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187 Channel Ln•, - Account #: 990000748 Billed To: Joseph Lawler Reference Name: Joseph Lawler Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-87G0 IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: 5820-83-6658 Subdivision Info: Location/Address: Channel Lane-27028 Property Size: 6.72 Acres ATC Number: 2162 **NOTE** This ImprovemendOperation Permit DOES NOT authorize the construction ofa septic tank system or any wastewater system. An ALTTHORIZATION 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 .2 Dishwasher: � Garbage Disposal: ❑ Washing Machine:� Basement w/Plumbing: ❑ BasementlNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size i G Type Water Supply �fL Design Wastewater Flow (GPD) ---`� Site: New � Repair ❑ System Specifications: Tank Size�GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width �� Rock Depth /� / Linear Ft 1Jj)� IMPROVEMENT/OPERATiON PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6" BELOW FINISHED GRADE. ****NOTICE: 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 130 p.m. on the o installation. Telephone # is (336)751-8760.**** � -� Q ,� J� �� r '�� I �/) �,�� Environmental Health Specialist's Signature: � % �� Date: �/� `�y" DCHD OS/99 (Revised) Account #: 990000748 Billed To: Joseph Lawler Reference Name: Joseph Lawler Proposed Facility: Residence ATC Number: 2162 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (33G)751-8760 Tax PIN/EH #: 5820-83-6658 Subdivision Info: Location/Address: Channel Lane-27028 Property Size: 6.72 Acres AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLJST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any buitding permit(s). T'his 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 WASTEW R CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: �l%� Date: ��/��9 � 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 Environmental Health Specialist's Signature : DCHD OS/99 (Revised) Date: ,�� —,U �" �� . ��/ • � .� n i ��cr� �� APPLICATION FOR SRE EVAWATION/IMPROVEMEM PERMR Davie County Health Department Envilronments/ Hewl�h Sec�tfon p.o. Hox 848/210 Hoapital 8tr�st t�loaksvill�, NC 27028 • �336)751-8760 •**Ii�ORTANT*'** THIS 71��I+ICIITION GNNOT ffi pROC�BB�D UNLa88 ALL Tiffi R$QVIRED =N8'ORbATION I$ pROVIDED. R�fer to th� IN8'ORt�9►TION HULLffiTIN !or iastsuctioas. i. �... to e. siu.n SosePH A•�.Q,tcJ l ei°, co��ot r.r.on SAmE �.si� �ae�... I� � Chan n e L' Lan.c. 8�. r� 95�0 - 20 � f cscY/4tiar../s:a ,/�a �1%l 1 ��i /li C o? %D� g swsA... at,�. .3�i� 107� Z. Nw oa� �s�ait/ATC i! Di!lrs�tnt thar �►bov� ltailiaq �dd�e��• City/Yl�ta/fip s. �►ppiiaatl.oa rors Q Sit� sva].uatioa 0=mprov�t B�rmit/7►TC j@( Soth a. e=.� to s.s.�o.� � Hons• Qd' MobiY� Hom� O Busiaess O tadustsy O Oth�r a. Zt tt��idu,a�: � p�opl� 2 � 9sdrooms _y� � Bathrooms •2 � Di�hxuh�r O Oarbaq� Dirposal 6 Rashiaq ltaohia� D Suu�t/pl�sbinq Cl suwat/No plimbiaQ a. sr swsA.../zndu.tr�r/oiA�rr tp.oity typ. � r.opl• � ssalc. � Coaeod�• i 8howr� i Oriaal• i Nalar Cooi�r� _! r0oD8$RV=Cs: � S�sts sstimat.�d IPat�r tiaaq� c�ioa. r.r a.Y1 �. �p� o! xat�r supply: �'Couaty/City 0 1��11 0 Community e. Do yoa �ndcipste �ddiHons or e�an�ion= of t6e fncWty thie ryatem is inteaded to rerve? 0 Yea @'No V yea, what fiypeT **'IMPORTANT�'** CL1ENf3 M[1ST C�OMPLETETHE REQUIRED PROPER'�Y INFOM'IA170N REQUESTED , BEIAW. Eit6er t PL,AT or SITE PLAN M[IST BESUBMITTED by the clfeut w�ith TH1S APPWCATION. Prnx:�::� :Da�emsio�? Lo.'l� L► c.�51� �a�� Taz 081ce PIN: � �8ao - 83 - � �.�a Property Addreas: Raad Name 1'�+ann e I Lczn� �i iu �� ui�tEC.TION3 (from Makaville) to PROPERTY: � �a�-nr r ��N� ��. lRr4hf;L— �o 1e55 �han i mi IL -(� p-�t r'u City2ip . i N C � n�u'Scc�� ar a� M�4 ��v CHu,R CH Rd • 2�0.2 , �St IeFT T M� %N �h .�l . U in �t Subdlvision provide Inform�tlon, �s follows: -� �455 �u81c-W� e on n�er �- sinq le P�t,sT Name: �,Ydc-�ro�ased 3ffG wi�l be an leF'1" ✓inq /e 1.�1 d e--r7r¢�5 AR t.�t c�/ �Elc�fri� �p / SecNont Blocks Lot: Dste Property FlagQeds y 1Noo ded a..r�a. 9�'►r n�c� ►�55 8f2� q9 Tids ia to ¢ertify t6at t6e informstion pravtded is correct to the beat oimy knmvledga I anderahnd t6�t �ny permit(e) issned 6ereatter are �abject to �aapenston or revocAHon, if the eite p1Ans or intended aa� c6Ange, or if the Information aabmitted in thV sppileallon V faisitied or c6an�ed. I, also, anderstand that I am responsl6le jor all cbarg�s iacumd jroni tbls appllcado�. I, 6enby, �ive conseot to the Aat6orized RepraeuMtivt oi the D�vie Coanty Halth Depsrtmea� to enter apou above dacNbed property located in Davie Coanty snd owned by � SPPH A! Ttfo �u U�,t? to condact �U tatin� procedarq at ne¢eassry to determine t6e dte �olts6Wty. DATE g 1 Z'rJ / 9 q $IGNATURE TH13 AREA MAY BE U3ED FOR DRAWIING YOUR SIT� PI.AN clade all of t6e follo�vingt E=iating �nd ptopaed propecty Uaes and dimenaio�u, etractar�e, setbacks, �nd �epHc locaHons). 8ite Revbit Char�e � I ��(s)� Client NotiAcat�on Dste: EAS: Revtaed DCHD (07/99) Accoant Na � �� o�� Na 9,�0 � �. \�� MsD � 4��o`;g� r2�.ssa� ��i 38 6��' �� '� 0113 ,.:=:w;;,;i;�•;:- �� '�=�-'�-��:�;;}�;:� '... , ;V�; ��Q� � �:: �5:,;: '� `�� yy~ � � � � �� ,� �,�"' -\�2, Q� � . This map is for PERC TEST and BUILDING PERMIT purposes only. The Davie County TaxAdministrator's Office assumes no liability for any information contained on this map MsB G / o RnD f50 752 � �4 m a'o ro � COUNTYID:G40000000902 2317 ?s , '�,� 'O's , • A August 23,199911:50 AM w �� ' 100 : 60 W �y �/ I � C2 �8 �IF. Parcel Identification Number .- (3.90A a�B2 5820-83-6658 ,. �. �. DAVIE COUNTY HEALTH DEPARTMENT ' ' � Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990000748 Billed To: Joseph Lawler Reference Name: Joseph Lawler Proposed Facility: Residence Water Supply: On-Site Well PROPERTY INFORMATION Tax PIN/EH #: 5820-83-6658 Subdivision Info: Location/Address: Channel Lane-27028 „ Property Size: 6.72 Acres Date Evaluated: ° / Community Evaluation By: Auger Boring � Pit Public f Cut Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group ^---=------ tc�� 1 xi�. i i v n nvnic.vi� SITE CLASSIFICATION: 0� EVALUATION BY: �� LONG-TERM ACCEPTANCE RATE: � OTHER(S) PRESENT: REMARKS: ��.4l�Gf/ c�0 � � /U .��i? �D / �� 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 Mineraloev 1:1, 2:1, Mixed Notes � Horizon depth - In inches Depth of fill - In inches Res[rictive 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 - gaUday/ft2 DCHD OS/99 (Revised) ■��■ ■■■■ ■■■■ ■■�■ ■ ■ ■�■ ■�■ ■�■ ■■■ ■�■ ■�■ ■�■ ■�■ ■�■ ■�■ ■�■ ■�■ ■�■ ■�■ �� ■�■ ■■■ ■�■ ■�■ ■■■�■ ■■■■■ ■■�■■ ■��■ ■■��■ ■■��■ ■■��■ ■��■■ ■■��■ ■�■�■ ■�■■■ ■�■■■ ■�■�■■■�■■�■■�■�■■■■�■ ■■�■�■�■ ■��■��■�■��■�■■�■�■ ■■�■■■�■ ■�■�■■��■�■��■■■��■■�■■■■�■ ■■■�■■�■�■�■��■�■■�■��■■��■■■�■ ■�■�■�■■■■■■�■■■■■�■��■■■■■■■■■ ■��■��■■�■��■■��■��ra�■■■■�■ ■�■�■��■�■�■■�■■�■■��■■■■■■ ■��■��■�■■■■��■��■�■��■■�■ ■�■�■��■■�■�■��■��■�■��■�■ ■�■�■��■�■�■■�■��■ ■��■ ■■■�■��■■■■�■■�■��■■■�■■��■ ■�■�■��■■■■■■��■■�■�■�■■�■■�■�■ ■�■�■a■�■■■■�■��■��■■�■��■ ■■■■��■�■■�■�■��■■��■■��■�■�■ ■ ■■■�►� ■■��i� ■■■■i� ■�■■i■ ■��i� ■�■�i� ■■■�L ■�■�■ ■�■�■ ■■��■ ■��■��■■■��■ ■■��■■■�■��■��■ ■■��■��■■�■■■■�■ ■��■■■�■■��■■�■ C:::C:C�:C:C:CiC ................. ................. ................. :::::i��■■�■�■��i� ■■�■■■��■■��■■�� ■■■■�■��■�■■■��■ ■■��■■■��■■■■�■ a■��■■■ ■�■�■■�■ ■■�■■■��■■�■��i■ ■��■��■��■ =�:::::i■■�■�■��■ ■��■■■�■■��■�■■�■ ■��■��7��■ ■��■�■■/!■�■■��■ ■�■�■�I. ■�■■■��■ ■�■�■�■ ■�■�■��■ ■��■�■■��■■ ■�■�■��■��■■�■�■■ ■�■�■��■��■0�■�■■ ■��■■■■■��■ ■�■��■�■■■ ■ ■ ■■■■■�■�■ ■■■■■■■�■ ■��■■�■�■ ■■■■��■■ ■■■■■��■■ ■■■■��■■ ■��■��■ ■■��■��■ ■��■■��■ ■��■ ■■��■■■ ■■■■�■�■■ ■■■■��■■ ■��■��■■■ ■■�■��■■ ■��■■■��■ _......� ...... ......... ......... ■��■■■■e ■��■■��■ ■��■■ ■��■��■■ ■��■■■■■ ■�■�■■��■ ■■�■■■��■ ■��■�■ ■�■��■■■■■�■ ■■■�■■■■■■■�■ ■��■��■■■�■ ■■■■�■■■■■■�■ ■�■■■■��■■■�■ ■■■��■�■■�■�■ ■��■■■■�■ ■��■■■■■�■■ ■�■■��■�■■�■■ ■��■■�■■�■��■ ■■��■��■ ■■■■��■��■■ ■�■��■■■■�■■ ■■■��■■■�■■■■ ■■■■��■■■■■■■ ■■■��■■■��■■ ■■■■��■■�■�■■ ■�■�■■�■��■