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584 Howardtown CircleAr �d DAVIE COUNTY HEALTH DEPARTMENT �r Environmental Health Section P. O. Boz 848/210 Hospital Street Mocktsville, NC 27028 (336)751-8760 Account #: 990002571 Tax PIN/EH #: 5860-19-6913 Billed To: GAAqqaW Nickey Strickland Subdivision Info: Reference Name: Location/Address: Howardtown Circle -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3354 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 WASTEWATER CONSTR CTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: Z'`�- 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. A CALL- QD5,:� rA,3 K 2--Z4 -U3 Septic System Installed By: HJT �rC— 1 Environmental Health Specialist's Signature: Date: 4L— 4 DCHD 05/99 (Revised) aJ _ ` � •,�t� Account #: 990002571 DAVIE COUNTY HEALTH DEPARTMENT '-3 : ao Environmental Health Section Q �\ ;� Id 7 P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 FJ IMPROVEMENT/OPERATION PERMIT V S� Billed To: X3000a bMickey Strickland Reference Name: Proposed Facility: Residence Tax PIN/EH M 5860-19-6913 Subdivision Info: -.9--70,2 Location/Address: Howardtown Circle - Property Size: see map ATC Number: 3354 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater systema 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 —y #Baths` Dishwasher. Garbage Disposal: ❑ Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow (GPD) --',�d Site: NewR-10' Repair ❑ System Specifications: Tank Size GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width :2L'Rock Depth �Linear FtZZO 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:OU p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** A 1515 C�4�� �1 4-5 Environmental Health Specialist's Signature: 411 Date: DCHD 05/99 (Revised) J . IL APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERh1IT & /ITC ` Davie County Health Department EnyironmentaiHeaith Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed YOXIontact Person Y 1 2 .J Mailing Address <� \ 6,�� Q' /V V� IIome Phone Sao /Ut� 69.pYness Phone City/State/zIP1 AM - 2. Name on Permit/ATC if Different thanAbove _ Mailing Address ',��i(,' \ City/State/Zip 3. Application For: ❑ Site Evaluation ��mprovement Permit/ATC ❑ Both 4. System to Service: ❑ House Mobile Home ❑ Business ❑ Industry ❑ Other 5. Type system requested: XConventional ❑ conventional modified ❑ innovative 6. If Residence: It People It Bedrooms _ It Bathrooms CJDishwasher ❑Garbage Disposal (]Washing Machine ❑Basement/Plumbing ❑Basement/No Plwnbing 7. If Business/Industry /Other: verify type It People It sinks # Commodes # Showers # Urinals It Water Coolers IF FOODSERVICE: # Seats 8. Type of water supply: /County/City Estimated Water Usage (gallons per day) ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes If yes, what type? MIN k"IMPORTANT*** CLIENTS MUST COMPLETE THE IZEQUIBED PROPER'T'Y INFORMATION REQUESTED BELOW. Eitlier a PLAT or SITE PLAN MUSTBESUBMITTED by the client witli THIS APPLICATION. Property Dimensions: Tax Office PIN: # Property Address: Road Name A&' -'J a�-1yJ,,, f� City/Zip If in a Subdivision provide information, as follows: Name: Section: Block: I Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Date home corners Ragged:2-N-63 This is to certify that the information provided is correct to the best of my knowledge. I understand that any perinil(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 I am responsible fur all charges rncilr•red fi•oln 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 _ to conduct all testing procedures as necessary to determine the site suitability. DATE SIGNATURE TIiIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setDaelcs, and septic locations). Site Revisit Charge Datc(s): • �/ Client Notification Date: w EBS: Sign given Account No. Revised DCHD (05/03 Invoice No./�``'`f �`3� , II 399) 9707 61 U r(1.0 14 3' C ti (1,0DA)'' u 3 u. ,� .,. r 1343 300 Po TIM All 74 O i764 f 4= ■wlr`: / m ffi ------------------------ 7@ F4 rin/y p APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department EnWinnmenla/Hera/W Sedfon P.O. Box 848/210 Hospital Street Q Mocksville, NC 27029 JAN (336)751-8760 ***Di PORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE n=R1aTION IS PROVIDED. Refer to the INFORMATION BULLETIN for ins 1. Name to be Billed Mailing Address City/state/LID Contact Person {-- 1-t - S iv -P,— see Phone qq v / /( q / Business Phone �7' a (0 (� g (n(n u`" 2. Nass on Pernit/DTC if Different than Above a IU Mailing Address lQj�(jCs�i�Ot�A�CaA—City/stats/Zip - UC� A (�C-� fes`• p,n- >--a7-03 3. Application For: J 4ite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. Breton to service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other s. If Residence: # People I # Bedrooms 3 # Bathrooms Z-- ,X-pishwasher O Garbage Disposal XNashing Machine O Basenont/Plumbing O Basenent/No Plusibing 6. if Business/Sndustry/others specify type # People # sinks # Commodes # showers # Urinals # Nater Coolers IF FOODSERVICE: II Seats Estimated Water Usage (gallons per day) 7. Type of Mater supply: Xcounty/City ❑ Kell ❑ Community 0. Do you anticipate additions or expansions of the facility this system is Intended to serve? ❑ Yes WAo If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: a 3 q k I(n4 x ,� - � x Tax Office PIN: e„ b l c? 3 Property Address: Road Name kOWCt teA fo W cJ Cityalop 21 0 ,(_C_ If In a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (from Mockrville) to PROPERTY: 1111 111151 . L✓ ' i ( 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 1, also, understand that I ant responsible for all charges Incurredfrom 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 to conduct sH testing procedures as necessary to determine the site suits Wty. DATE f - '1- 0 SIGNA QQ� THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (I Jude all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Cold -amu l 'f Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notiffcatiod' Date: EHS: Account No. I / Invoice No. a q APPLICANT INFORMATION Account #: 990002571 Billed To: Garry Potts Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax P;i ;%i: i r#: 5860-19-6913 Subdivi - ii 'o: Location/f. '.'r,.;ss: Howardtown Circle -27006 Property Size: see map , Date Evaluated: /::._ &-e-T Water Supply: Evaluation By: On -Site Well Auger Boring 1;!-, Community Pit Public Cut 6 7 Landscape position Slope % �= FACTORS 1 2 3 4 5 6 7 Landscape position Slope % �= HORIZON I DEPTHt. �� �� �� Texture groupU& C C L Consistence Structure Mineralogy HORIZON II DEPTH •t'' 7 43 /t Texture group Consistence r— (' Structure Mineralogyl 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 t SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RA �l REMARKS: EVALUATION BY: //Q,4 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 la r inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), S( rovisionally suitable) U(unsuitable) LTAR - Long-term acceptance rate - ga ay DCHD 05/99 (Revised) ■ ENO MEN ONE ■ ■EMMEME■ ■E■ME■E■ ■M■■E■■■ ■■M■NMM■ ■■N■■M■■ ■■■N■.■■ ■■■■NEEM MM■■■■E■ ■■■.■■.■ ■■■■M■.■ ■■M■M■■M ■■N■■■■■ ■NEEM.■■ M■■MENEM ■■M■EN■■ ■■.■■E■■ No ME ■■MEMMM■E■ ■■■■■■■■.■ ■.■..■■■ ■■M■■M■■■■ ■MM■■■■M■■ ■■NEEM■■■■ ■E■■■■MOMS ■■■■■M■■■■ ■■.■■■■■■■■■■■MMENONE ■e ■■EM■■M■■E■.MUEM■ ■E■■M■■E■■■■■ ■E■ ■EM■■■■N■■■■■■■■E■ ■■E■■E■ME■EEMME■■■ ■■M■■MM■M■■e■■■■■■ ■MME■■N■■■■.■■■E■■ M■■ME■Me■■■MM■■■ME ■■■NE■MM■■M■■■■■ME ■■■MME■■MM.M■U■■■ ■■E■■ME■■■■►RM ■■■ ■■■EMMMM■E■EEN■■■M ■■■■M■EE■■SMEE■■E■ ■■■■■M■.M■■MME■■■■ ■■■E■E■■■EM■■MEM■■ ■EEE■■■■■E■■EMEM■■ ■■■■E■■E■■■■E■■e■N ■N■■M■■E■■■■■ ■■■ ■■MAMMOM■■ME■ ■■■ ■■■►:M.■■■■MM■■■■■■ ■■■M■■■■■■EEE■■■■e ■ ■ ■■■■ ■M■■ ■■■■■■■■■■■■■■■ MEMO■.■■NN■■■■■ NEEM■■e■■■■■■■■ ■■■■M■M■■■■■MN■ ■MEM■■■e■■M■■M■ ■M■■M■■M■■■■NN■ ■■M■■M■MMM■■M■■ ■■e■■M■■M■M■■M■ ■■MM■■MMM■M■MM■ ■■■N■■■NM■■■MM■ ■■MMM■■■MM■■MM■ ■■■■■M■MM■M■M■■ ■MMM■■■►MMM■■■■ ■■MMEMEMEMMEME■ ■e■■MMU■M■■■MM■ ■■■■■eMMMM■M■■■ ■■■.■■.■■E■■■■■ ■■EENNNN■MMM■N■ ■■■■M■MMM■■■■.■ ■.■.■.e■■■■■■■.■■.■�■_�===�::i�■��.■■■.■■.■■Nee■E■■� ...... ...... .. ■■■■.■■.■..■..■■.■■■■.■M-...■■.■■..■..■■E■■■■.■■■EMs ■.■.■■■■■■■■■■M■■N■■■■■11./_■.■■■■..■■■.■■.■■■.■■Ott■ ■■■■.■■■■.■■.e■■■■■E■a■■■.e■■■.Nee.■■s..■.■■..■■■■ ■■■■■■■.■■■■N■ ■■■E■■■■ ■■■■■■E■■■■.■■ ■N■■■■M■ ■■■■E■N■E■■■E■ ■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■.■■■E■.■■■■■ ■■■■■■■■■M.■E■■ ■■■■■■■■■■■■E■■ ■■■■NM■■■■■■MN■ ■■■■■■■■.■■■e■■ ■■■■■NEEM■E■■■■ ■■■■.■■■■■■■M■■ ■■.■■■■■E■■■■■■ ■■■■.■■E■■■■■E■ ■■■E■■■■■■■■■■■ ■■■■■■■■■■■M■■■ ■■N■■■■■■■E■M■■ ■■■.■■.■■■■■■■■ ■■■■■■■■■■■■■■■ ■M■■■■■■M■■■■■■ Zoom Factor, 2X f' Radius Search (feet) 0 Draw select r kBoundary E' I r Census Trz Find Adjoining Parcels • County ID: F60000010606 • Account Number.F60000010606 • PIN:5860196913 • Legal 1:1 AC HOWARDTOWN CI • Owner Name: ALLEN ROGER L • Owner/Address 1: ALLEN ROGER L • OwnerlAddress 2. ALLEN MARTHA • Owner/Address 3.623 HOWARDTOWN CIRCLE • City,State Zip: MOCKSVILLE ,NC 27028 - 0000 • Land Value: $17,410.00 • Building Value: $0.00 • Land Unit/ Type: 0.83 J AC • Deed Book/Page: 00109 / 0614 • Deed Date: 1979/11/30 • Sales Price: $0.00 • Property Address. Cl • County Zoning: R -A • Census Code: • City Code: • Fire District: • Flood Zone: ZONE X • Flood Community. • Flood Panel.• • Flood Map Date: )U� dam This map is preps inventory, of real I within this jurisdic compiled from rei plats, and other F and data. Users c ENVIRONMENTAL HEALTH SECTION w P. 0. Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NC 27028 Phonea':# (336)751 8760 , E January 22, 2003 Garry Potts 194 Overlook Drive Advance, NC 27006 Re: Site Evaluation/ Howardtown Tax Office Pin : #5860-19-6913 Dear Client(s): As requested, a representative from this office visited the aforementioned site on January 21, 2003. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, the site was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr., R.S. Environmental Health Specialist RH/df Davie County, North Carolina Spatial Data Explorer 'SPa ial Data Em:06rer North Carolina Click on the Map to: (7*- Zoomin 0 ZoomOut (:- Recenter Map r Identify: I Parcels Zoom Factor. FEE Radius Search (feet) F277 Parcel Data Cc�cl��- Go..i-ter- eS 7S I - 97 toO Find Adioinin Pg arcels. 7/10 177 'ICA / ««a / .1))e)*T,.__-. •• Zc tiiw� R -A R -M F— E911 Fire Districts ❑ Flood Panels ❑ Flood Zones ❑ Paged of 3 OeOJ ti �Y 33 Map Layers Draw selected layers: oundary Census Tracts ❑ City Boundaries County Zoning Multi Symbol l C -S m C -S -S UD H -B E H -B -S ID I-1 I -1-S 1-2 1 -2 -SED I-3 1-3-S Ej 1-4 ■ 1-4-S ❑ R-20 R -20-S ❑ R-12 _ R -12 -SE) R-8 0 Zc tiiw� R -A R -M F— E911 Fire Districts ❑ Flood Panels ❑ Flood Zones ❑ Nov 04 03 09:22a FRCfM : B October 24. 2003 Rhonda Upright FAX NO. :6284 TO; Davic County Environmental Health Dear Sir., 704-856-1763 Oct. 25 2003 12:10PM P1 I am requesting to have a 25% reduction septic system to be installed at 584 Howardtown Circle. Mocksvil1c, instcad of a convemional septic system. Thunk you. Nickcy D. Strickland p.2 NOV U4 UJ Ub:CCa KnOnaa uprignz a 11,11 71ah.i]m] ! 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