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146 Pardue Loop (2)DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 60OL---, Account #: 990001090 Tax PIN/EH #: 5861-63-0330 Billed To: Danny Whitaker Subdivision Info: Reference Name: Jeff Pardue Location/Address: Juney Beauchamp Road -27006 Proposed racHity: Mouse Property Size: 5 Acres ATC Number: 2472 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 CONSTRUC4149N IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: A ko CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NOW Y tak as a guarantee that the system will function satisfactorily for any given period of time. %0qugo jj0 s Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 3 DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001090 Tax PIN/EH #: 5861-63-0330 Billed To: Danny Whitaker Subdivision Info: Reference Name: Jeff Pardue Location/Address: Juney Beauchamp Road -27006 Proposed Facility: House Property Size: 5 Acres ATC Nyr�t�ber: 2472 **NOTE** Thls 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 1 l 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 Dishwasher: 17� Garbage Disposal: ❑ Commercial Specification: Facility Type #People _S_ #Bedrooms Ll #Baths Z - Washing Machine: Er"' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ #People #People/Shift #Seats Industrial Waste: ❑ Lot SizeS4i&s Type Water Supply C& 9077 Design Wastewater Flow (GPD) Site: New Repair ❑ nI' �I I System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width Rock Depth ic Linear Ft. _%Q Other1 C • t'� 1 , Required Site Modifications/Conditions: ,ASTM,_ oc�j C.6. TWF,1/� (O; Qf U �, ka S 1� 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.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** 1 to -<__� Q134 t7 1 v� Environmental Health Specialist's Signature: DCHD 05/99 (Revised) %% x.12f I w�- U Date: & A3D/p t j i APPUCATION FOR SITE EVAWATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Secion P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 U JUN 3 0 2000 ENVIRONMENTAL HEALTH DAVIE COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS P OVIDED. Refer /t'o the INNFORMATION BULLETIN for instructions. 1 1 1. Name to be Billed AAI � / W � i I Q le(er Contact Person Ai}0JA11 Mailing Address %/Ky 1 )646.r 1,)ay o &dl- Rome Phone dseo- City/state/ZIP ``lG((iiQ��P. /l/_� • ,j %QQCp Business Phone 2. Name on Permit/ATC if Different tImsp Above/ � C / f I /�(r�C4 P Mailing Address -e Ar, /lIrc�City/State/zip 3. Application For: Site Evaluation ❑ Improvement Permit/ATC Both 4. system to service: I0' House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People 'S # Bedrooms Bathrooms c,1-49,_ O Dishwasher ❑ Garbage Disposal Wasbing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: specify type # People i sinks t# Commodes • showers 6 urinals #} Water Coolers IF FOODSERVICE: #) Seats �� Estimated Water Usage (gallons Per day) 7. Type of Water supply: O'County/City 0 Well 0 Community 9-. no you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes If yes, what type? ***IMPORTANT*** CLIENTS MIST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: fi ICS z'S l� Df" 15 WRIT �CTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # (0 3 - 0330 J7Svw &-'A0C'-MA . e Property Address: Road Name � AW X r`..1 6,3((-) / City/Zip A41,111gt l e ,� G �7 �7� 62 o u p bw-) If in a Subdivision provide information, as follows: Name: Section: Block: Lot: e Date Property Flagged: �f-> r%^a' ,AZT— This LZ— 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 oT revocation, if the site plans or intended use change, or if the information submitted in this application is falsifleid or c angel I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give cone th Authorized Representative of the Davie County health Department to enter. upon above described pro 1 at in Davie County and owned by to conduct all testing procedures as ec ry determine the site Ility. 1r DATE 3DSIGNA THIS AREA MAY BE USED FOR 1 property lines and dimensions, stru V Revised DCHD (07/99) A SITE PLAN (Include all of the following: Existing and proposed and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS• Account No. ID qO j Invoice No. ✓ �/ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001090 Tax PIN/EH #: 5$61-63-0330 Billed To: Danny Whitaker Subdivision Info: Reference Name: Jeff Pardue Location/Address: Juney Beauchamp Road -27006 Proposed Facility: House Property Size: 5 Acres Date Evaluated: Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % v HORIZON I DEPTH O Texture group ct— Consistence T S S Structure C-9— Mineralo t HORIZON II DEPTH Texture group Consistence ; Structure Mineralogy1: 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: p5 LONG-TERM ACCEPTANCE RATE: O' REMARKS: LEGEND Landscape Position EVALUATION BY: OTHER(S) PRESENT:U?_'o IX -WV Wt-kTA.KCL_ 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) SOME SEEM SEEN ■M■■ NOON ■■E■ OMEN MONO ■E■■M■ ■E■■E■ ■E■■E■ ■EM■O■ ■ ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■!�■■■■■■■■■�■SSSS■■S■■■■■■■■■■■■■■■■■■■■■■■■ ■ ■■ ■■■ ■ ■ ■ ■■■ ■ ■■ ■ ■■ ■■��■■ r■■ ■■ ■ ■ ■ ■■ ■ ■■■ ■■ ■ ■■ SSSS ■■ ■ ■ ■■■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■ ■ ■■ ■■■ ■ ■ ■ ■■ ■ ■ ■■ ■■■ ■■ 11■■ ■■■ ■■■ ■ ■ ■■ ■ ■ ■■ ■■ ■ ■■ ■■■ SSSS ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■ ■■ ■■■ ■ ■ ■ ■■ ■ ■ ■■ ■ ■■ ■■��■■■■■ ■■■ ■ ■ ■■ ■ ■■■ ■■ ■ ■■ SSSS ■■■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ uiiiiis MOMMEM EMEMEM MENNEN MENNENMEEMEMiiiiiiMENEEM ■■■■■■■■■■■■■■■■■■■■■■s■■■■■■■■■■i■SSSS■■■s■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■e■■■MM■EEM■■■■a....�■■■■■■■■■■■■■■■■■■E■■■■sE■■■■■ ■■■■■■■■■■■■■■■S■■■■■IE!,I�■■111L'�■'n\■■e■'��_!!!Jiii�\■■■\lee■■■■■■■■■■■e■ ■■■■■■■■■■■■■■■M■■■■■■ecce■■��a■�1■SSSS■■■a■■■■■■■■■■■■■■M■■■s■■■■ ■■■■E■■■■M■■■■■M■■■■■■■E■■E■■■■■M■■■■M■■■■■■E■M�i■■■SEN■■■■■■■■■■■■ ■■■■■a■■■■■s■■■■■■M■■M■■■■■■■■■■M■■■SSSS■M■■■■■1�■■■■■■■■■■■■■■■■■■ ■■■■■M■■■■■■■■■■■■■■■■■■■■■■■E■■■■■E■M■■■See■■■i�E■■EM■■M■■■■■■■ME■ ■SSSS■■■■■■■■■e■■■■■■■■■■■■■■e■■ ■■SSSS■■■■e■■■■■�i■■■■■■■■■■■■■■■