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138 Beauchamp Rd DAVIE COUNTY HEALTH DEPARTMENT � . �, �.'d Environmental Health Section . ' P.O.Boz 848/Z10 Hospital Street Mocksville,NC 27028 (336)7S]-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003875 Tax PIN/EH#: 5870-65-2977 Bilied To: Alan Mock Subdivision Info: Reference Name: Alan Mock Location/Address: Beauchamp Rd-27006 Proposed Facility: Residence Property Size: 458x612x222x **NOTE�*T'his Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHOWZATION 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 1T #People #Bedrooms � #Baths�,� Dishwasher: ,� Garbage Disposal: � Washing Machine: � Basement w/Plumbing: � Basement/No Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply C� Design Wastewater Flow(GPD) 3�� Site: New� Repair❑ System Specifications: Tank Size��'D�' GAL. Pump Tank/Od v GAL. Trench Width s�' Rock Depth /��� Linear Ft:-�S v Other: Required Site Modifications/Conditions: INIPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) TF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 8:30 a.m.to 930 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(33C►)751-8760.**** �'a�����e� � .�o j�j�7�x✓�a� �e��� ,� �' � yu�P � �°� Environmental Health Specialist's Signature: Date: `_� a �evne DCHD OS/99(Revised) � � • DAVIE COUNTY HEALTH DEPARTMENT ' '*;,�,' , Environmental Health Section . � P.O.Boa 848/210 Hospital Street n ' n� Mocksville,NC 27028 �U. (336)751-87C►0 �11j a� IMPROVEMENT/OPERATION PERMIT Account #: 990003875 Tax PIN/EH#: 5870-65-2977 Billed To: Alan Mock Subdivision Info: Reference Name: Alan Mock Location/Address: Beauchamp Rd-27006 Proposed Facility: Residence Property Size: 458x612x222x **NO"1'E�*"Th�is�lmpro4ement/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_� #People #Bedrooms � #Bath�� Dishwasher:� Garbage Disposal: ❑ Washing Machine:� Basement w/Plumbing:�� Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: � Lot Size� � Type Water Supply �-(> Design Wastewater Flow(GPD) ��v Site: New�Repair❑ �J System Specifications: Tank Size�GAL. Pump Tank GAL. Trench Width�l�Rock Depth� Linear F�� Other: accepted Systems may also be use Required Site Modifications/Conditions: IMPROVEI�1ENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF G"BELOW F'INISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 8:30 a.m.to 930 a.m. or 1:00 p.m.to 1:30 p.m.on the day of ins llation. T is(33C)751-87G0.**** ,..��4/I') 2�-�.. fs �c � ; �J � � . � ✓ � :� Environmental Health SpecialisYs Signature: � ✓ DCHD OS/99(Revised) . '� � , ' ' " ` ' DAVIE COUNTY HEALTH DEPARTMENT • � Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (33G)751-87G0 Account #: 990003875 Tax PIN/EH#: 5870-65-2977 Bilied To: Alan Mock Subdivision Info: Reference Name: Alan Mock Location/Address: Beauchamp Rd-27006 ATC Number: 4322 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his Authorization for Wastewater System Construction MLTST BE ISSUED 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 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRU TION IS VALID FOR A PERIOD OF F VE YEARS. Environmental Health Specialist's Signature: � / Date: � /��,e CERTIFICATE 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. � �-feh j s�e� r�� � � �Q�� ��/ , �,,--� ��' ���u�� ! �oo� ; a�y � � � Clc�,�� Dry1,A��v� �� S tic S stem Installed B : ��`L��" �` � '� � Y Y ; Environmental Health Specialist's Signahue: i � Date: / " DCHD OS/99(Revised) , Jan 3Q 06 03: 55p davie county envhealth 336 751 8786 ' . 3 . � • , p 1 � ' � : � � C� C� � � � �� �� ��P�I('�'"10.I�,�OR ' 'ALUA710N/lAti'll(!1lEhtENT PLRM1tiT&ATC Lw�Da ie-G nty Health Dep;.rtment • E iron ental Kea/th��:tcfion ENVIRONMENTAL ax 8 S/210 Hospit,�I. Street � 3�,�`[�� DAVIECOUNTY Macks ille, NC 2�q26 �,a; ��,�,,�,�,�.�.. 36)?51-8760 ��d,�„ ***I.b1PORTANT*** THIS API�LICATION CANNOT BE PROCESaED UNLESS ALL THE Rk�QUIR�D INFOIitlATiON ZS PROVIDED. Refer to the INFORMATIG>f BULLETIN for instruction9. 1. Nanw to be Dilled 1� 1���1 �YQ- 1 � 1�� Contact Yeraon _�(�'1 �+ 11 1� Mailin� �ddtesa �_��^,. � �-� 7[ome Phene 99�-a��� Cit•y/GLato/ZI? ____���L Businees Phona `, ��" � � �� e�') 2. Nnma un Petmit/ATC if ASLfereazt than Above ����, �� � '� l�� Mai7.ing ArSdrees City/�lute/Zip � z. Appli,c�tieion For: 4YSite J:valuatioA ��Imp.:avement Periait/ATC �CYhoch 4_ Syatetn to scrvice, 5d Hou�Q D Mobile Homo ❑ Busi.ness C7 InduJtry O Other 5. Typu uyuL•om requacted� tos�vontional � conventional ��4�dified ❑ innovaL'Svo paccepted 6. IE .3te�ldence: N Yeopl,� # IIadroc:;ns � # IIathrooms � '" Diai�waaher ❑Oarbage Dispc�sal 1�Hashing Machina �aaesc.anCfPlumbiag �Daaemont/2tv Ylumliing 7. If Luuiness/Indastry /OthaYo varify type 8 Psople �� IF Sinka ! Commoriva # 9howars �t Urir:►ls N Waeor Coolera IF FOODSERVICE: � Sestt; EstimatQd t�i��ter Usage (gallons per day) a. Type of wataz aupply: L1d C4u:a,ty/City I7 W�:.11 ❑ CoramuaiGy s. no you auticipate adJitlonu <�r expansinns of titc ladlity this sy:�l.cin is intcc�ded!o scrvc? cs �"lYo I[1'cs,iti•hat typc? oo(, _n ���V�- . � "*'�I;1IPORTi1NT''**CLllsl�l'S A4UST COhfPLETET1iE RLQUIl��i11 PROPERTY[N1�ORMATIOI�I liLQU1:5'I'�D [3E1.�\V. Cither a PLA7'or S.TL PLAN bfUST BL SUUblITTL•D by tLc clicnt with TliiS APPI.ICA'T'IO1�I. �• . Property I)iuicn�ions: `t 5�� .��i��� � ���'� �VRI'�'C DIRECTIONS(frum Mocltsvillc)to PKOPERI'1':` -r1x orrr�z�in: t� Tv -(�s= Z Y?? �r r.e�r � � �c��C c��-,� Property Adclress: Road Name_�e4.t,e�O�����d , '� �Y nQ-� ?��Y' c�cy�z�� � n�� N.C'. ��C�_ d. If in a Subditi•islun�rovidc iufarni:�tlo»,as follo►vs: �_, Natnc: . .�. � SCction: BloCk: __. Lot; DA�C Ii0[I1C COPIJC!'S jI�s�C(I: a — "1—O�-P 'Cizis is!o certit'y that iUe infornlatioi�,prov�dcd is correct to tI�c bcst of�uy kauivlcdgc. I understaud Uiat any per�uil(s) issac�I licrcaf(cr are subJect to suspensiou or revoca(ion,ff the site plan� or intc»ded use cl�auge,or if tbe inforn�atton � subrnitted in tl�is apl�]ication is fZlsificd or ci►anged 1,afso, ulyderstand rliat I unr responslGla jar al!cicarges Incrlrrer!jruur tlris upplicrrliorr. I,Gereby,give eons:nt to tl�e Autl�orized Rcpresc�it�ti�•c oC tl�c Davie County I•Ie•zllli Deparime^ ��t � to entcr iipou abovc Jcscribcd�ropc rty tocalcJ irt Davic County and o��+ncd by ��LLY� ��, (�Oc�h t� lo conduct all tesling procedures:is:,�ecessary to detcrnune the siie suit��bilit}�. � pAT��`-� �U� SIGNATURE � . � ----- �---• --•-•^^ ^•••.�n T�n �',n��xi�fv�'Vf1TTT7 C(•rr.rr.aiv'�tn��tudc al!of t{�c folloivin�: I�.eisfin�aitic(proposcd � . -L �. � • :��� ,� � �,., �E�� �`'�, `� � , :� c ..�., •y , 2 " ; . � �0 / ,� � � wn� � � � �P i' � �2SV � �`�� �7 :.-�7 ' . � ,� ' �.,, •��,', F�' �'',� �' � � � � !• ("Y V Y f �, � �� � � ��, / � . , �:� % / �N� � � �-t.r � ./ o��; / � • S��p � / � .�' � � �,,� ' ���� �,„� 2?p��` O.. � ..,._.. . � ' ." s.� ;� � ' � � . .�' f ,: r AREl� INSid� R/4V `�, eP�nr � � � / 0.74Q Acres. . .35. � � � : � :� / 32213 Sq.ft. ' 09, � � , �. s �g, . 35'36'72"E � ' l CP ; �' !,� AREA OUTSIDE R/1;'/ '�sr• (`'E�,K 3Q.40' Tl� > �'`'� • . �r�'- �cb 4.266 Acrc;s. \ � "-✓ � � � �'s' i 185840 Sq.ft. • � EPK � � 'Q f 'J/� ' Ok�'_ ��,F�, LOT 1 �� NIft '� ��s�s ��c�O o ' :p 5.005 ��r'��r� �'�� 3qQ9s. �'�. `�•�� � : / 21ES053 Sq.fY � � �� • � � 6�6I'��` }��� � S F n� ^ . �� � A� !c�'�� . � �� \ ��� � ' � � ��_ « 1 � � N ./cP � 'N��::� �--��,�� a � - J o I sso.r,�. - �• ' .�, 5S��4�14�'�At —"`---""""�„"'�"- E-�t..� NIP, p , 1 � �' � � z: 4• r=. . =�r: "` AREA I;JSIDE R/W ;� � ' �� 0 0, • �:� /� 0.182 Acres. ' �,.�• � � o M �: 7936 Scj.ft. � v� � N� � J� / AREA OUTSIDE R/V: REMAI! • `�/� 3.2�3 Acres. � � �� 139535 Sq.ft. � � 30.,. ;�/ TOTAL AREA LOT 2 ._ N • 3.3$5 Acres. ,�„� ppi� 147�71 Sq.it. c�rs�c��"""'�`-~.-ry.,,��3„9' � , cor,�:��, �"`-,•�.,�.,---.... �N:sos25a.2a 5�9.38' -'.. ? 7an t ti S7;37� T07AL�� 157.3g' ��"4Y E1R r�C��•�--__ 202.23' n� COtJT20L S�31'S9"yy CORhl�R ��� .._.__ Vd. M. ESSEX, HEIRS �F,�S s�ei$�� DB Q44, PG 203 ID. F-8-22_ t_EGENU �______._�.________�._._—_ — Rc�ference Surv�y: � PP �o�v�r po;� Plat of survey for Alan ?�ock,l'rustee and Thomas � t�,'CM ne�,:� control monurnent Meroney Essex 7rust. 6y Uonald J. T,�oore, P.LS. - � 1,vV �water vcive Dot�d 01/12/06. � ECM existing control moniamen't G EIR existing iron rod Rabbit Farm, �hase Ii, Subd'+vision Plot. Plat �ook U6, Pg. �y Gizinski Surue.ying Cc�. Qated March 1$ of 1994. �Q EIL' existing i�on pipe e�4 �;`,.,�-� nev.r iron rod (�set � Plat of Survey for Jahn H, Hoots, �tal. �'lot Qeak OS, Pg. � �y GizinsL.1 Surveying Co. Dated July 14 af 1��32. � tR�S er,i:sting railroad spike !�, s�P cornputeo point (nv't set) (> e:_r'i< exi�ting riai! D�vi,^ rourty Zonin,: R-A ;�;CC�`=: ,"�!c��'th Ca-olina Geoclefiic Survey �uiidina S�thoc�::> pe� �avi� Co. Zrn;ng: :;�'G: ��iate f=lar�e Coordi�ote �Sinim���r� Front yard: 4D f�:ei hRiriin�um Si�+� y���rc;: 15 fe�i hfinimum ���or ��rd: 30 feet �IVOSICin �-"iOI Ot C�r-��� f�4„ ....,,.....aw.......,_„_.,_„�..,...�,.�..e,.�.._,...,�a..,,.,_... ra.1.N,.<..�..�,.._....�....._.�._. ....,,m._.....,�. __.__..o...a..,..=�,..F.....e..,_........�,��......_,......,,...�,,.�.... , r1 k� F u00(?OU�23 T�:�y-i�t� 0#ti�er ox Dav+�a Co�r-�ty '"`. F "�" '3� ----_^ �.__ certify i!�at �i��: rne� t�r �;toi to ���;ch L����"�i:. � F.:..���:.o� ���":�:� 1 '�. /%, �'�j -�} C.6. R�(. tlys c�ti+cQtion is afifixed me3:s a:! �ptZer u� �CCUC�l�C1`P ROC� `/ ,�� �r {�J C� 045, PG 42?. statutory req�.r;-e�i2nis for rerorc���g. Tov:rst-�;p, Dav',d Coun:y, fu�irth C�ot;na �v' �,: "�r � � Oh2, PG 141. ��''�`���,.,�''14'.�J'�i'.'r7T.n�Tl��7rl� ~� Ratio of Proc�sion: __ .� � Re��i��,u Office+� Da:�. _._.10'�._..a..�..._.......w,...._D`�'�.Q i f 24/t�G �,:���..�__._._� 1:iJ,Q00 �,_._ ,..�..,n...,�._,_......,. �..._.,.�..�.��_,.w� . '-� -. ---�_._____..._�_____....-- -__._.—_ ��_ _.�._..__.�.__.._.�----------_._..---------`_�____ ------ +t. ` � � • DAVIE COUNTY HEALTH DEPARTMENT � � . • Environmental Health Section '` � Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003875 Tax PIN/EH#: 5870-65-2977 Biiled To: Alan Mock Subdivision Info: Reference Name: Location/Address: Beauchamp Rd-27006 Proposed Facility: Residence Property Size: 458x612x222x Date Evaluated: �/�d��� Water Supply: On-Site Well Community Public Evaluation By: Auger Boring_J,/ Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition � Slope% 6 � ' HORIZON I DEPTH '� G �� Texture grou L G L Consistence Structure Mineralo , ` HORIZON II DEPTH p/� �� Texture rou Consistence C Structure 1[ �l Mineralo �`/ HORIZON III DEPTH i l'� 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 T,�ndscape 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 Te�ct�re. 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 CnN4I�T .N . . �15� VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm � NS -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic S.ttus�u'g SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mine_ralo�v 1:1,2:1,Mixed lYnt�S 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 Classifcation-S(suitable),PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate-gal/day/ft2 DCHD OS/OS(Revised) ■��■�■■��■■■■��■�■■�■�����■�■���■�■��■�■��■�������■■�����■�■■����■ 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