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348 Michaels Road Lot 9AUTHORIZATION NO. I 4�t U DAVIE COUNTY HEALTH DEPARTMENT r Environmental Health Section PROPERTY INFORMATION Permittee's (j c`" P.O. Box 848 `- Name: Mocksville, NC 27028 Subdivision Name: — ALLI c A Phone #• 704-634-8760 Directions to property:. tGC%1 Section: Lot:l AUTHORIZATION FOR WASTEWATER Tax Office PIN:# c�-,/= iU _ �� SYSTEM CONSTRUCTION 3fi Road Name: MICd lrAr-'0 Zip: **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 f % ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION 1 IS VALID FOR A PERIOD OF FIVE YEARS. -4-ENVii81 M'�Ni AL HEALTH SLPECIALIST D TE ISSUED / T93' . �{ ✓i \... d -+t'. r '�.t'i' - w.'hy y }j�T• �1�y}:/��..�v! J �/CI�+n.• t r 11 4 0 DAVIE COUNTY HEALTH DEPARTMEiT { IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION `Subdivision Name: ' Duech s to roperty`: Ws It Section Lot: ' l` X= _ _� ' _ `: >� • IlISPROVE1VIElVT � -�i PERMIT TaxOJffice PIN:# _ -7- �•.. j Road Name: USA t Zip: �,**NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An w ` " AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the c6nstru6tion/uvstallation of a system or the issuance of a building permit (In compliancq with Article l .of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) f ***N(TICE*** THIS PERMIT IS SUBJECT TO REVOCAJrION IF SITE • ,� PLANS OR THE EVTENDED USE CHANGE YOUR W _ AT ' O AL HEAL ST SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE.. DTE ISSUED INSTALLING THE ;v • .• SYSTEM. � RESIDENTIAL SPECIFICATION: BUILDING TYPE M #BEDROOMS # BATHS" Z # OCCUPANTS. GARBAGE DISPOSAL: Yes COMMERCIAL SPECIFICATION:. FACILITY TYPE r # PEOPLE # PEOPLE/SHIFr # SEATS INDUSTRIAL WASTE: Yes or No LOT srm . aL TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) 3LOO NEW.SITE `— REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE. L,GO GAL. PUMP TANK GAL. TRENCH WIDTH _ ROCK DEPTH LINEAR FT. _ OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: f lh)mu. or') CC4To Je jt4uaf IQ t aiP ?Qpf, L iy-i G *"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. OPERATION PERMIT 4p� SYSTEM INSTALLED BY: i of Lit 3 Lit svr,�'1 • T �o AUTHORIZATION No. � OPERATION PERMIT BY: 2 a • DATE. S "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE S CRIBED AB VE BEEN INSTAL COMPLIANCE WITH ARTICLE 11, OF G.S. CHAPTER 136A, SECTION .1900 "SEWAGE TREATMENT DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. •• APPLICATION FOR SITE EVALUATIONAMPROVEMENT PE M Davie County Health Department � 0 U Environmental Health Section P. O. Box 848 JW ' 9 1998 Mocksville, NC 27028 (704)634-8760 .. lIT;'.L ii1' S; f ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSIs ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed SP I I t M &w Contact Person QC v Mailing Addressy� �W Home Phone - '? w� City/State/Zip 1 V V I ' rte' '-� ? 0 4 Business Phone c'1-04 6 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: 4. System to Serve: 5. If Residence: Llr/Dishwasher 6. If Business/Other: # Commodes If Foodservice ❑ Site Evaluation ❑ House Q' Mobile Home # People ❑ Garbage Disposal Specify type _ # Showers # Seats City/State/Zip M/ Improvement Permit & ATC ❑ Business ❑ Industry # Bedrooms 13 ❑ Other # Bathrooms ❑ Both d'/Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing # People # Sinks # Urinals Estimated Water Usage (gallons per day) # Water Coolers 7. -Type of water supply: (21/County/city ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Er No If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: 30Z x 100 Tax Office PIN: # 5 % z� lP - 16 - _ Property Address: Road Name 01 ( '0 l et 9-h " Q city/zip -'. 04S V) / ('e - -75&,-2- 62 ?0;,, If in Subdivision provide information, as follows: Name: &V-/ (-ltimg Section: Lot #: ! WRITE DIRECTIONS (from Mocksville) TO PROPERTY: &01 S fo fn ((Aa -h 10 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 Representatives off the Davie County HealthDepartmentD,elpartment to enter upon above described property located in Davie County and owned by v v� Sl`nI .l'LPV a'' / to conduct all testing procedures as necessary to determine the site suitability. DATE l// ` ? I SIGNATURE Revised DCHD (06-96) J rte„100.00, p V- 90. ACrlili 0.698 A.C­ as + 1 t z 1- 7 ! . . 1 r .1: 2 `­"kq1 $1004. CortIfy 'her Ili, ;"Jrvlslca tre-.5 ,urij u,v Plat wo- dr*wq Under ry rsserCaa In E'Do", 40 Ua4cr C�, Sw ,Qryl I fdtvl descr 17-13 Wrth Cm ­'A -_.4 Smeirsyg III I I*n , etc. 0 1),er ); th2.10"Ifill bounder 105 hot e"t CIVWly lri4jc�1.4 43 Cr4 PAW1 dr," tram friend IN 11"41 ;he PL_ cf hh-ty c"�-tv I Sbab ar" vX9 "-4 in OCCIF prtalcsloted I 1 / 41640tera, roolatration p,,,, el to 47-M oowAd:k*S am Wia ad bdcr, &-ii, G"I IN day of W;b%Q= rrf hend Q yg. rr, ef !Z�dy Co=d heral fWWJ ;4-- far thq, 9111 ill tato A.0. 12 9k Seal or S 4b% s. ASU.FICII: TI a' Date 2 MY 0-,jjwicl,,1 TJIE C-fUtFic 991DUC PLJ Jo '7 1. b* carr ect0 hereby cer a& -7 ssr Choi -Man, Co,�;4 p T�, i. _day Of --,-j t I f y that the sUbdIvIsl on Plot lh*;;Il hereon 7 cA CUA} cS has been found t o- C -TJ F -R6 h . County s,;' v 1 5 Ion Tax Lot 16 7 = 1. by 721 C, fio,ulatl01s, Tax MOP M-5 th* the Ox c OP t I n 0 0 C14 013 9(;Ch v or I c n c 3, I f an a t4, Y, or-# noted In' ' — 0 C N 51 Q. P\0 'T� x L6t 16 ­F,F I h to rn 1; �- V In VVw:_ ­� - tanning 96 'r t6s 61_-� the �P ando Tax V —5 Op ij 4het 1 ► hO2 be pr ov.ed DD V) f or., r 41cording In the 0 IF f I 6 0 Registe- �he 0 f Dc. -ds. Is hor*by no tad I h :,v such appr va f or.��Ffcord k1k N 1 0"24'4�0"E C ?'Ion Ccntn)4 Corne r 7 *V, Ppr'oval to F'i _W Uns eta rh `WWW WU4, goo U 31.74., 7041, N I 0*42'00"E 76. 1 1 J rte„100.00, p V- 90. ACrlili 0.698 A.C­ as + 1 t z 1- 7 ! . . 1 r .1: 2 `­"kq1 d APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMI O j Davie County Health Department JUL 2 1 1995 t Environmental Health Section / I P. O. Box 665 Mocksville, NC 27028 EWH Q-- � r 1. Application/Permit Requested By Joh 'aatryn Sen,/ 41 /!tar �i 19 33 Mailing Address =! !/ 1 Home Phone o p KS �,//!per Business Phone 2. Name on Permit if Different than Above 3. Application for: General Evaluation ❑ Septic Tank Installation Permit 4. System to Serve: ®'House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry r ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision `L Section _ Lot #� ,7 ❑ Basement/Plumbing No. of People No. of Bedrooms No. of Bathrooms Dwelling Dimensions 1010 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories ❑ Basement/No Plumbing ❑ Washing Machine /goo s r/— ❑ Dishwasher ❑ .Garbage Disposal No. of Sinks No. of Urinals No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: 4 -Public ElPrivate 8. Property Dimensions /00 -,:0Q©F S we age Disposal Contractoi 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? If yes, what type? ❑ Yes 940 ❑ Community "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. Directions to Property: � 0/ SO A -- � l ® S� y t M,<<tie.I-r IV This is to certify that the information provided is correct to the best of my knowledge, incurred from thi a plication. DATE V I understand I am responsible for all charges SIGNATURE V CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED f?ROPERTY 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 representativ of the De Co nu ty Health Department to enter upon above described property located in Davie County and owned by � c v dh, e� v; cL'11r�if . to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. e DATE DCHD (1193) _ 4 DAVIE COUNTY HEALTH DEPARTMENT _ Environmental Health Section Soil/Site Evaluation NAME ADDRESS J PROPOSED FACIILTY D use DATE EVALUATED 7S PROPERTY SIZE LOCATION OF SITE. Water Supply: On -Site Well _ Community Public Slope Z Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L /-- Slope Z HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 1 - Texture groupli Consistence r Structure / .0 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 i SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: Y 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 :lay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR- Vl---y 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