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336 Comanche Dr I.+.4"a'L l�i.. s DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT 0 IMPROVEMENT PERMIT J **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 �' , D e P /' PROPERTY ADDRESS 71 1 C•lh t II S' �"' DATE LOCATIONT/' llr'�� ,M, l�l SUBDIVISION NAME l!�/ ;G.� J4/- y J�S LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE BEDROOMS, T I* BATHS , t OCCUPANTS GARBAGE DISPOSAL: Ye iy COMMERCIAL SPECIFICATION: FACILITY TYPE t PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE TYPE WATER SUPPLY �_ DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE t� SYSTEM SPECIFICATIONS: TANK SIZE ALO GAL. PUMP TANK GAL. TRENCH WIDTH 3 '' ROCK DEPTH LINEAR FT. _� OTHER v REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. 1 i 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 1:00-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY ly 2A - } �rWy 1 AUTHORIZATION N�. IMEMTIMd PERMIT BY DATE jhDbr-1 **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 SATISFACTOPILY FOR ANY GIVEN PERIOD OF TIME. DCHD 10/95 y. w✓'v f:p DAVIE COUNTY HEALTH DEPARTMENT IMPRQVEMENT PERMIT and OPERATION PERMIT kOfDENT,PERMIT -**NOTE*4 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.G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) 536 ' NAME �� �'J C//ll°t c`' /' PROPERTY ADDRES5 'YI 1 Gll1 S' 06 j )1er/eDATE r LOCATION SUBDIVISION NAME, L--�rJ/ice`_ _/� LOT NUMBER ;SEC BLOCK NUMBER j- - RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS,=4_ BATHS # OCCUPANTS , -/ GARBAGE DISPOSAL: Ye !'1�6' COMMERCIAL SPECIFICATION: FACILITY TYPE""'; # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE TYPE WATER SUPPLYDESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR.SITE SYSTEM SPECIFICATIONS: TANK SIZE 1),949 GAL. PUMP TANK GAL. TRENCH WIDTH 'T, '' ROCK DEPTH c�/-" LINEAR FT. � � OTHER t REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. ti t IMPROVEMENT PERMIT BY **CONTACT A REPRESENTATIVE OF THE DAVIE.COUNJTY HEALTH 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 SYSTEM INSTALLED BY . j . i. AUTHORIZATION NO. OPERATION PERMIT BY ��V 1 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. t �DCHD 10/95 ..;.- ,w "fix, K �' .;1'oi` k.j � f t' .i,_�.,�" n;y r< �{'•i, `'Pn k. .. .., Tit " VX` 4 Davie County Health Department ENVIRONMENTAL HEALTH SECTION P.O. Box 665 ' Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) *** his 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.*** � �'" DATE A©��"�-1 � AUTHORIZATION NUMBER NAME . � N° U. ?7 CV NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM ***NOTICE*** THIS AUTHORIZATION FDR W TEWATER SYSTEM CDN T UCIIDN I ALID 7R A P RIDS DD IVE (`) YEARS. ` ENVIRONIENTAL HEAL SPECIALIST DATE �r SES' DCHD 10/95 ,- r DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION "NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC .10A .1934-.1968) Permit Number Name x- r'�. I Date Locationl Subdivision Name Lot No. Sec. or Block No. Lot Size_72-/L�— House Mobile Home _ Business __ Speculation No. Bedrooms No. Baths No. in Family _ Garbage Disposal YES ❑ NO Specifications for System: Auto Dish Washer YES NO ❑ �. :% / Auto Wash Machine YES $ NO '❑ Type Water Supply __— i _ *This permit Void if sewage system described below js..not-instafled within36 months from date of issue. Fi. Improvements 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 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by igh /ten?n +7 7-r„'- E G d J x Certificate of Completion �r E ��log. ! Date ' ” Z? - *The signing of this certificate shall indicate that the system described'above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT 0 ,0 Davie County Health Department Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN(�N ISSUED. � Home Phone I W00 / sq 1. Permit Rea-vested By �y L.3 E --'1 Business Phone qc��k 2. Address ) 2- D x 2 I cI � h t�' �,/ C, a-- 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair b) Privy Conventional Other Type Ground Absorption GGCC}} c) Sub-Division Sec. Lot No.� 5. System used to serve what type facility: Housey Mobile Home Business— Industry— usiness IndustryOther b) Number of people �4 6. a) If house or mobile home, state size of home and number of rooms. House Dimen ions �01) C)Bed Rooms Bath Rooms `tom Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes _L1 urinals garbage disposal lavatory 2- showers �— washing machine dishwasher j sinks 8. a) Type water supply: Public L�Private Community b) Has the water supply system been approved? Yes �No 9. a) Property Dimensions I &.C� b) Land area designated to building site t� c) Sewage Disposal Contractor 12_R. L L-L, -BVI b j x 155-4 1� �� 1 117:C/M 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? AI What type? This is to certify that the information is correct to the best of my knowledge. Date OwnePSignature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: t r DCHD(6-82) � F ' ✓ DAVIE COUNTY HEALTH DEPARWENT PERCOLATION TEST RESULTS DATE NAME LOCATION /' ., FINDINGS: HOLE NO. COARIENTS / 1/ �,'rt /lac A i LOT DIAGRAt:f - � R i )b7 f DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION / // APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) i�.511-4110 NAM Q PHONE NUMBER ADDRESS omnndle - SUBDIVISION NAME Q 7L 'G A10,0, d LOT # DIRECTIONS TO SITE / 71a 44/ � c D a D E S STEM INSTALLEDNAME SYSTEM NSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS NUMBER PE PLE SERVED TYPE WAT R SUPPLY SPECIFY PROBLEM OCCURRING DATE QUESTED INFORMATION " This is to certify that the information provided is correct to the best of my knowledge and that I understand I am responsible for all charges incurr p icatidn! SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev.1193 OCT-19-2004 02: 13 PM CENTURY21 3367513931 P. 01/01 s Dot to 04 11128a davits aountu envhtsalth 338 751 8700 APMCATION FOR 81TF EVAWATION/I111PAQVW04 PERMIT 6 ATC Q Davis County Health Dapartn ant 0T EnYroAfl�Ifl tiAtaft&r6ron C P.O. 9o: 048/210 Roapital Street / 9 ?004 MWAvville, NC 27020 ea•iNPOltrAxreee TRIO AiPLIChTZQK C.ANWr!B .`D)AWXVIUMXSa ALL Tile UQUIUD n,Wn+�IQ`/T}, e(� IltIVANA71W is Dtt PROVI . lelor to the IVOMIATION HULL8TIit for ia■truotian■. FCo�nn, i Noir to he milled 1AMPIOX _ esntwt ..reit 5'a m�• ✓w111na Aide-«. , � " i1'�Ctty/Ailsa/%KF ,(- •a sv.ln..e the..27(0' �R •lJl./._,�� //y�(�/I`�,yn t/'-� NW oo..raft/ATtc It Dieterunt Man Above (l �n t/'►v 1 ✓ y� .�.111elling Addee.a l✓—1TF' 1t OL IY/amen/rip O v "'� U ( �/ ~! Application tar, sits IIwluation ❑ Imprewaent Demerit/ATC D souk l tom. sysiam to s—lioa4 Names O Labile None O Nusinses ❑ In4ustry ❑ Other Tyne systaA eopwated+ Pt Con.antionel ❑ coweationel eadltiod ❑ inno.ett.e ,. -� S- It Residences a people a _ a sedraoms a notbroema Slim+ane/lNt EwaW O1.y1Ia! 10044's'sna Maallee [/)lYe►tn� �alleMsa!/Mo rivaw e 7. It bustneesiinAustry /0ttwr: verity'eypo a aaayla R Slake a Cnlowdes / ctyMrr.�' f winale a Neter&-low. 2u nooasaAvzcsr O motto Rs11LASted e Rater wage Italian*pec day) t V`mss. Type at.star a++,ply, Ceuuty/Ci ly � � I o. Do you antlet0ae additions or ezpaattoos of the fael!!ty tide system a intended to acme?D Yet I�.Xo It yes,what type? eeolM irAN7"•Cl 1PN1\MAST PLBTSTill RSQUIRSD PROPRRI•Y INFORMATION RCQUBSTI[D SI W. there PLAT Air 517 i PLAN J1 TOR SUOMlrris0 by tae Bleat wltb THIS A PPLICATION. C--Iroperly Dimentlonat ri-Al[t f. L—wain otRcmons Dram metwint)to ramp 'fv: ✓Air 0(fice Pint //'properly Add Road� e Q l' eltyl7lp /if // /�i l}.t_ A"jz f/ trim a Subdivision provide taibrmatkro,at follows. Law" ," s Name �nfe11Q.Ut°+�� S¢eT a rn Block: Lot:JAOL L,00s how careen Ragged: t;06 This is to cerllfy that the inforouidon provided Is correct to the best of my knowledge, i undonland that any ,111(s) issued beresiter aro subject to suspension or revocation,if the Lite plans or Intended site thaale,or If the IDlbrmslion ssibndllcl)Sa thU applleatloa b falcifisd or elomaal 1,Misr,andsrstand tkaf I ass rnpaadbfi fir d/i chergsy INnirrtd/tas+ skis n"Urafion. 1,hereby,give consent is the Authorized Repretentsove of the Dade County Health Dtportuwnt to vutor upon*Lova described properly located In Doyle County and owned by to tundurl all Ietgtlpt proeoduroe 111 nee story to dtlarmine lhr se ability. DATE l U�r�]—U�_.+. gjBftiMATU T1118 ARCA MAY lit USM FOR DRAWING YOUR SITZ PLAN'(Include all of tho following: hitting and propdsDd properly lines and dhntntiour. Mciur:a,sotbecks,slid septic location). site RDvUIt Cbarte Client Notification Past: �! IHS: Sian given V'• Account No. i2.ctiteti DCIII)(05103 c Invoice No. `—� :�f TTHO ZATION NO: 14 2 2 DAVIE COUNTY HEALTH DEPARTMENT '� Environmental Health Section PROPERTY INFORMATION Pe ittee's / P.O.Box 848 Name: t .G�'/"�E��1�� ' Mocksville,NC 27028 Subdivision Name: _Z ' Phone#:704-634-8760 Directions to property: (� ���,�Z � Section: /� Lot: AUTHORIZATION FOR � WASTEWATER Tax Office PIN:#. SYSTEM CONSTRUCTION Road Name: i in, A **NOTE**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. (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION:BUILDING TYPE_H #BEDROOMS 13' #BATHS— #OCCUPANTS_GARBAGE DISPOSAL:Yes or No COMMERCIIA•'L'SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE v C TYPE WATER SUPPLY �/ _� DESIGN WASTEWATER FLOW(GPD) d NEW SITE 1�` REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE -&-P GALL.PUMP TANK GAlL'.� TRENCH WIDTH :iV ROCK DEPTH 412 LINEAR FT. OTHER f(/[n (/GY/�c. ~ �/VJ ��1�51 REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT• } rf P b _ P : , t "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH 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 SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: 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 NOWAY BE TAKEN AS A. GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003392 Tax PIN/EH#: 5769-70-3256 Billed To: Pamela Tolar Subdivision Info: Indian Hills Lot#09 Reference Name: Location/Address: Commanche Drive-27006 Proposed Facility: Residence Property Size: 5 acres Date Evaluated: Water Supply: On-Site Well Community Public C/ Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe% HORIZON I DEPTH Texture group 4 IS61( Consistence Structure Mineralogy HORIZON II DEPTH ' Texture group C Consistence StructureP-"- Mineralogy /N Mineralo - 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 SITE CLASSIFICATION: e EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: v / 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) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MENNENEMEMM��l�:ii��iNit■■■���EMEMMEMENNENMMMEMM" ■■■■■■■■■■■■■■■■■■■■■ee■■■■■■■■were■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■�■■i■■e■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ee■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ NEESE ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■eee■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ r--• ,. :;7 -a aP:_-. 'a ..Y:� • 9,.,.K,•: 5+1 ..,rtr."aJiv,j `�p a,,.e � a •- it XUTHOR:ZATION NO: *1422 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permittee's P.O.Box 848 Name: Mocksville,NC 27028 Subdivision Name: / / Phone#:704-634-8760 property: 1/4 —4 t 4 C'/ �/ Section: � Lot: Directions to .rYl AUTHORIZATION FOR ` WASTEWATER Tax Office PIN:#. SYSTEM CONSTRUCTION Road Name: **NOTE**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. (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION F 'T1 IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST = DATE ISSUED ,^•y��y;���y�.ns.�nr.'�r+ +°^,�w i�`k e•.�G'R�.d. .- �y4"'�' '7,,•..1»e,�p�' �,_: ctp. v.. Fi 'i '' , 4 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Pei irittee's.-' f .,..��rr l `.Nanie ` 9'C" 'li ? Subdivision Name _./ htl�lf Directions to property: .+a 1�1!',d` Section: Lot: IMPROVEMENT . PERMIT Tax Office PIN:# `' ✓" � ` - 1) -_r, 5 ' Road Name: **NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system o&y wa to 4aie` 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) ***NOTICE***THIS PERMIT LS SUBJECT'I01EVOCATION IF SITE , r' r '_• z ` PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED :SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE #.BEDROOMS ' #BATHS _#OCCUPANTS GARBAGE DISPOSAL:Yes or No , COMMERC,IAAL'SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZEy fl C TYPE WATER SUPPLY / DESIGN WASTEWATER FLOW(GPD) Ox-d NEW SITE�.REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE/IMOD GAL. .PUMP TANK GAL.. TRENCH WIDTH ROCK DEPTH-fc LINEAR FT.X OTHERS REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT x4 t 1� r f ellLAV S� "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH 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)63478760. ' OPERATION PERMIT ` SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: 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 05/96(Revised) 1422 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Perm�ittee's 'A I �. Name: w- -/mss` { ' /: � %�"'" Subdivision Name: ��1f a !+ 1°<''. ` Directions to property: e s;7),L, Section: Lot: `~ IMPROVEMENT PERMIT Tax Office PIN:# ' a j � 1P, Road Name: : El�pfp%� - Zip:04 I **NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or Oy'waqewater 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) ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE.-kO`1R WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS IF #BATHS' -;V #OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY T'YPEL- #PI OPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes orNo t�" LOT SIZE TYPE WATER SUPPLY ��l` DESIGN WASTEWATER FLOW(GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE r A&GAL. PUMP TANK GAL. TRENCH WIDTH -7i5 ROCK DEPTH AV LINEAR Fr. OTHER t+t��rl� ti6l � REQUIRED SITE MQDIFICATIONS/CONDITION,S:�"" IMPROVEMENT PERMIT LAYOUT �� J •} oil 41 rk? ti. E .'INST A REPRESENTATIVEAF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAjPECT I6N OF THIS SYSTEMTWEEN 8:30 9:30 AZ OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(704)63478760. j✓ , OPERATION PERMIT SYSTEM INSTALLED BY: a- AUTHORIZATION NO. OPERATION PERMIT BY: 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 05/96(Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT EE Davie County Health Department �5 t. �/ Environmental Health Section �S 'y P O.Box 848 19% Mocksville,NC 27028 U' (704)634-8760 1 S , r B ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED " J= ALL THE REQUIRED INFORMATION IS PROVIDED. l I1 1. Name to be Billed ,e r1� A. Cr,r I Contact Person DCN-L a LH Mailing Address V�q So-h;c 0r- Home Phone 32G -1 C5( -on-�q City/State/Zip rj GV,:g AL, (\\%C 2-1 C�� S� Business Phone N J R 2. Name on Permit/ATC if Different than Above b C,y'(Q,r\-% IQ . r.1 .1 Mailing Address 139 4 e n, c �)r City/State/Zip <.k�U i�)' N(- 2l o p-S 3. Application For: Site Evaluation ❑ Improvement Permit&ATC Id Both 4. System to Serve: -<-Q House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People - # Bedrooms 3 # Bathrooms , \Q] Dishwasher fit! Garbage Disposal N""' `�] 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 '--,0 Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Q'I'N0 If yes,what type? PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE 5, 1 p r z s , -2 - / �O0 SUBMITTED WITH THIS APPLICATION. Property Dimensions: _ . a4 e_ %Q J &102- 1 WRITE DIRECTIONS(from / 1 Mocksville)TO PROPERTY: Tax Office PIN: # 5717q - �_ - �.2� 67 1 n LSOc.1~e-v m a-n c y-Property Address: Road Name � n oil r-Q-C �" S re_ . 1 1 city/zip Lk N(J' a re, c c. 1 33 C-) -75 l 33110 1 dor .. b If in Subdivision provide information,as ollows: X911 ( 4dr.ssi n ) 1 1 On 1 Name: 1 - on a n 1 Section: Lot #: ' r `(-4s �iY po 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.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 conduct all testing procedures as necess-tq deterrmue the site suitability. DATE, T, If L _ SIGNATURE Revised DCHD(06-96) = DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section SECTION LOT, Soil/Site Evaluation ArrLICANT'S NAME /" DATE EVALUATED PROPOSED FACILITY / PROPERTY SIZE SUBDIVISION / -` ROAD NAME �r1 � y°.0 Water Supply: On-Site Well Community Public c/ Evaluation By: Auger Boring t/ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position '4— Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON 11 DEPTH ' y'' Texture group L Consistence ' Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 61 LONG-TERM ACCEPTANCE RATE �/ SITE CLASSIFICATION: GLS $? EVALUATION 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-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(01.90) ■■■■■■■■■■■■■■■il■■■■■■■■■■■■■■■■■■■■�Ill1■■■.■■■.■■/�.■■■■■...■■ ■■■ MEMNONiiiiiiMEMNON '�iiliiiiiiiiONS Miiiiiiiiiii ■■■■■■■■■.■■■■.■■■■.■■■.■■■■.■■■■■■i■glee■■■■■■■e■■■e.■■■■■■■■■■■■■■ ZX Environmental Health Section P. 0. Box 848/210 Hospital Street Courier 09-40-06 Mocksville, NC 27028 November 4, 2004 Pamela Tolar 124 Conifer Court Advance, NC 27006 Re: Site Evaluation/Indian Hills Lot 9 Tax Office PIN: #5769-70-3256 Dear Client(s): As requested, a representative from this office visited the aforementioned site on, November 3, 2004 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 oversized modified 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 RBH/dlf Enclosure(s)