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2508 Milling Rd p,,p)4 a7-a/ DAVIE COUNTY HEALTH DEPARTMENT V Zoo .Z: Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990001267 Tax PIN/EH#: 5769-03-6784 Billed To: Robert Coil Subdivision Info: Reference Name: Robert Coil Location/Address: Milling Road-27028 Proposed Facility: Residence Property Size: 50 Acres **NOW* isl14 mprovement/Operation Permit DOES NOT authorize the construction of 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 ,tO(�� p g yp N #People 3 #Bedrooms 14 #Baths 3 Dishwasher: Garbage Disposal: Er`�'Washing Machine: ❑"'- Basement w/Plumbing: C2"--Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Sizes.11015 Type Water Supply /] Design Wastewater Flow(GPD) —1 W Site: New e Repair❑ System Specifications: Tank Size 1000 GAL. Pump Tank GAL. Trench Width.�(o Rock Depth IZ Linear Ft. 4> Other: 4 d►5fQf3JTt©•JE:�c.;.S, Required Site Modifications/Conditions: (N�Ti�ll o,J C�.SiW 2, 1C�P L j► Co- l��g�,• �Q I«D'rP.a.,,.- 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 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.**** 00_ o� i o�o� u►J Fccst _ CAL— uAes U n1 130'WN; K 12-!' �a ti:3 - t oto'�'.�o� �`12'► #u - I q=-I) V-3UI �Q2" Environmental Health Sp cialist's Signature: Date: 1 p DCHD 05/99(Revised) 7 1 O I Zl l0 I - POP'f (IC00 JF1 C=� ?1-Z4A I•Sb q&O—Si DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001267 Tax PIN/EH#: 5769-03-6784 Billed To: Robert Coil Subdivision Info: Reference Name: Robert Coil Location/Address: Milling Road-27028 Proposed Facility: Residence Property Size: 50 Acres ATC Number: 2742 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 buildin rmit(s)(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Trea ent and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA NST IS V LID PERIOD OF IVE YEARS. Environmental Health Specialist's Signature. D 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. v ZSfutSlf go�c 3 41z P ark � JSP L•..k.. F�CI-n R3 ^� ST DhtC "7 Zl Septicystem nstalled By: P r DATE `I-Z(-o Environmental Health Specialist's Signature: Date: 1 DCHD 05/99(Revised) APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&AT D Q W Davie County Health Department Environmental Heaft Section FEB — 7 2001 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ENV!RONi."ENTALHEALTH (336)751-8760 DAVIE COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to )the INFORMATION BULLETIN for instructions. 1. Name to be Billed �o ,�,{wf E �i / Contact Person Mailing Address N. Home Phone City/State/ZIP /p' L Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/state/Zip it 3. Application For: ❑ Site Evaluation iJ Improvement Permit/ATC ❑ Both 4. System to Service: XHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other ,, 3 5. If Residence: # People �_ # Bedrooms �! # Bathrooms �Y dishwasher M Garbage Disposal p-11isshing Machine P-lBasement/Plumbing ❑ 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 ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes -kilo - if yes,what type? ***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 1rt /j WRITE DIRECTIONS(from Mocksville)to PROPERTY: i Sfo i Tax Office PIN: # _� T /� c,✓ i� �o r C--, Property Address: Road Name 2 •6_6e 41"d rKs fu• - t ✓'iv 1 .4b City/zi&�_4y"'X ac , • t ,; n-d Y j/ l If in a Subdivision provide information,as follows: �e_ & I21A Name: tit y Jriyle U�—J � /. f�e� �A / C Section: Block: Lot: a PropertyFlagg rty 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 am responsible for all charges incurred from 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 ownedy to conduct all testing procedures as necessary to determine the site suitab' DATE 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). 3,' ):>P` I S Site Revisit Charge ff � 1 -J � ��v�� Date(s): �C3� � -3_ U Client Notification Date: EHS: V` 1 oy Account No. � 41:► !' v Revised DCHD(07/99) , Invoice No. y +! Davie County Neal th Department Environmental Nealth Section PO Box 848/210 Hospital Street Mocksville,ITC 27028 Phone: (336)751-8760 July 7, 2000 Mr. Robert Coil 2160B Country Club Road Winston-Salem,NC 27104 Re: Site Evaluation- 50 Acre Tract/Milling Road Tax PIN#: 5769-03-6784 Dear Mr. Coil: As requested, a representative from this office visited the above site on July 3, 2000. 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. Due to heavy woods and some complex and steep topography in the area around the proposed house, I was unable to make a determination for the location of the septic system. Please have all preliminary grading and clearing done prior to making a request for the permit. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct,the appropriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, you may contact our office at (336)751-8760. Sincerely, Jeff G. Beauchamp,R.S. Environmental Health Section enc(s) _ APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC - 00 Davie County Health Department Envfmnmenfa/Havith SeWonP.O. Box 848/210 Hospital Street 3 2000 Moakaville, NC 27028(336)731-8760 TAL HEALTH ***XfIPCRTANT*** THIS APPLICATION CANNOT BE PR4CV5SVD UNLESS ALL THCUQillfit�- 1. 0, 11 INFORMATION IS P/R�aNID1ED� Refer to the INFORMATION BULLETIN for �in)struan0knn Now to be Billed 1"� aLe r �• Cz I � Contact Parson )'SODe-0--7- F len) ' Mailing Address 21 GO a �Lwfrw C2114 Bone phone `33 6 - 7 7,314 City/state/BIP inf,Iyslkfs — S<< tt-.l. N 71 es Business, phone 3 3 _ ?2 --//9 7 2. Name on Perait/ATC if Different than Above Mailing Address City/stats/Zip s. Application ror: ❑ Site evaluation ❑ Improvement Permit/ATC Both a. system to services U-louse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other •••• s. If Residence: # People # Bedrooms # Bathrooms &Dishwasher B sarbage Disposal t3"Viashing Machine B'Baseaent/Pluabing ❑ Bassmant/No Plumbing 6. if Business/Industry/Othart Specify type # people # Sinks # Commodes # Showers # Urinals # Water Coolers Ir VOODSERVICE: I( Seats Estimated hater Usage (gallons par day) 7. Type of water supply: ❑ County/City 0-ie—ll ❑ Community e. Do you anticipate additions or expansions of the facility this system Is intended to serve? ❑Yes R-No If 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 TIIIS APPLICATION. Property Dimensions: / i WRITE DIRECTIONS(from Mocksvllle)to PROPERTY: Tax Office PIN: # . 719- 03—�i 7��q � r• )t Property Address: Road Name r( l �.L� ,a. d City/Zip /y1Ec �i�. �•; fit/,/ �7� D' e If in a Subdivision provide information,as follows: -rA C LJ Name: 410 �6� r/ Section: Block: Lot: Date Property Flagged: ele"-fy -,eOLf This is to certify that the Information provided Is correct to the beat 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 am responsible for all charges Incurred from this application. I,hereby,give consent to the Authorized Representative of the Davie County Health De artment to enter upon above described property located in Davie County and owned by rZy tyl-' to conduct all testing procedures as necessary to determine the site suitability DATE SIGNATURE TRIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed pro rty lines and dimensions, structures, setbacks, and septic locations). � Site Revisit Charge r Client Notification Date: EIIS: Account No. Revised DCHD(07/99) Invoice No. '�9 * A � 4.� N � �d��•� �� aA 1691 , �g�dK10 ^g :rel f # t 3 r, •gA 'SAM . .F v�4 SHOT « 1) �jSH '4 }.� t� ,g• i r( •yg• Y,. a`,tS�,�+«�K R�yj� ` ��y+ '� i FIOk 41 J, tOil's ,)xk �" cW MA, rig+ #np ra �43.`�' gz cy par r gq.r' `S �' + A S O E 7 k�� *'3L�, # `'v ',+ §4+f7�,` ,' ', a:� Y 7" i el ry �q c b1 "«5 p i t N Y '. i r '�> Y � �`. 1 t4 {'•ao. � r. � '�' �4 6�,t F+� "`"'`'ADD '�1�1�\d Y�� $i �spa g� <{b.�;t} f �'(�j �-� �y �� "�re4,sh ON FV 0 -4111A�k.� «a.1'6F� � � ;�4« $��t 3.•�'tg�r' '� yk +�g�r+ ��Yi"r.- i+.� Y,r § M./K. 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'� $ p W Fq��.r8� L� � I K� � $k yr. « a aka! a' n 71 t " x 7 � F fier. d t "'i.} 4 y - /. y"r �¢ x(,i� c �4 � V tri (,t { 4 1'R�,g V � 6 7 3'A V'..40Q«I N1�.: !i'n•".`yzriYc''}y �:� Ra, 4A -�« GlV 1/ .;,. !/ Sfi'kA �a,'r�`5� �"' � �"r* z iu, �"��; - � t, ��.� �� °. �y,;ki `� � � �''':�r, ,� �-• t t �* t �` (#i ��+�a s�;�g � �,� �, t 'OV'OL 0£ ryr �' .r'� , '� « Cu� #�: s, a S� ,✓ �,'�.`� '� ��..� ��j s� � ,e ri~ i°i A k w � F{ �� t+ v,} ,.�, $ 3?AAA 7., F«? y r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001267 Tax PIN/EH#: 5769-03-6784 Billed To: Robert Coil Subdivision Info: Reference Name: Robert Coil Location/Address: Milling Road-27028 Proposed Facility: Residence Property Size: 50 Acres Date Evaluated: 8� Water Supply: On-Site Well Community Public Evaluation By: Auger Boring _� Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Sloe% / 0 76 O HORIZON I DEPTH G 0- CP 0- 14 (9 - 1, Texture — Texture rou :C--L- C11- Ct✓ - ConsistenceCr-1-5 (-rSSSP F` Structure Ck Mineralogy 1 1 1 -, I )•"/ 1 1 HORIZON II DEPTH (,— JIL , q- 12. Texture group C -Y Consistence Structure 5 -� Mineralogy1 : / Ml'`l I ,'I I HORIZON III DEPTH 1 7 1 2 2' 40 Texture group e-_;S'D 0 4, Consistence to S Structure Mineralogy HORIZON IV DEPTH 2,4 a04- Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION PISS LONG-TERM ACCEPTANCE RATEn SITE CLASSIFICATION: t� EVALUATION BY: d1 - ��0V,-0 , LONG-TERM ACCEPTANCE RATE: T7 .2 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) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■M■■I�■M■■MM■■■■■■■■■M■■■�t■■■■■■■■■■■MOM■■■ ■■■■■■■■■■■■■■■EM■■■■■■■■■■M�1■■■ ■■■■■■■■■■■■■■erg■■■■■■■■■■■■■■■■ ■■■■M■E■■■M■M■■M■■■■■■■■■M��ll■■■■■■■■■■■eEe■�I■■eau■■■■■M■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■E■■■■�::-._■■■■■■■�e■■■■■■■SIN■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■E■■■■■■■■■I�■■Ori■■■■■■■■■�■eeir■■■■■■■■■■■■■ ■■■■■■■■■NO■OO1\■■■■■■E■■■■■■■MOOO11■■■■■■■e■■■■■MITI■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■\■■■■■■■■■■■■■■■■■■X11■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■��\1��■■ ■■■N■NiiMEMINOMME■■■■ ME■■■■ MOMMEM ■■■■■■ME■■M■■■E■■�■■■■e■■■■■■■■■■■■Ill■■■■■■■■■■■■■■■■■n■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■irrill■■�■■■!1!�■■■■■■I■■■■�Y9■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■u■��■�■■■■pili■■��■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�I■\illi■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■EE■M■■■■E■■E■■M■■E■■■■■■eEM■■■■u■■■�■■MMM■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■r�■■■r.■■■■■MON■■■■■■■■■■■■■■■■M■■■■■ ■■■■■■■■■■■■■■■■■■■■�■■■■■■■■■1/■ r/■■■■■■■■■■■■■■■■■■■■■■■■■■■OMEN ■■■■O■■■■■■■■■■■■■■■■■■■■■■O■■u■�11■■■■■■■■■■■■■■■■■■■■■■■■■■■SEEN ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�■■■I■■■■■■■■■■■■■■■■■■■■■■■■■NON■■■■ Davie County Nealth Department Environmental Nealth Sectlon PO Box 848/210 Hospital street Mocksville,NC 27028 Phone: (336)751-8760 July 7, 2000 Mr. Robert Coil 2160B Country Club Road Winston-Salem,NC 27104 Re: Site Evaluation- 50 Acre Tract/Milling Road Tax PIN#: 5769-03-6784 Dear Mr. Coil: As requested, a representative from this office visited the above site on July 3, 2000. 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. Due to heavy woods and some complex and steep topography in the area around the proposed house, I was unable to make a determination for the location of the septic system Please have all preliminary grading and clearing done prior to making a request for the permit. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct,the appropriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions,you may contact our office at (336)751-8760. Z incerely, ?� Jeff G. Beauchamp, R.S. Environmental Health Section enc(s)