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218 Vanzant Rd . _, � -.�r DAVIE COUNTY HEALTH DEPARTMENT ', Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (33G)751-8760 Account #: 990003755 Tax PIN/EH#: 5719-02-7493 Billed To: Raymond Robinson Subdivision Info: ���a��/V�� Reference Name: Greg Parrish Location/Address: 218�Vanzant Road-27028 Proposed Facility Residence Property Size: 1.729 acres ATC Number: 4212 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). 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 CONSTR CTION S VALID FOR A PERIOD OF FI YE . Environmental Health Specialist's Signature: Date: _ � CERTIIT TE OF COMPLETION **NOTE** T'he issuance of this Certificate of Comple ' shall in i e the system described on ImprovemendOperation Permit has been installed in compliance with icle 11 .S.Cha er 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY en as a a ntee that the system will function satisfactorily for any given period of time. � � ��'La��� �o � ��,-��c°� �,v� �� C.� .��� �s � �a �� � � �,� �� � � Septic System Installed By: ! �1 � �� (�' Environmental Health Specialist's Signature: Date: 6s DCHD OS/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT t � Environmental Health Section d , ; w r P.O.Boz 848/210 Hospital Street �, � , Mceksville,NC 27028 `'� 3I� (336)751-87C►0 I�I IMPROVEMENT/OPERATION PERMIT Account #: 990003755 Tax PIN/EH#: 5719-02-7493 Billed To: Raymond Robinson Subdivision (nfo: Reference Name: Greg Parrish Location/Address: 2180 Vanzant Road-27028 Proposed Facility Residence Property Size: 1.729 acres ATC Number: 4212 **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 � #People� #Bedrooms � #Baths� Dishwasher:� Garbage Disposal:� Washing Machine:� Basement w/Plumbing:� BasementJNo Plumbing: � Commercial Spe�ification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �/ Type Water Supply 1��� Design Wastewater Flow(GPD)—�t��`� Site: New❑ Repair❑ '` � System Specifications: Tank Siz%GAL. Pump Tank GAL. Trench Width S�(�Rock Depth� Linear Ft.� Other: s stated in 15A NCAC 18A.1969(5) Required Site Modifications/Conditions: aCCepted Systems may als0 b8 us�3d IlF1PROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFE'LUENT FILTER. RISER(S) IF G"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(33C►)751-87G0.**** 1 V e� ��✓l��E !�J"��L✓� �l�%>4-t� `�`'b'�"" �''����y"t_ �J � � ��,j-�ll Environmental Health Specialist's Signature: Date: �� DCHD OS/99(Revised) ����_ .� � � � _ 's '`� �jLl FOR SITC EVALUATION/IhiPtiUVEAtENT PC[ihflT&ATC � S�P Z O Davie County Health Department ��� . � En vironmenta/Hea/t/�Section �� �F����Zt1 P'O Box 848/210 Hospital Street ,�Ro����a�;�1 Mocksville, NC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. �Namo to be Billed .+�onL ,� `.,�ontact Peraon � �-?tailing Addresa .Zcy�,�.�Z},,� ,PraO xo�e Phone 33(�-�QL-S$/.� Ci�.y/State/ziP YV��,�v,��e ,�C� 2.7oLFf �—Busineas Phona 3.�fo`�{77-5/o3�f �. Naate on Permit/ATC if Different than Above�/Z.F9 7AI`ffSJ'l' 1 J�4Y �� ' `-"��•^�5�� Mailing Addresa City/State/Zip `'�3. Application For: lr�'Site Evaluation Ud Improvement Permit/ATC � �� Syatem to service: [a'House ❑ Mobile Homo ❑ IIusiness ❑ Induatry ❑ Other �--5: Type aystem requeated: ❑ Conventional ❑ conventional modified ❑ innovative pacCe ted / � If itesidence: t� People _�_ # I3edrooms -3 #� Bathrooms L ��LNDishwasher I.}SGarbage Disposal L�7Washing Machino l,�Basement/Plumbing ❑Flaaement/No Plumbing 7. If Businesa/Industsy /Other: verify type # PeoplQ # Sinka # CommoQes # Showera # Urinala � wator Coolera IF FOODSERVICE: # Seata Es�imated Water Usage (gaiions per day) Vs. Type of watar aupply: ❑ County/City CK Well 0 Community �� no you anticipate additions or cxpansions of thc facility tl�is systcm is intcudcd to scrvc? ❑ Ycs [H'No If ycs,�ti�liat typc? ***IA1P� IYTS MUST COdfPLETL•TlIC RL•QUIItED PROPCRTY INI�ORMATION R[:QULST['sD BELO�'V. hcr a PLAT or SI'!�'C PLAN 1LfUST BL SUQdfITTLD by thc clicnt with TIiIS APPLICA'TION. Property Dinicnsions: �• � vZ��'^^� WI21T�DIRECTIONS(froni Mocltsvillc)to PROPI'sRTY:` ��a orr,c�i'IN: t�S7/9nz7y93 � � �i<<s h � c� y c.-� �"' Property Address: Road Name.?Jg Vq�r2.4,�t�- ��t� ,�1 — `�D p�s 5 !/o �. F- � • ""'` City/Zip Moc.K.s►%,llE�d1 C L7aZ8` �-R-��- ( S�- j-- �/� �° 1�"'��`� � - -' h,�� �. I[in a Subdivision providc information,as follotiys: N�A Namc: {'�''�-'-S� �� Section: Blocic: Lot: "�ate home corners llagged: g L a.s Tl�is is to ccrtify tliat tlic information providcd is correct to tlie bcst of my knowledge. I understand tLat auy permit(s) issued hercafter are subject to suspension or revocation,if the site plans or intended use cliange,or if the information submitted in tliis applicatioii is falsificd or ct�anged. 1,also,turderstand tltat I nnt respousiGle for n!!clrarges incurrerl fro��i tlris applicaliou. I,I�creUy,give consent to tl�c Autl�orized Representative of the Davic County IIcaltli llcpartmeut to enter upon abovc dcscribcd property locatcd in Davie County and owne by to conduct al tcsli g proccQures as neccssnry to dctcrminc tl�c si ' ity.� DAT� ZD 0.� �-�3'�NAT � � TFiIS AR�A MAY B�US�D rOR DRAWING YOUR SI' LAN i udc all of tl�c follotiving: �xisting and proposcd property lines and dimensions, structures, setbacks, septi cation ). Sitc Rcvisit Cliargc � � �. . Datc(s): 6� f�� � Clicut NotiCcatiou Datc: � �I-IS: �} a ' �. 7-ss Sign givcn 1 " '-� '. Account No. � �� �7 Rcvised DCIiD(05/03 Lrvoicc No. NOTE This property is subject to aN sosertme+b. right-of-ways. drawls and aftsearvients.N any, as the some may appear of lFred Lanier Rd rocad in the office of the Register of Deeds. Clertu of Court, SR 1307 Taft or Call*Tax Office or which may have been acquired by - _ prlwelpEk*use. This survey is subject to any facts that may be disclosed by o full and accurate title search, NOT furnished us us as of this date. �YY 84 ( &► This map or drawing and any occornpanying ' docunw te acs furnished to the persoMe) nomad thereon OW no aNerations or use by others is permitted union authorised by Stone Land Surveying Co. SRe • Certified copies of this survey mop will not be issued beyond ninety(90) days of the original survey date. Mop not for recordation. aF Precision 1:10,000+ tpQ 4 QW98 rbbOrt Stan.,vrafwiana land swvf'or,L-3162.«racy to on. 41 Vicinity Map (Not to Scale) of the foNewkq se h+dkeled"fuss ® or ❑ a. That axle►le►Is of a 0xvey°ret create.a.6*Ad.of and ekhin \ 1� are Oreo of a oeun*or m%adoilpe tr that has an ordnance that-9 porcols of Ianx Tax Lot 46.04 ❑ b That thr peat is of a o.vW Mat le locate.N even paraan of a Tax Map H-2 / aornty or mrrrfolpaety tad r unregulated ae to an ordk acme that re9umt-pO1Cete of krr n/f Neil D. Larsson / and wife / - 0 c. That"tract Is of a survey of an exisarq parcel or poral. - Frances W. Larsson RB'605 O PG 247 Tax Lot 45 d. That this PW h of a Survey of another Elreoorr""tbau n of existing pomew a art ordered whr"eyy oas r � r other Tax Mop H-2 / � �epaarr to tt1e defedd n of subdwMan, n/f Angela Graham Robinso-1 do Regina L Graham / ❑ s 'tet the"rfon"dim evessble to MIs ourveycr in such that I am DB 185 O PG 255 arable to maim a Asksrminodw to the beet of my prateesia al .blit on b plowbi rr oarrtdrrd in(a)through(d)above. George R. Stone Prato" land Surveyor. L-3162 . \ �`R / \ f10/ \ \ •;- Vanzant Road S.R . 115 2 60' Public R/W 20'+/— Pavement \ �c g0a / CALL TABLE °G Tax Lot 45.01 Q�°�oJye Tax Map H-2 . / COURSE BEARING DISTANCE X- / L-1 S 39043'50"W 129.00' 1.739 Acres +i-- / L-2 S 45943'50"W 132.00' _ Per RB 612 ® PG 136 / L-3 S 55°43'49"W 172.33' I L-4 N 04°14'47"W 40.14' Tax Lot 46.06 / / L-5 N 04°14'47"W 197.88' Tax Mop H-2 / L-6 N 37'19'36"E 247.78' n/f Gerald E. Huffman / L-7 S 51458'58"E 237.07' and wife 111 / / T-8 S 35443'49"W 147.99' Tie Line Carol F. Huffman / / T-9 S 39443'50"W 135.00' Tie Line RB 607 O PG 661Tax Lot I / r I / Tax Ma 4H-2 Solid Line: Surveyed Line I ' / p / / n/f L. Roger Powell Rand wife Broken Line: Deed Line / Sue Forrest Powell DB 95 O PG 564 I C,019 R/W - Right-of-Way LEGEND FC - Face of Curt, EIP - Existing kon Pips BoC - Back of C^i-o /t I // / Site Plan for. E1R - Existing 1-prn Rebar PP _ Power Pole , P - Poet LP _light Pole i� Q �/ ' Greg Pa •s CM - Concrete Monument Mt, - Mar Hole �i / �� / g �}7m h IRS - Iron Rebar Set CH - Chord Distance % /' f t V P/L - Property Lire o/C - Part of C/A - controlled acc.a: ca - Deed Book . Robinson Residence CP - Concrete Pips PH - Plat gook / 00'CMP - CruMetol Pipe R8 - Record Hook / Tax Lot 45.01 CPP_Corrugated a!ed Plastic Pipe PG - page -F- 100 Year Flood Boundary CB - Catch Basi' -o- overhead txaitiss -s- sewer uTax Map H-2rs Record Book 612 ® Page 136 -X- Fang WM - Water Meter �iV` Fnd - Found WB - Water Vaive ! n/f - Now or Formerly she - Bench Mo'k goes eP+s 1.739 Acres +/- NMP - Nonmonumsnted Point TBW - Temporary Be,& Me-k '041% per RB 612 ® PG 136 !! opo CL - Center Line CRS - Rail Rood Spike ��Car COUNTY STATE DATE EP - Edge of Pavement CTB - Cable , T,Q,qfo Pedest,. ��•yN4set'°f.ted, op SCALE TOWNSHIP TP - Telephone Pedestal i:?9 - Electn<: �•a-�etormer Bo. ee• �` -W- Water Line CO - Sanitory Sewer sea• ouI decIathaTc• '✓9 20 1, = 50' Calahain Davie North Carolina 8-24-2005 we su yed: a Pro ty gflown Zn 50 0 _ 50 100 150 this ply f �r; SURVEYED- Stone Land Surveying Company jog No. SC,DB George Robert Stfine, Ply L-3182 12605 r MAPPED: r ri r;r. r, e `sone 3.36" 998-4733 MAP NO. GRAPHIC SCALE — FEET —+ cis M r 1 12605 '"041 silts"" , ; .,.. = .. � DAVIE COUNTY HEALTH DEPARTMENT ' , Environmental Health Section Soil/Site Evaluation � APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003755 Tax PIN/EH#: 5719-02-7493 Billed To: Raymond Robinson Subdivision Info: Reference Name: Location/Address: 2180 Vanzant Road-27 28 .✓ Proposed Facility: Residence Property Size: 1.729 acres Date Evaluated: � Water Supply: On-Site Well Community Public - Evaluation By: Auger Boring ,�_ Pit Cut FACfORS 1 2 3 4 5 6 7 Landsca e sition .f� Slo e % �` HORIZON I DEPTH 1. �� Texture grou L G,[., Consistence � 1/C: Structure �- l' Mineralo /,-( HORIZON II DEFTH " tJ�- Texture rou Consistence � Structure !`� Mineralo �`� 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 . > S SITE CLASSIFICATION: � EVALUATION BY: � % LONG-TERM ACCEPTANCE RATE: ��� OTHER(S)PRESENT: REMARKS: LEGEND i.�ndscaAe 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 � 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 CnNSIST .NC . �Z41S� VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm � � NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic SYT11�LuL@ SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineraloev 1:1,2:1,Mixed LY�s 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 OS/OS(Revised) ■■���■������■�����■�����������■����■�������■■■■■■■����■��■■■��■��■ ■0���■���■��■■■■���■�■■■������■��■■�■■�■��■��■■��■��■�■�■■�■����■ ■■■�■■■����■■■���■■■��������■�■■ ■�■��■■■��■��■■��■�■■■■�■■■���■■ ■��■■■■����■■������■■■�■■■■�■�■■■�■■■■■■■�■��■■���■■�■■�■���■■■■■■ ■���■■■■�■■��■�■�■�■����■���■■�■��■���■�����■■■����■���■■���■��■�■ ■���■�■�����■�■■���■�■����■�■��■■■■■■■■■■���■■��■■■■��■�■�■■�■��■■ ■�����■����■���■�■��■��■■�■�■�■■■■��■��■■■■�■■■�■��■��■�■■■������■ ■■��■■■■■�■����■�■�■�■�■■��■■�■■■�■■■■■��■■��������■■�■■�■�■■■���■ ■■����■■■�■��■■■■������■�■■■■�■■■��■■�■■��■■���■■�■■�■�■��■■■�■■�■ ■��■■■■���■��■�■�■���■�■■■■■■■�■���■■�■��■■��������■■���■�■�■�■�■ ■��■■�■���■�■■�■�■���■■�■��■■■■■ ■■■���■��■����■■��■■■■■■��■■���■ ■���■■�■��■�■■■■�����■��■■■■■■����■�■���■�■■■■��■����■�■��■��■�■■■ ■■�■���■■�■��■�■�■�■■■■�■■■����■■■■�■�■�■������������■■■■■���■���■ 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Environmental Health Section P. 0. Box 848/210 Hospital Street Courier 09-40-06 ' Mocksville, NC 27028 ���� ��� (336)751-8760� r � ��'' k: � E f � d � d ' � J-; h 4 , � .».n � �� . �t��' S, p �4 4� � . A. _ �,_.µm.....� s .._.,.,......wo.»�..s...ti_..._. _<,.-.,.�.,.,,...w,.�A, . ...�4........,.�a,....&:.a.......n..d...,.,...,...�.................>_..._�..._.,«...,...b...,;..�s._...�.�......,....._�....�� September 23, 2005 9 Raymond Robinson 204 Vanzant Road � Mocksville,NC 27028 Re: Site Evaluation/ Vanzant Road Tax Office PIN: #5719-02-7493 Dear Client(s): ' As requested, a representative from our office visited the aforementioned site on September 22,2005. Based on the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, it was found to be provisionally suitable for the installation of an on-site sewage system. Before and Improvement/Authorization to Construct can 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, ���:.,�������. Robert B. Hall, Jr.,R.S. Environmental Health Specialist RBH/dlf