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149 Starr Lane Lot 10AIZATION NO 184 OADAVIE COUNTY HEALTH DEPARTMENT ' e ' pp Environmental Health Sectlon PROPERTY It7FomTA'TION-""' „.NamePermittee's G �� W���L75c� a..t. P:O.iBox848 Lc L! C Mocksville, NC 27028 Subdivision Name: �p.$yIS, Oh he 336-751-8760' : 11 O Directions to property: �c i Section: Lot: F WASTEWATER��)`� AUTHORIZATION FOR , 71 t1d,1y J / *�QV�: } it I uG� SYSTEM CONSTRUCTION Tax Of11f11ce PIN:# Road a�e eTr, L Zi . �JV(o P:. **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 app yip g for Building Permits. .- (In compliancy "th" cle.I I of.G.S. Chapter 130A Wastewater System's; Section.,1900 Sewage Treatment and. Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION i 1 O IS VALID FOR A PERIOD OF FIYE YEARS .: ENVIR N ALTH.S¢ECIA IST i,DA E ISS ED _ v t r ' O17 DAVIE COUNTY HEALTH DEPARTMENT l f 1 IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION "' Xerltuttee s: Name / r ' Subdivision Name: . Directions to property IAe 4 0 ,sols ! Section: Lot: t� '.IMPROVEMENT (. 7 PERMIT Tax Office PIN:# ' ,,'. y 1 nC:rfu7 -► o /1� f 'ei ^l inCE L �.1 RoAUe- '"1 nc.c. , t— Zip:. u V.l a **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of aseptic tank system or any wastewater system.:An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the ; copstruction/instaIlation of a system or the issuance of a building permit. ' On compliance With' cle 1 'ofG.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Trmtmenf and Disposal, Systems) ***NOTICE*•*THIS PERMIT IS SUBJECT TO REVOCATION IF SITE G ( PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIR N HEALTH SPECIALIST ` DA IS D SYSTEM CONTRACTOR MUST SEE THIS PERMIT B FORE MINSTALLING THE SYSTEM. (o RESIDENTIAL SPECIFICATION ,BUILDING TYPVt_1i_ # BEDROOMS C . # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE # PEOPLE/SHIFT # SEATS_ INDUSTRIAL WASTE Yes or No LOT SIZE) 2 WATER SUPPLY "•� DESIGN WASTEWATER FLOW (GPD) �-Y�/ NEW SITE REPAIR SITE - SYSTEM SPECIFICATIONS: TANK S !-^C^0 GAEL. PUMP TANK\- GAL. TRENCH WIDTH+N ROCK DEPTH 17- LINEAR FT.1 , OTHER REQUIRED SITE MODIFICATIONS/CONDI I S. ' ��OYhr, L 1.3 f o t, U rk r..) tC: � NE0 --aj '�' I=XIST Co 1 . �:, l :i I aJ : of i�Dnt IMPROVEMENT PERMIT LAYOUT *+tRTSER(S) IF 6" BELOW FINISHED GRRDE+� a ROVED EFFLUENT FILTE .�,.., .. •, _ CHILL 1�� : x171i9 ; **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF nil S.SYSTEM - BETWEEN 8:30; 9:30 A.M. OR 1:00 -11:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704j 634-VA(XXXXX)tX OPERATION PERMIT H-�l Z••„ 1 �y yy 7 �/ S ST STALLED BY:A. CJ o tJi.l� ZSOs r`yJlo K ILS � -vltj.T7�rJK -P&Afto I*.9 s oG *36 •� -T1 ©r- � AUTHORIZATION NO. 84�.� OPERATION PERMIT BY: ATE: **THE ISSUANCE OFTHISOPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DES BE ABOVE HAS 134EN INSTALLED IN COMPLIANCE WITH ARTICLE1 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 TIME. I)'HD 05/96 (Revised) !/ x G DAVIE COUNTY HEALTH DEPARTMENT ll r. IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTE' Issued in Compliance With Article II of G.S. Chapter 130a \Sanita�ryy Sewage Systems Permit Number Name Date 7 i r..� r' ND 8 2 0 2 Location Subdivision Name Lot Size House f No. Bedrooms —_No. Baths — Garbage Disposal YES ❑ NO d Auto Dish Washer YES ❑ NO p1/ Auto Wash Ma^hine YES ©' NO ❑ Type Water Supply _ \ -_ i _ �/ _ Mobile Home --_ Business _-- InAstry f �} No. in Family — Public Assembly Other Specifications for System: 'r 'This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEETHIS PERMITILAYOUT BEFORE INSTALLING THIS SYSTEM. 1 '+ 1A c, 1('t _..,. Improvements permit by -- *Contact a representative of the Davie County Health Department for final Inspection of this system between 8:30.9:30 A.M., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634.5985. Final Installation Diagram: L'J ,I +� I �G a n System Installed by. S 4� —" �KN`r`, l S �� 11 .I J / 3 /60f ._— / oor Certificate of Completion _`_�D __ Date 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function ea9efaronrily for anv niven period of time. l DAVIE COUNTY HEALTH DEPARTMENT #I�UU. 0 0 - IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTE: Issued in Compliance With Article II of G.S. Chapter 130a Sanitary Sewage SystemsPermit Number, 7- Name 2\� ,:k �� �1lJw� . o�C>: "'A 'Date 1`1 N_ 0 8202. Location 3 (�� I_ ` _ Subdivision Name Lot No. ecQor Block No. Lot Size '��- House _ Mobile Home _�__ Business Indstry rl No. Bedrooms No. Baths _= No. In Family ) Public Assembly Other Garbage Disposal " YES !p NO.d Specifications for System: Auto Dish Washer YES p NO Auto Wash Ma-hme YES �' NO [] `O �r3\ Type Water Supply 'This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site pla.ris or the intended use change ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE.THIS PERMIT/LAYOUT BEFORE INSTAW NG THIS SYSTEM. i.0 nJ • Improvements permit by 'Contact a representative of the Davie County Health Department for final Inspection of this system between 8:30.9:30 A.M., 1:00-1:30 P.M. or 4:30.5:00 P.M. on day of completion. Telephone Number: 704.634-5985. Final Installation Diagram:. ��^n /� System Installed by s�� Q 16 r } a u /601 En-E-) 6 -0-. Certificate of Completion __-_ Date The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS Davie County Health Department ti Environmental Health Section 1 P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By. SL1 E i�ArJ 1F L_ �l'�it;tZ 1 �" Mailing Address 33-1 RIATLAMNViE UL ISR. Home Phone(9 10) -1101e-116Q4 X11OST00- �5ALEM i 0,C.. Q-110Business Phone (9101'1b0-3155 2. Name on Permit if Different than Above 3. Application for: 4. System to Serve: fq General Evaluation ❑ House ❑ Business ❑ Industry 5. If house, mobile home: Subdivision XSeptic Tank Installation Permit 1� Mobile Home ❑ Place of Public Assembly ❑ Other ❑ Unknown No. of People a No. of Bedrooms No. of Bathrooms a Dwelling Dimensions 2 X Q(p 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Sinks No. of Urinals No. of Water Coolers Section Lot # — E] Basement/Plumbing ❑ BasementlNo Plumbing 19 Washing Machine ❑ Dishwasher ❑ Garbage Disposal No. of Showers Water Usage Figures 7, Type of water supply: ❑ Public M Private ❑ Community 8. Property Dimensions S • 2(Q 3 AG . (SOuaee) Sewage Disposal Contractor toN V -00v.30 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ER No If yes, what type? *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: 'Ric m -ri4 F- W TE tLS EC.'r1 o 0 OF Hw l (A 4 Ovi v 00 � [-%p Sol-kTMpF O0 0I - -ruzw LEFT 00 121 V ERY I E W -1-U QNy LEFT- o Q SEPI=OZD -�- Go APPIZOX: 1m1L.1E= -F -ruk, LEFT onl TF+E G(LAVEL- ROAI� JUST 'SEFo(LE LYDIA 1✓LYDiq 1S ALSO A &RAVEL 1210) — IP 2p P ELT Y l S ori TI -IE: Li= F r APP 20x. �/y m I L -r~ Do L O Q TR G Ca2AVZL Zt7. IH6RE iS R �Y0 PFALTy SloiJ Tl -0, SAo(S SAC-9—GS 00 IT- —114C 2EALT`( SIGo lS A(3ovT I N TNG MIDDLE bF -NE P(LDPEZTY, This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this a plication. ql i 9Z DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. 4 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�gf the 5qra County Health Department to enter upon above described property located in Davie County and owned by /T-(2• 1//�AgJ5 to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. I_'- ?IZ, /% L J� 0_ J6I DATE SIGNA TURE DCHD (1/33) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section tp Soil/Site Evaluation NAME L e s a D ANI -+ J\nI�Q(L�Sa a DATE EVALUATED 9- ADDRESS�5n PK\e PROPERTY SIZE PROPOSED FACIILTY �\ - LA o,3 Se LOCATION OF SITE Water.Supply: On -Site Well ✓V - Community -- -- Public- _Evaluetion By:t: ELr Auger Boring V Pit - - - Cut FACTORS 1 2 3 4 Landscape position -5 Sloe R -IS°' - S 7g HORIZON I'DEPTH �1' Texture group.50-L- 5 Q_L CL Consistence __T1 FZL FT Structure Mineralogy :) .1 :) , HORIZON II DEPTH Texture group Consistence p fT— Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS S RESTRICTIVE HORIZON SAPROLITE -- CLASSIFICATION LONG-TERM ACCEPTANCE RATE t + SITE CLASSIFICATION: LONG-TERM ACCEP ANCE RATFr: REMARKS: DCHD(01-901 EVALUATED BY: ` Y rill o � - OTHER(S) FRESE__N\\ I o N-0, LbliL' 1V ll Landscape Position .,... . ,R -Ridge 57Shoulder 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 Aay loam- SIL -Silty loam CL -Clay loam SCL-Sandy clay loam - SC -Sandy clay SIC -Silty clay- C -Clay--- - CONSISTENCE Moist. VFR.V,..ry 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 Saprolile - 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 1,- 4- ._.ks1oN. 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E— 2000 S 50'-39-20E— 23.76 (� / 557•-Op_25 E— 57.80 �Z7—S68'-11-20 E-58.27. 1 �S 74•-5g _3O"E— 67.46 CR c� 67 ACRES ( to E R. 1813 E EASE.) � PARCEL <_ � r,` Q% G �; =S = / 1 15.047 ACRES / =rL 1 / ( to S. R. 1813) / s 4C) _ a 0 /!A ; / 3 Q i, Com. @1 02'- 30 - 45 E .. .. I a.r w. ••x•190.00 _ -- s_•-.�, _ / nOG 52-25.E -- 553 79 1 ' N 03• _09-2(i f