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140 Quarter Horse Trail Davie County,NC Tax Parcel Report Tuesday, December 20, 2016 21' . 137 408 416 I 424 1 + I 421 rf 428 444 r 140 __ ----- - — r - r? _....._._.............._..._..........................................................................................................__........ _. _. _._. - WARNING: THIS IS NOT A SURVEY Parcel Number: H30000010102 Township: Mocksville NCPIN Number: 5729271410 Municipality: ..Account Number: 82525623 Census Tract: 37059-806 Listed Owner 1: SALERNO LARRY Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 140 QUARTER NORSE TRAIL Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag.District: No Legal Description:- 20.000 AC OFF HWY 601 Fire Response District: CENTER,WILLIAM R.DAVIE Assessed Acreage: 19.98 Elementary School Zone: WILLIAM R DAVIE - Deed Date: 1/2005 Middle School Zone: NORTH DAVIE Deed Book/Page: 005910723 Soil Types: ApB,WeC,RnD,CeB2 Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding&Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: 101 All data Is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Davie County, implied warranties of merchantability or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to NC or arising out of the use or Inability to use the GIS data provided by this website. OPERATION PERMIT or Itice use Only Davie County Health Department *CDP File Number 188169-1 r � 210 Hospital Street r" P.O. Box 848 County ID Number: Mocksville NC 27028 EvaluatedFor. NEW Phone:336-753.6780 Fax:336-753-1680 Township: Applicant: Larry J. Salerno r operty Owner: Larry J. and Debbie Salerno Address: 428 Allen Road ddress: 428 Allen Road City: Mocksville City: Mocksville State2ip: NC 27028 State0p: NC 27028 Phone#: (W)A92-5457 Phone#: (336)492-5457 Property Location & Site Information Address/Road #: Subdivision: Phase: Lot: ..4uaa4R®ad )14 o CZ ua-rk r NoPse-Tira-1 Mocksville NC 27028 Directions Structure: SINGLE FAMILY Rd�601 North left on Allen Rd, property at 428 Allen . #of Bedrooms: 3 #of People: *Water Supply: EXISTING WELL *IP Issued by. 2140-Nations,Robert *System Classification/Description: TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *CA issued by: 2140.Nations,Robert - SaproliteSystem? ()Yes ONo Design Flow: 3 6 0 *Distribution Type: GRAVITY-SERIAL Pump Required? QYes (DNo Soil Application Rate: 0 2 2 5 *Pre Treatment: Drain field rNo. cation Field. 1 6 0 0 Sq. ft. *System Type: INFILTRATOR QUICK 4 STANDARD rain Lines 4Installer: Sherman Dunn Total Trench Length: 4 0 0 fl. Certification#: 2702 Trench Spacing: _ 9 Olnches O.C. Feet O.C. EH S: 2140-Nations.Robert Trench Width: _ 3 Oinches Feet Date: 1 0 / 0 5 / 2 0 1 6 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. 2 4 Inches Approval,Status, Maximum Trench Depth: 3 6 ® A oved O Disapproved 6 Inches pPr; pp Maximum Soil Cover: 2 4 Inches CDP File Number 188169 - 1 Septic Tank County ID Number: Manufacturer. Shoaf Lat. STB: 760 long: ' Gallons: 1000 Installer: Sherman Dunn Certification#: 2702 _ oats: 0 0 3 / 1 4 / a 0 1 6 *EHS: 2140•Nations.Robert *Filter Brand: POLYLOK PL-122 With Pipe Adapter Dater 1 0 / 0 5 / x 0 1 6 ST Marker: El Yes No Reinforced Tank: ❑ Ye5 NO = Approva[8tatus 1 Piece Tank: ❑ Yes lD No ® Approved❑ Disapproved Pump Tank Manufacturer. Installer. PT: Certification�9: Gallons: *EHS: I Date: Date: RiserSealed ❑ Yes ❑ No RiserHeight: ❑ Yes ❑ No (Min.6 in.) °.; Approval Statusi, Reinforced Tank:-❑ Yes ❑ No 0],Approved❑ Disapproved 1 Piece Tank:._❑ Yes -,E],-No Supply Line Pipe Size: inch diameter Installer: Pipe Length: feet Certification#: =EHS: *Schedule: Pressure Rated ❑ Yes _ ❑ No Date: Approved fittings El Yes_ El No Approval Status ❑ Approved❑. Disapproved Pu a ui e e Pump Type: Installer: Dosing Volume: — Gal Certification#: Draw Down: Inches *EHS: *Chain: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check-valve ❑ Yes ❑ No Approval Status"', PVC unions ❑ Yes ❑ No ❑ Approved❑ Disapproved Vent Hole ❑ Yes ❑ No Anti-siphon Hole ❑ YeS ❑ NO coP Fite Number 188169 - 1 County ID Number: Electric Equipment NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer: Box 12 inches Above Grade ❑ Yes ❑ No Certification#: Box Adj.To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No 'EHS: Pump Manually Operable ❑ Yes ❑ No "Activation Method: Date: , Approval Status Alarm Audibta ❑ Yes ❑ N0 ❑-Approved❑ Disapproved: Alarm Visible ❑ Yes ❑ No 214 •Nations,Robert *Operation Permit completed by: Authorized State Ag nt: Date of Issue: 0 0 a 1 6 Owner/Applicant Signature: This system has been installed in compliance with applicable NC General Statutes:Article 11, Chapter 130A, Rules for _ Sewage Treatment and Disposal,15A NCAC 18A..1900 et. Seq.,and all conditions of the Improvement Permit and ! LL Construction Authorization.This property is served by a TYPE It A. sewage septic system. Rule,1961 requires that a Type I TYPE II A septic system meet the following criteria: Minimum-System Review ByThe Local Health Department: WA Management-Entity: OWNER Minimum System Inspection/Maintenance Frequency By Certified Operator: NIA Reporting Frequency By Certified Operator: NIA Rule .1961 requires that a.Type IV and V septic systems designed fora home/business owner must maintain a valid contract with a public management entity with a certified operator or a private certified operator for the life of the septic system. Rule.1961 requires that Type VI septic systems designed for a home/business owner must maintain a valid contract with a public management entity with a certified operator for the life of the septic system. Rule. 1961 (2)(e)requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the system owner and certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibilities of the owner and systems operator,provisions that the contract shall be in effect for as long as the system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT 188169- 1 Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: Q Inch Drasvin9 Drawing Type: Operation Permit Scale: ON/A k ft. f I E r FT-1 I i I LL—.— I _ ff , CONSTRUiCTION For office use only AUTHORIZATION *CDP File Number 188169-1 °N Davie County Health Department County ID Number. 210 Hospital Street Evaluated For NEW P.O.Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax:336-753-1680 0 a / a 4 / a 0 a 1 Applicant: Larry J.Salemo Property Owner: Lary J. and Debbie Salemo Address: 428 Allen Road Address: 428 Allen Road CRY: Mocksville City: Mocksville State/Zip: NC 27028 State0p: NC 27028 Phone#: (336)492-5457 Phone#: (336)492-5457 Property Location & Site Information FAddross/Road #: Subdivision: Phase: Lot: d e NC 27028 Directions Structure: SINGLE FAMILY Hwy 601 North left on Allen Rd, property at 428 Allen Rd #of Bedrooms: 3 #of People: *Vy'ater Supply: EXISTING WELL System Specifications Minimum Trench Depth: a 4 Site Classification: Provisionally suitable Inches Minimum Soil Cover 1 a Saprolite System? OYes ®No Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 . a a 5 Maximum Soil Cover: a 4 Inches *System Classification/Description: "Distribution Type: TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 0 Gallons 'Proposed System: 25%REDUCTION 1-Piece: OYes ®No Pump Required: OYes (j)No 0May Be Required Nitrification Field 1 6 0 0 Sq.ft. Pump Tank: Gallons No.Drain Lines 3 1-Piece: OYes ONo Total Trench Length: 4 0 0 ft GPM—vs— ft. TDH Trench Spacing:.. — 9 Inches O.C. Dosing Volume: _ Gallons Feet O.C. Trench Width: @ Inches — 3 _ `='Feet Grease Trap: _ Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS-1 OTS-11 Septic Tank Installer Grade Level Required: 01 011 0111 OIV CDP File Number 188169 - 1 County 11ANumber. ❑ Open Pump System Sheet Repair System Required:DYes ONO ONO, but has Available Space rDesign System Trench Spacing: 9 Inches 0. . ification: Provisionally SuitableE3 Feet O.C. Trench Width: Inches w: 3 6 0 — 8 Feet Soil Application Rate: 0 - 1 a 5 Aggregate Depth: inches Minimum Trench Depth: a 4 Inches *System Classification/Description: TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover .1 a Inches' Maximum Trench Depth: 8 6 Inches *Proposed System: 25°!o REDUCTION Nitrification Field 1 6 0 0 Sq.ft. Maximum Soil Cover: a 4 Inches No. Drain Lines 3 *Distribution Type: GRAVITY-SERIAL Total Trench Length: 4 0 0 ft. Pump Required: Oyes @No OMay 6e Required Pro-Treatment: ONSF OTS-1 OTS-II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. ; This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit,not to exceed five years,and maybe issued at the same time the Improvement Permit issued(NCGS 130A-336(b)}If the Installation has not been completed during the period of validity of the Construction Permit,the Information submitted In the application for a permit or Construction Authorization Is found to have been incorrec%falsified or changed,or the site Is altered,the permit or Construction Authorization shall become invalid,and maybe suspended or revoked(.1937(g)).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,installation,operation,maintenance;monitoring,reporting and repair (1938(b)). Applicariftegal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Date: 214 - tons,Robert 0 a / a 4 / a 0 1 6 *Issued By: Date of Issue:..._ Authorized State Agent: Malfunction Log Oyes (F)Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CO; STRUCTION AUTHORIZATION 'bavie County Health Department CDP File Number: 1881$9 210 Hospital Street P.O.Box 848 County File Number: Mocksvilie NC 27028 Date: 0 a / .1 4 / 2 0 1 6 4 Q Inch Drawing Drawing Type: Construction Authorization Scale: , ON/A lock p NJ F:5` C70 CONSTRUCTION AUTHORIZATION , Davie County Health Department 210 Hospital Street CDP File Number: 188169 - 1 P.O.Sax 848 r,l Mocksviile NC 27028 County Fila' Number: ., Date- 02124 / 2016 Click below to import an image from an external location: Drawing Type:Construction Authorization � e COQ Application For: ❑ Site Evalgation/Improvement Permit ❑ Authorization To Construct(ATC) BlBoth Type of Apph n: 2rNew Systdm ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed LAf-a� • � '*b E6f J l: S ALE4u0 Contact Person ZA-r-RN 5 f}L&My Billing Address_V-2B A L k_rkV 9-0 Ar'�, Home Phone 3(0_ 49-7--S q-K-j City/State/ZIP B oCESVI LA-C t Me- 2--762-5 Business Phone 3 3 b- -7 0571 Name on Permit/ATC if Different than Above S A IA'G Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: E Site Plan 15PIat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name LA Mki-K. t b Eg 61E A LC--Fut 0 Phone Number 3310-4-9 2 S4-Sl Owner's Address +Z$ Auj--t� (Loh City/State/Zip MoC,kSVILLC- t QQ, Z7t�f3 Property Address' City P 0 LKS y l LLIr Lot Size �LO . 000 hZ.. Tax PIN# µ3 - 000- 0o- 101-02- #r r)-y Z.(A 2-11410 Subdivision Name(if applicable) Section/Lot# Directions To Site: If the answer to any of the following questions is"yes",supporting docume��►►tation must be attached. Are there any existing wastewater systems on the site? Pes ON Does the site contain jurisdictional wetlands? ❑Yes BNo Are there any'easements or right-of-ways on the site? V?es ❑No j Is the site subject to approval by another public agency? ❑Yes Ao Will wastewater other than domestic sewage be generated? ❑Yes PNo IF RESIDENCE FILL OUT THE BOX BELOW #People '�'? #Bedrooms 3 #Bathrooms 2 Garden Tu irlpool es ❑No Basement: ❑Yes Flo Basement Plumbing: ❑Yes ;?No IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People # Sinks #Commodes # Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: O(S`nventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ❑ County/City Water ❑New Well 05x'isting Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ,2'N'o If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and f locating a�a n"'r-staki !qo� se/facility location,proposed well location and the location of any other amenities. Site Revisit Charge Propp owne owner's leg-a-representative signature �� Date(s): 3 42—q Ao-E7v-> Vko C.k � PI&A� 14IDDEN VALLEY ALLEY SECTION TWO P.B. 8 Pg. 118 CT a F TRACT 8 { TRAC " # TRACT � r f � t • ?v5.c.g � �E.• a �,. �. v; 410 2 oZg x 5!0 ��ulal�r Li pF�-Frame i . z ��tnrell ;1 � " s�l•1 r? �rive w�� p AfX s,N►a�i� p+z2.3� .7.Ioa�G►►h �ariJ . 's .IMPROVEMENT PERMIT ,,For-Office use only *CDP File Number 188169-1 a+ � Davie County Health Department .- County ID Number, 210 Hospital Street V For: NEW P.O. Box 848 Evaluated Mocksville NC 27028 Township: Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID UNTIL 3116/2020 *NOTE TO INSPECTIONS DIVISION: Building Pennits cannot be issued with this Improvement Permit. Applicant: Larry J. Salerno Property Owner: Larry J. and Debbie Salerno Address: 428 Alien Road Address: 428 Allen Road City. Mocksville � Y Mocksville State2ip. NC 27028 State/Zip: NC 27028 Phone#: (336)492-5457 Phone#: (336)492-5457 Property Location &. Site Information Address/Road#: Subdivision: Phase: Lot: Allen Road Mocksville NC 27028 Directions Structure: SINGLE FAMILY Hwy 601 North left on Allen Rd, property at 428 Allen #of Bedrooms: 3 Rd #of People: *Vl/ater Supply. EXISTING WELL System Specifications nitial S stem *Site Classification: Provisionally Suitable Minimum Trench Depth: a 4 Inches Seprolite System? OYes @No Maximum Trench Depth: 3 6 Inches Design Flow: 3 6 0 Septic Tank: 1 0 0 0 Gallons Soil Application Rate: 0 a a 5 1-Piece: Oyes @No Pump Required: OYes ®No'0May BeReq uired *System Classification/Description: TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR Pump Tank: Gallons LESS) *Proposed System: 26%REDUCTION 1-Piece: OYes ONo _,I) Repair System Required:OYes ONo ONO, but has Available Space Repair System Site Classification: Provisionally Minimum Trench Depth: a 4 Inches Soil Application Rate: 0 a Maximum Trench Depth: 3 6, Inches "System Classification/Description; Pump Required: OYes @No OMaybe. Required TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25%REDUCTION Pagel of 3 CDP File Number 188169 - 1 County ID Number: *Site Modifications ❑ Open Fill'Sheet No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department: *Permit Conditions The issuance of this permit bythe Health Department in no way guarantees the issuance of other permits,The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements: a Site Plan The Improvement Permit shall be valid for s years from date of issue with a site plan(means a drawing not necessarily drawn to scale that shows the existing and proposed property lines wittt'dimenslons,the location ofthefacility and appurtenances,the ♦ site forth proposed Wastewater system,and the location of water supplies and surfaacewaters). Plat The Improvement Permit shall be valid without expiration with plat(means a property surveyed prepared by a registered land 0 surveyor,drawn to a scale of one Inch equals no morethan 60 feed that includes:the specific location of the proposed facility and appurtenances.thesite for the proposed Wastewatersystem.and the locationofwater supplies and surface waters. Plat also means,for subdivision lots approved by the local planning authorlty and recorded with the county register of deeds,a copy of the recorded subdivisions plat that Is accompanied by a site plan that is drawn to scale). .The Department and Local Health Department may impose conditions on the Issuance and may revoke the permits for failure of the system to satlsty the conditions,the rules,or this article:This permit is subject to revocation if the site plan,plat,or Intended use changes(NCGS 130A-335(f)).The person owning or controlling the system shall be responsibheforassuring compliance with the laws,rules,and permit conditions regarding system location,,installation,operation,maintenance,monitoring, reporting,and repair(.1838(b)). Applicant/Legal Reps.Signature Required? Oyes ONO Applicant/Legal Reps.Signature: Date: *Issued By: 2140-Nations,Robert Date of Issue: 0 3 / 1 6 / a 0 1 5 Authorized State Agent: OValid without Expiration? 0Create CA? ®Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT Davie County Health Department CDP File Number: 188169- 1 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: O inch Drawing Drawing Type:. Improvement Permit Scale: . OBlock O N/A ft. dd =P l i _ APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Environmental Health /'+_�` J P.O.Boa 848/210 Hospital Street l,(� Mocksville,NC 27028 INJG"., 0 (336)753-6780/Fax(336)753-1680 "V","`� Application For: ❑Site Eva]uation/Improvement Permit ❑Authorization To Construct(ATC) Arth Type of Application: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or t ***IMPORTAN7***THIS APPLICATION CANNOTBEPROCmED UNLESS ALL OF THE REQUIRED O TION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. "d CIO INFLICANT INFORMATION g a. Name to be Billed(.,, _S- S A l_CR1J 0 Contact Person LARD t S f}L�(L►>a Billing Address 42g LIU��oA)s Home Phone a-g;?__5_Y-r1 _ City/State/ZIP 4.(0C�kS V'I t_L r6 k j C 2'70 . _Business Phone 1 3 36 - Z Y-q-05"7'7' Name on Permit/ATC if Different than Above Mailing Address City/State/Zi PROPERTY INFORMATION *Date House/Facili Comers Flagged NOTE: A survey plat or site plan must accompany this application. Included: ite Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name � ` l i E= S AI.C-21,jc, Phone Number 556 -(92-S-FS_J Owner's Address 41-19 t igLLC- _3 2 ,4� oCity/State/Zip 1. 0CAS✓I I.LC Property Address %% 0,1 City Lot Size 2o A C Tax PIN# Subdivision Narnc(if applicable) 01)10, Section/Lot# n Directions To Site: (p 0 1 IUoLxV - LN= tT btl A A-K3 aS -p F-o��-t�f �2 kLW lam",- If the answer to any of the following questions is"yes",supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes klgo Does the site contain jurisdictional wetlands? ❑Yesego Are there any easements or right-of-ways on the site? ❑Yes 2NO Is the site subject to approval by another public agency? ❑YesRNo Will wastewater other than domestic sewage be generated? ❑Yes F.Wo IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms _� It Bathrooms Z. Garden Tub/Whirlpool❑Yes !� Basement: es ❑No Basement Plumbing: ❑Yes,0l�fo IF NON-RESIDENCE FILL 9UT THE BOX BELOW Type of Facility/Business [L Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested: ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type:❑County/City Water ❑New Well IJR<Stig Well ❑Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?❑Yes 191< If yes,what type? This is to certify that the information provided on this application is true'and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized presentative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable 4ras and rules. d tha I am r ib r the proper identification and labeling of property lines and comers and cati ' g i u i locati a,proposed well location and the location of any other amenities. Z. o r s or owner's legal representative signature Site Revisit Charge Date(s): Client Notification Date: Date EHS: Sign given ❑Yes❑No Account# Revised 11/06 Invoice# . I . ! DAVIE COUNTY HEALTH DEPAR NT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION 0 Acis i Water Supply: On- ile Well Community Public Evaluation By: Aug r Boring -Pit Cut j FACTORS { 1 2 3 4 5 6 . 7 Landscape position Slope % 1 HORIZON I DEPTH i b _ 3*7 4 —' ! Texture group G *Sr r-44'a Consistence i 5 Structure E;,t011 Mineralogy �- HORIZON II DEPTH Texture groupr ' Consistence j I Structure i Mineralogy I t HORIZON III DEPTH t I Texture groupE I Consistence Structure I Mineralogy ! HORIZON IV DEPTH j 4 Texture group ; 4 Consistence i Structure Mineralogy SOIL WETNESS } C RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION I I LONG-TERM ACCEPTANCE RATE 2 l SITE CLASSIFICATION: J EVALUATI�N BY: LONG-TERM ACCEPTANCEIRATE: G i `oTHER(S)PRESENT:: Laidl, d REMARKS: LEGEND �( Landscape Position R-Ridge S -Shoulder ' L-Linear slope FS -Foot slope N1. Nose slope CC-Concave slope CV- Convex slope T-Terrace FP-Flood plain H Head slope Texture i 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 ! ; , ( C'ON4IST ,NCF. Moist I I VFR-Very friable FR-F 'able FI-Firm VFI-Very firm IEFI-Extremely firm NS-Non sticky SS-.Slightly sticky S-Sticky VS-Very Sticky ' NP-Non plastic SP-Slig4tly plastic P-Plastic VP-Very plastic Structure i SC-Single grain M-M sive CR-Crumb GR-Granulaz ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1,2:1,Mixed )votes f Horizon depth-In inched 1 Depth of fill-In inchesO 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) - TTAT) T .-_---_-_ UIiAl ATION 1:011 SITE-EVALUATION/iNIP110KAlENT► 1:IIh11T�k ATC NOV - 5' 2004 Davie County Health Department Cer-rl Vf ;Ebvi�onmenta/flea/f/i Section P.O. Dox 848/210 Hospital Street �� . ENVIRONMENTAL HEALTH Mocksville, NC 27028 DAVIE COUNTY (336)751-8760 . ***IttPORTANT*** TRIS APPLICATION CANNOT BR PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for inDtructiono- 1. Name to be'Dilled Larry. cin (lemon Conl-acL PersonQ{7 8,er) Mailing AddressR_Bc, Home Phone � 1U._v City/State/ZIP Business Phone 2. Hama on Permit/ATC if Different than Above t` � Z_ Mailing Address City/state/Zip __,._......_....._.._...._ ]. Application For: .t-Site Evaluation ❑ Improvement Peiznit/ATC ❑ Thoth 4. system to service: L7 House ❑ Mo$ile Home ❑ Businets ❑ Industry ❑ OItha 5. Type system requested: 0-Conventional ❑ conventional modified ❑ innovative 6. '.If Residonce: 1! People # Bedrooms . „ ,_•� �Z NJDishwasher OG—a-rbage Disposal 91ashing Machine LBS sement/Plumbing ❑Dasemont/No Pluiubing 7. If Business/Industry /Other: verity type # People #'Sink # Commodes l! Showers # Urinals ii Water Coolers IF FOODSERVICE: ll: Seats Estimated Water Usage (gallons per day) a. Type of water supply: ❑ County/City ❑ Couuuuni ty S. bo you anticipate additions or expansions of tic facility this system is Intended to serve? ❑ Yes Lel N0 If ycs,tiviiat type? • i ***L41P0RTAjYP**CLIENTS AIUST COAIPLETL•THE REQUIRED PROPERTY INFORNIATION REQUESTED BELOW. Ettliera PaL1AI'orSIITE PLAN AAIUSTBESUB511TTBD by the client irilli'1'1115 A1'I'I.ICr1'1'I0N. Property Dimensions: hiC_ 1 �i9�` 1YIZITL DIRL—IONS(f rums A-locksOlic) to PRO Ill-It I'1': Tax0lficc I'IN: 11. �� 7�I CJ �n /V 1 e4V' A/11 AL/►�_ {.� Property Address: Road Namc ifzvd,4 )a-&,L, 2 z r_> A�blv City/Zip 5,' e.5 Ftj,-12' Ifin a Subdivision provide information,as follows: Namc: Section: Block: Lot: Date lnonne corners flagged: ��' d �° This is to certify that the innformatiou provided is correct to the best of my Iunowledge. I understand that ally permil(s) issued hereafter are subject to suspension or revocation,if the site plans or intended use cln:unge,or if lie iuforamaoln subutittcd in this application is falsilled or cliangcd. 1,also,Understand that I arra responsible for all Clrrtrges hicurrrrl,/i•uru MIS applitatiun. I,hereby,givc consent to the Authorized Represcutative of the D:nyie Cuunty IIealth Departnneut �. to enter upon above described property localcd in Davie County and owned by 37, to conduct all testing procedures as necessary to detcruline thesites ' bilH3 1. DATE SIGNATURE TRIS AREA MAY BE USED TOR DRAWING YOUR SITE PLAN nclude all of the following: Existillg ilia proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge i Dalc(s): Client Notification Date: EIIS• Sign given lJAccount No. 7" Rc%itctl DCHD(05!03' d- n.J _ zf` 7 7 ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003406 Tax PIN/EH#: 5729-16-5781.8 Billed To: Larry Salerno Subdivision Info: Reference Name: Location/Address: off Allen Road-27028 Proposed Facility: Residence Property Size: 20 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 groupC Consistence Structure Mineralogy HORIZON Il DEPTH Texture group �— Consistence r- 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 Sl-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) CV H DDErTVALL N O N N � v (coco �.- F 4 2& aD CeB2 WeC RnD WeC WeC WeC CeB2 PaD PaD A CeB2 a PcC2 PaD 302 . PcC2 �� - t,� L . i.«,. t1' psi. '!R• �Yt+ ".r.� ; ,.. "•t, tis; uyr� ta- as .' .. t`•'�"s } i,. '4 ,I m s. f 1 3 n t# { 'fie ,E eJ •,�i�a �"` ii:., �.'� }'Y C`r��,q t i = +4 ti ..+.^e* t r �S ;2 fr i!• �� R ..mi. �� t ; , « r ••tiittgi� i ► 97,685=.)7.60 PIE 95. 70 198 7 113.52 o- [{ A.c � ii#. L' a � 6.10 � sa ` ti'St't a't�t.iR Xt�J, � s` •;�'' �•+5 r ^p. �, ;wti�s �'+�•1« y '} `�. Az 7.42 T1sk4 Hp '�k�' ♦ � 1irwx�s� �"�-"pa.n�� C"�'.� k p � "',.�Z• �. R'�'�1".. 4 s•,!f `vf '•� .w 3 a. R r e � �)1 d 'Y�`�� fr'. � '� � r1�6 �Ga' • t i„�..j t.�� ,Jf : a•. t' * „t. ::y��§ C? af, = 471 k � ,}, � � yS1 i `* p '6T fa�..� ► } ' a'.,. ,�, ,, w t-#it• ' �a, '. ` tpv "f ;+„ ,!" $ \ �+ae lr ►( •�1.►fiQjh } _ s;«,.�`��.�.r�Frf fir¢{ +5` ,� .. e�t� �t' + $�" i ��;yk�#t*" '�, ""�� t' t�vf ', +.. S,M.a; _3 . •��" ` +tis ex'�'� �.Y rS'.�� x°i•.�� 'r� .x e« r.1Y• �';i.�r� tom' !+'e< �� _},�5��r��. ~ '+ r � ��i Y•�'� t� !};.;"�' =�iyy �Y.` f�� 3�`r " ''�sp}� �+� � ':R"�A�it^�� "`�'�7•�p�? a+ 1t"':p a "' � •ci1•Y'c -�„a�..l k. .� t „L �� k:y��''+�.d` � 'b J G ,t.>��• F,r-,Y,13.' 1�r7I.: i .# .Y '' .�.• 7v s f^f 3 F+Lp x:'L '9'. F s 4i' t' 5'�,.ra(., J jr, x':::111 $• 2 ! . 'tom_L t{1. ,r "`,"^ .r k .C141 T„.;•`dr atJ -.Y. 'CS Z / (58 A ;.) ft' a A ,�•: �s ry #�� ' �+ s� ,, x F y� d "'ti 4 ^ ..4 v. .� s yy�..y n' 'T'^ �^a;��d'� � 'G 34 r3W`.wx.'� t 't!'t�jt� ,✓C tw+^ Fto •r s. a t Fgx "�•,i�''r5 <iM t.)•n�.q�'�,? n7•"� 5,��'try � F4+- N�.. +► i.'� ' �r•',"s+,....ry R d� ,c.,xyir ', te, }„ri'••SEX '°Y. �q'# +f�R,t\ ��,''t. � -:�.�c rr !• ti t ,. Y. R :a � ;}- ,� "'xS Vit•. S`` +S�x #v,>j v,.??2�+�"+i�y1 h Li L., •Ef ^.'k '•,�"x�, ISrA. , # • f � L�„l s .-a >E'.'�a' �5, ,t,a. -a: ) ..� ' i 4 .0 $'- y� fit`i T;S.y '.t r,.S•# (:�. may, '�'7 i. � �$� rt�� ,a,, ;.�, �`��"��+:s�c.. +yt"•.' r•�,%� . .t2r. 9.�2+ ' '� _ !•)r _..:' :.-.2' .� _ � - . . - �� ,987.16, kl y"S to 3588 42 t, __w,- • — V ' =(18.28 Ac) a w - y T`,reg, `}" �,�,,` „�.,;�' . _ _ ••,, .rt ----» 564.99 11 Pte . W • r . . . _ .. _ ... . .. . • . . _ _ 95.02 ►° .:q by.9�d %^d,8 ,Q 2 va.m � � �.� .. > n✓ �r�,G-; "" 3 fi< Mt Y2 n-k L„ 1V i' IIaTT1N°T" ." � .� 1 Environmental Health Section P. 0. Box 848/210 Hospital Street Courier 09-40-06 Mocksville, NC 27028 November 23,2004 Larry Salerno 8 Babylon Street Islip Terrace,NY 11752 Re: Site Evaluations/ A&B off Allen Road Tax Office PIN: #5729-16-5781 Dear Client(s): As requested, a representative from this office visited the aforementioned site on, November 19,2004 . Based upon the information provided on the Application for Site Evaluation and after evaluations were completed on the sites,they were found to be provisionally suitable for the installation of on-site sewage systems. 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, xw�rs, Robert B.Hall, Jr.,R.S. Environmental Health Specialist RBH/dlf Enclosure(s) Davie County,NC Tax Parcel Report Friday, December 9, 2016 221 •13? 408 416 424 421 428 y 444 r 140 _ - } J a f A ._.. .......................:......................................................_.............._........._....r............._........................_. WARNING: THIS IS NOT A SURVEY Parcel Number: H30000010102 Township: Mocksville _': NCPIN Number: 5729271410 Municipality: .: .Account Number: 82525623 Census Tract: 37059-806 %ti Listed Owner 1: SALERNO LARRY Voting Precinct: NORTH MOCKSMLE COUNTY Mailing Address 1: 428 ALLEN ROAD ..,,.; Planning Jurisdiction: Davie County .City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-A .-_-State: NC Zoning Overlay: _ Zip Code 27028-0000 Voluntary Ag.District: No Legal Description: 20.000 AC OFF-HWY..601 Fire Response District: CENTER,WILLIAM R.DAVIE Assessed Acreage: 19.98 Elementary School Zone: WILLIAM R DAVIE -- : •--• Deed Date:'--- 1/2005 Middle School Zone: NORTH DAVIE Deed Book/Page: 005910723 Soil Types: ApB,WeC,RnD,CeB2 Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding&Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: 9 uys�NAll data Is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Davie County, implied warranties of merchantability or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to C+oUN� NC or arising out of the use or inability to use the GIS data provided by this website. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 lqo CQWj"fse ��j Account #: 990003406 Tax PIN/EH#: 5729-16-5781.A Billed To: Larry Salerno Subdivision Info: Reference Name: Location/Address: off Allen Road-27028 ATC Number: 4369 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: 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. 30 iq PAIJ s 4006 ,Vk C3,)J1Ct4-419TD Cir -w �^)k tL•z9 Septic System Installed By: Environmental Health Specialist's Signature: D e: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P.O.Boz 848/210 Hospital Street " Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003406 Tax PIN/EH#: 5729-16-5781.A Billed To: Larry Salerno Subdivision Info: Reference Name: Location/Address: off Allen Road-27028 Proposed Facility: Barn Property Size: 20 acres **NO�TQ*hiis4RfproveAPnt/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People #Bedrooms #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift � #Seats Industrial Waste: ❑ Lot Size Type Water Supply &,v// Design Wastewater Flow(GPD) -?a Site: New 1'Repair❑ System Specifications: Tank Size PV GAL. Pump Tank GAL. Trench Width\,�"Rock Depth,& Linear Ft/)0 Other: As stated in 15A NCAC 1.8A.196919;% accepted Systems may also-uiTs� Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Da �y Health Department for final inspection of this system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day f installation. Telephone#is(336)751-8760.**** ups 1 , Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) NOV 5 (P 2004 p C TION 1011 Sire[XVILUATION/IhIPHOV31 ENT r1110,11T A•1-c A Davie County Health Department PIS` EIMRONMFM� ,Environments/Nes/thSection S DAVIECO P.O. Dox 848/210 Hospital Street Mocksville, NC 27028 - (336)751-87601 ***IKPORTANT*** THIS APPLICATION CANNOT 131; PROC_rSSBD UNLESS ALL T11E REQUIRED INFORMATION IS PROVIDED. Refor to the INFORMATION BULLETIN for instructionn. 1. Name to be Dilled L r Contact Vernon Q{7! 14E 1'7 Mailing Address 110111a Plione -� _L.! J.3 City/sate/ZIP v Boniness Phouc .236_.-09.11._..C!..tl ._. 2. Namo on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: 0"Site Evaluation ❑ ImprovcanenL Permit/ATC 0 DuLh 4. System to Service: G idi['e ❑ Molgile Home ❑ DusinetD ❑ Industry ❑ Other ,y 5. Type system requested. Ea Conventional ❑ conventional modified ❑ innovaLiva 6. If Residonce: a People a Bedrooms A a BaLlirooia:; A ishwasher O arbago Disposal Mhing Machine ant/Plumbing ❑DanamanL•/No plumbing 7. If Dusinass/Industry /Other: verify type It People Il'L'iuls .� a Commodan a Showers a Urinals It WaL•or Coolorn IF FOODSERVICE: tl Sea'ta Estimat ed Water Usage (gallons par day) ._. S. Type of water supply. ❑ County/City Community 3. be you anticipate additions or cxpalis[ous of the facility this s3'stclil is iiltentic(i t0 servC:❑yes Er'N'-() Iryes,What type? ***,UrPORTAIYY'* CL1l:NTSBIUSTCONI'LLTZTHE 1U.QUIRL•-DPROl'ERTYINi�ORMATIONREQ UESTE'D r�f BELOW. Lldiera PLAT or SITE PLAN MUSTBLUSU114=6D by the client iritli'l'IIIS A1'I'LIC,1'I'ION. Properly Dinicasions: a � ��/q WRITL DIMC11ONS(rruu)11•luck5011c)lu 1,R01,E*R '1': Tax Office PIN: !� T�'7-�� Al Jr 79-1 Al- 1 eO 0V /°t Lj,/ Property Address: Road Nanic Erved 0 lel L,t, 7� 6 />~l h/j/ Citymp 11445//, �P .�? S�(�e-5 P1'1'121 If in a Subdivision provide[ufurniation,as follows: Nanic• Section: �_ Block: Lot: Date lionle corners flagged: This Is to certify that.the hirorniatioli provided is correct to the best of lily knowledge. I understand thatany periiiii(s) issued Hereafter are subject to suspension or revocation,it the site plans or intended use change,or if the inforni:ttion subluittcd iii tliis application is•falsilied ur cliungcd. I,also,understand thall fur)reshuusiblcjor till charges iilcurredJi•uar thisapplfcalluu. I,hereby,give consent to ilia Autliorized Represcutativc ortlie Davie CUulit3'IIC:d(li l)Cp:u'lu,cnl to enter upon above described property located in Davie County and owned by to conduct all testing proceduress,as necessary to determine the site s ' • bili(y. DATE__�[� Z�33 U `i SIGNATURL, THIS AREA MAYBE USED TOR DRAWING YOUR SITE PLAN 4clude all of the folloiring: Eaistilig tad prop used property lines and dimensions, structures, setbacIts, and septic locations). j. Site Revisit Charge Client Notification Date: ERS' ' 01 � h� D Sign given 1" /!q Account No. Atrisad DCI•tD(115/03` �� .. ♦ M4 . Y 4.4 97. 685^7,60 95. 70 g6 t 1 13.52 N { \'V 7y 6.10 y I — 619 101.01_ 1(IA Ac) Nva P' 2rt � N� m s: N 48.8. ., ro .,1 74 v 59 4 OD .. •� , ' IOG. 92 At 18. 3 Ac �— 100 Q P j + iP 6, •., � 50Ac. lb% r g8 •'x 87.16. + N ' 3588.42 (18.28 Ac) s• v y' ' � .j♦w�`° ssa --"" 564.99 rlb. 96.02 �+M+, 11*�"20moon any. rd =q H bCEdisc �"'UAL� r a.ess>"s ' s zwx cur { t,ro Z b f� ,'T' 1 � 3L yf� � �Ryg ��„ 3� e�sA is ' g � � �w� wri iew OUR 14 � �� .....•. .. ....-. ..G ... } W� 2(,►- .._d'z3 tm'�'�,.ss ��^�e;;� a r{k.S.2 �r�,9.`"� :i � n aD CeB2 "`i WeC Rn D WeC �aP a Y.,*yrtw. 7s c �" E�� r' WeC r NI 4 t WeC CeB2s b , PaD 3 PaD a CeB2r PcC2 Aj PaD W� } '—u^SMa A� �w. Q �. � �RLLi)`a k—a„x^' A 3 �A� �• �. PcC2*a 3 �`" T'zX` ` 3 �'Po } p yt �, a k•z T a m•c a a.:�. `-. Y4si#k,!' r MEW ,yam p "+ir � r" t�+ni a4*^�'; "� ' "'Fs.`„k,r� a�`.yy sslt,y'[,�s'S r 'm'�C` a�"-�r�2a'' .�i�S:�:•.{�. �. ,f a.} a A E u.: +, 7'�Sm Ta �n�'�" r. ;�,� �• e �,..t�-�ww,d' 4� d 'v.�s � •i C°�E t `�" X+-4 t..s' ��.z�L �*�`'M x � Of i +P•". �At'n m`z�,t^.,�- m' _. �.,.,o-,._.._..r�._. ,., ._4._,..n.i...�.i�� m _.i DAVIE COUNTY HEALTH DEPARTMENT ° Environmental Health Section ._ Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003406 Tax PIN/EH#: 5729-16-5781.A Billed To: Larry Salerno Subdivision Info: Reference Name: Location/Address: off Allen Road-27028: Proposed Facility: Barn Property Size: 20 acres Date Evaluated: / !� Water Supply: On-Site Well Community I Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position .i?--, Slope% HORIZON I DEPTH r l Texture group Consistence Structure Mineralogy HORIZON 11 DEPTH Texture group Consistence / Structure c 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: — Y7 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 Mineraloev 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) Environmental Health Section P. 0. Box 848/210 Hospital Street Courier 09-40-06 Mocksville, NC ,27028 wt5�dr9z;'F s : a t �& dzv. � p„��'%%*'� �,.,p��*;" lr •�'. *�5� q �: �s�s,��r ,,,'"n '�.�fi 1 Sri°'g��f / �' ,,� .e-" xx��..� � +a� a '',, .. R.;..., ,s, .. k°;._. f a'r�syS � ,;1 r �arrSar. a ... .a; + . .,,< S ,� au«' '`s*^�d,+ '�. "',�, n'.,'r, k ✓ 3't*r �:�....."r?"s,e ,a�.. November 23,2004 Larry Salerno 8 Babylon Street Islip Terrace,NY 11752 Re: Site Evaluations/ A&B off Allen Road Tax Office PIN: #5729-16-5781 Dear Client(s): As requested, a representative from this office visited the aforementioned site on, November 19, 2004 . Based upon the information provided on the Application for Site Evaluation and after evaluations were completed on the sites,they were found to be provisionally suitable for the installation of on-site sewage systems. 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 RBH/dlf Enclosure(s)