971 Burton Rd , � ' •
•- �� � DAVIE COUNTY HEALTH DEPARTMENT �� _
Environmental Health Section
. P.O.Boa 848/210 Hospital Street
Mocksville,NC 27028
(33G)751-8760
Account #: 990002293 Tax PIN/EH#: 5798-11-7825
Billed To: Branch River Ranch,LLC Subdivision Info:
Reference Name: Location/Address: Burton Road-27006
Proposed Facility: Residence Property Size: 2 acres
ATC Number: 3159
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST 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 11 of
G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWAT CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health SpecialisYs Signature: � .�� Date: C� ����
CERTIITCATE COMPL TION
**NOTE** The issuance ofthis Certificate ofCompletion sh 11 ndicate the described on Improvement/Operation Permit
has been installed in compliance with Article 11 f .S.Chapter 13 A, Section.1900"Sewage Treatment and
Disposal Systems,"but shall in NO WAY be tak s a guarant at the system will function satisfactorily for any
given period of time. � "�
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Septic System Installed By: � A1 , l�
Environmental Health SpecialisYs Signature: � � Date: �� / � ��i ��
DCHD OS/99(Revised)
• + � DAVIE COUNTY HEALTH DEPARTMENT ��- -it7
` ,, � • • Environmental Health Section
� , . , P.O.Boa 848/210 Hospital Street ���
Mocksville,NC 27028 �,� �r _ 6 -Z
. (336)751-87G0
IMPROVEMENT/OPERATION PERMIT
Account #: 990002293 Tax PIN/EH#: 5798-11-7825
Bilied To: Branch River Ranch,LLC Subdivision Info:
Reference Name: Location/Address: Burton Road-27006
Proposed Facility: Residence Property Size: 2 acres
**N����iib�Improveme nt/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). T'HIS
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 S' #Bedrooms� #Baths�
Dishwasher:� Garbage Disposal: ❑ Washing Machine:� Basement w/Plumbing: ❑ BasementlNo Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: �
Lot Size G Type Water Supply l�/�// Design Wastewater Flow(GPD) .����Site: New� Repair❑
System Specifications: Tank Size�GAL. Pump Tank GAL. Trench Width��Rock Depth�� Linear Ft.�
_ Other: �v
Required Site Modifications/Conditions: `
IA'IPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S) IF 6"BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for fin inspection of this
system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the y of installation. Telephone#is(336 51-87G0.****
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Environmental Health Specialist's Signature: �` ` Date: � '��1--
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DCHD OS/99(Revised)
. ._. . .
• .• - '
• , . APPLICATION FOR SI�E EVALUATION/IMPROVEMENT PERMIT � � � Q �/�
., V �
Davie County Health Department �
Envinvnmenta/Hea/th Section
P.O. Box 848/210 Iiospital Street ��AY � 3
Mocksville, NC 27028 2042
(336)751-8760 �'�RONM
�A� FNTq�N
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS AI,L THE RE
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be Billed �.�(�' { Q��''rr� �yJ� � (i(�(� Contact Person �r�} '�i__
Mailinq Address / (r �drQx ,�(�(� Home Phone 336- 4 q Q- ZS 3�_
City/State/ZIP �Y��/V� �e. L[�� �y_ Business Phone -" -/�� �7'v 8�
2. Name on Pezmit/ATC if Different than Above ^ ��. �
Mailing Address City/State/Zip
3. Application For: fiYSite Evaluation „�Improvement Permit/ATC 17 Bo�h
a. system to sezvice: �J House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People � # Bedrooms _� # Bathrooms 3'
,V�Dishxasher IJ Garbage Disposal l�f Washing Machine ll IIasement/Plumbing I I Hasement/ido P].umbing
6. If IIusiness/Zndustsy/Other: Specify type # People A Sinks _
N Commodes # Showers # Urinals It Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of watar supply: ❑ County/City t� Well II Community
s. Do you anticipate additions or expansions of thc facility tl�is systcm is intcnded to scrvc? ❑ 1'cs �'IVo
If ycs,what type?
***IMPORTANT***CLIENTS MUSTCOMPLETET'IiE RLQUIRED PROI'ERTY INrORMA'tION IiLQUGS'1'l;D
BELOW. Either a PLAT or SITE PLAN MUST 13ESUBMI77'ED by the client rvith THIS APPLiCATION. �
`
Property Dimensions: �� X'2�G ��1.. Z'��d> WRI'fG DIRGCI'IONS(from Mocicsviilcj to PKO1'GR'1'1':
Tax Office PIIY: # S79 Fl - ►1-"78 ZS ]yr,✓y b�. � Zi $01. �E,�r- o� 80� Nr,�,,�
Yroperty Address: Road Namc 13N,/LTDiJ �H,D�SR►��b��h�fl2a�{ � MI t�b, �1: Dv� �F.��'r� GRf�f.vC �-.D,
City/Zip ��PlvJ�2700h �T, qr1 (��23'Ur1 P�. �}'T� 6r�d4 � �J+f.,�n�
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If in a Subdivision providc information,as follows: �d ��KaKi 11��GON6tic 6�r"T� t�Q�n1G.� ��If.�./1Ar�Cc/
Name: �wt�,d'�� �S ���f Nh� DD►.� �tf�IbD�A.O Pf�$+�
SrW—P {�.i�Jj.�J .
Scction: Block: Lot: Datc Property rlaggcd: �-22 ��Z�
This is to certify tl�at the information provided is correct to the best of my knowlcdgc. 1 undcrstand that any permit(s)
issucd hereafter are subjcct to suspension or rcvocation,if tl�e site plans or intendcd usc change,or if ti�c information
submitted in this application is falsitied or changed I, also,rurderstaitd thut I nm responsiGle for aR clrrrrges inrrrrrrd frnm
!/ris applicatiar. I, hcreby,give consent to tlie Authorized Representative of thc Davic County I-Icallf� Dcpart���ent
lo cntcr u�on above dcscribcd property locatcd in Davic County and owncd by I�JCµ �d'�,,,/L n�v�1G-i U.�_
�---
to conduct all tcstiug procedures as ncccssary to determine thc sitc suit ility.
UAT� �I2�` J�2 SIGNATUI2� � � (�� ''�' M�w�.tG �Ap�,
THIS ARCA MAY BE USED FOR DRAWING YOUR SITE PLAN(Includc all of tLc following: �xisting and proposcd
property lincs and dimensions, structures, setbacks, and septic locations).
Sitc Rcvisit Cliargc
Datc(s):
l��`1��,�,� S7�$�,,,,., Clicnt Notification Datc:
�� �� �, .N-.� �� EHS:
Aceount Na. � o� I 3
C__._
Qeviscd DCHD(07/99) I�►voicc No. �� q �
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" , � - DAVIE COUNTY HEALTH DEPARTMENT
- ' ' . � , Environmental Health Section
" ' ' ` Soil/Site Evaluation
• APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990002293 Tax PIN/EH#: 5798-11-7825
Billed To: Branch River Ranch,LLC Subdivision Info:
Reference Name: Location/Address: Burton Road-27006
Proposed Facility: Residence Property Size: 2 acres Date Evaluated: �-Z�D Z
Water Supply: On-Site Well Community Public '
Evaluatioa By: Auger Boring � Pit Cut
FACTORS 1 ; �, 3 4 5 6 7
Landsca e osition �..
Slo e%
HORIZON I DEPTH � �
Texture rou
Consistence
Structure
Mineralo
HORIZON II DEPTH
Texture rou
Consistence
Structure ,-
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-Slightly plastic P-Plastic VP-Very plastic
Structure
SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky
SBK-Subangulaz 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
DC�-ID OS/99(Revised)
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12-12-202 12:d7PM FROM CRAIG CARTER BUILDER 336 9d0 2620 P. 1
, •
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• A
° � Craig Carter Builder, Inc. Hands�n
119 Hwy_ 801 S eui�dsr
AdvanCe, North Carotina 27006
N.C. License Unlimited
Nt�vember 26, 2002 �
Mr. Buck Hall
Davie County Health Department �
Environmentai Health.Section
PO Box 848
. Mocksvi{le NC 27028
.� Dear Mr. Hail,
� Craig Carter Builder, Inc. is currently constructing a house for me at 971
Burto� Road in Advance. I am requesting that the septic system utilize the
Infiltrator system. �
� Sincerely, , �
. ���2'�,(,cl �=�/��-
� Mrs. Charlie Branch
(336)940-2341 • Fax(336}940•2620