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109 Oak Leaf Ct Lot 18 DAVIE COUNTY HEALTH DEPARTMENT F"'(_ to —/3- '� Environmental Health Section • P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)7.51-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900063 Tax PIN/EH M 5708-06-7210.19 Billed To: Lary McDaniel Subdivision Info: Oak Crest Sec.2 Lot#19 Reference Name: Janice McDaniel Location/Address: Davie Academy Road-27028 Proposed Facility: Residence Property Size: See Map 2542 **N07I✓*This tmprovement/Operation Permit DOES NOT authorize the construction of 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 -2) #Baths Z Dishwasher: Garbage Disposal: ❑ Washing Machine: 17"' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type //�� #People #People/Shift �l#Seats Industria13l Waste: Lot Size c).(pq�-�M,SType Water SupplLxkny Design Wastewater Flow(GPDSite: New MalRepair❑ System Specifications: Tank Size QrAL. Pump Tank GAL. Trench Widthit Rock Depth Linear Ft. Other: Required Site Modifications/Conditions: STI\LL Oa C04TO 7Q, ICC cP !�--; oFf-14OVs-- P 1010X f V� IMPROVEMENT/OPERATION PERMIT LAYOUT- VED EFFLUENT FILTER RISER(S)IF 6 11 BELOW FINISHED GRADE. ****NOTItact a representative of he Davie County Health Department for final inspection of this system between439-�Tn.to 9:30 a.�.or., :00 p.m.to 1:30 p.m.o the day of installation. Telephone#is(336)751-8760.**** s� � ��D yaus tN c�2n A A Q n s 5, i=eo�lr 5s, Environmental Hea Specialist's Signature: te: ZQ da t7 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 #: 989900063 Tax PIN/EH#: 5708-06-7210.19 Billed To: Larry McDaniel Subdivision Info: Oak Crest Sec. 2 Lot#19 Reference Name: Janice McDaniel Location/Address: Davie Academy Road-27028 Proposed Facility: Residence Property Size: See Map ATC Number: 2542 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 WASTEWAT R CON CTIO S VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature/`---" Date: 912,e7-100 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. Gia v i i�00 Septic System Installed By: `J�'"��t� PT?4Ii 'LL/ Environmental Health Specialist's Signature: tl DCHD 05/99(Revised) APPIJCATION FOR SITE EVAUATION/IMPROVEMENT PERMIT&ATC Davie County Health Department .' EhvrMMWnta/Hmlfh Section • P.O. Bos 868/210 Bospital street AUG Moaksviile, HC 27026 (336)751-8760 - . EI�VIR�OAVIE COUNTY LjH ***XjRCRTAWZ*** TBIS APPLICATION QMwl St PR0=8= U=88 ALL Qorlrw ItY+ORMi1TICH IS PROVIDZD. Refer to the INl'OR WXOH BU=TXN for iastrnotioas. 1, name to be ruled L r r l.1 Mr (.)d Afo 4 NuArLo rs coataat *&teen --K(1 S(1 i i- Me t UsLU g Address P� fou ?�n�l' mom phone 35b- OP 9- 443a citr/.tata/s" �,��a� ����.��..,.� 3c,�p- s. name cn V*=dt/A= if Different than 1 Abo"e h-l_�l V r lT = 0.�P II ki j �P nuc ` lrl(.. Wiling Address City/state/sip 3. 7►pplioati0n Iror: 0 Site ivaluation )Improvement Permit/ATC 0 Both s. ftstan to servioei A Bowe 0 Mobile Boma 0 Business 0 Industry O other S. If Residence: # People f Bedrooms � • Bathrooms ` ADishwasher 0 Garbage Disposal X W&-hing Wahiaa O iti"emat/plumbing 0 sasemsot/ne Diu bung 6. =f businm a/Industsr/odes: specify tppe i sample i Commodes i sbowers Qrinals 0 water Coolers It 7=8ZRVICi: # Seats .�- estimated Nater Osage tgsn=w par mar) 7. Type of Water Supply: county/city a well 0 Cosmusaity s. Do you anticipate additions or eipsnsions of the faciUty this system is intended to sure? 0 Yes 0 No If yes,what type? ***IMPORTANT***CLIEN•f8 MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the dint wftb THIS APPLICATION. Property Dimensions: AEC WRITE DIRECTIONS(frau MockrAk)to PROPERTY: Tax Office PIN: 0-r- I' ?. g ��t S71 02'R-6(p '1 a 10ItL •t q Property Address: Rosit'Name abV I t Ocad e""a , laeS4 4r)MIU i t _ afk ';t Od, citymp A/IA )Gvi Ile 9-700-9 fg an 2,ak ar-adema KCS. If in a Subdivision provide information,as follows: (&kCre,�4 rnt- f`i A L 4- a bd7, 4 Name: G'es`r f��'L f ��� o nA-t;(e- Section: eSection: Block: Lot: I'I G Date Property Flagged: , 0 This is to certify that the Information provided Is correct to the best of my knowledge. I understand that any permtt(s) lamed hereafter are subject to suspension or revocation,if the site plans or intended use change,or V the information submitted in tbb applies"is fsbilled or changed I,also,xxdrntaxd that I am rapomdble for all cb qa/stand f vn Ab appUcadlox. I,hereby,give consent to the Authorized Representative of the Davie coast Health Do rtmenj to enter upon above described property located In Davie county and owned by t c to conduct all testing procedures a necessary to determine the site suitability. DATE_,_, ���-. SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE P clude all of toe . Eidsdsg and proposed propeMIlan and dimensions, strmctares, setbacks, and septick:catkros� 4�-r• Site RcvMt charge Date(s): R-S-b Mat Notification Date: 10,2 ERS• Accosnt No. Revised DCSD(07199) Invoice Na I r • t l N V-� �T a 4 . 7 O � ,4 + � '. y, s It �, j 5,. + If /ltd J.• :•N a xi P � � � '� { cc . '• a 68.81 ;N 17500' N.B '2 rr qK ,LEAF. QURT ��0'^PubUa R%}N 20'+fes ....,,,,.,,, �,....... „J.., I. � •; A t�ytlt �` v FF I- l ' t � 7ga ?a . ow t-t • .•7i r rr f ,`r • a . APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC 1E @ LE Q V LE Davie County Health Department D t Envfinnmen0l HesIM Section P.O. Box 849/210 Hospital Street SEP 2 1999 Mockaville, NC 27026 (336)751-8760 ***X1V0RTANT*** THIS APPLICATION CANNOT BE PROCNSSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INrORMTION BULLETIN For instructions. 1. was* to be silted _ Lay rtl hh f f dydo� U.1QA0 5 contact Peso, uIL0 fn(n/Y�l tl 11 Mailing Address Pct �OZ1. � 1' some Phone 3�%o- q(� �1 O- I 1 4Ja city/state/223? MOGCC 10 e, KX,19-702-V susiness Pbcne :;3U-- 2. Nam. on Permit/ATC i! Di!lerent than Abovel�.c y r \ C i 2,.�� d P,YS Meiling ]Address P) Ro X S^1-7 city/state/sip (T V'&k i 11 Q, 3. Application For: XSite Evaluation C Improvement Permit/ATC D Both 4. system to service: House . C Mobile Home 0 Business I] Industry D Other 14 5. If Residence: # People # Bedrooms _ # Bathrooms Dishwasher O Garbage Disposal /Y Washing Machine a sasemsnt/Pluabing a aasementmo Plumbing 6. If 9usinsss/2ndustry/0ther: specify type # People # sinks # commodes # showers # urinals # Water coolers iF FOODSERVICE: # Seats Estimated (Pater Usage (gallons per day) 7. Type of water supply: County/City o Well O Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes 0 No If yes,what type? ***IMPORTANT***CLIENTS MAST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITEPLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: L6 60 WRITE DIRECTIONS(from Mocknille)to PROPERTY: Tax Office PIN: # I P- gg Pim .S1 Os,-6(p - /I 1f 0 n n _� Property Address: RoaAame�P V 1 e. Qcaderu� (P�i UY,4 4O� U I f- (.Gll�'bzq�C , City/Zip NtocRg�;vi Ile 9-70ag Z't U le- /IC.ader�cu If in a Subdivision provide information,as follows: 6,I. f ,. 4 (1k r;4 0- d Name: l -� 'e S� "1 til �'t C 4 R" (e- Section: eSection: Block: Lot: I q Date Property Flagged: 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 ase change,or if the information submitted in this application Is falsified or changed. 1,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 r Health DepartmienI to enter upon above described property located in Davie County and owned by Vytt UCTS It C- to conduct all testing procedures as necessary to determine the site suitabW . � C DATE - - SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR STTE PLAN(In ode all of the fou": Existing and proposed prope Imes and dimensions, strictures, setbacks, and septic locstlons). O�� • Site Revisit Charge Date(s): lea •�s, Client Notification Date: EHS: U Account No. Revised DCHD(07/99) Y/ Invoice No. r. t Tax Lot 38 6.4 Acres +/- Angle Iron Stake Found Total 30,00 ' 352.34, N 36�02'W x.34 �'0�. jp0'00, 1/2" EIR .00 M M � `i U r 16 15 ~ 30,000 SF + N 30.000 SF + CO 30.000 SF + 14 30,000 SF N 3.4.73 Ar•)3, � 2t2•ga � 6,40' 2 373 in o h0 0 v� N 53.00' 39.53' ro 18 23.72 23.72' 13 0 30,000 SF + rrte`` 30,000 SF + 12" EIP to V to ant N 18.40'28"W 172.68' 15.00' %--th N 23.5423"W 192.35' � g o n n g 30,000 SF + 30,000 SF + �O H y116.82 .3569 112" EIR N 102.50' 50.00, 30.54' ` ~' S 22026'21 E S 23 28 �. IRS 30.02 291.95' p 96.8. 7' Davie .A cademy .R RR Spike Found r +*' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900063 Tax PIN/EH#: 5708-06-7210.19 Billed To: Larry McDaniel Subdivision Info: Oak Crest Sec. 2 Lot#19 Reference Name: Janice McDaniel Location/Address: Davie Academy Road-2,7028 Proposed Facility: Residence Property Size: See Map Date Evaluated: C' Water Supply: On-Site Well Community / Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe% ` HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence l 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)