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1200 Howardtown Circle• DAVIE COUNTY HEALTH DEPARTMENT . Environmental Health Section Ilk P. O. Boa 848/210 Hospital Street • Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900063 Tax PIN/EH M 5850-842049 Billed To: Larry McDan elSubdivision Info: Reference Name: Sa-1-4/J l'J1 Y��Sbi' Location/Address: Howardtown Circle -27028 Proposed Facility: Residence Property Size: see map ATC Number. 3106 **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 // #People 3 #Bedrooms -r,-? #Baths -2 Dishwasher: ;!r Garbage Disposal: Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #S//eats Industrial Waste: 13Lot Size Type Water Supply Design Wastewater Flow (GPD) •�� // d, Site: New 0' Repair ❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Widt0k Rock Depth , Linear Ft.�� Other: c�1f�Il/1��OGS Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LA' FINISHED GRADE. ****NOTICE: Contact a system between 8:30 a.m. to 9:30 a.m. or 1:00 p.rr. IVED EFFLUENT FILTER RISER(S) IF 6 L° BELOW the Davie County Health Department for final inspection of this the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: 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 #: 989900063 Tax PIN/EH #: 5850-84-2049 Billed To: Larry McDaniel Subdivision Info: Reference Name: Location/Address: Howardtown Circle -27028 P,-,ec Pro osed Facility: Residence Property ,Size: see map ATC Number: 3106 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 WASTEW E C NSTRUXIICN IS VALID F R A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: CATEiOft COMPLETION **NOTE** The issuance of this Certificate ofrorqpletion sh 1 ii has been installed in compliance ith icle 11 G. Disposal Systems," but shall in N W Y be take as given period of time. icate the system described on Improvement/Operation Permit Chapter 130A, Section .1900 "Sewage Treatment and guarantee that the system will function satisfactorily for any M Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date:�,1! `'�� L-11 r h ° APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC ` Davie County Health Department 2 Environmental Health Section (� C4- P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 7S1-8760 1 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS HE`ftEl?at INFORMATION IS IS PROVIDED. Refer to the INFORMATION BULLETIN for instnru 1. Name to be Billed 1 it � kJ�,e—� �cS Contact Person 1-09(W Mailing Address some Phonenly�"aILO^I City/State/ZIP M IXkSNJ C 5y� pC\i c - Business Phone •�J � � �� .� - 2. Name on Permit/ATC if Different �than Above Mailing Address 1 �� -�f City/State/Zip i Y1DC(CSUl I1X- 0r10P-!' 3. Vplicaticn For: Vsite Evaluation V Improvement Permit/ATC �oth 4. system to service% 9 House ❑ Mobile Home ❑ Business ❑ Industry (I Other S. If Residence: # People a— _q # Bedrooms # Bathrooms r )l Dishwasher ! Garbage Disposal ;Washinq Machine II Basement/Plumbing (1 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers I Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City ❑ Well ❑ Community 9. no you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes NeNo If yes, what type? ***1 MPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. 3.�Iz Property Dimensions: 5�t�.1 ID�t N73.U4 7�S40.1 O yC WR1TE DIRECTIONS (fries :'locksviiie) to PROPERTY: O `Tax Office PIN - # 't�WL✓1 I��%'l�' Property Address: Road Name Y Oyjo-f a4t�"y'-N City/Zip MC)6��Lvf- � 00wv 44- (a t✓' lSonQ If in a Subdivision provide information, as follows: Name: Section: Block: Lot: Date Property Flagged: '51 This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) 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 falsified or changed. I, also, understand that 1 am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by han-t S6-sa-- to conduct all testing procedures as necessary to determine the site suitability. DATE �` 1 '(0 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). C-� Please complete the highlighted area(s) and return Y_ ` e C tU Revised DCHD (07/9 Pro cQs5 w1i-koJ—t" Site Revisit Charge Date(s): Client Notification Date: EHS• Account No. / 00 � %a a In % 3 0-0 Invoice No. d \ pt3 I JJ 1" Tax Lot 33 pkintsd Stare Tax C 6 I Fnd Axle Fnd n/f David L 5teeiman ; wife Donna Ross S`teeln►or1 IL Tox Lot 32 .. ',' 19 DB 133 O PG 101 Tax Map (;-eI L-18 . n/f Larry Hobort Howrd 0&,188 O M 654 A)* Fnd I PK-Nall Set Axle Fid 477.04' C 0 r- pal L-7 Tax Lot 34 Pcti Tax Map 0-6. n/f Lester Ksoton L-6 �r*• and wife Ruth H. Keaton I DB 71 O PG 393 Pte. W by roy I PM Parcell �— Part of Tax Lot 96 ---� �' Tax Lot 35 5.523 Acres +/ TOx Mo G-6 .. (Includes Mea eithin S.R. 1635 R/W) n/f Ronold D. Keaton L-4 and We Judy H. Keaton D8 192 O PG 31,7 I PGY L-16 •FrA 3/4^ Elp 210.51' Fnd 10.10' l__,_ 200.48' P—K Nall Set ► 1L-10IRS \ L-23 I Plat Revision: 3-13-2002 � IRS pWOd k, Lk+s 323.42' 1 1. Subdivide 7.523 Aeras Portion I L-3 of Tax Lot 96. 30.00' I105.21' \ I Parcel 2 , �» Part of Tax Lot 96 a PCL 2.000 Acres +/— I(Includes Mea wRhin S.R. 1635 R/W) ss L-2 I L-1 L-- T-Bor r/cop Fnd P—K NO Set T—gar gent/Fnd 272.02' 30.33' L-11 pp 32.11' T—gar nd ,Fid 219.41' T—Bar W/cap L-14 L, I L-12 PCL •-- I Tax Lot 96.02 Tax Lot 96 1 Tax Mop F-6 Tax Map F-6 \ D8 55 0Susan B. Comer he n/f Joanne Frye 9lokky DB 155 O PC 34 and husband Robert U. 81okley, hip. Susan B. Anderson, 1 and Janft53 0 B. Speight IRB 351 O PC 328 I ti� Howardtown Circle ---- S.R. 1635 60' Public R/W 20'+1- Pavement APPLICANT INFORMATION DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation ' Account #: 989900063 Billed To: Lary McDaniel Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: PROPERTY INFORMATION Tax PIN/EH #: 5850-842049 Subdivision Info: Location/Address: Howardtown Cirde-27028 Property Size: see map Date Evaluated: On -Site Well Community, Auger Boring L/ Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group 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:�r� /�� /0 " EVALUATION BY:.�/ LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: �f l REMARKS: 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) AUG 23�.. D YVIE COUNTY HEALTH DEPT. August 20, 2002 Mr. Buck Hall Davie County Health Department Environmental Health Section PO Box 848 Mocksville NC 27028 Dear Mr. Hall, Craig Carter Builder, Inc. is currently constructing a house for me at 1200 Howardtown Circle. I am requesting that the septic system utilize the Infiltrator system. Sincerely, 01�04V e;'> Susan Anderson