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288 Deadmon Road Lot 6DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT PERMIT V A -u **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 oust 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) NA1 1Q'PROPERTY ADDRESS NA. .„6-n � LOCATION �(A S �, �Q PG lcr0 P R� Y101 4c� Slu SUBDIVISION NAME -O'y _ ��� �� "L'OT NUMBER SEC./BLOCK NUMBER RESIDENTRL SPECIFICATION: BUILDING TYPE ouao- # BEDROOMS # BATHS # OCCUPANTS I GARBAGE DISPOSAL: Yes Na COMMERCIAL SPECIFICATION• FACILITY TYP?'•i # PEOPLE _ # PEOPLE/SHIFT _ # SEATS _ INDUSTRIAL. WASTE: Ye`ftoo n LOT SIZE � TYPE WATER SUPPLY Q; DESIGN WA�,TEWATER FLOW fGPD)"9 i6o NEW SITE ✓ REPAIR SITE _ SYSTEM SPECIFICATIONS: TANK SIiEPUMP TANK _ GAL. TRENCH WIDTH _� ROCK DEPTH LINEAR FT.. I" OTHER It�'...I i .,l REQUIRED SITE MODIFICATJONS/CONDITIONS: +**THIS 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',HEALTH DEPARTMENT 8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OFAINSTALLAT ON. OPERATION PERMIT f SYSTEM INS LLED Y I/ FINAL INSPECTION OF THIS SYSTEM BETWEEN HONE # IS (704) 634-8760. AUTHORIZATION NO. D / OPERATION PERMIT BY //7 DATE 02 /e. **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 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. DCHD 10/95 Davie County Health Department rs ENVIRONMENTAL HEALTH SECTION 1 P.O. Box 665 �b• b ^' Mocksville, N.CqC.�S7028;, AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION 3 (Issued in compliance with Article 11 of G.S. Chapter 138A, Wastewater Systems) ***This Authorization For Wastewater System Construction must be issued by the Davie County Environmental Health&Eion prior to issuance ofq:any Building Permits. This Form/Authorization Number should be presented to the Davie County Building fnpect'igns, Office when applying for Building Permits.*** '� --�— AUTHORIZATION NUMBER. NAME 1IYM NN�Noa�oN DATE l��� N®':. 0071 WYE ON IMPROVEMENT PERMIT IIf different than above) + SITE LOCATION S 4 SNS' Rio 4 R COM ENTS/CONDITIONG ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM n ***NOTICE*** THIS AL as -Se DCHD JO/,95 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested Mailing Address 2!q:� Home Phonelp Business Phone 2. Name on Permit if Different than Above 3. Application for: ❑ General Evaluation Jli Septic Tank Installation Permit 4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision So 0 %fr b©Q Section Z Lot # ❑ Basement/Plumbing No. of People / No. of Bedrooms 3 No. of Bathrooms Dwelling Dimensions 3.� X 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 No. of Showers Water Usage Figures _ 7. Type of water supply: jkf Public ❑ Private 8. Property Dimensions /— Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes If yes, what type? ❑ Basement/No Plumbing �( Washing Me chine Dishwasher ❑ Garbage Disposal o ❑ Community i '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 N'REQUIRED: Directions to Property: Tax Office PIN # 6%k7. 3?- afrlJ Road Name Box # (if available) City T� b A3o/ f`c���-V 0/�° r co N ?r2d1 --- LOA -1V This is to certify that the information provided is correct to the best of my incurred from this application.DATE I am responsible for all charges SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 0( 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 gro bsorption sewage treatment and disposal system. //-- 7 ySVAL DATE QIUINATURE .. DCHD t11M - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section _TN Soil/Site Evaluation NAME 1 \'M. Q cn0 N "Vt'o DATE EVALUATED ADDRESS PROPERTY SIZE q�' tS i Jti / PROPOSED FACIILTY _ W o 032 LOCATION OF SITE �c���1 tKZ1jnA l o Water Supply: On -Site Well Community Public Evaluation Byt`� Auger Boring —7—. . Pit - - Cut - FACTORS 1 2 3 4 Landscape position Slope % (3 - d o �S4 HORIZON I DEPTH H. Texture group L - Consistence Structure C Mineralo 1 ;1 HORIZON II DEPTH t` L1 i Texture group Consistence -i F Structure pg Mineralogy t •1 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 5 5 �S RESTRICTIVE HORIZON SAPROLITE - CLASSIFICATION i5 .s LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: Q� I'S LONG-TERM CC REMARKS: 1 DCHD(01-901 EVALUATED BY:- OTHER(S) PRESENT: oNQ 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 e.lay 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 fine 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(suilable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/fla APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department i� Environmental Health Section E 'l� G P. o. Box 665 NOV 2 81994 Mocksville, NC 2702$ 1. Application/Permit Requested By / l l I C b9 �,ar Mailing Address ?^" .:a_ //J X/%% 2. Name on Permit if Different than Above Business Phone D 3 - 7-222- 3. Application for: eneral Evaluation O Septic Tank Installation Permit 4. System to Serve: use ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision rSOu4 a alLlaa— - Section —L Lot # G No. of People ✓�� No. of Bedrooms ;Z --p No. of Bathrooms Dwelling Dimensions A:14-zf• /�6� 6. If business, Industry, place of public assembly, other: Specify type No. of People Served . 44A No. of Commodes No. of Lavatories No. of Sinks No. of Urinals No, of Water Coolers ❑ Basement/Plumbing ❑ Base ent/No Plumbing asking Machine Dishwasher ❑ Garbage Disposal No. of Showers Water Usage Figures 7. Type of water supply: Public ❑ Private ❑ Community 8. Property Dimensions � 17e 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. This is to certify that the information provided Is correct to the best of Incurred from this app'catio . r ( DAT I am responsible for all charges CONSENT FOR SITE EVALUATION IQ BE DONE QN 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 to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE OCHD (1133) DAVIE COUNTY HEALTH . DEPARTMENT Environmental Health Section (j �-� Soil/Site Evaluation. NAME 1 , k\� Q DATE EVALUATED ADDRESS s' PROPERTY SIZE 1001. X 00 t PROPOSED FACULTY 0 LOCATION OF SITE Water Supply: On -Site Well - Community - Public V Evaluation By: - Auger Boring Pit ✓ Cut . FACTORS 1 2 3 1 4 Landscape position Slope S Ci - ° HORIZON I DEPTH 1Z rr— Texture group Consistence TS Structure Mineralogy HORIZON II DEPTH 3p E. Texture group Consistence - Structure Mineralogyt I', HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture grou Consistence Structure Mineralogy SOIL WETNEMHORIZON S RESTRICTIVSAPROLITECLASSIFICA C LONG-TERM SITE CLASSIFICATION: \� • • EVALUATED BY: � p LONG-TERM ACCEPTANCE RATE: '�_ OTHER(S) PRESENT: dRtA REMARKS: LPSGEND 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 cAay 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 -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky NP -Non plastic SP -Slightly plastic P -Plastic VP -Very plastic Structure 3C -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