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206 Riddle Circle DAVIE COUNTY HEALTH DEPARTMENT � ��%��6a � '� Environmental Health Section r.o.Bog sasnio x�p�tei sn�t Mocksville,NC 27028 (336)75]-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001138 Tax PIN/EH#: 5862-53-4509 Biiled To: Shannon Hollar Subdivision Info'�ZQ(p Reference Name: Shannon Hoilar Location/Address: .Riddle Circle-27006 Proposed Facility: Residence Property Size: 3.75 Acres **N07'E**"Tfii b�inproveirient/Operation Permit 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 I 1 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS PERNIIT IS SUBJECT TO REVOCATION IF SITE PLANS OR TI�INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE INSTALLING SYSTEM. � -� Residential Specification: Building Type � #People�� #Bedrooms � #Baths�,� Dishwasher: � Gazbage Disposal: � Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow(GPD)_�'Q� Site: New�Repair� r �� � System Specifications: Tank Size,��GAL. Pump Tank GAL. Trench Widthc�� Rock Depth� Linear Ft�� Other: ------__. � //lr1i� /�Q�`f 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 Deparhnent for final inspection ofthis 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.**** F —�_ Environmental Health S ecialisYs Si ature: � Date: ��� `�� P St► DCHD OS/99(Revised) : � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/Z10 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001138 Tax PIN/EH#: 5862-53-4509 Billed To: Shannon Hollar Subdivision Info: Reference Name: Shannon Hollar Location/Address: Riddle Circie-27006 Proposed Facility: Residence Property Size: 3.75 Acres ATC Number: 2415 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 WASTEWATE O STRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: �� ('�� CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on ImprovemenbOperation Permit has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken as a guazantee that the system will function satisfactorily for any given period oftime. ,��e�+�� �` F � ro �v �b S tic S em Installed B : �i�/ f ����%'(.C� eP Y� Y Environmental Health Specialist's Signature: / �'�� Date: DCIID OS/99(Revised) �.�...� • � APPLlCAT10N FOR StiE EVAUlAT10N/IMPROVEMENT PERMIT�AT � L� C� � 0 d � �-t '� Davle County Hesith Department Env�►�nrtmen[a/He�Iefi Se�tlon �R 2 5 2000 p.0. Hox 848/210 No�pital BtrNt • Moct�vill�, NC 27029 � • (336�7'Si-8760 � ,_ ENVIR�ONMENOAI HEALTH •*+►I�OATJIN?**� TAI8 ]1ppI.IC�1TtORi GNHOS 8� PIiOCC88�D UNL�$8 �1LI. T� REQIIIRaD , INa'OIt�ATION I8 pAOVID�D. R�f�r to th� I�I'OAMATION BULLZTIN !or iastruatioae. i. �... � b. ssu.a 5�cc n no n '�f l�� c�r..4t p.r.«� ��t'� e �� �... �S � �� /�'^�--;j/P �►�. �. �S 1 S'�-?b ���.�.�.�:� �'1oe��sr�/ � �'V C 2�c���.�... �. Z. Itaa. ca� p.s�aia/n=c u a�=t.i.at tlw� wa.• lftiliuQ �dds��• Cit!/itab/iip �. 7►pplioatioa ror: �:�t� =valus.tion � 2mprovamsat p�rmit/l►TC �Both �• Mt..� to ss�o.: �ns� O Mobil� Homa O Snsia�ss 0 tadustsy 0 Oth�r a. I! R�sidaA�: � p�opl� � i B�dsOoms � � 8atbrooms ���- SDi�bxu�r l9'farba� Dispo�d �'l�aa]�1aQ 1C�in� O sat�nt/plu�biaq 0 suu�nlhio pl�aibiaQ 6. Z! swir���/iesdwtsY/Ott�r� fp�aity tiyp� i �opl� • siak� � Coa�od�� i Qsow�s� � ori�l� i Rabr Cool� I! 1�O�f�8=AVZC�: � 8sats =stimat�d Ratar tTiaq� 10�� r� �r) �. Typ� o! xat�r supply: �uaty/City 0 1��11 � Commuaity e. Do yon�adcipste addiNow or espawton�oi t6e tadllty tht�ty�t�m b intended to urve! 0 Ya 0 No If yes,w6at type? . **'IMPORI'ANT'"*�CWENT3MUSTCIDMPLEIETHE RBQUIREDPItOPERTY[NFORMATIONREQUESTED BELOW. Elt6er a PLAT or SITE P[.AN M�)ST BESi1BM17TED b the ellart w�it6 THIS APPWCATION. Property Dimeaslons: �� �� .�7��� W 1tTi'E D[RECfIONS(tirom Maksville)to PROPERTY: T�s 081ce PIN: #� s��s G� � - S 3- �Sa 9 IS f� �-o �eo��/��d ��;� Property Adarea�: Road Name,�►�f���e C i(� �' ��'` A'ordon ���� �'"`"` ' Clty/Zip ,�O(/G/l C� o27OoC (�- 0!1 '�i C�� 1 e �r� � �� a���e o�, ��,�— Ula�SabdtrWon provtde tnformadon,u follmvr. N�me: sKaoo: s�alu r�oti � n,�te rroperey m.�ed: y— a 5—o 0 T61s is to cerHRy tLat t6e IniormaHon pro�vided is con�ect to the beat of my knowledga I andertbnd t6at�ny permit(�) tasaed heraRer tre�nbjat to tnapension or revoe�Hoa,if the itte plan�or tntended as�cbsn�e,o�ii t6e tnformsHon eabmitted in t6b sppltcadon ts talsliied or chsu�ed. I,aiso,andersto»d f�at I ans rupodslble jor afl clia�ges lncumd jr+eni tbJs apppcadoir. I,bereby,�ive eoaeeat to the Aat6oriud Itepreaenhdve of t4e Dsvle Coaaty Halt6 Department to eater npon abave deacrlbed prnperty locatal ta Dsvte Coant�►and awaed by to condact sU tatin�procsdara�u neeeaaary to determine the tlte soltabWty. DATL �` ^ aS— OO SIGNATURE ' �i� � � _ THI3 AItEA MAY BE U3ED FOR DRAWING YOUR S1T�PI.AN(Inclade�U of t6e follawinat E�stin�and propaed property Una and dinunato�u, �traetnra, utbAclu, aad repHe locatioa�� Sth Revbit C6sr�e Date(�)s Citent NoNHaiHoa Dates � LA3: Ae¢oant Na /� � Revised DCHD(07/99) Uvot¢e Na � �� . , ,., `', • ,�• '-s: . : . ..a' . . . , ' � . i . � . �. . D B NDRq C. CA UDLE �/ �, �pp� � . 128, PG. 32 f � �� rl'd � . D.B 89, PC. 422 �1 c;,;+�� �� �B �'sz; �' Iy �'y ,a�, IS�, � � • ~ Ac ' �93 N � 'b i � ,��q ; _ s 6a• S�9 - --- �, � �� - r � ;i - '_`.-1g90g3�A f y . ' ' � � �� �� ' � i � �Y Q � . j� / � . . , � . fy�m� �'. 0 / t q � a � ' � U . ? ' i B<y' ; � / NG , .. � Z ' . J '. 1 . . . C7 � / ' " , s � i z � i � ' + • . W � ' � � �� , �+ i �,h�, , i �';� i ry�' i _ . . • 2 :�� i' ,..s! � \,� �i ���� � i��,'` � �� ��,�• � �'c,• �`� ' �„ q %" � . _. . w��` ' �`'`� _'� y • , , , ,��• . —�, E,�sn�,c '. G %�� -3�' EaSE�ir�T . � � . / ', `\ . i � ' / i � : �n� '. ry�� 1 = ARE'A= 3.750 AC. ; ;. , ; ' AREA= 3.000 AC. . , , � � N:p I '- / %� - ` ��.. ..., -`,'f[�' r_'_.. C� � '�f&�.'�l _ � N 69•S 2. / i � 4 � �'_. . .. r� � . ' r - ' , - / - ' . ':_., ��... - '- . / . � _._.,.... `�•� J� . - � - � �� ��$C. / � ``` '��� i' ��/�. h 6J�33` f�, ; <,+ / �6�� =fF;.. �Y.- �^f::�gr ;� .� p fs`Q,yc �,' --.. --:.. , , a;��o• _ , ,. -- ' `.,' i� .q"C . \ 1 o .� V� �,' �`'_ •,'� :>9 •,s'• ve: � � � - � � •� ��9 to Q ��-J" 'y. ;�� ; 1^� - . LEG, C^ .PG, �l'G. �,y��„�� ,�, •E.I.P.a Ex� � ��9 °6'oe.� .._ O N.I.P.m NE1 -�i� - ' �= REBAR : v\ ��*`'� �� AXLE . ,. +a UNAAARK . / E� ' , IN C/L OF DRIVE . / J ; . � , ' ."• DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001138 Tax PIN/EH#: 5862-53-4509 Billed To: Shannon Hollar Subdivision Info: Reference Name: Shannon Hollar Location/Address: Riddle Circ1�27006 Proposed Facility: Residence Property Size: 3.75 Acres Date Evaluated: J���f d Water Supply: On-Site Well Communiry Public � Evaluation By: Auger Boring i.� Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca osition Slo % HORIZON I DEPTH Texture rou � Consistence Structure Mineralo HORIZON II DEPTH " Texture rou . Consistence Structure /L Mineralo ' f J.� HORIZON III DEPTH Texture rou Consistence Structure Mineralo � HORIZON IV DEPTH Texture ou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON . SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: i 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-Granulaz ABK-Angulaz 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 DCI-ID OS/99(Revised) ■■�■����■■■■���■������■�■■����■��■■■���0�■■��■�■��■■�■�■■���■����■ ■���������■���■����■■�����■����■■��■■■■���■���■■■O�■��■�■■����■\�■ ■�����■��e■���e■s■��■��■■�o■�■■��■�■■■■■o■■��■■■�■■�v��■■���■�■�■ ■��■�������■���■�■��■���■��■■■■■ ■����■■���■���■■�■���■�����■■��■ ■�����■����■■eooaa■■v■■��■��■■�■�■e■�■�■����■���■a�a■��■e�■�����■■ ■�e�■����■■��■��■��■■■■■■■��■�■���■�����■����■��■��■■■����������■■ ■����■■���■����������oe■�■�eo��■���■����■■��■��o■■m■�v�■��������■■ ■�■��■■■����■■■��■■�■��■��■��■�■����■�■��■■��■■�■■�■■������������■ ■�■■����■■ovo■�■�aom■��■■��■■■a■■��■■■■���■���■�o■m■■■■�■�ea�■o.■■ 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