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128 Rick Way Lot 8A2(In compGaar r ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF, FIVE YEARS AE''ALTHS CI LI ` DATE; SUE Petinittee, S , Daecttons to piopecly trr (r'• pe 41 it "NOTE" Thi$ Improvement Pei ` AAUTI-IORIZATION F constmWon/mstallafla �RESIDENTU ':`•'COMMERCI ' t y L �1. •{ STQ-�3uTo.J bo�c�S I ' , DNDITIONS WSTAtt_ ;'o,J C6�lTtx9k- 1p -C lo�t�. Ft't-l. Te o2161.SAL'�GRo�N�iv Golnu liJ 'JaQt�A of TQA{rJ "IrVao -lb ' IMPROVEMENT PERMIT LAYOUT �'VISzD ;�l �W.�tS I ySIpF� ; 1 /lvq/J �;�R.FAC,G WA.-tv2 �J�s I, i z .:.irk �..•t,�:.S ` .25t •? LoT'/% 1 0� - �� %1 Nl:.►-loraG . ;g�.Q,.J I-lovwb 'Tot.J/�li� ��' Q 1., 1' r � N 'I I :.r I , 61 x I � , , • , •+CONTACT A REPRESENTATIVE OF DA IE COUNTY, HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYS' TEM "BETWEEN 8:30:- 9:30 A.M.-OR :00 1: 0 P.M. ON THE DAY OF INSTALLATION. TELEPHONE N IS'(336)751-5760... OPERATION PERMIT �0'i�"IkQ"N 'f,; r ; SYSTEM INSTALLED BYi •' �' .< t" I n 'k I , fo�,JT h t � 1 v i Jr , , AUTHORIZATTON NO. t OPERATION PERMIT BY' DATE. I' I k 1q,D ' THE ISSUANCE OF THIS OPERATTON PE ., .. ..DESCRIBED... tt PERMIT SHALLINDICATETHAT THE SYSTEM .A O ... I $BEEN INSTALLED IN COMPLIANCE WITH ARTICLE II OF G,.S;CHAVIER 130A,SECTION;1900 "SEWAGE .TREATMENTrAND. DISPOSAL 'SYSTEMS!, BUT SHALL IN NOWAY BETAKENAS A• . - GUARANTEE THAT;T'HE SYSTEM WILL. FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF,TIME., '1)CHD 05/96(Revised). C1100NMEN14.0 APPLICATION FOR S17E EVALUATION/IMPROVEMFM PERMR &Davie County Health DepartmentEnvirvnmenla/HealthSection P.O. Box 848/210 Hospital StreetMocksville, NC 27028 (336)751-8760 ***ZMPORTANT*** THIS APPLICATION CANNOT 8E PROCESSED UNLESS ALL THE AEQOIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Nailing Address city/state/ZIP 2. Name on Permit/ATC if Different than Mailing Address Contact Person Qf some Phone �(.y'1 ��'1E% Business Phone 0 �0l/- p�st; f City/state/Zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC rBoth 4. system to service: ❑ House 0 Mobile Rome ❑ Business ❑ Industry ❑ Other // 5. If Residence: # People- # Bedrooms C31 # Bathrooms ❑ Dishwasher ❑ Garbage Disposal 05�1/shing Machine ❑ Basement/Plumbing D Basemeant/No Plumbing 6. If Business/Industry/other: specify type # Commodes # showers # People # sinks # Urinals --� # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City ❑ Well ❑ CoLmou+++ ty s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes No E•IMPURTAA-'T*** CLIENTS, IIUSTC0,11PLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN nMUST RESUBIIITTED by the client with THIS APPLICATION Property Dimensions: ,12,AC Tax Office PIN: IN Property Address: Road Name M 1 ahae—L (S d -� City/Zip A 7d.,( Q If in a Subdivision provide information, as follows: Name: Section: Block: Lot: 01)9- aS (from Mocksville) to PROPERTY: 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 Depa ment % to enter upon above described property located in Davie County and owned by >d0V/Z SrCJ ��no ate. to conduct all testing procedures as necessary to determine the site suitability. (� DATE V SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN: w.t( bcplan'eP- q_z.--9e 14 ald)p- No. �Y Invoice No. a0 / Revised DCHD (07198) 0 . ( i , 1-111 l\ 813.83' Total S 02°43'20"W S 7?°51'00"E 17.88' "Buggy" Axle Found 592.33' IRS N 16 P f— L-,_ -- -- - — P e Cine 46.91. �— Centerline Proposed 60' Access Easement See Call Table IRS N 02°43'20"E 314.5f'77IRS11 / of Tax Lot 16 N 65°: )'45"W / Parcel 2 64. i9' ,ea: 5.09& Acres RS l a fax Lot 16 � I Tax Map M-5 m /* n/f Roger P. Spillman I / 7/r DB 1900PG 101 P/0 Parcel 7 P o t14, 15 Tax Lor 16 D N v Tax Map M-5 t3 I A7 30 !� / '1l / n:'f Roger P. Spillman O E C [�Q. OB 190 0 PG 101 ti X2000' P/0 Parcel 8 IRS �Cer'fenne ` c,0 -- 'iI f'p IRS 1201.1 N 83`, 1/2" EIR S 05°24'05"W 119.89' Tie Line N Sheet 2 of 2 "Sallie Acres" a PB 6 O PG 160 E o Sheet 2 of 2 M PB 6 O PG 160 5.70' 14'35"W _._ `en`s -'q 125.00' 83°46'55"W V'S1lppaseu ce , VV See Cai, fable ss Easery'ent 1 IRS I � Tax Lot 16 Tax Map M-5 ` n/f Roger P. Spillman ? ` DB 190 O PG 101 0 1 lgpr,*,. r aresl . (Area: 4cro, +/! ,' Cn crf ix Lot 16 15 91 r Cb a „ 931 Acres Pi��y�q►� � Iol 119.22' �-1 1 1 S 03°56'35"W IRS j 1/2" EIR g Tis Line 1/2" EIR nr 1/2" S.,, ( N 05'24'05"E 255.67' I I I � 20 19 18 � T 17 1 �3 I 15 I 00 ^ I I I I n "Sallie Acres" ISI 1201.1 N 83`, 1/2" EIR S 05°24'05"W 119.89' Tie Line N Sheet 2 of 2 "Sallie Acres" a PB 6 O PG 160 E o Sheet 2 of 2 M PB 6 O PG 160 5.70' 14'35"W _._ 9A. Z DAVIE COUNTY HEALTH DEPARTMENT. Environmental Health Section SECTION "iGT_ Soil/Site Evaluation APPLICANT'S NAMEEV DATE f (Jltl YnA� 5 EVALUATED 6ol2t:o Iii `� , PROPOSED FACILITY PROPERTY SIZE SUBDIVISION ROAD NAMEr� Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut SITE CLA SSIFICATION: EVALUATION BY:AJGt1L� µl' LONG-TERM ACCEPTANCE RATE: �}� ' qq ) —OTHER(S) PRESENT: REMARKS: 1 OC& (Q 'b�— 7b '7TOP0 . 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 SII, - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE VFR - Very friable. FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet . NS -Non sticky , SS -. Slightly sticky S Sticky, j. 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 DCND(01A0) • • • • • Texture group HORIZONConsistence • •: sd�®ate®®®® ..EEKM — • • .. ��c-�►�®--ems Consistence rfxi gorrWEa semStructure . � �>•�—�®oma SITE CLA SSIFICATION: EVALUATION BY:AJGt1L� µl' LONG-TERM ACCEPTANCE RATE: �}� ' qq ) —OTHER(S) PRESENT: REMARKS: 1 OC& (Q 'b�— 7b '7TOP0 . 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 SII, - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE VFR - Very friable. FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet . NS -Non sticky , SS -. Slightly sticky S Sticky, j. 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 DCND(01A0)