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149 Howell Rd Lot 5 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 P �� IMPROVEMENT/OPERATION PERMIT Account #: 990002512 Tax PIN/EH#: 5822-53-5223 Billed To: James Gilmore Subdivision Info: Mary Beck Estates Lot#5 Reference Name: Location/Address: Howell Road-27028 Proposed Facility: Residence Property Size: 1.3 acres ATC Number: 3324 **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 IN'T'ENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People 3 #Bedrooms #Baths Dishwasher: Xr Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow(GPD) Site: New•0" Repair❑ System Specifications: Tank Size/d0 GAL. Pump Tank GAL. Trench Width-i Rock Depth�fLinear Ft.700� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S) IF 6 16 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: G Date: DCHD 05/99(Revised) f2 �� Z✓a2 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street • Mocksville,NC 27028 (336)751-8760 Account #: 990002512 Tax PIN/EH#: 5822-53-5223 Billed To: James Gilmore Subdivision Info: Mary Beck Estates Lot#5 Reference Name: Location/Address: Howell Road-27028 P,up U- -0 ed Feeility! ResideAGe P ope[ly Size: 1.3 acres ATC Number: 3324 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 WASTEWATYqCONSTRUCTION IS VALID FOR 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 Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. --j -7< Septic System Installed B : 44 P Y Y Environmental Health Specialist's Signature: /J Date: DCHD 05/99(Revised) • PPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC n Davie County Health Department Environmental Health Section N P.O. Box 848/210 Hospital Street Mocksville, NC 27028 v�IDV, pVN (336)751-8760 *IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for `instructions. /' r 1. Name to be Billed,—T- ( G/J—M01K4y— ''Contact Person �J( V.,q' �_O� Mailing Address /y�o ��+/- �1- Vr' 00 / /�/ 7 /may' Home Phone .336-76 [ cZ City/State/ZIP W I NSrj'O�- J �-L /`��2" /B�isiness Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation Improvement Permit/ATC 0 Both 4. system to service: ❑ House Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms fs Dishwasher IJ Garbage Disposal "ashing Machine U Basement/Plumbing 1.1 Basement/No Plumbing 6. If Business/Industry/Other. Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City 0 Well U Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes H No If yes,what type? ***Ib1PORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLATT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: ( ' ` WRITE DIRECTIONS(frooin Mocloville) to PROPERTY: Tax Office PIN: # CK) ©f-N r S Property Address: Road Name TI O W EI-t- City/Zip If in a Subdivision provide information,as follows: Name: Section: Block: Lot: J— Date Property Flagged: 4 o mel This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter arc 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 1 aur responsible for all charges incurred froin 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 of d by to conduct all testing procedures as necessary to determine the site su'abi 'ty. DATE SIGNAT RE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(In ude all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locati ns). Site Revisit Charge Datc(s): Client Notification Date: r 9 ) EHS: Account No. Revised DCHD(07/99) Invoice No. RS--7 SL✓'G'2- (�V 6572 qp1?I; ......... 5398 o0 O '` T_ `Z cN 2 6 5 340 4 1 . 1 8A 5023 2p s 2 138 63 (� 1 N ry ...,{' ( A� CAMON FOR SITE EMIAXION/1111PROVEMEW PERMIT&ATC Davie County Health Deportment NOV 17 1999 t Envimnmental Health SaWan ?.0. Box 848/210 Hospital street I Moaksville, VC 27028 LCdVliisli is.i�Pdliil.I ILALiN (3361751-0760 [)AVIt C01IN Y **It�t7RTAMi* THIS JMRLICRTION aR l+AOCE88= =288 III.L Ttla nQUIRaD iitrORMt►TI02i i8 i:Rtri/ID$0. Refer to the ItUWMi 22QH SMU219 for instructions. //yy�� ,p Be- L ^ Z/6 I. Vans to be Gilled INAo,-Y /J. � Ac �S l"t Content ftmeao C ky'i S C1 Y'0 CA, k"nnn� ttailtnq aaas s. r �a /.?cc.A 27*Zd am* n me _336- 4b8-4611 City/state/s:a �ZW14 44y 8Ul_ a. Viae• on ts+aivan is Dist s of thsmlsbo.•�� 4 �Ue plc day 1% ili,ig- dareks '�` 6 b�r-s� �� _ city/state/sip ,[fit_dev: /e Av c. -7b L l a. imr'k+.4ass1!or. *ate: 8i Bva.taatiou 0 =ssprove mt Versit/A213 O Both e. systa. to $•r.io•s '9 House XMobUe Rome 0 Business a industry 0 Other a. It RanLdenoes # people + Bedrooms Tor 3 i Bathrooms d! O Diebwaah r O gasbag• Disposal 0 Washing Waabin• a saamment/viumbing U sase•ant/tto plumbing e. st: s148ia•89/tadust3r/0tbes1 apMdit type ! People I $inks 1 commodes / abomme + urinal• I Wates Coolers I! 1'OOD89mcm: p Seats .r� lestimated Water Osage toallons per dair1 7. Type of water waggly: �County/City 0 V" �Nell 11 Community I. Do you anticipate additions or expansion of the facility this system b intended to serve? 0 Ya -4'N-'o If yes,what type? ***1MP0RTANT***CLiVM Nt1 TCiDMPL TBTHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITS PLAN MUST BESUBM IM by the client with T1414 APPI JC_k*!nN, Property Dimensions: .sc e- _/ ��'� F,9►'1. E:;MWi1GN6(nem Moelawille)to PROPERTYs Tai 081cs PINS N rl 6/T,i96 Property Address: Road Name we'll �� - U w K ' � , Cis i-4 CityrLipL: ��' �^ U in a Subdivision provide Information,as follows: l/?1 w U Name: � �� v"� &!n2 Sections Blocks uk/_ Af Date Property Flaggedt c • This b to certify that the intbrmation provided b correct to the best of my knowledge. I understand that any permits) Issued hereafter are subject to suspension or revocation,it the site piaw or Intended no change,or If the Information submitted in this application is falsified or changed. 1,also,unsditxtand that 1 ant imponsible for of charga incurresi tons this appUeadom 1,hereby,give consent to the Authorized Representative of the Davie County Health Departmen to enter upon above described property located In Davis County and owned by, to conduct all testing procedures u necessary to determine the site sultabWty. THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(include all of the followings 11filitting and proposed property lines and dimensions, structures, setbacks, and septic locations). site Revisit Charge Please complete the highlighted area(s)and Dah(s)s return. Client NotiAatiou Dates EAS: Account No. Revised DCHD(07/99) Invoice No. IQ �-3 S 84'2S'4S E 446.69' 1' Square Iron 34310, (jN 48. 2. u1 .2 7,128 eq.tt. 0.1636 acre h to r ' ,e!� 56.227 sq.ft m e 1 1.2908 acres FBD 40 PG 376 s as24.21' E I 0 370.42• Op 1 Of 133, 01'1 1.3456 acres20 58,615 sq.R. S W24'21' E '� r n 427.01 1 WILL DB ON 84'03,- w 57,071 p.R. � — 1.3102 acres o, ?05 .301n a; N ac560, .ft ipike 42 Z O 0.9770 acres 2 rym S44,120 do 44,120 sq tt _ acres t�d t o S 8535VT E O t Q 250.00• 57,488 sq.ft 1.3198 acres �Qdy� 10 \ `y 49.409 e csatxD 1.1363 0 .�.\ / � � e PROPL.RTY UNE W-,tn Of WAY UNE Q�� w -- UNE FROM DEED OR PUT 224.84' NOW OR FOR1/ERtY t?S/t� DEED BOOK PAGE 2 PUT BOOK 81.0- s] t DOME MERC N OISfANCE �\\ ^A CEUXERUNE 1 PROpum UNE u�iRIGm Of WAY n k�R EATON CHURCH ROAD ?'� S°`kc YNSNED FLOOR ELEVATION SR 1415 IP ( DUSMG KION FDum \\ \ IP ( KEW KION SET ) *fl ( Mo MONUMENUTUN SET ) Gs CONTROL MONUMLW ST" PK NW NAtI so "E METER PRELIMINARY PLA TWO T FOP ' n my _ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000872 Tax PIN/EH#: 5822.62-1818.05 Billed To: Grady Beck Subdivision Info: Mary Beck Estates Lot#5 Reference Name: Grady Beck, Executor Location/Address: Howell Road-27028 Proposed Facility: Residence Property Size: 1.34 Acre Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit , / Cut FACTORS 1 2 3 4 5 6 7 Landscape position , Sloe% Y HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON Il DEPTH ' L Texture group 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: EVALUATION BY: LONG-TERM ACCEPTANCE�RATE: OTHER(S)PRESENT:: REMARKS: LEGEND4,)�4W Landscape Position �z 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)