Loading...
814 Burton Rd � � .� DAVIE COUNTY HEALTH DEPARTMENT ' � Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (33G)751-87G0 Account #: 990004101 Tax PIN/EH#: 5798-04-9734 Billed To: Ron Williams Building Co. Subdivision Info: Reference Name: Location/Address: Burton Road-27006 Proposed Facility: Residence Property Size: 28 acres ATC Number: 4517 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 ON I VA ID FOR ERIOD OF FIVE YEARS. Environmental Health Specialist's Signature Date: /2� D(� CERTIFICATE OF COMPLETION �Z�� **NOTE** T'he issuance of this Certificate of Completion shall indicate the system described on ImprovementJOperation 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 nction satisfactorily for any given period of time. ���✓��(- •i(;` ' SS 1 Z- � s ��' 'e- �q `� Sh6aE �1���. �. � �°P'°`�v.�Y�;�� '� �����14 _�� , 2 ` _ �^' ,z, `• `, � . �; �� � Ra, Septic System Installed By:�►'L���ii�''�.5(/(/1, Environmental Health Specialist's Signature: � �I'�G�VV`'! �U� Date: Z �j � Q� DCHD OS/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT � . Environmental Health Section ��� V � � , ' � � P.O.Boz 848/210 Hospital Street 1"G • ' Mocksville,NC 27028 � 33C 751-87Cr0 �� � � ) IMPROVEMENT/OPERATION PERMIT Account #: 990004101 Tax PIN/EH #: 5798-04-9734 Billed To: Ron Williams Building Co. Subdivision Info: Reference Name: Location/Address: Burton Road-27006 Proposed Facility: Residence Property Size: 28 acres ATC Number: 4517 **NOTE**This ImprovemendOperation 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 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: ❑ Basement w/Plumbing: � Basement/No Plumbing: 0� Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size�[� Type Water Supply W�..l.� Design Wastewater Flow(GPD) (��D Site: New�Repair❑ � I�a� � �, , System Specifications: Tank Size GAL. Pump Tank �� AL. Trench Width � Rock Depth lJ Q, Linear Ft.J�f..� Other: I�1,�(��7'u, ��� ��J�-�%�l s�'�.,� �S�.E rVs�t�i Fo�..� Required Site Modifications/Condition�: `���f1LL be� �-f?nTiDJ�� �"p ��O ��oM. ��3L. �-� �,�� 1 I11'IPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF C, "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(33C►)751-87G0.**** �- � S �� "� �.�' 2�j' ZlO' . �vS /�,3°�(� p w��`�:""_J►1� t� .—(� QQ,��.��'' � �� � °yy�� �w �- w� ��° �,�,���u3 t7�H �`� ; �, � � �j , �,�{�'�W" c5', 7 M�.���� � ` i�" �{� ` �v` , � 1 � AF��vx 120' � �-- ` � O 1' � 8 �, '�,� � , qG" �7' �• vC �atA K � 230 ��i��f1 'a ��+� �yt_"Sc1�N0 '�( -r w�P Tiar01< Environmental Health Spe 'alist's Signature: Date: DCHD OS/99(Revised)�� � � r Davie County Health Department Environmental Health Section P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 Improvement Permit Ron Williams Building Co. Inc. 4010 Windsor Place Winston-Salem,NC 27106 Re: 28.032 Acre Tract/Burton Road Tax PIN: 5798049734 Dear Client(s): This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans or the intended use change. System To Serve: 1 'Wastewater Design Flow(GPD): �l�(,� Valid: �Years ❑No Expiration System Type: ❑Conventional Cd'Accepted ❑Innovative ❑Alternative ❑Other Site Modifications/Permit Conditions: {-�;IVI,Y�A��, �'��j��;�/IZItJ iF0.1�, �l.� �(.j� F�/�. bJr3L �tL`' �.� 21a �u.S Site n L7 ��� �� � c� � � � � � � ,� '� �3 � , � , � , � ,o� � � ,20 � �. P�.��,o' � • �� v r�� `��� V� i �� )2 ��! nvir e rt peci i t Date i.p.letter 7/06 \ �� _ .>, . . 655.09' NEW LINE %p � _._. S i S45'41'34"W ��S �� O �� , �� �� � ��� � �� c �p� � �� ��,- �' �,o'p�p '°0 . _ � ��► � , `L � �� S� � /�� � Nti,�� � p � �' � S � --a ' s c'� js`��j�'QS�'9 - cn o �.�°�` r' � � `q s � � tn � � _ ... .... ._ � �` d' �i ,� .,� � �is � ti._.. 7_�� >i a � � � 0 0,� �, F�, y o =-�.� __ __. .. � �. � �. �, � �` , .. _.��. •� ? 9 ,o yo a � ,;a� _...�..v �,,� � � . • 99D s, �s � s�o � , . ,L c s� (�yw�` '�� 3 '�[� `� �``� 3 v . � ��, \� '.4 �'� s ��g,�3 �" ti� � `S ���' �A' ,� � �c� o ��. � �6+, �'� �'� � �� cS`����C` �,g. �'�,� •3z ts` -4 9�,�,s��S � �, �3 ti�F � � � r'r,i G F !y � o�s s � �C. �y '���9�: o � � 800 � c�`�Ci,Qqy,o,�, '�,� q � �, O� � N Z `t',9qQ���► q c'9 IV c�''1D �/� - 'Q� ��� 'QD�s � o `9� � 'q j. ti��0 . - �- � s��p � �.� ,�,o� � � N ���� ��� rn � s, . �q��� '��.!^`� � ', � , �,.'�.-.m� r,..'�' ei�w � �' u:'�,s��. .u m � .„,'��� .m"k�"a���a4�k� '�4�,��'1�51¢=P�; e�'�,:^"� "°� ..,� e�� ° 1 :^o r i r a, f:�r '�fi� � �� �- a,- .'�.s,o �: � ?� kr%�' r�:.. O6" � � .�^ , ;. `�> "i m' �� '�:'� �§a �. +`,,a n r �y . a !xi�' � �y�,�1 �,.�� �k �II �� N�ty����. �'�� ra:� ,X'� ��f�ld�� i��+tw��S � �«. �m � �.�,. "��G�"� ' � � ��. ,� �` «� � . r ����� xC��,� �,��i ���������� � �.� �� ��� �s� � � m � w � � � �� � w t�� � ����. n � � t � . , ry) �,� �, s��� � N . g '��: �° : �� i�u�i��i: � � �¢ ai W" i8�'.�8��7 � ,�� U7 � P s . . � �,.. i � .y'i4,, �"'�i6 ��', '�� `� �- � M+�;�, :�9 � � ��r ,�. 'y, a � a 1 �i '��+�^ Rm� m�. I i�. ����� } 1 '�w�'�aci�^��i�i�ii���`s������i��i "� � � �� r � � P � �'""`� ;� �� � x��v�� t, r�„� r x�. �� ��' �H d ua « �.,' 4. � ' �� �� � ��Q ; ' i �."' , � 1 � r � ��, T� � � � t � � ' � �r r ,� '�' i(��� i� ��}� '�11 �� ` �{� ' 7�� � �� �0.. � `i �i �` � b p '��u �.� t 3 .g � � r'� t' t r� 5 � � N�%�_4 a� ,y IY g. � iE� �s� �" n� � � ���1 I�i i�I i� ^�� �i , �+� Y '�a �' t ��s ��� F �i ii t i ��` �. � �a� � �� ��i;�� � �,��� � ; �` *�"� �'�" a � i �p��,, � �#`�' �° § � �'�" '¢e � k � I r�t��' �a�; .nax` � r .� �� �'�,��iap aai ( �'^��' � .. �'= ,� x ..r^v '�+t�' � .�7r � i) ..� �;u, � � b� � A (� ,y�� ���b �}`��'i� � �g ���� ���� . � k� P �����K�� � : � �" k 't"5'�' � ��p�'. �t .� � . C �.: � x. �ah ' � �"i I. � '� ' &,ti ti� v�'�.� a �'�,``.� q' i� 'h��tlr�F � .�,�,�� °�^,���,��`^'„ i � � ��� ���I �I V � ,k�.�i�ii��„ ..� ,�a� �'''# r w � ' �� '���� �� �+� 'w� �i���ilV"°.:�?�ah ; � .� i `� � o- � i �.�" ��� � rr���i � � ����.. (f ,„ r �;e, �a- � ��`,a„ ,�� � �e�. ���� ��'� ( i � �1 � �� �,e ti ��� .� -� � � s��� � b � m t��� 6,� . � ����li��, }i " ��*'a .7p,i�1 �` ;��a. w ,r �6 �. {" � " � tg� a� ' � p �'�� v 7ij� ti� il6'�� r�. i k a�t�+'1 � r � 3.2 5s "� 41 ' Sn x � �����t;��3�'�� a �.n i,p�',�;��a °�� '��. '� e� ' li t i �I N '��� ,g h w�,l) � qi �' ,-.� Ir�a ���'�g�r'^�' ��: ix,arn i"' ,�.«. '�r. �,. � � r ��. e� `�' � �. .. a�9��,. '���xr�';Mt ^�y . �� �ij°7���,,,�i�ii �_.�w ��' � �,�;�wk. '+ w�" fh; - ,�� k � �N� , ...:��i�s< �5:�� �ilil�p�i�ry�d ii�l a q!��" u ,, ��a.: .s�. � t- �,ak�',t�'�4i d�9� � ?A��.4'�t�� ��,� i �� 'i '��: .. .,.» >:. T i i �i i IN i rrt"��� ^� � nF . r`"�.. q�{ f ' w - ,w" � ii.HUP`P � i � �Y ���+'� � �', �"�"'� ,»� ' , . ,. � ��, � � � � �� � �'t � �i �����ra, `�'h � �r �,,� �,� a,� ��,. � i+�, , k � � � 3R` � �� M�7u "�° �• �"�, *�� A"�. ;� � �M, ��� � �ya�`,"u', � � m�y{,�� 7 5v��'�}�;�,� lv� � i,� �"j"�6� �� � . �' iY� ��� � k `� �" e`m �W«� .a �y��`'^ . i � w ' ', �� � � �u g � �`�' e "�� h... � Ru x�� � � �e . �,,. �rra �,�,y� �;� ,.�� t,"� �"� ������'n� �i r�����np�i� - ,�� , �,�' '� �. V �' A'� ' at e u.� �< _ F � � � � � , � , � . � �,. ,�7 a; F a, , - _ .� ..� • ,, �' . � . ,, ,o � ;�r��, +�, a �: . � � . � � � � �, ,.. , , . �� .���� �. � ' , n, � k � q s-x �`, �� .,* � �. � r� ' @ xd .,�`o- r...^ty' 3 (i ��'i � ��I i ��� e �a � �� . � , . . ., : .,.�, . ' '. ...o � t'�. �"i „"�'y... .. , .: � � 1 M �. .r. " ! .< t. � , a nf.c � ° 4' �� � �. � ,..°a ; W. ��� � � „ � � , � ��, �� � �; �,, �� ..,. , . ;. � .. � . � ".�., - ����n 1' `. . ':: '�.(... l.� ( � { � 1 ��`:�. �3 �1IEi � ��� *� � A _�� � «����, d � �, � k� y I II � i � . KB 4.' (I �,�:_K'��`�'_ .�� . r �t i� � � ��iry �`� � �l���i�� ., �': ' '� � ,il { r'r � �� . »"" r.. ,� ��� X ��i�I� dd s c'�� ��� "r ���y �a� � �� �� � a� � "�: r. �,� � , � . �`� �� � i� � „ ���.„. � � ,��; � .�� � , � . n; A � : �' ��. ��� �s . �. ..,°� ��, � E y9�tr r a :��k :� � e r hr �� � 4;1�� �F�r��� ��. � � °�� #. I b �` ' `�y �� �1��F1�3�1 ��es � +�� � ��� i: . �� ����4�.� -� '�° `•i� ��Jr� ,. � q� �,c e,etpd �b��. m�a; ��'ff �'� �$i ? _g � �*a.� �:'1 � � , � . .:9 �'���'�yW� �_fi-�" ��: q '. i'< �c".,' �.t�+.�. � 4� �( �,�: , ''� (� �� Pl� W� ��S k^ ���& l. ��,`�,"�'' p. . � I ��( �i ha. ���,+ �A�' �QF bS+`e�. � � s ���� o�' si �<�� �i - > � � . � ,d ����� �.� � � ��� . � � s a � �pu ��� � .�d������ ���„ � � � 'i ' d�' � `��� '�� y ��� �< � �u' i i �a.���� � � _ � ' � ��� �� �� ���v ' ' �' � ��L c di .y�,��t�7�+i� �; ��� �;- �i7����i�i'� 1 � : � x.§`� . � � a , � � (� �7i '�s�4 �I�i i ��t� . r i g i,� � a. 5�� ' ° f ��.'* .� ���, �`�-�'�I���.�� �u u�''r L � r r � i � �• �i�`� a b ` , � li , t� 5 �i( ��� 'w�i��''�j'�i i4(��,�{� e �'s 3"4 �°� a�i�� r � '� � � � � �m �°�*..ti �+r w �li i V°�� i �i��u��9 c� ; �'` '�� ^� �'�' 4 . `�-�I�UyII�� . .,�'�a u (�� ,u �, 4. , ,�yt�`S��.w'� i � ,§ t'� �.. �p x �j� �, �7 i�� ����I��y ,-, � i *� : " sv ' i �� t �x�" �� ' �i 9 . 'i � „ „ �� � #': :� du�4� ui, d � i��� a�; � z� ,� *� � �� ��� , , "� Vi� � �� h.a, ' � � '� u �r��hvHii��s��u;���������i��� 4��GT '�it.��, ,� � .� r .a i i ;��� �Gi � ° � 64 y�. � � r+- �..�� . �, 4mr'c A*�, .r'= v 'a g r �4 ��,'a � .i � �gf.� � r.: �.. �- 4a.. �' �� ..,a', �& i �°` ,°`�-}i�4� e`` '� i. � �+ �i , : �� .,��'�� ,� � �:'� ,�....s.�. '� �r �I I ' l i � i I f n � � � I� �.� Pn � e� � Ob � � _� a ��°�"'�'> ; �, / _____..__ e_.. ., / � ' `., � I � °' _. �.. � ' �.. . ..._... .... ♦ . . . ... . .._....��. ' "` � 1 i �'��Q�� � � ,� „ �, , ` , _ ..___-----___.�. \ 6� �� _ _ __ __ _ � ��s� � � �� °� ��' � r� � - � w , ��r`.; ,, �' � � 'a��. °�' R �.A� °§�k .d `d`" ,� � Y N � . . �� � �.4. �� �� � � d 2 Rr ' . - .. �(� � �^4 J . u N �,�, . »,. .. � . '��t � ��so .i �§ �' �`9 g��. ^`"'�. � e. ���is . . . �i. . . . .v .. . �W d. , 4 �. ��, , � , � •��—. � s,: +� ; �.�� — . . _ 4,� + . �z� ��°� ��� L .�_ ,�, �" �� � �a � , � � �t , � ,��,��, � '�a r, �' � �� � � � ,: � a, � s � , � + q „ � � � �,� �,�„ � a � . a Ai ,,, � ��"��,� � s � y .� � i � ��,' " � � �, �� `� �" ,7�r� Q v s �� , �' � '� � ,�� �r.�R �'��' '"�A�s,i� r�`'� �t i�� ,,� d� � y�` " �a, � "aN..C� "�'i: �°q,� .. ��z� � 4 � '�'' � ,�, 4 'x fix' v` s a '�,`'�'°.? li �. $ �°+ � � ,�i� �``��'�. u�' �,h " ��'+�, �+ '°§�� t ` '�, � �e"" � "�`' "' ��`.��` 3 d�^�.ma�s �'� @' "'e�1�a, � - ' �,,`. ,, � ��� ,�" ��. . �I �`a,� '�'� �, ,. . r. .. , a.: >_ r = . �� �. ' ; , � ,�x �w ':�,� , . . U � �rc�,� �! 4 � �� �,� '6 � . . ' fl" fic� �`�.+d �q � '� �` a w. � �1 q,�� S ro � � ,�� t -����e�i,� � ,r,�+�#em� pt � ����y V44 ��� � � ��a : � �a�. ' e ..3a �v a'S� v� �„ ��. S� v � �t�u b ' r�tc, r�,, r; ��'wia �'R wp'� {� '�.� �`� a�"�;�� � i � ���� '� F i �� _ i � �� �uh'a . �^ A� � ?�r�i� �k ��.I �,.. � : ,., ' ��a ��� � ua�4� ��� ��d ;� g,�, ^�, � �a'��� � . ,�aF�'.�'�'� .��� .ti�mt , ��' � i � . .. �; , ��� � P � �.� �" � ��f� � °' � ���t� t'' �' � � d ,�� ��� � � $ :� �,°a r� �r �G-� � a� .� p �+ ,, � � ��� a � ., ��E � � ; , � , , '�q, # y;� g � +@ � �p i a k'"� • , �� a� + '���i� , .� �, a��.e �' "a, '� a �.+" r . � s ., ` ,y �. e �r. �� �u��t ;� r�s �-.��^� ��t � � �� +� � ���`� , � ` 1;: � �� .�,� � � a a"�a�.a, .a � �aa '�i � ,� �,� . � � �r � � ��'� ��` �N ` "� � � ?+`� � �t» �� �` � �� � � ���` . ' _�. �k 9 � � ���" �` � � �"� °�� �� p.a , � � '�y�Y `% �°�� i -�a A�� ,h � � t ,µ�r� {. � �� .� .v . � y y ¢¢���� � . � 6 1.M ' 1. s�x �„n.� � �j,��w�� h} � .\ $q��` r 3 RY pw ;g g �mg �" �.. , � _ ><Ra^ v�5', �• � `�� x p;����� C`;ar P�r ��� �� "-&� � Fl � I 4 4 � � —��,, �ll�i �����:. �S,v� _ �.' '� '� �� �i� �i, � a'� 4�: �'" `�� e �: �� '�^ . �•a �� ayi �'''"er`� ?j ,y'�` -.� . . �p �°#`.k;a ° �� p�'4 � q`�( . . i ,���,�,� � � . � �-��e �,� �� � ��i�W$u, »�A , , ` - . �) i / � o . '� ,4 - �, r..� � #%..� " .@•�K 4.r".} , �` . .:: ' . £ �' 4 . � . ` a n�.. �, aJ „ � -'�k �°rT§'f� . ., ; � i l. 3 � ���,,� � :� �a �� ����. � ��: ,.�� j � I .�1 `*�k..: �° .y bY.a;� �" }�M. ;-: � ,n 0: x T� '.� �'.iq �N��° p:�. � W `ts: . �y� . : �.,W .. � `�� - .Y�� . . � , � s�°�,M�� ""�y.'� � � �� � � ���� � *� � � � e��a����" �~ � � � � � � �"�� �*�� �»„ � � �o `� '���"��.�^ � �� ��, � ��� � �, a � �'� I :�` �'°` �q"�"' f s �, � � � � H � � ����� �� �r���a�°� � � � "' �'�`�� +,�� .�� �� ��� i �, �. . e. i F � ` � � - c� � � =i . � �` � �' �� 1'S"� 1`'` : � - Ec �'� ��p�D s �c n `t", �'�i�� , �� �� „ �. r i { �lA � " ��k:.. h �'��",'�� i i�`y g�' a �+ . ,� �d.� 1 a ,'�j` I % � �` ��.'''�i ��`t;�"�iq#..�„daq�`,i � �, �$! d} ���'�. ��a '.G�° �, Z I r s e� � � � . - � ' , w {� q � m P:�. tS � �, ,�7 ..���>�,�',° � r +� �-a� %e° t" 3'.�� ""T' h�'h'��I^�r�T7i q�s � . . ' .. —D YJ' I . : � .` (�,, . ,�. � � ,` F �. � a "����k� �' - ,V , _ , ,a i 1 � � i :: � �. ,� : �� "., ° � RS� °y�"3 .. � � myt ' �E �"� } c d� �`` 6� � k '��. 1� '�'� ,�:"' tX ��' �n� �n „ � � � � t,��'��"i� � ��� � , f,,� . ,�i� ' �P��{���� �� �� 4 a�§"���, ���. �� � � I �� � a� .��,.� F �' �W � ��� I ' �' '�a �r �'� F � '` � �4��� ;� I b � �. � � � � � ,E � r � � �� I � , ` ^ ��. .� k �.. �� � '� .. � � � �� � � � �� . . � .. -, _. . � ..� �� i � �. 6 � xb +d J� � ���ti�i +�� �i�t a '�.�a 9u�i'��:, �v ��� �.� =e, 5�'.� I k '��a ., � �` ,nV, R s' �;d w ��`"� +. � �� �" � �}� � �' I � . � �E .a� �� .� £�� � � • ��.�Y. ; ,� f��ro � � u� �, �t � . a ,�� I � � . . ex^ ' ,�' �� : ������`�<� �"` �' '�#�' � �'� � s� . . �' < b�'''�; �„'x �" - , � � ��v5 � �. �t xd� '�e��* ��� � �^���,�wt s r � �.r ��a . �� '«+>.k�y?� �.,i� �� . �"� .tr: '� s � � ��- "+F� �. � �� � �a � (� � � ' a u ' ,�a a� �w� `} yS' 3 � :� � � `� �� � a i � '�vs ' h•� e . `-' . '� � ... '' . a����P� �� ,y �yarM�' k� <.; �ii�"= � ,`+Ni� I ,'�i�" ��I. � ��,�' � t "� E� � �� F� :�I„"�" I .� ��,�,y�+.,�: �.�� � y �� . ,� ".�. :, . . � , � ','� '� . � - �p qU ^ � '� '` � � ,� �' � v�; �,� i � F r._�r iZ��lUTil➢�i+.' ; � ' f�". a.+��: � w ����`�° ��i�..�i.� �r :�: ��s... � � � .,�r�&° N r, � � ��f � � �. � � �� • �� ��,n�� �� '' . li.i . � . W N ,a�v��V,� . A� � . � V . . . � .da`.� v- . ��_�, . .. . . .. . . . . � .. � ... . .�t�:.�' _ ,.... �n:s.l�%2».�'�.ti.. ,,_ ... . . _ .��1` �O r ' .�,v — J / ,6� ,�� . I ` �, j � i � o � 2 � � � . � , � S� ,,,,,,���//+��� a�o � 6264 f53.84A) � � `� . , � ."��.j' 273 , 2� S� ..� . . . '� ' � '` � s , � , �� � ' 3214 ;�� _ � � ; , .. r . �, � 1 � . �,�_ � w 5&1 � , . B:StA : �' N '� 14JO6A � �� zoaa �� � " � � � � L �� a�s2 � � � � � � ���.. � , ��4� . - �� �� �I .� . ` ... . . . � 'i i 2633 � �t �� �,�� + �� � �a � �. e� � .. . S ; , � �� � � � �� �1� � (2.22A) .. � —� � (t,o� t� � . i � rszs� � ��� 1486 � � 159 ����� 6 � k I n,�"' r21> � �+� 7s4 : c�Z3� � j p ' � �t�0486 ���� � �� M1� �� �� � ' „ � ' ��� ���� �i59 '� Ci,��.�� -� . t�sa�., __ �,x � m , �P� �� r�3 �<�a,. . ai . m ._.. y �� \ w p.,_...._.�...�.� � (!� + � \ I .. .� � 732 " .. ,� }` .: \ j - `�, � {�a.30A) �N� '" � � �� � 4�A ° 4ozs � �� ;� �, �90�'�'>� ����'�,.���.. �p.�'�� `� � �j �������esan> �e .t� soa2 �� �� � SR�6���� $'� � � � R .� , . � �/� `-' �y�M�'E� � � ' �y.i �k r e �.omm ev a. a..713 „, '' a� � .��7.. �I� �;�� :;.. � � � �� (41.38A} i' �U� �`'��; " � � �°F � � 1 (5.32A} 3.4A • �w. r ( } I 9734 ` `,� 7874 �, J } � ,.�: �i. ... �. : �---� 695 _ �� PcC2 �'A ° � � ���� ��� .�'�` F I � � ��� ' �,' � �,.�`'� 3525 i . ' * °s ,.." PcB2 PcB2�,� � .. � �'� �� �,�� ,��� , ,� � . � � �`�1���� � ()jOJ � .", � � "� �, ��� 1 Q ° 1 � � � PcB2 � �,,�> R��'� � �,�� . � aa � , e _ p. � �,o ���, . � � . �� PcB2 �'cC2 � ��'i � � �,`� .9,� � �� t�� �: �.'�� ! s 'a k i . � ��. ^ ..4 °� �: , .... . ', ` . : ' , 'I �.� srcca�aue..el ... .. ... .. .... _ {ZOBBj _ �. . � . . ' . (1455 t-_�___ .. _. . .....�,.._._--•-____.�...,..,,.'A....,..». >._ . e..:���_..w,,....� .. � C . .(t243} � J �. ��� �. . . ' '2 � i / d I ... / . .� � F�< � � N i I I � a, D f� � � . C� i , e� n � � � � N � � `� � ii ,i��� � m 8 1 m li / g�4 � ' / '�� � ! � � ' � / , �/ � vw'�� ,i' �"� ���� � :aC m. / . . . .1`J . ...... .. < ..... . . . . .. . � . . _ I _. ., r>_ . '—�P�L� A T � � ITE EVALUATION/IMPROVEMENT PERMIT & ATC ., . ,����_���� � .- � avie County Health Department � �`�I! ,�h� �1� ��e '�� � 2006 ' Envirosamental Health Section ``.� �. 5E� `� P.O. Box 848/210 Hospital Street �7l�• �� �����S �b � � ' Mocksville,'NC 27028 uN jo�� �� � ENv�Rp�,MEco r n�TN (336)751-8760/Fax (336)751-8786 � s- ��3� Application For: ❑ Site Evaluation/Improvement Pernut ❑ Authorization To Construct(ATC) �o t h ***IMPORTANI'***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION � J / �� Name to be Billed +�t�� � „ �� ! . ��- ,tt� Contact Person " � D� �-�` � J���'"� Billing Address �l ���V o.� Home Phone �,��.-1 Z��s� City/State/ZIP�i(�C Z / d c., Business Phone y_�f- 5 �'? �j Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION NOTE: A survey plat or site plan must accompany this application. . •/ (Pemut is valid fo mon s with ' i an,no expiration wit cq�inplete plat.) �?9g�����73`�' Street Address `�r,(��,kU �� City C�U�ti� Tax PIN#1 ����'�'UOD/j a� Subdivision Name � Sect9 Lot#—.� �.n�Size �F(.V�Z R�• Dire 'ons To rte: � �� � ee < � r,l -(� � �,� . �,q,�, C; ' rUC� `7l U� i ! s✓UC Date House/Facility Corners,�Flagged �`-//-p�a If the answer to any of the following questions is"yes",supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes C�No Does the site contain jurisdictional wetlands? ❑Yes C3No Are there any easements or right-of-ways on the site? ❑Yes C�'�to (^ Is the site subject to approval by another public agency? ❑Yes O'iQo Will wastewater othei-than domestic sewage be generated? ❑Yes C�Io C IF RESIDENCE FILL OUT THE BOX BELOW #People � #Bedrooms r #Bathrooms �`� Garden Tub/Whirlpool �es.- ' o _ Basement: es ❑No Basement Plumbing: ❑Yes C� % ;; '� IF NON-RESIDENCE FILL OUT THE BOX BELOW t ;-' Type of Facility/B�zsiness Total Square Footage of Building #P�b` ���%`` # Sinks #Commodes #Showers #Urinals �! Estimated Water Usage (gallons per day) (Attach documentation of similar facility water onsumption) FOODSERVICE ONLY: #Seats � Typesystemrequested: 0'C`onventional ❑Accepted ❑Innovative OAlternative ❑Other Water Supply Type: ❑ County/City Water C�'�1ew Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes �o If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any pernut(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed. 1 z�nc�erstand that I ana responsible for all charges incai��red from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Deparhnent to conduct necessary inspections to de ermine co�j liance wi h applicable laws and rules on the above described property located in Davie nty nd owned by� " r(�� l�:��n.'c� ,/�� • l� Site Revisit Charge Property owner's or owner's legal representative signature �, Date(s): � -� �i' l� Client Notification Date: Date EHS: -� �}eNk/NNE� ,�0 ,� �q � ��� � � �::s-r�:- uYs dNo {/�Il(lrYti���A.��"'" .. � Account# � Qj Revised 2106 Invoice# 1 � , • , DAVIE COUNTY HEALTH DEPARTMENT � , �s�fnvironmental Health Section , � � • �:���' Soil/Site Evaluation � dyj ' APPLICANT INFORMATION� PROPERTY INFORMATION Account #: 990004101 � Tax PIN/EH#: 5798-04-9734 Billed To: Ron Williams Building Co. Subdivision Info: Reference Name: Location/Address: Burton Road-27006 Proposed Facility: Residence Property Size: 28 acres Date Evaluated: (b L "4� `�. Water Supply: On-Site Well � Community Public Evaluation By: Auger Boring / Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e sition L �. L L"V Slo e % (� o 0 HORIZON I DEPTH _G • 1 a - - � Texture rou V S c S�j- S G Consistence ; 1'y Structure � 5 Mineralo S S HORIZON II DEPTH (v- 1 (o - ' I �o . Texture rou S G G k L Consistence ; � � S Structure < - � Mineralo � HORIZON III DEPTH �(o- lc- Texture rou c s Consistence `� S 5 Structure C Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE Q p. �• SITE CLASSIFICATION: EVALUATION BY: � LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: �+J ��V-1�� REMARKS: LEGEND T,_ n�_dscapg pocition 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 Tgxtnrg 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 ONSIST .NC . 1�Q1S� VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFT-Extremely firm �Y�L � 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 MineraloQv 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) '1'�-�term acceptance rate-gal/day/ft2 DCHD OS/OS(Revised) NOTES: 1. RAW ERROR OF CLOSURE 1:10,000+, MISCLOSURE WAS DISTRIBUTED BY COMPASS RULE. 2. AREA DETERMINED BY COORDINATE COMPUTATIONS. \\ CSF <FS 3 DASHED I-INES REPRESENT INFORMATION TAKEN FROM F/r DEED OR PLAT. --- �'D 4. IMPROVEMENT NOT SHOWN HEREON. \ � 5. DISTANCES SHOWN ARE HORIZONTAL GROUND DISTANCES ��\ UNLESS NOTED OTHERWISE. 60 \ o Z 00 �O 6. THIS SURVEY IS SUBJECT TO ANY AND ALL FACTS THAT MY d W BE DISCLOSED BY A FULL TITLE SEARCH, WHICH HAS NOT \ Q } BEEN FURNISHED TO SURVEYOR AS OF THIS DATE. U '00op Y4 d O REFERENCES: U 1 ALL DEEDS AND MAPS SHOWN HEREON SITE \ C 00 2A 1 CA o C9 t/2 I R S VICINITY MAP NOT TO SCALE a a�A BRANCH RIVER RANCH, LLC v co DB. 178, PG. 485(TRACT 1) ti o z 42.798 ACERS BY DEED ro 0 COUNTY ID: I90000001903 A co* S38'06'07"E \ \ 20.06'T1E PRELM NARY PLAT � NOT FOR RECORDAT ON , CONVEYANCES , OR SALES RAILROAD IRS\ 2s SPIKE TRACT 1 OF DB. 178, PAGE 485 TO BE COMBINED WITH TRACT 2 OF DB. 183, S38'06'07"E PAGE 834. 128.69"TIE RESULTING IN A NEW 28.032 ACRE tiA TRACT AND THE REMAINDER NEWS -� "E \ s \ TRACT OF GREATER THAN 10 ACRES. P" 116?25'TIE \ S45'04'27"E S' 136.93'1IE v EIP BRANCH RIVER RANCH, LLC DB. 183, PG. 834(TRACT2) 183.4 ACERS BY DEED COUNTY ID: I900000018 tip M ��. 2ry BRANCH RIVER RANCH, LLC DB. 178, PG. 485(TRACT 2) 211 ACERS Y DEED LEGEND 9.) Gp � COUNTY ID:B 90000 02401 O� p'�t p ph EXISTING IRON PIN O EIP �• a EXISTING REBAR 0 EIR Mph Q NO POINT SET • NPS �� Qom• IRON REBAR SET 0 IRS p RIGHT-OF-WAY R/W '1 CONCRETE MONUMENT CM CHORD CH 26.7' IRS q�• SIGHT EASEMENT SE DEED BOOK DB N8327'02.W Off• PLAT BOOK PB 1 618.37' NEW UNE IRS CURB ANC GUTTER C&G REINFORCED CONC PIPE RCP j PROPOSED HOUSE LOCATION ON: CORRUGATED METAL PIPE CMP A' °p v I BRANCH RIVER RANCH CORRUGATED PLASTIC PIPE CPP a c� ) PEEBLES CEMETERY BOUNDARY LINE ��,�„y1 ^ , J DS. 61, PG. 336 /' ACRES. MARKED BY STONE FENCE POSTS, 0.083 LLC PR OPER T Y RIGHT–OF–WAY LINE — — 0�� � A DEED CALLS FOR STONE FENX POSTS TO RS UNSURVEYED PROPERTY LINE y�• �j V f CONTAIN 0.5 ACRES AND ACCESS EASIAENT TO SITE UNSURVEYED PROPERTY LINE 6 5� ASO /V75,�� FROM PUBLIC ROAD AS IT EXISTED IN 1959. FENCE LINE X y0G Os 4 .47'2"W GGRA SpA TIMENOTE OF SURVEY.G PATH TO NEW 28. 032 A CRE TRA C T EASEMENT _ _ _ SF.Fp 810 58 97'W E p5* SNE N09'38'06"E N S74'36'10"E 4- 59.81' 86 p3 BRANCH RIVER RANCH, LLC IRS 47.19' �� b�\ DB. 183, PG. 834(TRACT2) CONTRL POINT •.��,,��,, 183.4 ACERS BY DEED OWNER: NC GRID ESTABLISHED 821.88' NEW COUNTY ID: 1900000018 BRANCH RIVER RANCH, LLC BY GPS-VRS METHODS � UNE F PO BOX 320 N: 782,775.26' S8154•22"E IRS ADVANCE, NC 27006 E: 1,589,309.05' CONTROL CORNER CGF = 0.99990573 Allied Associates, P.A. TAISCALE 4720 KESTER MILL ROAD Phone (336) 765-2377 GRAPHIC SCALE WINSTON–SALEM, N.C. 27103 FAX 760-8886 e–mail– allied–engsurv.com 200 0 100 200 400 800 SCALE TOWNSHIP COUNTY STATE DATE 1" = 200' FULTON DAVIE NORTH CAROLINA 08/21/06 IN FEET SURVEYED: MAPPED: JOB NO. MAP NO. TDS 1 inch = 200 ft. CBO CBO PA060808 BRR.dwg BPR Allied Assoc„ P.A. 2006