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128 Peace Court Lot 4DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990004119 Billed To: M & M Construction Reference Name: Mark McKnight Proposed Facility: Residence ATC Number: 4518 Tax PIN/EH #: 577-33-1382.04 Subdivision Info: Still Waters Phase I Lot # 4 Location/Address: Property Size: see map As SystemsNCay alAC so be used 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 WASTEWATER CONS g17SALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatu Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completio dicate the system described on Improvement/Operation Permit has been installed in compliance with Articl 1 of G.S. C a Section .1900 "Sewage Treatment and Disposal Systems," but shall WAY be ' NO as a guarantee that the sys 1 function satisfactorily for any given period of time. 2 Vii. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) al w2lnv-� I cZ Date: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street MockvAlle, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990004119 Billed To: M & M Construction Reference Name: Mark McKnight Proposed Facility: Residence Tax PIN/EH #: 577-33-1382.04 Subdivision Info: Still Waters Phase I Lot # 4 Location/Address: Property Size: see map ATC Number: 4518 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 #People #Bedrooms _Z #Baths -2- Dishwasher: ZDishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size D. - Type Water Supply Design Wastewater Flow (GPD) Site: New 17"' Repair ❑ System Specifications: Tank Size ICCOGAL. Pump Tank GAL. Trench Width* Rock Depth 12" Linear Ft.�' As stated in 15A NCAC 18A.1.969(5) 1� Other: 'bA& r� �Ox� accepted Systems i -nay also be used Required Site Modifications/Conditions: k /SSTAI I. (>J (1)1=0, ��1 /[j t&Z� i© oweaf � IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00p. m. to 1:30 p.m. on the day of installation. Telephone # is (33C►)7_51-8760.**** 3' 1A 1 '531 1 Environmental Health DCHD 05/99 (Revised) Z .� .01 Signature: 10/08/2006 22:13 3369988780 M&M CONSTRUCTION PAGE 01 JUL 31,2005 17:08 000-000-00000 page -1. site SOC 091416 twte county •nvnintolth 929 791.9790- r:a. ATION FOR iTTEFWALUATIOWIMFROVF.MENT PERMIT & ATC U>.•ie County Health Department. EnWroawalrw asam Sroboa �.aAn B0210ltelWW sheep.. MotbV11104C 270:0 (136)751474W Pan (37�7Kt-r70i 11w);vrWnlvrinryleverantPtniit yl -s# nW-AnTvCv=rrtpAlC) 119sW "A11t/NCSfNP/O71tIA0GbSStOt1P'LyeeAlJ.tY.'t'1tr-p1CQ11911!A !tat •r I+tb Dwolt ovr10N IlumeTw fw larvrt%om. APPLICANT IN)'09MATION Nmt w to be pulc !—' r Coe�et prreoM �( flitting Admctf:j �r�; _Mmol 111erac• t'dyrletreiZd� �1 .�1��7QZ�_6.erAeltrfiorle_.. 2: �$G K-"w41A esnriUA'1C fD.f�ttrntd.:�A►vry—�_{�y/�� �(tr1led Addnne s�.���nv �r�i�C...L_-!•--)J�..��..� .�..—..���..•..�. !'Q<)IER1Y R�Q'C1K�NATION ...�_..._........ ., •. _..,.,.. ._..__....,. ---.. _ ... 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Dor . elag4v.w 10/08/2006 22:13 3369988780 AUG 01,2005 0:26 r ,'I M&M CONSTRUCTION 00040040000 PAGE 03 pac3e I PRELIMINAI§YMAP --1 FOR REVIEW ONLY i loocoloc"E 182.96,—.,— m IINARYMAP WIEW ONLY 30 0 30 60 90 GRAPHIC SCALE — FEES PRO POSCD HOUSE LANIOUT FOR MWfACY0i6H-r LOT A IN '14TU, WkTEKv. SUBDIVISION" RECORDED 114 P9. 7, PG. 215 7- 190 TAX MAP DATE -CA�W N. 4i 0 PT j04 _fZ(�� 'r .14X --B-C6CkL RONALDLEE OXENDINE SCALE SURVEYING 1 c: 30' 'TAX (AT No. 6nwipwl ALPI�W_I'.F ' APPUCATION FOR SITE EVALUATION/IMPROVEMENT Pi RMY & ATC ` Davie County Health Department !R 2 6 2001 P.O. Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 ENVIROP l. 1LTH DAV(; ***IMdPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. Cl S �jVL RVf';40 b, Cgm/16et i 1. Name to be Billed -T/ PI)ee.11 . 7,4[1 6PaQ� �'r je= , Contact Person Mailing Address 9000 .� ADlti.:fc'y i Ae,*e-��t . Home Phone -33G- i 9.� - 7t City/State/ZIP Wlti��"U/J-,1i1PiL1 ^ 7121 Aln, Z-7121 Business Phoma 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 Service: �( Housq' ❑ Mobile Home ❑ Business ❑ Industry Other Sck0 iv;sicIJ 5. If Residence: # People # Bedrooms 3-q # Bathrooms ADishwasher y Garbage Disposal k Washing Machine ❑ Basement/Plumbing X Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons par day) 7. Type of water supply: County/City ❑ Well ❑ Community o. 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 COMPLETE THE RECUIP.iiD PROPERT.' INFOP.%IATiON REQUESTED BELOW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: #„5-3 77- 3 3 -1 M,� Property Address: Road Name ll w �I go 1 City/Zip AJCR7006 If in a Subdivision provide information, as follows: Name: WRITE DIRECTIONS (from Mocksville) to PROPERTY: HOU b yP? A S+ 10- w Av 1. l u P'I u LeeA YL OA”; (e 0 /J t Section: e}Block: Lot: 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] am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the 12avie County Health Department to enter upon above described property located in Davie County and owned by _LPf4&" (l'S to conduct all testing procedures as necessary to determine the site suit b lily. �% DATE 3%30A 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 Date(s): Client Notification Date: EHS: Account No. ( % zk---o Revised DCHD (07/99) Invoice No. DAVIE COUNTY HEALTH DEPARTMENT • . • . Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001720 Tax PIN/EH #: 5777-33-1382.12 Billed To: Campbell's Quality Properties, Inc. Subdivision Info: Still Waters Phase 1 Lot #MO Reference Name: Location/Address: Hwy 801-27006 Proposed Facility: Residence Water Supply: On -Site Well Property Size: see map Date Evaluated: 5! I I I )ol Community Public Evaluation By: Auger Boring Pit Cut n1 17 FACTORS 1 2 3 4 5 6 7 Landscape position L- L Slope % SLf 26 3flo HORIZON I DEPTH — V o - 10 Texture group� L- S c L Consistence G-�S ii-C�S Structure Mineralogy:1 1 - HORIZON II DEPTH - Texture group5C, Consistence C' ` Structure Mineralogy 1= - HORIZON III DEPTH -- (4 S .' L Texture group�c Consistence Structure Mineralogy HORIZON IV DEPTH Texture group 50 Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 19. SITE CLASSIFICATION: Q S LONG-TERM ACCEPTANCE RATE: D.4 REMARKS: EVALUATION BY: V_ -o - cAA d 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 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) w AO Lor .2y APPLICATION 1=011 SITE EVALUATION/IMPROVEMENT PERMIT & ATC D Davie County Health Department • Environments/ Hea/lfi Section APR 2 6 2001 P.O. Box 848/210 Hospital Street Mocksville, NC 2702$ ENVIRDI ir: t1lTH (336) 751-8760 DAVIT ***IIdPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. n r 1 bl 1. Name to be Billed _ AMUMP49f I1 s � I ti je 1 ' r �LNL Contact Person 'Rf;tmO . Cquy6etl Mailing Address -9000 SAnD,�; V 1 I(Ilue+. Home Phone 33(,-795-- 37(,2- Ci1/l/ ty/State/ZIP 1"1-o/J-'S6le ili �C 1..Z7111 Businass Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/state/zip 3. application For: K Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: IJ( House,' ❑ Mobile Home ❑ Business ❑ Industry fX Other Sig ..,V%Sicd 5. If Residence: # People # Bedrooms 3-q # Bathrooms Dishwasher Garbage Disposal �, Washing Machine ❑ Basement/Plumbing Q( Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats tr Estimated Water Usage (gallons per day) 7. Type of water supply: JS County/City ❑ Well ❑ Community s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes OtNo If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRE] PROPERT; INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # 5 777 3 Property Address: Road Name 11W Sl/e City/zip IJCR7o06 If in a Subdivision provide information, as follows: Name: 1 Section: ASS Block: Lot: ]—�, WRITE DIRECTIONS (from Mocksville) to PROPERTY: tJ 6y eAS+ F"I G ASU OrU CeeA '14 M 1 (C v tJ 144' Date Property Flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits) 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 avie County Health Department to enter upon above described property located in Davie County and owned by �,M�c, Wi l ua� Pry II di'� T c'_, to conduct all testing procedures as necessary to determine the site suijab lity..�% �Q DATE �I j0/ fel 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 Date(s): Client Notification Date: EHS: Account No. 2 a Revised DCHD (07/99) Invoice No.Q--� Yf Z DAVIE COUNTY HEALTH DEPARTMENT ! Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001720 Tax PIN/EH #: 5777-33-1382.04 Billed To: Campbell's Quality Properties, Inc. Subdivision Info: Still Waters Phase 1 Lot # 4 Reference Name: Location/Address: Hwy 801-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: .5- Water Supply: On -Site Well Community Evaluation By: Auger Boring Public L.", Pit [/ Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Q r •' 4"(574' Texture groupCi Consistence i Structure ! S'/3 / 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: LONG-TERM ACCEPTANCE RATE: EVALUATION BY: OTHER(S) PRESENT: REMARKS: �� �`' ��� 0 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)