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154 Princton Ct Lot 12 • / DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001825 Tax PIN/EH#: 5860-81-5359 Billed To: Mike Hester Subdivision Info: Princeton Lot#12 Reference Name: Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: see map -fi ATC Number: 2907 /0 /'ONMON ff 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 WAS CO N IS V ID FOR A PERIOD OF22FIVE YEARS. Environmental Health Specialist's Signatu e: Date: c J b/ 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 AY taken as a guarantee that the system will function satisfactorily for any given period of time. Cos � LlrsG N oY fie% 5 to• U^1ioSD WATIER- 1-1-1E SST Septic System Installed By: A �✓� ^' �'�� Environmental Health Specialist's SignaCe: Date: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section ` P.O.Boz 848/210 Hospital Street Mecksvlllc,N'— 27028 — -� -- (336)751-8760 - IMPROVEMENT/OPERATION PERMIT Account #: 990001825 Tax PIN/EH#: 5860-81-5359 Billed To: Mike Hester Subdivision Info: Princeton Lot#12 Reference Name: Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: see map ATC Number. 2907 **NOTE**This Improvement/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 { Q OSC #People #Bedrooms #Baths 2 Dishwasher: Garbage Disposal: ❑ Washing Machine: 12"' Basement w/Plumbing: Ur" Basement/No Plumbing: ❑ Commercial Specification: Facility Type # EI „People #People/Shift #Seats Industrial Waste: Lot Size 3I 10�2 Type Water Supply CW� T Design Wastewater Flow(GPD) Site: New En/ Repair❑ System Specifications: Tank Size 1000 GAL. Pump Tank GAL. Trench Width &n Rock Depth cIT' Linear Ft.2S-b' Other: 3 'D1STP.Q�-r o•J`� t� SfAt� L.1��S l O•L' . Required Site Modifications/Conditions: C-0”Awoo,, r�CFQ is C.-C i40iaca , 1c,,—p 16 ap IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6"BELOW FINISIIED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system betty :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.**** LIN t5� Q�AI Q I GI U'1 G APA IS L —I h� uo rAP, Raw. I T- L+ S t►J d2- -� �s���s PezvtoxLY V-oP LOQ C T w&—ro- l.I-16 1SS0L;;11)-QAAt3(0E-b D0610 �E Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) ` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001825 Tax PIN/EH#: 5860-81-5359 Billed To: Mike Hester Subdivision Info: Princeton Lot#12 Reference Name: Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: see map ATC Ny��ppber: 2907 **NOTE** Thls Improvement/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 I 1 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—/� #Baths Dishwasher: 21/ Garbage Disposal: ❑ Washing Machine: 03PeBasement w/Plumbing: 21 Basement/No Plumbing: ❑ Commercial Specification: : Facility Type ^ #People #People/Shift #Seats Industrial Waste: Lot Size ,,l4q 47Type Water SupplyGOrW Design Wastewater Flow(GPD) 3(-00 Site: New E� Repair❑ System Specifications: Tank Size� GAL. Pump Tank GAL. Trench Widt Rock Depth Linear Ft.� Other: 3 471ST�tPZO i 10.A �xcS , ` STqu L1n1ES Required Site Modifications/Conditions: c.�S``All �l�Q 15 l7� 'pFF� G IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6 G°BELO7ofthis FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection s tem between 8:30 a.m.to9: a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.** T 20' N ,C�r424C- - �e lv Environmental Health Specialist's Signature: it-1 DCHD 05/99(Revised) r � • APPU FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC • JUN 2 7 2001 Davie County Health Department Environmental Health Section .O. Box 848/210 Hospital Street ENVIRONMENTAL HEALTy Mocksville, NC 27028 DAVIE COUNTY (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instruction/s.. I 1. Name to be Billed 11/ 4 1�-eS J-ej Contact Person Mailing Address a-t / 1 >6 s L /`f`' Home Phone City/State/ZIP 'Tv VA ti C -7 C.GG Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation vement Permit/ATC ❑ Both 4. System to Service: Clouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms -- .7- # Bathrooms -� 1-1- ishwasher L] Garbage L°f Garbage Disposal ing Machine 'Basement/Plumbing II 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: 0--do--Unty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes O NO--- 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 Mocksville)to PROPERTY: Tax Office PIN: # S (a G�11 — S 3 S79 ( S 'jam c, i3 c7 I ��"i c—< Property Address: Road Name LG% 5`I.L 117121 Act. C/' +C-4 v`^ cZ G •10 City/zip. k Lle--,-1 C. P y')co 6 C If in a Subdivision provide information,as follows: Name: Section: Block: Lot: Date Property Flagged: �c This is to certify that the information provided is correct to the best of my knowledge. 1 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 1 CJ/ 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: EHS: Account No. D-5- Revised DCHD(07/99) Invoice No. Doti 6Tr•etor, Davie County Planning •portm•ni i C, Parcel 65 F ' James Mayhew I o D.B. 071-392 CO NN a� o° m c 231.02' 150.08' S 83°51'35"E 150.08' 150.08' 150.08' n n `n Icr d Z (10- / fn Pn v (2D oNo r I I o N w ^' IL I �L 1! rJ O to 10 c6 ° cn `r O . .� 0 W 1 - � N - o W I - _ u7 m z � c \ t N 55°36'35"E 25.00' �y 209.01' �� 1.18.69' " E N 499.94' ° 5°44'15"W' 2 1'S(3:'E 31.62' — I- N 84°14'50"W 0 rovidenL ( N 14.10'2 31. 2' � 01' N 85°��."1 N 47°05'95"W5.00' 'Ib 1aC14 C4 rV - w � U') � w = z U) ►' X90 o O v 't u7 in N d � 11 0 0 - fb tJ 1 �J �-il �J I� N� � �� ,�� CO ►�• ` Lni S V) JS N ,n 0 li � v y r U N "r" �J ;1' 150.07' 258.03' 150 150.07' 3 N 87032'1 5C 4 - ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900111 Tax PIN/EH M 5860-81-3295.12 Billed To: Gray Potts Subdivision Info: Princeton Lot#12 Reference Name: Gray or Betty Potts Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: 132x317x99x2 Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit ,------ Cut FACTORS 12 3 4 5 6 7 Landscape position L Slope% �o HORIZON I DEPTH - b , Texture groupL'L Consistence $$ SS Structure k Mineralogy HORIZON II DEPTH 10 Texture group Consistence C: Structure 614 Mineralogy m i Y-iO HORIZON III DEPTH Iq •ZCo 10-2-4 - Texture group C-v Consistence G;S P R Structure dJ9 K Mineralogy ri► 1Gafl HORIZON IV DEPTH + f Texture group Consistence Cr 53 S F- SP Structure t_ PL Mineralogy ml SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE ..11 \ SITE CLASSIFICATION: V'� EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: l ale 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 fine 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) .l?h.IGATION-FO ;S TE EVALUATIONAMPROVEMENT PERMIT&ATC (� [ n _r . �, avie County Health Department ` O Environmental Health Section IM P.O. Bax 848 2 Mocksville,NC 27028 E V1011.Et1TAL hEALTil (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed G."2 A.C 1-9u7--/' S Contact Person Mailing Address /07n ss i?o� • Home Phone City/State/Zip sl p�44 rJC_gT, C` . Z 7 U U G Business Phone :5f9 fL 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: [Site Evaluation [ ]Improvement Permit&ATC [ ]Both 4. System to Serve: P4 House [ ]Mobile Home [ ]Business [ ]Industry [ J Other 5. If Residence: #People #Bedrooms #Bathrooms [ J 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? EIllli.:lf t 1'L-11 OR SITE- PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT**#,A-nNAT OF THE PROPERTY MUST$E' SUBMITTED WITH THIS APPLICATION. � Property Dimensions: G �� 66h I,'2a;WRITE DIRECTIONS(from Mocksville)TO PROPERTY. Tax Office PIN: # !5--66 o - �-— !_ 5� 1 _-(J. S /�P L74 5 ol Property Address: Road lame 43 A C 7WVyx�-�Tj?L� [ A L Zlz22oze ar le c. Ci /Zi A .4.�/[c Al. C'� ; 70c; � /1/v,rll �'c1 /- ?C��,il.� City/Zip P —2� � _ If in Subdivision provide information,as follows /�i��,c��d ; �c�4 v / G.i S ?' S/,c-0 4-;'— Name: ,Name: 4 ; Section: Lot#: 3(LOT I 1 iJ 040 M 4-P) M W rµ oe 1 co aJ �r ' This is to certify that the information provided is correct to the best of my knowledge. L 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 gr 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- / Z �y SIGNATURE e Revised DCHD(06-96) ' THIS AREA 11411 13E USED FOIA I)RAIVINC I101IR SITE PLAN: � r �� 'Ole Filed for regis iiy that the subdlvlslon plat shorn hereon has C&TWUate OJ Approval by the P(anniny �OaTd .imply with the County SuEdlvlslon Regulations, DEPARTMENT OF TRANSPORTATION -- - lion o1 such variances. It ony, as noted In the r ianning Board and that It has been o The Da"t•County Planning Board hereby hereby th•final Pkat far tr. DIVISION OF HIGHWAYS no office of the Register of Deeds. 111 svhereby °d•rood Subdk6ion. In Plat Book -h approval for recordation does not Include PROPOSED SUBDIVISIOIN ROAD ,stall and dflllce sanitary facilities nor does It CONSTRl1CnONSTANWDSCERnFICATION vl for the construction or occupancy of Dvlldings - Date Chd+mon,County PIamInBoard 9 Filing Fee Paid APPROVED DISTRICT ENGINEER ------ -- -- — Director, Davie County Planning OeDaritttenf DATE by� ---__- _— oF Parcel 65 James Mayhew D.B. 071--'92 --------------- S _yS 83°51'35"E 1548,89' 150.08' 150.08' 1 50.Ofl' 150.08' control corn 150.08' 1 150.08' 112.18' �9IV r' 5.04' w W �n W point W i 5 16 - 17 N tC' .— paint O d w lqo Z I—V Z Z O NO (V T n Z point 148.69' 150.0 int 0' 150.00' 150.00' 150.00' Providence Court S 85644'15"E 1048.69' ,050.4,' � S 8.5o44'1 5"E 1050.00' 6&0 ' public ZS ( 150.00' 15.0.00' 150.00' y 150.00' LO O tet - `t tT d' i n i` - �) _ U'; — 7 �n 77 ° 1 `' • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900111 Tax PIN/EH M 5860-81-3296.13 Billed To: Gray Potts Subdivision Info: Princeton Lot#13 Reference Name: Gray or Betty Potts Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: 150 x 282 Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope% HORIZON I DEPTH - �P Texture groupGCS G Consistence Structure IL 1Z Mineralogy M M HORIZON II DEPTH &-10 Texture group Consistence A. Structure Mineralogy 1 M � HORIZON III DEPTH I L4 -Z<R 70--03 Texture group C4- a C'4Consistence G' S S Y Structure :50k-- Mineralogy M )G-00 HORIZON IV DEPTH - Zo - Texture group Consistence Fe Structure S L Mineralogy �. SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION t?$ LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 5 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 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)