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115 Crawford Rd Lot 1 f 8 r.:a � .F s a r�,� t cs ..e', 1 .z:-':.•S'4er w,.«ter ^t`":.i .fix �.,..� t^.�-.r+ 1� yg' .�. f AUTHORIZATIdN NO: DAVIE 1UNTY HEALTH DEPARTMENT r �� X673 f iEn `ronmental Health Section PROPERTY INS TION 1'19 Permittee's ' x P.O. Box 848 Name: LL A Mocksville,NC 27028 Subdivision Name: — Phone # 3367751-8760all Directions to property: '�© �'tJaTD�I~. Section: Lot: _ ,-- AUTHORIZATION FOR . 1 l i ri WASTEWATER Tax Office PIN:# 73 - - 741,3 PJ " SYSTEM CONSTRUCTION C.l?��JCS¢r3 Road Name: Wip: **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 AUTHORIZATION FOR WASTEWATER CONSTRUCTION i ` [J IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRO H 1fSPECI LI —TE1 T H ,.. - ad G.R... ./:. .fi.^-..E t,y ,p14.: t e•..7,....:« .r - .'y,,. _• :4•t^.•?.a r.. 0 '' DAVIE COUNTY HEALTH DEPARTMENT I PROVE�: NT AND OPERATION PERMITS PROPER Ir � !'TION 1111q Permittee's `.`' Name � G�'Y `, Subdivision Name: Directions to.propertyi j It ��� LA1' f t, i `Section: Lot: ' IMPROVEMENT 22 rtt JG `." t a:' if r rj t` c t.t K C-;r PERMIT Tax Office PIN:# rt:J4 Lx, Road Name: (2961.A��t' ' Zip: 0.1. **NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater systema 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 pernut. (Incompliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ' / I; �-------.. ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONIv1E1tIT EAL' SPECIALIST. DATE I S D SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE r�N #BEDROOMSJ' #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes ortvn_.) COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No X$3�'1137'1�72Y. ,,3 LOT LOT SIZE I� TYPE WATER SUPPLY �rtJIJTY DESIGN WASTEWATER FLOW(GPD) NEW SITE.; � REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE 1 FUGAL. PUMP TANK GALA;TRENCH WIDTH ROCK DEPTH �Z LINEAR FT. OTHER-1 REQUIRED SITE MODIFICATIONS/CONDITIONS: ' y�F t"Nl�i=. K =�" �t (��� +" rA �-I IMPROVEMENT PERMIT LAYOUT 1�I kilt xl ,r JU 00 by fix. ice' T "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH D ARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY NSTALLATION.TELEPHONE#IS (336)751-8760. OPERATION PERMIT wo YSTE STAL BY: tt0 s � ( N0 st - AUTHORIZATION NO. 107.3 OPERATION PERMIT BY: DATE: bi "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM 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 Environmental Health Section O f P.O.Box 848 , Mocksville,NC 27028 Q (704) 634-8760 11 pgMEtdiUN1N �o AVIE,lA__....� ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESS E -UNLTSS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed Geft P LL,Y �' Contact Person �06EPJ Mailing Address PO � —138 Home Phone a,84—al L/-1 / City/State/Zip 1. kum ez NC- J-1 o f Business Phone 2. Name on Permit/ATC if Different than Above J. Mailing Address City/Stateop 3. Application For: Site Evaluation Improvement Permit&ATC [ ]Both . 4. System to Serve: [ ]House [ ]Mobile Home [ ]Business [ ]Industry [ ]Other - 5. If Residence: #People #Bedrooms--L #Bathrooms ? [ ]Dishwasher[ ]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: [YcOunty/City [ ]Well [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [ ]No If yes,what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:***MWORTANT**kkEt T OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: WRI DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: # 5-136 4-0 0 Property Address: Road Tame City/Zip If in Subdivision provide information,as follows: p q-Z'�f ry'�' Name: Section: Lot#• 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 13im Cfr d. � ►�T ,oxsoi1 conduct all testing qfpcedure necessary to determine the site suitability. DATE D---3 r q& SIGNATURE Revised DCHD(06-96) THIS AREA MAY 13E 11SED rOR DRA1VINC YOUR SITE PLAN: _ tf� N -Z W -a b ts v N00 Crawford o 261.42' O 5 64.55'00E 100.80' a-- 1 3 10 62 0 / 1 ©� p ''' - O Ln % C c" c14 N N n r d � h 1 00 !, v IS Cj ►��00 0 Scly v�Jy' tai Qi ' Q jam ) ° � . �� LLr N C'4 N DN O �• P) F �T SN vx � 8'155.3 $ N 56'48'20"W w c�' n ry ph + ( in .r 97.97' �o �� --� n N 56.48'20"w 3 r � 128.20'1 CN 0 o a �1 g�czi In b55'2 , 3 `O V I 5 �1 a p .001 Lot W J p *48A61.1 9 0A t ' 4 b b i d � � • - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION / LOT Soil/Site Evaluation APPLICANT'S NAME ,l`/ DATE EVALUATED PROPOSED FACILITY PROPERTY SIZEdqc> SUBDIVISION w ' ROAD NAME Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit z/ Cut FACTORS 1 2 3 4 5 6 7 Landscape position L- Slo e% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH S/d 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: EVALUATION 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-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 N" 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(O1-90)