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1675 Peoples Creek Rd Lot 3 DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street 0 Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990001382 Tax PIN/EH M 5880-40-7404 Billed To: Alan Nelson Subdivision Info: Marchferry Acres Lot#3 Reference Name: Alan Nelson Location/Address: 1675 Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: 400'x 1200' **NOT> * Bliss proveement/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 /T #People -.-T _ #Bedrooms 'V #Baths Dishwasher:A" Garbage Disposal Washing Machine: Basement w/Plumbing: 13 Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: Lot Size fi9 Type Water Supply LIrZ Design Wastewater Flow(GPD) fWd Site: New�epair System Specifications: Tank Size e4ffPGAL. Pump Tank GAL. Trench Width Rock Depth 1Z Linear FtS Ay Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 K 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: Ot Date:' Z '/ DCHD 05/99(Revised) DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001382 Tax PIN/EH#: 5880-40-7404 Billed To: Alan Nelson Subdivision Info: Marchferry Acres Lot#3 Reference Name: Alan Nelson Location/Address: 1675 Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: 400'x 1200' ATC Number: 2548 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 Systenis,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTE T ONSTRUCTION IS VA ID OR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature. Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system describe a ion Permit has been installed in compliance with Article 11 of G.S.Chapter 130A,Sect n.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken as a guarantee that the s wi nction sates ac�torily for any given period of time. 6 Septic System Installed By: Environmental Health Specialist's Signature: Date: 9�� 7`Q DCHD 05199(Revised) . .+ DAVIE COUNTY HEALTH DEPARTMENT - Environmental Health Section • P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001382 Tax PIN/EH#: 5880-40-7404 Billed To: Alan Nelson Subdivision Info: ftlAc.Q44t 46U,. 41" 3 Reference Name: Alan Nelson Location/Address: 1675 Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: 400'x 1209 ATC Ny�pp��beer: 2548 **NOTE** T his lrnprovement/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 14eop el _ #Bedrooms #Baths E� G�ke Hispvsa}•� V�sliig#atlrine- Basement w/Plumbing: ❑ Basement/No Plumbing: 0 Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: Lot Size T e Water Su ply�— Design Wastewater Flow(GPD) Site: NewKRepair . �dOF / System Specifications: Tank SizeGAL. Pump Tank GAL. Trench Width� Rock Depth /6T- Linear Ft ZA Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMI I LAYOUT- AP T TER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Conta ive o e lth 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 insta n. Telephone#is(336)751-8760.**** Alisd a-A2-e 7d �r - r Environmental Health Specialist's Signature: Date: -- DCHD 05/99(Revised) • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001382 Tax PIN/EH#: 5880-40-7404 Billed To: Alan Nelson Subdivision Info: Reference Name: Alan Nelson Location/Address: 1675 Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: 400'x 1200' ATC Number: 2548 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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE Environmental Health Specialist's Signature: Date: 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. Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) 1 e «vGl r✓`- [ C� ' D M rs ' APPUCATION FOR SIVE EVAUTATION/IMPROVEMENT PERMIT& Davie Cow*Health Department � Environmental Health Section AM 2 4 ?nnn I P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVID�E�D. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed °!f'f / I. a 1 SContact Person S G m e— Mailing Address •Q9LK' I PQ cry 1S Ross Phone 33b - 91 O - Q l 4O city/state/zip MAN 6 'Sa1 'V- 71 Z7 Business Phon. f 1 k - D 1 �U 2. Nam. on Permit/ATC if Different than Above Hailing Address city/ /sstate/zip 3. Application For: ❑ Site Evaluation [-improvement Permit/ATC ❑ Both 4. system to service: 01-House ❑ Mobile HomA ❑ Business ❑ Industry ❑ Other 5. If Residence: //t# People �. �_- i Bedrooms -, �_ ;�E ms - ishxash.r 6�Garbag. Disposal W4- ?tachin. t/Plvsbing t/No Plumbing 04E 6. If Business/industry/Other: Specify type ; People # Sinks / Commodes # Showers / Urinals # Nater Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) z. Type of water supply: County/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system Is intended to serve? es ❑No U yes,what type? 'Resrdehw �- ***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. +D D' X 12-00 t WRITE DIRECTIONS(from Mocksvilie)to PROPERTY: "a: v I C e_i R,Nh' ii 6W Q—O Z+D + L¢0 L;ai 1 4 1C0 Property Address: Road Name 1 b7S' I c ba lLS Crul L Act fol l -ro wM f) �dran t c� City/Zip AJ vu n M- NL Z7006 G rJs S KIZ 71rp,It_ If In a Subdivision provide information,as follows: I/43 mils bw JUVA t J►ti Name: c0 1c1 Cr. fb ' 1 b7S^ rt cr S(�rrDl�n bi cn,ES bt..�k. cde Section: Block: Lot: Date Prope Flagg •- 14 f 0y)--"C1 - Cant d"i This is to certify that the information provided Is correct to the best of my knowledge. I understand t at any permit(s) 570V 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 to conduct all testing procedures as necessary to determine the site suitability. DATE g f 13 2 TI21 Si sign a WS&Z atA-1 THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, sethaeks, and septic Iocafans). Site Revisit Charge Date(s): ---- _the- Please_complete htglilighted_azea(s)andClient Notification Date:. return.. --- EHS: -- - -— Account No. L g 2 Revised DCHD(07/99) Invoice No. Jq19a r�[.�l.S1t-.✓ �acl Al �ian..a. �-hsrsc Fe's kv"C- scJ3l t- 1a,��c pc h cL 1 -�L 3G)L 3b C-)run 4 Wh► ^6r6m l�✓tc ba�� � � ' I , � I Z �z I t � �°- tib. ►-�- .. ,o v `- 131 ji . hA}vire. Rct ► th -L- 60 s }- 3 d a�.� . — 3 bw1i� 7 fitnc I nth —!� C2& L7S PGO f)e-s Crcc lc J u G Ls v N.. P,ro PC y DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001382 Tax PIN/EH#: 5880-40-7404 Billed To: Alan Nelson Subdivision Info: Reference Name: Alan Nelson Location/Address: 1675 Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: 400'x 1200' 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 Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group 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 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 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 05/99(Revised) }"' '`ry�'uk'`;an•y�iL v"f"�f "+4i'd:na9i it wr i�!:r^s5"v'r`ti++crst: rr�`r .:rn� r s�w+.r�"'.'• .3's:wki�•ir.:.7..v.,'s.:-.�.r.r-+-w;v-j�a•z.,v--•`ir"�� t-•"-rra:a�.; -igsi�'P`ra�E.;Rfir-�.-. syn;=i'i" = ' ' DAVIE COUNTY HEALTH DEPARTMENT 10b.00 IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION _ *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewaae Systems Permit Number Name \V Q,SoN C�y��iA�� 1\eP Date ^�� �3 NO 72.31 Location 1 vX Subdivision Name \'`�R�� �e�� Res Lot No. Sec. or Block No. Lot Size `" House ` Mobile dome Business' Speculation No. Bedrooms '' .No. Baths 3 No. in Fatuity'` — Garbage Disposal:. YES ❑.r>NO f Specrfications of yst Auto Dish Washer YES'r�j NO•C] / �� NO . Auto Wash Ma shine YES' . ❑ r Jam' 00 /t , /► Type Water Supply *This permit Void i sewage sys�tetn,,described belaw is no 'rlstalled within,5 years from date of issue. This permit is subje o-r-evocatio j e intended use change.", . J 3 .'Y S •Q F :; . ..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 r Certificate of Completion Date *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. ,_+5.:r yP ,,,_ .,.`.4.. ,. .`.'G.•`.:' `i �.� ,.::,!; t ;iY Yf` .. 1 y3iq ._ .h:'�` „Jy _ :y, `l ,- :+J . DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT,AND CERTIFICATE OF COMPLETION " - *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a � ysteUmPermitP Tb.!e rnanita Se mV )2>Date N Location_ in -' �4.'. � ���� \(Jv 1 .:5 •- +1, f.S� t �,i-.r..�jJ.�.L �'�1:.�;,`„ I�+V �.� �'"� C�:� J Subdivision Name ��~ Lot No. Sec. or Block No. Lot Size �`� — House J Mobile Home Business Speculation No. Bedrooms i .No. Baths , No. in Family Garbage Disposal YES NOSecifications�for- ,System: Auto Dish Washer YES NO p ,p`�.� . Auto Wash Ma thine YES( NO Type Water Supply 'This permit Void ifsewage system described below isnow nstalled within 5 years from date of issue. This permit is subject to revocatiolr�if-site 1ans-or a intended use change.. J HU `{ L -Q - F 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 r - i f Certificate of Completion Date '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. @ `' Q WS10 ICATION FOR SITE EVALUATION/IMPROVEMENTS PE MIT Davie County Health Department 9 Environmental Health Section r 1993 P. O. Box 665 1993 Mocksville, NC 27028 Apptication/Permit Requested By—4 A V /L° D Mailing Address Home Phone Z���� ���� Business Phone 2. Name on Permit if Different than Above 3. Application/Permit for: General Evaluation ❑ Septic Tank Installation 4. System to Serve: Er go-use ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home:Subdivision ►' ! Section Lot#— _ ❑ Basement/Plumbing No.of People G-Basement/No Plumbing No. of Bedrooms p'Washing Machine No.of Bathrooms /�- (fl'151shwasher Dwelling Dimensions S ❑ Garbage Disposal 6. If business, industry, place of publi assem y,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: ZkAublic ❑ Private ❑ Community r 8. Property Dimensions -2'1 !/ `� Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 0 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: � ��-5 � ol��� �m 1. �,� . - �� �.�s �►��,�� This is to certify that the information provided is correct to the I t of my kn ledg nderstand I am responsible for all charges incurred from this application. DATE SIGNAT CONSENT FOR SITE EVALUATION M BE DONE ON ABOVE DESC:ah ERTY Fandd ECK ONE: ❑ 1. 1 OWN the property. OT OWN the property. ked Box#2,the rest of this form MUST be completed by the owner or a persby the owner: ve consent to the authorized representativ@@ of the, vie Coon Health Departupon above described cated in Davie County and owned by J)A411 Ate L', r�T roll- all testing procedures as necessary to determinesaid site's suita " f r a gpt' sewage treatme al system. DATE SIGNATYIE DCHD(12-90) r' .` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section l Soil/Site Evaluation NAME \ P� 4�s ^' DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY �O J S -4 LOCATION OF SITE C�Jvl9=lam +�cl Water Supply: On-Site Well Community Public V Evaluation By:QQ1_L. Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position _S Sloe % 0 - Q) do O HORIZON I DEPTH Texture groupL C L L Consistence , L Structure M/L Mineralo HORIZON II DEPTH 3�' " ' Texture groupC _ Consistence -S -1 Structure Mineralogy1� HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE — — CLASSIFICATION S LONG-TERM ACCEPTANCE RATE , o. L- .3 3 SITE CLASSIFICATION: •�- EVALUATED BY: LONG-TERM. (►CCEPTANCE RATE: 0-2 -1 OTHER(S) PRESENT: REMARKS.• �j - - '•I L LEND 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(01-901 ■..■..■■■.■■.■.■.........■■......■■.e■.......ee■..ee■eee.........■ ■■...■o...■....■■■■.■■■.■■...■■■�.■■.......e....e....e...■■.eee.■ ......................■.... ...................................... ■■ecce■■■e■■■■ee■......■■ee■■eeeee■..ee■e�..ee■.......ee■■■.e■ee.■ ■■..■e..■■e.■t■■.■■■■....■■■■■e�■■■ee.ee■eeeee.eeeeeee■■..■.e.e■ ■■.■■...■■e■■.■..........■..e......e..■■...eee.■ee.e■.e.eeeee■■e.■ ■ee■eee.■eee■ee■■e■■..■a.■■■■■■■■.■■..ee.eeee■.ee■=eeee■ee■...■.e■ ■...e..■eee..ee■.......■■....■..e■=e■..e■■....e..■ee.■......■.eee ■■.....■.......■■■..■....■■■i.■■�....■....■�........■e.....e.. ■■■ ■eeeee..eee.eeeee..e■Nee■■■■■■..e.N■.e.■eee■eNe.e■=e..eee....el� ENEENOMMOMMEN ■■.■■eeeee.■■■..e■■■.....■.■....■..■■....%■�l`i•■.■..�N..e......e■ ■ ■eee.\■eee.ee.eee■■■eee..\■�'�\■eee■eee.\\:�1\711\�L�]e.eee■eee■■e■e■■.■ ■e■eeee■eee.eeee.e■■■...■.■u■e►�.�ee.,csee.e■es.■ee....■■..■......■ ■e■■ee.eee.eeee.Ne....ee►.e►._==:a:::::e■eeee.ee.ee■.e..eee..ee.■ ■.■..■■.e■■...ee...■■...ee.\eee■.ee■..■!\e■■ee.eeeeeeee.e�.e■■.e■ �Y�YYYY�Y� ■■.■■e■■:■.■ee.■■e■.■e�z�■eee:■_�■■■eeee.l�11■■■•e_+■_]o■ee■■■e■■■■■■■■ ■...e..ei1GR�.....■...i►ll/�i.►►■■Il..ee.....li�■�ii%w/■�1i��■ee...e■...ee.■ ■ee.eee�eer,.ee■eeeee.e��e�!���,���eaee.eeeee■ee■e��.r e.ee.eeee.ee■■.e■ ■...■■..e:■.....■■.....ei�rili��..■.■■e...ee.e.e.e■e■ee..ee. .eee.■e■ ■■■eeee■■■eee■e■■■■■e...r�ell�lee.■e.eeeueIemom e■■INN e.■e■■■N■■.■■■■■ ■.■■..■■..■...■...■■e...■■.�ine...e.eee�.. ■.ee..e ■�■■■■eo■■■e■■■■ .......■.■.■...■..■■■■...■..11.■.■■!!!].■ .e■.e.■ ■ ■■■■. ■■.■■■■■ ■..■...■......N....■■■..■..Ile..■./I]e. ■ ■■ ■ .. ■ ■■ ■.e■■■ ..........N................tl...�....�.A■.H■.� C■C■■MEMONNIONEENNESOM C�......� ■.ee■eeee■e.ee■e.ue■eee..e...nn■.■■e.=l�.=of � euuae ■■eee■ ■ .......................■......�:�.r:;.lz=.�:......� Is■■ ■■.■C.■■■■■EE ■■ee.ee.eeeeee.■■■..eeee.■.■■■!/Y�i■ eee.eeul�... ee.■.■■.■■■e■■■■ ■..e..eee.ee■.ee■e.ee■.eee■eeee■e..e.e.e.. ■.ee ■ IN noENOS Heee■ee .....e.■ee.ee..■e..ee..eeeeee..e■e.! .... . eeeee■eeeeueeee■ ■■ee.■e ...e■e■e.■ ■ee■■■■.ee■ee..�eN.�e ■.. ■■e■■■■e ■■■e■ ....... 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NNeue...■.■■..■■■..■■ ■.......■....■e..■■...■e.■N.■.■.■...■... ..e. ■.■e■■■e■ ■■■■■■■■ .........................C.....■.■.e■...■ee■.■.e■ee.eeeeeu■■■■■e■ .................... ............................................. ................................ ........NOOSE OEM .....■■.■......■ .................................................................. ..................................■■..eeeeeee..eee.N.e.e.■ee.e.■■ .................................................................. .... ........................... ■..■.........■■.■.e.e.ee..u.ee■ 04/23/2002 09:08 3367663939 DAVIE CONSTRUCTION C PAGE 02/02 APR nal-2002 03:01P FROM:, L CS 6W "1j2�-i�J� 70:7663939 -fep71cl c.n (C. 2 /gc.in omw-) al X�YL3 r1 trbss InIU GV(k c't' �%.lvewAy ryAr of klum— ( t ak dt fh� I aRQa I . J suerri wG— ( LA14 It R,vt wA I 1675 1�To &1 Cr«lc P-d- M � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section •'» P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001382 Tax PIN/EH#: 5880-40-7404.A 3 Billed To: Alan Nelson Subdivision Info: March Ferry Acres Lot# " Reference Name: Location/Address: Peoples Creek Rd.27006 Proposed Facility: Bam Property Size: see map ATC Number: 2709 **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). TIM 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 / Dishwasher: Garbage Disposal: 13Washing Machine:Pr`o Basement w/Plumbing: Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply K— Design Wastewater Flow(GPD) o9 I Site: New Repair❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width Rock Depth Y4 je _ Linear FtoVb Other: Required Site Modifications/Conditions: 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.**** i r Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001382 Tax PIN/EH#: 5880-40-7404.A Billed To: Alan Nelson Subdivision Info: March Ferry Acres Lot# Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Bam Property Size: see map ATC Number: 2709 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 WASTEWATER CON TRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: J`o2, "e/ 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. i I l ppe,4e� Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) FSB MERCHANT SRVS PAGE 01 l 11!10!1996 14:36 910-784-0554 ���. •���.,` 4 AIT"CATION FQR.SITI:ENAU A'TION/IMPHO pERMjT&ATC 4 \ -^. Davie•County Health Oepatttnent . �Eirr>Mnmeabl flealth'S Pion• P.-O. -Sox 848/210'-Hospital street rtockoviil.e, KC ' 27028 (336)7518760 ' ' e*.*IMBCR�'AN'1`hx* ' $I8 •AFPLZCATIUIi° t•AHIPOT Bl: BROCK3MD UN=3 N.L THE RSQDIRED �I '4RbD4Tt02+Y ?3 PRMX)F.D_ Refer to the INIMbATION BtJLtliTZN for instrctctiolYa.. 1. • sxw►.to.D. aii-104.�,; ►Y G1S0�- Contact 214roon 2.�Z -R)(—O 14 O •Mailing Andress • omeone cttr/stAw.zzzi ini}inPbone 'f 2 Z. Kam than' wove !!wiling.Address City/state/zip a. Applin tipn s'orr':' 0 site Evasluatton �ovema;nt Permit/ATC' 0 Both o. syataa t0•ser9ric4:' louses D'Trtobil0 Home ' D auginess 0• industry' 0 Other .5. If Residence: # People 3 # Bedroozs �•. #'Bathxcoms _,,�'____ 0 Dishwasher 11 Garbage Di•.,posal (7'waohing Machine, 0 saae:ee,itMo FSubkwng &. 2l,)mueine,ss/Industry/other': specify types # People # SiakA j i ii •Comraodea ' # 8lxovere # ilrinals. iR lister Coolers IF:1f'oOD'$E1tVIC$: # Seats Estimat:gd Water Usage cRe ionz pmr may? 7,.. Type of watar.supply: ,County/City .0 Well 0 Community 0: Do you antir.Ipate'additions'or expaasions'of the facIllty.this system is intended.to serve' 0 Yes XNo If yes,what type? ".X�tf;PC RXA.N�'�*Cly 1i_1fi 1ti► CtflMPI- TE THE PEQUMEDPROJe R�'lc1'1WF0> TION ttlEQ13F,STED ttE.I:O►�• '1✓itl'r*i, k.k.i•orSi'i'PI,AIYMUSTBESUBMfr- ED.'b #d"t with-THISAPPLiCATION:." Proppriy.Dluteaslotiss +00f iZ D'6 WRITE DiREGT1014S(from hlocio►ille)to PROPERTY: Tii.OfTtcePIN: N I4wy 8o 1 •S Pnks. -.P .' •Address: Rosd•ftme 7 pee i as• !Cy. 1 lv ox_ ca )cs Cve L ; CityWo 4JV4 MCI- to CS N� Z o o(s fig. ►�1(t; c�. . iZ . '• 7b 1 f•�s If In.*Subdivision provide inTo X4011 its folio"; ��irr•�t 4 W 17i�i 1�Zrl js -- Name- Xx r� DNa IJi, un R op Piro�rr Section: Block: __ f got: Date Property•Fueged: -This is ta.certify that thea Information provided Ii correct to the best ofmy-ka4wledge:.I understand that.any pertuit(s) ' W ied bereatttt are subject lo,:suspeasiob'oar.rcvocation,if the site plans or intooded use ehsnge,'or If the Info r ' tion . std►tnittsd iq'ttiis.a' I ation is f:Lsi i r cbangcd. I,also,N�rderstaadlkat/am�sponsibkjor dlt c1fu Gt'iRc�rrncdfrom this appllcadoh. •I,hereby;give consent to the Anthorized Representative of the Davie County Reafth Department. •to enter upon abovr'described propertybrzated in Davie County and owned by • 9t41 't 'S i oisv>� to conduct all testing Rrocedares as necessary to determine the site saitshiii'ty. '• DAU.. . ' 21 17/0 l SIGNATURE ;'TRIS AREA;MAYBE t1S0-F0Ii'0R;ANV]NG'Y0URSFI'IT PLAN Qpclude all of the t'ollowing: Existing and proposed' ptoprrty II'es and dlmeusioos; strnctares, setbacks, and septic Iocatiogs). i Site Revisit Charge � Client Notification Date: ERS: Account No,. 'Revised DCHD1 (b7/99 Igvoice No.' b v ■■■■■.■■..■..■■..■■.■■■■■.■■■■■■■■.■...■..■..■.■.e.■.■.■.■ ■ ansa■ ■■■■■■■.■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■..■.Mee■■■■■■■■■■.■.■■■ .................................................................. .................................................................. MENNENMEMNONMENNEN MEMMEMMENNENMENNENMEMNON .■..............................�•�.............■.... .... Monsoon ■■■■e■■■■.■■■■■■■■n.■M■■■■■■■■■■YG�/!.s■.sM■■■■n■.■■■■M■.■.s..■�.o.■ ...............................■................. ................ ""' ■■■■■■■ .■n�■.....■■.■■■■n■s■■■.■■n■■■...ss.■.n■.s■■.■..■■n■ii�ii ................................ ................................ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■.■■■■■■■■■.■■■■■.■■■■■■.■■■.■■H■■■.Mei■■■■■■■■■■■■■■■■..■.■■■■.■ Alan D Nelson t� 2828 Windy Crossing Winston Salem,NC 27127 USA 5. i is 12'14 2 Phone 800 7218240 Fax 336 784 0554 August 21, 2000 Mr. Jeff Beecham, We would like the permit to be issued for both the guest house and the main residence which will be tied together in the same septic system. The guest residence is under construction as shown on sketch and the future residence( 3100 sq. ft) will be constructed in the spring of 2001. It would be appropriate for the two to be linked together and the appropriate size tank placed in the ground to accommodate both. Sincerely, Alan D nelson