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222 Springhill Dr DAVIE COUNTY HEALTH DEPARTMENT n��-2��p_ �.v� A ' -- r' Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000860 Tax PIN/EH#: 5745-37-3926 Billed To: Gregory Minor Subdivision Info: Reference Name: Gregory Minor Location/Address: Spring Hill Drive-27014 Proposed Facility: Residence Property Size: 150 X 125 ATC Number: 2257 **NOTE** This ImprovemendOperation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALTTHORIZATION 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 Tf�INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type � #People f #Bedrooms � #Baths_ �Z Dishwasher: � Garbage Disposal: ❑ Washing Machine: � Basement w/Plumbing: � BasementJNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size /_S�X/�S� Type Water Supply�_ Design Wastewater Flow(GPD)�3Z Site: New�Repair� � System Specifications: Tank Size ��GAL. Pump Tank GAL. Trench Width���Rock Depth� Linear Ft�G`v Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 u BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 830 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.**** l� f Environmental Health Specialist's Signature: �- �, Date: �1��i�/ DCHD OS/99(Revised) t _ � P .� . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section r.o.Bog s4snio x�p�t��sr��t Mocksville,NC 27028 (336)751-8760 AccouM #: 990000860 Tax PIN/EH#: 5745-87-3926 Bilied To: Gregory Minor Subdivision Info: Reference Name: Gregory Minor Location/Address: Spring Hiil Drive-27014 Proposed Facility: Residence Property Size: 150 X 125 ATC Number: 2257 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his Authorization for Wastewater System Construction MLTST 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 WASTEWA R CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: �l � Date: �l��4 '"�% CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis 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. 1�0�6 F��r �_ v I1p�_ p� 9�-,� �,� ��<< ��� G� Septic System Installed By: �. � Environmental Health Specialist's Signature: Date: 3 DCHD OS/99(Revised) APPUCATION FOR SITE EVALUATION/IMPROVEMEM PEHMR&ATC O � � � 0 d [� . • ._ , � Oavle County Hesith Oepartment Environmenis/Hea/th Se+cdon �.o. Bo: 848/210 8ospital Strset NOV ( p 1999 . Mocl�avills, NC 27028 � • (336)781-8760 � • ENVIROAN�MENTAL NEALTH ***?D�ORTANT�'�* T�I$ ]�PM.ICATI0T1 G71pN01' S� PROC688�D UNL�88 ALI+ T� t�iS�01t�91T=ON t8 PRGV=DED. ttiler to th� IN8'O1tMATION 80I►L�T2li for isistruations. ' i, �. tio b. asu.d o ' ' 0 2 co�t.ot r.=.o� __G2� 2�/ I�� ; �+02 K.sis� �... L c ao.. �oa� �v4 =�,l,S�-9 5�f y " ��r/at.�t..�asp ���,�Q n T_.� � �fs o 2 5 swsa... ��. _ 7(��(- 9 07- �'a 6� 4. Maa. on p.z�i.t/J►rc it aslr.s�.nb lbaa ]►bo.. Nsilieiq 71d�dr��• CitY/etat,�/iiP . a. �►ppiiaatioa gor: �t.� E�ralnatioa 0 Zmprov�msat p�rmit/Ils'C �Both �. sY.t.. to s.rvsa.� Gl�ious� O Mobile 8om� 0 8usin�sa O tadustsy 0 Oth�= a. _� ttesidu�a�: t psopio �_ � Badrooms �_ � Sathrooms �Di�hxaab�s �iasbaq� Di�potal O�aihis�q ltaohia� 0 sas�at/pluabinQ 0 Daa�n!/�to plm�biaq 6. i! swia���/Zndu�tsy/Oth�rs Bp�ai�Y t7tP� � �opl� + 81nka � com.oa.. � ehow.r. i vriaal� i 1�,at�r cool.z. ta a'OOD8ERV=C3: � S�ats =atimat�d Nat�r tJaaq� to�l� r� �r1 �. T�rp. cr nat.r .upplp: e�co,�ty/raty o xal a commuaity e. Do you�nHcipate sddiHona or eipansione of the faeWty this ayatem Is intended to�erveT 0 Yea p,A16 If yea,w6st type? . ***IMPORTAN7w**CLIENTS Ml/ST GbMPLETETHE REQUIRED PROPERTY INFORMATION REQUEStED BELOR+. Etther s PI.AT or S1TE PI.AN Mi/ST BES(18bIITTED by We elient tvtth THIS APPI.ICATION. Property Dimenslons: I�U K_� Z S R+RI'TE DIRECfION3(iram Mockaville)to PROPERTY: T�i 081ce PIN: # `7'?4�� _'�7 �- �9� 6 O � O , a� rf�I Property Address: Road Name �PfiLiN(r N:�� (Zi�e o ( � ` t � ' ' � � City/Zip�o�lPenne�. NC �'1�(4 If ln�Subdtviaion provtde intormsdon,aa follmve: : Name: � r= Secdons Block:� Loh � DAte ProPerty'Fl��ait ��/G-q q T6is is to certify t6at t6e informaHon provided is correct to the best of my knawledga I anderabnd thet�ny permit(e) iasned hereaRer sre anbjat to easpeneton or revocation,if t6e eite plans or inhnded ae�c6enee,or if the iniormaHon aabmltted in this spplicaHon W faleifled or ch�n�ed. I,also,anderstand tA�at I ani rGsponslble jor all charg�t lncamd jrone tbls appilcadox. I,6ereby,giva eouaent to t6e Aathorhed Repneenbtfv�of t6e Davie Coanty H W Dep�rtment to enter npon above deacribed prnperty lacated in Davie Coanty aad awned by '7v u[- lal.. :n�f� to coadact ali tesHng procedura na neceas�ry to deternilue the�ite�aihbW DATE I 1- �'D�^ q�l SIGNATURE THIS AREA MAY BE U3ED FOR DRAWQiG YOUR S1TL PLAN(Inclnde�il ot t6e follo�vring: F�isting snd proposed property linea snd dimenelons, etractarea, eetbacka, and eeptle IocsHons� Site Revbtt Charge Date(a): Client NoHBa�Hon Date: � EHS: Acconnt Na ��O v Revi�ed DCHD(07/99) ;, Involce Na ��� . — "I. C. RAY CATES certlty that on__ Jlll Y 2 , 19��, I surveyed the property shown on thfs plat; that the property line� and location ot all structures are accucately shown hereon; that no structure located on thls property encroaches on any adJacent street or property, and that no structure on adiecent property enc�����Mt��e premises .� RO •, surveyed." AUGUST �$. 1995 (inter�or IOi lines) .�� �N Ca' ( '� I I .` Q` ,......,,� ��•�� � I ��e ��ST�q�.,y : . I . . I I I I I I • + I . A�,. : o \: L_ + 92 I '�I 50 a9 48 I 47 I 4 6 I 4�S 44 4 3 4 2 4I ; O �,� • � � ��� I � ,I I I ''�o� �''S av;�� •�'�� ° qA C p• � •• Q• I I S 41°- IB W � � I I � s�e��� ��N��� � � ;�ound 149. 19� �' 21.5' 19' uon asph. ,Z. tound Q�� w ' �� I "6, ao 0.256 ACRE I M � -� N � 'M 40 ti �. I � � � _ I -ro,a� iso. is' � N` no�� oi � �� I ,fround I S 41°-23�- 40 � W ' ent �ron tound�ronN�oc�ed43 -15 E Q.' — — — — 99.20 — — 38. , I �0.84 ploced � I I � ���k +� w a�o� I — � 39 '� w I 3 i 3 z , ' � m 0.205 ACRE -,� � � I � � � M � � 27 28 29 3 0 TOtal � t c� � Q I I 1.7 5 AC E� y d. m.d.) I ' �ron N 40°-52�E 125.00� w a�� J � I '0 ---� 0. Qa0 AC�RF_ i � I 25 placed I�b� .. . . plo�eed J � I , ! � o i 3 I I ln �- --- - - - - - - , _I t � =O i c/� � qro e� O� 404 IACRE N � , I , � (> � � -- � - - - - - - - -_ , - -N z \� tonC paho �, � � � N ..� � � , , 1 � W I , � � , �� r � 33� 3 4 35 36 I 37 38 � I 'N � � I I � - I O � I� i "tn _ N 22.2' _ 58.4' Q1 �� � � �. _ � � � , I N NI slory bnck � I N � I Q Z I N � o� � c�D 21.5' � ' � I O — I I I ' I � I � I I � , 1 � �, � � , � � � � � � � � i . � � , � I i ron I 0.17 � � �QQ I no�l ot lound - P'P' _ � �ov rheod p wcr i� e I P. P. be iron und c N 40°- 52 E� '� pioced 250. 17 ° � EDGEWOOD CIRCLE DRIVE S. R. I I 32 N y� 0 PROPERTY OF �, `; . . PATRICK MORRISON PARCC� 3 DAVIE COUNTY TAX MAP M-5- 10 B LOT NO. 2g ihru 40 MAP OF REVISED MAP OF C�GCW000 DEVBLOCK NO. B DEEO DOOK 169 PAGE 668 JERUSALEM TOWNSHIP, PLAT BOOK � PACiE 3U DA V I E COUNTY, N. C. sCAL[: 1 INCH= 50 FtlT . __ .._ 3065-B-29 . � � .. - DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section Soi]JSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Accounf #: 990000860 Tax PIN/EH#: 5745-37-3926 Billed To: Gregory Minor Subdivision Infa Reference Name: Gregory Minor Location/Address: Spring Hill Drive-27014 Proposed Facility: Residence Property.Size: 150X 125 Date Evaluated: /1��7/�� Water Supply: On-Site Well Community Public �/ Evaluation By: Auger Boring � Pit Cut FACTORS 1 - 2 3 4 5 6 7 Landsca osition Slo e% .L ` HORIZON I DEPTH ' Texture rou ' Consistence Structure Mineralo HORIZON II DEPTH . (� '' 6 � Texture rou L Consistence � i Structure �C f Mineralo � HORIZON III DEPTH � � � � - � ' Texture rou Consistence Structure Mineralo • HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON � SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE L � SITE CLASSIFICATION: � EVALUATION BY: �l� LONG-TERM ACCEPTANCE RATE: � '/ 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 Mois 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 tructure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineraloev 1:1,2:1,Mixed otes : 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 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