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311 Getta Way4 DAVIE COUNTY HEALTH DEPARTMENT ' 1• Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900158 Tax PIN/EH #: 4891-85-4623 RH Billed To: Richard Hendricks Subdivision Info: Reference Name: Roger Holt Location/Address: Getta Way -27028 Proposed Facility Residence Property Size: 29 acres ATC Number: 4082 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST 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 buia permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .190 ret and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER -GA I ADI r{ON IS FnR A PERIOD OF FIVE,YEARS. Environmental Health Specialist's 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 I 1 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. C1i d. 1 �A it �4T10 1..1'to 'DIZA%JWAN� �A�Kaa�� �•Z� n Septic System It stalled By: Environmental He Specialir'sSignature_; t/Y_ _7::7 Date: Z7 6 e DCHD 05/99 1"a2 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 S ' / 7 — 06— (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900158 Tax PIN/EH #: 4891-85-4623 RH Billed To: Richard Hendricks Subdivision Info: Reference Name: Roger Holt Location/Address: Getta Way -27028 Proposed Facility Residence Property Size: 29 acres ATC Number: 4082 **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 PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type C�C� #People #Bedrooms .� #Baths _ Dishwasher: 17"' Garbage Disposal: 52"" Washing Machine: 13'*" -Basement w/Plumbing: G3 "" Basement/No Plumbing: El Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: El Lot Size G` � Type Water Supply , •' Wim- Design Wastewater Flow (GPD) 3W Site: New 12--<epair System Specifications: Tank Size 10CC) GAL. Pump Tank GAL. Trench Width 3t'' I Rock Depth 12- Linear Ft. 'FCC) Other: "i 115T -P -t6 %flo"J sCe3 Required Site Modifications/Conditions: I t-1E1T&l.A— e_oo l 7a, Q J � �� I /meq fiu — -s a� L3.t_ IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTE . FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County alth 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 installa " lept Lic > Environmental Health Specialist's S� re: RISER(S) IF 6 " BELOW Iment for final inspection of this me # is (336)751-8760.**** 4ectio It, ?-6 DCHD 05/99 (Revised) p -E'C E EI TION FOR SITE EVALUATION/Ih1PROVEh1ENT PERM1IIT &ATC Davie County Health Department MAY - 4 2005 Environmental Health section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 UMRONMEIJTALNUal (336) 751-8760 DAV1E COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed r G ' C . �,"..4 Contact Person Mailing Address Home Phone City/State/ZIP ,f%1��. rim, /�e_�, c�%i01 Business Phone 2. Name on Permit/ATC if Different than Abovz ,//G Mailing Address f /Yf i3l 3 b 1 a?t '541�,Lvi l/city/State/Zip -/-J/,j SlY % i 3. Application For: ❑Site Evaluation "provement Permit/ATC 11Both 4. System to Service: Ea/House 13 Mobile Home ❑ Business ❑ Industry E3 Other 5. Type system requested: L� Conventional ❑ conventional modified ❑ innovative 6. If Residence:// # People # Bedrooms # Bathrooms 13Dishwasher LJearbage Disposal OWashing Machine obasement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks _ # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats EstimatedWaterUsage (gallons per day) 8. Type of water supply: ❑ County/City 0--w—e-, l ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 0 -No If yes, what type? ***IMPORTANT*** CLIENTS AfUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by tl:c client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # / �S / ( �S 7� 3 Property Address: Road Name �,i4,au, Li!/ City/Zip A k,- ale- ir!� �r If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (frrom/Mocl(sville) to PROPER'L'Y: le Date home corners Ragged: J 5 OS This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred frons this application. I, hereby, give consent to the Authorized Representative of the Davie Comity Hcalth Department to enter upon above described property located in Davie County and owned b to conduct all testing procedures as necessary to determine the site suitabil' DATE a / SIGNATURE TIiIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). 0 � o Sign given_ Revised DCHD (05103 EHS: Account No. Invoice No. K. a 044wA. r rN x,• _ s�X}1ti C OG t -` CLL f " 4, � pu4W �tw�{iiwOti� �i AP -4. u II�:9g0y� a :w N d. P=• .. k4 SUPPC3- ��yJJ 1j L •m- Mia ry "" d } Y, s 1� z A _ i i L A �f tr iE h •' 4 i ��J t �a , 3 1 ur''3 A3�w 7 x,J y: v ,r- Ail r + �Kbi•1 •h: 9f� Y ¢ f:% ;y 1:� Se4 a davie county envhealth 336 751 8786 D %PP• APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC 0 Davie County Health Department OCI Env/ronmenta/ hfea/ph Sedfon I j �004 P.O. Box 848/210 Hospital Street a Mocksville, NC 27028 (336)751-8760£N�IRO' tg PORTANT*** THIS APPLICATION CANNOT BE PROCESSED BNLESS ALL THE REQUIRED may' QP INFORMATION IS PROVII)ED. Refer to the INFORMATION BULLETIN for instructions. 1 Name to be Billed --120 1– G (/Contact Person D '– A p— te- )tailing Addzeae L e `Nome Phone ?Oy ^ 3 J \ / City/Stage/zIP SES %!S "-r- nJ( 0 0 _ Business Phone 2. Name an Permit/ATC if Dift'erent than Above / Mailing Address ✓ City/State/Zip L--3. V eg. Application Fort Erst:e Evaluation ❑ Improvement Permit/ATC ❑ Both ✓'1. System to Services E House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other ✓5. Type system recuesteds Conventional ❑ conventional modified ❑ innovative 6. If Residences //I peo:?Ie . a i Bedrooms 0 Bathrooms ^ 4-�• nishvasher aGarbage Disposal 09LIsIng Machine 91 isement/Plumbing ❑Basement/No Plumbing `1 7. If Business/Industry /Oa..ers verify type I People t Sinks lv I Commodes I Showers 0 Vrinal■ t Water Coolers IF FOODSERVICE: N Seats Estimated Water Usage (gallons per day) I. Type of water supply, ❑ County/City Sd Well ❑ Comonuaity C;\ D1 l Cy ter. Do you anticipate additions or expansions of the facility this system is Intended to serve? ❑ Yes 2 N. If Yes, what type? n..IMPORTANT**•CLIE`1TSh/U� STCOffPLETETH. B °V. Either aPLAT nor:ilT AAh-TfUSTDESUUA `-� Property Dimensions: A -t^ e S -'Tax Office PIN: f! 1/0 3/- S.S--y 6193 Property Address: Road Name 6e -f A W.) ti bi. City/vp L°c/dfvi/ltz 770,2 n provide Information, as follows: Name: Section: Block: _ Lot: REQUIRED PROPERTY INFORMATION REQUESTED TTED by the dicnt with THIS APPLICATION. 1VRITE DIRECTIONS (from Mocksvllic) to PROPERTY: J,.J Sh e 4 t�t"e J nJ P4s 'e D–j 4f2 ogrotic4 Lerf�' you c tome corners Ragged: �r�e_ G,o�s� �.•lI tic -iL� rurnc'. This is to certify that the Information provided is correct to the best of my knowledge. I understand that any permit(s) s issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the Information submitted in this application is falsifi;d or changed. I, also, understand thatl act responsible for all charges hicurred front this appltcadon. 1, hereby, give conscut to the Authorized Representative of file Davie County Health Department to enter upon above described property located in Davie County and o:vncd by kJ c -/C 4 Fr'r,07 0 to conduct all testing procedures as necessary to determine the site suitability. DATE 7107 �J / O . �r�'ATURE ZI C� THIS AREA MAYBE USED FORD I AWING.YOUR SITE PLAN (Include 211 of Ile following: Existing and proposed property tines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Datc(s): Client Notification Date: IEHS: Signgiven Account No. -33-7-11 Revised DCHD (05/03 Invoice No. ?� 30.000 Acres l {f PROPOSED EASEMENT C/L BEARING & DISTANCE TABLE I1 4 UNE SEARING DISTANCE 1 L1 v ]6' 1702" E 84.61 i L_ 5 0I'!4'3e C 291.53 L3 S 01'14'13" E 295.43 1 0 5 0842'23' w Ta 1.43 • � 1 IS �I �rG r✓ S � 1' 29.21.4 .scree".r AA o P t ' rrpa rSb Ihw ,� Cn. w C•SC••d► RICKY A. FRAMMN D.B. 188 PG Sia tel+ . r NIR !! M• L� �� tOt1LL q�arp IIIc n �r.+r •� AREA = 10.000 AMS c Y 1"tif NW SW SE)ati.1 Data EM:plorer ® � Norih Carolina Click on the Map to: Zoomin Zoomout Recenter Map Identify: Parcels Zoom Factor: 2X'7.1 Radius Search (feet) 0 NE ' � t ! s i 9185462 1, t...... g E> n'f'J I r SE Parcel Data Find Adjoining Parcels • County ID: F10000001214 • Account Number.82518599 • PIN:4891854623 • Legal 1:29.646AC OFF SHEFFIELD RD • Owner Name: FRANKLIN RICKY ALAN • OwneNAddress 1: FRANKLIN RICKY ALAN • Owner/Address 2: • OwneNAddress 3: 288 GETTAWAY • City,State Zip: MOCKSVILLE ,NC 27028 - 0000 • Land Value: $85,300.00 • Building Value: $151,630.00 • Land Unit/ Type: F10000001214 VAC • Deed Book/Page: 00465 / 0840 • Deed Date: 2003/02/18 • Sales Price: $78,000.00 • Property Address: 000288 000288 WY • County Zoning: R -A • Census Code: • City Code: • Fire District: SHEFFIELD - CALAHALN • Flood Zone: ZONE X • Flood Community: 370308 • Flood Panel: 0025 C • Flood Map Date: 12-17-1993 Map U Draw L Draw select Boundary Census Tra City Bound County Zor Multi Syl E911 Fire D [] Flood Pane [] Flood Zone Q Parcels School Disc Multi Syl �] Soils [� Town Zonh [] Townships Multi .$yl E] Voting Prec Infrastructu [] Driveways [] Rail Lines Street Cent Q US/NC Higl Multi Syl L h F1 Aerial Phot 3hysical [] Creeks and E911 Addrt 0 Fire Depart Schools Draw L MAP Ci This map Is preps inventory of real I within this jurisdic compiled from reJ plats, and other F and data. Users c hereby notified th http://66.208.132.2541servleticom.esri.esrimap.Esrimap?name=Davie&Cmd=sParcel2&PI... 9/20/2004 APPLICANT INFORMATION Account #: 990003374 Billed To: Roger Holt Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 4891-85-4623 A Subdivision Info: Location/Address: Getta Way Lane -27028 Property Size: 29.2 acres Date Evaluated: I (--) I Water Supply: On -Site Well ✓ Community Public Evaluation By: Auger Boring LZ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L. Slope % L+7p HORIZON I DEPTH p - �- 1'Z. Texture groupt. -tf- 5 C_t r_ Consistence S .l S Structure L Mineralogyhe HORIZON II DEPTH 4- /0- ;W p- 17, Texture group Texture Consistence Structure r-, Mineralogy'1x HORIZON III DEPTH At Texture group(St G4 tiL Consistence (—r $ Structure Mineralogy < HORIZON IV DEPTH q0- Lit Texture group Consistence Structure MineralogytX SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION o. LONG-TERM ACCEPTANCE RATE CXI SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: ' L REMARKS: a#I �jtt✓ Z �i.�� 2�' ► fa I ' (-I-' EVALUATION BY:_'c(� OTHER(S) PRESENT: Landscape Position R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope CC - Concave slope CV - Convex slope T - Terrace 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 Mineralogy 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 05/99 (Revised) ■ ■ ■ ■ ■ A■/■■■■■■■■■■■■■■■■■ ■■■■■!MrJJ`.l�i■■■■■■■■■■■ SSSS■ iii■■■■■O■■O■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■M■■■■■Mlirz�■■■■t■■■■■tie■t■M■ MENNEN mommmu"MUMMENMENNEN MEN ■t■■■■■i■itOtt■■t■■t!■■r��:■Sri■■■■t■t■■■Ott■t■ ■■■■■■■■■M■■■■■■ ■■■■■■■■M■M■■■KW ■■■S■■E■■■■■■■IIW ■MMM■MM■MMMM■MLI■ ■ ■ in in ■■■■■■■ ■■■EM■■ SOMEONE MEMO NEW ■ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 / Fax: (336)751-8786 October 8, 2004 Roger Holt 140 Canterbury Drive Salisbury, NC 28144 Re: Site Evaluation - 29 Acre Tract/Getta Way Lane Tax PIN#: 4891-85-4623 Dear Client(s): As requested, a representative from this office visited the above site October 8, 2004 to perform a site evaluation. 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. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct, the appropriate application must be completed and submitted to this office. The location of the facility the system is to serve must be staked off. It should be noted that an existing well within the proposed house perimeter must be abandoned prior to construction. Information on properly abandoning a well can be obtained by contacting the North Carolina Division of Water Quality at 771-4600 or online at http://gw.ehnr.state.nc.us. If you have any questions, feel free to contact this office at 751-8760. Sincerely, Jeff G. Beaticlkinp, R.S. C Environmental Health Section Enc(s)