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198 Dayspring WayDAVIE COUNTY HEALTH DEPARTMENT /,� `�r �� a Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001163 Tax PIN/EH #: 5719-10-3903 Bilied To: Ron Poweit Subdivision Info: p.,,, .,e � Reference Name: I� Powell 8��--M-�^ Location/Address: Dayspring Way-27028 Proposed Facility: Residence Property Size: **NOT�*�itniib Tmpro4em8ent/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 Z #Bedrooms �_ #Baths 2. Dishwasher: �� Garbage Disposal: � Washing Machine: �� Basement w/Plumbing: ❑ Basement/No Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ �Co� l�o� Lot Size _�� Type Water Supply Ini � Design Wastewater Flow (GPD) vC'7 Site: New �Repair ❑ System Specifications: Tank Size i�:OC�GAL. Pump Tank GAL. Trench Width c�� Rock Depth I L�I Linear Ft. `�� Other: � D'_�`��'�'1 e� �Q�� r � 1 t Required Site Modifications/Conditions: t��LLr ��C��, �� c�t�'r ��3, 1,�tc'l.� .� �-�`�— .. z� . IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF G�� 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 (33G)751-87G0.**** T � z � Environmental Health Specialist's Signat e: Date: �� tp DCHD OS/99 (Revised) Account #: 990001163 Billed To: Ron Powell Reference Name: Ron Powell Proposed Facility: Residence ATC Number: 2428 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5719-10-3903 Subdivision Info: Location/Address: Dayspring Way-27028 Property Size: 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 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 WASTE O T ON IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: /. � 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. � h� � Septic System Installed By: Environmental Health SpecialisYs Signature : 23 s I�5 ^ � nE DCHD OS/99 (Revised) I I �_ L�,J„ �� l `'°M �`�,�GT�� r�7� i �"`Zt�l�--1✓�� ,r�i�1'1 ��' " Z� l/ / � µ J � APPUCATION fOR SRE EVALUA110NjIMPROVEMEfVT PERMIT Davie County Health Department Environmenta! Hea/tfi Section P.O. Box 848/210 Hospital 5treet Mocksville, NC 27028 (336) 751-8760 MAY 3 2aoo ***II�ORTANT*** THIS APPLIGATIQN CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Nnma to be Hillad 2. rr�iin4 �ee. I �%I � Avc��2in� C�Ay iT �/��1 �/ City/Stata/2ZP p C ��1 � � � / � .7- 3 Nnma on Pesm3t/ATC if D lfarent than Above U� k lA M,n Mailinq addreea Contaet Pereon �o� Phone 33� • Y q 2- 5'� �r � 3. Appiication For: 0 Site Evaluation ❑ Improvement PermitjATC �.Hoth a, sYst.m to s.n►ice: �J�'House ❑ Mobile Home O Business CI Industry O Other 5. If Residence: t People �_ t Bedrooms _�_ t Bathrooms �_ �DiehNaaher ,�I-I��arbaqe Diapoeal �:iaehinq Machiae I) Basemeat/Plumbing �aaement/No Plumbinq 6. I! Hueineaal=nduatry/Othor: Specify type / Commodea i 8hoxere # Urinala i Peopla M 8inka � Water Coolera IE FOODSERVICE: # SsSts Estimated We�ter Usage (qallona pe= day) 7. Type of water supply: 0 County/City ��ell ❑ Community s. Uo yau aaticipate additions ar ezpansions uf the facility this system is intended to serve? I] Yes � If yes, what type? ***IAfPORTANT*** CLtENTS MUST COMPLETETHE REQUlRED PROPERTY iNFC1RMA7'��!`i ::E�il: STGu BELOW. Eit6er v Pl.A'I' o: S:TE ::.�.�� i.iu�T F��'UtYA117TED by the client with THIS APPLICATION. Property Dimeusioas: c,�rt��.'N�'+'a �'/" t'/G �✓ WRITE DIRECI'IONS (from Mocksville) to PROPERTY: Ta:O�'fice PIN: #� � ,��'� �`�`'�,�_�� (9 � (,c)- l�l►N Z Aa� - L�. ��'—�- Property Address: Road Name �cT_N��_ 0 r1 t2'�1�.'�' b¢�c2 �. �N�*�' �� City/Zip I�i��cics., (/.e n1C If in a Subdivision provide informallon, as toliows: Name: Section: Block: Lot: Date Pca e Fla ed: J� ' 3'�� P rtY �g This is to certify that the information provtded is correct to the 6est of my knowledge. I understand that any permit(s) issued hereafter are subject to suspensioa or revocation, i[the site plans or iatended use change, or if the information submitted in this application is falsiGed or changed l, also, unde►stand that 1 am responsible for a/t charges incurred from �his applicotlon. I, hereby, give coasent to the Authorized Representaiive oi the Davie County Healt Department to enter upou above described property located in Davie County and owned by �1,r„• ��a to conduct a11 testing procedures as necessary to deterroine the si a� �^.� i � - �� ^�`�` a SIGNA�'URE . ( THIS AREA MAY BE USED FOR DRA G YOUR SITE PLAN (Include all of the following: Ezisting and proQosed property lines and dimensians, structures � tbacks, and septic lceations). G� Revised DCHD (07/99) L� r � Date(s): Account No. J �� Invoice No. � � 0 � I y/� f� 1 � ,�� r � _..,.. -- DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990001163 Billed To: Ron Powell Reference Name: Ron Powell Proposed Facility: Residence Water Supply: Evaluation By: FACTORS Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence SWcture Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure PROPERTY INFORMATION � Tax PIN/EH #: 5719-10-3903 Subdivision Info: Location/Address: Dayspring Way-27028 Property Size: 60 �t�res Date Evaluated: , 017 SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: � � S � D� �C ; �,-Q.��y,}� 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 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 tructure 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 - gaUday/ft2 DCHD OS/99 (Revised) ■��■�■�■��■��■�■��■ ■��■■��■��■�■��■�■ ■��■��■■■��■��■�■■■ ■■��■��■�■�■�■■��eo��■■ ■��■��■■��■��■�■��■■ ■��■■��■■��■■�■��■ ■�■��■■��■�■��■■�■ ■�■�■�■■��■o�■�■��■�s ■��■��■��■■��■ ■��■��■■■�■�■��■ ■�■�■��■�■�■��■�■■��■ ■■�■��■�■��■�■■�■�■ ■��■■��■��■��■�■ ■��■■�■■��■��■��■■■ ■��■■■■��■�■�■��■■■■■� ■■��■■■��■■■�■■■�■■■■�� ■��■��■■■■��■�■■■■►i■ ■��■■■■��■�■��■ ■■��■��■��■■■�■�■■��■ ■��■��■�■■�■�■��I��■ ■��■■■■�■■■■�■��/%��■�■ ■■��■�■�■�■�■�■■�►I�■��■■ ■��■�■■�■��■r.■�■��■ ■��■�■�■■�■�■■�■�■�■��■■ ■�■��■■■��■■�■■■■ ■�■��o��■■■►��■�■■�■ ■�■■■��■��■■■Ai��■�■�■■ ■■�■■��■�■�iv�l■�■��■ ■■ ii ii ■ � ■ ■ ■ ■ �� ■��■ ■■■�■ ■��■ ■■■■■ �� ■■■ ■�■ ■ ■ ■ ■ i ■�ns��■��■■�■�■■�■ ►\�J■��■��■��■■�■ ■��n�i�■��■��■�■�n ■►�■��r��■■�►�� ■�:-.===!.�■��s� �■ ■�■�■��■��■�■�i� _.�ri� ■�■�■�■■�■■�n�c�� ■�■■■■�■�■■��■■ ■�■■■■■��■■��C_1J�■ ■��■��■��■�■�IIIJ��■ ■�■■�■��■■��11■��■ ■�■��■■�■�■��11■■�■ ��LII�i�� ■��■�■■��■I��:�I��■ ■■�■�■��■��■■■'L9�■li■ ■■��■��■�I��■■■ ■■�■��■■��■r��■■ ■■��■��■��►,��■■ ■■��■�■■��r�■��■ ■■�■■�■��■■�/li��■■ ■■■�■■�■■�■■�1■■ ■■ ■O■v■��0�10��■ ■oe�■�ti�■�■�■��::�■ ■�■�■■i■��■■■��■ ■��■■i�■��■■■�■�i�■ ■�■■�■ ■�■��■�■��i�■ ■��■�■ ��■i■i��u��i■■ ■��■�■ ��i�ill►e��'■■ ■��■■■��\�I�■�■�H�■ ■■�■�■�■■��■�t��1■ ■��■��%Cir�l��■��■■ s■��■■��■■ ■■■��■ ■■■��■■■ ■■■�■■■��■ ■■■��■■��■ ■■■■�■■��■ ■■�■��■��■ ■■�■��■��■ ■��■■�■■■■ ■■�■■��■�■ ■��■■�■�■��■�■■■■■ ■■��■�v\■■�■�■��■ ■■��■■■��■��■ ■■■■■�■�■ ■■■■■■■■ ■■■�■■�■S�■■�■■■��■ ■�■■�■��■■��■�■�!■ ■��■�■■■�G:��!�\�� ■■■■■�'iii��■��■��■ ■■■�/��■��■��■�■��■ ■�■��■�■��■■�■��■■ ■��r■��■��■��■�■ ■■%��■■■ ■�■■■■■■ ■/I■��■��■�■ ■ ■�■ ■�■■■ ■■■■■ ■��■■ ■�■�■■■�■■ ■■■��■��■ ■��■��■ ■■��■��■■■ ■■��■ ■��■■ ■■■��■■■ ■■ ■■ ■■ ■��■■■��■ ■■��■ ■��■■ ■��■ ■■■■■��■■ ■�■�■��■■ ■■�■��■■ ■��■�■ ■��■��■ ■■■��■ ■■■■�■��■ ■■■■��■■ ��