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174 Ridenhour Rd DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 .(336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002186 Tax PIN/EH M 5764045747 Billed To: Anthony Branecky Subdivision Info: Reference Name: Location/Address: Point Road-27028 Proposed Facility: Residence Property Size: see map ATC Number. 3089 **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 EIlyS'T4.2L�I1I Go SYSTEM. Residential Specification: Building Type N�l)st #People 2 #Bedrooms {{� ✓ 11 #Batths,7 Dishwasher: Garbage Disposal: G2( Washing Machine: Basement w/Plumbing: d Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ InL ' Lot Size 3S Type Water Supply O LI_ Design Wastewater Flow(GPD) Site: New Repair❑ '�y00 System Specifications: Tank Size 110 GAL. Pump Tank GAL. Trench Width Rock Depth I Z." Linear Ft. _ Other: 3 STQ t L)TtE^.I `S 4rJS IdLL la 'S o•C. K,'123- s N�C.IC� Required Site Modifications/Conditions: �'ZsT4t — vN C Es.J1 e. tLL ) S`(D4-f— t-� IMPROVEMENT/OPERATIPERMIT LAYO UT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NO ICE: Contact a representative of the Davie County Health Department for final inspection of this j system between 8:30 a.m.to 9:3 a.m.or 1:00 p.m.t 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.**** f 3 5Q '� •-� 2►oaa �2 Wtx7� �V IF O�aD �4 V 4s to X3(o x-I Z U,Si.S t N C�21)+-.� loot loo' Environmental Health Specialist's Signature: Date: �L 41ZI jvq DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Bog 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990002186 Tax PIN/EH#: 5764-04-5747 Billed To: Anthony Branecky Subdivision Info: Reference Name: Location/Address: Point Road-27028 Pro osed Facility: Residence Property Size: see map ATC Number: 3089 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 WASTE ERC CTION IS V LID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature Date: IV CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Co pl tion h 11 i d Cate the system described on Improvement/Operation Permit has been installed in compliance with le 1 G Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO W Y t e as a uarantee that the system will function satisfactorily for any given period of time. c 1dw ,s o —1 r -I .A PJ K 14VTe 31 Septic System Installed By: Environmental Health Specialist's Signature: Date: / DCHD 05/99(Revised) --Feb-250 3:26P davie county envhealth 336 '/t)1 tf/t!6 P.C: �h O APPLICATION FOR SITE EVAWATION/IMPROVEMENT PERMIT&ATC Davie County Health Department """--- D EavftamentalHealdrSection V C`V P.O. Box 848/210 Hospital Street N��ZN Mocksville, NC 27028 (336)751-8760 �\Ay\RI *** oRTANr*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDER. Refer to the INFORMATION BULLETIN for instructions. Name to be Billed: /IA Contact Person • "c Mailing Addzeas B.. Phones 7f oV /JV 1,r6 City/State/ZIP G 194-v1-7C �Z7-7 Business Phone 70, (p 7 / C 7.d f 0 2. Name on Perait/ATC if Different than]Above SA"I E" Mailing Address - - City/State/Zip Application For:' 13 Site Evaluation 0 Improvement Permit/ATC Z-Both -4.-1 'System to service rt7 House 0 Mobile Home ❑ Business [�0 Industry 0 Other S If Residence: I People a I Bedrooms I Bathrooms 3 ✓ '.I Dishwasher` f Cazbage Disposal 1 washing Machine II Baseaant/Pluitbinq ri Basement/No Plumbing 6. If Business/Industry/Other: city type ! people 1 Sinks 1 Commodes I Showers 1 Urinals / water Coolers IF FOODSERVICE: Seats Estimated Water Usage (gallons per day) of water supply:,;r. O'County/City „B well 0 Community s 'Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes �o If yes,what type? ***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERIff INFORMATION REQUESTED 7 ir BELOW. Either a PLAT or SITE PLAN MUST BESUBM1TlF.D by the c lent with THIS APPLICATION. C,_ ✓Property Dimensions:',,—�? oCJJt/X 9.54)X �RITL DIRECTIONS(from Mocksville)to PROPERTY: -,;-f ix Office PIN ' #IS 7t'. OV 574/7 `Property Address: Road NameF6 INT a �} City/zip8yleentee, :270)� ejJ �Poi-rr- i2d• 0.0 \ I If in a Subdivision provide information,as follows: (� ( St✓E �ESi� f 5 ) Name Section: Block: Lot: ate Property Flamed.-. , `�" 7-✓ Z�Z 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. 1,also,understand That I am responsible for all charges incurred from this application. 1,hereby,give consent to the Authorized Representative of the Davie County.Heallh Department to enter upon above described property located in Davie County and owned by to conduct all tteesstisl procedures as necessary to determine the site suitability 2N ZBit;NATURE THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN(Includ all of the following: :sting and proposed property lines and dimensions, structures, setbacks, and septic locations) Site Aevisit Charge Date(s): 2— Client Notification Date: ^� ^ 10 r EHS: \ / J i ( � Account No. \ Revised DCHD(07/99) Invoice No. _ , 2�s�t c cl -rj t 0600000068 1836 060000006901 0600000067 r S� VA �, 060000006 � NCO o 95 AC Davie County assumes no responsibility for the data contained in ot the accuracy of this map. t1` N700000005 N 0600000066 ALCOR LAN w E { S ' .400 0 400 Feet Davie County Tax Mapping 02/15/2002 18:00 3367510131 DE N P DEED '8DOrc 93 PAG�f)(4(/ l ' ht.e To WARRANTY DEED–Form WD402 Printed and for We by lames Williams h Co.,hit..YadkhivEls.N.C. ' STATE OF NORTH CAROLINA, Davle County. THIS DEED,Made this__1ltyof Atiguet ,1l-74_.byand betwes- Qtls Lis Wtlliame and wife Mary A Williams of Davie Cnunry and state e(Narth Caeollna.Mtelr,aho esEed Graeae.and C;anrgn 0-1rnrrian and }gifw natp=,pJ ' Tflrd'n•. Tarr? B DPrlrne%n anti Wife Margip w Dedmetri nt natr;e called Grantee. a Coenq,and Sure of North Carolina herebufur WITNESSETH:That the Grantor.for end Inconsideration,ofthesure of _#R*#### Wis. and other good and valuable eonaideratlonl to him la band paid by the Grentce,the recelpt whereof it hereby acknowledged.has given,granted,bargained,sold -and conveyed,and by these revocau don gine,grant,bargain,sell,canny and confirm onto the Grantee.his heirs and/or successors and assigns,premises in Jer}Lalem Township, Davie Commy,North Carolina,described as follows: First T BEGINNING at a point in-the center of the Point Road (S.R. 1822), mutual corner for Gladys Davis and Alcoa, and also the southwest corner of the within described tract; thence with the center of S.R. 1822 the following calla and distances:. North 35 I deg*. 43 min. West 267.10 feet; North 34 doge. 36,min. West 324.67 feet; North 26 deg. 34 min. West 100 feat; North 15 deg. 18 min. West 127.47 feet; North 32 deg. 56 min. + West 117.97 feet to a point in the center of said road at Its point of intersection with l farm road leading to Rldenhour property; thence with the center of said farm road the following call@ and distances: gouth 80 deg. 10 tn. net 11 .00 feet; Nort eg. Z I min. East 50.70 feet; North 6a`degs. 34 min. East 440.07 feet; North.49 degs. 30 min. East 280.85 feet; North 23 deg. 46 min. East 60.92 feet; North 7 deg@. 12 min. West 59.45 feet; North 15 deg. 04 min. West 128.95 feet; North 11 deg. 16 min. West 83.12 feet to an iron spike Otis W1111atne corner In Pearl Ridenhour line; -thence North 84 deg. j 16 min. 08 sec. East 1138.35 feet to an Iron and poplar; thence South 5 deg. 30 mina 37 sec. East 853.88 feet with Alcoa line to an Iron; thence South 79 deg. 59 min. 14 sec. West 1138.16 feet with Alcoa line to an Iron; thence South 1 deg. 16 min..08 sec. East 271.41 feet with Alcoa line to an Iron; thence South 48 degs. 49 min. 31 sec. West 444.•65 feet to the point and place of BEGINNING containing 35.31 acres, more or less, as our- veyed by M.A. Head L-1102, July. 1974, and being a portion of those lands described In Deed Book .93, at page 453, Davie Registry. } Secon BEGINNING at a point in the center of Point Road (S.R. 1822. mutt corner for Gladys iVI1 Alcoa and also the Southeast corner of theescribed tract; thence South 50 deg. 55 m n. c. West 486.92. feet adys Davie line to j an Iron; theAce North 2 deg. 20 min. 34 sec. 0 eek with Foster and Alcoa line to an iron pin In center of Point Road (S. 21; a a southern direction i with the center of said Point Road to th INT AND PLACE OF 331JING the following courses and dletancei 15 deg. 18 min. East 127.47 feet; Sou deg. 34 min. East 100 feet; Sou deg. 36 min. East 314.67 feet; South 35 deg. 43 m n.. East 267.10 feet to OINT AND PLACE OF BEGINNING containing 4.05 acres, more or le s.surveyed by M.A.Head. L-1102, July, 1974 and being a portlo(r of those Ian ascribed In .Decd Book 93.. page 453, Davie Registry. RT S 0 lip. N A OTA . , 8T8 e AR I I l; TA% 520.00 ': $1.00 50� _4, (Cantlnucd On Reveres side) DAVIE COUNTY HEALTH DEPARTMENT t , ' Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002186 Tax PIN/EH#: 5764045747 Billed To: Anthony Branecky Subdivision Info: Reference Name: Location/Address: Point Road-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: to _D_L Water Supply: -�bn-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 12 3 4 5 6 7 Landscape position L L Slope% HORIZON I DEPTH c7- (o O — o- Texture groupt— G t- SG Consistence SSS -c SS IS Structure CSL C'V- Mineralogy HORIZON II DEPTH Za (o- Texture group C_ G Consistence.. .5 P Structure S L S Mineralogyt; HORIZON III DEPTH Z - av Texture group Sc f s � G F_107 Consistence 55 A fr5f, Structure `50�-Gg 6k-62- Mineralogy,'.,. 62 Mineralo 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: C>. OTHER(S)PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope 1 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) ■■■■■■■■■■■■■■/■■■■■■■■■■■■■■■■■y■■■■■/�■El�lil,llr111fi17■■\■■iii■e■■■■■■ ■■■■ee■■eeeeeee■ee■ecce■■■■■■eeeee■■■■eeeeee�►•�e■eee■ee■eee�.-�e■■ ■■ee■■e/e■■s■■e■■eees■■■■ee■e■ecce■■ee■■■■eee■e■e■eeile■r>leeeeeee■e■ ■■■■■■e■ee■■■e/e■■■ee■ecce■e■e■■e■■■■■■e■e■■■■■e■■■eril■■■iee.e■e■■■■ ■■■■■■■■■■■■■■s■■ee■■■■■■■■■■es■■■■■a■■e■e■ee■■■■s■ells■ol■ess■■s■■■ ■■ee■e■eeee■e■ee■eeee■eeee■■/�■■ ■■eeeeeeeee■eeeeeelle■�■eee■■e■e■ ■/■/■■■/■■■■■■■e■■■ee■e■■■■ee■■■eee■■eeee■■■ee■ee■■eeseei■eeeeeee■■ ■■e■■■■■■e■■■■■■■■■■■e■ee■e■■■■■■■e■■ee■e■ee■ee■■eeeel�eelle■eeeeee■ ■■eeeee■■eee■e■■eeeee■e■■e■e■■■■ ■■■ee■e■e■ee■■■eeeeue■11■eee■■te■ ■/■■■■■■■■■e■■eee■■■■eee■e■eee■■eee■■■e■eeeeee■e■eesellee�ieee■eeee■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■e■■e■e■■■ee■ee■■■■■nee�leeeeeee■■ ■■/■ee■ee■■■e■■eeeeee■■ecce■■■/ee■■■■■■■■eeeeeeeeeeee■1■e�eeeeeeee■ ■■■■/■/■■■/■/■/■ee■e■e■e■■■■■■ecce■ee■■e■eee■e■e■eeeereee��eeeeeee■ iiiiiiiiiiiiii■■ii:iieiiiiiiiiiiiol�iiiiiiiiiiiiiie::e��■■■i■■■■■■■■■ --��■eine■■■■■■■ ■■■■■■■e■eee■■�le■i�:nlr.cr�ee■■■■e■■e■■■■ee■e■■■ee■■e■/■■��■■11■ee■■■e■ ■■■■■■■■■■■■■■r■■►rcyirsi■■■■■■■■■■e■■■■■■■■■/■a■e■e■e■i■e■Ile■■■e■■■ ■■/■■■ee■■e■e■�■/r�■/■ecce■■■■e■■e■■e■■/■/■a/■■e�======�■eerieeeeeee■ ■■■■■■■■■■■■■e■eeeee■■■eee■■eeeeeeee■■■■■■■■■■■ee■■eeellee�ee■■■ee■ ■■eee■■ee■■eee■■■■ee■ee■■ee■■ecce■■e■■e■e■e■e■eee■eeeerieeerlee■eee■ ■■eee■eeeeeeee■eee■■e■ee■■■■■■/■ ■■■/■eeeeeeeeeeeeeee�eee►�eeeeee■ ■/■■■■■■■■■■■■■eee■■eeelr■e■■■■/■ ■■■a■■■■■s■eeee■eeee■>t■e>,�eeeeee■ ■■■■■■■eeeeee■■■eee■■■■Ilea■■■■■■■■■■■eeeee■eeeee■eeeeeea■ee►ieeeee■ ■■■■■■■■■■■■■■s■■■■■■e■Ilea■■■■■■ee■■■■ee■■■ee■ee■eee■ee■►�ee��eee■e■ ■eeeeeeeeeeee■e■eweeee■Ile■■■■■■■■■e■■eee■eseeeee■eeeeeee\�ee■aee■e■ ■■■■■■■■■■■■■■■■/elr.+.Ree■rleee■e■■■■■■■■■■e■e■e■■■e■■e■e■■■■■■■►�■e■e■ MENNENsummon ®siiiiiiiiii IMMEWii ■■■■■■■■■■■■■■■■■■eee■■�■■■■■■■■■e■e��rse■e■e■e■■■■e■e■■■■■■�e■�■e■■ ■■ee■■■■e■■■■■■r!r■■■ee■■eee■■■■rlee■r�■eeeeeeeeeeeeeeeee■■■e■e■►�■■e ■■■■■■■ee■■ee■■■��/��C:.iiiiiiiiiiiiiiiiir7■■■■■■■■■■■■■■■■■■\■■■\e■ ■■■■■■■/ilte/■/■/■/■/Ile■■■//■/■/■/�■!t■■■■11■■■11■/■■■■e■///■■■■\�■■!•/■ ■■■■■■■\11!'1■■■■■■■■■11l1■■■■■■■■■■■ ■■■■■■11■.'!1®■■■■■■■■/■■■■■■■\■■■►\ ■■■■■■■■f e■eee■■■e■IIG�■\■■■■■■■■■■■■■■■■■11l��IJ■■■■■■■/�/�:iiifir■\1■■■\ ■/■■■■/■■eeeee■■■■e■le■■■eee/ee■eeeee■■e�u��:��:::�:iieee■■ee■■�/■ ■■eeeeeeeee■■■■e■■■C1l��lee■■■■■■eee■■■/■■►it�!�■■■■■■■■■■■■■■■■■■■■\■ ■/■■ee■eeeeeeeeeee/e■ell■■■■■■e■■ ■■e■■ee■i■��tseeeeeeeeeeeeeeeee\�■ ■■■■■■eee■■eeeee■■e■leeeeeeeeeeeeee■■■■■■eeeeeeeee■■ecce■■e■eeeeeea ■■eeeee■■■■eeeeeee■■leeeeeeeeeeeeee■■e��■eeeeeeea.■eeeeeeeeeeeeeeeee■ ■■■■ecce■e■eee■■e■e■I■r�:e■■■■■■■■■■e■■■eeeee■■er�eeeeeeee■■■■■■■■■■■ ■■■■■■ee■■■ecce■■■/■I■e■e■■■■■■■■�ie■a■■■■■■■■r�■1■e■e■e■eee■e■■■■■■■ ■■■■■■■■■/■■■■■/■■/■le■■e■e■ee■e■e■■■■■e■■■■■e■Ir■e■eeeeeeeeeeeeee■■ ■■■■■■■■■e■ecce■■ee■lee■■■e■e■■e■■■■■■■■■■■■■■L'e■■■e■■■■■■■■■■■■■■■ ■■eeeeeeeee■a■■eee■■eeeee■■ee■■eee■■eeeeeee■eeeeeeeeeeeeeeeeeeee■■ ■■■■■■■■■■■n■■■■■■■■glee■■■■■■■■■�■■■■■■■■■■■■■■■s■■e■eee■ee■eee■■ ■■■■■e■e■e��■■■■■e■�•�■I!ece■■■■■■■ ■■eeeeeee■■eeeeeeeeeeeeeeeeeeee■ ■■rl■■e■■neeeee■■ee■r�■eerie■e■e■■■■■■e■e■■■■■ee■■e■■■■■■■■■■■■e■■■■■ ■■■■■■■■u.�■■■■■■■■■eee■e■e■e■■�■ee■■■■e■■e■ee■e■■■e■e■eeee■ee■eee■ ■■■//■■e��aeeeeeeeeeeeeeeeeeeee►elle■eee■■■ee■■ell■eeeeeeeeeeeee■/■■■ ■■■■■■e■�■■■■■■■■■■■■■■■■■■■■■■all■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■ ■■■■■■■■■■■■■/■■■s■eeeee■■■■■■■1■aleeee■■e■e■■■■e■e■e■■eeeeeee■■■■e■ ■ecce■■eeeeeeeeeeeelleeeeeeeeeee��eeeeeeeeeeee■■eee■eeee/■■eeeeeee■ ■■■■■ee■■e■e■■■■e�ell■■■■■e■■■■e■ ■■■■■e■■■■■■■■■■■■e■ee■■■■e■■■e■ ■ee■■ee■■■e■■e■■e■►��le■e■ecce■■■■�iee■■eee■eee■eeeeeeeeeeeeeeee/ee■ ■■■eee/eee■e■e■■■■■��e■■■eee■■■e■eee■■■■■e■■e■■e/ee■■■■ee■e■e■e■■■ I)PO"2u- J,4 $7&-IPnc. 73 �S •�Dios�-y, �'v �j 2�Ic/E� i �� , • • • •