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752 Pudding Ridge RdDAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section �- ' P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002112 Tax PIN/EH #: 5831-78-8617 Billed To: Aaron Logan Subdivision Info: '76 -Z Reference Name: Location/Address: Pudding Ridge Road -27028 Proposed Facility Residence Property Size: 5.6 acres ATC Number: 3051 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of septic tank system or any wastewater system. 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 permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. r Residential Specification: Building Type 0k) S #People 2 #Bedrooms �_ #Baths .2- S Dishwasher: Q"' Garbage Disposal: ❑ Washing Machine: 131" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 5, (-P tACAUS Type Water Supply O'er-- Design Wastewater Flow (GPD) ZLOO Site: New 111"' Repair ❑ System Specifications: Tank Size (CUO GAL. Pump Tank GAL. Trench Width 3C�' Rock Depth 12" Linear Ft. I/EnI Other: -S L7%STQ�Wylor.3 Required Site Modifications/Conditions: �jSi �l L 0.1 rlwnooe. 411=P10 MOA.—�1'a-�-, K�� 1Z3 cXP PC& U -e IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** 05/99 (Revised) 3& j -* �h� Lt,.1t:s to �ecialist's Signature: Date: L DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ' P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002112 Tax PIN/EH #: 5831-78-8617 Billed To: Aaron Logan Subdivision Info: 176& Reference Name: Location/Address: , _ . Pudding Ridge Road -27028 Proposed Facility: Residence Property Size: 5.6 acres ATC Number: 3051 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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/installation 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). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. t-10 OSI✓ �Sr Residential Specification: Building Type #People #Bedrooms #Baths " Dishwasher: Garbage Disposal: ❑ Washing Machine: 1750-- Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size ,q S Type Water Supply 0E1-- Design Wastewater Flow (GPD) q 8D Site: New Repair ❑ System Specifications: Tank Size 1 CCO GAL. Pump Tank GAL. Trench Width%- Rock Depth 12 Linear Ft. 550' Other: LA lsmr-116U-rr�.l 2ud& , It-3sTA1- U►Je-S.. GF©.C. VAIa, Required Site Modifications/Conditions: r-TOkL o,J C.c�IWZ, �'P I o0 ",Z)f. 1,,-mF- LL-, 0 IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representa ' ealth Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p on the day of installa on. Telephone # is (336)751-8760.**** ,q t)3 t so' I n0' Environmental Health Specialist's I DCHD 05/T 5/ (Revised) ABY, - (r0 sou D AFL Date: ��- Accoun! VIP": 990002112 8:ticd Ta: Aaron Logan {\V IVI V[IVV IVUtttV. A T C Nurnuer_ 3051 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax Fii iEH : 5831-78-8617 Wn Info: 162 V UiIViY[Ji Vt1 Ilil Lccut;c, Adds I Pudding Ridge Road -27028 i-`iii}.iciiy :�i�ir: �.O irG►CS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Trea ent and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER IS V LID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatur te: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 0 P ON FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department F 011-0, C Environmental Health Section P.O. Box 848/210 Hospital Street `1nC7e, /NsP&i�7-X Mocksville, NC 27028 (336) 751-8760 �3�6 Dn3 1� &A�`Z� **I O ** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED FORMAT N IS PROVIDED. . Refer /� ,to/ the INFORMATION BULLETIN for /) i/�nnstruction/s�.. /►� � 1. Name o be Billed MAJ � /��/ `6l/M/ �- �/ Contact Person / t /ill wN/ (Qi(W/�//}7�^V Mailing Address _C?5g5 Lpq c OAC w)4 Home Phone 3310 / % (!' [ 6qa City/State/ZIP CL6M S �, /V& pc1266) B ' ess Phone y-� 0 2. Name on Permit/ATC if Different than Above Mailing Address _ 3. Application For &KSite Evaluation City/State/Zip I rovement Permit C ❑ Both 4. System to Service: Mouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. Ifs� Residence: # People_ # Bedrooms # Bathrooms �_ 4J�Dishwasher ❑ Garbage Disposal P"WaWashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers` # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City "ell ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes � ��K-0 If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: ACkes WRITE DIRECTIONS (from Mocksville) to PROPERTY: R # �— -a9 10 E tAt MJ1y ;T0N t2- N,-: Road ame p0// j (1,l �� pUnpllly -7 j2106e (ZO,y,%) LCl (-D. city/zip moctcsUltcd 6N (Ll��N7— 5164 IN If in a Subdivision provide information, as follows: Name: Section: Block: Lot: Date Property Flagged: O I6 -Oa 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 conduct all testing procedures as necessary to determine the site suita ' , DATE Cv ' Z SIGNATURE 1 -tom THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). r - c/ 0 % -/ I Site Revisit Charge f IC -0 Revised DCHD (07/99) Datc(s): Client Notification Date: EHS: Account No. -Z,,.l t L Invoice No. e- -� 'uavie County, North Carolina Npat>al vata hxplorer XPi Vjc�' mse1.e'. i:1,ls3 �U N•S haC4$1 l_,3fr_llit13 t ,.. Click on the Map to: C Zoomin t' ZoomOut C Recenter Map C Identify: Parcels Zoom Factor: 5X"' C Radius Search (feet), • Parcel ID: E40000004609 • Account Number. 000043214000 • PIN: 5831788617 • Legal 1:5.85 AC SR 1435 • Owner Name: KOENEN HARRIETTE L • Owner/Address 1: KOENEN HARRIETTE L • Owner/Address 2: • Owner/Address 3: C/O CHARLES KOENEN • City, State Zip: WILMETTE ,IL 60091 - 0000 • Land Value: $46,800.00 • Building Value: $0.00 • Out Building/Extra Features Value: $0.00 • Assessed Value: $46,800.00 • Assessed Acres: 5.85 • Deed Book/Page: 00171 /0028 • Deed Date: 1993/10/27 • Sales Price: $41,500.00 • Property Address: 724 PUDDING RIDGE RD • County Zoning. R -A • Census Code: • City Code: • Fire District: • Flood Zone: ZONE X • Flood Community. • Flood Panel: • Flood Map Date: • Soil. • Township: FARMINGTON Page 1 of 2 Map U Draw L Draw select 3oundary Census Tra City Bound F_ County Zor Multi Syi r E911 Fire C r Flood Pane F Flood Zone Parcels r School Dis. Multi Syi r Soils Town Zonit Townships Multi Syl Voting Prec Infrastructu r Driveways Rail Lines r Street Cent USINC Higl Multi Sy U N F_ Aerial Phot Physical F— Creeks and r E911 Addre Fire Depart Schools Draw L MAP Ct This map is prep, inventory of real I within thisjurisdi( compiled from rei plats, and other F and data. Users c hereby notified th aforementioned E information sourc DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990002112 Billed To: Aaron Logan Reference Name: Proposed Facility: Residence Water Supply: Evaluation By PROPERTY INFORMATION Tax PIN/EH #: 5831-78-8617 Subdivision Info: Location/Address: 724 Pudding Ridge Road- 7028 Property Size: 5.6 acres Date Evaluated: On -Site Well Community Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH — 2 _ to 0— 0-10 Texture groupC-i-01 L Consistence r 55 S Structure Mineralogy t ,' t 1; 1 HORIZON II DEPTH to • VL, L - ( © ;Z18 Texture group Consistence _ - Structure 5 c Mineralogy HORIZON III DEPTH 2 •4 Texturegroup C k h., C C" Consistence ; S Structure 5 ' 195-k- Mineralogyt ; j HORIZON IV DEPTH Texture group Consistence Structure .. Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 'S .3 SITE CLASSIFICATION: EVALUATION B `� V 0h444— 1 LONG-TERM ACCEPTANCE RATE. �' OTHER(S) PRESENT: `-` AQ,.J Ucq� 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 05/99 (Revised) ■ ■ ■ ■/SSSS■■■/■N/■■■/■■ SSSS■■■■■■■e■■■■■/e■ ■■■■■■■■■■■■■■■■■■■■ SeeSSSSSSSS■■/■■■M■■ M■■■■■■■■■■■■■■■■ ■■■■■■■E■■M■■■■■■ ■■■■■■■■■■/■■■■M■ ■■■■M■■■M■■■■M■■■ ■■M■■■M■■■■■■■/■■ ■■■S■■■■■■S■■EMEM ■Se■■■e■■■M■S■■■■ ■■■■■■M■■■M■■■■■■ ■■■■■■■■■■■■■■M■■ ■■■■M■■■■M■■■■■■■ i on on ■■E■■■■■■■C ■■SM■■e■■M■. ■■■M■■■M■M■ ■■■■■■■■■■■, ■e■■M■■■■■■ MEMO■■■■■E■. ii ■ SOMME ■MSE■ ■E■E■ ■E■E■ ■E■■■ ■O■■ ■