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1092 Eatons Church Rd Lot 3 DAVIE COUNTY HEALTH DEPARTMENT ��� —C • Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)7.51-8760 IMPROVEMENT/OPERATION PERMIT Account M 990001026 Tax PIN/EH M 5822-62-1818.03 Billed To: Jerry Daniel Subdivision Info: Mary Beck Estates Lot#3 Reference Name: Jerry Daniel Location/Address: Eatons Church Road-27028 Proposed Facility: Residence Property Size: 0.9770 Acre **NOTI✓**This fg provement/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 #People #Bedrooms #Baths Dishwasher: 2T-1--Garbage Disposal: Washing Machine: Basement w/Plumbing: Basement/No Plumbing: 0 Commercial Specification: Facility Type #People #People/Shift #Seats Industrial0 �Waste: tr Lot Size Type Water Supply�� Design Wastewater Flow(GPD) �7 Site: New Repair 0 System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width � Rock Depth Linear Ft.sD Other: Required Site Modifications/Conditions: 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.**** Environmental Health Specialist's Signature: �, Date: v DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001026 Tax PIN/EH#: 5822-62-1818.03 Billed To: Jerry Daniel Subdivision Info: Mary Beck Estates Lot#3 Reference Name: Jerry Daniel Location/Address: Eatons Church Road-27028 Proposed Facility: Residence Property Size: 0.9770 Acre ATC Number: 2351 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 I 1 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTE WATE ONSTRUCTION IS V ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: 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. 4 -j «� E= Septic System Installed By: 0-A"'Old Environmental Health Specialist's Signature: Date:_ 2- DCHD 05/99(Revised) 22 M L5 V APPUCATION FOR SITE EVAUJATION/IMPROVEMENT PERMIT& Davie County Health Department MAR " 6 2000 Environmental Health Section P.O. Bos 848/210 Hospital Street Mocksville, NC 27028 ENVIRONNIENTAL HEALTH (336)751-8760 DAVIE COUNTY ***II4PORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed �4,h I)p 1 Contact Person Mailing Address ! Oc�r--J reL/15 it r v A Home Phone /� /� 'J-VL _ f�� nn O^^(� City/state/ZIP d(� S ()I /1 6Y' 01 7 pf ainess Phone 2. Name on Permit/ATC�1; Different than Above �C( 'W e— Mailing Address to/Zip 3. Application For: ❑ Site Evaluation 'a =mp ovement Permit/ATC ❑ Both 4. System to Service: 11 House f�bile Ho Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms I Bathrooms d. ❑ Dishwasher H Garbage Disposal Ll Washing Machine Ll Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/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: bounty/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes Et No If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BBE.SUBMITTED by the client with THIS APPLICATION. or Property Dimensions: V, R 2;0 f /"��.5 WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # ',2?—:�2,- zv f �G/!O — /1 �-C4D� Property Address: Road Name If in a Subdivision provide information,as follows: Name: ✓�Q�P_u ��� r�..ci� 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 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 — G — SIGNATURE 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: EHS• Account No. G 201 Revised DCHD(07/99) Invoice No. ��� Y f ` APPLICATION FOR SIFE EVAWATION/111PROVEMEM PERMff&ATC Davie County Health Department / otiJ NOV 17 1999 i `� Envim me�ntd Hudd,Secdon -r, 4 /• P.O. sox 849/310 Hospital street ¢ -A Mocksville, NC 27028 Li1`Jltci� ;.,oris;,►_11LAlfH (336)751-97160 DAVIE COLIi TY *'**?Mt7#tTAItT " 28I8 AI:P'LICA2It)8 CXMT ZZ PR0CC68SD Umass ALL TIM RZQMIMD ItitORMl 10111 IS PROVIDED. ,Refer to the INT+'OAMATIOli SULLETIH for'instructi/o 1ns. �/ 1. Inane to be sailed IWI&-y !J. BcG �S Tc cont / .oe �.r.oa (��+�.Y'i S Cr ro Gemy�tdk�NN I !tailing adds•.. ✓o o� �e cJL s0e. 9was, '3 34- 46 R-46 41 z7 o 7 Thr/stat./a:* �Z� �• 8U/ /hcoc,�d��llci�n snsia•ao ams, 336- d"? 4-a. Inaaie on ft=LWA!e ss al:s.:.ot tbao,abor..�Z _�. eP.G�e e4--5-14�„A� caddr•ji ci�?latet•/tiy ,[111 lP Al c- 2,7 L Y Bi c: Hwa ivation a 2wrovem mt hermit/ATC 0 Both a. ateten to s•svioet "KHouse HOWL* Home © Buaiaess 0 Industry O other S. It Residenost I people # Bedrooms 70! 3 1 Bathrooms c! O Mahwasher O Gasbag• Oiaposal O waahing Naot►ine Q aa.•neotlpluabing O naeementluo aiu•bing a. s! awi:►•aaltndustst/Oth•s� ep Dist type # a•api• # sinks # Conrod•a # shower. # urinal. # water coolers It M=8ZMCEt (i seats )estimated Water Usage tgailons pot day/ 7. Type of water supply: A County/City IC �Nell Ci community a. Do you anticipate addition or expausion of the hcUlty tbb system Is intended to serve? 0 Ya �o If yea,what type? ***IMPORTANT"'*CLIEM lll1LL"!•COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPS•i�C�'rin!�!. Property Dlmenslotut .SGS-__/ �?� 'xYUffrE:;1RlXilGNS(&*a Mockovilie)to PROPERTY: Tax OiAce PINI w D—? 0 Property Address: Road Name It in a Subdivision provide information,a follows: Name% � �' &deyvW Sections Slodu Lots Date Property VbUeds 4- «-.. Thb Is to certify that the information provided is correct to the but of my knowledge. I understand that any permit(s) booed hereafter are subject to suspension or revocation,if the site plan or Intended use change,or If the information submitted In this application L talsilled or changed 1,also,vn*rstand that I an responsible for all charges incurred from this appUcadon. I,hereby,give consent to the Authorized Representative of the Davie County Health Depsiftest, to enter upon above described properly hated in Davie County and owned by /�.r•T� to conduct all testing procedures a necessary to determine the site suitability. DA i E �6 f P' ISIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(include all of the follawingi Zftz and proposed property lana and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Please complete the highlighted area(s)and Dah(s)s return. Client Notification Dates EAST Account No.Revised,DCHD(07199) Invoice No. �� �3 S 84.25'45" E446.69- I' -44e.a9• � Ts�•�• r. 1' Square Iron 343.10' �N r2 v 7,128 sq.tt 0.1636 acre rn P ,e. 56,227 sq.ft 4 o ti 1.2908 acres � titi FRANCES BECK DB 140 PG 376 S W24'21" E g 370,42' 333' .01 1.3456 acre 1 26 58.615 sq-ft. h S 8824'21' E n 427.01' 1 VA LL n _ DB � O " 64.03.36'• w 57,071 1.3102 acres 6) o ls h a / 94.82. N 42,560 .t ipike z o 0.9770o serve � 2 O o.e \ S Inti o 44.120 sq.ft X22' E. r "� 1.01.29 clews S 85.35 W E 11 1� h� nb O x ° 250.00' 37,488 sq.ft , r 1.3198 acres \ ry 49,409 s 1.1363 o MIND PROPERTY UM iW WGtR OF WAY UNE 21QO1, UNE FROM DEED OR PEAT 224.64' NOM OR FORYfA>_Y 'U ' Om BOOK PAGE z ip IPUT BOOK N B0 eEn OOUE UERMM DISTANCE O�;ja` ;n` crtmRI NE w a PROPERTY UNE \ U %W OF WAY RS&�R EATON CHURCH ROAD ",A S°'k`� IN�SNED FTDOR EIEYATTON SR 1415 P ( OCI4TMG KION FOUlA ) P ( NEM KION SET ) 7 ( NO MONIIMEMTATION SET ) CONTROL MOWULNT s1Y+G Pre NAt 'NAr� sEt R,, PRELIMINARY PLA TWO F(l pETER ^ - -v a DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANTINFORMATION PROPERTY INFORMATION Account #: 990000872 Tax PIN/EH#: 5822-62-1818.03 Billed To: Grady Beck Subdivision Info: Mary Beck Estates Lot#3 Reference Name: Grady Beck, Executor Location/Address: Howell Road-27028 Proposed Facility: Residence Property Size: 0.977 Acre Date Evaluated: Water Supply: On-Site Welly Community Public Evaluation By: Auger Boring Pit c/ 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 )c S 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: i1E 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)