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220 Daisy Ridge Ln DAVIE COUNTY HEALTH DEPARTMENT 'Z'� Environmental Health Section �� ,,Z � � -�� � r.o.sog sasnio x�P�ca�sn��t v , ,>--'�' � Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001493 Tax PIN/EH#: 5779-84-1600 Billed To: David Harp Subdivision Info: Reference Name: Location/Address: /�'1 AR�t<�-�.� � • Proposed Facility: Residence Property Size: 1.673 acres **NO'I�.'*'�"Ttii b�mprb��ent/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AiJTHORIZATION FOR WASTEWAT'ER SYSTEM CONSTRUCTION must be obtaineti from this Department prior to the constcuction/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 PERNIIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE INSTALLING SYSTEM. /-iR.,P�E\ � Z Residential Specification: Building Type �• �OME l �J�j eople #Bedrooms 3 #Baths Dishwasher: � Garbage Disposal: ❑ Washing Machine: �" Basement w/Plumbing: ❑ Basement/No Plumbing:� - Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 0 Lot Size . N�X.�-�ype Water Supply t�t�l%l..t_Design Wastewater Flow(GPD) ? � Site: New� Repair❑ System Specifications: Tank Size�GAL. Pump Tank GAL. Trench Widtt��r Rock Depth��Linear Ft.3�� otn�: 2 �D�sT�►F�v-`��.J �}4�.�,� I*�sra.� ��,��� c.'I�o.G, w�i►S• Required Site Modifications/Conditions: �,�� '�QI.►, � C.��17�Q, {cLCt' S' �� � I�t=�-"'" �'��` � IMPROVEMENT/OPERATION PERMtT 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 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.**** ��� �P. uaE , , �P�� . �� '�iv� 3 � � - l-�a��� � ��'`� crzo� � � ieO• y��'x�z" C�. � � , �QMt.C.'f. � ��� Environmental Health Specialist's Signature: ate: �� 17 Zha v �`l V DCHD OS/99(Revised) � � �� DAVIE COUNTY HEALTH DEPARTMENT . ' r � Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 9900Q1493 Tax PIN/EH#: 5779-84-1600 Billed To: David Harp Subdivision Info: Reference Name: Location/Address: Proposed Facility: Residence Property Size: 1.673 acres ATC Number: 2643 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his Autharization for Wastewater System Construction MUST 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 Tre tment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWAT N C ON I ALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: � Date: l/ll7/Oa CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis Certificate ofCompletion 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. ���� .�-- � � `�z' �� �� , � ,� " � �� x !r �D � l,�p� Septic System Installed By: � � �� Environmental Health Specialist's Signature: � te: �Z DCHD OS/99(Revised) . , • �,._. `� �� � APPIJCATION FOR SITE EVALUATION IMPROVEMEAfT FERMIT&ATC D �� . / ~ Davie County Health Department ND ' Environmen[a/Hea/th Sec[ion - V � 3 2n.op P.O. Box 848/210 Hospital Street , Mocksville, NC 27028 (336)751-8760 ***ZI�ORTANT*** THIS APPLICATION C�INNOT BE PROCESSED UNLESS ALI, THE REQUIRED INFORI�TION IS PROVIDED. Refer to the INFORMATION SULLETIN for instructions. 1. Name to be Billed ��i/'Q ��G /�/.7 r'/7 Contact Person �J,r i � /�01 t�' �a Mailing Addreas ��n /� n v eL l�ome Phone -I -/� '� 7�� � City/State/2IP �!/�yvJ�-C 1(�_Lr �./t�d b Business Phone �0�� 2. Name on Pezmit/ATC if Ditferent than Above �dj''7 C Mailing Addresa Sqs�'+� � City/State/Zip —- �q�'"� � 3. Appiication For: � Site Evaluation, �provement Permit/ATC ❑ Both a. syet� to se��e: ❑ House �'Mobile Home ❑ Business ❑ Industry ❑ Other s. xf ltesidence: � People � � Bedrooms 3 i Bathrooms �- 1�Diahxasher ❑ Garbage Disposal I�TWaahing Machine � Sasemeat/Plumbiag ❑ Basemant/No Plumbinq 6. If Buaineas/Induatry/Other: Specify type $ People # 3inka � Co�odea � Shoxers # Vrinala N Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallona �= a$y� �. Type of water suppiy: ❑ County/City �'iWell ❑ Community a. Do you anticipate additions or eapansions of the facility this system is intended to serve? �Yes E�'�10 If yes,what type? ***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITI'ED by the client with THIS APPLICATION. Property Dimeasions: �' � 1 � � WRITE DIRECI'IONS(trom M ksville)to PROPERTY: Tax ORce PIN: # S 7�9�GI-1 I�OD „ _ � �°`T �o �� I �- .f-a w�..F- l�—t?—o o ��h4�'��v�� �� ,�/ � Property Address: Road Nam �,��,�<< �-�- ' '�d ll c�.nc� �L-/ d n �A"��`�'�a� %� �� � City/Zip 4,b u.�' � � �'1"4 S`�J � �r�/� � � � � � � lf in a Subdivision provide information,as follows: �'�' `-( L..O �.S ��( ��-- _ � Name: �-w-�- S� F-c�'L��" Cc1 �i.c_rv�.r.S Sectione Block: Lot: Date Property Flagged: �_��� �"b� 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 informatioa submitted in this application is falsified or changed I,also,understand that I ani resporrsible jo�a/1 charges incurred from . this application. I,hereby,give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie Couaty and owned by to conduct all testing procedures as necessary to determine the site suitability. , � DATE �l'�( ?,�l�� SIGNATURE_ .1-��..s�t� �-� ��/�i THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Eaisting and proposed ' property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge ���� Q ��� ' Date(s): �-�y�� S � �°� ���h Client Notification Date: . �,�,( -� �� r �� ( /4 '� ' EHS• �� �G- � � r ` Account No. � Revised DCHD(07/99) Invoice No. �1 / / � I r ' � � . �' - � . . � �'� �/ - � � = 2.342 AC. ��� - �. t � , . � ' I � I y �\� \._ �y � . . � 1 ' ceNfER Of �\ - ��_ /// . _ ` W N.I.P � �` . f. _j..-.-P�oEMENROFp:£n `� ~�� N ��6'I>• Y N.i.N i � �ENENT 10 r�4�\ '�29 j ;�� 1 � N.�,p � � � 7 �• 2S� �rc�7,,�+���s� i � � 49 � � � � w ( � � N�r � a . � � , , � � . ' _ -. � N g / ' . � . � I . �� AREA= ' '' ' �� �� � . �, � � � � ; 1.587 AC. .��� ;�� ; � ? . �=�"" ,:_ � , � ''� AREA= ;s � � ; � � �, . 1.867 AC. ��� . �c— N.,, R_c,mµ� � � i N 77.�,�q� � -� �p � HLi � � a/o f .. � t � - � � � �u � � ' ., � ' . � ' - � � I $ �" --EkISTi � . � 1 ,� . : �� 1 y � 70 Qt . , �w .Jr6 � 11 N�r (TOL� j , � �.: • .l.'•� • �,,, � � N>7•39,3 3.39) 1 , . .;'.:�..t _ � �0 �' V _ __ _ _ --— -- , _ _ __ _ _ _ - f -.r _ ^ ,. _n � �C33'� 1 � 208 3g ' N.I P , . . . . . . . . :. .. . . . . . � . N . . � � . . - .. . . . - . . . .. . ._ . _. . . :. � � . ... . � . . . . . :� .:� . - � . . � . .. . 2 37 C. � �, � �� �' � �� � , � � ' � -- ` ; �� ;�� AREA= ' � . --_. _.._ � _.,_ � �� 1.304 AC. ���a ' .�` � I �t� � E.�.p � � �w � Q ! ! � � 24a p�,_ � � i r � . . N 7g,�,�� y � i i � . ,D�I�I,�y ?, B � N.�P .�N �e, °� � B, ..�ss� p�1�ly.�,s, - °`' • � E:,.� 4 � �ILL jAM 7, � D�B� . 179� 1,G 8 R I _ �� � � � � �� � . �� � � . � . � . � � . / .�• � ':T� � � . . .'� . �� LEGEND . . � � .�E.I.P.= EXISTING IRON PIN .. ;<�:, � . " oN.I.P.= NEW IRON PIN ,.�,y . � � x= UNMARKED POINT� ' . � � . t � ` . ,:;� . . , ,� y ' ' ' � DAVIE COiTNTY HEALTH DEPART'MENT , �. � � ' Environmental Health Section � ' � Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001493 � Tax PIN/EH#: 5779-84-1600 Billed To: David Harp Subdivision Info: Reference Name: Location/Address: . �� �� � Proposed Facility: Residence Property Size: 1.673 acres Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring � Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition L Slo e% `HORIZON I DEPTH �. to — 4� Texture rou L SG ` Consistence +=�' � ' Structure Mineralo ��l HORIZON II DEPTH O� - - • O Texture rou S � Consistence S Structure Mineralo Y, � HORIZON III DEPTH - 2- �' ''.�Texture rou G t C �f � Consistence N .� S Wcture Mineralo :1 ( =1 : 1 . HORIZON IV DEPTH r Texture rou „ 4 Consistence � Strucfure ' Mineralo SOIL WETNESS RESTRICTIVE HORIZON • SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE Q�j. � SITE CLASSIFICATION: EVALUATION BY: � LONG-TERM ACCEPTANCE RATE: � � OTHER(S)PRESENT: 1 Yl,�►�1J 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 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 1V1-Massive CR-Crumb ` GR-Granulaz ABI�-Angulaz blocky SBK-Subangular blocky PL-Platy PR-Prismatic � MineraloEv . 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-gallday/ft2 DC�ID OS/49(Revised) ■�■����■■�■�■■■��������■���■���■■��■��■■■�■■��■���■������■■������■ ■■��■■�■■�■�■�■s��■■����■��■�������■��■■��■■��������������■���■��■ ■■��■��■■�■■■�■�■��■����■��■���■�■���■■�■■��■��■�■����■■��■�����■ ■���■■�■■■■���■�■�■■�■��■�■�■��■ 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