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146 Pepperstone Dr Lot 6 .f♦ r - ..-�y�,.�,.�,s�-. . .,. '�...•..--.• .a• ay � _ :..^ rx 1 r'iv'''.`t4 y,.„r+-.-r �r.rs,y h I�L..z:. AUT4ORIZATION NO: DAVIE'CQUNTY HEALTH DE ARTMENT 59. Environmental Health Section PROPER INFORMATION Perm�ttee'S r i P.O.Box 84Is 8" Named i 14 Mocksville;NC 27028 Subdivision Name: 1 �! 7 Phone# 336-751-8760 Directions to property: ��I `T Section: Lot: AUTHORIZATION FOR)t� �a�• WASTEWATER U6D Tax OfficeP.IN:# "SYSTEM CONSTRUCTION is U: J1,� Road Name* RRM5 ipn . *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 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) - *** NOTICE***THIS ORIZATION FOR WASTEWATER CONSTRUCTION t� S VALID FOR A PERIOD OF FIVE:YEARS. ENVIRON}YIEI;ITAL HEALTH PECI DAT iss ED + DAVIE C UNTY HEALTH DEPARTMENT '# �.� IMPROVMENT�IND OPERATION PERMITS PROPE INFOR TION . i, Pertntt '` . Name.. 1 f' 1+ � _. 1L ! . .•_ Subdlvis,on Name: -Directions to pro y r 1 `'l c Section: / Lot:' IMPROVEMENT n�-1 o t-� tJ nl i� ; PERMIT Tax Office PIN:# ,P` _ �- T 01 Road Name Cr. ��1s'� Zip : •Cs " ,**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 rm:&tallation of a system or the issuanceof a building perriut compliance With Article 11:of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) 7.7 ***NOTICES`**THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRdNMENTAL HEALTH SPECIALIST DA�t UE6 IS SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE T INSTALLING THE SYSTEM. . RESIDENTIAL SPECIFICATION:BUILDING TYPE 11 #BEDROOMS #BATHS _#OCCUPANTS GARBAGE DISPOSAL:Yes o� f;i�L)% COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLEISHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE 12U X32( TYPE WATER SUPPLY YDESIGN WASTEWATER FLOW(GPD):S�L NEW SITE REPAIR SITE SYSTEM 8PECIFICATIONSi TANK SIZE '00L1CAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH �Z LINEAR FT.:JCL7 OTHER j11 `) i�Xk� L�B,EQUIREDSITE MODIFICATIONS/CONDITIONS: `t� T�1.L lJ� Gc�^J7c�� �� � (D <T' PROVEMENTPERMIT LAYOUT *APPROVED EFFLUERT FILTER& *RISER(S)- IF 691 BELOW FIRISLUED GRADE*. t . . r lco' �Y� q'0.0 . T S **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 SYS M INSTALLED BY: - AUTHORIZATION NO.—1�—�-�=OPERATION PERMIT BY: DATE: *THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE ` WITH ARTICLE.1 I 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. DOM 051%(Revised) APPL111A110N FOR SITE EVALUAl1ON/IMPROVEMENT PERMIT do AT O ,��► Davie County Health Depatfinent Envinvamenfal Health SeWon mm P.O. Box 848/210 hospital Street MAR � " 319W 101 d Mockaville, NC 27028 (336)751-8760 ENVIRONMENTAL HEALTH DAVIE COUNTY ***ZWCRTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed �y� ��'�� /)/cc 1����s Contact Parson l�o7R 7'Tl�t pc,,/ /M,-�f Mailing Address /2/�� /J iZ/7Lj�,}y�t7�`7� /��� Game Phone City/state/ZIP �//Lti?C��'r ��- /`��� Business Phone Z. Name on Permit/Arc if Different than Above Mailing Address City/state/Zip 3. Application For: Vite Evaluation Improvement Permit/ATC ❑ Both 4. system to service: VK-iHouse 0 Mobile Home 0 Business 0 Industry 0 Other a. If Residence: # People # Bedrooms .3 # Bathrooms Dishwasher 0 Garbage Disposal PINOLhing Machine 0 Basement/Plumbing 0 Basement/No Plumbing 6. If Business/industry/other: Specify type # People # sinks i Commodes # Shavers # Urinals # Nater Coolers IF FOODSERVICE: # Seats Estimated Nater Usage (gallons per day) 7. Type of water supply: County/City 0 Well 0 Community e. Do you anticipate additions or expansions of the facility this system is intended to serve! 0 Yes 0'l leo If yes,what type' "t IMPORTANT'•' CLIENTS MUST COMPLE?ETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PIAN/MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: �2!PEf-'nONS(fm=K:.¢IrAlk)to PROPERTY: Tax Office PIN: # rt��zo-SSS a'�jG-N OO Property C?/ /t), nr'tE'r- Property Address: Road Name ��. ��, . -k► oY� � �. City/Zip 12 ` r71 b f4f4g J- -f .� �Di�i >5 G�� 7e -.a f �p ye If in a Subdivision provide information,as follows: �C Name: i�D O/ze xlereS Section: Block: Lot: Date Property Flagged: / This is to certify that the information provided is correct to the best of my knowledge. 1 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 rgponsiblefor all charges Incurred from this application. 1,hereby,give consent to the Authorized Representative.of.tbe Davi C nty_Heallh De artment to enter upon above described property located in Davie County and owned by � 4.' to conduct all testing procedures as necessary to determine the site suitabilih. DATE %�ax� 3 �� SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the followng: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Account No. 7 Revised DCHD(07198) Invoice No. �10 ,r ``�, { '?�+•1IIowa"auas w tK w war.wrlOaR CARA1 Am Gloom awl M Pam M is F ca �IOF 7 z M.?M"pop �-sli"" MI nat ■ ar teaWAN M�wi or tK M w was ININIMANK �6tMYaI+IR roe we ower av �oa�.°w _ A��l�>:V x .ay Yyy'r �.� -1laF AMOf'd'1R 1�1(If a0 ��t Comm �'•`:• s'•Y'..c:i�.rx ri. ^•�r: cy T34? -71 'i:i 1:r•• `Arb�:t' �lt ''.., ,..K4"f'r.et�tc �: 4'C„^ x/s}.� ,. �.. .v"y �>S��- '�t.� .}:. i+••� '•1'.ri.i t -ac.- +2t!,,.+. .i.:s .ti' R-. .aMR 001M1f GH•[ - .L _Yy1. .Sf, ,,F y. f'Jr.• 4 2i- h�.�. ,cl �. r.�r � �'Vrk .r . -. w. r V4t' tea}.._,�._a•4.•n. }.��� :�+.�.�. fi �� } low va .. :M. A'� , . ,, -7 arw�er „� ~"Ila -- ` 3•�`k '!..`a •.-� taR11a1 �tA1F�W M!. ' J! r C t s.f ;tery fAMllat I�ar�w! aaas IF flow 111M araarar "°•_•. s r r alae1M< IIC�a11PUBLIC p -Taft$.-eh�i•.;y', •.� 0lL OOOUMIIfY •. 11-�I�`'' 18• ,-. i ;:r `- (�� - l ,,�'`•.,�•,.:..• / / 3 mitts_,�N► > y a 11 Ilk on so .. iDT / ' 10 �\ \ ? 4�• 4 tt3tT ttO�y 'o c• ct. 40L at 100.00t +sxsa rr� / / �� �M1��dd Q ''•y\ a ti� e\ 100.00, rNJ ev ® o�♦ a r r x' .,.. Ajf. ♦ !l=� _ O� � \\Y �\ ”2 �-.` Ic .��_e_ © -1 O � - _.�� ^_......,. _ ,.v ...-r.,......cc.,rs-h». s. 2 ry 4. O N p� Jr_ �A3so a °off ° 40 ro.Or _ 3 ` ,;o O' gC1° \C9 t13•oo; '1 ' v"ny C,����, _� •�/ y K M101k�J ` `� `tls,ccp r 1180 103104*e =21PUSL .98. I IC� C4 C9 81 76.4N1 s -a r� i' y O5 • �C7 C8 — O � RlftRvev TRACT /^ �► o .o n S 66.34'48"'W • [• 16�T to n 8 � p 3 ; /53.73 cl vb ib 2100 ca 0 1 .r�. J .- .� Curve • s // �y-"w I� h `O a ,$� / �/ 4t 4t Is R . 76 ar / N e` .tress' t sob T - tso. / aa.1a .nta� e b0 O C' ��, • 21ffi0► L . 196.226 / 56.Jr W �8 /8° 8 66't4'tS7■ C r 5*03, N 78.0 6' 1l GRAPHIC SCALE X28 ' �' H °`osr te�•2a' e\ 1 1 n chi • _ " 100 P ao lao ' 200 CATMPRtN nAKP• Lle f00i Jule, 150.00' a't'J.1y 1 a 4 r X00 TAX LOT } 73 MAP O- ?`�' tY� —41'29" tM r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS PROPERTY SIZE J YG PROPOSED FACIILTY 't')lftire LOCATION OF SITE Water Supply: On-Site Well Community Public L/ Evaluation By: Auger Boring Pit ✓� Cut FACTORS 1 2 3 4 Landscape position L_ Sloe Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH f Texture group Consistence 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 SITE CLASSIFICATION: EVALUATED 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-Finn 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(01-901