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333 McCullough Rd .� � • ._ �-- � DAVIE COUNTY HEALTH DEPARTMENT , � . • Environmental Health Section ��3 �� ' P.O.Boa 848/210 Hospital Street �I I . Mceksville,NC 27028 (336)751-8760 Account #: 990004002 Tax PIN/EH#: 5746-09-4117 Billed To: John Rennix Subdivision Info: Reference Name: Location/Address: 333 McCullough Road-27028 ATC Number: 4430 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION . #*NOTE** This Authorization for Wastewater System Construction MUST BE ISSLTED 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 CONS UCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: /�'� Date: �/���i CERTI A�E OF COMPLETION **NOTE* The issuance of this Certi c of Completion sh indi the system d scribed on Improvement/Operation Permit has been installed in compli ce with ' e o . . 130A,S ion.1900"Sewage Treatment and Disposal Systems,"but shall NO Y be tak as�guar t that the tem will function satisfactorily for any � given period of time. � s� � I 3 G _ � � (� 2l- 3 ' Q,�� a,r. ,� F ��' lo � a� i ti�l � �., �, � M z 1 N 8`k � � � ., �^ p�� � �' � � a �...? � `�T —��'' � � � �1l �.�-w ���- � L �- ��� �pae�•�C_. � - N r ~ ` � ` //'t� " ^ _ .,. _ _ N 3—C�]�4 e7 �� � � � � Y ��� �vt.( $ t1C$ tCIIl jIIS�111Cd By: J� r �� �� `�-h�'' � � Z3-o7 Environmental Health Specialist's Signature: Date: ' DCHD OS/99(Revised) . � �•_"�i;, � • DAVIE COUNTY HEALTH DEPARTMENT � ' Environmental Health Section � r.o.sog sasnio x�P;��sn��t �, ' Mocksville,NC 27028 � (336)7S1-8760 � � ' 3�6� ' IMPROVEMENT/OPERATION PERMIT �` Account #: 990004002 Tax PIN/EH#: 5746-09-4117 Billed To: John Rennix Subdivision Info: Reference Name: Location/Address: 333 McCullough Road-27028 Proposed Facility: Residence Property Size: **NO�`��*��pro�e4i�gnt/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AiJTHORIZATION 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 PERMTT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type . `!� #People_o� #Bedrooms � #Baths � Dishwasher: � Garbage Disposal: � Washing Machine:� Basement wlPlumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: � Lot Size ��G Type Water Supply lil/Plf Design Wastewater Flow(GPD)ot 7o Site: New� Repair� r System Specifications: Tank Size��GAL. Pump Tank GAL. Trench Width�'�Rock Depth `i2�� Linear Fto�d Other: As stated in 15A NCAC 18A.1969(5) Required Site Modifications/Conditions: accepted Systems may also be used IMPROVEMENT/OPERATiON PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 f°BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe 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)751-87G0.**** �ov .� �Q��� 7.�a�-o7 , l+pO inJ�,1�j ih���- drd���� (�`` Quck - a�•Q j°` qvw��,C �'1°'"`'' V �.��;� .��yA. � . Q� �' ��. , /Z � �I / / / Environmental Health Specialist's Signature: �/'l/4� Date: G/��`6� DCHD OS/99(Revised) - ; � _ _ _ __ _ __ ____ _ _ _ __ _ _ _. ' Davie County Health Department Environmental Health Section P.O.Box 848/210 Hospital Street , Mocksville,NC 27028 - � (336) 751-8760/Fax(336) 751-8786 June 15, 2006 Mr. John Rennix 333 McCullough Road ; Mocksville,NC 27028 Re: McCullough Road Tax Pin#: 5746-09-4117 Dear Mr. Rennix As requested, a representative from this office visited the above site June 15,2006 to perform a site evaluation. Based on 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. This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans or the intended use change. � Improvement Permit . System To Serve: ,�D dL S� Wastewater Design Flow: ..-��� System Type: ❑Conventional �fAccepted ❑Innovative ❑Alternative �Other System Location: �C�i�`lDuq� ,�� Valid: �ears ❑No Expiration Site Modifications/Permit Conditions: � . ��� �� ����� � Environmental Health Sp cialist Date ps-i.p.letter 2/06 .: � ° Jun 06 n6 tOt3P� dM�ie countq �nvn��lch ��6 vet uiee «.� �..•'r . ,t1�► � . �` � r , . � �.� � � A'1'ION H'OR SIT���'.4I.IiAT10N/lNII'KUVE!V[�NT P�RI�itT&ATC (� � Dsvie Counry�Ciealt4 Di:p�rtmaut �' � � i�a �nvlronmrnta!�cc�Ni Sedlo�r � p.0.itox�elZ,�Hap�ti]s�ro�t ' MoclwlUc,NC 27�:28 J�� � 6 � (336 j7S1-87�i0/l+�s(336}'�Sl-8'►S6 nppliauun F ; "' Si 8vdhu�ttau'taqrcovemtns Yc+mic !i AuQWrhr��:Jn TO CM�tfuct(A fC) Q/Hah T.a!V7r•� S Af'PLIG:'T10N C_tNNOTB6 PR�i ESS6A t�NyESS f11d.OP tN6 RF.�jt"IREt� �T; �Rp�N�ME CNt►dA ' ��OYtpfiD. 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'; J�N Mocksville,NC2701d P�tot�e: (336jyS2.696} NEA� � N�RO��� ,�ST�WATER CERTlFiCA1'[QN FOR DWE'sLWTiC �(Gh c) RHPLA(. T� REMOD�I.tNG n RBCO !ON u aur:��E.t/Nf.Ar. ._ i'tmxyrNua�ber:� _��2,r (Hor+ne) �7niliag Addttsa;-�.�.�......�,C_C.�1.L .+�fR.tf���. .lL;.��.�....! (WorkJ _rI.'l.�ac..c�s.�.�ll_e.��±/�- �z.�.._ Det�ii�d Die�c.xic�nx'r�sSo.: !a o�_,�..-_.�._... �'.._�.�o u d 5.�...�.,E_._!�_.Q.�..��f_?' � - t... 3 3� �,'�l,c� �4 c.c,�...u�a,uc„�9� . A&�Y-._�`C�_��..cr..6�dCt�.2 w�� �� T aC �„r _ L ��..� ..�h°v��� ProperlyAddee�,,,,_--- ._.......� .,,,, ..,,._... ___�......_Y»�._...._...r.�,..,,_._...._.. Pleare�iU in The Follawi�n�Informatlo Abas�t'T't�e xia�ng Dweillt� N.rnz sy+�le�►I��swlird u�uter:_.:�..�i» P�'a i 2 , Typc ol vwelltng: �'c�c K Da�,a•�+n►tern imtalkd(MoMb/D�,V!'f );,J,Y67�,G�_N�mbsr &droaauc�-3 _Uumbez!Of I�ple;.�__. L 1'�D..�e]iti+a Curr�n,eiy vicer�t Ye.0 No� I!Yes.For How T.er,. .___,,..._�____,�.. 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Environmental Health Section ^ • Soil/Site Evaluation � APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004002 Tax PIN/EH#: 5746-09-4117 Billed To: John Rennix Subdivision Info: Reference Name: Location/Address: 333 McCullough Road-27028. Proposed Facility: Residence Property Size: Date Evaluated: ��,��/� Water Supply: On-Site Well Community Public � Evaluation By: Auger Boring � Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e sition J-�- Slo % • HORIZAN I DEPTH �/�� �� �, Texture rou C L SG' C Consistence ' " �' .� $trUCtllre /� r _( Mineralo /,- ,'( HORIZON II DEPTH .�L �' S�� �f�/ Texture rou C� Consistence � / .�` ,('� Structure 6�� � _ Mineralo -_`/ 'l � HORIZON III DEPTH Texture rou Consistence ' Structure Mineralo HORIZON IV DEP"TH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON � SAPROLITE CLASSIFICATION ." LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: � - . . .� EVALUATION BY: '' ; LONG-TERM ACCEPTANCE RATE: � - OTHER(S)PRESENT: REMARKS: LEGEND i.�ndccane Position R-Ridge S-Shoulder L-Lineaz slope FS -Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope � . S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SICL-Silty clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay . _ � CONSIST �,N . . MQi$.t VFR-Very friable FR-Friable FI-Firm VFT-Very firm EFI-Extremely fum � NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic ���]iCtli�s SC-Single grain M-Massive CR-Crumb GR-Granulaz , ABK-Angulaz blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogv � 1:1,2:1,Mixed LI� ' � . 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