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180 Dare LnDAVIE COUNTY HEALTH DEPARTMENT � �` Environmental Health Section �� 3"J �" �L j � �� P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (33()751-87C►0 Account #: 989900259 Billed To: David Mallard Reference Name: Proposed Facility: Residence IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: 5851-68-7228 Subdivision Info: Location/Address: Dare Lane-27028 Property Size: 6.77 acres ATC Number: 3684 **NOTE** "This Improvement70peration Permit DOES NOT authorize the construction ofa septic tank system or anywastewatec system_ An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior io the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.�. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMTT IS SUBJECT �'O REVOCATION IF SI'TE PLANS OR THE INTENDED USE CHANGE. YOUR '�'VASTEWATER'SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People _� #Bedrooms �� #Baths _� Dishwasher:� iGarbage Disposal: ❑ �Commercial'Specification: FacilityType Washing Machine;,� Basement w/Plumbing: � Basement/No Plumbing: � #People #People/Shift #Seats Industrial Waste: � Lot Size Type Water Supply � Design Wastewater Flow (GPD) �'�' d Site: Ne�Repair ❑ System Specifications: 'Tank Size/% GAL. Pump Tank GAL. Trench Width �� Rock Depth �,� Linear Ft. �� Other: Required:Site Modifications/Conditions: INIPROVEMENT/OPERATION PERMIT LAYOUT - P R ED EFFLUENT FILTER. RISER(S) IF G" BELOW F(NISHED GRADE. ****NOTICE: Contact a repres t ive�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• n the day of installation. Telephone # is (33C)751-87G0.**** � ��a� � � ��,�:�le r� Environmental Health Specialist's Signature: Date: � �� DCHD OS/99 (Revised) J � Account #: 989900259 Billed To: David Mallard Reference Name: Kesiaence ATC Number: 3684 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (33G)751-87(►0 Tax PIN/EH #: 5851-68-7228 Subdivision Info: Location/Address: Dare Lane-27028 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 WASTEWATER CONST UCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: �' / Date: � CERTIFICATE OF COMPLETION **NOTE* * The issuance of this Certificate of Comp tion shall indicate the system described on ImprovemendOperation Permit has been installed in compliance with icl 1 o G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO AY ta n as guarantee that the system will function satisfactorily for any given period of time. 1�po�'� x/ � ', �. Septic System Installed By: Environmental Health Specialist's Signature :_�/ y,C2 �/ Date: � � DCHD OS/99 (Revised) �pN 21 2p04 _.�.nALH�`� �N FOli S1TE CVALUAZION/Ih1PIiUV[:hlG11"f i'LIi�'4117' a �l'1'C Davie Couniy Health Department . " Environmenta/Hea/t/� Se4fion P.O. I3ox £34II/210 Iio�pital •$trect t�iock3vi].le, NC 2702II (336)751-a760 _...._.._..--- SPORTAIVT*** TIi25 I�PPLICATION C1INNOT DI; PROCBSSED UI7LLS5 ALL `1'IIL'' liLQUIliLll I27FORDiATION IS PROVIDED. Reior L-o �ha INrORMATION IIULLI:TTN i•or in�L-rucL•iona. 1. Name to be Dilled % � C. �ConLacL Per�on �� ,�/ �>��i��r�'!"C./. _._.. t•Sailing 1lddres� ��yj��!t� T� G�� ]!�� llanc Pl�onc �'�j ��.�.� C%�--�--r---- - CiLy/:, LaLe/'LTP ��,/; C�E�,' i -P � . � • � / �� _ ��_...�_.. _ ._ �� u:tinc�� I'l�uiic �5 � ..._ 2. Namo on Pcrmit/I�TC if DiLLerent than ]lbove � ASailing Addres� City/Statc/Zip ---- --- -..... .. .. . . . 3. Application For: �Site �valuation ❑ ImprovemenL- Pci7niC/A'1'C lSoLli j� 4. syctem to service: �House ❑ 2dobile iIome ❑ l3u�ine�� ❑ Indu:;Lry � OL-licl _ ___ ,,; 5. Type aystem reque�ted: � Conventional ❑ conventional modiEicd ❑ innovacivc G. Ii Residence: II Pcoplc �� It IIcdrooui� o� II L'aLlirouiu,� � �Diahwaaher ❑Garbage Dispo�al �[9ashing Dfachino ❑Ba�ement/Plwnbing ❑Ua::emenC/Ho 1�lwubin� 7. If Du3ine3s/Induatry /Other: verify Cype H Commodca 1F Showcra IF FOODS�RVICE: #k 5eaL•a I{ Ycoplc I! :;i3il:� _.___..._._.---- 1! Urinaln U {4alcr Coolcr� -----•--_- �atimated Water U.^,agc (�allona per ilay) _______�_______.__ 8. Typc of water aupply� County/City ❑ Well ❑ C0lruuunlL'y 3. Do you anticipatc additiona or cXp:insiotls of thc f:tcility tl�is s)'stc��i is iulciicicd lo s�r�'c': ❑ �'cs j�l�'u lf J�cs, ��'l�at t�'pc? ��F�n1��u�c�:i�v1�� CLlLIY'fS�11USTCOAf1'L1:TG •ri1t; ru:�uurLo i�iio��Lit•i•�� ivi�otin-r,�•i•�otv ici.�ui.sri:i� I3GLOIV. I.ithcr a PLA'I' or SITG PLr1N �11UST 11CSUI3�11lTTED by thc clicnt ��itli '1'IIIS �1PPI,ICA'I'ION. I'ropert�• Dimaisions: � r (� Z—�"'� 1VR('Cl; ll11ZLC'1'IUNS (Iroui fllocl:sville) lu 1'1tUl't;lt'I'1': �Ui'�v (o ovoo.,osgos..�� l— � i�:►x orr�� i'IN: f� S $" 7�z� %� ��" �G. ,�ca ' ��l ss v� PropertyAddress: RuadNamc 1�]�P L�l�— �Q� ��J,'�s .-�-�C'� --' �t� City/Zip � -��,.�✓c+� %�.��'7` �� II111 a SUli(I1V151011 IJI'OY1VC lllrU!'JII1I1011� as follotivs: '�%; ^� � ��- �!% � �.Z/'}%-> ri'amc: ��_.r•J �C�i ` .�/�L� Scction: Blo�k: Lot: � Datc Uomc corucrs Ilabbcd: �/� 0 �'�2��s f 1'his is tu ccrlify tl�at tl�c iiiforci�atioii providcd is corrcct to tl�c bcst of nry I:uotiti�lcd�;a I uudcrslai�cl llial any periuil(a) issucd licrcaffcr are subjcct to suspcnsion or rcvocation, if tl►c sitc pla►is or iutcudcQ usc cllilllbC� 01' !r Il1C lIlI0I7U1lI1U11 sub►niltcd in ll�is appIicatiou is falsircd or cIiangcd. I, also, �tnticrslrtnrl ll�nl l a�n rc�purrsiLlc fa• �rl! c/rru3�e�• iucvu•rrrl.%runr llris «pplicutio�r. I, Ucreb}�, bi�•e cousec�t to the Aulliorized Represeutalive of lhe•ll:n�ic Couiit�' lle:iltli Dcp:ir(u�cut tu cntci• upon abo�•c dcsci•ibcd pl•operty lucalcd iii llavic Couiity arid o��i� � �� ,L p/Z�' �p$' j-' lo conduct :i11 tcsting proccclui•cs as ticccssai'y to d�lci•minc tl�c silc ':ibilily� llA"I'I; ��`�/ r � 7 SIGNATU � �.� ,, � TIiIS A.REA I1�AY li� USLD I+OR ll1ZAbYING YOUR SIT� PLAN (Iiicludc all of llic 1'ullotiviub; I;sistinb :uui propc�scd property fincs and dimcnsions, structures, sctbaclts, and scptic locations). Si�n giti�cn R�riucl DC1I1) (OS/03 Sifc ltcti�isit Cli;u•�;c ll:�(c(s): Clic�il Nolil'ic:ilio►i ll:itc: �IIS: Accuuul l�`c�. � � � �'.� 1 "'�, C ✓ l�i��oicc Nu. s�� ! <__� A _ f I IVAN D. A4AMS ID8. 137 PG, 267 elp lolld 5 B�• 4]' 19" E-----_�, •ip 975.06 BB• U' 2B` W A2B.63 � O � � BIILY F. WES' �� m n� DB. 86 PG. 17: � � `° AREq , g,2q� p,:RES w B 0 �'� � �Ip D--- —.--_• -�• --� - 9, � �m asa°�,� N� ARNOLp R. SMtT � � � �''h� �� ;5 Y� a a�'i D8. 78 PG. t05 � LIAM J. HAftTLEY I O 5�y296E � 91919 `� �B. 103 PG. 840 W Ps506 5g ��V �� N B9'33'JI' E � y . �. ai ^---a eeA�o_ca- w I Q ;y F././ � v�P. �, N 0 pG</j �.. , p w rS 89' -06' 0�",E �. /\� V\ � Z�o ti l - � P �a o� �41838 __. �i •O �^ � •..�. ' rrLar N � � 6• ? e� 6u' P `, �; ' a ' a��. s ` � � �' �' �oanct c, cc . � Q,� . o i n P 3�. � mG DB. H7 PG. 7� ��Y �d �,e.,� ��. seaia { 3�see y t�69t, . os�'+ J - S 89• 43' 36" W J rsEu S A9• 45' 39" W 4. ��.. . 4 s `h� �— V'` '� W , �,� . �f` ' L- j� Q'� 1N0, O }O- ss /B�9 ��6 p N n . _ ^'P 35��`, ror b� n p 1D S 89• id' 26' E ii a� p` °� / i�z ee �9'35g .,�o �.� o � � . ? p � /� ian s � .`�P S 86' 48' �5" E- % �� c+ _ � 597.13 �,P 'qn�p 530.23 TOTA aata � ,� � a O N l O � el qum zs.os �z' i3• ia- w o 5 �o m Soa.i� '�—�� P n' O nip . AREA = 5,331 ACRES � n, 2 .ry ry� a � y AREA . 5,503 ACRES i F07.73 iOTAL i s . n�p N OB• 56' 29" W "�P � = o ti m 580.Ca 27.69 � B2? 39 TaTAI �~ "� � � �,;. --- S BB' S6' 29" W p"-'-• LEE JUDiTH WARD �o P o`' ,,,P ��.;,y 754.65 n� J� D8. 99 PG. 54 <� � � on 1 � q q = S.OQI ACRES �• � 4 n pRHA . 5 B94 ACRES nlp � ( Ia05.49 ��,r� -..--- 5 BB' S6' 29" W 1405.i5 TOTAI J, C. BFAUCHA".4P, HEIRS rn M � _ rS�o cS� 6.77A 7228 - 1 13 ( 7$} Ij 975 �•• �� I I � � �� ' DAVIE COUNTY HEALTH DEPARTMENT ` �� • Environmental Healtti Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900259 Billed To: David Mallard Reference Name: Proposed Facility: Residence Water Supply Evaluation By: HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence SWcture Mineralogy HORIZON III DEPTH Texture group Consistence �.__....._,. SOIL WETNESS PROPERTY INFORMATION Tax PIN/EH #: 5851-68-7228 Subdivision Info: Location/Address: Dare Lane-27028 Property Size: 6.77 acres Date Evaluated: 4 On-Site Well �^ Community Auger Boring ✓ Pit LV 1V lJ-1 CIC1V1 HL.I,IIt' 1 H1V l.D 1(H 1 D SITE CLASSIFICATION: Public � Cut LONG-TERM ACCEPTANCE RATE: �� OTHER(S) PRESENT: REMARKS: Cy � 1' �i � �' � �� " � y "`" ' / 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 Wet NS - Non sticky NP - Non plastic FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm SS - Slightly sticky S- Sticky VS - Very Sticky 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 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 Classifcation - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gaUday/ft2 DCHD OSl99 (Revised) ■■ ■■ ■■ ■■ ■■ ■■ ■ ■�■ ■�■ �■�i�■ ■��■ ■��■ ■��■ ■��■ ■■�■ ■��■ ■�■■ ■��■ ■■■■ ■ ■ ■ ■■ ■�■ ■�■ ■N■ ■��■ ■�■■��■ ■��■��■ ■��■ ■��■�■ ■�■�■�■ iii i i ■ ■ ■■ ■�■ ■�■ ■�■ ■�■ ■�■ ■�■ ■��■��■ ■��a�■ ■��■��■��■ ■��■�t■�■ ■��■■ ■�■�■��■■ ■�■��■ ■t■■��■ ■��■��■■ ■��■■��■■ ■��■ ■��■��■�■ ■��■��■■ ■��■ ■�■��■��■ ■��■��■ ■��■��■�■ ■�■�■■��■■ ■■��■ ■■��■ ■�� ■��■■■ ■��■ ■��■�■ ■�■■�■ ■��■■ ■■��■■ ■ ■ ■