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144 McDaniel Road Lot 6M IMPROVEMENT PERMIT DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT **NOTE** This improvement permit DOES NOT authorize the construction or installation 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 13OA, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) NAME _PROPERTY ADDRESS 100 6 DATE LOCATION��//f7�/i���f -� SUBDIVISION NAMELOT NUMBER SEC. /BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE fo # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes/No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE ��� TYPE WATER SUPPLY n DESIGN WASTEWATER FLOW (GPD) ,jlj! FEW SITE c/ REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PIMP TANK GAL. TRENCH WIDTH � t�� � ROCK DEPTH LINEAR FT. -:5�9 0 OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***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. d) )Ilr � .1,K 11411, 47 r IMPROVEMENT PERMIT BY 4/�e/ **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH 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 INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYST ALL BY 4 Ot - 0 �a�le� d;�el ���� ►7 AUTHORIZATION N0. 41 , OPERATION PERMIT BY -2&Z/ 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 13OA, 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. i DCHD 10/95 d IS s Davie County Health Department, ENVIRONMENTAL HEALTH SECTION P.O. Box 665 Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION 0 (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) r�5to f. t?o ***This Authorization For Wastewater System 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 ppl ing for Building permits.*** AUTHORIZATION KP%'R NAME 5'�' DATE NAME ON IMPROVEMENT PERMIT (If different than above) j SITE LOCATION—r�r� /� s'�✓i'� i�' 3 COMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM t Application/Permit ReqL Mailing Address APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PEF Davie County Health Department ��� E � ironmental Health Section P. O. Box 665 Mocksville, NC 27028 n n C' C� L O M CE JUN 0 T( Business Phone 9V r3. l &0 ' 2. Name on Permit if Different than Above 3. Application for: General Evaluation ❑ Septic Tank Installation Permit 4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry y❑D Other% ElQUnknown 5. If house,.;nchile hew+e� Subdivision 1 0 P t y� ' .J( J'+ Section / _ Lot # No. of People No. of Bedrooms 3 No. of Bathrooms 1�1/ Dwelling Dimensions in e 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers 7. Type of water supply 8. Property Dimensions ublic No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures ❑ Private Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? ❑ Yes ❑Baseme UPlumbing asemenUNo Plumbing ashing Machine ishwasher ❑ Garbage Disposal 2-1�o ❑ Community '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: /Vu{ y� T4 ry � `► CL fv, rA pi b 1V , &t e IN This is to certify --&at the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application.. lv % — ,;;>z DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: Ei-t—r—QWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: 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 said site's suitability for a ground absorption sewage treatment and disposal system. 4 _� 4,J, ��J DATE SIGNAT RE DCHD W93) J I IL 0 v K Roj v I �Jn9� �. 2 � �o. SOLD S Q Q P4 nt- Y L POTTS ,..,, ,. FtO -2400 ' RES 1919) 99 -' (gig) 998-2i 00 . OFFICE (.`.. 20 w 1 tv - J I IL 0 v K Roj v I �Jn9� �. 2 � �o. SOLD S Q Q P4 nt- Y L POTTS ,..,, ,. FtO -2400 ' RES 1919) 99 -' (gig) 998-2i 00 . OFFICE (.`.. 20 w v J I IL 0 v K Roj v I �Jn9� �. 2 � �o. SOLD S Q Q P4 nt- Y L POTTS ,..,, ,. FtO -2400 ' RES 1919) 99 -' (gig) 998-2i 00 . OFFICE (.`.. ' DAVIE COUNTY HEALTH DEPARTMENT . Environmental Health Section Soil/Site Evaluation NAME SA I / ADDRESS PROPOSED FACIILTY DATE EVALUATED PROPERTY SIZE Z e .4 e LOCATION OF SITE Water Supply: On -Site Well _ Community Public Evaluation By: Auger Boring r/- Pit Cut FACTORS 12 3 4 Landscape position L Slo e 7. HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH It 73e b �6 v Texture groupC Consistence Structure $ 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: i y LONG-TERM ACCEPTANCE RAT/E-- REMARKS: 192Q Rci`1rit'l DCHD (01-901 EVALUATED BY:�/�A, OTHER(S) PRESENT: LEGEND Landscape Position R -Ridge S -Shoulder L -Linear slope FS-Footslope N -Nose slope CC -Concave slope CV -Convex slope T -Terrace FP -Flood plain H -Head slope Texture 5 -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 Davie County Health Department and -Come Health Agency 2nvironmenta(Heafth Section P.O. Box 848 / 210 HOSPrrAL STREET COURIER 1109-4-06 MOCKSVILLE, N.C. 27028 PHONE: (704) 634-8760 June 25, 199f - Lyndon D. Ball c/o Roy Potts P. 0. Box 11 Advance, NC 07006 Re: Site Evaluation Poplars—Lot 6/McDaniel Road Tax PIN: #5870-22-9931 Dear Mr. Ball: As requested, a representative from this office visited the aforementioned site on June 24, 1996. Based upon the information provided on the application for site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on—site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, A41-:1? Robert B. Hall, Jr., R. S. Environmental Health Section RH/wd Enclosure(s)