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129 Brookside Ln � . • - DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990003056 Tax PIN/EH#: 5863-48-3164.A Billed To: Homes by Jonathan Lee,lnc. Subdivision Info: Laurel Brook Lot#5.A Reference Name: Location/Address: Laurel Ridge-27006 Pro sed Facility: Barn Propedy Saze7 see map ATC Number: 3697 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 11of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CON IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: OT 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: `y �� � iG Environmental Health Specialist's Signature: 9 L' DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section + P.O.Boa 848/210 Hospital Street n �/ Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003056 Tax PIN/EH#: 5863-48-3164.A Billed To: Homes by Jonathan Lee,lnc. Subdivision Info: Laurel Brook Lot#5.A Reference Name: -S►N► DYS0Q Location/Address: Laurel Ridge-27006 Proposed Facility: Barn Property Size: see map ATC Number. 3697 **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 2 #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply k)G" - Design Wastewater Flow(GPD) Site: New Repair❑ System Specifications: Tank Size IOC'OGAL. Pump Tank GAL. Trench Width Rock Depth 12 Linear Ft. 10L> Other: 1 1�ST4 l�yT o.J _�D1C Required Site Modifications/Conditions: _In1.ST6.µ- JQ. F y S 91F —6ddI006i g '-:7P /&D &,)ELL. IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISERS)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie Coun Health Department for final inspection of this system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of instal ation. Telephone#is(336)751-8760.**** 7jQ1�1�= 'FLq.)T X z;. s• s 25 Li Environmental Health Specialist's Signature: �1�/ ' �'� 4ate._.34 0 `� DCHD 05/99(Revised) Woe/ /0:00 D � C � o � � t TION F011.SITE EMILUATION/1MPHOVEAMNIT 1'L•tiillfl-&JCl-C Davie County Health Department FEB 1 0 2004 Enyironmenta/Hea/t/ISection P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ENVIRONMENTAL HEALTH (336)751-8760 DAVIE COUNTY ***IDIPORTANT*** TRIS APPLICATION CANNOT BE PROCESSED UNLLSS ALL THE REQUIRED INFORMATION IS PROVIDED. nnR{efer toll the INFORMATION BULLETIN for instructions. 9 r 1. Name to be Billed 14Ll ,96, LJ ] ;Jqi t'�F�4 gfs1 �°•'�: 11 d--L-act Peron �� E��L Mailing Address K7 home Phone City/State/ZIP L�W IS V ILL�J �1 2'7() Business Phon "17.7,�.. 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip _�__•�,._„_ 3. Application For: ❑ Site Evaluation >5�zmprovemcnt Permit/ATC ❑ 1loLh 4. System to Service: iouse El Mobile Home ElBusinebs ❑ Industry El Other j / i'Wti 5. Type system requested: Conventional ❑ conventional modified ❑ innovative 6. If Residence: 1) People _ L It Bedr—ins 11 L'athroolm; Unhwasher ❑Garbage Disposal !Washing Machine Casement/Plumbing 013anement/110 PlucubinU �- 7. If Dusiaess/Industry /Other: verify type }} People 1} Siiil:s •_ _ . It Commodes it Showers It Urinals �� It Water Coolern _ IF FOODSERVICE: #p Seats Estimated Water Usage (gallons per day) 8. Typo of water supply: ❑ County/City Well ❑ ComilluniL•y 9. Do you anticipate additions or expal1si011s or the facility this systenl is hitcllde(I to servc?�fycs CI No If yes,tivllat type? ,Q ' / ***IhIPORTANT-t CL-1 S111UST COAIPLETETIIE R1:QUIRED PIZ01'LR'1'1'ING0101ATI 0N IZEQIIE'STI?1) —I BELOW. Eithcr a PLAT or SITE PLAN d1USTBESUBb1I77ED by the client with TUIS API'L1CATION. Properly Dinicasiuns: SCC Al iy r' 1VIZ1'fL ll1KL:Cl'IUNS(f-ow IYluclsville) to :1x Office PIN: S8 (?— 3 I Property Address: Road Name ,t�0%5 LA Uig�L f C-7r' C1ty/Zip�A/ZYLtJIt+ AQ 7 �MH!e If in a Subdivision provide hifornlation,as follows: Nalne: A-Iz Section: Block: 010 Lot: 3 Date holne corners flagged: 2 17- V 7' This is to certify that the hiforniatiou provided is correct to the best of lily knowledge. I Understand (hat any pernlit(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 Thal t run responsible jar all chur es incurred frau, this application. I,hereby,give couseut to Elle Authorized Representative or the Davie Cuuuty IIc:11111 1)cp:u hucnl to cuter upon above described pruperty located ill Davie County and owned by `f CYc/ to conduct all testing procedures as necessary to dctc1'111i11C the site suitability. llAT'L 2`it - ¢ SIGNATURI; THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN(Include all of Elle following: Existing and proposed property lines and dimensions, structures, setbaclts, and septic locations). Site Revisit C11a1-l;e Ati Client Notification Date: EES: Sign given -e Account No. ; S Revised DUID105103 ` Invoice No. 77U _.• �p APPLICATION FOR SITE EVAUJATION/IMPROVEMFM PERMIT 8 ATC n u U • Davie County Health Department - - - Environments/HMIM SecGton f f`�,,�•�.- P.C. Box 868/310 Hospital Street MY 9 2000 1 tr Hockavilla, NC 27038 (336)751-8760 ENVIRONMENTAL IHEALTH ***Zi►lpORTANT*** %BIS A>:> ic"ION CaI=r BS no== UNLII+SS sIS. TB>C =QUIR>!:D INrOMWION IS RROMM. Refer to the IVITORMATIM; BULL 11= for instructions. 1. Sam to be sill•" l,U,11't ctM C-, M CC�Cr��Li contact "e"on sQrk-e Snelling sddseee _131 13r•*-AJfwoo d e rti ve ame "boa. city/state/as" _AAVanc f N C 1700(o swia•.a "tno�. _ �` - 735-6051 _ a. ::aa• on "•salt/AXC It Di!leve nt than above Sctr►'L Ilailiuq lddsoaa city/ to/ LP s. application For: L_ site evaluation 6'Improvement Pemit/ATC 13 Both 4. systea to 54CTio•i O'House O Mobile some O Business O Industry O Other s. If��tzasie•nce: E >zeopie // a Bedrooms _ a Bathrooms 3 t3'Dishwaahu 5-Carba9• Disposal tj' aQaahinq Mold" -U sasaao►t/"imibiaq 0 saaement/so plud"q 6. If sasino@s/Zn&wtsy/OtWwa sp•oify tno t} "•opt• • sick. t} Commode@ shows@ IIrinala ! Qatar cooler" I! 7=112MCM: # Seats �— =stimated hater �Usage (gallons p" "ay) 7. Typ. of ,rater supply: O County/City O community e. Do you anticipate additions or expansions of the facility this system Is Intended to serve? O Yes al(o If yes,ghat type? ***IMPORTANT"**CUENTS MUST COMPLEMTHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AfW BESUBMITTED by the ellest with THIS APPLICATION. Prope Dimensio :_ib. zl9P caC= C. �✓47WRITE DIRECTIONS(from MocWlle)to PROPERTY: Tax r Bice PINI S # 2�1 a -X 110 E +0 80� tm�- Lot 3, Lo�orel 0roc Property Address: Road Name Sa.d P,+ R aet k A+ $01 >r hh- Aurn 00 s ,Prok. CityrLlp PJvctnce, NC A?OOG Sin+I1-e - 4prr, 01 QA Ygdk;r, Valley 0 - U In a Subdivision provide information,as follows: a e a„ ar. 3 N k f --VUtA c 0.J Name: Layrel 6cook Rd - a"roxc 1 n'•.1e--kuru o� - go Def CC,,,-' 3 rw,Vex — on Section: Block: Lot: 5 Date Properly Flagged: . -Ma roti =00 This is to certify that the Information provided Is correct to the best of my knowledge. I understand that any permlt(s)' Issued hereafter are subject to suspension or revocation,if the site plana or intended sere change,or if the information submitted In this application Is faisilied or changed I,also,understand tAat d an responsible for aU charges Incurred from this appUcadom I,hereby,give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures a necessary to determine the alto suniittaabbiiliity. DATE SIGNATURE Y/ THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property tines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notitkation Date: ERS: Account No. Revised DCHD(07/99) Invoice No. �'� DAVIE COUNTY HEALTH DEPARTMENT 'L Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001174 Tax PIN/EH#: 5863-48-9271.05A Billed To: William McCarthy Subdivision Info: Laurel Brook Lot#5(Site A) Reference Name: William McCarthy Location/Address: Sand Pit Road-27006 Proposed Facility: Residence Property Size: 5 Acres Date Evaluated: Ls, Ivo Water Supply: On-Site Well f Community Public Evaluation By: Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L Slope% %Z0Z© HORIZON I DEPTH 0-0 O - 10 Texture group c L L S LL Consistence Gf NS r-ff Fr SSW Structure G2 CA 2 Mineralogy 1:1 : 1 HORIZON II DEPTH to -IV � to Texture group G GL -+S" Consistence r—r S rJ r SS q Structure Issk CJ4S�1[ Mineralogy M% rD 1.11 HORIZON III DEPTH --Lo -Z Texture group G{ SL Consistence F; SS ijf Structure Ask Mineralogy /fit ygol� HORIZON IV DEPTH Yo+ Z Texture group Consistence F{ Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION Us LONG-TERM ACCEPTANCE RATE O SITE CLASSIFICATION: PS EVALUATION BY: LONG-TERM ACCEPTANCE RATE: O►2 OTHER(S)PRESENT:_i> t _ 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 Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1,2:1,Mixed Notes Horizon depth-In inches Depth of fill-In inches Restrictive horizon-Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) 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 05/99(Revised) ■■■■■■■■■ovs■■■■■■■■■■■Dela■■■■■■■■■■■■■■■■■■■■�i■■s�>a■.r�■■■:c�:■■■■■ ■■■■■■■■■■■■■■■■■■■■■■11■I■■■■■■■■■■■■■■■■■■■■■■■■C\■G■!■1!:■■■■■N■■■■ ■■■■■■■■■e■■■■■■■■■■■■1I■I■■i■■■■■■■■■■■■■■■■■■■■■■■■ia■r•qtvop-q■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■1lw■■,■■■■■■■■■■■■■■■■■■■■■■■■■■■mi!-t-MIr■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■1l■■■■■■■■■"1■■■■■�i■■■■■■■■■■■■mmrwii■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■11■■■■■■■■■ ■■■■`1J■■■■■■■■■■►!■■■■cm■■■■■■■■ ■■■■■■■■■■11■■■■■■■■■■■11■■■■■■■■■■■■■■■■I►7■■■■■■■■■■■■■1■■■■■■7■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■11■■■■■■■■■■■■■■■11■■■■■■■■■■■■■\■■■■■■■\rb\■■■ ■■■■■■■■■■I■■■■■■■■■■■■11■■■■■■■■■■■■■■■11■■■■■■■■■■■■!SLI■■■■■■■■■■11■■ ■■■■■■■■■■,■■■■■■■■■■■■LI■.■■■■■■■■■■■■■GSI■■■■■■■■■■�■■►�^■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■�I■i■■■■■■■■■■■■■,ill■■■■■■■■■,■■■I�■�■■■■■■■■■■■■ ■■■■■■■■■■■Ilial■■■■■■■■■11■I■■■■■I�■■■■■■■■■■■■■\►1■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■1►.a1■■■■■■■■■11■I■■■■■Ill■■■■■■■■■■■■■■■■■■\■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■��■■■■■■■■■■I■■i■■■■■1�■■ ., ■■ul>t■i■!M■■■■■■r�i■■■■■■■■■■■■■■■■■ ■■■■■■■■■\Il�i�■■■■■■■■■It■.■■�■■■It■■��■1�:X11111�1■■■■■■i11■■■■■■■■■■■■■■■■■ ■■■■■■■■■■11■■■■■Lir;SILy�:�:ral�lil■I■■\.�_�.■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Uiiiiiiiiions Emmonsiiiiii ::EiiiEmmonsiiiiiiNo:ME" Nunn ■■■■ v • , 1 1 `: Davie County,Meal th Department Environmental Wealth Section PO Box 848/210 Hospital Street Mocksville,NC 27028 Phone: (336)751-8760 May 31,2000 William McCarthy 131 Brentwood Drive Advance,NC 27006 Re: 2 Site Evaluations-10.498 Acre Tract Laurel Brook/Lot#5 Tax PIN#: 5863-48-9271 Dear Mr. McCarthy: As requested, a representative from this office visited the above site(s) on May 31,2000. It should be noted that this tract was originally evaluated on December 7, 1999 and classified provisionally suitable for a single residence. The evaluations that were performed today reflect dividing the tract into two approximately five-acre tracts. Based on the information provided on the Application for Site Evaluation and after the evaluations were completed, both sites were found to be provisionally suitable for the installation of an on-site sewage disposal system. Site A was evaluated for a three-bedroom residence. Based on the evaluations performed today and the previous evaluation at the site, approximately 600 linear feet of drain line will be required for this three-bedroom house. Site B was evaluated for a four-bedroom residence. Approximately 600 linear feet will be required for a four-bedroom house on this site. Based on the proposed house locations,no pump station will be required for either system However, this is subject to change and actual design and dimensions of the septic drain field will be determined at the time a permit is issued. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization 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,you may contact our office at(336)751-8760. Sincerely, L�* Jeff G. Beauchamp, R.S. Environmental Health Section enc(s) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 , l2 $ooLde.-PAZ. Account #: 990003056 Tax PIN/EH#: 5863-48-3164.1 Billed To: Homes by Jonathan Leejnc. Subdivision Info: Laurel Brook Lot#513 Reference Name:_ Location/Address: Laurel Ridge-27006 Pro osed Facility: Residence Pro a Size: see ma ATC Number: 3698 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 WASTEWATE S TI IS A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: -AzkK �K � �EI�TLov nti5 CERTIFICATE OF TION 1 **NOTE** The issuance of this Certificate of Completion all indicate the described on Improvement/Operation Permit has been installed in compliance with Articl 1 of G.S.Chapter ion.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY taken as a guaran that the tem will function satisfactorily for any given period of time. � 1 1� ItZ ►� , tz �J r o,kl 2" 1f? u Septic System Installed By: y1(aQtI,J � �1e' Environmental Health Specialist's Signature: Date: f DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT 2 Environmental Health Section • P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003056 Tax PIN/EH#: 5863-48-3164.6 Billed To: Homes by Jonathan Lee,lnc. Subdivision Info: Laurel Brook Lot#5B Reference Name: .mr^ D4Sot-1 Location/Address: Laurel Ridge-27006 Proposed Facility: Residence Property Size: see map ATC Number: 3698 **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 q0ose-- #People Z #Bedrooms #Baths Dishwasher: [Pr Garbage Disposal: ❑ Washing Machine: © Basement w/Plumbing: lea Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #SSeats Industrial Waste: ❑ Lot Size D.5ACQESType Water Supply OE'-L- Design Wastewater Flow(GPD) ` �S� Site: New Repair❑ System Specifications: Tank Size I0MAL. Pump Tank IOUL6AL. Trench Width�Co• Rock Depth 1'2:' Linear Ft.j C:f Other: Foxas Required Site Modifications/Conditions: 1 A)S7-oa, arj C,0nITOd49,, 4-1sP /S T— INIPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the da installation. Telephone#is(336)751-8760.**** pussoua �> / P I oo F2o�. )ELL N Environmental Health Specialist's Si ure• Date: ;& DCHD 05/99( evised) M O� ID•0o DR, ECC -0WE I TION FOR SITE EVALUATION/INIPIIOVBIGYf 1'LliitillT&JVI'C Davie County Health Department FEB 1 0 2004 ,EnyironmentaiHeaithb'ection P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ENVIRONMENTAL HE01 (336)751-8760 DAVIE COUMY ***ItIPORTANT*** TIiI5 APPLICATION CANNOT BR PROCESSED UldLES5 ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed 140M65 131 JONrI T.OP.- a /N1–G'ontact Person l v lT!/�`.V L"6 t` /f �/ ---- - Mailing Address /,U, /)oX V Q�7 e7 IIome Phone City/State/ZIP L wasyre.� rJC /() Business Phos, 336 –3 2. Name on Permit/ATC if Different than Above ! Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation >51�mprovemenL- Permit/ATC ❑ 13oth n,, 4. System to Service: X House EJMobile Home ElBusinets ❑ Industry ❑ OL•hcr �/s/V j c; f -- — S. Type system requested: 9 Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People. 0 Bedrooms 11 I3athroolnu 3 _ �(Diahwasher ❑Garbage Disposal Aashing Machine Basement/Plumbing ❑Da-cement/No Plumbing 7. If Busineas/Induatry /ether: verify type tF People I1 Sinks # Commodes # Showers t! Urinals i_5���` # WaL-cr Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) S. Typo of water supply: ❑ County/City Well ❑ Community 9. Do you anticipate additions or expansious of the facility this systein is inteadc(I to SCl*veCS EI No If yes,what type? ***IMPORTANT***CLIENTSAIUSTCOAIPLETL•THE 1ZEQU1ItGD PROPLIUl'Y INFORA4ATION REQUE'STEA) BELOW. Either a PLAT orSITE TED PLAN AfUSTBESUBAHTby the client wiUl'1'111S APPLICATION. Property Dimensions: 15'CC AL I P WRITL�DIRL:CTIONS(1'run1 Mucksvillc) to I'ROVE'RTY: Tax Office PIN: fl �$� ��'3i�`� O l �'J Property Address: Road Name LOTS L/4 UACL 121 City/zip 1ZwAl c'iyo'i V�MHle J� •. ,� — 5� ,,;� If in a Subdivision provide information,as follows: Name: Section: Bloch: (}jt) Lot: Date home corners flagged: 2 ,-1 7� � This is to certify that the infornnation provided is correct to the best of illy Knowledge. I understand (bat any perulit(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 and responsible for all charges incurred f-oln this application. I,hereby,give consent to the Authorized Representative of the Davie Count),lle:dUl Dep:u tll1c 1I to cuter upon above described property located in Davie County and owned by J /IAA o APr-y%f DY to conduct all testing procedures as necessary to determine the site suitability. DA'Z'E 2.U.) SIGNATURE THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). C�L o Site Revisit Charge Client Notification Date: Sign given -Q �' � Account No. Revised DCHD05/03 Invoice No. T O Yurunl J( ' Tax Map B-7 Virginia G. Walker River Bend Hills D.8. 075-153 ` P.B. 6, P. 162 o 0ryoo David M. Hanes o o— y`c N 89045,15"E N 1392.97' 6>•S1� 5° G\L-10C• \'�, �� ,a P v I�3, J�25 �^� y —17PL-184 Op6 65 0 W oo,,�, C N 28 t0 °ec•� y0F \i a a° Wi 14.700 Acres Nrn Z 202.54' yo�a9� 066 n a / 97.5p• S 88°08'35"E P �° y / 'P � �x0 50 ox a ou 1 54- oo o 'S4i � � �Q !j In Li ^ C rn n P 4 y 77 iT l i oDo ) Vv� z Cy P 10.4 Acr Ov tP .,oma oxla at atone •+• S7 QO„ rL� �O '01 Q a: c^ corner ` h a �$8 33. £ ? �/-7, c CO S 40°40'00"E 91.88' to / eZ'u9 t P S 51.56'40"E 75.63' point 4 O E\P C/6 S 4136"@5'-E,.7;4.70' 632'8967�,B9' 5.105 Acres o a zg OCO .0 5.815 Acres :e IS 17°56'15"W 87.32' o "' °' / w rV� cid o P S 38°51'25"E 70.95' Z to ,Z o n a°la P , u t" P S 43°40'20"W 33.11' / q- HIP NIP �S 55°20'00"E 1348 �S 36°49'35"E 61.03' 1 oc \ ;. y0c°� nIP S 53°13'0 'E 88.98• 10.640 Acres 'C� 71.27 S 25.22'35"W 124.63' / h �u o� N 89 10'50"E r �n ° 154.67' ` =r'�j (D2- 0 NIq� �— HIPnO+ S 79°46'15"W 39.07N 88 dlgi�`"W a / EIP P a = COtP N�s u 5.014 Acres P) -\N 68 s9 s S ��°? s 40►s Cm so 50• moo �� o` a ran tr access easeent IP C 30• P \'a rO S 60 0• NI �1 P 86.48,2p,.E P P �y b L-1 4 —f— 6O P • / .36, P L-2 L-3 L ` ti l ¢0" Hia _ 60 0 0 ~ E 32.81' 369.25' 'r ' a •' S 83°39'50'W 402.06' / 1 DYCOMP 3367660734 04/08 '03 12:10 NO.774 01/01 FAX NO. Apr. 07 2003 09:56AM p1 tapr 07 U3 lt)s��e davie Cnunty envheeleh 33C 791 0700 p. r APPUCAT10N FOR AM EVALUATIC(vAMPROVE MEM PERMIT d ATC cavle county Health Department 61rr/stloi/riWibJNBiM/ZAr Set�iVd P.O. BOX 949/2it) Ilvspitsi 9t=oot seoero Luse. tet: 27028 (83e)75L-8760 •toZl •R TRIS AWMZC TX= Gffra= +av ahocssM= VN=89 Asa. Te>rACQUx�� zwwOtboAZOr 22 vx*Vxc". iL=sa to the Qt MtLS.1jz= Pot inetzvetsone. w-%. V-0 be w WILIZed ,?^ and _1Saye^ 014Lson CO� n *".-Jan ar};er ,.. Koumn* adaeoee ?`Q 0 Peq,}( V rt V b 7 I aaerfatasefaw CieMt++c,nS' L 29012. Q2.(0 72-2 Vit'. e.r. s aeswLs/7� u nseroe«.R ae.w wt..M._ 54tr�! Qs: la(aeve. a. Appitcatdao f wi r•'! SL%6 Ewwluatsoa O ZWVQvamant P+ettaWATC G bath �^•• Arabs sn awaoioe. ttoaso Q 11eebtze Race O wwwAne" O tadttetwr Cl Otber P44-"-d 6-,34 ....s* YE •Mellnnaa+ • people 3 1 sa .dsoce _ a Dathr000a -3 J e� n tf Ob"wob.— C, �Olorep 1 )'was%&"aftw me, xa+.rent/Dlprbt+.f I I auesent-f" tl�erpsHp e.�/:s a V059" a esao. a Commons {,,_-� a q►r.rere 1 • vss+..s. g rotes covLore r� �t�, :! troevsMRvtCAs. t iea.ta uatia.tad Maur 'aara0 tss>.CA taali+ee pas aver) J G—�- Two aP aabow IwPF YS O Co.uatT/GiCTr RM7.l a tq�muQaieY C.—S. Dv awn apticipste additives or expsadaes of the%eiliCy this system.s fa to wr ve7 d Yb CI No !t)a4 what gno? •••IAI/O/tTwN>*++cLuINl'a nm=rc 7afrcA TJSTviz Rt34t micD 1ritargtTY INvoRwAirioN It•RQU!.Vrzo tbW. Rilye.a r(.AT 9w3r=PLAN NCfSrJ -FV&Mrrf=b%We d"t with TRIS AFFLIICATION -'ProPEr gY Dlnsglpioas: _ (0-4q S /n,,G. v!rs prNa M N ,r tri itti'4 D1AaCrt Paan Ile)tr pstppCRTY: 4--l-ax office PIN: If��rv3 -SFS - 3 t est . D r-�..-•r $o I N1-- rfraPery Addre n. Ratad nave t 5 $'art1,P i f' „R- Gr:�'-�'- 4tje� Cy cxtr2ap:AdVrAIACC. NC_2'7- (p Ste 5�). ,1 1. 14 �1fia a lsabdtvJsloa pevriAo taroreiatten,as Ibtluw's: tom k_ �aIl��ss G f6eetlgat illaek: �� lot:+ IrDs/a 'Mftitr��s This it to t wary that am isforwatioe previdrd is correct to IAe brat etMtr k.wwk ftc. J nedrtstand*as any Atr>htitis) lsswd hemsUcr are shbjfct to sttspesston or re"cation,itthe sift pings or latsodod wr obaayr.or it tie In(brtaatiea tnbm)ttea ht ebb appiteatton h fat"A"ar ebanpd. /.o/sw.w Atfttoad that!RPR rcv^W*(We,(or all charges/noir"jtnnt �\ IGIs epplitadva• I,bc•etry.give eoesent to the Auttwrixed Rtpraseatetivo otthe Davie Coanty Health Departhlo.ni to aster"on A4vwe dera ibed Pro p+Mae, led In Dario County Mao awma 27 c to oeadaer an getting plot Wes as'accessary to detara:ae the Site oe tab.. `. ATE- 019 N^• V Rx A TIM AItZA MAY 98 USED FOR DRAWING YOUR SITit PLANT(ta a as of Wo*11awlax; ExIst4undpropesW Property Naas and divrsesesa #Wwhsres, setb"l% ass soptic socsaeas). JJ Sao Rewlsit(.'ha►ce DaevO): carat Notlaratloa Dote: VJA3= Account No. Revived PCItD(Wil") [avoiea No. /Vo v� 70 �rr�►o y 4v— Z4 � Z ��a3 Tax Map B-7 i Tact i i o, Virginia G. Walker \ River Bend Hills oi`1' P.B. 6• P. 162 o A David M. Hanes o D.B. 075-153 00%`c N N 89045'15"E ` 00 � I 1392.97 '�6>°S�� `ay -4 � 1a 2 a, � 0 S ��5 L-17 TL-18? 0 06 N e OCb TSP N 28 c� � c°ems•,y�AyOF of,,°� 14.700 Acres 0 o CV A, 0 O / 202.54' $ 91 06 / w 97.50' S 88°08'35"E °o do y0 0 °10•451,W axe our Ine P 1f�.54' CD 01�10- V. M NyQQO� Z p C • 10.498 Acres '09 L, o� axle at atone w F o Domer 'O " �S 40040'00"EgY D-C-9 u P S 51°56'40"E 75.63' E1P I point 30 c . i6 � nQ' x hN S 41 36'65" 1_14.70' 63259, 672.89 J, �O4 5.105 Acres o v 30 N P. CO a 5.815 Acres _� a /S 17.56'15"W 87.32• u off' P of° p S 38°51'25"E 70.95' /z ' oq ° co . tr_ q P `-1- / o to P S 43°40'20"W 33.11 W NIP NIP S 55620'00"E 1348' �S 36°49'35"E 61.03' 10.640 Acres OceF o I NIP S 53°13'0 'E 88.98' S 25.22'35"W 124.63' C) Nip W °w4 ` I N 89 10'50"E 71.27 / / lto ;° �O t 154.67• p! / Na Nt 88F_ NIP n0+ S 79°46'15"W 39.07 UCO of n 71r ° EIP j 1 Co �S 6•¢O, V. 5.014 Acres P �' N s8°0 6• s l,3°2 °' 150, �� I /,�0" �?o W oo. N ac ran � cess easement / 6Q00, on. IP 30' P �• O S IP P Itl 86.411.29.,EP .5 s P ,4�' I / 6'40„ Hip E P N L-2 L!3 L o / F 60 00' 32.81' 369.25' `* E J r S 83°39.5 402.06' Parcel 48 J l 92'S�9David M. Hage$ �� / 1 Owner : David b Total Area 9 A • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002698 Tax PIN/EH#: 5863-48-3164.JD Billed To: Jim& Karen Dyson Subdivision Info: Laurel Brook Lot#5 Reference Name: Location/Address: Sandpit Road-27006 Proposed Facility: Residence Property Size: 10.498 acres Date Evaluated: Water Supply: On-Site Well ? Community Public Evaluation By: _ Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope Texture S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SICL-Silty clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1,2:1,Mixed Notes Horizon depth-In inches Depth of fill-In inches Restrictive horizon-Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) 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 05/99(Revised) • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002698 Tax PIN/EH#: 5863-48-3164.JD Billed To: Jim&Karen Dyson Subdivision Info: Laurel Brook Lot#5 Reference Name: Location/Address: Sandpit Road-27006 Proposed Facility: Residence Property Size: 10.498 acres Date Evaluated: Water Supply: On-Site Well i Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope Texture S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SICL-Silty clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1,2:1,Mixed Notes Horizon depth-In inches Depth of fill-In inches Restrictive horizon-Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) 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 05/99(Revised) r APPUMPON FOR SITE EVAWATION/IMPROVEMENT PERMff&ATC D Davie County Health Department NOV 9 1999Environmenial Health s6won P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336)751-8760 ***IbY1PORTANT+r** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the IMRMATION BULLETIN for instructions. , 1. Name to be Billed Lay,A n7. 14ANCS Ccl .J 1 CAdtlwt 0J^ - Contact Person J)A u%i0 "ANC% mailing Address 30k 1�aM.�i rGi fioma Phone clgg' S 1�7 city/state/LIP OVA•",Car+/J. C.. -2-700r. Business Phone qqg-Sbq) m. 3 ads•1110 2. Name on Vomit/ATC it Different than Above %eeyel, '7 /0_q«l mailing Address City/State/Lip 3. Application For: 0--eite Evaluation 0 Improvement Permit/ATC ❑ Both 4. system to servioa: Wfouse 0 Mobile Home 0 Business 0 Industry 0 Other 5. If Residence: s People # Bedrooms s Bathrooms D Dishwasher D Garbage Disposal O washing machine D assament/Plumbing O aa•amant/No Pluwbing S. it ausine•s/Industry/Others specify type # people f sinks C t showers # Urinals i water Coolers. f Ir FOODSERVICE: # Seats Estimated Nater Usage (gallons per day) 7. . Type of water supply: 0 County/City 0 Community e. Do you anticipate additions or expansions of the facility this system is Intended to serve? 0 Yes 0 No If yes,what type? ***IMPORTANT'**CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 10 rr• ' WRITE DIRECTIONS(from MocksvWe)to PROPERTY: Tax Mee PIN: # SCC fa tat 4+Mer` Property Address: Road Name S MN o Roo City/ZIp RoyanCE 7—'7000 If In a Subdivision provide information,as follows: Name: L cwn E' Q R d e, K Section: u1 Block: �1 Lot: `Date Property Flagged: t 0 M(a h 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 ane responsible for all charges incurred from this applicadom I,hereby,give consent to the Authorized Representative of the Davie County Health Department t to enter upon above described property located In Davie County and owned by O c u t h M t•kh'0s C. "iMCA1*'44 to conduct all testing procedures as necessary to determine the sitebWty. DATE�,��' i ( CI SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property Uses and dimensions, structures, setbacks, and septic locstians) Site Revisit Charge Date(s): Client Notification Date: U//D� r� r 5� N � C: Y t� L-D J Z ar RiV«p cr.J j e-4 3 S L�u`FRtnLr- �o Lo`i"$�6 L��rcl oro.lL ' Tax MOP B-7 Virginia G. Walker River Bend Hills i^ D.B. 075-753 \ P.B. 6, P. 162 ,�00 David M. Hanes N N N 89.45'15"E 0 0 }s 1392.97' 0,6 o em 4 t:9p55.0 Ln �y V�tS L-17PL-18P X06 re b (//�\ 79 pS 6 IF N 7h Dry C~ E\P N 2a f m �f hit a�0 a ♦ /. 14.700 Acres j N [ 202.54• 0o n 97.50• S 88°08'35"E 0 b D P 1�5"W °: n• pS't,, F, ,p6 o A6 Qo oo W 1f�1� 'c. 7 �� �• v C 1 cP .54' Ia. Q�a o g ti� 1 ry S\4 TJ �i} A°j py i / o Na'SO � h `` t o W ^ / = P p0 / 6 10.498 Acres \P N 26 ' � °ale m atone • 5 10\ 'JO � e vA. ^ o e35• Ir IV Cp P / O v \ 40°40.00"E 91.88' �7 i�!7(,x' Z o 30 p S 51.56'40"E 75.63' jo M � ^00 h y E ` E\P v :).105 Acres p e y° S 4�6�'E-.114.70' 6728967X89. ,,..6n• O10 Jq WA& 0 C2 514 O y r a : ;g /s 17°ss 15 5.815 Acres 'w 87.32' /g �• m �Ia o _ �+ .o N a° i �P 38°51.2 o 5" 70.95' E NIP Np 55°20'00"E 134. 8' p �S 43°40•20"W 33.11' \ �S 36°49.35"E 61.03' 10.640 Acres / F 3 kyati N,p,s 53°t3.0 "E 88.98' / 0 0 (\ N 89 10'50"E 71.27/ S 25.22'35"W 124.63• / h �° 154.67• y N p CONP S 79°46'15"W 39.07' / y 2 N 5.014 Acres 1 h \p N .s�s s s l 401 o/ eeo 3• Ilk 6 ^! 1 50• access easement 7 ? 30„W ?3?0• 000' N h rpp 30• P =0 60 P 86°48.20„E p p r5 '� / S 00• �l y in L 1 L-2 L-3 L 4 V �y w I / Be3640,e X76°36'g0„ E 32.81' 369.25' '� / SQOp.^ See ecce e' S 83.39'50"W 402.06' o`l a / N s°3s I E a 74p„W ,P 5' 9 9 ' as David M4 Hanes I S 13°23 20, o� r Owner : David M. Hones Carl 301 Han Advance hb,,,,T.otal Area - C� 1 --;19 A ~ : , DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900641 Tax PIN/EH#: 5863-48-3164.05 Billed To: David 'M. Hanes Contracting Inc. Subdivision Info: Laurel Brook Sec. B Lot#5 Reference Name: David Hanes Location/Address: Sandpit Road 27006 Proposed Facility: Residence Property Size: 10 Acres Date Evaluated: /2 7 Water Supply: On-Site Well J Community Public Evaluation By: Auger Boring Pit 4,1� Cut l FACTORS 1 2 i Q A A� E S 6 7 Landscape position L Slope% '?o G? HORIZON I DEPTH O ©-/Z - (� _ to C>_ ex Texture group CL SG L- Consistence . S n1P Cr i.1sa S r P Structure 2 (1- ak CO— G2 Mineralogy : I I .- ( ): 1 HORIZON II DEPTH 2Z / (0 , 12- (o- t% S -2(0 Texturerou t i G C-L S C-ASP Consistence ; s 1=:S SSfjP t-r 5 Structure L ; L 4. GR Sf3k Mineralogy ! ►�-��c�D M �ssD HORIZON III DEPTH 2Z 3(0 - '� 2 - 2p 2Li Texture groupG C-1 S c Consistence ; R. S � Structure Q k Mineralogy HORIZON IV DEPTH 3 •t, - - - Texture groupl?DCLC Consistence N Structure Mineralogy SOIL WETNESS ?J-f RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: �r Gt1 A Grp LONG-TERM ACCEPTANCE RATE: 0• C;;'1� OTHER(S)PRESENT: "ALL-: J14V)D 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-Finn VFI-Very firm EFI-Extremely firm Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralog 1:1,2:1,Mixed Notes Horizon depth-In inches Depth of fill-In inches Restrictive horizon-Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) 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-tern acceptance rate-gal/day/112 DCHD 05/99(Revised) APPUCATION FOR SITE EIIAUJATION/IMPROVEMENT PERMIT&ATC D Davie County Health Department Environmental Health Section JW 9 2000 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ENVIRONh1EN1'AL MIA (336)751-8760 DAVIE COON __._ _ ***LMPORT7INT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed (,() 11,Ct y% C. c'C, fit rTh til Contact Person �iSa Ai,e. Mailing Address A3( B ire \1(, ooA Dr. Home Phone 336-9Q�-9 3 ,k City/State/ZIP AAyavI e— WC- V700(D Business Phone - 735-(o05 L 2. Name on Permit/ATC if Different than Above .SaM e Mailing Address :�t/ytate/zip 3. Application For: E, SSiite Evaluation mprovement Permit/ATC ❑ Both 4. System to service: V House ❑ Mobile Home D Business ❑ Industry ❑ Other s. if//Residence: ` # People -� # BedrooBedroomsq # Bathrooms 3 C/Dishwasher l�!'Garbage Disposal ti 0 Washing Machine Basement/Plumbing 1.1 Basement/No Plumbing 6. If Business/Industry/other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of tater supply: ❑ County/City B'Well 0 Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes 19'No If yes,what type? ***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: '!" X98'4 c�eI (see�o% WRITE DIRECTIONS(from Mocksville)to PROPERTY: U4-le ,�C ­ l _TazPIN: # �O /0 "/ < ' J 140 E. -fie 8'O1 Ek.-- (Lo"t'"S' Lavrel Brook Property Address: Road Name Sand Pik- R ou A+ 2401 EX%J- --kU(A Le-4+ a Ok. city/zip Advance 2700(e hi n.:k - 4Vrn e'rM o. `k+dt4i. Vd1ky Rd- If in a Subdivision provide information,as follows: o gWwr.-I n,;1t t- Aur& r t fj, •m Gr,-f{'i Name: 1-ayre-1 Brno K ao .appro)' leo OA Ai Section: Block: Lot: ; Date Property Flagged: (narch, CC) 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 'hOyla 0, RQ'Ae.r to conduct all testing procedures as necessary to determine the site suitability. DATE S- -0 O SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS• Account No. Revised DCHD(07/99) Invoice No. �-��2 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account M 990001174 Tax PIN/EH#: 5863-48-9271.05B Billed To: William McCarthy Subdivision Info: Laurel Brook Lot#5(Site B) Reference Name: William McCarthy Location/Address: Sand Pit Road-2M3000 Proposed Facility: Residence Property Size: 5 Acres Date Evaluated: Water Supply: On-Site Well /✓ Community Public Evaluation By: Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L L_ Slope% Zv to 7D HORIZON I DEPTHI to - O Texture group L G- S,.GL Consistence t=r we,t.1fl r SS SP Structure 6101G Mineralogy 1: 1l: HORIZON II DEPTH 1 L - 1 n- 2 Texture group 5C_ <S1 C Consistence SS r Structure 53 Mineralogy HORIZON III DEPTH 74L Texture group f4004- 5C±S5e Consistence ; Structure Mineralogy ; HORIZON IV DEPTH e72 Texture group G Consistence Structure Mineralogy2; SOIL WETNESS 32 RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 3 SITE CLASSIFICATION: PS EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: ­50vLl. �f'y 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 Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1,2:1,Mixed Notes Horizon depth-In inches Depth of fill-In inches Restrictive horizon-Thickness and inches from land 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■■■■■■■■■■■■11\■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■eeee■■■ee■ ■e■■eeeeeeeeli�■�■■■■■■■■■■■■■■■■■■■■■■■eeeee■■■■■■■■■■■■eeee■■■■■■ ■■■■lace■■■■I!\�■,■■■■■eee■ee■eee■■■■■■■■■■■■■■■■■■■■■■■■■■■eeee■■ee■ ■■■■■■■■■■■e1E►1■lice■■■■■■■■■■■■■e�l■■■■■■eee■■■■■■■■■■■■eeeeeeee■■■ elr■■e■■■e■■■I■■■11■■■ee■e■■■■e■■■■■■■■■■■eeeee■■■eee■e■■■■■■e■■■■■■■ ■■eeeeeee■■■��■■■■■■■■■■■■■■e■■■■■■■■■■■■■■ee■■■■■■■■■■■■e■■■■■e■■ ■■■eeee■■■■■i1J■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■a■■■11`lees■■■■■■■■■e■■ee■■■■■■■■■■■■ee■■e■■■■■■ee■ee■■■■■■■ ■■■■■■■■■■■■i■■■■■■■■■■■■■ee■eee■■■■eee■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■It■■eeeeeee■■■■■■■■■■■■■■eeee■■e�le■■eee■■■■■■■■■■■■■■■■■■■■■■■■■■ Davie GountV)Yealth Department Enwronmental)Yealth Section PO Box 848/210 Hospital Street Mocksville,NC 27028 Phone: (336)751-8760 May 31,2000 William McCarthy 131 Brentwood Drive Advance,NC 27006 Re: 2 Site Evaluations-10.498 Acre Tract Laurel Brook/Lot#5 Tax PIN#: 5863-48-9271 Dear Mr. McCarthy: As requested,a representative from this office visited the above site(s) on May 31,2000. It should be noted that this tract was originally evaluated on December 7, 1999 and classified provisionally suitable for a single residence. The evaluations that were performed today reflect, dividing the tract into two approximately five-acre tracts. Based on the information provided on the Application for Site Evaluation and after the evaluations were completed, both sites were found to be provisionally suitable for the installation of an on-site sewage disposal system. Site A was evaluated for a three-bedroom residence. Based on the evaluations performed today and the previous evaluation at the site, approximately 600 linear feet of drain line will be required for this three-bedroom house. Site B was evaluated for a four-bedroom residence. Approximately 600 linear feet will be required for a four-bedroom house on this site. Based on the proposed house locations, no pump station will be required for either system However, this is subject to change and actual design and dimensions of the septic drain field will be determined at the time a permit is issued. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization 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,you may contact our office at (336)751-8760. Sincerely, Jeff G. Beauchamp, R.S. Environmental Health Section enc(s) YADkw VALLEY - SR NSI �• •' .7- �q SIL-T' . E.PR6TFGTIO_NPEN Vicinity Map Notscale---117 — Nto stole north lzi rV NO N -; .•1- •--—-'._- _ - ,moi��J� J' '.�b '�•--`.� %iJi�//'T �J '�'y�;/. �\ \., �,Y\ r�,•,i� 1 /� �� / /'' '� i•'T, h.�'•281 lb' `� .•;, �.:�a // j / � -"� - � / /�283• � p' - � l� �•' � 266 T.>.• \ 7TREL ! i . ROT \'�REA 6N' =„ OIL PA PATH a t• ^234_.. GON57R!JGTiO` REMOVAL tri f a� - Ak