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310 Seaford Road Lot 7HEALTH DEPARTMENT RELEAS *„n F Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: James R. Nolan Address: 310 Seaford Road City: Advance State/Zip: NC 27006 Phone #: (336) 940-5582 PERMIT VPD 0 6 -/ 1 8/ 2 0 1 9 1 iMni "'Property Owner. James R. Nolan Address: 310 Seaford Road City: Advance State/Zip: NC 27006 hone #: (336) 940-5582 Property Location 8 Site Information n Address310 Seaford Road Subdivision: Seaford Acres Phase: Lot: Road # Advance NO 27006 SINGLE FAMILY Township: *Structure:- Directions # of Bedrooms: 3 # of People: Hwy 64 East, turn right on Hwy 801. Left on Riverview Rd. Left on Seaford Road then property on right 'Water Supply: PUBLIC Basement: F] Yes ❑ No *Proposed Improvement: Sunroom Type of Business: Total sq. Footage: No. Of Employees: cn.,.nen flemaninp 750 This release in no way expresses or implies that the existing subsurface sewage treatment and disposal system serving the site will continue to function for any period of time. Applicant/Legal Reps. Signature Required? OYes ONO ApplicanVLegal Reps. Signature• *Date: *Issued By: 2140 -Nations, Robert .� *Date of Issue: 0 6 /_1 8 / 2 0 1 4 Authorized State Agent: � v �q **Site Plan/Drawing attached.** F ®Hand Drawing Olmport Drawing Drawing Type: HEALTH DEPARTMENT RELEASE 139046 - 1 Davie County Health Department CDP File Number: 210 Hospital Street K&000-00-022 P.D. Box 848 County File Number: Mocksville NC 27028 Date: 06/ 18/2014 O Inch Scale:. Oelock Health Department Release O N/A Drawing Type: HEALTHDEPARTMENT RELEASE Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Health Department Release Page 2 of 2 CDP File Number: 139046 - 1 County File Number: K8-000.00.022 Date: 06/ 1 8 /.1014 Davie County Health Department Environmental Health Section "CEINED 41 a I �I Data Phone: (336) - 753 - 6780 P.O. Box 848 210 Hospital Street Courier #: 09-40-06 Mocksville, NC 27028 Date: le / 4 l I ti Received by: IjBM ON-SITE WASTEWA (Check One) Replacement Remodeling Reconnection Fax: (336) - 753.1680 Name: /VO let h Phone Number 3 3 (o ^O!6✓Q— SSS& ;L (Home) Mailing Address: 3 /OSea Fo h d �!l • Q ^ i eat n (work) f� of (/a riC e JV C `L iPco & EmailAddress: j I LW e -'h A �(,C /, CD /y7 Detailed Directions To Site: 40 gas C 7o f o / SD U Th To � eE C& h i&ein !r L C t(j Tn Lei 7- a )1 sea rte! Property Address: S Q /M P CLS Cd A& v e Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: j:LiL e S /40 I&W* / Type Of Facility:S%lLe A, A /�y Date System Installed (Month/Date/Year): I;99 i Number Of Bedrooms:__3_Number Of People:_ Is The Facility Currently Vacant? Yes ®° If Yes, For How Lc Any Known Problems? Yes ® If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: ��� I ]/ o /7� iIU SOD M Number Of Bedrooms: Number of People Requested: " For Environmental Health Office Use Only Approved Disapproved Environmental Health Specialist Date: *The, signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time.. Payment: Cash' Check Money Order Paid By: 13gohy(e By:V` l t 0 6% 9 DAVIE COUNTY HEALTH DEPARTMENT AU1'HORIZ;STION N7: Environmental Health Section PROPERTY INFORMATION 'LZi Pe � tees- ' ' • / P.O. Boz 848 ) n0 Name pp BLit - - - - - --� - � - Mocksville, NC 27028---- Subdivision Name: N - ��� Phone #:704634-8760 Section: Kt' -� 'Directions to property: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN SYSTEM CONSTRUCTION Road **NOTE** This Authorization fm Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to.issuance of any Building Permits. This FormAuthoriratlon Number should be presented to the Davie County Building Inspections Office when applying for Budding 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 IS VALID FOR APERIOD OF FIVE YEARS. I AL SPECIALIST DATELSSUED COMMERCIAL SPECIFICATION: PACEITYTYPEEq #PEOPLE_ APEOPLPISFEFP_ #SEATS_ INDUSTRIAL WASTE: Yw w No LOTSIZE—?,ye TYPEWATERSUPPLY_[_Q_ DESIGN WASTEWATERFLOW(GPD),Own NewsrrE—k---,,� REPAI(SIIE SYSTEM SPECIFICATIONS: TANK SrLEAM—GAL PUMPTANK_GAL TRENCNWIUIHiB ROCKDEPTII �LINEARFTML� REQUIRED SITE MODIFICATIONS/CONDITIONS: **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 (706) 6348760. OPERATION PERMIT SYSTEM INSTALLED BY: `JtI6E-r"+� J�JNN FEaN Q (51-osr Pco L— ILII I�DGK ZI(,1 Llwlc gib+ t i F p AUTHORIZATIONNO. OUTS OPE BY: , `— DATE: C7 I **TFILF ISSUANCE OPTHIS OPERATION PERMIT SHALL INDICATE THATHE SYSTEM PSCREgED ABOVE HAS BEEN INSTALLED WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECrION.1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE TRATTHE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OP TAME. DCIm0396 (Raviud) 1380`% AUTHORIZATION NO: 009- DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Pe 'F1 P.O. Boit 848 n Y�� Name ` IVlocksville, NC 27028 Subdivision Name D /HG Phone #: 704-634487.60. Directions to property: �dSection - Lot: AUTHORIZATION FOR -. - WASTEWATER - Tax Office1. PIN: # Or SYSTEM CONSTRUCTION - ,,__..,,��� Road Name:7K+p i **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.l l of G.S. Chapter 130A, Wastewater Systems, Section :1900 Sewage Treatment and Disposal Systems) F ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIROHEAtTH SPECIALIST ' DA0 - , DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATIO£T PERMITS PROPERTY INFORMATIONNn Nam �jy)Ok2h Subdivision Name: O MC3Y�5 Direchansrty: Section. � y/ Lot: IMPROVFAIENT PERMIT Tax Office PIN:#,5/�/ Road Name: ,I-t:u C rd 1p: **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 constructionlinstallation of a system or the issuance of a building permit. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Secdon .1900 Sewage Treatment and Disposal Systems) �� ,�_ /1S ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE i) M p. U G PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM: RESIDENTIAL SPECIFICATION: BUILDING TYPE —A -,v—' # BEDROOMS # BATHSIL-l' # OCCUPANTS —T GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFf - # SEATS INDUSTRIAL WASTE: Yes or No LOTSIZE246 TYPE WATER SUPPLY L(' DESIGN WASTEWATER FLOW(GPD)% NEW STE---,&--� REPAIR SITE SYSTEM SPECIFICATIONS:- TANK SIZE D GAL. PUMP TANK - GAL. TRENCH WIDTH TgL. , ROCK DEPTHZ2L DEPTH/2LLINEAR FI'2 .. - OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: - IMPROVEMENT PERMIT LAYOUT " **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-< . 'SYSTEM INSTALLED BY: IIGR+�`-I' Q .t1c, 2110° LIrJ` L abb pot, t-- ALT -- �+ t � Q AUTHORIZATION NO. OVA - OPE P BY: DATE:- **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT SYSTEM DESCRII(ED ABOVE HAS BEEN INSTALLED COMPLIANCE WITH ARTICLEI I 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 TALE. - - DCHD 05/96 (Revised) Ell r APPLICATION FOR SITE EVALUATION/IMPROVEMENT PE ! IS Davie County Health Department D .QJ Environmental Health Section 1 P. O. Box 848 FEB 1 11997 Mocksville, NC 27028 (704) 634-8760 ENYIROWNIENIAL H 1P1 Y� DWECOUtM ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSE At ALL THE REQUIRED INFORMATION IS PROVIDED. q �� ` �D I Name to be Billed -J / nY Aw0- Contact Person ci Mailing Address 3 d/ jw a K L[ -,eC V/r�h Home Phone City/State/Zip ��/� � K 6 / � C a / �Q � Business Phone 7/O- 'g KA 2. Name on Permit/ATC if Different than Above Mailing Address _ 3. Application For: 4. System to Serve: 5. If Residence: O'Dishwasher 6. If Business/Other: # Commodes _ If Foodservice: ❑ Site Evaluation 0 House ❑ Mobile Home # People 7 ❑ Garbage Disposal Specify type # Showers # 'Seats City/State/Zip UY Improvement Permit & ATC ❑ Business ❑ Industry ❑ Other # Bedrooms —3— # Bathrooms l�shing Machine El"iBasement/Plumbing ❑ Basement/No Plumbing # People # Sinks # Urinals Estimated Water Usage (gallons per day) # Water Coolers 7. Type of water supply: ❑ County/City U4ell ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes alNo If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: -3 !0k� 1 WRITE DIRECTIONS (from 1 Mocksville) TO PROPERTY: Tax Office PIN: # i 7 ? G - 13 LIP G / Property Address: Road Name �.6Z2 cGLB� l' 1 f NPdsrrd .6 City/Zip '% i Cf 1 / 6, 'M' ie -4 To l� fro If in Subdivision provide information, as follows: 1 1 1,046, dd re ke-'Taw Name: / 1 %'O weocle I a hB4 e, 1 Section: K- Lot #: 1 1 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 A- //-97 SIGNATURE Revised DCHD (06-96) 4 APPLICATION FOR SITE EVALUATION/ Davie County Health P.O. Bd Mocksville; (704) 63 M ****IMPORTANT**** THIS APPLICATION CA%b B + UC�SSEbgo zL LL THE REQUIRED INFOR . ' N IS PROVIDED. I ;Name to be Billed � /-�� Y /AContact Person' /Ak fol Mail : - Address -!I Home Phone City!':tate/Zip 4 all LEL 6/. Business Phone 9 7n � a. 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: [ Siete Evaluation [ ] Improvement Permit & ATC [ ] Both 4 `System'to Serve. VrIlouskasement/Plumbing bile Home [ ]7Business [ ] Industry [ ] Other 5 If Resid nce:: #PeopleBedrooms' J # Bathrooms Dishwasher [ ] Garbage Disposal [ si&g Machine ' [ . [ ] Basement/No Plumbing 6 a If Business/Other Specify type # People #Sinks # Commodes # Showers ' .# Urinals # Water Coolers 'l IfFoo#Seats Estimated Water Usage (gallons per'day) n '' 7 "Type of water supply: [ ] County/City V41 ell [ ] Community 8 ;Do you anticipate additions or expansions of the facility this system is intended to serve? [ ]Yes [ If Yes"W at type? PROPERTY INFORMATION REQUIRED:*** IMPORTANT*** A PLAT OF THE PROPERTY MUST BE s ) ' - - - - SUBMITTED WITH THIS APPLICATION,,. Property Dimensions t�0 "�� . / G aGl1 5; cl_'y ' WRITE DIRECTIONS (firom Mocksville) TO PROPERTY: Tax Office PIN:. #-_- _ Prope_u Address: RoadN city/Zip Y-1///./ a. rD If in Subdivision provide formation, as follows: Name. P 0 >' 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 RepresentzLtive of the Davie County Heath Department to enter upon above described property located in Davie County and owned A-4 , r J c nduct all as n cessary toetermine the site suitability. DATE' -7SIGNATURE dRevised DCHD (06.96) A 7-Z� Q; Cf h r 6-,'v 9 0 l PTd n 0.608 ACRES J - E ,•V� _... 26950°'-0T__."E� / t t0 ti J_ K_ IbIJ t 'L 3U CHJt.1 1 _'-. _ ( 30' c.. c.._. s0`• 297..33 '�S16 �S2Y-32- 50 44 SJ°. '79 E,\ _- 45'_c�"33-//``d'' 4 -�73 Og`-ap E-32 8 - — SC3•-2a_ 3p'w—� "Sts' -IB -70 w --- /' oV .. r.<w __26937"500__41 .50 w__�M.w—^-• 532. '°5-. J7 -Tp„ "79 F\ Vol°O. 777\\ ' %e.'�/ S49'. a4.- E-20700 'y."�•<,• S q4' a4 $" E- 957.00 �vOT•59-31 �+ - S.J 56- 0', SS J E\ f\ 9 23.76 / 1 X55039 -20E— 57.80 E� / 38 89 _ Y 4- .g Sg .66- /`�--557•-00-25 58.27 I f 574•-58-30 6746 Q 10.002 ACRES >f 29.039 ACRES �' � z3j,' `.J 15.047 ACRES �i 18131 - N (to IL S. R. 1813 E 30 EASE.) ~� ( S g_ R. L 942 46 • �- 03 32 10 E -- =62. T7 .. ..c.• 32. 77 I QI O m 9 a5-0 00 553 79 396.52 a" n.... --------------- 02 - 51 E oz DAVIE COUNTY HEALTH DEPARTMENT i Environmental Health Section SECTION LOT_ Soil/Site Evaluation APPLICANT'S NAME 4114r/ 114x/ DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE ZYC SUBDIVISION ROAD NAME Ire er, Water Supply: On -Site Well !/ Community Public Evaluation By: Auger Boring ie Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L ,L Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON H DEPTHi— Texture groupC Consistence i Structure 5 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 i SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE:_ r%i�0=1 1 DCHD(01-90) EVALUATION BY: OTHER(S) PRESENT: 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 EFT - 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 ■0■ Davie County Heafth Department and Lome Heath Agency EnvironmentafHeafth Section ` P.O. Box 8481 210 HospuAL STAeu ' COURIER 809-40-06 MOCOVIUE, N.C. 27028 - - PHONE: (704) 634-8760 January 29, 1997 Lee & Jim Nolan c/o Potts Realty P. 0. Box 11 Advance, NC 27006 Re: 2 Site Evaluations/Seaford Road Tax Office PIN: 45776-59-3496 Dear Clients: As requested, a representative from this office visited the aforementioned sites on January 24, 1997. Based upon the information provided on the application(s) for site evaluation(s) and after the evaluations were completed, the sites were found to be provisionally suitable for the installation of an on-site sewage disposal system on each site. Before any permit(s) can be issued the appropriate application(s) must be filled out and the house/mobile home location(s) staked off. If you have any questions, please feel free to contact this office. Sincerely, Q Robert B. Hall, Jr., R. S. Environmental Health Section RH/wd Enclosure(s) cc: Jesse Boyce, Zoning Officer G -