230 Pratt Farm Ln11,951,
Account #: 990001898
Billed To:
Reference Name:
Proposed Facility:
DAVIE COUNTY HEALTH DEPARTMENT
f C .3d
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Alan Hinkle
Boger Real Estate
Residence
Tax PIN/EH #: 5813-79-4399
Subdivision Info:
Location/Address: Pratt Farm Lane -27028
Property Size: 6.82 acres
ATC Number: 2632 (PzV%S77>
**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 I I 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
Hoose
#People 3 #Bedrooms 14 #Baths 2 -
Dishwasher: El"' Garbage Disposal: Er Washing Machine: Et"' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type . 1 #People #People/Shift . ##Seats Industrial Waste: ❑
Lot Size(o•gz Type Water Supply Wim- Design Wastewater Flow (GPD) q9D Site: New 03 '.., Repair ❑
ti
System Specifications: Tank Size IUO GAL. Pump Tank GAL. Trench Width � Rock
Depth 17-" Linear Ft.�O '
p
Other: ^ j� � -rjo.3 Cr'� 0 Its l Ll�i.S `"I,O.C. ►tAtom} .
Required Site Modifications/Conditions: 1.A.S m , o.-� C.O� D� �� Opp oza l,i 5 c" 144--n-f-
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.****
,R� slog P� �+�►�
IN
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
Souj
Date:
��rn2 lSSva,
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 990001898 Tax PIN/EH #: 5813-79-4399
Billed To: Alan Hinkle Subdivision Info:
Reference Name: Boger Real Estate Location/Address: Pratt Farm Lane -27028
Proposed Facility: Residence Property Size: 6.82 acres
ATC Number: 2632 (aeoLsz-li-)
**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 CONTRACTORMUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type 1 =jIDV - #People 3 #Bedrooms #Baths '2 -
Dishwasher:
Dishwasher: d Garbage Disposal: Q" Washing Machine: GR
Commercial Specification: Facility Type #People
Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
#People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water Supply 0 EI -L- Design Wastewater Flow (GPD) Site: New M Repair ❑
System Specifications: Tank Size(, ? GAL-. Pump Tank GAL. Trench Widtztz Rock Depth 12 Linear Ft. &Q0
Other: TSS 1 K 1 ai ) I o"I YIE- _�-�_ I N =T -ALL- Lt rz zz, , TO.C. MirJ .
Required Site Modifications/Conditions: I C-T&LUy rJ c vL)Q , �' 1 ji[� FacIA PQoP.
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW
INISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
Tsystem between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.!n ighe day of installation. Telephone # is (336)751-8760.****
P LI t1E�
J'
(\ WW Qj
i
WCC T�,� ueJtS 1s•1 D
En ironmental Health Specialist's Signature: Date:
(q 1 /gyp/
4D 05/99 (Revised) —"
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990001898 Tax PIN/EH #: 5813-79-4399
Billed To: Alan Hinkle Subdivision Info:
Reference Name: Boger Real Estate Location/Address: Pratt Farm Lane -27028
Proposed Facility: Residence Property Size: 6.82 acres
ATC Number: 2632
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 WASTEWAT 7�119,
VA FOR A PERIOD OF F VE ARS.
Environmental Health Specialist's Signature ate: f'�
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/.`
DCHD 05/99 (Revised)
-41 -
#2
�?�f
fil L .
S�
Date: 11 O
hoop
eta►
)ac
Account #: 990001898
Billed To: Alan Hinkle
Reference Name:
Proposed Facility: Residence
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Tax PIN/EH #: 5813-79-4399
Subdivision Info:
Location/Address: Pratt Farm Lane -27028
Property Size: 6.82 acres
**N&I�L,mhc�r: 2632
q* I his-l-mprovement/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 I 1 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
-TOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM.
Residential Specification: Building Type rn . m e— #People 3 #Bedrooms _ #Baths ':>,
Dishwasher: �Garbage Disposal: [E�' Washing Machine: �! Basement w/Plumbing: ❑ Basement/No Plumbing: 13
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 13
Lot Size 6P er- Type Water Supply L) i I Design Wastewater Flow (GPD) 3 a Site: New 91' Repair 0
System Specifications: Tank Size 1 Doc GAL. Pump Tank
Other:
GAL. Trench Width 3 4 Rock Depth Linear Ft. sc o
RPnn,irp.d Site Modifications/Conditions: n S 4-11 or, C on 4v w e e_ oo fro /I oft,-
IMPROVEMENT/OPERATION
fIMPROVEMENT/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.****
Environmental Health Specialist's Signature:
DCHD 0'/99 (Revised)
Account #: 990001898
Billed To: Alan Hinkle
Reference Name:
Proposed Facility: Residence
ATC Number: 2632
DAME COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Tax PIN/EH #: 5813-79-4399
Subdivision Info:
Location/Address: Pratt Farm Lane -27028
Property Size: 6.82 acres
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:
CERTIFICATE OF COMPLETION
Date:
**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:
DCHD 05/99 (Revised)
Date:
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DAVIE COUNTY HEALTH DEPARTMENT d / J
j Environmental Health Sectionov
• P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990001448 L Tax PIN/EH #: 5813-79-4399
Billed To: -Mefs Hetes- /fin ' ` "� � Subdivision Info:
Reference Name: Boger Real Es Location/Address: Pratt Farm Lane -27028
Proposed Facility: Residence! y/�,/ Property Size: see map
ATC Number: 2632
**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 m • I IU►i15 #People 2) #Bedrooms - :5_ #Baths '—
Dishwasher: Cir"' Garbage Disposal: M"" Washing Machine: Tr 'e, Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #/S_eats Industrial Waste: ❑
Lot Size •� ype Water Supply w��L- Design Wastewater Flow (GPD) 3w� Site: New L/ Repair ❑
System Specifications: Tank Size 100aAL. Pump Tank GAL. Trench Width Rock Depth �Z Linear Ft.
Other: 3 DIST" go -no si
Evy-16 ,
W`jT4u u S
1 1 • C�
f4 -4 .
Required Site Modifications/Conditions: I-JbT& L 4-i �Q�%�, � DO FWD- ii.`�;`tit.-,�^ �o 0"
�'-1--1 ^l(:S
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) IF 6 " BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
CA,q
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.****
A�P�• Its ��. L� �
APPWY.
Environmental Health Specialist's Signature:
DCHD Oj /99 (Revised)
Dater { tpl ®O t/
• DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990001448
Billed To: Melissa Haas
Reference Name: Boger Real Es
1-I%JP%JJG4 1 0%.'I I Y. V0 V1 IVG
ATC Number: 2632
Tax PIN/EH #: 5813-79-4399
Subdivision Info:
Location/Address: Pratt Fane Lane -27028
r I UPUI Ly JILO. .ICC
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article I 1 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WAST C TIO IS V D FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signatur Date: 1% 6 00
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:
DCHD 05/99 (Revised)
Date:
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department
Environmental Health Section OCT 2 5
P.O. Box 848/210 Hospital Street 2000
Mocksville, NC 27028
(336) 751-8760 ENVIR01! ENT HE1 H
DAVIE Co11 ,
***IMPORTANT*** THIS APPLICATION CANNOT BLA PROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED.
C Refer
�to-the INFORMATION BULLETIN for instructions.
1. Name to be Billed k'— C( S +fid T �L� J J� Contact Person t i S SQ✓
Mailing Address J/1 �VAI'-'o
99/1 �6ri ev- torek ed - Home Phone _ /�J — (�/
City/State/ZIP A61 VA I' - 'o, �C—c�7bl� (t Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address City/state/Zip
3. Application For: Site Evaluation [➢ty�Improvement Permit/ATC ❑ Both
4. system to service: ❑ House C -*"Mobile Home ❑ Business ❑ Industry ❑ Other
S. If
Residence: # People # Bedrooms # Bathrooms _
14 Dishwasher IYGarbage Disposal kK Shing Machine F1 Basement/Plumbing ❑ 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: VCounty/City ❑ Well ❑ Community
s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No
If yes, what type?
***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: x — '- � - ? WRITE DIRECTIONS (from Mocksville) to PROPERTY:
Tax Office PIN: # 5.P13- / q '7293 ( 00 /c't�h-f�l '-� . t1'/Wk; N Vile -
Property Address: Road Name l _&2i-±6Tj2 Ln 1,0FCj t) ,LJ C ti't W �-G/[.s Ljn, � 6"1.
City/zip k ftsy l I L'(-, /\z 5-�. �'fY e �-E t Et n l P0'a)
If in a Subdivision provide information, as follows:/Y� t1 • (�w� �'Q l-} (7
Name: I re 14_ Al-ee
Section: Block: Lot: Date Property Flagged:
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s)
issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information
submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from
this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described property located in Davie County and owned by
to conduct all testing procedures as necessary to determine the site suitability. �1
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property lines and dimensions, strugLures, setbacks, and septic locations).
Site Revisit Charge
Date(s): 1 1 i db
D'9
Client Notifi_ ion Date:
EHS-'
Revised DCHD (07/99)
��/7/(' /
,Icy ll
1 o 5 e2_e sem! /. J JOt`,
Account No.
Invoice No. t S
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P/0 Tax Lai 6
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• P/0 T ' Lot 6
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TOR flap 0-3
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Tax tot 6.02 •
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Tax lot S. S ` '� •`
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Tax Lot 6. 13 Tox lot 6.Q3
Tax L40p 8-3
a*•. a...r Tax Unp 6-3
Tou Lot 6.14
s � N �� '��..�•- '� lox L40P 8-3
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L0 8 Tax map 9-3
Ott C!.mm OWA*, ek."
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Lota
APPLICANT INFORMATION
Account #: 990001448
Billed To: Melissa Haas
Reference Name:
Proposed Facility: Residence
Water Supply:
Evaluation By:
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
SoiVSite Evaluation
PROPERTY INFORMATION
Tax PIN/EH #: 5813-79-4399
Subdivision Info:
Location/Address: Pratt Farm Lane -27028
Property Size: see map Date Evaluated:
On -Site Well Community
Auger Boring Pit
Public
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:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
LEGEND
Landscape Position
EVALUATION BY:
OTHER(S) PRESENT:
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)
APPUCAHON FOR SIZE EVAUTAlION/IMPROVEMENT PERMIT & A
Davie County Health Department
Environmental Health SmWon
\�! P.O. Box 848/210 Hospital street FEB 171997
Mockaville, NC 2702
00
(336) 751-8760 1-7,
***I21PORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED
r
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. llama to be Billed Xr e, 9 CSI" Qe-,* itS7,Y 4 e- Contact Person C; 0) eel
/sailing Address,j � U-5,14!21 /`S-�i Bome Phone /
City/State/ZIP _4 d t meq to C e Al, C. o27on 4P Business Phone �q �— I� 3 3
2. Name on Permit/A1C if Different than Above J4 -e- n i n w K. e� 9, b i lc--
Hailing Address .SCAN d 4, &L,) y e- City/State/zip
3. Application For: Site Evaluation ❑ Improvement Permit/ATC ❑ Both
4. system to service: ❑ House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
a. If Residence: # People 4 # Bedrooms . # Bathrooms Z
0 Dishwasher Garbage Disposal washing Machine 0 Basement/Plumbing 0 Basement/No Plumbing
6. If Business/Industry/Other: Specify type # People # Sims
# Commodes # Showers # Urinals # Nater Coolers
IF FOODSERVICE: ii Seats Estimated hater Usage (gallons per day)
7. Typo of water supply: ❑ County/City 'y well ❑ Community
S. Do you anticipate additions or expansions of the facility this system is intended to serve! ❑ Yes ❑ No
If yes, what type'
***1MF0RTAN7'*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBAHITED by the client with THIS APPLICATION.
Property Dimensions: oD WRITE DIRECTIONS (from
/Mocksville) to PROPERTY:
Tai Office PIN: # 813 _ ~q — 4,3 g �(d01,6> 6, DI /V o ✓T
Property Address: Road Name
r' arm ,Ln
Citv/Zip %D &Loa (f ifI If
If in a Subdivision provide information, as follows:
Name:
Section: Block: I/ ' Date Property Flagged: a'`�`' S� U
This is to certify that the inrormation 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 or the Davie County Health Department
to eater upon above described property located in Davie County and owned by
to conduct all testing procedures asnecessaryto determine the site suitab ' -.
DATE — -2- �'" 7 �7 SIGNATURE�
36 -
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed
property line;, and dimensions, structures, setbacks, and septic locations).
Revised DCHD (07/98)
Account No. /96
Invoice No. 5d3
VIA ef&
Ass., Ae-re
1+S roP�r�y or
• � 53 acres � �
F.- �k V% %' tP i --i=:= N
e 1' a alt . n be notated tluou h the
r ' DAVIE COUNTY HEALTH DEPARTMENT
' r Environmental Health Section SECTION LOT,
Soil/Site Evaluation
APPLICANT'S NAME sUO
PROPOSED FACILITY
SUBDIVISION
Water Supply: On -Site Well
Community,
Evaluation By: Auger Boring Pit
DATE EVALUATED C/013// IJ
PROPERTY SIZE //1///z',,,,
14 e
ROAD NAME,LU f7 J / ✓tr A A �r
Public
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
Slope %
�----
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
J
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
SAPROLTTE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: 2
LONG-TERM ACCEPTANCE RATE: J
REMARKS:
DCHD (01-90)
EVALUATION BY:
OTHER(S) PRESENT:
T /
— ,512 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/ft2
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. 0. Box 848/210 Hospital Street
Courier 09-40-06
Mocksville, NC 27028
(336)751-8760
March 3, 1999
Boger Real Estate
5284 U.S. Hwy. 158
Re: Alan R. Berkebile II
Advance, NC 27006
Re: Site Evaluation/Site 1
Pratt Farm Lane/5 Acres
Tax Office PIN: #5813-79-4399
Dear Client(s):
As requested, a representative from this office visited the aforementioned site on
February 23, 1999. Based upon the information provided on the Application for Site
Evaluation and after an evaluation was completed on the site, the site was found to be
provisionally suitable; however, the system must stay on the ridge in the open field.
Before an Improvement Permit/Authorization to Construct can be issued the appropriate
application must be filled out and the house/mobile home location staked off.
If you have any questions, please feel free to contact this office.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health Specialist
RH/wd
Enclosure(s)
cc: Zoning Officer