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226 Speer RdAUTHORIZATION NO: 1543 DAVIE BOUNTY HEALTH DEPARTMENT ` Environmental Health Section PROPERTY INFORMATION Permittee'' � �� �^ P.O. Box 848 Name: !J0W AR �k � Mocksville, NC 27028 Subdivision Name: Phone # 336-751-8760 Directions to property: �� 4�`t' I I; jrJ 1 Section: Lot: AUTHORIZATION FOR l- f r.} i ! f� �} WASTEWATER Tax Office PIN:# SYSTEMCONSTRUCTION /� — 4^1t–�r'N,J'�PEL� C� �t(�,I.) ; f l�Si r_2 2 Road Name: eeg o Zip: **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 I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) • ' ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION 'f'�'_ r!a�.s _, '• IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRON ENTAL HEALTH SPECtXLISf- DATE KSUE OUNTY HEALTH DEPARTNNT DAVIE IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Penruttee's.. - 9A!)Name: u, L �!% � i� Subdivision Name: Directions to property: i { L' `i. ? _ t.. {'�' } , Section: Lot: IMPROVEMENT PERMIT Tax Office PIN:# - - s ' , i l s ` t % , c 1 r C r . ,1 't I ;" ,'1.'- I Road Name: P=. Zip: cq f NU **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 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) .. ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE 1 4 PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ' ENVIkONIAENTAL HEALTH SPECIALIST DATWSSU'Eh SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE _ # BEDROOMS _�? _ # BATHS � # OCCUPANTS GARBAGE DISPOSAL: Yes or(D COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE C %X TYPE WATER SUPPLY S DESIGN WASTEWATER FLOW (GPD) NEW SITE M REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE is.JL�D GAL. PUMP TANK GAL. TRENCH WIDTH r'r' ROCK DEPTH I <' LINEAR FT. l ) OTHER Z :7L� je-Ta-1 REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT. 12."�Co��D eJGi �C�'Ta� c9(— Nc,Js� "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 (336)751-8760. OPERATION PERMIT —n SYSTEM INSTALLED BY: \7v '`�,, �o 0 f~2 -d> -j -r AUTHORIZATION NO. OPERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE Sts1w StsDESCRIBED BO E 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 GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) 'Ti TAt- r Z c2 Is 4-0 c r, t- fL �- IT1 A� 12."�Co��D eJGi �C�'Ta� c9(— Nc,Js� "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 (336)751-8760. OPERATION PERMIT —n SYSTEM INSTALLED BY: \7v '`�,, �o 0 f~2 -d> -j -r AUTHORIZATION NO. OPERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE Sts1w StsDESCRIBED BO E 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 GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) 1 rr_, 10:1,40 ' APPLICATION FOR SITE EVALUATIONAMPROVEMENT Pf RM I . - AV Davie County Health Department t1 L5 Environmental Health Section U P. O. Box 848 1 [ APR 3 0 1998 Mocksville, NC 27028 (336)751-8760 E:iT :�_ !T1L� ****IMPORTANT**** THIS APPLICATION CANNOT BE PROC EDzUWUS ALL THE REQUIRED INFORMATION IS PROVIDED. Name to be Billed A Cn e ►' 1�- • 'beck Contact Person 'P)L^6'! CHIC. a �� �u�//✓mss Mailing Address � J �cY f� pLa C� -H=e Phone ??to -7 51 - d / t' I C City/State/Zip "(]C1CSVJ 1?, >jZ�Phone 33Lo`L4Q0-7I (oci 2. Name on Permit/ATC if Different than Above r yLicr - C t' i 100- -) CC'(- Mailing Address S Dee t-j� -oa City/State/Zipgq Nl OC kS L 1 1 1(. NC- ;1 o "A 3. Application For: Site Evaluation ❑ Improvement Permit & ATC ❑ Both 4. System to Serve: 5. If Residence: 0 Dishwasher 6. If Business/Other: # Commodes _ If Foodservice: ❑ House ;d Mobile Home ❑ Business ❑ Industry ❑ Other # People ❑ Garbage Disposal Specify type _ # Showers # Seats # Bedrooms, 3 # Bathrooms Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing # People # Sinks # Urinals Estimated Water Usage (gallons per day) # Water Coolers 7. Type of water supply: X County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 10� No If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PbgXW THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: l0O A. X 360 1 WRITE DIRECTIONS (from 1 Mocksville) TO PROPERTY: Tax Office PIN: # S cal 1 /Po/ NV pm, It. k 4'ho Property Address: Road Name Qg `S IDe e V l�cad Oil VCl) RV )_ hemA; City/Zip �10Cksv►11r. NE If in Subdivision provide information, as follows: 1 /� 1 lr)�c rL Irc�. 7�(rn it f� Name: 1 1 C/1 �5i r'r PY. an:2( driyc , Section: Lot #: 1 1 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 l DCi i- -az IL _;3C'C/L c /`3eC/t- to conduct all testing procedures as necessary to determine the site suitability. DATE 1130 mss/ SIGNATURE 60AA J CC-Cv Revised DCHD (06-96) YOU MAY USE THE 13ACK Of THIS FORM FOR PRAWING YOUR SITE PLAN. i v DAVIE COUNTY HEALTH DEPARTMENT " Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME I1� PROPOSED FACILITY '" `. H) &X G - SUBDIVISION Water Supply: On -Site Well Community Evaluation By: Auger Boring �� Pit DATE EVALUATED i?-r�� PROPERTY SIZE It i{300 ROAD NAME 51 -kc -a eo Public LI -11 Cut FACTORS 1 2 3 4 5 6 7 Landscape position L (� Slope % Zw HORIZON I DEPTH o-05 0 - Texture group S . CL_ 75: C L. Consistence$ 5 (--r SW Structure 1,L 3I, - Mineralogy ( (: HORIZON II DEPTH Texturerou S" ' C C ' C Consistence S ,'S Structure V_ 45 MineralogyI 1 Nt M HORIZON III DEPTH - 5 D Z+ 4 f Texture group r�A `C•t57qg, Sc S Consistence l Structure k Mineralogy (V1l,LV M►X HORIZON IV DEPTH S6_41)+ Texture group c Consistence { Structure S6K L Mineralogy XeD SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S J LONG-TERM ACCEPTANCE RATE U• SITE CLASSIFICATION:��I �3 LONG-TERM ACCEPTANCE RATE: EVALUATION BY: C'ErP OTHER(S) PRESENT: REMARKS: 111 1 Xao M i � eeA l_V('qq Sat L _DSPT )4 1 j 1.4 5_ VSO S y,STaPN_' 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) ■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ 1MMUN■ NOME NONE ■■M■ NOME ■ME■ ■■■■ ■■M■■M■■■■■i■■M■M■ ■■MOM■■■■■SIMMM■■■ ■■■■M■■■EM■ MMMMM■ Davie County Health Department N� Nva"�E1998 and Come Health agency CN 22, FEVIVE151 8760 Environmenta(Health Section 336 P.O. sox 848 / 210 HOsPITAL STREET COURIER #09-40-06 MOCKSVILLE, N.C. 27028 PHONE: (704) 634-8760 June 5, 1998 Roger D. Beck 222 Speer Rd. Mocksville, NC 27028 Re: Site Evaluation Speer Road Tax PIH: #5812-62-9218 Dear Client(s): As requested, a representative from this office visited the aforementioned site on May 2.2, 1998. Based upon the information provided on the application for site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for installation of an on-site sewage disposal system. Before a permit can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions, please feel free to contact this office. Since ely Jeff G. Beauchamp, R.S. Environmental Health Specialist JB/wd Enclosure(s)