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1084 Eatons Church Rd Lot 2 DAVIE COUNTY HEALTH DEPARTMENT '31 /6 • Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001631 Tax PIN/EH #: 5822-52-0808 Billed To: James Champ _ Subdivision Info: fAAp y &j CX QST_&r/LoT 2- Reference Name: Location/Address: Eaton Church Road-27028 :- Propos'ed Facility: Residence Property Size: see map **NOT�C*Thi blmprovem8ent/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 CO'N'TRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type 1'100sg' #People 3 #Bedrooms 3 #Baths 7-- Dishwasher: Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type //��� #People #People/Shift #Seats Industrial Waste: El Lot Size Type Water Supply lVV0TYDesign Wastewater Flow(GPD) cl 0 Site: New Repair❑ 1 „ ,� ' System Specifications: Tank Size 11"0-t'AL. Pump Tank GAL. Trench Widthc�o Rock Depth 12 Linear Ft. Other: 'e-7 -P► �J Tia-S 1 Ns!:-Z&LL- l��►zc.5 Required Site Modifications/Conditions: 11E� F � � �Z& �o Mov. s IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISERS)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. r �X1oP vat N_ N s U1 �' loot �ptool v � Lt--Z Environmental Health Specialist's Signature: Date: !9 01 DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street MockvAlle,NC 27028 (336)751-8760 Account #: 990001631 Tax PIN/EH#: 5822-52-0808 Billed To: James Champ Subdivision Info: Reference Name: Location/Address: Eaton Church Road-27028 Proposed Facility: Residence Property Size: see map ATC Number. 2750 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 Tr ea t and Disposal Systems). THIS AUTHORIZATION FOR WASTEW N IS V ID FOR A PERIOD OF FIVE YEARS. -57 Environmental Health Specialist's Signatur7 Date: 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. r All �/l107 OJ 1 41s 25 R- F©fl7eec y1eep Septic System Installed By: �"3c Environmental Health Specialist's Signature: Date: 7Z DCHD 05/99(Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT& Davie County Health Department Environmental Health SeWon P.O. Boa 848/210 Hospital. Street MAR 12 2001 Mocksville, NC 27028 (336)751-8760 . EP4V'RONMENTAL HFA I TY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS UNTY INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for insftrpuctions. 1. Name to be Bill f �jfC ,m Contact Person G�5�7A ( -7/ Mailing Address' 'Z ',�'' �+ tet"'` l Rome Phone _( ` 5 ter`/ city/state/zip 4d�il��- / �-` /'7y 0,6 Business Phone ` sl-fff/J" 7_f 1 T2;::> 2. Name on Permit/ATC It Different than Above Mailing Address City/state/Zip 3. Application For: 0-tite Evaluation 0 Improvement Permit/ATC ❑ Both 4. system to service: Douse 0 Mobile Home 0 Business 0 Industry ❑ Other 5. If Residence: i People # Bedrooms # Bathrooms Dishwasher n Garbage Disposal Wishing Machine O Basement/Plumbing O Basement/No Plumbing 6. If Business/Industry/Other: Specify type i People ti sinks # Commodes i showers # Urinals # Hater Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: U—county/City 0 Well 0 Community a. Do you anticipate additions or expansions of the facility this system Is intended to serve? 0 Yes No If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. a Property Dimensions: l 3/ 1/c ��f>9 1� '�SWR ITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # Property Address: Road Name e4k /� �, ea 0 A Ae�4P City/Zip moelt/ ./ 6�w `1 If in a Subdivision provide lnformation,as follows: Name: AA4tV Section: Block: Lot: Date Property Flagged: 0 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 falsilled or changed. 1,also,understand that I ant 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 e����'� SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN clude all of the following: xisting and proposed property lines and dimensions, structures, setbacks, and septic locations). ite Revisit Charge j F S _ Date(s): t � Client Notification Date: EHS• Account No. Revised DCHD(07/99) Invoice No. S �s 0�t� ,H�R�--- a _`� ��� • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001631 Tax PIN/EH#: 5822-52-0808 Billed To: James Champ Subdivision Info: Reference Name: Location/Address: Eaton Church Road-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 Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: 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-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) APP CATION FOR SiTE EVAWATION/IMPROVEMENT PERMIT&ATC Davie County Health Department NOV 17 1999 Enwim mentd HwIds Section 1.0. Box 818/210 Hospital street i Mooksville, VC 27028 L(�Ufi It'LAL`iii (336)751-8760 UAViE CUlii'll`t • of#Ii�CRTIItiTR** THIB llp>:LICIITItyN CZMT ffi PROCS8011D UN 288 AM THIS nQUIRZD t g*FMUIQH 18 PROVIDIM. pRefer to/the IIiS'OMWICH SULTS21H for instructions. ZA I. haus to be Milled//��✓'Y /J. �CJCc JAG �S�� Contact Ors.a► C-WY'i S U- r0 C� yukdk� Wiling address ea or /J eC e � y�Zrd some ame 3 36— 4b8-4b 41 nuc �7ai citylstat.Isn �ZG �/ 8Ul. /koc.�'dv.l�ei n Business /scone a. Wamm an ft=LWWM is Different tbar b e� _�. ee G/G �$ /i �` iZ 66Ec4 r ryjLt_ go/ _ city/otate/sip n/ A. Xate Rraluation O Improvealeut Qassii.tlllTC D Both t' e. system to sevvioer U House, Habits HOMO 0 Business D Industry 0 other a. It Residences I people I Bedrooms lel 3 s Bathraoms QL O Dishwasher O Oarbaye Disposal 0 lhahing Machine 0 Masement/QlnabLag 0 Massnent/No 91tobing a. !t susinesslFndustsy/OtMrt specify type i people i sinks I Commodes 1 showers I Urinals f Water coolers It Il'0008smcx: # Seats intimated Water Osage t9allons per day) v. Type of rater supply: County/City C Ve Nell 13 Community s. Do you anticipate additions or expasrlons of the hefty this system is Intended to serve? o Ya No Dyes,Wbai type? ***1MP0RTANP**CLIENTS MGLST CDMPLETBTHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Eliker a PLAT or SITE PLAN MUST BE SUBhfITIED by the elient %JJk TtH1R APPr.1k'!I%?a , Property Dimension: Yr-" _/`�`'j'� VILI':E:;;Rwn0N6(nom idoclavWille)to PROPERTY: Tax 081cs PINS Y M d/5-81 6 � /44z) Nd'i Property Addrea: Road Name well/ jQp4 w �-�` •c ' Citylzlpe"r✓ C,4"-.4 ,- f� C/J- It in a Subdivision provide Information,a followas 6 Name: � �� ego4ewvw : ,y Section: Bloch Lots Date Property 111agged: This b to certify that the information provided b correct to the but of my knowledge. I understand that any permits) issued hereafter are subject to suspension or revocation,If the aIle plans or Intended we change,or If the Information submitted in this application Is fabilled or changed It also,understand that I an raposslble for all charges lncsrresi ftom this appUcatiom 16 hereby,give consent to the Authorked Representative of the Davie County Health Depa en to enter upon above described property located In Davie County and owned by y_&V, 4L G�F� to conduct all testing procedures a necessary to determine the site sdtsbfty. iDAiE A0 �"zP-—7-9 SIGNATURE THIS AREA MAY BE USED VOR DRAWING YOUR SITE PLAN(include all of the following: :fisting,and proposed property lines and dimensloM structures, setbacks, and septic locations). Site Revisit Charge Please complete the highlighted area(s)and Dste(s)s return. Client Notilleation Date: EAS: Account No. 0 , Revised DCHD(07/99) Invoice No. ?!U I I S 84'25.45- E 448.69' -s�.ee tti• 1" Square Iron I 343.10' (Tie) 48.may' 2 I ^h � Q 41 7.128I sq. IQ - 0.1636 acre: rn b9�� tA I xl- ,e. 56,227 sq.tL o ti 12908 acres FBD 40 PG 376 ti S 86.24.21' E 9 370.42' 1 O111 N 133• .ot• 1.3456 acres 1 24 58,615 sq.ft. S 86'24'21' E � N n 427.01' _ " 1 WILL _ DB N 84.03'38' W 57,071 sq.ft. _ ?os� 1.3102 acres o, 8 C1 O 94 Iipike Z N 42,360 sq.ft. � -� 0.9770 ocres � O t� 4.4.120 sq.ft. 1.0129 ocr" S 85!35W E O x ° [] 250.00- 57,48S sq.fi 1.3198 acres 49,409 s l 1.1363 0 z�m tsa ��\ W i••� PROPERTY 114E ao �- RIGN1 Of WAY lWE 1, UNE FROM DEED OR PIAL �\ 224.6.4' NOM OR FORIIEALY DEED Boon PAU N PIAT BOOK ODUME UM" DISTANCE CE?(TERLNE Ir .-d PROPERTY uNE L( RIGHT DF WAY R EATON CHURCH ROAD Spike ,URB AL GLrM 1N1S11ED FTDOR EA.EVW04 SR 1415 P ( DU5106G NtON FOUTA ) � w \ D ( NEM IRON SEI ) on ( YO YONWEMTA110N SEI ) GS CONTROL WOMMINT FwbG Py, % NAaI SE1 - --- rn° 1.10K PREUMIA14RY PLATWO T Fr)C> ^ " 31 YElEH DAVIE COUNTY]HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000872 Tax PIN/EH#: 5822-62-1818.02 Billed To: Grady Beck Subdivision Info: Mary Beck Estates Lot#2 Reference Name: Grady Beck, Executor Location/Address: Howell Road-27028 Proposed Facility: Residence Property Size: 1.01 Acre Date Evaluated: Ll/ Y/Q7 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit /� Cut FACTORS1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence r Structure ll- Mineralogy Mineralo HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE /�/ / SITE CLASSIFICATION: 42K EVALUATION BY: �C Oa !� LONG-TERM ACCEPTANCE RATE: 7 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-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineraloav 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)