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2553 Davie Academy Road Lot 66AUTHORIZATION NO. + DAVIE COUNTY HEALTH DEPARTMENT"`` s Environmental Health Section PROPERTY INFORMATION Permittee's `y P.O. Box 848 ` Name Mocksville, NC 27028 Subdivision Name: i;` Phone #: 704-634-8760 1 %, Directions to property: s t Section: Lot: AUTHORIZATION FOR 1 r>il c c- Ctp`i \ 1 C\•�, WASTEWATER Tax Office PIN:476o SYSTEM CONSTRUCTION Road Name: J1e, ip i **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 s��•,� ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED - 2 DAVIE COUNTY HEALTH DEPARTMENT - t r t IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Permlttee's «a. w 1 1 Name' Subdivision Name: U' -C",. F', 1 Directions to property:_ ; �,i - .. �y;�.,r. Section: Lot: !' �IlVIPROVEMENT r: t ;, , PERMIT Tax Office PIN:d,r 61 Road Name: IbAli1P ��aI., Z p: **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a 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) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE��)-� • = #BEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL: Yes o No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZEt�U�Ob TYPE WATER SUPPLY' DESIGN WASTEWATER FLOW (GPD)?0 NEW SITE REPAIR SITE � j� SYSTEM SPECIFICATIONS: TANK SIZE 0 D GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH —1-< LINEAR FT. REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT t s;j...,, 1 **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 N l ` SYSTEM INSTALLED BY: J/ N -7o s D Feo-4,— AUTHORIZATION NO. OPERATION PERMIT BY: —DATE:A�Lhk **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIB OVE 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 05/96 (Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 MF (- -- '-, OCT 1 01997 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed — (fA�a Mailing Address City/State/Zip �• %D D� 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: [esite Evaluation Contact Person Home Phone / z� — Business Phone 5`'/11 City/State/Zip [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: [ Wi ouse [ ] Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People # Bedrooms .3 # Bathrooms Z [ 9'Kishwasher [ ] Garbage Disposal [ -Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes — # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [ ] County/City [ ell [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT **NNJffOF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: /d0 x 0-04 WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: #6-709 - 0 2 - Property Address: Road I`�ame 41f '- !1 �� 67 City/Zip If in Subdivision provide information, as follows: lkt !�; 07-_ �icei,�z ex' -Z4 Name: rr Section: G 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 Represe ative of the Davie County Health Department to enter upon above described property located in Davie County and owned r by to conduct all testing procedures as necessary to determine the site suitability. DATE �D —/ 0 _ ir% SIGNATURE Revised DCHD (06-96) THIS AREA AWy 13E USED FOR DRAWING YOUR SITE PLAN: X0 i, /0 0/ NO.: ADDRESS: =00 00 LOCATION: --- MAR I -1-1 1 PARCEL DEED BOOK 95 PAGE: 4 7 2 ' t lOKK LOT f DWIPTIR SO. FT. (BUILDING) ------ YEAR BUILT: - - - - - - - e DIREUMS:Highway 64 West turn left on Davie Acad on left OMMNETI•H a r r i s SIGN: yes FIRMHoward Realty PR.: POSS: closing LSA Debbie Pennington PH: LK. BX. --- t °5 w / iro. fv I✓ ..-i it �J y ° lL "� • `� l J 'moo � `` ,` ` • J! ✓ ♦ i M1 0 ; ; y Lf r if �'l ` .. � Y�, I � y 27 ° r h Y w ` ; _•� /II.IS * !DI ff i, Y ��- ^ I/ / 0 1 47 1. ��� to e A `r .fie ,o* o^Q ♦. t° c, ♦y� ; ifl v I, .v'ry �vir•.�l.., Q 5 • i 90 7 , y •..• O� , -ei✓ � � w e v ► y ,wti .� .� ♦ ° `h 2 � 1 'I ♦ iP cf • ..♦ 4� 4 ' Ad, 00 -•'" � ,.. ,fes I .. y \ . _ NO.: ADDRESS: =00 00 LOCATION: L�- 2. MAR I -1-1 1 PARCEL DEED BOOK 95 PAGE: 4 7 2 ' t lOKK LOT DWIPTIR SO. FT. (BUILDING) ------ YEAR BUILT: - - - - - - - DIREUMS:Highway 64 West turn left on Davie Acad on left OMMNETI•H a r r i s SIGN: yes FIRMHoward Realty PR.: POSS: closing LSA Debbie Pennington PH: LK. BX. --- t °5 LISTING WILL BE RETURNED IF NOT COMPLETELY FILLED OUT. TYPEWRITER ONLY. J0 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION E LOT Soil/Site Evaluation APPLICANT'S NAME 4� DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE 1'U SUBDIVISION ROAD NAME y� Water Supply: On -Site Well Community Public Evaluation By: �� Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position 5 Slope % -•Y� O HORIZON I DEPTH (o Texture group C,I _ CL Consistence IV Structure �- Mineralogy1 ORIZON II DEPTH Texture group Consistence Structure Q� Mineralogy�\ .l 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: M LONG-TERM ACCEPTANCE RATE: •� REMARKS: Nqa� \\ DCHD (01-90) Landscape Position EVALUATION BY: \ e�� OTHER(S) PRESENT: S9 LEGEND 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 ■E■■ME■ ■O■MEN■ MONSOON ■■M■MM■ ■■■MMU■ ■O■■■M■ ■■■■■M■ ■■M■■M■ ■MMM■M■ ■■M■ME■ ■■■MEE■ SOMEONE ■M■■M■■ ■M■M■M■ ■E■■■M■ ■■■MMM■ ■M■■■M■ ■■M■■E■ ■ ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■fir■■�■■ ■ ■■■E■ ■■NE■ ■■M■■ ■■E■ MEMO ■ ■ ■ OMEN ■ME■ ■M■■ SOME MEMO ■E■■ OMEN ■ ■ ■■■■ME■■ ■■M■MME■ ■ENCEME■ munammms ■■M■M■E■ ■■M■MME■ ■E■■M■M■ ■M■■■N■■■■■RI ■ME■OM■■EM■■ ■ME■■■■EMEM■ ■EMEME■E■EM■ ■NN■■■■M■■■■ ■■ME■EM■■■E■ ■ME■ME■■■ME■ ■WEE■■■■ME■■ ■ENEEMEMEME■ ■■EM■MMM■M■■ ■M■■EME■■NE■ ■M■■MME■■ME■ ■EMM■M■■MEM■ ■EME■MEMOM■■ ■■EM■ME■■NN■ ■■■E■ME■■■M■ ■ME■■M■■■ME■ ■E■■M■M■M■M■ ■M■■M■■M■MO■ ■■M■■MMMM■■■ ■■■M■ME■■ME■ ■■M■■M■■MMM■ ■N■■M■■M■ME■ ■MMM■M■M■M■■ ■■M■NMN■■■■■ ■E■■ME■■■ME■ No No 4 Davie County Heafth Department and Home Health Agency Environmenta[Health Section P.O. Box 848 / 210 HOSPITAL STREET COURIER 809-4.06 MOCKSVILLE, N.C. 27028 PHONE: (704) 634-8760 October 13, 1997 Ronald G. Jones 185 Livengood Rd. Advance, NC 270QIG Re: Site Evaluation Oakland Heights E/Lot 66 Tax FAIN: #5708-07-1547 Dear Client(s): As requested, a representative from this office visited the aforementioned site on October 13, 1,937. Erased upon the information provided on the application for site' -evaluation and after the evaluation was completed, the site was found to, be provisionally suitable for the installation of an on—site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, C� �- ZM Charles E. Little, R.S. Environmental Health Specialist CL/wd Enclosure(s)