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145 Idlewild Rd Lot 10 • DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account M 990003354 Tax PIN/EH#: 5862-34-9883.10 Billed To: H&V Construction Subdivision Info: Idlewild Lot# 10 Reference Name: Location/Address: Gordon Drive-27006 Proposed aci i y Residence PropertySize: see map ATC Number: 4229 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 1 I of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: /0 CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of C mletion shall indica the system described on Improvement/Operation Permit has been installed in compliance with Artic eo . .ChaplteFJJAA,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO be taken as a guarantee t the system will function satisfactorily for any given period of time. F Septic System Installed By: �`i127 Environmental Health Specialist's Signature: Date: l2 . DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT n� Environmental Health Section c P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 l �� (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003354 Tax PIN/EH#: 5862-34-9883.10 Billed To: H&V Construction Subdivision Info: Idlewild Lot# 10 Reference Name: Location/Address: Gordon Drive-27006 Proposed Facility Residence Property Size: see map **NOAT C*I¢II[ tIffpro929nt/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. 1 Residential Specification: Building Type #People #Bedrooms S? #Baths _ Dishwasher: Garbage Disposal:,1210' Washing Machine:,O Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seatts Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow(GPD) Site: New 00'* Repair❑ System Specifications: Tank Size/ AGAL. Pump Tank GAL. Trench Width 36"Rock Depth��Linear FtsSo As stated in 15A NCAC 18A.1969(5) m Other: accepted S,stems alt-also be used Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFF T FILTER RISER(S)IF 6-BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie o Health Department for final inspection of this system between 8:30 a.m.to 9:30 a.m. or 1:00 p.m.to 1:30 p.m.on the day i t Nation. 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'Ab�btonpy0ttt0clatoraeQaoJml�dtrto,sataCaSet,lagka°"{y�,IyJatWtJW{upltorpdtf�) mimix ormtk aoct,$=IrkhIGawam�Kal�C 6rrt0W, � 6aebJ;{lrctmaetGtlt�lt�l�ac�facd��tlw(a�rerJap�lalra9eAaeraruarmlJhR 1►a�fa�iaDottOtxdbwl afOoD,rkGuulJUaU4Dq,vau■i �" PtP�7Latsd4Alrgf:adylJdJnual6r L. p� lrR911AM adimdAt4MtmtWB7CYOIJfIl7EPLAU(5{dldealafOJ:tpJdalt��Aapaed a' aJdqoc I. �\ 5lxicrtdlC6arte DAM: I \ GlatitaODcuauD,ts SB'd £t£tSZi9££ r • r ASH Htl 9C:10 60—it—d3S DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003354 Tax PIN/EH#: 5862-34-9883.10 Billed To: H&V Construction Subdivision Info: Idlewild Lot#10 Reference Name: Location/Address: Gordon Drive-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: I` 2 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position (� Slo e% Vk HORIZON I DEPTH - Texture group Consistence f g Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure S Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: ?M' LONG-TERM ACCEPTANCE RATE: D• 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-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) • W y i+ 00, 793 ------------------- _ s O Al t li moo. o. `r wCV =fvvLkj>rtfe 4LIC3 s So, -2 7 a3 d