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620 Deadmon Rd0 - DAVIE COUNTY HEALTH DEPARTMENT � , Environmental Health Section l P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900063 Billed To: Larry McDaniel Reference Name: Proposed Facility: Residence ATC Number: 2604 Tax PIN/EH #: 5747-72-5649 Subdivision Info: Location/Address: Deadmon Road-27028 Property Size: see map AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION �� I**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 WASTEWATE ONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: �. . �� Date: r� ��� '�� CERTIFICATE OF COMPLETION **NOTE** T'he issuance ofthis Certificate of Completion shall indicate the system described on ImprovemenbOperation 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. f,Sv ,� �e�s��n, � .� , � � f,� y�Yt�C �r�( /d �'- Septic System Installed By: r ��n � �� � , �P��� �� /�� S ' � mr�s� � C�, J�r � � � �� �ra:� �'� P s ri-�_�a ��� Environmental Health Specialist's Signature : �:�'' rG�� Date: �`�/�/— �1� b DCHD OS/99 (Revised) 0 DAVIE COUNTY HEALTH DEPARTMENT �?.�,Ll l— �--?— �' Environmental Health Section � P. O. Boz 848/210 Hospital Street C� ��' �� Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900063 Tax PIN/EH #: 5747-72-5649 Billed To: Larry McDaniel Subdivision Info: Reference Name: �li�,q�,-� -� f���;�.T Location/Address: Deadmon Road-27028 Proposed Facility: Residence Property Size: see map �TC N�.�p b�r: 2604 **N TE* *"l his mprovement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AiTTHORIZATION 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 Dishwasher: V� Garbage Disposal: � #People s� #Bedrooms c� #Baths r� Washing Machine: }� Basement w/Plumbing: ❑ BasementlNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ ) �/ Lot Size ..�� 7� Type Water Supply �?s Design Wastewater Flow (GPD) � Site: New y� Repair ❑ System Specifications: Tank Size�'l�T�� GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width �� Rock Depth �� Linear Ftc;��f� 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 day of installation. Telephone # is (33G)751-87G0.**** �- Environmental Health Specialist's Signature: �, Y�`�' � Date: %� "/� -��} � DCHD OS/99 (Revised) �u-ru���uN tu�t bl lt EVAWAl1UN/IMPIiOVEMENT PEflMIT dc ATC • Davie County Health Departrnent . Environmenta/HeaKfi Sectton , • P.O. Box 8�B/210 Hospital Streeti Moaksville, NC 27028 � � �336)751-8760 D ��� M �j 1 0 2000 •**IIKPO.RTAI�T**• TilIB APBLICl1TId1Q CAl�1' 8S PItOC�BSaD tINLE88 ALL TiiB ItEQOIRED' INFORMAT20N I3 PROVIDED. Itefer to the INFORMATION SOLLBTIN for iastrnations. i. llaas to be BtiYea � jy2�1�`�`�i�e�u!?`�,���s,l��l�o..aat nar�oa Larry McDaniel 1�aslitW �+3drw pn unx S 7 7 ' � p� 7 51 - 9 0 2 2 ctty/staee/zzr _ Mocksville, NC 2%OZH �i�a p� 940-81 64 s. Ilaa� oa i�tsit/J11'C 1= bi!lares�t thati 11bws g h�,,-,-� �,-a n t t� u i c k Je f f r i e s x�sii� �aa��. PO Box 577 a��8t,���pMocksville, NC 27028 �. J►ppliaatioa sor: U Site Evalnation 0 Impsoviemeat Bermit/ATC ,�Both s. sy.tiem to eesvsos: �i Honse 0 Mpbile 8o�ae U Bnsiness 0 Induatry 0 Other e. ti Resideace: / people 3 ! Hadrooms 3 • Bathsooma 2 �Distnrasher 0 Oasbaqe Disposal �Nashinq ttaahins 0 8asesa�t/Pimbiaq [I 8asement/No pinabin� 6. i! 8nsiness/lnQnstry/Othes: SpeailY tYPe _%U� � i peaple f Ccamodes * Shcwers f Urinals / Sitsl�s • Natar Coolers IP 1'OODSERVICB: � Seats ��- $stimsted Aatar Osage (4alloz�s p�r day) 7. �p� ot trater snpplp: �Connty/City 0 Rell ❑ C�ity e. Do yau aat�cip�te additiow or e:pandon� ot the t�cllitJ� t6b ry�tem b intandcd to arve! 0 Ya �No U ya, wbat type' "* *IMPbRTANT"" CLIENTS �llUST L��llPLETE THB REQUIRED PROPLRTY INFORMATION REQUESTED BELOW. Eit6er a Pl.AT or SITE PI.AN MUST BESUBMIITED by the clieat with ?H1S Al'PI.ICATION. Prope�ty Dimen�ions: ) I�. 0 I X�� 3•�� Tai Ottice PiN: # ��1 � � - �a - � c�y� Prnperly Addra�: Rnad N�une l>���cwOC1t� c� City/Zip Y��ClocrkSv�l�o. N�- ��oa� 1� in a Subdivi�ioa provide iaformatioo, �u folbw:: Name: Scctioa: Blak: Lot: WR1TB DQtLCt'IONS (fram Mock:v[Ile) to PROPERTY: ��O � �.,�.�ur� �O c� �2a� rnon �c� . ( ,.,��r r� �-�--� �- �Jl� i S �-�c�- � �� �Z�.� ' DstcPro Ft cd: C���! � p��7 s8t Thi� is tvi certify t6at tbe informatiou provided is corntct to t6e best of mr knonitdga I anderstand 16at any permil(s) issued 6e�t'ter arr subject to aa�pension or nevocatioo, if t6e aite plana or lntended nae cbange, or if t6e intormatioa aubmided in t6i� spplication i� �alaiBed or changed. I, olso, andersta�rd tArai I ani rrspox�ible jor o!! climga inc��d from tlUis arppllamtion. I, ber+eby, give consent to the Aat6orb.ed RepraentaNve of l6e Davie County Healt6 Department to enter apon above deacribed property Iceated in Davie Coanty and owoed b� ���.� .L ,(�-, r c, n-4- to conduct ali teiting procedura as uaatary to determiae t6e dte witabilih-. DAT� �� II � I� SIGNATURE �.� �S�.JL4. �,_�` I�.C.I��'� THIS AREA MAY BE USLD F'OR DitAWQIC YOUR SITL PLAN (Inciade all otthe following: Eitatiog aod prnpoaed p�operty liva and dimeasion�, strnctara, utback�, aad �ptic locattoaa). Rtvised DCflD (07/9�� . �I �5 Accon�rt Na � � -3 Invoice Na � � � 3 `� Deddmor� Road S.R. 1801 60' Public R/W 20'+/- Povement — _ NoA fwnE 1 ^vprox7moh _ _ - - AC-NoW Ss! � Appro.LraN - _ - _ _ - Mwl FwnO O Approiumah c.M.r u�. a sa ieo� c.,�e.r t;�. o� srr +eo i c.�eK �,. w sr im i S 69•10'00`E —+ 132.83' S 69'M'00"E--+ 11f.01' IO2.68' �-- N 69•40'OD"M fls LLM . rs lirw 79.61 ��" E7R J0.00' � b.00' — —_ 10.88' FwrM In Llrr� ' � � � � � � � � � � � � T � � � � � � � � I yi �I C� Kn i. Wayner 1?3 O PG iil u.. P„oo,.a .0 r„ tot ss -•-�' � Tar Yap K-3 .°�. n..r ��m fn p g OB210OPCJ24 ° . �� N ► Zo y usr yA N t)��� . o � . H u � = o � f � � _ o _ o � � �" POl"f Of � w 1M Tax Lot 59 e 0.767 Acres +/- � �_ __ �r—ea../�,p FounO Brit ` \ ` ` 111.01' N 69'IO'00"W Tm Lot 39 Tnx Yap K-5 DB2100PCJN fu (W SY �T// Nop K-3 Y.�wie �Du�sr�, . .. CMnAo AWMM Kys, . t Jo1Ma RNne Grmit DB Yf0 � PC J1f IYcinity MoP (No i ae�.r� aw ww..1.�� ir i+w. w,a r..r�ti��r....w.. � . g � ` :.�w�...........�.,.... _........�..�.. �/Y��I�MYr . � � L+�YMI�I��1'M�WYr �...� rwr���...�.r. ❑ . w.rrN.�r.wr�rr.r..+ � . u... r.... -........+�..,. ...r�n r .✓+� �.r...n-«. ...w. r r .wr r..w: ❑ ` rrw�.+r�rr�ri.w�� w. r.r...rrr.� r r.r r.. +w �...w...+.... w w. u Gap� R 5lan� � n+r.. • TT� mn.�yw�cv o/ a bt a 6xt /or or e+�y a�e e.e...n �.no�. �.rm rn. enna e.y.« s�.a unr�tP. Survey for: Sherri Lynn Crant Port W � Lot 59 � � Toi Mop K-5 - Oeed Book 210 O Poye J71 0 76� �r�es a/- A� �.�.�.n....... ....-...w... _. - DAVIE COUNTY HEALTH DEPARTMENT � �• ' Environmental Health Section , , Soil/Site Evaluation �APPLICANT iNFORMATION PROPERTY INFORMATION Account #: 989900063 Tax PIN/EH #: 5747-�2-5649 Billed To: Larry McDaniel Subdivision Info: Reference Name: Location/Address: Deadmon Road-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: ^/� 1��� Water Supply: On-Site Well Community Evaluation By: Auger Boring Pit Public Cut icx�uic �ivu� 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 HORIZOP SAPROLITE CLASSIFICATION LONG-TERM ACCEPTA SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: LEGEND 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 day 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 - Angulaz blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralo�v 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 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