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2716 Hwy 601NyDAVIE COUNTY HEALTH DEPARTMENT %? r Environmental Health Section I P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003475 Billed To: Jimmy Gentle Reference Name: Proposed Facility Shop ATC Number: 4187 Tax PIN/EH #: 5820-37-0250 Subdivision Info: Location/Address: Highway 601 N-27028 Property Size: 3 acres As pted In 15A also .be used 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 building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage reatment and Disposal Systems). THIS AUTHORIZATION FOR WASTE W O ON V R A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatu Date: 'g -70a 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. -TAt - 'bb TIu 4 -23 Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 18 e,baPr-vV DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section :. P. O. Boz 848/210 Hospital Street v Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003475 Tax PIN/EH #: 5820-37-0250 Billed To: Jimmy Gentle Subdivision Info: Reference Name: Location/Address: Highway 601 N-27028 Proposed Facility Shop Property Size: 3 acres ATC Number: 4187 **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 #People #Bedrooms #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ M M'4tl-G Commercial Specification: Facility Type S►bp #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply eb-)"Ty Design Wastewater Flow (GPD) 14o Site: New 2y" Repair ❑ System Specifications: Tank SizeIWO GAL. Pump Tank GAL. Trench Width �� Rock Depth le ' Linear Ft. ISO As stated in 15A NCAC 18A.1969(5) Other: 1 D1�TQA &LM0, 3 �,o accepted Systems may also be use�dl Required Site Modifications/Conditions: lfS:�-- 11ALL 0-3 C.B ITOLX' V -1:.P 6' pFF gJlLdil�lb IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this s ste� m between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** 0 Z, Md" tr,115 s1-�P tKJ(o DCHD 05/99 (Revised) 4 mi L,�LXbOm3L.." r- 1 CTION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION I9 PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. 'Name to be Billed t /7l Iyl7 l �/ 'G.t /C Contact Person �/ /, Set Mailing Address J J-6 I �h t hA;u I. ✓�,,//�� r Home Phone �(� 1 6� �� city/ Vi /C /�((, Business Phone 3 -!-�c� J C1 2. Name on Permit/ATC if Different than Above L Mailing Address City/State/Zip znkJ izws k.k 3. Application For: �te Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: ❑ House ❑ Mobile Home E k'9'u-.s i n e s s ❑ Industry ❑ Other S. Type system requested: 121 Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People # Bedrooms # Bathrooms ❑Dishwasher ❑Garbage Disposal Mashing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /other: verify type # People # Sinks # Commodes C2 # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seat --s Estimated Water Usage (gallons per day) 8. Type of water supply: 0- Cea�ounty/City ❑ Well ❑,,Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes E No If yes, ,what type? ***IMPORTANT*** CLIENTS MUST CO/IIPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client witl: THIS APPLICATION. Property Dimensions: J ,4C , WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: lE —17 % " �� lid ` /� JLh e r7? A- r roperty amProperty Address: Road Name / 1'ar �h 1, ,4 -re h n 1-1 S 0-71 City/Zip , h If in a Subdivision provide information, as follows: Name: 4 l Section: Block: Lot: Date home corners flagged: 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 ain responsible for all charges hicu red frost this application. I, Hereby, give consent to the Authorized Representative of the Davie County IIcalt11 Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. _ DATE SIGNATURE TRIS 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). -Sign given Account No. , Revised DCIlD (05/03J0%d -1~ Invoice No. `� p SO o d J�- : + <, 1 .too (1260) gggZ L \ LggZ ZLgZ L6gZ J IP S 6)L'FALZ M M 0 -01g1' ` Lf o C/ I\j FACTORS 1 2 3 4 5 6 7. F � . DAVIE COUNTY HEALTH DEPARTMENT . Environmental Health Section Soil/Site Evaluation — APPLICANT INFORMATION to— .i PROPERTY INFORMATION Account #: 990003475. Tax PIN/EH #: 5820-37-0250 `Billed To: Jimmy Gentle Subdivision Info: Structure Reference Name: Location/Address: Highway 601 N-27028 Proposed Facility: Shop Property Size: 3.acres Date Evaluated: Water Supply: 12 - 2' -3q Public On -Site Well Community Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7. Landscape position LbV Slope % HORIZON I DEPTH — to— .i Texture groupC�— Consistence Structure Mineralogy HORIZON II DEPTH i 12 - 2' -3q 1 Texture groupG Consistence 5S 1` Structure S�lc c G13 c MineralogyS;- HORIZON III DEPTH -- ti Texture group C., VS4 0V -4 0 Consistence F :�- SP r5s S Structure Ask *A -SI514n MineralogyS HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE 99 CLASSIFICATION S LONG-TERM ACCEPTANCE RATE 0 3a SITE CLASSIFICATION: EVALUATION BY: (71r=' &40c,+Y`4 LONG-TERM ACCEPTANCE RATE: 3 OTHER(S) PRESENT: n REMARKS: ` Ar13 QNA(1-1 ZG Su -1- .. LEGEND h y 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 "A, 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 f 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 :p9}en!eA3 a}ea sejoe g :eziS A}aadad doyg :Al!!!oed pasodo,td Miner 1 �d4eMg61H :ss9app`d/u0!1e001 :eweN aouaaala�! Notes n :ojul uo!s!nlpgng al;uaO �(uaua!p' :ol pall!8 DeptNb 0 :# H3/Nld Xel 5LK00066 :# lun000y Depth o i In me es 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) MONO MEMO ■ ■ ■ ■■■H■■■■■■moi■■■■■MH■■■■ ■O■■MMM■EMM■■■■EM ■■MNO■■■MM■■■OM■■ ■E■■■■OE■■■■■■■■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■■■■M■M■■■ ■M■M■M■■M■■ ■M■■■■■MM■■ ■ ■ ■ ■ ♦ • r w • • r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 /Fax: (336)751-8786 February 2, 2005 Mr. Jimmy Gentle 186 Chinquapin Road Mocksville, NC 27028 Re: Site Evaluation - 3 Acre Tract/HWY 601N Tax PIN#: 5820-37-0250 Dear Mr. Gentle: As requested, a representative from this office visited the above site February 1, 2005 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. It should be noted that due to complex topography on the tract, space for the on- site wastewater system is limited. Additionally, a pump station may be required. System design 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 and submitted to this office. The location of the facility the system is to serve must be staked off. Additionally, please have the new tract surveyed and the property corners located prior to making this request.. If you have any questions, feel free to contact this office at 751-8760. Sincerely, Jeff G. Beauchamp, R.S. Environmental Health Section Enc(s) 0 I Parcel #: F30000008202 Page 1 of 1 AV77N Davie County, NC - Basic Estate Search oo U ti Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel #:F30000008202 Account #:29040000 129,57 01 Owner Information Tax Codes land• 7300 ENTL.E 3IMMY D& GENTLE MELINDA M ADVLTAX - COUNTY T sseS. 20257 186 CHINQUAPIN ROAD FIREADVLTAX -FIRE TAX MOCKSVILLE NC 27028 Property Information Township nd (Units/Type): 2.920 AC Fddress: CLARKSVILLE N US HWY 601 Deed Information Local Zonin Pate: 05/2005 Book: 00610 Page: 0145 Plat Book: Page: L.e al Description PIN 13.000 AC HWY 601 5820268907 PropertvValues uldin 129,57 01 BXF: land• 7300 Market: 20257 sseS. 20257 Deferred: Sales Information �No. Book Page Month Year Instrument Qual/UnQual Improved Price 1L 00610 0145 05 2005 WD Unqualified Vacant 30,000 View Property Record for this Parcel View Mao for this Parcel View- Tax Bill Information « Return to Basic Search All information on this site Is prepared for the inventory of real property found within Davie County. All data is compiled from recorded deeds, plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be consulted for verification of the information. All information contained herein was created for the Davie County's internal use. Davie County, Its employees and agents make no warranty as to the correctness or accuracy of the Information set forth on this site whether express or Implied, in fact or In law, including without limitation the implied warranties of merchantability and fitness for a particular use. If you have any questions about the data displayed on this website please contact the Davie County Tax Office at (336) 753-6120. 1.5.9 http://maps.daviecountync.gov/itsnet/View.aspx?prid=785477 8/16/2016