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187 Pond Ln (2)ATC Nuant er: 3046 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION This AuWwiufim fix Wulexater Systan CmaOuctim MAST BE d be Pramted to with Mick 11 of THIS Envvmmmal Health specialist's Sip CERTIFICATE OF COMPLETION ^^NOTE'^'Ihe iwumw ofthia Cvtifiwte of ComPletim shill mdiwte the syAen dosaibad m ImProvaPmUOpaaim Permit has treat installed in cwnPlimwsvitM1 Articie 11 of G.S. Chapter 130A, Sxtim.1900 "Sewage TrwMmt and Disposal Systms;'but"I in NO WAYbetakm as e gumnamot Thal the"an will 6maim satisfaaPrilYf any given PaiW often`. i eX.—. ��T Q17CK 4 �D e�Aw.BSZ I4dK Dans, VZ -9 Septic sntan Installed By:�A�=s'�7�,gga .nwrmunmtal health Specialist's Signmue: / YVDntc I OCHO 05199(Hevisecil DAVE COUNTY HEALTH DEPAR'T'MENT Environmental Health Section P.O.I1m018210DmpiWStrult ' Mock"mitm 2mg 1336)751-100 Acoount#: 990003320 Tax PIWEH#: 50]1-91-]448 Billed To: Deana B Tom Browder Subdivision Info: Referance Name: WcetionlA ms: 288 Hillcrest Ddv V(l6 Proposed FadlXv Residence Prooedv Sire: 5]aaras ATC Nuant er: 3046 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION This AuWwiufim fix Wulexater Systan CmaOuctim MAST BE d be Pramted to with Mick 11 of THIS Envvmmmal Health specialist's Sip CERTIFICATE OF COMPLETION ^^NOTE'^'Ihe iwumw ofthia Cvtifiwte of ComPletim shill mdiwte the syAen dosaibad m ImProvaPmUOpaaim Permit has treat installed in cwnPlimwsvitM1 Articie 11 of G.S. Chapter 130A, Sxtim.1900 "Sewage TrwMmt and Disposal Systms;'but"I in NO WAYbetakm as e gumnamot Thal the"an will 6maim satisfaaPrilYf any given PaiW often`. i eX.—. ��T Q17CK 4 �D e�Aw.BSZ I4dK Dans, VZ -9 Septic sntan Installed By:�A�=s'�7�,gga .nwrmunmtal health Specialist's Signmue: / YVDntc I OCHO 05199(Hevisecil ATC Number: 3848 "NOTE" This Improvrnmt/Operelia Prank DOES NOTaulhmiw Ne cansnuctia afaxplictak syal® osanywaslemta syslen. MADTHOR TIONFDRWASMWAMRSYSMMMNSTRIICnONmWWb amodhmnthis Depmtmmt psimw the cmmuniWinstallalim ofa s3Mmi aNe ismwmofe building permh (m camptimwwith AsidellofO.S.Cha%m130A,WMtewata Systmas,S im.1900Sewage Treammland Dispmal Sysmns).THIS PERNDTI38UB3EC MVOCATIONH•SFFEPLANSORTREINFENDEDUSECHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE TRIS PERMIT BEFORE IN6TALLWG SYSfEM. Rmidml'ul Spaifintiw: Building Type MPwplecl� HBNrwms pBdhs_ Dishwuhm: d Garbage Dlspsml: Or Washing Maehine: Er� lineament w/Plumbing:❑ RoemmtlNa Planting: Cuommcial Speoffeaim: FacilityType #People_ BPeepl iR_ MSmts_ Infusaid Wane:❑ Lm Sim Type Weser Supply Off— Design Wasteweta Flow (GPD) qln Site: New M/Repwa Syslan Spgifimfions: Tank Slzek—DQOAL. Pump Tan:_GAL. Trach Wift ZtAr Rarklhplh )Ln L' emfttsbol RequrM w".L1_eJ C1s/7DQ 410 � DFF Yn�T IMPROVEMENT/OPEATIONPERMITAYOUT- APPROVED EFFLUENT FILTER RISER(S) IF 6- BELOW FINISHEDGRADE ""NOTICE: Cwwdar�Miwoflhe Davie CawyH Ids Depmlmmtf Bnnlinspectimofihis ayatem betw<en 8:30 e.m. w9:30 e.m, a 1 W p.m, w 1:30 pm. a Ne dryofinsmlhtim. Telephwe g is (336)751-8160.111" �t i Lf Sas W ti z x 9 p. Mw `kN � 6 S �I� 'el -�- Evviromwmtalx1 somi.Iia•a slgnmme:. alp,=/ DCHD OS/90 (RevisM) g -fpr: DAVIE COUNTY HEALTH DEPARTMENT IS It Environmental Health Section P.O. Buz &8210 Hmpital Street Malmille, NC 27028 (336)951-8760 IMPROVEMENT/OPERATION PERMIT AcwuntM 990003326 Tax PINIEHM 58]1-91-]448 Billed To: Deana S Tom Browder Subdivision Info: Reference Name: LowtroNAddress: 288 HMmst Drive -2)006 Pmposesd Fadliy Residence Property Size: 57acres ATC Number: 3848 "NOTE" This Improvrnmt/Operelia Prank DOES NOTaulhmiw Ne cansnuctia afaxplictak syal® osanywaslemta syslen. MADTHOR TIONFDRWASMWAMRSYSMMMNSTRIICnONmWWb amodhmnthis Depmtmmt psimw the cmmuniWinstallalim ofa s3Mmi aNe ismwmofe building permh (m camptimwwith AsidellofO.S.Cha%m130A,WMtewata Systmas,S im.1900Sewage Treammland Dispmal Sysmns).THIS PERNDTI38UB3EC MVOCATIONH•SFFEPLANSORTREINFENDEDUSECHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE TRIS PERMIT BEFORE IN6TALLWG SYSfEM. Rmidml'ul Spaifintiw: Building Type MPwplecl� HBNrwms pBdhs_ Dishwuhm: d Garbage Dlspsml: Or Washing Maehine: Er� lineament w/Plumbing:❑ RoemmtlNa Planting: Cuommcial Speoffeaim: FacilityType #People_ BPeepl iR_ MSmts_ Infusaid Wane:❑ Lm Sim Type Weser Supply Off— Design Wasteweta Flow (GPD) qln Site: New M/Repwa Syslan Spgifimfions: Tank Slzek—DQOAL. Pump Tan:_GAL. Trach Wift ZtAr Rarklhplh )Ln L' emfttsbol RequrM w".L1_eJ C1s/7DQ 410 � DFF Yn�T IMPROVEMENT/OPEATIONPERMITAYOUT- APPROVED EFFLUENT FILTER RISER(S) IF 6- BELOW FINISHEDGRADE ""NOTICE: Cwwdar�Miwoflhe Davie CawyH Ids Depmlmmtf Bnnlinspectimofihis ayatem betw<en 8:30 e.m. w9:30 e.m, a 1 W p.m, w 1:30 pm. a Ne dryofinsmlhtim. Telephwe g is (336)751-8160.111" �t i Lf Sas W ti z x 9 p. Mw `kN � 6 S �I� 'el -�- Evviromwmtalx1 somi.Iia•a slgnmme:. alp,=/ DCHD OS/90 (RevisM) We1—%� UPPIJCAHON FORSIIEounty Health FM PERDIT&Arc ISO U Davie mm Health Dhsectfnl W:^ £lex 848a210 Hospital PUO P.O. lex 848/410 HOepi a Street Meek, NC 27028 (336)7 .cMNtO� 1336)?51-8760 I8 PBOV . Refer to the INPORYATIOH HOLLeTTV for 1. now to be Billet YI}1J1ii -` ICM. b�rWLN�i``Contact Person millions Adnreee 20 � Xeon PG a city/St to/all, �4Y'.1_ . &e Z�( - Baeae.e Pbm.(c '1 ) �13-j$lnL(O I. Raw an Pervlt/ArC if Diaaecont thea Abive Railing And"', City/stawa/zip J I. application For. �0 Site Evaluation Cl Improvemeat Patm Re it/hTC fYBoth e. "atm to Service, x_pouse 0 Mobile Remo ❑ business O Industry ❑ Other a. Me vystr YJ compared, Conventional 0 conventiowi aceiriea1. ❑ imevatbe a. If RRealdence, _/ a People 4 e Bedrooms `f r Bathrooms _ 4901.Ma.mr idOsrbwe, u.Pe.el aheng linear.OB..wnt/el,mbip JL✓e+ mO[Me p tannin r. II Boninesslmd,utry /Othar, verity type a Pawls a means I C ng A Bowen 1 Vvfaaie F Rater motors IP piIOBBER Ut i Beats Batimeted Rater Osage Isalleea Per dant a. Type a never niggly. 0 county/city or 0 Community r. se Pow anticipate aadttime or expansions of the facility this system is Intended to serve? 0Yev ONo Itym,whattype? eeelAfPORTAN?vee CLIENTSMUST COMPLETE THE REQf/iRED PROPERTY INFORMATION REQUESTED BELOW. Either a?"Tor WE PLLA.^.ppNMUSTBESUBMMTEO the client with THISAPPLICATION. PropertTDlme:ulOBR SIAy�''WHITE DIRECTIONS(from Mocinville) to PROPERTY: Tax once Pm: g 5$11.'g1 -'l l4i Properly Address: Road Name 22k PItdaz� nr� �_ slez%/A'YS IIin a Subdivision provide Information, as follows: Name: Section: Block: Lot: Date home corners no 6 to certify that Ilia information provided Is correct to the best0fmy knowledge I understand that anypermit(P) Issued hereafter are subject to smpensian or revocation, if the site plain or Intended use change, or if the information submRted In this application b f stalled or changed t, also, understood that lam rcpunsiblefor all charger bmarradfrom Misapplication. /,hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property Involve in Davie County and awned by to conduct all testing procedures as necessary to determine the Site suitability. DATE SIGNATURE THIS AREA MAY DE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property live and dimemtom, structures, setbacin, and septic locations). Site Revisit Charge Date(s): Client NotlDaatlon Date: MS: SEP given_ 1 Mengel Me. ��z��eza( Revised DCHD(05AO \ Invoice No. 63 DAVIE COUNTY HEALTH DEPAR _ E Environrnental Health Section mEor8481zo 3osphelstrM AUG 7 ) Morksvme, NCU TH Phone (33%6(751-8760 ,.amCrygyn�N ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) REPLACEMENTo REMODELING RECONNEMON❑ �'i'1/ A13 %gyp IICIpN F)�u� PPCttFII�II�ii�lIf ll/n7IMLAYAXr M'KAMRAN <i�7ie R uh i Please Fill In The Following Information About The Existing Dwelling: Name SysNm hutaEed Under: DCr1-10. %�T= 1`YV'/51LAfr TypeaDwelfinm i—vat I la The Dwelling Cunmtlyvauntt Yw0Q No❑ RYes,Forliowlangt 4±� Ar X "Pmt$mns7Yea0 N If Yes,Exp6 Please Fill In The Following htformation About The New Dwelling: n r. (5ipieaue) For Environmental Health Office Use Only Approved D Disapproved ❑ `TM si�dng of 0us form bytlw Environmmml Hea1N 51aff b Inrw way mtmded, rwrshonld bedkm ss a ae(e.tmaea or uvdceal tFet ueomsimwaaceweevryaemrwnl ramam toren peaod oftmie Payment cvn0 ar M Money oraero a slmwm: S Deer. Account DAVIE COUNTY HEALTH DEPARTMENT i IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION - "' :NOTE Issued In Compliance With Article 11 of G.S. Chapter 130a nary savages le a �� Permit Number .6889 "- rniisw is ✓.� SubEiviNon Home Lot No. See. or Block No. Lot Size S%d P House -'_ Mobile Home _� Business _ Spemlatlon No. Bedrooms. rM. Same No. in Family Garbage Disposal YES ❑ NOD Specifications for System: _ Auto Dish Washer YES O NO ❑ i Auto Wsm Ma:hine YES o NO ❑ Type Water Supply ry00A'3 Orb 'This permit Is su if subject to revocation describedplans r the not installed within n 5 years from dialect casae. This permit is subject to revocation 11 elle plana or the intentletl use change. is Improvements permit by .Conbq z representative of the Davie County Heats Depenment for final Inspection of this system between 8:30- 9 30 :30-9:30 A.M. or 110.1:30 P.M. on day of completion. Telephone Number 704-634-5965. Final Installation Diagram: System Installed by la Cenificab of Completion Data 'The signing of this certificate Niall Indicate that mo system described some has been Installed in compliance Wm the standards set forth in the above regulation. but shall In NO way be taken as eguerenbe met the syabm wIII lwWon setisfectodly for any given period of time. DAME COUNTY �MDEPARTMENT - Environmental Health Section SoiVSite Evaluation APPLICANT BiF'ORMATION - PROPFUnIT INFORMATION Account #: 980003326 Tax PIWEH#: 5871-91-7418 Billed To: Deana 8 Tom Bragger Subdivislon Info: Reference Name: Wc211onlMdress: 20 Hillcrest 0Me-27 6 Propoeed Facility. Residence Propmry S'u8: Waves Date Evaluated: I tamer Supply: On -Sire Well Canmunity Public �.Vrrr��ry���r�wwww EvahmEon BY: 'Augcr Barin{ NI W Is' tWeir ��wa�s�oaoa ��w©wwwww �.Vrrr��ry���r�wwww Is' tWeir r.>I�rrr saw �[Tc`VJt�SiLr� -MWAOM Vwwww 4Y1' 'r!-Ww4 � F.zvM�r: ����wr�wawwww �r�_ardTF=rSM"awwww �Qa��^ea�nawwww ����wwwww 4^__�FTO:awwwww wwwwwww wwwwwww wwwwwww ' wwwwwww .., wwwwwww wwwwwww wwwwwww wwwwwww a ����rr�wwww SDECLASSMCATION: EVALUADONBY'�! LANG -TERM ACCEPTANCE RATE: OTHER(S) PRESEM: REMARKS: LEGEND IaREsouPwltl9B R -Ridge S-SlwWdv L-Limarslope FS -Foot slope N -Nose slope CTensile ve ilope CV -Canvey elope T -Tartare.. FP -Floodplain H -Head slope le S -Sand LS CL -S CCS -Loamy saM. SL-Sendy low L-Iuam SI -Sian ilrydry baSIL-SErym CL Tea -Gley loam CL S -Selly clay lwm SC SIy clay SIC-Silryclay C - Clay CONFIFTFNCE maw VFR VPR-Vmy friable FR -Friable- Fl -Film WI-Veryfnn ER -Extremely film IlfJ NS -Non sticky SS -Slightly mirky $-Sticky V P-vSticky NP - Non PtastiP c SSlightly Y Plastic -Plutic VP-Vervy Plastic BIDRBIQ SC -Single grain M -Massive CR -Cramb (IR-Gzanular ARK-Angularblocky SBK- Subangular blocky PL-Plary PR -Prismatic MNenithis I:1,2:1'Mixest twha Horizon depth - ht inches Depth of fill. In iiuhea Restrictive horizon - Thickness and inches from IoM surface Sapmlile- Shemable), U(umlitsble) Soil wnmss -hichu fmm Iaul surface m free weer or inches from Iund surface to sail cobs with cluoma 2 or less Gessificmi®-Settitable),PS(pmvisiovuY suitable), U(unstimble) Llr R- Longterm ecaptmre one -gaVEay#t2 DCHD OSN9 (Revised) Jam, ✓� � S ° �s so rr ss11 AAr� 1 1 h d bT r 1 , f Ia, •.. Cir vI; h'� i..n i �qy C 11 i_`9 s,. 9 J �> a