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126 Parkway Ct Lot 27 �y r--r�,�y�e +�b'`t. n 4 �.a. �f*-r, _..- R;,yi . t/a:-+}v .'s•�t.;,. ., t i — ir.«6:,:; i.: - - - .,- i R,{'Y. al�t ��'f ¢'44'I ski j"'t S �4 Y'�YEi•ti �,r.i 'L -614M"^ �:}+.�1y / gayJ 1022 ORIZXAON NO DAVIE COUNTY HEALTH DEPARTMENT A �, Environmental Health Section PROPERTY INFORMATION Permittee s WO-4 P.O;Box 848 Name: Mocksville,NC 27028., Subdivision Name: Phone#:704-634-8760 r- Directilins t�+�iroperty: Section: c� Lot:. AUTHORIZATION FOR / WASTEWATER Tax Office PIN:# �_ / - f SYSTEM CONSTRUCTION Road Name: !� ���17 `�" ip: �a�►' **NOTE**This Authorization for Wastewater.System Construction MUST:BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits.This Form/Authoiizkion Number should be presented to the Davie County Building Inspections Office when applying for Building Permits: (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage,Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEAL SPECIALIST -.DATE ISSUED N1 DAME COUNTY HEALTH DEPARTMENT * ' ' IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Subdivision Name: d.a«�,y Dtrecti ns t& roperty: Section: r Lot:' -O 7 ," ENPROVEMENT _. PERMIT Tax Office PIN:# + - " ,.� � fi j Road Name:_I'tyL{�l�l'rLip: 1-�t� 7 r.*11,1.� NOTE �LTTHORIZATION FOR WASTEWATER authorize CONSTRUC17IONanm must be oon of a btaineded fromthisDe any wastewater system.'An "NOTE", the construction or partment prior to the constiuction/mstallation of a system or the issuance of a building permit (In compliance with Article I I of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE ::lti f ,�{! 5...lf..' aC���;.� e /y�+,a,.•�,;. t PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED. SYSTEM CONTRACTOR MUST SEE THIS PERMPT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE `'`*� #BEDROOMS■-7 #BATHS .2) #OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE/ #PEOPLE #PEOPLE/SHIFT #SEATS INNDDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD)) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE ®dd GAL. PUMP TANK GAL. TRENCH WIDTH ��~ ROCK DEPTH Z2 LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT r .1^ **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH D PARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M:ON THE DAYOF STALLATION.TELEPHONE#IS(704)634-8760. OPERATION PERMIT. SYS INSET L D BY, \0 AUTHORIZATION NO. OPERATION PERMIT BY: � '�7% DATE:-�! / - . **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED INCOMPLIANCE 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 05/96(Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT &ATC Davie County Health Department r '- Environmental Health Section D OUR P.O. Box 848 Mocksville, NC 27028 AUG 1 51997 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSE L THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed i/�Lm J / Ile,7 d!`,,I s Contact Person Mailing Address (A4%a J- Ar/{,r L/t/ Home Phone 3 Y- y") 8 City/State/Zip ,� �� c,. /�� � �O of Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip - 3. Application For: [ ]Site Evaluation [1�J l Improvement Permit&ATC [ ]Both 4. System to Serve: [V]'House [ ]Mobile Home [ ]Business [ ]Industry [ ] Other 5. If Residence: #People #Bedrooms #BathroomsC [Dishwasher[Garbage Disposal [cor"gashing Machine [ ]Basement/Plumbing [ ]Basement/No Plumbing 6. If Business/Other: Specify type #People #Sinks #Commodes — #Showers #Urinals #Water Coolers If Foodservice:#Seats Estimated Water Usage(gallons per day) 7. Type of water supply: LKO�unty/City [ ]Well [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [ ]No If yes,what type? PROPERTY INFORMATION REQUIRED:***IMPORTANT***ACF4F THE PROPERTY MUST BE SUBMITTED WITH T tS APPLICATION. Property Dimensions: 5—� �< WRITE DIRECTIONS(from VIocksvffle)TO PROPERTY: Tax Office PIN: # Property Address: Road Namek City/Zip ; If in Subdivision provide information,as follows: Name: Section: Lot#• 1;?7 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 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 byv.Rovice_ �{ duct all testing procedures 4 necessary to determine the site suitability. DAT —l SIGNATURE Revised DCHD(06-96) THIS AREA A(Ay BE USED FOR DRAM NG YOUR SITE PLAN: ora 00 oar I � � 21 #23 2 : � (0.694 AC ) .ob °� - , .� LOT - � y Vie "ti LOT... #22. (0 86o:.AC.) • l -(0.75C) AG. #24) LGA' Lj (1.225 AC.) �• CONTROL j� CORNER s,70 I t Op • d / ( 9h f 0, 8 z '� N b'1 A9 Og d 60) 3� J ,A CIS Cf9 C est 38 C16 TJ1.130 s CDU � �r�, 4 .698 AC. ' � 1 Ll 44� 4` z2 LOT X25 . LOT r 29 10'cunmy `C21� (1.1.04 AC.) 2 co N (0.700 AC.) EASEMENT o 0 DoTir % 2�� w CD • 2n� (0.789 AC.) " LOT X27 a (0.705 AC.) °� g LOT #26 N (0.855 AC.) N cu cu 100.00 95.00 CONITROL 100,00 100.00 20.00 �'-- N 88.33'12' W 0.0 *100.00 CORNER 928.93 128.93 r _ LOT , �. ; LOT 6 . LOT 7 LOT 8 LOT 9 r ~N0RTHBROO.K PNASE PLAT BK s Pg. 124 ,�,� �' 1' r_ G/K j NOTES• ; APPLICATION FOR COOSEVALLIATIOWIMPROVEMENTS PERM •� E Davie County Health Department '. Environmental Health Section SEP 1 8 1995 P. O. Box 665 Mocksville, NC 27028 ENVIRONMENTAL DAVIECOUM 1. Application/Permit Requested By t Mailing Address ` o CS Home Phone Business Phone 2. Name on Permit if Different than Above 3. Applidation/Permit for: WGeneral Evaluation ` ❑ Septic Tank Installation 4. System to Serve: house ❑ Mobile Home ❑ Place of Public Assembly i ❑ Business ❑ In lIgntry Other ❑ Unknown d7 5. If house, mobile home: Subdivisionwo �Raa�SPPon Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms ❑ 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: ©'Public T. ❑ Private ❑ Community 8. Property Dimensions ) 12-A&aakjz G deemdz Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ 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. i �`j �_� � ,p,, �,, �/ Directions to Property: f �j►j� �( yy�y�y �lU�1Gli1f/ 71G L'" %�%� .- This is to certify that the information provided is correct to the best of my knowledge,and I understand I am responsible for all charges incurred from this application. DATlt SIGNATURE IF CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1. I OWN the property. ❑ 2. 1 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 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 said site's suitability for a ground absorption sewage treatment If disposal system. DATE SIGNATURE DCHD(12-90) t DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME >,>� -` �^��i"C DATE EVALUATED ADDRESS S `cc�� PROPERTY SIZE PROPOSED FACIILTY O o LOCATION OF SITE Water Supply: On-Site Well _ Communit Public Evaluation By-(q.1— Auger Boring Pit_ Cut FACTORS 1 2 3 4 Landscape position Sloes - 6 HORIZON I DEPTH ig Texture groupt: Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy \1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S$ RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION ,S- LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: `�• EVALUATED BY: LONG-TERM ACCEPTANCE RATE: �� OTHER(S) PRESENT: �U 4'Ns REMARKS: LEGEND Landscape Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Floodplain 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 3C-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralo¢y 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 ■■■■■■■■■■■■■■■.■■■■■■■■■■■/■■■■■■■■■■■■■■.■■■.■■..■■.■■■■ ■■■■o■■ CCCCCCCCCCCCCCCCCCCCCCCCCCCCC�i�iiiiiiiiC■C■iisiiiiiiiiiiiiiiiiii ■■■■■■■■■■■.■■■..■■■...■.■■■f/►\■■.■■......■�...�....�■■■■■E■..■■■■ ■■■s■■.■■■■s.■s■■■■.■■■■■m.r�r���■■■..■■■■■■■ ■■■ ilii ■■■■■■■■■■■■■ CCCCCCCCCCCaiiiiiiiiiiiiiiiiiiiCc■+��CiiiiiiiiiiiiiiiC=CCCCCCCCCCCCCC :::::::CCC:::::CCCCCCCCCCCCC206ME:CCCCCMENOMENN MEMO MEMO MEMMEMEM niii�CCCCCCCCCCCClool mom MMMNMMMMMMM ■■■..■ ..■.■mill ■■■.■■■..■■■..■■►■■..■■..■►■■■■■�■■.■.......■■■■■.■■...CMH■..■.■ CCCCCCCCCCCCCCCCCCCC::CCCCCCCCCCCC■CCCCCCCCCC:CCCCCCCCCCCCCC='"mommamm OEM CCCCCCCCCCCCCCCCCCCCCC: :C:�::CCC::C::CCC:CCCCC.::':::_•••••••••• C ........H.................��.....................■ :ME momCCUME CMO MIM .0 ■■■■..■■■.■■■■■■■■■■■■..■■■\■�[JU/■.....■ ■ .mill■. 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