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187 Ralton Eugene Trail , � R ' � . . ��" � DAVIE COUNTY HEALTH DEPARTMENT ' � Environmental Health Section P.O.Boa 848/210 Hospital Street Mceksville,NC 27028 (33G)751-8760 Account #: 990001151 Tax PIN/EH#: 5863-83-7311 Biiled To: James Reeves Subdivision Info: j�, Reference Name: James Reeves Location/Address: Ralton Eugene Drive-27006 Pro osed Facility: Residence Property Size: 281x330x295x ATC Number. 3115 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSLTED 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 WASTEWA ONSTRUCTION IS VA A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: � Date: �//'`�.� � 3 �ed�od�c.s CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis Certificate ofCompl ' n shal indi te the system described on ImprovemendOperation Permit has been installed in complian wit icl of . .Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall ir�� t n as a guarantee that the system will function satisfactorily for any � given period of time. � � ��� � � Septic System Installed By: ���� Environmental Health SpecialisYs Signature: � Date: �`"��� DCHD OS/99(Revised) , DAVIE COUNTY HEALTH DEPARTMENT y• ; � '� : Environmental Health Section �i�- ��3 -�� � ` -' P.O.Boa 848/210 Hospital Street ' Mceksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT �, J�� / Account #: 590001151 Tax PIN/EH#: 5863-83-7311 Bilied To: James Reeves Subdivision Info: � Reference Name: James Reeves Location/Address: Raiton Eugene Drive-27006 Proposed Facility: Residence Property Size: 281x330x295x ATC ly�rpber: 3115 **NOTE** is Improvement/Operation Pecmit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALJTHORIZATION 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 1] 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 PERNIIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type �j #People ( #Bedrooms � #Baths �C Dishwasher:� Garbage Disposal: ❑ Washing Machine:� Basement w/Plumbing;,� Basement/No Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 0 Lot Size Type Water Supply ��i/ Design Wastewater Flow(GPD) c3C�� Site: New�Repair 0 �, .� / System Specifications: Tank Size pD.GAL. Pump Tank GAL. Trench Width�6 Rock Depth� Linear Ft.� ocn�: o� -� ��a��ovm Required Site Modifications/Conditions: INIPROVEMENT/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 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.**** w " r _� Environmental Health Specialist's Signature: Date:�l�'�� DCHD OS/99(Revised) . DAVIE COUNTY HEALTH DEPARTMENT , ., ' ', . Environmental Health Section : • • P.O.Boa 848/210 Hospital Street � • Mocksville,NC 27028 � (336)751-87G0 IMPROVEMENT/OPERATION PERMIT Account #: 990001151 Tax PIN/EH#: 5863-83-7311 Billed To: James Reeves Subdivision Info: Reference Name: James Reeves Location/Address: Ralton Eugene Drive-27006 Proposed Facility: Residence Property Size: 281x330x295x ATC Number. 3115 **NOTE** This ImprovemendOperation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALTTHORIZATION 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 � PERNIIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People '�l #Bedrooms � #Baths_� Dishwasher: � Garbage DisposalX� Washing Machine� Basement w/Plumbing:� BasementJNo Plumbing: ❑ Commercial Specification: Facility Type #People #PeopleJShift #Seats Industrial Waste:0 Lot Size Type Water Supply_�� Design Wastewater Flow(GPD) ,`��� Site: New l� Repair❑ r� ���� System Specifications: Tank Size�GAL. Pump Tank GAL. Trench Width��'�2ock Depth� Linear Ft.J�UU Other: Required Site Modifications/Conditions: I1�IPROVEMENT/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. .to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-87G0.**** 1�� `� �� � �_� �- , ) ,-n"'� � �- 1 �� �� � �� � _ �./ Environmental Health Specialist's Signature: � Date: DCHD OS/99(Revised) Jan 29 02 09: 33a davie co�nty envhealth 336 751 � ��d ,' ` _ \ � �''� _ L IV . �r'�i.. ,..I- '. ' � i�l _ � � -- ll ,-.� . � � � �1. � . `v ,`�.{�"� � � APPUCATION FOR SITE EVALUAT7UN/1MPROVE6tEPfT PERMI7' &A ���n'�'� + -� Q� 1' Davie County Health Department �---, . 'fl:�� .,,1„ � � /� ��� Environmenb/HFa/th Section • ' ��Al � /ZJ. P.O. Bos 848/210 Hospital Street � 1. � �IZ V�' Koc3cavi1la, NC 27028 � _ ��I�� �� (336)75I-8760 **+Zl�pRTANT�+* T}iIS APPLICATION Cl�2VN0T SE PROC.ESSED UL•ILE3S ALL THE REQUIRED SNFOFt2A:�ION IS pROVIDED. Ra£er to tha INFORt�aTION BiJLi,ETIN :Cor instructions. n .rJ1�L,m� to b� Bill�d �n-YY1 Q_� KP�P� �(<<; Cootstst Par�on __J�C./7 ��_<w.� -�-(', r' � . . �✓ fv � Hailinq .1�ddrr■a �(JOr �C[c�k�/1 �4-11<<! K-C:` � tloma Phono�.3_JG•� ���/ c�` +-<i�..)�% /1 / � ��1{/f city/atam/Zzr A�-J J G�r1 r.P_. N C� ,�"�c�0 o Husino�s P2�on.�.. 3:tG.) ��`�- �j(o :�� V 2. Nemo on P�rmi!/A2C i! Di!!�=�rft t?�ar� ]Wev + n � - , _,��r._ rv�C `S !�P(�.� S � lla.ilin J1ddr��a �UC:F �/ � � - ' . � � `�rczc��C;n Vr_t���, � City/st�s_Gro. /Z3p 1?C_��;_„p�c' �.?i��.< ) o 3. Appl3cation For: &(3ita Eveiluatioa 2mprovement��t/ATC f.l Soth .�- a. ey.c� ca e�r..s��: FiYHouae Ll Mobila tiome ❑ Business Ll Ir�dustzy fl Other � 1 � s. sf Roaidanca: / p¢opla ^7 � Bedrooma J r Bathrooms �� � ll�ni�hr��t�or 1) C�rbsqo Dispossl U'Ms�hinq tlaoitilno F.i�Hanaa�at/Pl�smbing I I na�omanG/No Plaambinfl . . � 6. i= Husinos�/Zntius�sy/Oth�rs 8psaily typa I Pooplo � 91nke .� � � � , � � Commodo■ � � BAorars '- . / Urinale �I Hetar Coolars SF FOODSERVICE: # Settt9 Estimated Hater U9ago (��s11an. p.r dsy) 7. lype of water supply:' D County/City L'YWall ❑ Community e. Do you aoHcipate additloaa or ezpansiona oI the faciltty this syatem is inteoded to scrvc? !]Ycs Il No Ifyes,wh�t type? . ._� �+*IAlPORTANTi**CLIEIYI'S bfUSTCOAfPLETETlIE REQUJRED PROPERTY INFORMATION REQUESTED BELOW. Eil6er a PLAT or SITE PLAN MUST BESUBhIl7T£D by Ihc ciicnt with T1ilS APPLICATION. i Property Dimensions: �.��•4� x 3:�0•�%�.�� ,i $•a(o�'3,fO WRtTE DIRECTIONS(1'rom Mocksvillc)to PFiOPL'RTY: 5 � 1 Taz 0(Tice PIN: # � rc /�., u y�. - .Z y C7 LU� . -f-c..��r• k� �l�.J�� �5�� i �x:�- Property Address: Road Name �Sc:.1����� �uy��e f,I- fvrn �e{�f -�,.�.�a��!s -�.�:�..>':i�r-lo r,���� e�xr,.f City/Zip �/r�!/�L'j�c_� N�: ��c��a i voU �/c_��1 c �F..rn �r•�� v� Yc���C'�v� �w��c•r �'•t� !f in a Subdivisfon provide iaformatioa,as follows: �,Yc7 �• I �.,,:(r� •tr �vr.-, �c{/- �,-, /�.i l f�•;, <<ya,.� 1�Iame: Dr:vt� Pro�Pr�v i's /uan .�ar/s o�� �FeFf J'•••f Section: Block: Loh Date Pro a S pi�' edr.•L/C y��� - �O ' Pe�'�' Sg This ia ro certify t6at the informatioa provided is correct to the best of my knowledge. I u:nderstnnd that any permit(s) i�sued hereafter a�e sabject to s�upenaian or revocatioo�if t6e aite plaa�or iatended use cl�ange,or iC lhe ioformalioo submitted iu lhis applicallon is faisified or changed !.aLro,t�rtderslaad tha!1 orn ruponslG/efar a!/charges incurred jrom thls applicatlon_ i,hcreby,give consent to t4e Anthorizeti Representative oCthe Davic County fie:�i16 Dep�rin�cnl !o enter upoo above dcscribed property locatcd In Uavlc Couoty and owacd by .Sf!..n �.�i-�<'_Y" ..._„a�::c:a�::rs:iug procedures as aecessary to determine the sile suitability. aA� _1.�� / OJ sicrrwz-u�E_ ��-�c�n � �f'�z-��� : THIS AREA MAY SE USED FOR DRAWING YOUR STTE PLAN(lnciude n11 of!he follow9ug: E�sting and proposed property line�.stnd dimensiona. atructures. setbacka, and aeptic localions). � Slte Revisit Charge � ' �(� '�'D Date(a): (_?�"� ' � (�Q��� Client iVotification Dafe: �i �aa s���. EiiS• j� 9�— 73 ° � �. ��,��o � �-- �� c�-� r- � Account No. � . Revised DCHD(07/99) `� Invoicc No. �� - ��� �[ / � • �/ t�C. . -� � ��— ��3 9 ,,. � -� �,o S , - � '' '� • � • DAVIE COUNTY HEALTH DEPARTMENT . ; ,� � Environmentai Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001151 Tax PIN/EH#: 5863-83-7311 Bilied To: James Reeves Subdivision Info: Reference Name: James Reeves Location/Address: Ralton Eugene Drive-27006 Proposed Facility: Residence Property Size: 281x330x295x Date Evaluated: �l���'Z--- 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 % HORIZON I DEPTH � - �� Texture rou S' � Consistence Structure Mineralo HORIZON II DEPTH � �° ..3�r Texture rou G Consistence Structure �lG Mineralo `� ,'/ HORIZON III DEPTH Texture rou Consistence Structure Mineralo � HORIZON IV DEP'TH Texture rou � Consistence Swcture Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE < , SITE CLASSIFICATION: ►�� ' EVALUATION BY: '� C� 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-Tenace 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 tructure � SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineraloav ' 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) ■�������■��■����■��■��■���■��■�■■��a■��■��������■■�■���s�������■�■ ■��■��■��■e��■��■�■■■�■�■�s■���■�■�����■■�����■�■■��■■�■�v�������■ ■�����se�����■��■������■■�■■��■��■��■��■■���■������■e�■■���■����■ ■■�■���■■■���s■��■��■��■■��■���■ ■■�������■��■�o■e��■���■������■■ ■�■�����������■■�oeae��e�■�e■�������������■������a■e��■��■��■����■ ■�■�■�����■�■�����■■�■���■■���■■■��■■�■�����■��■■����■���■■������■ ■�■��■�����■���■���■��■000■■oo�■■�����■■������■o��e■����e�s�����■■ ■��■■�e�■■��■■■�■m�so�a■■o�■■■■��■■�a■�■■■���■��■e�■■■■■���■�����■ ■■■�■����s���■■��■��■��■■■�■�����■■����■■■���■��o■�o■.����o��s■�■■ 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