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145 Old Oak Ln Lot 10 y N+fi—dP Ots. ."b"'v"a'r'z A"k'+'�'"` j, F �,Y *.bc.4 is: =,..,q. �.:� a�"'R:>s r.,..,r, �i.a�74,...�cy.Fw., >.rr'a } ,,.x;ti:m r.. F::,.,�Y': -•' IION NO: . T , DAVIE OUNTY HEALTH DEPARTMENT " 1 Environmental Health Section PROPERTY INFORMATION Permittees. _ P.O.Box 848 ��yy Name: Mocksville;NC 27028 Subdivision Name: QA CS'1"'d OR, Phone# 336-751-8760 Directions to property: 'CJ U1 �q�,-fU Section: Lot: l0 AUTHORIZATION FOR SYSTEM CO STRUCTION Tax Office PIN:#WASTEWATER (J`U D /c Road Name: `"Ljy%-oO t ►..a Zip, 7 1�, Z **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 Fon n/Authorization Number should be presented.to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of GS- Chapter 130A,Wastewater Systems,Section.1900Sewage Treatment and Disposal Systems) �. ._ ,i / — --r� ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. 'ENVIRONM9IV EkLTH' VtCIAUT DATt ISSU D. co DAVIE OUNTY HEALTH DEPARTMENT y✓eta IMPRO EMENT AND OPERATION PERMITS PROPERTY INFORMATION Narm� (:J4 S Subdivision Name: 0.9 fro Ve ss (/ Directions Io property: Section: Lot: ! IMPROVEMENT ! �``W ! � A -1 r,G I PERMIT Tax Office PIN:# .., Road Name: Y t:i ► �,, �•�.�.� . r�`-� �,� � l 5 /d 0 K Zip: " **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***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE . d ^? ,1 PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER. `ENVIRONME&I A.L HEALTH SPECIALIST DA ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING TIE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE !V't- _ #BEDROOMS.Z_#BATHS_�#OCCUPANTS_ _GARBAGE DISPOSAL:Yes or,�o ) COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE:3-44p,5AE WATER SUPPLY At-L. DESIGN WASTEWATER FLOW(GPD) NEW SITE -:7:'REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE 1�,aGAL PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH Iz LINEAR FT. �� OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: 1 1^�-�- �", L'�n�lOe�Q, �� :i i;rv� S' og tjoo z, SD' SaPTY' IMPROVEMENT PERMIT LAYOUT e Aff,?Ux. !/O �1AP1!0A r �= -To US Noy(ao 1 "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 (336)751-8760. . OPERATION PERMIT �Iq u_%? 3-ca Cx24n155 SYSTEM INSTALLED BY: Owe�- C o F 7f/ loft AUTHORIZATION NO. 4&) L OPERATION PERMIT B 'I v DATE: **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) : a �r } L5 L5 U l5 APPLICATION FOR SIiE EVAUlAT10N/IMPROVEMEM PERMIT Davie County Health Department11 Envinvnmenta/Hea/tfi.Section SEP 141998 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ENVIRONMENTAL HEALTH AVIE COUNTY ***IPWORTANT*** THIS APPLICATION CANNOT BE PROLMSSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Contact Person h Mailing Address ` ` Home Phone City/State/ZIP o C> Business Phone r) 2. Name on Permit/ATC if Different than Above Mailing Address City/state/Zip 3. Application For: ❑ Site Evaluation i1Imprcvement Permit/ATC ❑ Both 4. System to service: ❑ House obile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People _ # Bedrooms _ # Bathrooms _ shwasher ❑ Garbage Disposal aching Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City ell ❑ Community S. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes B-N-0— If yes,what type? ***IMPORTANT' CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION R3QUEST.'ED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 7rD s^�. WRITE DIRECTIONS(from Mocksville)to PROPER""Y: Tax Office PIN: # NJ��3— C 1 Property Address: Road Name JLq US City/Zip m('> <Al I t`Q� c�-� If in a Subdivision provide information,as follows: ty V , Name: Y10 C y , Section: Block: Lot: _ Date Property Flagged: �" � /el 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. I,hereby,give consent to the Authorized Representative of the Davie County Health 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 suitability. DATE — I — SIGNATURE 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. ��nD Revised DCHD(07/98) Invoice No. o�a� ' ? APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT Davie County Health Department Environmental Health Section SEP 2 7 1996 P.O.Box 848 Mocksville,NC 27028 ENVIRONMENTAL HEALTH (704)634-8760 DAVIE COUNTY ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed �L1 w v. 14N., R t.C Cp- Contact Person L-- h 1, .e Mailing Address 11L Vi,:.,. cr"" 6. Home Phone q t0--36 6—y3 C 6 City/State/Zip n e�s'o n , N . 7o i 7 Business Phone 910- 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: W'Site Evaluation ❑ Improvement Permit&ATC ❑ Both 4. System to Serve: 2"'House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms 2— # Bathrooms -.2 Dishwasher ❑ Garbage Disposal 2"Washing Machine * ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage(gallons per day) 7. Type of water supply: ❑ County/City IB 'Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 2-1N o If yes,what type? PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE v pw SUBMITTED WITH THIS APPLICATION. Property Dimensions: ¢- 9\d,\ a l��a /fF�a�% l WRITE DIRECTIONS(from 1 �� (��� 1 Mocksville)TO PROPERTY: J Tax Office PIN: #1,6b. .y - v 1 Or% \ \ 1 Property Address: Road Name ��.S. t-} r �„ 2s• :`0►r tos I 1 4brftJR City/Zip I (1 0 Aq 1 -t- If in Subdivision provide information,as follows: cncf 1 J 1 Name: On �` (^-T r tiV e Section: Lot #: 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.I,hereby,give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by L id to conduct all testing procedures as necess Etoetermine the site suitability. DATESIGNATURE A%* Revised DCHD(06-96) DAVIE COUNTY HEALTH DEPARTMENT 10 Environmental Health Section SECTION LOT 13 Soil/Site Evaluation Lynn M. Reece / J APPLICANT'S NAME DATE EVALUATED House PROPOSED FACILITY PROPERTY SIZE SUBDIVISION Oak Grove ROAD NAME Highway 6010. Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit ?"_/ Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH - /r % -yp1 Texture groupC Consistence i Structure 1 �/ Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION STT LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 6: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: Zo Vr 13 C 4? LEGEND IVA- #11 Landscape Position AF 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) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MENNEN� iiiiiiiiiiiiiiiiiiMENNEN� ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ PWMILR OF MEOW THAT SUCtf MrPaOK, FM pn=MM Oq OM NOT ff a CN1Q ,, t To 01SVIM AND DM R �,�p'�'w01Mt !UR MlZX lS MftW frJk�lM MM " t 9CiED t' Q ��10= Cot =RLL -- tJCT10M OR OOCtJpI '7 or owa• , ow+E ca,rn PU"w , 00%RTM fr ! 7AX tar 3LO4 / FE UX L CARBAjA_ �� TAX LDT 3L= LE / 172-331 8 L DALTON 1 174-773 ! �/ ` � l• �= .___� ,..? �__-- �" - �/ � `� ~ 6.pe- 7 .19' 2t1•` , 0 / J 40' t ~ � I 4- j 1 PHASr !91 1 C Co 1 1 / t -i ' cct id l gcu Yo . 1 � • 0-1 ` ,o �' t ccu tcu lz t ti !H •� � til :�••—.._.._.._ . . 1 I t ' PCHD g cot 'fit -rr► I N t DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT1G ' Soil/Site Evaluation Lynn M. Reece APPLICANT'S NAME I • DATE EVALUATED !' PROPOSED FACILITY House PROPERTY SIZE , "We SUBDIVISION Oak Grove ROAD NAME Highway 6010. Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 1 2 3 4 5 6 7 Landscape position s Slope% HORIZON-1 DEPTH �- Texture group Consistence Structure Mineralogy HORIZON 11 DEPTH 3G SO " Texture groupC , Consistence Structure rn Mineralogy , •/ j 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: ��•-S ilof 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-CIay CONSISTENCE of t 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-Sliehtly nh-tic P-Plenty VP-VPR/ n1.wt;,- DAVIE COUNTY HEALTH DEPARTMENT R Environmental Health Section SECTION LOT 10 Soil/Site Evaluation Lynn M. Reece / APPLICANT'S NAME DATE EVALUATED & 1Y1,P"1 PROPOSED FACILITY House PROPERTY SIZE /. P4;W SUBDIVISION Oak Grove ROAD NAME Highway 6018. Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position XS Sloe% HORIZON I DEPTH �- Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupC Consistence , Structure jYI 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: C/l�� ile[ EVALUATION BY: �� LONG-TERM ACCEPTANCE RATE: ./ ��� OTHER(S)PRESENT: REMARKS: J .�O r LY, l Grz /o1/ a/',u 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 I 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(OI-90) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■it■■■■■■■/■■■■■■■■■■��■■/■■elft■■■■■■■■■■■■■■■■■■■■■■■■■■■■t■■ ■t■■ti■■■■■■■■■■■■■t■■tont■■■■■�■■■■■■■■■■■■■t■■■■■■■■■■■■■■■■t■ MENNENiiiiiiMENNEN iMENNENiiiiii