The URL can be used to link to this page

3297 Hwy 158 DAVIE COUNTY HEALTH DEPARTMENT I1:00 Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 /2t (336)75]-8760 IMPROVEMENT/OPERATION PERMIT Account M 989900216 Tax PIN/EH M 5850-38-9268 Billed To: Paul Willard Subdivision Info: Reference Name: Charles Hendrix Location/Address: Highway 158-27028 • Proposed Facility: Residence Property Size: .657 Acres ATC Number: 2863 **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 &OZ6 #People #Bedrooms 3 #Baths 2. Dishwasher: 12( Garbage Disposal: ❑ Washing Machine: 1!T Basement w/Plumbing: ❑ Basement/No Plumbing: d Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 0461 QCT Type Water Supply ►N Design Wastewater Flow(GPD) 3(CO Site: New d Repair❑ System Specifications: Tank Size IOOOGAL. Pump Tank GAL. Trench Width - Rock Depth Linear Ft. Other: �S?c+ tkX��a ��4'S1� .`i p14T N1�_.5 NL'Q -- : 1�A .I q(oq 0 Required Site Modifications/Conditions: mesuk l_ O►.) Cc,-� I5'ofF ' IMPROVEMENT/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 in.on the day of installation. Telephone#is(336)751-8760:**** Dc�xJa IIJ�7 i�wwoaizen 8 �' •� I �-�ec:2 OF Ir 1►�IO�JII�� M &CJAVS', ti` 07' (Nt)ST 3c «1S�ALL� 10, 6, S► NoQ'-s-TY u,110 7Q let LOILL be-SD a 9ENX XID,5 :;�n T��tx-'jS Q&E -19 �k�r OOW�S >7-aw be -naeb hT-Llolip- Environmental Health Specialist's Signature(�Y'A5� Date: J 1)5]0 .��tLr>,�oQ-('�+J�M�T ��"►S ell �C�►^Sf`II tJ(r DCHD 05/99(Revised) .N O �SL�� DAVIE COUNTY HEALTH DEPARTMENT r Environmental Health Section l P.O.Boa 848/210 Hospital Street %�� `v Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900216 Tax PIN/EH#: 5850-38-9268 Billed To: Paul Willard Subdivision Info: Reference Name: Charles Hendrix Location/Address: Highway 158-27028 ' Proposed Facility: Residence Property Size: .657 Acres **NOT E Thiss prov8eginent/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 ROLr3C #People #Bedrooms 3 #Baths 2 Dishwasher: 2f/ Garbage Disposal: ❑ Washing Machine:d Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size D lL�5-7 xtc Type Water Supply Design Wastewater Flow(GPD) 3(40 Site: New 6Z( Repair❑ __ i System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft.a w Other: 2S2 Ze>�To,—A SST rw Required Site Modifications/Conditions: 1 cASTNI- - Cr-) G01-AT-00(z O0IZ_ ep 5, plzr- t400n . (SSP to, pW- MPto IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 K 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.**** •7q' • (ti1oTP— - 1�Ot7S� I.DGL�Ti��J LS oC3 O TJ � �/ •Sirp �'j�lJ$ MJS"` � Sc�4 �Te.2T T � --► M 1,.1 . 2' leo msµ— _ — —� i5 ► Mt� Sep-,IQ_ -rN0�/pjV.�1� ZyM • 1E I,J�e,V..� m�gT �E Qt7'�oP� �� MA�S Environmental Health Specialist's Signa a) --e: 4CV.S-TQ C�'li Z7Cnr-u,r,T TN 1S o f-1=ic c- Y �2� I�a►a I,J�o,� -S-ySTV-AN P X12 s�sTcrti �lC�1U_ 3� ta�Vez u� r �- v\�T � S�nuz2. DCHD 05/99(Revised) �� Tto,J SgSTc;w ilAl �1•sN�� l0 DF St9 , 1g5lo P�Lt7iMu�lS �Q 0,2x: A inn f4iu�R� 'ToMCE:T /arJY OF YT�� W�I.v tZ�s>7�i 5'i�T�O� - �a J -r.oa osr TI�►S Q��T DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section (/ P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900216 Tax PIN/EH#: 5850-38-9268 Billed To: Paul Willard Subdivision Info: Reference Name: Charles Hendrix Location/Address: Highway 158-27028 Proposed Facility: Residence Property Size: .657 Acres ATC Number: 2863 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 CONSU3 - S V LID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatu e: Date: p 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. Llo2s V�-� T I+J ceb a�v, �3 J -Qr1Pcw-q G cri(7 e ai o a st4o,aa oa-s t ra- Septic System Installed By: �1—LdHfJi� Environmental Health Specialist's Signature: DCHD 05/99(Revised) IP TION FOR SITE EVALUATIONAMPROVE IENT PERRUT&ATC Davie County Health Department En&1=7menW Ifealth Section P.O. Box 848/210 Hospital Street QY ' .Vol Mocksville, NC 27028 v (3j6)751-8760 ?�� / rUCAITO 2v *** LICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED nISPRO�VIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed aVA i- w M(mr A Contact Person Q /� Mailing Address v hh Home Phone M /4I A� 8 q City/state/ZIP S�6C)1 CSC m Q e ��, a� Business Phone �p 4 D / 2. Name on Permit/ATC if Different than Above Mailing Address City/State/zip 3. Application For: ❑ Site Evaluation mprovement Permit/ATC ❑ Both 4. system to Service: X House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. if Residence: # People # Bedrooms .3 # Bathrooms _-a.ab Dishwasher 17 Garbage Disposal Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Businesa/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: X County/City ❑ Well ❑ Commun ity a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes o If yes,what type? ***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: p 9/�� -Z ME-33 X//2,0'VRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # ,'i �l7 3 Clod�y� _ ISS .Q d'cj* �.�nA� Q p_ Property Address: Road Name MW V �� 0 _Q1`5�. kk4 YA I City/Zip If in a Subdivision provide information,as follows: Name: Section: Block: Lot: Date Property Flagged: _ v�- / - d 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 am responsible for all charges incurred from this application. I,hereby,give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE _f 3_ e/ SIGNATURE ✓C 1�e�-L(lt �d/�,Q�s�� Q7.- M- 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). Site Revisit Charge Date(s): Client Notification Date: Jr Q EHS• Account No. Revised DCHD(07/99) Invoice No. �3L rte.. APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC . ' Davie County Health Department ' Env&vnmenta/Heal fi Se+cdon +� P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336)751-8760 , THIS APPLICATION CANNOT BS PIt =SSND UNLESS ALL THE REQUIRED INFORMATION IS PnRODVIDED. Refer to the INFORMATXON BULLETIN for/instructions. do,1. Nage to be billed ( /��,�n�. ' '- Contact "coon Mailing Addre.me1O Roma Phone Q�}%��(ai,—3/C, // City/state/LID -, (.� r, �lC business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/state/Rip r- 9. Application For: Site Evaluation -'Improvement Permit/ATC ❑ Both 4. system to servioe: House ❑ Mobile Home ❑ Business ❑ Industry 0 Other 5. If Residence: • People s Bedrooms T Bathrooms M Dishrasher O Garbage Disposal O'wuhinq Machine O basement/Pluabinq O basement/No Plumbing . 6. if business/Industry/other: specify type • people • sinks Commodes # sbovers f Urinals # Nater Coolers IF ]FOODSERVICE: # Seats Estimated Mater Usage (gallons per day) 7. Type of water supply: 19'County/City ❑ Well ❑ Community e. 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 BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: t Ao%,14 X31.1 e U WT 33 X //a.M WRITE DIRECTIONS(from Mocksville)to PROPERTY: X ossa-S;)- Tax Offlce SaTaxOSice PIN: # -, a 11IAJ., � S Eau o- Property Address: Road Name ll w-, ISL e- City/Zip X%z&s j&e \\Va'7D If in a Subdivision provide Information,as follows: Name: Section: Block: Lot: Date Property Flagged: 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 pians or Intended we change,or if the Information submitted In this application Is falsiikd or changed 1,also,understand that I am responsible for all charges incurred from this application. I,hereby,give consent to the Authorized Representative of the Dom*County Healtlj Dep�rlment to enter upon above described property located In Davie County and owned by G a4 r;(�S /y d e,y to conduct all testing procedures as necessary to determine the site suitability. DATE 3 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimens ons, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS: �j (�oo go 2 Account No. Revised DCHD(07/99) �� Invoice No. <--' sol-e.n.>�-�S t' • ,� �,�• � �cJ � e,J �tom-Lel o�o� h� 2• 3a ep REA = 0.67 ACRE (IN UD S. HWY., 15 R�W) tp / NY bi CS \ OQ,G��,• Q� ` \ I LEGEND �.= EXISTING IRON PIN AXLE JNMARKED POINT q IN C/L OF RD. j. DAVIE;COUNTY HEALTH DEPARTMENT R Environmental Health Section • SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001621 Tax PIN/EH#: 5850-38-9268 Billed To: Charles Hendrix Subdivision Info: Reference Name: Location/Address: Highway 158-27028 Proposed Facility: Residence Property Size: see map 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 t_ L L Slope% G Z5 S HORIZON I DEPTH - ' 0_ 0 Texture group C e- G C Consistence S 5 S. Structure 5 - Mineralogy ( l : HORIZON II DEPTH _ 2q (p — t —1 - (o- 10 Texture group 0 C46?19 C+C" S� Consistence ' • S d r Structure. CC � S Mineralogy :i 2• t 1 l HORIZON III DEPTH ?-i4 1 Z-ZCn 1Z Texture group Gn Zs C_i-4G'_0 Accl< Consistence Structure G2 iL Mineralogyt HORIZON IV DEPTH Texture groupL Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATIONA9S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: C� KJ� 2&��ALUATION BY: s2_-A4 4v-) LONG-TERM ACCEPTANCE RATE: Di 2 1 OTHERS)PRESENT: REMARKS: a'ft'0 MCD 5oUCy %,j 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 �d Mineralogy5 1:1,2:1,Mixed b5 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) ■ecce■■e■■■■■■■■■■■■■■■■e■■■■■■s■■■a■■■■■■■■■e■■eee■■ecce■■■■■e■■■ ■■■e■■eee■■■■■■e■■e■■■■esee■■e■■ ■■e■■■■e■■■e■■eee■eeee■■■■■■■■■■ eeee■■■■■■■e■■■eeeee■eee■eee■■■■■■■eeee■■■■■■e■■e■■■■■■■eee■■■e■■■ ■■■■■■■■■■■■■■■■■■■■■a■■■■■e■■■■■■■■■ee■■e■■■eee■■■■■■■■■eee■eeee■ ■■■■■■■■■■■■■e■■■■■■■■e■■e■■e■■■e■■■e■■■■■■e■■e■■■■e■■eeeeeee■■■e■ ■■e■e■■ee■■eeeeeee■e■eases■■■■eee■■■eeeee■■■■e■■■e■e■■eeeeeee■eee■ ■■■■■■■■■■■■e■■■■■■eee■■■■■■■■■■■■■■eee■eee■■■eeeee■■seeeeeeee■ee■ ■ss■■■■e■■■■■■eee■■eeesss■eeeee■I�I■s■e■e■■■■eeeee■sees■e��e■eeee■■ ■■■■■■■■■■■■■ees■e■■■■ecce■e■■e■ ■e■■■■■■■■■■■e■■■e■■■■eee■■e■■■■ ■■■■■■■■■■■■■■e■■■■■■eee■e■■ee■e��e■eee■■■■■■■■■■■e■■■■■e■■■eeeees ■■e■■eeee■■■■■eee■■■■■e■■■e■■■■■■■e■■e■■■■■■e■■e■■■■■■■■■■■■■■■■■■ ■■■■■eeee■■■■■■■■e■■■■eeee■eee■■■■■■ecce■e■■■eee■e■eee■se■■see■e■■ ■e■■eeeee■■■■■■■■e■eeeee■ecce■■■■■■■eee■■■■■■■■■■■■■■■■■■■■■■■■e■■ ■■■■■■■■■■■■■■■■■■■e■■eeeee■eee■■■■■eeee■ee■■■ee■■■■e■■■■■■■■■■■■■ ■■eeee■eeeeeeeeeeee■e■■■■■■■■■e■Flee■■■■■ee■a■■■e■■■■■■■eee■■■■eee ■■■■■■eee■■■■■■■■eee■■■■■■■■■■e■ ■eeee■■■e■■■■■■■■s■■■■■ss■■■■■■■ ■■■■e■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■eee■■ ■■■eeee■■■■■■■■■■■eee■■eeeee■eee■■■■■■■■■ee■■■■eeee■■■■e■■■■■■■■■■ eeee■e■■■e■■■■■■■■ee■e■ee■■■■■■ecce■■eea■ee■■■■■e■■e■■■■■■■■■■■■e■ ■eee■■■ee■eeeeee■■eee■■■■■ecce■■■■■■■■■_��:=�:::lie■i■■■■■■■■■eeeee■ ■■ecce■■■e■■■■eeesee■■■■■___===�:ii�■■ieii■■■■eeee■ie■■■ease■■■e■■■ ■■e■■■■■■■■■ees;=c::il■■■■■■■■■■ecce■■■■■■■■■■■■■■■■i■■eee■■■■■e■■e■ ■eee■■■■■■e■■■.■eeeee■■■■e■eee■■I�1■■■■e■ee■e■■■■■e■ieee■■e■■■■eee■e ■■■ee■eee■ee■■■■eee■■eee■■■■■■■■ ■■■■■■■eee■■■■■e■i■■ees■■■■eee■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■ee■ieee■■■e■■■■eee■ ■■■■■■■■eeee■■■e■■■■■■eeeeeeeee■e■■ecce■■■■■■■eeee■ieee■■■e■■■■■■■■ ■■■■■■■■■■■■■■a■■■■■■■■■■■■■■■e■eee■■.e■■■■e■■e■■■■i■■e■■e■■■esee■■ ■■■■■■■■■■■■■■■■e■■■s■■■■eee■■■■■■■rui��e■e■esee■■■■ie■■■e■e■■eee■■■ eeee■■■■e■■■■e■■eee■■■■■■■■■■■■■■■ell■sem■■■■■■■■■■■■I■■■■■■■■■esee■■ ■■■e■■■eeeee■■■■■■eee■■eeeee■■e■■■■II■■■■■ee■■e■■ee■ise■■■eeee■e■ee■ ■■■■se■■s■■■■s■■ss■se■■eeeees■ssl�eIles■sssee■■■■se■iesss■■■■■e■■ss■ ■eeee■■■■e■■■■■rE■eee■■e■■■■■e■■ ■Il��eee■■■■■■■■■■i■■■■■■■esssss■■ ■■■e■■eee■■■■■■�■■e■ecce■e■■�■■■■■seer!eeee■e■■■■■■■■■ie■■e■■eeeee■ee■ ■■■■■■■■■■■■■■■.e■■■■■s■■■■�!r■■■��■■II■■■■■■■■■■■■e■■ie■■■■■■e■■■eee■ eeeeeeeeee■■■■■iese■■■■■■■eerasss��s■11■■■■■■slnr■i�:!�eee■�■■■e■■■s■e■e■■■ ■■e■■■■■■■■ees■i■■e��e■■■■ecti■■■■e��e■■■■■■■camel.■■e■�■■■eee■eee■■■■■ ■■e■■■■■esee■■■ice■■■■e■■e■■i■■■e■■■■■■■eseeeeeeeeee■ieee■■■■eeeee■e■ mom ■■etc■■■■■■■■■■�s■■e■■■■■■■yiieee■■ee■■■■■■■■■■■■■■■■ie■■■ecce■■■■e■■ eeee■eeeeee■■■■ie■■e■e■■■■■■iteeeeeee■■■e■■■■■e■■■ee■ie■■■■■eessssss■ ■■s■■eseeeeeee■is■■ss■nesessli■eeee■■■■ees■eeee■e■e■■i■■■■■■■esssss■■ ■e■■e■■■■ecce■�ieeee■■::Ise■■■11■■■■eeee■■■■■■■■■■■■ss■isss■■essesss■e■ ■e■■■■■■■■■eee\'�iii�iiiiii��iiiiiiiiii�!leeeee■ecce■I■■e■■■■■■■■■■■■ ■eee■■■■■■■■■■■11■■■■■■■■■■G11■■■eeeee■■■I■■■■■■■■■■■■I■■■■■■■■eeeees■ eeee■■eee■■■■■■1■■■■■■■eeee■11■■■■�■■■■■I■■e■■■■■■■■■I■eee■■■■■■■■■■■ ■■■■■■■■■■■■■■■I■■■■■■e■■■■sl1■■■■ ■■ess!■e■■e■■■■■■■I■■■■■■■■■■■■■■■ ■eee■■■■■■eee■■ice■■■e■■■■e■Ileeeleee��■■ei■eeeee■es■s■issss■esse■sees■ ■s■■■■■■■■■■■■■esss■■■■■■■e■Ileal!!�rter�■■■i■ee■eeeeee■■i■■■■eee■eeeeee■ eeee■■■■e■ecce■le■■■■■■■■■■■11■■Yi�i!%:revel■■■■■■■■■■■■I■■■■■■■ees■ees■ ■■■■e■■■■essee■ie■■■eeee■ee■Ile�e■n■■■eeee■■ee■■■■eee■i■■■seeeeeeeeee■ ■eeee■■■■■■■■■■issss■■■■■■■■t1=��+��■■sss�■ssss■■ssse■ie■■■e■■esss■■s■ eeee■eee■eee■■■i■■■■■eee■■■e►�■■■ur■■■■■■■�■■e■■■■■■■■■i■■■■■■■■■■■■■e■ ■ess■■■■■e■eee■ie■■■■■■■■■■els■■■■Ile■■■■■■ee■■■■■ee■i■■■■eeee■■ee■e■ ■■■■■eeeteee■■■i■■■e■■■■e■eelleee■ eeee■■■e■■■ee■■■■ieee■■■■■■■■ess■ ■eeeeee■■■■eee■ie■■■■■■■■■■■11■■■■■■■■■■■■■■■■■e■eee■ieoee■■eeeeee■■■ ■eee■■eeseeeeeiie■■■■■■■■■■■11■■■■■■■■■e■■■e■■■■■■■e■ieee■e■■■■■■■■e■ ■■■e■■eee■■■■■■ie■■■■■■■■■■■11■■■■■■■■■■■■■■■■■■■■■■■i■■e■■■■■■■■■■■■ ■■■■■■e■■■■■eerie■■esss■�ew■ell■■■■■eee■■■■ssssess■■e■i■■■■■e■■■■■eee■ ■■■■■■■■■■■■e■ii■■■e■■ela�eeell■■■�e�ee■■■■■■■■eeee■■■i■■eeeeeeee■eee■ ■■■■■■■■■■■■eeii■e■eeee►erre■■1�•9■[!1e■■■■■■%��I■eeeeeee■ieeee■eeeee■■■■■ ■■eee■■e■■■■■■il■■eee■11►1■■■■1I,�]■■■ ■■■e■Iliriileeeeee■■■I■■■■■■eee■■■■■■ eeeeeeeeee■■■■ileeeeeeeee■■elleeee�ee■■■■■■■■eeeeee■I■■■■■■eeeeeeee■ ■eee■■sseesessll■■■■■ssssss■Ileeeee■■■■■■■■gess■■■e■■ie■■■■■■■■■■■■e■ ■eeeeee■■eeee■Ile■e■■e■■■■e■11■■■■■■■■■eeeeee■■■■■■■■i■■■eee■eeeee■■■ ■■■■■■■■■■■e■ellee■■■■■■■■cell■■■■eee■■■e■■■■■■■■■■■■i■■■■ee■eeeeee■■ ■■■■■■■s■■■■ssllssssssssss�sll■■■■■■■■■■eess■s■■■■■■■i■■■■■■eeeeee■■■ ■■■■■■■■■■■■■■II■■■■■;��z�■■IIs�I■■■■■■eee■■e■eee■■e■■ie■s■■esee■■ess■ ■■eee■eeeee■■■Ile■ee__�ge■ee��_■we■■r.=ee==■eee===-E;e■■■■■■■■■e■■■■ eeeeee■■■■■■■e11■eee■■eee■esl�■fes:!'" Zfviii■�■e■iisse■■■1■■■eee■e■■e■e■■ ■eeee■■■■■■■■■II■■■■■■■eeee■JAS!■■�:ie■■eee■■■■eee■■lee■■■■■■■eee■■■ ■eeeeeeeeee■eells■_eee■eerie■■e■eeeeeeeee■■■■■■ee■ee■iee■e■■■■■■eee■■ ■eeeee■■■e■■■■rl■■eeeeeeeee■■■■eeee■eeeee■e■■ee■ee■■iee■■■■■■■■eee■■ ■■eee■eeeee■■e11■■■eeee■eee■■■■■■ee■■esee■■■■■eeee■■i■■eeee■■■■■■■■■ ■eee■eee■■■■■ells■e■■■��■■■ewes■■eeee■■i■��s�e■■eese■s■isss■■■■■esss■■■ ■■eeeeee■■■■■■Iles■■■e■e�ae�eli■■lie i■■■■■�iee111%■eee■■lee■■■■■■■■■eee■ ■■■■e■eee■■■■ell■eee■■■■■■e■■■■■■�■■■■■■■■■eee■■■■■I■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■II■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■ee■■■i■■eee■■■eeeeee■ ■■■eeee■■eee■■■eeee■■e■■■e■■■■eeeee■ t, DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION P.O Box 848/210 Hospital Street Mocksviiie,NC 27028 . Phone#..:.(336)751-8760 March 20, 2001 Mr. Charles Hendrix 110 Dulin Road Mocksville,NC 27028 Re: Site Evaluation- 0.657 Acre Tract/Hwy 158 Tax PIN: 5850-38-9268 Dear Client(s): As requested, Jeff Beauchamp, Environmental Health Specialist with this office on March 19, 2001, evaluated the above-referenced property at the site designated on the plat/site plan that accompanied your improvement permit application. According to your application the site is to serve a three-bedroom residence with a design wastewater flow of 360 gallons per day. The evaluation was done in accordance with the laws and rules governing wastewater systems in North Carolina General Statute 130A- 333 and related statutes and Title 15A, Subchapter 18A, of the North Carolina Administrative Code,Rule .1900 and related rules. Based on the criteria set out in 15A, Subchapter 18A, of the North Carolina Administrative Code, Rules .1940 through.1948,the evaluation indicated that the site is UNSUITABLE for a ground absorption sewage system. Therefore,your request for an improvement permit is DENIED. A copy of the site evaluation is enclosed. The site is unsuitable based on the following Rule.1941(a)-Soil Characteristics, Rule.I943(a)-Soil Depth Rule.1945(b)-Available Space. These severe soil or site limitations could cause premature system failure, leading to the discharge of untreated sewage on the ground surface, in surface waters, directly into ground water or inside your structure. The site evaluation included consideration of possible site modifications, and modified, innovative or alternative systems. However, this office has determined that none of the above options will overcome the severe conditions on this site. A possible option might be a system designed to dispose of sewage to another area of suitable soil or off-site to additional property. For the reasons set out above, the property is currently classified UNSUITABLE, and an improvement permit shall not be issued for this site in accordance with Rule.I948(c). However, the site classified as UNSUITABLE may be reclassified as PROVISIONALLY SUITABLE if written documentation is provided that meets the requirements of Rule.1948(d). A copy of this rule is enclosed. You may hire a consultant to assist you if you wish to try to develop a plan under which your site could be reclassified as PROVISIONALLY SUITABLE. You have a right to an informal review of this decision. You may request an informal review by the environmental health supervisor with this office. You may also request an informal review by the N.C. Department of Environmental and Natural Resources regional soil specialist. A request for informal review must be made in writing to the Davie County Health Department, Environmental Health Section. You also have a right to a formal appeal of this decision. To pursue a formal appeal,you must file a petition for a contested case hearing with the Office of Administrative Hearings, 6714 Mail Center, Raleigh,N.C. 27699-6714. To get a copy of a petition form,you may write the Office of Administrative Hearings or call the office at(919)733-0926. The petition for a contested case hearing must be filed in accordance with the provision of North Carolina General Statutes 130A-24 and 150B-23 and all other applicable provisions of Chapter 150B. N.C. General Statute 130A- 335 (g)provides that your hearing would be held in the county where your property is located. Please note: If you wish to pursue a formal appeal,you must file the petition form with the Office of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER. The date of this letter is March 20, 2001. Meeting the 30 day deadline is critical to your right to a formal appeal. Beginning a formal appeal within 30 days will not interfere with any informal review that you might request. Do not wait for the outcome of any informal review if you wish to file a formal appeal. If you file a petition for a contested case hearing with the Office of Administrative Hearings, you are required by law(N.C. General Statute 15013-23)to send a copy of your petition to the North Carolina Department of Environment and Natural Resources. Send the copy to: Office of General Counsel,N.C. Department of Environment and Natural Resources, 1601 Mail Service Center, Raleigh,N.C. 27699-1601. Do NOT send the copy of the petition to Davie County Health Department. Sending a copy of your petition to Davie County Health Department will NOT satisfy the legal requirements in N.C. General Statute 150B-23 that you send a copy to the Office of General Counsel,NCDENR. It should be noted that this site could be reclassified PROVISIONALLY SUITABLE for a two- bedroom residence, all other information on the application being the same. Please call or write this office if you have any questions or need any additional assistance, as follows: Telephone number: (336)751-8760 Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville,NC 27028 Sincerely Jeff G.Beauchamp, R.S. Environmental Health Specialist Enclosure(s): Soil-Site Report Rule.1948 Invoice LAWS AND RULES FOR SEWAGE TREATMENT AND DISPOSAL SYSTEMS 15A NCAC 18A.1900 Rule.1948 .1948 SITE CLASSIFICATION (a) Sites classified as SUITABLE may be utilized for a ground absorption sewage treatment and disposal system consistent with these Rules. A suitable classification generally indicates soil and site conditions favorable for the operation of a ground absorption sewage treatment and disposal system or have slight limitations that are readily overcome by proper design and installation. (b) Sites classified as PROVISIONALLY SUITABLE may be utilized for a ground absorption sewage treatment and disposal system consistent with these Rules but have moderate limitations. Sites classified Provisionally Suitable require some modifications and careful planning, design, and installation in order for a ground absorption sewage treatment and disposal system to function satisfactorily. (c) Sites classified UNSUITABLE have severe limitations for the installation and use of a properly functioning ground absorption sewage treatment and disposal system. An improvement permit shall not be issued for a site which is classified as UNSUITABLE. However, where a site is UNSUITABLE, it may be reclassified PROVISIONALLY SUITABLE if a special investigation indicates that a modified or alternative system can be installed in accordance with Rules .1956 or.1957 or this Section. (d) A site classified as UNSUITABLE may be used for a ground absorption sewage treatment and disposal system specifically identified in Rules .1955, .1956 or.1957 of this Section or a system approved under Rule.1969 if written documentation, including engineering,hydrogeologic, geologic or soil studies, indicates to the local health department that the proposed system can be expected to function satisfactorily. Such sites shall be reclassified as PROVISIONALLY SUITABLE if the local health department determines that the substantiating data indicate that: (1) a ground absorption system can be installed so that the effluent will be non-pathogenic, non-infectious, non-toxic, and non-hazardous; (2) the effluent will not contaminate groundwater or surface water; and (3) the effluent will not be exposed on the ground surface or be discharged to surface waters where it could come in contact with people, animals, or vectors. The State shall review the substantiating data if requested by the local health department. History Note: Authority G.S. 130A-335(e); Ef£ July 1 1982 Amended Eff. April 1, 1993; January 1, 1990. '49 ► 1 Davie County Wealth Department Environmental Nealth Section PO Box 848/210 Hospital Street Mocksville,NC 27028 Phone. (336)751-8760 April 25,2001 Mr. Charles Hendrix 110 Dulin Road Mocksville,NC 27028 Re: Informal Review- Hwy 158/0.657 Acre Tract Tax PIN: 5850-38-9268 Dear Mr. Hendrix: At your request, Scott Greene, Regional Soil Scientist with the Department of Environment and Natural Resources,visited the above site on April 23, 2001 to review the site evaluation performed by a representative of this office on March 19, 2001. This evaluation found the above site to be unsuitable for the installation of an on-site sewage disposal system. After consulting with Mr. Greene, the"unsuitable"classification for this tract referenced in a letter dated March 20,2001 can be changed to a"provisionally suitable" classification for a three- bedroom residence with the following restrictions/requirements: 1) The initial installation shall be an innovative on-site sewage disposal system that meets criteria as a"25%reduction system"under Rule .1969(3) of the North Carolina Administrative Code, Title 15A, Subchapter 18A. 2) The repair installation shall be a modified design on-site sewage disposal system described in Rule .1956(3)(a)(ii).(Prefabricated, Permeable Block Panel System) 3) The house location must be moved at least five feet back from the staked house location. 4) The driveway must be single-width(12 feet max.)and located along either side property line. 5) Water line from public water supply must be located within ten feet of either side property line. In order to gain an Operation Permit, certain requirements must be satisfied for the approval of the installation. These include, but are not limited to: 1) The innovative system must be installed in accordance with T15A: 18A .1900; 2) The septic tank contractor must be certified to install the chosen innovative septic system; 3) A pumping station may be required; 4) All requirements specified on the Improvement Permit/Authorization to Construct must be met. 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, feel free to contact this office at(336)751-8760. 4Sincerely, G. hamp, Environmental Health Section c V�y lg�s Residential Specification: Building Type #People #Bedrooms #Baths ? - Dishwasher: Garbage Disposal: 0 Washing Machine:d Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ ' Lot Size D•U>57 W:c Type Water Supply C m"TY Design Wastewater Flow(GPD) 3L40 Site: New[;J Repair❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft.L-`�D Other: 25% P-r-1 -Tlc j Required Site Modifications/Conditions: C,0r3 1 D0(Z VCCP 5" ,q- 14,p-t-v 10, (T'X u-� IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S) 1F 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 1:00p. Ao 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.**** •�,`.. ,�(? ��._ � 7c1f ��1GTE - 1�L11;�1� t_C>GL�T�LrJ tS t y o er ys, I , � CV- 0 Nix, Vj 1"Zi—% 1-I pip- e-1A ,Q .` 1*7 MOST ia At9�110?.t2 Environmental Health Specialist's Signa J 'TMS p��1C� :W :gz(moi rJ�a i►J.V U Aity� 4WST1~ i -s Sf6: tx)1LL: �v 4'3 ='j'`C� Ll►•J ��Q'j c n1"JfALL-L' DCHD 05%99(Revised) IG' CA- �n��T s �'-u-� , �ast° ►s.t��r t�;.3��,�,� �,,�,� .. �L C.��,L,� q P��N1P _ � AI-Ye 'TI�a . �3 cG- z'i1�� Fn,.,�7 it S►h.ii0 property tines and dimensions, structures, setbacks, and septic locations)uc all ut enc ionowmg: Existing and proposed Site Revisit Charge Da te(s): 20 t� Davie County Wealth Department Environmental,Health Section Po Box 848/210 Hospital street Mocksville,NC 27028 Phoxim: (336)751-8760 November 9,2001 Paul Willard PO Box 1109 Cooleemee,NC 27014 Regarding: Improvement Permit/ATC#2863 0.657 Acre Tract/Highway 158 Tax PIN 5850-38-9268 Dear Mr. Willard: On November 8,2001,Jeff Beauchamp, R.S.,Environmental Health Specialist with this office,visited the above site and found violations of conditions of the Improvement Permit/Authorization to Construct. As a result, the Improvement Permit/Authorization to Construct is now void. When initial construction/grading began, I was concerned when I drove by and noticed that dirt from offsite had been brought in and filled in the area of the front yard designated for the septic system. However, as this could be moved to restore the ground to its natural contour for the installation of the septic system,no contact was made. I stopped by the site on November 8,2001 because it appeared the garage of the house opened to the front,which would mean that the driveway will encroach on the area designated for the septic system. During this visit,I found the following violations of the Improvement Permit: 1) The drainage tile for the driveway is 12 feet from the side property line. 2) The house has a basement,which was not indicated on the application. 3) The garage opens to the front(facing Highway 158)which means the driveway would be over area designated for the initial and repair installation(s) of the septic system. 4) The house dimensions are 73' x 32'. The staked house size was approximately 45' x 30'. It should be noted that the water meter has been set 32 feet from the southwestern side property line. The water line must be trenched to the house within ten feet of this side property line to avoid encroaching on the area for the septic system. • The following is suggested to remedy the situation: 1) Eliminate the front-entry garage,change garage to side-entry into the basement on the opposite end of the house,move the driveway to the southwestern side property line,twelve feet maximum width, or 2) Eliminate the front-entry garage,change garage location to behind house, side-entry with driveway in front of house moved over to adjoin side property line, twelve feet maximum width,or 3) Change house plan to two-bedroom design, driveway extends no more than thirty feet straight out from garage,with remainder of drive along side property line,twelve feet maximum width, or 4) Acquire additional property or receive a deeded easement from an adjoining property owner for installation of a septic system on his property. Either of these will require an application be filled out for a site evaluation and a provisionally suitable classification of the site. Copies of documents recorded with the Davie County Register of Deeds must be provided showing that; a) You are the owner of the property,or b) An easement for the installation of a septic system on this property has been deeded to you or by the property owner. A map showing the surveyed easement must also be provided. If you choose to change the house design, a copy of the revised floor plan must be submitted to this office. A new Improvement Permit will be required to install a septic system for this project. Any questions may be addressed at this office or by calling 751- 8760. Sincerely, Jeff G. auchamp, S. cc:Joe Mando,Environmental Health Director Joseph B.Bass,Health Director John Gallimore,County Zoning Officer William Whaley,County Inspections Director Davie County Wealth Department Environmental)Yealth Section Po Box 848/210 Hospital street Mocksville,NC 27028 Phone: (336)751-8760 November 15, 2001 Paul Willard PO Box 1109 Cooleemee, NC 27014 Regarding: Improvement Permit/ATC#2863 0.657 Acre Tract/Highway 158 Tax PIN 5850-38-9268 Dear Mr. Willard: As a result of site modifications and relocation of the planned driveway at the above site, a new permit has been issued under the same Authorization To Construct(ATC) number to allow you to continue with this project. The new Improvement Permit reflects the current house location(approximately twelve feet farther back from Highway 158 than the proposed house location), change in driveway design and a revised layout for the septic system. As the area for the septic system is limited,please be aware of the conditions on this permit. The septic tank and drain field must not be under the drive and must meet setback requirements. Please have the septic contractor contact this office prior to beginning construction of the system. Any questions may be addressed at this office or by calling 751-8760. Sincerely,, Jeff G. Beauchamp, R. . Environmental Health Specialist - cc:Joe Mando,Environmental Health Director Joseph B.Bass,Health Director John Gallimore,County Zoning Officer William Whaley,County Inspections Director Parcel#: F600000020 Page 1 of 1 o�'- Davie County, NC - Basic Estate Search ®rjk-s Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search 0 .View Property Record for this Parcel View Map for this Parcel View Tax Bill Information Parcel#:F600000020 Account#:82513251 Owner Information Tax Codes OMEZ]OSE&GOMEZ SANDRA ADVLTAX-COUNTY T 297 US HIGHWAY 158 FIREADVLTAX-FIRE TAX OCKSVILLE NC 27028 Property Information Township land(Units/Type): 0.480 AC FARMINGTON ddress: 3297 US HWY 158 Deed Information Local Zoning ate: 03/2003 Book: 00469 Page: 0588 [Plat Book: Page: Le al Description PIN 1 LOT US HWY 158 5850389268 Property Values uildin : 135 64 BXF• Land: 14 79 CI arket: 150 43 ssessed: 15043 Deferred Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 00333 0261 05 2000 SD Unqualified Vacant 20,000 00368 0649 05 2001 WD Unqualified Vacant 15,000 00469 0588 03 2003 WD Qualified Improved 141,000 View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information « Return to Basic Search All information on this site is prepared for the inventory of real property found within Davie County. All data is compiled from recorded deeds, plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be consulted for verification of the information.All information contained herein was created for the Davie County's internal use. Davie County, its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or implied, in fact or in law, including without limitation the implied warranties of merchantability and fitness for a particular use. If you have any questions about the data displayed on this website please contact the Davie County Tax Office at(336) 753-6120. 1.5.9 http://maps.daviecountync.gov/itsnet/View.aspx?prid=1475733 6/14/2016