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130 Walt Wilson Road Lot 10r IMPROVEMENT PERMIT DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT **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 he obtained from this Department prior to the construction/installation of a system or the issuance of a building permit. (In compliance with Article it of S.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) NAME ,�,. a A4 PROPERTY ADDRESS W $ !'{ 12 S d %l DATE 44 LOCATION �� ��f/.9'//7/ 1��i�/J�/bw/ G-�/C61 x SUBDIVISION NAME LOT NUMBER SEC. /BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE !° M BEDROOMS ' i BATHS A OCCUPANTS _ SARBAGE DISPOSAL: Yes/No COMMERCIALSPECIFICATION: FACILITY TYPE I PEOPLE U) PEOPLE/SHIFT _ 8 SEATS _ INDUSTRIAL WASTE: Yes/No LOT SIZE TYPE WATER SUPPLY C / DESIGN WASTEWATER FLOW (GPD)JW NEW SITE + REPAIR SITE SYSTEM SPECIFICATIONS: TAM( SIZE/ GAL. PUMP TANK _ 6RL. TRENCH WIDTH 5l / ROCK DEPTH 47 " LItOtWR FT. � OTHER REQUIRED SITE MODIFICATIONS/CDNDITIONS: MTHIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. IMPROVEMENT PERMIT BY **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY%{V EPRRTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 R.M. OR 1:00-1:30 P.M. ON THE DAY OF TALL TION. TELEPHONE A 15 (704) 634-8760. OPERATION PERMIT SYSTEM PNSTUED BY AUTHORIZATION NO. OPERATION PERMIT BY DATES 1 **THE ISSUANCE OF THIS OPERATION PERMIT SHALL -INDICATE THAT THE.SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH l ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 'SEWAGE TREATMENT AND DISPOSAL SYSTEMS', BUT SHALL IN NO WAY BE TAKEN PS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTU�IL'Y FOR ANY GIVEN PERIOD OF TIME. DCHD 10/95 N',`: pr ...-.'+•r � , •'r:.:AY ry .w6rV .a:,,.i f,. �-.'.. vw^i'4,U+• ...a�...r ,,. .y ,,1 Davie County Health Department a ENVIRONMENTAL HEALTH SECTION P.O. Box 665 u'^ Mocks* Ile, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) X ,1 ***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 PNAME I ermits.*** /� AUTHORIZATION NA'BER SSD;�t°�-1 DTE �v- No- 0390 NAPE ON IMPROVEMENT PERMIT (If different than above) SITE LOCATIONJDLC %A �! r �C — .CIT 14, 1h COMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM *HNDTICE*me THIS AUTHORIZATION FOR CONSTRUCTION IS EN IRONENTAL HEALTH SPEP DCHD 10/95 V APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PER Davie County Health Department U Environmental Health Section MAY 2 8 1996 P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By /7'' Mailing Address 7o,? C°d�.riro T 2�/z Zdna Home Phone 41%%dCtl5r//,1 [ C /f/ C Z 7c'D28 Business Phone 910 97f_971713 2. Name on Permit if Different than Above 3. Application for: ❑ General Evaluation 4. System to Serve: X House §WSeptic Tank Installation Permit ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Jou?t; 1q0,60/C Section Lot # No. of People No. of Bedrooms -� No. of Bathrooms Dwelling Dimensions $V X 5_4 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures ❑ Basement/Plumbing ❑ Basement/No Plumbing .0 Washing Machine Z Dishwasher ❑ Garbage Disposal 7. Type of water supply: (8 Public ❑ Private/J ElCommunity S. Property Dimensions /fir 1< 2 8a Sewage Disposal Contractor '10IX oa /% Al erz 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 2�-No If yes, what type? "NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. PROPERTY INfO TION U . Directions to Property: `� 20 oQ �r•+u� 1� � ��' w w,\� W',1 i a� moi. �cT �, Dc. This is to certify that the information provided is correct to the best of my incurred from this application. 5=2�-96 DATE Tax Office PIN: #S7gl-31 - q9 73 PROPERTY ADDRESS, as follows: Road Name: �Q��.\•� W.�$�7+-5' city: YY. cy-4U,IIC_ 1%L. Z7ozp SUBMIT A PLAT WITH THIS APPLICATION. Revisions effective October 1, 1995. and I understand I am responsible for all charges CONSENT FOB SITE EVALUA ION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1. 1 OWN the property. ❑ 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 of the Davie County Health Department to enter upon above described property located in Davie County and owned by Al to conduct all testing procedures as necessary to determine s ' site's suitabliftyfor a round absorption sewage treatment and disposal system. C�Sa�- 9G DATE SIGNATURE DCHD (1193) APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 N 0 V 2 81994 Mocksville, NC 27028 1. Application/Permit Requested By /� j^ F Mailing Address �� S• L/la. ✓ f� Home Phone /U / 3Y`'•,� Business Phone 7D4�/3`� ZZZZ 2. Name on Permit if Different than Above 3. Application for:neral Evaluation ❑ Septic Tank Installation Permit 4. System to serve: Owl use ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry / ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision SOU4 of (2.Section T_ Lot # /0 No. of People 3/Z No. of Bedrooms C3 No. of Bathrooms Dwelling Dimensions 4qAMar• �36p 6. If business, Industry, place of public assembly, other: Specify type No. of People Served 144A No. of Sinks ❑ Basement/Plumbing ❑ Basement/No Plumbing ashing Machine Dishwasher ❑ Garbage Disposal No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No, of Showers Water Usage Figures 7. Type of water supply: Public ❑ Private ❑ Community 8. Property Dimensions Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is Intended to serve? ❑ Yes 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: This Is to certify that the Information provided Is correct to the best of Incurred from this app'catlo . t AT I am responsible for all charges MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 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 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 said site's suitability for a ground absorption sewage treatment and disposal system. SIGNATURE DCHD(1193) i Water Supply:- On -Site Well Community .Public - L.", -- ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section . Cut . 0-%I Soil/Site Evaluation 6- 21' 10, NAME. L O w 1 e a 4y00p DATE EVALUATED L Consistence ADDRESS ! tvQ _PROPERTY SIZE Structure sandSL-Sandy loam L -Loam PROPOSED FACIII, [� _V S LOCATION OF SITE clay loam, . SIL -Silty loam CL -Clay loam HORIZON II DEPTH 73 t Water Supply:- On -Site Well Community .Public - L.", -- Evaluation By: Auger Boring -, Pit: V Cut . 0-%I HORIZON I DEPTH 6- 21' 10, FACTORS 1 2 3 4 Landscape position Landscape L Slope S C) - a 0-%I HORIZON I DEPTH 6- 21' 10, Texture groupL -'.. 'Texture L Consistence .. - S' -Sand Structure sandSL-Sandy loam L -Loam SI -Silt Mineralogy clay loam, . SIL -Silty loam CL -Clay loam HORIZON II DEPTH 73 t Texture groupC C Consistence Z =J Structure C C Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 5 LONG-TERM ACCEPTANCE RATE U SITE CLASSIFICATION: �l S EVALUATED BY: Llr��y LONG-TERM ACCEPTANCE RATE: L4 OTHER(S) PRESENT: anrivs2 REMARKS: %'A CONSISTENCE `Moist VFR-Very friable FR -Friable FI -Finn VFI-Very firm EFI-Extremely firm Wet .. _ NS -Nom 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 LEUEND 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 sandSL-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 -Finn VFI-Very firm EFI-Extremely firm Wet .. _ NS -Nom 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