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725 Richie Rd Y *, ��+ h� i '3. f.Y"�. ,� i�L i '�1F1}.- wb ...4.•fJ. ,�, ae Jli.. r .l..t i f, f , -'� ,.: +-:r-,//k0: AUTOR; ATION NO; U DAVIE COUNTY HEALTH DEPARTMENT ( 1� " • Environmental Health Section PROPERTY INFORMATION Penii}ttee's P.O.Box 848 �bp Name: "- u `Subdivision Name: Mocksville NC 27028 -444517 J Phone#:704-634-8760 Directions to property: f 4 Section: Lot: x6b d eK . _ AUTHORIZATION FOR vvnn 1 WASTEWATER Tax Office PIN:# p�5/ SYSTEM CONSTRUCTION' Road Name: N I `2i•: A o Al P **NOTE**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. (In compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION , ' �, G`�r ;'�Y, /'% r�- <' '1 IS VALID FOR A PERIOD OF FIVE YEARS. S. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED 1►. � f c,,.l q'Lriaf}' tdvy r�,Z, .y y_.{,�.n ».y..y 'f: 1f r y. 5 e �n G`© DAVIE COUNTY HEALTH DEPARTMENTY R IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION d' q"Rp � (� NTe — ri o! Subdivision Name: -Directions to property: Section: Lot: Awa d k IMPROVEMENT PERMIT Tax Office PIN:4 Road Name: Vit' 'a iP; o ; t� **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.Chapter130A,Wastewater Systems,Section.1900.Sewage Treatment and Disposal Systems) r ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE 9 PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION:BUILDING TYPE //FL #BEDROOMS' #BATHS _#OCCUPANTS GARBAGE DISPOSAL:,Yes or No COMMERCIAL SPECIFICATION: FACILITY.TYPE #PEOPLE #PEOPLE/SHIFT 1 #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY-- DESIGN WASTEWATER FLOW(GPD) �Jy NEW SITE !/ REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE z! l// GAL. PUMP TANK//.i�GAL. TRENCH WIDTH ROCK DEPTH f.1 LINEAR FT. 4,0 OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: , IMPROVEMENT PERMIT LAYOUT **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-.9:30 A.M.OR 1:00 '1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(704)634-8760. OPERATION PERMIT SYSTEM INSTALLED BY: va bb . 1-b 1-b baa' AUTHORIZATION NO. O� �3 OPERATION PERMIT BY: C � DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11.OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSALSYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96(Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC Davie County Health Department 2 @ [E O�n 1 +�f Environmental Health Section D L� V ,a P.O.Box 848 Mocksville,NC 27028 SEP 1 91997 ✓ 704 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed Q�e� NQ' M S"�2� Contact Person l r'�Cva oc r�C� Mailing Address D15 ?, N%cM,Q- rM Home Phone City/State/Zip2'7092 Business Phone a Lf^ � 4 5-35 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: [ ] Site Evaluation [ ]Improvement Permit&ATC �vl Both 4. System to Serve: [ ]House\J,.,]Mobile Home [ ]Business [ ]Industry [ ]Other 5. If Residence: #People-_ #Bedrooms 3 #Bathrooms a '�,]Dishwasher[ ]Garbage Disposal 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 ,]No If yes,what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT**%VMM OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: 5, 5 WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: #51 J- - ( -53 Ccs v.o W1 vta.5k WP, —0'04'2 Srinoa' Property Address: Road) ame 7 a 5 R C w'Q JA 'C'N a city/zip MQckS4A\g- W- ; &r' J-Q� r3rN c'.o�n� �b -\o QAC' If in Subdivision provide information,as follows: rotw Name: Section: Lot#: ; 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 2 c Q S� "S�'. t^,S k-�kr to conduct all testing procedures as necessary to determine the site suitability. DATE SIGNATURE Revised DCHD(06-96) THIS AREA MAY BE USED FOR bRAWINC7 YOUR SITE PLAN: 42 7.12 Ac � ti: 3 c rn . . 38 . AcD ,p • 50 .58 c` Cl! IACD N 2g I t} �� �36i44 v �. 303.6 =j a. 4 .. {23 J23 159 _ �� 39.01 - 1.46 :AC. C7 39 t �, �,. ► . 13 N N rn 2,25 AC• CDco Q 10 », d co 65 O I "p 123 130 10 100 17 .4 183. 135.3 .. . A 4 '1 33 ROAD EATON CfitJRCH 730 100 5 100 17 5 b 368.4 . .c-�3 6 i75 45.IO I vm 142 �� axe �' _� �•. pp co C� "'3 C� 1 N I ���N 0 tr I A c N 64 �, �. co rn v ,� =9 cv p OI V a '. Lt K2 K' N ,..": .. N M �`1 - ri - - Cq�� upp 42.3 1J , - _ 1075.8 _ �_ Lo rn �n m C 4 32 7 = 3 3 (3 AC� 62 4. -r N Q w '� 6_�--'�� - 5.CJ2 _ ��Ac- 6,5.03 �.. A ----� m co 3.1S Ac r- ,p �,, , . 32j54 6AC1 O w 5 Ac 65 20 40 v _ v � w M co J ' cn 5 A , ,2_03 1 o m 61 305.A tP41 r 3ORk 5• G� ' - N 18.1 I AC 494.93 554-650 415 _ - 217.5 i' 4 40> 0I .g3 843.48 ' . U8 S4 99 p � t. •.�' 338,36, OD If QD 14 (3.27 AC)� 552 n 543.40 299.72 533 r N -300 533 I4 5 8316 191 p _ I M 33 AC 18.6 240 - 445.04 0 7 3 i . 2 72cc :� 3�_ F c M •-. r -[t I I r,C-- . 72 CO r .01 70 � ° I ;oSA�)N 69 698_96,tc � 7.98 ASD o; 31 4 cpn co � (9.25�c) A ) _ (5.75 •.�� N 48! 75-: � (4.35 Ate.) 300 n ' - 3I 1- 10.7 t< 28-7i 9 �,- ttlF' ) +� 1 3.7zi a� ? 250 Q Q- 71 C - 30 94.OG �'vq^COecV ,c0 .: _.- 252 co 673.2.- 301 9.4 $6 !aC_0 122.16 * T 933.9 m 6 7 o - 74 _ _ n 3 1 ..r 7.3 . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME Z21'1�5_16101 DATE EVALUATED PROPOSED FACILITY �'2 PROPERTY SIZE SUBDIVISION ROAD NAME Water Supply: On-Site Well Community Public Evaluation By: Auger Boring t/ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH (- Texture groupC Consistence Structure Mineralogy 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: EVALUATION BY: �Gl LONG-TERM ACCEPTANCE RATE: L/ 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 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(01-90) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■.■■■■■■■■.■■■■■■.■■■■.■■■■■■■■■.■ ■■■■.■..■■...■■..■■.■..■■■..■.■■■..■■■■■...■■.■..■Mee■■■■■■■■..■.■ ■■■■...■■t■■■■.■■■t■■.■■e.■■■■■.■■■■■■t■■■■t..■■■et■■■■■See■■..■■■ ■■.■■■■t■■■e..■■.■■■■■■..t.■■■.■�.■■■■t■■eee..e■■■...■.■■Ott..■■■ ■..■■■■■■■.■■■.■■■■■■..■■.■■■.■■ ■■■■■■.■■..■...■■■■■■■■Ott■■.■■■ ■.■...■■■■■■■■e■■■.■..■■e.■■e.e.■■■..■e■■....■■.■...■.■Mee■■■■■■.■ ■■.■■■■.■■■...■■.■■■.■.■■■■■■■■■ ■■■■■..■..e..N■■Mee■■■■■■■..■■■■ ■■■■■■.■■■■.■■■t■■■t■t■■■■■■■.■t.■■■■■..■■■■■■■■■■e■■■■See■■■■■.t■ ■■■■■■■■■■■■■■e.■■■t■t..e.■■■■■...■■■■....■..■.■Mee■■.■■e..■■■■e.■ ■■■SSS■■■■■■■■.■■■.■■.■■..■■■■\f1 ■■■■.■■.■■■.■■..■■.....■■■■■■.■■ ■■■.■■■■■■■■■■■■■.■■■■■.■■■■■S■■■■■■■■■■.■■■..■..■■■.■■■■Ott■■.■■■ ■■...■■■.■■■■■■■e.■■e■■.■■■.■.■■■.■■.■■e■■Mee■■■■■■e■■■■■■■■■■■■■■ ■■■..■■..■■■■■■..■■■■■.■■■.■■■■■ ■■..■t■Mee■■.■■■■■■■■■■e.■■■■■.■ ■..■.■.■■■.■■■..■■.■..■■.11■■t■t.■■t■■■.■I.t■■■.■■t■■■....■■■■■■■■■■ SSSS.. ■■M■■■ ■■MONS ■■■N■■ ■■■■■■I ■■M■M■ ■■■■■■ ■■■■■■ MEN ■■■■■t■■■■■■t■■■■■■■■■■■■■■■■■■■I%■■■t.■■Ott..■■■tee.t■■..■■■.■■te■ ■■■■■■■■■■■■.■.■■■■■.■■■■.e■■■.■ ■■■■■■■■■■■Ott■■■■■■.■■■■ttS.■■■ ■.■.■■■■..■■■■■■.■■■■■e■■■...t■■■.■■ane■■e■■..t■Mee■■■e■■t■■■■■■.■ ■.■■■■■...■■e.■■■.■.■■■...■■■..■ ■.MOMS■■■e.■■■■..■■■■■■e.■■■..■■ ■■■■■■e■■■■..■■e■■e■■■■■■.■■■■...■.■■■■■■e.■■■■■■■.■■■Mee■■.■■■■■■ MOSS■■tee.■■■■■■■■■■■■■■■■■■■■t.■■■■■.■■.■.■■t■■MOO■■■■■.■■t■MSS.■ ■.■■..■■■■■.■■■■■■■■■■tS■■■■■■■■�M■■t■■■■■tM■t■■Ott■■■■■Ott■■■■■■ ■■■tM■■Ott■t■t■■■■■■.■t■■■t■■■■■ ■■t.tt■Ott■■t■■■t■■■■■.et■■■.■.■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■.■■■■■e■■■e■■■■.■■.■■■.Mee■■■■■■■■ ■■■■■■■■■■■S.■■■■■■S.tt■tS■■t.t■■■tM.Nt■■St■■■■Ott■■■tOtt.■■■■■■■■ ■■t■■■■t■■■■■■■■■■■■..■■S■■■■■■■■tMO■t■■.O■■MSN■M■NM■■t■■■■■■tM■■■ ■■■■■■.■■■■■■■.■■■■■.■■■■Ott..■■■■■■■■■t.■■■■■■■.■.■■■.■■Meet...■■ ■■■■■■■t■■■t.■■■■■■t■■■■■t■■■■t.�■t■■t■■t■■.■■.e■■■e■■■..■■■■Mee■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■.■■■■.■■■■.■■■■■■...■■..■■e■■■■■■■t■.■e■■■tN■■tN■■.NSM■■■■■■■tN■ ■■■t■.■■t■■■■■■■t■.■■■e■■■.■■e■■�■■ett.■Nt.■..■■t.■■tt■tte.■■■■t■ ■■■■■■e■■■■t■t■■■■■■■t■■■t■■tet■ ■■.N■■■■.■■t■■■t.e■■.tte■■.■■■e■ ■■.■■■■.■■■.■■■.■■■...■■■■■■.■■.■■■MOSS■e■■■e.■e■■■■..■..■■.■■■■.■