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244 Pepperstone Dr Lot 17! Y .� � �'ya��ii.fN"Y't-'�.. 5h�Y�r�'U.4}��♦� t"�r �•'`7,f-.1r J Py�V j-. ' y.:�1 0 �,,ti �, h ,i''d« ti,' T , : i-. .: �._d=.�. 3,$c AUTHOR17ATION'NO 11:7$ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Permttee"s "s ` P.O Box 848d Name: ���f/ ID/AQ Mocksville NC 27028 Subdivision Name: ��►�i�er Phone#:,704-634-8760 Directions to property: L Section: �.,•�_.,_° Lot: AUTHORIZATION FORWASTEWATER ^,2 4r SYSTEM CONSTRUCTION. Tax Office PIN:#�P Road Name: / A : ip: **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,.19.00 Sewage Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. •ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED 1178 DAVIE COUNTY HEALTH DERARTMENT 3 3 IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Pe f,- � � NametA ` Subdivision Name: �e t ppp Directions to property:4=��/� r 9�Ir/ Section: � Lot: '' /7 IMPROVEMENT PERMIT Tax Office PIN:#� '� Road Name: p `�- **NOTES`*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/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 ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE_ � #BEDROOMS #BATHS ► #OCCUPANTS GARBAGE DISPOSAL:Yes or No. COMMERCIAL SPECIFICATION: FACILrPP TYPEi J� #PEOPLE #PEOPLEISHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE ASO D TYPE WATER SUPPLYy DESIGN WASTEWATER FLOW(GPD),-W NEW SITE.-t/ REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE gt'� GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH.C� LINEAR Fr.,'-?.oO OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M.OR 1:00.11:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(704)6348760. OPERATION PERMIT SYSTEM ; LED B pcfil )J u 1�a1 • b�2�148' 3 e-45r c.,.Jp- SPacS gY / CvnFTYAe-�ra2 r...�o-r 3•—�s AUTHORIZATION NO. '` OPERATION PERMIT BY: DATE: Z7 **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED A E 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&ATC Davie.County Health Department ( 2 Environmental Health Section IE D L52 152 P.O. Box 848 g Mocksville,NC 27028 A - 20 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESOIM-17-ulljurl;� THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed7 r- © io Contact Person Mailing Address 6 '# Y.2f1ey Home Phone City/State/Zip /Y1O ekw- 1c6 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: [cite Evaluation [improvement Permit&ATC [,]'loth 4. System to Serve: [House [ ]Mobile Home [ ]Business [ ]Industry [ ]Other 5. If Residence: #People #Bedrooms #Bathrooms_ [Dishwasher[ ]Garbage Disposal [ITWashing 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: [✓f County/City [ ]Well [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes KNo If yes,what type? EZTHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT*** OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. i Property Dimensions: /DOS /X WRITE DIRECTIONS(from Moc�k�sville.)TO PROPERTY. Tax Office PIN: # ✓d - -�[J/d ? 04.�L Property Address: Road Dame L 5 `e 1 1./ City&p 2 7v2k a?rS b h� Dlt S�t If in Subdivision provide/information,as follows: Name: ✓�b�d�6 5'tGf1 LX- �a Section: I Lot#: ' 2t�f� 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 nduct all testing procedu s as ssary to determine the site suitability. DATE �`' �` SIGNATURE ` Revised DCHD(06-96) THIS AREA AI AJ $E USEb FOR bRA1VINC YOUR SITE PLAN: ti • 17 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ,�P�-s ADDRESS PROPERTY SIZE t�C PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well Community Public !I-11, Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Y F 11 Texture groupC Consistence 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 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATED BY: I a /Z LONG-TERM ACCEPTANCE RATE: - ' T 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(01-901