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1184 Eatons Church RdDAVIE COUNTY HEALTH DEPARTMENT . • Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000756 Tax PIN/EH #: 582242-5116 Billed To: Tabitha Alder Subdivision Info: Reference Name: Tabitha Alder Location/Address: Eatons Church Road -27028 Proposed Facility: Residence Property Size: 18.419 Acres ATC Number: 2167 **NOTE** This Improvement/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 1,9/ #People -2 #Bedrooms —7 #Baths Dishwasher: lZr- Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 'r A Type Water Supply Design Wastewater Flow (GPD) Site: New 0�- Repair ❑ System Specifications: Tank Size,4MD GAL. Pump Tank �01=17 Required Site Modifications/Conditions: GAL. Trench Width -re � � Rock Depth ,t? Linear Ft300 IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 « BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this 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.**** � F Environmental Health Specialist's Signature: ;7 Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990000756 Tax PIN/EH #: 5822-42-5116 Billed To: Tabitha Alder Subdivision Info: Reference Name: Tabitha Alder Location/Address: Eatons Church Road -27028 Proposed Facility: Residence Property Size: 18.419 Acres ATC Number: 2167 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 WASTEWAW CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: -'/ld /�7�p 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. E; f>C Septic System Installed By: Environmental Health Specialist's Signature:. 40, Date: /0 -1.2 DCHD 05/99 (Revised) IL APPLICATION FOR SITE EVAWATION/1111PROVEMENf PERM Davie County Nep.11h Department Envlionmentyl Mex/M Sectfon AUG Z 7 099 P.O. Box 848/210 Hospital Street Mocksville, HC 27028 ME (336) 751-8760 ENVIRONNAL THEALTH F DAVIE COUNTY THIS APPLICATION GINI m BX PROC 5SBD UNLESS 71I.L THE REQUIRED nVOSUMION IS PROVIDED. Reyor to the INrORMATION BULLETIN for instructions 1. Hams to be biked Wiling Address N ' Eft*ns Rd, City/state/nip M DC��S V it,Lt, N, C. ajo.) Z. Reale on pecait/ATC It Different than Above_ Contact parson ausiness whoa. J"1 A_— Wiling Address city/state/sip 3. Aro4lication Port (3 Site XwPIrxtion O Enprovo wnt Pa=it/ATC Both 3. states to ssr!doet 13 House Mobile Home 13 Business O Industry O Other S. If Residence: i people 13 s Bedrooms Bathrooms 2 4 Dishwasher O Garbage Disposal � washing Madtins O B"eaent/3?lm&ing O aassmantMo Vlisbinq 6. I2 business/zadustry/other: specilg type i* people i sinks I Commodes tl showers i urinals • Water Cooless I! 1=82MCE: # Seats Estimated Hater Osage (gallons per day) 7. Type of Mater supply: /ountty C" 0 Community a. Do you anticipate additions or expandras of the facWty this system Is intended to serve? o Yes )K No If yes, what type? ***JMPORT4NT*** CLIENTS MUST C1DhiK7 FW'THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUS , BB SEW26'fT1W by the client with THIS APPLICATION. Property Dimensions:.5'0�� ! WVM. DIRECTIONS (from MoeWile) to PROPERTY: Tax Office PIN: � .. 5—�� -'�a ,5//1 a � c�,L r, E -Io vis Property Address: Rosd Name h,S Cj,. to . U . , aJ iu q Cityrnp JM oAS V LL , R i roQ If in a Subdivision provide information, as follows: i S o a Name: Section: Blocks Lots Date Property Flagged: This is to certify that the information provided Is correct to the but of my knowledge. I understand that any permit(,) Issued hereafter are subject to suspension or revocation, if the site plans or Intended use change, or if the information submitted In this application is faisifled or changed I, also, understand that I am responsible for all charges Incurred from tila appUcadon. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located In Davis County and owned by to conduct all testing prwedures as necessary to determine the site suitability. DATE; '�,� ' al Q SIGNATURE_A�JLC l�l� LY THIS AREA MAY BE USED FOR D-gAVMG YOUR SITE FLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s)s ' Client Notification Date: EAS: Revised DCHD (07199) Account No. Invoice No. i t SE ' RIp' ERV �O ,gp' 6 t ['�• I �Erri S 9� 9.12 RIP ~p of °ac`rt�E 16- tRpN PfO M S \�� N. JORDAN W t1f:N OA ✓' � ti ib K 5 Pg, 618 sRed~` w z OD LACED AT �t15 4 �I I OUND ay '. C \ �I 387.04 1' SOLID IROtl cr rouND 'fr.� 2.632 ACRES E, ''- * � ' ` AS SURVEYED BY � ��•,< <.. ,, TUTTEROW SURVEYING CO. u '• I ; SEPT. 21, 1998 O AREA 16.000 ACRES s 04-31-34- w' EXISTING } S 83'09• ! rust 00 rREE AREA = 18.419 ACRES r; 0 Y1 Iri � gn 1 S7� 33 . RoN PUCED "4--N 06.01'03• W NEW IRON SE1 �^ N eR'01'03' y 344 13 IV 04,04. 39• y ' SWEET CUM rREr JAMES & CHARLES EATON W D.B. 152 Pg. 13 E.rIStrN(, rRO DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section Soi1/Site Evaluation APPLICANT INFORMATION Account #: 990000756 Billed To: Tabitha Alder Reference Name: Tabitha Alder Proposed Facility: Residence Property Size: OPERTY INFORMATION Tax PIN/EH #: 5822-42-5116 Subdivision Info: Location/Address: Eatons Church Road -27028 18.419 Acres Date Evaluated: _ FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH G'' r Texture groupG 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: LONG-TERM ACCEPTANCE RATE: ' REMARKS: EVALUATION BY: e�c LZZ OTHER(S) PRESENT: 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 M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogy 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 05/99 (Revised) Water' Supply: On -Site Well Community Publicy Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH G'' r Texture groupG 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: LONG-TERM ACCEPTANCE RATE: ' REMARKS: EVALUATION BY: e�c LZZ OTHER(S) PRESENT: 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 M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogy 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 05/99 (Revised) i ■ ■ ■■M■■■■■■■■■■■■■■■■■■■■■■■ ■EMM■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ss■mos■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■E■■■■ME■ ■MM■■■■M■■■M■ ■■■■■■■■■■■■■ ■■■■■■■N■■■■■ MEMS■■■■■■■■■ ■■e■■■■■■■■M■ MMEN■■MME■■■■ EME■■M■■■■■■■ ■■■■■■■■■■■M■ MMM■■■■M■MME■ ■■E■■■■M■■■■■ ■■■■■■■■E■■M■ i ■ ■■■■■■■■■■■■■■■■■■ MEMO ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■et ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■E■■■■■■■■■■MME■■■■■■■■■■■■■11■■■■■OMEN MMEMO ■■■■■■■ moms MEMO OMEN OMEN SEEN MEMO ■■■■■■■■■■■■■■■■ell■■■■■■■■■■■■■■■■■■■■■ MENEM iMOMEMNEmilmom MEMNON MEMEEM ■■■"M■■■■■■■■■I■■■u■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■E■■I�E■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■ ■ ■EMNO■ ■■ME■■ ■■E■■■ ■EMN■■ ■ENN■■ ■■■■■■ ■■■■■■ ■ ■ ■ ■EMNO■ ■■ME■■ ■■E■■■ ■EMN■■ ■ENN■■ ■■■■■■ ■■■■■■