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2441 Hwy 601N Lot 3 { Da vi County Health Department ! ENVIRONMENTALHEALTH SECTION ' �¢ �C..... P.D. Box 665 Mocksville N.C. 27028 `CSV C' AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of �t G.S. Chapter 130A, Wastewater Systems) ***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.*** NAME l��fi?t`� ( �i� C`% DATE �—��" y AUTHDRIZAT0 9ER NAME ON IMPROVEMENT PERMIT (Ifdifferentthan above) SITE LOCATION COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM - t **WICE*H THIS AUTHORIZATION FV SYSTEM CONSTRUCTION IS VALID FOR A PERIOD OF FIDE (5) YEARS. ENV AL wxilf SPECIALIST DATE DCHD; 1Q/95 DAVIE COMITY HEALTH DEPARTMENT g IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT;PERMIT **NOTE** This improvement permit DOES NOT authorize the construction or installation 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 13OA, Wastewater Systems, Section .1960 Sewage Treatment and Disposal Systems) NAME (,. f rz llli PROPERTY ADDRESS 4//V 70 DATE LOCATIONnr SUBDIVISION NAME lFl��fi� /� LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMISI,� # BATHS # OCCUPANTS _-4 GARBAGE DISPOSAL: Yes/No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPI-E/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZEWK TYPE WATER SUPPLY < DESIGN WASTEWATER FLOW (GRD) Ole NEW SITE .�f REPAIR SITE SYSTEM SPECIFICATIDNS: TANK SIZE,*_{ w GAL. PUMP TANK GAL. TRENCH WIDTH_ 's��• ROCK DEPTH ,A!,.?! LINEAR FT. .c OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. IMPROVEMENT PERMIT BY **CONTACT A REPRESENTATIVE OF THE DAVIE TYJALTH DEPARTMENT FOR FINAL INSPECTION THIS SYSTEM BETWEEN 8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE Y OINSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT � / STEM INSTALLED BYE-�/t. 1�esvA )AUTHORIZATION NO OPERATION PERMIT BYDATE i — **TME ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 13OA, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS', BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTOFILY FOR ANY GIVEN PERIOD OF TIME. DCHD 10/95 APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&AT t Davie County Health Department Environmental Health Section 7G< `� P.O. Box 848 Mocksville,NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE RE IRED I ORMATION IS PROVIDED. 1. Name to be Billed Contact Person Mailing Address ILL O f'A Home Phone L- �17 / City/State/Zip 2 / Busines Phone L 2. Name on Permit/ATC if Different than Ab9ve G Mailing Address I City/State/Zip RX--�' 2 2U a 3. Application For: [ ]Site Evaluation [ ]Improvement Permit&ATC [ ]Both 4. System to Serve: [ ]House j�V� 4obile Home [ ]Business [ ]Industry [ ] Other 5. If Residence: #People / #Bedrooms #Bathrooms M Dishwasher[ ]Garbage Disposal [k'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:'(]County/City [ ]Well [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes M No If yes,what type? PROPERTY INFORMATION REQUIRED:***IMPORTANT***A PLAT OF THE PROPERTY MUST BE �j SUBMITTED WITH THIS APPLICATION. Property Dimensions: "u WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: # 7 Property Address: Road Name City/Zip IAZO If in Subdivisio provid info ati n,a follows: .0 o:�T ./ �/L•4ll -71/-� Name. r C4�J Section: Lot#: �� '9�y 1 6�L C/4,01AC-'6 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 A the avie County Hea h Department to enter upon above described property located in Davie County and owned by t �� �/� to conduct all t7'4'f3::n g procedures as necessary to determine the site suitability. DATE y—�1 SIGNATURE �g � �a»�� Revised DCHD(06-96) APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT • Davie County Health Department Environmental Health Section / P. O. Box 665 '�/b 1.4W Mocksville, NC 27028 1. Application/Permit Requested By Mailinq Address Home Phone Business Phone 2 Name on Permit if Different than Above ���� 3 Application for: 2General Evaluation ❑Septic Tank Installation Permit 4. System to Serve: ❑ House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. / If house, mobile home: Subdivision !� ,f � Section_� Lot #Z ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms ❑ Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type i No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories / No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ZPublic ❑ Private ❑ Community 8.•Property Dimensions Sewage Disposal Contractor 9. Do you anticipate add itions/expansion.of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes, what type? 'NOTE: Improvements Permits shall be valid from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: PROPERTY INFORMATION REQUIRED: Tax Office PIN: # PROPERTY ADDRESS, as follows: Road Name: } City: � OcIZS✓il�C= �} ( (yV SUBMIT A PLAT IVITH THIS APPLICATIONJA . f; L Revisions effective October 1, 1995. This is to certify that the information provided is correct to the best of m knowledge, and I understand I am responsible for all charges incurred from this application. I �� DATE SIGNAT RE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY 'MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. E If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: ' 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 :r to•`conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD(1/93) , DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation J� NAME , �IG/` yOf � GC DATE EVALUATED ADDRESS PROPERTY SIZE ` PROPOSED FACIILTY LOCATION OF SITE , Water Supply: On-Site Well _ Community Public Evaluation By: Auger Boring 11� Pit Cut FACTORS 1 2 3 4 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure / / Mineralogy Al ' 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: EVALUATED 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 :lay loam, SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-V,:�.-y 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 ,3C--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(01-901 ■■■■■■■■.■■m■■■mE■■m■mmm■E■■mmmmmmmmmmm■ ■■■m■■■m■m■■■■■■ ■.■■■■■ ■■.■■■■■■■■■■■■■■.■■.■...■.■■■■■■■■Nmmmmml■m■mm■mmmmmm■■mmmmm■■■■ ■■mmmmmm■■mm■mmmmmm■mmm■mmmmmmm■ ■mmmmm■mmmmmmmmmmmmmm.■■mmmmm■m■ ■■■■■.■■■■■■■■■■■■■.■■■■■■■■■■■■ ■■■■■■■IKmM■■■■■■■■■■■.■■.mmmmm■ ■■■■■■■■■■■mmmmmmm■mmmmmmmmm■mm■m■mmmmmmm ■■ ■■■■■■.■■■■m■■■m■■■E■ ■■■■.■■■■■■■■■■■■■■■■■■■■■■■■■■■■■.■m■mmmmm■■mm■mmmmmmmmmmmmm■■.■■ ■■■■■■■■■■.■■■■■■.■■■■■■■■■■■■■■■■■■mm■mm■mmmmmmmmm■■mmmmmmmmm.■■■ ■■■■..■■■■■■■■■■■■■■■■■■■.■■■■■■■■■m.■■■■■■i■■■m■■..�■■■■■.■■■■■■■ mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmMMMMMMM. ■■■■■■■■■■■■■ ..■.■■■■■■■■■■■■■.■■■■mm■mmmm■mm■mmmmmmmmmmmm■m■■■■� m■■■m■■■■mm■■ ■■■■■■■■■■■■.■■■■■■mm■■■■.■■E■■■U■■■■m■■■■■■m.■■■■ .mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm ■..■..■..■.■■ ■■■■■■■■■■■■■■■■■■■■■■■■.■■CE■■■■■■■■■■m■....■.�m...m.■.■■.m■■.■■■ ■■.■■■■■■■E■■■■■■■■■■■■■■■■ ■■■■■■■■■■■.■■■E■■■ ■■m..■■■■m■■■■■■■■ ■■■■■■■■■■■■■■■■mmmm■■mm■mmmmmmmm■mmmmmmmmmmm■ ■.■■■.E■ ■■■■■■■■■■ ■.■■■■■■■■■■.■■■■■■■■■■■■■■■■■■■.■mmmmmmummmI ■�■I■■■I�■■■■■.■I■■ ■■■■■.■■■mm■mm■mmmmmmmmmmmmmmmm■mmmmmmm■ ■EE ■ ■■■ ■■■■■■■. ■■ ■.■■■■■■■.■■■■■■■■■■■■■■■■■■■■■■■■.■mmmm.mmmmmmmm�.■■■■■.■..■■■■■■ ■■■■■■■■■■■■■■.■■■■■■■■■■■■■■■■mm■■mmmmmmmm■mm.m■....■■.■..■....■ ■m■mmmm■■mmmm■m■mmm■■mmmmmmmmm■ ■mmm■mmH.■■■■■■■■■..■■■■..■■■■■ ■■■■■■.■■■■■■■■■■■■■■■■■■■■■■■■.■■■■■■■■■mm.■■■IlMEE= ■.m■■■■■■■■ ■■■■■■■■.■■■■■..■■■m■■■■mm■■■■■m■■■■■■■■■■■■■■■ _■.■....■....■■■ ■■■■■■■■■■■■■■■■■■■mmmmmmmmmmmm■mmmmim■Emmmimmm■■■ ■.MEMO.■EE■.■.� ■■■■■■mmmmm■mmmmmm■mmm■mmmmmmmmmmmim ■■■■■■ ■■■um■■■■■■ .�■...i .� ■.■■mm■■mmm■m■■■■■m■■■m.m■■■■■■■■■ ■■m.■■■■.■N■■.■■I■■■■■ ■mun ■ ■.■.■■■■■■■■■■■■■■■■■■■■.l■■■■■■■■■■.m■■■■■■■■■m■■.E ■■■■■■■■ _■.. ■..■■.■HEEEEEE■■EEE.■EEEE■.■..■�.E.E.HN�.■E■E.H.■.■■.■... 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Box 506 Mocksville, NC 27028 Telephone: (704) 634-2136 NC Watts line: 1-800-842-1648 July 1A 21 9(:j eubbaJJ�ud e 129 Fosthall Drive Mocksville, N.C. 27028 Dear Mr Caudle, Permission is granted for you to use our R/W located on lot# 3 of the subdivision known as "The Reid Patch" for the installation of septic tank drain lines only. These rights are granted based on the understanding that the property owner or owners shall be responsible for any damages that may occur due to our use of the Right of Way. Crescent EMC reserves the right to revoke such permission as necessary. If I can be of further service to you, please let me know. Si erely, ' chard Broadway Crescent EMC Davie County Nealtlr Department and .Moine .fealtfr Ayency 210 HOSPITAL STREET P.O. BOX 665 MOCKSVILLE. N.C. 27028 PHONE:(704)634-5985 May 7, 199E Mr. Jesse Boyce, Zoning Officer County Office Building 123 South Main Street Mocksville, NC 27028 Re: Reed patch Subdivision Dear' Mr. Boyce: This letter is to confirm our conversation on May E, 1995, regarding the power line right-of-way that crosses several lots in the Reed patch Subdivision of Davie County. The above mentioned right of way is controlled by Crescent Electric. They allow for the installation of septic tank drain lines under said right-of-way; however, they require the property owner to sign a disclaimer should their trucks rupture or damage the lines. If you have questions, feel free to call. Sincerely, Robert B. Hall, Jr. , R.S. Environmental Health Section RH/wd 'q 1 l s y Crescent Electric Membership Corporation P.O. Boz 506 Mocksville, NC 27028 Telephone: (704) 634-2136 NC Watts line: 1-800-842-1648 June 3, 1996 Memo To: Buck Hall From: Richard Broadway Subject: Use of Utility Line Right of Way. Permission is granted on an individual basis to property owners for the use of our Right of way for the installation of septic tank Drain lines only. Each Property owner must submit a request to Crescent EMC for approval. These rights are granted based on the understanding that the property owner or owners shall be responsible for any damages that may occur due to our use of the Right of way. Crescent EMC reserves the right to revoke such permission as necessary.