770 Chinquapin Rd.• ,
Account #: 990Q00946
Billed To: Ruth Styers
Reference Name: Ruth Styers
Proposed Facility: Residence
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
�%� 02-/� c�
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Tax PIN/EH #: 5813-59-6101
Subdivision Info:
Location/Address: Chinquapin Road-27028
Property Size: 20.25 Acres
**NOTE"`*'Ttiibgmprov3em8ent/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater
system. An ALJTHORIZATION 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 r/f f� #People �_ #Bedrooms �#Baths �.
Dishwasher: � Garbage Disposal: ❑ Washing Machine: � Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size � y`��f l� C Type Water Supply �j�/l // Design Wastewater Flow (GPD) 02 Y� Site: New �Repair 0
System Specifications: Tank Size%D GAL. Pump Tank
Other:
Required Site Modifications/Conditions:
GAL. Trench Width 3G � Rock Depth � Linear Ft.�S a�
IMPROVEMENT/OPERATiON PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6" BELOW
FtNISHED 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)751-8760.****
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Environmental Health SpecialisYs Signature: ' � �^ ` 7 �� Date: �02— �(� !��
DCHD OS/99 (Revised)
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Account #: 990000946
Billed To: Ruth Styers
Reference Name: Ruth Styers
Proposed Facility: Residence
ATC Number: 2318
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Bog 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Tax PIN/EH #: 5813-59-6101
Subdivision Info:
Location/Address: Chinquapin Road-27028
Property Size: 20.25 Acres
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
�
**NOTE** This Authorization for Wastewater System Construction MLTST BE ISSLJED 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 CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health SpecialisYs Signature: �����(��( `� �� Date: ��� aQ 6 a
CERTIFICATE OF COMPLETION
**NOTE* * The issuance of this Certificate of Completion shall indicate the system described on ImprovemendOperation 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 guazantee that the system will function satisfactorily for any
I given period of time.
QDp
Septic System Installed By:
Environmental Health Specialist's Signature
DCHD OS/99 (Revised)
Date: � � —�l �
� . . �� 2 � � iif EVAUlATION/1141PROVEMENT PEHMR �C A7C
�. ... a� D�5 fe County Heaith Department
vfronmentaJ He�lth Se�t,toa 3 �.(
JAN 1 2�00� p• • �x 818/Z10 Horpitsl BtrNt -��y1� 1� a o 0 0 o a v
. �o�.�iii., r�c z�oze .
(386) 751-8760
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t��D►TZQ2i I8 PAOVID�D. A�t�r to th� II�l'OR�AT=C2i BULLZT2N !or instruations.
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a. sY.t.�a to s•=.so.s � 8ons� 0'Mobil� Hom� 0 Huain�ss 0 tadustry 0 Oth�r
a. I! R�siduta�: f p�opl� ___,�__ i H�drooms � M Bsfi�rooms �.
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7. syp� o! �n�r supply: � Couaty/City �R�11 0 Commuaity
e. Do yoa �nHcipate �ddiNow or e:paatlow oit6e tncUliy tL4 tyttem b intended to �ecve?
Ityes, �rhat type?
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"*'IMPORTANT"*� CWENTS M(IST GiDMPIETETHE REQtlIRED PROPERTY INFORMA't'�ON REQUESfED
BELOW. �lthec s P4AT or 8ITL PL.AN MI�ST BBSUBMIiTED by t6a cUent �vtt4'fNi9 APPWCATION.
Property Dimeastons: � 0� a 5 A �
T�:Omcc PIN: p� g I 3- � q-(.p 1 O �
rro��cy �aa�: Ro,a rt.me C�•
c�r�r��p �.I ��,oag
U iu s Sabdiv".�lon pravide iuform�Hoo, ai fotimvr.
N�me:
SecNoas 81ock: Lott
WILlTE DIRECflONB (from Moeksvtlle) to PROPERTY:
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T6b b to certitj► th�t t6e iatorm�tlon pro�vide� is correM to t6c best ot my knmvledga I nndertbnd i6�t �ny permlt(�)
iaeotd 6ereafter 4re �nbject to �aspeneion oc revoeation, ii t6e dte pf�n� or lntendal ase ch�nQe, or It Ihe lnform�Hon
�abmiHed in thb spplic�Non fs fnL�ifle� or c6anQed l, also, u»diratand ta►at I an� respa»sibta jor a!! charg�s lncumd jrot�
tA�u appUcatlon. I, hereby, Qive eonseut to the Ant6orized Acpressntstive ot the Ds H{ 6 De rtmc
to enter npon abav� daeribed prnperty {oc�t�d In Davle Cannty snd o�ned by •
to condoct sU tatin� proctdara �s aceea�ary to determine t6e tite tnitsbplty.
DATi: � - �I ' U � SIGNATURE
TEiIS AREA MAY BE USED FOR DRAWING YOUIt !�i'i'L PLAN (inclade alt ot t6e %llmvinat L�tin� and propa�ed
praperty tina �ad dimenaiaw, etractara, �etbaclu, snd kpt[o loc�Non�).
Revised DCHD (07/99)
8itt Itevbit C6ir�e
I D�te(�):
� Ci{ent NotiHaiHoa Date:
IEAS: - -- -
Accoant Na �7 �
Invoice Na ��
Davi� County, North Carolina Spatial Data Explorer
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� Zoomin � ZoomOut � Recenter Map �' ide�c�ry: Parcel �
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Parcel Data
• Parcel Number(PlN): 5813596101
• Counfy lD: 02 B200000034
• Property Address:
• Legal Desc.: 20.25 AC SR 1328 DB 136-453
• Use Value: $0.00
� Building Va/ue: $0.00
• Extra Feafuies Value: $0.00
• Land Vafue: $1,420.00
Locality Map
• Total Va/ue: $1,420.00
• Owner. STEELMAN BILLY R& DOROTHY C
• OwnerAddress: 1405 YADKIN VALLEY RD
• OwnerCity: YADKINVILLE
� Owner State: NC
• Owner Zip: 27055
Page 1 of 2
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found wdhin this jurisdidion, and is compiled from
Find a parce/ by one (or parts of one) of the following: recorded deeds, plats, and other pubiic records and data.
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ddress: �� � be consutted for verification of the information contained on
../esrimap. dll?Name=davie_sde&Cmd=Clk&Left=1513472.94500997&Right=1516934. 85125997 1 /6/00
� � �' � � DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION
PROPERTY INFORMATION
Account #: 990000946 Tax PIN/EH #: 5813-59-6101
Billed To: Ruth Styers Subdivision Info:
Reference Name: Ruth Styers Location/Address: Chinquapin ftoad-27028
Proposed Facility: Residence Property Size: 20.25 Acres Date Evaluated: y1� -p�'�� ,
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
SOIL WETNESS
SITE CLASSIFICATION: EVALUATION BY: ��" �1
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 - Cn�mb GR - Granular ABK - Angular blocky
SBK - Subangular blocky PL - Platy PR - Prismatic
Mineralogv
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
DC�ID OS/99 (Revised)
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