228 Meadowlark Lane Lot 19f
AUTHORIZATION O. DAVIE COUNTY HEALTH DEPARTMENT �o
Environmental Health Section PROPERTY INFORMATION
Permittees �,. P.O. Box 848
Name:t �,°'; 'r'�n' : �' ' f.ytr ` ' Mocksville, NC 27028 Subdivision Name
�Phone #• 704-634 8760
Directions to property:
AUTHORIZATION FOR Section: Lot:
WASTEWATER ''
SYSTEM CONSTRUCTION Tax Office PIN: �''"-9'`) -_
Road Name: rt'� .111 h 6 V t`i Zi ! 7 "i1e)
**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)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED
' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT4
Soil/Site Evaluation
APPLICANT'S NAME ` DATE EVALUATED40,
���>
PROPOSED FACILITY / PROPERTY SIZE S 14e
SUBDIVISION a"
ROAD NAME
Water Supply:
On -Site Well
Community
Public L�
Evaluation By:
Auger Boring e/
Pit
Cut
FACTORS • 1
2 3 4 5 6 7
Landscape position orlk
I'll
Slope %
HORIZON I DEPTH : •
i�
Texture group
e7Z
Consistence
Structure
Mineralogy .
HORIZON II DEPTH
G 'o
Texture group
Consistence
Structure
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: Xf
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD (O1-90)
EVALUATION BY:
OTHER(S) PRESENT: _
h 4,YL
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
I
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
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1
'.DAME couwry HEALTH DEPARTMENT .
IMPROVEMENT AND OPERATION PERMITS. iPROPERTY INFORMA
`N Subdivision Name: 1
Dltii(�nB�tO.pro ' Section:_ Lot:
< EWMOVEM ENT
PERNU . Tax Office
d F
Road Name: Zip:
**NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system An
'AUTHORIZATION FOR,WASZEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
cons0�uction/insfallaiion of a system -or the'' ce of a building permit
(In compliance with Article 11 of G.S. Chapter 130A, water Systems, Section.,1900 Sewage Treatment and Disposal Systems) . t x
***NOTICE*** 119S PERMITIS SUBJECT TO REVOCATION IF RTE
r '
PIANS OR TBE INTENDED USE CHANGE. YOUR WASTEWATER •
SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE '
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED ]BALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS _ # BATHS # OCCUPANTS ' GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION:- FACILITY. TYPE # PEOPLE. # PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE .SLAC. TYPE WATER SUPPLY DESIGNWASTEWATER FLOW (GPD) NEW SITE tom" REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE -Z0__&4 GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH '- � LINEAR FT.�
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) 634-8760.
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & AZ
Davie County Health Department
20RTANT**
EnviWmental Health Section
b �P.O. Box 848
Mocksville, NC 27028�p(704) 634-8760� �5r�****I 1 -p 4LICATION CANNOT BE PROCESSED S
60'to' REQUIRED INFORMATION IS PROVIDED. L
1. Name to be Billed 4/7R l 0 /1 P r' 7� Contact Person
Mailing Address e l Home Phone
City/State/Zip /,Llh /*ACJ/ Ile A4/ 0;yelz2- Business Phone 6ZIA C/X 1`p -- /35-/
2. Name on Permit/ATC if Different than Above
Mailing Address
3. Application For: [n Site Evaluation
4. System to Serve: PfHouse [ ] Mobile Ho
5. If Residence: # People- # Bedrooms # Bathrooms
P<Washing Machine [ktasement/Plumbing [ ] Basement/No Plumbing
.Iq'
[ ]Both
1 Other
[dishwasher [Garbage Disposal
6. If Business/Other: Specify type # People #Sinks # Commodes
# Showers # Urinals # Water Coolers
71007
ks 1 i�
If Foodservice: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: NITIC"ounty/City [ 1 Well [ ] Community
8. Do you anticipate additions or expansions of the facility this
-system is intended to serve? [�es `0No
If yes, what type? w i I b I� l4 -t -4 w -A
PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***A*I"OF THE PROPERTY MUST BE
SUBMITTED WITH T � APPLICATION.
Property Dimensions:�P�e 1Cx t ; WRITE DIRECTIONS (from i I ocksville) TO PROPERTY:
Tax Office PIN: # ' a'1 - - t�5 "� \ '�-L1 O t , �� �b���[ I I -C70 rn" �-e_ t
Property Address: Road Name Mc -c-, 6 . c ,r V1 '-?1C-1.A �.�,,,F C h
C'n n d l n/eo • ID YY�l i I -e.j
city/zip !cnuc, "o � we r o i j Yl ��� D - i�' • l
If in Subdivision provide information, as follows:
Name: h� - - ��l ► 1 ;
Section- Lot #:
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,
DATE S—.3 / - � %
Revised DCHD (06-96)
conduct tin`g:gc�dures as necessary to determine the site suitability.
'7� 61
THIS A1?EA MAY 13E USED rOlt bliAWINCG YOUR SITE PLAN:
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION---,L-LOT
Soil/Site Evaluation
APPLICANT'S NAME '111Wl�
PROPOSED FACILITY
SUBDIVISION
Water Supply: On -Site Well
Community,
Evaluation By: Auger Boring _/ Pit
DATE EVALUATED ��Y%AD
PROPERTY SIZE
ROAD NAME
Public ✓
Cut
FACTORS
1
2 3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
g-
Texture group
Consistence
i
Structure
Mineralogy`
HORIZON II DEPTH
Texture group
0
Consistence
Structure
/�
�1✓
Mineralogyr
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
PE
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD (01-90)
EVALUATION BY: A.- /'Z
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
Davie County Heafth Department
and Home Health Agency
Environmenta[Heal& Section
P.O. BOX 848 / 210 HOSPITAL STREET
COURIER #09-4-06
MOCKSVILLE, N.C. 27028
PHONE: (704) 634-8760
June 26, 1997
Ronald C. Monger
544 Woodfield Rd.
Whiteville, HC 28472
Re: 2 Site Evaluations/Whip-O-Will
Tax PIN: 45822-86-6714/Lot 19
#5822-86-3445/Lot 20
Dear Mr. Monger:
As requested, a representative from this office visited the aforementioned
sites on June 20, 1997. Based upon the information provided on the
application(s) for site evaluation(s) and after an evaluation was completed on
each site, the sites were found to be provisionally suitable for the
installation of a modified, oversized on-site sewage disposal system on each
site.
Before any permits can be issued the house/mobile home location on each
tract must be established and that immediate area evaluated.
If lyou have any questions, please feel free to contact This office.
Sincerely,
�Y'
Robert B. Hall, Jr., R.S.
Environmental Health Section
RH/wd
Enclosure(s)
cc: Zoning Office