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341 Bailey Rd . . • , ��- ' • , , ' , � • DAVIE COUNTY HEALTH DEPARTMENT ' ' � ' Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-87G0 Account #: 990002739 Tax PIN/EH#: 5880-85-1081 Billed To: Chad Fuller Subdivision Info: Reference Name: Location/Address: Bailey Road-27028 Proposed Facility: Residence Property Size: see map ATC Number: 3459 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLJST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). T'his 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 .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CON TR CTION IS VALID FOR A PERIOD OF FIVE YEARS. + ` ��� i � Environmental Health Specialist s Signature: Date: ��� ?J� CERTIFICATE OF COMPLETION **NOTE** T'he issuance ofthis Certificate ofCompletion shall indicate the system described on ImprovemenUOperation Permit has been installed in compliance wit icle 11 of G.S.Chapter 130A, Section.1900"Sewage Treatment and Disposal Systems,"but shall i O WA en as a,guarantee that the system will function satisfactorily for any given period of time. �p�� � ! �.� �j. ��� �� � �� �^�a`� � � I�i Z., ����� � � � �- � !t7 IT a� 90� ������S� J G�11�-bfl.T�,y—�(o .�-�o�J-�'" Septic System Installed By: `��=h'ti-'�'� `-,-'�/ � .�r � Environmental Health Specialist's Signature: �'� Date: � � i DCHD OS/99(Revised) . . . DAVIE COi1NTY I�EEALTH DEPARTMENT �� 5� � � r� M , Environmental Health Section � �. ; • � ', ' P.O.Boz 848/210 Hospital Street a Mceksville,NC 27028 (33G)751-87C0 IMPROVEMENT/OPERATION PERMIT Account #: 990002739 Tax PIN/EH #: 5880-85-1081 Billed To: Chad Fuller Subdivision Info: Reference Name: Location/Address: Bailey Road-27028 Proposed Facility: Residence Property Size: see map ATC Number: 3459 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AiTTHORIZATION 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 #People � #Bedrooms� #Baths_� Dishwasher:� Garbage Disposal:� Washing Machine:�Basement w/Plumbing:�� Basement/No Plumbing: ❑ Commercial Specification: Facility Type r #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply�� Design Wastewater Flow(GPD)� Site: New� Repair❑ System Specifications: Tank Size�d GAL. Pump Tank GAL. Trench Width c� �`Rock Depth /�r,��Linear Ftcf�� � �/D d Other: Required Site Modifications/Conditions: 11�1PROVEMENT/OPERATION PERMI ' � EFFL R. RISER(S)IF 6"BELOW FINISI�ED GRADE. ****NOTICE: Conta resentative ofth�Davie County epartment for final inspection ofthis 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 installatio Telephone#is(33G)751-87(0.**** �k/1�'� /I'Jf�{� p� � � a ;��/u�,,�f�, �b�J �,o ,�� - � �� � � ���� � � � r � , 7 , , �� ��� t� I/�S� �' �e �� ��/ )�' � � �a � G� � � o� t �. � N� c�r �� � ��� � � � , c��" �l ����''' -� � I � G � Environmental Health Specialist's Signature: Date:����� DCHD OS/99(Revised) e ' � � � � � �iT�l,�'�;r-�;�....._ . �. • ► . • ° APPLICATION FOR SITE EVALUATION/IhiPROVEM[NT PERMiT& TC N11�t>>�1�U3t��p�,��r� � + Davie County Health Department "�'^--. � ' •Q N� Environmenta/Hea/th Section �'AY � � ����`�1 p.o. soX s4s/aso Hospital street _ 9 2�03 ; � ,� Mocksville, NC 27028 � (336)751-8760 ''��� � �l p �.� 1 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQU INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. � �'l-�a� ��-��� 1. Name to be Billed �' ' / �'��- Contact Person Mailing Address �/ / � Home Ph e ��� ���/ City/State/ZIP ������Sl/I//Ci /��� ����ess Y��one ��� 1�� 2. Name on Permit/ATC if Different than Above Mailing Addrass City/State/Zip 3. Application For: Site Evaluation Improvement Permit/ATC 4. Syatem to service: House Mobile Home Business Industry Other 5. �f Residence: # People � # Bedrooms �� # Bathrooms Gf --r ---.. ,_ �ahwasher Garbaga Disposal% ashing Machine asement/Plumbing Basement/No Pluxnbing --_._�____----'""_-„_� '�,,�,-,____'___ 6. If Businesa/Induatry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Watar Usage (gallons per day) 7. Type of water supply: County/City Well Community a. Do you anticipate additions or expansions of the facility tl�is systcm is intended to serve? Yes No If yes,what type? � �s��f��''�.��i''�. l�l ��'.>Cn/ZCj'L ***IMPORTANT***CLI�NTS NIUST COMPLETE 1'HE REQUlRLD PROPLRTY INFORIVIATION RGQULS'I'GD BELOW. Eitl�er a PLAT or SITE PLAN MUST BE SUBMITTED by U�e client �vith THIS APPi.ICATION. Pro rty Dimensions: ������� WRITL DIR�CT[ONS(froni l�locksvillc)to l'ROPGRT�': �'��o --gs-� ��r��c��x����� �'���d D//l���s Tax O fice PIN: # Property Address: Road Name ����et/��� <�►'l��,�/"—'4'�1� � City/Zip �"��/'/�/�,� � ' i/pr�. CE� �7ad� If in a Subdivision provide informat�on,as follows:� Name: Section: Block: Lot: Date home corners flagged: `� � _ This is to certify tl�at the information provided is correct to the best of my Icnowledge. I widcrstand tliat any permit(s) issued hereafter are subject to suspension or revocation,if tlie site plans or intended use change,or if the information submitted in this application is falsified or changed. I,also,understaitd that I nu���espousiGle for all clta�b�es uicurred fi•om this application. I,hereby,give consent to tl�e Authorized Representative of the Davi C�un,t��'H h gp artment to enter upon above described property located in Davie County and o�vned by���r�'� � / � � to conduct all testin procedures as necessary to detcrmine the site suitabi ' DATE � � � � SIGNAT'URE THIS AREA MAY BE USED FOR DRAVVING YOUR SITE PLAl�t(Include all of ttic followii3b: Existing and proposcd property lines and dimensions, structures, setbRcks, and septic locatioris). Site Revisit Charge Datc(s): . Ciient NutiGcation Date: F:HS: Sign given Account No �� 3�� Revised DCHD(07/99) Invoice No. �b s f Iron Bent Edgard E. Vogler I Lance D. Schamback, certify that this plat was draw under my supervision i from an actual survey made under my supervision (deed description and/or Deed Book: 53 Page: 421 ' Map Book _SEE—, Page _ NOTE—2 That the boundaries not surveyed are clearly indicated as drawn from information found in Book _N1A Page _N1A_; that the ratio of precision as calculated is 1: 10,000+ that this plat was prepared j Found Flat Bar w in accordance with the Standards of Practice for Land Surveying as amended. (Tie Llne) o Nee ,w Witness my original signature, registration number and seal. 691.94 Found a This _ 16_—_day of __ DECEMBER 2002. File ad — — — -- � On Llne L NCE . S AMBACK, PLS Found 14 Found /4 (Tie Line) Rebar ° '� LICENSE NUMBER: L-4295 O Rebar S9000'00'W 523.38 (�e?4/", �o�^ 6��1//IIIIIItgtrt A IPS = ���� Edith Bailey Slagle Page: 376 Deed Book: 65 Pa g �Q s Q r' L-j4 0 X,:v ,s y�.��-��. s l�h 5 1'215, /Ps 95 Tote f 3S4 99 / Found 14 Found 1 1/2" Rebar P/pe ?3a 46 i /PS I 1 William A. Bailey Eta] Deed Book: 431 page: 453 o�o 'TT % � NT a i �n l ) w i O Road O Vogler o SiteO 8 William A. Bailey Eta] Deed Book: 431 Page: 453 O ° Bapey Road � Tract 2 15.00 Acres Tract 1 Mill Peoples Creek 1 Feed Mill � 15.00 Acres Road M / LINE TABLE o LINE LENGTH, BEARING Vicinity Map Not to Scale ti ti �� �-�- \_ L 1 51.40 I S86 57'11"W o L2 53.60 N70'10'00"W ti O :H � I LEGEND C(I,4VF_ TABLE R/W = Right—of—way CURVE LENGTH , MDIUS BEARING CHORD Cl 78.701.,,'744.76 N85'10'09"W 78.70 I.P.S. _ #4 Rebar Set C2 338.03 i 2!44.76 N8931'08"W 337.82 --A, = Not to scale E] = Telephone Pedestal c-QL) = Utility Pole = Cable Pedestal VIM = Water Meter Guy Wire � I j RCP = Reinforced Concrete Pipe ® = Well Found/'4 1) This property may be subject to any Easements, Ips Rebar R/►,, IPs Found 14 C2 Rebar Rights-of-way, and/or Restrictive Covenants. Line) - Cl Found 14 �n� W 229.os Ll Paved�V -- 50'Public —•� N84.2o'S,2 � Rebar Found/4 ' 2) Boundary information based on Deed Book: 431 a t - r 576.5+'2'" y`-"ie"RCP~ � Rebar Q GRAPHIC SCALE 1 ___ -- 248.85 Page: 453 as recorded in the Davie County Register of Deeds. _ Rte, 1a'RCP ~ NB3!"15'43���. `°' zoo 400 234.32 100 0 50 100 L� 15' Drainage Barley Road 3) This survey was prepared for the purpose of showing the proposed Found /4 Rebar Easement 5. �• 1657 division of two 15 acre tracts, for Taylor F. Bailey. Deed Book: 144 15' Drolnoge �1 N�'a, Page: 92 Easement "1 Deed Book: 144 / J IN FEET 15 Page: 98 1 inch 100 ft. 4) No N.C.G.S. or U.S.G.S. Monuments �,�- William A. Bailey = could be located within 2000 . / Deed Book: l00 Page: 878 5) Area by coordinate method. o 6) #4 rebars set at all corners unless otherwise noted. Albert B. Russell a� Found 114- J❑B NAME; Deed Book: 124 Page: 166 Solid Iron 7 Points not labeled found or set are computed points only. aft/ Boundary Survey for 8) Right of way agreement: Deed Book: 144 at Pages: 91, 92, 94, 96, / PATTIRSON '9y 98, 99, 100 and 101. �g T� for Bale Found LOCATION! SHADY GROVE TOWNSHIP, DAVIE CO.7NC DRAWN BY, PAF CHECKED BY, JHP /4 RebarTAX PARCEL NUMBER: A PORTI❑N ❑F F90000004SCALE; 1' = 100' io Engineering * Surveying * Planning OWNERS DATE ❑F FIELD SURVEYS DECEMBER 2002 Post Office Box 1387 * Mooresville, NC 2.8115 DATE ❑F MAP; DECEMBER 16, 2002 F /ound Found 4 Rebar 704/662-0100 * Fax 704/662-0101 J❑B NUMBER SHEET NUMBER M02279 ' � . '. , . , DAVIE COUNTY HEALTH DEPARTIVIENT . � � ' Environmental Health Section � ' ' � ' '' Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002739 Tax PIN/EH#: 5880-85-1081 Billed To: Chad Fuller Subdivision Info: Reference Name: Location/Address: Bailey Road-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: ��'�2 "?1� Water Supply: On-Site Well �� Community Public Evaluation By: Auger Boring � Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition .L Slo e% HORIZON I DEPTH �� � Texture rou l C Consistence Structure Mineralo HORIZON II DEPTH '` `y Texture rou �'j Consistence Structure i S' � Mineralo - �" HORIZON III DEPTH Texture rou Consistence Structure Mineralo � HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE �' � SITE CLASSIFICATION: � EVALUATION BY: � 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-Tenace 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-Slightiy 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 Mineraloev 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 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