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
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0^ Crescent Electric
Membership Corporation
P.O. 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.