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226 Pepperstone Dr Lot 15 AUT140 IZATION NO: 1289 DAVIE COUNTY HEALTH DEPARTMENT r Environmental Health Section PROPERTY INFORMATION P.O.Box 848 Name: t~�l 11 L � r21 Mocksville,NC 27028 Subdivision Name: trltr IBJ Phone#:704-634-8760 Directions to property:' W)'1) -1C? '' '" Section: Lot: " til �? AUTHORIZATION FOR {t% �.=7 t rl I t l f i c'`�riaC ,�. :T �► ( WASTEWATER Tax Office l SYSTEM CONSTRUCTION Road Name: rTrwtr�p; , **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/Authorizaiion 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 IS VALID FOR A PERIOD OF FIVE YEARS. IVViRD1VIvfEEAL7fR SP EIAST DATE ISS ED 8 9 DAVIE COUNTY HEALTH DEP TMENT IMPROVEMENT AND OPERATIO ERMITS PROPERTY INFORMATION +P,�rmit s N;fme-`_--"t1jaD ir,tjA , _1-b If, �� Subdivision Name: a�, lrlkk; B .Directions to property: �r2`! tr V '"'�� Section: Lot: " IMPROVEMENT tY" PERMTf Tax Office PIN:#-2 .1 - r "._;,--�.✓ - . Road Name: ►U1 �0�1!<; ' **NOTE**This Improvement Permit DOES NOT authorize the constriction 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 cofistruction/mstallation 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 PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER $NVIRONMENTAIf HEALTH SPECIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE � � #BEDROOMS--,3—#BATHS Z #OCCUPANTS GARBAGE DISPOSAL:Yes or C) COMMERCIAL SPECIFICATION: FACILITY TYPES - #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE CZ7I ZX 27d TYPE WATER SUPPLY 2&1VDESIGN WASTEWATER FLOW(GPD),al�p NEW SITE `" REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE ! GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH jL LINEAR FT. �' OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: C-) IMPROVEMENT PERMIT LAYOUT 7 t K 2' llX I 5\ J' �4; yam, TV f�1 X21 "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(704)6348760. OPERATION PERMIT 170 L� y 1 TG+Il� SYS TAL DBY: 1/a►�1►Jy O Z G AUTHORIZATION NO. Z OPERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT _4DESCRIBED 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) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&AT Davie County Health Department (y Environmental Health Section D R P.O.Box 848 MoMAR Z 41998 c8 - 760 OUC E 1 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESS D U§E%" COU'. HEkLti1 L'B�J .tiY ALL THE REQUIREDINFORMATION IS PR . 1. Name to be Billed / aI�d/ ,f e S .f/1 L'- Contact Person ZV.Ln —T-j � t / i Mailing Address Home Phone 5779- 3�t '6 City/State/Zip �i DC��SV -// .& /U- ,G Business Phone ���' /7�°� 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation 0 Improvement Permit&ATC ❑ Both 4. System to Serve: WHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: # People # Bedrooms 3 # Bathrooms WDishwasher ❑ Garbage Disposal W 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: 0 County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes � K-No If yes,what type?_y 1 EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PAIRW THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: AM X Q / WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: # 7 _ _ 1 1 7e Property Address: Road Name City/zip � �DC`��/ c�P �O li— /9 /a 1 If in Subdivision provide information,as follows: 1 1 � Name: -9 1 1 4 oA S o (/4r �! Section: Lot #: '1115; 1A 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 Cot, ty 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. L&��DATE oT % SIGNATURE Revised DCHD(06-96) YOU MAY USE THE BACK OF THIS FORM FOR DRAWING YOUR SITE PLAN. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY � �P LOCATION OF SITE Water Supply: On-Site Well Community Public t/ Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position y Slope Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 1i f Texture group Consistence Structure Mineralogy - � l 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 EVALUATED BY: // ZZ 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-Anirular 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 4.271 j 25 C14 719.53' 140.22' 24 C1a 715.53' 62.76' CENTCRLINL- CURVE DATA 24 C16 $5.000 43.36' CURVC'fit.S CURVE * 4 23 CT? 556000 35.30' 14.45'05" A - 16.30'48" 22 C18 55.000 42.12' R - 347.6.0 R - 689.13` 21 C19 S&OIW 111.81' T - 46.00'. T - 100.00' 20 C20 30.00' 36.224 L - 89.50' L - 198.61' 20 C21 650.1y 94.66' 19 C22 630" 16.27' .28 C25 377.6Y 99.34' 27 C24 317.63' 83.94' NIA C25 417.23' 55.04' 1s 27 C26 417.23' 112.50' 200.35 s c25HCNDRICKS 10gp SIGN l?0 ON TAX LOT • 3.01 MAP F-3 k 7p X50 x t DEED 500K 162 PAGE 016 PROPER 8C'N * X10 x 70�S� e� LINE `� ♦1 4,g?� L2 N 1 Ll 152.35+ Igo ' 0 16 7- 1 N S 7� + YV of 0 ,1 O Z 28 541004 S 54'OOM C J O m I N p- D ml G J41+29N e 0 Ilo 1 N 1 232.41+ Z 2S. .. O ,24 O�� e N l 0 71 a \.� .0 bg' O O r �6 • p1! 1 �° of 3 1 1 _ C14 C15���6 X10 x 70 SE --C13 J a �- D yell° IL f_ - - 235 C� • 4 X �O n Op, 10, ppVL'tA�NT 1 _C21 CSO 70. 95.69' V/ 0 IV 111.0 '- ,T� 86a�9' - � Y¢o7s3 je�,tc 1 1�2.p0+_ � c1e 4 �_q� 3-117 112.05- 0 :;Wont '� �' 0� S Sility C�0` ,'� - � d• + W N 21 �j `5?� � o � v�O, 0 a_ O S 18 0 A iw • s 6 �o cQ3 © �. n 70 Ov OV O A 5 O - A 176.36' r A 115.31' 5�5 111.96' 112.00 + 112.00 + EDITH BROWN RUMMAGE 111•p0 TAX LOT t 74 MAP G-3 11.00` 1217.86 DEED BOOK 047 PAGE 208 9 7� 41`29" W 1531.09' -Total GENERAL NOTES: a LOTS SERVED BY. DA GRAPHIC SCALE 9 PRIVATE INDIVIDUAL 30 0 50 too 200 400 • NO DRIVEWAYS SHAL OIs A STREET RIGHT • ZONED R-A A 2675 LINEAR PEET O IN FEET 1 Inch = 100 M 7