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116 Williams Rd (2) . , ' . � DAVIE COUNTY HEALTH DEPARTMENT / �(,�iCS • � Environmental Health Section � � /,��/I � � P.O.Boz 848/Z10 Hospital Street '� � � Mceksville,NC 27028 1 (336)751-8760 Account #: 990003531 Tax PIN/EH#: 5758-87-7210 Billed To: Bobby Winters Subdivision Info: Reference Name: Ronald Winters Location/Address: Williams Road-27028 Proposed Facility Residence Property Size: 3 acres ATC Number: 4069 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 building 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.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature:��b��,,/�� Date: j�� /3-�S� � �✓?1 d1'N�5 CERTIFICATE OF COMPLETION **NOTE** T'he issuance of this Certificate of Completion shall indicate tem described on ImprovemendOperation Permit has been installed in compliance with Article 11 of . . ha r 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be en a uarantee that the system will function satisfactorily for any given period of time. ��(y r�`� t9 �C � Septic System Installed By: fi(.� ��L° Environmental Health Specialist's Signature:� Date: ��'��Q (�tJ ,�-W.;:. DCHD OS/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT ,� ;� �-`J�'� � ' •e Environmental Health Section � �^ ; . P.O.Boz 848/210 Hospital Street 3 _�— g r 0 J Mocksville,NC 27028 (336)751-87f►0 IMPROVEMENT/OPERATION PERMIT Account #: 990003531 Tax PIN/EH#: 5758-87-7210 Billed To: Bobby Winters Subdivision Info: Reference Name: Ronald Winters Location/Address: Williams Road-27028 Proposed Facility Residence Property Size: 3 acres ATC Number: 4069 **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 INSTALLING SYSTEM. 1 Residential Specification: Building Type � #People <,� #Bedrooms� #Baths� Dishwasher: � Garbage Disposal: ❑ Washing Machine: � Basement w/Plumbing: � BasementlNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size C Type Water Supply �CL Design Wastewater Flow(GPD)�� Site: New�Repair❑ System Specifications: Tank Siz�C��GAL. Pump Tank GAL. Trench Width��Rock Depth�f Linear Ft�a� Other: Required Site Modifications/Conditions: INIPROVERIENT/OPERATION PERMIT LAYOUT- APPR VED EFFLUENT FILTER. RI$ER(S) IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representaff Davie County Health Department"for final inspection ofthis system between 8:30 a.m.to 9:30 a.m. or 1:00 p.m.to 1:3 � y of installation. Telephone#is(33G)751-87GQ:**** �� . r �� ;�! , � Environmental Health Specialist's Signature: � Date: / DCHD OS/99(Revised) . � �� , . � � ��/2�/G s • � a , , � ; i - � � � � �IP TION FOR SITE EVALUATION/IMPROVEMENT PCRM1IIT&ATC D Davie County Heaith Department ;`� �,u,�,r� �, Environmenta/Hea/th Section .Q �QD�j P•O. Box 848/210 Hospital Street U. �(1�h� �4AR � � Mocksville, NC 27028 'r— (336)751-8760 ..� ��1 ***IM �� `�+� CATION CANNOT BE PROCESSED UNLESS ALL TAE REQUIRED IN S PROVIDED. Refer to tha INFORMATION BULLETIN for instructions. 1. Name to be Billed �D ��V lJ' • W 1,11� _�S Contact Peraon �S�, t) (r . �j1�1 n�-�r s � /� /� �y Mailing Addreas �� ( /�/`/7Q�7�r R/�• Home Phone 7��, q7�- j rr�� City/State/2IP /'tOCl�.SVI 1�L' /V� C� a 7��S� Husinesa Phone 2. Name on Permit/ATC if Different than Above � ��„Q_�( .p . � / /ti 7� <� ,� Mailing Addresa ��3� /1 Mt� w�� City/State/Zip �/Y�►`L� �"�' 2 ? Z g�' 3. Application For: ite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. syatem to service: ''0 House � Mobile Home ❑ Business 0 Industry ❑ Other 5. Type ayatem re 3 � b� quested: Convention� ❑ conventional modified D�pvative �q,�� ly � 6. I f R a s i d e n c e: # P e o p l e # B e d r o o m s � y # B a t h r o o m s S�.�r ahwasher ❑Oarbage Diaposal U d W a s h i ng Machine ❑Basement/Plumbing ❑Basemant/No Plumbing 7. If eusineas/Induatry /Other: verify type # Yeople # Sinka # Commodes # Showera # Urinala # Water Coolera IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) s. Type of water aupply: County/City ❑ Well 0 Community ✓ 9. Do you anticipate additions or expansions of the facility tl�is system is intended to serve? ❑Yes ❑No If yes,what typc? ***IMPORTANT''°**CLIENTS MUST COMPLETE THE REQUIRED PROP�RTY INFORMATION REQUESTED (3ELOW. �ither a PLAT or SITE PLAN MUST BE SUBMITTED by tl�c clicnt witl�TIIiS APPLICATION. Property Dimensions: _� �VRITE DIRECTIONS(from Mocicsvillc)to PROP�RTY: Tax Office PIN: #�7 5�"� �� .� � �C� �.� L— a--r�.. Property Address: Rond Namc � � ��l"+�3 � ,�`w�7�Ze� — ?j �.-. � . � ' City/Zip � L� If in a Subdivision providc information,as follo�vs: • �`.(.,. � , Namc: Section: Block: Lot: Date home corners ilagged: � � � Tl�is is to certify tl�at thc information provided is correct to tlie best of my kno�vledgc. I undcrstand tl�at any permit(s) issucd hcreafter are suUject to suspension or revocation,if tl�e site plans or intended use cl�ange,or if tl�e information submitted in this application is falsiGed or cl�anged. I,nlso, tt�rderstnnrl Qiat I nm respousiGle for al!chRrges incttrred fronr t/iis npplication. I,hereby,give consent to the Authorized Representative of the Davie County I-Iealth Department to enter upon above described property located in Davie County and o�vned by to conduct all testing procedures as necessary to determine tl�e site suitability. � DAT�_��5 SIGNATUI�F I f � , Ti�IS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of tt�e follo�ving: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Cl�arge , Datc(s): � � Clicnt NotiGcation Date: 5 p q�� EHS: � 5'.� i Sign given � Account No. �� f Revised DC ID(OS/03 :` � � � Invoicc No. __�� S [,i� 1 n J L/ fr�� , � `,� _�. __ � � �,� 3 +��--,.� v . ' • � . , . d- . • �� • . • , . .-. �92 r � ' - LlI�qM�—�p,� _ 150 � �74) - _ . .. .. (14p) a (677) ; � _ � (204) �� o . � M ' O �• 160000003 � (8.87A) � 7210 (3.61 A) ^ (2.96A r � 1186 575ss772�o � 112 0 W 21 .� �o� � : .�� 0 172 195 � 150 42 � 179 135 � 210 � • , ' � DAVIL COUN"I'Y HLAL.TtI ll�I'AIZTMLNT ',,� � � Environmental Health Section Soi]/Site �valuation AI'P1,TCANT INrORMATION I'ROI'ERTY INFORMATION . 531 Tax PlN/EH#: 5758-87-7210 '�' � Billed To: Bobb Winters Y Subdivision Info: Reference Name: '� Location/Address: Williams Road-27028 Proposed Facility: Residence Property Size' 3 acres Date Evaluated: -J Water Su 1 On-Site Well / Community Public ✓ PP Y� Evaluation By: Auger Boring � Pit Cut FACTORS 1 2 3 4 .5 6 7 Landsca e osition �-^ ,L Slo e% � HORIZON I DEPTH " �/ Texture rou .G � Consistcnce i Structurc f Mineralo HORIZON 11 DEPTH " y O�I Tcxture rou Consistcncc - • Structurc /� L Mineralo .� HORIZON III DEPTH �� i Tcxture rou ! - Consistcnce Structurc /G / Mineralo HORIZON IV DEF'TIi Tcxture rou Consistence Structurc Mineralo SOIL WETI�IESS RESTRICTIVE HOKIZON SAPROI_iTE CLASSIFICATION � LONG-TERM ACCCPTANCE RATE SITE CLASS1f7CATI0N:�_�/� � EVALUATION BY: LONGTERM ACCEPTANCE RATE: �� OTHER(S)PRGSENT: REMARKS: L�GEND ' L�ndscape Position • . R-Ridge S-Shoulder L-Lincar slope FS- Foot slope N-Nosc slopc CC-Concave slopc CV-Convex slope T-Tcrrace FP-Flood plain H- Head slope Tc ur 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 S[C-Silty clay C-Clay �ONSISTENC� Moist . VFR-Very friable FR-Friable FI-Firm VFl-Vcry�rm EFI-Extrcmely Grm . � � NS-Non sticky SS-Slighdy sticky S-Slicky VS-Very Sticky � NP-Non plastic SP-Slightly p]astic P-Plastic VI'- Vcry plastic rc 'SC-Single grain M-Massivc CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangulaz blocky PL-Platy PR-Prisqiatic Mincralopy 1:1,2:1,Mixed Notes � Horizon depth-In inchcs Dcpth 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 lcss Classification-S(suitablc),PS(provisionally suitablc),U(unsuitablc) , LTAR-Long-tcrm acceptance rate-gal/day/ft2 C :C:=:'C:C::CCCC:'C:'CC:C��C:::CC:C::C::::::CC::o:::'�:: EO..C::':::::::�::�::'C�:::::::C:CC::::C:CCC:CC.::C': . C ..C......... ...0..............................�. � . .C...�e.......�.................................... . ..... ............................................ � C... ......s..........................................■� ..■...........■.......................................■ .. ...■..........�.......■....■■■■■■■■■.■■.■..■■...■. . �B:CE.........�.........�..........................��. ......... ......... .......................... . . 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Box 848/210 Hospital Street Courier 09-40-06 Mocksville, NC 27028 �� ;, � : �,� � ; �� 9 � �� a �` � � �� 336)75,8 60 �� t� � � �� , � �� , ��'�. y .v� �. a a� .x e ' r r r . f a: *� s'�7 �� d }i.R�i�f +�Z� � � �. °�'h -. i� � "._ � �i s ra�f � ,Pi et"�� , _ x f �5 " :s '� '� 7; 9"� :- y �. a v rr✓ w S� - 3 � ��.�.;.�..r.,�'4<"�"��..s�..,. ��u�° ��'.:,�«�_.�..�..�.�;::�.c...��..�'��`` "�.�'�:...'..� �� '`J.,� '�3'`a ',., ..,.a''£:"�a�.,,.,�c..�:.�:�..w.,�..�„�_...z 'r,�.W.m'"� ±, March 23, 2005 , Bobby G. Winters 821 Cornatzer Road Mocksville,NC 27028 Re: Site Evaluation/Williams Road Tax Office PIN: #5758-87-7210 Dear Client(s): As requested, a representative from this office visited the aforementioned site on, March 22, 2005. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, the site was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Constra�ct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions,please feel free to contact this office. Sincerely, �a��• Robert B. Hall, Jr., R.S. Environmental Health Specialist RBH/dlf Enclosure(s) . � . p��D 3;�4if �.�t?�.—FAG�p EX�IBYT A BEGII'�N�NG at a persimmon in Koontz line ruruung South 9.40 chains to a stone in line af Lot No. 6; tk�ence West 3 deg. North 31 chains to a stone; thence Soutla 2 chains to a stone; thence 3 deg. North 11 chains to g stone,�lorthwest side of Public Road; thence Nvrtheast with said road 15.45 chains to a post oak; thence East 3 deg. South 32 chains TU THE BEGYNNING containing 38 1i4 acr�s, more or less being Lot No. S and allotted to Mattie Sparks in the Division of the Lan�ds of Obediah Foster, �tecord�d in Book 25 at page 1$9, in the Register of Deeds Office of Davie County. This desc�iption taken from the docurr�ent recorded in Deed Book 86 at page 83 bf the Davie County Registry. Save and except from� the above the Following tracts or parcels: 1. 2,49 acres in Deed Book 94, �a�e 437; 2. 5 ac�res in Deed Book $8,page 5�43; 3. 5.35 acres in Ueed Book 88, page 490; 4. S.p acres in Deed Boak 88, page 466; S. 7.1$ acres in Deed $ook 1 Q5, page 7b4; 6. 1.6 X 2 acres in Deed Book 110, page $60, Davie County Registry. NTE:TAF 13855.1 x:Mflrral est desclrichic,david,13855.1,pg � n��.Y n' � �V ` � U � f /Ih � �� t 1 l/ V � � . .