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330 Angell Rd DAME COUNTY HEALTH DEPARTMENT Environmental Health Section 7 P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001804 Tax PIN/EH#: 5840-242135 Billed To: David Whitaker Subdivision Info: Reference Name: Location/Address: 330 Angell Rd.-27028 Proposed Facility: Residence Property Size: see map **NOTEC*' i slmprovement/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. Residential Specification: Building Type 0 46� #People 2 #Bedrooms? #Baths Dishwasher: Garbage Disposal: ❑ Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply O'y,— Design Wastewater Flow(GPD) Site: New h Repair❑ System Specifications: Tank Size�_GAL. Pump Tank GAL. Trench Widt `' Rock Depth l Linear Ft. Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTE RISERS)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health for final inspection of this system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installatio T ep is(336)751-8760.**** S Environmental Health Specialist's Signature: Date: 6,2/ DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001804 Tax PIN/EH#: 5840-242135 Billed To: David Whitaker Subdivision Info: Reference Name: Location/Address: 330 Angell Rd.-27028 Proposed Facility: Residence Property Size: see map ATC Number. 2903 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 WASTEWATER CONS UCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: (9 "•2?'��/ CERTIFICATE OF COMPLETION **NOTE** The issuance of this 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 a t e sy r3- t l�function satisfactorily for any given period of time. f7 to 1 5r - Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) •~ APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT (n1 �n (� Davie County Health Department D U� E 0 V E 1 j Ensilonmeafa/Health SeWon P.O. Box 848/210 Hospital Street �� lS Mocksville, NC 27028 Q,^) (336)751-8760 (�***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS THE REQUT=NiY INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed � u d A wh-4 h&`r _ _ _ _ Contact Person99 C—ale Mailing Address o 1' % h '`a ^�, p Home Phone s- ��//��Y City/state/ZIP >r s1):J1e- s `(�7v�O Butsiness Phone 2. Name on Permit/ATC if Different than Above Mailing Address T/ tat,eS /Zip e3. Application For: Site Evaluation mprov ement Permit/ATC ❑ Both a. system to Service: ❑ House CI Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms #•Bathrooms fyd Dishwasher ❑ Garbage'Disposal Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City C�'Well ❑ Community S. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes "o If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION. Property Dimensions: 1-162 - aoWRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: #_ S��/l1 - a�- a I3S 1 s� ✓j7�i<<7 G1iu�� Property Address: Road Name l9 f On Som A o crell kP�n n City/Zip_Y/I'0 l�(" �"�`-� wex) On A1,15r If in a Subdivision provide information,as follows: Name: Section: Block: Lot: Date Property Flagged: To / 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. I,also,understand that I am responsible for all charges incurred from this application. I,hereby,give consent to the Authorized Representative of the Davie B�,ounty Health Department to enter upon above described property located in Davie County and owned by ,�J ;4 �e(� to conduct all testing procedures as necessary to determine the site suitability. - DATE (' SIGNATURE SC1�v I THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge 4 y�\ W o o k S Client Notification Date: EHS: Account No. go ' T Re ed DCHD�07(?9) Invoice No. Ir _� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001804 Tax PIN/EH#: 5840-242135 Billed To: David Whitaker Subdivision Info: Reference Name: Location/Address: 330 Angell Rd. 27028 Proposed Facility: Residence Property Size: see map Date Evaluated: 4f- Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position < 4- Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH pet Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATnE �/ �/ / SITE CLASSIFICATION: D �C vGf P /CJ /7C' EVALUATION BY: AL �L LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: f 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-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) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■' ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■[i■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■ Monson iiiiiiENMESH MEMMEM MEMNONiiiiiiMENNEN ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■.■■►�■■■■■■■■■■■■■■■■■■■■■.■■peri■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ � � � ��A;�; � �� ' 8� ��sr r; ' � c;� � S 12'S6'04' W�/ 42. 32 I� �• /W � � ' / y �� ! � 'y • �,. � - - �- �, a,F � 1 ! 4 cw .N� S. Q '� .>N vnit- Rc cnc o s' r n;, ,,, � 1�=— N 12' S7' 00' E � 57. 64 VAt� k � ��, '-4� �'�T �F � � � w �. �� / �v � / 2 �.Ai: 3 cAF� �� ' 6' cAJT U� ' 't � e � 8�• 4�'S�" � n,q�� C ��t.19 � 4 �6fNl Z�� ': �C:��7 S- � / "��N � :)F 'l % �( � Z � 0 h`� a � \ �,�otioo• � � , z� � � NA;L h CAP � ;,2� FAST JF. � � ��• �V'�'�' �� 1�� 4 � �� j� O� O� • '�'� �� a�' � I ' P,' Pav .; �- n�tE Fo�.;Np 1 � ,0�_nu q; ;_i��E ��n�� & ;A�: VERNON L. yl'I�ITETAKER ,Ir, JUDITH F. iPHITA.KER D. B. 92, PG. 569 '�E yna �o.,h�, ''� �" ��vE 11 b2. 2g S 85•47'pp' E _--,_ TOTAL= 1207.28 58�10-2y,2�3s� TOTAL AREA= 6.300 AC. — -- ---- ---- ------ ---- - -- AREA IN R/W OF ROADS= 0.206 AC. INCIUDES S.R. 1406 R/W INCLU�ES S.R. 1466 R/W n N 83•ae��s. r------________--�-------------`,_ ! � � � � � � � \ � � \ 100 50 0 100 200 300 SCALE IN FEET �a.�v. ��<<or: Ri�D 0 NEJv :R'1N ❑ G•H• McCLAMROCK � B• 92—E— 98 D. B. 33, PG, 400 D. B. 45, PG. 45 D.B. 40, PG, 467 `�� •� -�N CAR '��, tix� � �•�Q, . ,,.........�� '�. i. =O,�oFEss�oti.,y . ` ' Q '.� ' ' .•� SEAL � - = L-2527 : � ` =< , . �o _ . Q, ' � e. :�9�1�I�suRv., � � �� / � �� / � , �� e�� I, GPADY L. TUTTEROW, CERTIFY THAT UNDER MY' DIRECTION AND SUPERV[SION, THIS MAP uAS DRAIJN FRDM AN ACTUA� FIELD SURVEY MADE BY TUTTER01! URYEYING COMPANY. - --- -=- � � ----------- PROFESSION L L D SU YE L-2527 TUTTER i�P SURVEYING COMPANY 124 SOUTH SALISBURY ST. MOCKSV I LLE, N. C. 27028 ( 336) 751-5616 � 1 DAVIE-COUNTY DEPARTMENT , ENVIRONMENTAL HEALTH SECTION P.0. Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NC 27028 Phone #::'tAA6)751.8760 June 27, 2001 David Whitaker 330 Angell Road Mocksville,N.C. 27028: Site Evaluation/ Angell Road Tax Office PIN: #5840-24-2135 Dear Client(s): As requested, a representative from this office visited the aforementioned site on June 26,2001. Based on information provided on the Applications for Site Evaluations and after the evaluation was completed this site was found to be provisionally suitable for the installation of a modified, oversized on-site sewage system. Before Improvement Permit(s)/Authorization(s) to Construct can be issued the appropriate application(s)must be filled out and the house/mobile home location staked on each site. If you have any questions,please feel free to contact this office. Sincerely, Robert B. Hall, Jr., R.S. Environmental Health Specialist RH/di 9n-closure(s)