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543 Riverview Rd (2) �- �. DAVIE COUNTY HEALTH DEPARTMENT (/� , 2Q,�, 7�G-cx� Environmental Health Section ` P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 �/��' 1� � � L� (336)75]-8760 � � IMPROVEMENT/OPERATION PERMIT ��� Account #: 990000778 Tax PIN/EH#: 5776-45-6277 Billed To: Bradley Godbey Subdivision Info: Reference Name: Bradley Godbey Location/Address: Riverview Road-27006 Proposed Facility: Residence Property Size: 6 Acres ATC Number. 2191 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AiTTHORIZATION 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 PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type ,/}� }� #People�_ #Bedrooms � #Baths ��. Dishwasher: � Garbage Disposal:� Washing Machine: � Basement w/Plumbing: ❑ BasementlNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size���c Type Water Supply /l Design Wastewater Flow(GPD) c��i� Site: New� Repair❑ System Specifications: Tank Size�GAL. Pump Tank GAL. Trench Width���Rock Depth 1� Linear Ft.3lJ(�� Other: . 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 Department 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.**** � r Environmental Health Specialist's Signature: �� Date: ,/�`��� DCHD OS/99(Revised) r 1 • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990000778 Tax PIN/EH#: 5776-45-G277 Billed To: Bradley Godbey Subdivision Info: Reference Name: Bradley Godbey Location/Address: Riverview Road-27006 . Proposed Facility: Residence Property Size: 6 Acres ATC Number: 2191 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION � **NOTE** This Authorization for Wastewater System Construction MUST 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 WASTEWA CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: 6�,, Date: �1J�C"fQ� 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.Cha ter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY cen as a guaran ee tem will function satisfactorily for any given period of time. ��0 7t� f� D _ Septic System Installed By: Environmental Health Specialist's Signature: 4 � i Date: ll ` `� DCHD OS/99(Revised) .� , � [�C� C� OMC � • ' APPLICATION fOR 8RE ElfAWATION/IN�HOVEAIENT PERMR�c ATC D Davie County Health Oep�rtment SEP � 6 �c� Envi�vutmental Neu�itlh Se�ot�loa p.o. Box 8�8/210 Ho�pit.al �trNt . Mack�vill�, ttC 27028 � • - - (336f751-8760 ,� ^ �**L�OQtT1lHT+�*! TAIB IIpIILIQITZCN QIaTC? 8Q pROC�88ZD ONLZBS 11I� 'lA3 REQOIR]ED TtA�ORkATIOti i8 RAGVID�D. Aalar t.o th� iNf�ORMATiOti BULt��iti !or iastzuatioas. 1. 11aa� to b� siud co�,tawt �s•o:► ��N�,� Nt111AQ �ddi��• ��7� t G Ici h G �w • I� �OM � y�,��n ` '7 1 !. � V� � l% c�hr/atas.lszs�'],qz�s J,��e -rJC � �a 7� Gla�'- ZS'l� -'�.ear.nSl�wl:a tt. 1t� oa �sait/�!C i! pitl�tsat th� �bot� God c` _J 10ai1loq �ddsas� Cit7/staw/sip �. I►ppiiostion lor: 0 Sit� svaluaatioa� 0 Impzov�t ��rsithlTC � Ho�h �. Ma. to �.rrto.� 0 Hont• �l�obil� 8om�a t] 8uaia��• U =adu�tsy [l oth�r s. _� �..���_ � p.��. � � �.�o�. 3 . ��oo� a �/ �Di�btisstwe D Oasaq� Ditpo��l �1�a�1�inQ liaobina O sa�wnt/pin�bi:p i] Da��aant/1to Dlu�biaq l�ji �. =t susia�ss/S�ustsYlotb�s� fp�oii'Y t7tD� � p�opl� t siak� � Co�od�� � �how�ss i nsiasl� ! Nabs Cool�s� I* �'00�$iRVIC.�: # 8�iti i�tims�d l�it�s O�aQ� Io+ui� w� �Yl 7. syp� o! �t�r �upply: O Couaty/City �It�ll O Commuaity �. Do yoo aaNcipate additlaas or e�satiaw oltLa facillty WV syitem b intended to�erve? 0 Ya �No Uya,wh�t type? �� "'+IMPORT'ANT""'CIJEI�fS N[J�'1'WMPLETB'THE REQUIRED PROPERTY INFOItMATlON ttEQiIESTED BELOW. $litier a P1r1T oc S1TE 1'LAN MUST B�SUBbiI7TED b the cllent w�ith TU1S APPLICATION. Prnperty Dltnewianut lo �}(,Y,Q.�' R►R1TL DIRECL10N8(tenm Ma{�vllle)to PRC'ipERTY: T�:Ofice PiN: il ��(�- �l.S-- C(Jo�.77 �o�� � '�i.�r y� ��c �,'�' Z.�r1 ��� Property Addreo: Aaad Name�i'Jfi�V��+� �t� � � CI o � ' ci�►n�p A���nce NC 27DOfo i m��Q on ��p��' ►��►��2 . if iu a Sa6dtv4ton pcavlde tatocrosdun,Nt folla�trr: i(I Q "�""��1'� C�C��n � . N.me: dr��w��, b�►d� ;f- �°`���. � 8l�Cty00i BIOC�[2 ' T.Oti �ZO pf'0[IEi�►��,l�1 -�J �r �/ T6b b to eertlh►t6st tbe Intorm�Ho�pravided b eoe�et to t6e bat oimy knm�ted�a I mder�tsnd th�t�ny permit(�) taoed henA�ter are�abject to swpeaslao or revocsdon,U t6a dta pt�a ar tokadcd ase c6sn�e,ar I(the tnformsHon �abmitted tn t6b�pplluNa►b 4Wtled or ch�a�ed l,a(so,anderstaad that 1 am raponsl6lt jor oli ciargu lncurrcd frotu tits appJkadoa. i,henby��Eve wo�ent to the Aat6oched ltepcaedhtfre ot t4e Dav1e Conuty Halth De�ur nen to eater apon above dact�d pcopetty loatted ta ihvte Coaaty and m�aed 6p to�ondnct�il tatin�praalara at acceaary to determine the�tte taltabWty. DATL q'�lv` 9q SIGNATUR� �i Tql9 AREA MAY BE USED FOR DRAWINO YOJit STI'�PI.AN(Includ li oitbe idlawia�t sL1in��nd propo�ed property fina snd dimen�tons, ttraetnra, Ktbsc{u, �ud uptie{ocattow 8ite Revbtt Ch�r�e *,H►k(�): d � Cllant NotiQaiHon Date: � � �a . �� �" o �As: '��'" G;,�� 1� �f . d����� � Ae¢oaat Na 7� Revtted DCBD(07199) � q-�/- ��.0 oj"�� �°�v �o Iavo[ce Na ��� ���j o % Ga—p� � C�� �„� t 1 a = � _ Z . o/ ��. �d .� _., ., . O � - - � �.. 170 J . J .,_ _ � 13 p � �o ��d� \ 20 . 47��5 , 533 . , _ _ _ ,, �.` 05515 � �,; ; .� � _ � �� ���� . ��. �. � —. �� 35� . . ',,� , � — —- _ ___ _ — ,a, �� 545_ 9 C � _ ��. .,,' ; ; ' DAVIE COUNTY HEALTH DEPARTMENT Environmentai Health Section Soi]/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000778 Tax PIN/EH#: 5776-45-6277 Biiled To: Bradley Godbey Subdivision info: Reference Name: Bradley Godbey Location/Address Riverview Road-27006 Proposed Facility: Residence Property Size: 6 Acres Date Evaluated: / Water Supply: On-Site Well l� Community Pub�c Evaluation By: Auger Boring � Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca osition Slo % HORIZON I DEPTH Tezture rou Consistence Str�cture Mineralo HORIZON II DEP'TH « '� Texture rou G Consistence i Structure r /l Mineralo .•/ �.' 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 c. ,� SITE CLASSIFICATION: /f� EVALUATION 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 clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay ' CONSISTENCE ois 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 Mineralo�v 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) ■������■■���■�■�■���■�����■■�■��s��■■■■■����■�■■��■�����■■�■■■■■■■ ■■�����■■��■■�■���■��■��■��■■■■�■■■�■�■■����■��■��s�����■■■�■■■�■■ ■�������■■��■s����■��■���■��■■���■����■■���������o�����■�■��■��■■ ■�������■■��■■■����■■■������■�■■ ■�����■��■�■�■��■■�■■�■■■�■■��■■ ■����■■���■����■.■e■■■■��ovo■■■��■■����■■�■■■��■�e��s����■■es■�■■■ ■■�����■■�■■���■�������■������■��■■��■����■■■�■■��■��■�����■■■��■■ ■■������■��■���■�����■o■■■■���■���■����■�■�■■■�■���o■■■■�o�v�����■ ■■��e��■��■■■ee■■s■��■��s■s���■���■���■■����■■e■■�■e���eee�e�■eo■■ ■����■■������■��■�■��■���■�■■��■��■■■■■■■■����■■��■�■■■■�����e��■■ ■���■�����■�■■m�so■s■■s����■■��■�vaos���■■■■���■���s■e��■�■o��o��■ ■�■�■�■■��■��■���■�■■■�����■■■�■����������■■■�■■���■����■■��■���■ 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