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1585 Hwy 801N-7� Account #: Billed To: Reference Name: Proposed Facility DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 990003711 Tax PIN/EH #: 5852-66-3921 Cornerstone Christian Church Subdivision Info: Location/Address: . Hwy 801 N-27028 Church Property Size: 10 Acres ATC Number: 4264 As stated in 15A NCAC 18A.1969(5� accepted Systems may also be use 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 CONST IS V R A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 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 Disnosal Svstems_" but shall in NO WAY be taken as a euarantee that the system will function satisfactorilv for anv 0 period of time. K74D�. Ll tJF-- Environmental Health S�st's fgnature SL)M,q uA= m 4, DCHD 05/99 (Revised) Wµ % © 1p 5 -7 -1 -OU �►sr j � W SDHs M3 m c Ho 3 6' TRAP k -r Date: 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 990003711 Tax PIN/EH #: 5852-66-3921 Billed To: Cornerstone Christian Church Subdivision Info: Reference Name: Location/Address: Hwy 801 N-27028 Proposed Facility: Church Property Size: 10 Acres **NO�jQ%rRq%r4?ftit/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: 173 Basement w/Plumbing: 13Basement/No Plumbing: ❑ Commercial Specification: Facility TypeeAlby—A. #Peopl People/Shift #Seats Industrial Waste: ❑ Lot Size ' 1 Type Water SupplyCtLDesign Wastewater Flow (GPD) Site: New Repair ❑ System Specifications: Tank Size AL. Pump Tank iAL. Trench Width � Rock Depth 12 Linear Ft. t� Other: Required Site Modifications/Conditions: aE M6A IPL; 1 o Ff SI OK-- IMPROVEMENT/OPERATION ff(= 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.**** Ice T� 0"k C'Ofaw-3 -Tills oFPCE iV-leF--M eOL-444416 Environmental Health Specialist's Sign Cpr•��t)t�tOn) ���� DCHD 05/99 (Revised) TM�4'TL-Lp - KJI--Y 1- OPIPOI E 61-D,61 Kj' V Date: (10 FL 16 DAME COUNTY HEALTH DEPARTMENT i Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003711 Tax PIN/EH#: 5852-66-3921 Billed To: Cornerstone Christian Church Subdivision Info: Reference Name: Location/Address: Hwy 801 N-27028 Proposed Facility Church Property Size: 10 Acres ATC Number: 4264 **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 #Peoples #People/Shift #Seats Industrial Waste: ❑ Lot Size tI o Type Water SupplyL ONTV Design Wastewater Flow(GPD) &00 Site: New Ce Repair❑ T System Specifications: Tank Size � AL. Pump Tank GAL. Trench Width �r�Rock Depth 12� Linear Ft. I Other: ALTIV4VO62 FED ✓A%-VLW Required Site Modifications/Conditions: VJ�TC Lv- CA , to c 'F ,, . 4,5 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.**** TIC,Tr 3{,(b-t- P1a1 ab� \ • \ i �o �� v �nS� -f o�+P�ic ITc1. t ` 1,e FL0�1 �GT�nQ� CJQ..s�.e2 Enviroltfneniar%alth Specialist's afore: Date: 05 Ix e75� DCHD 05/99(Revised) As stated in 15A NCAC 18A.1969(5) accepted Systems may also be usedd l+ RRA APPLICATION FOR SITE EVALUATION/16IPROVEh1ENT PER1111T& Davie County Health Departmentp 9 Environmental Health Section P.O. Box 848/210 Hospital Street Mooksville, NC 27028 � Ir' (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORZIATION IS PROVIDED. Refer to a INFOMIATAN BULLETIN for instructions. 1. Name to be Billed on I Mailing Address $ VS #"'�� 4-J Pers �� on actHome Phone City/State/ZIPy � Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip . eu11Qg4a Z/ �T ll`1Lilet' 3. Application For: Site Evaluation Improvement Permit/ATC ❑ Both 4. System to Service: ❑ House ❑ Mobile Homo ❑ Business ❑ Industry P"'6ther 600&4 S. Typo system requested: Conventional ❑ conventional modified ❑ innovative 92aCCepted 6. If Residence: it People # Bedrooms it Bathrooms ❑Dishwashor ❑Garbage Disposal ❑WashingMachine ❑Basement/Plumbiingg ❑Das ant/No Plumbing 7. If Business/Industry /Other: verify type NO" # Peopled�•� Sinks # Commodes # Showers # Urinals Z it Water Coolers - IF FOODSERVICE: 11Seats Estimated Water Usage (gallons per day) acc,-�Q7 8. Type of water supply: 0eaCounty/City ❑ Well ❑ Community 9. Do you anticipato additions or expansions of the facility this system is intended to serve?P-'Irc-s ❑No If yes,irliat type? �'�-rt e'3 64-- ***1AIP0RTANT***CLIENTS MUST COMPLETLTHE REQUIRED PROPERTY INFORMATION REQUESTED IML01V. hither a PLAT or SITEPLANMUST BE SUBMITTED by the client with TI IIS APPLICATION. Property Dimensions: (t9 A - WRITE DIRECTIONS(froin Mocksville)to PROPERTY: Tax Office PIN: ll 52 .(e� "J-z�©�i �(� Al SSS 9•✓ Property Address: Road Name ��� ��� I U,. .-ArJ City/zip �'lA ✓h,t� ,,1� If in a Subdivision provide information,as follows: Name: p Section: Block: Lot: Date ltome corners flagged: t I This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued liercafter 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. 1,also,understand that f an:responsible for all charges incurred from alis application. I,Hereby,give consent to the Authorized Representative of the Davie County 11calt i Department to enter upon above described property located in Davie County and owned byVIZI) l . Ca. to conduct all testing procedures as necessary to determine the site suitability. DATE "l I��I t7S SIGNATURE: THIS AREA MAY BE USED FOR DRAWING YOUR SITE,PLAN(Include all of the ollowing: Existing and pi oposcd property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EI-IS: Sign given Account No. f coo 371 Revised DCIID(05103 Invoice No. 0 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003711 Tax PIN/EH#: 5852-66-3921 Billed To: Cornerstone Christian Church Subdivision Info: Reference Name: Location/Address: Hwy 801 N-27028 Proposed Facility: Church Property Size: 10 Acres Date Evaluated: I-01 os Water Supply: On-Site Well Community" Public Evaluation By: Auger Boring Pit �O Cat rr� FACTORS 1 2 3 4 >5 6 7 Landscape position L L L L L _Slo % 70 Z Z7v HORIZON I DEPTH — . (v 0—Z- 0 - 40-59 Q 011 Texture group Consistence . v . Structure VA yv� VV . Mineralogy per L- L t. 6XV u5p 54 HORIZON II DEPTH Z 3 730 Texture group G� Consistence t'6N r N S iQ Structure M ►�.-- ' lam- . /'-- Mineralogy L HORIZON III DEPTH }3 Texture group 17OC44- ConsistenceL S Structure Mineralo N HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS35"Ie RESTRICTIVE HORIZON SAPROLITE S S v CLASSIFICATION LONG-TERM ACCEPTANCE RATE1 0-2 0 LS, , - SITE CLASSIFICATION: EVALUATION BY LONG-TERM ACCEPTANCE RATE: ©�Z_ OTHER(S)PRESENT. . .. ...... . ttjOi REMARKS: P43 Pfty of I Sols,At�0 �.�Q � 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 loamSCL Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay._ CONSISTENCE MOW 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 Mineralogy 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) • �3 L DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003711 Tax PIN/EH#: 5852-66-3921 Billed To: Cornerstone Christian Church Subdivision Info: Reference Name: Location/Address: Hwy 801 N-27028 Proposed Facility: Church Property Size: 10 Acres Date Evaluated: L� Water Supply: On-Site Well Community Public a Evaluation By: Auger Boring Pit 1!3OPFV Cut n D � -4- -R FACTORS `}� 9'to 811 A VL_ I t3 81'� Landscape position e. L, Slope% HORIZON I DEPTH 6-2-0 0-322' 046 Texture groupG Consistence IF,vsvv vr�%S�d S �5v . vs I;w Structure M3 it �v— tn.- 1•- r� Mineralogyv O t, �1G HORIZON II DEPTH - --3 9 -�q 33a Texture group W CASko 30 Consistence S If Structure 46(< 4 Mineralogy 1 wrt� HORIZON III DEPTH 2 0-L-, 41& -10 3o - b - -ul' Texture group <1 A L_ S SL- S S SC Consistence rJSr, SP, MIS Structure Mineralogy S.PCP HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS tF , RESTRICTIVE HORIZON SAPROLITE L S - 5 CLASSIFICATION �S LONG-TERM ACCEPTANCE RATE 0.2- o.v ! 1 0.2 1 I SITE CLASSIFICATION: EVALUATION BY: '- MO uI' '^l" �� LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: 31S SO P-1 e%f eAk 1.1 a Pyr QtrL .a�-r �.►r3 '�ici hew 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 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 ]�tt� 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) r� +» i i � .. '�. DAVIE COUNTY.HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: Tax PIN/EH#: Billed To: Subdivision Info: Reference Name: Location/Address: Proposed Facility: Property Size: Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit ✓ Cut FACTORS 17 60 ITIJ V20 I sn i 5 6 7 Landscape position LL Slope% ZZ -5 Zo HORIZON I DEPTH b-70 e -L�t m -3 0 -Z4 Texturegroup (2-- 0— C. Consistence P,VS V 1=` V1 2f F` iV,(. Structure h.-- V_ V^_ wl Mineralogy Lam.v e p-]c HORIZON II DEPTH 20 _q(., _,74_, 20 Texture group - Consistence 55 SP SSg p Ss 5e, Structure Mineralogy .5 HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE S S CLASSIFICATION -S S LONG-TERM ACCEPTANCE RATE O• Z_ p.Z (0-2, SITE CLASSIFICATION: EVALUATION BY: �"'^+ LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: I� >]��+��� REMARKS: '11"I 'IaW P7- q3 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 1VIoist 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) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 /Fax: (336)751-8786 September 23, 2005 Cornerstone Christian Church Attn: Todd Naylor 5385 US HWY 158E Advance,NC 27006 Re: Site Evaluation- 10 Acre Tract/HWY 801N Tax PIN#: 5852675906 Dear Client: As requested, a representative from this office visited the above site September 20 and 21, 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. a It should be noted that soil conditions and facility size/location may necessitate the use of an approved or accepted alternative on-site sewage disposal system. Actual design of the system will be determined at the time an Improvement Permit/Authorization to Construct is requested. 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. Please have the survey completed and new corners located prior to making this request. If you have any questions, feel free to contact this office at 751-8760. Sincerely, n Jeff G. Beauchamp,R.S. Environmental Health Section Parcel#: C60000002302 Page 1 of 1 9N4 -, Davie County, NC - Basic Estate Search 06,4 .� . Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search VIew Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel#:C60000002302 Account#:82523627 Owner Information Tax Codes ORNERSTONE CHRISTIAN CHURCH ADVLTAX-COUNTY TT 1585 NC HWY 801 N FIREADVLTAX-FIRE TAX OCKSVILLE NC 27028 Property Information Township nd(Units/Type): 11.550 AC FARMINGTON Edress: 1585 N NC HWY 801 Deed Information Local Zoning ate: 11/2005 Book: 00637 Page: 0173 Plat Book: Page: Legal Description PIN 11.936 AC HWY 801 5852670976 Prope Values ulidin : 2,806,72 BXF• nd: 132,98 0011 Market: 2,939,70 ssessed: 2,939,7001 [Deferred: Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 00637 0173 11 2005 WD Unqualified Vacant 0 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=1163418 9/20/2016