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270 Boger RdDAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ` P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002441 Tax PIN/EH #: 5851-63-0416CB Billed To: Clint Boggs Subdivision Info: -�,, C�7v Reference Name: Location/Address: Boger Road -27028 Proposed Facility: Residence Property Size: see map ATC Number: 3410 **NOTE** This Improvement/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 1 l 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,P-----Garbage Disposal: ❑ Washing Machine.,E Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow (GPD) Site: New2�' Repair ❑ System Specifications: Tank Siz%GAL. Pump Tank GAL. Trench Width 3� Rock Depth � Linear Ft. * Other: l "C / 41 G'o/Ulv- Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department 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 installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date: _y1e, DCHD 05/99 (Revised) ' DAVIE COUNTY HEALTH DEPARTMENT Account #: 990002441 Billed To: Clint Boggs Reference Name: Proposed Facility: Residence ATC Number: 3410 Environmental Health Section P. O. Boa 848/210 Hospital Street Moclksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5851-63-0416CB Subdivision Info: �170 Location/Address: Boger Road -27028 Property Size: see map 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 CONSTTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: /�Date: —/ -or 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. m :o Septic System Installed By: /'ilii; �%� %i1N ��e., �L Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) A P UCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT &ATC t Davie County Health Department Environmental Health Section je , S P.O. Box 848/210 Hospital Street 4^1":,' f Mocksville, NC 27028 r (336)751-8760 ^ Q� ***1MP0RTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed t�f"_j ` Contact Person C/,'7/ ,- 6 -i-V Mailing Address 516 '12'11^ /\ ec.J Home Phone �% �/2/K City/State/ZIP Z -7O 2 a Business Phone 2 . Name on Permit/ATC if Different than Above ` v Mailing Address Ci / / i 3. Application Forrovement P Site Evaluation ❑ Impermit/ATC 11 Roth 4. System to Service: Nr House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. IffResidence: # People # Bedrooms 2 # Bathrooms Z .,❑ Dishwasher 0 Garbage Disposal ashing 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 )(Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? F]Yes `j No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: /-� Tax Office PIN: # Sg S^' /6 3 b Property Address: Road Name City/Zipv If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITEDIRECTIONS(from Mocksville) to/PROPERTY: ';—d v, G' 11r) v/CW Date Property Flagged: r 177 -- This %— 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. 1, also, understand that I ant responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health, Department to enter upon above described property located in Davie County and owned by % r J to conduct all testing procedures as necessary to determine the site suitability. DATE 17- " & " O Z SIGNATURE 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 Date(s): Client Notification Date: EHS: Revised DCHD (07/99) Account No. / Invoice No.a • DAVIE COUNTY HEALTH DEPARTMENT _ Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002441 Tax PIN/EH #: 5851-63-0416CB Billed To: Clint Boggs Subdivision Info: Reference Name: Location/Address: Boger Road -27028 Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: On -Site Well ✓ Community Public Evaluation By: Auger Boring /__" Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position 2— L, Sloe % HORIZON I DEPTH �' G Texture groupL C� Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure L 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 RATE SITE CLASSIFICATION: Q ad LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: Zya__Z_X OTHER(S) PRESENT: 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■M■ ■E■E■ ■EMM■ ■ENE■ SOMME ■MMM■ ■E■E■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■MM■■E■■■■E■■■■M■■■ ■■■■■■■■■■MM■■■■■■■ ■M■■■■■M■MM■■■MMM■■ ■■■■■■■■■■■■M■■■■■■ ■■■■■■■■■■■■■■■M■■■ ■■■M■■M■■MME■M■M■■■ ■■■■■■■■■■■M■■■■EM■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■ ■E■ U ■■ ONE no ■ME■■M■ ■■MEM■■ ■■■■■■ a■■■■■ ■■ ■■ ■ ■ ■■■■E■■M■■■E■■M■■ ■MOM■EMMEME■■MME■ ■■ME■■MMEMMOMEME■ ■■■MMEMMEMEMME■M■ Immmmmmu MOMMEM�iiEMEMME ■EMM■M■M■■E■■EMM■ ■■MM■■■MMMMMMMM■■ ■■■MM■■■■■M■M■M■■ ■M■■M■M■MM■■■■M■■ ■■■M■■■M■MMM■■■M■ ■■MM■M■M■M■MOMM■■ ■■M■■MM■■■M■MM■M■ ■■■■■■■■■E■■■■M■■ ■■■■M■M■M■M■■■M■■ ■■■■■■M■■■■■■■■■■ ■MMMMMMMMMMMMMMM■ ■E■EMEME■E■M■MME■ ■MM■■■MMMMMMMM■■■ ■■MM■MMM■■MMMM■M■ ■■M■■MMM■■■■MM■■■ ■M■■■■M■■■■■■M■■■ ■■M■M■M■MMM■M■M■■ ■■MM■■MM■■■MM■■■■ ■MM■M■M■■MMM■■MM■ ■■M■M■M■■M■M■■■■■ ■■MMM■MMM■■■M■■■■ ■EOMEMMMM■■■M■■E■ ■E■■MEM■■■■■■■■E■ ■M■■■■■MOM■■■■■M■ ■MM■■■M■■■M■■■■M■ ■M■■■■M■■■■■■■M■■ ■■M■M■M■MM■■■■M■■ ■E■■MMMEME■■■M■E■ ■■■■MM■■M■M■■M■■■ ■■■■MSM■■MMM■MMM■ ■MM■■■■■■■ ■■■■■■■■■■ MOMMEMEMME Ex�snNc iaoN a�N MARK E. ROY �� s a5•s �oo• E---�, D.B. 202 PG. 4>0 eo ., CCcR �. 336.87 R� � �yi�. ; PL4CED IRpN O �_ -"— --- --- — __ . Uj' EXISTING IRON PIN �^ -- -�-- ----_ J' p�A� FeR Op� Scy � ��( Rp w v CUg N FF N N AREA = 4. 972 ACRES cR � . � ------- ______ _ _ NO SCALE �'tiF o � _ Z RAYMOND J. MARKLAND �; VICINITY MAP D.B. 174 PG. 261 �• DAVID R. CDURTEMANCHE � ;-� � D.B. 308 PG. 195 a � � . n � � n � � ao � ' � o � .\ � ��� c' ExISTING EXISTING IRON PIN IRf�N PIN ��� � ' N 83•44�34 y ' (TIE> EXISTING 61,02 466,34 IRON GRA CE A. DRAMAN ,` �(��T�A`w P�N s8,22 �"� D.B. 173 PG. 147 � �— N e�•44-3�• � crlE� I Ss�'57 EXISTiNG !� N 83'44'34' y tRON (tIE> P� W I ' � I I N �N i : , I � ' I 2 , ! GRACE A. DRAMAN D.B. 173 PG. 147 60' EXISTING � � EASEMEN7--� so' EX�Sr�N, I JASON T. STEWART ; EASEMENT � D.B. 357 PG. 192 � � I . GRACE A. DRAMAN P��E° � ` -- -- I , IRON PIN �- �_ __ � D.B. > 73 PG. 147 -" -- -_ _ . , , � � � _ � ; _ � W � ` , , � ' N ` I � ' ;r n \ i :° N SEE D.B. 178 PG. 343 FOR EASEMENT OF INGRESS, EGRE55 AND REGRESS. � � � �a ----- ------- ------- � -- ---- -- - - ----- Z � [, GRADY L. TUTTEROVJ, CERTIFY THAT UNDER � � MY DIRECTION AND SUPERVISION, THIS MAP 1JAS DRAWN FROM AN ACTUAL FIELD SURVEY H�, ' JOSEPH F. NEELY MADE BY TUTTEROV SURVEYING COMPANY. ON��Nf� 'OlN S 86�26�02'! � �.D. 314 PG. 699 / � ExisnNc ���/���Aa�, , __ \ ,�, _ \ S686u26 prI �N PIN CTIE) , i STONE ```��.(N lir1R0/ ��� -�-- ----- - �-,'�------ _ `9 �9 a,AL CHARLIE W. WILLIAMS . `` '' . —� 4 w D.B. 160 PG. 686 ;o�:�''Ftiss�� ••;� �' PROFESSIONAL LAND SURVEYOR L-2527 �i" i N 86'26'G2• �, � ' � �Q� ���•���"r'�: . . �'',--Q Y�': � �n' �T I EI> � � S��1 , � . PROPOSED t 5' `� �� _ ; L_2�'�7 EASEMENT CALLS � � � `�. -� TUTTEROW SURVEYING COMPANY I :�9'•:�'� --+-- ,: 107 NORTH SAL I SBURY ST, LINE BFARING D!STANCF J I � C ,- •° :^�` y � �-9�•.., s��vi{�``� M�CKSV I LLE, N. C. 27028 l ! S 86'26'OZ'� � �S.00 i !z s oz•3a'Sz� w aa�� � I � � I '�,},C. TU.�9;�•` � 336) 751-5616 L3 N 56'�8'49" W '�7,4g /�� L4 N C2'34�5?" E 31.38 ^ � C/'�l- .� G� � r � � ''6, � `� Q O� � —_ PLAT OF SURVEY FOR� JOSEPH F. NEELY . ,���-. �� �'��. � -- � _ , RA YMOND J. MARKLAND D.B. 314 PG. 699 1' Q ` � � �9"A ��s / REVISIONS �E, � = 80 APPRWED BY� ORIIYN EY� FILE �MIE� TIK�-0NE � ,� ��Fo �u�Y-2-2o02 T , 6-20-02 G.L.TUTTEROW FP, J caoun. rwE,TfKIMAR-57 � 8� 4� 0 8� 1(�� 24� 4.972 AC. ADDED i -- — -- --- -- ---- ! � 60' EASEMENT AND 4.972 AC. TRACT FOR RAYMOND J. MARKLAND X = UNMARKED POINT C/L OF ROAD ; SEPT-20-02 �_____ _______________; 15' EASE�AENT (D.B. 174, PG. 261) LYING IN THE FARMINGTON TOWNSHIP SCALE IN FEET �OED pAVIE COUNTY, NORTH CAROLINA �tAVING MNI�E� . ' 16002-3 ' 0- 44, d 4- _T I- 4,P- -_T14,P- & J � January 2,2003 Clint Boggs 516 Dulin Road Mocksville, NC 27028 Re: Site Evaluation/ Boger Road Tax Office PIN: #5851-63-0416 Dear Client(s): As requested, a representative from this office visited the aforementioned site on December 31, 2002. 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, A�a &. Robert B. Hall, Jr., R.S. Environmental Health Specialist RH/df Enclosure(s) ZZ '0 O