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1505 Peoples Creek Rd Lot 8 . + 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 B.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) NAME '?.V LS PROPERTY ADDRESS MO rC 4 frrr,1 PL 1.49 DATE LOCATION 5 '"' �\ C7c1 d , .5 tx\ y Q) ay�A SUBDIVISION NAME A'F'��� F2 \I �LR�S LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE v5¢ # BEDROOMS # BATHS 4 # OCCUPANTS 2 GARBAGE DISPOSAL: Yes/No COMMERCIAL SPECIFICATION: FACILITY TYPE ''`� # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Ye No LOT SIZE QUA k,,JYPE WATER SUPPLY l�q'>. A DESIGN WASTEWATER.FLOW (GPD) IaBn NEW SITE REPAIR SITE SYSTEM SPECIFTANK SIZE 1 00 GAL . ICATIONS: PUMP TANK­ GAL. TRENCH WIDTH CROCK DEPTH LINEAR FT. OTHER � 0O ` .� �1 -V)4�f t i REQUIRED SITE MODIFICATIONS/CONDITIONS: z ***THIS PERMIT I5 SUBJECT TO IEVOEATION IF SITErPLANS"OR THE INTENDED USE CHANGE, YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING tHE SYSTEM. ` } 1aovs � y 8 AR LTA-`_ o y ` r IMPROVEMENT"PERMIT BY r **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. , - � s. a SYSTEM INSTALLED ' OPERATION PERMIT 1C '� LED BY fF AUTHORIZATION NO. O L\`1 OPERATION PERMIT BY P\ DATE 3 **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 10/95 � ,., Davie County Health Department '� ;' ENVIRONMENTAL HEALTH SECTION P.D. Box 665 1 su p. So.W) • '�1 ,� y Mocksville, N.C. 27028 - ! AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Y (Issued in compliance with Article 11 of I G.S. Chapter 13OA, Wastewater Systems) ***This Authorization For Wastewater System Construction must be issued by the Davie County Environmental Hearth Secti"onpprior 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.*** (� q AUTHORIZATION NUM' R f :NAM E �o� N �4- D �Ss2. An V 1 S DATE _ t `a !�a �Q.: 0447 ..i 'INAME ON IMPROVEMENT PERMIT (If different than above) ` SITE LOCATION \`` R c COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM • rc *HNDTICE*** THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIVE (5) YEARS. ENVIRONMENTAL HEALTH SPECIALIST: l DATE a DCHD', 10/95 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE Davie County Health Department Environmental Health Section P.0..Box 665 Mocksville, NC 27028 1. Application/Permit Requested By- _ �a�e d ✓ohn DQ vis —' Mailing Address Home Phone_L? 76 (0 Business Phone 2. Name on Permit if Different than Above 3. Application/Permit for: General Evaluation ❑ Septic Tank Installation 4. System to Serve: E)/House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry• _.❑ Other ❑ Unknown 5. If house, mobile home:Subdivision ``\a��� ��`(L� �L�� Section Lot # ❑ Basement/Plumbing No.of People z ❑ Basement/No Plumbing No.of Bedrooms LT/ ❑ Washing Machine No.of Bathrooms ❑ Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, Industry, place of public assembly,other: 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: 9rI5ublic ❑ Private ❑ Community 8. Property Dimensions QGrGS Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem Is intended to serve? ❑ Yes 2-No If yes,what type? '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. Directions to Property: IS Ea54 8 b 16 o t4i-h &+ on Vel)a Crecj� :Roa �,J rn(,rA Farr �1gCye$ Op . This is to certify that the information provided is correct to the best of my knowledge,and I understa 1 am responsible for all charges Incurred from this application. /45 DATE SIGNATU01-1 17 CONSEN FSH an EVALUATION IQ BE DONE QN ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. Fri. I DO NOT OWN the property. If you checked Box #2,the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Davi o_ynty Health Department to enter upon above described property located in Davie County and owned by 177P,/q ITS to conduct all testing procedures as necessary to determin said site's suitability for a ground absorptio sewage treatment and disposal system. DATE SIGNATU DCHD(12.90) " DAVIE COUNTY HEALTH DEPARTMENT t •t Environmental Health Section Soil/Site Evaluation / NAME DATE EVALUATED ADDRESS 5 AYvr,-.P PROPERTY SIZE 4 ��AA PROPOSED FACIILTY ft_1 0 ale- LOCATION OF SITE 0,2 Ra Water Supply: On-Site Well _ Community Public Evaluation By:( ,U. Auger Boring Pitt Cut FACTORS 1 2 3 4 Landscape position Sloe Z !3," O HORIZON I DEPTH Texture group t- C L CL-- Consistence Structure C Ce MineralogX HORIZON 11 DEPTHtAiuv_ Z'' Texture group Consistence Structure R Mineralogy :i HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS V$ RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: S EVALUATED BY: LONG-TERM ACCEPTANCE RATE: 3 OTHER(S) PRESENT: N O tJ s }� REMARKS: ekCQ,ian p I �" .s�e..�. ,,,�stL *13 ,�� 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 :lay 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 ,iC-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 wateC 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 ■■■■■■■■■/■■■■/n■■■■■.■monomono/■■■■■■■■■■■■■■■■■ ■■mono.■ Noon ■® ■■■.■..■■■■.■....■■.■■■.■.■■■.■..■.■..■■■■■■■■■■.a■N■■■■■■■MEN ■a.■ ■■■■.■■.■mono■/■■■■■■■■■■/■■■■e■ ■■■■.■■■/■■/■.■.■/.■■■/■■■■■■■■■ ■■■■.■■■■nn.n■■■eon■■■.■■>•.■■■■■■.■nN■■m.s■E .E■...■■■c■..mm�nme.■ ■■■■■■■n■■.■■.■.n..■■.■■.■■.„c..eeeeel�■■■■.�■■■■■�.■■■ ■■■■m■■■Om■■■ ■■■■■■rl■■/n■■■■■Oo■■Donn■■0000■■ii.■■■..■■.■■.■■■..■■■■■ONOOO■OEll■ ■■■■EN■I■N.■■■N■■.eN■mm�mn■■ ■■■■■■■.■■■■■■N■ms■ ■■■■■■■■■ ■■■.cell■ ■■..../1■■■NN■.N■.N/wON..N.NN■NN■N.■NEE■ ■■■■E�■ .■■■u�Monon■an an ■■■■■■riN■.■N■■■N■■■■nn.■.mNn.■■N.E■■■.N■■Nem■■■■■O■■■■■■.■■■cm■r�■■ ■..........■.......................■.......■... ■ _ ■■■■N■■■■■■■■■ Naaaa aaaNONNEOaaEENEO�aa:: ■�aENOmOENEOOEOOO■OEOO■NENEEEE■OONNI N ......1....■....■.■.�m..■0•.....mN•I.E...■...N..E...■■.�..■..N■■■■■EE ■■■e.Ian■nm.n■c■•c■.■■■®m■■..n..■m.Co..■w■■mm■.■■■■■. ■N■EE■■■■=■■ ....■■MN ■.■..��.nn■■.a■.■■■■■.■nun■n■n■■�.nOCNNN�N■N■NNN■■■Ec.N.n imN■ ■■O..r/■s.er�c.■■c■■..■.■...ccc... ■■ N■■■■■■■.■e...lc■. aaaNa:NODI:aEn■aaaaaaaN.:aaaaaaaaaaa■ia:■n■OOO::oN■ =NEOEONEIEMM OlIOnO ■■■■■le:nammo■■o■■■■mmmono■mommommonomm■mm000O■n■■ NONE momn.ln ■.■■■le■■■■■■■■■■■m■ee■■s:e■■■■Nom■■■■■■■■■■■■■■►�_■ ■■E■■■■■■.�■■N ■■N■ ►i■■■■.■■■■■■■�cr�■■c►..��■cc■■■.■c.■■e■■■■■■■■■ al noon ■■■M■■■■■■■ ■cnnliOnmm.nNO/l"�Cd.n.!!�iiom'O.■■oOl \I�1■IE/!■■mNON1�ON.■m■mN ■■■■■■mall ■ ■ENO■■NE■ONENNmN/�■�NOa®:■:■a■Nm■aNa■:E:NGr=i/■�oNrci!_i•�r.a.NErO■E■:O:. ■m■■■ ■ mmom INmEEEMEMNON EEENENMEaNONE EEN ■ ■■■ ■■■■■.NEO ■■o.IOD■.O►In.O■I■Ona■onOlmH�%%�OOaaNEO O '' :OO � ■■O Imo■m. ■■■.I■■■■■►'■■■i/l■■■■N■■■■■I'!■■■■■■■■ ■N , Np�/� OMEN N■■ O■m■.■ ■■NE Oninoo■ m■mmom ■■■■E. ■■■■■m ■l■■E■a��l�\■■MEIMMMMMMMMMMMN■ Sam N■■■■N■ . ■mw�l■NOEN■NNON■■mm■■■Nisi ■■i■■■■■■■. ■■■■o.■■■m■■ ■NN■Imo■■■O■■N■■■ON.NN■■■i.;•_!■■■,G�■■■■■N MONSOON ON■E■■E■ ■■.■I■■■■■En000.00OmOOO■ciiifN■mOO.INE CNE E■RUEI�Oa Nno m■■JI■.■■■EmN■E■■ ■■■■■JpNEMNu■� EOE:aaaOOON:::OOONOEOOO� .::_�=:��a■ ■OEEEOO::O�IEE MM ■N..m.■N■■■■■NNN■NN■aaDaa?sMME ■■ ■■Os ENE■E®1 E ■w■■■■■■N ■■■ uNNNNN■ ■■■■■■E■■Omoommo■Nut oN=\■■►� ■■ ■■■ noon■OI ■.■I.■■■mom■■■m■■■m■■■■mo■■o■m■■�i��O 3ia ■■.Im on ■■■I■■u■■■■■■ ■ N■m■■m■■■■■ I• mN■■■■■■■■I■ E•••■■EI■■m■ ■ E�EE 00 min •••• EmN mmoEOENOOOEEEEENOuiiiOEE ■ ifamagam■ MEN ■■■E■E■E■E■E■■■N■■■.■ ■■ NE.■ MEMOMMUM ■DOL"":=======���N■■���■t■OOmn■...�mm■N ■m p■.1 NNNa:■OOCNOOOOOON■uilaaaaaaaaaaaaalliaaaan ■ WEENIVE aaaaNOaaaaom.a�aaaaaaaNOONNN:■a■:a:NO ''MMOaaME:NanOOIOMEN 0 mm � MMEM MEN w■E■O /■O.NNOOIOOn.NOONO..00/lO■ . . mOO r■N■EN■NNE■■E.E ■naEEN aOSN:a\ONO■aN■oEOOENNOONN■I■N�iONNEN■■.,E.." ■■■mEO■On■,■■ N■■.■■■N■■■NN■NE■■E■■■■■■E■EON '11N MEMO ■■.n..000■■.000.00.■NOON■■■■non■11.■■.O�■.■O■NNiE;NOO■n./■.n.00ne.O aaaENEOa�O:: aaasaaaaaaia/aENN■I■aaaaaaaaiaaaaa .-.OaaaaaaaaivaaEa R I ` \ .���t\,. � '- - � �. j� , ' ' _ ?�•� � Jay/ / ' \ _ jh.:.Y-1:. - r �:s — LS • JJ of •.\ \ 11i:. 1 � 1 �.'T I 1 %/j_ f . Ar�t,�. 3��i,�is'. >�f� "•R. i 1 / i s .0 '� /� 1 I t• r, \ `yt)z q6 �-1h 2� ♦• '. i .� _ E ( ( ) - 3 .. '. 7s .. r} `fin r !oS SS Al.r �'J .. 4�r t •s � �'s II ' �,ag�r �/1 I sem. t _ ' „ cr.(�:. i + •e .u+.l ...>yasa $ �7i1 r Favre County .��ealtfr Department and .Mame Nealtf ffyeney 210 HOSPITAL STREET I P.O. BOX 665 MOCKSVILLE.N.C. 27028 PHONE:(704)634-5985 June 28, 1995 Page & John Davis 6317 Millbridge Rd. Clemmons, KC 27012 Re: Site Evaluation/24 Acres March Ferry Acres-Lot 8 Dear Mr. & Mrs. Davis: As requested, a representative from this office visited the aforementioned site on June 26, 1995. Based upon the information provided on the application for site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. If you have any questions, please feel free to contact this office. -'' Sincerely, r Charles E. Little, R.S. Environmental Health Section 7 CL/wd ``i Enclosure(s) DAVIE COUNTY HEALTH DEPARTMENT x•30 • 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 B.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)., R PROPERTY ADDRESS More.4 Ft rr,l �f l o� � Z 7°°� DOTE l LOCATION I Jr �1 tarso ` �' Uc�► Qjv.� I. V4 ) SUBDIUI5IDN NAME �,���� �� R\ P+�ReS. LOT NUMBER SEC:/BLOCK`NUMBER - i RESIDENTAL SPECIFICATION: BUILDING TYPE oSE # BEDROOMS 1�' #.BATHS '-� # OCCUPANTS D. GARBAGE DISPOSAL Yes/No COMMERCIAL SPECIFICATION: FACILITY TYPE '�'� # PEOPLE # PEDPLE/SHIFT, # SEATS INDUSTRIAL..WASTE Ye No LOT SIZE L l� WATER SUPPLY: 's:= DESIGN WASTEWATER.FLON (GPD) IoSO NEW SITE REPAIR SITE 'SYSTEM SPECIFICATIONS• TANK SIZE G ' 1 �� ►1 �t. + bbd GAL: PUMP TANK.' . GAL. TRENCH WIDTH CROCK.DEPTH: _ LINEAR FT. ... OTHER 10 0 0 REQUIRED SITE"MODIFICATIONS/CONDITIONS: •a �` I` �. '�' *"THIS PERMIT 11 SUBJECT TO )EVOCATION IF SITE.>:Rms-OR THE INTENDED USE CHANGE, . YOUR WASTTERWATER SYSTEM AONTWTOR rpt`` � SEE THIS PERMIT BEFORE INSTALLING � SYSTEM.` ` 'IMPROVEMENT"'PERMIT BY v, 7z A f*COrITACT.A REPRESENTATIVE OF THE pAVIE 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) 630-8760. a ;OPERATION PERMIT SYSTEM.INSTALLEIr''BY ���'�►� �•�C�g; . ' � CPj ba Lo 'Q_13 AUTHORIZATION N0. .'V `1 AERATION PERMIT BY, r- P�1 DAjE• 3' ±; **THE'ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN-INSTALLED-IN COMPLIANCE WITH ARTICLC A OF G.S. CHAPTER- 130A, SECTION .1900 "SEWAGE TREATMENT,AND DISPQSAL 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