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112 Parkway Court Lot 29 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section rG P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 989900571 Tax PIN/EH#: 5820-31.5889 Billed To: Shuler Building Subdivision Info: Northbrook Lot#29 Reference Name: Gene Shuler Location/Address: Parkway Court-27028 Proposed Facility: Residence Property Size: 100 x 292 ATC Number: 2111 **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). 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 jA0QSC5' #People #Bedrooms #Baths �— Dishwasher: u Garbage Disposal: Washing Machine:121""- Basement w/Plumbing: 2'--'Basement/No Plumbing: El Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: Lot Size E7,7�.Ql C��6�,T Type Water Supp1� Design Wastewater Flow(GPD) tr Site: New 02"." " Repair System Specifications: Tank Size 1000 GAL. Pump Tank GAL. Trench Width �3U'Rock Depth 2� Linear Ft.30p Other: D4sreAs 7rroi a-iw-- iaJ P��•PFo� - FIl�T+y S Required Site Modifications/Conditions: 14gf4 LL o.J C O-J700 Cs r `M� m4 OFF- �p,�s IDS oFG PeDP 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 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.**** � r H N O l 't�tiv� 33 ,r Environmental Health Specialist's Signature: ate: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Bog 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900571 Tax PIN/EH#: 5820-31-6889 Billed To: Shuler Building Subdivision Info: Northbrook Lot#29 Reference Name: Gene Shuler Location/Address: Parkway Court-27028 Proposed Facility: Residence Property Size: 100 x 292 ATC Number: 2111 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,Sectio .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEX C UCTION I ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatu e: Date: r 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 giveneriod of time. too 9 +tv a` Septic System Installed By: P Y �n Environmental Health Specialist's Signatur Date: CD )3 DCHD 05/99(Revised) APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&AlD Davie County Health Department Environmenta/Health Section A 19 1999 P.O. Box 848/210 Hospital Street Mockoville, NC 27028 ENVIRONMENTAL HEALTH (336)751-8760 DAVE COUNTY ***PORTANT*** THIS APPLICATION CAM= BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. / Refer to the INFORMATION BULLETIN for instructions. i. mama to be Billed L�/i all-^ 6l;; Contact Person Mailing Address ��dd Home Shona City/State/ZiPe A Z! a 7DZ SO Business phone 9fi/ 7,002. 2. Name on permit/ATC if Different than Above Hailing Address City/Stats/Sip 3. Application For: ❑ Site Evaluation Improvement Permit/ATC ❑ Both 4. system to Service: 0 House ❑ Mobile Home ❑ Business ❑ Industry 0 Other 3. If Residence: # People # Bedrooms _ # Bathrooms 2 Wiishwasher ff"Mwbage Disposal U41"hing Machine kBasement/Pluxmbin� ❑.Baseasnt/mo 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 Mater supply: Q--eo'unty/City 0 well 0 Community , e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes fA-No- If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: #'er'oZ,6 ho 9 f� /4i/y cn Property Address: Road Name ��i•f�4yc, �'T r� rn��-- �i �-i9 /�;� os-:- City/Zip 2;V2 If in a Subdivision provide information,as follows: ar el �D➢� 74 ifs� Name: /110 �� brov 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. 1,also,understand that 1 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 E'.,r4r�-n Sx yk.-- to conduct all testing procedures as necessary to determine the site suitability. DATE 7_ /9-yPi' SIGNATURETHIS 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: ERS: Account No. r7 Revised DCHD(07/99) Invoice No. 0 vo \\ \\ LOT #18 ► / J CENTER OF BRANCH LOT fig\ f f / LINE BEARING DISTANCE I(WE) HEREBY CERTIFY THAT 1(WE) L14 S 4716'09" W 30.82 PROPERTY TIHE HOW ON O PLAT. F THE L15 S 47'16 06 W 43.01 \ \ \ / f L16 S 53'41'54' W 169.39 \ \ LOT 17 \ I / L17 S 58'14'39' W 78.20 LOT #20 f L18 S 58'14'39' W 100.00 L19 S 58'14'39' W 110.31 \\ \ \ L L20 S 32'04'06' W 63.11 \ \ \ J L21 S 60'29'02' W 71.52 \ \ LOT #16 \ f L22 S 53'35'59' W 110.00 \ \ \ J L23 S 5335'59' W 37.84 LOT 14 \ LOT 15 \ _—-T—;% —— I L24 S 373L25 S 74!11 501* W 29.45 \ \\ \\ / // _— / /�� I L26 N 61'14'57' W 55.04 \ \ \ /' 1 L27 N 41'16'06' W 24.83 L28 N 8725'18' W 151.22 ' L29 S 35'16'55' W 46.84 •F�f; L30 N 70'46'09' W 49.19 LOT X21 LOT #23 S 33'2452: W 32.67 LOT 22 / / L32 N 7700 18 W 47.65 / / / LOT #24 f L33 S 70'2329' W 41.12 y LOT #13 \ / ' L34 N 22'14'05' W 19.03 � / f' / f L35 S 73'50'59' W- 41.10 ` Y / +\o�s� I L36 r�_86'08'374 110.89 / 0 / J4 f I / O' PHASE THREE .� _ .�. LOT X30 �/ T +COUI?Ti � LOT X25 f _ 1 NORTHBR00i / \ / LOT #2970 /� �. Y.. :f. lo�•t J OWNERS ------------------ DEVELOF / a/ \ / LOT X28 LOT #27 EUGENE BENNETT, FRED ELL, LOT X26 \\ f DELBERT BENNETT, J"ES NAA / LOT $31 3 % � , 30107 HAIL f`rORt' R�Q•r MOCKSVILI.E. N.C.NE27028 (910) 99J3-4727 �-._--mod.----�-�--��---L-----L-------\�f 6 '7 CALAHALN .TOWNSHIP NOTES: DAVIE COUNTY. NORTH CAROLINA f O — iron stake found I 9 - iron stake set spRIL 11, 1997 f + — unmarked point in center of branch No N.C.G.S. monument within 2000' SURVEYED BY: THIS SURVEY CREATES A SUBDIVISION MINIMUM SETBACK LINES: Front - 40'. TUTTEROW SURVEYING COMPANY OF LAND WITHIN THE AREA OF A Rear — 30 127 LIBERTY CHURCH ROAD COUNTY OR MUNICIPALITY THAT REGULATES Side - 15 MOCKSVILLE. NC 27b28 PARCELS OF LAND. Total Area •= 63.244 acres (704) 492-5616 Total lots -• 10. Avg. lot size - 6.24 Ao. _ This parcel and all adjoining parcels 150 75 0 150.. 390 —— GRADY L TUTTEROW R.L.S. are zoned R-20 and RA Water to N. suooited by Davie County Water Deot. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERM Q U Davie County Health Department Environmental Health Section SEP ( 8 19% P. O. Box 665 ` Mocksville, NC 27028 ENVIRONMENTAL DAVIE OU 1. Application/Permit Requested By 4ullzt ✓y�A Mailing Address � Home Phone !29,F#rf 7 Business Phone' ' I 2. Name on Permit if Different than Above 3. Application/Permit for: f/General Evaluation ❑ Septic Tank Installation 4. System to Serve: [P/House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ In Other R ❑ Unknown 49 5. If house, mobile home: Subdivision �"0r vRaa�Sebin - Lot #,r ❑ Basement/Plumbing No.of People ❑ BasemenVNo Plumbing l 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 No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No.of Showers Water Usage Figures 7. Type of water supply: ErPublic 7 El Private ❑ Community f 8. Property Dimensions ( a4(e ax m-Q/ 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: This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. DAT SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: 1. 1 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) y DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation C� NAME � s'LT� `�J DATE EVALUATED ADDRESS S�` � PROPERTY SIZE O 'K PROPOSED FACIILTY d9 LOCATION OF SITE b � Water Supply: On-Site Well ContrVity Public Evaluation By��'� Auger Boring Pit t/ Cut FACTORS 1 2 3 4 Landscape position Sloe Z 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 S LONG-TERM ACCEPTANCE RATE �p SITE CLASSIFICATION: y S EVALUATED BY: LONG-TERM ACCEPT NCE RATE: 1� OTHER(S) PRESENT: m -0'0 REMARKS: ��!� �,�s-S �x a 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 :lay 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 ■■.■.....■■.■.....■■......■..MOOS.■■...■.■s■.■■....■■■...■ ■.■a■■. ■■..■....■..■..■.....■.■....■..■ ■...■.....■.■..■■ ■■■■■.■■■■■■■■ ■■.■■.■■■.■■!OO■■.■■....■■...■■..■...■.■ ■■S ■ ■■■.■........■■.■■s.■■■.N..N...■e■■.■■■M■..■N■■■■ ■.■.■!C■■■■■■.■■ ■..■■...■■■.■■........■..■.....■ .■O■■..■■■■......■..■■ ■■■■■■■.■ C■C ■■.■■■■■■■■..■.■.■..■.H....��.■..,.■.►�......■.■■..�..■ ...E■■....CC ..........................................�...... 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S 31.87 41'466 N S 86.08'37' E2 '"0 I N 33.16'33' E 110.89 S B N.jZ_-33'01' E 46.84 X9.45. .3 87,23-10# N 33.35'39• E 37.64 131.22 d' '!' y� �o• 1 00 9, E u r I t32 �� ` °s.��44r �{ out,.ros9 l�R'7 1 r aj,t�q!6L c'C' 6 • D \S (I j, .104C.)' R \ m # x f ^ V_ Jim\ \ s''. LOT #17 81 g (O 942 AC.) C10— \(0.942 LOT #20 001 (2.913 AC.) �s 's•�\ LOT #16\ \\' \ �4> \ 0.162 AC.) \. \ LOT #15\\ \\ 9/�� '°'� , losN 85.30'27' E 436.94 1 \\ (t.o9s AC.) tiCi / � 12s,o0 171.94 N\ rri A \\\ IN �J. O p r, ti X04 �F•�ro #\`\ iJ �� l�0 / LOT #21 %2 / (0.694 AC.) = LOT #23 r 0OT #22 (0.860 AC.) LOT 3 t #24 2 g� N ; ,� (1.225 AC.) 0. /ti�k.'bk(QQ��� k�0i / ('9hf>O• �� N ,0 Z 6 -�9 09 ' 94 VoJse \ s he PJ \CIS— CD G Cr9 2 ��, .3 ``�` Y ; �' Pte►►-VT1 / LOT #30. s COURT N s � / (0.698 AC.) o�� 0e,, zz i LOT25 i �� `LOT 29 . . —C23_ _ (1.104 AC.) / \ � # �10' UT7LRY C21— (0.700 AC.)`� f EASEMENT 4 �+ �^ LOT #28 (0.7 9 Ac.) o LOT `�2q� (0.70527 !.! !w LOT #26 ,� ( ) OT 96 A3� � ' ? S� ti l a a 0.855 AC. s9 CU lop 100.oo sroo 100.00 93.00 100.00 CONTROLS N 88.33'12' y 100.00 70.00 0.0 100.00 CORNER ' 928.93 128.93 I I LOT 3 1 ' J JI . ' I I