The URL can be used to link to this page

547 Juney Beauchamp Rd- DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002944 Billed To: Structure Investments Reference Name: Proposed Facilitv: Residence ATC Number: 3627 .Tax PIN/EH #: 5861-52-7591 6ql Subdivision Info: Location/Address: Juney Beauchamp Road -27006 Property Size: 2.20 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 COINS�RUCTION IS VALID FOR A PERIOD OF FIVE YEARS. �Y / -^ 3 Environmental Health Specialist's Signature: Date: ` oC Y l% 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. lab 56 At I1o��,eejj Septic System Installed By: \fit �e 0/ C C/bL Environmental Health Specialist's Signature: �C/ yr((/I Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT ,.; Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002944 Billed To: Structure Investments Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-52-7591 Subdivision Info: Location/Address: Juney Beauchamp Road -27006 Property Size: 2.20 acres ATC Number: 3627 **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. I � I Residential Specification: Building Type #People #Bedrooms �S #Baths Dishwasher,; Garbage DisposalWashing Machin Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seeats Industrial Waste: ❑ Lot Size Type Water Supply _S_- Design Wastewater Flow (GPD) Site: Nevy,�Repair ❑ System Specifications: Tank Size,/ -Bt GAL. Pump Tank GAL. Trench Width ��Rock Depth%��Linear Ft. o Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED, EFFLUENT FILTER. RISERS) 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) 0 n O1� APPUCATI FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department 4i+ i (/ (` Environlnenta/Hea/th Section P. Box 848/210 Hospital Street O Mocksville,,NC 27028 3 (336) 751-8760 ** ADTT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQ 'D INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN, for inntrucL-ion3. 1. Name to be Billed �o Q. �/� f'l t.h� n�b so � o LC Mailing Address n� �G.�'I VV Home Phone Q"t' Lt /nl0-1 City/State/ZIP I' `�I OG ICSVi N G 2762Business Phone 2. Name on Permit/ATC if Different than Above1 1 .1(>�►,C f`fyD` � c Lin l� t'S 1-I &In'1_ Mailing Address �$5 �►`1�%L. Ltv i City/Sta a ip j �C.-L�/w1ce— iJ-�� -off 3. Application For: —h�/Site Evaluation $�mprovemen Permit/ATC ❑ Both 4. System to service: 1st' House ❑ Mobile Howie ❑ Business ❑ Industry ❑ Other 5. Type system requested: 0/Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People II # Bedrooms ! # Bathrooms 2— ED hwasher -ClDiahwasher C7Garbage Disposal E ashing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/industry /Other: verify type # People 1t Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE:. # Sats Estimated Water Usage (gallons per day) 8. Type of water suPe y: [County/City ❑ Well ❑ Community 9. Do you anticipate Editions or expansions of the facility this system is intended to serve? ❑ Yes i40 If yes, wliat type? ***IMPORTANT#** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client ivitli TIIIS APPLICATION. Property Dimensions: (' Ac WRITE DIRECTIONS (from Mocksville) to PROPE'RTI': # Tax Office PIN: # Property Address: Road Name 5 lq J0 C -t4 't � City/Zip AJy-ti, cQ- c- 2 1 - �( i�IfAaAlt--X . If in a Subdivision provide information, as follows: Namc: 51�I Junes \ 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 perniil(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the infornualion subinitted in this application is falsified or changed I, also, understand that I aui responsible for all charges incurred fr-onr Phis application. I, hereby, give consent to the Authorized Representative of the Davie County IIeallli Dcl�artmenl ,.."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 I D -(o - C-18 SIGNATURE I "bj, THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the fo ig: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Sign given Revised DCH (05/03 if 100,.L- a -t-- Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. Invoice No. ✓ Z6L � 0 6EZE `d5 VZ OL6 19LL Net 0 9166ti 9199 ( tee) E 0 Cl.) 8L AVL DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site.Evaluation APPLICANT INFORMATION PROPERTY INFORMATION ;Account #: 990002944 Billed To: Structure Investments Reference Name: Proposed Facility: Residence Property Size: Water,Supply: On -Site Well Tax PIN/EH #: 5861-52-7591 Subdivision Info: Location/Address: Juney BeauchampR d- 7006 2.20 acres Date Evaluated: b - Community Evaluation By: Auger Boring ✓ Pit Public Cut SITE' CLASSIFICATION: EVALUATION BY: LONG -TERM -ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: f ¢�U TC1 S60r �� ► 7� t 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 - Plastid 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) Landscape position • 10 VA• I g I 1115 1�� - • --O® Texture group - consistence Texture group JrA SAMMMEM MA WARM, MUNIMP50 Consistence Structure Texture group -®--®- Mineralogy • .. Y �S�S 0��-® SITE' CLASSIFICATION: EVALUATION BY: LONG -TERM -ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: f ¢�U TC1 S60r �� ► 7� t 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 - Plastid 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) ■■■ ■ i ■ NONE ■■E■ OMEN ■MM■ MEMO ■ NEON MEMO ME■ MEE ■■■ ONO ■■■■■ ■■■■■ ■UN■■ ■■■■■■M■■■■M■■M ■■■■MU■■■■■M■■■ ■■■E■■■■■■MMM■■ MEMO■■■■■■EM■M■ ■M■ME■■■■■U■■M■ ■■■■■■■M■■■E■■■ NESE■■■M■■■N■■■ ■■U■■■■■■MMEN■ ■■■■■■■E■■M■■■ ■■■SEMS■■■■MM■■ ■■M■■■■M■■■■■■■ ■■E■■■■■■■NE■■■ ■■■M■M■■NE■E■■■ ■M■MM■■■■■MMS■■ ■MMMM■■■■■■■N■■ ■■MEMS ■NEEM■, EM■NNE MENNEN ■■M■■■■■■ESM■■■ ■ s ■ M■■■ SEEM NONE ■■■■ ■■■O■ ■■N■M SEMEN ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ See■■■■N■■■■UN■■■eM■N■ ■■■■■■s■■■■■■N■■Sees■■ ■��■■►�■■■U■■■■MSN■■■■■ ■U■EUes■■■s■■■■■■■See■ MEMO E iiiiMENNEN M■■■■■Moe■■■ae■sNN■■■■ Es■■■■■■■■■■EMM FAMEMEMMM■■■EME S■"►■M■■U■■M■U■ N�L'T■fid!\SSSS■■■ ■NM��eM�®'SSSS■■ ■ , P O9R a ,s UT / . 59 , . qx r . yet ;sem a " 10 t (1Q\ 7215 i6 3 4"7 v la 3 2766 3 �� 3, l (2.08Aj 5097 �N �46 v (3 @� � 3 x ..' 8 oil Qo " .x � 491,28 _ - (1.28A)+ ., 7781 ---- - k d 77 c n62 3 �43 � 218.59 a9 `- 576 16 kJ"a �s 7591, a' WIN CP I ST r I 2.15A X239 s VV 1220 (2p� 7g2 s- rn 9 —�— a p" It' NAY B AC, (526) 1 , i �, l V� (407) , (2:98 h � 7921 (2.76A) 9. o4A) A . (4.79A) 3 (3.02A) 9911 ' 4888 2829 ,XpA C IS 2 0, ' , r a 1g. ��. s x may'" 8 q- e r '� s qe x ie � `yr DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 /Fax: (336)751-8786 October 8, 2003 Structure Investments 285 Bridle LN Advance, NC 27006 Re: Site Evaluation - 3/4 Acre Tract/Juney Beauchamp Rd Tax PIN#: 5861-52-7591 Dear Client(s): As requested, a representative from this office visited the above site October 8, 2003 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. 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 parcel surveyed 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) t • -FAX INIEN10 FAX MEMO FAX MEMO r. ,*r From: Environmental Health Section Davie County Health Department P.O. Box.848, 210 Hospital Street Mocksville, NC 27025 Fax Number: 336-751-8786 Phone Number: 336-751-8760 Date: a " "-� .3 No. of pages 2 To: r= Fax number: COMMENTS: Signed D.C.E.H. SECTIO\ CONFIDENTIALITY: THE INTORI ATION CONTAUNED IN THIS FACSIMILE MESSAGE IS PRIVILEGED AND CON-FIDENTIAL IN-FOR_INLATION INTE\-DED ONLY FOR THE LSE OF THE IN-DI\'IDL7 AL OR ENTITI' , A�fED ABOVE. IF THE READER OF THIS MESSAGE IS NOT THE ENTEN-DED RECIPIENT,YOU ARE HEREBY NOTIFIED THAT ANI rY DISSEMINATION. DISTMUTION. OR COPY OF THIS TELEFAX IS STRICTLY PROHIBITIED. IF YO : PE:CEIVE THIS IN ERROR. PLEASE NOTIFY US IMNfEDLATELY BY PHONE AT 3,36-751-S 760. 2003 and recorded in Plat Book -_-._____._-___-__, Page_..• and described hereon, which locnted in the I that I hereby adopt this plan of subdivision established minimum building setback lines a alleys, walks, parks and other sites and east private use as noted. Furthermore, I hereby sewer and water lines to the County of Davi Filing fee 3 p' -M. M. BRENT SHOW —DAME Co. Register of Deeds UATF tby _ _ _ _ � OWNER DEpurr-Asslsrrwr OWNER r p. LOT 3 1 1 ,:a.4MES A. MAR''i'IN PROPERTY' GUT _ ,! ' 1 IJ ,1 ,?V riX 1, ,�a A. hA.4 I?7'T N PRO .�'.F.I.7' 3' � a 11- I K, 6, PGt 611,141 �1 s LOT 1 JAMES A. MARTIN PRO,ILYRTY s PI,.B)(. 6, P4'.-1. 62 �. 1EW DFF1t ER'S CER _IFIC<f7E _ _.- R6�Jew ;)fficer of Davie County, i.ify that the rnop or plot to which this certification ffixed meets o'I statutory requirements for recording. I If'W '�FF1 rR DATE__ I i f f -f_ ....._._.__.-_.._ _... 1.'f,1�� 1NG IRON PIN NIP= 11 4E IRON PIN R/R SPIKE = REBAR - NAIL. &_ CAP OR. P/K NAIL UNMARKED F:)OINT IN '/L OF ROAD 4�: +e. AREA= 1.212 _AC. INCLUDES S.R. 1632 R/W total c'7 ?.86 AREA= 0.990 AC. ^INCLUDES S.R. 1632 R,/W