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149 Crows Nest LnDAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section -/ ` P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000884 Tax PIN/EH #: 5823-61-9475 Billed To: Howard Realty Subdivision Info: Reference Name: a.L-L W. -L+ -.as Location/Address: Howell Road -27028 Proposed Facility: Residence Property Size: 10 acres **NOTE* iiss improvement/Operation vent/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 T� #People 1' _ #Bedrooms #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) _ Site: New Repair ❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width,,o Rock Depth— Linear Ftp Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) IF 6 " BELOW FINISHED GRADE. ****NOTI E: ontact a representative of the vie ty Health Department for final inspection of this system between 8:30 a.m. to 9:30 a. . or 1:00 p.m. to 1:30 p.m. on t e in allation. Telephone # is (336)751-8760.**** ,00 dsw/ to110 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 #: 990000884 Tax PIN/EH #: 5823-61-9475 R� Billed To: Howard Realty Subdivision Info: ;Reference Name: a. j i ` Lt `'�5 Location/Address: Howell Road -27028 Proposed Facility: Residence rroperry maize: I acres ATC Number: 2883 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 WASTEWA NSTRUCTION IS VALID FOR A PERIOD OF FIIVE YEARS. Environmental Health Specialist's Signature: Date: (0/ 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. 0) W 1041111 � rJ 00 o Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) v Date: APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMI TC� C E 0 U E Davie County Health Department ,- Environmental Health Section '' 1 P.O. Box 848/210 Hospital Street 1�" JUN % 2001 Mocksville, NC 27028 i (336)751-8760 I ENVIRONMENTAL HEALTH ***1HPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed k� LT'S Contact Person �xoo� kl�,� wZ IF- 9tS2(� Mailing Address �' cc Home Phone ]i� City/state/ZIP �Os -'%" l lIC c 0—i l Business Phone 20, . �� a�� 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC ,Both 4. system to service: VHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: # People! # Bedrooms_ # Bathrooms 2� Dishwasher ll arbage Disposal Washing Machine 6. If Business/Indu's`try/Other: Specifyytype # Commodes # Showers Basement/Plumbing p Basement/No Plumbing # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: ## Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City e. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? ❑ Community ❑ Yes ❑ No ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBM17TED by the client with THIS APPLICATION. Property Dimensions: I C r - Tax Office PIN: # sz -�" - (j2 � • `'1 -i J Property Address: Road Name City/Zip If in a Subdivision provide information, as follows: Name: Section: . Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: OFA lg��V-LL )RD (�1tiuy� iL SC- K aa-, Date Property Flagged: 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 I 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 to conduct alltestingprocedures as necessary to determine the site suitability. / DATE �Q•�D=O� SIGNATURE k 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). Site Revisit Charge Date(s): Client Notification Date: EHS• Revised DCHD (07/99) A Account No. t -� Invoice No. / �� :::.��':�a�.r..o-r-w-e.=.+u::u:.!-w.w_:�=�3"srS:.r-isu.T�_w-�r...i:.wa.-i:,o-r...._c.+-:..r:•rw:aeA-..J.�J��J.sl:..-.)..'.:.<:a..n:,V.....vf..->sarf-� - a.�--...u. -..«__x:. «�.�, ., ...,_.�.:..a.. .,_w .ti,..:,..• .. .. _ 3c�.?s+�-.tisv...x:a+w.c;.+. }--;-:rt '..a-..•i-..aS-4YII3Fe:ti'YY.i:•JOI..$'_:ui_:��ti"e.r..._.._y....,,.'.......�: '- .��i_ __ . . :379 57: — . .. _ _ C30000012406 - Y-. i - X1152 o -� C3000012405 . 41 � j 00 0 030 01240 2917 � 211 - ^ t . . .. (1.51 A) .- --.... 3718 ,. S O A-' C3000.0012407 _ x 734 _ .. - -C300000�12404 - — _.. ... . .. .. - •493 .. _468 249 j (174) lipN 030000012402 29928 8335 r 030ta 0000124 i- F i :I. i r (3 32 A) 3272 74 i r •^ •• - — 359.79 7_ APPLICANT INFORMATION Account #: 990000884 Billed To: Howard Realty Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5823-61-9475 Subdivision Info: Location/Address: Howell Road -27028 Property Size: 10 acres Date Evaluated: , / T 44 Water Supply: On -Site Well L/ Community Public Evaluation By: Auger Boring Pit Cut HORIZON I DEPTH � �y FACTORS 1 2 3 4 5 6 7 Landscape position L. G Slope % HORIZON I DEPTH � �y Texture groupL (' Consistence Structure Mineralogy HORIZON II DEPTH Texture group' Consistence Structure _ b Mineralogy 1 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 i SITE CLASSIFICATION: /'_ T EVALUATION BY: l LONG-TERM ACCEPTANCE RATE / V OTHER(S) PRESENT: REMARKS: �U�GS% Z ��! /%oC 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) MEN ■■■ son i s ■ ■■■■■■■■ ■■■■■■■11■►:II■moi■I.■��11�7■!I ■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■c■■■■■■■■■■■■■■■■■■■■e■eee■■mese■■■■■■ ■■■■■■e■eee■■■■■■■■■■e■■■■■■■c■■■■■■■■■■■■ ■■■■■■■■Flee■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■ ■■■■■■e■ ■■■■e■■c■■■■■■■e■■■■e■■■■■■ecce■ ■■■■■■■■■■■eee■■■■■c■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■e■■■■■■■■eee■■c■■eee■■■■■c■■■■■■■■■■■■■■ ■■■■ecce■■■■c■e■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■eee■■■■■■■■■■■■■■■■■■■■e■■■■■■■s■■■■e■■■ ■■■■e■■■ ■■■■e■■■■■■11■ell■■■■■■■■■■■■■■■■■ OMENS ME■■NEN MEMEMEME■■■N M■■■■■MEN11EN1MEMENNmommmm ■■■■�■■■■■■■■■■■■■■■e■■■■ca■■■■■eee■■■s■■■ll■■i■■■c■■■■■■■■■■■■e■ ■■■■i■■■■■■■■■■■ecce■■■■■■ecce■■■■■■■■■■■eell■■i■■■■■■■■■■■■■■■■■e ■■■rim■■■■■■■■e■■■■■■■■■■■■■■■■■■■■s■■■■■■■tl■■i■■■■■■■■■■■■■■■■■■ ■■■��■■■■■■■■■■■■■■■■■■■■■■■■■�■■■■■■■■■cell■■11■■■■■■■■■■■■■■■■■ rim■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■i■■■�■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■Ile■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■■ecce■e■■■e■c■■■■■■■■■■■■■■■■■■■■■■■■■■■i■■s■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ ■■ DAME COUNWHEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION P. 0. Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NG 27028 Phone #s (336)751-8760 June 14, 2001 Bill Walters C/O Howard Realty 330 S.Salisbury Street Mocksville, NC 27028 Re: Site Evaluation/ 10 acres off Howell Road Tax Office PIN: #5823-61-9475 Dear Client(s): As requested, a representative from this office visited the aforementioned site on June 13, 2001. Based on information provided on the Applications for Site Evaluations and after the evaluation was completed this site was found to be provisionally suitable for the installation of a modified, oversized on-site sewage system. Before Improvement Permit(s)/Authorization(s) to Construct can be issued the appropriate application(s) must be filled out and the house/mobile home location staked on each site. If you have any questions, please feel free to contact this office. Sincerely, X0 g; 0 j V, e. g; WA. Robert B. Hall, Jr., R.S. Environmental Health Specialist RTI/di Enclosure(s)