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320 Meadowlark Lane Lot 24✓X D DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT s IMPROVEMENT PERMIT **NOTE*4 This improyement'permit DOES NOT authorize the construction or installation of a septic tank g4tem 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 136A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) NAME ^%! • K� �U1.�r✓ PROPERTY ADDRESS meu.LcAA o9DATE LOCATION���/�OC-fJ SUBDIVISION NAME 1���, _�1,,- Z/ LOT NUMBER SEC. /BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS _�/ # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes !O COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE c TYPE WATER SUPPLY Z> DESIGN WASTEWATER FLOW (GPD) NEW SITE V-"' REPAIR SITE ' SYSTEM SPECIFICATIONS: TANK SIZE INO UMP GAL. PTANK GAL. TRENCH WIDTH ..� �ROCK DEPTH LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/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. ez fur fo9s,Pn�e �� Qt 4,��� o IMPROVEMENT PERMIT BY I� W **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. OPERATION PERMIT �k AUTHORIZATION NO. OR SYSTEM INSTALLBY 1 ills I eAct 1;Ne e4 DATE **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 ENVIRONMENTAL HEALTH.SECTION P.O. Box 665 Mocksville, N.C. 27028 ' AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION A1C v -(Issued-in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) WThis Authorization For Wastewater System Construction must be issued -by the Davie County Environmental Health.Section prior to issuance of any'Building Permits. This Fore/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits.*** /f n 2Z0 Asada ,o JTdU N N1J%XR DATE ;�T5;�Z NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION 7r t COMKNTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM 1 vI APPLICATION FOR SITE EVALUATION/IMPROVEMENTS P Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1. Application/Permit Requested By Mailing Address ISS h 2. Name on Permit if Different than Above 3. Application for: 4. System to Serve: 2 House ❑ General Evaluation ❑ Septic Tank Installation Permit ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown Ll 5. If house, mobile home: Subdivision ld ' d - rI Section Lot # No. of People No. of Bedrooms No. of Bathrooms Dwelling Dimensions 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers 7. Type of water supply: Public 8. Property Dimensions No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures ❑ Private 1�r Basement/Plumbing ❑ Basement/No Plumbing CDWashing Machine ED/Dishwasher ❑ Garbage Disposal Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? Directions to Property: FROM MOCKSVILLE: I-40, L FARMINGTON RD. L PUDDING RIDGE RD, R CANA RD., L INTO WHIP -O -WILL, L MEADOWLARK LANE, LOT BEGINS WHERE ROAD ENDS This is to certify that the information provided is correct to the best of my incurred from this application. DATE ❑ Yes PROPERTY INFORIaTION REQUIRED: ❑ Community Tax Office PIN # 5822-95-0257 Road Name MEADOWLARK LANE, WHIP -O -WILL Box # (if available) City MOCKSVILLE and I understand I am responsible for all charges GNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. C12"2. I 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 _WHIP -o -WILL LAND & CATTLE, LLC Carl Boon/John Shie to conduct all testing procedures as necessary to determin aid site's suitability for a ground absorption sewage treatment and disposal system. 1ly - " -4,1 J/7 �7e , , ") - z DATE N U DCHD (1/93) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME obt 1po_ DATE EVALUATED ADDRESS PROPERTY SIZEf%c PROPOSED FACIILTY LOCATION OF SITE Water Supply: On -Site Well Community Public 1/ Evaluation By: Auger Boring I Pit te— Cut FACTORS 1 2 3 4 Landscape position L L L Slope % HORIZON I DEPTH Texture group Consistence Structure MineralogX HORIZON II DEPTH f 3 G Texture group Consistence Structure A6t- A6 4_ 79 7 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: c_ EVALUATED BY: Ala"f/ LANG -TERM ACCEPTANC RATjOTHER( S PRESENT: REMARKS: /' e LEdEND 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 �aay 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 ,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 ut Davie County Nealt`r De artment and .Moine NealiFr yency 210 HOSPITAL STREET I P.O. BOX 665 MOCKSVILLE, N.C. 27028 // PHONE:(704)634-5686 vlbO Michael & Elette Owen 155 Major Rd. Advance, HC 27006 January 26, 1996 Re: Site Evaluation Whip-O-Will/Lot 24 Dear Mr. & Mrs. Owen: As requested, a representative from this office visited the aforementioned site on January 25, 1996. Based upon the information provided on the application for a site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of a modified, oversized on-site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, A., J/ Robert B. Hall, Jr., R.S. Environmental Health Section RH/wd Enclosure(s) Davie County Nealt`r De artment and .Moine NealiFr yency 210 HOSPITAL STREET I P.O. BOX 665 MOCKSVILLE, N.C. 27028 // PHONE:(704)634-5686 vlbO Michael & Elette Owen 155 Major Rd. Advance, HC 27006 January 26, 1996 Re: Site Evaluation Whip-O-Will/Lot 24 Dear Mr. & Mrs. Owen: As requested, a representative from this office visited the aforementioned site on January 25, 1996. Based upon the information provided on the application for a site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of a modified, oversized on-site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, A., J/ Robert B. Hall, Jr., R.S. Environmental Health Section RH/wd Enclosure(s) 09/06/2012 03:45 3369225719 AFC AGE Sep Od 12 04:?@p 4ormabon $"am a�uio�onu , PAGE Dmie County Health Depanmlent 064,, Environmental Health Section P.O. Box 848 210 Ha pitai Street Courier 9 : 09.40X* loll limk%Wle. NC ; 7028 L-;%"-. 00 - 753. coo ON -SPIE WAS IX V-A CAMON 7=900-733-1680 (Check One) Replacement Remodeling Itecounecden 01 To 751 Fmperty Address: I= adIAw2cz leadL&LAI ut T : .. L4l (o oA DOZE/ ?lease l t�'Il In The Following WormatianAbo The PXIStXNG F egtty . Name Stmt (Mmffed LWer A,&- & -- Type Of Facility: uje- Date Syitun Losudw (M0n"4LtraYeaO /4&/q&p Nwubcr Of 6cdrewua:--#^N0� Orpea) k:, r— X4 The Facility Curteazly Vacsat? Yes No if Yoe, Vcpr Hcw Long9 �( AnvKrmwa rrobleme. Vcx S 1(Yes, Explain: Pleaac FM In The Following Inform a" About The.#VEW F•ci1lty: 'type j� Poo) Regot Dieapprovod Environciicit-.i Health roonn;Numtni of Peop!x_,�_ Raquxtield• For Fa vimnmentak Health OfTme Use Ooiy tlign;ttg ofthis forgo by the Ettvirontn�tttl Health StzRis in na wry intruded. nor should ba taken es $ guusmteio (extended or limftcd)fttth3 on site wastewater syrtem will fummo n proptrly for tory given period of time. Pa) -=I. Q.0 Check Moray 0rdar P Amount:$ Date Paid By: &eceivsd 8y: gcxvn:+r:_ ,,,.,��j� lavoicta• L'Dp 4� 0 10 09/06/2012 03:45 3369225719 Sap 08 12 Od:26p irtarmafion SeTwces - Doll MD p 1EUR tEtAATUIT tloDoihlw OEAM17 .'d GRalloo %SIIT IN�DKMT PERNJT ' AFC tos1wu uipip• this ievref"wUps.rll MM IIT •stMrlre the w4tratier or iWL41dieri at a scour "A "stet r ant m1lo tier swagg. M ROOM pnf P PGI IAA.W= MM WOMIN ark u Ntalmd bis tole berteAt plop 11 W# Wd•eesbtlimtautiet K • ow" or we iss"m of a Irildns Ire>it. tit Rre+tlmw vltn wtine it M LL 000or UK Uutmtw Sate % 9&4-' m -110 Imp Trfame" to III,eMI gram) WE . 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