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138 Brave Ln (2) ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990003338 Tax PIN/EH#: 5871-71-9228 Billed To: James Tucker Subdivision Info: Reference Name: Location/Address: 138 Brave Lane-27006 Proposed Facility Residence Property Size: .512 acres ATC Number: 3863 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 --UnCTTIION IS VALID FOR A PERIOD OF IVE ARS. Environmental Health Specialist's Signature: " [ Date: d L 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 1 I 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. 1L 1 li Septic System Installed By: > � d Environmental Health Specialist's Signature: / Date: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT ~ - Environmental Health Section P.O.Boz 848/210 Hospital Street Moclksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003338 Tax PIN/EH#: 5871-71-9228 Billed To: James Tucker Subdivision Info: Reference Name: Location/Address: 138 Brave Lane-27006 Proposed Facility Residence Property Size: .512 acres ATC Number: 3863 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of aseptic 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 #People #Bedrooms #Baths Dishwasher: Garbage Disposal: ❑ Washing Machine E Basement w/Plumbing:Z"' Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply &40 Design Wastewater Flow(GPD) �� Site: New Repair❑ System Specifications: Tank Size ✓GAL. Pump Tank GAL. Trench Width Ced, "Rock Depth Ir.7 Linear Ft. ,Zo Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMI LAYOUT- APPROVED ENT FILTER RISER(S) IF 6 "BELOW FINISHED GRADE. ****NOTICE: Conta a represen i vie Co ty Health Department for final inspection of this system between 8:30 a.m.to 9:30 a.m.or 1:00 . . the day o 'n llation. Telephone#is(336)751-8760.**** Y, 4 � l" v � Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) D 'E C Q I CATION FOR SITE.EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street AUG 2 5.. 2004 Mocksville, NC 27028 (336)751-8760 13MRONMENTAL *** ***THIS PPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed � �1'ylE's ��'/C�/� Contact Person Mailing Address � j ��/�G� !�'� Home Phone ` / /� 0,3 City/State/ZiP A -O-'q Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip I� 3. Application For: Site Evaluation Improvement Permit/ATC Cl Both 4. System to Service: ;,"House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. Type system requested: ❑conventional ❑ conventional modified ❑ innovative 6. If Residence: # People , # Bedrooms # Bathrooms NDishwasher Garbage Disposal GaNashing Machine (�Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seaats Estimated Water Usage (gallons per day) 8. Type of water supply: M, County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes ANO If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: ' moo' WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # r7l / (9'9- /5V/ TMJ `"&�U-`— Property Address: Road Name 3g Oaa L/1. w.-/I ,�� Or! City/Zip /� ✓d�r��',ll�C �loob �o� r r�,c.-� If in a Subdivision provide information,as follows: /���/ z6 &�U-� Name: Section: Block: Lot: Date home corners flagged: 1S` 27 3 4V 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 lucurred 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 to conduct all testing procedures as necessary to determine the site suitabi y. ' 10C/ DATE 0� (/ / SIGNATURE ��- THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, stru tures, setbacks, and septic locations). Site Revisit Charge Datc(s): Client Notification Date: EBS: Sol Sign given Account No. Revised DCHD(05/03 Invoice No. .d- '. NC HWY 801 NOTE: Hillcrest Or This property Is subject to all easements, fight-of-ways, site SR 1624 streets and assessments, if any, as the same may appear of L record in the office of the Register of Deeds. Clerk of Court. Brave Lane Town or County Tax Offioe or which may have been acquired br prescriptive use and were not visib4e of the time of this survey. This survey is subject to any facts that fray be disclosed by o full and accurate title search. NOT furnished as of this date. This mop ar drawing and any acoomponying documents are furnished to the pason(s) nomad thereon and no alteratlons or use by others is permitted unless authorized by Stone Land Surveying Co. CertMed copies of this survey map will not be Issued Hillcrest Dr beyond ninety(90) days of the original survey date, \ SR 1624 Map not for recordation. NC HWY 801 Precision 1:10,000+ \ Vicinity Map (Not to Scale) '!G \ \ Tax Lot 64 Tax Lot 65 \ Tax Map n/f Barn/f Barbara 0. Frye Tax Ma F-8 DB 212 O PG 37 \ Bor0. Frye Map DB 131 O PG 779 \ \ 3/4" EIP Fnd0. . j l�- 3/4" EIP Fnd L-6 IRS 4 2" EIP Fnd \ \ tSQ \ �, \ QCT Tax Lot 63 Tax Lot 62 2, 0.512 Acres +/- 0.513 Acres 95.6' L \ Noy 83.4' Proposed House Tax Lot 60 -- Tax Mop F-8 \ Tax Lot 61 t n/f Marvin Kermit Myers \ -O \ CP Tax Mop F-8 ~ DB 185 O PG 261 O 0 n/f Timothy Lee Myers and wife 3co \ Kimberly Small Myers l� DS 192 O PG 305 \ r --- -- A �i 0 \ J Tax Lot 59 l f Tax Map F-8 C l n/f Jerry K. Myers k David T. Myers ^ I , \ DB 161 O PG 856 f t2&1/2" EIP Fnd GrovelDrive ----'-- -----_Parking Area - - - - __ 25' Access Easement co - -- - - - -- _ - -- Reference RB 327 ® PG 289N Existing Building Concrete Fod l Gravel Drive/Parking Mea a - - - - - _ - - -- - - - Shed Crosses Property Ling N l CD Brave Lane n 3/4" EIP Fnd L-3 3/4" EIP Fnd L-2 IRS T-2 2" EIP Fnd Existing Private Gravel Road \ \ \, 25' Access Easement �? ' Reference RB 327 ® PG 289 �, �----- --- ..- - - -- - -- -- -—- ---- - — ----- - ------ - ----- - --- --— - - - ---- -- - -- - Tax Lot 59 Tax Map F--8 n/f Jerry K. Myers & David T. Myers `L DB 161 ® PG 656 Tax Lot 59 Tax Mop F-8 n-/f Jerry K. Myers do David T. Myers DB 161 O PG 856 Site Plan for: R/W Right-of- hay LEGEND FC ace of Curb James M. Tucker EP Existing iron Pipe BoC - Back of Curb R Existing ting iron Rebor PP Power Pole & Tammy M. Tucker P post LP - Light Pole PROPERTY UNE CALL TABLE TIE LINE CALL TABLE CM - ConcreteMonument MH Man Hole -- 1. IRS - Iron Rebar Set CH - Chord Distance George fithet Stone, Professional tad Surveyor. -3t62.cartHy to one P/L Property Llne P/0 - Part of of the ronowing as indicated thou, ® a C/A Controlled Access DB - Deed Book COURSE BEARING DISTANCE COURSE BEARING DISTANCE a this ~so a vubd6islon of CP Concrete Pipe PB - Plat Book -J the a reof _f a county or muncipalky,that has an ordinance that Tax Map� Tax Lot 2- 8 CMP - Corrugated Metol Pipe RB - Record Book L-1 S 02°49'21"W 194.50' T-1 S 02°56'02"W 65.06' regulates parcels of land: Record Book 325 ® aye 33 ' CPP _ Corrugated Plastic Pipe PG Page L-2 N 87°16'45"W 115.16' T-2 N 87016'45"W 115.00' F- 100 Year Flood Boundary CB - Catch Basin a That this f.of a survey that is located in such on ora 0.513 Acres +/-- by COfT,pu:er -0- Overhead utilities --S- Sewer Line L-3 N 87009'40"W 114.44' T-3 N 02045'59"E 129.46' I_! t p� -X- Fence Will - Water Meter02048"1 ° o rr county a rrxmldpdity that w unregulated a to on ordinance ax Lot 63 Fnd - Found WV - water vows L-4 N 02 48'12 E 194.33' T-4 N 87 17'23 W 115.00' that regulates parcels of land. Tax Map F--8 n/f - Now or Formarlv BM Bench Mork L-5 S 87°14'00"E 114.82' NMP Normorumented Point TBM - Temporary Benct, Miry L--6 S 87°17'23"E 114.84' mat thio plat is of o sunny of an existing parte or porch• Record Book / i ® r aye 286 CL - Center Line RRS Rail Road Spike o n L l of land, •,•,�stNse�����els� 0).51 2 Acres �/- C r COfT'Puter -P Fdge of Pavement CTS - Coble Teievisior Pedesto t. 7 S 02 54'57 W 194.48' •• .[[H AR d. 'hat this plat Is of o wrvy,W orwthar category,such as the ,•• Qv`••,.•. .. TP TP -- Telephore Pedestal ETB Electric Tronsformer Box recombination of existing parcelsa court-ordered survey or other •�e�0.•�essj' .eti,9 i00 SCALE TOWNSHIP COUNTY STATE DhATE -W- Water Lme CO - Sanitary Sewer Clean Out exception to tordtlon or wibdlvle4on; • jQ- !�o h : 1" - 3C' Shady Grove Dave North Ccrollna 8--20-2004 That the infomhotim available to this surveyor u such that i am I declare t t ort o. �r-A 1 ` � 120 unable to male a determination to the bast of my professional 4-» obllty,as to provisions contained ir. (a)through ;d)o e we surveys thetpro wq_pn • 30 0 30 60 90 this plat: Q. .'7 0: 1 t- --- �'- � �.. LU r Stone Land Surveying Company ,,oB No. SURVEYED- Y 9 P Y _ :�/r SC,DB George Robert Stone, PLS L-3162 404 --- a _ George R. Stone ••.S R, 1401 cz • esus MAPPED: u- La ,MAP NO. CRS Mo k oiIIF, N GRAPHIC SCALE — FEET -- - Prolff Land Survsyor,L-31112 ��nqp '•�•.• ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003338 Tax PIN/EH#: 5871-7109228 Billed To: James Tucker Subdivision Info: Reference Name: Location/Address: 138 Brave Lane�70(j6 Proposed Facility: Residence Property Size: .512 acres Date Evaluated- Water Water Supply: On-Site Well / Community Public 1/ Evaluation By: Auger Boring °' Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% .� HORIZON I DEPTH Texture group 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: EVALUATION BY: 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 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 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