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1852 Underpass Rd (3) _ DAVIE COUNTY HEALTH DEPARTMENT � rf_�G_ � ; ` Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 " (336)7S]-8760 IMPROVEMENT/OPERATION PERMIT J,r p c� � Account #: 989900011 Tax PIN/EH#: 5871-77-8297.Barn Billed To: Carolina Building Systems Subdivision Info: Reference Name: Christine Dean Location/Address: Underpass Road-27006 Proposed Facility: Bam Property Size: 15 Acres **NOTE**'I'fii b�mprovement/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 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 #People #Bedrooms #Baths� Dishwasher: ❑ Garbage Disposal: 0 Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size ��AU Type Water Supply�V�// Design Wastewater Flow(GPD) /,,�� Site: New� Repair� System Specifications: Tank Size//Idi? GAL. Pump Tank GAL. Trench Width��Rock Depth�.Z Linear Ft. d� 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(33G)751-87G0.**** �� �� Environmental Health Specialist's Signature: �� �//y Date: �'`i ;�„��-�7(� DCHD OS/99(Revised) 1 � � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 9$9900011 Tax PIN/EH#: 5871-77-8297.Barn Billed To: Carolina Building Systems Subdivision Info: Reference Name: Christine Dean Location/Address: U�derpass Road,27006 Proposed Facility: Barn Property Size: 15 Acres ATC Number: 2461 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION '�*NOTE** This Authorization for Wastewater System Construction MUST BE ISSLTED by the Davie County Environmental Health Section prior to issuance of any building permit(s). T'his 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 Treahnent and Disposal Systems). THIS AUTHORIZATION FOR WASTEWAT CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: � �� Date: � ��� CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis Certificate of Completion shall indicate the system described on ImprovemendOperation 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. �1`�� I ���� L � V � c� �x� � Septic System Installed By: � Environmental Health Specialist's Signature: - I � Date: �J —/D rd� ✓ DCHD OS/99(Revised) c .+.� M � APPLICATION FOR SRE EVALUATION/IMPROVEMENT PERMIT I�I �"� � � a u � ' Davie County Health Department Environmenta/Heal(fi Section � — $ 2��� P.O. Bou 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ���DAVIE COUNTY H ***II�ORTANT*** THIS APPLICATION CANNOT HE PROCESSED UNLESS ALL THE REQUIRED INFORt�TION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. /�- _J /�/f r � 1. Name to be Silled (�6�c(//2Cry �/�(l�l�`Iji i Y�� Contact Peraon fF(�� , ��� Mailing Addresa �� �jpf� ��g? Some Phone City/State/ZIP ����IL��i IV� L�jJ L`t'� Busineas Phone (�'f— �3�� (G�I 2. Name on Permit/ATC iP DilPerent than Above ��`����� J/!:� r�iiing naa=ees 1$.r'�Z UN���ASS � city/stata/zip �flVA�1C�F /�C Z?��o 3. Appiication For: ❑ Site Evaluation ❑ Improvement Permit/ATC � Both a, sYatsm to sez�ice: � House ❑ Mobile Home ❑ Business ❑ Industry � Other B� 5. If Residence: # People � Bedrooms # Bathrooms ❑ Dishwaaher ❑ Garbage Diaposal ❑ Washinq Machine fl Baaement/Plumbing CI Basement/No Plwnbing 6. IP Huaineaa/Induatry/Other: Specify type �� �`�r'F'�1.1 Y People �i Sinka � � Commodes � • Shorera � # Urinala � Water Coolera IF FOODSERVICE: # Sests Estimated Water Usaqe (qallona per day) �. Type of water suppiy: ❑ County/City �Q Well ❑ Community e. Do you anticipate additions or eapansions of the facility this system is inteaded to serve? ❑Yes �No If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Eit6er a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: �� �� WRITE DIRECfIONS(from Mceksville)to PROPERTY: Taa O�ce PIN: . # .5�7 I- 77- 8Z 9 7 ��� �l�sr � gv� � C o � Property Address: Road Name �/���<'/✓�tJS �d. V�Da��S � f�"� TL. lOU Y,I�S. City/Zip /7�U�s-aCC ���'G� Ul`� 2l�at-fT . If in a Subdivision provide informallon,as follows: Name: rV f� Section: Block: Lot: Date Property Flagged: � � �U'� T6is is to certify that the information provided is correct to the best of my knowledge. I understand t6at 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 jor all charges incurred jrom this appl�cation. 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 �Pl S!lN� ,I��1t,1 to conduct all testing procedures as necessary to determine the site suit•bili . DATE��/Z�aU SIGNA � � —�- THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Ezisting and proposeci property lines and dimensions, structures, setbacks, and septic locatio s). Site Revisit Charge . Date(s): r�� _ ( � � Client Notification Date: ; ._ j l' _.,� EHS: Account No. V j/ Revised DCHD(07/99) Invoice No. /�� �' �L 7Gl oG£ .; , . � . . . � _ _ - . 8�-,es-•"' - ' t . - p£ . gt yZ9 M'.• �+ '{�+~ '�O �.� . ,e: . -:y_:. a, � ' o1ArJ 4:� '•T''� L��A� LD� � Q �i`� �t'y y� �..'°� � • 9v S8 D Y cS:4I'•ZL S �" 40 ���. b' ydll4 K. �� ����i � • � • "..i Y— • /Y�L4S6S M�' �O .9.c�6\ O• ,10 Z S t = `ow� �w�y�� �� � Y • •�i , M..��;�y•.[t S �= o� r �9s9i �� •• .0 !� `'� ��oVi o . 'y' � '1f . �i/ ,y . , •C��~ � .02 �� `` , a� - � ' � ,y�~�: �'�f� �O`��0 �r'?• O � e~/•( 1+4+ �y'f � �r . 'cr`� '. . � ,�d . �� S����Oy,��y � f 9 . 0 �.Q, S *� �}. �'' y :� �`'ca, �S�'� a� d, �U �' :�,�' • ♦ ��� / . ,,,� �'d�j y .c, ,d�a . „ a ��D� �: ��o ., � o,� r �• ,,;=� ri �� G�g� `�' r r' ? ; '+� _ ��1� I ` . ' � ` , � . �" g � N �9 �C 2. • 1 �� , b' 3�,;ss'�L•Fb��S ,J. � L�i ,t�'�'4 .O,: ' -� o �Q/�%O/si��� r � �,l/�0:� 9989► s , ��', : � 8O ,�j' �� �,��� �� 3�yp�££'.69 N / Zf'68 Oi' � . 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'91�y �" _ .��S �.���2b \ , ''�2H � � T"- - + £'�l ��� . � - . . _....:�: �_' � _ . : • f.5 . ._ : . . � ; " , �. � DAVIE COIINTY HEALTH DEPART'MENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900011 Tax PIN/EH#: 5871-77-8297.Barn Billed To: Carolina Building Systems Subdivision Info: Reference Name: Christine Dean Location/Address: Underpass Road-27006 Proposed Facility: Bam Property Size: 15 Acres Date Evaluated: �,��� Water Supply: On-Site Well Community Public �� Evaluation By: Auger Boring � Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition Slo e% ,,,.� HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH '� ` - ` Texture rou Consistence ( Structure Mineralo �` "/ HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE . L ,, S/ SITE CLASSIFICATION: 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 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 plas[ic 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 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 Classifcation-S(suitable),PS(provisionally suitable),U(unsuitable) r, LTAR-Long-term acceptance rate-gallday/ft2 �•DCi�15�05/99(Revised) �.-..,� �'� ■������■■■�■����■�■��■■��■■���■��■■■�����■�■�■��■■��■■■■���■■��■�■ ■����■■■■��■������■��������■��■���■��■��■■�■����■■�������������■�■ ■�■��■■■�■�■�■����■��■���■��■�■■�■■�■���■���■■�■■�■���i������■��■ ■����■�������■■��■��■�■�■��■�■�■ ■■■�■��■���■��■■�■■■■■■��■�■���■ ■����■�■■■■�■a�■�■�s■■�■■�■��■��■��■■�■��■�■■�■■e■e■■v�■��■�■��■�■ ■■�����■■■��■■■o��■����■��■�■■������■■■����■��■■■����■■■■�■�■■■��■ ■�����■�■■���■��■��■����■�e■�■��■�■■■�■��■■��■■�■�■■■o■���■��■■■�■ ■■■��■■■■�■�■�■�■��■�■■��■��■��■�■��■�■■�■■��■�■■��■������■�■■■■�■ s�■■�■�■■e■m�s■■o■�so�■���a■■�■��■■■���■�■■��■��s■�■■■■���■�■■■��■ ■■■�■�■�■■��■��■■����■■�■■��■■■■�■����■■�■��■■��■��■���■■�■■■■■■�■ ■���■�■■��■�■��■�■�■■�■■�■�o■�■■�■�■■■■v�■■■■��■■�■■v■■����■■■■�■ ■�������■��■���■�■�■■����■■���■■ ■��■����■■�����■�■■�■���■�■■■■�■ 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