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P161091 Lot 3 SK Beauchamp IMPROVEMENT PERMIT For office Useonly *CDP File Number 161091 - 1 Davie County Health Department , o County ID Number.5861-62-4335-03 210 Hospital Street P.O. Box 848 Evaluated For. NEW Mocksville NC 27028 Township: Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID UNTIL: 10/17/2019 *NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit. Applicant: JHMJ Enterprises, LLC Property Owner: ScottKimber Beauchamp Address: 895 Ridge Gate Drive Address: 153 Longwood Drive CKY: Lewisville CRY: Advance State2ip: NC 27021 State/Lip: NC 27006 Phone#: (336) 399-0398 Phone#: (336) 399-0398 Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: 3 Juney Beauchamp Rd Advance NC 27006 Directions Structure: SINGLE FAMILY Hwy 158, Right on Baltimore Rd. on left before #of Bedrooms: 4 Baltimore Rd #of People: *Water Supply: PUBLIC Initial System S stem Specifications sst*Site aICa Ion: Provisionally Suitable Minimum Trench Depth: a 4 Inches Saprolite System? QYes QNo Maximum Trench Depth: 3 6 Inches Design Flow: 4 8 0 Septic Tank: 1 0 0 0 Gallons Soil Application Rate: 0 3 1-Piece: QYes (R)No Pump Required: QYes 0N QMay Be Required *System Classification/Description: TYPE III B.SYSTEM W/SINGLE EFFLUENT PUMP Pump Tank: 1 0 0 0 Gallons *Proposed System: 25%REDUCTION 1-Piece: QYes QNo Repair System Required:®Yes ONO QNo, but has Available Space Repair System *Site Classification: Provisionally suitable Minimum Trench Depth: a 4 Inches Soil Application Rate: 0 .1 7 5 Maximum Trench Depth: 3 6 Inches *System Class ificatan/Description: Pump Required: (2)Yes QNo Q Maybe Required TYPE 111 B.SYSTEM W/SINGLE EFFLUENT PUMP *PropOSed System: 25%REDUCTION Page 1 of 3 C -161091 1 N 5861-62-4335-03 CDP File Number County ID umber: 'Site Modifications ❑ Open Fill Sheet No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. 7! *Permit Conditions The issuance of this permit bythe Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. 7; Site Plan The Improvement Permit shall be valid for 5 years from date of Issue with a site plan(means a drawing not necessarily drawn to O scale that shows the existing and proposed property lines with dimensions,the location of thefacility and appurtenances,the site forthe proposed Wastewater system,and the location of water supplies and surfacewaters). Plat The Improvement Permit shall be valid without expiration with plat(means a property surveyed prepared by a registered land surveyor,drawn to a scale of one Inch equals no more than 60 feet,that Includes:the specific location of the proposed facility O and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surfacewaters. Plat also means,for subdivision lots approved by the local planning authority and recorded with the county register of deeds,a copy of the recorded subdivisions plat that Is accompanied by a site plan that is drawn to scale). The Department and Local Health Department may Impose conditions on the issuance and may revoke the permits for failure of the system to satisfy the conditions,the rules,or this article.This permit is subjectto revocation If the site plan,plate or intended use changes(NCGS 130A-335(f)).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,installation,operation,maintenance;monitoring, reporting,and repair(.1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature. Date: 'Issued By: 2140-Nations,Robert Date of Issue: 1 0 1 ? a 0 1 4 Authorized State Agent: ��.� --�--� `____� OValid without Expiration? 0Create CA. @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT Davie County Health Department CDP File Number: 161091 - 1 210 Hospital Street 5861-62-4335-03 P.O.Box Bas County File Number: Mocksville NC 27028 Date: Q Inch ock Drawing Drawing Type: Improvement Permit Scale: A ON/ QN/ �ft. ; 1 ; n t G { l N r Donn Z nf'l APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC RECEIVED Davie County Environmental Health P.O.Box 848/210 Hospital Street Date: b'� Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 Application For: fa'Site valuation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both Type of Application: Xew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name _�H M S ENTER P 2).S C-5 E L�/— Contact Person &AtiT V.G��y 7 Address u9 S' R►OG 6 6.ATf- 1RkyE Home Phone .S316-39-1 -0896 City/State/ZIP LC-W L:5Vt" x'1 U2=$691 Business Phone 33(,--7-1-7 —00'18 Email br4nraad�"(e4 5la�rng�l.4orh ' Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan C'Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name SCOTT (UMBER BEAU04AIAP Phone Number 3361'N-031f Owner's Address 153 Lamcw4co DttwF City/State/ZipApyAr/LE 1 Y< 11,046 Property Address Juuc _CA J0Vw\P QQAD City-&1211 , � Lot Size /.29 Az-"S Tax PIN# MICt S$G 16Z-4335 Subdivision Name(if applicable) mot, KirraM BEhydarAp Section/Lot# 3 _ Directions To Site: WU/,1 (�_ e,J 3ylxY $EAvutnmQ pRoPE*.r/ o. L,5pr APPPcecWAr<-t y � ?,ad -r:r F'dmo,V'n IM01� 111&4y _ 6Ad4PG P Wir2A 2AISiyv�y/1-(r RoAU, Specify Problem Occurring: IF RESIDEN FILL OUT THE BOX BELOW #People 5 #Bedrooms tf #Bathrooms Garden Tub/Whirlpool ❑Yes o Basement: 6Yes ❑No Basement Plumbing: C'fYes ❑No IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People # Sinks #Commodes # Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: S/County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this.system is intended to serve?❑ Yes VINO If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use charges, or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules I understand that 1 am responsible for the proper identification and labeling of property lines and corners and locating and flagging or stakinA the house/facility locatio ,'p?oposed well location and the location of any other amenities. Site Revisit Charge Property owner's or o)V's's al&Ves ntative signature Date(s): 1'/2v Client Notification Date: Date EHS:— Sign given ❑Yes ONo Account# /6` Revised 11/06 Invoice# • � f f DAVIE COUNTY HEALTH DEPAR NT ! Environmental Health Section Soil/Site Evaluation f i APPLICANT INFORMATIONkOPERTY INFORMATION Juney Beauchamp Rd 7.j °'<rJHMJ EnteipnsesLLC Lot#3 ! '•Brant,Godfrey ��;'336 399 �7391 .29 Acres Water Supply: On- ite Well Community Public i Evaluation By: Augr Boring Pit � Cut 1 FACTORS 1 1 2 3 15. 6 7 Landscape position L ! ! Slope % 44 HORIZON I DEPTH 0 _ p 3 Texture group L SG L Consistence i Sp p. Structure i Mineralogy G19 HORIZON 11 DEPTH Texture'group j: G Consistence ! 5 r I i V'Structure 'S g L-' ! Mineralogy ! i j HORIZON III DEPTH - Texture group . ! Consistence ! Structure' 1 Mineralogy ; I i HORIZON IV,DEPTH #. Texture groupi -Consistence 3 Structure k i Mineralogy ; SOIL WETNESS RESTRICTIVE HORIZON i SAPROLITE CLASSIFICATION f LONG-TERM ACCEPTANCE RATE ©. ,f �•" i I SITE CLASSIFICATION:M EVALUATI} N BY: /p, J . 1lo�I1� LONG��'ERM ACC AN CE RATE: OTHER(S) RESENT: rias "RE S LEGEND 4 i Landscape Position } R-Ridge `S-Shoulder L-Linear slope FS-Foot slope N-Nose slope', i CC-Concave slope ' CV- onvex slope T-Terrace FP-Flood plain H 7 Head sloe „,. ! , ! Teziut•e,. S -Sand LS'-Loamy sand] SL-Sandy loam L-Loam SI-Silt f SICL-Silty clay loam SII.-Silty loam CL=Clay loam SCL-Sandy clay loam SC-Sandy clay SIC Sil clay C-Clay E CONSISTENCE lYIQiSt VFR Very friable FR-F>�*able. FI-Firm VFI-Very firm EFI-Extremely firm I i NS-Non sticky. SS-Sligl tly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-,Very plastic I S I r> >r , SC-Single grain M-M 'sive CR-Crumb GR-Granular ABK-Ang}lar blocky SBK-Subangular blocky PL-Platy PR-Prismatic f Mineralogy 1:1,2:1,Mixed I Horizon depth-In inches t k ,Depth of fill-In inches Restive horizon-Thickness and inches from land surface i 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) TTA TI T ■■■■■e■■■■■■/■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■eee■■■■ ■e■■eeeeeee!■e■■■■■ee■ecce!■!/■/■/ee■e■e■■ee/■/e/■/e■■ee■eeeseeee■ ■■■■■ecce■rc::�.:.::::::i::::::e�=--■.�eee■■■en■ee■■■■■■■e■ee■■■/■/■■ MEMNONMONROEMEEMEe MEMNONMEMNONNEEMMEME���% ■■■■■■■/■■■■■■■■■■■■/■■■■■■ace■�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■eee■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■/■■■■■/■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ TRACT I OF THE PLAT ENTITLED "PLAT MAP: SUE BEAUCHAMP ELLIS" -- PIN 5861620689 I PIN 5861 E�24647 TRACT II OF THE PLAT EN TITLED "PLAT MAP: SUE BEAUCHAMP ELLIS" — — --. ._ _ _ CONTROL EIP CORNER PIN 5861527585 �� eook ¢ � A9CE 5� � N � � � Q. — --�—� _ �� O � N � W a" PIN 586158421 � H QyQ-T B00+�� O V' � M � EIP PRIVATE ACCESSI EASEMENT --------- S 83°33'S8"E 218.60' TOTAL s E E E pL A T B 0 0 K 1 1 P A G E 1 3� --- 125.00' IPS 93.6Q' S 83°32'03"E 493.6 3' TOTAL 31.40' IpS 125.00' Ips 125.00' IPS 212.28' AACE 6o N � 1.23386±ACRES W � BY COORDINATE COMPUTATION o (INCL IZG RIGHT-OF-WAY) � - � � �� -" — �,e -� �� E� E�E-. � N � u� i` � � � � w O �h O on � � � 1.33336±ACRES BY COORDINATE COMPUTATION (INCLUDING RPGHT-OF-WAY} 1.38711± ACRES BY COORDINATE COMPUTATION (INCLUDING RIGHT-OF-WAY) � 0 F � � � � . � C�7 'd' r� d� W M 1.43215 ±ACRES �,'�'� HY COORDINATE COMPUTATION o (INCLUDING RIGHT-OF-WAY) z EIP 5.52749+ACRES BY COORDINATE COMPUTATION (INCLUDING RIGHT-OF-WAY) PIN 5861636067 SUE BEAUCHAMP ELLIS DEED BOOK 156 PAGE 493 S 83°41'S3"E 262.01' ACTUAL LOCATION OF BRANCH � � � �� H �W � �� FLnT z � Bnx w w �h aa F L� � W � � � O ax O o� " c�Y, w � �` � A N � 00 � z a I � � 0 o� 0 � 0 � � � E-� W �� r, z� P� � a� a z H z �' _ 3� _--� 1�,- - ' ' W� � - 5G � �' �' —� o `o ^ 1.137 - RES 1.2 670 ±� RES 1.2 �-4�,A,CRES 1.33558 ±ACRES � EIP � x BY COORDIN TE COMPUTATION BY C, ORDINATE CO PUTATION BY C00 DINATE COMP TATION BY COORDINATE COMPUTATION 5.18295±ACRES p (EXCLUDING RIGHT-OF-WAY) INCLUDING RIGHT-OF-WAY HY COORDINATE COMPUTATION � (EXC UDING RIGH ,-OF-WAY) (EXCLU ING RIGHT- F-WAY) � ) (INCLUDING RIGHT-OF-WAY) orq / -� - g� - -_- � 8� � - � -.�. _ - �--- - -- . _ _..._ - __ � W IPS r �--- %r,� r 1 � �A ; �� � � � � �,N s � ' -`- ---�.�' r � �� . co 5°3 aG � I�U �_���j}� in co � 3 4 i "" � �� I � � 1 h' z _ . � 39 B2 , I39, 6�, _ , ' " a a^,...-_- - -- . � ` � fi6'31., R, y'�� � , .'V 73, ' , _ _ - - - ,r-- - • - -- _ _ - --- � - . ., - - R _. , . _,- . . - _. ti 8 . . ,.� _ �. _ , h, 3 e , , 2p,� •,, � .� , � � _ . .::- ..�.. • c� . _ . ,. t..� _ � . _ ` � � � , p. 56 65 C �„W � ,. U . ,. ,,.r,.,- �.� o � � 14 � � , , � IPS N�RD T . ..- �p ` � �'8�' � � , , 0 83.14, � , ' ^' _�� ' ... � N , � .� � R�7S3'e�' '14�Sg � 73 26 p3„W N 75°34 33„�, Ip IYS 21.87' PT �. � o \� `` PT 56 3 4 C HORD 5.01' o TOTAL ° ��w, ?� u? � � e +;, � N 7'�°O6' � tv \ PT 4�58 52„N, 117.g4� IPS . i . - � ;', PT ih `�� N 75�3¢33 iy ,,;,,lp'2f}.43 PT o N 7 oos, � 7 52��w y � 5. O1 ' ch 139.80. IPS o � _ � _ N 77°06'S7��jy ; o ,...3 120.43 � �' '-`_ PT :,, o N 77°pg�52„ � DAVIE COUNTY REGISTER OF DEEDS -''�- - N 77' w 140.79� � w 150.8g. . 06'S7" ';., PT PT ---------- Pl�[i 1 REl?1S 1 RA 11�1� - ��� N 79°17'00"�y 131.13' - - - - - - N 89°41' 14"W - - - - - - - 216.59' - - - - IPS `� w 1-�-_ � .. N 77°06'S7"�y 149. PT � FILED FOR REGISTRATION AT 0'CLOCK . M. - -� _ 1 35' PT �' _ _ _ _ _ _ - - - PT 2014 AND RECORDED IN �- — � — _ _ N 79°17'03"W 131.51' - - - - ' - - - N 89°21'59' W 219-2fi �" ^ � pT PLAT BOOK PAGE - � _ _�_ _ fI FILING FEE $ 21.00 PAID M. BRENT SHOAF - DAVIE COUNTY REGISTER OF DEEDS O1fNER CONSENT CERTIFICATION LEGEND ---�,_ �_ __ _,_ _.``.�� EIP EXISTING IRON PIN — -- I HEREBY CERTIFY THAT I AM THE OWNER OF I'HE PROPERTY SHOWN AND iPs ixorr Ptrr sET BY PT POINT DESCRIBED HEREON, WHICH IS LOCATED IN TH1�, COUNTY OF DAVIE, THAT I RCP REINFORCED CONCRETE P1PE DEPUTY - ASSISTANT HEREBY ADOPT THIS PLAN OF SUBDIVISION iNI'I'H MY FREE CONSENT. - E- ovERxEaD uTiLtTtEs REVIEIP OFFICER' 5 CERTIFICATE I, , REVIEW OFFICER OF DAVIE COUNTY, CERTIFY THAT THE PLAT OR MAP TO WHICH THIS CERTIFICATION IS AFFIXED MEETS ALL STATUTORY REQUIREMENTS FOR RECORDING. REVIEW OFFICER DATE SURVEYOR CERTIFICATION FOR SUBDIVISION DAVIE COUNTY — NORTH CAROLINA I, THOMAS A. RICCIO, PROFESSIONAL LAND SURVEYOR, CERTIFY THAT THIS IS A PLAT OF A SURVEY THAT CREATES A SUBDIVISION OF LAND WITHIN THE AREA OF A COUNTY OR MUNICIPALITY THAT HAS AN ORDINANCE THAT REGULATES PARCELS OF LAND. THOMAS A. RICCIO L-2815 DATE: SCOTT KIMBI�R BEAUCHAMP SURVEYOR CERTIFICATION OF CLOSURE I, THOMAS A. RICCIO, CERTIFY THAT THIS PLA'C WAS DRAWN BY ME FROM AN ACTUAL 5URVEY MADE UNDER MY SUPERVISION ( DEED AESCRIPTION RECORDED IN DEED BOOK ; PAGE , ETC.) (OTHER): THAT THE BOUNDARIES NOT SURVEYED ARE CLEARLY INDICATED AS I?RAWN FROM INFORMATION FOUND IN F'LAT BOOK , PAGE , THAT THE R�TIO OF' PRECISION IS CALCULATED AS 1:20,000+; THAT THIS PLAT WAS PREARED IN ACCORDANCE WITH G.S. 47-30 AS AMENDED. WITNESS MY ORIGINAL SIGNATL' RE, REGTSTRATION AND SEAL THIS ?ND DAY OF SEPTEMBER, 2014. . THOMA;� A. RICCIO , P.L.S. L-2815 TOTAL AREA 1. 0.91397 ±ACRES 8Y COORDINATE COMPUTATION (INCLUDING RIGHT-OF-WAY) JUN BEAUf L4CATION MAP NOT TO SCALE SURVEY AND RECORD PLAT PREPARED FOR SC TT KIMBER BEAUCHAMP DIVIDING PIN 5861624335 FARMI GTON TOWNSHIP * DAVIE COUNTY * NORTH CAROLINA DATE: EPTEMHER 2ND 2014 DRAWING NUMBER 14254 50 0 50 100 150 G HIC SCALE - FEET ONE INCH = 50 FEET SURVEY PREPARED BY THOMAS A. RICCIO AND ASSOCIATES 440 WEST END BOULEVARD WII�ISTON-SALEM, NORTH CAROLINA 27101 336-773-0211 �