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110 Autumn Ct Lot 4 DAVIE COUNTY HEALTH DEPARTMENT /doh/G-.2.2 :// Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900063 Tax PIN/EH#: 5708-06-7210.04 Billed To: Larry McDaniel Subdivision Info: Oak Crest Sec.1 Lot#4 Reference Name: Larry McDaniel Builders Inc. Location/Address: Davie Academy Road-27028 Proposed Facility: Residence Property Size: 0.692 Acre ATC Number: 2198 **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 /T #People #Bedrooms #Baths Dishwasher: E!r, Garbage Disposal: ❑ Washing Machine: Er"" 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) Q- Site: New❑Repair❑ System Specifications: Tank Size/ V GAL. Pump Tank GAL. Trench Width- !, Rock Depth /�� Linear Ft.TOO,- Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISERS)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 on the day of installation. Telephone#is(336)751-8760.**** r Environmental Health Specialist's Signature: _ Date: �X DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPAR'T'MENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900063 Tax PIN/EH#: 5708-06-7210.04 Billed To: Larry McDaniel Subdivision Info: Oak Crest Sec.1 Lot#4 Reference Name: Larry McDaniel Builders Inc. Location/Address: Davie Academy Road-27028 Proposed Facility: Residence Property Size: 0.692 Acre ATC Number: 2198 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 CONSTRUCTION IS VALID FOR A PERIOD OF/FIVE/YEARS. Environmental Health Specialist's Signature: • �� Date: CERTIFICA E F OMPLETION **NOTE** The issuance of this Certificate of Completion hal ind' to the system described on Improvement/Operation Permit has been installed in compliance with Article 1 of .S Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be en as guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: J/7 W, Environmental Health Specialist's Signature:. Adki Date:��—d�9'00 DCHD 05/99(Revised) Arrut;A110N 1-011 SIIE EVAIMAIION/IMPROVEMENT PERMIT do ATC @ [E ow I2 Davie County Health Deparbnent V EnWivamental Health SmWon OCT I 1999 i P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 zr . ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Mama to be Billed EE::-q1 J t! C=taotPerson'7-VsA() Ar0 NP- LMIOL !failing Address ! Hama Phone City/state/LIP I IE Bus ness Phone 2. Hams on Persist/ATC if Different th/a'n� Above Mailing Address P•. L���jJ ty/state/Lip 3. Application Sor I !Lte Evaluation RImprovement Permit/ATC 0 Both a. system to service: y House 0 Mobile Home 0 Business 0 Industry 0 Other S. If Residence: # People # Bedrooms # Bathrooms 'AUishwasher 0 garbage Disposal -\rNashinq Machine 0 Basement/Plumbing 0 Basement/Ho Plumbing S. If Business/industry/Other: Specify type # People # Sims # Commodes # showers # Urinals # Nater Coolers IF FOODSERVICE: # Seats Estimated Hater Usage (gallons per day) _ 7. Type of water supply: �ounty/City 0 Well 0 Community e. Do you anticipate additions or expansions of the facility this system Is intended to serve! 0 Yes 0 No If yes,what type' ***IMP0RTANT***CLIENTS AIUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SI7f-,,,e E PLAN MUST BESUBMITTED by the client with TINS APPLICATION. Property Dimensions: WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tai OMce PIN: # - `I= ► "�n- �]o�)( 6 y Property Address: Road Name -I C -j City/Zip CLL V 1 I �7( 1,44 W VAiAio A If In a Subdivision provide information,as follows: a*a asl r-W (1112-d 1 Name: Section: Block: Lot: Date Property Flagged: i his t,to certify that the information provided is corral 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,xndaatand that I am reVonsMlefor all charges Incurred f v= thb appUcadom I,hereby,give consent to the Authorized Representative of the &vie County Depart Bt to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE 1 1 I SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property Fines and dimensions, structures, setbacks, and septic locations). Ck-44� ,on.aq Account No. Revised DCHD(07/98) Invoice No. /�� .+, .Litsanuiv run blit tvAL11AHON/IMPROVEMENT PERMIT do AIC Davie County Health Department41 Environmental Health Smffon P.O. Box 848/210 Hospital Street APR 2 0 1999 Mockaville, NC 27028 (336)751-8760 ENVIRONMENTAL HEALTH ***IW0JWANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. J 1. name to be Billed Ld"G C&sc/,-L / 460ontact Person L/l/i7i Cep/V/ %1,' w Hailing Address JrSame Phone J?J" -- /�0 k�-� City/state/zip lU s(l/ e- G D rv�8�fs/ituse/Phon7e 3 --- �S-7 - ��20 Z. Name on Permit/ATC If Different than above �C(/Z/'cu X lOaft;eL Hailing Address ZDcity/state/zip a. Application for: U Site Evaluation XImprovement Permit/ATC 0 Both 4. system to service: A House 0 Mobile home 0 Business 0 Industry 0 Other S. It Residence: i People i Bedrooms i Bathrooms r *Dishwasher D Garbage Disposal )(Hashing Hachins D Basement/Plmbing 0 Basement/No Pinabing 6. If Business/Industry/other: specify type i People i sinks i Commodes i shovers i urinals i Nater Coolers IF FOODSERVICE: g Seats Estimated Hater Usage (galions per day) 7. Type of water supply: County/City O hell 0 Community u. J�.;yer anticipate additions or expansions of the facility this system Is intended to serve! 0 Yes 0 No it yes,what type' ***IMPORTANT***CLIENTS MUST CVAfPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Eilher a PLAT or SITE PIAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: WRITE DIRECTIONS(from MockrAlle)to PROPERTY: Tax Office PIN: !! � / _3 �!•sl"'J����" 06 "��'�B Property Address: Road Name City/Zip Acko/*/L /kaa7 r ,10 ^/ ` O-L- :� p ©S�7 ���i� dh /f; If in a Subdivision provide information,as follows: � �� Name: � A2,, tr Section: Block: Lot: Date Property Flagged: This is to certify that the information provided Is correct to the best of my knowledge. I understand that any permits) 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 din roFonstble for all chmges IncunYd from this appUcatlon. 1,hereby,give consent to the Authorized Representative of the Da County 8 th Department. to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitab , DATE SIGNATURE G tiC.cpJ THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Account No. Revised DCHD(07/98) Invoice No. APPUCAIION FOR SITE EVALUA1 ION/IMPROVEMENT PEAMR do A -�a---�-- A% Davie County Health Department d R Environmental Health SftWon P.O. Box 848/210 Hospital Street NOV 1 g fig% Mockaville, NC 27028 (336)751-8760 ENVIRONMENTAL HEALTH ***I WWrAIVT*** THIS APPLICATION CAWM BH PR=SSED UNLESS ALL THE MQUIRED- INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Dams to be Billed e7 1 contact Person Mailing Address Mo l , f t� Some phone / l Q �1 / City/state/ZIP _r( 1e-'l ) I A) • iL - �-1. ,4 Business Phone f2 262 ( �V Z. Dame on Permit/ATC i! Different than Above `�'�a /Z- Mailing Address ���_ City/state/Lip 3. A"licatioa For: L' site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. system to service: fel'Nouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other a. If Residence: # People # Bedrooms # Bathrooms 0 Dishwasher 0 Garbage Disposal 0 Washing Machine 0 Basemient/Plumbing 0 Basement/Do Plumbing 6. If Business/Industry/Other: Specify type # People # Sinha # commodes # shovers # Urinals # water Coolers Ir FOODSERVICE: p Seats Estimated slater Usage (gallons per day) 7. Type of water supply: non- unty/City ❑ Well ❑ community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes ❑No If yes,what type. ***IMPORTANT'**CLIENTSAIUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PIANU M/ST RETTESUBMID by the client with THISLI APPCATION. Property Dimensions: _f a('!- L "' S WRIT4 DIRECTIONS(from Mociuvllle)to PROPERTY: Tai Oflice PIN: # 570 - 6 004-44 t Aj-i I IN 1 11 J 6 ' J Property Address: Road Name ' OLALny C-h J r-,vt-��;J 41-Lia" �m City/Zipa, )`�0 T� - n 1 If in a Subdivision provide information,as follolvs: -►/Irl tl „ oR kr��� Name: TSI c,ayni� Section: � Block: Lot: Date Property Flagged: C L ANG 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. 1,hereby,give consent to the Authorized Representative of the Davie Ounty Health Dep a went to enter upon above described property located in Davie County and owned by od to conduct all testing procedures as necessary to determine the site suitability-. DATE A ' S SIGNATURE THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN(incl call of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Account No. 6 -3 Revised DCHD(07/98) Invoice No. _ (A 1 ' LI DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION__LOT Soil/Site Evaluation APPLICANT'S NAME ��G`l DATE EVALUATED L&Am PROPOSED FACILITY PROPERTY SIZE 5 ,470 SUBDIVISION 45 -gleC're-S d_ ROAD NAME dJ�4vi C Water Supply: On-Site Well Community Publicy 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 Structure /L 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 M is 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(01.90) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MENNEN ' �MENNENiiiiiiMENNENMEMNON ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■/■■■■■■■■■■/■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ a � Q GHTS OAKLAND HEI 0 p9 4 0 PG 122 co3 09 '61' e; O ►� p n to p 3 O 900, 9, o Z oNi 3 t, O a 7 N �2 w N NQD X25„W 287.29 ?��• �^ N 11°26'25,., - tJ 28 ° 3 O ,z28.�9• ; � WON ow Hou s!se i - ° L-161 ; �t •1 f'25.,W 287.97' 8 g5' 24 1 N 1 E $ 5 / N 22.23'50"W 270.91F -------- ' 0 5 3�f r .1", 1 L-4 r � 1 I J L "Ig , o L-3 i /N 23'28'35"W 167.11' .♦...►—_ 285.95' -- —"---- / N x°26'20"W — — — - �I_�'� __- - • _ lodbey Road d G nave Acordem Road c-iD150