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157 Thoroughbred Lane Lot 21AUTIxoRIZATION NO: 0938 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION _ Permittee's-1' P.O. Box 848 Name: �.kl,2 Mocksville, NC 27028 Subdivision Name: --- Phone #: 704-634-8760 Directions to property: Section: Lot: AUTHORIZATION FOR .! WASTEWATER Tax Office PIN:#� SYSTEM CONSTRUCTION Road Name: 11%rp: '' **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 applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) •� ,' ( r ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED Lon found 331 �' � S 40,98 ESS AGC (20' pU7il!'iy ` Iron found �) (P� � jam, PLAT SKr 6 P9. 69 / LOT #2 I PLAT BK. 6 Pg. 69 I '- 0 ' o► a+ �o � I � � w 1 I .r 1 0 � z 1 i _ _ •_,� g ► WHIP -0_ Wl A LANLL D.B. D174 CATTLE CO. Iron Ifound 9 434 UNE DATA FOR DRIVE & LANDSCAPE EASEMENT UNE BEARING DISTANCE L1 S 21'04'39' W 82.85 L2 S 88'34'37' E 34.97 L3 S 01'25'23' W 30.00 L4 N 88'34'37' W 56.30 L5 N 21'04'39' E 124.82 D. A. A. p LT2 9. 498 NOTES A L4! p 1P -O -WILL Pgrn 2Co. D.B. 172 - J►Q M WHIP_ A LAND, do 0—WILL CATD.B. 174 p ECO, (PLAT 8�. p9 4,34 A WHIP-O—MLL LAND D.B. 74 CO. (PLOT BK, 6 p9 4,34 123'e3' ontrImn olmeruco N 82•0 ' V� \ 0 - NEW IRON STAKE SET O - IRON STAKE PLACED + - UNMARKED POINT ON EASEMENT R/W MINIMUM SETBACK ONES: SIDE - 15' (FROM EASEMENT R/W) FRONT m 40' REAR 30' THIS PARCEL AND ALL ADJOINING PARCELS ARE ZONED RA WATER TO BE SUPPLIED BY DAVIE COUNTY WATER DEPARTMENT NO N.C.G.S. MONUMENT WITHIN 2000' BEING A PORTION OF TAX MAP C-4. PARCEL 6 PRIVATE SEWER SYSTEM (SEPTIC TANK) SEE PLAT BK. 6 Pg. 68 FOR EASEMENT DESCRIPTION TO CANA RD. I 33'26'14' Y 31.58 J S 244.8 9' M �. 244.83 S 333431' W WHIP- 0 - WILL LAND &CATTLE CO. SECTION 3 OWNER =----------- DEVELOPER WHIP—O—WILL A LAND & CATTLE CO. 371 9RANOUS WAY MOCXWU.L N.C. 27028 (910) 998-4661 CLAW%SVN.LE TOWNSHIP DAVIE COUNTYe NORTH CAROUNA OECEMM 31. 19 SURVEYED LAY: TUTTNROW SURVEYING COMPANY 127 LIBEIM CHURCH ROAD MOCKSVKLA N.C. 27028 (704) 402-5818 150 75 0 130 300 450 SCALE IN FEEL Lb + )b,3+ 0. DAVIE`COUNTY . LTH D . ,,, RTMENT ' , f, BWROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Ne: Subdivision Name: ,� .Directions to property: { fiJt�r Section: Lot: D4PROVEMENT gyp. P.ERhM Tax Office IN:# e� f� - Road Nairne.4)20 **NOTE** ThisJrnprovement Permit DOES NOT autl>oiize the construction or installation of a septic t ' system or any,wastewater systema An AUT140RIZATION FOR WASTEWATER SYSTEMCONSTRUCTION must be obtaihM from this Department prior to the constrUctionlinsta.Uation of a system or the issuance of a building permit. " . (Incompliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, -Section .1900 Sewage Treatment and Disposal Systems•' NOTICE*** THIS PERMIT IS SUBJECT' TO REVOCATION PIANS OR THE INTENDED USE CHANGE. YOUR WASTEWATVM ENVIRONMENTALHEKTH SPECIALISTDATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM: , Y RESIDENTIAL SPECIFICATION: BUILDING TYPE 6' # BEDROOMS- # BATHS _.4 # OCCUPANTS � — GARBAGE DISPOSAL. Yes or No .COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY O DESIGN WASTEWATER FLOW (GPD) 4" NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE /ADD GAL:, PUMP TANK GAL. TRENCH WIDTH �� ROCK DEPTH LINEAR FT. ,o�rD%a OTHE4=6 40 REQUIRED SITE MODIFICATIONS/CONDITIONS: **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL' INSPECTION OF THIS SYSTEM BETWEEN 8:30 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 6348760: .OPE TION PERMIT ,A too.SYSTEM INSTALLED BY: • �% A A "ZO, aNo Xswfl )t2 to L �100 11D . ST 1poq0 AUTHORIZATION NO. 0 gag OPERATION PERMIT BY: 9a • DATE: **THE ISSUANCE OF THIS OPERATIORPERMIT SHALL INDICATE THAT THE S TEM 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 TMIE. 1. APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT C A l L -q Davie County Health Department D ` ��_ Environmental Health Section Cabs �L _�� P. O. Box 848 Mocksville, NC 27028 q-ef *7 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED INt ALL THE REQUIRED INFORMATION IS PROVIDED. Name to be Billed •� a � 4 i � ✓ 0. Contact Person I- - -._- Mailing Address 4a14ZG-14r.fl Home Phone �- r9a 9 �� City/State/Zip Tf�Q� e -e /l C 7066 Business Phone - o1i r�srf� 2. Name on Permit/ATC if Different than Above Mailing Addressa� � ' City/State/Zip lQ oL �� 3. Application For: Sit valuation C9_ Improvement Permit &ATC lYBoth 4. System to Serve: :/House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. I,f Residence: # People ;Z- # Bedrooms .5 # Bathrooms _7 CTDishwasher ❑ Garbage Disposal Wwashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Other: I Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well ❑ Com�munittyy 8. Do you anticipate additions or expansions of the facility this system is intended to serve? L] Yes �No If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE It- r1� It, 0� SUBMITTED WITH THIS APPLICATION. Property Dimensions: 3 r7a 3 (-:5X 'a57 X a l �,r a a'1 X Y 7? Tax Office PIN: # 5,5 a a` - 9(a - DI a -(P Property Address: Road Name Thi obrcA n City/Zip &a, v Ole , n C p -q 62Z If in Subdivision provide information, as follows: Name: UAW- W- o- W.' Section: Lot #: WRITE DIRECTIONS (from Mocksville) TO PROPERTY: 6 0 l /l— R o h Tkorou Gr�tJ Ltt. 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 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 n./` & a 6 hip - 0 - 40 W 4. LC � �, ` C • to conduct all testing procedures as necessary to determine the site suitability. DATE ^ Z �— SIGNATURE Revised DCHD (06-96) s/ 7171 �Cla � ' 1I O Q /' Z�'?�•. rl.-�5- L __� q 0V •� i�'>��♦ � +-34'•1 41b.o �. N ao ^r'7 • � .' ... s02 •.G L �.. � .S. dos 'L _ -••3�J �r-np' � i'moo-,�•o�- r � ��',,, 40�.0�• t On ,...., (1��I C -A P. `JOil N SAS. i r.00 .c= � 1 IV 4• p • h ,.are a. � ,� ry�i• �� 5.0o eGar 7 e AF ori Bio r� i1 N 1� Oo 1� u�C-A WA�,.� TO C -A or Y J z 1 o c�okOV" � ti O - V - �-, y '• t,��?\ W s.os .mac= V�� `�� / �L I �°`�(., c, v q1P r<. \\ z�$6 y rr�b o \ 1. .�.-►•� irw C �� i3 �o• c;\ oc q we, o 'U,J� �� M V� ~�� gip• ��' � �� r�� S85 AG t J Aj �O `�� -,'ti � Via. NJ- ''a04.oi-' - - � • ; oma_ rit Y, R*.. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION_ LOT Soil/Site Evaluation APPLICANT'S NAME _ g§l3 D D!i✓ DATE EVALUATED 7oV, Lg?�2 PROPOSED FACILITY 4:e PROPERTY SIZE SUBDIVISION �l/�j �:,� '�- G�-� ROAD NAME Water Supply: On -Site Well Community, Evaluation By: Auger Boring Pit Public L FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group C . Consistence ; Structure Mineralogy t ' HORIZON III DEPTH Texture group Consistence Structure Mineralogyt HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION PIS LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD (01-90) EVALUATION BY: 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/daylft2 ■ ■ No ■■ ■■ ■E■E■ ■EN■■ ■ENE■ ■ENE■ ■ENE■ ■E■■■ ■■■E■ ■MM■■ ■■■M■ ■E■M■ ■■EO■ no ■ ■E■■E■■■ ■EM■■■M■ ■EMM■■M■ ■EME■MM■ ■EMM■■M■ ■■M■MME■ NONSENSE ■E■■E■■■ ■■■E■EM■ ■■■■NSE■ ■■M■■■E■ ■■M■■EM■ ■EM■■EM■ ■EM■■MM■ ■■E■SEN■ ■■■■NES■ ■ESE■EM■ MEMO ■■M■ ■■M■ ■■N■ ■ ■EM■ OMEN NONE ■E■■ OMEN MONS■■ ■■MMM■ ■■■EE■ ■ESM■■ ■ENNEN ■E■E■■ ■MMM■ ■ESE■ ■EM■■ ■MM■■ ■ESE■ ■ ■ ■■■ ■■M■" ■E■■E■ ■■MME■ ■■■■EE ■MEMO■ ■E■ME■ ■MESO■ ■