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256 Wildwood Ln , � . DAVIE COUNTY HEALTH DEPARTMENT � � �� � " Environmental Health Section O / • ' P.O.Boa 848/210 Hospital Street • . - Mocksville,NC 27028 (336)751-8760 � IMPROVEMENT/OPERATION PERMIT Account #: 990001728 Tax PIN/EH#: 5769-46-6372jm Billed To: Jerald&Patricia Martin Subdivision tnfo: Reference Name: Location/Address: 256 Wildwnod Lane-27006 Proposed Facility: Shop Property Size: 13.489 acres **N07'�*'�'�iibgmpro 8e3ient/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALJTHORIZATION FOR WASTEWAI'ER 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 PERMTT IS SUBJECT TO REVOCATION IF SITE PLANS OR TAE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE INSTALLING SYSTEM. � ' n°T �A1 Residential Specification: Building Type C����ople � #Bedrooms #Baths � Dishwasher: � Garbage Disposal: ❑ Washing Machine: 0 Basement w/Plumbing: � Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 0 Lot Size C Type Water Supply—��� Design Wastewater Flow(GPD)��� Site: New�Repair❑ System Specifications: Tank Size%dD GAL. Pump Tank GAL. Trench Widtl���� Rock Depth��Linear Ft.� 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(336)751-8760.**** �-- �r Environmental Health Specialist's Signature: Date: ����� i DCHD OS/99(Revised) . , . � � DAVIE COUNTY HEALTH DEPARTMENT � � Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001728 Tax PIN/EH#: 5769-46-6372jm Billed To: Jerald�Patricia Martin Subdivision Info: Reference Name: Location/Address: 256 Wildwood Lane-27006 Proposed Facility: Shop Property Size: 13.4$9 acres ATC Number: 2831 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSLJED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA NS UCTION IS VALI F PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: � Date: �'2 �(?� CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on ImprovemenUOperation Permit has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. �DO�X��` r Septic System Installed By: Environmental Health Specialist's Signature: Date: �~" S '"�� DCHD OS/99(Revised) SYNAGRO � �, � 33b 766 8b52 05/03/01 09:00 � :01/02 N0:155 � , , � , • �+ " �� � � 11 FUli SITE L•VQLUAI'ION/fhIPROVEMLNT I�L•RMlT&ATG � � �avio County Health Department AP{� � 6 �� �nvirvnmenla/Hea/t�ft Section P.O. Boz 848/210 Hoap�tal 8treet Macksvill�, NC 27Q28 ���Q�'��� I336)75i-8760 TANT+�** THIS A�PLxCATION CANHOT B� PROC�SSED LTNLESS ALL THE REQUIRFD IN�'ORiQITION I3 PROVIDED. R�Pax to the INFOR2�iTI0N StT7.L£TIN foz ittstrpetions. 1. Namw to }aa Di],let! �.Tf� �Q � JJ��� / 17 _ ----��-�d /.�.���n Contec4 Porsan /' T/ 1sai�inq Adeireao `t�� -SfiC��[' ��j"'I71 �/�. itom� Pnon�.J�3�o"'Y 7 Z ' ��'7 7 city/stace/1Gxa �Q,I^!'�CZl��-� � c'���oy�ll , au,in*.s 8hoa� �3�" 7��o '-Q.��� 2. Ham� on F�rmit/]►TC i� Di!lor�t tAan ]lbovr ?!a_i2lraq 11dr,iroes City/aCaLt/Zip �. Applxession 6orr G1. Sita•$valua��on ll Ymprovemertt �Pos'm�.ttATC ._. . • - �io�h �"�'"'•'"'• �. ByaW�m �a s.r,.i�a: I] Flou$e C1 Mcbile Home C1 gua�es� � Yndu�tzy �-O�h � s. 2r Rosidence: � Peo$1s � Sedt�oo�$ � Bathrooms I.I Di�h�A�?��t i l Gdiaba� Di�ppsal (7 ilaar,inQ Niahin� U Bas�eht/Piu�binq [1 Baepmonn/Ho B,Lvmbinq 6. if Buainsis/Ir+duotzylather: 8paoity typa i People � Siakr �� � Commod�a � � 8howore �` � Urinals f 1falor Coolprs �P' FooASERVICE: # Seats �� &�timated Water Usaye c��ior,a �= asy� P.r �1�"�G �. �pa of xater �upp�y: 0 Couaty/Ci�y ��,Tell f,l Commqnity e. Do you anlicipute�Jditions or ezpansioaa ot the f�ciltty tbis syste�es intended to sorve'� L7 Ycs �o Ityca,'What typc? `++I11�PURTANI"""*CL�EI�ITS MUS�'CpMPLL'TETI�IE ItEQUIRliD PJiUPERTY INFOKMA'I'!ON RF:(tUFS1'LD BELAW. Either A PLA7'or SiTE PI.AN l�lUST BESUI3M!?7CD by tLe client with THIS API�LIGATiQ1V. � P�operty I)imonsionx: /�.�.���1 Q�C�� WR1TE DIRECI'IONS(tro#u Mq�li,irille)io PROI'Clt'1'Y: ...._.. . �Y'ux UfficC Pl1�l: #.J�� 7-�� -(�,3 �2 j Y�^ /���1/M a � � lCrYlQ,rz��/Cc/ i-ccrf� r �.+t�n c.�c� Property Addreas: Road Numc��.�o �i�C�ttJOocf�ti/1� y /P-��� ��l�'��a� „ s h� Clty2ip �JIdC�-sd,�le. N� z Taz�' ��.�r{ �. �?�ASS/i1� �'D ��l�irloor� � i If in u 5ubdivi�ion providc inCorr,patioa,aa fullows: n 1�,r�i-� Ci�,pre,� �o m. . 1�ur'r� �P�� � N8[17C: Q�J�i'ar � U���r'{� a/� �P�i•• SCeC���.Ju�raP/S ScctEvn: Iilvck: � I.ut: Date Froperly Rlag�;ed: '1,/j��/ I� � T6is ia tu certlfy thut t4e intorneation prov�ded is correct to the best of my kaowledge. I understand that a�y per�pit(s) issued hcreufter nre xubJect tu suspeasIon or cevocatlon,ltthe ait�Q1an�or intCndcd use c�aage,oc if t6e infnrmati�n submittcd iu ibis applica;eon es falsificd or c6sngcd !.Qlso,anderslaxd tbat!ant respoRslblcjos aAchar�c.�Inc���rcJjro�ri lbis appllc•vlioa. 1�hcreby�give consent to the Authurizcd Rep�es�entative uf the I)avie Couaty X�caltli Ucpnrtnient ln enter uj�un ubuve�escribed properly lacated iu Uavie Cuunty uad owncd by �, tu conduct •rll tCstit:g prucedures us veccssary tu Jetermine the aite au[tAbilily. DATN: r/-• 7�-cJ/ SIGNATUltE . . . .., —' THIS AkEA MAY BE USED FOR DR1I,WING XOUR S�TE�' (Iaclade all of t�e folldwiug: Esiatlog aqd ptopoocd pronetly 1(nes and diwtusFoaa, structures, setbacks, aad aept ocations). Sile Rcviait Charge ...._.. , ... _. . 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INC. � ��SEE D.B. ;l!1 P�. �} 1 . - � . . . � � WI'f�lMl � 9.650 ACRE TRACT ' . � �- v�i SAYt1EL o. r_u�ea�u � • . . ' . . • ���� � , . DAVIE COUNTY HEALTH DEPARTMENT - • � - Environmental Healih Section � • • Soil/Site Evaluation APPLICANT INFORMATION ' PROPERTY INFORMATION Account #: 990001728 Tax PIN/EH#: 5769-46-6372jm Billed To: Jerald&Patricia Martin Subdivision Info: Reference Name: Location/Address: 256 Wildw�ood Lane-27006 � Proposed Facility: Shop Property Size: 13.489 acres Date Evaluated: !6!d Water Supply: On-Site Well `/Community Public Evaluation By: Auger Boring � Pit Cut FACTORS 1 2 3 ' 4 5 6 7 Landsca osition � � Slo % HORIZON I DEPTH - Texture rou � Consistence , Structure Mineralo HORIZON II DEPTH �` '� Texture rou ` Consistence /� / Structure i: , Mineralo .� HORIZON III DEPT'H Texture rou Consistence Structure Mineralo � HORIZON N DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON � SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 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 day C-Clay CONSISTENCE oist 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 tr c r 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 otes 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 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