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P0446 Gregory Ln y ii+n sr.w•..r.. !r_`ru ri X iV.. r 4 4 ' _ / .s , .. - �� a- DAVIE COUNTY HEALTH DEPARTMENT t IMPROVEMENT PERMIT and OPERATION PERMIT �,JB IMPROVEMENT PERMIT **NOTE** This improvement permit DOES NOT authorize the construction or installation 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 B.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) NAS S L\L\o N P Z=, 2o WN PROPERTY ADDRESS C 2?o 2 Cl DATE LOCATION SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS !� # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes to COMMERCIALSPECIFICATION `TACILITY TYPE`_ # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No:. LOT SIZE �, TYWWATER'SUPPLY W' .'DESIGN WASTEWATER FLOW (GPD) l NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANKhMZE1MD 6AL. PUMP TANK GAL. TRENCH WIDTH 3 � CROCK DEPTH y LINEAR FT. OOH OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: 4 ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS�R THE INTENDED USE CHANGE. YOUR WASTERWATER SYS TEN-CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE'SYSTEM. o�se OQ9 i IMPROVEMENT PERMIT BY **CONTACT A REPRESENTATIVE OF THE'DAVIE COUNTY iFALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT 'b SYSTEM INSTALLED BY eld AUTHORIZATION NO. D'y OPERATION PERMIT BY /L ' DATE **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. DCHD 10/95 Davie County Health Department gBA ENVIRONMENTAL HEALTH SECTION is P.0.•Box 665 JOp.dd Mocksville, N.C. 27028 g (/Jf� AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued incompliance with Article 11 of B.S. Chapter 130A, Wastewater Systems) ***This Authorization For Wastewater System Construction must be issued by the Davie County Environmental Healt�Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Buiil ng Inspections Office when applying for Building Permits.*** NAME e DATE o N R Q a -1 AUTHORIZATION NU/9ER NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION NZ Ca N�— COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM fMlOTICE THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. J. EI(na ENTAL HEALTH SPECIALIST DATE DCHD 10/95 ' �6:t e,, va._ .�. . a�Y4: '� _-,t;;. S"r. Baa-•. r'._ .t v:+ r,r ._r. w:a t ..,r },. _ ," .. ' r _ .-,. s _ N:r� a w-. -. . ..�t ... + APPLICATION FOR SITE EVALUATIONAMPROVEMENT PE Davie County Health Department 0 W 1E Environmental Health Section D P.O. Box 848 AUG - 71996 Mocksville,NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed N6L >' Contact Person, ,zP Mailing Address P, ell Home Phone City/State/Zip ' Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: [ ] Site Evaluation 4QImprovement Permit&ATC [ ]Both 4. System to Serve: House [ ]Mobile Home [ ]Business [ ]Industry [ ]Other 5. If Residence: #People—,2,— Bedrooms #Bathrooms [ ]Dishwasher[ ]Garbage Disposal [ ]Washing Machine [ ]Basement/Plumbing [ ]Basement/No Plumbing 6. If Business/Other:Specify type #People #Sinks #Commodes #Showers #Urinals #Water Coolers If Foodservice:#Seats Estimated Water Usage(gallons per day) 7. Type of water supply: [ ]County/City X Well [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes K No If yes,what type? PROPERTY INFORMATION REQUIRED:***IMPORTANT***A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: # d LS U Property Address: Road Name e { City/Zip l/L GZ If in Subdivision provide information,as follows: Name: ; Section: Lot#: 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 t e Davie County Health Department to enter upon above described property located in Davie County and owned by / to-conduat all testing procedures as necessary to determine the site suitability. DATE �7��j`� IG TURE Revised DCHD(06-96) Wp s� 10 85 Ac m 220 Sg 6g, N r m X12 % 81 c Ac ISQ �a 8348 22o — v 4 "R5 Ac 55 5 . a, 13 6 A W 8712 2 R8 IL5 - w E ° c ✓ ! m $I Ac %4?e 14 W k° urzo� 7^ 5.51 Ac a 5 ;1 2Ac ,S30 r; 15 B30m 297 `54 -- 51A8 X 38.6 7Ac e r m _ 52 �15 _ 5 3- 49 g3 /S s <n " h 126z C) .(-1 co m P 242.02 18.7 2M'83 11 Q 17 as 144 X53 51 5p 82764 1. 6� 731 45a3,� e.ss' ° —1.2 Ac, 2At: n I. f 3 m F _ 17.78 Ac y� til20 21 ' SAcJ8 -� o- 8 c [ t{ 6s 30.34 Ac 19 r 4 N X3.01 X22 5774 0 W `16 132 33 nm1Ac 4i6.� 236GA3 �p �� 420 m 8 e �a s �N22, 10 83z 37 6 3 w �23AcZ 4a0 37a 05 25 24 4 aas-s `:. .. ?7 14.45 C�•c r'. 1. r. 400.3 1792 6.4 _ s 20 A m "4Srn3 ," ^ Ni0 A) 5.2 281.14 1 W N 2oa 26145 AC, 1652 28 5.5 AC 78731 CIA- 35 415.os z 77a 2 AC. " ��i (9A) N .5AC n « m ?9 35 17 Ac.) - •- 2839.95 @ a" -- - R ��� (il) 15_'q ( 5. 19 4c.�u, 2980 m 31 9 t --�C. Fi 5 4c 3a 1p ^� (7 u 32 A) - "- 29oom —" 2s_5 - f5 A, o v ,1 3514 sA) 3=�7 B r • DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section Soil/Site Evaluation NAME A Vo�o u¢. Q `���� DATE EVALUATED ADDRESS Q K'`Q PROPERTY SIZE PROPOSED FACIILTY �boSQ � '�`yJ LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation Byc v_ Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position -5 S Sloe R - "" $' Iso HORIZON I DEPTH '' Texture group L Q L Consistence �- Structure MineralogX1'. HORIZON II DEPTH Texture groupG Consistence 5. - 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 L-L SITE CLASSIFICATION: �'S- EVALUATED BY: LONG—TERM ACCEPTANCE RATE: '� OTHER(S)- ESENT: REMARKS: �'A J 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 :lay loam- SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Ve.-y 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 3C-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralo¢y 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(01-901 .......................................... ........ ............. ........................... ................... 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