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1381 Hwy 64W _ DAVIE COUNTY HEALTH DEPARTMENT /! :~ Environmental Health Section P.O.Boa 848/210 Hospital Street i Mocksville,NC 27028 (336)751-8760 I bI��lo IMPROVEMENT/OPERATION PERMIT Account M 990004122 Tax PIN/EH M 5709-53-1666 Billed To: Sam Heaton Subdivision Info: _ 13 S j /32M Reference Name: Location/Address: US Highway 64 W127028 Proposed Facility: Residence Property Size: See Map ATC Number: 4515 **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 1 l 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 2•�� Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: I71" Commercial Specification: Facility Type #People #People/Shift 2#Seats Industrial Waste: ❑ Lot Sizes,-9 2. Abe6 Type Water Supply Design Wastewater Flow(GPD) 7(00 Site: New u Repair❑ System Specifications: Tank Size 106QCAL. Pump Tank GAL. Trench Width -3C;' Rock Depth IZ" Linear Ft.�QO �i5 8 JVD J As stated in 15Atem N may 18Aalso be usN Other: �� accepted Systems may also be usegd Required Site Modifications/Conditions: I4K1g14,00 a`pt'MW 7.t ktZP 5D lc c o— /�0 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.**** 3 v 114opm +--tom l,.s F-&M ,C)o ` �(L" ` nvir mental Health Sp ialist's ignature: afi A: AD J& L49(P C DCHD 05/99(Revised) •� W� 1 DAME COUNTY HEALTH DEPARTMENT Environmental Health Section ed' P.O.Bog 848/210 Hospital Street 0� Mocksville,NC 27028 6 113 I (336)751-8760 Account #: 990004122 Tax PIN/EH#: 5709-53-1666 Billed To: Sam Heaton Subdivision Info: Reference Name: Location/Address: US Highway 64 W-27028 Proposed Facility: Residence Property Size: See Map ATC Number: 4515 As stated in 15A NCAC 18A.1969(5) accepted Systems may also be usedd 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 WASTEWA ON IS V D FO A PERIOD// OF FIVE YEARS. Environmental Health Specialist's Signa re: Date. / 0 CERTIFICATE OF COMPLETION *N TE** 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. a' (00 Septic System Installed By: E.nviroj imental Health Specialist's Signature: � �% Date: DCHD 05/99(Revised) Davie County Health Department Environmental Health Section P.O.Box 848/210 Hospital Street Mocksville,`NC 27028 (336)751-8760/Fax(336)751-8786 Improvement Permit Sam Heaton 3186 US HWY 64W Mocksville,NC 27028 Re: 22.93 Acre Tract/Highway 64 West Tax PIN: 5709531666 Dear Client(s): This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans or the intended use change. System To Serve:rRESIWastewater Design Flow(GPD): alid: eYears ❑No Expiration System Type: .-Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other z� Site Modifications/Permit Conditions: C� Site Plan L IQ /a 1TIAL 177.4- = Cry TO Lat- G�++vl t�aa �t11�a1Iio nviro n Halt i ist Date i.p.letter 7/06 w a ?� � i ✓ it a, ..y> I" �r?I •t t'7��"`. ' /i4,{yy��>R; ) h `•���l , IY✓� � 1.Tim��� 3r- 41 � rr -� (�.�'7 fl�rw �4 ✓rr' �0�y� � � �� Y1 ��)� �)�j�y "R,,,�� r � ' .}I � �+ �•pr, � w.IN�'...r'!''l7" .,. � .j(•n' Mo � a. - 7•{ �: 6 . J r s �A i sy n 7R, llf uut•�• sy ti'J� .-tK \ r ,\`• 'ae iP� - vr a>.,���"ii li:.d$..:+ ' - 's.' Oil y i tl � t,L �, h�5 �3 1 # : 1� �i LIQ .[,iit I I ♦.�Y 'r,�r r .�. , I► s w a s '�lr 1 � /P � n �,kyrl4 r � � � r -+' ���•s+`�„ jv \ ';\, \ ty�sY,��y'v{kl�il�•����� � r r ,� r�..k no" M4 �*iC�/'ls v'+3'ta+��{.�-.:.f+C�R��C r '\ \♦!\' :o�/ �t��'�'��,�il�{� 1 -0z r .�' + ".Ji' ..iittl�c pyL S•�� 'r' .R � Y'�Ml'F- ^ I� Y�r y 'i. 3. . 350 . � � Y 27 y,, u PI An" 230 13a f I Pv,\ i 17 - f� 1 !T �� a�r� r ' r ✓+t t APPLICATION FOR SITE EVALUATIONAMPROVEMENn:1 Davie County Health Department Environmental Health SectionP.O.'Box 848/210Hospital Street Mocksville,NC 27028(336)751-8760/-Fax (336)751-8786 Application For: ❑ Site Evaluation/Improvement Permit Authorization To Construct(ATC) ❑ Both ***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed ContactPerson Billing Address 6 CIS wq L t e- Home Phone City/State/ZIP AA ccles Business Phone :7oLf-g�— 53 2.3 Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION NOTE: A survey plat or site plan must accompany this application. (Permit is valid for 60 months with site plan,no expiration with complete pla .) Street Address__'3(" CJs &,, (,'C4 C,,frsf— City Tax PIN# 59W-516,66 Subdivision Name Section/Lot# Lot Size Directions To Site: Iff 6 U S I I G We ` ` e-' Cay ' qX to v Date House/Facili Corners Flagged 3 0 6 If the answer to any of the following questions is"yes",supporting documentation t be attached. Are there any existing wastewater systems on the site? ❑Yes p Does the site contain jurisdictional wetlands? ❑Yes �N Are there any easements or right-of-ways on the site? ❑Yes Is the site subject to approval by another public agency? ❑Yes p' Will wastewater othet than domestic sewage be generated? ❑Yes o IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms 3 #Bathrooms ;Z t/:I_ Garden Tub/Whirlpool es ❑No Basement: es ❑No Basement Plumbing: ❑Yes QNo" IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #Peopled #Sinks #Commodes #Showers #Urinals - Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY:��#Seats Type system requested: C�onveritional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ❑ County/City Water ❑New Well "Xistg Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 5. If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed. I understand that I am responsible for all charges incurred from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determi a complianc ith applicable laws nd rules on the above described property located in Davie County and owned by C /.� s � �= �� Site Revisit Charge Property owner's 90 - &'s legal representative signature Date(s): C) I5 B Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# ZZ Revised 2/06 Invoice# r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004122 Tax PIN/EH#: 5709-53-1666 Billed To: Sam Heaton Subdivision Info: Reference Name: Location/Address: US Highway 64 W-27028 Proposed Facility: Residence Property Size: See Map Date Evaluated: 10-10-0& Water Supply: On-Site Well V Community Public Evaluation By: Auger Boring Pit Cut FACTORS Al1 2 3 4 5 6 7 Landscape position + Slope% TV 70 HORIZON I DEPTH Texture group Consistence StructureSAC Mineralogy SE P S HORIZON H DEPTH Z,_ _# Z Texture group AF t.+ Consistence -S P5 t� P Structure 21 Mineralogy F SE16- E HORIZON III DEPTH Z'' G g Texture group (', 1-5AP SAP Consistence Ss sp Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS — RESTRICTIVE HORIZON 7 2 - SAPROLITE -- CLASSIFICATION LONG-TERM ACCEPTANCE RATE C Q• D• p. 'SITE CLASSIFICATION: Os EVALUATION BY: LONG-TERM ACCEPTANCE RATE: 19 OTHER(S)PRESENM; 1&cce `„�i�x REMARKS:MA l:�� G�e o;� AL 6�c Sl�o u,.. < ,? Landscape Position LEGEND 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 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 Mineralux 1:1,2:1,Mixed Nato 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 05105(Revised) J .W. SM0OT DH, 46 P6. 516 ti 36. 10 26 E --" 750.42 PIP J. W. SMOOT C) n �V- t 2ro P I P o NO 19 t� r PIP Z RAC z . o ao AREA = 22 . �C ARE_S GR{E� GI'dN1NC; CC. � DB. `v 1 �r ory ; �(JQ CK)t N ��' l " ,►� T R AC T 3 4 26'. ARE = 5. 414 AIR n D r ..NSP:. i 6C `r 6.? 4 'r 'G"I r V°7. V ��t�- � ,�c� ��.1 NIP - : NIP r + 0� g TRS T ^dI P a HARR( L. vllLAM U. DB.98 PG. 388 ACT 4 k'� (--' R / rti � � A R F n _ % ACRES R ES v> c�• �3 D rvl C> - � 2 to 12 t Is 6 � LEGEND / r ^JIp o EIP _ EXISTING IRON P!N 39'° �°, 239•37 NIP O PIP PLACED IRON PIN 5 36Sa..W EiP 382. 85 E.IP I �0 n NIP NEW IRON PIN ``'� 2 -..•---- 5 45009 ' 2 5" W -..... 33o, 01 ,�'`Qi O = POINT Q' .... TGT , b. 6t +~ �,,� 02 4V E I P HARRY i_. vi(l_AM o f C% N ` qC op R TOTAL AREA37, 132 ACRES i `'`•... ;` ,, Toy.€RnWees REv►t�lONli PROPERTY OF 19XCa,TA%NOTC04 No. nwT: ey ESSIE HODGSON WHITAKER ,qHE orc+�+A4 a BEING 4 TRACTS,TOTAL OF 37.132 AC. OF }' HC3DSON WHITAKER PROPERTY (DB.57 P ? s PGS 116 &193)LYING IN CALAHAN TWSP. D. - FRACTIONAL . ..Mr..� nRAwNGT scA�.c t 0© , MAs�cR+A_ jt4CHK;D T oATt 4- 11�79DntwwoN ANGULAR TO CRD AM n 37 t s x _4 - 4FFr 2 ( I k � I \ (5.40A) 7955 \ �3 \ \ \ 22.930A \ 1666 i l \ ws \ ` PaD ` PcC2 LP (534A) \ \ � 5383 \\ \ CeB2 \ 3 \ \ lY \ (3.19A) ,�M - \ & \ 9883 l \ 1 \ \ l � f �D LNY-�Y+j�ys�nCO yad,��j4 �/ f 4' M�"(�y r ; "11c,='E ��}!f''-S` t ♦ '�c• "�� f � ,�7� %i r .'..( �tTc J�$�T t b 'd'i . .:• 22:: rt$'�l a ~ y��j = ���h T� w � �1�y .• ]f � t/FYf {Tj' y'�J•.����A�Su`!'l J t� T�� �.�.,A�'�Z �t $. �w 7 } y. /'� � ��• 7�. ilk f�K4 � r Rey - Y I•`• /(' f � , . to ,Emil , t t P