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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� / 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.**** � (/, �� G, � �� p�``� � � � ���� � �� / � 3�"�x-� X� � � � Environmental Health SpecialisYs Signature: ' � �^ ` 7 �� Date: �02— �(� !�� DCHD OS/99 (Revised) � 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 •�*T��?--. ...t�-- -s�+.� �0►�1 CJIIPlPD? a1D pROGaB�D Z1NLa88 71LL T� REQUIRaD t��D►TZQ2i I8 PAOVID�D. A�t�r to th� II�l'OR�AT=C2i BULLZT2N !or instruations. , 1. lQas. !o n. asll.e coa�tsot p.r.oa vy�-� 1�atiix�q l�dds... 1 � 7'�t' �Q.�f� %�Cc..,.. ll�n nQ7�" to.. �o:►. _ 7TD �' r�"7 t c� t'�P.Cto-� C�, �����►wf=�► w . � _ 70�5. �... �. _ �� 3 - sa I � ��el�� ��-�, .�.� . . � L Z. x.■. oi► 4�it�aZc s: ais:.r.at t.han 1►bo.�. 1 ,tav,rl� Nailiaq �+ddr��� CitY/ttabl:ip �. �►ppiicatioa �ors O 8ita ivalnation O improv�maat p�rmit/71fiC f� Soth 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 �. [YDi•b«aab.s O aas�b�q. ai.po•al �iRa.t�iaq laobsa. o sa..a�.atlaluabsaQ 0 ss..�at/1to D1u�btnQ 6. 2t awi���/iadu�Y�/Oth�se /p�oil�[ tiYP� i Coa�od.� i Yhows� � P�opl� f siak� 4 ur.iaal• i Rat�r Cool�r� I! 1'00�DS=AVIC�: � 8��ti =�tims�t�d 1t�t�r �raq� to�l� r� �r� 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? 0 Ya p'No "*'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: . , � �C` ' �� � 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 ,.,avr�, <.-i . � �.�i. .7t �i;� c"7I �r#lel ���� �-it"L�i" � _ � � `' Nnrit� �arnlir�a ,' . w Click on the Map to: � Zoomin � ZoomOut � Recenter Map �' ide�c�ry: Parcel � N SCALE 1 : 4522 � � � Zoom In Zoom Out Full Extent Reset Map ( � 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 Map Layers Draw se/ected layers: Transportation � Street Centerlines Interstate 40 � US Highways �— NC Highways — Other Streets — r Rail Lines E Government r CRy Boundaries r Townships � Census Trads r School Distrids NaturalResources r Hydrology � Soils Localities r scnools � Fire Departments Parcel Data r Parcels Draw Layers I Parcel Query This map is prepared for the inventory of real property 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. Users of this map are hereby notified that the St. # St. Name St. Type aforementioned public primary information sources should 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) i ■ ■■■■ ■��■ ■�■■ ■��■ ■■■■ ■�■■ ■■�■ ■■ ■■�■■■ ■���■■ ■■���■ ■■���■ ■■■■■■ ■�■■�■ ■�■��■ ■�■■�■ ■�■��■ ■ ■����■ ■■■■�■ ■■■�e■ ■���■■ ■�■�■■ ■��■■■ ■��■�■ ■��■�■ ■■�■�■ ■�■■ ■■■■ ■■■■ ■�■■ ■��■ ■�■■ ■��■���������■■�■■��■■�■���■■■ �■�■■■�������■���■■��■���■ ■■ ���■��■■■■■�■■■��■�������■ ■■ ■■��■��■�■�����l��■�����■�■��■ ■■�����■���■��■������■�■��■■■■ ■■■���■■■��■��■�S■���■�■����■■ ■�■■■����■■��■■■�■��■■■■��■■�■ ■�■■■��■■���■�■■�e■�■■■■■o■■■■ ■■■■����■�����■■�■��s■■■■■■■■■ _■■�����■���■�■■�v■�■■■■��■■�■ �■■■■■■■�■■���■■■■��■�■■■■��■ ■���■ ■���■ ■��■■ ■���■ ■�■�■ ■��■■��■■ ■���■���■ ■���■■■�■ ■�����■�■ ■����■��■ ■�����■�■ ■�■�■�■��■�■��■■■�■■�■■�■■■��■■■■■■■�■��■■■■■■����■■■�■ ■�■�■■�■�������■������■■�■■■■�■■�■■�■��■■��■■■■������■�■ ■■■■���■�■��■�������■��■��■�■��■��■�■��■■��■■■■■��■��■�■ ■■�■���■■■■�■������■���■■�■■■■�■�����■��■���■�■�■�■■��■■ ■■�■■�������e■���������■��■�■■�■■����■���■■■■������■■�■ ■��■����■■■�■■��■�■���■■�■�■■�■■��■�■■��■■�■���■�■���■ ■�■�■��������■■�■■��■ ■■����■��■��■�■■�■■■■■��■��■■��■ ■�■�■■�������■■■���■�■�������■�■��■■■■■�����■�t■��■���■ ■�■�■�■■�■����■�■■�■�■��■■�■�■■�■■�■��■■�■■■■■����■■■�■ ■■■�e�■����■��■��■■■����■■■■�����■�■��■■��■����■������■ ■■����■��■�■■�■��■■■��■■�■■■�■■��■�■��■���������■���■�■ ■���■�■��■��■�■��■■■����_:�c:r�•�■■■■��■■����■��■■��■�■ ■�����■■������■■�e=�:i���■■�■�■■�.��■■�■■������■■■��■■■ iiiii�iiiiiii�iiiiii '�iiiiiii�iiiiiiii�iiiiiii�iiiiiii�i ■�■��■�■����■■������■■�■■�■�■■�■��i���■■�■�■�■�����■�■�■ ■�■■�■��■�■��■����■��■��■�■��■��■���■��■��■■■■�����■�■■■ ■�■��■��■�■��■���■����■■■■����■��■■i�■■����■■■■���������e ■■�■�■��■�■��■��i■■���■■�■■�■�■■�■■u■■��■��■�■■■����■��■ ■■�■����■����■��i■��■�����.......==�■■■�■■����■�■■■■���■ ■■���■■����■�■■�i�!==:���■�����■��■■����■■����■����■■■�■ ■■���■■�����■■■����■■�����■■�■■�■■�■■��■■■��������■■■■ ■■■�■�■■��■��t■■t��■■ ■���■■�■■����■■■�■■■������■■■��■ ■■■�■�■■�■■■■��■■o■■��■■���■■��������■■��■■■������■■■�■ ■�■�■�■va■�����■■�■����■�.��■■�■������■�■■�■■t��������■ ■�■N�■■����■��■■�■�■��■�i�■�■■��■�����������■■■�■��t�■■ ■�■�■��■�■■����■■■■�■■�■u�■�■■■��■�■■��■���■�■■■■■■■��■ ■�■■���■■�■��■��■�■�■■��■■■��■■t■��■■��■■��■������■■■�■ ■��■�■����■��■�■■■���■■�■■�■��������■■�■■�■■������■■■�■ ■■■■��■�■�■■�■■■�■�■���■■■■��■■��■��■���■■■■���t��■■■■ ■��■�■■�■��■��■��■�■■ ■���■■�■■��■��■■�■■�■��������■■■ ■■t■�■■��■�■�■��■■�■■�■����■■�■■�����■��■■■�������■�■■■ ■■�■■�■��■■■��■��■�■��■�����■■����■������■�■■■t��■��■�■ ■■■■■����■�■■■�����■■�■�������■���■�■���■■�■�������■��■ ■���■�■■�■����■��■�■��■■t���■�■■�■■��■■�■■■�■������■■�■ ■���■�■��■��■■■■■��■■��■��■■■■�■�■■��■■��■■�■■■������■■ ■���■�■■�■��■��■��■�■��■■�■■■■t�■■�■���������■■■■��■�■■ ■�■�■��■■��■■■�■■�■�■ ■■■��■■��■■■�■��■�����■■■■■■��■■ ■������■��■����■■■■■��i�■�■��■�■■■■■■■�■������■■■■■���■ ■■���■��■��■�■��■�■��■�■■■���■■���■����■���■������■■��■ ■■�■�■��■�■��■■■■�■��■��■■����■���■��■�■■■■■■����■■��■■ ■■�■�■����■■■�����■■■■■■�■����■������■■�■�■�������■■■■■ ■■�������■■■■���■■■■■�■����■■■■■■■■■�■■�■■■■■��■���■■�■ ■�■�■�■��■����■■�■�■���■��■■■■■�■■■■■■���■■■■�������■■■ ■���■�■■�■■■■■���■�■���■����■■�■���■��■��■�■■������■■■■ ■�■■■�■■�■■■v��■■■■■■�■����■��■■■■���■■■■���■����■■�■■ ■�����������■■■�����■ ■�■■■■■�■�■■■■■����■�■■■�■�■■��■ ■����������■■������■���■■■��■����������■■■■■���������■■ ■��■����■■■■■���■■■�■�■■�■����■■■��■�■������������■■��■ ■■��■■■■■■���■■■■■�■■■■���■■■■���■�■■■��■�■■�■�■■■■���■ ■■���■■�■�■�■■��■������■■�■��■�����■���■■■■e���■■���■�■ ■■���■��■�■����■■�■��■���■■�■��■■■■■■■��■■�■■■■■���■■�■ ■■■■����■������■■■■■��■■■����■■■■�������■�■■����■■�■�■■ ■■■�■■■■■��■■■■■■��■■ ■���■�■�■�■���■���■■■■■���■�■�■■ ■�����■��■����■�������i��■■■■■�■��■■■���■�■�■���■■■���■ ■�■■■■■■■■���■�����■■■��■�����■■�■�■��■■�■��■���������■