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2516 Milling Rd �� DAVIE COUNTY HEALTH DEPARTMENT • . ��'�c'_. ' ' ' Environmental Health Section � P.O.Boz 848/210 Hospital Street ����' d 3 Mceksville,NC 27028 -� (33G)751-87C►0 C'� !-� -70 � IMPROVEMENT/OPERATION PERMIT ��t��03-��y� Account #: 9900015��QTNQ2 Tax PIN/EH#: �Er�fi�=63=8�8� Billed To: Ronald�-,� Subdivision Info: Reference Name: Mary Nichols Location/Address: Milling Road-27028 Proposed Facility: Residence Property Size: 7.078 acres ATC Number: 3536 **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). T'HIS 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:X� Garbage Disposal: ❑ Washing Machine:� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 0 Lot Size Type Water Supply ��� Design Wastewater Flow(GPD)_��� Site: New�Repa�ir,�d� System Specifications: Tank Size ��GAL. Pump Tank GAL. Trench Widtl�� ��Rock Depth /� �Linear F� Other: Required Site Modifications/Conditions: I1�IPROVEI�9ENT/OPERAT[ON PERMIT LAYOUT- APPROVED ' 'I L N FILTER. RISER(S)IF G "BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe D vie o n ealth Department for final inspection ofthis system between 8:3Q a.m.to 9:3b a.m. or 1:00 p.m.to 1:30 p.m.on the day o in al ti n. Telephone#is(336)751-8760.**** 5��� ���" ` s �y� ,s`�` •�'�����` ti �' n�� �,l �`� c� � . � � ,c� �� s�� � � �� �� e�` ���° � � � �— Environmental Health Specialist's Signature: Y ' Date: `V S v� DCHD OS/99(Revised) • DAVIE COUNTY HEALTH DEPARTMENT �``� Environmental Health Section � P.O.Boz 848/210 Hospital Street ' Mocksville,NC 27028 (336)751-87G0 ��f O Account #: 9900015�1 Tax PIN/EH#: 5769-03-6�8#— p FLT N t/`' Billed To: Ronald Fee4er Subdivision Info: Reference Name: Mary Nichols Location/Address: Milling Road-27028 Proposed Facility: Residence Property Size: 7.078 acres ATC Number: 3536 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSLIED by the Davie County Environmental Health Section prior to issuance of any building permit(s). T'his 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 WASTEWATER CON T UCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: �` Date: � J �3 CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis Certificate ofCompletion shall indicate the system described on ImprovemendOperation 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. y�� � � � Se tic S stem Installed B : � t � �� �/ P Y Y Environmental Health Specialist's Signature: � � Date: � � DCHD OS/99(Revised) • ' -�� PPLICATION FUR SITE EVALUAl10N/IMPDOVEMFM PEfiM[T&ATC � � � �� `S � �' ���v��s� ,,� Dudle County Nealth Department D � � a �t�Y l`'' Envfronment�a/He�a/th Se�allon ( � 7;�,�� � �� . �p.o. sox 848/210 xoapital. street ,/ � QEC J� Mockevilie, NC 27028 y �`b � � • � � � . (33f)751-876Q �l I *�'*Zl�ORTANT**� THIS ]�PpLICATION CANNOT � PliOCS38lCD UNLLr38 ALL TH� REQUIRED SNH'OI�TiON IS PRONZDbD. Refez to the INFORMATiON BULLETIN !or inatxuatioas. 1,�,�/ • 1. N.m. to b. a�ll.d , ��' • y'�, � , contuct n.r.on / �' ,CI S Nailinq 1►ddru• ?(� I, i/✓� /� �C Boam� ?hon� `j� J��� � � City/8bat�/LIp %,1'� ✓�. ��. � � Bu�i�u ?hon� 2. Nas� on ?�rait/]►TC i! Di!l�rust lhaa 11bow �.-.___--_._.__—�------..__.... Nailinq 71ddr��• City/8t.�t�/Eip _"",-�_ � �S-�{<� �C O J 3. Application �or: Q Site Evaluation --� ❑ imp�rovament Permit/ ❑ Both �. eY.t.. to s.roso.� f�ous� � Mobile Homa � Busineaa 0 Zadust4sy 0 Other �•� � s. If Rssidence: � People � Sedrooma � # Bathrooms ��_ 8 Diihrut►�r C3-�i�baQ� Dirpo�al B'NashinQ Machin� O Sasmnt/pluabiaq O 9aa�nt/No plumbinQ 6. I! Hutin���/Saduatry/Othrrt Sp�oity typ� � p��pl� � � Siake # Commod�• i Bhox�r� � Urinal■ • Nat�r Cool�s� IF E'OOD3ERVIGE: � 3eats Eatimated Natar Osay� toaiion. y.= a.Y) �. Typs o! water suppiy: ❑ Cotuity/City N�11 ❑ Community e. Do you anticipate additioaa or e:paneiona of the facility thts syatem Is Intended to aerve? 0 Yca � If yes,what type? *"*IMPORTANT""*CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either�PL.AT or 31TE PLAN MUST BE SUBMITTED by t6e client w�ith THIS APPLICATION. Property llimenalon�: /, ///�J /�-� ✓ -�9�`WRIT�DI�REC`f10NS(from Mocksville)to PROPER'I'Y: ��i� _ /1-n_ � �c��l_ . ^/h /��/�r, �-� -� 7 Taz 08ice PIN: # i _ Property Address: Road Name r �� 'V' � L� ,7 ' " _�j � � C1ty/Zip ��be��:�� /��. n��l�� �/��'-Ld1 ���i� �l ����`� If in a Subdivision provide information,as loltows: l, � � � C �'�" t1/ Name: �u%' �.r. �� � � , � �/ . Sectlon: �'. Biock: Lot: Date Property FlAgged: �� --l�' ��"Z"? T61�i�to eertify�hat t6e in[ormatton providcd i�correct to the best ot my knawledge. I anderotand that any permit(s) issned hereaRer are eubject to ewpenston or revocation,If the elte plana or Inteadcd use change,or it t6e tnform�tion • aubmitted in this appiication t�falsiDed or changed. I,also,Wnderrtand tbat I ent responJlbl�jor all cbarges tnrurnd jrom tbls appllcatlon. I,6ereby,gtve cousent to the Authorized Repreaentative o!the D,a�'e Coanty H�1th.Department to enter upoq above deacribcd property locsted In Davie Coanty and owntd by ����'-r�f>_r_-,� __ to conduct all tesNng procedares As necessary to determine the alte ealtab Ity. �. ,-- ,� � �` �� � � DATE �i�;'"�—�s-�� SIGNATURE - � �°"''��L%- r TH1S AREA MAY BE USED FOR DRAWING YOUR STTE PL.AN(Inciud �11 ot the follawing: E�sttng and propoacd prnperty Iines and dlmenston�, etractarea, aetback�, and aeptic Iocallons)� �� i') Site Revislt Ch�rgc �� I Dste(s): ' r �--� Client Notitication Dste: ,� � �^�� / EHS• .../�%',-� ��� � l � � � Account Na � Rcvised DCHD(07/99) Invoice Na � � � � 'a"`�� . _ p ;�P-e- �' �_�l L�{ 5�-0 �F-,� Ca n.��. /,S t- � � ' � � • ( C ��� c�i c� �" ��� �e✓�S� o-n ` �v �. ot�� i� t YUJ.L� � • _ 1 L7 N 58'29'27' E 190.18 • ��� � .,.,:�: ' L8 N 5T48'26" E 75.87 � . CS�� ,...;«"::� • . � ` -`J--- ---�`_�._ �i X �"'. .:`, - ' ' ` '. ��6 <9 (IV ,~f � -.. , . . ... � --- � . .,,,. � °� ..�,..,� � TRACT AR�F -- - �------ -- - ----- ---- �� L9 S 55'35'S3' E 4321 ; � � . v �Jr r.;p""",'��`� 1 ... .. . __ _�_ - _- Lt Q S ST16'08' E 73.62 ""�� �' � "+ ' _ �n,';. � ` ` L71 S ST16'O8" E 104.50 �t� �- ` � � - A= 0.1 15 � , D ;' __. , ��2 s ,5•4s'3z- w 2s.�8 �Z 2.798 AC. ., __ . �, 1 ��G. a, _ B= 0.� 17 : ��3 s �s•as'3z' w 2�.sa ' � R. 1e O� C= O.fi02 � 114 S 75'46'22" W 162.42 ^ �-$ -6.9y - ._ -- -- ..' ��4 J ��5 r, 2s•23�o0' F ta2.�z 266. � � DO D= 0.298 � L16 N 29'23'00' E 30.29 ;-� - 44 - • r, m _ _ ..- ---- �--- --- -- --_. _ ' .., �,:..•.:, �273�436'32- y Q= C0 BETTY J. BOWENS �z : E= G. 175 r ..- � � .,.._Tora�� o;� ti D.B_ ' 15, PG. 661 "• � .. . _.._ _ .. .... .. �o � z ' ,f N 0 202.974'\ .� � r.� .'A � Q` �� THE 2.798 AC. TRAGT IN �� S o � � � � 30' PROPOSED EASEMEN S T UART KURFEES' �� � 6 p �� o o '�' � TO S.R. 1600 R/W • � GARLENE KiIRFEES �'o, a - S B' �, � r�cTs �, B, dc D AREA: � .C% g" 4" " �.R 1600 R/W � D.B. 331. PG. 803 ' :159.oo ' " S9 F � 4 Q�„ � W , � N 31192.��14, E �456.67 TDTAL� . � 81 2661 ; �,c E-� � I (� �_ � � � u v. . o .._, � s� • � ,E �' - •. S 83•59'44• E - - o, w Cr Cli � �t� ��' � 196.42 ;. - �,i .. \ � ^ � �Ca ! ?' � _ � N 06'S9'S6' E �o � Q � , �' '' y ! 1�'5,�. � 176.57 � 1 N U4' � 83'S9•aa• E 173.12 � . � 88.qg 30' PROP05ED ! �` � ' — '� : _ . ,�, o �, EaSEMENT �, � — _ _ o�V . p ^^ � _. ,Lq �p � N 06'S7'21' E � _ .. � r � � 8.727 ��. ��o.�� , -.� G � . � ` � . p v �� ooi �, fn ' , z /� [ ►/ ty �1'49'69 . . (p,l�f� 223 , � = BETTY S. BOwENs , ' WILL BOOK 94—E-140 , � �� REF: D.B. 48 Pg. 581 ���'�� �``. ��l� � � � �( Z q � '",°� ,ti�' o �o s ,�,�.. ����3� �� �- � M p J Q / Y ��h*�, �O N W 28�,68 9� f (C I` -��-�Ei-�'� a, '� O . A �,,� ��oj.,p � . � - - � `JP��.�°� t o� v N,�� H�NNAH JONES - � � - o N �� 6.961 AC. ^ �' D.B. 140, PG. 506 ll-3�t000 � � . 2 ' '- --- . ... ,� y . N 31'OQ'OS' Y \ �-��-V �,�•OC� � 25.00 ' ' ' � . E �6,01' E M l06.S� , <T�TqC` ' �.�.� ��3<' N 533.85 " S � Sqs N 5g•3Aa�269 43'04,2�. �o� _. 9, P C�24'2� �" . � �3 P�� - • , _.... , k 23p,�2 ,'"�,2p V � �e � � �, � � c� I 1��,� . _ � � � � �- � -- \ N 06'S9'S6' E � � A ' � �. N Oa•i�'S4• � 176.57 r " � I _ . �: 83•59'aa• � 173.12 _ � ��08�� " •� ' 88.48 - _ � ' — 30' PROP05E� " � _ S 69• TOT , . E�SE�AENT o N �' '— - -. !S 9p 51'pp A�) n IS 4p f v � N 06'S7'21' E n v^i j P 8.727 AC. ieo.o� � �o . � �; .. - -- -- � �,• oo. E " y_„ ���� '' N „223 69 _ ;.A, � , .�. . S �1NG Ro �1 Qh ;B; _� R. �eo AD ��,;�� o No 0 . _ � � �� e ' � �� v N ti HA.NNAH JONES 3 N� � � { D.H. 140, PG. 506 � 6.96 I AC. � o . • r� _, �__ . .. , BETTY J. BOWENS � ,Z " . D.B. 315, PG. 861 ;� Zj ,n ' '' o V � m y � � ��3TqC� S4 � q �' 439 q.��5�0� � � � � 13 , Q a ti. Q _ � � -. . . . � k 23p•�2 ��' ,n � � •-, ' ��'20- �, ` �'�^o. � U� � } ��N � a � � _. �.;no � Q q - 3 '� � �o� � „2 . t �b h�j '' i� � - - � 30' PROPOSED H G. H. ALLEN EASEMENT D.B. 58. PG. 594 N �. N 06• • � allo _ 14�i56• E ` ri v N 56'05'<7' V l,t,r � . � � � _ _ � � � . � � � � � ' � ' ` • DAVIE COUNTY HEALTH DEPARTMENT . • • ' Environmentai Health Section , , , Soil/Site Evaluation � APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001511 Tax PIN/EH#: 5769-03-6784 Billed To: Ronald Foster Subdivision Info: Reference Name: Mary Nichols Location/Address: Milling Road-27028 Proposed Facility: Residence Property Size: 7.078 acres Date Evaluated: /,-���r� � Water Supply: On-Site Well v Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition L ,� Slo e% HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH � � � '� Texture rou Consistence � Structure /Z � Mineralo 1/l �� � HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION � LONG-TERM ACCEPTANCE RATE SIT'E CLASSIFICATION: �� EVALUATION BY: �� LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: �I����✓ �'Z�� �" ✓� LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Tenace 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 Mineralo�v 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 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■�■����■�■�■■��■■■■�■�■■■■��■�■�■��■�■�■■����■�■■��■��■�■����■�■■■ - „ . � .. � . � .r ' 1 u �- ...:. ...�.... ...;. _' ..;." . __ e}��"s..Y t f{.r i t 1 t �; f .i.i a �. �:S.! 3�.:�.a.}�t�d.a � '�t t _i: 4 c-'�s.�;c_Y .a. 1.. / �o't .. A a,a..s s ..ta.�,➢AI. ��e .l��Y L.1.t. el .r.:.'t .: €N!llR�f�P.7€N�'AL H€ALTH �EC�fON P. O. Box 848/210 Nospital Street Courler #09-40-06 Mocksville, NC 27028 _ . Phone #: (336)751=8760 _. ,. . , . December 20, 2000 � Ronald Foster � 1876 Yadkin Valley Road Advance,N.C. 27006 Re: Site Evaluation/Milling Road Tax Office PIN: #5769-03-6784 Dear Glient(s): As requested, a representative from this offce visited the aforementioned site on December 18, 2000. Based upon the information provided on the Application for Site ' Evaluation and after an evaluation was completed on the site, the site was found to be provisionally suitable for the installation of a modified, oversized on-site sewage system. Before an Improvement Permit/Authorization to Construct cazi be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions,please feel free to contact this office. Sincerely, /�4'7�.� ��a���j. Robert B. Hall, Jr., R.S. Environmental Health Specialist RH/di Enclosure(s)