181 Lowder Ln DAVIE COUNTY ENVIRONMENTAL HEALTH
' ,i � P.O.Box 848/210 Hospital Street
Mocksville,NC 27028 -
, ' (336)753-6780/Fax#(336)753-1680 �
REPAIIt OPERATION PERMIT
i � Account #: 990005779 Tax PIN/EH#: G500000007
___ Billed To: Robert McClamrock Subdivision Info:
� Address: 181 Lowder Lane Location/Address: 181 Lowder Lane-27028
` City: Mocksville Property Size: 21.5 AC
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Reference Name: Jamie Barnes
Proposed Facility: REPAIR
**NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC 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
w ' time. ,
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�' System Type: S.T.Manufacturer�Q Tank Date�_ Tank Size /
Pump Tank Size —��
System Installed By�Q,YY1;1�. �JQ1�nQS E.H.Specialist: U ate: Z uZ�
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� � ' DCHD 11/06(Revised) -
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,t DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O.Box 848/210 Hospital Street
' Mocksville,NC 27028
(336)753-6780/Fax#(336)753-1680
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Accau�t #�: 990005779 � , '�ax Pl�€!�H�: G500000007
�iiled Ta: Robert McClamrock : , Sukidivisior� Infa: _ . ,
Refer�nce Narne: Jamie Bames � . ` : . .,:_::LocationiAddr�ss: 181 LowderLane-27028 : . ::, , � _
Proposed Faci€ity: REPAIR ,; ., . _. ;:,, .: .,: Proppr�y�ize: 21.5 AC : : ..., : �. ::�:. _ . : . .
ATC Number: 5843 . . � ,. .. . �-- Site Type: ❑New ClRepair ❑Expansion,
**NOTE**This Authorization to Construct(ATC)MIJST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A
Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FNE YEARS. This ATC is subject to revocation if site plans,plat ,
or the intended use change.
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Residential Specifications: #Bedrooms � #Bathrooms 2 #People.� Basement❑ Basement plumbing0
Non-Residential Specifications: Facility Type #People #Seats
Square Footage(or Dimensions of Facility)
Lot Size � �a Type of Water Supply: �County/City ❑Well ❑Community Well
System SpeciScations: Design Wastewater Flow(GPD) ��� Tank Size X �It'I�GAL.Pump Tank�GAL.
Trench Width��` Max.Trench Depth ��r Rock Depth� Linear Ft. �CL•�� �J��e
Site Modifications/Conditions/Other: �?.�'(��1�Gr
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760.
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Environmental Health Specialist ` t�. ' Date: �� 2C
DCHD 11/06(Revised)
'• DAVIE COUNTY HEALTH DEPARTMENT
� ' Environmental Health Section
Soil/Site Evaluation �
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990005779 Tax PIN/EH#: G500000007
Billed To: Robert McClamrock Subdivision Info:
Reference Name: Jamie Barnes LocatioNAddress: 181 Lowder Lane-27028
Proposed Facility: REPAIR Property Size: 21.5 AC Date Evaluated: � Zb��
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit � Cut
FACTORS 1 2 3 4 5 6' 7
Landsca e sition
Slope% ,
HORIZON I DEPTH
Texture rou
Consistence � - -
Structure
Mineralo �.,,,,�: .,. ,-;,��r>
HORIZON II DEPTH
. ._. .,.
Texture rou _ _
Consistence
�Structure .
Mineralo
� HORIZON III DEPTH
Texture rou
Consistence s
Structure
Mineralo
HORIZON IV DEPT'H
Texture rou
Consistence . ; ,
Structure
Mineralo � .
SOIL WETNESS
. RESTRICTIVE HORIZON -
SAPROLITE , ,;
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: F `� EVALUATION BY:
LONG-TERM ACCEPTANCE RATE:_;�__ . . OTHER(S)PRESENT: _
REMARKS:
LEGEND
i, n ane Pocition' _
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
T�ctiug _ .
S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt
SICL-Silty clay loam SIL-Silry loam CL-Clay loam SCL-Sandy clay loam
SC-Sandy clay :SIC-Silty clay C-Clay ;
CONSISTENCE
Mulst
VFR-Very friable FR-Friable FI-Firm VFT-Very firm� EFI-Extremely firm: . . ..
�
• NS -Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky
NP-:Non plastic SP-Slightly plastic P-Plastic VP-Very plastic
�uctnt�
SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angulaz blocky
SBK-Subangular blocky PL-Platy PR-Prismatic '
Mineral��' .
1:1,2:1,Mixed
�s
Horizon depth-In inches �
Depth of fill-In inches ;
Restrictive horizon-Thickness and inc6es 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-gaUday/ft2 DCHD OS/OS(Revised)
o av�
, DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME O"t)� M�� (.Q V1'��IG�� PHONE NUMBER
ADDRESS ��� CGId� :� �L4 �� SUBDIVISION NAME
LOT#
DIRECTIONS TO SITE ��/�� � 4 G�'l L�SL.(�,/,��/�I� , LGt�T /ID'Gf� O<� L
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS Z NUMBER PEOPLE SERVED
NPE WATER SUPPLY_ SPECIFY PROBLEM OCCURRING__����`— � `Z
DATE REQUESTED � �O�� INFORMATION TAKEN BY �1 I
This is to certify that the information provided is con�ct to ths best of my knowiedgs,and that I und�rstand I am nsponsibls for ali eharpss incurred from thia applieation.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev.1/93 p ,
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