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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.**** � 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. �P m �a,��p �' d�S1 � � i `r'�� , � ..� i � Septic System Installed By: Environmental Health SpecialisYs Signature:___���2� Date: �".� '�r�`�J � 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. ��,.w�.,==p �/�a�3G� �.�... �,. Z. xaa. o� p.sasb/a�c is atss�nt lhau abo,� kailiaq �dds��• City/ttata/iip . �. 1►pplioatioa tor: 81t� ivaltutioa 0 ImptE�v�me�at P�rait/IITC 0 loth �. �r.t.s so �.�so.� Q Hons• 0 Mobil• 8om� 0 8nsia��• 0 Iadustry 0 Oth�r a. i! R�sidu�o�: � p�opl� � f S�drooms 3 � Bsthrooms z @'Di�hxuh�r o� ai�po.al � lhohis►� O'sasu�e�t/pinabinQ�'U suwat/1to DlmibiaQ 6. 2! luaia���/2ndu�tsY/OtMst fp�oilY typs ! O�opl� i /ink� i Coa�od�� � ibow�s� t Csiaal� � Ifat�s Cool�r� =r rOo�StAVZCs: � 8�ats _, =stimatad Kat�r Osaq� �Qauoas r� �r1 7. Typ� o! xat�r �upplyt 6'Cotu�ty/City 0 1��11 � Commuaity o. Do yoa�ndcipate�ddiNow or eipao�tons of the tacWty t6b ry�tem b Intended to urveT 0 Ya �.P�Id Ii ya,wbst tYPe= ..__ . "*'�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: � � Tas 08ice PIIVs i� ����'-- � ---J'S�S� � !Jk- �� �P,� Property Addrass Road Name J� ��'L�iGl.o . eJ � CUy21p ��,��/V G �6 u�f � � �r ���-GsC ��DL 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). ' „j,��� . 8ite Revisit Char�e � 'l���/I" " Dah(s): J f � • J �� Cllent NoNBaiNoa Dstes �� � � ERs: Accoont Na �� � �,/ �S�fC Revtaed DCHD(07/99) Invotce Na �-! �—�`�`°�' �"//�7-�°��'�`�- � r I ' DEED MAGNE7IC J.J. GOBBLE , - & wife GLADY GOBBLE D.B. 54, PG. 174 � \ I � —+ < tt E� \ cTte> —� S �•�•�y v — �� N OS•28'29' E N O1•29'29' E �.41 0� 9(a.7B D 156�77 2 � � T M; � � y� � � �9 � � y � � 0 � � �� �:� � � � . � - �(�, a N �r y T �v �� � `a � !y m� � �:j N 19• � '"� c � �� �6.A' 30 QO�� f Vl `J �j � s �� � � � So6,c'•�J �' H 19 2 f� ���J�a 6�. �N �',�`�152�, f zv � z � r �s' ��W v � � � - �A o� �1 •r� '•`JS . . �� �a N,�'*� f D b �`�' � ' y �� � 4' � � 1Y59'W� +�. 6t��f,� �/3260 f � w a l7 b��. 9e�,f�-` � 388.2, °�' w� �� ��� . � S 10•t 1'S9' M ` �O� �� � f = S9 c'gfJ � �(ti ,e�o!- � L A �, • K� b ��� S��'35• 4 N � !T E) � � 52.�2 13'2B'35' E �' �, � �TIE) 518.12 ��� � � .. .. . . . , ----•--•r-^-�-- � , , " �,� 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) ■■�■������■���■�����■��■��■��■■�■■■■■�■■���■■���■�■���■�■■���■��■■ ■�■��■■■■�■�■��■�■��■�■�■■■■�■■��■��■■■■■��■������■�����■���■���■■ ■�����■��a�■���■���■■���■��■��■��■����■■■�■�����■■�����■■���■���■ ■��■�■■■■�■■����■����■■�■■■�■��■ ■■■■�■■���■��■��■■�■■�■�■���■�■■ 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D�1lI� ��U1V'TY�I�frLTii B���k�T��1iT 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)