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201 Maplewood LnDAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section D P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900241 Tax PIN/EH #: 5863-69-1281 Billed To: Craig Carter Builders, Inc. Subdivision Info: Reference Name: Location/Address: Rooster Trail -27006 Proposed Facility: Garage Property Size: 330 acres ATC Number: 2991 **NOTE** This Improvement/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. Residential Specification: Building Type #People #Bedrooms #Baths tv Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply 111 Design Wastewater Flow (GPD) Site: New-Ee Repair ❑ System Specifications: Tank Size GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width ZI 6 Rock Depth Linear Ftp IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County 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 of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 17.9 MR7r., ; rul .rr Environmental Health Section P. O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900241 Tax PIN/EH #: 5863-69-1281 Billed To: Craig Carter Builders, Inc. Subdivision Info: Reference Name: ATC Number: 2991 Location/Address: Rooster Trail -27006 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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA C NSTRUCTION IS VALID"13,-A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: �wlcDate: Z CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. r Septic System Installed By: �p X3 X/2 6^0 X Environmental Health Specialist's Signature : ��(� Date: DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERM ® T Davie County Health Department i� O EnvironmentaiHeaith Section r� P.O. Box 848/210 Hospital Street Mock ` e, NC 27028 OC I 8 2001 336) ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLES THA-;; INFORMATION IS PROVIDED. Refer the INFORMATION BULLETIN for ins ons. 1. Name to be Billed oto �-�'o i c dole,,,4. 11Gl.2;;e- Contact Person i1 /' Mailing Address ��Nf �O� S Home Phone `` City/State/ZIP�/JrfeL /✓� 4�7d�� Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC Both 4. System to Service: ❑ House ❑ wMo�bile Home ❑ Business ❑ CQ� /Industry ther 5. If Residence: # People N%�f— # Bedrooms �/ # Bathrooms 11 Dishwasher U Garbage Disposal 1.1 Washing Machine 11 Basement/Plumbing II Basement/No Plumbing 6. If Business/Industry/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 t6Well LJ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes J<No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with TIIIS APPLICATION. Property Dimensions: 330 Ae/e S Tax Office PIN: # My — l0//'-- /�,fl �Ce Property Address: Road Name eSlt/ City/zip 97006" , "Ally'-fee— If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONSS((/from Mocksville) to PROPERTY: g-61 -- Dale Property Flagged: zo-h This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter arc 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 and responsible for al/ charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie Cou 1-lealth Dcpartmcnl to enter upon above dcscriV proj4rty located in Davie County and owned by� to conduct all testing r as necessary to determine the site suitability/ DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. Invoice No. �O �� 181cl -0 -F-99-S aca 0- £900000OL8 90 CM NO O3X30NI I � i S. ZEN a i r Nam IS LL a (YOU / i 7 C � I " CM 1-4 i l0£9000000L8 LBLt f .II ro &Zos czn £9000E OOL9 t " ssss hr000 s� Ir�O N i KL6 LLl9 i czar � cr ec s�L 0L000000- v . n z roa rots "aoa' 4 -f .roc c � f uzs FwU N F L6K H r su, �U , a s . � I � i S. ZEN a i r Nam IS LL a (YOU / i 7 C � I " CM 1-4 i l0£9000000L8 LBLt f .II ro &Zos czn £9000E OOL9 t " ssss hr000 s� Ir�O N i KL6 LLl9 i czar � cr ec s�L 0L000000- v { DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900241 Tax PINIEH #: 5863-69-1281 Billed To: Craig Carter Builders, Inc. Subdivision Info: Reference Name: Location/Address: Rooster Trail -27006 Proposed Facility: Garage Property Size: 330 acres Date Evaluated: Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH a Texture groupG Consistence Structure j Mineralogy 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: d/ LONG-TERM ACCEPTANCE RATE:_ REMARKS: EVALUATION BY: aZ OTHER(S) PRESENT: 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)