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127 Griffey Trail` AUTHORIZATION NO: i j 4 #1DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION Perntittee's P.O. Box 848 Name: Mocksville, NC 27028 Subdivision Name: Phone # 336-751-8760 Directions to property: ��-� l,). 't O Section: Lot: AUTHORIZATION FOR CWASTEWATER �I�'� �Si�� SYSTEM CONSTRUCTION Tax Office PIN:# C r j t i Road Nam`e7 l ` 11 �E `{ ! Zip: ri�"?cS **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applyi g for Building Permits. (In co m Tian ith le 11 f G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION !! IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRO MFr ALTH SPEC AL DAT ISSU D M f / DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION -Jerthittee s - _ Name: � t-�-� - \ i i\L tSubdivision Name: Directions to property: ��i` `. ` "t Section:_ IMPROVEMENT Lot: t. ! !' (: i eft PERMIT Tax Office PIN:# - - ,, Road Name **NOTE** This Improvement Permit DOES NOT authorize the construction or installation 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/install tion of a system or the issuance of a building permit. (In compliance7ith Article l l�f G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) '�4 ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIROIVMENTAL-HEALTH SPECIALIST' DAISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE ,.- INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE V\ H # BEDROOMS -3 # BATHS _ - # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE • 1 � ``'4 - S'PE WATER SUPPLY � '� �" DESIGN WASTEWATER FLOW (GPD) si40 NEW SITE REPAIR SITE .+ �i it SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH --�UROCK DEPTH 1 2 LINEAR FT. �Y OTHER 1 �L9IMOTLOA t-AkS (TO.0• k1 --1J REQUIRED SITE MODIFICATIONS/CONDITIONS: I P, Jl tku- 0-1 co ,J Too ,-ud '75' !`",rc &YACIt 16X- -r 101 torr 02a a IMPROVEMENT PERMIT LAYOUT *APPR VEMA ILTER* *RISER(S) IF 6" EEL -011 FINISHED GRRD-=* LV,1STI+j (:Z, Ex i s r,►�v I ta' 0 Cd 160 r. O` **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON T AY OF INSTALLATION. TELEPHONE # IS (336)751-3760 OPERATION PERMIT 00 �� SYSTEM I TA ED BY:ee T - AUTHORIZATION NO. YMOPERATION PERMIT BY: ` DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. DCHD 05/96 (Revised) 1 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS ,,: ,0rt#tttree s { - , PROPERTY INFORMATION Name: t •_ ,- * ! '' "a L ., s' Subdivision Name: Directions to property: ts k "' ` 3 ° Section: Lot: IMPROVEMENT PERMIT Tax Office PIN:# - - Road Name: E_ t, Zip: **NOTE** This Improvement Permit DOES NOT authorize the construction or installation 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 11f'of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) . / ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE s r INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE M { # BEDROOMS # BATHS 7- # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE ` r \' a TYPE WATER SUPPLY {' DESIGN WASTEWATER FLOW (GPD) •. % t-' NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH" OCK DEPTH = LINEAR FT I ELT 10A } is - � �•1` nl'!. l t x • Ci • f t t.h r„1 , OTHER 1) 1: ) i' REQUIRED SITE MODIFICATIONS/CONDITIONS: 11� ()-3 t_.. t' p�+r� _ V ) •Y( ?-`'��T tt-t-3 f V! l_' f 4 t IMPROVEMENT PERMIT LAYOUT-X-P}PPRrUEt� rITUi,'�T7ILTE[7* vRIC-01(5) IF 644 BEL00 1 INISIiED 00101".* tz IM • ' ♦7 .. 7. a � "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTkgN . � r IS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON TftSDAY OF INSTALLATION. TELEPHONE # IS�7 OPERATION PERMIT /� J SYSTEM I STA ED BY: s AUTHORIZATION NO. </ OPERATION PERMIT BY: `/ / / / DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE •,;,AKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) REPLACEMENT ❑ REMODELING ❑ RECONNECTION ❑ Name: L'A� RE`cs �' Phone Number: b-7 1.9i ?J,�r `f (Home) Mailing Address: tD3� '33,'o -7 q R77C) (Work) �) L _ Detailed Directions To Site: Hvoy ; SSS C"'3 Property Address: C—_,a_A Please Fill In The Following Information About The Existing Dwelling: Name System Installed Under: '� i'��'J V DSSKS Type Of Dwelling. �� OSS Date System Installed(Month/Day/Year): 73 Number Of Bedrooms: �Z- Number Of People: Is The Dwelling Currently Vacant? Yes 9'lNo ❑ If Yes, For How Long? 2 Y�,_-AQF- Any Known Problems? Yes ❑ No e"' If Yes, Explain: Please Fill In The Following Information About The New Dwelling: Type Of Dwelling: 0 fv�-E Number Of Bedrooms: Number Of People: Requested By: Date Requested: t -7 D1 (Signature) For Environmental Health Office Use Only Approved ❑ Disapproved ❑ Comments: Environmental Health Specialist Date *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee(extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash ❑ Check ❑ Money Order ❑ # Amount: $ Date: Paid By: Received By: Account #: Invoice #: !` T DAYlE COUL�TY HEALTH_DEPARTMENT Environmental eat 'Section PO Box $48/210 Hospital 9' eet - Mocksville, NC 27028 _ Phone: (336)751-8760 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING ` (Check One) REPLACEMENT ❑ REMODELING ❑ RECONNECTION ❑ }�t Name: �� - � '`A '" � � t �= Phone Number: -� ' (F < -�� L;' Z 77 (Home) Mailing Address: �/� �S ^551 r 6-7 4 6'7 ND (Work) Detailed Directions To Site: i-1�'�!� { (1 0�•3�f`r �Q Property Address:�'� Please Fill In The Following In ormation About The Existing Dwelling: Name System Installed Under: ,�-1 � - —V� +� �-�'� t - I Tie , f Dwel%iFA1-2 Date System Installed(Month/Day/Year): `ql2- - 7-7 ' Number Of Bedrooms:_-/ Num'ber Of People: s The Dwelling Currently Vacant? Yes R""No ❑ If Yes, For How Long? Any Kno Problems? Yes ❑ No L" If Yes, Explain: Vit( Please Fil Inge Following Information About The New Dwelling: Type Of Dw lli�'� V1 i� U 1r1^� F Number Of Bedrooms: Number Of People: Q� Requested B G� n Date Requested: ? { O� rl ' (Signature) =— �� o� For Environme 1 Health ffice'e-OnTy� Ap �rwe ❑ Disapproved El .� -..' ( 2 - Env%iiiital Health Specialist nate "'We, signing of this form by the Environmental Health Staff is iAo, N\ay intended, nor should be taken as a Quarantee(extended or limited) that the on-site wastewater system'WiU function properly for any given period of time. Payment: Cash ❑ Check ❑ Money Order ❑ # -----ZAmount: $ Paid By: Receidt Account #: Invoice', #: 0 Yzz to �y JIS( t r1 )I3 Davie County, North Carolina Spatial Data Explorer o P /fi S` D p�A. Nortf, Carolina Click on the Map to: d Zoomin 0 ZoomOut G Recenter Map 0 Identify: Parcels Zoom Factor: 5X C Radius Search (feet) F7_ SW 4. Parcel Data Find Adjoining Parcels • Parcel ID. F600000073 • Account Number.000069692000 • PIN:5850471777 • Legal 1:1.13AC HWY 158 • Owner Name: SPEAKS VIVIAN VOSS ESTATE • Owner/Address 1: SPEAKS VIVIAN VOSS ESTATE • Owner/Address 2: C/O JAMES E SPEAKS • Owner/Address 3: 2030 US HWY 158 • City,State Zip: MOCKSVILLE ,NC 27028 - 0000 • Assessed Acres: 1.04 • Deed Book/Page: • Deed Date: 00/00/00 • Sales Price: $0.00 • Property Address: 127 GRIFFEY TR • County Zoning: R-20 • Census Code: • City Code: • Fire District: SMITH GROVE • Flood Zone: ZONE X • Flood Community.' 370308 Pagel of 3 NE El SE Map Draw sed 3oundary ❑ Census l City Bour ❑ County Z Multi I. ❑ E911 Fire ❑ Flood Pai ❑ Flood Zoi Parcels ❑ School D Multi ❑ soils ❑ Town Zoi ❑ Townshil IN; Ulti ❑ Voting Pr nfrastruc- ❑ Driveway ❑ Rail Line: ❑ Street Ce 0 US/NC Hi MUlti_ Aerial Ph - Physical 177 Creeks ai ❑ E911 Adc ❑ Fire Depe Schools I MAP I ./esrimap.dll?Name=Davie_sdx&Cmd=Clk&Left=1553548.03125&Right=1554822.09375&Bo 12/27/01 Davie CountOlealth Department Environmental Wealth Section PO Box 848 / 210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 January 14, 2002 Mrs. Renee Speaks Staley PO Box 16343 Greensboro, NC 27416 Re: Bacterial Water Sample - 127 Griffey Trail Dear Mrs. Staley: As requested, a water sample was collected by a representative from this office on January 7, 2002. The bacterial sample that was collected shows no presence of coliform bacteria. Based on these results, this water is considered safe to drink. However, this should not be considered a complete analysis of the water system. It should be noted that the well is not properly protected; that is, it has no concrete slab at the ground surface. Protecting the well according to the enclosed sheet is recommended to prevent surface contamination of the well. enc(s) If we can be of further assistance, feel free to give us a call at 751-8760. SiZ.eauchamp, JeR.S. Environmental Health Specialist A E, f l� 11 I w f � m V Si V t]vm � ]�y G aY - x H e € >xE g g € y OL W N z 40 40 VEL=F ♦ 1 b ! E_♦ \ 6p S z ♦-S? k + 1 zz 41 A �, ♦ � � .A -� VEi �A 9� S q ¢w A A 40 to ! to 9 .1 AA HAI�Tl�1 � I 1 I ♦ 1 1 V- ► � 1 1 �►. r,'♦ A 3 twit � g 7 1 1 APPLICANT INFORMATION Account #: 990002897 Billed To: Terry Bias Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation Property Size PROPERTY INFORMATION Tax PIN/EH #: 5850-47-1777 Subdivision Info: Location/Address: 127 Griffey Trail -27028 1.13 acres Date Evaluated: Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: OTHER(S) PRESENT: LEGEND 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) z 3 3661 32 A 9' N307 0388 \ 3 926w8 \\ 3 2 i `�� \ 8169 5895 , ;ah , ,&4%3A) 7 I n ut1) O' t l