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206 Baltimore Downs Rd Lot 6 Davie County,NC Tax Parcel Report Wednesday, October 19, 2016 243 190 Q�Of Q , `..153 1 I 163 206 -� 183 r�.l ! 1 •'-`~--- ' '-199 t 210 f ! 197 .J r. I 169 WARNING: THIS IS NOT A SURVEY _. Parcel Information Parcel Number: G701OA0006 Township: Shady Grove NCPIN Number: 5860639729 Municipality: Account Number: 82526417 Census Tract: 37059-803 Listed Owner 1: JOHNSON JIMMY W Voting Precinct: WEST SHADY GROVE Mailing Address 1: 206 BALTIMORE DOWNS ROAD Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code: 27006-0000 Voluntary Ag.District: No Legal Description: LOT 6 BALTIMORE DOWNS Fire Response District: CORNATZER-DULIN Assessed Acreage: 5.02 Elementary School Zone: SHADY GROVE Deed Date: 5/2006 Middle School Zone: WILLIAM ELLIS Deed Book/Page: 006610690 Soil Types: GnB2 Plat Book: 0008 Flood Zone: Plat Page: 150 Watershed Overlay: DAVIE COUNTY Building Value: 314900.00 Outbuilding&Extra 18720.00 Freatures Value: Land Value: 59240.00 Total Market Value: 392860.00 Total Assessed Value: 392860.00 101 All data is provided as is without warranty or guarantee of any ldnd either expressed or Implied 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 County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to NCor arising out of the use or Inabllity to use the GIS data provided by this website. r ; DAVIE COUNTY HEALTH DEPARTMENT r' Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990002780 Tax PIN/EH#: 5860-53-5745.06 Billed To: Blake Hope Subdivision Info: Baltimore Downs Lot#6 Reference Name: Location/Address: Baltimore Downs-27006 Proposed Facility: Garage Property Size: ATC Number: 4443 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: A6Z/ 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 I 1,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. S+ar�dc�vd Qutc_k.y CLQ 51koA'F-I o00 S-r6'11o0 -ro�nK 2a' ST 7 iq X 4') q5� Septic System Installed By: Sc* Environmental Health Specialist's Signature: Date: (0 DCHD 05/99(Revised) • DAVIE COUNTY HEALTH DEPARTMENT •I" Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990002780 Tax PIN/EH#: 5860-53-5745.06 Billed To: Blake Hope Subdivision Info: Baltimore Downs Lot#6 Reference Name: Location/Address: Baltimore Downs-27006 Proposed Facility: Garage Property Size: ATC Number: 4443 **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 #Bedrooms #Baths Dishwasher: ❑. Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow(GPD) Site: New2`'*%epair❑ System Specifications: Tank Size/6 O GAL. Pump Tank GAL. Trench Width,& "IRock Depth / Linear Ft,� Other: As stated in 15A NCAC 18A.1969(5) Required Site Modifications/Conditions: acce ttpti Systerna p use IMPROVEMENT/OPERATION PER IT ,AYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: onta a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m.to 9:30 a.m. 1:0 he day of installation. Telephone#is(336)751-8760.**** Environmental Health Specialist's Signature:�l/ �� Date: D DCHD 05/99(Revised) .o Davie County Health Department Environmental Health Section P.O.Box 848/210 Hospital Street Mocksville,NC 27028' (336) 751-8760/Fax(336)751-8786 July 10, 2006 Mr.Blake Hope 342 Kingsmill Drive Advance,NC 27006 Re: Site Evaluation: 206 Baltimore Downs Road Tax Pin#: 5860-53-5745.06/Garage Dear Mr.Hope As requested, a representative from this office visited the above site July 10, 2006 to perform a site evaluation. 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. This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans or the intended use change. Improvement Permit / System To Serve:_ (S/1CA4 Wastewater Design Flow: System Type: Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other System Location: 20b BRl�iit'Yi()!Z� �(�L1/ Valid: R Years []No Expiration Site Modifications/Permit Conditions: Acz stated in 1-5A NCAC 18A 1969(5) accepted Systems may also be use - ..e/ly, 2//1e Environmental Health Sp a ist Date ps-i.p.letter 2/06 1 - A�PLI�C' 'I R SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department °LpZ5 Environmental Health Section P.O. Box 848/210 Hospital Street `A Mocksville,NC 27028 iRorlM�SaLH _ (336)751-8760/Fax (336)751`-8786 � ppV1ECDUN� A ication For: ❑ Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) VKth ***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION,D Name to be Billed & Contact Person Billing Address P. Home Phone City/State/ZIP , A6 27006 Business Phone Name on Permit/ATC if Different than Above C511me Mailing Address City/State/Zip PROPERTY INFORMATION NOTE: A survey'plat or site plan must accompany this application. (Permit is valid for 60 months with site plan,no expiration with complete plat.) Street Address City Tax PIN# V5k&6-0 -57gr Subdivision Name Section�//Lo�t# Lot Size Directions To Site:_zoo, XvWimD/�_ Date House/Facility Corners Flagged 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? ❑Yes [moo Does the site contain jurisdictional wetlands? ❑Yes 2Vo Are there any easements or right-of-ways on the site? ❑Yes CTNo Is the site subject to approval by another public agency? ❑Yes ONo Will wastewater other than domestic sewage be generated? ❑Yes 6N' o IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms #Bathrooms Garden Tub/Whirlpool ❑Yes ❑No _ Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑No IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building X 0 #People #Sinks--_1 #Commodes J I _ #Showers I #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested: De-6n–ventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ❑ County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑No If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(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 understand that I am responsible for all charges incurred from this application. I hereby grant 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 on the above described property located in Davie County and owned by Site Revisit Charge �Pr ty owner's or owner's legal representative signature Date(s): &/?iZ �p _ Client Notification Date: —Dat ', EHS: Sign given ❑Yes 1 Qo Account# Revised 2/06 Invoice# i VIE COUNTY HEALTH DEPARTMENT v Environmental Health Section PO Box 848/210 Hospital Street Mocksville,NC 27028 t �VN 2 Phone: (336)751-8760 ASTEWATER CERTIFICATION FOR DWELLING (Chec e REPLACEMENT❑ REMODELING NK RECONNECTION ❑ Name: 1C k� Phone Number: 3� I V (Home) Mailing Address: 3l -7 1�117urpl I J//11 (Work) Detailed Directions To Site: �I house, on I d- (4 iv y l aAarow a Property Address: 2 a (, O/'' G'/' Please Fill In The Following Information About The Existing Dwelling. Name System Installed Under: �e. t 1 1 C��'S Type Of Dwelling: 5 nj/, G/�1�r�/ Date System Installed(Month/Day/Year): Number Of Bedrooms:Number Of People: Z / Is The Dwelling Currently Vacant? Yes❑ No'ff*"� If Yes,For How Long? Any Known Problems?Yes❑ No t;/If Yes,Explain: Please Fill In The Following Information About The New Dwelling. Type Of Dwelling: Number Of Bedrooms: Number Of People: Requested By: %"! A""�'� Date Requested: 7.2 ` (Signature) ' a,g+/, For Environmental Health Office Use Only Approved ❑ Disapproved ❑ Comments: Environmental Health Specialist Date '"The signing of this form by the Environmental Health Staff is in no way intended,nor should be taken as a guarantee(extended or limited)that the on-site wastewater system will function properly for any given period of time. Payment: Cash❑ Check❑ Money Order❑ # Amount: $ Date: Paid By: Received By: Account #: Invoice #: =.v:^YI 8 � :.... ry . a.J ...v.vv' � •.- - - _ a ::l.i �-..4'✓i� ff..vt(v'n":. ° [7SkT . DAVIE COUNTY.HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville,NC 27028 Phone: (336)751-8760 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One)`REPLACEMENT,a REMODELING RECONNECTION ❑ a Name: U to per Phone Number: `3l 1 Y �� (Home) mailing Address: K,40-clo-7 1/,i (Work) 106 Detailed Directions To Site: �1r lAott a ll !JA! l"l inor e pop gal, 3rd ho e, ©n ' i vi «. I-d" oft ow&,�T y� Property Address: z 0 /l(,r7 ar 'VIS I1 Please'Fill In The Following Inform) ation'About The Existing Dwelling. , Name System Installed Under: e S Type Of Dwellmg: �/►� ot'� Date System Installed Month Da Year : 0 Number Of Bedrooms: Number Of Is The Dwelling Currently Vacant? Yes❑ No�if Yes,For How Long? ' + Any Known Problems?Yes❑ No,,;/If Yes,Explain: -------------- Please'Fill In The Following Information About The New Dwellings ra` Type Of Dwelling: giro Number Of Bedrooms: Number Of PeoplR 04 Requested By: � � �� ' ' ` Date Requested w. .. (Signature) For Enviroi entM1ieafth Office Use Only Approved Disapproved ❑ Comments: ? yqo 77I EnvironxnP�# Health Specia Date "The signing of this formbrjteEnv 'nnmen Health S#aff j jzuno way.intended,nor should be taken as a guarantee(extended or limited)that the on to wastewater�system will function properly for any given period of time. Payment: Cash❑ C ck 0,Money Order❑ # Amount: $ Dat �. Paid By: l Received By: Account #: Invoice #: , DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990002706 Tax PIN/EH#: 5860-53-5745.06 Billed To: Jeff Hayes Subdivision Info: Baltimore Downs Lot#06 Reference Name: Location/Address: Baltimore Downs-27006 Proposed Facility Residence Property Size: 5 acres ATC Number: 4111 As stated in 15A NCAC 18A.19$9(5) cocepted Systems may also be UWG 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.1 00 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWAT ON IS A A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatu Date: 17 !J 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. L p3 u. w& r /nl�aU'lo� 0-0 Nis►+�c6► � c T to 10 tcvc q S� c c�a ` Sir � a•- Septic System Installed By: � - Environmental Health Specialist's Signature: Date: L do(o 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 M 990002706 Tax PIN/EH#: 5860-53-5745.06 Billed To: Jeff Hayes Subdivision Info: Baltimore Downs Lot#06 Reference Name: Location/Address: Baltimore Downs-27006 Proposed Facility Residence Property Size: 5 acres ATC Number: 4111 **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). TIM PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING STALLING SYSTEM. Residential Specification: Building Type4C)L-S� #People #Bedrooms L4 #Baths 2-S Dishwasher: Garbage Disposal: ❑ Washing Machine: 0"' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 4214+ � Type Water Supply Design Wastewater Flow(GPD) Site: New 11� Repair❑ System Specifications: Tank Size IOCOGAL. Pump Tank GAL. Trench Width:ZV Rock Depth I Z.' Linear Ft. C � Other: As stated in 15A NCAC 18A.1969(5) rtetY3l►stem n F also- tae 1-M- 01 Required Site Modifications/Conditions: IMPROVEMENT/OPE ION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 "BELOW FINISHED GRADE. ** N TICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 .m to :30 .m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.**** 10i .�� U�,� �� 02V S Environmental Health Specialist's Signature: Date: CP 7 se DCHD 05/99(Revised) R AIIPLICA71ON FOR SITE EVALUATION/Ih1PItOVIll Nf PI UIIT S ATC Dayle County Nealth Department fayirca/a wa(lica/tb Selina P.O. Box 840/210 hospital Street Kockuvillo, XC 27020 (336)751-0760 *e:IMPORTANT*** TRIS APPLICATION CANNOT AS PROCESSED UNLLSS ALL THE 3tL011IIC-1) - t INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for inat'ructionn. tl 3. Name Co be D3lled Contact Person M, nailing Address fey Pit S nom.Presse city/State/%Z2 A1ti 0% �10(76Duolnws ries..�. r � .�r-F•:�� T 1. Napes on permit/ASC if Different than Above Hailing Address city/state/YID „�ti_..._......_ 3. Application Fort ❑ Site L'valuation, ❑ mmprovoment elz.it/ TC ❑ nolh 4. Sretem to service, Mouse ❑ tdollile come l3 Business ❑ Industry Q Other y, S. Type system requonteds%?5Convoationa1 ❑ conventional modified ❑ 3111wrative 6. If Residences 0 People a Bedrooms y' Q Bathroaua )II-iehwasher 13garbago Diapoaal �6,23hing machin. ❑Dasement/21umbing ❑Dacement/No Pluwbiag 7. If Dusinaoi/Industry/athero verify type I People I Dinka 1 Commodes I Showers 8 Urinals I water Cooloru Xr FOODSERVICE: 0 Seata l:atiutated Water Usage (gallons par day) I. Trpa of watts supply:/Y County/City C3 Wall Q Conuuunity s. Do you anticipate additions or expansions of the facility this system is iulendtd to serve?C3 Yes )PI-1 If yes,ghat type? ° DELOW. Either•aPLAT orSITGM.Ai'tdIUSTBCSUD§fr77EDbythe dicnlWLILTHISAPPIACArION. J ProperlyDImensious: lYlumDImCt•(ONs(6•uw htudtst•lltt)to 1.1tUrlitr1•Y: Tax OfficcPIN: fE Property Address- RoadNamc CitympV ell - /Qitto a/-e Irin a Subdivislann�}'tYpr�o`vide iuformat(on,as follotvs: _ Naule Q.XI' n_e_ -bdWV% Section: Iiloeli: Lot-. _ Date hone corners flagged; 46 This is to certify that theiuformatiou provided Is correct to the best ormy knowledgc.I tuiderstand that ally perntit(s) issued bereafter arc subject to suspension or revocation,if amsite plans or Intended use change,or it clic iurontimion subtuit(ed in this application Is falsified or changed.I,also,andcrsrand diet 1 ual respousibic jar all charb as lacurred fi-aat this applicativa. I,hereby,give consent to the Authorized Reprrswitativc of clic Varle County Health Dcparflncut (o enter upon abort described property located iu Davic County and owned by 10 eoaduci all(estigg prprocedures as necessary to determine the site suitability. Will rY O� SIGNATURL TRIS A=A MAY BU USE,D FOR DRAWING YOUR SITE PLATY(Include all of(he fulloiving: Existing and proposed Property lines and dimensions,structures,setbacks, and septic locations). Site ROVIAt Charge Datc(s): Client Notification Date: M-1s: Sign given Account No. ReviscdE/Z ' ��JZZL'ON ZW 866 +4VR1 190 WdSZ:E —SOOZ '9 d. 'Nflf DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002706 Tax PIN/EH M 5860-53-5745.06 Billed To: Jeff Hayes Subdivision Info: Baltimore Downs Lot#06 Reference Name: Location/Address: Baltimore Downs-27006 Proposed Facility: Residence Property Size: 5 acres Date Evaluated: �0 <<v cs- r� Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit �� Cut FACTORS 1 2 3 4 5 6 7 Landscape position t. Sloe% HORIZON I DEPTH Texture group Consistence Structure - Mineralogy , HORIZON II DEPTH ,. Texture group Consistence Structure 3 Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE Q v.2-5- SITE 5-SITE CLASSIFICATION: ` S EVALUATION BY: LONG-TERM ACCEPTANCE RATE: 2� OTHER(S)PRESENT: REMARKS: BL CL t,5 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,foam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay ' SIC-Silty clay C-Clay k« CONSISTENCE moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm 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 Not s 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) eeuee a e ::useON MEESE sUsHim HUHHUMMENEI� so M MEMEMME MUM MOM OEM Mission MEMO M MENEM ON Mom 00 Mill Um BRUCHEE M COU MH ie2e222euee: � ee'�eeee22eu malmommiNsic: eeuee DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990002706 Tax PIN/EH#: 5860-53-5745.06 Billed To: Jeff Hayes Subdivision Info: Baltimore Downs Lot#06 Reference Name: Location/Address: Baltimore Downs-27006 Proposed Facility Residence Property Size: 5 acres ATC Number: 4111 As stated In 15A NCAC 18A.1969(5) 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 I 1 of G.S.Chapter 130A,Wastewater Systems,Section .1 00 Sewage Trea ent and Disposal Systems). THIS AUTHORIZATION FOR WASTE WA N ON IS A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatur : Date: al7 As CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improve nt/Operaiion Permit has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Freatment and Disposal Systems,"but shall in NO WAY be taken as a guarantee that the system will function atisfactorily for any given period of time. {{; Q 9 ` fiat: we r (T FIAS►f PC6 A) �. ;C:- T 10 b 1 ID s' CVVIAC t{ ST-D GC(A "'`�'� Dn>"µc� ger — "6tj V,-Cgq Septic System Installed By: �c Environmental Health Specialist's Signature: Date: Ll U0 -(�A E21 DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section Soil/Site Evaluation L,ICANT INFORMATION PROPERTY INFORMATION Account #: 990002706 Tax PIN/EH#: 5860-53-5745.06 Billed To: Jeff Hayes Subdivision Info: Baltimore Downs Lot#06 Reference Name: Location/Address: Baltimore Downs-27006 Proposed Facility: Residence Property Size: 5 acres Date Evaluated: 60 r/ Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit �� Cut FACTORS 1 2 3 4 5 6 7 Landscape position t� Slope% HORIZON I DEPTH 0 Texture group Consistence Structure Mineralogy HORIZON H jPL.1 Texture groupS Consistence G Structure 3 Mineralogy , HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 5 EVALUATION BY: %� t LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: a AY' t,5 / 'REMARKS: ��-, C �� ���- s�"G Landscape Position LEGEND R-Ridge S -Shoulder L-Linear slope FS -Foot slope N-Nose slope . 1l�C 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'�am SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE �'IQ1St VFR-Very friable FR-Friable Fl-Firm VFI-Very firm EFI-Extremely firm 3Y'et v 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 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-Lone-term accentance.rare.- anUti—NO