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287 Bailey's Chapel Rd + r :. ' " DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section P.O.Boa 848/210 Hospital Street Moctcsville,NC 27028 (33G)751-8760 Account #: 990001626 Tax PIN/EH#: 5779-24-7532 Billed To: Steve Beauchamp Subdivision Info: Reference Name: Location/Address: Baileys Ch. Rd.-27006 Proposed Facility Residence Property Size: 42 x 76 ATC Number: 4245 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). 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: /�' Date: ��' Z "jJ� CERTIFICATE OF COM f`�E IO I�` **NOTE** T'he issuance of this Certificate of Completion shall indicate the sys em d ibed on ImprovemendOperation Permit has been installed in compliance with Article 11 of G.S. Chapter 13 A, ion.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken as a guarantee t at system will function satisfactorily for any given period of time. ��� �� ���� ����e�s � � Septic System Installed By: ��� / � Environmental Health Specialist's Signature: Date: �//�f�i(� DCHD OS/99(Revised) � � DAVIE COUNTY HEALTH DEPARTMENT ���� , ` Environmental Health Section ,I� - . • P.O.Boz 848/210 Hospital Street �C�� Mocksville,NC 27028 �� (33G)751-87(0 IMPROVEMENT/OPERATION PERMIT Account #: 990001626 Tax PIN/EH#: 5779-24-7532 Biiled To: Steve Beauchamp Subdivision Info: Reference Name: Location/Address: Baileys Ch. Rd.-27006 Proposed Facility Residence Property Size: 42 x 76 ATC Number: 4245 **NOTE**This Improvement/Operation Permit DOES NOT authorize the construction ofa septic tank system or any wastewater system. An AiJTHORIZATION 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 #People � #Bedrooms_ �� #Baths� Dishwasher� Garbage Disposal: ❑ Washing Machin� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply C v Design Wastewater Flow(GPD) �� Site: New� Repair❑ System Specifications: Tank Size�GAL. Pump Tank GAL. Trench Widtt�� Rock Depth�� �Linear F - DU� Other: aCcepied Systems may �,Iso�be use5d Required Site Modifications/Conditions: INIPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLU .N ILTER. RISER(S) IF G"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie Cou ty H alth 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 inst 11 ti n. Telephone#is(33C)751-87G0.**** � GC/!1� %y1 /`'� y �� V re ;r�� � % -�' � ��. � ;�f ,`�-�. s����-�".- b � � , ���'�� - s' Environmental Health Specialist s Signatwe: Date: J! �`� DCHD OS/99(Revised) Oct 26 2005 3:59PM RLLIED HOME MORTGRGE CRPT 3364995922 P-2.._._,.__� �, .. . f,� - Oct 20 OS 08:47a d�vi• courity envheatth 338 751 8�86 p.E APYU+:+tt10N TOIt SITE EYq(!y►TIOWNIF ROYC6fHJT PQISfR S ATC . Oarle Cnuhty Haa1N p�paRman! • EnvuvnmetrtalHealll�Sec[falt P.O. 8au B48/310 84sp:�ta1 SEro�t � rt�� . Skcksvllle, IaC ..7028 � Lt'��-l�'L �• '�'�l�.Ca1a+^+p � (336)751-876:1 �1 � •a�S17AGRiMn'v�• 27[IS MPLSCATSDN.GM.^�I'8S FROQSSBD 3 7SL 7IIZ RC(�y21lEo � It•7�IIliATIDN IS AAOS'ZLtD. y.�la to t3��r=p1{ [or inatruetiens. V . 4: p�e c.f b.011l�d� .... 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' � S(le]EceisltC6a�Tc . . . Dalc(�): ' C7to�cNatllntia�Datc: EAS: I_ ' l� ��„ �tn���� . . „AeeauntNo. � Sal� ftnised DCII�(OS'C3 � . IuvoiceNa . / �_ � �i l ea5� C c►...li {�sh"w" �°"'`� �j ,r,.��e e.-� �c� �... yL..� �,�e, �. 3us.�4�14 , . h9 �� ,. ��� ���� MT 3/4' IR❑N U �1°S � v �� �� � �,� T PT. FREE CONSEN7, ESTABLJSHW MINIMUM�BUILpING SEfBACK UNES AND J DEDICATE AU.$7REEf5 (ROAD), ALLEYS, WAU(S, PMKS AND OTHER SRES AND PIPE 1 a \ _ � C.0 � EASEMENT TO PUBLIC OR PRNATE USE AS NOTED. �O ' � � OWNERS / oo �s 9� pq V, \ \ D DATE SICNED �` r / IPS S �I�S3�2Sa E/P \R/W e � GARY F. YARBROUGH � IS0°0' e �` E,P DB 326 PG 281 � IPS � � / N �.t°� / / I HEREBY CEKfIFY THAT THE OAVIE COUNTY HEALTH DEPARTMENT HAS / EVALUATED THE SUBDMSION ENTITLEp CHRIStt ROELS WRH � RESPECT TO CRITERIA AND CONOITIONS ESTABLISHED BY STATE U1W OR - PROMULGATEO THEREUNDER AND THE SAME IS FOUNO TO COMPLY WITH SUCH / CRITERIA AND CONDITIONS EXCEPT AS FOUND IN SUCH EVALUATION. FOR FlLE AT THE SWD DEPARTMENT, . IMPORTANT NOTICE: THIS CERTIFlCATE DOES NOT / CONSTIME q PERMIT OR APPROVAL OF INDIVIDUAL lOTS IN / SPJD�Z �118DMStON FOR IN LATION SEWACE FACIUTIES , Cj.'a— �A� � COUNTI'HEALTH OFFICIAL / \ / � a / ;� O / O � / � � NO APPROVAL REQUIRED BY THE DAVIE COUNIY PLANNINC DEPARTMENT � 3 � / Q � PLANNING DIRECTOR OATE � ` � / �� � LOUIE S. BEAUCHAMP / � P/o � � + �' DB 152 PG 471 � _ � . 001 Ac - m � � � P/o DB 152 PG 471 � . � NOTES: / 1.) THE CURRENT ZONING IS R4 2.) THEIR IS NO NC GEODEf1C MONUMENT FOUND WITHIN 2000' / 3.) AREA BY CO-ORDINATE ME7HOD / � IPS � �N 1 S0,p�, I �l°.5�,.. To� . - .�- - � • DAVIE COUNTY HEALTH DEPARTMENT ��' ' ' . Environmental Health Section � Soil/Site Evaluation � APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001626 Tax PIN/EH#: 5779-24-7532 Billed To: Steve Beauchamp Subdivision Info: Reference Name: Location/Address: Baileys Ch. Rd.-�7006 Proposed Facility: Residence Property Size: 42 x 76 Date Evaluated: �1'�3 �'G?S� nit Public � Water Supply: On-Site Well Commu y Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e sition L Slo e % � L HORIZON I DEPTH G' �. �. Texture grou Consistence �" Structure � / Mineralo HORIZON II DEPTH �' �`' Texture rou Consistence � Structure � /{ Mineralo � ` HORIZON III DEPTH T Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: LEGEND T,andsca,�e 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 Textur� 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 .ON4IST�.N . . �'IQ3SY VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm � � NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky . NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic S r, ,r SC-Single grain M-Massive CR-Crumb GR-Granulaz ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralog,v 1:1,2:1,Mixed 1Y4�& 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/OS(Revised) ■���■����■��■���■■■�■�■��■�■��■�■�■�■■�■■■■■�����■�������■■■■�■��■ ■■■�■■�■�■■��■�■■■■������■�■��■■ ■■��■��■■�■■����■��■������■����■ ■�����■�■■■■�����■���■�■�■��■■■■��■��������■���■■■■■�■�■■■��■�■�■ ■■■�■�■��■�■��■�■�■■■■■����■���■�■�■�■�■����■■■■■�■■��■��■���■�■�■ ■■��■■�����■��■�■■�����■��■■��■��■������■��■■���■��■��■■�■�����■■■ ■■■■��■■■��■�■■�■��■�■�■■■■�■■■�■■�■■�■■■■�■■��■����■��■���■��■■�■ 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