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371 Brangus Way Lot 30Account M 989900063 Billed To: Larry McDaniel Reference Name: ATC Number: 3100 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH M 5832-08-2439 I Subdivision Info: Whip -O -Will Lot # 30 Location/Address: Brangus Way -27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .19 a Trea pt and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA1 rGN CT V L QD QaIVE,YEARS. Environmental Health Specialist's CERTIFICATE OF C� l **NOTE** The issuance of this Certificate of Completion s has been installed in compliance with Article 11 Disposal Systems," but shall in NO WAY be tak given period of time. HW L} -2,D Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) to I b0 � ys'tern 130 e; t th�l 'tq, ro f A C gwImprovement/Operation Permit 900 "Sewage Treatment and will function satisfactorily for any L-10e� f-� I r, r->QDL"- Date: I DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street C� Mocksville, NC 27028 (336)751-8760 **NE** Tlilblmprovem0 OTent/Operation Permit DOES NOT authorize the construction of septic tank system 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 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type Old _ #People Z #Bedrooms q #Baths Dishwasher: Garbage Disposal: Cr- Washing Machine: 17!r- Basement w/Plumbing: ❑ Basement/No Plumbing: ©� Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 5� CW*�6-we Water Supply CtOl'� Design Wastewater Flow (GPD) 4 KD Site: New e Repair ❑ ,I %) f System Specifications: Tank Size 1 000 GAL. Pump Tank GAL. Trench Width ::S(� Rock Depth 1Z Linear Ft. 90c� Other: 's- A--)C.-Vf-1 &--T, !tib ZE [ t- IMPROVEMENT/OPERATION PERMIT L ) e)� — l I ().0 • N -I s j Required Site Modifications/Conditions: I f32:lAyi- 0'J C` Account #: 989900063 Tax PIN/EH #: 5832-08-2439 Billed To: Larry McDaniel Subdivision Info: Whip -O -Will Lot # 30 Reference Name: Location/Address: Brangus Way -27028 Proposed Facility: Residence Property Size: see map **NE** Tlilblmprovem0 OTent/Operation Permit DOES NOT authorize the construction of septic tank system 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 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type Old _ #People Z #Bedrooms q #Baths Dishwasher: Garbage Disposal: Cr- Washing Machine: 17!r- Basement w/Plumbing: ❑ Basement/No Plumbing: ©� Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 5� CW*�6-we Water Supply CtOl'� Design Wastewater Flow (GPD) 4 KD Site: New e Repair ❑ ,I %) f System Specifications: Tank Size 1 000 GAL. Pump Tank GAL. Trench Width ::S(� Rock Depth 1Z Linear Ft. 90c� Other: 's- A--)C.-Vf-1 &--T, !tib ZE [ t- IJ�%d l J� L ) e)� — l I ().0 • N -I s j Required Site Modifications/Conditions: I f32:lAyi- 0'J C` f U f.) L,S 1 '� n" & IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** ►.u-)) `7 f ttlojflz !i Si DC- -•rb4J ►Ttis cz""9-- of Environmental Health Spe ialist's Si DCHD 05/99 (Revised) W-, Date: lTa- F�WR u 6Q tun 511E EVAWAIION/IMPROVF1MENT PERMIT do ATC Davie County Health Department Environmental Hea/Ys3 5be fon Hoz 848/210 Hospital Street Mockaville, NC 27028 (336)761-8760 I •:,►IP APT+�pa lE I 'APPLICATION CNINOT Ea PROCESSiD UNLESS ALL THS REQUIRED ZNFO .Tom— DED. Refer to the ^�IMU MKTION BULLETIN for instructions. 1. Maas to be Billed La( -r -k (1'1Ct 1e- ( 7A 1a k �tlrS Contact Person�- Mailing Address + ��` X 1S,, )'� I\ n¢-�s��`� Boas Phone`,fir 1 - '. City/State/LIP I 1 � E de--!�Ju , 3Q- a' 1t b Business Phone aJ�P `t.�-}-o - � Cc Ll 2. Paas on Pewit/A2Cr\if//\\Different `than Above'Ro-u 4 � 1 sRKQ ( Ra1.nAo I I 1 � r�2 � flailing Address (y V ��.,J 1 LSU i S 1 f ac -S . pity/state/Zip f o r t,TU ny Q dC aIU CI A 3. Application ror: U Site Evaluation Improvement Permit/ATC 0 Both s. system to Service: �ouse 0 Mobile Hales D Business 0 Industry 0 other o. If Residence: # People # Bedrooms # Bathrooms 3 `J X161-shwasher *i"age Disposal ;;:.flashing Machine 0 Base men t/Pimbiog �asement/no Pimbing S. If Business/Industry/other: specify type # Commodes # shovers # People # sinks # urinals # hater Coolers Ir NIOODSEMCE: 11 Seats ,/ Estimated Water Usage (gallons per day) 7. 2"m of water supply: ' <�" ty/City U well 0 cenommity s. Do you anticipate additions or expansions of the facility this system Is intended to serve? 0 Yes NO If yes, what type' *"IMPORTANT"" CLdENTSMUSTCOMPLEfETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUAWTTED by the client with THIS APPLICATION. ^ � � Q,NLt..aC'X CPO Property Dimensions: ?%` X c�5 Y-qgi)c % 0� G r� WRITB DIRECtiuNS (from Mocksvllle) to PROPERTY: Tax Office PIN: # OWL( (,Q d 1 - 'T OMY Property Address: Road Name + 30r �� Or S C City/Zip ©C�sy� " 74,o W4- c /ll -b A) LA>e f(Rd— a r�-- If is a Subdivision provide information, as follows: vara u -S Name: OR' n - C) ' � . Z�� OL o1 Iqc� {- int ,ca Section: Block: Lot: L -5D Date F'ro �iei Flagged: —(Q C'� This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits) 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 falsif ed or changed. I, also, aadastaad dial I mar rqpons0lefor all charges Incrured from this application. I, hereby, give consent to the Authorized Representative of tb Davie County Health artment to enter upon above described property located In Davie County and owned bti HrS' -t;o to conduct all testing procedures as necessary to determine the site saltabillh. DATE �'" lQ ' ®oC SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, six ctares, setbwJu4 and septic locations). Revised DCHD (07/98) UV Account No. Z fS 9 Invoice a N D $ 6 of R APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMI �) A TC�`' M L/ ` Davie County Health Department Environmental Health Section JAN P. 0. Box 848 9 Mocksville, NC 27028 I (704; 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS Idl, ALL THE/REQUIR�Ed D �IjNFO ATION IS PROVIDED.Aa 1. Name to be Billed `-� 0` I 4 w L��/eContact Person Mailing Address \r Z/ Home Phone City/State/Zip c�LT- OJ[5-5-Business Phone a� 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: A Site Evaluation 4. System to Serve: X, House ❑ Mobile Home City/State/Zip ❑ Improvement Permit & ATC ❑ Both ❑ Business ❑ Industry 5. If Residence: # People # Be rgoms t� - --TL 4t ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing, ❑ Other # Bathrooms ❑ Basement/No Plumbing 6. If Business/Other:J�Oecify ty e # People # Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply:CElK ounty/City El ElCommunity 8. Do you anticipate rdditions or expansions of the facility this system is intended to sgrve? Yes No If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST i _ SUBMITTED WITH THIS APPLICtsT. 4. Property Dimensions: IL�s E? . WRITE DIRECTIONS (from � Mocksville) TO PROPERTY: Tax Office PIN: # - ©Q - ��Q _ Property Address: Road Name City/Zip L12 Ce P, ;4nie-A,l R— If in Subdivision provide information, as follows:WA Name: Section: W ��-CLtrSS �:�i�Ci Lot #: 1 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 l harges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Depar:ment to enter upon above described property located in Davie County and owned by as necessary to determi a the site suitability. DATE SIGNATURE Revised DCHD (06-96) r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT �Z Soil/Site Evaluation APPLICANT'S NAME DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE SUBDIVISION ROAD NAME ZlfJ G11 Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit ✓ Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Sloe % 02 HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence ; Structure 0177 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:4e� ixe EVALUATION BY: Azz LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS 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 DCHD (01-90) ■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■ UMMEMMEMEMNONMENEM ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ moon ■mm ru�-a■ NEON ■■■EN■■EMM■■■ ■E■O■■E■E■EM■ ■E■■■■E■EM■M■ ■EM■■■■EM■■M■ ■E■■N■■■E■E■■ ■■NO■■ME■■E■■ ■■■■■ENE■ME■■ ■MM■■■EM■■EM■ ■E■■E■■EEE■■■ ■E■ENE■■E■■M■ ■E■EM■■M■■E■■ ■■■MMMMM■M■■■ ■■■■■M■■■EEE■ ■■NEN■■■E■EM■ ■EMMN■■M■■■E■ ■■E■E■E■E■EM■ ■■■EMMU■EEE■ ■■mm■■ ■■■E■ ■■E■MEM■■EEE■ ■E■■M■■ME■■■■ NONE MEMO NOME ■■N■ moon ■E■■ ■O■■■■■ SOMEONE ■EOE■E■ ■■■m■ ■OM■■ ■E■E■ ■EN■■ ■ENE■ ■E■■■ ■ENE■ ■■M■■ ■■O■■ ■ ■ ■■■NE■ ■E■■O■ Iron found S 81 'S0'31 • E --�. 855.37 -------------- (10 ----- rn rn CL Om CL LOT #30'03 AREA 5.044 ACRES a s ss s -col 3' 03' S p61 ' �7 232 6a � r S 7 S X6.33, 8 � E 4p, 5 40, (20 CPA & LMLJ7VED)Y (PR 4S ori. LOT � PLAT 3 i BK. 6 p9 69 1 1 1 1 l I 1 z 23' 227, 97 t .f LOT #29 ` AREA = 5.006 ACRES • O8� Z,Zr � j� X952.96 X39. • /N 1545S-15%. '�I N 3251 g� V Iron found N 01 32 15 E 70.97 LOT #2 PLAT BK. 6 Pg. 69 J Q D r, o, co LO W 1D v - <r tJ� 0 Z L AREA / / 3' 03' S p61 ' �7 232 6a � r S 7 S X6.33, 8 � E 4p, 5 40, (20 CPA & LMLJ7VED)Y (PR 4S ori. LOT � PLAT 3 i BK. 6 p9 69 1 1 1 1 l I 1 z 23' 227, 97 t .f LOT #29 ` AREA = 5.006 ACRES • O8� Z,Zr � j� X952.96 X39. • /N 1545S-15%. '�I N 3251 g� V Iron found N 01 32 15 E 70.97 LOT #2 PLAT BK. 6 Pg. 69 J Q D r, o, co LO W 1D v - <r tJ� 0 Z L AREA