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119 Phillips Ln�� � 4 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mceksville, NC 27028 (336)7S]-87(0 IMPROVEMENT/OPERATION PERMIT Account #: 990002011 Billed To: Joseph Phillips Reference Name: Proposed Facility: Residence , , �. �/-/--�/ � Tax PIN/EH #: 5759-31-4750.JP Subdivision Info: Location/Address: Copperhead Road-27028 Property Size: 2 acres ATC Number: 2989 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AiTTHOWZATION 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 SIT'E 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: ❑ BasementJNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: � Lot Size Type Water Supply '� Design Wastewater Flow (GPD) —`;�,�-6� Site: New�Repair ❑ System Specifications: Tank Size � GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width � Rock Depth �� Linear Ft�� INIPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF C" BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 8:30 a.m. to 930 a.m. or 0 p.m, to 1:30 p.m. on the day of installation. Telephone # is (336)751-87G0.**** , D�-�;�� , R� �� r°� � P ���� -�(' ���� �� a' � �� � Environmental Health Specialist's Signature: Date: /� �yl%l DCHD OS/99 (Revised) ti � Account #: 990002011 Biiled To: Joseph Phillips Reference Name: Facilitv: Resitlence ATC Number: 2989 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5759-31-4750.JP Subdivision Info: Location/Address: Copperhead Road-27028 5ize: � acres AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION �� **NOTE** This Authorization for Wastewater System Construction MLJST BE ISSLJED 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 �ONSTRUCTION IS VALID FOR�'IS�RIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: CERTIFICATE OF COMPLETION Date: /� 2Y`'� � I**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit I 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. Septic System Installed By: Environmental Health Specialist's Signature : DCHD OS/99 (Revised) Date: � � `�� 7 0 OCT I 2 ���� ?P,UCATfUN FUR SlTL- EI�ALUATION/IM1tF'ROi(CAtENT �'EIth91T �c ATC �. `; � Davie County Health Department Environmenta/Hea/th Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNI.�SS AI,L Tfi� R�QUIFi�D INFORMI�TION IS PROVIDED. ReEer to the INFORMATION BULLETIN for instructions. 1. Name to' be IIilled _W }(�s ��� � L(� � UJ Contact Pcrson � U5 A� �/-t-� �=Li- L } Mailinq Address I � � � ► ►' 1 � L�. � /v� �� fIome Phone/ 'S ��} 7 5, ` OC `7 � L_ City/State/ZIP m (7 C,KS l� ) C. �, (� „� a7 � � � IIusiness Phon� � � � � � yo - a � a o 2. Name on Permit/ATC if Different than ►�-,; ling Address City/State/zip 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC ��Both 4. System to sezvice: J�J House �� Mobile! Home ❑ Business ❑ I dustry l I Other / � 5. If Residence: # People � # Bedrooms `j ;� Bathrooms —�— ': ishxasher LI Garbage Disposal e.l-I�FTashing Machine ll IIasement/Plumbing II Basemenl-/No Plumbing 6. If Business/Industsy/Other: Specify typo # Peoplo 1! Sink� N Commodes $ Showers # Urinals I! Water Coolers IF FOODSERVICE: # Seats Esti.mated Water Usage (qallons per day) 7. Tj�pa of water supply: ❑ County/City Q�11 I I Community s. Do you anticipatc additions or cxpansions of tl�c facility tliis systcm is intcndcd to scrvc? lfycs, what typc? Il 1'cs I o ***lA1PORTi1NT*** CLIENTS MUSTCOAIPLCTCT'HC RCQUIRED PKOI'L;It'CY INI�ORMA'17t)N RLQUES'1'EU [31;LOW. Eithcr a PLAT or SITE PLAN MUST 13ESUBAIITI'ED by t6c clicnt with TI11S APl'1,ICA'I'IOIV. Property llimcnsions: ��J WR('1'i: U(RI;CI'IONS (fro�u h7ocicsviilc) tn 1'KUI'I�,IZ'I'1': TaxOffccPlN: -.. #��5�' 3�' I�Sd ��P�f�����h G�v( TU /-�'���hSL/I, Property Address: Road Namc C a�p �� �-e a�( �'� • c;ryiz�� �7�2-� ll'in a Subdivision providc information, as follotivs: Namc: Section: I3locic: Lot: �G+n-, �•��i � vh r� L e/��'Io-`,Pti� Yo��,( . Datc I'roperty Flaggcd: / v /� /�/ This is to ccrtify that thc information providcd is corrcct to thc bcst of my Icno�vlcdgc. 1 undcrstand t]iat any permit(s) issucd hcreaftcr are subject to suspension or rcvocation, if ll�c sitc plans or inlcndcd usc change, ur if ilic in(i�rmatio❑ submitted in this applicatiun is falsificd or cl�angecL I, nlsv, rur�Jerstand t/rr�t I a»i respo�tsiGle fi�r rr!/ c/rurges incrnrer/ jrurn t/iis applicatio�r. [, I�crcby, givc conscnt to tlic Authorizcd Rcprescntativc of thc Davic County Flcalili Dcp:u•tmcnt lo cnicr upon abovc dcscribed property locatcd in Davic•County and owncd by • •----__ __-----.._ . . lo conduct all tcsting proccdures as ncccssary to dctcrmi�ic tl�c sitc suitability. UATE SICNA'1'UIZ� / " • ^ THIS AREA MAY BE US�D FOR DRAWING YOUR SIT� PLAN (Includc all of tl�c following: �xisting und proposed property lincs and dimensions, structures, setbacks, and septic locations). `. Rcviscd DCHD (07/99) Silc Rc��isit Cl�ar�;c � Datc(s): Clicnt NotiGcation Datc: �HS: Account No. � � Invoicc No. ''�' � � � 0 � a ��. ��� �\��� Sq;M R� FASE'a'-'�� r oa � i^��� � SQF. �:. _�C�, .. VI CINI T Y MAP �� CHARLES W. WOODRUFF D.B. 113 PG. 159 , D.B. 142 PG. 646 � O � � ` ` _ _ � t T I E) 1�� — � � � ' ` � � ` ,�f; . .M ,�, �°:T�,� NEN 439. 00 �Ew � �� �� C T I E) 198. 30 `�"�"'`_"' , � � ._ ___ � � S 89'31'00' E F��;',, '' `� S 89�31'00' E '�o ', . -- S 89'31'00' E '�0N S 89'31'00' E koti � � 461. 50 J �`--�.�_ __�_ .—__—._— — — — — — — — — — — — --�3! �.1_1 �8--y ,� 215.56 w JUSTIN PHILLIPS �'��"4 � ~ � N AREA= N D.B. 321, PG. 203 �,� 2 � °�? � AREA= 2.095 AC. � '� 1.000 AC. � � L'�� �Z �v �p� CO --— ----------_ --- N � ----- ---- N U� - �l � a�-� .1� D�"� ••. �` o ch o M ����0� II l�(1 � �RON N o N O • a � a o � N `�65•38 tieW R� N 215.56 N y o z ,5•S9�51• R�N S 821.6044� � N 89•31'00' W �`-�w, C 7 I E> . � ._: 4� �- I✓ 08 N 87'16'l0' E ���. �,�; , " � r� -- 1399.23 '�� ��.��", ' , '�:,.��-�.i�� �� — — — _ � � �. � � �-�.1�-- � �--- " — —L]� — t14-- �� /� / � "L1� —�_ � `�o, ' `{'�---�1 ---�'0�� CHARLES W. PHILLIPS � �, � � �� � - ;-`� & SON Inc. �� � r�a- `�o_ ��- ' -,�Z�'� -- — D.B. 49 PG. 637 �--- - (� ✓ N� � / ; `:;� ��N111l�� I, GRADY L. TUTTEROV, CERTIFY THAT UNDER 6 , � � , - , ��� _ _ � P.B. 2 PG. 37 �� �. , � � ���� /` MY DIRECTION AND SUPERV[SION, THIS MAP \��S,�� � ��J ---- ----` r�"r . ++,�+�Q�G .....,.�.��f��i MADEDB uNUT� OVNSURTUAINGIEOMPANRVEY y-L24 �_.� , ����� •�� 'i ;1^', -� � �_iNE BEARING DISTANCE ( � 9 � i L.1 S 89'1 4'1 3" w 34.21 I � ' � �_2 S 83'S7'10" W 92.St i � ���- � � � , �_? s a,•s� 2s�� w 89 28 - � L-2527 ' _ � - •- - `�- - �� 5 73'�9 58" W 58 �4 �Q;� Q'�� PR�FES IONA� L N S RVEYOR L-2527 L5 S 5`'34'S2" W 7F 89 � •.9 �,►O;• : � i 7 � �"F3't 5" W 88.7y I ���990•�.�$URV�;.'Q�: ��'i9 3a" w 625 ' �s s 6o•os'os� w '4745 ��''�},����T11��.G'�� TUTTEROIY SURVEYING COMPANY ; ��o S 75'33'10'� W '3.02 124 SOUTH SALISBURY ,,T, �.�' S 8�'2a'St" W 6255 MOCKSV I LLE, N, G 27028 � ��' N ?8'17'15'� W 75,68 � ; ��.� N 81'05�24" W ,3a �i �'��:''�Kr_ ' ���'�"� ( 336i 751-5616 � L'4 N 87'49'10" W 102.36 ! Li`� N 88'47'S3'� W 1 36 85 � ��E N 86'36'08'� W 163 88 I �7; r� 76'35'29" w ?8.t 6 i f "�3 S 89'!3'19" w 55.15 ' i _ � � 58'33'09" W 53.95 s as•oa•��•• w a�.9i PLAT OF SURVEY FOR� ( i-��� S 6�'4?'S3" � �090 ' `-=� ' ,°�,;�3'�� w "� 38 � JOSEPH PHILLIPS i ��'� > '1�57'1^_" w �a8 23 � � �4 � 79'07'23" W 7U.t 5 I . ; t_2� '� ?0'15 �p.. �N 1 10.86 ---�— v 53'7 3'a7" w ;a6-d REV I S I�NS SCALE� 1" = 150' APPROVED BY� DRA►fN BY� JOSHUA ; � G �.TUTTEROW ��� DATE� SEPT-19-2001 FILE NANE� PHIL—JOE BEING 3.095 AC. TAKEN FROM THE CHARLES W. PHILLIPS & SON Inc. PROPERTY. (D.B. 49, PG. 637)(P B. 2, PG. 37) LYING IN THE MOCKSVILLE TOWNSHIP iSO 7S O iS0 3OO 4SO DAVIE COUNTY, NORTH CARO�INA SCwLE I�IV FEET • � DRAWING NUMBER� 26401 -3 • � . DAVIE COUNTY HEALTH DEPARTMENT � � • ' � Environmental Health Section i� ' � -� � Soil/Site Evaluation APPLICANT INFORMATION Account #: 990002011 Bilied To: Joseph Phillips Reference Name: Proposed Facility: Residence PROPERTY INFORMATION Tax PIN/EH #: 5759-31-4750 Subdivision info: Location/Address: Copperhead Road-27028 Property Size: 2 acres Date Evaluated: Water Supply: On-Site Well Community Evaluation By: Auger Boring Pit Public Cut 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 """ " '� ' , "" " , , '�` " VFI - Very firm EFI - Extremely firm � VS - Very Sticky ic VP - Very plastic GR - Granular ABK - Angular blocky >matic surface �r inches from land surface to soil colors with chroma 2 or less , U(unsuitable)