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175 Brookside Ln DAVIE COUNTY HEALTH DEPARTMENTS ` Environmental Health Section P.O.Boz 848/210 Hospital Street •` R Mocksville,NC.27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002887 Tax PIN/EH#: 5863-48-3164.6B Billed To: Alex McGuire Constr. Subdivision Info: Laurel Brook Lot#613 Reference Name: Location/Address: Sandpit Road-27006 Proposed Facility: Residence Property Size: see map ATC Number: 3590 **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 T #Baths L 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 dVell� Design Wastewater Flow(GPD),2�/2 Site: New 0 Repair❑ System Specifications: Tank Size N GAL. Pump Tank GAL. Trench Width Sb _(Rock Depth J.2�"Linear Fk2�0 Other: Required Site Modifications/Conditions: IMPROVEMENT/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 day of installation. Telephone#is(336)751-8760.**** ED F Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990002887 Tax PIN/EH#: 5863-48-3164.613 Billed To: Alex McGuire Constr. Subdivision Info: Laurel Brook Lot#6B Reference Name: . Location/Address: Sandpit Road-27006 Proposed Facility: Residence Property Size: see map ATC Number: 3590 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: Date: �/ 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) - P � 3145 -ZC:,\Qo LICATION FOR SITE EVALUATION/IMPROVEh1FM PE 1L" T t -�-✓�S `, Davie County Health Department VU- EwiFonmenta/Hem/tfi Section V � 3 P.O. Box 848/210 Hospital Stre t " J Mocksville, NC 27028 J S (336)751-8760 HIS APPLICATION CANNOT BE PROCESSED UNLESS A ,� INFO N IS PkZOVIDED. Refer to the INFORMATION BULLETIN for ins Y tions. 1. Name to be Billed ` Contact Person Mailing Address / \ Home Phone _i�C3 !�' �M4(n � y City/State/ZIP &--)-`' � '` \ f ) Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City tate/Zip O)—� 3. Application For: S' a valuation Improvement Permit/ATC ❑ Both 4. System to Service: ,_,u ee � ❑ Mobile Honle ❑ Business ❑ Industry ❑ Other 5. Type system requested: O Conventional ❑ conventional modified ❑ innovative ! t 6. If Residence: # People � # .Bedrooms # Bathrooms \ DCI ishwasher ❑Garbage Disposal Q ashing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks f. # Commodes _ # Showers # Urinals '! # Water Coolers IF FOODSERVICE:. 1# Seats Estimated Water Usage (gallons per day) 8. Type of water supply: ❑ County/City ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes P-M-0� 3i If yes,what type? I i; 'IMPORTANT?"CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUES'T'ED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client ivitli THIS APPLICATION. Property Dimensions: .�g WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: #�� 3 ^ b�' 31 f Property Address: Road Name L �o C.V-P-1 AXy! o h Y o-d L'i JA City/Zip If in a Subdivision provide information,as follows: 2-03 Name: C-C�'zl' %ve- to z�r, - Section: Block: Lot: Date liome corners flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permi (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 l ann responsible for all charges incurred f!•oln this application. I,hereby,give consent to the Authorized Representative of the Davie County Ilealth Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE�/ ��-(��j 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 Datc(s): Client Notification Date: EHS: Sign given Account No. D-tf& -7 Revised DCHD(05/03 Invoice alien ■/a% %Nauman ■ /■/■/°/ °//a/■a as■ ■■°■/ ■/%°°°°e/■e%%�°a/■nnnn//'°■°°e°a ■aim°h °°°aaa/°°°°///a■■ //�e ■■■ae/a■��a/°/o/■/i°=°°■ aaaa��aea�iaaaaaaa�iaav�aa ' /a■a/e■■/■■■■a■aaa■a�/aaaaaa aaaaao�aaaaaai- a►�aaaaa aa/�°a/a a■■aa■ a■i�aaaaa /aaaa°°/aaaa/ aa■area■a aa��/a/aar/i°a■saaaaaa°°�� ° aee■aaaa a■�aaa■a °°°aaaa// ■/aaa aaaa■ aa■■a■■.��- /aaea eaaer:��a■a --�■ aaiiaaaaaasana■■■,>,a■ aaiaaa■ - aaaa °aaaueaa�'■aaae■a■ aa■aaaaaa°■e■r�aaa■aaaaaa°■ .. aaa■a■aaa //■aria/ a■aaaa� � a■aaaaaa aeaaa■aaria■aa°°ea //aaaa °aa■eaa■e� a■aa■aaa�� /aaaa■°/aaaa/// //aaaa ■a�>, ■aaa MINIMUM ae■aer� Ina IN ■■a.-,...a■aaaarx■ aaaa aaa■aaa�1°°aaaa- ■aa■°■aaaaaaa aa■■a■MINOR °°aa■■aa°°aa■■■aa°°ea■■■■aaaaaa aaaa /aaaa/■aaa°aha■a■■aaaaa ■/a■aaaaaaaaaa ■a,.�a■■a aaaa aaa //■aaaa°aa�r■■aaaaaaaa ■ea�ia�aeiaaaaaaaii°°aiaa■■■aaa •• ■aaa ■■a■ • a�aaaaa■aaiiaaaaaaaa�aae■a■aaa■ aaaa ■//aaaa ■aae■a■eaaaaaa°°a aaaa■°aaeeeaeaaea■a■■aa■■■ aaa■ •: ' �■■■ aaaa aaaa ■■aaaa/ ■■aaa■aa�aaaee■■e aaa°aaaaaaaa■ //■aaaa �i■ia ■/aaaa°°�■a'ra°°aa■iiaaa°°■ iaa■a °°°aaaia/° aa■ a■aai ■■■aaaaaaaaeaeaaa■°aaai■■■aaaaaaaa '°°aaaa■aeaaaaa■ aaa■■■■ aaa■■aaa■■aaaaaa■°°aaoiaaa441111 i�■ a■■■aaa /■/aaaa ■■■■aaaa ° a■aa//a■aae■aaa a■a■a■eaa■aai 41 aaaa/°°°aaaaaaaaa°°aaaia■°° ■ a■a■■aaa/ °aa /aaaaaaaaaa■ aaa■a■■aaaaaaae■ a■/aaa�' ■■/■■aaa■ °°///a■aa■■eaaaaa■■aaa■aaaaa■aaa/aa aaia/° aiaasaaaa■aaaaaaaa �aaaaaaaa°°°a■a ■ iiaaa °a/a aaa°°aa ■■aaaa/ °°a■■■a/aaaaa°aaia�iaaa■iiiia�°,�■i ' aaaa■ aa■■■aa■aea /aaaa aaaa/° aaa aaaaaaaae°°aaa NIXON aaa/ aaaa°aaa/aaaaaaaaa■■aasaaaaaaaaaaa �aaa=aaa■a■a■aaa°/■■■■/aaaa■ °aaaa /■iia■aaaa/ aaaaaaea■a /■aaaa °aaa/■//aaaaaaaaaaaa■■aea■aaaaa°°a aaaaaaa■aa°aa ■�%ea aaaa �a■■ ■/a/%°/ ■■/aaa ■■■■°°■aaaa/a■■aaa °°■a■ a■■■°■/a/■■eaaa■e '�SIRaeeaa■■eaa�iaa e■e■e■aeaeaeasiii� ii■iiiNva�ae PPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Health Department Enviromenta/Health Section SEp 1 Q 2001 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 MENjp`H,`p�TH (336)751-8760 �NVlRO VIECOUt�`t IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESSALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for �instructions. � 1. Name to'be Billed // ! S Contact Person ! / /j(�/ 76/ Mailing Address W4L4 0 Home Phone 333 7--77 16 gS aS �2) L -7� 9�3 City/State/ZIP _5 � Business Phone �/� /� 1'� 2. Name on Permit/ATC if Different than Above I Ifl �s F� "� 1 1 ` i 1 '{ l El Ls Mailing Address a lNe, City/State/Zip 3. Application For: Site Evaluation ❑ Improvement Permit/ATC I] Both 4. System to Service: - "House ❑ Mobile Home ❑ Business 11 Industry 11 Other f Z hidrm Cabana., S. If Residence: # People ,L-3 # Bedrooms I Bathrooms UYDishwasher 'Garbage Disposal P-Wlashing Machine 11 Basement/Plumbing II 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 water supply: ❑ County/City IZWell II Community -{vr no m e. Do you anticipate additions or expansions of the facility this system is intended to serve? 1-1 Yes 1-1 No If yes,what type? ***IMPORTANT***CLIENTS MUSTCOMPLLTETIiE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Eithcr a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 2 � WRITE DIRECTIONS(from Modisville) to PROPI-1,10 1'. Tax Office PIN: # �11p 3 `C1 )—, /L o��I —q D E 17L) SCS �?� Property Address: Road Name & LO'Ux I bn�)L 6 rJ --! q C)l 4( f\ V Cl (It-" Pd City/zip � mW, Q-700(1 Y1 ►'I f- c�n &ri If in a Subdivision provide information,as follows: (,1'i {7 d Name: 6yoyL Section: Block: Lot: Datc Property Flaggcd: T-1,1O This is to certify that the information provided is correct st 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 ant responsible for all charges incurred from this application. 1, hereby,give consent to the Authorized Representative of the Davie County I-Iealth Department to enter upon above described property located in Davie�County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE, LII d I 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 5 bt Dalc(s): Client Notification Date: Org#, Q—a 8-e Account No. Revised DCHD(07/99) Invoice No. :153 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001918 Tax PIN/EH#: 6863-48-3164.06me Billed To: Michel Ellis Subdivision Info: Laurel Brook B Lot#6 Reference Name: Location/Address: Sandpit Road-27006 -77I �L Proposed Facility: Residence Property Size: see map Date Evaluated: / % d/ Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 43 4 5 6 7 Landscape position L Sloe% (01/0 HORIZON I DEPTH n—C4D - r Texture group S;C-L C L 'C L- Consistence CrSS SS<X r S5 Sf Structure S Com- C Mineralogyw� HORIZON II DEPTH - I (p X r Q Texture group C- --t- Consistence F• _ Structure 3k- Mineralo (1M 1E¢� hM , HORIZON III DEPTH Texture group Consistence ' S55 Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 2 RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 0 S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: C> OTHER(S)PRESENT: REMARKS: ' OA- itJ 6A_6A/11eJ67 mai T W4-649L6 L GEND A LandscapePositionPosition 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) ■■.■.ri.■■■...■..■..■..■■s■..■rig...■....■■..■.■.■..a■■..e■■e.■o■..■ ■■.■.■■.■■.■■■..■.■.■■..■..■■...■■.■■■■■.■■.a�■ars■■■.■■■rug...■■■..■ ■■■..�i..■■.■.■..■.■.■■.■Iwo■■.■..■i�■■..,iii■■ri►�■�...■■.■■..■.s.■.■..■■ .......................■.V■.■■■■■�.....,■■■�lIIII..■■■■■..■■■......MEMO ....■..................■................`■�■�,..■......■■.....mom■■■ ■........■.fyA17■■.■......11.■■Ii►�7■■■Gr■...■■I,.■■■....■■f�■i�G1■■......■ ■.■ani■...■■..■...■......■..►■:-.:�■..■■..ri.■..■■.■■..■■.■■■...t■■■■e ■...Ih.■I��a�..■■.■.■..■...■■iia■�.■■.■■..w..■..■■.■■...■■E.e.....■■■ ■..iii■.■...■.■..■..■■.■■.■..■■■w::�.■■...■...■■...■.■■s■...■....■■■ ■■ei�...■■.■s.E.■■.■■■enc.■.■w_�::�■_■■■..■......■..■■..■.....■.■.■ ■:air.....■......■■■..■a..■w��.■..■..■.-�■.■■....■..........■■.....■ APPLICATION FOR SITE ElIMMTION/IMPROVEMENT PERMIT&ATC D • . Davie County Health Department Environmental Health S&don NOV 1 91999 P.O. Box.848/210 Hospital Street Mockaville, NC 27028 (336)751-8760 ***DDU3'ORTAWZ*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed '� OVI0 rn UANC- C.c.J111.'A,-fkn.,,AIS-' contact "roan S)AU%A "A W 6S Mailing Add"aa 'A 0 VA --e,i l r'4:% I some Phone q9a- 5197 city/stat./slip 6OVz v%ce ,/J. C.. .2700 G Rusin ee Phone°Igg-50% m.,3Ns-1110 2. Nage on Perait/A= if Different than Above 6CLQ$" 70.q I31 Mailing Addrees city/state/sip 3. Application For: V.-dits Evaluation ❑ Improvement Permit/ATC ❑ Both 4. Brat" to service: "Ouse ❑ Mobile Home ❑ Business ❑'Industry ❑ Other 5. If Residence: i People t Bedrooms i Bathrooms O Dishwasher O Garbage Disposal O Washing Machine O Bassmeat/Plumbing O "sement/No Plumbing 6. If Business/Industry/others Specify type # People i Sinks • commodes 1 showers i Urinals i Water coolere. Ir FOODSERVICE: g Seats Estimated Nater Usage (gallons per day) 7. . Type of Water supply: ❑ County/City 0,06611 ❑ Community e. Do you anticipate additions or expansions of the facility this system is Intended to serve? ❑Yes ❑No If yes,what type? ***IMPORTANT""CLIENTS MUST COMPUMTHE REQUIRED PROPERTY INFORMATION REQUESTED BEI,OW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the client with THIS APPLICATION. Property Dimensions: G 01 WRITE DIRECTIONS(from Mocinvifle)to PROPERTY: Tax OfIIee PIN: # <SS5 3 YFi— 3l-6` �, $e¢. Rc 1.v„cr•� Property Address: Road Name S AV00 Ac QJ CityrLip �)OVc,NCE 27ooc, If in a Subdivision provide information,as follows: Name: Lt;0A E•1 Qnoc3 K ' Section: 2 1 Blocla Lot: Date Property Flagged: 11t51t qct This Is to certify that the Information' provided Is correct to the best of my knowledge- I understand that any permits) Issued hereafter are subject to suspension or revocation,U the site plans or intended use change,or if the information submitted in this application is falsified or changed I,also,understand that I an responsible for all charges incurred front this application. I,hereby,give consent to the Authorized Representative of the Ie County Health Department to enter upon above described property located Io Davie County and owned by_e-3 r0 M. VAions to conduct all testing(procedures as necessary to determine the site suitability. DATEG' �I, SIGNATURE ems•- M THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following. Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. �T a Kingi je4 l o� 10 0 i • Q H LOT1 a3 ��(!�✓{3rn� ��^'tii�$ ,S V � � v S ISN o FiR 1 cony. 4 e Mday 4 e a.Y r w TM und.nlyn•d n✓.�'ooknoal.dg.Nat 1 am(" W to o .ubdir of M. Ptla ad N s—dr+de°••�a1Ot ins. `G�,vy,yay tM ai.Met�°•dO°"1°'�"� Petr anoan and duulb.d lhr.w• sbiok io bdn.w r ai••Y•"d .uv�•LIe1 rn.n..mal ware n,ed.awd ay ncn.+°"(a..d e..al4de^ NLn vian or r..andy ryrnd "_d tM r•a.enY Ld"'"'a e•8• Wdlcaon o1 Dari.county one Nal I h--by.b odOpl wn+ny MM N dlldd w4 MY P• ed ...4 IAeY 1'XI.Pep•2t..Jd)(eMr): our Ir..corwnt r4s. and lMr d—�.to •,ate..w d•n•1 Yrded•e r been nvm L b'p � �abdniswn 0"my( ) .RODG.b minlmum bWldin p 11M Pay a•et tln nb d puede^r n1an+n•!edYYd ..took 1.... and d d al.dl.heel.,dlsP•sanot d. ❑ am Md a Mrp�io sale .)-JO r a��d•a N.l nee✓N .e.e and.w.m.^to to public or pMal.u•.w nol` . der d NUS—'w. 5.7 srK a sulr ... ❑ � dY .1g d Yy a '- aaY+.— ❑ d. DO na $.ol or Stomp Dol. °1r' r :� i Tr 0'N 2623 — DoW roil c: .nn..n•. _ • o :7:7.. ......r... _ L oy e66 .1...:.. �y o°o mri..• 'ri..C.;.'.; Tract 11 iti� ar S N River Bend Hills o "� David M. Hones 'cb '6 ` 'ate PoreMl 50 P.B. 6, P. 162 9 jiA N y Tax Map B-7 \ 0 }� ✓ Yrginio G. Walker o eye ♦ti N.; D.B. 075-153 5e u L.10� �' N� 7,0 w ' cp c P lr�, o• N 89°45'15'ES1, 551, ,9 -16 v 93 09 Z 7' 1392.9 251. 3• 3728 V 5 L-17?L-18}9p Ob�r,.g1 o Sb s or 81 572.02' R 70 / va, �°50'50"WElpoP/La Dna aun / a a / C'� W � O6 fC 14.700 Acres n , •ob0Lit Parcel .38 oe°a z7 z 202.54' 97.50' S 88°08'35"E Tax Map 8-7 p Zti5,•yk' `, �"�o �Q ,� // _ Anthony B. Butner N 82010.45"W 1/G \4 ry�'S� D.B. 146-539 } h N n a o fv in 3. yoo 10.498 Acres J ° -IPA o n i e you A.al alone `� 3 268,3 f @ e ••a ,y aom.r, (. 0 5• ? S 40°40'00"E 91.88' OR w a n � 5 51.56'40"E 75.63' A9, n,.a••' s � • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900641 Tax PIN/EH#: 5863-48-3164.06 Billed To: David M. Hanes Contracting Inc. Subdivision Info: Laurel Brook Sec. B Lot#6 Reference Name: David Hanes Location/Address: Sandpit Road-27006 Proposed Facility: Residence Property Size: 14.7 Acres Date Evaluated: T1Zj7 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit -/ Cut ✓ FACTORS W.v3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture group Consistence ~ Ixri Structure 2 Mineralogy HORIZON II DEPTH Texture group G Consistence : S Structure Mineralogy I V M HORIZON III DEPTH :30-419 Texture group Gt-S Consistence Structure Sg k Mineralogy k HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION vs LONG-TERM ACCEPTANCE RATE O. 3 SITE CLASSIFICATION: QHS EVALUATION BY: `&40GLIAi LONG-TERM ACCEPTANCE RATE: O• "D OTHER(S)PRESENT: 1" IJALL- , IM/ID j4A-,JgS REMARKS: S&A 20Cac SAa1J/C LAV -tb ao) C Y(F t S P 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/112 DCHD 05/99(Revised) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■s■■■■■■se■■■■■■■■■■■■■■■■■SSSS■■■■■■■■■■e■■■■■■■■■■a■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■SSSS■■■e■■■e■■■E■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■SSSS■e■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■E■■E■■M■E■■■■■■■■■■■■■■�■■■■■■■■See■■■■■■■See■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■SSSS■■e■■■■■■■■■■■■■■■■e■■■■■e■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MENNENMEMEMEMMEMEMMENNENMONSONMEMNON ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■SSSS■■■■■e■■■■■■e■■■■e■■■■■■■■■ ■■■■■■E■■■■■■■■■■■■■■■E■■■■■■■■■■■■SSSS■■e■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■SSSS■■■■s■■■■■■■e■■■■E■■■■eE■■■ ■■Mese■see■■■■■■■■■ee■■■■■■■■■■■■■■■■■■s■■■■■■■■■■■■e■e■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■E■■■■■■■■■■■■■■■■■■■■■■■■■■ESE■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■SSSS■■■■■■e■■■■■■■■■■■■■■e■e■■■ ■■■■■■■■■■■■■■■■■■■■■■■M■■■■■■■■■■■SSSS■e■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■S■■■■■■■■■E■■■■■■■■■■■■■■■■■■■■■■■■■■E■■■■■■■■■■■SEEM Davie County Wealth Department Environmental Wealth Section Po sox M/210 Hospital street Mocksville,NC 27028 Phone: (336)751-8760 September 19, 2001 Mrs. Michel Ellis 4448 Winterberry Ridge Court Winston-Salem,NC 27103 - Re: Site Evaluation- Laurel Brook/Lot 6 Tax PIN#: 5863-48-3164 Dear Mrs. Ellis: As requested, a representative from this office visited the above site on September 18,2001. 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 on-site sewage disposal systems. 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, feel free to contact this office at (336)751-8760. Sincerely, Jeff G. eauchamp,R.S. Environmental Health Section enc(s) Davie County Health Department Environmental Health Section Payment Due Now. PO Box 848 (210 Hospital Street) Please Return a Copy of the Bill with Payment. Mocksville,'NC 27028 Your Check is Your Receipt. (336)751-8760 Michel Ellis Account No: 990001918 4448 Winterberry Ridge Court Invoice No: 2532 Winston-Salem, NC 27103 Billing Date: 9/19/01 Sry Date Service Code ID/ATC# Description Sry Cost Quan. Extended Cost 9/19/01 SITE EVAL-PS Laurel Brook B-Lot 6-27006 $75.00 1 $75.00 Balance Due Now: $75.00 , V y DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account M 990002887 Tax PIN/EH M 5863-48-3164.6B Billed To: Alex McGuire Constr. Subdivision Info: Laurel Brook Lot#6B Reference Name: Location/Address: Sandpit Road-27006 Proposed Facility: Residence Property Size: see map 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) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�■■E■■■■■■■■■■■■E■e■■■NNE■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■a■■■�■NOON■■■s■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■aE■■EE■■E■■■N■■■E■■■■■■�■■■■■■■E■N■■■■e■■■■■■ENE■E■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■s■■■NEE■■■s■■■E■■■■■■■■■■■■■■■■■■■■■■■■■ EmmonsMEMNONEMEMEMMEMNONMEMEMEMEMNONMENiii ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■E■■EN■a■■E■■■■■■■■sea■■■■■■�■■■■■■■�■■■■■�■■■■■■■■■■■■■■■■■■■ ■■■■e■■■■■■■■N■■■■N■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■E■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■NONE■■ ■■■■N■■■■■■■■NOON■■■N■■■■■■■■■■■E■■■■■■■■■■■■■NNE■■■■■■NE■■■■■■E■■ 1 Davie County Health Department Environmental Health Section Payment Due Now. PO Box 848 (210 Hospital Street) Please Return a Copy of the Bill with Payment. Mocksville, NC 27028 Your Check is Your Receipt. (336)751-8760 Alex McGuire Constr. Account No: 990002887 5723 L Country ClubRoad Invoice No: 3812 Winston-Salem, NC 27104 Billing Date: 10/2/03 Sry Date Service Code ID/ATC# Description SryCost Quan. Extended Cost 10/2/03 SEPTIC-NEW-O 3590 Laurel Brook-Lot 6B-27006 $150.00 1 $150.00 Balance Due Now: $150.00 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002887 Tax PIN/EH#: 5863-48-3164.6A Billed To: Alex McGuire Constr. Subdivision Info: Laurel Brook Lot#6 Reference Name: Location/Address: Sandpit Road-27006 Proposed Facility: Residence Property Size: see map ATC Number: 3555 **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 AS' Dishwasher: Garbage DisposalEr, Washing Machine:ET' Basement w/Plumbing:•EI`'r Basement/No Plumbing: ❑ Commercial Specification: Facility Type #�P/eople #People/Shift #Seeatsl Industrial Waste: ❑ Lot Size Type Water Supply Ale,/! Design Wastewater Flow(GPD) Site: New❑ Repair❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width X Rock Depth / Linear Ft4U Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUEN LTEk RISER(S) IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Fla h artment 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 . 1 hone#is(336)751-8760.**** r �nA ev \/ r Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990002887 Tax PIN/EH#: 5863-48-3164.6A Billed To: Alex McGuire Constr. Subdivision Info: Laurel Brook Lot#6 Reference Name: Location/Address: Sandpit Road-27006 Proposed Facility: Residence Property Size: see map ATC Number: 3555 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: Date: �p 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) 11PLICATION FOR SITE EVALUATION/Ih1PROVEMENT lillft' '�ATc Davie County Health Department Z7Yftnn1CM71Hee/t/J Section C �A P.O. Box 848/210 Hospital Street �p V Mocksville, NC 27028 �9 `> �NM` C (336)751-8760Co IMPORTANT*** TIIIS APPLICATION CANNOT BE PROCESS'ED UNLESS ALL '1 INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for Ln, -ruction., rr i'1 1. Name to be Billed Contact Person �L,t J — Mailing Address Ilolnc Phone City/State/ZIP Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/ tate/'Lip 3. Application For: O Site Evaluation n Improvement Perinit/ATCoth 4. System to Service: L'S House ❑ Mobile Home ❑ Businets ❑ Industry ❑ Other 5. Type system requested: Conventional ❑•conventional modified ❑ iunovaLive 6. If Residence. tl People 11 Bedrooms _ it Bathroonlu Ld'bishwasher aearbage Disposal Mlashing Machine 1�8•ss-ment/Plumbing ❑Basement/Ilo Plumbing 7. If Business/Industry /Other: verify type t) People II Sinks # Commodes 0 Showers tt Urinals It WaLer CoolcrLi IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) S. Type of water supply. ❑ County/City ❑ Well ❑ Colluilulllty 2. Do you anticipate additions or expansions of the facility this syslclll is intended to serve? ❑ Yeti o l If yes,11-hal type? 'IMPORTANT "CLIENTS r11USTC0dIPLETE•TIIE REQUIRED PROPERTY 1NG010-1ATION REQUE'ST'ED `I BELO\V. Eitllcra PLAT or SITE PLAN jVUSTBESUBr11ITTL•D by the client wills THIS APPLICATION. l Property Dimensions: 264 Y x-�1 qO',- I(c I %' WRITE DIRECTIONS(from Mucl:sville) to PROP :l?TY: Tax Office PEN: #��G3 ' 7 �~ 3 Property Address: RRoAlllc IN & {J t t 1�� c. �.l�� >,Vev 1"L J c City/Zip Adcza ace ?Q0-05- C�Itl- c s 1 1� A. If in a Subdivision provide inff oormation,as follows: Natnc: LA f�� 1 ►cJ0e)c� Lo TAl t, Zaj Section: Block: Lot: Date !ionic corners flagged: 0 This is to certify that the information provided is correct to the best of my knowledge. I understand that any perwit(s) issued hereafter are subject to suspension or revocation,if the site plans or intended use change,or if the infornlatiatl submitted in this application is falsified or changed. I,also,understand that I urn responsible for all charges ineurrcal frons Misapplication. I,hereby,give consent to the Authorized Representative of the Davie County health 1)cparinIall to enter upon above described property located in Davie County-and owned by to conduct all testing procedures as necessary to determine tic site suita ' DATESIGNATURE TIIIS AREA MAY BE USED FOR DRAtiV G YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, stru tures, seZ63, and septic locations). Site Revisit Charge Client Notification Dale: EIIS: Sign given Account No. Revised DCIID(05/03 Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002887 Tax PIN/EH#: 5863-48-3164.6A Billed To: Alex McGuire Constr. Subdivision Info: Laurel Brook Lot#6 Reference Name: Location/Address: Sandpit Road-2700 Proposed Facility: Residence Property Size: see map 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% ZY HORIZON I DEPTH Texture groupS Consistence Structure Mineralogy HORIZON II DEPTH h Texture group Consistence Structure - Mineralogyr 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 I 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) ■■■■■■etc■■t■■■■■■■■■■■■■e■■e■■■■■■■t■■ae■■■■■■■■■■■■■■■e■e■e■■■t■t■■■e■■■■■e■■■■ee■■ ■■■■a■■■■■■■t■■■■■■■■■■t■e■■■■■■■■■■t■■e■■■■tes■■■■■■■■■■■■■■■e■■■■ee■■■e■■■■se■■■■e■ ■■■■■■■■■t■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■t■■■■■■■■■e■■■■e■■■■e■■■■a■■■■■■■■etc■ ■■■■■■■■■■■■■■e■■c■■■■■■ce■■■■■■■■■■ce■■■ ■■■■■■■■■■■ac■ec■c■■■■c■c■■ee■■■c■■■■tc■■■ MENNENiiiiiiiiiiiiiiiiiiii iiins■ ■MENNEN■■t■■ ■MENNEN■■■■■ ■MENNEN t■■■t ■ee■■■NE■ ■■■■■■■■■■■■■■■■■■■■■■t■■■■■■■■■n■c■c■■■sic■■■c■■■■■■■■o■■�■■c■■■■■■c■■■ec■■■■e■■■tees ■■■■■■■■■■■■■■■e■■■■■■■■■■c■■■■■e-....tetee■■e■■■■■■c■■■�.jc■■cc■■■■e■■■■■■■■■■■■ect■■ ■■■■■■■■■■t■■sec■■■■■■■c■■■ec■■c■■■■■■■■■■■■■■■c■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■c■■t■■ ■■■■■■■■■■■■■■■■■■■■■■■■eec■■■■■■■■■■■■■ec■■■■■■tet■■■■■■ec■■■c■■■e■■■■■■■■■ec■■■■e■■ ■■■■■■■■■■■■tee■■■■■■■■■■■■■■■■■■■■c■■■■c■■■■■■■■c■■■■■■■■■■■■e■■■■ec■■■■■■■■■■■■■e■■ ■■■■■■■c■■■■■■■■■c■■■■■■c■■■c■■■■■■■■■■■e■c■■■■■■■c■■■■e■■■ccc■c■c■■■■■ec■■c■■■eec■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ee■et■■■e■■■■■■■ee■■■■■e■■■■ ■■■■■■■■■■■■■■■■tees■■■■c■■e■■e■■c■■■e■■■c■c■tee■s■■■ce■t■■te■■■■c■ee■■ct■■■■■■■■■ ■■ ■■■■■■■■■■■e■■■■■■■■■■■■■■c■e■■■■■■■■■e■■ ■ec■■■■■■■■■■■■�■■■■■■■ecce■■■■■■■■c■■■■e■ DQvie'County Oealth Department Environmental Health Section Payment Due Now. PO Box 848 (210 Hospital Street) Please Retum a Copy of the Bill with Payment. Mocksville, NC 27028 Your Check is Your Receipt. (336)751-8760 Alex McGuire Constr. Account No: 990002887 5723 L Country ClubRoad Invoice No: 3751 Winston-Salem, NC 27104 Billing Date: 8/28/03 Sry Date Service Code ID/ATC# Description Sry Cost Quan. Extended Cost 8/28/03 SITE EVAL-PS Laurel Brook-Lot 6-27006 $150.00 1 $150.00 8/28/03 SEPTICNEW-R 3555 Laurel Brook-Lot 6-27006 $150.00 1 $150.00 Balance Due Now: $300.00 � 0 / I ` i � I i � , i ___ � ; _ _-- __ i ,'` - ' . � 1 '� _...-� - `, ' I . --. ; i ' % ; ' ; �' ' , . ;, . , , , � -: ; ' � �' � `� / _ _ � �, � : ,� `---_ .. ....___--�. . ,� 4 . - . � ..- ��....\ . '�'.�/ ., ... .\ : , ��.. .. � / \ .. � , �E , _____ � , 't�� / N '`� _ - . �:�o �� ic .. , ; , �; _ ----_. _____ ____,_. , ._ __, �, . . 1 ! � _ 1 �� ' � __ _ - � , , . � '� � ;i , '� '', � ,i I ,' i i Notes ------------------------ 1, p1L distsnces shown on thla plat are horizonlal Qround diatance�, unlesa otherwL�e noted. 2. All bearinge ehowa on thie plat are based on deed or plat bearing., +w noted. ___ Lepend ____ � I.PS. Iron Pin Set (3/4" conduit) Q E.IP. Existing Iron Pin (As Shown) �., Utility Pole j�Q Wa:er Meter cv �Q Gas Valve NN pQ Watsr Valve � 2' �y 2' Drop Inlet Bollard � ca o �,, N R � �,, �oti�'s's�p�,. ��'-s� F�-....... >,�.� WAaO � •'� �c�'.A lawrence Joel SI+ h s Veterons �• �� Neroorlal 0 X � CoUseun A 1� Collseun Twent Seventh �- Drive Street Vfcinity Map Not to Scale Pro posed Dtivtision o f Land Owr►er/D�eveloper: Alex McGuire S�C11�6 i�� = i�� f00 50 0 50 f00 200 FIELD WORK BY CHECKED BY.• CJ GS PJ JEB Block: PIN: TOIINSHIR CITY.• COUNTY.• TYINSTON A'lNSTON—SALEM FORSYTH STATE: DATE: SHEET NUAlBER: NORTH CAROLINA August 20, 2003 JOB NUXBER DRAWN BY.• � O f � 03100.001 DAW BEESO� Et161�EERit16 ItiC. ENGINEERS SURVEYORS PLANNERS 503 HICH STREET iYINSTON—SALEM, NC 29'f01 TELEPHONE: (336)-748-0071