317 Aubrey Merrell Rd DAVIE COUNTY HEALTFI DEPARTMENT �d �-�y Gd
" , _ .. Environmental Health Section
P.O.Boz 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990000910 Tax PIN/EH#: 576&50-3551
Billed To: Tamra Phelps Subdivision Info:
Reference Name: Tamra Phetps Location/Address: Aubrey MeRell Road-27028
Proposed Facility: Residence Property Size: 1 Acre
**NOTE�*T[ii b�riiprovem8ent/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater
system. An AITTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this
Department prior to the construction/installation of a system or the issuance of a building perrrtit(in compliance with
Article 11 of G.S.Chapter 130A,Wastewater Systems,Section .1900 Sewage Treatment and Disposal Systems). THIS
PERNIIT IS SUBJECT TO REVOCATION IF STI'E PLANS OR THE INTENDED USE CHANGE. YOUR
WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type � #People J� #Bedrooms � #Baths�_
Dishwasher: � Garbage Disposal: CC�'� Washing Machine:�� Basement w/Plumbing: ❑ BasementlNo Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size �f�'G Type Water Supply� Design Wastewater Flow(GPD)�� Site: New� Repair❑
� J
System Specifications: Tank Size�Ol� GAL. Pump Tank GAL. Trench Width��• Rock Depth L Linear Fts.�S(�
Other:
Required Site Modifications/Conditions:
IA'IPROVEMENT/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
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 installation. Telephone#is(336)751-87G0.****
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Environmental Health Specialist's Signature: Date:y�f�''��
DCHD OS/99(Revised)
, ` . �
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
r.o.Bog sasmo xo�P�tei s��c
Mocksville,NC 27028
(336)751-8760
Account #: 990000910 Tax PIN/EH#: 5768-50-3551
Billed To: Tamra Phelps Subdivision Info:
Reference Name: Tamra Phelps Location/Address: Aubrey Merrell Road-27028
Proposed Facility: Residence Property Size: 1 Acre
ATC Number: 2298
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MLJST 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:� ���GF�V� � G�' ��,1 Date: ���9'D�
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 guarantee that the system will function satisfactorily for any
given period of time.
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Septic System Installed By:
Environmental Health SpecialisYs Signature:___���2� Date: �".� '�r�`�J
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DCHD OS/99(Revised)
� •u '` APPLlCATION FOR 8iiE EVAWA110N/IMPROVEMFM PERMIT&ATC D L5 � � � ��
� C� Davle County Health Department
Envr�anmental He�Ie�i se�ron DEC 2 0 (999
p.0. Box 8�8/210 �ospitsl 8txa�t
1�� ' . Moohtvill�� NC Z702B • ENVIRONP:IENTAL HEALTN
(336)951-8760 D1�VIE COUNTY
♦**I1�QRTANTi►*• TQIB 11QIILiC11TIGN GpN01' 8� BItOC�88dD UltIa88 IILL TEi� RaQVIR�D
IN�OIt�ATION IS gRGVIDSD. R�l�c to th� RZATION BULLSTIH �or iastruotions �
1. It.a. to n. aill.a L -� caara►cet p.r.ea
Nsiliaq �dds��• � • .—._.. RoM p!►oa� �3�0 7"7lS-'.3�~Z.
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7. Typ� o! xat�r �upplyt 6'Cotu�ty/City 0 1��11 � Commuaity
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. "*'�IMPORTAMf"*+CLiENt8 AfUSTCbMPI�TETEiE REQOIRED PROPERTY INFORMATION itEQUEStED
BELOW. Eit6et a PLAT or SITE PLAN MGtS1'BBSUBJIi77TED b t6e clieut �vlt6 Td18 APPWCATION.
Prnperty Dimen�ion�s ��� X 3 88 R►IUTE DIRECTtONB(trom Mak:vtlle)to PROPEItTY:
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Tas 08ice PIIVs i� ����'-- � ---J'S�S� � !Jk- �� �P,�
Property Addrass Road Name J� ��'L�iGl.o . eJ
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It lu s Sabdividon provide tntorm�Noa,u folla�vet d� ,
N�me: / 5170 � '
ex.
SeeNons Blocks Lots Date Property Fia�ed:
Thb b to certiry th�t t6e intormstion providni b eorrect to t6e bat ot my Iman►ledga I anderabnd t6st�ny permit(�)
iesned 6ereafler�re�nbject to�aapewion or revocadon,it t6e�ite pl�n�or tnteoded a�c6sn�e,or If t6e Inform�Hon
�abmiqed in thV appiicaHon V tAlstfled or c6anQed. I,also,understand tAiat I am rupoasl6le jor al!cArargulncurrcd jrom
tJils appilcadoa. I,6ereby,Qive comeut to tLe Aathorizai Repcaenbttve of the D�vie Cona�Hait6 Departme t
to enter npoo sbove dacrlbed property locatal in D�vie County aad om�ed by�_a�„
W riIYYM'��rii��Ca{��p��a�u 0���O YCW�O�O�IiO/WNYW�.
DATE $IGNATUItE � �
7NI3 AREA MAY BE USED FOR DitAWING YOUR Sl'I'L PLAN(inclade�Il oi t6e follarvin� EziaHa�snd proposed
property lina and dimen�low, �tra�tnra, utbsclu, and�epdc locations). '
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DEED MAGNE7IC
J.J. GOBBLE , -
& wife GLADY GOBBLE
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� , , " �,� DAVIE COUNTY HEALTH DEPART'MENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990000910 Tax PIN/EH#: 5768-50-3551
Billed To: Tamra Phelps Subdivision Info:
Reference Name: Tamra Phelps Location/Address: Aubrey Merrell Road-27028
Proposed Facility: Residence Property Size: 1 Acre Date Evaluated: /—�' ��
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring ►/ Pit Cut
FACTORS 1 2 3 4 5 6 7
Landsca e osition
Slo e%
HORIZON I DEPTH
Texture rou
Consistence
Structure
Mineralo
HORIZON II DEPTH " �°'
Texture rou �
Consistence / �
Structure � /l
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 � r
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 day 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
Mineraloev
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-gaUday/ft2
DCHD OS/99(Revised)
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ENVIRONMENTAL HEALTH SECTION
P. 0. Box 848/210 Hospital Street
Courier #09-40-06
Mocksviile, NC 27028
Phone #: (336)751-8760
January 6, 2000
Mr. Gary Phelps
609 Dillon Street
Thomasville,NC 27360
Re: Site Evaluation/Aubrey Merrell Road
Tax Office PIN: #5768-50-3551
Dear Mr. Phelps:
As requested, a representative from this office visited the aforementioned site on •
January 5, 2000. 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 Construct 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,
,�o�!�����.
Robert B. Hall, Jr., R.S.
Environmental Health Specialist
RH/mp
Enclosure(s)