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321 Burton Rd DAVIE COUNTY HEALTH DEPARTMENT. _ Environmental Health Section P.O.Boz 848/210 Hospital Street Moclksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000854 Tax PIN/EH#: 5798-18-3166.03 Billed To: Clint Babcock Subdivision Info: Green Acres Farm Lot#3 Reference Name: Clint Bobcock Location/Address: Burton Road-27006 Proposed Facility: Residence Property Size: 5.899 Acres **NO41'J&* YR?Pfi�pr6t ent/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 71— #People_ :2= #Bedrooms�_ #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial11lWWaste: Lot Sizey , O✓�C Type Water Supply�/ tr Design Wastewater Flow(GPD) Site: New Repair❑ System Specifications: Tank Size/N? GAL. Pump Tank GAL. Trench Width_?el, �Rock Depth 1-2 Linear Ftr.20X- Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 K 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.**** F Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) P J`- DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990000854 Tax PIN/EH#: 5798-18-3166.03 Billed To: Clint Babcock Subdivision Info: Green Acres Farm Lot#3 Reference Name: Clint Bobcock Location/Address: Burton Road-27006 Proposed Facility: Residence Property Size: 5.899 Acres ATC Number: 2273 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 WASTEWATE CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: ,/��/�' -41 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:n f� �D Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) APPLICATION FOR SUE EVALUATION/IMPROVEMENT PERMff&ATC a 1 Davie County Health Department D Envfronmenfa/Heia/tfi Seadon 1 P.O. Box 848/210 Hospital Street NOV 51999 -R, Mockaville, NC 27028 l/ (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDEID Refer to the IMRMATION BULLETIN for instructions. 114 1. Nam* to be Billed _ C hs '60..10� Contact Person 19,r Aq 9 Mailing Address Pc�'%*s6f iGOy ffome Phone 1Oy"aZs-Va 1\ city/state/sxP a l-eb mon S ►JC:, a-] 0 IZ Business Phone 2. Name on Pernit/ATC if Different than Above Le- Mailing Address City/state/sip / ✓ 3. Application For: WSite Evaluation 0-2mprovement Permit/ATC th a. System to service: 6r'House ❑ Mobile Home ❑ Business 0 Industry 0 Other a. If Residence: # People # Bedrooms # Bathrooms 0 i.hrasher [-Garbage Disposal e'xashing Machine a Basement/Plumbing o Ras ement/No Plumbing 6. xf Susiness/Industry/Others specify type # People # Sinks # Commodes # showers # Urinal• # Water Coolers Ir FOODSERVICE: # Seats Estimated hater Usage (gallons per day) 7. Type of water supply: 0 County/City Befell ❑ Community 9. Do you anticipate additions or expansions of the facility this system Is intended to serve? 0 Yes ❑No U yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 'I(''-' F-,O WRITE DIRECTIONS(from MockrAlle)to PROPERTY: Tax Office PIN: # S 7 29- V G 0 6q C sw 2' A� o v Property Address: Road Namel/h�n/IJ City/Zip Advii ye-e—. fie,4 /-05T U in a Subdivision provide information,as follows: Gl')O.� d-A/es -5,z, Corr 4W'd Name: (Olrelpw 9 " Section: Block: Lot: .2 WmF Date Property 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 ant responsible for all charges Incurred front this application. I,hereby,give consent to the Authorized Representative of the Davie Couvtyy�leg th)Department to enter upon above described property located In Davie County and owned by_JD h/z/ to conduct all testing procedures as necessary to determine the site suitabill DATE 4'�a,5"7'7 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). Site Revisit Charge Date(s): Client Notification Date: EAS: Account No. Revised DCHD(07/99) Invoice No. . ra"t lir ,�� '�,V r S3•� t � • ..',`• ' � t ;!�+> of :, . Y.. �,j gra., .ts•q ,'�+s• 1 G .w. r./ rAh q, ' . AI bo ✓•-'� I +. 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'•t r .•`g),1��.11�i�-�- 4yy,,,��r ,;� :a- . - (�y-`"..� jr ♦ .1 t '.�` qF {. r,N � j�'.. -/' ri 1�k.�- • , i t y I's d,rV�,✓�+ / ^j i l,v r ti ti' .a 'N.t 7+" ►t.y ";r �' ;'' ' X k.i•,Y'r �'k:4v ��.yyliy`y ='A k�di 9��•,.k ''� �_ :a^'r �. �"r47�,��,i i •+�„� - 31�,�� ;i,i.,' .�'r'� w'.� -r: _1j"{!M-.. w '{a-� - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000854 Tax PIN/EH#: 5798-18-3166.03 Billed To: Clint Babcock Subdivision Info: Green Acres Farm Lot#3 Reference Name: Clint Bobcock Location/Address: Burton Road-27006 Proposed Facility: Residence Property Size: 5.899 Acres Date Evaluated: %/krpl � Water Supply: On-Site Well ✓ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscapeposition Slope% HORIZON I DEPTH << Texturegroup .fG� Consistence Structure Mineralogy HORIZON II DEPTH i Texture group C Consistence i Structure Mineralogy /;- HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S 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-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) ■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■ecce■■e■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ iiiiiiiiiiiiiiiiii MENNENiiiiiiMENNENMENNEN ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■-�::■■viii■■■■■■■■■■■■■�/��■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ DAME COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION P. 0. Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NC 27028 Phone #: (336)751-8760 December 1, 1999 Clint Babcock P.O. Box 1604 Clemmons,NC 27012 Re: Site Evaluations—2 Sites Green Acres Farm/Lots 3 &4 Tax Office PIN: #5798-18-3166 Dear Client(s): As requested, a representative from this office visited the aforementioned sites on November 30, 1999. Based upon the information provided on the Application(s)for Site Evaluation(s) and after evaluations were completed, sites 3 and 4 were found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked on each site. If you have any questions,please feel free to contact this office. Sincerely, o A404�vs. Robert B. Hall,Jr.,R.S. 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D 4 1.•f; ' J1 11x" - Y. - -• ” APPUCATION FOR SUE EVALUATION/IMPROVEMENT PERMIT&ATC a Davie County Health Department nn Envlivnmenta/Hera/th Ser~Cion V !. P.O. Box 848/210 Hospital Street NOV 5 1999 Mockaville, NC 21028 (336)751-8760 !!ii ***IMPORTANT}** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INrORMATION BULLETIN for instructions. 1. liana to be allied ^C Q k 1$0r6 C-� Contact person ar&qB Nailing Address Roma phone 10'p1��i2�'V F3 1\ City/state/sip _C(-eM MOni S �-7O 1"Z. susiness phone 2. Nass on permit/ATC if Different than Above �7hL� Meiling Address City/state/Zip 3. Application For: B'Site Evaluation ❑ Improvement Permit/ATC O Both e. systas to services er'House ❑ Mobile Home O Business O Industry ❑ Other s. If Residence: # People # Bedrooms (-0 # Bathrooms EDishwasher 8-0-stbage Disposal B'Rashing Machine O aaeement/plumbing O nasesant/lio plumbing 6. tf business/industry/other: specify type # people # sinks # Commodes # showers # Urinale # Rater Coolers IF IWDSERVICE: # Seats Estimated (tater Usage (gallons per day) 7. Type of water supply: ❑ County/City "Oil ❑ Community 9. Do you anticipate additions or expansions of the facility this system Is intended to serve? ❑Yes O No If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUUSSSTT B�ELSUBMITTED by the client with THIS APPLICATION. Property Dimensions: �• / /GG�S WRITE DIRECTIONS(from MockrAlle)to PROPERTY: Tai OMce PIN: # S 7 29 I g -3/4 � �� O�) 6 C L e� 2' Al 0 u Property Address: Road Name ewh O'y R00k,5 61"ic 0f1/ City/Zip Adam NC e-, &"Ll/ If in a Subdivision provide information,as follows: 4-AI46 .5141 yy 90i4 Name: Section: Block: Lot: Date Property 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 fabifled or changed. I,also,understand that I am responsible for all charges Incurred from this applicadon. I,hereby,give consent to the Authorized Representative of the Davie Can tyHthpartment n/ to enter upon above described property located In Davie County and owned by JO �/� v2 to conduct all testing procedures as necessary to determine the site sui bili CJ DATE �D� "1�9 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). Site Revisit Charge Date(s)- Client Notification Date: ERS: Account No. Revised DCHD(07/99) Invoice No. a0 tr t• r. . }f ��` 1Y) , r• I,i 1• Imo ` :.X.' � .T ry••w"��=s , t F > .�� .r.r• - } �v••''7?.�`}�wJr' .u" '' .{',,5+, ' �r r � ,., y .�. _ 'I :.•/'h' .,`,��1, •''�1 ter. .. i � i /�. •r .('.f r. 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'>�r• .'t, '}'ti' ,'4 rt Af't.,, I•��r;��.: it �1.�"�•S','iu� yi'• 'K" - ay.. - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000854 Tax PIN/EH#: 5798-18-3166.04 Billed To: Clint Babcock Subdivision Info: Green Acres Farm Lot#4 Reference Name: Clint Babcock Location/Address: Burton Road-27006 Proposed Facility: Residence Property Size: 5.439 Acres Date Evaluated: z4/ze ha Water Supply: On-Site Well ✓ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope% HORIZON I DEPTH Texture groupL Consistence Structure Mineralogy HORIZON II DEPTH __?G A Texture groupC G Consistence r Structure /� L 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: EVALUATION BY: G 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 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) DAME COUNTY HEALTH DEPARTMENT T ENVIRONMENTAL HEALTH SECTION P. 0. Box 848/210 Hospital Street Courier #09-40.06 Mocksville, NC 27028 Phone #: (336)751-8760 December 1, 1999 Clint Babcock P.O. Box 1604 Clemmons,NC 27012 Re: Site Evaluations—2 Sites Green Acres Farm/Lots 3 &4 Tax Office PIN: #5798-18-3166 Dear Client(s): As requested, a representative from this office visited the aforementioned sites on November 30, 1999. Based upon the information provided on the Application(s)for Site Evaluations) and after evaluations were completed, sites 3 and 4 were found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked on each site. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr.,R.S. Environmental Health Specialist RH/mp Enclosure(s)