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252 Ijames Church Rd Lot 6 DRVIE COUNTY HEALTH DEPARTMENT j�O IMPROVEMENT PERMIT and OPERATION PERMIT U 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 G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Dis osal Systems) ` NAME P���` 1�J N AMv,PROPERTY ADDRESS DATE LOCATION A,,U ( N h` 1, P SUBDIVISION NAME �U O RC R�d LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE o vsa # BEDROOMS 3 # BATHS # OCCUPANTS GARBAGE DISPOSAL: Ye N COMMERCIAL SPECIFICATIOW-.*F CILITY TYPE # PEOPLE # PEOPLE/SHIFT .� # SEATS INDUSTRIAL WASTE: yes/No 0.1 LOT SIZE`b0 31n�i WATER SUPPLY CpuN DESIGN WASTEWATER FLOW (GPD) �' 'p NEW SITE V REPAIR SITE 1— f------------ SYSTEM SPECIFICATIONS: TANK SIZE` Oo GAL:S PUMP;=TANK GAL. TRENCH WIDTH'-Z', I CROCK DEPTH LINEAR FT OTHER y „, a�. . Ire J Y REQUIRED SITE MODIFICATIONS/CONDITIONS: AA ***THIS PERMIT IS &BJECT TO REVOCATION IF' SITE R*S OR THE INTENDED USE CHANGE. YOUR WASTERWATER.SYSTEM CONTRACTOR MIST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. �TM t� p uS4 j � v a I ROVEMENT 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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT ry SYSTEM INSTALLED BY p ar..mwm.Y yC /S'`, 4 Q d AUTHORIZATION NO. b C7 O OPE TION PE IT BY �?�.) DATE -**THE ISSUANCE OF THIS OPERATION PERMIT SHALL IND TE THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 REATMENT AND DISPOSAL SYSTEMS', BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATI ACT LY FOR ANY GIVEN PERIOD OF TIME. ry DCHD 10/95 ` }n - .�.s'�"`„ �`+,+�L+ �Ft }.l:K'�..,.y,..r: �`�+Lr"' T�e,..jr, , ,C.'4f:t <a ! .�- r' �,'.�''' :i. .-`r c'• - . Davie County Health Department ENVIRONMENTAL HEALTH SECTION ,. P.O. Box 665 Mocksville, N.C. 27028 i AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) # ***This Authorization For Wastewater System Construction oust be issued by the Davie County Environmental Health Section prior 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.*** 1 . NAME \ar �\ P ew DATE / 011 — �� � NAUTFpRIZRTI� NUMBER f LARNE ON IMPROVEMENT PERMIT (If different than above) SITE'LOCATION 601 N " 1�, 4`c�. c .,�a '�7.r' nC In \X) COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM '' **OWICE*** THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRU.CayTIIOON; IS VALID FOR A PERIOD OF FIVE (5) YEARS. . ENVIROMENTRL HEALTH SPECIALIST....: DATE -DCHD 10/95 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER t N Davie County Health Department SEP Z 9 ,: Y' p� Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By aev►e L "I-A6 Mailing Address l 3 AU6L b � Home Phone ge/L-)- Business Phone 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation Septic Tank Installation Permit 4. System to Serve: OHouse ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry [IOther ❑ Unknown / 5. If house, mobile home: Subdivision "Allo and k- Section Lot# ❑ Basement/Plumbing No. of People /��A ❑ Basement/No Plumbing No. of Bedrooms 3 Washing Machine No. of Bathrooms Dishwasher Dwelling Dimensions s,;;! ❑ 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: 9/public ❑ Private / ❑ Community 8. Property Dimensions �G7� Sewage Disposal Contractor • C' ��•7LG,c�'i�� 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 2-"N'-o 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: 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. g - DA E SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY Ftaondodisposal ECK ONE: pd 1. I OWN the property. ❑ 2. I DO NOT OWN the property. ked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative of the Davie County Health Department to enter upon above described cated in Davie County and owned by all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment system. DATE SIGNATURE DCHD(193) APPLICATION FOR 8-',.TE EVALUATION/IMPROVEMENTS PERMIT D d U Davie County Health Department JUL 1 1 i - Env;ronmental Health Section P. O. P.:^,, 665 Moc:<5viile, N; 27028 ENVIRONh1ENTAL HEALTH DAVIE COUNTY r, 1. Application/Permit Requested By, �+ Mailing Address f Home Phone !?!Z I&7-1Business Phone Name on Permit if Different than Above 3. Application/Permit for: ��eneral Evaluation ❑ Septic Tank Installation 4. System to Serve: m ouse ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. if house, mobile home: Subdivision &.ag Section Lot# ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms ❑ Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions Z - /aA!i� ❑ 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 supe;y: Public ❑ Private ❑ Community 8. Property Dimensions �{�.,t)r�lt��. l� �,t/�� Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? 44es ❑ No If yes, what type? ,�aY� (rte rr v P P. Or� '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: 0-,r-Vv 04V 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. 14 19 9� U G7 DA E SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: IP/1. 1 OWN the property. fi/an P1 ❑ 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 representati a of the Davie Cou Health Depa ment to enter upon ab ve des ib property located in Davie County and owned by to conduct all testing procedures as necessary to dee mine said site's suitability f ground absorption 96wage treatment and disposal system. SATE SIGNATURE OCHO(12-90) `� • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation DATE EVALUATED NAME � gg 'p ADDRESS S h 'Q PROPERTY SIZE •� O O G�j�A PROPOSED FACIILTY LOCATION OF SITE Water Supply On-Site Well _ Coty Public L_/ Evaluation By5�jl�.L Auger Boring Pits ✓ Cut FACTORS 1 2. 3 4 Landscape 2osition Sloe R -�Ga - HORIZON I DEPTH ell c' Texture group C I_ L Consistence F Z Structure Mineralogy 11.E 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 $S SS RESTRICTIVE HORIZON — SAPROLITE CLASSIFICATION QS. S LONG-TERM ACCEPTANCE RATEI C "q SITE CLASSIFICATION: 'J EVALUATED 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 ;lay loam, SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-V,---y 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 Mineralog 1:1, 2:1, Mixed Notes Ilorizon 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 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■./.■/■/■■■■■■ ■iitM■ ■ � iiiiiiiiiiii=iiiiiiiiiiiiiiiiiii■■ii1■isy�.■ii�iiiiiiiiiiiiiiiiiiii�Ci� ■■■■■■■■■■■■■■■■■■■■ ■�■w■■■■■■■■■■■■■■■■■.■..■■■.._ ■■■■■■M■■■M■■ ■■■■■■■■■■■■■■■■■■■■c:.■■■■■■■■■ ■..■■.■■.■■.■■■■■ ■■■■■■■■■■■■■■ iiiiiiiiiiiiiiiiir ����iiiii■iiii■■iiiiiiiiiMEME 0 MEOMMMEMEMEMMEME MEMOME MEN IN No OEM mommomillom iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii�=i�►■iii .�iiiiiii■iiiii=MINE iiiiiiiiiiii■�iiiiiiiisiiiiiiiii�iiiioiii►■ i►■iiiiiiiiiiii■i=iii ■■■■■■■■■■.■■■■■■■■■■N■■■/.■.■■■■■■■■\Ott\\■■■►■ ■MEN�■■■■■■■■■■o ......................■■.....................M\1■ M■■ M■■NOMM■■■� ..........................................MORE I M■�■N..■..■� .....................u.■..■R■■/�.■■.. .MNL-A!m .■■■■0 MAINE MINOR �■■■.■ENNEMMEM■■■ ■■■■■■.M■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■N■■■■■I■ /■N■■■. ■■M■■■■■ MEN ON mom ONNEMEN 0 no MEMO OEM mom MEMO 0 ■MMM■MM■MM■M■M■MMM■M■11 MONM■■■■ IN IN MMEEMSEEMEN ■ ■iiia ' .■�■ M■■■■NN■EMI ■■■.■■■■■.■■■■.■■■..■11■.■■■■■■.■■■. 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