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1317 Beauchamp Rd � � DAVIE COUNTY HEALTH DEPARTMENT �J y'� Environmental Health Section P.O.Boz 848/210 Hospital Street � ' Mocksville,NC 27028 . , (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002227 Tax PIN/EH#: 5861-93-5291 Billed To: Kim Beauchamp Subdivision Info: Reference Name: Location/Address: Beauchamp Rd-27006 Proposed Facility: Residence Property Size: 9.52 acres ATC N�u�pber: 3114 **NOTE** "1'his ImprovemendOperation Permit DOES NOT authorize the construction 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 ll of G.S.Chapter 130A,Wastewater Systems,Section .1900 Sewage Treatment and Disposal Systems). THIS PERMTI'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 3 #Baths 2 .Sr Dishwasher: �" Garbage Disposal: � Washing Machine: � Basement w/Plumbing: ❑ Basement/No Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: � Lot Size�s�NI,�S Type Water Supply�l� Design Wastewater Flow(GPD) �� Site: New�Repair❑ System Specifications: Tank Size�GAL. Pump Tank GAL. Trench Width z �Rock Depth ,Z�� Linear Ft. �f�'"JI Other: � �►�TQ..1�UT 10� �jC, ��j—el.l. �..1►`� `"!�f�.C, h���• t Required Site Modifications/Conditions: �lJ�T4l.1� O� C..O��D�2- . � � S O� �-�� IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department 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 installation. Telephone#is(336)751-87G0.**** � 3 �� � ��g� � f�� � � '` -� i33, 5T x � /3�, 3(����� . � 3� ��� Environmental Health Specialist's Si ��' Date: 5�f OZ��-v'1Sr� DCHD OS/99(Revised) J�w��� . � Account #: 990002227 Tax PIN/EH#: 5861-93-5291 ,� Billed To: Kim Beauchamp Subdivision Info: "'� RefePtnce Name: Location/Address: Beauchamp Rd-27006 Proposed Facility: Residence Property Size: 9.52 acres RTC Number: 3114 DAVIE COUNTY HEALTH DEPARTMENT � � - Environmental Health Section / � � - d � � ' � . P.O.Boa 848/210 Hospital Street � �1 ' • • Mocksville,NC 27028 � � (33G)751-87C0 IMPROVEMENT/OPERATION PERMIT Account #: 990002227 Tax PIN/EH#: 5861-93-5291 Biiled To: Kim Beauchamp Subdivision Info: Reference Name: Location/Address: Beauchamp Rd-27006 Proposed Facility: Residence Property Size: 9.52 acres **NOTE��This-I"mprovement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALJTHORIZATION 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 �l� � #People�_ #Bedrooms�_ #Baths 2�� Dishwasher: � Garbage Disposal: ❑ Washing Machine: � Basement w/Plumbing: ❑ BasementlNo Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �'S2""-�-'� ype Water Supply 1�8�Jn�fiY Design Wastewater Flow(GPD) �� Site: New�Repair❑ � � ,� � System Specifications: Tank Size ���'AL. Pump Tank GAL. Trench Width� Rock Depth �2 Lineaz Ft.� Other: � ���l" �J"T"t c�� 6►-3�T�,1.1� �--l�S rD.C. . �t,��J. Required Site Modifications/Conditions: ��v��Q t.,l� C�� ��^����, �I" �� , ��� ��(�:. INIPROVEI�IENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF G"BELOW FINISNED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 830 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)7 1-87G0.**** •�+�'�P O u7 G� , u n9�. � x z�' �20, '�-�,o M4�o��,� �—�0 3�c.�a�P�j =' � � ,� f- ti . l.�� � !� � :x izz.i� � 0 2� � �- � .�' .�� � , � �� , ��°t�� ��� u�s � �oD�Q� � � Environmental Health Specialist's Signature: Date: �7 �� � / DCHD OS/99(Revised) t, • 1 ��� • . , DAVIE COUNTY HEALTH DEPARTMENT C���–� �— , . Environmental Health Section � P.O.Boz 848/210 Hospital Street � Mocksville,NC 27028 (33G)751-8760 Account #: 990002227 Tax PIN/EH#: 5861-93-5291 Billed To: Kim Beauchamp Subdivision Info: Reference Name: Location/Address: Beauchamp Rd-27006 Pro osed Facilit : Residence Pro ert Size: 9.52 acres ATC Number: 3114 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLJST BE ISSLJED 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 I 1 of G.S. Chapter 130A, Wastewater Syste .1 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEW TER CON IS VA FOR A PERIOD OF FI�/E YEARS. Environmental Health Specialist's Signature: ate: � CERTIITCATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. �--� v.�A,A�'�S �� �, �,,��- �'' �G S /� ► �`�Z,�� �� �3� •, �2.'�1 ��� ��-<, rS 57 � � �'�Lmn1 i 'i�tc �p�z . q � y �1 t y�Septic System Installed By: `��'J� "" �TA I�i'�- Environmental Health Specialist's Signature: � Date: � � � DCHD OS/99(Revised) , � . ' �,,,""� ��(���� � ���,,��'"= �� APPLICATION EOR SITE EVALUAiI(��J/IMPRi�ilER1EiVT PERR9f�&t�TC ��,1 �• • �- 3� ' - Davie Coun ty Hea l t h Depa r tmen t � "� ��� ' Environmenta/Hea/th Section �� ���E��j N P.O. Box 848/210 Hospital Street ���F'�a�'U�yS`t Mocksville, NC 27028 F.�1��gpp���� � (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL TFiE REQUIRED INFOF2I�TION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. �!�Name to be Billed !�1 r� /`, i--�LtU��Q4"� Contact Person !`/M. /��e..�C C�l'� Mailinq Address (.�3-1 ��'IC U11C��/ /�S• Home Phone �33�) 9Cf O ����0 �City/State/2IP /7�X(�Cu1��?- /��' a7� Business Phone <��=) �"�( —�07� r �s3�, ��S�5-� �2: Name on Permi.t/ATC if Differant than Above Mailinq Address City/State/Zip ��: Application For: ❑ 'Site Evaluation ❑ Improvemeht Permi.t/ATC Both -��system to service: � House ❑ Mobile Home ❑ Business ❑ IndusL-ry 0 Other � If Residence: # People ��- _ if Bedrooms .3 # Bathrooms o� �o�. �'Dish►rasher ❑ Garbage Disposal �ashing Mactune Basement/Plumbiny �Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Vrinals # Water Coolers IE FOODSERVICE: # Seats Estimated Water Usage (gallons per day) �7�Type of water supply: �, County/City ❑ Well ❑ Coa¢nunity �e! Do you anticipate additions or expAnsions of the fucility this system is intcnded to scrve? ❑ Yes �LNo If yes,what type? ***IMPORT -r�ff�S�OMPLETETHE REQUIRED PROP�RTY INFORMATION REQUGSTED BELOW. �ithcr a PLAT or ' T BESUI3MI7TED bv the clicnt witl�THIS APPLICATIOIV. t Property Dimensions: Q•J� G�CI�� WRITG UIRGCI'IONS(from Mocicsvillc)to PROPI:R'fY: / __ � a^C c � �.z" •/ Tax Office PIN: S�lol 9�3.5�97 /��C'�5-�- -�o ,C�-�-�imo�. ,P�P�'-,��-%�(� (/ j-��P��Y Address: Road Name ,�PCLe.eC`�KD !�'G+'. �-�i���'� �'• Yc� �(o.'� ���p'� City/Zip �►,t�nit-� o��C� �� z�,�l ��-� �/t�(Je_�C��pr�J�.. ('�/�-LE' lf in a Subdiv' ' providc information,as follows: N 4�.e.G<C'!/�'� /� � �- Ur/�O. � , / � •. Name: /S�F7 ClD/'�iC�r v��L'�",C� � ���, �� sn�cyofo/'ox. �c_b ' am, Section: Block: Lot: 1�f7"ate Property Flagged: cr> � This is to certify that the information provided is correct to the best of my knowlcdgc. I understand that any permit(s) ; issued 6ereafter are subject to suspension or revocation,if the site plans or intendcd use change,or if the information submitted in this application is falsified or changecL 1,also,wnderstu�id tlrat I ai�t resporrsible fur«//c/rarges iircurred froul this application. I, hereby,give consent to the Authorized Representative of the Davie County Hcaltl�De �rtn�cut to cntcr upon abovc dcscribcd property located in Duvic County and owncd by %�(�r n� 2. �C�e.rG�1l'w� to conduct all testing procedures as necessary to dcterminc the site suitability. ��DATE___ y /�Z U Z �IGNATUI2�_��� ' � / � THIS AREA MAY BE USED FOR DRAWIIYG YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). � Sitc Revisit Chargc � Datc(s): ° �/`�"'"' � � Client Notification Date: G�R ��- ( d�-� 1 �j�j(� b S I�� �1 2� s� EHS: / _ �� ., � Account No. o� l�� , Revised DCHD(07/99) ;��� �� Invoice No. � / �� �� � � L • r .• . ""�' � � nJ� ` \ � �____- t � � ,'� ; / 1�� s r � ,so �' � ��� - , �,;� � �. � /Jb� � , Davie Courity,North Carolina Spatial Data Explorer Page 1 of 2 O�isV3s��+' . a �: - .. S D x ��� n�� �.� Nor1h Carolina Click on the Map to: Mep L� ,-�. _-. r'Zoomin r ZoomOut r Recenter Map r' Identify PBfC@IS � DfBW:I: Draw se/ect Zoom Factor 2X _::� r Radius Search(feet) 0 , BOUt1d8Y1/ � �Census Tra , ' ` ; ': ' oun „: ' ' „ '' ` � �`Ci unty Zo � �."�� ; : , r , , . ; ' !: s ,, : MUltl$yl ; _ �..__.�. < ; , ; ;, ' ; ' I - ;: , ' E911 Fire� r ;; s ; ":: ' ;. , loo ane r:F dP _ , ; ; lood Zone �F , > ; ..: . : , , ' `' ' arcels ` ' ,; s '. ,;....;: �� � s.. ,:: > ,:: ,.��... . �.,. , , �P ` , - t i = _... ,, . ,. ,.,_ �S�hoo�o�s, '; : �861935291: Multl Syl � ' ' � �wn Zonfr ; ;; ;.; : o ;, , f-T � ": � : � � . � , . ;,,, : �Townships ` ' , ; ; ; ...:. . ; ,; ___.__...�___ ' MUltl Syl ; ' ' , ` o , ` , : : ��� �V ting Pre< � � ; ; �: , • ,; ; ; ' Infrastruc#u '< ,; ' Y . ; , , ; :. 'i: ; I-D rlvewa s ,` '- _ . ail Llnes ` ;' : .. . : _. , , ' ; , <: _I. ; et ent ; " > ;' C Stre C . � , s s I z ` i ,-:� ' ;� „ ? ; r`US C Higl , _ .... . ..:. ,. IN , ; ': , ' ; 5849 ;: , tl $YI _ . ; Mul.._ ;::. : ; :. ., u Y N Parcel Data � " Davie County,North Carolina Spatial Data Explorer Page 1 of 2 O�is 6��' , a � .. S D x ���� �'q� �.� NoMh Carolina Click on the Map to: Map Li W.m .. _._....__ r'Zoomin r,ZoomOut r' RecenterMap � identiy: Parcels � �CaW'l: Draw se/ect Zoom Factor 2X '� r Radius Search(feet) 0 BOUtldBP)t ^ �Census Tra ; "s ;: '.: , ; , ' '; Clty Bound : r County Zor ; ; i ; ; '; ,.,....; __::, ' __..����.�....�, ' Multi Syi ,; , ; ; , :., ,, (-E911 Flre 0 ` ; _ loo ane ;: i .;. ::' ; ' ; (�F dP s �' ` �� � � i ;' �� _ lood Zone I �� � F r �5861935697 ' ' ' arce s � ; '� <,: ;'; . �;P I , ,. ;' , s ` < : _ :. ,;' r:School Dis� ':: . ` > ' ' ,'. ' ' ; MUltl SYI ` ' ; " � own Zonl� ' r ; ns _, ; , o . > C-T '` r.. '' " r' _ ; ", ' ° - �Townships ; ; ' ,,, , ., ,.; . . ........ .: : ,; .... ..... s I _____ ; i , , , � � ' � , � I , r Voting Prec �.: � � � `� � � :�;�� '; 1 `i ,.r...,,. ., . � ...�:.-...., � �' �� �� � �.:::.., . , .:.�..': .:::::.:..:.. ,.- ..:1 : , (nfrastructu (�Driveways �Rall Llnes `; ' ` � reet Cen ;' ' ;: _ :. : ;.: �St 1 ,: .�. �:: :: ; i : ,�,. : :�: - c �. _: . .,._ - ; , � . .�i :., ::i � ..:.:: . ` .� , .. :� ' ; �! ? ,`�'. r`us,Nc H�9r ; ;. , , ; , , ._ ... .. . .. ;;': ; . . s : seas ;: . ... .,: ' ': rr u • • ' N Parcel Data � .� . ' DAVIE COUNTY HEALTH DEPARTMENT . r"� , , Environmental Health Section � ' . • � ' Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002227 Tax PIN/EH#: 5861-93-5291 Billed To: Kim Beauchamp Subdivision Info: Reference Name: Location/Address: Beauchamp Rd-270 6 Proposed Facility: Residence Property Size: 9.52 acres Date Evaluated: S . Water Supply: On-Site Well Community Public � Evaluation By: Auger Boring "^� Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition • Slo e% (� HORIZON I DEPTH � -Z2 -' Texture rou �'it�� �"i Consistence ; S'S Structure G Mineralo ; � HORIZON II DEPTH - - � 1 �C Texture rou � t� Consistence i� Structure Q , 1,G � Mineralo �� � HORIZON III DEPTH � Texture rou Consistence � Struc[ure C Mineralo � HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE p. ' � S SITECLASSIFICATION: EVALUATIONBY: ������'C��An-�Y__ LONG-TERM ACCEPTANCE RATE: �'� OTHER(S)PRESENT: F-+►�"'`- '�t=t��k--r-��""� REMARKS: !k�� .���T' T� 4(0�' ' 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-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 Mineralo�v 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 OS/99(Revised) ■�■����■■■����■���■���■�■�7�■������■■■��■�������������■ � ■���■■ ■�■����������■����������■�;���■��■��������■■�����■�����■���������A■ ■����■�����■���■���■������I■���������■�����■����■��■�����������■�■ ■����■■������������■������I��■■■■ ■■■■��■�����■���■■�■��■��■�����■ ■������■�����■■�0�00��■■��������■■����■�������■�■�����������������■ 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'' t • :'i.��r�",d- r6�, ":�r�ry,7.Ca,,-�,� �n�-? r'Y f.�1'. , , ;i �J"r A : f ,_ - ) ` r 'f'; J.M f �'�+-Z�( ^!,F•—i� '[ f " 'A r H sY'. ' .rpt i ' ... ... _. � �l 1 f _1 ,4fiT� r�i, k' RY! [-��`�� `,,,.•nR �"�, i' F � h. f:=,. � kP /,Gun Club Rd _ �, ,,2— S / SR 1e1Ef °A 7! ' t , z a �. Y. 7 ry I wWIWI, v Tax Lot 127 Boo Rd ` Tox Map E-7 ❑ no�ye OO w. #4 M h! A 4 rsar n/t Mary Ermon B. Blackwelder dory! Will Book 95 E-237 D8 31 O PG 386 \ p ° tr PM if 4"Mor an of ` —Major Rd r { s s 1697 Beauchamp .Road S.R. 621 d TW '!!A�a o a ' aB lax Lot 127.04 \ \ a. a !a�+y w"OW- SR n4 , i*�'• ,. Tax Map E-7 60 Public R/IN claimed by NCDOT +``'' ,, ♦ i S , rt �t't n/t Bryce C. Blackwelder [] �eon• ur. w won tt[ l tsw S i and w a 20" , /­ Pavement wra-to"w � •o (" � � �?P not akar' a k Ermon B. 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Formerly Part of Y 'r \� Tax Lot 144 1 s Y lv t D Tax Map E-7 �, } n�f Klrr1 Rlloy Beauchamp r ,< k`, and wife46 c� Kimberly Robertson Beauchamp r s R9 383 O PG 41 t k e f ti���'µµµ F F ♦' • r . . � w � � t it .. IRS �:. - 1 �. , ht !1r �• r fir M Fr d - __ ____�__________ _ 9999 Major .,load S.R. 1697 `xr, Axle Fnd - -238.70' N 8901513011W -- --- - --`- 6" Motor Grader B1add Bent/Fnd 60' Public RIW claimed by NCDOT 20'+1- Pavement ` ;i I y a4.f r j* , I 1 •' [y '1 �' a Tax Lot 116 Tax Map E -7 DBf 148 O Pi;s64 i c;rnotzvr on i� %'d RR Spike Fnd * Approximate Tax Lot 144 Tax Map E-7 Center Line of S.R. 1697 and wife n/f Lo Wade Beauchamp I +x ^? Mildred I R. Beauchamp DB 156 O PG 307 Surve or, I js47`` t Kim Riz1eY.-,.fleaudAqm op LECi!✓N❑ / / ' a ,, «' t� , v• . �y, � ��`( "' �"�y')?r vr.d'' ' ♦ 1F f.` JJJYYYYYY°O°°°° 1 R/W - Rigl'.t-M W;., Cvter ine / (�rl R�] ` !t ' . FJP - Exiatkt Iron P ► Cdnt f Line I / ' 4f° `C 51R - fxlei'n {Nn !b cPof Point Edge of Fcvor^er t P pp ur- n M ... 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