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365 Bobbitt Rd Davie County,NC Tax Parcel Report Monday, September 26, 2016 B 3B1T RD "�jar jf ff r`�A BiLLS.a LPA+AY ;z Z_ lRn 0 C4 r), 4 {{ r / Y ©0 WARNING: THIS IS NOT A SURVEY . .,. .Parcel Information Parcel Number: D600000007 Township: Farmington NCPIN Number: 5852431162 Municipality: Account Number: 75183000 Census Tract: 37059-802 Listed Owner 1: VESTAVIA II FARMS LLC Voting Precinct: FARMINGTON Mailing Address 1: PO BOX 596 Planning Jurisdiction: Davie County City: WINSTON SALEM Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27102-0596 Voluntary Ag.District: No Legal Description: 94.605 AC BOBBITT RD Fire Response District: FARMINGTON,SMITH GROVE Assessed Acreage: 94.88 Elementary School Zone: PINEBROOK Deed Date: 4/1995 Middle School Zone: NORTH DAVIE Deed Book/Page: 001800086 Soil Types: ArA,MrC2,MrB2,EnB,IrB Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 189510.00 Outbuilding&Extra 18810.00 Freatures Value: Land Value: 618390.00 Total Market Value: 826710.00 Total Assessed Value: 296660.00 I.v All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Davie County, Implied warranties of merchantability or fitness for a particular use.All users of Davis County's GIS website shall hold harmless the County of Davis,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to rap UN�y NC or arising out of the use or inability to use the GIS data provided by this website. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street ` Mocksville,NC 27028 (336)751-8760oo a� IMPROVEMENT/OPERATION PERMIT Account M 990001475 Tax PIN/EH#: 5852-75-1300 Billed To: JQba-Tumer ves40V1&Fir r, Subdivision Info: 2, Reference Name: Frank Hinman,ll Location/Address: Bobbitt Road-27006 Proposed Facility: House Property Size: 22.38 acres **NO7ll;*-This Improvemeent/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 6 Type Water Supply M,-*11 Design Wastewater Flow(GPD)-3�6 4?) Site: New PJ' Repair❑ System Specifications: Tank Size /j>d(}GAL. Pump Tank GAL. Trench Width 3� `'Rock Depth /.?f� Linear Ft.&W Other: 216 v ROted in15A NCAC 18A.1969 5Required Site Modifications/Conditions: cd Systems may IMPROVEMENT/OPERATION PERMIT L - APPROVED EFFLUENT FILTER. RISERS)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a re esentative 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. 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.**** /T C Environmental Health Specialist's Signature: Date: A14��, DCHD 05/99(Revised) + DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 7 ?j Account #: 990001475 Tax PIN/EH#: 5852-75-1300 Billed To: JohnTu=er Ves aula-fiq -M Subdivision Info: Reference Name: Frank Hinman,ll Location/Address: Bobbitt Road-27006 ATC Number: 4330 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 I 1 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATWCCOSTZRUCTION IS VALID FOR A PERIOD O FIVE YEARS. Environmental Health Specialist's Signature: 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. .0a' i to Jso i� Q~� Septic System Installed By: /l•r�l�� Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental HealthSection 848/210 Hospital Street ksville,NC 27028 "EvariCafior,44rMent N760/Fax (336)751-8786 Application For: ❑ Authorization To Construct(ATC) 'Both *"IMPORTANT** �M NOT E PROCESSED UNLESS ALL OF THE REQUIRED INFORMATIOIS PROS Wo the INFO TION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed Ves-r AV 1 A- Contact Person Fcr��r+�- �-�►�M Billing Address 'Po Sox 5gto Home Phone 339-- '6Z- to"1Z City/State/ZIP Stern wc- 7-7 ta'Z Business Phone o Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION NOTE: A survey plat or site plan must accompany this application. 5596 75-j30 (Permit is valid for 60 months with site plan,no expiration with complete plat.) . Street Address City;,lav"c.e--- Tax PIN# nom. 6o->000o-71c> Subdivision Name ulA,- Section/Lot# Lot Size zz. 36 Ott- Directions To Site: isr3 e- i4j-- w r w• Z a- .., ,`,AA i .,twL 11Z t1ta k- _/1-w a1�s_ i��-�.+- 1L— /s C��...� ►,yrl laa� Date House/Facility Corners Flagged z�i-t o to If the answer to any of the following questions is"yes",supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes 1t1No Does the site contain jurisdictional wetlands? ❑Yes 14No Are there any easements or right-of-ways on the site? ❑Yes BNo Is the site subject to approval by another public agency? ❑Yes Belo Will wastewater other than domestic sewage be generated? ❑Yes J2No IF RESIDENCE FILL OUT THE BOX BELOW #People 3-4-1 #Bedrooms 3 #Bathrooms Z Garden Tub/Whirlpool ❑Yes 9No Basement: ❑Yes 9No Basement Plumbing: ❑Yes 5No IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested: Xconventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ❑ County/City Water ❑New Well )dExisting Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 14No If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permits)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed I understand that I am responsible for all charges incurred from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules on the above described property located in Davie County and owned by =off L•ur-mer- d6+ V,k.4AvtA- V'�A.A, Site Revisit Charge Property owner's or owner's legal representative signature Date(s): Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# �" ` Revised 2/06 Invoice# 5a 9Z a W � �S m 13.60A 4609 a 21196 e� 1154 (12.89A) 4515 h . o QQ� P (13.34A) (2 .a 41C1300 0313 p 1300 c° A— (698) D60000007101 ® Std IV (4.78A) 264 0962 (2.21A) N 170 5894 (z.OSA) 1 - sQ (485) ns) (300) - _ (514) (751) (355) (629) 347 844 363 76 (151) (4.80A) (17.97A) �o4a 0391 �'�`�� � X51 �► -� DAVIE COUNTY HEALTH DEPARTMENT „ f - • Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001475 Tax PIN/EH#: 5852-75-1300 Billed To: John Turner Subdivision Info: Reference Name: Frank Hinman,ll Location/Address: Bobbitt Road-27006 Proposed Facility: House Property Size: 22.38 acres Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L, Slope% b �/ HORIZON I DEPTH Texturegroup v C�, d Consistence `1_ yk Structure Q/` Mineralogy HORIZON II DEPTH Df` D t Texturegroup ,�C L L Consistence V Structure Mineralogy v HORIZON III DEPTH x" Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE . - CLASSIFICATION LONG-TERM ACCEPTANCE RATE nn �4 SITE CLASSIFICATION: yvEVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope j 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 M41St 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 Structure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1,2:1,Mixed IY�tes 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 05105(Revised) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■a■■■■■■ass■■■■■■■s■■■■■■■■■■■■■■ iiiiiir�iii� ii�iiii■■ii�iiiiiii■ ' iii■■IN MEiiiiiiiiiiMENNEN� ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Davie County. Health Department Environmental Health Section P.O.Box 848/210 Hospital Street Mocksville,NC27028 (336)751-8760/Fax(336)751-8786 February 22, 2006 Vestavia Farm P.O.Box 596 Attn: Frank Hinman, I Winston-Salem,NC 27102 Re: Bobbit Road Acres: 22.38 Tax PIN#: 582-75-1300 Dear Mr. Frank Hinman,II As requested, a representative from this office visited the above site February 21, 2006 to perform a site evaluation. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed,the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans or the intended use change. Improvement Permit System To Serve: E Wastewater Design Flow: tib System Type: conventional Accepted ❑Innovative ❑Alternative ❑Other System Location: a.�� � Valid: 5 Years []No Expiration Site Modifications/Permit Conditions: nvironmenta ealth Specialist Date ps-i.p.letter 2/06 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section l / P.O.Boa 848/210 Hospital Street PC/— 'T�'l `J G Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002228 Tax PIN/EH#: 5852-43-1162 Billed To: Vestavia Farms, II,LLC Subdivision Info: Reference Name: Location/Address: 365 Bobbitt Road-27006 Proposed Facility: Residence Property Size: 96.4 acres **NOTEc'** This improvem8ent/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 PEpRtMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type _,1# 6 y��1�JPeople f/ #Bedrooms ;VX #Baths Dishwasher: 13 Garbage Disposal: Washing Machine: 0 Basement w/Plumbing: Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: Lot Size Type Water Supply P/l Design Wastewater Flow(GPD) Site: New-2' Repair El System Specifications: Tank Size ys p / GAL. Pump Tank GAL. Trench Width� Rock Depth Linear F 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 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.**** Environmental Health Specialist's Signature: Date: 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 #: 990002228 Tax PIN/EH#: 5852-43-1162 Billed To: Vestavia Farms, II,LLC Subdivision Info: Reference Name: Location/Address: 365 Bobbitt Road-27006 Pro osed Facility: Residence Property Size: 96.4 acres ATC Number: 3118 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 WASTEWA CONSTRUC ON IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: 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. -rl Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) • APPLICATION FOR SITE EVALUATION/IMPROYERIENT PERMIT&A Davie County Health Department Environmenia/Health Section APS ` 4 2002 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 DoWfou y MY ***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 \/G5-rn.V 1 A Tisco kS Ld.L Contact Person r ��H�a W1en1 3� ''159�j n@ Mailing Address �O I�jS� Ccltsa -pKp '� D ►7LS �S '�!j��j City/State/ZIPLJINS:awl' SAS-�Nl�t�C 7-7102— Business Phone r-g*FtcE 3754. 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip / 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC T Both 4. System to Service: ❑ House ❑ Mobile Home ❑ Business ❑ Industry N Other_YD Ke—^A 5. If Residence: # People U Bedrooms # Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing fl Basement/No Plumbing 6. I£ 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 rd Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes l►J No If yes,what type? ***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. ( Property Dimensions: 9��'E f I7-`' ' WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # Z-`f'3l 1 I�Z Faswwc.;o�l eb r* Property Address: Road Name �� �� ��• d^�' � .k acs / p?�• 3 S.r•-:1�i�_ do�v City/zip Ilk-- �7Av-,�k t� on r<<�lt sE P'`Sk n lxln If in a Subdivision provide information,as follows: ��� Name: Section: Block: Lot: Date Property Flagged: ' This is to certify that the information provided is correct to the best of my knowledge. 1 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 an: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 to conduct all testing procedures as necessary to determine the site suitability. DATE SIGNATURE ' :f.— '�-�-��—� 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). —17—rr 4 Site Revisit Charge '�c�eusecl Idrt•+Z� (;r Datc(s): Client Notification Date: EHS: Account No. 1 VAI Drr(6 Revised DCHD(07/99) Invoice No. /3 316 N 219 261 (1146) (422) / 367 365 94.60A 1162 DAVIE COUNTY HEALTH DEPARTMENT - Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002228 Tax PIN/EH#: 5852-43-1162 Billed To: Vestavia Farms, II,LLC Subdivision Info: Reference Name: Location/Address: 365 Bobbitt Road-27006 Proposed Facility: Residence Property Size: 96.4 acres Date Evaluated: `- Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH -/ Texture group �j 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: /1�SS �� /-]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-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 Structure SC-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 05/99(Revised) ■■■■■ee■cce■c■e■■ecce■c■e■aec■■■■■■■■ccc■e■■c■c■■■csccc■■secs■ee■■ ■■■ec■■ceee■■ee■c■eec■eeeee■eeeee■eeee■eeec■see■■■■■ee■■■eee■ee■■■ ■■■■■a■■■a■ss■■■■■■■■■■■■■e■■■■■■■■■nese■■■■■■■■■■ee■■■■■■■■■■■■■■ ■■e■■ec■■■■■■■■■■■■■■■■■■■■■■■■■■■ce■e■cc■■ecce■■■■■■■■■■■■■■■■■c■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■e■e■■e■■ee■■■■■■■■ee■■■■■■ee■ee■■se■eeee■eseee■■■ee■e■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■e■e■■■■■■e■■■e■■■■e■■■ecl�l■■eee■c■eece■c■■e■■■■■■■■e■ce■■e ■H■■■■eee■e■■eee►�1■■■■■■■■��■■■■■ee■■ee■■■■■■e■■ie■■■■■e■■■■■■■e■■■■■■ MENNENliMENNENONHOMiiiiNEN MEiiii" ■■■■■■■■■e■e■■■■c■■■■■■■11■■■■■■■■■■■■■■.....e■■■■■■■■■■■■■■■MEN■■■ ■■■■■■■■■■■■eee■■■■■■■■■■■■■■■■■■■■■■■■■ee■■■■■e■ee■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ eee■e■■■■■■■■■■■■■■■■■s■■■■■■■■■■■■■■e■ee■■■■■■■■■■■■■■see■■■■■e■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■e■■■■■■■■■■■■■■■■■■e■■■■c■■■■■■■■■■■■e■■eeeeee■eee■■e■■■■■■■■■■■ ■■■■■ee■eee■■■■■■■■eeeeeee■eeeeel�ii■ecce■■■■e■ee■e■■■ee■eeeee■■■■■■ ■■■■■■eee■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■e■eee■■■■■■■e■■■ee■ec■■■■ DAVIE COUNTY HEALTH DEPARTMENT 4 r. IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance Wfth Article II of G.S.Chapter 130a Sanitary Sewage System /i�, ��' j. `� r Permit Number s. Name :Z21 � -- == rpil' ---Date d N2 8015 Location _/f /'�; /, - s�'3 ir. 4r.. -^`' / %/ /r/r,✓ �i Subdivision Name Lot No. Sec. or Block No. Lot Size �; ! — House _ ''' Mobile Home ---_ Business -- Industry No. Bedrooms —.No. Baths —Z-- No. in Family — Public Assembly Other Garbage Disposal YES ❑ NO p– Specifications for System:, Auto Dish Washer YES ❑ NO p'• Auto Wash Ma,:hine YES ❑ NO [I"' Type Water Supply 'This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change ..ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS RM LAYOUT BEFORE INSTALLING THIS SYSTEM. Improvements permit by -- J4`11 *Contact a representative of the Davie Coun Ith Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M.or 4:30-5:00 P.M.on day of c mpleti le hone umber:70 34.5985. Final Installation Diagram: System Installed by J� L 0 Certificate of Completion-- Date 'The signing of th s certificate shall indicate that the system described above has been installed in compliance with the standards set orth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for a y given period of time. o�r.�.er�r■ APPLICATION FOR SITE EVALUATION/IMPROVEMENTS P Davie County Health Department Environmental Health Section P. O. Box 665 W -30 Mocksville, NC 27028 MAW I WI it A 1. Application/Permit Requested By. 'Jo AJV I U I&�2 Mailing Address 380 gye&aaafil;7 rtfiVj/o6eSAA(_ 11 Home Phone 7A • doh B' Scc,'%f fV6 Business Phone 6 3/' 9000 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation Urgeptic Tank Installation Permit 4. System to Serve: ❑ House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry �Other�A fj�N ❑ Unknown 5. If house, mobile home:Subdivision Section Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms z- ❑ Washing Machine No. of Bathrooms ❑ Dishwasher Dwelling Dimensions 26 , K 2 0 ❑ 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: ❑ Public C-Private ❑ Community 8. Property Dimensions AC. Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes 23'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: //I _ i dN Rf /0 �edd:! /?cr %�c'4'v Ri F' FO A6ew %1E -3 ibis, �iRs 1 nA;loa o,v 1?i11 �o W o o d(s /r�d�., vc.r he !!D �10,w,J S ,Ter O,v S o u # �- �v�� 0 7� �o•v a/ I 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. s rt'3-- !,S ZA,�v DATE 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 thg,D,,aMe County Health Department to enter upon above described property located in Davie County and owned by .d ola.v to conduct all testing procedures as necessary to determine said site's suitabilityfora groun absorption sewage treatment and disposal system. ooal s - p>' ATE SIGNATURE DCHD(1193) i I DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation / J NAME ��r/>C2 DATE EVALUATED ADDRESS PROPERTY SIZE ^/ /� PROPOSED FACIILTY C ��� LOCATION OF SITE /S/J� mo/ Water Supply: On-Site Well �� _ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position ,L Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture groupG 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 PLATE SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: J 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 ;lay loam- SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-V! .-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 Mineralog]► 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 ■■.■■....■■...■■.■.E■.■MME■■........■Ei■■■■■■■Ee■=NEEM.■■■ ■■.■■.■ .......................................... ........ ............. ........................... ................... . . ............. 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