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633 Ratledge Rd , . � . � DAVIE COUNTY HEALTH DEPARTMENT Environmentai Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900184 Tax PIN/EH#: 5726-35-0889 Billed To: Jeff Frisby Subdivision Info�,33 ��9�'` _ � Reference Name: Jeff Frisby Location/Address: Ratledge Road-27028 Proposed Facility: Residence Property Size: 139 Acres ATC Number. 2435 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLJST 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 WASTEWA CONSTRUCTION IS VALI FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: Y� Date: �� S 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 I 1 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken as a gvarantee that the system will function satisfactorily for any given period of time. /" � / I�� 0 io �v /� iD�b /a ! Septic System Installed By: </J/,�y�� /09 Environmental Health SpecialisYs Signature:�rGL/� Date: /�� —� DCHD OS/99(Revised) t , DAVIE COUNTY HEALTH DEPARTMENT (�� S�2�S'-vr� _ �� " • ' Environmental Health Section 1 . P.O.Boa 848/210 Hospital Street �� Mocksville,NC 27028 , (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900184 Tax PIN/EH#: 5726-35-0889 Billed To: Jeff Frisby Subdivision Info: Reference Name: Jeff Frisby Location/Address: Ratledge Road-27028 Proposed Facility: Residence Property Size: 139 Acres ** �T�*N�be�r. 2435 N T �s mprovemendOperation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AiJTHORIZATION 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 1 l of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THLS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE TIiIS PERMIT BEFORE INSTALLING SYSTEM. 1 Residential Specification: Building Type � #People #Bedrooms�� #Baths�_ Dishwasher: � Garbage Disposal:� Washing Machine: � Basement w/Plumbing:� BasementlNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply�� Design Wastewater Flow(GPD)�� Site: New�Repair❑ System Specifications: Tank Size��GAL. Pump Tank GAL. Trench Widtt� Rock Depth��Linear Ft,�r2� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis 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.**** )��' `.;,ru �7�t _ - � �j�� " , � , ��y , Environmental Health SpecialisYs Signature: � Date: ,.�fr,CcJ '�� DCHD OS/99(Revised) , . ` � � � D �' � c� aa � APPLtGAT10N fOR SSTE EVALUATION/IMPROVEMEM PERMIT T Davie County Health Department MAY I Envinonmenta/Hea/dr Section 6 Z��Q P.O. Bcx 848/210 Hospital Street Mocksville, NC 27028 EPIYIRONP,IENTAt HEALTH t336)751-876Q DAViE COUNTY ***IMPORTANT**• THI3 APPLICATIQN GINNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer fo the INFORMATION SULLETIN for instructions. 1. l7amo to bo Hilled `,�7 r ,1,�Sa1 Contact Parson ��{ �� HailinQ ]►ddrass �0�0 IZ.�U$��Jv9 �I�. Home Fhona 3�' /'i'� ' �! !/ CityJStato/22P �1t1t/rf�,i _ �L �,'�Qb(p Buainess Phona _�G-?tp�' ��3Y 2, tiaaw on Fo=mit/)►TC i! Dilfosont thes� Above Mailinq I►ddress City/Statel�ip 3. Application For: 0 Site Evaluation F� Improvementi Permit/ATC 0 Hoth 4. sy�st� to sos.�ica: �p" House Q Mobile Home Cl Business ❑ Induatry O Other s. If Residence: It People t Sedrooms �_ �1 Hathrooms �Z l�ishxaaher (�arbage Diaposal 1{/�Itaehinq Machina I�eament/Plumbinq II Saaement/No Plumbinq 6. Zt 8usiness/Iadustry/Othor: Spacily type /T � Peopla � Sinke i Commndee � Sho.rers � Urinals � Watar Coolera IF FOODSERVICE: # Sests E8timclted WBter Usage tqallons por day) 7. Type of water supply: 0 Couaty/City Well ❑ Community e. Do you anticipate additioas or ezpansions of the facillty this system is inteaded to serve? es t]No If yes,what type? �0 D(� ***I�IPORTANT*#*CLIENTS MUSTCOMPLETETIIE REQUIRED PRQPERTY INFORMATION REQUESTED BELOW. Eit6er a PLAT or S1TE Pl.rlN MUST EESUE,'.fI:TE�3�y ti�t ciieot with TiiiS APPLICATION. Property Dimensions: � 3 1 �T��✓ WRiTE DIRECTIONS(frnm Mocluville)to PROPERTY: TasOfficePIN: # �7��" 35 " 0 �$g�, R�ru:aG� /�BR.D - (�,Q/✓�"k?A� _ Property Address: Road Name_�e33 �ATI.�DC�E R0�}.p l� 6tJ K:Fr �j�02L ��ty�Z;p Ih�sv�u�. ,�c a�ea� �uN�-�,� �e�� If io a Su6division provide iaformation,as fallows: Name: Section: Block: Lot: Date Property Fiagged: J �G Z g�� This is to cettify that the information provided is correct to the best of my knowledge. I understand that any permit(sj Issued 6ereaftec are subject to suspension or revocatioa,�f the site plaas or intended use cbange,or if the iaformation submltted in this application Is falsified or cLanged I,also�understand that I am responsible for alt charges incar�ed f�om tbts apptIcatlorr. I,Lereby,give consent to the Authorized Representative oi t6e Davie County Healt6 Dep�rt ,eat to enter upon above described property located in Davie County and owned by ��F- �Eb,�1� �i�15 Q��" -, to coaduct ait testing procedures as necessary to determine t6e site suitability. DATE �I 17 I Z 9� SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR STI'E PI.AN(Include all of the followiag: Ezisting and proposed pcoperty lines aud dimensioas, sttuctures, setbacks, and septic locatious). Site Revisit Charge Date(s): Client Notification Date: EHS• � Account No. __,�� Revised DCHD(07199) Invoice No. /(p ,��-a-� , �► � � � . �,p�� Q�j�'�� • , APPLICATION FOR SITE EVA U��'I 3��(IMPROVEMENT PERMIT& M R r D ie �i�1ty�lth Department � � � � � V L5 �� Env�ime�t�$�1 ealth Section r , _��i �e �' �.��4 8 S E P � 7 �� (1 ��' o�sd 1�,NC 27028 E� nC �� . � � � V �` '� 6)751-8760 Et�ViRONh1ENTAl HF�y ` ,j OAVIE COUMY D` ****IM P OR ANT** T S�APPL CATION CANNOT BE PROCESSED U � , � AL�THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed ��Fr- f�t s'aY Contact Person Mailing Address 7a 6 ��✓�8� ��✓E Home Phone 33�- p��-s9 yi � City/State/Zip fj'DV.►rrcB � N L 270 o b _ Business Phone ? �=��==-�-o��-�'� I' 2. Name on Permit/ATC if Different than Above ��6-76�'��9 9� Mailing Address City/State/Zip 3. Application For: � Site Evaluation ❑ Improvement Permit&ATC ❑ Both 4. System to Serve: �House ❑ Mobile Home 0 Business ❑ Industry ❑ Other 5. If Residence: # People � # Bedrooms 3 # Bathrooms � �Dishwasher �azbage Disposal L�}�Vashing Machine L�Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Other: Specify type ��f� # People # Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage(gallons per day) 7. Type of water supply: ❑ County/City E�Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes �No If yes,what type? � _ EZTHER A PLftT OR SZTE PLfIN PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A�THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: 1.3�1 Ac,2ES � WRITE DIRECTIONS(from Mo ksville)TO PROPERTY: Tax Office PIN: # .��7�1 n - �� - ' �� 1 Property Address: Road Name (�33 ,EnTG&7D�� 2o�-1J 1 ��T��`� �2 0,� City/Zip M ocxt�«t.�'i nf G � 1 1 If in Subdivision provide information,as follows: 1 Name: �� r 1 Section• Lot #: � 1 1 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 �a v► and owned by �� r�i:,, to conduct all testing procedures as necessary to determine the site suitability. DATE ��/�' / S SIGNATURE t Revised DCHD(06-96) ��+� �g� 1�0U 1�{�ti�f USE Tt1E $�ICK O� THIS �OIZM T0:2 bRAWING 1�OUR SITE P1.,4N. a�jt�, ap�� , _, r ' i 2�.� zoas ZO �i �. . :y -- I 27 � — �.'• 2nq- jr. 20.41 1� � " � "� a 25.9Ai a �3g � �4.57Ac) 18 v A` , r,� m � 12 <,'' 2$ ;, S� 212Z8$ I'� v. :a r - a / ., 24.66AcP (p.Cwqcl: 2�2T.as �' + a� - 33q.o> `by36 23n `Z 4� 9 m �' -� '' ��/ "' i'So , ^ ' . e �, 6� 18.01 ' � (18.02) •, ..�. , ' 4` , , � 27. Cjl. o ° ,a2° �s 14.57Ac° 0�,�� 2iso.ss `�;ti rr, o°',' . _ .i4 �' � w r, . R ,'�. � y .� a /�l. .t . ` ' � h. �9�F�b ( 3A¢,:) �2 � i^ ,. �� , ' . 52om ' F4 . � . . , �. Z•M � � 1 � ' N ' . y1 � c, � . ��•a��n`�'.'., I . '� �6\'l � � � � � n . � � ::-l',�.nS� �r �` I � 1630.2 2$ .4; . r,t�a � V ;k.��^,5 � I . . t6 23�. 6 , �. � ' �.�iAi . �i,F J .. � Y. � ��' ..�' � 17 � . � . - � w• .. " ' f .� . , �" Yt�• .. 139 Ac . I ��" q.�i , '°�t.�� ' ?�A�� . , � i 1 � - �. �;i. ' , w a r �i y • � , Y� \ \ � . ' �' t�a.), t a . - 1]��;� � yJ i.�:� �^, * . 94 j � � '+G� ' •� �N"� ► a��.\}.� .,J, N . .rh"`. + . � /�� . � - .��' . ��, c� _ r �. � • . � ��• � . .� � e . 7.J �� 2 �Y ' r,f� :l ,� 1 . ,\ . . N w , > m w , `'y rti N •r�1 3�.32 AC � � . I a ' � m u: ' �y4� I A ' ,n vy�i 'c°°v M v�s „ X� 'H :�f�, `. ,,,�-4�'m � i . � - "_' , �, ( 7 4 A c ) �NTIN '�.. �-:�.;x � , t � � ', �' ( 65Ac.� ' � / ^� . l , . .. . . . ,-. �� i . � �_. � . , " � D� . , ;,�ic. 142 � F,�>. �� ' "� . � os z a ` ' _ ,�y r�'r;' ' 35. 5 A . . n� �4 �as. a �r..,.- �?: ro � \ a� . : .. `r.� � .. a �2I4 . �0 3 ? ; � . �. `�` � 214.5 2 � ;'^....y��8�� \ id �n�- . . 6�� 5 1 _ � � S � Q\ �J>� h 2-j 4 �e q i 9 /`� � . �`. i�. _ � g zBA; � 8 � zrr �F � � � r;„1�` 5 o2lu:. \ 3j� zrn z � 3 a ' _ . s s33 3 N Fy ��\ � 3? . �\ . � $ {. '� Y� . �' �\ o � � � �v ; *Y4`�! , � � = 12 � � �4 - , � �'#`/, "• .' �2 \\ N I�'�.. S •��.+�"r :_ . 10.97 Ac. m .1�.98Ac � I .76 ,',c. ,�� ,, • '1� + I2 2�AC . , =� ,_` '� ,,,' '1� � \ ' . ,;� ie. l . � ;Yt� ��3 � to \ � ♦ � ' �� ;`, es 20947 3 q � o- o ' ' •� ,r _ .a"',�+"�4..6.r!r v p p ` ��y' -i-,+ Sp \ I 2 _J � ' ��.� 3 \ � � �� 5 24 � ' 450 �r' 4��5 t�V . ► 301 � � 9 , 25565 �/� /� ,� .. . ,� . N ,pN� •'• _ " 1 • ` 1 9 Q C.� � t.�'�¢r�l+ (169. .�1�- 'N �. h , ♦ r �i,� ' . y,i � ��w. ��Di: .. 4 t` -# p / � ` � , �: � , � •� �� q/ . l2� • .A ,�� aR '�.• _ �� 16 � J l � . � \ m ,: •, �� , a, . ,.,,�.: � i.. 1 . �i� �. 18 ', . 15Ac �` \\�� , ` • �' , , _ - � I �. . .. 'SL '1 Lf b , ol, , \' y � �t t (33 75Ac.1 l , ` � �a' `.t ' c r � � r, ; h �- � \ ` � �' ��, �+�'' ' � ` � 'E"i' .:� � �y 3'�,�t� yti:.f+i . � . \ i - �_ ___ __ ir 1 i.. ` � fF �� ,$.� T r. �,�y. 1 -l ♦ • � . DAVIE COUNTY HEALTH DEPARTMENT � � � . • ' Environmental Health Section sECTiorr LOT SoiUSite Evaluation APPLICANT'SNAME /r:7�CJ [/I DATEEVALUATED Gl�O/�� PROPOSED FACILITY PROPERTY SIZE SUBDIVISION ROAD NAME /�OJ��d c- -� Water Supply: On-Site Well 1� Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osi6on L L . Slo e% HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH ,��'' �/•� Texture rou C Consistence �'r � Stnicture /� iL Mineralo HORIZON III DEP'TH Texture rou Consistence Structure Mineralo � HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION .S LONG-TERM ACCEPTANCE RATE , , SITE CLASSIFICATION: �� EVALUATION BY: ��G� 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 is 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 tructure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangulaz blocky PL-Platy PR-Prismatic ' Mineraloev 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-gaUday/ft2 DCHD(01-90) . � � • . _ . ��yi��coviv�rY:�L�t��rr ` ENVIRONMENTAL HEALTH SECTION , P. 0. Box 848/270 Hospital Street Courier #09-40-06 -,_ . . ,. Mocksville, NC 27028 .. .,,_ _ . _.._ ...-'; Wione #t:T(336j757-8760 �; . . October 6, 1998 ' . Jeff Frisby 706 Riverbend Drive Advance, NC 27006 Re: Site Evaluation/139 Acres Tax PIN: #5726-35-0889 Oak Grove Church Road Dear Client(s): As requested,a representative from this office visited the aforemen6oned site on September 30, 1998. Based upon the information provided on the Applicabon forSife Evaluation and after an evaluation was completed,the site was found to be provisionally suitable for the installa6on of a modified,oversized on-site sewage disposal system. Before a representative of our office will revisit the site to issue an lmprovemenf Permif/Auffiorization lo Construcfthe appropriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, please feel free to contact this office. Sincerely, .�Gz��',��'��S Robert B. Hall,Jr., R.S. Environmental Health Specialist RH/wd Enclosure(s) cc: Grady McClamrock 9Jati _ __�. 2391 � .. ' . . ` } ____ - . , . ' ' S52A k :..,. .. � ..__ __ � ' � V ' - 4107 91 _ ��^'emr (13J2A1 O �� .� �� "� 5 Q � 7967 � 19.96A) �ryl � (])]A)� W ]OJA i0 3839 1 15o]nl 8817 �v 5912 � - F � Q 3812 K s' ,�` � � (3 35A) L300000017 8�^ 's � � �SOIA Np 5025 / � IO919A) . I laseaal ' � � �. �89 . �I 4I15 � ' Nxa3n) �. . � g� 6826 / �� Q� - G , � cy I�a�an� 2t� y � SJ � 2918 � 6 Z \ � �w f �b .� _� � b z R � b _ 8535 m 6459 '�+ a 4 � p i 26n) o tl0.9]F) � p (It�BA) 8252 � 3223 " 9200 p0aBa1 � ..• ' ' �� . 4193 � � j / "� m fi� R /, �. „�. ...,. � iiv n�s� 23i1 n