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P0046 Daye Ln + DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT .IMPROVEMENT PERMIT l **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) NAME hS PROPERTY ADDRESS r 7 C. . DATE 111 LOCATION' ` 7tors" �.�,. - 1 SO t+;- G•// / �- + p t `J�/' c SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE 101X& # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes/* COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No " LOT SIZE ;All is 0 TYPE WATER SUPPLY 1, DESIGN WASTEWATER FLOW (GPD):, NEW SITE C/"REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE � i GAL, PUMP TANK GAL. TRENCH WIDTH_ 'Tl `' ROCK DEPTH /?„ LINEAR FT. <'.� r OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS ' ERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE IS PERMIT BEFORE INSTALLING THE SYSTEM. IMPROVEMENT PERMIT BY **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN :8:30-9:30 A.M. OR 1:N-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BYtwsr- E-ve(d AUTHORIZATION N0. O D y `OPERATION`PERMIT BY ��ca n "= �N� DATE )l **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 SYSftkil 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 ENVIRONMENTAL HEALTH SECTION P.D. Box 665 Mocksville, N.C. 27028 36 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of r G.S. Chapter 130A, Wastewater Systems) ***This Authorization For Wastewater System Construction must be issued by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits.*** AUTHORIZATION NUMBER , NAS �° DATE ia, �1�r N2 0 6 A 6 NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION . 0A Me 1,61e 6rf—t , Am r Z6�1 . COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM **WICE*** THIS AUTHORIZATION FD WASTEWATER SYSTEM CONSTRUCTION I5 VALID FOR A PERIOD OF FIVE (5);'YEARS. ENV RL HEALTH SPECIALIST. DATE �. DCHD 10/95 1 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department tJ Environmental Health Section n P. O. Box 665 `y{ Mocksville, NC 27028 ! 2 4 1. Application/Permit equested By aLC4-1 Mailing Address / Home one Business Phone 2., Name on Permit if Different than Above 3. Application for: ❑General Evaluation eSeptic Tank Installation Permit i 4. System to Serve: ❑ House 2.1 obile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # Al ElBasement/Plumbing No. of People � ❑�Base ent/No Plumbing No. of Bedrooms Washing Machine No. of Bathrooms P, B-D-ishwasher Dwelling Dimensions J04 ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No.of Lavatories No. of Water Coolers E. No. of Showers Water Usage Figures 7. 'Type of water supply: ublic El Private ❑ Community 8.'Property Dimensions �ZD 3,;Z Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes, what type? 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. PROPERTY INFORM l Tax Office PIN # Directions to Property: ?„ ,t Road Name Box (if available) city ,'• a i i' t This is to certify that the information provided is correct to;t th t f my k wledge, and I nderstand I am responsible for all charges F incurred from 4his appl' on. ATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1. I OWN the property. ❑ 2. 1 DO NOT OWN the property. , 7 If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by,the owner: 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 said site's suitability for a ground absorption sewage treatment and disposal system. _ f DATE SIGNATURE . DCHD(193) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation / NAMEA6� DATE EVALUATED A2 ADDRESS PROPERTY SIZE PROPOSED FACIILTY Z�g zlv� LOCATION OF SITE Water Supply: On-Site Well _ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Slope HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH Texturegroup Consistence r Structure /1 / Mineralogy /. HORIZON III DEPTH Texture group Consistence Structure • Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S^ LONG-TERM ACCEPTANCE RATE LjL SITE CLASSIFICATION: EVALUATED BY: / LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: 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-Finn 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 Mineraloay 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 ■■■■■■■■■■■■_■■■■■■■■/■°■■■■■■■■■■■Eet■■■■e■eeee■ ■ecce/■■■■e■Ee■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�■■■■■Mee■=�■t■■ee■■■■■■■■■■■■■E■ ■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■eeee■■eeee■■eeeee■eee■ ...............t................e■eE■/■■■■ ■eeeeeee ■e/eeee■ee■■■ ........................... ................... .... ............. ■■■■■■■eeee■e■■■■■■■et■■■■■■■■■■■■■eee/■■■■eee eeee■■n ■eeeeeee■■ ONO ■� � ■■■■■■■■■■/■■■■■■■■■■/■■■■eO■ecceeee■■■e ■M■�eeee■■■e ms■■■��■ ■ ■■■ �■■■■■■!�■■ ■■■■■■■■■■■e��e■■■■■■■■■■■�■■eee■E■■■■■e ■■ ■■ee■ee■■■■e■e■eee■■■■■se■ ■eee■eeee■■/eee■e■eeeE eeeea■Eeee■ee■e■ � ■■■■e■ee■■te■e■ecce■e■■eeeeeeee ■ee■eee■eeeee■Me■e■Me■MEe■eeeeEE ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■E■■■■MN■■eee■M■■■eei■■■eee■e■■ ■■■e■■■■■■■■■e■■e■■■■■■■■■■■■■■■■■■■■■■■■eee■e■■e ■ ■MM■MMMMMMM■M■ ■eeee■eee■eee■■eee■■e■e■eeeeeeeeeeeeee■Meer�e■e■O ��i■■■■■■eet■ee■■ ■■■■■■■E■■tee■■■E■■■■■■E■■■■EEEEe■■■�e/■■e��■■e■e/ eeee■=E■ee■eee :::.:::::::v :■ ........N/■M■■■t■........■...................... 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