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160 White Dove Way Lot 13AUTIjDRIZAT.ION NO:679 DAVIE COUNTY HEALTH DEPARTMENT -� `Environmental Health Section PROPERTY INFORMATION Permittee's /t_ P.O. Box 848 } / Name: �� �c'1,��LOn� [�a��� Mocksville, NC 27028 Subdivision Name: i J ► + 'a t Phone # 336-751-8760 ► -a Directions to property: 1"i -y 1 � (� Section: Lot: AUTHORIZATION FOR [^)nY ,—!2/IL7 11/3 WASTEWATER Tax Office PIN:# • - o_ (rLl r SYSTEM CONSTRUCTION Road Name: I, 1111 c rc JG k) ip: 21 4 **NOTE** 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 applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) = ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION � � << — f % ;, , . 1 + >� =� IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONAAt_11E-A H SPECIA IST DATE ISSLIED ��J "- . �.,,.i''ec—t3`4y'E'C �'G""Biu...aG..l•v'—'yt'`i+'.�.w..+f".y�.�'-vt�w..� .`.J. „v.. r.. � .'.{C , .•}:. ,tw,v..,;,.ly. ,..•......,.,-Mc . 0 P -/6,7'' ` �1 � � f .. DAVLE . OUNTY HEALTH DEPARTMENT IMPRO MENT AND OPERATION PERMITS -PROPERTY INFORMATION ' Name. �.�:Ia° 'rA Subdivision Name: D. M.0 ns,to.pzoperty: ` % "I i ' Section: Lot:' II_ NPROVEMENT 45 , f PERMIT Tax Office PIN: # .c f - (0,L/ .vsq Road. Name: w it t iWAtip: �. *'NOTE**This Improvement Peimit DOES NOT authorize -die conswction or'installatiori of a septic tank system or any. wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construct onAnstallation of a system or the issuance of a building permit (In-compliarce with Article 11. of G.S.,Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and. Disposal Systems) . ***NOTICE*** THIS PERMIT•LS SUBJECT TO REVOCATION IF SITE PLANS OR THE r4nmw USE CHANGE. YOUR WASTEWATER Q ALS S61T., DATE ISS SYSTEM CONTRACTOR MUST SEE THIS PERMITBEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS #.BATHS _� # OCCUPANTS GARBAGE DISPOSAL /Y� No COMMERCIAL; SPECIFICATION: FACILITY TYPE #• PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No. LOT SIZE WATER SUPPLY Cay DESIGN WASTEWATER FLOW (GPD) NEW SITE v REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE I©c� GAL . PUMPTANK' GAL. TRENCH WIDTH.�� ROCK DEPTH (Z ' LINEAR FT.. � OTIM REQUIRED SrrEMODIFICATIONS/CONDTTIONS: !NSTALLr I.YV (.(71V�oi)�. kts.EP Is o�F ao' :*'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 (336)751-8760. u -nu tOM (ceVUW) r APPLICATION FOR SITE EVAUJAT10N/IMPROVEMENT PERMIT a A r Davie County Health Department U Envirwnmental Health Serdon • P.O. Box 848/210 Hospital Street SEP 3 0 1998 Mocksville, NC 27028 (336) 751-8760 FNviPnNh"FNTAL HEALTH ***ZMPCRTAN"** THIS APPLICA`*ION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PRMDED. Refer to the INFORMATION BULLETIN for instructions. 1. Dass to be Billed Zt�7 /" Z,:2 a �� � � � j��_� Contact Person Mailing Address a?(O Sr/rr�rT+coY4 ��/ /�I-> Home Phone -3 3� -�S-5-FQ City/state/ZIP 2. Name on Permit/ATC It Different than Nailing Address _ Business Phone City/State/Zip 3. Application For: U Site Evaluation 'Improvement Permit/ATC 0 Both 4. system to service: X House 0 Mobile Horan 0 Business 0 Industry 0 Other S. If Residence: / People &_ i Bedrooms 3 i Bathrooms 6_ Dishwasher )(Garbage Disposal )(Dashing Machine 0 Basement/Plumbing ',k/Basement/No Plumbing 6. If Business/Industry/other: Specify type # People Sims • Ca®odes t# shovers # Urinals i Nater Coolers Ir FOODSERVICE: d Seats Estimated water Usage (gallons per day) 7. Type of water supply: County/City 0 well 0 Community s. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes XNo If yes, what type? 'IMPORTANT"' CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPWCATION. s;o3 ycre5 Property Dimensions: !;o'X /'I' ST/ �ly 456 Tax Office PIN: # Property Address: Road Name 1),4;7L-- DdV& CJaY C1ty1zip ."Ze'&V;/� �� 70,E 5� If in a Subdivision provide information, as follows: Name: Z' X'& &- res Sertion: Block: Lot: 13*'/ 3 WRITE D1RRCTIONS (from MockrAlie) to PROPERTY: Ai V . s oh Al. i nv�47- '1P 5�' QL A7 Th' )�-,o77 LST 7 /7E 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 front this application. I, hereby, give consent to the Authorized Representative of the Davie County Heal 4 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 suitabilih. DATE ,/ y CH `IYr i -'-Ul " 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). Revised DCHD (07/98) Account No. Oto Invoice No. 69.*,5" • '.AI 1 I •1 • �O 1 � uo L19 2 1 Q6 L12 No •" LIS L14 L13 � N •35'27'32' E• . �' 29.79 � • " N 52' 21' S8' W 69.26 CD N� 2 N WHITE DOVE ACRES ' AT BOOK 6 Pg. 193 c� ww .� �" t3 N ACRES AREA w a LOT #6 o� 5 `N MAREAp`( 7 Qg' 93 581' U7 S 78.15,1-�• V .��"I�ee000cnnndrr e`'y c i�/j`c.�•j� "��•� Ali nPpc � 9 a SE14." � O T • � i 0 I i ; ,ti^'• fen<<eoc�c�9ez�' I, SAM P. HALL, CERTIFY THAT UNDER MY DIRECTION AND SUPERVISION, THIS MAP WAS DRAWN FROM AN ACTUAL.FIELD SURVEY MADE BY TUTTEROW SURVEYING COMPANY. ,. PPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section R @ V gP.O. Box 848 D Mocksville, NC 27028 NOV 2 41997 (704) 634-8760 n ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSVD THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed 1 1 _ P I '1Qa I A Mailing Address �1D,0Q?4� City/State/Zip / / J)_�C�t -1J�C Q�7�Qma g 2. Name on Permit/ATC if Different than Above t t-C7ZSL9- rt Mailing Address Contact Person��1� Home Phone 63 Business Phone `- City/State/Zip %l. � t � (� ,t ,`„�,QO 3. Application For: �k Site Evaluation [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: Wouse [ ] Mobile Home [ ] Business [ ] Industry � [ ] Other 5. If Residence: # People -S_ # Bedrooms _ # Bathrooms IX J [V Dishwasher K Garbage Disposal P< Washing Machine KBasement/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 XWell [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes W No If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***,)XU= OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: � YY)a--n 5.00 ��, �1���.',,..�� WRITE DIRE,C�TIONS (from Morc�ksville)' TO PROPERTY: Tax Office PIN: #_ Property Address: . Road lame City/Zip If in Subdivision provide information, as follows: Name: C -t) �� 1 Lot #• Section: ' 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 Healtlj Department to enter upon above described property located in Davie County and owned _. k \., AA by. Revised DCHD (06-96) to conduct all testing THIS AREA AtAJ $E USED FOR DRAWING JOUR SITE PLAN: to determine the site suitability. ,7Url=n SUs zmw COMPANY 127' LIBERTY CHWMi ROAD L. (704) 4W -M6 sk- P2 �- c.twci Q-/)Oi )R - MAP SHOWING DMSION OF: WHITE DOVE ACRES MAY 12, 1997 REVISED: JULY 21, 1997 300 600 900 SCALE IN FEET ,,� r 241E-11 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION f LOT i3 Soil/Site Evaluation APPLICANT'S NAME SAM 14A i _L_ DATE EVALUATED ( j PROPOSED FACILITY1 _ ��-I cosi PROPERTY SIZE S A S SUBDIVISION 08 -Ft rc. ))C")C' ROAD NAME 1" 1 Ovve ,/4Y Water Supply: On -Site Well ✓� Community Evaluation By: Auger Boring °� Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L Slope % It Zo g , HORIZON I DEPTH - y Texture group G L C CL Consistence r 55 S Fr SS f 4 r 55 rSS'SC Structure '7 Q -Q Mineralogy 1; I ; / I.'/ HORIZON II DEPTH Lj - Z 4-2-1 2-- /S' 2 - Z60 Texture group C Consistence n, 1C.• S Structure S(3 k Mineralogyj I ; HORIZON III DEPTH Texture group a Sq C Consistence - ; 5 F : S : 5 Structure k k 5 S < Mineralogy HORIZON IV DEPTH 4K 32 + 3 + Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: r S LONG-TERM ACCEPTANCE RATE: D EVALUATION BY: -i- Lx'"44 OTHER(S) PRESENT: REMARKS: SL,E An10 Garin _70Ar C Jf 'f N L000 a `TQA c) ACCT 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 blockv 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 (01-90) ■■ ■■E■ OMEN ■■■■ NOME NOME NOME OMEN ■■E■ MEMO M■■■ ■MN■ NONE ■■■■ ■EN■ NONE moon ■■■■ OMEN ■■■■ MEN MEN ENO IM■ ■■■ ■ ■ ■ ■■■■ ■EN■ MEMO 1\M■■ ti■■■ ■E■NE■ ■■■NO■ ■NE■H NONE ■■E■E■ ■■■■E■ ■■■EM■ ■ ■E■ ■■■ ■E■ ■N■ i ■ No NOME NONE ■EN■■■I■ME■■■■ ■■■■MMIN■■■■■■ ■M■■■■IIM■M■■■ ►FNM■■MIN■M■■■■ NMEM■■IN■M■■■■ UWM■MMIN■■MMM■ ■IIMM■MI■■M■MM■ ■\IMME■I■MEME■■ ■R\MMMINMMMMM■ ■■►`1■■MIS■■M■M■ ■MRIM■MIZMM■M■■ ■MMUM■I■■M■M■■ ■MOI\■■I■■E■■M■ ■■■KIMMINM■■M■■ ■■M■\■I■E■■E■■ ■MMMIXMIiIMMM■M■ ■■M■■MIIMMMMM■ ■MM■M■IN■■■■■■ LZ;. ci F- L4-. �jY F Ll 2 o4 L '4 x ASCjSS EA SE�AENTS S5•?_7'3?' V r e trS�. °��'.•' 30p �9' of X55Es 13 v8RS S 5 69.26 8' E N 9w`N�Ri N 26'16'57' V 1� N 0' Q�• Z 50.00 t1t to > • L0� k W� t �t11 poo 65 pp,00!10 O •10� k /. •epos W� r NW w N 3? • ' B .D �� cA_ o 4.678 ACRES \ p ' �'' 1.076 ACRE''%/ 22 N 22.20'18' V 179.96 TOTAL c. •. �. 1.499 ACRES Q ' g IHQ�ca�l Z ti �~ extg �N• ti sUn o WN dwelling o � N 2156 4Z 1.147 ACRES 1�q,7 \ JUNE . V •,a, -314 09 TOTAL v F1-7 •375,p0.•• 15 $ :g: g 7g�pTAI-� F - �pOVG�S 3 Q v ,.�s.:2..� _- ... ., . , - " .. ..+. ,. .. -- - - -. - r _. - �- w • : , Davie County Heafth Department and Home Health Agency Environmenta[Health Section P.O. Box 848 / 210 HOSPITAL STREET COURIER #09-4-06 MOCKSVILLE. N.C. 27028 PHONE: (704) 634.8760 December 2, 1997 Sam P. Hall- P. allP. 0. Box 294 Mocksville, NC 27028 Ke: Site Evaluation White Dove Acres I/Lot 13 Tax PIN(s): 15820-64-9480 Dear Client(s): As requested, a representative from this office visited the aforementioned site on November 26, 1997. 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 installation of an on-site sewage disposal system. If you have any questions, please'.feel free to contact this office. JB/wd Enclosure(s) Sincerely Jeff B Environmental Health Specialist