Loading...
174 Harrow Ln � ` . _ DAVIE COUNTY HEALTH DEPARTMENT ' ..�:, -_--...., , Environmental Health Section � �� � � U� P.O.Boa 848/210 Hospital Street � . �� Mocksville,NC 27028 -� (336)7S]-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002436 Tax PIN/EH#: 5769-46-9102 Billed To: Darren Burke Constr. Subdivision Info: Reference Name: Chris Waddell Location/Address: Leatherwood Trail-27006 Proposed Facility: Residence Property Size: 5.087 acres ATC ���b r: 3462 **NOTE** This�mprovement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AiTTHORIZATION FOR WASTEWAT'ER 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). THLS PERMIT IS SUBJECT TO REVOCATION IF STTE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type ` ��= #People #Bedrooms 3 #Baths Z-- Dishwasher: � Garbage Disposal: ❑ Washing Machine: � Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �i-'n��' Type Water Supply� Design Wastewater Flow(GPD) ��� Site: New� Repair❑ 11 � _ System Specifications: Tank Size �O�DGAL. Pump Tank GAL. Trench Width3�' Rock Depth�� Linear Ft.�O� och�: 3 �►sT���t� 3�c,�, I�sr� L�aES 9'0.e• +ti.,,.�. Required Site Modifications/Conditions: �l��� f�(}, �c.k� �� �� IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a repres tative ofthe 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.t 1 30 p.m.on the day of installation. Telephone#is(33()751-87G0.**** �Q . ' �I�' i�� �J („l n�t,s.s I,.S � /��p �% � P�`��`a �� �- �oas� N Po�r+ - �Fan�s I 3y'"3�'x{2" � 5""`,�• ►33' ►33' Environmental Health Specialist's Signature: ate: �"t � DCHD OS/99(Revised) • , 4 � ' � DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section ' P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990002436 Tax PIN/EH#: 5769-46-9102 Billed To: Darren Burke Constr. Subdivision Info: Reference Name: Chris Waddell Location/Address: Leatherwood Trail-27006 Proposed Facility: Residence Property Size: 5.087 acres ATC Number: 3462 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLJST 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 CONS VAL FOR A PERIOD OF FI YEARS. Environmental Health Specialist's Signature: � ate: � CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on ImprovemendOperation 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. _ � � Septic System Installed By: /��� `� Ov Environmental Health Specialist's Signature: ��//��(�/ Date:� V DCHD OS/99(Revised) � May' 05 03 02:2?p Darren Hurke 336-778-0436 p. l � � haa Q2 03 12:D3p davie eounty envhealth 336 751 8?86 P•2 . : a ��� .J C�,� t • A1'PUG���ON fOR SITE EYAlUAT1pN/t�1PROVF�IENT PEBNlT 8 ATC �� J Davie Counly HeaJth Oepartment �,_,,. /,�I n £nrl.ar�menta/slraldirSecdo�t Cif'J HLJ P.O. Boz E�B/210 Hoipital Strcet r Mockevi2le, NC 27078 (37G)751-8760 � •�rjMppATANT�•• SA29 APPLIGTSQN CAl�IIITOT 8B PIZOCSSS.� UNLSSS ALZ 1718 REQQIRID , 2NAOAIlhTION 25 PBAM1IIDID. ROEez t0 the 2�trWn11►TI017 SIILLSIIN for lustrnctions. � � � ya_ �..�e te f.atlloa� '�cont�ct rorwn tJr/(/C(�A �!N�� r - -f�v-•--� � . f„�Kailln4 addr�es ��,Q��' ��Z �• � � . ' 8ora Phon� �j.������p� . . v Kty.)Sues/uY �IC.Y�Y�kVYr� i1V���eusiwss PDoaa ��Yt'�tN'. ��'�'�rj4� ��. pa..e..rr�se/atc u a�t[�ec.e edan abo.. '•;�+�_-.. ���''� � w.lit�Aaa�.�. '•%�.�i__ '�dd1��3 - aqrouatziv :t t�...'�.. S�IlGZ'� � Applacstioa lor: 8it� tvaluation Smprnvemeat pe�pit/A1'C Both r�. srcw co�•�+te•= $oua '• itobila Itome Dusiaess Sndustzp otL�r r5. �If lesidance: �Paople _ � � 8adrooma �� � • 8�ttuooms _�,_ � D1�l�aahK Gaxypa Ci�P]J�1 `'M��hla9 Mae� s�rwa�a[/P11�oblaq , �aseMnG/!fo PI+mDing t. 1L au.iq�a�/Ip4u�C�•/OWr SO��Y-LyM • Deople • Sin]�n . . � Cw�ed�� • 6hn.•r� •9rin+1. � �Nae.z CoOl�n . � IY i00D$lQVICE: Y 8e�t� Sskia�ted Ntter IIaags 19a11m.per aarl . . � y�. iyp• oe.+ataz �upplyi vnty/City`� Nal2 Commuaity �L. Do ror oaticipde�dditionsor __ ..dN�tcu►is iatcnded lo scnr' Ves No:` lf ye;aVt t�pe? "`[M!'ORTANT"'CUENT::MUSTCOMPLL•TETIiEREQUIREDPitOPER7YINFORMA7lONliEQUES?ED � �� . BEIAW. Fit6tr a%,AT ar SIT�MAN AlUST BE SlJBMIJTED by t4e d:eaf ailY THIS A!lL1CATION. /� � ��7-� � ► ✓Properlr Dimensians: i �re5 'wR1Tl:D1ttEC7(ONS(hom Mx4svitic? 1'ROPF:RTY: ���[ I'az Urticr pIN: t� ��� / /��a. �Or ita ✓" �`C�C � A .y ��! a� L� ''�PrepertyAddras: ItcadName ���`+ �/tr'/— �;��p � � � � h�� if io a Subdlviston provide lpiormation,az foUows: _ _ ��i C. hGo�c..' Bo'I N�lYG�i1 L/�> .r_�..... Name: Sectiou: Bbtk: Y Loh �Ds�tc home eornert ttageed: �'�/ " � Tlus u to cer6Ty tliat the[e[otmstion pPorfded is eorrect to tht bat of my kaoerledge. 1 raderstand Ihat any peroo�(s) Issaal perca[tQ are subJeet u suspmsiea or nrocatioa,if the site plaas or inteuded use thaoge,o�ftlhc ia[o�nation submGUed is tMs appUeatioo is Wsified ur edan6cd!,�lro,aade►amnd d+�t I w.�►espsns(We jor aR cl6argesinurredJrw� tUis app('reatiou I,[ure6y,�[ve eowent Io tAe Authoriud Represeetative of�4e Daric Conolr Hca)tl�Drpartment to cnlv npon al�we datribed propury located in Aavit Coanly and ow�ed�y to eondncf ap tcsting prottdum x pecrssory to deter.nina the stte s�itab ' � DATE �'7 "D 3 ✓SIGNATURS �� THIS AREA MAY bE USED FOR DR�.WIIVG YUUIt SI'fE PLAN(Ine ude alI of tdc lullor►[np: ExFsting am!preposed �:.`/ property!lneasaddieneasiens.slruclur�s,sdbacks, andsepticlocatiou3). ��( Si(e Revis[t Clur�e ��� Da1c(s): � Cficat NaiAea�ion Da�c: � ��.� ✓ T�tIS- ' Sien tiren J Auount Na � /—--�� � Re+ised DCHD(07/99) Invoite Nlo.__��� ' , May' 05 03 02: 27p Darren Burke 336-778-0436 p, z • .Ma� •05 03 02: 09p davie county envhealth 336 751 8786 p.2 . ' �?� � �z5 `'� � s� s - :~z 70 �- - , � ":+- C. ,�f � 'L , � � ! _ _ r^`�yl.:Y h - , J� �y,'`-� --r _ c � � O .R _i, W � S 4 I � - � :�.1 - - - �'� � o-------- - -- ____ __ 5384 _ � � �' � ( Q�o -- ----- --- - —---- -- - -- 0 17� ' ��°-o - `' �r ' I �• _ - � ? �'� ` j ti� -5 08A:; 1. � � N ti :`9102,7 ^, \ � 1 - �,� � � � :r � 2 �. � \•;�- - � ' � .... � �. . .. - . _ ' i, �. . �:.: ; .. ;. � f, S ' ' � ' 1+ i G� 1�� .., f � ' _ ��� \ . .:- .. - ' :. �•.�. �.: ` 3 '- ._.. :121 „ : '124_ .., .' _ _ � �r��— �„�uel /�v�0 � � �� �� s� (4.91 A) 1732 � ��� 9.65A 5665 �� ------------ �<� � �,� 194 �y 52 63 (330) ,y� &� z +w � �. �S @`� � n �� ��� _, � a4 . �°fi� , a yy . � � „��;� �„�� A � � 8'��� "%��� � ���� y� �a� � Y� ` �'i`: �s � � � � t�,' u;.�% .�' „ .. , .:: ' �ly $j` t� �. .i//A' . ' b � . .� , . , �,: � "F ., f n�b 9 , ������ � E , ����� � �� ���'��� � �. � _ � � �. � �� �.-: , , '; , . , �s" ,�3 �j� ,� � 1; e ��, ������ �� (� �` �,. -� " ,_� � r �+� �' �r, u a , ,;,���' _ �3 ...�`. ��' �� � �„ � �, � �r' E , d. � ' '�ri' � k �'� � Ita �w �� '�; d w E���a w II r , _. �'"��p� ; p"E m v,��'� +�Pw�'�� q u v./ � a�� � _y ��" ' ' �� ... yy� 9���nMtl � ���S ��g�A � . � � � :.�� q �' �� �' -� � �' :. � � Z ��, fi �y,� �� »�. � �� �'� � � � ��L'� ��'yi,�4 / P � � . A,�j���k�.F�` �� is'3� F � ���A�bc,� :,� .a „ . ,`e; . �: �� a. � � � �z�`�� � .fi h � �� „ ��� m E � � y�S.w � q h� � �� �; �' �. �� ���^ � �:: ..�P4�'k�9���r �y, ��E � ��� � w� ,s v�'�k$'r•b s psr { � f �. rtv � �r: M�'�" � � -� E ��� / '� : i..� � �� $t. ":� � " � d 3�i '� � �A. Y ` � ��� ��� ���45,�a / /. �� � '��3 ,��'' / �,� rt� �� ec, ,,�„��� �y�i„� � w� �-� raµ �, ,d� ��%' ,� s y/ �, a�. ����-"��'�.:'3j 5 ����� 1,., 9 �A f�'y w' m k � ...:h, . , � � ' ; �� � -s � k � � f � 5 � ..� � �, S� ' / � /� ' fa. ra � ` , N � � � � ' � - � � �.,. u: �� y� � �i�'n, � �1 x�,r " � � �r ��u�Y�4�� � �� �. �� s .u'. � g v�,�`�'rx' ��#ai � .y ��r � '�, s T ,� � a�' A� k " i r, . 7t . 6" wt�' _ . �" y � � � �: x Sw w �w . ,� � �� x � �� q �t'', a� �'�"�� �}'� r� ��1 m " � - m � T m �. r:� ��� ri w �' � , �� », � ��i y � �" a r t,� A' �"� ,� �� � �� � ,.E. ♦�_«` _ � �'} �tlo a ,�',:. �a" yN �, �'i + 6���wa t a 5�'�,.,. � ;f� � ��� �; ; � x �"� : ' ..�._, �� � �,..;g � �� � P � � E N��,� � ^ � � ��' � � ��� � ���� t : _ 'S 5 1� Y{,,'..1� t.� , _ '����"` '�2� �"�`��.� i� � �'��x� ��� �� �,+�� v 'i ' ��If �f � «� � �. a'� � �"�. � ���,.. - _ x � � J� � � �� - ,� � � ��.�� 1 �; � ' �� � ' � �3,'� �� ���� ��,:. � F e ��+�� kn s,�� , f �r ���1 . ;>y� a. � ��� �� '� 7, w7� '�a� t��� � wa�� � . �� � � x � � � . '�, !�a �� � *F ��� t➢ � M sa , � ,� � �E � � � ' �� �"� ' � � � �' ry��� '�� � �� w�� ��" � w � �y R y�� ��"�a,C«F-'° �`��� �` A � ' � � �' v yi� �a� � y� � � �' %n '"� p '�� �{ �. „z�J�jw,� '�� �T: s� �:_.' °� = '�g'�. � � q{� � Y�* � _ . _ . ' �.;. � � � �y_ D�'`���,���, � „ n � �` �� � • ' " �ro� , �,,, i�+ �� ���Il��wt" t; I',��I , w h.,, , �'*' ,' '^v�,i°3 i' , ,� �� ,^ �ii�, .I �4 . , � _ � �� < r� " �� + � � , �.� �� , ���i� �� f'/ k i� ��� � ���-� ,-',� �"� �a , . �w�.� � � , � � ���'" �;�,��t.� ? "�� a� � ,� ���i� �n�, .. � �.: � ��°��:�. '�����, y�;�' � �� � �, ,_. � �' ��� ��� , Q�. E � � � �r ��' a� ����b' ����;� �.. ' � �� ' �v� - °� � �,;����;. � � ����� � �" ,�;��. ,�,�ti,f r � ,�� �E ��.:y ���_ �' , � � 4 .,�{ � ��x, ��` �� :r � � �����R� - � �,: ' � �) 3� � � ., ' . � � . � ' �,,+�{ �� A � �� b ;Y . �,',� � 't : 5 �� �y -� - v� �` ���.# ����,� e z , ' 'i i�1 ti� fl � � r� ��.. �, �' �, `�'a .� y���r� � . � .., � �„ �' �� �+''� . ��� � _ �i : , �' .. ;, .. G � :�+' f� �Z�� �� � � �-'� f . Ax ec €t ���' u� ,_:- �� �S' . `,�r����,����x . '���.. y,� ���.;y� ����� � � �� � � €� E� �� � � � w x�§.„r a �`�q� �� S'� �-'`� k �� /'�4k: '� � ��� ,�� y f ��1 �� �l'.;/ �� ���,. �w�� ��. i . '� N � 8�3 ' � ., � �;Cy �€""� ,�,.:, ��� �' '��, Y , � ,t�8 ��s� � �' ' � �- �9���� h,' � �i � :� �� � a�F. rfi 4 y{ I '� � ,:� �� ^i� �` � � ;p.,/h/�( � '�1i '� � � i-��' .. � j ��� 1�#� p i g� wl� r � ���� � ` � w�.��� ,�� ;� �''� ��,������`��,� +° ����, f r ��4, �2. x- "� � av�s � �d� �rr s Fr -. "S' � . n � � $�.�n „� at�:, �� i���� � "'�. � � ����� �� ��`, f � �, %���j��� �t�P��3 r� o ,� � a� µ� i �i � "• �Q ,�� r '.. � �.. ' � I r,,9���s,�'�� s� g � " �� ����.,;�,��. � �, � y��� ��, �„� r �`""�,. �� � ��l��i ;-x. � fi� ��' $� . r���: �"s3� ^ : � ���y� ;.`�'�l��x � ._ r���.,..�� �:: �/� �, ���� v ��f,.. k .i �+w t& , / � � i � �X y � g �. 'i rvi : �'�"� 3v" � � �n �r ' Y ..,��,,�"» .; 3 �� � ? J �� Au�"��b. 3 . . �'',b� F b y�F�/��j� ��.al {.� �� �. ,�::��� �/�. ,... . � % .� . '� � � � ��� ��� ��i ��'' �{J��n�:: �p�'lj'.,� �G � �$ ��,?$,�9�� ���/a"`�a��t{ � � �%/� A�?� � � s�"''� �� t '� y z�d�Fe�',`'�E �: � �z�s �s ; � $ ..� f�' �� a� � ���-'�&<- ' �.:r,l� � � . . ��a� �rt,. �J `� F� u t��„ ,"�z�'`�"*� +iz� � � �.� �:� � �' � � �� 3: �'Fu� '� �; �� �� ���� � '�y ���� rec����.�� �� ��° �e �xg�y��.`�, ���������#��/ �4 s �� � �„ � �.,, . k a � k� �, � � � � � r s � '� /� r � , �� � `�� "�� �5���;� + ��� 9 � � '� � �� � � a� � � ����a� ;:.�� � q'�� "�� �� � '� ��� � :. ,���a+�� a.���� ��� _ � � ��.� I� ��u , ��:.�� ur� ���. > �S, � i ��J�� �����ek� �3- i ,.��.b ��'�� �.�� ` �� z � i t�3 d„ c� s' � � � �� � ' ii�' ��� � ��� � � ,��'�,d'a�a y.� a a d �.� '�� ��,� � �� ' �,n E � ����,� x�w��� ,�" �y g � E � i � s h ���` ���� � r����, �a� E�i� � � � � � ����� 5:�3��w� ���� �� ���� � � �' . ��y��t/ �r 5 bE � �.. � r �3°��. � � ��s / . �'���y�� fe� ki � � '� i, � a��.�'�� 3 -�� �� ,� � '�f�, �, ���,� . �``� u v ��,� %� > :��ne L� �3 ' s. �y t 3�,. ���'��..�� ��"����i � �� ���� � , '�z 1 "�'���F` E�{.: � � � �1�" w.3s�� - ,�, ��E :v/� h :: �,�&� ./J$ n �a - � f�;� ie ��,.. � ���� a w ��a a�' �°�tl� � ,�� ,. �°"�,�;�.s��`°�1v" n� & �.t /� '��r y��, � ��� :E �w" �r a � : �� v ° R% � z�' a , t�'�y��, ., z .� ����i� i�s � � �� '�.�� '�f�'b� ff 3 r . �"[�. a�3 � � �. � � �w it� �. �� fd � ��, '� t o- � �' -� �` �� �` �?� a '. �,� �' 3s.-+ " j' - t ,�j�a ���ak'� �:.��"���1� �� :_���� €�i �, �� ��y# y '����> . 4�������.r... .�.;. �� �§�� �w �� � � y�/�.���E,.� ���a��� �;�9f� id �s���f ���- ��� �� ���,�.- - `� � .�' �ff � ,� :,,z � rw � �,: tt ,� � ��. �� ` � ��- E £ L� ��ty'��r ��,���.-- � � :. :��r v ��%���f E?� �f , 'fiu� r, � �' � ����'a#1 �. � � Y�y�w. � �� �# ; �" � u�����x+�i �� ?� a �� . �u ���'� �� � � '��. �'.z�,( � � u � ✓id � � i'�'�``� �' r� � �,� . �1'�. - fb 3 :. s��� 33� /� R�€� �'�'f z � �ez�� �` � ���� ,v� � .. m �� � �.t� �a ffi � *�y . ���� a�e��'�tys ��� � � �, � '�.=�� t �y y� � '�` ;� ,v�, ��-� � ������ � '-;.� �, �.� '��� � "�, g,,, a�,. .:�- L.'�'�, ;� �- �.. ' • � f � ...___ . ., . ......,.,��.u•uu�cmtril rtliMU 1�cA1C 2 2 �n ' . ., Davie County HealUt Department �5 � 15 0 V � , , Envfivnmental Healdfr,Se�fon . D _ , . . ' , ' p.O. .Hox 8�B/210 Hospital 8treet � ., . , : . �s,►iiie, xc 2�o2e . . . . � DEC 71999 � �336�751-8760 •**2�T1�NT+►** TAIS APpLICATIO� d!lfiPDi' ffi PI�OCSSSED UlQLESS ]+LL �'� IN�'O�TiON IS Pit�OVIDED. Aafer •to the I�i�TZON BOLLSTIN for inatruations. , ���� �. �� � �. ���.� c h r;s ���-� �,�� � C h��� t��f 1 �� �. P.o. f3�� a� � �. /�,� '���-g�a�o . a�i8�ti.iz:p Cl e�,rnn�,o►►� �C �,7 a�a,- ��„ rh«» 133�> 7�5-oaQ7 �l�a� Z. Ma.. oa p.ateh►sc i! Ostreraa�e than 7►bwe 1taili�q 1lddca�a City/8tate/L1p �. �,siiwscioa ior: t�Ysita.Evalaatioa 0 Impsovesannt l�asmit/!►TC U Both �. srstan to aervio.: [�"Honsa 0 Mobile Ho�e U Bnsiaess 0 Indnatry 0 Other e. It Resideaaa: i People �- f Badrooms � # Batbsooms � Q'Dishvasher 0 ciasbaqa assposal 6 xashinQ wmlta. 0 sas..eat/almibse�q @'sa�em�s►t/no rinabsaQ i. i! Basineas/Zodnstsr/Of�ar: Spsailp �ypa • people / 91N�s # Cac�odea ' f 8howers f urinals ; Nater 000lars . Ip ?�'OODSEAYICS: � Seats =st3matad Aater OsaQa �qaiions par day) . 7. �p� o� Mitar s�ply: U Conaty/City ld'ifall � . 0 Com�ity • e. Do yoa�ntkipak addidans or espanaow ot t6e�icitit�r t6i�sydem b iatended to arve! 0 Ya �1'�l0 U ya,what type' ***IMPbRTAN7'""CLIENTS MUST Cti�llPLElE THE REQUIRED PROPERTY 1NFORMATION REQUESTED BELOW. Eitber a PI.AT or tTB PI.AN MU BESUBMIITED b the clknt witb TNLS APPLICATION. G�rf'' � /��'��.�` , Pr+operty Dimewion�: WR1T6 D�tECT10NS(trom Mocksville)to PROPERTY: Ta:OtRce P1N: # '� ��e 9 — 7,(�l�3/",�_ �v �n - �'h �Dr.t/a��- --, � '��' Property Addras: Road Name� City/Zip � ��S�,t,���� ����� � 1�io a Subdivi�on prnvide information,�1'olbw�: � Name: /� . ., sauon: B�oc�c: t.ot: nate Pruperty Fiaggea:�- .-- ---- _��-�'�/ -- This i�to certifT tbat t6e info�m�tion provided b eorreet to t6e bat of m�kno�kdga I anderstaad t6at uay pesmit(a) � issaed ber+eatter ar+e wbject to mspmaioe or revaaHos,it t6e tite plan�or iateaded nx change,or if t6e In�ormatioa submitled in tbi��ppiicstion i���laitkd or e6anStd. I,also,a»dastaird tArat I anr�ponsTbl�jor all clia�ga lncrrmed from fliis apptk,�,fon. I,6er+eby,give tooteot to t6e Aatbo�iud Repr+aeaitative of t6e Davie County He�alth Depavtment to eoter apon a6ove desc�ibed properry laated in Davie Coantp aad owoed b� _ to condnct all te�ag pr�ocednra�u neca�ary to determioe t6e dfe'ai�lit�. DATB foZ-'�-9'r'1 31GNATURC� � aT/' TH13 ARLA 1NAY BL U$LD l�'OR DRAWING YOUR SITE PLAN(lncinde aii otthe toilm►iog: L�dng and proposed property Ilna and di rirnctura, setbuks, and teptk locatioa�). $�S4�r P�� � 8,� �n� � � � ' � � . Accoant Na ��' � ` .2-� Rrvbed OCHD(07/98) N iavoice Na �'�"I __.... ... .. _ . . - . � , DAVIE COUNTY HEALTH DEPARTMENT � ' Environmental Health Section ' Soil/Site Evaluation � APPLICANI'INFORMATION PROPERTY INFORMATION Account #: 990000892 Tax PIN/EH#: 5769-46-6372 � Biiled To: Chris Waddell Subdivision Info: Reference Name: Chris Waddell Location/Address: Harrow Lane-27028 • Proposed Facility: Residence Property Size: See Map Date Evaluated: �� 7 � Water Supply: On-Site Well �/ Community Public . ; : Evaluadon By: Auger Boring, Pit Cut � FACTORS 1 2 3 4 5 6 7 • Landsca osition � L L Slo % � - 1 HORIZON I DEPTH _ �- �C O � Texture rou P 5'GL Consistence' S i� rS Structure � � � 5 Mineralo / HORIZON II DEPTH rG } $f ' 2 [� '-2 Texture rou � • ;G Consistence r S ;S Structure .: 5 - Mineralo . 1•` l + HORIZON III DEPTH -N� 7_c�- � Texture rou Sc G�- ' '"`� Consistence: � SWCture i , Mineralo � i. HORIZON IV DEPTH Texture rou Consistence . .Structure i Mineralo SOIL WETNESS � � RESTRICTIVE HORIZON • SAPROLITE CLASSIFICATION� � tJ LONG-TERM ACCEPTANCE RATE ' b.3 SITE CLASSIFICATION: � EVALUATION BY: �V� �J..l�-�.-1/ ; . . � c�"a�s►�b�� LONG TERM�ACCEPTANCE RATE: �_J OTHER(S)PRESENT: REMARKS:� �..��LL .J�..� 'ro p�r�P FP�.: �P�a�� �� s rr� -ro oP� �.� 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 i Texture � S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt i SICL-Silty clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC'-Sandy clay SIC-Silty clay C-Clay , � CONSISTENCE �.: M is `�" 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 � ; . � tructure j " SC.-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky � SBK-Subangular blocky PL-Platy PR-Prismatic , � � ; � � , Mineraloav 1:1,2:1,Mixed � � Notes Horizon depth-In inches ; Depth of fill-In inches I 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 DC�ID OS/99(Revised) j . ■������■■�■���■�■��■�■■�■■�s■�■��■��■�■■�����������■�����■�■■���■■ ■■�■��■■��■�■�■��■■�■■���■�■■�■���e���■■■■���■■■���■����■��■■��■�■ ■����■�■��■�■s■��■���■■��■�■■�■■���■■■■��■������s���■■�■������■�■ ■�■o��■����������■�■■�■��■��■�■■ ■�■��vo■��■�■■■�■��■�■■��■��■��■ ■�■��■■�■�■■��oao��■�■e■�■��■�■■�■o�■■■�����■���e�e�■■�es��e�����■ ■�o�■���■��■■������■��■�■■�����■�����������■■������■�����■�������■ ■�■�����■■��■�■■■�■■�■s�o■a■�■�■■��■�■■���■■■��oa■v■�o�e■�o■���■■■ ■����■■■�■e■e■■■e■e■e�■��■�■■��������■■�■�����o�s■�we0■es■��e�■�■■ ■�■��■������■■■■����■�■��■�o■�■■■�■�■■��■�■■�����■�■�■�■������■■�■ ■�■��������■■■o��■����s��■�■�eAo■�■■s�o■�������■■�■a�o�s�■�ooe�■�■ ■����■�■���■■■■��■�■■���■����■�■�■■���■�������■■��������■■�■�■��■ ■�■��■���■e■�■�����■��■�■�■���■■ ■�■����■■�■■■���■�■��■�■�■����■■ ■�■e■■■����■���se��■e■�s.s�se■■s�■■■��■■■■��■�■�■s����■��vo■��■■�■ ■�■�■�o■�■�■■����■�■�■�����■�■���■■��■�■�■��■■■■���■��■�■■�■��■■■■ ■�■■��■■���■�■�■���■�■■��■�■�������■�■■■�■����■■�■�■�■��■����■■■�■ ■�■■��■■��■■■��■�����■■����■������■���■■�■��■■■����■��■�■���■����■ ■�■■��■�■�■■■■■�����o■��■■■■■■■■��■�■�■��■o■■■■.■��■�■��■������■■■ ■�■��■��■■■■■■������■■�■■■■■■■■■■��■���o�■■��■e�■����■■■���■���■�■ ■�■��■��■■■■■��■■�■�■��■■■■�■■■■�■■�■��■■■����■�■��■■��������■��■ ■�■�����s�■■■■�■�������■■■■■■■■■ ■��■■■■■����■�■���■■■■�������■�■ ■�■�■■�o��■■■■■■��■■■��■■■■���■��■■�■������■��■�■�■�■■■�■���■��■�■ ■�■�■■�■���■■■■■■�■■■■�■■�■���■�■■��■�����■■■■�■�■�■■��■■��■■���■■ ■���■■e�■��■■■�■s�■■■■��������■��■��■��■■■■����■�■�����■����■��■■■ ■���■�o�����■�e■��■■■�■�■�■���s�s■s��■��■�■�■■■■��■���■■��■■■�■�■■ ■■�■■������■■■�■��■■■■�������■■■�■�����■���■�■■���■����■��■��■�■■■ ■■���■sv■■�■■■■■■t�■■■o■�■■�■■■■■��■���■■���■■■��■��■■��■■■��■��■■ ■��■���■■o■���■o��■�■■��■�■��■■���■�■■■■■�■o�v�■�■�o�■n���o■�■�o■ ■■��■■��■■■■■■■■■��■���■■■■■■■■■ e■���■■�■■����■■���■�i�n■■■■��■�■ ■■�■��■�■�■■�■■■■������■�■■■■■■■��■■���■■�■����■■■���■���Y.1�■��'��■ ■��■���■■�■■�����■��■■■■■■■�������■�i■■■�■�■��■■��■■��r��1I�l���■■■ ■■■■��■■�0■��■�■�■■���■■e■����■���■i������■■����■■��t�l�r■���i�■0�■ ■�����■■��■�����■���■�■��■��■■���■■�■■■��■�■■�■■�■�vj�l��������■�■�■ ■■�■�■e■��■�����■■■■■o���■�■�■�■�■��■■�■�����■■■��s���■���������■�■ ■����■■��■■■�■■�■���■��e�����■�■�■■■■■�e��■���■■■�'�o��►��■�����■�■ ■■■��■���■������������■■■���������������■�����■■��■������■■���■�■ ■�■�■■■■��o�■����■�����■�v■■���■ ■�■s�■��■■■■■■�����■■�►�■■e■e�■�■ ■�����e����■�■■■■������������■■�■■■���■���c��■�■■�■�������aa■■■�e■■■ ■�■■■■■s�■���■���■■■■���■�■���■e■■�■���■��6:��■��■�a�����r■�■■■�■■ ■o■��d����■■���e���■■��o�■��■■��■�������■���■■��■�■���■�■�.■■■�■��■ o■■���ea■�■���o�■������■��■�■�■■■������■■���■�■����■�■���■■■■����■ ■■■■���■■■■■■■■■■■■■■o�■��■�■�����■���■■■��■■■■��■�■������■■����s■ ■�s�■■i�e���������t�e��■■■■■e■■■■���■��■■■��e■■�■���■��■���.�■e��■ �iiiioi�iiisiii�iiiiiii�isiiiii '�iiiiiii�iiiiii�iiiiii�iiiiii� ■����■o�■�■��o���■■■■■�����■�■���■■o■�■���r�n�����o■�■�■�o■■����■�■ ■�■�■�ta�■��s�■�����■■��■��■��■��■■���■�t���:a.-������■�■��■����■��■ ■��■■�o��■�■����■��������������■�■���■�■�■������a�����■�■■�■��■��e ■�������■■■���■�■����■s�■■■��■■■�■■����■�■�■������■��:��■��■����■��■ ■���s����a■�e■■■e■■■■■■�����■■■■■���■�■���■�======���■��e����o■�s■ ■�■■��■��������■■�■�■�■�■■■�■�■■■�����■��■i�����■�■o��■■����■■���■ ■�■■��■�a����■�■■���■�■■�■■�■�■���■�t■■���■e��■��■■■v��■����■■��■ ■o��s�■■�■■�■■������■���■■■■■■�■ ■■���■■���■�n■■���■��■��:����■��■ ■■■■��■■����■�o���v����■�■�■v��■��■�s■���■��■r.;u���s������,�■s■�.�■■ ■■■■�■■���i���■■�■oe■■�����■■■o■���■■��o■■�■■�■i�■��■■�■■i■■���o�.■ ■�■��■o■■i■■►�■������■■■�■�■■�����■���■■��■■�■�■��■■���■■�i■■o■■�■■� ■s■■e�eereae�■■�es�■�■���■■■�����■��■■■■�■■�■o■��■����■��i�■■■■�■�■ ■■�■■�ei■�■■�►�■��aoe�■■■■����■■■■���■■��■■�■■�■�■■��■����i■■��■■��■ ■■�■�■�����■���■�■■■■■■�■��■�■■■��■■■��■����■�t�����■����t��■■■��■■■ ■■�■■■■■����■■a�■■■�■�■��■■■■�■���■������■�������■������i�■■�s��■■ ■s�s��■■�t�■■����■■s■�■se■�■■■■■ ■■��■■s�■�e■■■■�■�■■■�r�■���e�■■■ ■����s'■�►�����■��■■■■■■��■�■■�����■■��■■�■■��■■■■es��■■���■��e�■■■■ ■�����r.����■��i■�����■■�■■���o�■�■■�■���■■��■��■■���■�■.����■■���■ ■���■��c���■��■■�����■■�■�■��■■■����■��■■��■■����■��■��r����■■����■ ■■�■sasV��H■�■�o����■■■������■■���■■■■■■■��■■���r�■■■�■■ro�■■■���■■■ ■��■rin���u�le�■���■■■■�■��■■■■■��■■���■■�■■���i��■■�■���.�■■■����■■ ■■�■f�ti!I�fi1��7\ir���■■■■■����■■�■v■�■■�■■��■■�■CLi��■�i.7!!�f/Iv�■ie■■���■ ■■■■�f�<!�!11f1�■i��■■�■�■��■�■■�■��■��■■���■[IIIIL������i/li\�1/���■■■���■■ ■■����■i�r��■��■■���■�■��■����■■ ■■���■�i1\�����■�■�O�I����■■���■■■ ■■■a�■�s�■�■��■■�■�■■s■■■■��■■����■os��►�■■��■��■a■�����■■����■��■ ■�■�■��■�■0■■�■■�■���■■■■■��e■�■�■■■ri�L����■■�■�■■■■■o�ri�■�����■■��■ ■■■��■■��■�■��■■�■�■■■■�■s����■e��■�:����■�■��■�■■�■■����������■���■ ■■■��■■��■�■�������■�■��■�■�s■■��■■���a■��■�■■��■�■�■i��s�����■����■ ■�■��■��■■■��������■■■�■��������■���i�■����■���e���■��■■■��■���■■■ ■■■�����■■■■��■�■�■■■��■��■■■■�■■���■��■■�■■��■���■����■■��■�■■■■■■ ■■�■■��■��■�■��■■���■�■■�■�■■��■��■�■�■��■����■a��r��■��■������■■■ ■■■�a�■■■���■■���■■���■■�■�■���■ ■■���■��■���■■■�����o■������■�■■ ■�������■■����■����■�������■���■��■■■��s�■��■��■������■�■■����■■�■ ■��.�������■���■■��■�■����■■■��■����■■■�e■��■�■■�r��■�s■��■����■�■ ..����.-_����■■���o■�■�■��■�■�■�■��■�■■�■��■�■��a��■�■���■�■■��■��■■ \�\�I�'�`.���\■���■���■■■�����■■��■��■■■■���■�■■\■�/i■■■■�■��■��■■��■■ �!��%�:llfl■�■�\`\����■�■■■��■��■�■■■■■■■■■���■���r1���■�■i■i�■■��■■�S■■ �/:�/f�L'!:Ll7�!f■�\���■�■����■�■��■�■�■��■��■���■!\l li�■■�■��l������■��■■ '��i�L!17rriJ��■���■�■����■�■■■■�■���■����■���1%i��■■■■��■��■��■����■ ■��■e��■������►�■���■��■e■■�■■�■ ■��e��■r������■�e■��■■�■■��■���■■ ■■��■���������,�����������■�■o■■�■�o�������ti�■�■■■�■■�■■��■�■�■��■■ � � • %� v `,• �,,.-/� , � natl d� cop M �nt�r ot rood S 83•p�3. �N�T, QATA ' N 44'3H'32' E ilg�� E y ISTMlCE 136,16 76.71 N 46'34'08' � �°n %R� "227.33 122�10 81.�40 �. 84.1� N 50'48'31' E �' 123.03 ��� 111.71 ,;�„ Y0,• 17'.Be 312.95 , 185.93 � N 55'20'20' E � 127.17 � ';�°��� 116.44 \ ; � . 203.13 '`'.7.. �''_ 1?."1.92 N 60•32'IS' E \ ,•Y1. �,. . f 24.07 ' ' 144.'99 \ , 80.72 �x ' N 65'18'02' E � ' ` Y e"Y ,' ��, 158,52 \ .,��' •' 184.74' � , ,p .•'/. � 41.7� ' �' .' / , ��: � �, , ,•; ��, �,; �? ��R� � ., � ' .�. � X� �.f�•�� . '�' , � °'�. '!:) . ��'O6 �` � �.. i . s'•+ f �/ 214.73 '" ' .1� chonnN yoq fW ���1 .'' +-N 88•22'OS' W.g nd 233,Bl T�TAL.•'� � 986•]1 � ./,%/� -,.�' •�2, ��� ~ N e4•08'46' V O� � •• . � �^,:• i" �,�,_ �3�� ��M'�.R OF /�•r- ' CENTE:R OF ��pppSE�50 � :.� , ED E��' � � ���; 6 � ;; � /� � � ��tr �� i Og�� �' `V '' �� � JAM�S E. NANCE � i � ��� s' � . , ' /�'� '(�. . �. ��' D.B. 137 Pg. 249 ' '� .y ;, - �, �.t;�4 " a� D.B. 137 P . 245 2nd �,, , g � r� ti. 9 � tract) �� � ,� 3.'�. , D.B. 137 Pg. 250 , ; � � �`� � +�r �, w . : � <� . �: , , , , , x �� �t �'�� ��;.,� � ,��-� ,��;� � , ,�.� n � lJ � '' '��9� �'NIS . 3�{� 1.�.._ � a� ,�E � 1 £i i P�1 r'� 'Y�I ��'7t 1u 1 °r ' I � % � �� . �c-' .p ; �.�y � . i�` !�'.� , ., .. � . �.'t.1k"di:y� �. . r., . . J2' . +i��i �2�' ( . b�s ,� - I ,... a�4 t���� .� ,;��+,7��� ' 7'i� f' y , �� � , is, -DUKE�'`POWER �CO. . ,+�� , � • � �� �J E. 9a���Q ��� ��� ���: r�>> . �" • �,; �• ^� •. iron 9vw�d at }�,• c ' �`M V � �`4� r«,ce QOR,.r ti:, E �. . � ChAP��y ``�^, s s9'25'S9' E --� -- - -_____..�__ � z 1 Pn Yo-, 1 s� :r, -, „� ♦L�V�! v I ` / / I• �- ` _' -- - � . � _ . � '� W -� � , ,.,\ ��� � :- � w -',�`'°t. �' ' / � / \ y� � . . � � � .� � �� - �� �y�� „ . � � � � � � � ��p a.�� ,. . ,,�. . � __ , .__ ��� � � � "Y.�� . ,.5- � � � t� � �, .,� ., nHi' i�n on ot 12x 1 �� \�� 'rt,��`' � ��� � ►.bar tound �� .. . �' ACRES , -�. � n�. ,� ti �� d ��, � • ' . , . (1liCLUDES DUKE rOW�: R,�M� _ � �;�15.00 409.16 ti`d� �� , , �!. �y �N 17 08 11 E � � 39 b �.� � ti� . J �'• : 65.63 ��' 'i `�� •� N 84. 4. y�`�b�' '�� o� \ ' 1' so1M Iron found ' �+ _ i � f! � f 49 ��'ti�' .c�2'1�� �'J { ',; �1'�, ,`'/' N 17•08'11' E � .. '+ '�. " Q" S 3 62 8g 3' u � '°�`�� .�ti � .',� ���i i z4,ze � � � � � �''� � `� � Q�-° / � rJ. ���S 30'�56'02' V � ' �� � �_ � � �,�titi~~ rebar found . ��� � , t �-- 113�32 , � : � � � � - � � -• �� �S 2927,3�• u J � � � ,, � : � � �_, �'�,� �� �S 47'S1'10' W p . \ � ! ner lron on �'�. � � �• 89.79 .S 6��� �.., ,h�: \ � propsrty nne��.•'_ dy� � /��S 4�4'11'37' W .64 . �S�• f� �'�'• � \ r � . �� �•. � , C,�v �. 155.Ol ... 6 .�' �' , �, . � � �p� .�tip� . v.. �e�... �.f+, � , I--�-S 09'S8'03' E ��, � ' � ��\� .h� ��ti�, \, � 92.54 N . C1;' � .. ...�,... � � �� �`��+ � .-.�o .k O,P i �S 03'�45'S2' .W• O L9 • . . �- � � 141.�4• � �bmatk�d.Dolnt, .` '�S O�.� �Li l _� L1� t � �� ' � j � '�G� .•�' .(tr�x{ ,�orn.r . . . . . �F \ :�' �w�. ' `� ��` .... . c�� °'�, �, � ,� .,� .�r. ...� � JAM�S � JAMES E. NANCE o,l;�,, ���cE:r� oF � � r ��. ..�. • _� D.B. 137 � D.B. 137 P �'' ':� y P��oPosm � � , ��f�� " � a `� � 4b� (see als� 9• 2438 ��;f '��; so' �seM�rs � o \ ' � � ti ti o � .,, � � ;o; , �G � � �9 yt. `r6'. • ,9' �� ; ��.j; ,''ir \ �tn � � �' ��� '9�f,9 0' � ; ! h' - :� ° `� �rc o � � � � 'F�`�.` ��°�'` �''`,�',fa. I :� �� : � �� `� v' � Q'r���'h �a� ` � � �ti�. � � � ,�y� \ `, `� `' P�,��'�'� ,,, � ` iron found : I • . 1 1 � ,Q0• , �- -- __" '- - • : _ 1 1 ' ; � 475.72 ` ' , � rsbvr "`' ►� '?4•35�-___" 42"y----._.-�,,.�_ � round Z• �ro JAMES � 20'x20' Wq7-�R UNE ..�,.�---�►-_._ n tound f� E. NANCE ! eAse��rv-r . �►«�� � �, � '�__ti _ -' _i � D.B. 137 Pg. 244 I ' , � (see also D. Pg, 18! �"• � B. 81 I r `� A� � JAMES E. N�NCE � fs �' rs �'9- � D.B. 137 Pg. 247 � � 9r'9_ �s��a�. � : � , � y � � ; 1 � 1 � � � ; • a ' r y , • � . Z�avle County,�fealth Z7e�artment E�rvtronmerrtal,�fealth Sect�on ro�s4s�no x��r�s�c Mocksville,NC 27028 Phoir: (336)751-8760 December 21, 1999 Mr. Chris Waddell PO Box 23 Clemmons,NC 27012 Re: Site Evaluation Harrow Lane-5 Acre Tract Tax PIN#: 5769-46-6372 Deaz Mr. Waddell: As requested, a representative from this office visited the above site on December 17, 1999. 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. The proposed house location will require setting a pum�p station. Before a representative ofthis office will revisit the site to issue an Improvement PermidAuthorization to Construct the appropriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. . If you have any questions, feel free to coritact this office at (336)751-8760. �Sincerely, JeffG. Beauchaznp, R.S. Environmentat Health Section enc(s) j 7 � �. , , �� � � � � S�� _ a _� �.G-----� . � � .� . � _---� �-, �. �1 N � oC� . � _ � _ � , � . , _ _ ._ .. _ � ' �•' ` , ,