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503 Griffith RdOPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 1r �Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Michael Mitchell Address: 7210 Turner Creek Rd Cay: Cary State/Zip: NC 27519 Phone #: (336) 462-7258 *CDP Fite Number 187316-1 6x63-87-7687 County ID Number Evaluated For: NEW � Township: %Property Owner: W. Lawrence Riddle Address: 503 Griffith Rd GAY: Advance State2ip: NC 27006 Property Location & S i Address/Road #: Subdivision: P/0 5-3 Griffith Rd Advance NC 27006 Structure SINGLE FAMILY # of Bedrooms: 5 # of People: Water Supply: NEW WELL *IP Issued by. 2140 -Nations. Robert *CA issued by: 2140 -Nations. Robert Design Flow: 6 0 0 Soil Application Rate: 0 - 2 5 Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: one # Phase: Lot: Directions 1-40 East to Hwy 801 go North, right on Yadkin Valley Rd. then right n Griffith Rd. to the end. *System Classification/Description: TYPE III A. CONI! SYSTEM > 480 GPD (EXCLUDING SFO) SaproliteSystem? Oyes @No *Distribution Type: GRAVITY- SERIAL Pump Required? O Yes (DNo *Pre Treatment: Drain field 2 4 0 0 Sq. ft. 6 0 0 ft. Inches O.C. — + Feet O.C. gInches Feet inches *System Type: INFILTRATOR QUICK 4 STANDARD Installer: Martin Carter Certification #: 3027 *EH S: 2140 - Nations. Hobert Date: 1 1/.2 5/ 2 0 1 5 Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. 2 4 Approvra Inches Maximum Trench Depth: 3 6 ®Approved Inches ,Maximum Soil Cover. 2 4 Inches is sapproved CDP File Number 187316 -1 Septic Tank County ID Number: 5863-87-7687 Manufacturer. Shoat Lat. STB: 64 Gallons* 1500 Date: 04/ 05 /.2015 *Filter Brand: POLYLOK PL -122 With Pipe Adapter ST Marker 0 Yes 2 No Reinforced Tank: El Yes E No 11' I Piece Tank: El Yes ff) No Manufacturer. PT: Gallons: Long: Installer.. Martin Caner Certification #, 3027 THS: 2140 - Nations, Robert Date: 1 1/ 2 4 / 2 0 1 5 Approval Status , R Approved El Disapp roved Pump Tank Date: / / RiserSealed El Yes El No Riserftight: [:1 Yes 11 No (Min.6in.) Reinforced Tank: 0 Yes r-1 No 1\ �,Piece Tank: E3 Yes n No Pipe Size: inch diameter Pipe Length: feet *Schedule: Pressure Rated 1:1 Yes rl No approved fittings 0 Yes 0 No Installer: Certification 9: 'EHS: Date: Approval Status O'Approved 0 Disapproved -1 supply Line Installer: Certification #: 'EHS: Date: Approval Status ❑ Approved 0 Disapproved Pump Type: Installer. Dosing Volume: Gal Certification #: Draw Down: Inches THS: Thain: Date: Valves Accessible El Yes El No Flow Adjustment Valve El Yes 11 No Check -valve El Yes El No Approval Status PVC Unions [:1 Yes El No 0 Approved El' Disapproved Vent Hole El Yes El No Anti -siphon Hole El Yes El No CDP File Number 187316 - 'I I NEMA 4X Box or Equivalent ❑ Yes Box 12 inches Above Grade ❑ Yes Box Adj. To Pump Tank ❑ Yes Conduit Sealed ❑ Yes Pump Manually Operable ❑ Yes =Activation Method: Alarm Audible ❑ Yes Alarm Visible ❑ Yes *Operation Permit completed by; Authorized State County ID Number: 5863.87-7687 CICULFIG CUL111AIM11L ❑ No Installer: ❑ No Certification #: ❑ No ❑ No *EHS: ❑ No Date: No Approval Status ❑ Approved ❑' bisapproved ❑ No 2140 - Nations, Robert Date of Issue: 1 1/ 2 4 / 2 0 1 5 Owner/Applicant Signature: This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for Sewage Treatment and Disposal, 15A NCAC 18A .1900 et. Seq., and all conditions of the Improvement Permit and Construction Authorization. This property is served by a TYPE III A. sewage septic system. Rule .1961 requires that a Type TYPE Ill A. septic system meet the following criteria: Minimum System Review ByThe local Health Department: NIA Management Entity: OWNER Minimum System Inspection/Maintenance Frequency ByCertified Operator: NIA Reporting Frequency By Certified Operator: NIA Rule .1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract with a public management entity with a certified operator or a private certified operator for the life of the septic system. Rule .1961 requires that Type VI septic systems designed for a homelbusiness owner must maintain a valid contract with a public management entity with a certified operator for the life of the septic system. Rule, 1961 (2) (e) requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit for a system required to be maintained by public or private management entity, unless the system owner and certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibitit3es of the owner and systems operator, provisions that the contract shall be in effect for as long as the system is in use, and other requirements for the,continued proper performance of the system. R shall also be a condtion of the'Operation Permit that subsequentowners of the systems execute such a contract. @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC Drawing Drawing Type: Operation Permit s CDP File Number: 18131 I -1 County File Number: 5863-87-7687 27028 Date: Q Inch Scale: OBbck ©NSA 6 iII Ii'_ IIII il. illil a 54 ^L III°\v5... it I i .III _ V C o b-In 7 � .� i y 5� L. 7 1 bb ak4 a �� CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 187316 - 1 ' Davie Count Health Department 5863-87-7687 Y p County ID Number: 210 Hospital Street . Evaluated For: NEW P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 0 1/ a 9/ a 0 a 0 Applicant: Michael Mitchell Address: 7210 Turner Creek Rd City: Cary State/Zip: NC 27519 Phone #: (336) 462-7258 Property Owner: W. Lawrence Riddle Address: 503 Griffith Rd City: Advance State/Zip: NC Phone #: Property Location & Site Information Address/Road #: Subdivision: P/O 5-3 Griffith Rd Advance NC 27006 Structure: # of Bedrooms: # of People: *Water Supply: SINGLE FAMILY 5 NEW WELL 27006 Phase: Lot: Directions 1-40 East to Hwy 801 go North, right on Yadkin Valley Rd. then right n Griffith Rd. to the end. \SiMinimum Trench Depth: /Site a 4 Inches Classification: Provisionally suitable Minimum Soil Cover: a Saprolite System? O Yes (9 No —1 Inches Design Flow: 6 0 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 a 5 Maximum Soil Cover: a 4 Inches *System Classification/Description: *Distribution Type: TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 a s 0 Gallons *Proposed System: 25016 REDUCTION 1 -Piece: O Yes ® No Pump Required: O Yes ®No O May Be Required Nitrification Field a 4 0 0 Sq. ft. Pump Tank: Gallons No. Drain Lines rJ 1 -Piece: OYes ONo Total Trench Length: 6 0 0 GPM --vs-- ft. TDH ft, Trench Spacing: —9 ® Olnches O.C. Feet O.C. Dosing Volume: _ Gallons Trench Width: 3j Inches Feet — Grease Trap: Gallons Aggregate Depth: inches Pre -Treatment: O NSF OTS -1 OTS -11 Septic Tank Installer Grade Level Required: 01011 O 111 01V / Page 1 of 3 s ,.i CDP File Number 187316 - 1 County ID Number: 5863-87-7687 ❑ Open Pump System Sheet Repair Svstem Required: W Tey v Ivo v Ivo, out nab flvdndLJlt: J Kepalr System *Site Classification: Provisionally Suitable Design Flow: 6 0 0 Soil Application Rate: 0 a a 5 *System Classification/Description: TYPE III E. PPBPS GRAVITY DOSED SYSTEM *Proposed System: 50% REDUCTION Nitrification Field .2 4 0 0 Sq. ft. No. Drain Lines 1 0 Total Trench Length: 4 0 0 ft Trench Spacing: 8 O Inches O. — ® Feet O.C. Trench Width: — a R Inches Feet Aggregate Depth: inches Minimum Trench Depth: 3 0 Inches Minimum Soil Cover: 1 a Inches Maximum Trench Depth: 3 0 Inches Maximum Soil Cover: 1 a Inches *Distribution Type: GRAVITY - PARALLEL (eq. d -box) Pump Required: OYes O No O May Be Required Pre -Treatment: O NSF OTS -I OTS -II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. Characters 750 *Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. Rem'a�'�9 2000 This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit, not to exceed five years, and may be issued at the same time the Improvement Permit issued (NCGS 130A -336(b)). If the installation has not been completed during the period of validity of the Construction Permit, the information submitted In the application for a permit or Construction Authorization is found to have been Incorrect, falsified or changed, or the site is altered, the permit or Construction Authorization shall become Invalid, and may be suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, installation, operation, maintenance, monitoring, reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? OYes ONO Applicant/Legal Reps. Signature- Date: *Issued By: 2140 - Nations, Robert Date of Issue: 0 1 / 9 / .2 0 1 5 Authorized State Agent: =� T Malfunction Log OYes ® Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 2 of 3 • •J r • CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number: - 210 Hospital Street Count File Number: 5863-87-7687 P.O.Box 848 y Mocksville NC 27028 Date: 0 1 / .19 / .2015 O Inch Drawing Drawing Type: Construction Authorization Scale: , O Block Q N/A I I I ... i ....... - - I I _ ... .... - ... - -- I �! ! ........ -- - - - - f ... -- I D I I I , I .......... � / I I f ! i I -- _ - - -- . - _ ----4 -_.._ .._..__. ...... -� - - - ....... ... .. ...... ------ I II ZS �.' 62( ! Joe. ^7 - m ,As N U of (�ty ---- I � I � I I ! ! fI I I I i III _ I _ ----- i Page 3 of 3 P1 P2 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: P.O. Box 848 Count File Number: 5863-87-7687 Mocksville \ NC 27028 y Click below to import an image from an a �J ZA\ -f tr 0.1/-19/a015 \ �,�Cuho4 J` ,e a) Date: Anal IocatioS,: Drawing Type: Construction Authorization —,, -Fdvw 1 Pa�e3of3 I P1 P2 IMPROVEMENT PERMIT . r*, Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 For Office Use Only *CDP File Number 187316 - 1 County ID Number: 5863-87-7687 Evaluated For: NEW Township: Phone: 336-753-6780 Fax: 336-753-1680 PERMIT VALID UNTIL: 1/29/2020 *NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit. Applicant: Michael Mitchell Address: 7210 Turner Creek Rd City: Cary State/Zip: NC 27519 Phone #: (336) 462-7258 /Address/Road M P/O 5-3 Griffith Rd Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 5 # of People: *Water Supply: NEW WELL *S Subdivision: Provisionally Suitable Saprolite System? O Yes (9 No Design Flow: 6 0 0 Soil Application Rate: 0 a 5 *System Classification/Description: TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR *Proposed System: 25% REDUCTION /"Property Owner: W. Lawrence Riddle Address: 503 Griffith Rd City: Advance State/Zip: NC 27006 Phone #: Phase: Lot: Directions 1-40 East to Hwy 801 go North, right on Yadkin Valley Rd. then right n Griffith Rd. to the end. Minimum Trench Depth: a 4 Inches I Maximum Trench Depth: 3 6 Inches Septic Tank: 1 a 5 0 Gallons 1 -Piece: OYes ®No Pump Required: OYes ® No OMay Be Required Pump Tank: Gallons 1 -Piece: O Yes O No Repair System Required: ®Yes ONO ONO, but has Available Space Repair System *Site Classification: Provisionally Suitable Soil Application Rate: 0 . a a 5 *System Classification/Description: TYPE III E. PPBPS GRAVITY DOSED SYSTEM *Proposed System: 50% REDUCTION Minimum Trench Depth: Maximum Trench Depth: Pump Required: Page 1 of 3 3 0 Inches 3 0 Inches OYes ® No O May be Required CDP File Number 187316 - 1 County ID Number: 5863-87-7687 ` *Site Modifications ❑ Open Fill Sheet No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. Rama 750 *Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. Rema -g 750 The Improvement Permit shall be valid for 5 years from date of issue with a site plan (means a drawing not necessarily drawn to Site Plan scale that shows the existing and proposed property lines with dimensions, the location of the facility and appurtenances, the (9 site for the proposed Wastewater system, and the location of water supplies and surface waters). Plat The Improvement Permit shall be valid without expiration with plat (means a property surveyed prepared by a registered land O surveyor, drawn to a scale of one inch equals no more than 60 feet, that includes: the specific location of the proposed facility and appurtenances, the site for the proposed Wastewater system, and the location of water supplies and surface waters. Plat also means, for subdivision lots approved by the local planning authority and recorded with the county register of deeds, a copy of the recorded subdivisions plat that is accompanied by a site plan that is drawn to scale). The Department and Local Health Department may impose conditions on the issuance and may revoke the permits for failure of the system to satisfy the conditions, the rules, or this article. This permit is subject to revocation if the site plan, plat, or intended use changes (NCGS 130A -335(f)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, installation, operation, maintenance, monitoring, reporting, and repair (.1938(b)). Applicant/Legal Reps. Signature Required? O Yes O No Applicant/Legal Reps. Signature: Date: *Issued By: 2140 - Nations, Robert Date of Issue: 0 1 / a 9 / a 0 1 5 Authorized State Agent: OValid without Expiration? ®Create CA. ()Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT 187316 - 1 Davie County Health Department CDP File Number: 210 Hospital Street County File Number: 5863-87-7687 P.O.Box 848 Mocksville NC 27028 Date: O Inch Drawing Drawing Type: Improvement Permit Scale: , O Block O N/A ft. _. ( � LAN' ! _ _ l top __. -- -- ......--- -., �i ----- ---. ....... I..... --I- -,....... _ -- .- ----- __ ..-- __............ _ — - ------ -- ' I . ...... .— - _ r _.. ........ _ ... i - - .... _ } _.._..... -_ I _i If r I , If _ 1 I -- _ a _ I Q' I I I r% � Ta I ` vt a I 1�. ...... L Page 3 of 3 P1 P2 IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 CDP File Number: 187316 - 1 County File Number: 5863-87-7687 Date: .0.1. / 29 / a0 15 Click below to import an image from an external location: Drawing Type: Improvement Permit Page 3 of 3 P1 P2 D APPLICATION FOR SITE EVALUATIONIIMPROVE.MENT PERMIT Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-67801 Fax (336) 753-1680 & CP, Melt t -r Application For. PxSite Evaluationll.mprovement Permit L Authorization To Construct(ATC) L .Both Tv pe of Application: XNew System LRepair to Existing System i Expansion/Modification of Existing System or Facility :*'IMPORTANT"** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THF. REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION NametobeBilled fAtCi{ACi- MtrCtltt_" Contact Person tole-,fAC- M-TTIC ' CILL. Billing Address 72 1 f2 Te c- t.1 Q Ct?r tZ a o Home Phone 3 ,3 r. - t/ 4.2 - 77 2 5`2� City/State/ZIP C At -t -f rJ 41. 7 -1 SI�-r Business Phone " !2 - ec r ; - t c 2- Name on Permit/ATC UDierent tlian Above Mailing Address City/StateJZip PROPERTY INFORMATION *Date NOTE: A survey plat or site plan must accompany this application. Included: P'Site Plan RPlat(to scale) -3 G 5lG (Permit is valid for 60 months with site plan, no expiration with complete plat) Owner's Name r2 sQ p Lcf Phone Nutnbet Owner's Address :-,o3 tib Z . F f="s i-#4 4,7 o A O City/StatcMp A-0 c/A 0 e:r N e - Property Address --!5 ,4 "e - Ciry_ Ad >--/A t;x::,6 Lot Size P Aar -am T Tax PIN# ;5-66, > Ys 776 '_3"'j� � �� � - (� �� Subdivision Name(if applicable) Ail a • Section/Lot# t/f� Directions To Site: ells «^_ t F ta= t 7-r4 r2 o AaN 5 t". E A.rZ A ('. tit i--; a 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? f,)Ycs 440 Does the site contain jurisdictional wetlands? 1 Yes 9No Are there any easements or right-ofmways on the site? tlYes n No Is the site subject to approval by another public agency? Ryes S No Will wastewater other than domestic sewage be generated? GYes ANo IF RESIDENCE FILL OUT THE BOX BELOW # People t5 # Bedrooms 5 # Bathrooms 5' Garden Tub/Whirlpool MYes ONo Basement:4XVes UNo BasementPlumbine: 9Yes CINo 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: `fCConventional C.Accepted DInnovative CiAltemative t:.lOther. Water Supply Type: tl County/City Water XNew Well l::? Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ':i Yes If yes, what type? XNo This is to certify that tite information provided on this application is true and correct to the hest of my knowledge. I understand that any petntit(s) 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 hereby giant 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. I understand that I am responsible for the proper identification and labeling of property lines and comers and locating and tlag;Ang or st1king the house/facility location, proposed well location and the location of any other amenities. tai — Site Revisit Charge Property owner's or owner's legal representative signature j 71 It Date(s):. Client Notification Date Date EI IS: Sign given EYcs [..,'No Revised 11/06 Account Invoice P A !R «--- Grtiff� ep - -—_— �. B Ep RIM Onxe/. [officals p1/2"OP STATE OF NTN CARaiNA Op NO PIAW41NIG DO'ARTWNTAP.•ROVAL REOWtED. DAVIE COUNTY REGISTER OF DEEDS I COI;NTy OF DAVE I PLAT REGISTRATION J�I� 4 .-- . R.'W. Onko of '- D-4 C -1y, nr1lf, "I ro. a•aP r N�,t PLAmm DIRECTOR FILED FOR REGISTRATION AT O'CLOCK .n<n lois aeuP,mim k anp.a m..;. ai •tatutry r•Wk•m cote nearairtg !o -- _M, THIS, THE DAY OF 2014, AND .MM L 1tr.a K RECORDED IN PLAT BOOK PAGE �_.. 'um r- Rom 82"72ts Mae ntksns�ss R•Ne+ orn�. MM &q c c )A, BRENT SHOAT, REGISTER OF DEED_ IDs 73 M vo Dat• Jm P" rd su �'N' FILING FEE PAID. 3 t Road ao'YP+btb R/17 � `-----�-RL� BY: - ----- !R «--- Grtiff� ep - -—_— �. B Ep Lawrow VA A" RWAIo Wv 77"7 D6 $72 Pk7 4R.. CERTIFICATE OF OMVFRI41P AND DMCATION I h—y .otdy Not I em the a+nw of Ih• wwafly a..caw ..- .nxh 1. 1—t•a k e.+s iar�op y Wxtmn of b.4. Oo.nly pod Inot 1 ha+ky adapt int. wpOA Nn plop .7th y e•• —4 t,M::eh xkn LaHhg ••tb"k Sew a d.exol+ dl .tr+.i.(loads), 1.y.. walk. pack. eW alno aH•. a ---to to P.M. cr Prirot• P.• M pets& Lawrelw W. mda. Dot. body V. Rkta• Dol. . mI"F%7411. .. � -., i/. .1;/ ;. L ,/:._-I', { p1/2"OP /'\,� X11 L' f � 1. I :� \'• I I � I I ��`•-..ice/�� !!�;! /! ,+1, fr� J�I� ! P` Lawrow VA A" RWAIo Wv 77"7 D6 $72 Pk7 4R.. CERTIFICATE OF OMVFRI41P AND DMCATION I h—y .otdy Not I em the a+nw of Ih• wwafly a..caw ..- .nxh 1. 1—t•a k e.+s iar�op y Wxtmn of b.4. Oo.nly pod Inot 1 ha+ky adapt int. wpOA Nn plop .7th y e•• —4 t,M::eh xkn LaHhg ••tb"k Sew a d.exol+ dl .tr+.i.(loads), 1.y.. walk. pack. eW alno aH•. a ---to to P.M. cr Prirot• P.• M pets& Lawrelw W. mda. Dot. body V. Rkta• Dol. . mI"F%7411. .. � -., i/. .1;/ ;. L ,/:._-I', { p1/2"OP I ��`•-..ice/�� !!�;! /! ,+1, fr� J�I� ! P` pwift9 JUA& MM S7uf74692 PRELIMINARY PLAT _ — NOT FOR RECORDATION, ---'--0�:•E)R \ 1/2»Ppm CONVEYANCES, OR SALES NOTES: L PM A pWfl p pf 7863/77687 L A p.1W +f D/ 178 N 496 L Z."RA Minor. S�bd!A.ion «*" F191°E' ..IGLU. 1. �(�—L«— _..11r,naLtNt.w•t.p. Michael & Anna Mitchell ua.• LB' MM !i{Dt77N7 s7. 4 r. DD P4 6a.n ,nax my wpr�a':an 7ra,r:11an ect+m wnr rmar rtd• my w per sn (deal de.i,a E« a dad M soar GriNth Rood R.tr.60' -]Z➢.. page 49i 1• toot ta. pouedok. cot —"o Farm,n9ton Town.rtip, Davie County to TOW A—R,mt Aa,. Nal kw�-at•a a. ao.n Avm M,bm,of;pn faxro k Doou _ DW Ii0T1� toot M+ ratio of w•eakp a NORTH CAROL17vi =Wct*d s 1;10.000+: NM tni+ pmt .a 1—ma n 80' '.0' 0 60' 120' 180• LE6ENO up exuTa q 04"FDE c rdancs wltn 65. 47-]U as om•need; emtr•granq aS 4]-3(%ixlla this wMy I. a wompnatiw M ..2 tkq 9—.. nd Nen. •sr»ppn Ic M. d•INllin M- —� ESA EWT7N6MMk-9AR waatutorK Nat m• aakm P"UD q Syel•rn (.p S) SCALE DATE JOB / DRAWN EA% OM51INi A108 tn. a dA W..*wy fwmoun .a• used to pnbrm f0/X%/T1 0573 JCA/DCF ECM EXUTp10dommmAUM A10NJMBIT Em ( lTli NAf y W{71' RTK Nelwok prwsir• n ID/%N[/T14 8 10/%%/t 4. NA083 Datum I Epe.h 2011 / M0004: TIM E7aST" TRON'1• Ux 7RS SETPAVE M. e W P1 .fd NCGS I/ mwt 'xt(X VrA%%Y: 7 F•.l IM F Of d EOGs Of PAYERJ:N1' Cemd d Gid Factor O.IXNx%k a0 j /1�Y EC ME Of PAre' 9/W W4?-0FWAY Nlln+ts my srlRk,al .Ipnapr•, r•gi,tvtko npm6.' o' enc .ed Ini. YYxtn ea O.tob- 2Ct4. y llJl7 p T u• v E 12.6 mH PNK821)ERnY LATMNtri)UM - t o• -0- oymc.10VRLTf1' tt Vnuly POLE Latvw"W'plddk Deny V. Riddle alien Geomctic., P.C. C-3191) k( Lrswp tE PROFESSIOWAL LAND s:RVEYOR L-3810 80S SHffitA Read PO 8.X 89, Advance, NC 27008 (336) 998-0218 E TeLe"40NEFwESTA.27006 W W WA)IenGaomotice.Com i . - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section I Soil/ Site Evaluation APPLICANT INFORMATION ' PROPERTY INFORMATION M,Aad M I I 2A, Water Supply: On ite Well Community ! Public Evaluation By: Auger Boring_ �_ Pit d�� , 5 ' Cut FACTORS {hT PAT Atl_ &2t AR f Landscape position Slope% -- ;a 14 -1( HORIZON I DEPTH L ^ SGL Texture group L N Consistence r i0 YPh 'n t ik N Y ^ Structure 6 _ 7 2� Mineralogy? /�l/LE 5 /HORIZON gn�v II DEPTH ? S-- G I — Z blk /L cl d / U opTexture rou 5 C S S An cAk cg Consistence P(' �r ,y _ Structure / n.cs;.n k — Mineralogy 15 (_ HORIZON III DEPTH ! Texture group�D Consistence Structure MineralogyI HORIZON IV DEPTH ? 1 Texture groupI Consistence { Structure MineralogyI SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE i I CLASSIFICATION 1,UL LONG-TERM ACCEPTANCE RATE x.'15 s U• 2 ay%av� s SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: ClK REMARKS: LEGEND Landscape Position ? R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope, U`� CC - Concave slope CV - C onvex slope T - Terrace FP - Flood plain H -- Head slope Texture NgN� c�1: TT S - Sand LS - Loamy sand; SL - Sandy loam L - Loam SI - Silt �'� C 4 SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam I �NC(I� SC - Sandy clay SIC - Silty clay C - Clay E CONSISTENC Moist — C SL 5 Or VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely � firm SNC i NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic �— Structure S SC - Single grain '31,I - Massive CR - Crumb GR - Granular ABK -Angular blocky. '55I> f'f I �5 SBK - Subangular blocky {PL - Platy PR - Prismatic Mineralogy j :1, Mixed 1ot2: Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Q Y• L 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) r Property Owner: Michael Mitchell Address: 7210 Turner Creek Rd City: Cary State/Zip: NC 27519 Phone #: (336) 462-7258 For Office Use Only *CDP File Number 188208 PIN Number: Tax Lot #: Tax Block #: Evaluated For: WELL PERMI I VALID LIN I IL: 1/29/2020 Applicant: Craig Carter Builder Address: 157 Yadkin Valley Road Suite City: Advance State/Zip: NC 27006 Phone #: Property Location & Site Information Address/Road #: Subdivision: Griffith Road Advance NC 27006 Site Address: Griffith Road Phase: Lot: *Proposed use of Well: Directions If Other: Directions: 1-40 East exit Hwy 801 go North , right on Yadkin Valley Rd. right on Griffith Rd. Well Contractor Information Yrilling Contractor G / O Driller Registration CIL C Permit Conditions *Permit Conditions Characters Remaining 4000 Well location, construction and protection must meet all state and local regulations and must be inspected and approved by an authorized representative of the Local Health Department. The permit may be revoked at any time for failure to comply with existing regulations. The siting of approved well construction area(s) by the Health Department is to provide protection from the known possible sources of contamination. The approved well area(s) may not be changed without written permission from an authorized representative of the Local Health Department. No volume of quality of water is guaranteed by the Health Department. *Issued By: 2140 - Nations, Robert *Date of Issue; 0 , 1 , /1.)191/,.),0j,5 A� � � ® Hand Drawing O Import Drawing Authorized State Agent: **Site Plan/Drawing attached.** Page 1 of 2 Well Construction Permit Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Property Owner: Michael Mitchell Address: 7210 Turner Creek Rd City: Cary State/Zip: NC 27519 Phone #: (336) 462-7258 For Office Use Only *CDP File Number 188208 PIN Number: Tax Lot #: Tax Block #: Evaluated For: WELL PERMI I VALID LIN I IL: 1/29/2020 Applicant: Craig Carter Builder Address: 157 Yadkin Valley Road Suite City: Advance State/Zip: NC 27006 Phone #: Property Location & Site Information Address/Road #: Subdivision: Griffith Road Advance NC 27006 Site Address: Griffith Road Phase: Lot: *Proposed use of Well: Directions If Other: Directions: 1-40 East exit Hwy 801 go North , right on Yadkin Valley Rd. right on Griffith Rd. Well Contractor Information Yrilling Contractor G / O Driller Registration CIL C Permit Conditions *Permit Conditions Characters Remaining 4000 Well location, construction and protection must meet all state and local regulations and must be inspected and approved by an authorized representative of the Local Health Department. The permit may be revoked at any time for failure to comply with existing regulations. The siting of approved well construction area(s) by the Health Department is to provide protection from the known possible sources of contamination. The approved well area(s) may not be changed without written permission from an authorized representative of the Local Health Department. No volume of quality of water is guaranteed by the Health Department. *Issued By: 2140 - Nations, Robert *Date of Issue; 0 , 1 , /1.)191/,.),0j,5 A� � � ® Hand Drawing O Import Drawing Authorized State Agent: **Site Plan/Drawing attached.** Page 1 of 2 WELL CONSTRUCTION PERMIT 188208 � 4 Davie County Health Department CDP File Number. , 210 Hospital Street P.O. Box 848 County File Number: Mocksville NC 27028 Date: 01 / ,29 / .20 1 5 O Inch Drawing Type: Well Permit Scale: , O Block O N/A ft. __._ .__ I I � I i i I I _ i _... _... -._. .............. _.... - i _ .............. . _ I t ..... l ! _ _ ! L — {,Q -- - -- - - ..... ------ --�..- I i I I i ! I I _.. _ .......... - --------­ i � 1 - ...................... .............. i zl , ......................... ................... --------------- ................................­,­ ............................................. .................................. ...... ........ - 1 ..................... 1 i 9, P L ---� _ ............. I t�1 I ! I I ! i ----- ....... ........................... I ! .........._.............................. 1 i Page 2 of 2 P1 P3 WELL CONSTRUCTION PERMIT d Davie County Health Department _ 210 Hospital Street �p P.O. Box 848 Mocksville NC 27028 CDP File Number: 188208 County File Number: Date: .0.1../ -19 / a 0 15 Drawing Type: Well Permit Page 2 of 2 P1 P2