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1526 Davie Academy Rd • DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001673 Tax PIN/EH#: 5707-99-8039 Billed To: Richard Cartner Subdivision Info: Reference Name: Ryan Noble Location/Address: 1526 Davie Academy Road-27028 Pro osed Facility: Residence Property Size: see ma ATC Number: 4355 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 WASTEWATER CONSTRUCTION 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 com 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems" t shall in NO WAY be t en as a guarantee that the system will function satisfactorily for any given peri une � 1 g 5 Septic System Installed By: L Environmental Health Specialist's Signature: / f 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 IMPROVEMENT/OPERATION PERMIT Account #: 990001673 Tax PIN/EH#: 5707-99-8039 Billed To: Richard Cartner Subdivision Info: Reference Name: Ryan Noble Location/Address: 1526 Davie Academy Road-27028 Proposed Facility: Residence Property Size: see map **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 C�— #Bedrooms 1 #Baths DishwasherX Garbage Disposal: ❑ Washing Machine:0"" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seaatss� EIIndustrial Waste: Lot Size ��' Type Water Supply GUd/1 Design Wastewater Flow(GPD) ��W Site: New 0"" Repair❑ System Specifications: Tank Size hO GAL. Pump Tank GAL. Trench Width 4W' Rock Depth,.Z2' Linear Ft 'V Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISERS)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 ' S ecialists Signature: /�lr P 1� / Date: DCHD 05/99(Revised) rtarr'1 OB i t SNa Davi• cnuney envhea l tr+ S38 751 6786 P APPLICA'T'ION FOR SITE T,VALIIA'I'ION!'IMI'ROVE4IT�NT PERMIT&ATC Davie County Healtb Dt partment Environmental,Nealth Sevion P.U.Bou 0431210 Hospital Street MoelcavUle.INC 271123 (336)7:1-671+0!Fax(336)'X1.8786 Ap)hratioa yor: Stte F:vatuaur!mtm,:roventtn:permit �thorin fon To Cotracirt(A7 C) D Moth j •'•1NP:)P.ri4 ' H-F,APPt.tt;i.tlOt7 CAA76UT XS•PP.0=;,F.D t IMMS ALL OF TFE REQUIRED —� N1Y`kMATi,J l:S PROVIDED. R+hr to the INPOKh(.AT)ON DULLETIN for instnictlom. APPLICAN't"INFORMA'l ION Il3ilirr to be bills.! '0:ltact Yerwa • -_—� Nlb.�<..��-'� Ii-.%9 Addnge b (!� H:ste Ph -IV�O ilk i ,,:o isMont33(�9 1 Name on PnrriivATC 611%ii,8orim thm Above �i—.4laihnitdtrsss PROPER VY W_F_ORM.ATION NUM A survey plat or site plan muse a:company tlie application. (Penmt is valid for dll rrtar6i,.icls him p o ezpincon with comrttte p)at SccnAddrcssl5`LfrQAJ/t' r�.E' Ciry13� ;,1/G__T.M40-59 -7-!S-kU3_t SAbdi.isjon Name„•_.„___„_ —...._-----5ectoti/l.otrit !at Size 9.t/4! t Dircerinm To�%tc: I�:7atc lfou!e/T:uci)ity t:��r.+ers litprr.�_ __ ��vrp � �Ar� l i If:h:arstst;to any of the folinwme curt s u yes;.rhprntt.'rr 4mummliti.on rrntettx etuehed- —— } Arr•dteft any vibang wute`vam systems as ibt sAV ''.Yc Fmo C/o/a 1Sa a:m.or_tain jauis.t ;i nal"Wacdl? .3y. acro Me that u•y easements Or rr.I-%-of--w1Yf.A1!!)e.&ite? "We 1NO Is:Le uts su►iuet to aprrova'b••suothar 2AISC agr.-XY7 0,141 ETNo N'tll.•atx agar o•Lat dun a.yn•.tYRt avave GYt+ 140 F TF kESADEN Pil.).OUT TF E;BOX BELOW Pcoplt M Ha',ta rrsis P Batnrtwcns srder.Cvh/A'.Apool , f-nb j IHacetrrnt:=)1'sa o Aav::r:n'Plt"binj -_Ycs It NON-1t15SIDENCE FILL t O_UTFL;BOX B—OX�3111,07 TWe o; eooflu hg _ . coplelr t C Sial t _ 1i Cothtnwilei Shower: _ b Vrifrila _ I l Ev:mated Waicr Usage(gallom r,;r is a••--_ _(Attach docurutnta'ion of similar facility Warr ennsums ui a) 1 • :FOOLSERV1cEON1.ti: oSrna .--_.—._____—. .. ._.. � Type ty+tenr tquered narent4,nal "Accepted DInnn.nti•.•e ttA!rq"j.tnX '.rOlhrt,_ _ pater Supply Type:.1 counrytcity Wat::r New wel: rds:ing N-p L?cemmur.9v Weil Iia you amietpate addinons or atpansioe.of ttt!hrmty otic s.sttrn to itlmtme a to serve?•'t Yew 1f:1et,wku Type' Tnis it tp etttlfy that thb reformation PTO.ided on this aFpliGt•ort is true and cntrect to tta herr of o-y know!edge. I cede s and l at any PSn+altos)fit ATM)issued hetaafxv are wbjevl Us►wper;sion er M-vM4Lo-hr if the sre:i altered,the c.tetded use changes,or it tae in(trrmetwst submitted io tiffs soul:r tm ie ID):glee or crunRed. :undem;,nAtaor 1 es"rra,7000;W015—11!chit rs w.$"Off jrpm rout appheddeA. 1 etereby trait 12't of euty the Au•tmead Rtprtse:.tstive of be Dvie C runty Heath nepartnuttl to eundhheh n.et c++ptmtimis tr:t Low re` appy�el+k ws a•Kt riles vu tht above dmitbrs property bared in It..,r Cow d a.xtJ A&L._I.S•I X ._ _ I_...r :,itt Rt+'inn targe P.rpestnru--�� ro/atr'alegnireprec-A-wivetlinatxe D r�lir:l l.�efw:.t.ur.u4tr:- �at. i LH3 N.V. tn.n ntie.1'�� Aarncrua A-a— Re.iste?!0o Nvoiuek � �- 2 ' APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATCE=ENVIRO ,M;s Davie County Health Department Environmental Health Section I ' P.O. Box 848/210 Hospital Street � IMocksville, NC 27028 (336)751-8760 NMENTAL HEALTHAVIE COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. .a,P,A Gy'L- Contact Person c 1. Name to be Billed /L�� / A � Mailing Address �%J�y �� Home Phone City/State/ZIP /j c��r�t� �G��i7fT Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address +/ City/State/Zip 3. Application For: L7 Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: PKHOuse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People J� � # Bedrooms �5� # Bathrooms re--31 Dishwasher E3 Garbage Disposal W-Washing Machine ❑ Basement/Plumbing Basement/No Plumbing 6. If 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 Gell ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? IBJ'Yes 0 No If yes,what type? yid if Es/l7exeC ***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: / ��s WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # J/70�� Property Address: Road Name/f.�� 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. 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 to conduct all testing procedures as necessary to determine the site suitability. DATE �O�Od/ SIGNATURE / 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). Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. Revised DCHD(07/99) ��.-d ✓ Invoice No. �'6, CARTNER TH0MP_.3 ET AL J2 000 00 055 1526 DAVIE ACADEMY RD Mapp S M Bk Lot Sp1 000082513342 NN 98 D68-P8 ID NO: 4124000 5737-99-8039- DAVIE COUNTY (2001 REVEL) C FIRE CARD NO. 1 OF 1 9 .89 AC SR 1143 9 . 89AC 9 .890AC SRC= 4INS' • APPRAISED BY 11 ON 07/01/1999D V - - - LAS ACTION 19990910 - CONSTRUCTION !):•_TAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE E;_ SE4OD EFF. AREA UAL BASE RATfi REPL. COST NEW EYB AYB NORM CO UN CT. COND REDENCE TO - MARK �UBFLR* 4 PLYWOOD * 8 EPR. BUILDING VALUE X WL1* 04 S IL:� NO S HTG * 19 - TOTAL DEPR. OB/XF VALUE F STR* 03 GAE.T E * 7SCALE 1 289 STORIES 03 2 . 0 STORIES TOTAL LAND VALUE - MARKET 38, 540 RF CVR* 03 ASF 'ICOMP SHNG* 3 TOTAL MARKET VALUE - CARD 72, 710 INT W1* 2 WLL,BRD/WDD * 9 FL00R1* 09 PIN: * 4 FUEL * 02 OIL 7W00D/C0AL* ?-TEAT * 03 AIF -NOT DUCT * 2 TOTAL APPRAISED VALUE - CARD / AC` * 01 NON-E * TOTAL APPRAISED VALUE - PARCEL 72 , 710 BEDRMS* BAS-4F'JS-OLL- 0 BATHS * BAS-1F'JS-OLL- 0 * 8 QUAL DESIGN- DUAL*SIZE * 62 AVG 1 . 02 1 . 0095=* . 97 TOTAL QUALITY INDEX * 60 I---22---I I------38-------I FUS 2 I I I 0 I 2 I TYP GS AREA PCT RPL CS +--16--+ 3 I 2 PRIOR PERMIT INFO 3AS 1, 43" 100 45, 538 +8-+BAS 6 I I 30, 930 656 035 7 FOP , 314 IFOP I +----26----+ I 14, 360 FSP 208 040 2, 6391 I I I 8 I 45, 290 F'JS 1, 00s 090 28, 843 I I I +-12-+ I I I SALES DATA I I +---22---+ OFF. RECORD DATE fryPE Q// INDICATfiD I I IFSP 8 BOOK PAGE O YR IN. U I SALES PRICE 4 3 1 +-14--+ I I 18- + I I 1 I I I 2 2 I +--16--+ 0 NOTES I I UWNER FIREPL 2 PREIFAB 1200 +-----32-----+ 9-OBXF-NV 4 _ODE ( DESCRIPTION 4:.TH WTH UNITS UNIT PRICE ORIG AYB YB PCT. OB/XF DEPR. cOND TEVGOND VALUE HTD AREA 2440 24 SHED 1 27 19 513.00 1.25 100976 994 OS 0.65 417 0: (STORAGE ( l8 11 198.00 2.50 100 976L994 03 0.79 391 BUILDING DIMENSIONS BAS=W22S20W16S2F0P=W8S46E32N20FSP=N4E14NSW22S 12E8$WSS12W16N38$S38S16N24E22N36$PTR=El0FUS=S 38S32W12N8W26N24$W10$. TOTAL OB;'XF VALUE 808 HIGHEST AI1D U=_: LOCAL FRONTAGE DEPTH DEPTH ND COND OTHER JUSTTES LAND UNIT TOTAL LAND TOTAL ADJUSTED LAND VALUE LAND NOTES BEST USE COG:•: OONING /S I26 403 FACT RFLr—Tu T PRICE UNITS YP ADJST UNIT PRICE ICI.. 1_ - + + + + , , M3 , TOTAL LAND D.=A 9428 38540 M.;�RYNELL.TAX=,EPT WED, MAR 7, 2001, 3 : 51 PM INDEXED ON ' . (133) 5718 4s2 273 (11.88A) (1.53A) 7774to 124 i37 (15.79,A N 66812 A) •�.�� ''+fin;.::_ A (1.24A) �,�A < r't{ ��°t: i �f3zzzz Ys�lt-- Ur ;' r 156E ec •hhvwr+. `+Y4+.rWwW r `.rd{ r§ N w r z wr -mac. ION9 5344 'X DE:U r Sys' ' � '•�� t''J "�}r�l#•,�Fx ttrft�s{m�� off'i 1 a» �> 3 �J (9.44A) 8039 � Y - 1526 �Q.f�Sf I. %p i i (11.49A) 2790 �cp • r' 1 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001673 Tax PIN/EH#: 5707-99-8039 Billed To: Richard Cartner Subdivision Info: Reference Name: Location/Address: 1526 Davie Academy Road-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: —l-t '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 �. Consistence i Structure L 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: X/ 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 ois 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) waness-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Ii I ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■tat■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MEMNON MEMNONiiiiiiiiiiONS Miiiii ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ DAT BOUNTYRE LTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION P. 0. Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NC 27028 Phone #:. (336)751-8760 April 9, 2001 Richard H. Cartner 1454 Old Coach Road Kernersville,N.C. 27284 Re: Site Evaluation/Davie Academy Road Tax Office Pin : # 5707-99-8039 Dear Client(s): As requested, a representative from this office visited the aforementioned site on Apri16, 2001. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site,the site was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/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 RH/di