The URL can be used to link to this page

1760 Angell Rd. � �:. - �'..._.'", . tc .:-r'. '_.. ' '_�•.= t•. �.. ' t..: : � ^r�-.- �.�..�.�-:.��.r�` n + • , � > .r - '. ,r4- rv`+ .... r y. .,ir.'r .�:Y'i�t:T ''. _� .. .. � . . .. � ... . � . .. +�%V .. . . .. . � . . "..-. . � . � . .. � . � . • AUTHOR;ZATION NO: '� �, a�'�� DAVIE OUNTY HEALTH DEPARTMENT ' ; Environmental Health Section PROPERTY INFORMATION Permittee's r {�� ' P.O. Box 848 Name: ��A d� �K�.V� Mocksville, NC 27028 Subdivision Name: , . . f� � �) Phone # 336-751-8760 Directions to property: �'�"�� " 7i'� ��'��-�'' Section: Lot: ,� ff,= � � � AUTHORIZATION FOR r� �~ �� Y f �Gt "�� t �� C~� �� SYSTEM CO STRUCTION Tax Office PIN:# ,� � 7 � r'� � _ L� �� '�,, . �j J {�T � I �� i iOv1 Road Name: �/1��CL. � Zip: �� Gc� **NOT'E** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building-Permits. This Forrn/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Artide I 1 of G:S. Chapter 130A, Wastewater Systems, Section .1900Sewage Treatment and Disposal Systems) - -�•-�`:�_,� �, - : -. ��t / �L`` c..--`-,-r'"� �HE�CLTH SP IAI�3T DATE I ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. --.:.: --v.� Er �..�,., -,- -�...,. � -• � . : ... . n . . . . , r , - _ , .. . .� , , : . � . . .. . . _ . . . . � r--.. � . . ....., .--.... . � _ , . _ . , _ ., . �-,.- .. . . . - �..,.� . .. , � , . ��,� + � .=✓%�C' O � t'� � DAVIE COUNT� H�ALTH DEPARTIV�ENT , r',��,�:l-� � ,� " IMPRO�EMENT AND OPERATION PERMITS , PROPERTY INFORMATION �', Pern�ittee,s. 1 t� " ' . a' . : Name: 'V�� D� �K.�� Subdivision Name: „ . , : , : � DirecC'i"ons fo�properiy: ` °� �'� � `� �`'� +� + r"� �' � � �� ' Section: Lot: ._ � � � Il14PROVEMENT . ,. � t- �' ` f .» � n , t. � .i f :w:t ,� >.� �� it �-C r 3 �. i�� PERMTI' Tax Offce PIN:# �-� r _ ',:.... .�• `�'��,1 .:ii'��. `µt`� ��'��i f ��'7 �Ov� : Road Name: ��+'��.. !'�� `Zip: Y��e. ,:: �C: - **NOTE** This Improvement Pernut DOFS NOT authorize the construction or installation of a septic tank system or any wastewater system. An AUT'HORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the coristructio�nstallation of a system or the issuance of a building permit. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section�.190QSer�ra e,,Treafinent and Disposal Systems) , �. . , , ;� ''�� 1, ",,,� , �.� ` ***NOTICE***'TI�I.S PERNIIT IS SUBJECI' TO REVOCATION IF SITE , y:'�j �.,..,• .,. ,%',;,::.,/�� PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONME�TAL HEALTH SPECI fS'� r�DATE ISSUED SYSTEM CONTRACTOR MUST SEE THI3 PERNIIT BEFORE � �...- INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE �# BEUROOMS �# BATHS �# OCCUPANTS � GARBAGE DISPOSAL: Yes or� COMMERCIAL SPECIF[CATION: FACILITY TYPE # PEOPLE # PEOPLFJSHIFT �# SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE � r� TYPE WATER SUPPLY I�� DESIGN WASTEWATER FLOW (GPD) � �/ NEW SITE V REPAIR SITE 1 � ' I ��,,, � SYSTEM SPECIFICATIONS: TANK SIZE 1�GAL. PUMP TANK GAL. TRENCH WIDTH .� ROCK DEPTH � 2- LINEAR FT. � OTHER � � �?�"' ` % v t ��I �7� REQUIRED SITE M ODIFICATIONS/CONDITIONS: ��Tb1�.�. �� 'v IO�'� � h�� C C�, ��" � 1��?� • iii�� i kt.-i=J" �� r !_(' **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM II BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. OPERATION PERMIT S TEM INSTALLED BY`� �d !1 1�D � � �ucil AUTHORIZATION NO. � OPERATION PERMTT BY: � C�;5�'� Y DATE: �O /�S `7 � *"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPUSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WII.L FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD OS/96 (Revised) .• " �1PPl1CATION FOR SITE EVALUATION/IMPROVEMEM PERMIT & Davie County Health Department Environmenia/Hea/th Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336J 751-8760 ***II►�ORTANT*** THI3 APPLICATION CANNOT 8E PROC,ESSED UNLESS ALL Tf� REQIIIRED INFORI�ITION I3 PROVIDED. Refer to the INFORMATION BULLETIN for instructions. i� / 1. Name to be Billed Q S � Contact Person � � l�E�� Mailing Address � ( J / , %i � �� So�e Phone 'y9�' �.3 � City/3tate/ZIP �� 5 ��( QD �v �U �/� Business Phone / J / — ,�5� % 2. Name on Permit/ATC if Different than Above ?lailing Address City/3tate/21p 3. Application Eor: �Site Evaluation ❑ Improvement Permit/ATC �Both 4. System to 3ervice: 0 House Lt�Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: $ People � # Bedrooms �_ � Bathrooms � ❑ Dishwasher 0 Ciarbaqe Disposal l9'iiashinq Machine ❑ Basement/Plumbing 0 Base�ent/No Plumbing 6. If Business/Industry/Other: Specify type � Peaple � sinks $ Commodes �k ShoWers � vrinals 1F water Coolers IF FOODSERVICE: � Seats Estimated Water Usage (gaiions per day) �. Type of water supplp: ❑ County/City 'tri+Tell^ 0 Com¢aunity a. Do you anticipate additions or ezpansions of the facility this system is intended to serve? If yes, what type' 0 Yes � '**IMPORTANT'�* CLIENTS MUST COI�fPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Eit6er a PLAT or SITE PI.AIv MUST BESUBMITTED by the client with THIS:APPLICATION. Property Dimenaions: `. �l� s � DIRECTIONS (from Mocksville) to PROPERTY: Taz Office PIN: # � - d a - , Q�Q�v" / �/j � �OQ� 'fl1 (,� N Property Address: Road Name 2� Q !!"� City/Zip � SI/7�P �o v�7C�� O"�//h—� d% ,I�� If in a Subdivision provide information, as follows: Name: Section: Block: Lot: Date Property Flagged: � �� ! d This is to certify t6at t6e information provided is correct to the 6est of my knowledge. I understand t6at any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use c6ange, or if t6e information submitted in this application is falsified or changed. I, a/so, understand that I am responsible for all charges incurredJrom this application. I, hereby, give consent to the Authorized Representative of the D� County Ae31th Department to enter upon above described property located in Davie County and owned b�- ,��n G� ��(�11 �� to conduct all testing procedu as necessary to determine the site sui bili �. DATE � � SIGNATURE •Lr L� �-� THIS AREA MAY BE USED FOR DRAWII�IG YOUR SITE PLAN (Include all of the following: Ezisting and proposed property lines and dimensions, structures, setbacks, aad septic locations). Revised DCAD (07/98) Account No. % `7 d Invoice No. � � � - ::� u I. C. Rcy Calss� certlfy thol Nb plal �m dra�m urd�r my wp�rvkdai irom on actual wrvy rtwd� und�r my n+p�rvldon (d«d descriVtb^ ncore.a In eoo+� es� Pop. 3«, �lo.> (otlwr); cnal en. e«.+aa+a not wrwy�d an ebory k�Aeobd o� dra�n irom imormatlon taxd M Book w notW poq� • tlwt tM rotb d pneWo� et cak+�lat�d b 1:70.000: that tAb `,�1111111��' ' pbt ras pnpa�d in oecadrna rlth G.S 47-30 w ortrrW�d. WItMp my a1qlr� // dpnotun., nqbt.otbn numb�, and »u� �•?*_� S'� N�iAq,1 P.,` u,e� 4TH ,,y,, Nov. �o. 1997 ,;,o�``.'e ° '�S7L�-'•��y��, �`J • c,G �:� °•, d ; °Q,,. � -q . � � s Seal or Stamp ° v�=,�L a • ;. � L-��a3 � s w . o:' � 2623 ,��"�,i �'! �^.�I �� ` qa`' Rpkftrotlo� N�r � ' . , .• ' � G� _ave 100 0 10p 200 300 GRAPHIC SCALE — FEET LEGEND R/W-Right-of-Woy � - enter Llne EIP - Existinq Iron Pipe �� _ e�ter Lipe EIR - Exiating Iron Rebar ge oi Povement P- Point ce o{ CurD CI�A - Concrete Alonument �� - War Pola ht Pole NIP - New Iron Placed �H - n Hole PiL - Property Ll�e R- Ra�us C A- Controlled Acceae �H - hord Dietance RCP - Reiniorced Concrete Pipe P�� - POr' °� CMP - Comigated Aleial Pipe y eA Bookmerti CCP- Corrugated Plastic Pipe ' � �a{ gq� � -F- 100 year Flood Boundary alch �ae n• Parcel 16 -O- Overheod Util'rtiea nce o -X- Fence -S- S er Line I NOTE = THIS PLAT-IS SUBJECT TO A►sY EA MENT9, AGREEMENT3, OR RIGHTS Of WAY OF RECORD PRIOR TO �.�IE D TE ;F THIS PLAT. THIS 9URVEY 19 SUBJECT TO ANY FACTS 'HAT Y BE DISCLOSED BY A FULL AND ACCURATE TITLE SEARCH, NOT FURNI.iHED �►E AS OF THIS DATE. � A�gell Rd. N SItC � S.R. 1414 � Location Map n.t.s. NiP �� \ S � °\s e Porcel 16 6, � � 4 ��w /;nc \' c m � 0 W c � o �'1.034 o�o 2 NIP� N 16•01'35'1V 22.91 %'� N/P - i I.Sg• 142.g�. new �►ne �',N 1 °37'S0'�W iP ,[Q) � 54.43, N �4•O1'30"W 38.87' ^, �� \ N 15'33'35"W 39.78� ,' N 04•4J'10"W 40.24'—�� c i ' a� 1 � � N 02•2J'S5"E 44.14' 0 a, � � h y 4 � N 08•09'00"E 55.18'—�1 V O O _ � Parcel 16.01 John Frank Ferebee D. B. 105 — 778 Parcel 8 J.G. Ferebee D.B. 71 — 284 � N 87°SS'25"E _ 311.47' — r;° 157.70' NIP�—�38.63' -- 15.14' R/W ae clalmed by I the N.C. Hlghway Comm.� � SCALE 1 " = 100' � j � I5 � O I� �p � O I; ^ � Q ; c�v � U � W ;o �!�� ; �� ;o ;z � bent EIP . � U ° � � � a � �� r. c � D�r nl li1 i� N C.,, 16 N N � I E`r' N f� ` u) 1� w I � �� 3 � ��.( � `� N `.J m0 O I p O Q � .— � o . ^ � o o h Na�o 0 H ^ ^ 2 � � r+� N N � — -- � 154.77' N 89°59'40"W <-- Plat For Parcel 16 John M. Ferebee D.B. 62 — 344 I � An ell Rd. 5.�. 141�� John M. Ferebee See Deed Book 62, Page 344 Part oi Parcel 16, Dovie County Tax Mop E-4 TOWNSHIP COUNTY STATE Clarksville Davie North Carolina C. Ray Cates suRVEYED: 119 Depot Street CRC Mocksville, NC 27028 MAPPED: P Il 0 fl e( 704 ) 634-3735 CRC F a x ( 704 ) 634-2750 DATE 11-14-1997 12-08-1997(add 1.013 Ar_� 03-23-1998( Lot at Rd.) JOB N0. 3468 MAP N0. � 3468G 0 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT SoiUSite Evaluation APPLICANT'S NAME v � � �� PROPOSED FACILITY SUBDIVISION Water Supply: Evaluation By: FACTORS Slope % HORIZON I DEPTH Texture group Consistence Structure HORIZON II DEPTH Texture group Consistence Structure HORIZON III DEPTH Texture group Consistence Structure HORIZON IV DEPTH Consistence On-Site Well Community Auger Boring Pit SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RA REMARKS: DCHD (01-90) �•�� DATE EVALUATED � " z Z —� � PROPERTY SIZE ` � ROAD NAME Jl'1v�.�-�`-� Public Cut 3 4 5 6 7 EVALUATION BY: OTHER(S) PRESENT: 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 - Subangulaz blocky PL - Platy PR - Prismatic Mineralogv l:l, 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 - gaUday/ft2 ■■■ ■�� ■■■ ■■�■ ■■�■ ■■�■ ■��■ ■■�■ ■��■ ■��■ ■■■■ ■■ ■�■ ■�■ ■�■ ■■■ ■�■ ■�■ �� ■�■ ■�■ ■�■ M\■ l:��! �i�►� �� ■ ■ ■■■��■ ■��■ ■■■■�■ ■■■■■■ �� ■■■■■ ■■■�■ ■■�■■ ■��■ ■■��■ ■�■■■ ■�■■■ ■��■■ ■■■■■ ■■■�■ ■��■ ■■��■ ■��■■ ■��■■ ■■■■■ ■��■ ■■■■■ ■■■■■ ■��■ ■��■ ■■■■■ ■■■■■ ■��■ ■■■■■ �i�� : ■■■■■ ■■■�■ ■��■ ■��■ ■�■■■ ■��■ ■��■ ■■■�■ ■��■ ■■■■■ ■�■■■ ■��■ ■�■■■ ■■■■■ ■��■■ ■