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151 Northbrook Dr Lot 13 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section �Q� W— %) ,I., P.O.Boa 848/210 Hospital Street (J Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002309 Tax PIN/EH#: 5820-32-4100 Billed To: Raymond Stevens Subdivision Info: North Brook Lot#13 Reference Name: Location/Address: 151 Northbrook Drive-27028 Proposed Facility: Residence Property Size: see map **NOTES*Tliis�iiprovement/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:. Garbage Disposal: ❑ Washing Machine-. Basement w/Plumbing: ❑ Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply�� Design Wastewater Flow(GPD)' — Site: New.B—Repair❑ System Specifications: Tank Size/d'0 GAL. Pump Tank GAL. Trench Width, / 'Rock Depth /.7�Linear Ft.-T,'40' Other: Required Site Modifications/Conditions: 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: n the day of installation. Telephone#is(336)751-8760.**** Environmental Health Specialist's Signature: DCHD 05/99(Revised) • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990002309 Tax PIN/EH#: 5820-32-4100 Billed To: Raymond Stevens Subdivision Info: North Brook Lot#13 Reference Name: Location/Address: 151 Northbrook Drive-27028 Proposed Facility: Residence Property Size: see ma ATC Number: 3169 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 WASTE WATE TRUCTION IS VALID O A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: , • i 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. S,e eh r Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Health Department D Environmental Health Section P.O. Box 848/210 Hospital Street JUN Mocksville, NC 27028 (336)751-8760 ENVIRONMENTAL HEALTH DAVIE COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Contact Person i Mailing Address Home Phone ' �xo v 2 City/State/ZIP Y)"k��- `�l/� 'I ,�� ���� Business Phone -2243 L152— J� 2. Name on Permit/ATC if Different than Above Mailing Address ..�C[[ity/State/Zip 3. Application For: ❑ Site Evaluation l� Improvement Permit/ATC ❑ Both 4. System to Service: House ❑ Mobile Home '❑`Business ❑ Industry ❑ Other 5. I£ Residence: # People 7 # Bedrooms _ # Bathrooms _ )(Dishwasher ❑ Garbage Disposal —Kwaashing Machine ❑ 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: County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes -KNo D If yes,what type? *7� o ***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. ) Property Dimensions:/ .ALA WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: #. 221 1 V ±2 Property Address: RoadName5/ ✓ �1! )�T b✓� --�Q.✓ e5 ���✓ City/Zip Mltfk �_7 �7 Sfi If in a Subdivision provide information,as follows: I' 1[�� / !/1�►��(��. �I�� I � dyl Name: DY � (' Y� �� ' Cof e ""5�ohq Section: _ Block: Lot: 13 Date Property Flagged: -417 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 9Pie County Health Department to enter upon above described property located in Davie County and owned by -S JZe,r?S to conduct all testing procedures as necessary to determine the site suitability. DATE SIGNATURE ?CaeK�� 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 = Zepp Site Revisit Charge Date(s): Client Notification Date: 24 � EHS: ►�- _ `-. �s- Account No. � V Revised DCHD(07/99) e Invoice No. �L 1013 APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERM U Davie County Health Department Environmental Health Section SEP 1 8 1995 P. O. Box 665 Mocksville, NC 27028 I ENVIRONMENTAL DAVIE COU 1. Application/Permit Requested By .�y�� Mailing Address /�"�ac C Home Phone !?9,9#719 Business Phone' ' 2. Name on Permit if Different than Above 3..Application/Permit for: General Evaluation " ❑ Septic Tank Installation 4. System to Serve: [P/House ❑ Mobile Home ❑ Place of Public Assembly s ❑ Business ❑ In Other1 ❑ Unknown 13 5. If house, mobile home: Subdivision NO 1r, ��aa�section Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms ❑ Washing Machine No.of Bathrooms ❑ Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks s No.of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: EI''Public 7 ❑ Private ❑ Community 8. Property Dimensions 1- i�aaa4a4k, 4 igxemw Sewage Disposal Contractor ? 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes, what type? *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to(Property: Dtesti This is to certify that the information provided is correct to the best of my knowledge, and 1.understand I am responsible for all charges incurred from this application. DATff SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1. I OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box#2, the rest of this form MUST be completed by the owner or a person authorized by the owner: 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 said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD(12-90) "► DAVIE COUNTY HEALTH DEPARTMENT p�• # 3 • Environmental Health Section • --Soil/Site Evaluation �} p NAME DATE EVALUATED + xi` 1� ADDRESS S A'n`r Q PROPERTY SIZE {5 t /Y l PROPOSED FACIILTY ,� 9• LOCATION OF SITE Water Supply: On-Site Well Community Public Evaluation By _ Auger Boring Pit ✓ Cut FACTORS 1 2 3 4 Landscape position Slope R - HORIZON I DEPTH Texture groupCL Consistence Structure MineralogX HORIZON II DEPTH Texture group Consistence Structure Mineralogyti HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS SS RESTRICTIVE HORIZON — SAPROLITE CLASSIFICATION . 5 LONG-TERM ACCEPTANCE RATE'-- SITE CLASSIFICATION: `V 'S l EVALUATED BY: p LONG-TER CCEP NCE RATE: OTHER(S) PRESENT: N REMARKS: `•� �� tiq 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-Vc.-y 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 3C-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(01-901 ■....■■.■■■.■■■.■SS■SEH■■■■.■■■■.EH■■■■■..■■■■■ ■■■■■■..■■■■■■!■ iiiiiiiiiiiiiiiiii�iiiiiii�iiii■■iiii� MEIN MMIMMMMMMMMMMM ■■■■■■■■.■■■■..■■.■.■■..■■■�■.SSS■■■■■■�■■■■■■■ ■■■■ ■■■■E■■■■■■■■ ■..■..■■■.■■...■..■■.■■■■■■.■.■■■■■■■...■■■.■��' NC■■■■■MM ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�■■■ ■ ■ ■■■ ■■■■■■ ■■ ■■■.■■■.■■.■■..■■■■.■.■■..■.■■..■■■...■■ ■■■ ■ MV ME ■■■■■■.■....■■■■■■■■■■■■■■.■■■NE.■■■■■.■■■■■■■■■■■■■■■■■■■■■■■■ iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiieii=i''■i■iiii=ii'■ui■iiiii=i=iiiii=■� iiiiiiiiiiii■�iiiiiiiiiiiiiiiiiiii °■■ ISO MEMNON .�■NoON MEN °°"■u"'°°"'°° "' ■■■.■■.■H.■..M.■■■■■■■..■■■■■■■....■■■■■■■SHE ■ ...■ ■■.... iiiiii°iiiiiiiiiiiiiiiii'iiiiii'o■■°iiiiiii i�MEMNOiN EM NONNI ENNNEE ilii:iiiiiii■iiiiiiiiiiiiiiiiiii�NONSENSE ■� iMENEMiMIMONOSSON MMMMMMMI ■■■�N■■■■■■■H■N■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■N■NNEMESES ONE ...■..■.■..■.■■■..■.■■■■■■..■■■■■ ■■■■.■■■ ■ ■■ ■ MMMMMMMI ■■■■..■■■...■■■■■■..■■■...■■■■■N ■ ■■■■ ■ ■ ONE MEM■■■ ■..■■..■■■..■■■■■ ■.■■ HN■■■■■ ■ ■ M■ ■SMS!. ■■■.....■E.SHE.EEEESEEEEE■■■MSE.■■N ■■ ■■E■SO■■ ■..■■..■■.■EMNE■■ESS■■■■■■■■■■■�■o■■ ■ ■■ ■E■EM�■■ S.SEEEES■EEHNMEEE.EM■EEE■S�N� ■ N■ ■■ ME■■■ ■■ i:i �ii ii =iieioIN Yii �iiii=iii ■■ S "ii ii■°iii'i ■■■S■■E■EIM■S H■NEE■■ ■■■■EMM■■ MMMM■■M■HM ■■■ ■■N■ ■■ ■■■ ■■MMES ■■■■■M■■■■■■■■■E■N■■■■u='■■■■=■■N■ N ■■ N■■■■■ iiiiiisaiai's'■�Biii °iiiii�iiie�i i� MONSOON°"°' MMONS NEMESES I No OEM ■■M■SES Imul EMEMEMEND SOME 0 = N .■E ' O�: ■MMMMM■ --......■■ .. . . .H ■ ■■.■■■■■■■Is MENOMENE, ■E■■■■■■■■UNIONM■■ E■■■■ ■M■■.■.■■■.■■■■■■■..■'�■E1'�■■■/E■■■■■■H M■� EE ■■■■■■..■■E.■■■■■■■■■■.■■����■■■■ ■. ■..■■■■■■. on E ONO ■■■■EEM■.■■■SME■S.N .S ■ ■ME H EMM■■■ ■■■■■■ MCMEH■■■ M■MME■ ■MME■■■MMI MEIN ■� MN■■■ ■E■EM ■ENOH■E■ EEEME■ESEEM■HE■ . ■ ■� MNMMUHMMMMMM■ ■■SS■■ ■■ M■NEE M ■■MESME.MES■■■ ■■ ■■■ .■■ ■■■E■S■E■■■E■EE■ mom M EME■■E■HSE■.EEH■EEE■■ME■EE.■EE�HEE■■E■ SES.S.S.EE.E■■E■EE■■.S■ mommommummlmmmmmmmmmmMMMMEMMOMMMMMMUMMMMMMMEMMMMMMMMMMMMEMMO ..■■.e■.■ee■■e■■■■.■.e■.■■■■e■■■■ee■E■■■■■MM■■■■■■■■e■■■■■e■■e■■e■ ■EEE■■■■■■■■■■■..■■■■■E■■■■■■■■■■■■■■■H■■S■■MMMM■MHE■MEMMEM■MM■■ ■EEE■M■■■■eM■■■E■■M.■■■■■■■I■■■■■M■E■■■■�t■iE■■■EM■■■i■i■■■■■■■■■■ ■ ■ °i =iiii� iiiiiiiiiiMMMMMiii° MMMMMMMMmMMMMMMMw1iiiiaiia ■ ueMMMMMMR EN 'tMMMMMM°iiiiiiiiiiitmoi° iiii'iiiiiii�iiiMEMOBEEi ■ eMi 4 , cICG%a:�i c v Q gi�00p• Jl - � �• LANA ''���, gadecN �,• i 601 O r vicinity map r) fl Q S� ALL LOTS SUBJECT TO DAVIE COUNTY HEALTH DEPARTMENT REQUIREMENTS. ROADS ARE TO BE PUBLIC ROADS. AS PER DAVIE COUNTY STANDARDS, WITH ' A 60• RIGHT—OF-WAY AND MUST MEET (-e .t f' NCDOT STANDARDS. ":f ALL PROPOSED UTILITIES B EASEMENTS SHALL BE DETERMINED AT A LATER DATE BY UTILITY COMPANIES. FIRE HYDRANTS TO BE LOCATED PER DAVIE t: COUNTY STANDARDS. \ •+� nJ �J t: ,, 1400! FT. OF ROAD CONSTRUCTION. THIS PROPERTY AND ALL ADJOINING A� J j PkOPERTY IS CURRENTLY ZONED: RA 8 R-20 CRAIG BOGER ALL LOTS TO HAVE INDIVIDUAL SEPTIC TANKS, D.B.D,9 115 PG.727 pj/4 \ i ' �' I (zoned RA 8 R-20) WATER LINE ALONGVGUN CUB ROADG Lf \ WATER TO BE t/ 30.000 SOFT. MINIMUM LOT SIZE. MINIMUM SETBACK LINES: 1: AiF EUGENE BENNETT J. D.8.181 PG.I D.B.178 PG.65 4, I ! ! I PDyA3F TWO NORTHBROA&r wil Ov4YERS DEVELOPERS — \ \ \ O I O I ® + O ! ® I ( O I — — — — — EUGENE BENNETT I HAREVY L. ADAMS I I I ! I / DELBERT BENNETT \ 0.8.102 PG,795 \ I I f� D.B.93 PG. .JAMES NANCE \ � f � r'^ (zoned RA 8 R-2-2 0) I I f I I � I I + ! ` I I ROUTE 3 BOX 540 60' R/W f + I �f �� MOCKSVILLE, AIC 27028 (9/O) 996-4727 20' PAVED eo Et/ Cr4LAHALN TOWNSH/P / DAVIE COUNTY _WANIESH ROAD — --- — — — — — --- NORTH CAROLINA S-FL 1307 TUTTEROW SURVEYING COMPANY, 127 LIBERTY CHURCH ROAD_ MOCKSVILLE,NC 27028 (704) 492-56/6