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194 Potters Ridge Dr Lot 4 f DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT PERMIT *+)NOTE** This improvement permit DOES NOT authorize the construction or installation of a septic tank,4L�t r On&astewater 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) NAME n PROPERTY ADDRESS �U �' 1"�S G-�l'� �� a'rl DATE LOCATION 1 1 T�i�S 6G�►G)P. SUBDIVISION NAME �o��Q S ►a e LOT NUMBER 14 SEC./BLOCK"NUMBER RESIDENTAL SPECIFICATIONSBUILDING TYPE '}-�otno # BEDROOMS 3 # BATHS # OCCUPANTS 2 GARBAGE DISPOSAL: Yes No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Ye`s/No_ LOT SIZE 5 o.r l TYPE WATER SUPPLY CT DESIGN WASTEWATER FLOW (GPD) NEW SITE ✓ REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE)66D GAL. PUMP TANK GAL. TRENCH WIDTH _ ROCK DEPTH C � LINEAR FT. 41,06 OTHER REQUIRED SITE MODIFICATION �NDITIONS: ***THIS PERMIT;IS SUBJECT TO REVOCATION IF�SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. r :, u s C' . `,IMPRQUEMENT PERMIT BV **CONTACT A REPRESENTATIVE OF THE DAVIE'COUNTY"HEATH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF I TALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY �ro ' AUTHORIZATION NO. (� �j �� OPERATION PERMIT BY � �fi C��� DATE **THE 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 THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 10/95 -,T ✓k Davie County Health Department =r=` ENVIRONMENTAL HEALTH SECTION P.D. Box 665 Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION " (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) 1�1J ***This Authorization For Wastewater Osten Construction must be issued'by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits.*** �f l I ' J QO17 �S �CpIoRIZATIDN tLJRBER NAME mss. ���^cam. DATE b � QN NAME ON IMPROVEMENT.PERMIT (If different than above) SITE LOCATION .._ N Q V �\\Q oe 2S V�,► J COMMENTS/CONDITIONS ON AUTHORIZATIOW TO_CDNSTRUCT WASTEWATER SYSTEM r M"ITICE4" H AUTHORIZATION FOR WASTEWATER-SYSTEM CONST CTION IS VALID FOR A PERIODOF FIVE (5) YEARS. ENVIRONMENTAL HEALTH SPECIALIST j DATE DCHD 10/95 — APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER r* Davie County Health Department +.. Environmental Health Section P. O. Box 665 Mocksville, NC 27028 MAY' 1 31996 1. Application/Permit Requested By Mailing Address Home Phone Business Phone 70?- 2. 022. Name on Permit if Different than Above 3. Application for: ❑General Evaluation Septic Tank Installation Permit 4. System to Serve: X House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # _ 5 2 ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms Washing Machine No. of Bathrooms e- n ,�, dishwasher Dwelling Dimensions 30 Co / /d0NJ_ fil rotK 6t2,Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: X Public ❑ Private ❑ Co unity 8. Property Dimensions C U�2S Sewage Disposal Contractor 9. Do you anticipate additions/expansio of the facility this sytem is inten ed To serve? q Yes ❑ No If yes, what�ype? / 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: �WI�Xu�a)� / � R1, f Vk , R-` . �O Pt y vi Cf e W . ,ro x / <<� �-F'-� �,A MA La V� 4<- Tt-�- v., 4 1-96, 71n&LVk�0ur This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. ( — 9 DATE SI NATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY [and ECK ONE: 1. I OWN the property. ❑ 2. I DO NOT OWN the property. ked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner: ve consent to the authorized representative of the Davie County Health Department to enter upon above described cated in Davie County and owned by all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment al system. DATE SIGNATURE DCHD(1193) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE Water Supply: On-Site Well _ Community Public, Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH j Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATED 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 ':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-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 3C-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy /) V Y 1:1, 2:1, Mixed (� Notes ,(t 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(01-901 ■M■■Mi/N■■■MwI■M■■ ■■ ■N■ INH ■N■■N ■■NN■MMMM■■■■OMM/■/■■NO ■N■mM ■■/■■.■■■■■■■i■/■■:/■/MMNNNNN■M■N�■■■■■■■■■■■/■/■■■■■/■■■■■■■■■■ M=M■1iN■■■///\lt/t//nH■■. 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" .,+ r Is in +a�•• y' a l�ow TTNfUCENaEiltM[4• by A � YIIERSEC1101[Of - � Ni 1431 AND$4 14/o 1� y • a r Id 14R �A 5.2326.010 ac. 4,p B 143 $33, 368 " SOLD POWOSEGMILCO #A ww,�a�� i41 R � w - N' •Mr w i5.0011 O0 cc A ^ a IC 5.100 ar- - r w $OLD AV AMA co y r<a'u~it^r ">s547gpr $32,590 N i j M ib`�• n r \ M." m �•A� s � a t� di' 1 � w�sRw a,, M : u � 1 LL ) S Iis w / II�p • cn SOLD •serer• i •+s � t/Vi S�1"3Sti!'E o 1 44. s •w,• /�• O 5.001 0� .w•re• Z N� 5 t Lw •, `p• la.er r ! rrera WNIi',. O i. w sgrftr P�'• �► fte Z 5.001 ac. g st—A- ape $ a S O© a _. 'SOLD e�' M 5.995 cc. n w, W. ,pr. Is 5.255 ac. , SOLD = r_ SOLD \ w 5.274 or— w (n 1 M - *33,,616 zI` s Oftf" 4Ne3.Tt• Jo .. 5.098 ae. s as'44 4 � I CE SOLD P » SOLD ;p _ A5.132 oc. -- a c pi DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation E B)11\/ S (�1 1,�, >;1J DATE EVALUATED RESS s th 'Q PROPARTY SIZE r�• g4A S 'ROPOSED FA IIL Y �u s LOCATION OF SITE _ C T k>i p /0-�/3-g Water Supply: On-Site Well Community Public Evaluation By: L Auger Boring Pit 1� Cut FACTORS 1 2 3 4 Landscape position Slope Z -IR ° - HORIZON I DEPTH " b' Texture group L Consistence =S Structure C Z MineralogX ' HORIZON II DEPTH 2 '' Texture group C C Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS S _Z5 RESTRICTIVE HORIZON — — SAPROLITE — CLASSIFICATION S �, LONG-TERM ACCEPTANCE RATE U SITE CLASSIFICATION: =1 EVALUATED BY: p LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: \,\0 -tel 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 ::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-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 .3C-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(01-901 ■■■■.■■■■■■■■■■■■■.■■■■■■■■■..■.■■.■■■■■■■■.■■.■■■■■■/■■.■ ■■ ■■■■■■■■■.■■■■■■■■■.■■■■■■■■■■■■■..■■■■■■■■■■■■■■■■■■■■■■■.■■■■Sic ■..........■■■■■■..■■.■.■■...■■.■■■■■.■■■■.■..■■■■■■■.SMN■■■■.■■■■ ■...■■..■■■........■.....■.■...■ ■MONS■■■/■.■■.■.■■.■■■..■■.■■■■■ NOON ■...■■■................................■ ..M■■■ S S■■■■■■M■■M■■■■ ■■.■.■.■■■.■■■■■..■■■■/SSSS■■/■/■■.■■■■■■■■■.■■■■■ ■■■■■■.■■■■./■ iiiiiiiiiiiiiiiiiiiiiiisiiiiii°.■i��=nniiiiiiiiii■i■iiii■iiiiiiiiiii=? ■■■.■■■■■/■■■■■■■■■■.H..■■■MM...■.N■■■/.■.■■■■.■■■■�■.■■■■■■...■ ■■■■■■■.■.■■■■..■■■■■■HS.S■■■..MMSMMM.MMM■■.■■■...■■ .■MONS.■■■�. ■NN■■S■■■■■■■■■■■■■■■■■■■■M�N■\\MSN\1MM■■M■.S■N■■■■■■M■■N■■■■■■■.■■ ■■■■■■MM■■■.■■■S■S■■■M.■■..SSI■MMS■MfI.SMMMMN■■■■/�■■■■■■SS■�M■N■eM■ ■■■■..■■■.■.■■■■■■■■■■■■/■■■�■■■/�■■►I■■■■■■■■■■.■MONS SONS SSSS■■. ■■.N■■■■■■■M.SSOM■■MMM■MMMNMNMNi�■■■■M=■ SSSS■%■■■■■■■■■■■■■■■■■■■ ...................................... 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