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661 Cherry Hill RdDavie County, NC . Tax Parcel Report Tuesday, October 11, 2016 WARNING: TIIIS IS NOT A SURVEY Parcel Information Parcel Number: M60000004601 Township: NCPIN Number: 5755778930 Municipality: Account Number: 82529250 Census Tract: Listed Owner 1: WILLIAMS JAMES L Voting Precinct: Mailing Address 1: 661 CHERRY HILL ROAD Planning Jurisdiction: City: MOCKSVILLE Zoning Class: State: Zip Code: Legal Description: Assessed Acreage: Deed Date: Deed Book / Page: Plat Book: Plat Page: Building Value: Land Value: Total Assessed Value: NC Zoning Overlay: 27028-0000 Voluntary Ag. District: 3.563 AC CHERRY HILL RD Fire Response District: 3.56 Elementary School Zone 6/1989 Middle School Zone: 001480823 Soil Types: Flood Zone: Watershed Overlay: 35510.00 Outbuilding & Extra Freatures Value: 36200.00 Total Market Value: °�°°'�' Davie County, n�UN�C� 1rC 1 80030.00 Jerusalem 37059-807 JERUSALEM Davie County DAVIE COUNTY R-A JERUSALEM . COOLEEMEE SOUTH DAVIE WeB,PcB2,PcC2 DAVIE COUNTY 8320.00 80030.00 No All data is provided as is without warranty or guarantce of any kind either expressed or implied including but not limited to the implied warrenties of inerchantability or Titnoss for a particutar use. All usen of Davie Countys GIS website ehall hold harmless the County of Davie, North Carolina, its agents, consultants, controctors or employees from any and ail elaims or causes of action due to or arising out of tho uso or inability to use the GIS data provided by this website. ?J�X'd AUTHORI7.AT�ON 1v0: O 9 4 Z� DAVIE COUNTY HEALTH DEPARTMENT ��< '' • � Environmental Health Section PROPERTY INFORMATION Permittee;�f�� � P.O. Box 848 %�'ar�J� N�tne: ' •� � Mocksville, NC 27028 Subdivision Name: , . �. ` , � -//v'= ,•�`"r'.'i'� j t'r Phone #: 704-634-8760 Directions to property: �'� Section: Lot: AUTHORIZATION FOR dp WAST'EWATER Tax Office P:#.�7�'� .'7 - o/ 3� SYSTEM CONSTRUCTION 'E►�1'l�► Road Name: f � �• ' . � I**NOTE** This Authoriza6on for Wastewater System Construction MUST BE ISSLJED by the Davie County Environmental Health Section prior to issuance of any Building Pernuts. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Pernuts. � (In c�mpliance with Article 11 of G.S. Chapter 130A; Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) �Gf �' ` � � -. ,�`�.-� �;'',� ;!= ,�''- �✓� ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION cr , r , IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED j,,... � �" _ / : . .:. ... :: ,. � ,_ . .. , � � . �. : _ .. ��A�� � t ,::�; � ;DAVIE COUNTY HEALTH DEPARTMENT �� ': �,��-�`=�`-' �``� Jr i IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION , Pernuftee:s � t t : ; ��) . ', � ".,• � - � Nan�: ����j�' �W/', ��,5 � Subdivision Name: � _ . , Directions to property: �- q�. • -'' Section: Lot: " � ' IIVIPROVEMENT : :,�� PERNIIT Tax Ofiice PIN:# _hJ'1 �� . _ .`% r� - ;�a � * Road N **NOTE** This Improvement Pernut DOES NOT authorize the construction or installatian of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUGTION must be obtained from this Department prior to the constructio�nstallation of a system or the issuance of a building pernut. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ��' ***NOTICE*** THIS PERMIT LS SUBJECT TO REVOCATION IF SITE •, .r �-, .;' ;; ' PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACl'OR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFTCAT'ION: BUILDING TYPE !%,�r� # BEDROOMS .�✓r' # BATHS �. # OCCUPANTS � GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICAI'ION: FACILII'Y TYPE # PEOPLE # PEOPLEJSHIFT # SEATS INDUSTRIAL WASTE: Yes or No ! �'',e/ LOT SIZE �J!` TYPE WATER SUPPLY ��F' DESIGN WASTEWATER FLOW (GPD) d=�>" � NEW SITE� REPAIR STTE SYSTEM SPECIFICATIONS: TANK SIZE %� I GAL. PUMP TANK GAL. TRENCH WIDTH ��� ROCK DEPTH �� LINEAR FT. ?�„� OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: � **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY: � �� M,. •1-I�, � Z _ _ ���/ . AUTHORIZATION NO. �� OPERATION PERMIT BY: ' �t� I.���T_ DATE: � l� **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED COMPLIANCE WITH ARTICLE 11 OF G.S. CHAP'TER 130A, SECI'ION .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. DCHD OSN6 (Revised) �� APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC ' Davie County Health Department ( � � � a � � ' Environmental Health Section I D P.O. Box 848 � Mocksville, NC 27028 i '�.�.. — 3 �9�7 � (704) 634-8760 i ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCES�Hi THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed ��/YI�S L-.. L�r JL� /�i-/!7 5 Contact Person �j�}'i'�i E.S �� �/ t- � f/�m.5 Mailing Address � �i� � /�/e �l' / L.� �� Home Phone 9�� " 7 /�!J ✓ 7U � � City/State/Zip �i�G�(�/ �. L � . N• G • � %O� Business Phone �%� `� — �o � �' � �:� � 2. Name on PermibATC if Different than Above /v ��� Mailing Address City/State/Zip 3. Application For: [] Site Evaluation [] Improvement Permit & ATC �Both 4. System to Serve: [] House [] Mobile Home [] Business [] Industry [] Other 5. If Residence: # People� # Bedrooms�_ # Bathrooms�_ [�] Dishwasher [] Garbage Disposal /' [� Washing Machine [] BasementlPlumbing [] Basement/No Plumbing 6. If Business/Other: Specify type .NC� !l� � # People #Sinks # Commodes # Showers # Urinals # Water Coolers n. If Foodservice: # Seats Estimated Water Usage (gallons per day) /�i l/-t� 7. Type of water supply: [) County/City [� Well [] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [] Yes � No If yes, what type? EITHER A PLttT On SZTE PLfIN PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A:�OF THE PROPERTY MUST BE SUBMITTED WITH T �S APPLICATION. Property Dimensions: � � WRITE DIRECTIONS (from V�Iocksville) TO PROPERTY: Tax O�ce PIN: #S'7 S�- %% - %-3 ; �01 S' ' cy l3 e�'k'Ta�.,:�; A_p Property Address: Road Name���%�T ��- � �� �C 7'�e c� ,� �/5 ��. /i' e R R V N � 1/ City/Zip�%%2C_��//�.�.� . /V� ; '�v►RrJ i; � �tr'T' �..3 ��-'I � i:R �f sJ�i� If in Subdivision provide information, as follows: �� 7��`� � ? rJ � H o u� �r c� pl �e �� � Name: � � � Section: Lot #: � 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 incuned 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_�.�a�:� •:�? �1��� --� to conduct all testing plocedures as necessary to determine the site suitability. DATE 7— � �- �I'rJ SIGNATURE� ._.�,} �- Li�.,�L.l�e:--� Revised DCHD (06-96) THZS AREA Mtl� $E USEb �OR blZttIVZNC JOUR SZTE PLAN: � . .. '� �� � , DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section SECTION LOT SoillSite Evaluation APPLICANT'S NAME �/ ���� DATE EVALUATED s��J'�" �7 PROPOSED FACILITY ��G`�' PROPERTY SIZE � t� �� SUBDIVISION ROAD NAME /�m � � Water Supply: On-Site Well � Community Evaluation By: Auger Boring ✓. Pit FACTORS Landscape position 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: �) LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD (01-90) 1 2 L � r r -Yp +` 1 /� c� '�'/ � /C S �L :-/ /. �/ � Public Cut 3 4 5 6 7 EVALUATION BY: OTHER(S) PRESENT: LEGEND Landscape Position R- Ridge S- Shoulder L- Lineaz 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 MineraloQv 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 �� ■�■ ■�■ ■■■ ��� ■ ■ ■■■■��■��■■�■■■�■■ ■����■■■■■�����■■■ ■��■■■■���■ ■���■ ■■■■����■�■��■�■■ ■��■■■�■■��■�■���■ ■■�■■���■■�■���■�■ ■��������■■�■■���■ ■�■■■■■■�������■■■ ■�■��■■■�■���■���■ ■■■■��■■����■■��■■ ■��■■■■■��■ ■���■ ■■■■�■��■������■■ ■���■������■�■�■�■ ■■■����■����■����■ ■�■���■��■■�■■��■■ ■�■�■■■�����■�■�■■ ■■■��■■■■■■■���■■■ ■���■���■��■■����■ ■■������■�■ ■���■ ■■��■�����■�■■■�■ ����■■■■���\��■■■■ ■■�■��■��■■�■■��■■ ■■■■��������■■��■■ ■��■■■■■■����■■��■ ■��■�■��■■■■■■�■�■ ■�■�■■�■■�■ ■■■�■��■�■■ ■����■�■�■■ ■■■������■■ ■■�■���■ A ■��■���■ !� ■�■�■■��■�G' ■■���■��■�[ ■■�����■��■ ■���■�■■��■ ■��������■■ ■��■■■��■■■ ■ ■ ■ ■�■ ■�■ ■�■�■�N■ ■■����■■■ ■��!����� ■��■�■■�■ ■����■�■■ ■�������■ ■■■■���■■ ■■���■ ■ ■■■■���■ ■����■■�!� ■�■■■■�■r` ■■■�■■■ ■■■■��■ ■■��■■■ ■�����■ ■��■�■■ ■��■■�■ ■■�■■ ■��■■ ■■■■■ ■��■■ ■�■�■ ■■ ■■■■■■■■■■■■ ■■������■��■ ■�■�■����■�■ ■��■■■■��■■■ ■�����■■■��■ ■■■�����■��■ ■■���■■���■■ ■���■�����■■ ■■�����■■��■ ■�■����■■��■ ■■�■�■■��■■■ ■■����■■■�■■ ■���■�����■■ ■�■■■���■■�■ ■�■���■■�■�■ ■�■����■■��■ ■�■■■����■■ ■��■����■■■ ■��■■�����■ ■�����■■��■ ■�■■■■����■ ■�■■����■■■ ■■■�■����■■ ■■�■����■■■ ■��■■�■■��■ ■�■���■�■■■ ■���■■■���■ ■��■�■����■ ■■��■�■■■■■ ■■ ._ u ?ixP:�Aa#'9ll.�e:."5:���v�'v._u'Q•'xc'<sqp`./1c4.Wt.RO�: `L Y!:-»,•+. �. �P�lt'fL!r� YMH,iI��v:ati6lT^s�.itOY+wHAiPyM ' . � � ' � ,4L�:i;ISiS[iI/IJl. 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J(1 Fi��E�°�J �. r^s��i� ��, r�� P�. s8s LEGEt�C �1D ' ExIS"�r: _ ; -rtv Fir� \ PIP = PL�C�D 1RON PIN NI� = N�:W lRON PtN N�C=NAIL � CAA t�OTE � aLL AR�AS tNCLUi;ED RO�tO RIC•N� 0�' WAYS • TOTAL A,REA = 5.754 �aCk�S rr�x ��:a� : n�-6 Pa�c�i 46.0� � .�.�...��._.�-..��-.�;�.,.�.�.�� ��.�; TOLERANCES �EJ'S�G"•S � (''� Q �ExCtI� wSraC�fG� tiU � tJ-07E � 8Y _ �J�l:��� COn • r • `� �L 1 \ � �. VI��V��t �I i • � P DEC�MAL �;----- .---- g���y� � 3�C1.i:1'S CF ?FtE ROBERT �. GFtUSBS, JR ' � ` -�`---- FPROPc'kTY {r$, tI4 FG.43�,) LYlNC IFi JEitUSALEht � ` �TOW��SH�� "�g'd1E �{1s'�'�TY Fi.C. k �RncnokH� -•-- - ------ - - _ __.�.�'.,.__ . ; _ _ _ . . 3-�.�:A �'s g+� � S�AI_. u t I �dA;ERIf.� _ � ; � y cc.� r � !oo —� i.;lJ iY JL �. • C . ��v " �'' _ ._ -- �f-k _—.— _' -..__._____'_ _ ._.._..._�_»..—� -"___ _. .. � ✓ �.�- y � . DAi£ � 6RAWING "+ i _': :; �„ r ANGULAF ° ul..T ' (0��1 '£i' ' � � , ' -- -----_ _ _ �����:.:. —_ _ ._-- AF, - .. --- �- t596 7 - 2 � . . ' .� 4 . �. ii' .. . " S—' . sw� abraw.[a�rwc�ri.u+�P,Y:3ra ....xs - "--_ _ -av�e.v_.�.7"�__'.=..e_rr�.�.._. ---mf�"�+0e�.fnuY�9m2�s'�>s`� ,. .>: ; , _- , ,., , . , . . ,.: ,: .. . , , ; _ _ _ , . _ „ _ - . S�� AUTxoRi�aTiorr rro:. q^� e� DAVIE COUNTY HEALTH DEPARTMENT ���-(,(J;/iJJq� � "' i J� f�,�,/�_/ Environmental Health Section PRi O_ PERTY INFORMATION ,,. �pj���J PerfnitEee's ' �C�il �� f���/�7� P.O. Box 848 �� i • Name: �'�';s��° =--xr- Mocksville, NC 27028 Subdivision Name: " ,r T , j� ! Phone #: 704-634-8760 Directions to property: / r�.��. %1 �i 1.� l!�" �" Section: Lot: AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Tax Office PIN:#� �� - � Road Name`. � � Zip: a� I�� **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Pemuts. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Pernuts. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ENVIRONMENTAL HEALTH �'/.�.��'� � DATE ISSUED ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALm FOR A PERIOD OF FIVE YEARS. ,�_ , , . ',�� .. . - . : : . , _ � . � =�o-v _ - � �, � �' DAVIE COUNTY HEALTH DEPARTMENT ��y���S(,{Jillifl/1'IS � � � ` �, � - �s•'�&''� `" � ,/ �; �.� IIVI ROVEMENT AND OPERATION P�RMITS PROPERTY INFORMATION ` Pe�it�'e��'.'"`t'..�.:.-'',���� 11 C�f1 ��:/",e'Jf�',o �.IQ- __._.__.._. .�� � P� �r (1^�'��ai�1 �.�< <_ Name"" �"�-�� � '�'� ~ Subdivision Name: .�� y. ' ;..,.f:,,:�.:. �_ t:::,_ - -il- � � ' i-3irections to property: : `� ,-�' r .�; ,� ��= � ✓ Section: Lot: � ` Il14PROVEMENT '�;. � .,� $ ._...� s ,-r,r .-�, PE�T Tax Office PIN:# ..� ��".� _� - .`� �, / , y �7 Road Name: �"-� f� % Zip: �.� ��- � j **NOTE** This Improvement Permit DOFS NOT authorize the construction or installation of a septic tank system or any wastewater system. An AITTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building pernut. (In compliance with Arkicle 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) /� ��,1 f!�� l,, f,, e ,!, ***NOTICE*** THLS PERMIT IS SUBJECT TO REVOCATION IF SITE ,�'. % /. 14.. � �t`;,� �f ,.y�;' F y� o;� � �!��, ,�� , , . , ,r ,� ,�' „�f� , PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL HEALTH $PECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE Tf�S PERMIT BEFORE INSTALLING Tf� SYSTEM. RESIDENTIAL SPECIFICAT'ION: BUILDING TYPE /�.� # BEDROOMS �L # BATHS �# OCCUPANTS �f GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFTCATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFI' # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE !% C TYPE WATER SUPPLY �E� DESIGN WASTEWATER FLOW (GPD) '��� G' NEW SITE_[� REPAIR SITE �- �' i SYSTEM SPECIFICATIONS:. TANK SIZE /On O GAL. PUMP TANK GAL. TRENCH WIDTH S'% ROCK DEPTH ,:� LINEAR FT. '1/<?fJ REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT � „�....�,�,� �......-.--- *"`CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMTf AUTHORIZATION NO. _ � � � SYSTEM INSTALLED BY: 5 �� 1-\. �� 40� ov I . \_ �op � �c � �oo �oo � �c.3lA' � � OPERATION PERMIT BY: DATE: 'S I L % � "`*THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THA'� THE SYSTEM DESCRIBED ABOV� jg� BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAP'fER 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. DCHD OS/96 (Revised) �„, APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMI __ � , Davie County Health Department ;, � Environmental Health Section P. O. Box 848 Mocksville, NC 27028 ('�`iS���� (336)751-8760 L ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESS - ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed ��i%/�eT�"► V�J�'e'� �'�� Mailing Address V�� r� / 1(�tJf,� (o U� �02%7� City/State/Zip ,,�O�GKS l/ e //� , /�/� �7� � Business Phone _ Contact Person l�e�� Ur �Oh/ 77�' Home Phone �� `����� 2. Name on PermidATC if Different than Above Mailing Address City/State/Zip 3. Application For: ,� Site Evaluation ❑ Improvement Permit & ATC � Both Qv�.b� u.��d� 4. System to Serve: ❑ House � Mobile Home ❑ Business ❑ Industry 0 Other 5. If Residence: � Dishwasher # People � # Bedrooms � # Bathrooms � ❑ Garbage Disposal � Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Other: Specify type # People # Commodes # Showers # Urinals If Foodservice: # Seats Estimated Water Usage (gallons per day) _ 7. Type of water supply: ❑ County/City � Well # Sinks # Water Coolers ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? ❑ Yes � No PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A P��� THE PROPERTY MUST BE , SUBMITTED WITH THIS APPLICATION. Property Dimensions: %� ���d X� • � a� - Tax Office PIN: # J'�'1 � � - _�_ - �13 U Property Address: Road Name ��e(�U I� (� I 1`� City/Zip 1�loc���� � I I�, a� o�-� � If in Subdivision provide information, as follows: Name: Section: Lot #: WRITE DIRECTIONS (from Mocksville) TO PROPERTY: /� I ��„�C, -l-n rr 11 co,�►ne � l l Rd - le 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 and owned by ��m'�� �— � W� �� 1 Q VYl S to conduct all testing procedures as necessary to determine the site suitability. DATE � � � � / � SIGNATURE ' I Y 1 • l�.l d � O �� �E ��d,� ,�/m� � � Revised DCHD (06-96) � �� �+ Q� �` � 1,0U Mtli�J USE THE $ttCK O� ZHIS �OIZM �OR bRtIWZNG l�OUR SITE PLAN. � V� M :.' � .� � � ���s u� ��c "� �o � g � � .� s�r,e►��� �" � � �, �� p� � s� �� � � ����� � � \ \ � � � -� � � --- � �' �` � � ��, � .�� � —,�, ,'�^� �' � ' :Qe t I001.22 5It1.5 �s 5., 2 � �� �5�5 � ' � ~ ,ta.�^�c-,��,� ��� Y*o�3�4 Y` k � � � . - . e!6.�J � ..st ky ���c� .� . , ....d,s� � 3��29 ti �t' y ` � '� ,.: i � A : .. �� �� �; �, � ��` �r .�.'< � �4 ! � i #���4 � ��., t� ,,�� d"�i. � V � y�' �'" p '4;:� A� � W , .�,. ' � .. '. I � i IA IQ3, t , , - s � � �', ,�a ,�, - . 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' �� ^ � � .. . b . . , � � � �. � ��- . . ` " ' '� A ": . \ .; / ,x. � .� �... a`# � ��; "_. - }. " 1t z`' \ �. '. `� . t �' � . � . .� . . . . " . L •j • �� �, (847) � , . � �, ' 299 . �. � �'� � (2.�OAI c� N C� � N � i �� (8.67A� 8086 �r � V 299 5907 (1501 0 � N 82s � � o� r- ` Scale:1" _ •'••'`•""• April 06,1999 4:37 PM R' ,` . DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section � Soil/Site Evaluation NAME � DATE EVALUATED S ����G ADDRESS PROPERTY SIZE lJ9 C PROPOSED FACIILTY � LOCATION OF SITE ��//r/nsr �Yo�,, .., Water Supply: On-Site Well /� Community Public Evaluation By: AugerBoring Pit Cut FACTORS 1 2 3 4 Landsca e osition �. Slo e 7. HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEPTH Q �t '� Texture rou ' Consistence � � Structure i( h! Mineralo HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSZFICATION LONG-TERM ACCEPTANCE RATE _ SITE CLASSIFICATION: EVALUATED BY: LDNG-TERM ACCEPTANCE RATE: c v.� 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-Tenace FP-Flood plain H-Head slope Texture S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SI�L-Silty �:lay loam� SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moiat VFR- V;;.ry 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 ,iC-Single grain M-Massive CR-Crumb GR-Granular ABK-Mgular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Min eralo�y 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 wate�' 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 ■��■�������■■����■����������■�������■�����������������■��■ �� �/�■ ■����������������������/�■�\�������/�����■�������������/���������■ ■■�■����■�����■����������������■ ■�����■�■�����������������■��ow� ■��■■�■■■■�■�■������■���������������■�■�■�����■�����■�����������■ ■��������■����■■��■■■���■■���■�����������������������■■���������■■ ■■■���■���■����������■��■�����■�����������������������������■��■�� ■�■��������■�������������■��������������■■�����������������������■ ■�����■■�����■■���■■�����■���■��■������������■�����■����■�■����■■■ 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