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247 Willow Creek Ln (3) . DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section ��7j ' � P.O.Boz 848/210 Hospital Street Mceksville,NC 27028 (336)751-87C0 IMPROVEMENT/OPERATION PERMIT Account #: 990001304 Tax PIN/EH#: 5820-80-2267 Billed To: Elizabeth Cox Subdivision Info: Reference Name: Location/Address: 1443 Willow Creek Lane-27028 Proposed Facility: Residence Property Size: 7.176 acres **NOTE*��iibgmprovemendOperation Permit DOES NOT authorize the construction ofa 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). THLS 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 1� #People � #Bedrooms�_ #Baths�_ Dishwasher: � Garbage Disposal: ❑ Washing Machine:� Basement w/Plumbing:� Basement/No Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size "71q�i Type Water Supply f/�1t' Design Wastewater Flow(GPD) Llp� Site: New� Repair❑ System Specifications: Tank Size �V GAL. Pump Tank GAL. Trench Width C�C� � Rock Depth� Linear Ft.�� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROV F T FILTER RISER(S) IF 6"BELOW FINISHED CRADE. ****NOTiCE: Contact a representative ofthe D ie o ty ealth Deparhnent 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 i ta at on. Telephone#is(336)751-87G0.**** � r Environmental Health Specialist's Signature: �!�,��"-�/ Date: ���� � DCHD OS/99(Revised) ' • . ��� . DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Heaith Section P.O.Boa 848/210 H�pital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001304 Tax PINIEH#: 5820-80-2267 Billed To: Elizabeth Cox Subdivision Info: Reference Name: Location/Address: 1443 WiAow Creek Lane-27028 Proposed Facility: Residence Property Size: 7.176 acres ATC Number: 2515 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his 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 11 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 SpecialisYs Signature: �� Date: ?f '��S ��� CERTIFICAT COM **NOTE** T'he issuance of this Certificate of Completion shall indicate e system on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S.Chapte 30A, S ion 1 0"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken as a guarantee t t the sy em 1 function satisfactorily for any given period of time. t�. QC.., Q� �� � F _ � _ Septic System Installed By: '/ Environmental Health Specialist's Signature: Date:^,������ DCHD OS/99(Revised) �:� , • � T � . • APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC � � � � � M � Davie County Health Department � Environmenta/Hea/th Se�dion � _ � 2000 � � P.O. Sox 848/210 Hospital 3treet � P� �o�xsoiiie, rrc z�o2e (336)751-8760 ENV{RONft9ENTAL HEALTH DAVIE COUNTY ***Sl�ORTANT*** THI$ APPLICATION CANMOT HE PROCESSED UNI.�$3 ALL THE REQUIRED INE'ORMATION I3 PROVIDED. Refer to the INB'ORMATION BULLETIN for instructions. 1. Nama to bo Hi114d ��1 2 f� ��7'� � l d K Coatnat F�rson MailinQ 11�ddtos• ( � ���C �Y Y 3 6oma Phono Z���� 3 S � City/Stat.o/ZIP !�(O C KSVi11 Q /��L Z�a2.�' 8winoss phono 7 � � - S7 O � 2. Nam� on p�zmit/ATC if Dilf�rant Lhan Abovo Mailiaq ]�d�dros• City/8tato/Lip �D� 3. Application For: e�3ite Evaluation ❑ Impronement Permit/ATC �'Both a. sYec� to s.�c.: H House ❑ Mobile Home ❑ Busiaess ❑ Zadustry ❑ Other s. it Residenca: t People Z t Bedrooms � � Bathrooms _�_ [7 Dishwashor fl Garbaqo Di�posai i�'ilashinQ lsachino �Basomant/Plw�biuq ❑ Sas�nt/No ?lumbinq 6. 2! Bu�ino�e/Induetry/Othor: 8pocily type � Pooplo / Sialcs � Co�odos # ShoMors � Urinals N Rabr Coolors IF B'OOD3ERVIC�: # Seata 8stimated Water Usage tQ�ion, �: asy) 7. Type of Nater supply: 0 County/City C�'Well O Gommunity e. Do you anticlpate additions or e:pansions of t6e facility this system is intended to serve7 9'Yes D No If yes,what type? 1 6C��J fo�M ***lMPORTANT't**CLIENTS MI/ST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED �BELOW. Eit6er a PL.AT or SITE PLAN MUST BESUBMITTED by the cllent wit6 THIS APPLICATION. _ _ Property Dimensions: /• � �P � �r'P1' WRITE DIREGTIONS(trom Mock4ville)to PROPERTY: Tai Oftice PIN: # .�S Z U - �C�-Z 2(c 7 CQ U 1 n� �-a Cq�� �� Property Address: Road Name ),�/, ��� w L/�-c� jn ��" v� �a�� ��ar c�n !�� City/Zip �I o c,�s�� ��� 27�2� ��- v n G�, I i v w Lr`ee k L� If in a Subdivision provide information,as follows: i AS3 s�n��� w i �C-' o�. I'�: Name: �/'a(�e`'�y lS 7 ,Q cI'QS �QrweP�'� '�^ti"�" sr��'�e WI� Qd_ Section: Block: Lot: Date Property Flagged: rt����e G1i,Q� This is to certify that the infotmallon provided is conect to the best of my knowledge. I nnderstand that any permit(s) issued hereatter are subject to suspension or revocatlon,lf t6e aite plans or intended ose change,or if the intormatlon submitted in t6is appllcation is falsified or changed. I,also,understand that I ant responslble for a/1 charg�s lncurred jroni th�s applicatlon. I,Lereby,give consent to the Aut6orized Representative of t6e Davie County Health Department to enter upon afwve described property located in Davie County and owued by L�l t G I> e,�� (��h to conduct all testing procedures as necessary to determine the site suitability. DATE �� ���v SIGNATURE �:���/( C`� � THIS AREA MAY BE USED FOR DRAWING YOUR STI'E PL.AN(Include all of the following: E�aNng and proposed property lines aad dlmensions, structures, setbacks, and septic locations). ����� �.� �F( ��5�� .���� Slte Revisit Charge . �v �C�f'� � 6�C K . �� ����S Date(a): Client NotilicaHon Date: -�I �sfl � ��e �a �� n�S L. o�.J� , EHS: Account No. ��5 �' � ��� �� � Rev[sed DCHD(07/99) Invoice No. �� n/f CJaude Foster f I and �fe 18 � Carline B. Foster I p9,g 0"W t dc 1/4"-EIP OB 50 O PG 257 D B 5 8 � pg N I \ N J2o ���E � ���� �R � � � \ APProximote Co�ation of 8ipxh � — — � � � / 784.85' � _ � 1 � \ \ � i/2" E/R N ' o � � � 2�pp"E 357.83' E V� � �/2"EIR 243.57' E � Tax Lot 49.09 � S 78°00'00"E �` P Part of Tax Lot 49 raX MQP c-4 �N� , Bobby D. Browning .�E � �� Tax Map G-4 DB 192 O PG 354 �Z86' u j,/���-�__ , �ne� +/- , / _ �5�+,� /- � 20, � � �/2,� ErR N 2 151.81' /�' i S 22°14'35"E L 642.01' 77.57' p . ��ese�°9��� � /' Part of Tax Lot 49 j 72°35'35"W S 00°23'25"W � ��5 �' Tax Map G-4 � S � � 0 1�� i /�' � 4 H�—'�r 1/2" E!R ° P �R '`� �`N 00°23'25"E � 539.65' TlE LINE 1/2" E1R PP �1� P /� -- ,30oE �` `—'4E�� I 3°� / 5� / � ` ���' �' z I 12' / PP / / I / ' IRS �' � ` ���� '� I � , 6, c .� 1/2" E!R �69 6 / Tax Lot 49.03 I � //' Tax Map G-4 Kevin Gerard Wright , "�°t�1 � � c a/w Kathy Laigh Wright 'a',196 /� �I D8 188 O PG 276 � 1\ � �� ~I I / - o0 . . ,..ti A '. � J � DAVIE COUNT'Y HEALTH DEPARTMENT . � � Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001304 Tax PIN/EH#: 5820-80-2267 Billed To: Elizabeth Cox Subdivision Info: Reference Name: Location/Address: 1443 Willow Creek Lane-27028 Proposed Facility: Residence Property Size: 7.176 acres Date Evaluated: �''-��D(� Water Supply: On-Si[e Well � .�' Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition Slo e% /�U HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH (v �' ' Texture rou Consistence Structure /c Mineralo •l .`r 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 SITE CLASSIFICATION: EVALUATION BY: �i�2�/ LONG-TERM ACCEPTANCE RATE:� OTHER(S)PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Lineaz slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Tenace 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 Mineraloev 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-gaUday/ft2 DCHD OS/99(Revised) ■�■���������■��■�����������������■■��■������■������������■��■■���■ ■����■����������■��■��■��■�■����■■�■�■���■���■��■■�■���■�■�■�■�■�■ ■�■�■���■����■■��■���■■��■■�■��■��■■�■■■■�■■���■����■■����■�■■��■ ■�■��■■�■��■��■���■�■■�����■■■�■ ■��■■�■■■■����■�■■■■■�■�■��■��■■ ■�■��■����■��■e■�e�����■■■■��■�■���■�■��■���■■�■■ss��■■���■■■����■ 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