2000 Farmington Rd (2)DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002085
Billed To: Sherman Dunn
Reference Name: APAC
Proposed Facility: Office
112
Tax PIN/EH #: 5841-71-6454
Subdivision Info:
Location/Address: Farmington Rd -27028
Property Size: 5 acres
ATC Number: 3630
**NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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: ❑
PI -A -m
Commercial Specification: Facility Type oiP1e.E #People Io #People/Shift #Seats Industrial Waste: ❑
Lot Size & • 05 MU4 Type Water Supply wWIYDesign Wastewater Flow (GPD) 2SD Site: New e Repair ❑
System Specifications: Tank Size 1000GAL. Pump Tank GAL. Trench Width �� � Rock Depth )Z," Linear Ft.Am—
Other: 4 1>15TV-1 P-X)Tlo-� Bo -,=-S
Required Site Modifications/Conditions: Vcd.Ll-OL-:�� KZ=P `5, e:�W 60I -9O(c, k+cL=Q COT C4--
IMPROVEMENT/OPERATION
FIMPROVEMENT/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.****
Zcx�
Health Specialist's Signature:
(Revised)
4k%- Vbl -ro Oil QQ01 PIN)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-87(0
Account #: 990002085 Tax PIN/EH #: 5841-71-6454
Billed To: Sherman Dunn Subdivision Info:
Reference Name: APAC Location/Address: Farmington Rd -27028
Proposed Facility: Office Property Size: 5 acres
ATC Number: 3630
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 WASTEWA N TR TIO IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature- Date: �� d
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion sh 11 indicate the system described on Improvement/Operation Permit
has been installed in compliant with Article 11 f G.S. Chapter 130A, Section .1900 "Sewage Treatment and
Disposal Systems," but shall in O WAY be tak as a guarantee that the system will function satisfactorily for any
given period of time. iz
1 � k Dan. jt
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
��fl El
Ai
NOV �, 4 2003
"RON MAL"
D OWE
)N FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department
Environinenta/Hea/th Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
Z OD
1. Name to be Billed -J Ll '-J Iv Contact Person
tl
Mailing Address / a n�3 V r y9 l/, �) x� .( -y , Home Phone'32 (.-'4 0)a— s
City/State/ZIP OL� , U ,�� 10 AJ, IC, L Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATCBoth ,
^ C (— \L C/
4. System to Service: 11 House ❑ Mobile Home 11 Business 11 Industry 11 other
V
5. Type system requested: ❑ Conventional ❑ conventional modified ❑ innovative
6. If Residence: # People # Bedrooms # Bathrooms
❑Dishwasher []Garbage Disposal ❑Washing Machine ❑Basement/Plumbing ❑Basement/No Plumbing
�Z. If Business/Industry /Other: verify type # People # Sinks
\ # Commodes Q— # Showers %' # Urinals It Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
8. Type of water supply: County/City ❑ Well ❑ Community
9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes No
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: A G. WRITE DIRECTIONS (from Mocl(sville) to PROPERTY:
Tax Office PIN: -a # < 14 7 --�- t✓t_ 1. �«
Property Address: Road Namc% A r-&, Nn`tori
City/zip M D ck SU l) )& i Oa
If in a Subdivision provide information, as follows:
Name:
Section:' Block: Lot: Date home corners flagged: `/-/C)' - Q
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 aur responsible for all charges incurred fironn
this application. I, hereby, give consent to the Authorized Representative of the Davic County IIealth Department
to enter upon above described property located in Davie County and owned by -,SQ )J *J
to conduct all testing procedures as necessary to determine tate site suit, ' ity.
DATE 1/ , a Y• d 3 SIGNATURE 0
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).
V -
Sign given
Revised DCHD (05/03
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Account No.�
Invoice No. C(
t: r � i yu1 3692
i3
z � E
735$
R F t2ru'11
z
CF
----
t52 VA} �'9,p
------.700
5512
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2143
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56
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20A)
i 6454
77 ,;
izv ?r
e; NDEXI
0781 "�J '.
41 r
(aa7r,y (ra51 �(
(3.87A) i
6564 R
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1 l 16A) E\J/L%-,/-A T�R
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INDEXED ON 5840.08
6
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7234
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2t a9 _
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
SoiVSite Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990002085 Tax PIN/EH #: 5841-71-6454
Billed To: Sherman Dunn Subdivision Info:
Reference Name: Location/Address: Farmington Rd -2702
Proposed Facility: Office Property Size: 5 acres Date Evaluated: ' J
Water Supply: On -Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS
1
2 3 4 5 6 7
Landscape position
1
Slope %
HORIZON I DEPTH
-
Texture grou
L
Consistence
Structure
Mineralo
(In t Y"-,- 9
t V%( -f)
HORIZON II DEPTH
1to-
Texture group
G J
Consistence
Structure
Mineralogy
HORIZON III DEPTH
Texture groupr
Consistence
Ivs
Structure
Mineralogy(M
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
5 -
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE
REMARKS:
> EVALUATION BY:
o' 2— OTHER(S) PRESENT:5^'^�
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(provisional Iy suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ft2
DCHD 05/99 (Revised)
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NCGS NAD 83
Y • 811T31.23
X • I548537.88 ��
om POO
e
471.86'
S 87°09'57"E
6.027 ACRES
lR
a
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r N 89° 1 1 '07"W q INTomm N 89° 1 1 '07' W
CORM 154.53'I CORM 471.33'
wr Mom Pei
wr taxi Psi
REFERENCES: UNRECORDED SURVEY BY THIS
COMPANY DATED T/29/02.
ACCESS TO LEASE TRACT VIA 00ST ING AND
FUTURE QUARRY ROADS.
NOTICE: THIS SURVEY DOES NOT CONSTITUTE A
A TITLE SEARCH BY HELMS SURVEYING COMPANY
TO DETERMINE OWNERSHIP OR EASEMENTS OF
RECORD. THIS MAP IS NOT FOR RECORDATION.
NOTE: DISTANCES SHOWN HEREON ARE NCGS
GRID NAD 83. COMBINED FACTOR - 0.9999191
DATUM PROVIDED BY MARSHAL. MILLER 8 ASSOC'S
WO D 109 .299 300
GRAPHIC SCALE — FEET
N 8901 I'07"WMWT
SURVEY OF_ 672.27'
A.PAC-CAROLINA, . INC.
LLASL' 4 ITE AT
VULCAN �ATA'RIALS COMPAN.r.7
SMITH CROTT QUARRY
BEING A 6.027 ACRE TRACT OF LAND OUT OF
LADS DESCRIBED IN A LEASE AGREEMENT
RECORDED 1N BOOK 383 AT PAGE 119 OF THE
DAVIE COUNTY REGISTRY. LYING IN FARMINGTON
TOWNSHIP, DAVIE COUNTY, NORTH CAROLINA.
TRACT LINE
PREPARED BY:
HELMS SURVEYING COMPANY
P.O. BOX 734
CLEMM ONS, N.C. 27012
336—T66-6949
DRWG NO 03-0805
r
\`zoQQ Fess Zz", i
HEREBY CIrRTIFY THAT THIS PLAT IS THE
SEAL
RESULT OF -AN ACTUAL FIELD SURVEY BY ME
ON AUGUST 5, 2003
= '-
-3087
4h � \_
0 `
c
y
ututn�"����\
PROFESSIONAL LAN SURVEYOR NO. L-3087
—�
wr Mom Pei
wr taxi Psi
REFERENCES: UNRECORDED SURVEY BY THIS
COMPANY DATED T/29/02.
ACCESS TO LEASE TRACT VIA 00ST ING AND
FUTURE QUARRY ROADS.
NOTICE: THIS SURVEY DOES NOT CONSTITUTE A
A TITLE SEARCH BY HELMS SURVEYING COMPANY
TO DETERMINE OWNERSHIP OR EASEMENTS OF
RECORD. THIS MAP IS NOT FOR RECORDATION.
NOTE: DISTANCES SHOWN HEREON ARE NCGS
GRID NAD 83. COMBINED FACTOR - 0.9999191
DATUM PROVIDED BY MARSHAL. MILLER 8 ASSOC'S
WO D 109 .299 300
GRAPHIC SCALE — FEET
N 8901 I'07"WMWT
SURVEY OF_ 672.27'
A.PAC-CAROLINA, . INC.
LLASL' 4 ITE AT
VULCAN �ATA'RIALS COMPAN.r.7
SMITH CROTT QUARRY
BEING A 6.027 ACRE TRACT OF LAND OUT OF
LADS DESCRIBED IN A LEASE AGREEMENT
RECORDED 1N BOOK 383 AT PAGE 119 OF THE
DAVIE COUNTY REGISTRY. LYING IN FARMINGTON
TOWNSHIP, DAVIE COUNTY, NORTH CAROLINA.
TRACT LINE
PREPARED BY:
HELMS SURVEYING COMPANY
P.O. BOX 734
CLEMM ONS, N.C. 27012
336—T66-6949
DRWG NO 03-0805
7A -W
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION/ i_ M L mol
e APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) tl �� C
NAME mi ���EL�� PHONE NUMBER q,0q 2-/07
ADDRESS �70 vo SUBDIVISION NAME
f ' _ LOOT #
DIRECTIONS TO SITEZ-i�%(�
DATE SYSTEM INSTALLED NAME SYSTEM INST LLED UNDER
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
Au,w,j 6 of
DATE REQUESTED1 IC1,092 INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge. and that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1193