470 Vanzant Rd � 4
° ' V. DAVIE COUNTY HEALTH DEPARTMENT ,�. �
�.� Environmental Health Section i'L Zv'�
P.O.Boa 848/210 Hospital Street "1�
Mocksville,NC 27028
(33G)751-87G0
Account #: 989900063 Tax PIN/EH#: 5709-92-0066
Bilied To: Larry McDaniel Subdivision Info: �,��
Reference Name: N��►c�c-�t�nrniN� Location/Address: Vanzant Road-27028
ATC Number: 4299
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSLJED by the Davie County Environmental
Health Section prior to issuance of any buitding permit(s). T'his 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.19 0 Sewage Tr tment and Disposal Systems). THIS
AUTHORIZATION FOR WAST TIO IS ALI FO PERIOD OF FIVE YEARS.
Environmental Health SpecialisYs Signatur • Date: �
As stated in 15A NCAC
ms may a so uso
CERTIFICATE OF COMPLETION
**NOTE** The issuance ofthis Certificate ofCompletion 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 oftime. �s�
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Septic System Installed By: �Y�O�.r� 'MC.(��,v���.�
Environmental Health Specialist's Signature: A Date: l -- �/-��
�
DCHD OS/99(Revised)
• � DAVIE COUNTY HEALTH DEPARTMENT
' __,� Environmental Health Section
' ' ' , P.O.Boz 848/210 Hospital Street
� Mocksville,NC 27028 � `,,�j o�
(33G)751-8760 v �
�I
IMPROVEMENT/OPERATION PERMIT
Account #: 989900063 Tax PIN/EH#: 5709-92-0066
Billed To: Larry McDaniel Subdivision Info:
Reference Name: M►►cEG,lnnn���65 Location/Address: Vanzant Road-27028
Proposed Facility: Residence Property Size: 6 Acers
**NO"1'E�*�is�lmpro4emn t/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater
system. An AUTHOWZATION 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 �(��� #People � #Bedrooms�_ #Baths Z
Dishwasher: � Garbage Disposal: � Washing Machine: � Basement w/Plumbing: � BasementlNo Plumbing: �
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 0
Lot Size��c� a�'=5 Type Water Supply 1.0��1T� Design Wastewater Flow(GPD) ��'� Site: New�Repair❑
r
System Specifications: Tank Size��� GAL. Pump Tank GAL. Trench Width�_ Rock Depth N Ea Linear Ft.��
Other: ���Ic�1�l Bl7Tlo.� �jXES � �lJ=i I�=-���� ��t?C.'no��.���--
�e � '
Required S'fte R7lotiific�ti�n�3��i��'����.l. C�r.� �J'�0��. �p ��� �� �CL�,J j_ j �Ea.c.
•,v:;�.:.rns b
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11�1PROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF 6"BELOW
FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis
s�tem 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(33G)751-87G0.****
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Environmental Health Specialist's Signature: Date:
DCHD OS/99(Revised)
-Feb 04 OS 1Q:03a davie count� envhealth 336 ?51 � � � }� n� �
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� JA N 3 200a
� APPUC��T►ON FOR S1T[EVALuaT10N/In1PROVEhfENT PERh11T&A C
Davia County Heaith DQparUnent
Environmenta/Hea/thSectron ENUIRQNA-TEfd7F,L HE�ILTH
a.o. sox eas/zio xospitai srx�ot DAVIECOUfJTY
Mockaville, NC 27028 O ��: �C
(336)752-8760 J
ii*ZMPD&TANT**� THIS APS'LICATION CIWNOT BE pROCfiSSED IINLESS AI.L TSE REQIIIREL
INFORMATION x5 PROVIDED. Rnfer t0 the zNFORbtATION IIUZLETZN for inetructiona.
vY. S7uso Co bo 8111od !��—lJW 11� �`""�� Contact Peraon �
� �'Mailing Addroee � . ��� Some YAona
�City/State/ZIP� IJLS ��..J� ! �� o� llX�ic Hueinesa FAoas ��I' /lJ�� �
./J. Ham� au Parmit/71TC i! Dil;arort t2�an Above
� ✓Ms�11ag IWdroOa C14y/sCaca/'Liy
�7• a➢Dlica[ion Foz: ❑ Sito Evaluutioa �Improvement Permit/ATC ❑ Both
c�t. sy.eam ro s.rvsco� �Houae ❑ Mobile Iiome ❑ Bueiness ❑ Induatry CJ OChar
5. Typa syntem raquastad� �Conv::ntional � convantioasl modilSed ❑ lnnovativa
, �e. Zt Rosideacas M People 1 Y Badrooma _,,�_ A BaChroom8 _�___
,/ �pishraatwr �ubaqe Diaposal �1Pa9hlnfl Mact�,tna �Baaemeae/rlucnbiag QEasem.ne/tto plwoblag
7. It Durineso/Induatry %Other: ��•artty typa 14 Daoplo M aiok�
i Comowdaa i Shawara t Urinala 1 N�Cet Cooiera �
I! 800DSS8VICE: # Saata __ Botimatod Watar Vnagu (gallonu pur d►y)'
�Y. �po ot ratrr suyply� Couat;��/City . ❑ Wall CJ Community
�s. Do you aneicipats aaaseto;,■ or eYpansions of t6e Cacllity U�is systciu is iatc��dcd to scrvc?O Ycs �No
If ycs,�vliat typc? ,
+�'!A!P A'USTCOAIPLBTBTIIG REQUIRED 1BOPCRT'Y INNORhIATlO1V REQUCSTC➢
UELO'�EttUcr a P��n E f'LAN AfUSTQESUDAf/7'7'ED by tGe cUeat with T}IIS APPLiCATION.
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� ro crt�Dinuns(ons: ��L72S -e"V�I'��I 2ITE DlR�:CPIONS(from dlucksvWc)lu NROPERTY:
✓ �
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✓Property Addresr: Road Namc �� ��` � S �1 L'�
,_ � C,�q�,P r.��-���'�c.� c� -. �a �-��� �e�'-�
p a Su ' ision proriJc IofornuGun,as foUows: ��� �� �� �� /C�C�� ���f rJ�y
G�# r,l�t�vje IS
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cction: Block: Lot: vH3ra komc wrncrs Aa�cd: � rn�� �
Tlais ts to cCr(ffy tuat the informafion provided is correM!o tde best ot n�y kno�rlalga I aaJentaud tl,at auy pernut(s)
����
issucri lurca[ler are subjcct W suspcsuion ar�cvacaUm�,if Uu site plans or intcudcd usc cLan�q or iC tLc IuformaUa�
submiLtcd In tLis application is falsiQcd oc r•hapgcJ. l,also,arrdcrstuird J/taf t aui rcanousiGle jur a!!cJ�ar�es i�rc�rrrad jran
(his appltcarfou. I,hcrcb}',glvC conscut tu L iC Authorized Represcnlativc of tl�c Davic Cauuty Ilealt6 Departmcnt -
co Gncr upai�bovc Ocscribed property locatcd ln Davic County anJ oti�•ned by
to couduct�A tcsifug procedures•rs ucccssa_-y ta detcrmtuc tlic silc suilabil! •.
✓Tk / �� �,�(''� �^ �SIGNATUIt� 1� f
TIiIS AR�A MAY BE USL�D FOR DRAWING YOUR SITE PI�AN1(L�dnd of thc faIIutiving: Ezlsting and proposcJ
property lincs and dlmcnsions,structures, :�etbackt, and scptic locations).
. Sitc Rcruit Cl�argc
Datc(s): �
Clicnt NoUficution Datc:�_
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NCTE.
This property is subject to of!easements, right-of--ways. Coloholn Rd Rfs4 Wier,0d s.
SR 1313 SR 1307
streets and oeasserrtents, i1 any, as the some may appear or '
record in the Wttoe of the Register of Deeds, Clark of Court, i
�ROF'GRTY LINE CALL Tai?` Town or County Tax Office or which may have been acquired by
�Sl' St Fr ARINv i3{$"ANr i prescriptive use. This survey is subject to any facts that may
i be d ectosed by a full and accurate title search, NOT furnished Sip
' S
.390'13";9"W 30.0
49026"10"W 6.2�,, 'I as of this date.
-No mo or drawingand an occ r
documents are furnished to the person(s) non-ad
•_- ', ti 48`1 Ta "Wt' 74.41' � y `�° �`�
-4 N 45°`8'43"W 69.14` thereon and no attarotio is or use by Others
5 N 43°34'41"W!' 30.fiC` ! is permMed unfesy authorized by Stone Land Surverirg Cc,
Certified copies of this survey map will not be issued
_-+i N 42°i`1'55"W,! 25.1 Z' t>e}ured ninety(90) days of the original svrvsy data. C},, -• rt'!
ti :38°44'06"W 49.1()`
8 111 31 a()C'10''W 48.34'
-9 N 22°41'36"W 4.5.i 4' Map not fur recontatior•. *1
- i, ti 1 0-3. , r
i 7 I. 25'Wr 61.04'
Prscision • !0.000+
N 12026'08"W' 48.:��•'
-12 N :'9°44'20"W` ± 3 00,
Not to Scale
-- ;' ri •�4'Ci;'13''W 4 .,);�` Vicinity Map ( )
,__ 1 d "- t�0°79'08"W 30.40' •
RB`4022"L 29.93'
n S 83°40'22"e. 7£s6.84'
250 5C' y�
87°5$ 46'W Y46_K'
9 15 .:39°1 w.'t 9 1W 295.61' d1 Tract 9
Rober+ Craig Levan Estate
# FB 8 O RG 106
L tir 'ASL TAB
jiJ i-tARIN v S:--Ati r
-1 N 39'30'50"[. 30.1 ; !
.i tV 82015 52"{
-_
L-16— ._..__
A 3 Plot Cal! - __ _ ___.— ___-_ _�-- Pi. N
at Corner
/L,: E;RFn4 4
Tract 9
r �- Robert Craig Levan Estate
i
FRAC-T P8 8 O PG 106
''ROBERT CRAIG LEVAN ESTATE"
i PS 8 @ PG 106
° f I r; 0.^.O Acre- +; per F'r u. U t 1;)6
r � �
j � � �_ � &..�,� � ' '"�• Q� -fir - - _
Van'
z an'
t't Rd � Plot Call
4-- N Piot Corner
►J R 115�G Plat
o a Corner
j 60' Public R/W 20'+/- Pavement \ \ `, Al
\ o
' ` n Denotes NMP O CL+/--- of S.R: 1152
Prop ouse Si
\ --20 Zonir,
/ ♦ t / Tax Lot 25
�/ ♦ ` Tax Map 1-2
_, ♦ ` ` ` n/f Charles R. Lee, Jr.
DB 110 O PG 1 •X.�
i
co
00
o \ ¢ .
\ I,
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3
R%N - Right-of-way IFJG<c�iD FL' - face of Curb ��
EIP - Existing Iron Pipe eoc - Bock of Curti i, Robert�»,���L Site Plan for:
EIR - Existing Iron Retmr PP - Power Pole George Survyor.L--31412,certify to one
\
P - Post Lf' - Light POI• of the/Wbwirp a.indooted thus. f[�I or C�: \ r •
CM -- Property
Monument MH - Mon Hof a, That m@ f a Mao�that f "Wrt a e,ran on°n o/ane cuts in L a MeD ar�Ve 1 Builders
IRS P = Iron Rsbor Set CH - Chord Distance the ono of a %�s�yo� /
F/L - Property lJne P/0 - Part of 3 °°"n!y or rratNplpo�ty stat hw on oMhono•recut f , ti7/
C/A - Controlled Access DB - Desd Book nqukRee parcels a rorw; /
C Concrete, Pipe PS - Plot Book
CMP - Corru tad Metal Pipe Re - Record Book C1 b. That this plat M a o Mat is located in eUah portion of a
CPP-Corrugated Plastic Pips PG - Pa county or munddpMity that is u
• (Michael Cuznmtir�,q►s Sits)
qs rMyQWOtnd M to an Wdlrtanl.`e /
G- i 00 Year flood Boundary CB - Catch Bohr that nqulohs poroeM of tu+d; Tract
lt � 44:-
.-X- A�•-
-O- Ovsftteod Utilities -S- Sewer Lute rFx
rnd Fence wM - water Mete c. That this plot a of o survey of 0n existing parch or parosy `,,
CARO "ROBERT CRAIG LEVAN ESTATE"
n/f - Found BM - water-vat"Mar of kew / I`
n/f - Now or Fam,.rty BM - Bench Mork Plot Book 8 O Page 106
catego
r rp
NMP - Nonrnonumentsd Point RRS - Temporary Bench Maris d That thio plot Is a a survey a Prather rt-ordry,such ey the :�D�F.SS/p' • 6.000 Acres +/— per PB $ ms's 106 {
TBM
CL - Canter Line RRS - Roil Rood i pike rseo ti n to t e exletfno por sutm a crour!-ordand survey or other 1 �N s
EP - Edge of Pavement CN - Cabin Television Pedestal suaePMon to the defkitlan a subdlviwa+; +Q � �
'P -- telephone Pedestal Ere - Electric Transformer Box I declare that On V u 20 SEAL
-W- water Line CO - Sanitary Sewer Clean Out ❑ a. That the M/ennMian orafdsbie to little surveyor is such that I am
J unowe to make a detem+Wft to the bad of my professional ' 1" = 40' Colahaln Davie North CarofiW 12-'4-105
amts provisions contained In(a)vlrougt,(d above- Solid Lines Depict Surveyed Lines we surveyed the property shown on ,:•t„ L-3162 �i LU
this plot: t
`°�,•'zd su �•A' Stone Land Surveying Com
40 0 40 80 120 •`•'• SC, DB, DT Reb.rt suds, tis -stBSt
------i George R. Stone Gj
3 i 3 3 i i 3 i t i 1 i Broken Linea Depict Linea Computed from Deeds or Plots F Z '
GRAPHIC SCALE — FEET
Land surveyor, -31412 RQBER yilPPfp 113 Drum Lone Phone (3m) 9wr4T.3z
GRS Mocksvilie, N.C. 2 028
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
PO Box 848/210 Hospital Street
Mocksville, NC 27028
Phone: (336)751-8760 / Fax: (336)751-8786
January 11, 2006
Mike Cummings
C/O Larry McDaniel Builders
PO Box 577
Mocksville,NC 27028
Re: Site Evaluation-
6 Acre TracWanzant Rd.
Tax PIN#: 5709920066
Dear Client(s):
As requested, a representative from this office visited the above site January 9 and
10 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.
House location, size and other design criteria may necessitate the use of a pump
station and/or an alternative/innovative system. System design will be determined at the
time an Improvement Permit/Authorization to Construct is applied for and issued.
Due to an uncertainty of the house location and the possibility of the removal of
the power line right-of-way, I am going to delay issuing the Authorization to Construct.
Please contact me once those decisions are made.
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.
If you have any questions, feel free to contact this office at 751-8 0.
Sincerel
Jeff G. Beauchamp, R.S.
Environmental Health Section
Enc(s)