197 Dare Ln (2)DAVIE COUNTY HEALTH DEPARTMENT
�
Environmental Health Section
�- . P. O. Boz 848/210 Hospital Street
' Mocksville, NC 27028
(336)751-87G0
IMPROVEMENT/OPERATION PERMIT
Account #: 990003107
Billed To: Ridge Top Builders
Reference Name:
Proposed Facility: Residence
Tax PIN/EH #: 5851-67-8960 A
Subdivision Info:
Location/Address: Dare Lane-27028
Property Size: 363' x 161'
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**NOTE�*�Tfiis�mproveme7iit/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 � #People _� #Bedrooms � #Baths �_
Dishwasher:� Garbage Disposal: ❑ Washing Machine� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size f� C- Type Water Supply � Design Wastewater Flow (GPD) � jJ� � Site: Ne� Repair ❑
System Specifications: Tank Size � GAL. Pump Tank GAL. Trench Width lS ��Rock Depth /,�. �Linear Ft.�l' /
Other: �CJG��I ��l�Gi/U� `� C�l-�l/ f��`�'�
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) 1F G" BELOW
FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Deparhnent for final inspection ofthis
system between 8:30 a.m. to 9:30 a.m. or .m. o. the day of installation. Telephone # is (33G)751-87G0.****
Environmental Health Specialist's Signature: Date: � �
DCHD OS/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
r. o. Bog sasmo x�P��i sr��t
Mocksville, NC 27028
(336)751-87G0
Account #: 990003107
Billed To: Ridge Top Builders
Reference Name:
ATC Number: 3717
Tax PIN/EH #: 5851-67-8960 A
Subdivision Info:
Location/Address: Dare Lane-27028
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MiJST 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 CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health SpecialisYs Signature: � Date: (1 ��'�� �
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.
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Septic System Installed By:
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Environmental Health Specialist's Signature : ���(��
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DCHD OS/99 (Revised)
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Date: �
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A('E'LICATION f=OJi S17E i:Vt1LUATION/lhli'ItUVG11L11T YL'Ii�111T �C Il'I�L'
� Davie County Health Department
• EnYironmenta/Hea/t/r Section
P.O. Dox IIhII/210 Ho�piL-a7. atrCeL-
tdocksville, NC 2702a
(33G)751-8760
......-- - -- �-- - _
***ITSPORTANT* ** TIiTS 11PPLICATION C�NNOT DL•; PROC�SSED UIdLLSS ALL `1'IIL 1:LQUI1�Lll
INFORMATION IS PROVIDED. Retor Lo L-ho INFORMATION IIULL�TIN Lor in��rucCion:c.
_ -
1. Namc to be Di21ed � �'Q �_ ConCacL I'cr:�on �(�l __L��MS
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Flailing Addre�� + - O '` � - Ilauc Ylioric �]��J ^d� �0 d ���
t--4-'�-{------• •--� � : ...
City/Statc/ZIP �/+�i �^��M_�`�Q��^"�• (�ll_ Z')�LI Du�inc:�a Pl��uc y��__���.�.\�!�'�)..._
2. Namo on Pcrmit/nTC ii Difierent than l�bovc��+-���-.�,.,",� F._� d�/^h11�-__ 's'e�
I � j K Oc _,.�_ s'�.?:'_ _:.{�r �.
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Mailing Addre3s City/SCaCc/'Lip __�_._,.,,_..,_. .._._... _
3. Application For: ❑ Site Evaluation � TmprovemcnL- Penni�/A`l'C ❑ IJoLI�
4. syatem to service: �+;Housc ❑ tdobile Home ❑ Du�ine�:s ❑ Tndu:;L•ry ❑ OL•l�cr ___ __ ___
ti.
5. Typc system requc�ted: �. Conventional ❑ conventional modificd ❑ innovaLivc
G. IL Residence: IP People �� IF nedroom� � • Il I3aL•hrooiuu 2--
�Diahwaaher ❑Garbage Disposal `�Wa�hing Dfachina ❑IIasemenL'/i'luinbLng ❑UasemenL•/t�o l�luiubi�i�
7. If Duaineas/Indu3try /Other: verity �ype !f 1'coplc
� Coa�modes 1� Showera � UrinalD
IF Sinl;�
I! WaL-cr Coolcr�
IF FOODSERVICE: �� SeaL'ti �FTtintated Water U:;age (gallonn per day) ____ ___
8. TypQ ot- watcr supply: �Coun�y/Ci�y ❑ WeJ.l ❑ CoirununiL-]r
9. Do you anticipatc additiona or CXi)AI1S1013S Uf il1C r:iCllli)' fI11S S)'S1C1111S 1111L'IIt�C(1 lU Sl`1'1'l:': ❑���J ����
jr}'CS� 11'll�� f)'j)C� •
***IAIPORTi1/Y"l"°** CL1L''NTS d1US'l COAIl'LL•Tl:'I'IiL l�QUlItGU Pit01'L1L'1'Y 1Nt�OH11�IA'1'!Ol`! 1tLQUl:S'1'lil)
13CL01V. I.ithcra PLAT orSIT� PLrII`! 11IUSTBCSU11�1I177'I:'D by thc clicn( titi�i(h'1'lIIS r1I'1'I,ICA'1'IOIY.
1'i•operl�' D1111CIIS1UllSc'�' 3G .3' � �ip [ �
�:�x orr« i>irr: rE ,���� �p -1�Q �
Properiy Address: Roail Na►uc
Cily/Zip
If itt a Subdivisioii providc iiiCol•matioii, as f�llo�vs:
Naiuc: � �
Scctio�i: Blocl:: Lot:
IYRI'Tl; ll1K1;C'1'IUNS (fruni Il•lutl:s��iltc) lu I'itOi'l;l�'I'1':
i �� ` —�vwa,� s /'��/'G;A.�c:�--
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Datc lioitic coi•nci•s Ilabbcd: � O
Tl�is is to ccrtify tliat Uic iufortuatiou providcd is corrcct to tlic bcst of ury lcuotiti�lcdbc. � u,�a�,•si11,a u�:lt auy periuil(s)
issuccJ licrcaf[cr are subjcct to suspcusion or rcvocation, if tlic sitc platts or intcncicd usc cli:uibc, ur if flic iul'oriu:i(iau
s�bii�ittcd ici tl�is appIicatio�i is f:ilsilicd ur cliatibcd. I, nlso, uudcrslanr!!lrn11 uur re�/�u�ra•iGlc jur ull chrr�b�cs irrcru•r���/Ji•urr�
flris �q�pliculiu�t. I, licrcb}', biti'c conscut to ttic Authoriud Rcprescti(ativc of llic 1)avic Co�ui(,y IicalUi 1)c��:u•luicn(
ta ci►lcr upou abo�•c dcsci•ibcQ pruperly lucalcd iii llavic Couiity aiid u�t•ciccl b�� ______
lu cunducG:lll ICSII!]� jll'OCC(IUYCS 1S I1CCC5S:u•y to �ctci�iuiiic llic si(c suitabilil��.
DAT'i; SIGNATUItI�.
TIiIS AItCA MAY 13E USI�D TOR DRAWING YOUR SIT.0 PLAN (Iucludc all of tlic 1'ullotiviub: Lxisliub aud pruposcd
property lincs aud dimcnsions, structures, sctbacl�s, and scptic locations).
s;s,� scY�n
Rc��iscd DC�iD (OSl03
�� 5ilc 1Zcti�isil Cliar�;c
Datc(s): --
Clic►il Nolilic:iliuii llatc:
�IIS: '
Account No.
Inv�icc No.
3.-�0 7
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NEALtW
,TION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department
Environmenta/Hea/th Section > / ' ,. . �
P.O. Box 848/210 Hospital Street • eN
Mocksville, NC 27028 ���
(336)751-8760
PPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULL�TIN for instructiona.
Name to be Billed QI'O/U WQ /p1� Contact Person CCYOXJ WQl��/�__
Mailing Address � J � N � /���( 6 � � �� ` � �'\ Home Phone ��6 "" �0 8� �
City/State/ZIP /'j�dY7C'E'-' �e- • �-7�� � Businass Phone �Ca,� 7 /� � 3(O��
Nazne on Permit/ATC if Different than Above '� ��;� ��CS ,��.v�- S�-"`-r �
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C.t�iL }� t �v-�A
Mailing Address City/State/Zip
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3. Application For:�Site Evaluation ❑ Improvement Permit/ATC ❑ Both
4. syatem to service: �House ❑ Mobile Home ❑ Busine�s
❑ Industry ❑ Other
�5. Type system requested:� Conventional ❑ conventional modified ❑ innovative
5. If Residance: # People � # Bedrooms �_. # Bathrooms �--
❑Dishwasher ❑Garbage Disposal �Washing Machina ❑Basement/Plumbing ❑Basement/No Plumbing
7. If Business/Industry /Other: verify type
# Commodea
# Showera
IF FOODSERVICE: # Seats
# Urinals
#� People # Sinks
# Water Coolers
Estimated Water Usage (gallons per day)
8. Type of water supply: ❑ County/City � Well ❑ COmmunity
9. Do you anticipate additions or expansions of tlie facility tl�is system is intendcd to scrvc? ❑ Ycs �No
If ycs, �vhat type?
***IMPORTANT'k** CLIGNTS MUST COMPLETL THE /�QUIKED PROPLRTY INFORMATION RCQUGSTGD
BELO�V. Either a PLAT or SITE PLAN MUSTBESUBMI7'7'L•D by the client �vilh 1'HIS APPLICATION.
Property Dimensions: �--° ' �--��
; -�a o rirr: � �'��'"/(0 789 �► D • ✓�-
PropertyAddress: RoadName-S�T�a� �t"r`� tt� �/S
City/zip
If in a Subdivision provide information, as follo�vs:
Namc: �' ! �-e-- �
Section: Block: Lot:
WRITG DIRCCTIONS (frmn Niocl:svillc) to PROPF.R'I'1':
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ls�.tuY� ���.� ��� �o�,�bo� ��.
C�ass o�e� br��•1�� o�er �� � ��
q ���e� ra� oN ����
Datc homc corncrs IIaggcd: � � 6 3
This is to certify that tlie informatiai provided is correct to the best of my knowledga I understand tliat any peri�iit(s)
issued hereafter are subject to suspension or revocation, ifthe site plans or intendcd use change, or if tlic information
submitted in this application is falsified or changed. I, also, ttuderslaiid tltat I mn respousiG[e for rrll charges i�icur��ed fi•om
this application. I, hereby, give consent to tlie Authorized Representative of the Davic Coun�X He ItL llepartmcut
to enter upon above described property located in Davie County and o�vned by TQm Q,S /• �qn L e t.�.i
to conduct all testing procedures as necessary to determine thc site suitauility.
DATE �C/iv� 2` Z o0 3 SIGNATURE � �j� l�t� ,��
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includc all of thc following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
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Datc(s):
Clicnt Notificatiou llate:
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'� ,- ' � �. DAVIE COUNTY HEALTH DEPAR'I'MENT
• . Environmental Health Section
' Soil/Site Evaluation
APPLICANT INFORMATION
Account #: 990002785
Billed To: Aaron Walker
Reference Name:
Proposed Facility: Residence
Property Size
PROPERTY INFORMATION
Tax PIN/EH #: 5851-67-8960 A
Subdivision Info:
Location/Address: Strawberry Hills-27028
10 acres Date Evaluated: � l� ��
Water Supply: On-Site Well Community
Evaluation By: Auger Boring � Pit
acntuic SivuY
Consistence
Structure
Mineralogy
HORIZON II DEPTH
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
SITE CLASSIFICATION: !`'7
LONG-TERM ACCEPTANCE RATE: / °��"
REMARKS: ����������''�11Jl�' �` �
Public �
Cut
EVALUATION BY:
OTHER(S) PRESENT:
�_ "
LEGEND
Landscape Position
R- Ridge S- Shoulder L- Lineaz 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
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
Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ft2
DCHD OS/99 (Revised)
�?��I� C��1�'I`1� �I��T�I I��.�P��Tl�i�b�
: .
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_
ENVIRONMENTAL HEALTH SECTION
P. O. Box 848/210 Hospital Street
Courier #09-40-06
Mocksville, NC 27028
w .,. ._� __ _ . u.,�.�. , �_.�. � � . ... _.. . Phone # �(336)751 8760.. . �_. .. ,.�_. � .....s. , . �..z..,..�.. �
. . �.. . ._. _.�
June 12, 2003
Aaron Walker
351 N C Highway 801 N
Advance, NC 27006
Re: Site evaluations
�
Tax PIN: #5851-6708960 A & B
Strawberry Hills
Dear Client(s):
As requested, a representative from this office visited the aforementioned site on June
11, 2003. Based upon the information provided on the application for site evaluation
and after an evaluation was completed, the site was found to be provisionally suitable
for the installation of a modified, oversized on-site sewage disposal system.
Before a representative of our office will revisit the site to issue an Improvement
Permit/Authorization to Construct the appropriate application must be completed in
full and submitted to this office. The location of the facility the system is to serve must
be staked off.
If you have any questions, please feel free to contact this office.
Sincerely,
/�a� c� ���� •
Robert B. Hall, Jr., R.S.
Environmental Health Specialist
RH/df
Enclosure(s)
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