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153 Tara Ct Lot 3 DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001425 Tax PIN/EH#: 7922-7843-7679.03 Billed To: Fleetwood Mobile Homes Subdivision Info: Meadowwood Lot#3 Reference Name: Biterbo Ortiz Location/Address: Junction Road-27028 Proposed Facility: Residence Property Size: see map ATC Number: 2688 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 CONSST�RUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature:�/ Date: 19�� 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 a guarantee that the system will function satisfactorily for any given period of time. r Septic System Installed B : w ep Y� Y _, p� �j Environmental Health Specialist's Signature: ��'f Date: C DCHD 05/99(Revised) DAME COUNTY HEALTH DEPARTMENT Environmental Health Section • P.O.Boa 848/210 Hospital Street • Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001425 Tax PIN/EH#: 7922-7843-7679.03 Billed To: Fleetwood Mobile Homes Subdivision Info: Meadowwood Lot#3 Reference Name: Biterbo Ortiz Location/Address: Junction Road-27028 Proposed Facility: Residence Property Size: see map ATC Number: 2688 **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 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 Design Wastewater Flow(GPD) Site: Ne4:1�Repair❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width`=& Rock Depth Linear Ft,-4?e,,� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 u 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: Date: Za- DCHD 05/99(Revised) APPLICATION FOR SITE EVALUATION/Ihll)IIOVF&IFM I'Ulri2i &A \I • Davie County Health Department Eni ilrinmenta/Health Secdw P.O. Box 848/210 Hospital Street - Mocksville, NC 27028 (336)751-8760 ENVIRONMENTAL HEALTH DAVIE COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed J / fI Contact Person iI ►/�-�- Mailing Address -7 LOY U016 . Home Phone City/State/ZIP mO L, 11 , Y BusinessPhone 1 2. Name on Permit/ATC if Different than Above ` I U L// +) Mailing Address I% ��I! 1 rF-}-; 1 City/State/Zip 3. Application For: ❑ Site Evaluation X Improvement Permit/ATC ❑ Both a. System to Service: ❑ House 1 Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People — # Bedrooms 3 # Bathrooms _ ❑ Dishwasher ❑ Garbage Disposal Washing Machine ❑ Basement/Plumbing ❑ 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 ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes klflNo If yes,what type? ***IMPORTANT***CLIENTS MUSTCOMPLETETIiE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: I /-efe A WRITE DIRECTIONS(from Mocksville) to PROPERTY: Tax Office PIN: # 7�12-7 8 93- 7�7 c/- 0 3 --� i ►tet^► a^- ��*-tier o Property Address: Road Name Ifyf.. • a►.,)d x ( �`' o J City/Zip ff Lk)111_'Z-702 R--- If in a Subdivision provide information,as follows: 1J AX-n Name: Section: Block: Lots Date Property Flagged: 10 This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) 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 froin 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 to conduct all test*n procedures as necessary to determine the site suitab' ity DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existi and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Datc(s): Client Notification Date: EUS: Account No. Revised DCIID(07/99) Invoice.No. d JE.s-s/E ,QtiT.•/ �.v/�iTA.CE.� �rlABE I ' I 7: _3 N 88 3Z' 44'W 220,00' 220.00 zs 250.UD '�. r v1 � � i i tv.c FuT�J¢E ✓Ecur'ME../T % OJf�D I �I 0` IpMI ZOO O �Ih Q1 33, 17.3 s ,cT 4.,�r � h 9' Z I r♦ o SG 7AG 4-! 66 TA RA , = /•-3,5"CO U RT ',� -.�D /1.��,✓ -:F4.n.0 N87oS4- /3 "i1/ Ld - ` 4a3 • 90 • so.,o /�9•83 20(0.85' ;� IO 02 1 /•GSiAG O �`7 /ice N 37 Zzq s9 Fr Io �I 35, 3/ j s.f "415_17' d� 25_0.00' 258.0 S 87' 25' 23" E 1355.17' �- p� 07 ' .vC.0 ,�c9uJrzF�,�ENTS Y Nf•t•ut a11uN 1-011 Davie County Health Department PEIIM1i do AIC �s ,1 Envhvnmenfal Health Se+ctfon D -- P.O. Box 840/210 Hospital Street JUN — 4 1999�, J Moaksville, NC 27028 (336)751-8760 ENVIRONMENTAL HEALTH ***IMPORTAN"** THIS APPLICATION CANNOT BE PROCESM UNLESS AL1, REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. Napes to be Billed / to k\ )• =T0VtA� Contact Person SCL � 1� / Mailing Address (.L2 w ikka VC me Sophone City/statelziP 1 �/�r , NC i✓Le+,i.•p Business Phone t. Name on Permalt/ATC It Different than Above flailing Address _ / City/state/Lip 3. Application for: tT Site Evaluation ❑ Improvement Permit/ATC ❑ Both 1. system to service: Q-Rouse oY "bile Rome ❑ Business ❑ Industry ❑ other a. If Residence: ��I People _ tI Bedrooms 3 I Bathrooms %161shwasher WG;O Cbage Disposal W"Washing Naehine U Basement/Plumbing O Basement/No Plumbing d. If Business/Industry/Other: specify type tt People / sinks I cocowdes f shavers # Urinals g !tater Coolers IP FOODSERVICE: I Seats Estimated Mater Usage (gallons per day) 7. Type of water supply: County/City ❑ well ❑ Comtmmnity s. Do you anticipate additions or expansions of the facility ibis system Is Intended to serve! 11 Yes [ If yes,what type! ***1HPIDRTANT***CLIENTSIIIUSTCti11tpulETNE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Eltber a PLAT or SITE PLAN MUST BESURA11TTED ky the cllent wltb THIS APPLICATION. Pruperty Dimensions: L o-an- . 4— WRITE DIRECTIONS(from Mocbsvtlle)to PROPERTY: Tax Office PIN: #�� `T 9 •og J n-t W- T UFT J(4-n -y, Property Address: Road Name Dz' i- 1��_ 940- Gy „p, I 11•i. Ie— u-' R+ CityiZip M 1Q v%k9,A)C;LT04 -�e Fw- w1..: If in a Subdivision provide information,as follows: j Name: ►� �r�S, eady�u lUooc�t Section: Block: Lot: Date Property Flagged: m This is to certify that the information provided Is correct to the best of my knowledge. t understand that any perruh(s) 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 1,also,understand that I wn re enslblefor all charges incurred fr+vm this application. 1,hereby,give consent to the Autborized Representative of the Davie County Health Depart meal to enter upon above described property located in Davie County and owned by " \% UA b1% y to conduct all testing procedures as necessary to determine the site suitability. 4-- Do ow..,.., I(. W DATE C �9 Z SIGNATURE; THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(luclud all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Account No. G Revised DCHD(07198) Invoice No. �� • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900606 Tax PIN/EH#: 7922-7843-7679.0e'- Billed 922-7843-7679.0 "Billed To: Mel Jones Subdivision Info: Junction Acres Lot## -3 Reference Name: Mel Jones Location/Address: Junction Road-27028 Proposed Facility: Residence Property Size: 1 Acre Date Evaluated: Water Supply: On-Site Well Community Publicy Evaluation By: Auger Boring Pit / Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture grog Consistence Structure Mineralogy HORIZON II DEPTH 3,57' Texture group Consistence Structure k �C 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: a—S 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 Minern!W I: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 (Revised 05/99) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MENNENMEMNON MEMNON MENNENMMEMEMnommomMENNEN ■■/■■■■/■/■/■■/■/■/■/■■/■■til.■/■■ ■■■■////■■■/■■■11/■■/■/■/■/■■■■t■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■/■/■■■■■■■■■■/■Iii■■■■■t■■■■■■■/■■■■■■■■■■■■■■■■■■