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107 Princeton Ct Lot 1 DAVIE COUNTY HEALTH DEPARTMENT f • " Environmental Health Section P.O.Boz 848/210 Hospital Street �l�,{ 7 —//— at Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001825 Tax PIN/EH M 5860-91-1088 Billed To: Mike Hester Subdivision Info: Princeton Lot#1 Reference Name: Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: see map **NOTE'S*Tiiibfmprov�t/Operation Permit DOES NOT authorize the construction 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 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 3 #Baths 2 Dishwasher: 133"' Garbage Disposal: ❑ Washing Machine: M/ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification:: Facility Type 1Q1� #People #People/Shift #Seats Industrial 13all Waste: Lot Size 30 .}Type Water Supply&r4w Design Wastewater Flow(GPD)SOD Site: New a Repair❑ System Specifications: Tank Size[QnAL. Pump Tank GAL. Trench Width Rock Depth 12:' Linear Ft.5CK.�)' Other: 1�1ST2lC�JTio� ,7L tasT•�lU— L-1r.1J�:s `ISO. c- k�t t-S Required Site Modifications/Conditions: 1�-EQ �, � t Had5 C , 165W ID"(SCF PaoP. Lt P IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S) IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this 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.**** Z O� G AQdGE � O � n 1412-n j 1 UO(G 1 Y-�to G ('� loo` ' too' 7S' Environmental Sigctate= Date A DCHD 05/99(Revised) DAME COUNTY HEALTH DEPARTMENT Environmental Health Section • P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001825 Tax PIN/EH#: 5860-91-1088 Billed To: Mike Hester Subdivision Info: Princeton Lot#1 Reference Name: Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: see map ATC Number: 2906 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This 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 WASTEWAT STR VA FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: 7��te: 2 �� CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation 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. � _ � 0 Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) Davit County Planning Depar trnentr% I )rt I Ur irH 1 R. ' 20' —0' 0 —0' t101LDfR PAVEMENT a0mmotl DITCH i t �� IN' FT. it rTJ I' PER FT. IH' FT. 65 *� Mayhew 1-392 RESIDENTIAL COLLECTOR ROAD S 83051'35"E 1548.89' 300.16' 1 18.1 1' 1 19.88' "control come Et 121.73' 123.68' 125.71 103.40' 5.04' S 10034'3 point' w w w w w o S 0701-c in � D13 �u 14 P N 15 w ^ �, m ° tri 'n m ;� 16 �, � 17 po nE° cD ° co `t Cii to 1.860 Acres o `�' N In ° < S 03°5t ° N p d N �} N ' O N O N (tl Z z z z z z 31149 Sq. Ft. 0 1 31149 Sq. Ft. 31149 Sq. Ft. 31149 Sq. Ft. poin�cD 1 31149 Sq. Ft. 31149 Sq. Ft. o S 000' Point �1 I 1 i 298.69' 1 18.04' 119.81, 121.67' 123.61' 125.65' 141.22' _ --S 02- S 85044'15"E 1048.69'--D. Princeton Court '°��.4'. 60 ' public ; Q' S 85'44'15"E 1050.00' 50.00' 300.00' 116.92' 118.61' 120.38' 122.23' 121.87' ! ~' O / approx. Oca604I pond 3 ' 3 3 3 3 CI i CIL Ci :S \ N to Ln O N Inn 1.833 Acres 30347 Sq. Ft. 30347 Sq. Ft. 30347 Sq. Ft. 30347 Sq. Ft. 30347 Sq. Ft.� 1� 12h.�1' 3.16' EiP! i` x rf1 1 b.9F°' 1 18.67' 120.44' � �� rtJJ.1 J' W 1616.41' "control comer N 87°32'15" AP91E17 TION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC 11 , �+) ""' Davie County Health Department t viroamwfa/Health Section JUN 2 2001 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ENVIRONMENTAL HEALTH (336)751-8760 DAVIE COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1Refer to the IFORMATION BULLETIN for instructions. 1. Name to be Billed 1 T/e �c O'irM CO Contact Person I / I u 0" Mailing Address t y� S 41f � y'� (! oe ��. Home Phone �P- — City/State/ZIP A- C-rt 01 C e' Business Phone -51 al-I G?� 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation R-Xii;—rovement Permit/ATC ❑ Both 4. System to Service: Q-House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: # People # Bedrooms # Bathrooms ft Dishwasher ❑ Garbage Disposal L+'Vrashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: U,County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. 4 Property Dimensions: WRITE DIRECTIONS(from Mocks We)to PROPERTY: Tax Office PIN: # S O '-� G S 1s d� G l d i� ''7 C�'"P Property Address: Road Name l/CJ/ &h Ct% Crrl City/zip 4-ZIiC 1 C C) If in a Subdivision provide information,as follows: G tiy Name: / p. Section: Block: Lot: Date Property Flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that 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 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 to conduct all testing procedures as necessary to determine the site suitability. DATE (O a'��' SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Datc(s): Client Notification Date: �J EHS: Account No. Revised DCHD(07/99) Invoice No. 8 L. TE EVALUATIONAM[PROVEMENT PERMIT&ATC Q' d avie County Health Department Environmental Health Section n P.O. Box 848AL 2 Mocksville NC 27028 (704) 634-8760 a I'm.MrIly ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed C1-907-1 -5 Contact Person Mailing Address /.0. n u4'z =ZU c s IZ04 Home Phone City/State/Zip .4 2M Ale i 0 . Z 7V U G Business Phone :5." � 6.Z. �L 2. Name on Permit/ATC if Different than Above .9rlL� Mailing Address SAr! L- "- City/StateJZip 3. Application For: [Site Evaluation [ ]Improvement Permit&ATC [ ]Both 4. System to Serve: PJ House [ ]Mobile Home [ ]Business [ ]Industry [ ]Other 5. If Residence: #People #Bedrooms #Bathrooms [ ]Dishwasher[ ]Garbage Disposal [ ]Washing Machine [ ]Basement/Plumbing [ ]Basement/No 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 [ ]Well [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [ ]No If yes,what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT**'QT'OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: 5 C �� 4�T3 S WRITE DIRECTIONS(from Mocksville)TO PROPERTY: Tax Office PIN: #S"66 D -��- �_� ; . < S T 7710 Property Address: Road ame & M222oC"� city/zip 4 a N&d Aee c itl, C'• 7ocy /1/ve4A ci F G2,<,V-47Ze`.t— If in Subdivision provide information,as follows: V 's?a A AJ Gni S' ? -5"l AD Lr— Name: = '7 Section: Lot#: This is to certify that the information provided is correct to the best of my knowledge. I understand that 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 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 to conduct all testing procedures as necessary to determine the site suitability. DATE 7- 17- �_ - SIGNATURE Revised DCHD(06-96) THIS AREA MAY $E USED FOR DRAIVINC7 YOUR SITE PLAN: /f714#,C�� a ---- -- -Parcel 65 James Mayhew D.B. 071-392 I o Ito II 7 I� S 95°37.40"E 1599' 150' 150' 150' 150' r.r1 y a aN � N N f J 17 18 19 20 021 - I 22 � C iso. 50' 150 � cv { ( 60 ' PtTI3LIC ) 150' J` r' _.I X 63 ID i . . ..'k' .. - --- DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900111 Tax PIN/EH#: 5860-81-3295.01 Billed To: Gray Potts Subdivision Info: Princeton Lot#1 Reference Name: Gray or Betty Potts Location/Address: Baltimore Road-2790,6 Proposed Facility: Residence Property Size: 150 x 247 Date Evaluated: 6 Water Supply: On-Site Well Community Publicy Evaluation By: Auger Boring Pit [l Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L Slope% a 1I HORIZON I DEPTH (v `"v Texture group Consistence Structure Mineralogy HORIZON 11 DEPTH •� .� �' Texture group C Consistence 77 StructureA- Mineralogy HORIZON III DEPTH 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: EVALUATION BY: � d'l 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 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 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 05/99(Revised) w r L I i 1 S� 1 , � i