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2722 Hwy 601SAccount #: 990001259 Billed To: Trinity Church Reference Name: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5745-69-2761 A Subdivision Info: Location/Address: 2722 601 S.-27028 Proposed Facility Building Property Size: 260 x 270 ATC Number: 3907 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 Fonm/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 WASTEWATER CONSTRUCTION//IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: /�l�/ Date: A0 &11A� 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.. e 1 /O .�f Ato h oM/ �y1� 3j?yk jer, V, qc gs LX �v 13 ulo b . TO Septic System Installed By: V - Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) 'S DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001259 Tax PIN/EH #: 5745-69-2761 A Billed To: Trinity Church Subdivision Info: Reference Name: Location/Address: 2722 601 S.-27028 Proposed Facility Building Property Size: 260 x 270 ATC Number: 3907 **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: ❑ Commercial Specification: Facility Type' �J k /C/t #People j�:h #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow (GPD) Site: New PTRepair ❑ System Specifications: Tank SizeA25—&4GAL. Pump Tank GAL. Trench Width'Rock Depth 'Linear Ft.� / Other: A /Z Ay //AlUG Required Site Modifications/Conditions: 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 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 installation Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: / Date: DCHD 05/99 (Revised) ' Oct 14 04 03:14p dbC 1 • Oct 1%04 01:50p cfavie county envhealth 919-661-1523 �� p•2 338 751 e06 r. .2. (1 6D APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Deptidmht EnAhaamental i/ealth Sea ky7 P.O. Box 348/210 Hospital Strwat ltoaksvillo, NC 27C28 (336)751^8760 **aXKPQFTANI'ai• T=S ASDZICATION all=07 AW PROCE=SISD MMESS AU RM17YRCD MWORnTION IS PROVIDE.!:. Refer to the INFOAIWION 33VUETIV for inatructioan.Ti� - t- e�l. Name to b• Gilled-�(}_©ii� l {1 U �! h Goneact Iuawa� ✓� Mfaiiirg AAdreasAall _ _ 1-1 xome Plan mat./sea:•/zxr�1)� ��P , auaioaaa am.. t -•R. !Yana oa paean/ArC if aiffar,mt thaw abcv. .-.-Mailing sddraae city/itate/Up Appliaetion For: 0 Sita 3valuativa 4 Improvezeat Varatit/ATC U/Both U1• ayatew to SwtviteS O House LI ttobil• Home C] suaineaa ❑ Itftstry WAthepr� 7►/ L..�-S. Type syata. r veaced: i/Coarontional n corvoAtional awditiad ElLneevati" J��L(/` 41 x,16. IftfRasidenca: 0 Paoplc _ a Sadrooms a Bathrooms —i 1Daanwaahar Dcarbage %upcsa! Owaahiry Nacai.ae �saoeaMai/elwming ❑saaemaat/No Fl—bl-9 7. If sadness/Indestry /Other: vsray type R peopla a Zink* e Commae3 -4-% ---' w tJawrn a Vrinals '0.2— a water cowers U FOODS&RVIC@a It Sante txtimated Water Usage (gal/oas per d..yl�610d e. Type of water supply: Q/.:ounty/City 13 Well ❑ Cc==Lty 1. Do you anticipate addttio,.a or expansicmatthefacility tltlssystcmlibStended toserve? 0Yrs Q(No irSyx, witat type? ••`IMP TAIPT'a• CLSENTI sff/STC ZLTBTI(C "12a IW PROPERLY INFORMAT10-1 REQLUTED OW. .Ilher a PLAT ur u1TF: PLAN Sf T dBSIldH177ED by thccliect with THIS APPLICATION. C�—~Property Dirneolurls.. RITC DIRECTIONS (from 17ocksrilic) to PROPCRTY: nr Oftco PINS M �J/t� ON( //'Property Andres:: Road Nitnit G11 cJq Cityfb(p le ►�.Z�C..�7y 14 If in a 3ubdhiston provide inlaraaation, as follows: Name: Section: Brack: . Lot: _ L. -00a host corners flagged: This is to ccrtily that the information pr ruined is correct to the best of my lnaowledge. f mtdtntand that any perSwit(r•) issued hcrtafter are subject to suspensloa or revocation4 if floe site plats or h tcudcd use ebangc, or if flat iufonnatlon subuaittcd in this application is lalsitfed or ebzngatl. 1, chs undcrrtaied s/tarld:uS resppasibfejo►all eHargesiacurredjrnvr dik arplitnriora. 1, hereby, give roaseat to the Aatharizcd Ropresta tativo of flu Daric County Hcalth D%annicut ro tater upon above described property located in Davit County and owned by to cuuduci ail�^Usting proceduresas necesary le determaine the site sui it / -,- i . DATE �V I i � C_ — C�yP'NATUiti f THIS AREA MAY�BE USSF.D FOR DRAW= YOUR SITE PLAN,(Indudc sli of Ike following: Existing and proposed properly lines and dinacntionr, structure;, setbacks, ant! septic location). I !Set Revisit Charge �o 19 Sign gi-.iu ! • y Rek-hed DC11D (05403 Client NotiIIcatiou Date., J x t Account No. / -D-5 7 Invoice No. /V -I e • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAMES G PROPOSED FACILITY SUBDIVISION DATE EVALUATED PROPERTY SIZE �,� ROAD NAME �Q�•S' Water Supply: On -Site Well Community • Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % 2. HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH moi' , 77 f Texture group C__ 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: U =, EVALUATION BY: Oke 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 - 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 Mois 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 SF - 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 (O1-90) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ iMENNEN MENNEN�CMEMNON :CG:::i�:::C:: ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■iii■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Parcel #: M5060B0002 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search Vigw Property Record for, this Parcel View Map for this Parcel View Tax Bill Information Parcel #: M5060B0002 Account #: 73806000 Owner Information Tax Codes NITY BAPTIST CHURCH ADVLTAX - COUNTY T EMo722 US HIGHWAY 601 SOUTH FIREADVLTAX - FIRE TAX CKSVILLE NC 27028 Property Information Township Land (Units/Type): 5.310 AC JERUSALEM ddress: 2722 S US HWY 601 Land: Deed Information Local Zoning Date: 05/2002 Book: 00423 Page: 0096 ssessed• Plat Book: age: Deterred: Le al Description PIN 5.353 AC HWY 601 5745692761 Pope Values uildin 2,445,38 BXF• 9,03 01 Land: 4982 Market: 2 504 23 ssessed• 2,50423 Deterred: Sales Information No. Book Paye Month Year Instrument Quai/UnQual Improved Price 1 00423 0096 05 2002 WD Unqualified Improved 20,000 View Property Record for this Parcel View Map for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oP�r� Davie County Web Site 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/itsnetfView.aspx?prid=1469126 7/29/2016 t DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • P. O. Boa 848/210 Hospital Street % Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990000963 Tax PIN/EH M 5745-69-2761 Billed To: Landmark Builders Subdivision Info: Reference Name: Michael Johnson - Location/Address: Hwy. 601 S.-27028 Proposed Facility: Church Property Size: 4.36 Acres ATC Number: 2308 **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 CL /(' #People #Bedrooms #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type / �C #People � #People/Shift #Seats _� Industrial Waste: ❑ Lot Size Type Water SupplyDesign Wastewater Flow (GPD)- Site: New Repair ❑ System Specifications: Tank Size/_2GAL. Pump Tank GAL. Trench Width Rock Depth ° `Linear Ft.� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAY FINISHED GRADE. ****NOTICE: Contact a r system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. d t Vi,(r 4f, wil� /�l! `�N � d rale �ie d;,ljr�c a C b� NT FILTER. RISER(S) IF 6 K BELOW ty Health Department for final inspection of this lation. Telephone # is (336)751-8760**** '-/ IR // J-/" 1A , 0,0, 9 / '/ AWQf kr5- Environmental Environmental Health Specialist's Signature: �Zve Date: DCHD 05/99 (Revised) • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990000963 Tax PIN/EH #: 5745-69-2761 Billed To: Landmark Builders Reference Name: Michael Johnson Proposed Facility: Church ATC Number: 2308 Subdivision Info: Location/Address: Hwy. 601 S.-27028 Property Size: 4.36 Acres 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 Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALIDR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: �� Date: 3- 06 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. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) y Date: ?�2a -eo '-`t^"."''.' i �waC' r: Za ,.�f k, .3. ..-.:c-a+, i .�i••:4 ,R as�a zt5't ,:5.. -. �.. }:.,^ -';�' t+, .',.c `, i _ ,..yam,....,. _._ <r: .-. _. .. -, «. .� w .a=..,.. .. - �' YX o 0 ~' DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT PERMIT **MOTE** 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 11 of B.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment,and Disposal Systems) _a7aa \ f (�RRDPERTY ADDRESS D. I I�L U� �. �� wy G, (X oy ("� DATE LOCATION S o SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS / # OCCUPANTS GARBAGE DI : Yes/ o C A t "� �• �Y 1. �; �r COMMERCIALSPECIFICATION.'"FACILITY TYPEQ22�,& � # PEOPLE # PEOPLE/SHIFT S# SE4TS JNDUSTRIAL WASTE: Yes'No LOT SIZE TYPE WATER: -SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE 0,Q SYSTEM SPECIFICATIONS: TANK SIZE ;GAL"; PUMP TANK GAL. TRENCH WIDTH ROCK;DEPTH ,�.� LINEAR FT.`� _ OTHER , REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS,PERMIT IS SUBJECT %TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. ` w ^Z ~1 i OF THE. 'DOOV •1:30 P.M. IMPROVE BY I JTY-HEALTH DEPARTAENTFOR FINAL INSPECTION OF THIS SYSTEM BETWEEN DAY OF INSTALLATION."'TELEPHONE'#'IS (704)-634-8760. SYSTEM INSTALLED BY, u ° ` W 1J AUTHORIZATION NO. L OPERATION 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 BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DOHD 10/95 **CONTACT A SEN' 8: X-9! . M. OR OPERATION PERMIT ^Z ~1 i OF THE. 'DOOV •1:30 P.M. IMPROVE BY I JTY-HEALTH DEPARTAENTFOR FINAL INSPECTION OF THIS SYSTEM BETWEEN DAY OF INSTALLATION."'TELEPHONE'#'IS (704)-634-8760. SYSTEM INSTALLED BY, u ° ` W 1J AUTHORIZATION NO. L OPERATION 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 BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DOHD 10/95 DAVIE COU1NTY HEALTH DEPARTMENT IMPROVEMENT PERMIT and OPERATION PERMIT ?bdn0n11Cbinff WOUTT **NDTE** 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 It of G.S. Chapter 136A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) :0 �L U, Cl. f-1 4,ROPERTY ADDRESS uj� DATE LOCATION SUBDIVISION NAME LOT NUMBER SEC./BLOCK NUMBER Rf RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes/ o COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS IINDUSTRIAL WASTE: Yes No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GkPUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJEC-�TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. k o IMPROVE LBY 'Y HEALTH DEPARTMENT FOR FINAL INSPECTION OF -THIS SYSTEM BETWEEN ',OF INSTALLATION. ``TELEPHONE # IS (704) 634-8760. SYSTEM INSTALLED BY 7 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 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. A DCHD:40/9-5-.- I f **CONTACT SENTI 8 :30-9 APPR MM. . OR I OPERATION PERMIT k o IMPROVE LBY 'Y HEALTH DEPARTMENT FOR FINAL INSPECTION OF -THIS SYSTEM BETWEEN ',OF INSTALLATION. ``TELEPHONE # IS (704) 634-8760. SYSTEM INSTALLED BY 7 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 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. A DCHD:40/9-5-.- I f `.N... -n i e V Davie County Health Department .;~ ENVIRONMENTAL HEALTH SECTION _ ZJ P.O. Box 665 Mocksville, N.C. 27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issued in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems) ***This Authorization For Wastewater System Construction oust 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 Countj,Building Inspections Office when applying for Building Permits..*** NATE' � 1� 0 0 c DATE NAUTHDRIZAT0 2 FL1R'.9 7pvo NAME ON IMPROVEMENT PERMIT (If different than above) t SITE LOCATION COMMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT,WA5TEWATER SYSTEM *"NOTICE*** THIS AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION IS VALID FOR A PERIOD,OF FIVE',(5) YEARS. ' ENVIRONMENTAL HEATH SPECIALIST DATE ACHD 10/95 'f 1_ .e .. .i+ . - ... �t:.-' _ ,r.v . .r 5r ._ �-. }.. 4 .i .Y•..,.. i .. , ..-.�.b.J ;,.^: i. _ _a ::�s.<V..-. .i..�w. f v • DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAM PHONE NUMBER ADDRESS Z 2 U 'S �� w &,61 S 6- L SUBDIVISION NAME "M 0 c\<r u �� `'� �. k'I 0' - LOT #, DIRECTIONS TO SITE Lo S " �- -73�� Q�S 15 DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED�'�`" TYPE WATER SUPPLY---LQ-SPECIFY PROBLEM OCCURRING�rc. DATE REQUESTED y 'cl INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge, and SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1/93 r Incurred from this application. V .-IFSS lf_?J', M n n 4 13.- 52'0�t 20 G lut cr_g n ti ., rr- ;h.' l^e- - puce - Ir x co P1915 N�,'i915`�� ' �� II rriiC) 37.13 a /it 40 q I l a h 1 N ,�--• 1�W(� ,�e.tF.sst"�kf ® -�- b.7$ _ 'f' Y' II ��• W ;t ® 3 Nt '-- �t - i •tJ Z z f_ -i rl •� ' „w+•tsj°s;S'•'S v ® - _- I il�tdgl3S cIQ�I(1g i _ 9 – x ri I D _ •°� mob• 1,;q� � ' ' i` g� • ,0 � t Zrr- 1 • INC G-41 AS E— • ��b •20• m C7 PV 1577 m 1 ° XIST �A l M. F F E N $6SAN� TVA \� a 0 617780 RY -o r- o o m CD cxsrcv _ �►1j1 ALi6y� m N w' t _ ' + R* •aU. 'r pO BRJ E W D5. v C p i! T F_ .`&;-".m- S \ "k.00—is- i"'""+r+fu'�.7trNa'a"'^'€��+"� 7G' 1 ti4.,u4� ,ee•��. `- O ((�ijl t� � Ty v ,3 , r� It m rn µ 0 It i Lin ,� I �� • \ � _ n � �a � � �. z 16Aj LI D5 �k� X fi rn \ 1 100.38% NE '4L p y -- w ------ -- tJ'�t TAP ft+.wa.lF w I i z o _• J 7�u [ J~� _g • ° • • °: X^it.,,.yyr i!.em t€eMc-:Fars .€eaaa rF AMa- i r� �t �•• • i \ r -RC r: apRp Et>R�ii RNs .Z1 8 J t a OQ I I OHO HH �� r' C3 rn _n Al � 4 ev ° Z _ D I kzi 0 rn ° b°rn g Z adz rn C 1 Ur Z� Nm rn rr rN rno UN �O mm z� AO m I° co Q o °� r 14 ri j A/ WOE y J. Io° o*oc• ° PROPOSED ADDITIONAL SEPTIC FIELD ELD PI -O , 51ZE REQUI v.� ' I. , .� C R:Eh1ENT5 Si8.lEGT TO APPROVAL) AREA: 18,481 S.F. Ioou IlI 2 -i ° ` '° z • i .I a _ ( °a,�Rki wss 3t arra€k€.wS;€SYE itlaa%7t+�•Sl saes se wRR fFe-a!€�wsv aa+Rfe:titt raeSe 713tT+�St axwSfflua{ g [S § A z D rti; 1 1 r o 9 m l € N01 --- ----------- ----------L----------1---- ----�—--`— 1 i Its - To0r9E 1 61• ISI �pjj to–)q. i 00't�l 6 I t --------- N it I i I I I I t I i j / / IQlt(1S IS .SI ��yg13S 9N� saw ` I I IF..aR ii � Ei eseR i € ysu; ' ...sty'€k�'c• � / / - iL____- EX. 24' R.C.P - VER/Pr LOC I ( I I 1 ( I ( I ( I I � i ( I / 1 � 1/ Ir II u u Y a7 r cn 0 0 _1 m <C-)>�7r S�> DrTI mcn�T r m LAYOUT ANCP fD M z S r I� UT I l.. l 1 T PL -AN D 0 O �� C f Q 1999 LANDMARK BUILDERS 13 1!'E TRIAD, INC. -� This dhadng Is the property oIF LwKbark Binders of the Triad Inc, and Is not to be reproduced or copied In whole or In part. It Is not to be used on any other project, and Is to be returned upon request. PROPOSED BUILDING AND SITE IMPROVEMENTS FIIR: TRINITY BAPTIST CHURCH CONTACT PERSON{ PAS -OR DARRELL COX (336) 284-2420 2722 U.S. HWY, 601- SOUTH, MOCKSVILLE JERUSALEM TOWNSHIP, DAVIE COUNTY, NORTH CAROLINA OC7�NOz -1>k O` �� !J� w�� _n J F -I 0 imrC1�rOm600 z3J�o� 3 wprn-i� �1 -1�7D rn�rnl�I uCi Irnm(Pr-O . XX Nm �n70�- �70 r�i -i ns >z>m �z03rn>prnOOc N NNAO rnAz�c rnAzl(itClrnzrnt�t r�r� rn-> �r z r �0 �, � 7� �N>_10 >z- ou 4rn�°�� 0� C_ rn �>>Dz�c�n Q0� I �` 3 rn�� u C_ g _A _ g rnpZNO�z3m rn �Op�>AA j=azDc>p,��7D�O ' QZQ2� n1 1C1Z 70 mI 3D A ➢-iAMMO N rrn 0 �TAz>nDrnc �rnirnzrn»?D O O r z� -A-pp.. �3c�rnnArn Z>7>OC7Wm>2 °z Ns 0 t N*A-ZIIz�UNiN3�NJl z�►-i�tt-4>Q�N c >3 (DAD r�ApDO U>01: xm>> _(3zCm o �r-7�Or ��- ZU Wo�N<rn� -+ (ten- n➢ A �C I�i Um w DO�z�Or D� N > NOA-n1 ° < m C m Oz 103ri A n z z > ° rn O °z D > N O rn N rn O z UN 0 m � X lN z Cl z _ J rl IIrn I I I II ( I (I ,v1pr ZJ rn0 Z x lu rn o i II I I U 3 O -i £ N N j N m j j n N N '-• m Z 0 m N r'T r,•I r Z O 3 D 3 3 D O Z £ Z M= S m D 3 A m D 0 0 Z m zO 0Z D 40 N O z m X D O r 70 (/� D p D D ,rte r --1 -4 r t7 � td m z N £ -< � -< -< 7K < � o _U a n 70 < z r m m td 0 m vl �l 70 rD n i z C) n z m < -Di a o d z o z � C z m cl � m 70 m m z (4 "" n z z D -t m n ;O :O .-€ 3 O bd M �1 N 'Tl C7 m m C7 i.l ITl D [I .. r z Z m m Z O O fI N m £ m Z m ZO Z bC €r -t n -4 z M Cl D z " A n M 0 O M Z r D r m Z D 3 m bd m Z C) n T A 1► TT -%1 A- A T% T7 tJni v IJIVIIA- « 3520 TRIAD COURT WINSTON-SALEM, N.C. 27107 910-784-2000 MA ao t 1 {t 1 s,,,,,' CAR TEPHENS .�,..•.., o - SSOCIATES, ; O ..V rE,�•a s PUC _ �: S E II = 3520 Mad Court WlnsWn,ftiftm NC 27107 ' hon .• Far (810) 78f1-2014 ��, IZ q� 71 rl °� r 14 ri j A/ WOE y J. Io° o*oc• ° PROPOSED ADDITIONAL SEPTIC FIELD ELD PI -O , 51ZE REQUI v.� ' I. , .� C R:Eh1ENT5 Si8.lEGT TO APPROVAL) AREA: 18,481 S.F. Ioou IlI 2 -i ° ` '° z • i .I a _ ( °a,�Rki wss 3t arra€k€.wS;€SYE itlaa%7t+�•Sl saes se wRR fFe-a!€�wsv aa+Rfe:titt raeSe 713tT+�St axwSfflua{ g [S § A z D rti; 1 1 r o 9 m l € N01 --- ----------- ----------L----------1---- ----�—--`— 1 i Its - To0r9E 1 61• ISI �pjj to–)q. i 00't�l 6 I t --------- N it I i I I I I t I i j / / IQlt(1S IS .SI ��yg13S 9N� saw ` I I IF..aR ii � Ei eseR i € ysu; ' ...sty'€k�'c• � / / - iL____- EX. 24' R.C.P - VER/Pr LOC I ( I I 1 ( I ( I ( I I � i ( I / 1 � 1/ Ir II u u Y a7 r cn 0 0 _1 m <C-)>�7r S�> DrTI mcn�T r m LAYOUT ANCP fD M z S r I� UT I l.. l 1 T PL -AN D 0 O �� C f Q 1999 LANDMARK BUILDERS 13 1!'E TRIAD, INC. -� This dhadng Is the property oIF LwKbark Binders of the Triad Inc, and Is not to be reproduced or copied In whole or In part. It Is not to be used on any other project, and Is to be returned upon request. PROPOSED BUILDING AND SITE IMPROVEMENTS FIIR: TRINITY BAPTIST CHURCH CONTACT PERSON{ PAS -OR DARRELL COX (336) 284-2420 2722 U.S. HWY, 601- SOUTH, MOCKSVILLE JERUSALEM TOWNSHIP, DAVIE COUNTY, NORTH CAROLINA OC7�NOz -1>k O` �� !J� w�� _n J F -I 0 imrC1�rOm600 z3J�o� 3 wprn-i� �1 -1�7D rn�rnl�I uCi Irnm(Pr-O . XX Nm �n70�- �70 r�i -i ns >z>m �z03rn>prnOOc N NNAO rnAz�c rnAzl(itClrnzrnt�t r�r� rn-> �r z r �0 �, � 7� �N>_10 >z- ou 4rn�°�� 0� C_ rn �>>Dz�c�n Q0� I �` 3 rn�� u C_ g _A _ g rnpZNO�z3m rn �Op�>AA j=azDc>p,��7D�O ' QZQ2� n1 1C1Z 70 mI 3D A ➢-iAMMO N rrn 0 �TAz>nDrnc �rnirnzrn»?D O O r z� -A-pp.. �3c�rnnArn Z>7>OC7Wm>2 °z Ns 0 t N*A-ZIIz�UNiN3�NJl z�►-i�tt-4>Q�N c >3 (DAD r�ApDO U>01: xm>> _(3zCm o �r-7�Or ��- ZU Wo�N<rn� -+ (ten- n➢ A �C I�i Um w DO�z�Or D� N > NOA-n1 ° < m C m Oz 103ri A n z z > ° rn O °z D > N O rn N rn O z UN 0 m � X lN z Cl z _ J rl IIrn I I I II ( I (I ,v1pr ZJ rn0 Z x lu rn o i II I I U 3 O -i £ N N j N m j j n N N '-• m Z 0 m N r'T r,•I r Z O 3 D 3 3 D O Z £ Z M= S m D 3 A m D 0 0 Z m zO 0Z D 40 N O z m X D O r 70 (/� D p D D ,rte r --1 -4 r t7 � td m z N £ -< � -< -< 7K < � o _U a n 70 < z r m m td 0 m vl �l 70 rD n i z C) n z m < -Di a o d z o z � C z m cl � m 70 m m z (4 "" n z z D -t m n ;O :O .-€ 3 O bd M �1 N 'Tl C7 m m C7 i.l ITl D [I .. r z Z m m Z O O fI N m £ m Z m ZO Z bC €r -t n -4 z M Cl D z " A n M 0 O M Z r D r m Z D 3 m bd m Z C) n T A 1► TT -%1 A- A T% T7 tJni v IJIVIIA- « 3520 TRIAD COURT WINSTON-SALEM, N.C. 27107 910-784-2000 MA ao t 1 {t 1 s,,,,,' CAR TEPHENS .�,..•.., o - SSOCIATES, ; O ..V rE,�•a s PUC _ �: S E II = 3520 Mad Court WlnsWn,ftiftm NC 27107 ' hon .• Far (810) 78f1-2014 ��, IZ q� APPUCATION FOR SITE EVAUTATION/IMPROVEMENT P Davie County Health Department D Environmental Healtfi Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 3C JAN 2 6 2000 * * * IotPORTANT* * * THIS APPLICATION CANNOT BE PROCESSED UNTO Gs nT T: - TIFF 'RVoUIRED j INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. i. Name to be Billed b9yvVM-oa Rulaw6 Mailing Address 3,520 7p,0 Cat4a;r City/State/ZIP IA)tAJ670AJ-5.-f1Q*-/Pl, Alr- 27107 2. Name on Permit/ATC if Different =%_:: Abc re �/%y► i_�h Mailing Address 3. Application For: ❑ Site Evaluation Contact Person ActfrfE'L =OtmjSON Home Phone Business Phone !L7 7' city/state/Zip ? Improvement Permit/ATC 4. system to service: ❑ House ❑ Mobile Home ❑ Business ❑ Industry & Other C11URC-/ 5. If Residence: # People # Bedrooms # Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type CfiU/ZGf/'/'LL lklTM49by # People 36 ( # Sinks 7 # Commodes # Showers �_ # Urinals Z # Water Coolers 3 IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) IM 7. Type of water supply: County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes KNo If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 113 6'tc Tax Office PIN: # Property Address: Road Name Z722 uS* /f wy 601 St1ttT{/ city/zip lWocksvILA& 27028 If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Date Property Flagged: I 2 0 0 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 from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by T iAirry RAP,71sT CuuACA4 to conduct all testing procedures as necessary to determine the site suitability. 1 DATE SIGNATURE THIS 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). s I TE P LTJ 15 A-rT✓} C N-6,0 Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. Invoice No. Vic►. P��U�v� , : �� • aAPPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT Davie County Health Department Environmental Health Section lea P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 4 ! ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed 7-iQ/A)ITy &4PT7S r (74UkC fi Mailing Address Z-7 ZZ LAS 2Jq L o 1 50 u Td City/State/Zip N6Ck6yi LLL, , n1C, 2, -7o ? -,R 2. Name on Permit/ATC if Different than Above Mailing Address ALL Contact Person /04ST0k fivresC_C_, L24 Home Phone Business Phone City/State/Zip 3. Application For: [yJ Site Evaluation [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: [ ] House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other CHyP-fi 5. If Residence: # People # Bedrooms # Bathrooms [ ] Dishwasher [ ] Garbage Disposal [ ] Washing Machine [ ] Basement/Pluinbing [ ] Basement/No Plumbing 6,00 -SEAr 6. If Business/Other: Specify type 0-1409k .A # Peopl^DM %Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: K County/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? D4 Yes [ ] No If yes, what type? dWRCH Cl?OIU-M "'EITHER A PLAT OR SITE PLAN-' PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** AXVffii:OF THE PROPERTY MUST BE CLANS w Ct{-- o �D. Pu�� SUBMITTED WITH APPLICATION. 4-59 Ps—�— e-2 ,Property Dimensions: 'i WRITE DIRECTIONS (from ocksville) TO PROPERTY: Tax Office PIN: #514�5 - 69 - Z7 1_ �i W Y D ( S O t .cT KGo 1 h"u C H Property Address: 1 Road Name 2.'1 ZZ US 14A b01 Sogj -17N-11Q S EC'ixo 0 O F Fk) y F, b 1 fhu 1� City/Zip MOM-KSU1 LI e -,NC Z?62R 11- 1iWY RID I — n,q Lk ePCq IIZ (ki L- ' If in Subdivision provide information, as follows: D r1 121 (-� H T Name: Section: Lot #: 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 from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by T,2 U P I TV -g,�l S_'r-. C14 U 2 eA to -conduct all testing procedures as necessary to determine the site suitability. DATE SIGNATURE Revised DCHD (06-96) n (THIS UREA MAY BEUSED TOR -DRAIVINQ YOUR 3ITE.-PLA:4 Scpe_ �ac.(oSed 01aw EY ISSUBJECT TO ANY FACTS THAT MAY BE DISCLOSED BY A FULL ATE TITLE SEARCH, NOT FURNISHED TO ME AS OF THIS DATE.. THIS PLAT IS SUBJECT TO ANY EASEMENTS, AGREEMENTS. OR IF WAY OF RECORD PRIOR TO THE DATE Of THIS PLAT. U.S. Highway 601 (south ) I>AR Q AR EL 2 T nity Bar D. B. 1 1 2345678910 12 1es For 'nit B tis Ch rch of avi 1 1 D.B. 6- 77 v `Poir t S 90 51 20 it Trinity: aptistsChurch w .50 49 f �, LEGEND R/W — Right—of-Way — Center Line EIP — Existing Iron Pips EIR — F sting Iron Rebar - —_Mori LineXment C PeCM PoC ncrote Monument ��pp�f Ole MH Hole IRS — Iron Rebar Set PA —.Property Line — Mbn R — Radlus C A — Controlled Access — Chord Distance P 0 — Part RCP — Reinforced Concrete Pipe — Sight Easement CMP _Com9c rs �p Fl :n 100eBoundory -o- Cd UUI?U —X— Fence _W S 39"35'00"E 2E 6.0 Ust' DO-�270rch I I. I I rn 0 14 IV n 18 20 22 1 5 to 19.' 21 23 6 7 5'0 "E 00' MAN10101116161111M LlXll-Ve61 'ON ASVA&AiUW 70111D/iM —� 83 316.46' ��—PREUMINARY POSITION S 48°47'05 E—� NCGS DAVIE AZ MK 2 �e vine N = 759,096.823 I E = 1,546,967.581 N10' X 2 7 5' DRAINAGE EASEMENT N 24 26 a0� . LOT NUMBERS SHOWN REFER TO PLAT OF HOLIDAY ACRES, SECTION 1 'a RECORDED IN PLAT BOOK 3, PAGE 108 2*03 O CP 0 100 0 100. 200 300 NIP GRAPHIC SCALE FEET 10.c � PARCEL 3 48 43 4 66.40' 5 3 31 29 28 47 Z 2°0 20 w 3 3 \ 22 4 N f-._ $41 ° 15.2 E ~ P°�� \ L� olntl 4FAR EL 4 a�0 45 o- ( 30' to CL �— 1 2 � 3 2 187 AN0 W irH 60uA0 SLCIG, 2.403 ACRES ( by d.m. db ` ) _ �r� l SCALE J 1, C. Ray Cates, certify that under my dlrtriNgpGihd;C� �� supervision, this map was drawn from an gE°+u,.f•Petd, 1. = 100 survey. .��'Q��STF9�O:y SEAL 3 SURVEYED: L-2623 0 CRC Registered Land Su veyor L-2623 o` ' •'•.�D .Ito MAPPED: PLAT FOR Trustees for.. _ Trinity Baptist Church. PART OF DEED BOOK 170, PAGE 681 PORTION OF PARCEL 3 AND 4, DAVIE COUNTY TAX MAP. M-5-6.-I.. TOWNSHIP COUNTY STATE DATE Jerusalem Davie North Carolina 0 2 0 8 9&.: 02-1,9�9�; C. Ray Cates 119 Depot Street JOB NO. 1121 Mocksville, NC 27028 MAP N0. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT, Soil/Site Evaluation APPLICANT'S NAME /t PROPOSED FACILITY SUBDIVISION Water Supply: Evaluation By: On -Site Well Community Auger Boring �� Pit. DATE EVALUATED��% PROPERTY SIZE ROAD NAME Public r� Cut FACTORS 1 2 3 4 5 6 7 Landscape position ,L Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH i 7 Texture group Consistence Structure C-..4 -'e 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: L REMARKS: DCHD (O1-90) LEGEND Landscape Position EVALUATION BY: OTHER(S) PRESENT: 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 Wet NS - Non sticky NP - Non plastic FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm SS - Slightly sticky S - Sticky VS - Very Sticky 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 MENEM MENEM mommm mommomp MEMEMEN MEMENEW MENNEEM MEMMEME MEMMEME mommmom MENMEME MEMMOME EMENMEM mommumm moommon MEMEMEM Emmomms MEMENNE MMEMEME MENNEME MENMEEM MEMENNE mommoom NNE MEN NNE ONE MEN ENNNEEMEMEMEMEMEMEM ENNNEEMEMMEMMEMENEM MENNUMMENEEMEMEMEN MEME MEMMENEEMONNO MEMEMEMENEMEMENNEME ONOMMEMEMOMMEMEMEME MENNEENNNEEMENNEMEM MENEENNOMEMENNENNEM NEEMEMMEMEMEMMENMEM EMEMEMEMEMEMEMMMMEM MEMMUMONNEEMENNEEM OMEN mommommomommo MONEMENMEMMEMEMENEM EMEMSENEMEMENNEEMEM EMEMEMEMEMEMOMMEMEN MEMMEMEMEMENOMENEEM EMEMEMOMEMENEENEEME MENOMONEE MENEENNOM 0 BEESON mommommom MENMEEMOM MENOMONEE MEMONNEME mommommon NEEMMEMEM EMENNEMEM MEMEMME mommomm MMENNEM MEMEMEN EMEMMEM MENEMOM EMEMEME ONEEMEN mommomm NEEMEMEMMEMEM NEEMEMENMEMEM MEMEMENOMMEME MENEEMOMEMMEM MEMEMENNOMMEM mommummumonom NEEMEMMEMEMEM OMMEMOMOMENNE NNEMEMENMENME EMEMEMENNOMME MEMOMMENNOMME EMENEENEEMEMM MENESOMMEMEMN NEMENEEMEMEMM ONEMEMOMMEMEN MEMENEMEMMMEM MEMEMENNEMEME MENOMMENOMMEM nommomommmmsm MENEVEMEM MEMNON 0 EMMOMMEME MENNEENNE MENMEMMEM MENOMONEE MEMENNEEM MMENNOMEM mommomomm mmomommon EL4161WAMENNEEN mommmmommmi EMEMENEMENI W�W�Wfjmmmml XURN-Amomil mommommommi MELE=Nkimmomi MENEMINMEMNI Emommimmommil MEMEMIENME11 MMEME MENEM nomms smoom no IMENNE MENEM ZMEME IMMMEM IMMMEM IMMEME INEEME no No MEMENEEM EMMEMMEM EMMEMEME ONESEMME MEMEENNE ommommon OMEN NONE OMEN NONE NONE OMEN MEMNON WOMEN MENNEN MEMEME mommum mommum MENNEN MENNEN MEMNON MEMNON MEMEME MEMNON MENNEN MENEEM No ON No ME ME on MENESEM EMEMMEM ONMEMEM MMEEMEN MEMEMEM EMENEEM MENNEEM ONEENSE Davie County HeaCth Department and.Come Health Agency Environmenta[Heaf& Section P.O. Box 848 / 210 HOSPrrAL STREET COURIER #09-4-06 MOCKSvaLE, N.C. 27028 Trinity Haotist Church Attn: Darrell Cox 272E U.S. Hwy. 801S. Mocksville, NC 27028 Dear Client: As requested, a representative from this office visited the aforementioned site on May 27, 1997. ' Based upon 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 systema If you have any questions, please feel free to contact thisoffice. RH/wd Enclosure(s) DAYIE COUNTY HEALTH DEPARTMENT w , ,;.-'• (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorvtion Sewage Disposal System - G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR I +l r* .� "' - fi C DATE PERMIT �oISN° 731 LOCATION l Li T f" :°� . ,,r S.R. N0, SUBDIVISION NAME t /,' iw r=.+ LOT NO, SECTION OR BLOCK NO. HOUSE ❑ MOBILE HOME BUSINESS House Trailer 800 Gal. 400 Sq. Ft. NO. BEDROOMS N0. BATHROOMS Two Bedroom House 800 Gal. 1600 q. Ft. GARBAGE DISPOSAL UNIT YES ❑ NO ❑ Three Bedroom House 9 Gal. 900 Sq. Ft. AUTO. DISHWASHER YES ❑ NO ❑ Four Bedroom House 000 Gal. 1200 Sq. Ft. AUTO. WASH-. MACHINE YES ❑ NO ❑ �^• SITE SUITABLE YES [3NO ❑4 SIZE OF TANK,p gal.S'r V fN +� . <, NITRIFICATION FIELD Sq. ft.. C 1 i1 j e S ! : b . ey., DEPTH OF STONE IN LINES: WATER SUPPLY 'Individual Public ❑ ft 3&;1Jc6 !da X 3 IMPROVEMENTS PERMIT BY INSTALLED BY --T CERTIFICATE OF COMPLETION BY— (8/16/73) *Construction must LOT AREA t t- VN\" Date d, -2-7 - 2 f- ly ly with all other applicable State and local regulations �I DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. Permit Number Name 7r�� a ri �S � Gy�u.►`c� Date % 9 1 �� Location (00is d22 us &W -Y &WS Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES ❑ NO ❑ Specifications for System:--�fsao��«4��!'� l Auto Dish Washer YES ❑ NO ❑ Auto Wash Machine YES ❑ NO ❑ p,c-f'�Qv}L_- ,Zr�rf1C8 aC�S� Type Water Supply C' L,� w°��- _— �tsdlon T'1J<c C� tG nec'ed= for to S,tn leu. ' C)V%.: *This permit Void if sewage system described below is not installed within 36 months from date of issue. 4-1I ti. _ jr Improvements permit by �` `ti' �, a• ., ��. *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 day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: *The the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. System Installed by 7ig& mkhy'# � DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION P.O. BOX 5a, MOCKSVILLE, N.C. 27028 (704) 634-5985 STATEIMENT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS NAME Rtt3. Cyr..e letcXur h DATE ► . _ . _ [ yy� ADDRESS O r.,:.�1 s`y=e �'; ; C,1. PERMIT NO. ; EXPLANATI014 OF CF.ARGE '; .>' �; , — 1 • �, �` _�,'C :CT A +- � y tet.; . AMOUNT DUE 2, .,"O SANITARIAN C YN-\c, a PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT. *NOTICE: Evaluation(s) can not be completed until payment is received. Improvements Permit(s) can not be issued until payment is received.