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157 Racoon Trail . , DAVIE COUNTY HEALTH DEPARTMENT ���J��-�—c�� ` ' Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)75]-87G0 IMPROVEMENT/OPERATION PERMIT Account #: 990001119 Tax PIN/EH#: 5843-09-1291 Bilted To: Mike&Yckie Whicker Subdivision Info: Reference Name: Mike&Vickie Whicker Location/Address: Wyo Road-27028 Proposed Facility: Residence Property Size: 11 Acres **N�E*��iibgmprove2ment/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. Residential Specification: Building Type � #People�_ #Bedrooms � #Baths�_ Dishwasher:� Garbage Disposal: ❑ Washing Machine: 0'— Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ �� \ Lot Size /j�i'�C Type Water Supply� Design Wastewater Flow(GPD)�r,�i[✓ Site: New�Repair❑ �f l� J System Specifications: Tank Siz%�GAL. Pump Tank GAL. Trench Widt}�G Rock Depth� Linear Ft�1C1 Other: __p1 �:�i�(C'f Ii6�ttC�,�l,�„ �� Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 8:30 a.m.to 9:30 a.m. or 1:00 p.m.to 130 p.m.on the day of installation. Telephone#is(33G)751-87G0.**** �� � Environmental Health Specialist's Signature: �+%,!� � - ! -� . Date:��`'�� DCI-ID OS/99(Revised) i 1 DAVIE COUNTY HEALTH DEPARTMENT Environmental Heaith Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (33G)751-8760 Account #: 990001119 Tax PIN/EH#: 5843-09-1291 Billed To: Mike 8�Vckie Whicker Subdivision Info: Reference Name: Mike&Vickie Whicker Location/Address: Wyo Road-27028 Proposed Facility: Residence Property Size: 11 Acres ATC Number: 2424 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLJST 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 Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: � ! i Date: l��-' r'''—l�� CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis Certificate ofCompletion 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 Treahnent 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. , %� �SD Septic System Installed By: Environmental Health SpecialisYs Signature: Date: � ���� DCHD OS/99(Revised) , � �� , , r�. , , � ....�.____...� n � 3 � ` • 1�� APPLICATION FOR SITE EVALUATION/IMPROVEMFM PERMR& CJ � � � �l� �5 � � � ��� � Davie County Health Department �J"' � N'� 5''� Envinvnmenta/Hea/th S�ction � , �, 2��� ��.k �,2 P.O. Bou 848/210 Hospital Street k4� Mocksville, NC 27026 EPJVIRONh1EP�TAlHEA1.TH (336)751-8760 DAVIE COUNIY ***I1�ORTANT*** THIS APPI�ZCATION CANNOT �E PROCESSED UNLESS ALL THE REQOIRED INFORMATION IS PROVIDED. Refer to the iNFORMATION BULLETIN for instructions. 1. Name to be Billed : 1 \��Qi ��f 1 ��\C f���\e�Contact Person � �O� � � �� ���'� Mailinq Addreas ��� �T�O�I.��'t'�JO�� F3ome Phone \-1 q'��� City/State/2IP �d���`�, N � ���1� Buainess Phone � 1 b'� (�� 1� 2. Name on Permit/ATC if Different than Above Mail:7ag !_r3:eas City/State/Zip s. Appiication For: �Site Evaluation ❑ Improvement Permit/ATC ❑ Both a, b�atem to service: �ouse��M Mob le Home � Business ❑ Industry ❑ Other s. xf Residence: � People �_ � Bedrooms �_ � Bathrooms �— �shwasher CJ Garbage Diaposal L1YWaahinq Machine fJ Basement/Plumbinq� CJ Basement/No Plumbing 6. If Susineas/Induatry/Othar: Specify type �k People # Sinke � Co�odea i Shorers 11 Vrinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallona pe= aay� �. Type of water supply: 0'County/City ❑ Well ❑ Community a. Do you anticipate additions or ezpansions of the facility this system is intended to serve? ❑Yes E�"No If yes,what type? _ ***IMPORTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESU14MlT7'FD h�rhp AliPnr .,,:rt�'�'r��c pppi,rr��ranr.r, � �4- Property Dimensions: �� C�,�C1�2Js� . WRITE DIRECTIONS(from Mocksvillc)to PROPERTY: Tag Of�ice PIN: # .�J��3�O� r i aQ\ �Rmi�a�� �iP /� fa ��v;>�� .� �o�► Property Address: Road�T�c� C.� �� ., '�!/c — -�i� .r dr • T�'o-, � City/Zip�Oc�Sv�`�e. '(� C- ci-o �7-3 1,/��Xs -o.+ ���r`l� i.J'� If in a Subdivision provide information,as follows: �'�'� ��'�a �� �At�iGl �e'�'�i��'�^f Name: �c+.�t �;'s� c�tc.� ���� � enc�� o��e_ � D^ �-�- �� �,� Section: Block: Lot: Date Property Flagge�.� ��5-dD This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued 6ereafter are subject to suspension or revocation,if the site plans or intended use change,or if the iaformation submitted in this application is falsitied or changed. I,also,understand that I am responsible jor all charges incurred from thls application. I,hereby,give consent to the Aut6orized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned hv /t cU`G Dwr.kcrs�,'nc L�.�-, �1�, (.LPs�,,,� 3�sendt��at�tQs�i��Qcxp�aaes ac�nece�sary tn���te.rm�nr�t�e site cuitability. �/ �f1 ,�,'.,_ ,�/� DATE �" ��'D� SIGNATUREvC��- �„C/!�1/'�%�� THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: E�sting and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit�`harge Date(s): Client Notificadon Date: C� �I� �U � ��7� Gc>/l�/1 (�D(� Co•n.e� EHS• � �`� ������'f �`A,a-73�°� , Account Na �! Revised DCHD(07/99) ��'"`' ����-3'�i d-� �'� Invoice No. /��✓ � Gz��-�'- -�:. � - � A �.� � . mssmn �`'. .DOI1� ' .�'� i - '� -"�.. :;"'- 6 ,��s,� ��._:� , :�,. _ �' _:��, �;s_,'#�-`� -�'�.,.�,�'' ..- t•" $�'�a � G635� _ H'��DKtN GOUNTY ��� - � -(3.o�Aj ' .� _. � # � ��' � ;. ; 0603 - � � N � � . . . � � .. . . . � _ .. . . . . . . . .. . . . ., . . . . (397) {25G} � �m � (780) _ = = 8� �' � _ ! � _ _ _ _- - ` d. o, . ! - - `- � B500�00001 �,� N; ` � � (7.81A) . � � _ `fc� /�'��.�7,-��� � � (22j� 224$ �• � ` - a . � ; iNDEXED ON : - (��.�oa) � _ 1291 _ 'o0 5843 (2.01A) �0� . �� � �oo � 9096 �oo �oo ��o : :� � (1.44A) s 6013 ��; � �u,� .� _ � � � (393)_ `° G,rEG �� aa 2� ' — � � _ _ — \ (1.32A) , � 0�98 � � i�� �a� c� �. � � � (2.5A) ���s � � 6861 � � � � (2.4sA) � INDEXED ON � / � (s.�oa) � � � � � � � � ti v 4757 Q t 5843 4776� �"�t�'✓ � �� /�� � � � � ��uP N t vJ J• /��`O \ � fi661 � �,`° �� '�'S � ' � _ %� � . � � �`" 0650 �� 1 2�2 no � �s�a� v �----- ; os ' / s�� i N (1.63A) �� �- � �_ � l�/ nos� (895) aa , � `• � (2.49A) � is, 5Z N; .. ' 1478 'f. � �\�� �5 c� 391 � " ��1 o � � � � �D Y�/�'Oq� � � � ,; '''Q� (9.81 A) ` \ � ,� ��'� c� �- \ (�1 r'S°S: ��0� �� � (�� � I 7214 � ; L� �� • � � ,, t �� Q�.u � SR �43 � ( ) ► . .� � �� � �, \ � V" � 50.92A � ��•.r' , � °, " ' "~" � ' DAVIE COUNTY HEALTH DEPARTMENT � ' Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001119 Tax PIN/EH#: 5843-09-1291 Billed To: Mike�Vickie Whicker Subdivision Info: Reference Name: Mike 8�Vickie Whicker Location/Address: Wyo Road-27028 Proposed Facility: Residence Property Size: 11 Acres Date Evaluated: S�"3 �G?C� Water Supply: On-Site Well � Community Public `"'�/ Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition L Slo % �T -� HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH �� � y�� Texture rou Consistence - " • Structure i: / Mineralo ' / ` r! HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION � LONG-TERM ACCEPTANCE RATE "� SITE CLASSIFICATION: � �? �O `�� EVALUATION BY: /-/t'-} �/ LONG-TERM ACCEPTANCE RATE: /.,./ OTHER(S)PRESENT: REMARKS: �✓�/��r''�J/Z7Cl'/'i !(� � 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 Mineraloev 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-gaUday/ft2 DC�ID OS/99(Revised) ■�������■��■��■����■■■����■■���■�■■��■������■��\���■■■■■��■■■��■■■ ■���■���■�■�■��■��■��■■■■�■���■��■■��■■■■■■��■■�■■�■■■■■���■■■�■�■ ■���������■����■��■���■■■�\■I��■�■��■�■■�������■�■■��■■����■■■�■ ■■���■�■�■���■■�■���������■O��■■ ■����■■■■■I1�■■�■������■�■■ ■�■�■ ■������■■■�■��s�■■�■e■■��■��■�■��■■�����■■������■■�■�s����■■■■■��■■ ■�■�������■■■�■��■�■■■����r�■�■■��■���■�■■��i■���■■■������■■����■�■ ■����������■���■�■■�■��s�r■�■■�■���■�i■�■■�����■�as■�■■■■■���■��■■■ ■���■���■��■�■�■■���■��■��■■�■��►��ri�■�■■i����■■�■■�■■■■■������■■■ 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■�■■■■■■■■���■��■■■�■■■■■����■■■ ■■■��■�■■�■■■■■■��■�■�■■�������■ ■�■�■��■■■■■�■��■■■■■■■■■����■■■ ■■�����■�■■■■■■■■■■■��■■■■■■■�■����■�■■■■■■■■���■■���■■�■■■���■■�■ . � �:. . . . _, . . ._. ...:. .. , . .,-.:.... _.._ _. . � .-, D�.11'I�CaUNTY�I�I.T�i I���'f1f��NT _ � ENVIRONMENTAL HEALTH SECTION P. O. Box 848/210 Hospital Street Courier #09-40-06 Mocksvilie, NC 27028 Phone #: (336)751-8760 May 4,2000 Mr. &Mrs. Mike Whicker 161 Shallowbrook Road Advance,NC 27006 Re: Site Evaluation/Wyo Road Tax Office PIN: #5843-09-1291 Dear Client(s): As requested, a representative from this office visited the aforementioned site on May 3, 2000. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, the site was found to be provisionally suitable for the installation of a modified,oversized on-site sewage system Before an Improvement Permit/Authorization to Consiruct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions,please feel free to contact this office. Sincerely, �r��t��/��. Robert B. Hall, Jr., RS. Environmental Health Specialist RH/mp Enclosure(s)