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138 Baltimore Downs Rd Lot 3 Davie County,NC Tax Parcel Report Wednesday, October 19,2016 r-- 108 ; 124 144 r1�60 BRUSHY-It9TN TRL 1148 - 188 -`---- ------------------ 1171 -------`- ------ 1171 l 4 1161 ` 1181 51 122 110 r 0� 138 , ' �r1s�ZO 1205 Ot 170 109 243 ,t tit ',153 . 163 --- ------------- 1249----- ------ WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: G701OA0003 Township: Shady Grove NCPIN Number: 5860745687 Municipality: Account Number: 82527593 Census Tract: 37059-803 Listed Owner 1: CRESON LARUE H Voting Precinct: WEST SHADY GROVE Mailing Address 1: 138 BALTIMORE DOWNS ROAD Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27006-0000 Voluntary Ag.District: No Legal Description: LOT 3 BALTIMORE DOWNS Fire Response District: CORNATZER-DULIN Assessed Acreage: 5.17 Elementary School Zone: SHADY GROVE Deed Date: 2/2007 Middle School Zone: WILLIAM ELLIS Deed Book I Page: 006990543 Soil Types: MrB2,GnB2,MsC Plat Book: 0008 Flood Zone: Plat Page: 150 Watershed Overlay: DAVIE COUNTY Building Value: 379190.00 Outbuilding&Extra 8750.00 Freatures Value: Land Value: 60610.00 Total Market Value: 448550.00 Total Assessed Value: 448550.00 9 bl� All data is provided as Is without warranty or guarantee of any Idnd either expressed or Imp-fled Including but not limited to the Davie County, implied warranties of merchantability or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the �r County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to �o 6l1'Si NC or arising out of the use or Inability to use the GIS data provided by this website. Y ,. �^' • APPLICATION FOR SITE[VALUATION/IhII'ROVC11lENT PERMIT S!instructions Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital StreetOCT '•1 8 2005 Mocksville, NC 27028 (336)751 .8760 DMRONMENTgL H***TFIPORTANT*** TIiIS APPLICATION CANNOT BE PROCESSEDUNLESS ALLINFORt•IATION IS PROVIDED. Refer to the INFORMATION BULLETIN for . 1. Name to be Billed Contact Person Mailing Address �� I� �f)Y`/\ Home Phone t9p O Y�J City/State/ZIP Dustiness Phone J�% `! 7-3.J • 2. Name on Permit/]LTC if Different than Above Mailing Address _ City/State/Zip 3. Application For: S/itc Evaluation ❑Improvement -Permit/ATC El Both 4. System to Service: 2--, ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. Typo system requested: ❑ Conventional ❑ conventional modified ❑ innovative Maccepted ' t. 6. If Residence: 11 People 0 bedrooms � 11 Bathrooms 121 tL/JDishwashdr ❑Carbago Disposal Washing Machine ❑Basement/Plumbing ❑Basement/lio Plumbing, 7. If Business/Industry /othor: verify type # People it Sinks a Commodos It Showers tl Urinals 0 Water Coolers IF FOODSERVICE: It Seats Estimat ed Water Usage (gallons per day) ti. Typo of water supply: ❑ County/CityVL7 Jell ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes ❑ No If yes,ii-hat type? ***D1fP0RT11NT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUES'T'ED BELOW. Either n PLAT or SITE PLAN MUST BESURMITTED by the Olent with THIS APPLICATION. Propet•ly Dimcuslons: � i'h1/1-22 Tax f""�'` \YRITI:DIItIsC1'IONS(from hIocicsvillr)to T'1t01'L RT1': Tax Office PIN: 111 3 3- 5�`7Y5-.0`3 B Properly Address: RoadNanlc �I%i,LV,lncne / 3 City/Zip If in a Subdivision prJovid�ei inforam tion,as follows: Naine: Sectio Block: Lot: 3 Date Monte corners nagged: "Phis is to certify that tile illfor•Illatiou provided is correct to the best of lily knowledge. I understand hint any pel•lnit(s) issued hereafter arc subject to suspension or revocation,if the site plans or intended use change,or it'tlle information submitted in Misapplication is falsified or ctlanged. 1,also,understand ilrat l aal responsible fry•all charges iucu red frons t1tis applicafion. I;hereby, give consent to the Authorized Representative of the Devic Cotulty 11ca1Ll1 ll?alrh.l'Fnt to enter upon above described properly located its Davie County and ownedby to conduct all testing procedures as accessary to determine tile site suits ility. DATE /&y OS 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 Client Notification Date: EI-IS: Sign given .Account No. Revised DCIID (05/03 Invoice No. 5 l! d DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section •r Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003775 Tax PIN/EH#: 5860-33-5745.03 B Billed To: Terry&Gail Butler Subdivision Info: Baltimore Downs Two Lot#03 Reference Name: Location/Address: Baltimore Downs-27006 Proposed Facility: Residence Property Size: 10+acres Date Evaluated: 'd�c— 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 V, Texture group ConsistenceTJi-- Structure r e— Mineralogy ! ' ` HORIZON II DEPTH r• /- Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group [/- Consistence t ""Y ' Structure law Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE , 41 CLASSIFICATION — LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: `¢ EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OT ER(S)PRESENT: REMARKS LEGE 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 Mdq VFR-Very friable FR-Friable FI-Firm VFI-Very firm. EFI-Extremely firm met 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 rtes Horizon depth In inches Depth of fill-In inches Restrictive horizon-Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) Soil wetness-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification-S(suitable),PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate-gal/day/ft2 DCHD 05105(Revised) f 40T 2 AR w O. 00+ � AC�RES.f � 1 545.97 LOT 4 AREA 4. . -I+ ACRES G ">` L0T 3 AR .A . ------ -_ - :-- ` LUT 12 AA 777 - - - !.1 xi �j► �r t A-- _ O ARR 1p n pr 5 06 02:00p davie county envhealth 336 751 8786 p.4 4• APPLICATION FOR SITE EVALUATIONIP4PROVEMENC PERn— *'UPCR Davie County Health Department Environmental Healtfi Section P•O.Box 848/210 Hospital Street 6Mocksville,NC 2''0282006 (336)751-8760/Fax(336)751-8786 Application For: fI Site EvahiationtltnpruvementPermit n Authori ation To Construct(ATC) HEA AL L�TANT***THIS APPI.ICATION CA NNO T BE PR OCESSED UNLESS ALL OF-nfE REQUIRED INFORMATION IS PROVIDED. Refer m the INFORMATION I3ULLrnN for instructions. APPLICANT INFORMATION Name to be Billed E 04tS Clarl.st� G)ntact Person__L 2 S Cr�S Billing Address_ _Z -� mr»Dnt�;'I l t .1 I Lome Phone City/Statc/ZIP '�/Z 7 Bt r lo e PhonePhone---3 7 Name on Permit/ATC ifDierent-.han Above .S QM e Mailing Address ' !! City/SlateMp PROPERTY INFORMATIOlN NOTE: A survey plat or site plan nwst accompany this application. (Permit is valid for 60 months with site plan,no expiration with cot iplete plat.) Street Address City Tax PIN# _ Subdivision Name i M&I ,pD W n 5 Section/Lot#_a ' Lot Size Directions To Site: _./" aC�G s Date House/FacilityComers A7agge:d If the answer to any of the following questions is"yeel,supporting documen ation must be attached. Are there any existing wastewater systems on the site? IJYr s BNo Does the site contain jurisdictional wetlands? ❑Yes$lvio Are there ally easements or right-0f-ways on the site? ❑Yes(]NO O wh-C P e weir Is the site subject to approval by another public agency? ❑YeS owo Will wastewater other than domestic sewage be generated? OYe S ANo lF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms #Bathrooms Y•s Ciar b/Whirlpool es ONo Basement: '(e.Yes ONo Basement Plumbing: Va es []No IF NON-RESIDENCE FILL 0111'THE 13OX BELOW Type of Facility/Business #Sinks � -'------Total Square Footage of Building`_ #People #Commodes_ #Showers _ #Urinals_ Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested:e9tonventional ❑Accepted ❑Innovative OAltenstive ❑Other Water SuppiyType:114.11nty/City Nater U New Well ❑Exis•:ng Well ❑Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?O Yes "o If yes,what type? This is to certify that the information prc vided on this application is true and c onect to the best of my knowledge. I understand that any pennit(s)or ATC(s)issued hereafter are subject to suspension or revocati nr if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed I understand that I am responviblefor all charger incurred front this application. I hereby grant r ig tt of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws z ltd rules on the above described property located in Davie County and owned by_E—J'_:VQ'/tiG$ Com„ F.0 t•(JOl1 Property owner's or legal representative signature Site Revisit Charge Datc(s):_ Client Notification Date: Date EHS: R9 ) j q Sign given 0-Yes ONo Axount# ` `co / Revised 7/06 Invoice# _ :Z„0 Rpr 25 06 01:59p clavie county envhealth 336 751 8786 p•2 E,AVIE COUNTY HEALTH DE PARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street • Mocksville,NC 2702f (336)751-8760 IPROVEMENT/OPERATION PERMIT Account #: 990003275 Tar PINIEH M 5860-74-5687 Billed To: Childress Constniction Subdi vision Info: Baltimore Downs Lot#03 Reference Name: LocatioVAddress: Baltimore Road 27006 Proposed Facility Residence Property Size: 5.17 acres ATC Number. 4109 **NOTE"Ms Improvement/Operation Permit DOES NOT authorize the construction ofa septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the const'uctionlinstallation of a system or the issuance of building permit(in compliance with Article 11 of G.S.Chapter 13,)A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS UR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type. bt� #People^ #Bedrooms_�_ #Baths �- ! Dishwasher: GT"" Garbage Disposal: Washing Machine:Er Baserent w/Plumbing:0"' Basement/No Plumbing: Commercial Specification: FacilityTypa_ #People #Peoph,Shift / #►Seats Industrial Waste:13 Lot Size Type Water Supply&V�jry Design Wastewater "tow(GPD) "">� Site: New 1?' Repair 0 t t � System Specifications: Tank Size IOOtAiAL. Pump Tank GAL. Trench Width:&� Rock Depth 172L•« Linear Ft.(Ocb As stated In 15A NCAC 18A.1969(5 Other: bC4-P49OT+OJZV)�'S ampted Systems may e1w be t� Required Site Modifications/Conditions: _1.-�Ma.- V-) 4-0r-j g t z& 1-5occi Si �1_+`J Key--p Ides •t IMPROVEMENT/OPERATION PE11311T LAYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the vi Cc uni y Health Department for final inspection of this system between 8:30 a.m.to 9:30 am.cv 1:00 p.m.to 1:30 p.m.on the d kylin ital lation. Telephone#is(336)741-13760.**** o 1C. a ARmb U.Se& 1,3 �� _ , Environmental Health Specialist's Signatu ri 6,: Date: C011710 p�D,�CHD 05/99(Revised) Apr 25 06 01 :59p davie county envhealth 336 751 6786 p.3 13AV11E COUN'T'Y HEALTH DEPARTMENT • Environmental Health .vection P.O.Boz 848/210 Hospital Street Mocksville,NC 270211 (336)751-8760 Account #: 990003275 Ta> PIN/EH#: 5860-74-5687 Billed To: Childress Construction Subdivision Info: Baltimore Downs Lot#03 Reference Name: LocatioVAddress: Baltimore Road-27006 Proposed Facility Residence Property Size: 5.17 acres ATC Number: 4109 As stated in 15A NCAC 18A.1"9(S accepted Systems may also ba use AliTHORIZA"I ION FOR WASTEWATER S'YS'TEM CONS?'RUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building;Inspections Office when applying for building permit(s)(in compliance with Article I 1 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Tr , ent and Disposal Systems). THIS AUTHORIZATION FOR WASTE O ON ►VAUD FOR A PERIOD OF FIVE YEARS. �? Environmental Health Specialist's Sig►tae: Date: CERTIFICATE OF COMP.,ETION **NOTE** The issuance of this Certilicite of Completion shall indicatethe:vstem described on linprovement/Operation Permit has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will 1 unction satisfactorily for any given period of time. o Septic System Installed By- Environmental yEnvironmental Health Specialist's Signature: Date: DCHD 05199(Revised) DAVIE COUNTY HEALTH DEPARTMENT 1 Environmental Health Section ' P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003275 Tax PIN/EH#: 5860-74-5687 Billed To: Childress Construction Subdivision Info: Baltimore Downs Lot#03 Reference Name: Location/Address: Baltimore Road-27006 Proposed Facility Residence Property Size: 5.17 acres ATC Number: 4109 **NOTE**This Improvement/Operation Permit DOES NOT authorize the construction of 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 bosAz- #People #Bedrooms L #Baths Dishwasher: [Z"'. Garbage Disposal: e Washing Machine: Basement w/Plumbing: d Basement/No Plumbing: ❑ t Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow(GPD) LTgn Site: New 2"'Repair❑ 1t � System Specifications: Tank Size I CC'iAL. Pump Tank GAL. Trench Width Z(O Rock Depth (7-M Linear Ft.(60D As stated in 15A NCAC 18A.1969(5) Other: C blemsVTra-3uiw-s cmepted Systems may also be used Required Site Modifications/Conditions: :fit,�Il - t-) 6-01J D01Z, Kl:& 16 15" 5 Id 19W l- u� IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S) IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the E vi C(uni y 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 d ty c f in tal ation. Telephone#is(336)751-8760.**** IZA OA UT 1�s S� Q1v z' Environmental Health Specialist's Signatur : Date: 5 DCHD 05/99(Revised) ��� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 8481210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990003275 Tax PIN/EH#: 5860-74-5687 Billed To: Childress Construction Subdivision Info: Baltimore Downs Lot#03 Reference Name: Location/Address: Baltimore Road-27006 Proposed Facility Residence Property Size: 5.17 acres ATC Number: 4109 As stated in 15A NCAC 18A,1969(l accepted Systems may also bo use AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article I 1 of G.S.Chapter 130A,Wastewater Systems, Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTE O ON VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa e: Date: � ? CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) • APPLICATION FOR SITE EVALUATI ON/INIPROVE&I ENT PERtiIIT& Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street , Mocksville, NC 27028 , (336)751-8760I#LZ�q�' ***XlfPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL"'�T_ INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for Inst 1. Name to be Billed C�/Il%//7� 4zke --5- Contact Person c� �'Li e— Mailing Address ]/v2 �r,� G✓�� / / Home Zone ne / =.fir P'-Ie- " City/State/ZIP /,rdc,ratIle a7d.2 // Business .2 �cJ 2. Name on Permit/ATC if Different than Above �c��+n�"i�tr Mailing Address /_79 /Ci i?j2 e��/ �r. City/State/Zip '00 Ile e- ivL" �7D�y 3. Application For: W Site Evaluation ❑ Improvement Permit/ATC ❑ Both 9. System to Service: K House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. Type system requested: K Conventional ❑ conventional modified ❑ innovative tClaCCepted 6. If Residence: # People # Bedrooms # Bathrooms 'JUDishwasher koarbage Disposal Owashing Machine ,kBasement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /other: verify type # People # Sinks # commodos # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 8. Type of water supply: )X County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes No If yes,what type? ***IMPORTAN2-**CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELONV. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 5 j' WRITE DIRECTIONS(from Mocluville)to PROPERTY;` Tax Office PIN: #�5r(663 7%5Z4 97 ,/s$ 76 c-3Q+'dJ AO ✓anA Z Property Address: Road Name Be City/Zip AaLrycC o?7GL� g_L��ik��✓G Daw*1s z-0 D�'1 If in a Subdivision provide information,as follows: C� Section: Block: Lot: 3 Date home corners 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 Cho r/es 4- P-,1� hi CSS' to conduct all testing procedures as necessary to determine the site suitability. DATE (iv/3-D-!r SIGNATURE '&aLJ TIIIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposer} ,. property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Datc(s): Client Notification Date: •cr C Sign given Account No. �� � ( / cy Revised DCIID(05/03 Invoice No. 7 cs W cu 346 116 ►ARY P f LOT I � i LOT 2 ' d&EA=5 2? / dEA 5 nq N . / R0. AC 3 ,r Q �` C17 e.` G1 OT >2 ��� LOT. 5 os ... c, � 85 CRE N I LOT LOT 6 uq 4ti W A 5 90 r \ I f AREA=5.07 ACRES Flo :LOT. 10' r ,� �4RE'A=8 05 L0�' �R�A 8• � , LOT 7 ARE_ ' AREEA=S 3N7 137./ \ AC—G / / / / G CD 17 co 70 304 Ile _ . PRELIMINARY . 200 -ioo o zoo 400 600 a SCALE 'IN' FEET _ ';+u 2:.�.. .+.:w:i✓-3- :"L ..� ' 'tet' � °. ' ti:yy isrµy 1vt1 . F' fY r, . _ . DAVIE COUNTY HEALTH DEPARTMENT • - Environmental Health Section • Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003275 Tax PIN/EH#: 5860-74-5687 Billed To: Childress Construction Subdivision Info: Baltimore Downs Lot#03 Reference Name: Location/Address: Baltimore Road-27006 Proposed.,Facility: Residence Property Size: 5.17 acres Date Evaluated: fD f�0 a� Water Supply: On-Site Well Community / ► Public ✓ Evaluation By: Auger Boring Pit ✓. Cut 0 FACTORS 1 2 3 4 5 6 7 Landscape position -1L L L Sloe% S HORIZON I DEPTH — lk Texture groupL 1- Consistence - S f 3"S Structure -S DO Mineralogy HORIZON II DEPTH Texture groupD G-1-� ' Consistence e -SV' Structure ,Q c Mineralogy HORIZON III DEPTH (� Texture groupC (� Consistence ; 5 Structure R< k Mineralogy5�5/ HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION P� LONG-TERM ACCEPTANCE RATE 0• D• 3 SITE CLASSIFICATION: PS EVALUATION BY: LONG-TERM ACCEPTANCE RATE: �'�S.C2 3 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 moist VFR-Very friable FR-Friable FI-Firm VFI Very firm EFI-Extremely firm �YCt 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-Subangulu blocky PL-Platy PR-Prismatic • '4 Mineralogy 1:1,2:1,Mixed LYotr� Horizon depth-In inches Depth of fill-In inches Restrictive horizon-Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) Soil wetness-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification-S(suitable);PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate-gal/day/fU DCHD 05105(Revised) ■■e■■■■■e■■■■e■■■■■■eeeee■■■■■e■■■■■■■■■■eeeee■■■■■■■■■■■e■■e■■■■s ■■eeeeee■■■■■e■■seee■■eeee■■■■■■e■■■■■e■■e■■eeeeeeeeee■■■■eeee■■e■ ■■■eeee■■■■■eee■eeee■e■■■■■■e■■■ ■■■■eeee■■eeee■■eee■■■eeeeeee■■■ ■e■■e■■■■■eeeeee■■■■e■■e■■eee■■■�ie■■■eeeeeee■■eeee■■■■eeeee■■■■e■ ■eee■■■■■■eee■ecce■■■■■■eeee■■■eee■■■■■■■e■■■■■eeeeeeee■ ■e■■eee■ 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■eeee■e■eeee■eee■■■eee■eee■eeee■■eee■■■eeee■eeeeee■■■e■■■■■e■■■■■■ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990004019 Tax PIN/EH#: 5860-74-5687 Billed To: E.J. Hanes Construction Subdivision Info: Baltimore Downs Lot#3 Reference Name: LaRue Creson Location/Address: Baltimore Road-27006 As stated in 15A NCAC 18A.1969(5) ATC Number: 4109 accepted Systems may also be used 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 A 900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTE CO IS IA PERIOD OF FIVE YEARS. I Environmental Health Specialist's Signature: - Date: Deo QI Xg CERTIFI �ryE OF COMPLETION' **NOTE** The issuance of this Certifica ' pletion shall indicate em described on Improvement /Operation Permit has been installed in . ce with Article 11 of G.S.Chapter ,Section.1900"Sewage Treatment and Disposal Syst , but S40 , SAY be taken as a guarantee t t the system will function satisfactorily for any given per' of time. 3 t� l ei -fir Jjr14i *,?"o DOG �i.t�+J1LC1r-> ►-�oJ7`. Par✓fwil Fi c-fv(z Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street t„ Mocksville,NC 27028 ,� (336)751-8760 �A IMPROVEMENT/OPERATION PERMIT Account #: 990004019 Tax PIN/EH#: 5860-74-5687 Billed To: E.J. Hanes Construction Subdivision Info: Baltimore Downs Lot#3 Reference Name: LaRue Creson Location/Address: Baltimore Road-27006 Proposed Facility: Residence Property Size: 5.17 Acres ATC Number: 4109 **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 4DO JE #People L4 #Bedrooms 14 #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ET"' Basement/No Plumbing: ❑ Commercial'Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot SizfS 0 9- @6Type Water SupplyW JWII'Design Wastewater Flow(GPD) 4)�O Site: New Repair❑ System Specifications: Tank SizeICCOGAL. Pump Tank GAL. Trench Width-�V, Rock Depth Linear Ft.CG I �r -� As stated in 15A NCAC 18A.1969(5 Other: �� X�-S accepted Systems may also be use Required Site Modifications/Conditions: �/J�7��I_-L- D J C rJ7-0 >Q �rP IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S) IF 6"BELOW ' FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Dc p ent 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 installati el h e#is(336)751-8760.**** It's C� Q X 'o-VJ •p UJ �A►�l►�a Q ~LL5 R OT 25 mut Environmental Health Specialist's Sign atur : Date: 7©' D(o DCHD 05/99(Revised) • t2g