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P0040 Lydia Ln DAVIE COUNTY HEALTH DEPARTMENT �;. IMPROVEMENT PERMIT and OPERATION PERMIT 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 6.5. Chapter 13OA, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) NAME —�&`h.As \��c\'s\"1 ANPROPERTY ADDRESS �7L 70D�D DATE LOCATION = — �6 0 ��� �\ ELI, � � o"1RLo SUBDIVISION NAME , + LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE i loo sa # BEDROOMS q # BATHS # OCCUPANTS GARBAGE DISPOSAL Yes No COMMERCIAL SPECIFICATIO .`FACILITXjYPE _ _ # PEOPLE #.PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE:�Yes/No LOT SIZE WATER SUPPLY �s��.` DESI6NYWASTEWATER FLOW; (GPD) r D NEW SITE REPAIR SITE P y a SYSTEM SPECIFICATIONS: TANK SIIE Lin GAL PUMP,,TANK GAL. 'ATRENCH WIDTH i ROCK`DEPTH LINEAR"FT. ` `AL OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJEtT.TO REVOCATION IF SITE PLANS:.OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS.PEM,I,T�BEFORE INSTALLING THE SYSTEM. C3,V l p ✓� 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 IN-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. 1 t . OPERATION PERMIT "'� SYSTEM INSTALLED BY W LH doses � d AUTHORIZATION NO. Q Q L40 OPERATION PERMIT By Z5NAX 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 13OA, 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 F ,.JLS��rri+1"{, r}'9ri�'/.:..; r::...°"r� ::. fy� ,'T} :.„�Ir: k"y%,. �i•'s,'�r ..G�;.-,,..j �� ,. ' - ., t�' ,r.. ,. ..r.;.,.-. .F . � .,. E p Davie County Health Departmentd ENVIRONMENTAL HEALTH SECTION P.O. Box 665 i Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of B.S. Chapter 130A, Wastewater Systems) ***This Authorization For Wastewater System Construction must be iss,/je y tte�Davie Coun`fy n� 6ifental Health tem on 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.*** NAME �-, ^. A�� ��otc..t�s Mc \�1A\ANDATE AUTHORIZATION NICER NAME ON IMPROVEMENT PERMIT' (If different than above) SITE LOCATIOFt COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM '% t '4 ***NDTICE*** THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. , .,. ENVIRONMENTAL WEALTH SPECIALIST ` DATE DCHD 10/95 ` APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department ED Environmental Health Section P. O. Box 665 FEB �, 1J Mocksville, NC 27028 03 1. Application/Permit Requested By, ��"�t� f�t� s �11r�lcb'�•�1sYJ Mailing Address q,-' /l KS v;11-p- L �� Home Phone — y S /�IDdd Buses�ess Phone -7o g 2. Name on Permit if Diffy0than Above 3. Application/Permit for: !+General Evaluation eptic Tank Installation . 4. System to Serve: .: [ /House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot# Basement/Plumbing No. of People t �� ❑ Basement/No Plumbing 73 No. of Bedrooms V/r` Washing Machine No. of Bathrooms Dishwasher Dwelling Dimensions o�as(�Q 'o ► ' X Garbage Disposal 6. If business, industry, place of public assembly, er: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public ll� Private ❑ Community 8. Property Dimensions 0 I Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is inteno C. �? es ❑ No If yes, what type? aSS r Ac e '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. yftdk.`v Directions to Property: -svPGL � xy+ a.,A ,�• `�. p FAGS s StIz f0J _ vz o. . � �,� � �d►� '�re . This is to certify that the information provided is correct to the best of my knowledge,and I understand I am responsible for all charges incurred from thisapplication. 173 -7 �S � a 3 �cb � DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. 2. 1 DO NOT OWN the property. If you checked Box#2, the rest of this form MUST be completed by the owner or a person uthorized by the owner: I hereby give consent to the authorized representa' e of the Pavie�County Health Department to enter upon above described property located in Davie County and owned by unpald 1JCA1uJ✓S to conduct all testing procedures as necessary to determine said site's suitabiBty for a ground absorption sewage treatment and disposal system. l9 9:3 DATE SIGNATURE DCHD(12.90) Y• ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS s m e PROPERTY SIZE ? g► TS PROPOSED FACIILTY �oys LOCATION OF SITE Water Supply: On-Site Well v Community Public Evaluation B)�-� L Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position S ,_.S Sloe % E- e- r6-i HORIZON I DEPTH 1`b Texture group L s C L C L S c C Consistence T=F1 Structure ?_ C V_ Mineralogy 1 I , l V.1 HORIZON II DEPTH a' 3 O h Texture group C S Consistence Structure $ Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS >S S Ss s RESTRICTIVE HORIZON SAPROLITE — CLASSIFICATION LONG-TERM ACCEPTANCE RATE ILA SITE CLASSIFICATION: S EVALUATED BY: C LONG-TERM ACCEPTANCE RATE: i 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 watet 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 ■....■■.■■ect■e■■.■■e.■■■■■■■......e..ee■■ect■■■■.■■.■■...■■ ■■■ems■ ■....■e...e■ecce./■■■■ect■.■...■...■...............■...■.eeeeeeee.■ ■■■■■■■■■■■■■■■■■..■■........■■■ ■■..........eeeee■■e........■■.■ ■.■....■■■■■e■■.■■......■■.■■....■■■■eee■■eeee.e..■e■e.e..eee■.■.■ ■.■.■.■■.■...e.e■.■■■■■.■.■■■■■..■■■e■■■.e.e■.eeee■eeeeee.e.■eee.■ ■..■...■.■■■...■.■.......■.......■■...ect■■eee■eeeeee■eeeee■e■■.■■ ■.■■...■■■e■■■■■.■■e■■■■■■eeeeee■■eeeee■■ee■.eee.■■.■■ee.e■e.■ele■ ■■■..................■■....■...■ ■......■eee■■e■aeee.eeleeee.e.■■ ■...■■ee.eeeeee■■■■eee....■■eeeeee■lel....■.■.■.■■.■■■..e■■■...■ ........................... ..........................■.■......... .................................................................. ■■.e■■el..ct■■!■.eeeeeee■■ct■.■■e■�■...■■eeleecte■.e..ee.e.e.■i■■■.■ ■■■..■cele■■ect■e■.e■e■■e.e....ee.■ee■.eee■■.eeeee.■■■■■..........■ ■■.eel.■eee...■■■■■..■■a■■■..■■■.■■ee.■.e..■..e.■■■■.■.....■■.■.e■ ■.e■■■ee■eeeeeee.eeleeee■■.eee■ecce■e■■e.eeel.ee■■..■■■e■eeeee.l.f� ■■..■e!■■eeeeeee!■......■ect■■■e■■■eeeeee■■■■■e..eeee.e■■.■■■e.■■ ■■■..e■l..e■■■■■e.e....eeee.....■eee■.eee..■leeee■■..eteeeeee.=.■■ ■!.■■■eH■■■■■eeeee!.■....■■!■..�.l.ee■e■..lelelect....e.eeeee ct!. ■■■ecce..■■e■■ecce■■■e■e■■e■ect.■■eeN■ee.e■■■eeeee.■■eeeeee..■■.■■ mmomom 001111 ■.ee.■e��eleee■..■■e.........■■■ect..■.e■■eee..eeeeeeee.eelele■■e�l■ ■eee!■ect./■!■■ect■■ect...■■e.......■e.e...leeee..■.ee.ee.■e■■eeeee ■ ■.eeeeeee■■■eaeeeleeeee■■eee./.eeeleeeee.e■e■■■..■...■■..■■■..■..■ ■lss■eeeeee...ecce■■eleee■■ect..■■eee■..■.eee.■■■■■e.■.■.e■■■..■■■■ ■■.eleee■...e.eele■■...■.ect■■eeeee.■..■eee■■■..ect■■.■eeee■e...■■ ■■.e.e■e■.■e.eee.eee■■..eee■ect■■ ■.e■■e■e■■■■.■e■.■.ect..■■e■■eee■ /.■■■.■.e....■■■ect.■■■■..■.■■■■■■.■■ee.e■.■....■■.■e■.■.e.■..■■■.■ .....■....................eee.e■e■....................... ........ .............■.................................................... ■..elect■.!ecce■eee■■\I��e■.■e■■■..�■..■■.■..■■■■■ ■.■...■...■.■.■.■ ■■ect.■e!e■..■eeeee■■► .en..■■l.e�ee��.■■■■.■■■.■.■..■.■.■.■ ■eee■■■■ ■.■.■■■■■■.■eee...■■fe ►.�■■■■■■ri�ee►�..e■■■■ee■e■■■.e.■■e.■.ele■e■ee ■eeee.ee■ee.eleeee.....■■e■eee►-e��■.■eeel.e■ee./eeeeeelee.elee..l■ .... ....... ................................ ...�......................�.■.! 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BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634.5985 February 9, 1993 Gerald Thomas McMillan Rt. 7, Box 153 Mocksville, HC 27028 Re: Site Evaluation Off Seaford Road/8.1 Acres Dear Mr. McMillan: As requested, a representative from this office visited the aforementioned site on February 8, 1993. The site was found provisionally suitable for the installation of a ground absorption sewage system. If you have any questions, please feel free to contact this office. Sincerely, 4� Charles E. Little, R.S. Environmental Health Section CL/vd Enclosure