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5175 Hwy 601N Lot 7 ���, f Y� `. .—a.=rcA.,r,r-r�. .:�..� ..-`.,.a-�}; 'z5',.�. -� :"`�-y< h Y t" :�Y`t� i4 .ay ,=s;,x.yT-; i,1 Ta ,:, �..�n ,.•o: .. _p, .. Kw;d.r�•sR aU `�IZATION NO: 1553 DAVIE CPUNTY HEALTH DEPARTMENT .�► ;Environmental Health Section PROPERTY INFORMATION j� 'qg Permit l s P.O.Box 848 Name. Mocksville,NC 27028 Subdivision Name: - ,a Directions to property: /�� Phone# 336-751-8760 Section: Lot: AUTHORIZATION FOR 100 WAS Tax Office PIN:#�Zg- - SYSTEM CONSTRUCTION Road Name: .. Zip: r�w *.*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 l l.of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION 4 s r.. . f Y IS VALiD FOR A PERIOD OF FIVE YEARS. ' : �:,. ENVIRONMENTAL HEALTH SP hALIST DATE ISSUED o DAVIE C OUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATIONAN 'Perm1ji Naw; ' Subdivision Name: Dlrections"to property: Section: Lot: g� IMPROVEMENT PERMIT Tax Office PIN: . - y Road Name: Q1 Al. Zip: 1 1.j' **NOTE**This Improvement Permit DOES NOT authorise the construction or installation of aseptic 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) r ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE ✓ .�, r Yom'; PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALTH SP CIAL IST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE #BEDROOMS �,C #BATHS_ #OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE/ #PEOPLE #PEOPLE/SHIFT #SEATS IINNDUSTRIAL WASTE:Yes or No LOT SIZE-z-1/-:d-f--TYPE WATER SUPPLY �`rl/ DESIGN WASTEWATER FLOW(GPD) NEW SITE L/ REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK- GAL. TRENCH WIDTH ROCK DEPTH A3 LINEAR Fr. � OTHER REQUIRED"SITE MODIFICATIONS/CONDITIONSc IMPROVEMENT PE IT LAYOUT aaX 10 **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 h 0 SYSTEM INSTALLED BY: o D r AUTHORIZATION NO.. OPERATION PERMIT BY: DATE: 4 22&J4�901 **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT &ATC Davie County Health Department Environmental Health Section Q P.O. Box 848 NEW PHONE NUMBER: Mocksville,NC 27028 EFFECTIVE MARCH 22, 1998 J- a 10 (704) 634-8760 336 751-8760 S APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed L q'i P , - Contact Person 1-0-i 1-r � �L Mailing Address `7�S'o S /1wAj xr CT z-1 Home Phone ���{r 6 37— 8'8 7/ City/State/Zip t 5 aV Al,C 2-8/q 7 Business Phone -7,rl- -7 3 2. Name on Permit/ATC if Different than Above h/1,4- Mailing Address City/State/Zip 3. Application For: [ ] Site Evaluation Improvement Permit&ATC [ ]Both 4. System to Serve: [ ]House Mobile Home [ ]Business [ ]Industry [ ] Other 5. If Residence: PPeople_ #Bedrooms #Bathrooms 2- KDishwasher[ ]Garbage Disposal [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 KWell [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes KNo If yes,what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT*** Nff OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: ��-�-�5 WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: # Y913 - 8 7 - 7 Z/ T14/.ac V, 5A(,j Y 60l Property Address: Road Dame City/Zip 4161 CAOs�//GL C �O L 40 (S and LEFT If in Subdivision provide information,as follows: L-1Cr'`IGrsr /d'I AGES Name: 6A3 &yLd Section: Lot#: 7 -4—Y L- F&YL 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 proce es as necessary to determine the site suitability. DATE SIGNATURE ` Revised DCHD(06-96) THIS AREA MAY $E USED FOR DRAWING YOUR SITE PLAN: 0,#,) 71 G-141- o r- �-o-r -V- -P/ s J _ W t Com[_ �� `7� c'�°S s of Fd a �a� t�Woo � � or �L t4 w, f i, t '1 J APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT Davie County Health Department Environmental Health Section SEP 2 1996 P.O.Box 848 Mocksville,NC 27028 �yV1RONMENTAL HEALTH (704)634-8760 DAVIE COUNTY ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ..t� ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed h r, tV 'e e C Ce Contact Person Mailing Address 11L UK:ew C(-,5s--r . Home Phone g iD-��� City/State/Zip b S'o n� N. -7o i 7 Business Phone 910" !946- 429=3 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: Site Evaluation ❑ Improvement Permit&ATC ❑ Both 4. System to Serve: ("House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People 5- # Bedrooms _3 # Bathrooms -.2 (Dishwasher El Garbage Disposal l"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 l'Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ElYes 2""N o If yes,what type? PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions. T 2 Q- O\ I'������7J�/o�l 1 WRITE DIRECTIONS(from J %1 � �,.0� M p _Z 1 Mocksville)TO PROPERTY. Tax Office PIN: # X • J 1 �h�t,r.s'Cc. i On 1 1 Property Address: Road Name City/Zip rTVvti.� OQ 1 O 1 If in Subdivision provide information,as follows: 1 1 Name: t Section: Lot #• 1 1 1 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 de ermine the site suitability. DATE k SIGNATURE , Revised DCHD(06-96) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT7 Soil/Site Evaluation Lynn M. Reece / APPLICANT'S NAME DATE EVALUATED House PROPOSED FACILITY PROPERTY SIZE SUBDIVISION Oak Grove ROAD NAME Highway 6018. Water Supply: On-Site Well t/ Community Public Evaluation By: Auger Boring Pit 7 Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% .41 HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH © f Of Texture group Consistence Structure C 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: 3 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) ■■■■■s■■■e■■■■■■■■■■■■■■■ecce■■■■■■s■■■■■■■■■■■■■■■■■■■■■■■■e■■sr■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■eee■■■■■■■■■■■■■■■s■■■■■■e■■■�■■■■■■■■■■e■■■■■■■■■■s■■■■s■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■e■ ■■■e■■■■■eeeee■■e■■■ee■eeee■ee■■ ■■ssss■eee■eee■■■■■■s■■■■■■s■■■■�■■■■■■s■■ees■■s■■■■■■■■■s■■■■■■■ ■■■■■■■■■s■■■■■■■■■s■■■■■■■■■■■es■e■s■s■■e■■■■s■■■s■■■■■■■■■■eee■■ ■■■■■■■■ee■■■e■■■■■■ee■■ee■■■eee■■■■■■e■■e■tee■■e■eeee■e■see■se■e■ ■■■■■e■■eee■■■■■■■■eee■■s■■■■■■s■■■■■■s■■ea■■s■■s■■■ss■s■■■■■s■■■■ ■■■■■■■■■■■■■e■■■■■ee■■eee■e■ee■ ■■e■eeeees■e■■eeeese■eeeeeeseee■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■e■■■■■■■■e■■s■eee■■■■■s■■■■■■■■see■■s■■■■■■e■■s■■■■s■■■e■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■e■s■■■■■■■■■■■■■■■s■■■se■ss■■■■■s■■sse■es■■s■■■■eee■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■s■■■■■■■ss■■■s■■se■s■esse■■■s■ ■■e■s■s■es■s■■ss■es■■ee■■s■■■s■■ sees■■■ee■■■eee■■■eee■eee■■e■■■■eee■e■e■■e■ee■ese■eee■■e■t■eee■ee■ ■■e■se■sse■■■ee■ss■■■■s■■■eee■■■■■■■e■■■■■e■■■s■■■s■■ss■es■■■■e■■■ MEMNONiiiiiiMEMERE iiiiiiMENNENiiiiiiiiiiii ■■s■■■■s■■■■ss■■■■se■s■■■s■■■■■r�'�■■ss■s■■e■■e■■eee■eee■■■■■■ss■s■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■erg•.■■■■■■■■■s■■ss■■ss■■se■■se■■s■s ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■eee■■■■e■■■■■■■■■■■■■■■■■■■■■e■■■■■■■ee■■e■■■e■■■e■■■■■■■■■■■■■■ ■■■■■■■■■■■■■s■■■■■■■■s■■s■■ss■s■■■■sss■■s■e■ss■es■ess■s■■■■■■■■s■ ■■■■■■■■■■■■■■■s■■■■■■■■■s■■■■■s■■■■■■■■es■■ss■■ss■ess■s■■■es■■s■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■s■■■■■■eee■■■■■■s■■■■■■■■■■■■■■�■■s■es■ees■■s■■■ss■■■■ess■■■■■s■ ■■■■■■■■eee■■■■■■■■■■■■■■■■s■■■■s■■■■■■ss■■s■■s■e■ss■■■■■■s■■e■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■s■■■s■■■■■■■■■■■ ■■■■s■s■ess■s■■■■■■■■■■eee■■■■s■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■s■■■■■■■■■■■ss■■s■■■■s■■■ss■ss■e■■■■se■■e■■■es■sss■ ■s■■■■■■■■s■■■e■■se■■■■ss■■eee■■■■■■■e■es■■e■■e■■■■■■■e■■■■sse■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■s■s■s■eee■■■es■■s■■■■tees■■s■■s■s■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ 206.19' 14657' 149.50'1 40A0' PRIVATE ACCESS AND ---'~ 50 M 40' MBL — r r �r � '\ r� 11 i c$ �� \ 12 \ � � 14 =r � o r I 52V 207.13'r ' 2 i O / 168,72' 29 / 148.46' /143.38'n r _ 130.00^ I N 28.00'00'.W d v I J ? o I g a g- cu e Itoi 0 L3 1 I NESBERT SALMONS O = r O Z O Z O t 191-913 / ! a 11 ' 30 X 100' DRIVE _40_MBL _ r r ! __/— _ _ _ _ _ 40' MBL �— 21.00' tgG. ACCESS EASEMENT + / I r NEG ACCESS EASEMENT I NEG ACCE �63.23' 130.00 '130.01Y r r 143.38 S 28.00'00' E U S HWY 601 LIMINARY SITE PLAN-NOT FOR SALES,CONVEYANCES OR RE GENERAL NOTES. (1) FRONT YARD SET BACK LINES ARE AS SHOWN (PROM R/V LINE) NUCHAE (2) SIDE YARD SET BACK LINES ARE 15'TYPICAL (3> REAR YARD SET BACK LINES ARE 30'TYPICAL (4> ALL LOTS ARE A MIR" OF ONE ACRE EXCLl1DING ROAD R/W (5) THE CURRENT ZONING 13F PROPERTY IS RA 47 (6) THE LOTS ARE TO BE SERVED BY PRIVATE WELLS AND SEPTIC SYSTEMS Cl. (7) THE POWER FOR THESE LOTS SHALL BE OVERHEAD AND PHOS LINES UNDERGROUND TELE (8) NO DRIVEWAYS Sl WLL. BE LOCATED WITHIN 30 FEET IF A STREET RIGHT OF WAY INTERSECTIOK (9) TOTAL GRADED AREA IS LESS THAN ONE ACRE THEREFORE AN EROSION CONTROL. PLAN IS NOT REQUIRED BEING Ti DEED BK 1 CLARKSVI 400 THS WtL CERTIFY TW TK SUBJECT PROPERTY ( ) IS I (X) IS NOT IAC/1TEO N A SIAL RDOG WI M AREA c