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570 Becktown Rd e , DAVIE COUNTY HEALTH DEPARTMENT _ , Environmental. Health Section � ' " . ^ j - P.O.Boa 848/210 Hospital Street ���"� �—'�� J L� Mocksville,NC 27028 (336)75]-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001687 Tax PIN/EH#: 5755-66-6942 Billed To: Joe Barbee Subdivision Info: Reference Name: Location/Address: Becktown Road-27028 Proposed Facility: Residence Property Size: 15.06 acres ATC Number: 3190 **NOTE** This Improvement/Operation 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 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 PERMTT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type TI #People 7 #Bedrooms_� #Baths_� Dishwasher: �" Garbage DisposaL• � Washing Machine:� Basement w/Plumbing:� Basement/No Plumbing: 0 Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size /�/�'�` Type Water Supply�i'�// Design Wastewater Flow(GPD)�� Site: New�Repair❑ System Specifications: Tank Sizei�r�"AL. Pump Tank GAL. Trench Width��Rock Depth�Linear Ft. �� �� � Other: Required Site Modifications/Conditions: Ih1PROVEI�1ENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF 6 "BELOW FINISFIED GRADE. ****NOTICE: Contact a representative ofthe Davie Coun alth D artment 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 da a io ep ne#is(33C►)751-87 **** ,0 h /�B 69 i re d �. � �� ��� � � � / � r� � sh �j �a� i�������� �� � � , � 3 , � ,�'lo ��G � �� , � , J � � �� � � � �� ��e r � �' 5.�� , ,- �-� � � - / Environmental Health Specialist s Signature: � Date: �`�� "��V DCHD OS/99(Revised) , . �� . ' . . � DAVIE COiJNTY HEALTH DEPARTMENT . ,.. Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (33G)751-87G0 Account #: 990001687 Tax PIN/EH #: 5755-66-6942 Biiled To: Joe Barbee Subdivision Info: Reference Name: Location/Address: Becktown Road-27028 Proposed Facility: Residence Property Size: 15.06 acres ATC Number: 3190 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MiIST BE ISSLIED 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„S tion .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEW � R NSTR TION IS VAL D �PEWOD OF FIVE YEARS. ' / � �� -- Environmental Health Specialist s Signature: � , � � Date: � ���_ 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. /�� �� � t � � �—'— Septic System Installed By: �� Environmental Health Specialist's Signature: Date: ��-��, � `d'� DCHD OS/99(Revised) __; 'I���� �0`�v t �~ � ,• +��..�,._,._.n-.-�A�j� ' CATEQiI FOR S1TE NALUATION/(!'�1PROVEMEM'PERfl�71T�A�'C � � "o�. � " � � �lfu� � �l Davie County Heaith Department �� � � 2� � Environmenla/Hea/tfi Section � -� P.O. Box 848/210 Hospital Street _ •, _ Mocksville, NC 27028 �, �i«'' ENVIRONh9ENTAIHEALTH (336)751-8760 ✓ ` DAVIE COUMY ***IMPORTANT*** THIS APPLICATION CAIVNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN Eor instructions. 1. Name to be Billod .iG� E• �.�i�ry/��^L� �+ Contact Peraon T�i� os /jin y B�i��� Mailing nddresa �•Z6/ C�s..p�a///Y'�, Bome Phone �G'/- .Z��- �38 / � City/State/ZIP �G"L��r�� i✓C .��OfY Buaineas Phone 2. Name on Permit/ATC i£ DiEferent than Above Mailing Addresa City/3tats/Zip �'2� cc�5 f',td Z- ^ 3. Application For: �Site Evaluation ❑ Improvement P rmi /ATC ❑ Both 4. Syatem to se=,.��a: �House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other s. if Residence: # Peo�le / ik Bedrooms y # Bathrooms � _ Diahwasher ,. ,t3`arbage Disposal LiT Washing Machine 0 Basement/Plumbinq ❑ Baeement/No Plumbing 6. If Bueiness/Industzy/Otherc. Speci£y type $ People # Sinka � Commodes 0 Shoxers Y Urinals # Water Coolera IF FOODSERVICE: # Seats Estimated Water Usage (gallona per a�y) �. Type of water supply: ❑ County/City [3�e11 ❑ Community s. Do you anticipatc additions or ezpansions of the facility this system is intended to scrve? �s 0 No If yes,what typc? ���,.r„[-' - -- ***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION ItEQUES7'GD BELOW. Either a PLAT or SITE PLAN�1UST BESUBMIT7'ED by the clicnt with THIS AI'PLICATION. Yroperty Dimensions: l�• �� �C � ,,.^��� WRITE DIRECTIONS(from Mocksville)to PROPLIt'I'1': 6 � Tax Oflice PIN: # S 7.SS'6 6 �'9 y Z �c�faq,A i/�� rfd/ -ra�,tti �-�.;�a LP f f �..� PropertyAddress: Road Name ��cr��o�c�� r?�' , ,tPe��h•:..t� iC�+, ��r�%j.. rP.->,�/4� cy,J City/Zip/�'Ioc�/�,r•%�e u.�,�r�,�- /i-z�,%�'.! �.� �yp�.�-/-/.%/ a..�/�;�s ��. lf in a Subdivision provide information,as follows: fr.�.� 4�r •�.+y �'��0�'�y ' °I�r`F�� /f�i� ,,E//or /rjbr� �a.� /�fi �'.iF.,.� v r�.�,�r/+�l�a"� Namc: Section: Block: Lot: Date Property Flagged: /�i�� %/.�/ �"�� This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issucd hereafter are subject to suspension or revocation,if the site plans or intended use cLange,or if the information submitted in this application is falsitied or changed I, also,undersland lhat I am re.rponsible for all charges i�rcr�rred from this application. I,hereby,give consent to the Authorized Representative of the Davic County Health Dci�artment to entcr upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE �,��/?, 2-�T// SIGNATURE ���U�'- THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Eaisting and proposed property liaes and dimensions, structures, setbacks, and septic locations). , Site Revisit Ct�arge Datc(s): � � �~ ' � � ���. Client Notification Datc: � -�� ,� � ��f/attic"'� � � � /�� ee�is � . ,' !►."�''�' ,.� . � � � F.., e��,� ,/:, ''�'"� � ` � �'^--�� � p� ���- y r� ; �-�� ccount No. b S a' `��� 't' �„_,�. �t /�Y�� � Revised DCHD(07/99) ` � rt -"�' Invoice No. �� � � i� ���r� �' �• � 011 F.�� ,i.�n� • '"�` '�N �' �.�lo�-�-�.�'�`' `�-`" P'�'1� � �` 1 To .f�Ki Lo.....1. �«� }^-Q�—" �pr` V ,��ok rv.�,� Rd c�-"' �►:tt ' � DAVIE COUNTY HEALTH DEPARTMENT ' ; '�'• ,: + Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001687 Tax PIN/EH#: 5755-66-6942 Billed To: Joe Barbee ' Subdivision Info: Reference Name: Location/Address: Becktown Road-2702 Proposed Facility: Residence Property Size: 15.06 acres Date Evaluated: /`, c� 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 % lC� HORIZON I DEPTH � - ' � Texture rou �' Consistence r 'S G-C Structure C Mineralo i ' �. 1 �� HORIZON II DEP'TH � • l i}' (�' \ Texture rou C Consistence , Structure � � � ''. Mineralo - 1 HORIZON III DEPTH �-�{2 \ ' - - Texture rou C'_k, � {- ' Consistence � - � Structure 5 5 � Mineralo �� I 1 HORIZON IV DEPTH � Texture rou .� q �c �. ^ Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE Q • (� .' SITE CLASSIFICATION: EVALUATION BY: r LONG-TERM ACCEPTANCE RATE: O�`"� 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-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 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 acceptance rate-gaUday/ft2 DC�-ID OS/99(Revised) � r ] ■����������i�■��■�������■���■�■��■■��■�■■��■���■■��■■����■■�■■��■■■ ■■�■���■■����■��■��■�■■■■■��■�■�■■��■■■�■��■�����■����■���■�■■���■ ■�■����■�`������■��■���■■■■���■■�■■�■��■���■�■�■��■��■��■�■����■■ ■�������■����■■■�■�■■���������■■ ■■���■■■■■�■■�■��■■■■■■■���■���■ ■■����■�����■■■■�■��■����■�����■���nn����■�����■■��■��������■■���■ ■����������■�■��■�■��s■����r�t�r!e����i�����■���■��■■��■vo���■■�■■���■■ ■���■�■�r�■�■���■��■�■■�■��;�:iii�r���■���i�til��\■7e�■.�■■■■■�■����■■ ■■�■�■��F���■�■�■��■■■��■■Y■��■�■��\■�■�■■��I�■�����■��■■■�������■�■ ■■��■��■�■i�os■■■�■so■�\■■■■�����\■■����■■■1,��■■■■�■��■■■���■���■■■ ■■�■�����■���■■■���■�■��■���■■��il�i■■�■�■■■�1��■�■■�E::/I■�■�■�■���■�■ ■■�■����I��■��■��■�■■�����i■■■��w����■■■�■■�I/A���■�,��Y���������■�■ ■���������■��■■�■���■■��■��■���■ ■��■■����1i�1�i17�■����■�������■■��■ 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■�■�■���■��■■��������■■■■■■■��■�■■�■■��■■■�■■■��■����■■�■■�■■■�■�■ � • . i w y• n - � ►� Z�anfe Gounty,�feal t�h Z�epart�ment �nvrronmental,�fealth Section PO Box 848/210 Hospital Street Mocksville,NC 27028 Phone: (336)751-8760 Apri120, 2001 Mr. Joe Barbee Jr. 1261 Campbell Road Woodleaf,NC 27054 Re: Site Evaluation- 15.06 Acre Tract/Becktown Road Tax PIN#: 5755-66-6942 Dear Mr. Barbee: As requested, a representative from this of�ce visited the above site on April 19, 2001. Based on 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. Based on the evaluation, a four-bedroom residence would require approximately 4601ineaz feet of septic drain line. This is subject to change as actual dimensions of the septic drain field will be determined at the time an improvement permit is issued. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct the appropriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. If you ha.ve any questions, feel free to contact this office at (336)751-8760. Sincerely, � JeffG. eauchamp, R.S. 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