Siaka ! Coamod�• f 8hox�r� i tlrinal� � Mai.�r Cooi�r� Za II'OODSERVIC3: � S�ats 3stimat�d 1Pat�r tTaaq� �Qauon, r•= �r� ,. �. o# ,►:t.r .��Y: a co,�ty/rat� �ai o co�itp e. Do yoa andclpAte nddlHons or eipanaione of the fa�ility this eystem ia iatended to eerveT 0 Yes 8�'� If yes, what type? ***IMPORTANT*** CLIENTS MiIST C�UMPLETE THE REQUIRED PROPERTY INFORMATION REQUESfED BELOW. Eit6er a PI.AT or SITE PI.AN MI/ST BE SIIBMIT?�D by t6e elient w�ith THI3 APPLICATION. 3oyX �8! X3o�1 Property Dimeaalons: � Ae X'7 ,5 O WRiTE DIRF.Cf[ON3 (irom Mxksville) to PROPERTY: Tai OHice P1N: # ���� i - � 9 - oZ � � % Property Address: Road Name �PdG1�' C�!P_ �K l�i � �/ � .1 • L __ � . If in n Sabdivision pravide informaHon, as follows: Name: Secdoat Biock: Lots , / i �lr. �. r �. � � : t ' i �. i . � � k • � � • � . � � •� �. I♦ I l 1 �.. I 4. � � ' �� '. � � � � �, � _ � � � . This b to certify that t6e inlormsNon pravided is con�eM to the beat of my knawlMge. I anderahnd t6�t sny permit(s) iaaaed hereafter ere eabject to ewpeneton or revocaHon, if the s[te plans or intended as� chen�e, or if t6e informaHon aabmitted in t61s applicaHon ie falsifted or changed. I, also, ttnd�rstand tArat I ar» nsponslb[e jor all cbaiges irtcumd frone tbls app/lcatlon. I, hereby, give conseut to the Aut6orized RepreaentAtive of We Davie Coanty Hadth Dep�trtment to eater npon above deacrtbed property locahd In Davie Coanty snd awned by to condact �Il testing procedara As necesaary to determine the site =ultsbWty. DATE o SIGNATURE /,i'�i%L/,/':/�',�.0 ��� THIS AREA MAY BE USED FOR DRAWQiG YOUR SITL PI.AN (Inclade All of t6e foUa�wing: Eztating and propoeecl property Ilnea snd dimenst nq3 etractarea, eetbacka, aud aeptic locutions). �� � d� i� _. _._ .... _ _---- j ,_ �x��� � C I nnte(a)s � Cllent Noti�caHon Date: � � ...---------- - Accoant Na �� Revised DCHD (07/99) �� � , Invoice Na �� � (h4k 1 L (i�( v F ����5 ��Y� �"�� j oa � rq0 � v S. R .1434 � 6.0� N/�� ROAD \ �, 3 �o N M a m � 0 EIP JERRY D8. I , 7.5 � W�� ROAD R/R SPIKE N 03° 49�-43 E R/R SPIKE _ Zso 0o CEDAR CREEK -. z � �D I I M �J� (L� NIP I I i �/ I � ,� y� � I �,t� �-- °� TO BE CONVED TO I I i�� �{ AS STEPHAN GRAY LOGAN �' I I 1�L � O N I I I li � ro .a � x — �F_ x ,� � " � � + ACRES AREA =�J.000 ACRES � � TIMOTHY F Ei.' R/W INCLUDES S R 1434 R,%W AREA = 4.��� QC� � DB. 35 PG. 33 3 INr�uuES �=i i+S � R/ w � � � � � M � � I I m z 3 I I � 80° 35� 43 �� E a I I 799.46 m m ° I I o ^ a I I � Z I I _� LOLD ROAD BED r- � I _ ` I I ` � � �I � � / � � � � ` � ` `��� � � � / ` ` � � � � NIP � � / � ��_ ��_,/ i ` / � � i EATON, HEIRS S 16° 42� 27�� W 202 86 PI P ..' � DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990000877 Billed To: Candace Link Reference Name: Candace Link Proposed Facility: Residence � PROPERTY INFORMATION Tax PIN/EH #: 990000877 Subdivision info: Location/Address: Cedar Creek Road-27028 Property Size: 5 Acres Date Evaluated: � Z�9�j Water Supply: On-Site Well � Community Evaluation By: Auger Boring � Pit Public Cut SITE CLASSIFICATION: P s EVALUATION BY: ���C�t,-I-�-,,_� LONG-TERM ACCEPTANCE RATE: D• Z OTHER(S) PRESENT: ��1 \� REMARKS: __ �c�'`'�� �'-'l� . �1��t,1.1.0 v� �ao �►,. 1� �UM.�: PL4Gi;5 - QOSS ���-�i.,f Y ��c.�cX o� LEGEND ��p�aG� �w.,� ,� t�, Landscape Position R- Ridge S- Shoulder L- Linear slope FS - Foot slope N- Nose slope CC - Concave slope CV - Convex slope T- Tenace 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 frm 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 Mineraloav 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 OS/99 (Revised) � ■ ■ ■■■�■��■ ■���■��■ ■■��■■�■ ■■���■�■ ■■�����■ ■■�■■■�■ ■■�■�■�■ ■■�■�■■■ ■■�����■ ■■■����■ ■■■���■■ ■�■���■■ ■�■■■��■ ■��■■�■■ ■�■■■■�■ ■���■■�■ ■■■■■■�■ ■�■�■�e■ ■�■�■�■■ ■�■■■��■ ■■ ■■ ■s■■■■■ ■���■■■ ■�■■�■■ ■�■��■■ ■�■��■■ e����■■ ■�■���■ ■■���■■ ■■�■��■ ■■�■��■ ■��■��■ ■■■■■�■ ■■■■■�■ ■�■���■ ■�■�■�■ ■■■�■■■ ■���■■��■ ■�■■��■�■ ■����■■■ ■�■ ■��■ ■ ■��■■ ■■�■■ ■■�■■ ■��■■ ■■�■■ ■�■�■ ■■■�■ ■■■�■ ■■■�■�■■���■■■■�■■�■■�i ■■■���■�lrJ��■�■�■���■�I ■■�■■�■�Y���■■��■■�■■�1 ■■��■�■�■���■�■����■�1 ■■��■�■��R►�1�■�■�■ ■■�I ■■■�■�■�� Iir���■��■�■■�1 ■■��■�■�� ���■■■L!�C���■■�I ■■��■�����■�■���5�����i ■■■■■■■■■ii�����iririiiiil ■■■�■■�■■■��■����■����1 ■■■�■■■■�■■���v�����■�1 ■■■�������■■■■■■■ ■■■1 ■�■��■■■�■■■���■■ ■�■1 ■�■■�■����■��■�■■�■��■1 ■■�■�■��■�■■�■■■�■■��■! ■��������■■■�■■■�■■■��1 ■������■�■■■�■■■��■■��1 ■�■■�■��■■■�������■��■I ■��■��■■■■■�������■���1 ■■�■�■■■�������������1 ■�■■■■������■■�■■ ■�■1 ■����■��■■■��■�■��■��■I ■■�■����■����■�■��■�■■1 ■■■■■■■■■��������■■■■�I ■■■■■■�����■������■■��I ■■�■■■�■■��■���■��■���I ■■��■��■�■■�■■■■��■�■■I ■■■�■�����������■!!■■�I ■■�■�■���■�■■ ■��■■��■�■��■ ■�■�■���■���■ ■�����■����■■ ■■��■�O�■��■■ ■■■■�����■■�■ vi■■������■�■ ■■■■�■���■■�■ ■������■■■■�■ ■s���■�■�■■■■ ■�■■�■■■■■��■ ■�■■�■■■■���■ ■�■■�■�����■■ ■�■■���■����■ ■�■■�■■■��■�■ ■�w■��■����■■ ■�■■��■■��■�■ ■������■■��■■ ■��■����■�■■■ ■�������■■�■■ ■���������■�■ ■■■�■�■■��■�■ ■■�■��■�����■ ■■■�■■�■�■�■■ ■■■�■���■��■■ ■■������■��■■ ■■��������■■■ ■■■�■�����■■■ ■■■�■�■���■■■ ■■■■■■■���■�■ ■■■■■���■��■■ ■�■�■���■��■■ ■��■■■■��■�■■ ■■■■�■■�■■■�■ ■■���■�■■■��■ ■■���■■■����■ ■■���■��■■■�■ ■�■��■■■■��■■ ■e■��■■■■■��■ ■■�■����■■■�■ ■�■��■■�■��■��■■����■�����■ ■n���■■■���■���■■■�����■��■ iii�iiiiii�iiiiiii�iiiiii= ■��■�■■�■■�■■��■�■�����■■■■ ■��■��■■■■�����■■■■�������■ ■■�■����■■��■�����■■■�����■ ■��■■��■�■■�������■■■■■���■ ■�����������■■■�����■■■■■■■ ■■��■■�■���■�■■�■�����■■■■■ '■��■■■■�t■■�■■■�������■■■■ a■■�■��■��■■■■■������■■■■■■ ■�■■��■■��■ ■�����■���■ iii1������■ ■�■II��■��■■ ■��11��■���■ ■■■�I��■���■ ■■■�1■■■■■■■ ■��II■■■■�■■ ■��r��■■■■■ ■�J■�■■■�■■■ V�■�■�■■��■ C�■■�■■■■��■ ■■■■■■■■��■ ■■■■■■■�■■■ ■■■■■����■■ ■��������■■ 1�1■��■��■��■ L�■■■�■��■■ ■■■■���■�■■ ■■■■���■■■■ ■■�■�■■■�■■ ■