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324 Feezor RdDAVIE COUNTY HEALTH DEPARTMENT z`l / Cr _ Environmental Health Section c P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 Z gra (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990001268 Tax PIN/EH #: 5727-98-5176.02 Billed To: John Yarbrough Subdivision Info: Reference Name: John Yarbrough Location/Address: Feezor Road -27028 Proposed Facility: Residence Property Size: 28 Acres ATC Number: 2720 **NOTE** This Improvement/Operation 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 flposc#People #Bedrooms 3 #Baths 2— Dishwasher: Dishwasher: 1 " Garbage Disposal: ❑ Washing Machine: Ca"_ Basement w/Plumbing: ❑ Basement/No Plumbing: ®"_ Commercial Specification: Facility TypeqqL #People #People/Shift #Seats Industria13l Waste: W Lot Size Type Water Supply ELDesign Wastewater Flow (GPD) � Site: New u Repair ❑ System Specifications: Tank Size 1000 GAL. Pump Tank 1 OCOGAL. Trench Width Rock Depth 1;, Linear Ft .4w Other: L� ,�i2� Q it©� �K�S �"-�► at_I✓ / Require Site Modifications/Conditions: 0 _� I cd �aon_ L,) =_L_, Vj:r_P I5 I ROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S) IF 6 "BELOW INISHED 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.**** 1 ' FES uPSc--- t o C) c� P ✓� `tom' N 3 Environmental Health Speciali 's Signature: � v ate: v 01 DCHD 05/9f L>vis d) fz SZC2 •T art C,C DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001268 Tax PIN/EH #: 5727-98-5176.02 Billed To: John Yarbrough Subdivision Info: Reference Name: John Yarbrough Location/Address: Feezor Road -27028 n......,..4.. Q:-,.,. 792 A^rce Proposed Facility: Residence ri�Nai►y ATC Number: 2720 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 ). 00 Sewage Treatpient and Disposal Systems). THIS AUTHORIZATION FOR WASTEW CO ON IS ID FOR A PERIOD OF IVE YEARS. Environmental Health Specialist's Signa re: Date: U/ 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 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 function satisfactorily for any given period of time. V Septic Syst Fastalled By: r E Environmental Health Specialist's Signature: DCHD 05/99 (Revised) .I X24 AQ- , J' -r 1 L 14tJ V— L tt-Y� li n� n L r Date: 9A3 LO 1/ g� -1 -,7 - 0,0 APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & Yf' Davie County Health Department Environmental Hea/ffi Suction P.O. Boa 848/210 Hospital Street JUL 2 4 2000 Mocksville, NC 27028 (336) 751-8760 ENVIRON HFGITU ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED - INFORMATION IS PrROVIDE{DD. Refer to the INFORMATION BULLETIN for instructions. 1. 1. Name to be Billed�(1�O f k) f © Contact Person l)� ►1 Mailing Address 7 � D � � V1 C�j1 G4' S ®(• Some Phone 13(o 7(0 (0 City/state/SIP CIe,M ri.� �,�, N C �o ra Business Phone 2. Name on Permit/ATC if Different than Above Hailing Address City/state/Sip _�- P—Q �. S�lt.{ o�%a o /O / 3. Application For: Its Site Evaluation tB=ZineasmantmpovePermit/ATC ❑Both s. system to service: �ouse ❑tMobile Rome ❑ Industry ❑ Other 5. If Residence: # Peopler - s� # Bedrooms # Bathrooms Z n Dishwasher n Garbage Disposal UlWashinq Machine U Basement/Plumbing U Basement/No Plumbing 6. If Business/Industry/Other: specify type # people # sinks # Commodes # showers # Urinals # Nater Coolers IS FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of Nater supply: ❑ County/City 11 ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes IeJ K0 If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBM17TED by the client with THIS APPLICATION. Property Dimensions: 2 0 " � WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # J -7Z----7 -q%' 0 �' -ST -rn 47 Property Address: Road Name P�-ZDQ. RCAD City/Zip {V,OCtL�h L1.� Z%� 6"3 Q i If in a Subdivision provide information, as follows: Name: Section: Block: Lot:Z- Date Property Flagged: -M MLI=f c - 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 ane responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie unty HSa hh Department to enter upon above described property located in Davie County and owned by `�)JL — to conduct all testing procedures as necessary to determine the site suitabiluv. DATE?4� /SIGNATURE ` THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAIanclude all of the folio g: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge J Date(s): Client Notification Date: I EHS: Account No. Invoice No. w r 2J�(a„ �o w 6✓ �i N 4.S iii r �%f a'Nai r .''� •. :�. "Oft, •i, CK OR �► 12 27 •• •�� •'+;4�' -;•, . .6'', 7Atir4.t♦ r, * r as X-1 .1.� (28.4 AG• b,00.58 '`•1 . 441 # + 0 223 08 :. 2 1-434. l;u� .� 6Ac'.) ' ".tom ►�' '�r A6. o o' t�•r y • , r' ► 679.8 ,• 161.0 (n — — J �•• ''', ` ► 118 53 i3 ,f to ►h Ac �•Y• • i i • ' .,. .•��•, Q) I23.15 tir?�' 15. r.... A0 . ? MT fi"4rs s. 48 800 ,. 18.5A a' 54.J.•.; �1. tit• ' I ; •�• r•,`�.'i + 13`1 `!� I • A M1'.. �: ,� IA I r, �' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001268 Tax PIN/EH #: 5727-98-5176 Billed To: John Yarbrough Subdivision Info: "�.S t +e— 9. Reference Name: John Yarbrough Location/Address: Feezor Road -27028 Proposed Facility: Residence Property Size: 28 Acres Date Evaluated: Water Supply: On -Site Well ✓ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L Sloe % HORIZON I DEPTH O — — Texture group CL Cl Consistence r S P S Structure CIL Mineralogy HORIZON II DEPTH IV ILI 12 - Texture groupG Consistence VP VS V Structure L Mineralogy' 1 1 HORIZON III DEPTH X1-3® 12- . Texture group C.+ Sc Consistence ; < ,p SSv Structure I< Mineralogy 1; MIX - ; HORIZON IV DEPTH 30 - + Texture group Consistence Structurek Mineralogy` 1 SOIL WETNESS Z� RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE ,3 SITE CLASSIFICATION: IS LONG-TERM ACCEPTANCE RATE: O's REMARKS: EVALUATION BY: OTHER(S) PRESENT: �?l�t��1 �R�r0G 14 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 suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/99 (Revised) ■ ■ ■ ON so No ■■■■■■■ ■■■■■■■ ■M■■■■■ ■■E■■■■ ■■■■■■■ ■■■NOME ■■M■■■■ ■■■mems ■■■■M■/ ■■ME■CE ■■■mJ■■ ■EN%E■■ ■M/MMM■ ■ommmm■ ■WNEEM■ SEEM SEEN BEEN SEEM moon ■■M■ ■■■■■■■■■■■■■■ ■■■■■■■■■■■■M■ ■■■■■■■■■■■■E■ ■■ON■■■■■■M■■■ ■■■■■■■■■■■■■■ ■■■MM■■M■■■■■■ ■ecce■■■■11■■■■ ■■m�■■■■ell■■■■ ■■■■M■ ■■■■■■ ■■■■■■■■r■■■■■ ■■■■■■■■e■■■■M ■■■■■■■■■■■■■ NEI ■■■i.1■l111111111"'UH ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■�■■■■ NOON ■■■■■■��■■■■■■■■■■■■moi,■■■■ 1■■■■■■lem■■■■■■■■■■■ SEEM ■■■Y:■■i'■■■■■■■■■■Yii►IISYIfIIZYt1 ■■Yiii7ee■e��e■■■■Y!MLI■l�iY►`■ ■■■MBB■■■■■■■■■■■■■■■■■■■■ Ilii■■■■■■■■■■■■CeYt■� ■C��II i■■■■■■1>t■■■■■■■■■■■■ NEON ■nee■■■I11■■■■■■■m■■■■■II%■■■ ■■■■■■■Ile■■■■■■■■■■■■■■■■■ ■■■■■■■I1■■■■■■■■■■■■■■■■ mmam ■■eee■■l'1■Is■r�eN�•c�s�eS■�1■■ ■rlrree:ll.1■■■eeeeeeYlBtB: ML�!1�■ ■�leZ!J■YII1■■■■■oe!•eeii■B■e■ire tet! ■■�ze�me■ei■sm�mm■■■■eee■ E�w�■■■■mM■■■ter,■■■■■fsl■■■■ ■■■E■■EMEME■ ■■■■mMMMMMM■ ■N■■■■M■■E■■ ■■■■■■■M■■■■ ■M■■■■■■■■■■ ■■■■■■MB■■■■ ■■mm■■m■■■■■ ■■■m■■■■■■■■ ■■■■■mom■■■■ ■■■■■■■m■■■■ ■■■■■■■M■■■■ ■■■■■■■■■M■■ ■■■■■■■■■MM■ ■■M■■■■■■M■■ ■■■■■■■■■E■■ ■■■■■■■■■■m■ ■■mm■■■■■■m■ ■■■■■■■■■■■■ ■■MM■■■MMm■■ ■■■mom■■m■■■ ■■■■■MMMMm■■ ■■EMEMEMM■■■ ■■M■MMMMM■■■ ■■■■m■■■■MM■ ■E■■E■■■■■E■ ■E■■M■■■■■M■ ■■■■■■■■■■■■ ■M■■MM■■■■■■ ■MMMMMMMMmm■ ■MMMMMMMM■■■ ■■■■NEE■EN■■ ■MM■MMMMM■■■ ■■■MMMMM■M■■ ■■■■M■M■■M■■ ■E■■■■MEME■■ ■MM■■M■M■M■■ ■■■■■■■■■■■■ ■■■■■■■m■■■■ Davie GountVWealth Department Environmental Yfealth Section PO Box 848 / 210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 John Yarbrough 4208 Sandhurst Drive Clemmons, NC 27012 Dear Mr. Yarbrough: July 25, 2000 Re: 2 Site Evaluations - 28 Acre Tract/Feezor Road Tax PIN #: 5727-98-5176 As requested, a representative from this office visited the above site(s) on July 24, 2000. Based on the information provided on the Application for Site Evaluation and after the evaluations were completed, both sites were found to be provisionally suitable for the installation of an on-site sewage disposal system. Based on the evaluations performed, Site 2(Open field close to tobacco barn site, closer to Feezor Road) will require approximately 400 linear feet of drain line for a three- bedroom house and Site 3(Includes open field toward branch on back side of property) will require approximately 600 linear feet. These are subject to change as actual design and dimensions of the septic drain field will be determined at the time a permit is issued. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct, the appropriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, you may contact our office at (336)751-8760. Sincerely, Jeff G. Beauchamp, R.S. Environmental Health Section enc(s) c