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771 Turrentine Church Rdt, •2G•oz� DAVIE COUNTY HEALTH DEPARTMENT S30 Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001098 Tax PIN/EH #: 5757-23-1753(,& Billed To: David & Tina Reid Subdivision Info: Reference Name: David & Tina Reid Location/Address: Turrentine Church Road -27028 Proposed Facility: Residence Property Size: 3.608 Acres **NOTEC * I his improvement/Operation Permit DOES NOT authorize the construction 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. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT 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 PZ O #People #Bedrooms y #Baths_ Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industriall Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow (GPD) —hL Site: New 9? Repair ❑ System Specifications: Tank Size GAL. Pump Tank Other: '7� �,//'11 t1, Required Site Modifications/Conditions: GAL. Trench Width Rock Depthnn� U Linear Ft, 4.41/ �� r� IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this 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.**** Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001098 Tax PIN/EH #: 5757-23-1753.66 Billed To: David & Tina Reid Subdivision Info: Reference Name: David & Tina Reid Location/Address: Turrentine Church Road -27028 Proposed Facility: Residence Property Size: 3.608 Acres ATC Number: 2405 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 I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: CERTIFICATE OF COMPLETION Date: SA —dcD **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation 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 guarantee that the system will function satisfactorily for any given period of time. �)so 75I 17� 7si Septic Systtsm Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) ME Date: (,--, —e --� t 7cz APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 **:THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED S PROVIDED. Refer to the INFORMATION BULLETIN for instructions. be Billed Mailing Address City/state/ZIP 2. Name on Permit/ATCC if Different than Mailing Address Contact Person City/state/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC moth 4. system to service: ❑ House Vl�obile Home ❑ Business 0 Industry ❑ Other s. if Residence: t People # Bedrooms�— # Bathrooms _ (I Dishwasher (I Garbage Disposal or-'shing Machine II Basement/Plumbing (I Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # showers IF FOODSERVICE: # Seats # Urinals # People # Sinks # Water Coolers Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City Well ❑ Community a. Do you anticipate additions or expansions ofthee facility this system is intended to serve? 9-1res ❑ No If yes, what type? �--�1A� ko 11 .aa ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 5OD� V`T�� 1 RITE DIRECTIONS (from Mochsvilie) to PROPERTY: Tax Office PIN: # S-757—� � � � '�t ' -4- Con Joo-&oI +(-)-L21Va& Property Address: Road Name ad n omm Qnocl,5 0 Ad City/Zips'yCCk"ife If in a Subdivision provide information, as follows: n)&M Name: Section: Block: Lot: Date Property Flagged: 00 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 to conduct all testing procedures as necessary to determine the site suitability. DATE A 110 l0 SIGNATURE )01G 6 THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: ERS: Account No. IoAr r Invoice No. 0 RUTH W. SEAMON D. B. 155, PC. 420 87*50'33' E 432.95 - AREA— 5.001 AC. N.i P STONE 287.90 AREA= - 3.608 AC. INCLUDES S.R. 1802 W INCLUDES. S.R. 1802 I 1p tr cl) m oc)o co z z s z cr) Q, ko ko q N I p -7 N I P 3/4' 71 p 0 12- pit4E BRUCE CASKDDON 5.001 AC.---D.B. 89, PC. 426 S.R. 1802 R/W In 10 ID Lo 'u Cl 4 CD _-ft ko Ln Zo 96 N.l.p CD NIP K4A(; NA.P L 1-0 MAr, �7 NAIL TURR -5- ENTINE ko - Dill CHURCH RD. co <3 00 % 1802 S.R. ul co m co z z s z SITE CLASSIFICATION: Ar I EVALUATION BY: LONG-TERM ACCEPTANCE ACCEPTANCE RATE: • OTHER(S) PRESENT: 0 REMARKS: LE ND LandscaPosition 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 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 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Landscape position Environmental Health Section Soil/Site Evaluation HORIZON I DEPTH APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001098 Tax PIN/EH #: 5757-23-1753 Billed To: David & Tina Reid Subdivision Info: Reference Name: David & Tina Reid Location/Address: Turrentine Church Road -27028 Proposed Facility: Residence Property Size: 3.608 Acres Date Evaluated: Consistence Water Supply: - ite Well Community Public Evaluation By: �BingPit Cut SITE CLASSIFICATION: Ar I EVALUATION BY: LONG-TERM ACCEPTANCE ACCEPTANCE RATE: • OTHER(S) PRESENT: 0 REMARKS: LE ND LandscaPosition 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 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 05/99 (Revised) Landscape position HORIZON I DEPTH HORIZON II DEPTH Consistence HORIZON III DEPTH r��fmr��*AW2MelI EMM MISr������� HORIZON IV DEPTH TM Consistence SOIL WETNESS SAPROLITE Nia SITE CLASSIFICATION: Ar I EVALUATION BY: LONG-TERM ACCEPTANCE ACCEPTANCE RATE: • OTHER(S) PRESENT: 0 REMARKS: LE ND LandscaPosition 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 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 05/99 (Revised) ■ ■N■ ■E■ ■ ■ ■■■■E■ ■■M■■■ ■■MNO■ ■EMME■ ■E■NE■ ■E■■E■ ■EN■E■ ■EN■■■ ■■ME■■ ■■E■ ■ON■ ■OE■ ■■E■ ■ME■ ■■E■ ■■ ■■■■■■E■ ■EM■M■■■ ■E■■EEM■ ■■■ME■■■ ■E■■ME■■ ■MM■■■M■ ■M■■■ME■ ■■E■■ME■ ■■ME■ME■ ■■■EMEM■ ■■■E■ME■ ■E■EMME■ ■E■M■■E■ ■EMEMME■ ■OM■■■E■ ■E■■M■M■ ■E■■E■■■ ■■E■■M■■ ■ ■ ■■■ ■NM■ ■NE■ ■E■■■■■ ■EE■■■■ ONENESS ■■ENE■■ ■■E■E■■ ■■M■■■■ ■MEM■■■ ■■MMEM■ ■■M■■E■ ■■E■■M■ ■■M■■E■ ■M■■■M■ ■■■E■N■ NOON■■■■i ■■�NMfrMri■■■■■■■■■■■■■i�■r� ■■■■■■Ori■■■■■i■■■■■ri■■■■■■■■■■�r�■u ■■■■E■ M■EEO■ /EE■■II summ■■ /■ ■■■■■■■■■■■■■■■■�■■�■■��■■■Ori■►�■■ ■ENN■■ ■■■■■■■■■■■■■%■M%■■■�■■■■ ■■■■■■■■■■■■■■■■■I..\.�7I■■►.NOON■I■■ NOON■■ ■■■■■■■■■■■■■■■■■■■■■i�■■■ ■E■NO■�■■■■■■■■■■■■■■■■■■■/.■■I.■■ ■■■NOON%ill■■■■■■■■■■■■■■■��■■■�■I ■■■■■■■■■■■■■■■111■■■■■■■■■� ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ NONE MEMO ■■M■ ■O■■ ■■E■ ■■N■ ■■N■ ■■M■ ■■E■ ■■M■ soon ■■E■ ■■M■ ■O■■ ■ON■ ■ME■ ■OO■ NONE ■E■■ ■OO■ ■EM■ ■■M■ ■■M■ ■E■■ ■E■■ NEON