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207 Dublin Road Lot 8I 1 u DAVIE COUNTY HEALTH DEPARTMENT j —//,00 JD i?D Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900050 Tax PIN/EH #: X88 5789-73-3047 Billed To: Wayne James Subdivision Info: Shamrock Acres Lot # 8 Reference Name: Wayne James Location/Address: Dublin Road -27006 Proposed Facility: Residence Property Size: .884 Acre **NOTE*Vfilis 1 uprovemlent/Operation Permit DOES NOT authorize the construction 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 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 tlnoS - #Pfeople #Bedrooms 3 #Baths Z Dishwasher: Er"' Garbage Disposal: ❑ Washing Machine: u Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size •ffi4 ACType Water SupplyCE�tnlW])esign Wastewater Flow (GPD Site: New ©- Repair ❑ n System Specifications: Tank Size1000.GAL. Pump Tank GAL. Trench Width Rock Depth Zy Linear Ft.20o' Other: Required Site Modifications/Conditions: I t,�STN-L. ofl Cf)r-�Slboz Y-ua S� evp NaJS6/ to eat 16 Pa.o" ?->c Uwl IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW •FINISHED GRADE. "'*NOTIC-E-Gontact a representative ofthcDavie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on they of installation. Telephone # is (336)751-8760.**** g (Z8)o0 I X3�'nZct I� �- I NN3C _ ➢ t��T--TA o tL 10 f Aww U-1� Environmental Health Sp iahst's 91 nature: T7 l Date:ZcS00 DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900050 Tax PIN/EH #: XN47CA09M 5789-73-3047 Billed To: Wayne James Subdivision Info: Shamrock Acres Lot # 8 Reference Name: Wayne James Location/Address: Dublin Road -27006 Proposed Facility: Residence Property Size: .884 Acre ATC Number: 2381 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). TIES AUTHORIZATION FOR WASTEWATER C ! 1 ] ' ON IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa l::4Date: O CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article I 1 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. �1oC)S6 Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Ia,tiYs Ft-� i�� 0-j� q!j- 1,9 t1l APPLICATION FOR SITE EVALUATION/IMPROVEMENy PERMIT & ALR:T Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital StreetMocksville, HC 27028 (336)751-8760 ***��TW'*** THIS APPLICATION CANNOT BE P_ INFORMATION IS PROV'I)DED. Refer two the INFORMATION BULLETIN fo= instructions. 1. Nacos to be Billed 1�4 A/k _M - `/(�. ngS - /L 1' Content Person I�A-WNE 4r�s Melling Address P 0 + & r- city/seat./zlP /V4 6(' IVG 1 % LBome Phone L NC' .1 Ob pBusiness Phone 2. Name on Permit/ATC if Different than above Nailing Address City/state/zip 3. Application For: ❑ Site Evaluation � Improvement Permit/ATC ❑ Both �• system to aerviee: WIROUse ❑ Mobile Home ❑ Business ❑ Industry ❑Other 5. If Residence: / People ! Bedrooms a Bathrooms �_ IuDishwaehes II Garage Disposal �/ __ bI� Washing Machine I 1 Basement/Plumbing I I Basement/No Plumbing 6. If Business/Industry/Other: specify type / People Y sinks / Cosmwdes j! Showers 1 Urinals t: Water Coolers IF FOODSERVICE: (I Seats Estimated Water Usage(gallons per day) 7• Type of water supply: Xi County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes ❑ No If yes, what type? ***IAIPORTANT*** CLIENTS MUSTCOMPLETETHE BELOW. REQUIRED PROPERTY INFORMATION REQUESTED Others PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLI ATinm }'roperty Dimensions: o ax Office PIN: # —15 — — 8 �38 Property Address: Road Name City/Zip If in a Subdivision provide information, as follows: % Name: �/lQ/h'1An4slJ AAml) Q Section Block: Lot: p WRITE DIRECTIONS (from Mocksville) to PROPERTY: ALL 8//b 1 - p-1 les egL ,& IV612 946&%u.& (2Ik ,4# EA)0 bF/P� "3 L 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, orf the information submitted is this application is falsified or changed. 1, 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 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). Revised DCHD (07/99) Site Revisit Charge Date(s): Y� Client Notification Date: EHS: Account No. OS—a Invoice No. / � tl' " HIL COUNTY AL OFtICE DATE q -- — I, ' IRISH + i MAA' CERTIFICATE OF APPROVAL BY THE FLAMNWO BOARD LOT #9 + _ Th. D°w Cow# PIai9 Bond %w-byI ww.d tb. 4.d pw for t°. SHAMROCK -- -----_ ACRES SUBDIVtsKOIL CURVE DATA _ ' I i.. ' TANGENT CONTROL 1. CHORD BRG CORNER I AWRIM DAVIEC PL.AIIYM6fO.RD DATE CURVE DELTA RADIUS ARC CHORD _______-- I I Cl 25'50"25" 220.00 220.00 99.22 98.38 50.47 179.79 118.31 61.42 S 50'36'04' W S 22'04'57" W E ��' ---- n + �n I o `.1- n C2 31.11'49' C3 5702'14' 280.00 278.74 267.37 75215 ti 35'00'1C• I o oo' rIj ci LOT X31 i� h N of CENTERLINE DRAINAGE EASEMENTS ^ P Lo 8 a �, } , v I Z n 1 - 0 I 1 o wm UNE BEARING DISTANCE N = o I , G' (L1) L2 N 7721'06' W y72= N 26.28'43' W 118.51 i'' } + o I o 208.10 ° 125.00 83.30'57' v L z I S 83 30'57 • :. t� Ch k_a at tb. Davi. Coa°ty Bondcs txa ' { 62 P 9' 6 _— -_ ot oms+b° �. h .►+ c..1ny that .dd bond oppr p(t plmI M.d SHAMROCK ACRE a. W. tb. day at ` N PgO�- Z LOT t7 , :�0': RO- 0.709 AC. I LAT #.32 CORNER 0.684 AC. I 3 l I M 5 • 111 `� 3ze �a ' �� . G�6 g OT 8 L0.696 P9 SOP p 'i2�8 p5'Sa C• AC. L 22 e,3 N � V I , 2 a' ✓ LOT 15 ~ _ 6'�• �• 3C ^ ~ S �5('j�Pv 3 pp 6CR1PnOH A 161 pF5 3p1 • ' T. �- -•� �o 0.7'. B AC. t • �' / 0 E.• I 12 o 0• ENZ 30 �� Gl �?`t, . ,N LAT 14 CONTROL I Bq `p 0.755 AC. o CORNER�No \ ^ LAT f3e,,"Q,K.9e w ` CllJ GG.. 0.779 AG. �. V s LOT #211\0N /15.25 ` Z S 85.41'53' E —y 287.38 0.906 Ac. 5 G 272.13 \ ij 7, CE LAT it 0.775 AC. C 6,10 ,,51 �oo `p EJ7 Q r 9 3TES: _ 7, = iron tktown �ron sstookee se: � V, ~_-• y `y M "or S+ set -d FACTORS 1 2 3 1 4 Landscape position L +Y •' • + � DAVIE COUNTY HEALTH DEPARTMENT Texture group Environmental Health Section Consistence Structure Soil/Site Evaluation Mineralogy NAME HORIZON II DEPTH DATE EVALUATED / a ADDRESS _!:��IOCA 4"A4 PROPERTY SIZE ;Uyxc PROPOSED FACIILTY Mineralogy LOCATION OF SITE HORIZON III DEPTH Water Supply: On -Site Well _ Community Public c/ Evaluation By: Auger Boring Pith / Cut HORIZON IV DEPTH Texture group FACTORS 1 2 3 1 4 Landscape position L Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH h Texture group Consistence -i Structure f �C 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: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: + OTHER(S) PRESENT: REMARKS: 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,,.Iay loam SIL -Silty loam CL -Clay loam, SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay Moist VFR- Vc.ry friable FR -Friable FI -Finn 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(01-901