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137 Sherden Ln . � , � ' • DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990003412 Tax PIN/EH#: 5758-60-4285 Billed To: Greg Weaver Subdivision Info: Reference Name: Location/Address: 137 Sherden Lane-27028 Proposed Facility Residence Property Size: 24 acres ATC Number: 3933 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his Authorization for Wastewater System Construction MUST BE ISSLTED 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 N CT N IS A OR A PERIOD OF FI YEARS. Environmental Health Specialist's Signature: � � Date: �Z +� CERTIFICATE OF COMPLETION **N T ** The issu ce of this ificate of Completion shall indicate the system described on Improvement/Operation Permit has instal��m mpliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Dispo 1��s," ut shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given eridrYofti e. ltlO l,r,,,a'� �� G�l�II� � ����+. y�� �,�,.. �- �� , an�� , � � � � � � ����s ,�,; �5�. �1�,� , � � :, � � a �.`�l •I f7C� 2 Septic System Installed By: Environmental Health Specialist's Signature: � Date: � � DCHD OS/99(Revised) .• � ', DAVIE COUNTY HEALTH DEPARTMENT �' � `� Environmental Health Section �� � z—I�v�S' • ; • P.O.Boz 848/Z10 Hospital Street t Mceksville,NC 27028 , (336)751-87G0 IMPROVEMENT/OPERATION PERMIT Account #: 990003412 Tax PIN/EH#: 5758-60-4285 Billed To: Greg Weaver Subdivision Info: Reference Name: Location/Address: 137 Sherden Lane-27028 Proposed Facility Residence Property Size: 24 acres . ATC Number: 3933 **NOTE** This ImprovemenUOperation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system."An ALITHORIZATION FOR WAST'EWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/instal(ation 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 SUB.TECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type fT��'l�� #People 2 #Bedrooms� #Baths � ' Dishwasher: � Garbage Disposal: � Washing Machine: � Basement w/Plumbing: ❑ BasementlNo Plumbing: ❑ . Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size � Type Water Supply ��1� Design Wastewater Flow(GPD)� Site: New�Repair❑ , +r tr � System Specifications: Tank Size ��GAL. Pump Tank GAL. Trench Width �' Rock Depth �2 Linear Ft.�� �l `� aa ` �.,��` � Required Site Mod' ication tions: �/�1,1. �N l�'fiC�(.� � � � % �L-�-j� Ll��`�)� ��� I1�IPROVEh1E T/OPERATI N PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6"BELOW FINISHED G . ****N TiCE: Contact a representative ofthe Davie County Health Deparhnent for final inspection of this ' system betw 8:30 a.m.to .30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(33G)751-87G0.**** \ ,� �'(',f�1T��'X�-�3J1�1�.'�" `�Iis D�IC� '�x���� QP�� 70 �t+.�'"�co � Ce�S�`Q�oa c��'ati�`�_' 2 09� �o' . O . � FRot�T � r1• • � 3 62 �,n 5' � �� No�'� � '7�' . �� � � �s' � � \ d Icox�c���,yZ�� v /. Environmental Health Speeialist's Signature: Date: 12 O� .1.� a� DCHD OS/99(Revised) �wCC � \ . � D � t� C� � � � +" ,j � , ' r� L � • APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department NQ� � 6 �(� Environmenta/Hea/th Sect�ion . P.O. Box 848/210 Hospital Street Mocksville, NC 27028 EPMROfV11RINTAtYu'�� (336)751-8760 ����� ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed v�'e� � ` ��V�r Contact Person Mailing Addresa 2 3og LyylG(7l�(y� A�f c.. ' Homa Phona ������d City/State/ZZP W1 Yl �D►'1—Sa�2 r►��,1J C 7�1 10 3 -g��i phone ��b �b ���J �. 2. Name on Permit/ATC if Different than Above Mailing Addresa — City St t /Zip � �r�� �z , ^ 3. `Application For: �Site Evaluation I�I mprovem�nt Permit/ATC O Both 4. system to Services� House ❑ Mobile Home � Business ❑ Industry CI Other 5. Type system requested:� Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People Z # Bedrooms � # Bathrooms � �Diahwasher �Ciarbage Diaposal �Washing Machine ❑Basement/Plumbing �Basement/No Plumbing 7. If Business/Induatry /Other: verify type�� # People # Sinks � '� # Coamiodes �"— # Showers # Urinals '—' # Water Coolers "— IF FOODSERVICE: # Seats 1V � Estimated Water IIsage (gaiiona per day) � 8. Type of water aupplys �County/City ❑ Well ❑ Community . 9. Do you anticipate additiona or expansions of the facility tl�is system is intended to serve? �Yes �No If ycs,wl�at typc? ' ***IMPORTANT"'**CLIENTS hfUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTGD - BELON. Either a PLAT or SITE PLAN MUST BE SUBAfl7'TED by tl�e client �vitl�TIIiS APPLICATION. Property Dimensions: 2 g- �C1^P�5 WRITE DIRGCTIONS(from A'Iocksville)to PROPGRTY: Tax OfCce PIN: �� -�r''7��� ��-7-85 (�� Nu�u C�4 � -Fro� ^I�/�SIT!��e liady;f�)� -J � Property Address: Road Name �3����1'�'� �� �J L€,�'Tr bh �N✓►Q't� '�(,�t-[QiV��i�1N�S � c�ty�z;p V�'�sv,�I.e,,�JC2�oZ� U �ti�' m►�e -�� ��d� �a,tic.-�'UQ� ���� If in a Subdivision provide information,as follo�vs: �q�I �(�lN 1,11 �h I-��i-�; Namc: �,��i�� ' �S��� �1�� �2P�a�v►o� VYGn�� Scction: � Block: � Lot: � Date home corners flagged: l 1 Tl�is is to ccrtity tl►at tlic information provided is correct to tt�c best of my kiio�vlcdgc. I undcrstand tl�at any permit(s) issued hereaftcr are subject to suspension or revocation,if tl�e site plans or intended use change,or if the information submitted in tl�is application is falsiGed or cl�anged. I,also,«�rdersta�rd tliat I ai�r respo�rsiGle for al!cl�arges i�rctrrred froni tliis applicatio�r. I,hereby,give consent to tl�e Autliorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by �l,l�s,r� 'Ta��W L�,�f�/�� to conduct all testing procedures as necessary to determine tlie site suitability. � S'. ��a.�.�,r DATE_T�D� SIGNATURF THIS AI2EA MAY BE USED FOR TiRAWING YOUR SITE PLAN(Include all of tlie following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge ,�./��_- p�-� �.�-�n, — D�t��s�: �� -F� �'�-nr-� . i S �f�� I� ) / �,.� Clicnt Notification Date: G Yw-,,�,a.c, s i� S`u`'"-"� Ld EHS: � Z ��/ JC SZ� ��'"/ �,�., .-� Sign given ltvl�.t� �la� `� ,� Account No. ,�-�-� -� ' �" � Revised DCHD(OS/03 Q.d f�� ,�,�� Invoicc Na y � �g � �� ,i ������ ��s f- 2�� d� � �� y� � � . ��� � SHtFtUtN JOHN � � � � , , • GARWOOD �OHN FRHNK � 1 ,,�, , � >>��� Y I .. s:.,.s . (•y�O Q/1,��Q� � p R� � tr� e � i . �� � l3'� S�t'`da", {n' �,��,� �,,.� � �. � ��� ` • � ���N f� ' �g, >, �. � . . 1 ~ � z�o� }�i � f, ,' I r �� ! � � % .ff o-cz�,,,v-�� � �r , �;.���",,_ ,,�. �. �� � ,�� � � i �� , ` �� � f'� ; � � I � �` � �� � ��— � �� - ' ' � - �, ��� �' ��' EA ��TUDOR TROTTER���f��� - ,� � �ti�' ,� �z�ae,, / . �1 L ��';� � p�J azes �. '� � � WALLACE ROBERT L � ; �4 G��c'�dr7 S. U�AV'�-V�) 'F -- - -- =----- � -- ---- � � � � � i :r' '` �� � � i CROWE GNI_ C % � / I / ,JJ / / � . . . . � . � �4 yn :.. .,, / �/ . . . . _ _ ' ' - �l / - � � 3$4(; / i � ' / f �e? 7 � / I �C/�/ ' �� . I ..� �-�—__--__— U� �� � � GROWE GAiI D `1E '3A I i : WOOG IVAN DARRELL � cs cc�a' 4598 �� , `r � 3508 � ��, � � t,� ����,� � ���5� � ,� �5 ; ' d i � ` �G.r�P � . : AY1tiAl.T R �. ' ,a �. V�� ;4MBE WOODROW 1 � 3s�; � � � �i� � � _ Y"�—� \�/ � , �� � � � � �� _�t � . — w �- l�l� 6N��1�y/ � � �. � '• , • DAVIE COUNI'Y HEALTH DEPARTMENT - ' y Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003412 Tax�PIN/EH#: 5758-60-4285 Billed To: Greg Weaver Subdivision Info: Reference Name: - • - Location/Address: 137 Sherden Lane-27 28 � Proposed Facility: Residence Property Size: 24 acres Date Evaluated: ��, .. . ,F.',i ' ' . . Water Supply: On-Site Well Community Public --,: Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca osition � _ Slo % Z.Z+ , HORIZON I DEPTH — �— , -�Cn • Texture rou _ � i�- i C L �L , � Consistence � � 5S� � Structure .. Mineralo HORIZON II DEPTH � Q � J � � Texture rou ', 5' Consistence - ` � Structure -� �}3� s 5�{� Mineralo Ylni ff �Y+r Y�n.t t��,l HORIZON III DEPTH �-� Texture rou C� 'Ct� Consistence � ��'.a Structure Mineralo NU1C1 MA � , . HORIZON N DEPTH " �- L _ Texture rou ��, � � Consistence S S SS 5 Structure • C Minerald - � SOIL;WETNESS RESTRICTIVE HORIZON ' ' SAPROLITE -...::.:..: S CLASSIFICATION LONG-TERM ACCEPTANCE RATE �2 P .2) , . SITE CLASSIFICATION: EVALUATION BY: - �t� • ,,�" LONG-TERM ACCEPTANCE RATE: �'2� OTHER(S)PRESEN'�: REMARKS`�a��' -��,J�L�U,JV 5tN1� rnaXts�� t� �OUGrTS t!� rwxa � A���� 'Cl'�MIXr� �drf 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 ". f'.;; • 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 firtn EFI-Extremely�firtn ' Wet • ��;. NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic - tru t re SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic ' MineraloEv 1:1,2:1,Mixed tes 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 DCHD OS/99(Revised) . ■■�e�ev�■■o■��■�����■�■■���■��■■��s■�■��s�■���■■�■■��■■■■a�s�����■ ■o�s�����v��o��■��■�■��s���■����■��■���a■������■��■s�■0■���■oee�e■ �■�s�o�o�e■��■��■�ss�■��■■�■■�����■■s■��■������■�■��s��■��s��s■o� ■oa�������e�����■���e■oo�■s�■�■■ s�■o■��■���■��■��■�a�■■�■oo�o��■ ■���aa�s����■������a■�o�■■��■�s������■��■���s����■�■.s0■.v�e�.v��■ 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