126 Oak Leaf Ct Lot 15 DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
' P.O.Boz 848/210 Hospital Street
Mocksville,NC 27028 ,
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 989900063 Tax PIN/EH#: 5708-06-7210.15
Billed To: Larry McDaniel Subdivision Info: Oak Crest Sec.2 Lot#15
Reference Name: Janice McDaniel Location/Address: Davie Academy Road-27028
Proposed Facility: Residence Property Size: See Map
** *N�1b%r. 2538
N is mprovement/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 Hou #People L4 #Bedrooms 3 #Baths 2—
Dishwasher:
Dishwasher: I" Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type ,", ,� #People #People/Shift #Seats Industria13l Waste:
Lot Size I� �ype Water Suppl)//��WDesign Wastewater Flow(GPD Site: New M alRepair❑
System Specifications: Tank Size
y p 1QQCbAL. Pump Tank GAL. Trench Width.5Z Rock Depth %Z I� 'Linear Ft�
Other: . 1STQ—+ TICcJ -6&XES
Required Site Modifications/Conditions: L.L 0 A TO 0a Lc-a " = "
Ni3
IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"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.�1:30 p.m.on the day of installation. Telephone#is(336)751-8760.****
�7 U��
Environmental Health Specialist's Signatur Date:
DCHD 05/99(Revised)
�?
DAME COUNTY HEALTH DEPARTMENT f/
Environmental Health Section
P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
Account #: 989900063 Tax PIN/EH#: 5708-06-7210.15
Billed To: Larry McDaniel Subdivision Info: Oak Crest Sec.2 Lot#15
Reference Name: Janice McDaniel Location/Address: Davie Academy Road-27028
Proposed Facility: Residence Property Size: See Map
ATC Number: 2538
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 ewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTE W CO IS ALID FOR A PERIOD OF FIVE ARS.
Environmental Health Specialist's Signa e: Date:-8hAl",
CERTIFICATE OF COMPLET N
**NOTE** The issuance of this Certificate of Completion shall indicate the s tem bed on Improvement/Operation Permit
has been installed in compliance with Article 11 of G .Chapte 30A ection.1900"Sewage Treatment and
Disposal Systems,"but shall in NO WAY be taken as a guara ee t the system will function satisfactorily for any
given period of time.
�G
r
Septic System Installed By: ,v 6W 1 E�--
Environmental Health Specialist's Signature:
DCHD 05/99(Revised)
f = • - APPIMCA?ION FOR SrrE EVALUATION/IlI1PRM MENr KRQtir&AT
Davie County Health Department D --
JftbYn ru» wW fta tis Sectforr
P.O. Box 948/210 Hospital Street AUG 2 L
Iookaville, ITC 27028
(336)751-8760
•**ZiNGlrtZANT*** THZ8 APPLZCRTIOMT CANN= JW 374=Aw Ta88 A='THZ RZQVB
ZNYCFM21OU Z8 PROVIDED. Refer
��to the ZIt> RMICH 80=2111 for iaatsuatioaa.�,�,
1. ]lane to be sills (�rX1 ,(J`/ul 1build C'� Coalaot Vs.o& `w.P_ 1_ICJJ J
Wailing addcoss Ptd Vox :q-l1 now mase _ 33u- qqg- LA LD3a
City/statemp wc\"6�ille \"i G -10971? sacra... . 38(Q- r7 51_0.x,
s. Now a4 Vemit/M it Different thea a mm r1V Ycr m( rhnij Buiders
SA.ilsaq addimes Y 511 cihr/stet./ria,�(;�C 'S11 t I IP. k4 C., colmq
a. appiioation lost 1:1pite svaluatioa Znprovenw at Permit/ATC 0 Both
4. ftstea to sesvloei House 0 Mobile some 0 Busiaeas 0 Iadustsg O other
s. I! Rasidenos: t People s Bedrooms _,�_ f Bathrooms _
` "ShWWbes D Q=bape Diepoeal Reebinq Wdaiae O neeeReat/91taib4 0 naeeoeot/so 11mbim
6. Ze mesa***/Zn*=tr=/other: speoift type I ftople f ""a
i Cawood" i sboress i criaele i Rates Cooler.
It >fMSEMCK: # Beats Zstimated Nater UsaQe (vauoos pet day
7. Type Of xater supply: 21(Couaty/City 0 Nell 0 Comsuaity
s. Do you aatkipate additions or expansions of the facility fhb system Is Intended to serve? 0 Yes 0 No
If yes,what type?
***JMP0RTAffP**CLIENTS MlA'T'C0MPLETETHE REQLRRED PROPERTY INFORMATION REQUES'M
BELOW. Eltrer a PIAT or SITE PLAN MLIS'T BE SUBMITTED b &*chest with THIS APPUCATION.
Property Dhmensons: �-e if he I r)u) WRITE DIRECTIONS(ban Modwille)to PROPERTY:
Tax 011lce PINI A -T I z`N?i ng- O to• "1 a.1 O.I
Property Address: Road eeT"_'1_v j 2,ACadea 1
cityrzlp M Qtol QIP. c271 t 1:e; on 7 a u i e. owd
Uis a Subdivbloa provide iaforaudoo,as follows: L�CM�+ (113 K,t'a4. ri 6TAI I
N. QLPreS+ 1 -�szlins 01 w i Ie, _
Secdous Bloch Lot: '5' Date Property Flagged:
Tbb Is to cer ft that the Iuformatbs provided is correct to the best of my knowledge. I understand that any permlt(s)
issued berea ter am subject to suspension or revocadou,If tke site plans or Intended at change,or lithe Inforatation
submitted In this application Is fabilled or changed 1,also,understand that I an respoudblt for oil ckMes wwredfrom
Ah gppJicedoa %hereby,give consent to the Authorised Representative of the Dqvie County RealtkDown
to enter upon above described property bated In Davie County and owned by, r✓U 00)0111 I 1 d elS /Ac.
to conduct all testing procedures as necessary to deteratiae the site salability.
DATE SIGNATURE 00L,,��
THIS AREA MAY BE USED FOR DRAWING YOUR SITE P (Include all of the foilvw[ng: EsbNng and proposal
property lines and dimensions, structures, setbacks, and septk badoas).
A�Q CL Site Revidt Crarge
Date(s):
Client Notit ation Date:
EAS:
Account No. b 3
Revised DCHD(07/99) Invoke No. 1
:
" COURSE E
Y "t
ill y 1�2•t>R t S,4r
so,
z 1 � 6,•Fh Y - ' }t`.ii yr .�y •. _t - •Y lh"•
t: •` 'fDAKlAIVO HEX;FIIS" � `
Section p',:
PO 4 49 PG 15t
Y
1. 43 Acres
Myle Iron stake Fns ,�` ,f 1 r
♦ OiK r
r N 36'34'02"w - Proposs� r 4 Phase II
y 30.00' i/2" hbuee s Phos,
amu, ✓ _t/3'Eft .
S E11t
t - '
"OA
O �
Phase U
MAI
APPUCATION FOR SITE EVALUATION IMPROVEMENT PERMIT&ATC 0 v
�- Davie County Health Department
D
Enwimnmentol Health Seacdon SEP 2 1999
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
***DWMV l V** %HIS APnIMIOM MMM W M=S= UNLESS AIM THE REQUIRED
nwmi nmi IS PROVIDED.A ARefer to the mroRwim BULLETIN for instruations.
I.. haus to be Billed f Yl� I VI,f�QYI l� �Jll( � contact person .�(Y Y11 fQP.ryp 0 C�.. i o 0
Nailing Address /P�f�� o� `� `1 n am* Plhons 33U- 1n'9- LA b32
City/stat•/sxp 1 y U)�iSy- e- N\AG +g-lox Business phone( 38(Q- 1 51 �10a
Z. Xt on Vemit/ATC It Different than Abo" l C` yy-(l m� M001-6v
nQ ! )U11�QXS
cil�,�tGn• !y�
Nailing Address �f-1 X � ^l ty/stat•/sip I 001- y 1 I IP. 1V�J oC r
!. Application For: Fite Evaluation 0 Improvement Permit/ATC 0 Both
a. systen to servio•: House 0 Mobile Home 0 Business 0 Industry 0 other
5. If Residence: # people • Bedrooms _ # Bathrooms
*Dishwasher 0 Garbage Disposal Nsahing Naohine 0 Basement/plmbing 0 Basement/no plm&ing
6. if Business/industry/other: Specify type # people # sinks
# cosmodes # shovers # urinals # Nater coolers
Ir FooDamm: (# Seats Estimated dater Usage (gallons per day)
7. Type of aster supply: "]County/City 0 W011 0 Community
a. Do you anticipate additions or expansions of the facWty this system is intended to serve? 0 Yes 0 No
If yes,what type?
*"IMPORTANT"**CLIENTS MUST COWUMTHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPUCATION.
Property Dimensions: -e if,be_,I nom) WRITE DIRECTIONS(tram MocksAle)to PROPERTY:
Tax Office PIN:
Property Address: Roams O
City/Zip Motk�sv��1Pi r --1 ILA,,, On . QW¢teACadirm �d
If in a Subdivision provide information,as follows: e n a• a -
Name: akCred+ Im i IP,
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 permit(s)
Issued hereafter are subject to suspension or revocation,If the site plans or Intended we change,or if the Information
submitted in this application is falsified or changed. I,also,understand that I ant responsible for all chaigea Incurredfrom
this appUcadom I,hereby,give consent to the Authorized Representative of the Djvie County HalDepartmea�# , J
to enter upon above described property located in Davie County and owned by l-�-e[rr(l /ACI 1n re.I Ertl �Ue/S (hC-
to conduct all testing procedures as necessary to determine the site saib
DATE `� I Cf SIGNATURE w
7 2
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Incl a all,of the ng: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations
Site Revisit Charge
Client Notification Date:
EHS:
�i Account No.
Revised DCHD(07/99) ( Invoice No.
Tax Lot 38
6.4 Acres +/—
Angle Iron Stake Found
Total 30,00
352.34
N 36.34 02 222 34' 270
100'00, 1/2" EIR
�S00
Kf N ►7
M
i
� � � 16 � ifi •
y
30,000 SF + N 30,000 SF +
I30,000 SF + 14
o
30,000 SF + W
in Iq 4o, o
•`�'�.. ,y 34.73
7 8, 212.98
2
40"N
a o h0 c
cn m 53.00' 39.53' ~
1 B 23.72 23.72' 13 0
`c
30,000 SF + a, r `Q 9911 30,000 SF +
12" ap t V ;o
ent N 18.40'28"W 172.68'
15.00' N 23.54'23'W 192.35'
$ � g
c
ig gy 0 12
g 30,000 SF + Q�� O 30,000 SF +
N � (0
`n N " EIR
35.69 1/2
� 116.82' _
102.50 �'�•
30.54' S 22°26'21"E S 23 28'
IRS 30.02' 29195'
. p 96.8
- - Davie .Academy R
RR Spike Found
I
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
• Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 989900063 Tax PIN/EH M 5708-06-7210.15
Billed To: Larry McDaniel Subdivision Info: Oak Crest Sec.2 Lot#15
Reference Name: Janice McDaniel Location/Address: Davie Academy Ro d- 7028
Proposed Facility: Residence Property Size: See Map Date Evaluated:
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS 1 2 3 4 5 6 7
Landscape position L
Sloe%
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure Cr7h a /(
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: AS 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)