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185 Whetstone Dr, r , , . . ;,.. : , , 0 � r._.. . .::p . � . . . . . . . . � - : . . � � - . . '.. � . . . , � � . � . �i . , _ . : � . �,JI' ��I�rl� AumHOxizA'riON No: O 5 4% DAVIE COUNTY HEALTH DEPARTMENT �� �• U� �� b b h�.��� ;. ,`, ., �, Environmental Health Section PROPERTY INFORMATION /� N,�� Perr�iti�e's 1_ ► . P.O. Box 848 �.j Name: �n�,�'�t � �y�e�4 Mocksville, NC 27028 Subdivision Name: �� Phone #: 704-634-8760 � Directions to property: �> t-'� �'�� ��`r► C�s�>� �� Section: Lot: _T? �bQ� \ AUTHORIZATION FOR , t; WK� �� S q� 1.�� u� �.�' 4 s� Q �,�;,� �, �"�5� WASTEWATER R; 1 _�J �7 �� SYSTEM CONSTRUCTTON Tax Office PIN:#�� y t: -`;—. � `;'.._ �n-•�?- �� �' ^ �, ' �:� ���.. � .�. � L�}:� Road Name: W LA�'' -�d Ti � ��ip: �"? �� **NOTE** This Authorization for Wastewater System Construction MIJST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Pernuts. This Forn�/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Pernuts. � (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) �._ �;�.,.,. ***NOTICE*** THIS AUTI�ORIZATION FOR WASTE�?VATER CONSTRUCTION �. �',,-..�-,.�3�.� ���� D' � IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED +�`s+ 3 t; ��'+• - �! �.. , bi ✓j/i` �'•`, �i� M1 t'� ,�,� ,, j,-- �`�� bAVIE COUNTY HEALTH DEPARTMENT ��` {�� `' �� b b .., ,` IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION �= }y,,f�� Per�ruti�ee's 1{ , �_�. �Name: ��'� �,�,.�2_ ��I; i -'�%. � t�L'�c� �1tt ' - `, , �r Directions to property: � � ; � ". :.. �. ( ,•� ''r .: : � � ��. ,� ;,, `� ,3,.�� .� \' ''� c Y : . l .. ° , , `� "� ., ,� �::i,, ' �� : , � Y �� _ � , . �;, p ;,:, IlVIPROVEMENT PERMIT , � �Q-ai � Subdivision Name: ' ��'� �' �1u Section: Lot: � _-1 b; � � ,� �1�� Tax Office PIN:#' •' �� %. - -' - � � � ►. +•,- � s�"' Road Name: �-h���w �c� n� : � ���ip: �.� �r-.�S **NOTE** This Improvement Pem►it DOFS NOT authorize the construction or installatiQn 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 pemut. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF STfE . �^ -`%•�-� 1+`.�i "" ��"�'i,, PLANS OR Tf� INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE TEIIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE�i • i��'+it,4# BEDROOMS �# BATHS ��`'� # OCCUPANTS � GARBAGE DISPOSAL: Yes o io COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLFJSHIFT LOT SIZE�> � R c�.-r� Z'ypE WATER SUPPLY ���. DESIGN WASTEWATER FLOW (GPD) �,�� SYSTEM SPECIFICATIONS: TANK SIZE �) U 0 GAL. PUMP TANK GAL. TRENCH WIDTH J 4 REQUIRED SITE MODIFICATIONS/CONDITIONS: �': IMPROVEMENT PERMIT LAYOUT cJ �= /= L', �.� -.��____-..,� ^�� � � � Y� # SEATS INDUSTRIAL WASTE: Yes or No _ NEW SITE � REPAIR SITE � t; ROCK DEPTH I-Z LINEAR FT�-� C)�� � **CONTACf A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR I:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT �� � SYSTEM INSTALLED BY: J�� � 0.� F d�� S�,a��,� _. AUTHORIZATION NO. G b�17 OPERATION PERMIT BY: C� ��� DATE: I� y� �_�� **TI� ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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'Tf� SYSTEM WII.L FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD OS/96 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section P. O. Box 848 Mocksville, NC 27028 (704) 634-8760 C� � �s1� �� 5� ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed .�,CU1.���J � �� Contact Person Mailing Address � Home Phone ��y — y�r3� (a �ot7�/ �, �� City/State/Zip d�F' ��Y(A-Q 'l�l:_ Business Phone 2. Name on PermidATC if Different than Above , Mailing Address 3. Application For: ❑ Site Evaluation City/State/Zip ❑ Improvement Permit & ATC �Both 4. System to Serve: ❑ House I�YMobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People � # Bedrooms �_ # Bathrooms �� ❑ Dishwasher ❑ Garbage Disposal �Washing Machine ❑ Basement/Plumbing ❑ BasementlNo Plumbing 6. If Business/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City ell ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes f�No If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: �` 1 ��`� � / I Tax Office PIN: # � % �b - � sz - � \.� � Property Address: Road Name Wh��' S�G jJ 'e ��� � I City/Zip �oC�t � i��-o � � � 0� � � � If in Subdivision provide information, as follows: Name: Section: Lot #: � WRITE DIRECTIONS (from Mocksville) TO PROPERTY: f �1 S -- �-,� ct��S�� � � A`���3!iQ� � �_'� _. Q. This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter aze 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 as necessary to determine the site suitability. 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'a � � / q� , i �� / ,� � , . �.. , � , , � . / / i / �-,�� - '� / 'o � / -� % ,� ; ' ' ' -: � i 2 �.'� � , ;' 'l � , '� i , / ; . , ,. °, � 2 , � / , � , /� / � � ; ;y 1 � -- . � , ,/ / ; - � , , � � .,� , __ . , ,- � ,� , ' � � � � � �.� / > � � J � i / ,y�` `�'�' � � / / (S i, � j ] / / A ,^`, � ' '� �/ / ^ � l9 � � � , � ``� / � 3l . '#� � � � / /� i , \ . ,� , � ; .... �' � � � / �� ;' , �, ,, - � � ��� � � � � �i � � i ���- —' � I g � ' A , h� � � � . � �t :: :�+ �? � e� }� � , "�-� �'� ?� " � i4 . � �O� � / 5.6 A C � ��� U � . ;��,,� � �,� �..�� �,a / � � .� � � �� , / `( . ! �� , �� .� . � �� �1 � � � � N I � ( �� � � a � � �� � � � '����> �� � �� � ` �,.. �,��+''� � i � " ' � '�. 'e � K '�'., � c ' • ,� � �%' � I . . � . .,., r } . R , � . f � s �� � �. � � �1�� ` '': � � ` ��'�� � � 7w � � � •C � . rir� � ,.��. _` �� I PHOTOGRAPHY BY �����., L-� ''�� �-�- I L-5-i2 NORTH jSTER 8c ASSOCIATES, INC. �.UMBIA, SOUTH CAROLINA �-� '�` �-�-14 �-.`.�-13 PHOTOGRAPHY: MARCH 28, 1976 � M-5-2 M-5-3 M-5-4 DAVIE COU��: T A X N� SCALE� I"= �, � ,' . ' ` ' � '• DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section Soil/Site Evaluation NAME �r���'- DATE EVALUATED � b- I? /� ADDRESS S'A`cc�..-� PROPERTY SIZE �� � �� PROPOSED FACIILTY �� H� � Q LOCATION OF SITE Whz�" s'�C'o N-Q O R Water Supply: On-Site Well ✓ _ Community Public Evaluation By: AugerBoring j/ Pit Cut FACTORS 1 2 3 4 Landsca e osition S � Slo e 7. O-8° �' HORIZON I DEPTH fo �� Texture rou �,1._. Consistence Structure Mineralo • '. HORIZON II DEPTH 1" �` Texture rou � Consistence -�I. Structure k Mineralo :1 ' 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 .L1 .i SITE CLASSIFICATION: �S- EVALUATED BY: CSL.,os� ��� LDNG-TERM ACCEP ANCE RATE: ��^ OTHER(S) PRESENT: ���� REMARKS: � �•� �z7� — — � _ - ---- LEGEND Landscape Position R-Ridge 5-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 �;lay loam• SIL-Silty loam CL-Clay,loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-V+��y friable FR-Friable FI-Finn 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 ,iC--Sin�le grain M-Massive CR-Crumb GR-Granular ABK-AnQular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralaicy 1:1, 2:1, Mixed Notes H orizon depth - In inches Depth of fill - I❑ inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free watef 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/f12 DCHD (01-90� Ni■�■��■ ■ ������������■■�������■��■��� ■���■ ■�■����������������������■■ ■�■���■■ uti������� �������������������■������������■■a�����■����■�■����■����■���■�����■�■�■■ ■���■���������n�■■��■�����■���■�����■���■�����■■ ■■��■�■■�■���■�■������■�������■���■ ■���■�����■���������������■■������e��■���■�����■■_�■����������■■���■■�������■�■�����■ ■�■�■���■■■������ �������■�■■�s����������������u■���s■�■��■���■■■�■■�����■■��■�����■ .................C...... . ..................... .. ................................. .......... ..........C. ........ ..o.........C..=................................. .:C::::C:=.�:::::::�:� ........0......................'.......................... .............. ........... ... .......................... ..........................■..............i�..........._.............................. ■��■s����■ �n ��■�n��������u�■ ����■ ■��■���������■���■��������������■����������■ ..�....._.�.. ...................C.�..._............................................ �� ■■��■ ■■ �� ���■������■�■■�� ■ ■ ■ ■�������� ■���� ■��������■■�■��■���■�������H■ ■���■������■ ■ ■�■���� ������� ������■�����������■�■����■■■�■�������■��������■ ............�. ........C:C�...=...�s=............................................... iiiiiiiii��������������■n= ��■ _�■ �����■���■�■ ■���������■■�����������������������■ ■�����■�■�■��� ■ ����� ��■���■■ ■����■�■�����■■���������■��■��■����������■ ■������■ ■�■■���■ ■■■������� �■ ■������i���■ ■■����������■�����■���■������������■ ........C........0 ...■. ..■.C�� ._.■...........�.................................... ■�������������■���_������■���� ■=���n�■��■�■������������������■■����■■�������������■ ■���������n.��������■ ■����� ■ ■■��������■��������■����■�■���■���■��������■������■■ ■■�■���u�i����-.�::�i��■=i�i����■� ■��■��������■�����■ ■�■�■ ■���������������������■���■■ � ■■���������■��������i�■ �����■�� ■■�����■ ■�■ ■■��_��■■ _��■ ■����■�����■�������■�■ ■ ■�����������■�:��������_ ������ ■ ��■�=����ii ���������=�■��5�����■����������������_■ ■��������i���������.�i���=���■����■����� ■ �_���������■���������������■����■��������■ ■��■�����I/��n7��V■II��n■�■������� �������� ■�■��������������������������■■■�����/�■ � ■������������Gi �Er 1��� ■�■H� ������■ ��■���■�����������■���■■��l�N������������■��■ .............�3.��C��..�:......D...=.=.0.............................................. ■���■�■■■�����7�t������ ���r-���� ■ ���■�■���������■����������■�■�������������■����■ C:::CC:CC::::�:::::�:::.C.�':'::�:::C::::::::C::::::::::::::CCCCC:::C:::CC:C::::C:CC: • _..::::::..��.��..�■..� ':C�=.��.■......�..�.................. ................... ,.J i��� i �n �N■�l■_e �u �� ■����■ ����■■ ■����■ ■�■��■ ■■ , ��■������i�s�=���ii��� ,i����-�.�-=��•�����.►�������■���������■ ■����������■��i�■ ��■��������i�� �■����i�u��ii��• ��������►�iiiiiiiii�iiii■iiiiiiiiiiii=iiiiiiii�i ■��������� c���N�■ �'" ___��■�� _ � ■��������i��■ ��n■ �� ������ .� ����■ ��������■ ■■��■u�■���■��������������■ ■ ■��������i���■ ��n = �=�i=i u�■�i� ���::�����■������■■■■�■��■�����������■�■■�������� ■i�■=��ii� � � - 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