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2499 Davie Academy Rd Lot 2 p. `::�"' ar..3 t°w. 'J' t:."'W-,;r:s /i,r..,'.'a:.'d6rs �,.�.k':rY`Yf W,'+fzMa»•Yy.+f. ;r.. t-.-:.�ix,•t�}hr +:*i7=f({"i"{{y4W�,>*ea... �,�,�ry_ ,.�.f. r,�r�w.., rbc _"`.. .:�,...0.: AUT o ATION NO: j 2 A DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permittee"',.., P.O.Box 848 Name: ; !J" eoig,T i f Mocksville,NC 27028, Subdivision Name: Phone# 336-751-8760 T Directions to property: 44,-1P r:r, Section: Lot: AUTHORIZATION FOR r WASTEWATER 27 QQ ��t.,u Q/._ Tax Office SYSTEM CONSTRUCTION {� n Roa Name: :[/Ar Zip; **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/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I 1 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 HEALTH SPECIALIST DATE ISSUED %-�8 , .-t�'sFT tw_ ".i.L�. ..,:,.l :.t..Pra Y.,."e'''t y'.i'.+` fit' .. .j'Si i4 -• � ,�e.rf�, -. w.J. 4,a�i .c ,4-is. .i -.-r E ._; .a, _ ;, 2 9 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Permittee'�+�-{ Name: ttr.'" =s r •r I Subdivision Name: Directions to property: 1 Section: Lot:. c IMPROVEMENT 1 C1 .,a PERMITTax Office PIN:# - ?,' i2t�99 oA Name: Ar:. Ir'r` ,,/ .Zip: :~* A 4- **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 Disposal Systems) ' "*NOTICE***.TI-IIS PERMIT IS SUBJECT TO REVOCATION IF SITE el ', PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ; ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE' . INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS #BATHS _#OCCUPANTS_ GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY f ?7 DESIGN WASTEWATER FLOW(GPD) NEW SITE // REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZEI000 GAL. PUMP TANK GAL. TRENCH WIDTH �!o/ ROCK DEPTH LINEAR FT. ©o OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT*APPROVED EFFLUET FILTER* :RISERISI IF fi • RELAH FINISHED GRADEt **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(,qf}jU3f2bVx 4336)751-8760 OPERATION PERMIT YSTEM INSTALLED BY: .7' 15 , 24 AUTHORIZATION NO.j "�OPERATION PERMITTBY: DATE,r **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. DCHD 05/96(Revised) t ,.. . .. soze.ui..vIG 015L twUVAlI0N/IMPII0VEMENF PERMIT&ATC Davie County Health Department D A Q (� " Envinvamenia/HwIfhSert w P.O. Box 848/210 Hospital Street APR 2 0 1999 Mockaville, NC 27028 (336)751-8760 ENVIRONME ***nWORTAItT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL INFORMATION IS PROVIDED. Refer to the I/NFORMATION BULLETIN for instructions. J 1. Dame to be Billed V CE9YCitI�G / FiCScontact Person L l/�/,7,(n:�-/y/(�Cd'-'�M Ey Mailing Address P e �1 r/1r/Hums Phone City/State/ZID U S(f/ Gi �L D jj'v B�fsSnes, Phone a. Name on Pewit/ASC if D/ifferennt�7thaaJn Above Mailing Addresspd "3d / / City/State/Zip (J�/�SL/•//C°i/t/C cal/�� zV a. Application For: U Site Evaluation Improvement Permit/ATC 0 Both 4. system to service: A House 0 Mobile Home 0 Business 0 Industry 0 Other S. If Residence: # People # Bedrooms � # Bathrooms ADishwasher 0 garbage Disposal XRashing Machine 0 Basement/Plumbing 0 Basement/No Plumbing S. If Business/Industry/Other: Specify type # People # sinks # commodes _T # Showers # Urinals # Rater Coolers IF FOODSERVICE: # Seats Estimated Rater Usage (galions per day) 7. 7"m of water supply: County/City 0 hell 0 Community s. Do you anticipate additions or expansions of the facility this system Is intended to serve! 0 Yes 0 No If yes,what type! ""IMPORTANTV" CLIENTS MUST CVi(PLE1E T11E REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST DESUBMITTED by the client with THIS APPLICATION. Property Dimensions: J WRITE DIRECTIONS(from Mocksvllle)to PROPERTY: Tax Oliice PIN: # ' I .3� �! J���L?— o6 " °�'/B O6Z� Property Address: Road N� %e -1 � ll;' log City/Zip RNIDr A( le Affo � I,/ �i t- ©s�7 � fi If in a Subdivision provide information,as follows: �GC.(.���,� dyl zz; � Name: //��L� �1 ��' i-•7/zs `�i Section: Block: Lot: 2— 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'am rrponsible for all charges Irreurred from this apptfcation. 1,hereby,give consent to the Authorized Representative of the Dav County Blealth Department. A to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suttab Od DATE SIGNATURE GJ THIS AREA MAY BE 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. 65 Revised DCHD(07/98) Invoice No. ly 5'3 ��...�... Davie County Health D p�� A1C %pea us PERMIT do FENVIRONMENJAL Environmental MMIN SMWOn P.O. Box 868/210 Hospital Street OV ` g 19�Mocksville, KC 27028 IS86)781-8760 HENT ***IIV0Jd%W"** THIS APPLICA121M C71WNM 81: PR=SSBD UMSS ALL THB AEQ IIiFOPIMION IS PRMIDED. Refer to the INFORMATION BOLLSTIN for instraetions. i. name to be sill" * L i elCoataat Person Mailing Address WA I eusome Phone City/state/ZIP �/7 L/Q l ,1 /I I . �. . d110A Business Phone �25(0) d — a /L Z. name on Penh/ATC i! Different than Above Hailing Address City/state/Zip 3. 1lpplication For: Site Evaluation 0 Improvement Permit/ATC 0 Both a. system to Service: B'House 0 Mobile Home 0 Business 0 Industry 0 other a. If Residence: # People # Bedroo:as ' # Bathrooms 0 DiMmasher 0 Garbage Disposal 0 Rashiag Machine 0 Basement/Plumbing 0 Sasemm►t/no Plumbing 6. It Business/Industry/Other: specify type # People # sinks # Commodes # shovers # urinals # nater Coolers IP Ti'OODSERVICE: # Seats Estimated Nater Osage (gallons per day) 7. 2y" of water supply: N" o my/City 0 well 0 COMMnity s. Do you anticipate addition or espauslons of the facility this system is intended to serve! 0 Yes 0 No U yes,what type' ***IMPORTANT•**MENTS MUST COMPLETE THE REQUIRED PROPERTY MFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST B)ESUBMITTED by dw client with THM APPLICATION. Property Dimensions: f.}- e, y-S WRITE DIRECTIONS(from mwimQle)to PROPERTY: Tai Guice PIN: # ff" 6 6 ` --1 g. Property Address: Road Nameh 4M 1 Citymp AV kz' J I ,�`�d .z If In a Subdivision provide information,asfollows: D� 1� L 1- Name: z �� ProprtyFatBed.Section: Block. Lot. This 6 to certify that the information provided is correct to the best of my knowledge. 1 understand that any permit(:) issued hereafter are subject to suspension or revocation,If the site pian or intended use change,or if the Information submitted in this application Is falsified or ebaaged. I,also,andaatand Mag I on negwnsMlefor all charges lncarred f an this appy 1,hereby,give consent to the Authorized Representative of the Davie Kwaly Health Depa+�neat 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. 'J/ DATE �] / Q _ S31GNATU RE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Inc all of the followfor. Ezyting and proposed property lines and dimension, structures, setbacks, and septic locations).. Account No. Revised DCHD(07/98) Invoice No. 9 - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION_LOT Soil/Site Evaluation APPLICANT'S NAME �AIIJIJ/�°/ DATE EVALUATED PROPOSED FACILITY �► PROPERTY SIZE SUBDIVISION j4le � ROAD NAME Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit [ Cut FACTORS 1 2 3 4 5 6 7 Landscape position L 2— Slope Slo e% 1- HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence r 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 (fir 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(01-90) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■c■■■■■■■■cccccc■■■■■■■■cc■c■■■■■■■c■■■■ecce■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MESONSSEMMESiiiiiiME SEE 'DOS i VV N 01 h "3' uttar�Eosnent � ... a o"� �r,, isr}• . -N 24.11,25"W': 287.97' Ile rti. B.BS� `N 23.728'35'W +ry i dam— Coa6eR y . , '. '. 1150 0' Public R/W 18'+/— Grovel