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196 Saddle Up Trail � � ' �.ia DAVI�COUNTY HEALTH DEPARTNI�NT _ � Environmental Health Section � P.O.Bog 848/210 Hospital Street Mocksville,NC 27028 (33G)?51-8760 Account #: 990003266 Tax PIN/EH#: 5755-37-6212 Billed To: Spencer Lane Construction Subdivision Info: Reference Name: �����-7 S�..u.,L�e.•< Location/Address: 196 Saddle up Trail-27028 esidence Pro ert Size: 10.56 acres ATC Number: 3838 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 e tme and Disposal Systems). TI-IIS AUTHORIZATION FOR WASTE ION IS V LI FO RIOD OF FI YEARS. Environmental Health SpecialisYs Signature: ate: � Q� CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on ImprovemenbOperation 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. �r- 3� �T � � � � � — K � „ Q°`,�c�►� �°� a , lc.�x�'��'Q � r��-t�t�s 6�-7,7 � !�o' 9 �, � Septic System Installed By: �InJtl� ��i:�" Environmental Health SpecialisYs Signature: Date: �� f� +� DCHD OS/99(Revised) � �' DAVIE COUNTY HEALTH DEPARTMENT ��� �� �`� ` • � Environmental Health Section � ." �/ P.O.Boz 848/210 Hospital Street � Mocksville,NC 27028 (33G)751-87C0 IMPROVEMENT/OPERATION PERMIT ' Account #: 990003266 Tax PIN/EH#: 5755-37-6212 Billed To: Spencer Lane Construction Subdivision Info: Reference Name: � ���,,.y �1.,.�(,�...L Location/Address: 196 Saddle up Trail-27028 Proposed Facility Residence Property Size: 10.56 acres ATC t�irpber: 3838 **NOTE** is 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 PERNIIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type � �_ #People 3 #Bedrooms 3 #Baths 2 Dishwasher: � Garbage Disposal: � Washing Machine: d Basement w/Plumbing: ❑ BasementlNo Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size ��� Type Water Supply �V�?t`j Design Wastewater Flow(GPD) �t.G� Site: New� Repair❑ System Specifications: Tank Size R.UCJ GAL. Pump Tank GAL. Trench Width��� Rock Depth �Z� Linear Ft.�� ocher: �`�51-Q.���E..���� Required Site Modifications/Conditions: __�.JC�„U.. �aJ ('��Jt-U 12_��� 1 S� aF��p,��s IMPROVEI�1ENT/OPERATION PERI�'IIT LAYOUT- APPROVED EFFLUENT FiLTER RISER(S IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for al inspection ofthis system between 8:30 a.m.to 9:30 a.m.or 1: p.m. o : p.m.on e y of installation. Telephone#is( G)751-87G0.**** 3��2 t�� _, ��o' w� �5,� � �e'�'� - . - � � /�k � �- �.. �� �2 , � � � . Environmental Health Specialist s Signatur Date. � �`7 . DCHD OS/99(Revised) � 86/07I2�04 84:32 7046338759 SPENCERLANEC�NSTRUCT PAGE B2 � "�, ` � �• �v,.y;`� . . - - ;�. � / / . , •� + ' y �r •. pPPUCATION FpR SiTE EVALUATION/IMP40V[hfEM PERh117&ATC�� �,/ ( � { � •E , : davie County Healtli Department � ���� � Fnvironmenta/Hea/th Sectivn � � � /� j� P.O. Box 848/21� HoBpital Str¢et � � � f � . Mocksville, NC 27028 , � ����G� �� (336)751-8760 r I„jS -n � /��� (� **�IMPORTAN'l�*� �'FiIS APPLIGTION CANNOT BE PROCSSS!>D UNLESS ALT, THE REQVIRI:D �y � �.1) �� ZNFO1iMATiON IS YROYYDED. Reier to the INFORMATION DUT,LBTZN £or �patzucCioas. (/ � /h' ..� � � � 2. Name to be Hilled�C�i.�er ��_ �+�� IQ cone►ct Pazson ��.Y7CCY' �nQ `_ �� `� � (� 1Sa131ng Addrese�JU � � K�C��(�. 8pma Dhane -b33^ � nW ��' . � Clty/$q[e/ZIF �� Husiaase PIIo b -aoa� � /� ,/ �` � . � -/� �r /Q('a � /1� C � . 2. Namo on Pexmit/A7C if DifLer<nt t an Above_(:7 ef � T V J l� . 14Sling Addrsss�_ �r • Ciey/8eaco/zip p � � . . 3. Applicatios1 i'ors tn 8vaxuntioa j �g=gvemsnC>PezmitfATC � Q $oth �v� �/ j���a..�3+�,r_, ��' `� +. arac� co sar.ten: fi(gouse ❑ Mob11E Iiome p Susinesa ❑ Indusery ❑ other 3. Type syatem reauwt�d�: � Comr�nCiaul ❑ eonvehEia'�nal modiLAed ❑ SnnOvative \� t. S! Residence: t people 3 y Dedroem� �___ � Hathrooms a O �Dishvanher ❑Cazbage Dl�poi�l �ua�ping Naohin� '�+o��.�oc/ri�utny �aaemen[/�o exum»inq ^ / 9. IL Suaiaas�/Zadaatry�/OCiur: o�r;ty �ypa . � paopl• • SSnks ` �/• i.commoaes � SAowra � 1 Ozina?s •liat�r coola7rs _ . / � � ZF FOODSERVICE: q Seate Estimated Water Ueage (galloaa pes aay) � e. 7yp� of �ater �uyplr: �CouIIty/City " ❑ We11 0 Commuxlity 9. Do you dnticiyace aQditloas or espansions of the facflify this systcn��is Lttcnded to scrve?O Ycs Q No � !�)'CS�����lil[)'pC� � ' . . '""INIPOSTANT'""CLIENTSMI/ST.COAlPLCTBT}IB REQU/RlD PROPERTY INfOI2MAT101V RCQUCS7'�U OELOW. Efther a PLAT o�S(TC PC,A(V MUST 6ESUdMl7T.ED by tAe etieae w[th TN(S AVPLICATION. . Properly bimcnsions: �V'' �� �� 1VRITB DIRECTIONS(fYom�7oclsvillc)t0 h1t01'Eli7'1': ���xo�;«rzv: s 5�5537�0"�l� _ �DL� �'roperty AJdress: Road Name Fq�. Sa�tl���In Ird�� � 4 / S � �� �� � /���� ��rir�p 1Ct�►1�C. C'.a-toa� �J/�� l'"�e-ni�' � _ w�Jf in s Subdir;sion providc inforn�ation,as toilo�vs: �'� Y l � /� Namc: f"� � "'�"/�� �i� i`-'" � / �� . Scctiwr IIlocic: Iat: � Datc lionie corners ilagged: �6 !�r � � ���� pv_ .(' h_ ���r <3 /a 7Lis is to ccrtifp that thc information proviJcJ is corrcct to thc best of m�•kno�rlcdgc. I'mulcnwnd that any permil(s) � � j� ��� � �--- issucd l�crcaflar aro sabject to suspc�uioa or revocation,It tl�e Si�plans o�Iatca�etl use d�angc,or if the iuformatIo�t [J subinittcJ in tGis appliCation IS t9lsificd or citan�ed. I,also,ui�dcrstaud d,at Iau,rerponrib/�jnr all chnr��sG�cnrred Jroui / tltis application. I,Lereby,givic eonsent to thc Authorized Representative vf the Davic Connfy FIaalth ar ncnf T J Q.p/ tu enter upoo aUovic eescriUcd propertylocatcU in Davie Countr and o�vncd Uy {.• l� �v - ta rnudFut alE testin��roctdures as aececsary w detereune the site saitability. � llATC ( � SZGIVATUItE � • � JV (/" � ✓ �;(la-�Q � THIS tUt�A MAX BE USLA FOR pxt,A,WIIYC XOUIt SITE PI.AN(1 �e aJl of the following: Existing and proposed � /t�'(' ,� ��, � properly 6na�nJ dtmensions, siructures,sctbukcl and septie ineationa). J t�-�'�- �Sitc Ticvisit Cl�arge � �" �a��s,:� b �� C1iCnt IVolifiCltion�atc: �/. ��� � � �`� � EHS: � � Sign givcn , . Accoutit No. � �� `p ltcviscd DCtill(OS/03 • Invoice No. �. ������ —_��' ���'"� ' ` �� .Z, jj�d'4-7-Ati Gv�� � . � � 1 . � � .- . �� n � � � � 19 � �� 3ga � �1� N-� N A ' 7657 � O � � , � ,�g3 � ^ rn � ��/� 1$O tI- 112Q t � 1R201 m (6.14A) v ; . _---- 8308 , � _ _,_ __ - _ _ � _I ' (137)� �8� �,I.� � � I ���' � � `° (10.56A) � � � v � � 6016 �' _ _ � . , ��'�� ------------- -_ - ^,e-� I � 1137 � ��o� �i o rn .�� � ' � (�o.5sA) INDEXED � __ _ � : -- ------------- _ - - -- O N �, ��� 5693 5707 � 0 i � ;---------------------------------------� 16� , '�� ,l-' �o " �� � � uJ� ►��`� ,: 'w ��� i� �. � N (10.40A) \�.- ' INDEXED ;� 6217 ON w 5707 ^' 1181 , • �. DAVIE COUNl'I'HEALTH DEPARTMENT �- , . � Environmental Health Section �` � Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003266 Tax PIN/EH#: 5755-37-6212 Billed To: Spencer Lane Construction Subdivision Info: Reference Name: Location/Address: 196 Saddle up trail-27 28 j , Proposed Facility: Residence Property Size: 10.56 acres Date Evaluated: Water Supply: On-Site Well , Community y � Public Evaluation By: Auger Boring . �/ Pit � • Cut FACTORS 1 2 3 . 4 5 6 7 Landsca e osition " L Slo e% (o HORIZON I DEPTH D— Texture rou C� • Consistence �� , SS ; 3 Structure __ Mineralo �,�X HORIZON II DEPTH g,. � " � Texture rou � Consistence ' ;� '` Structure S� Mineralo � HOWZON III DEPTH r32� - Texture rou sc- 5 C} Consistence F S S Structure � Lc S Mineralo S- HORIZON IV DEPTH 3Z— Z r Texture rou Sc►, Consistence �,-N /-� ��SS P Structure � Mineralo SOIL WETNESS RESTRICTIVE HORIZON .SAPROLITE ; � CLASSIFICATION _, `LONG-TERM ACCEPTANCE RATE O• SITE CLASSIFICATION: �`S 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 p�ain 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 f rm � � 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 Mineraloav 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-gaUday/ft2 . 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Q 'i '�K . �}. r fT� t'n"�X a-. :'� .�' c �` ~ t' - .. I �r �Se �S�Y,. 'iv� i�,f . � �. � . � � /t ,��j(� � �' �/ ti y'�� � \ � .�"`.'� ' � � � / I)5JA) � iti! '� � . tw Y3� � \ . ,. � - ' `. � � 16t0 � . � �::�4� � .� � . . ��_ . i ` � ��� � �I � �� � : 24445 �* 3"R.w_ i. T,k � d ., f3.13P.7 ' � T ��. � ` BQ)� � , �4'�� '�. � '�! \ � _ __ ^ � ! Y] ...b''� � ' .��� � ".� .�t �' ��ooui - �? ..� � „', „ \ { �' kr� i' � �.3370 Rau}' � � �� ; .' y� -� f. ��. i � 82W k �, �` " � c-�'' ° �,',��� � t . K �. � .ryy�ai qj N. 'e.�. � "f :' � } xh�,. � I�°i�� .. • � �"'�'`��,�,y "�"� . .``� . V ��y......... .. 'C'�� � � ` . A }.��j g lJ' � L � •���r�1 . - Y� /Y' �Jgr A , It�?T_ ' ( -'� o �(}l �i � ��� '$p � S � / '�ry* . e y� ' . �. : . � I^';� r.; � � �l�y��c, f� �' i .� � 789�' � , l 4' OJ • � ��� t �p�'> �Fy�, .s f;� . a y[ . °' �.. . � � � 7822 nM��.� 'd ` F� ��'y � Y %�! L t � '( d"�' .� . � � � 4; �il/58 li� '� .{��. P f Y .. i. . � �.4 � ' I�S 'T A T� "Y. � I�-�>�� . . _ .� � . . ���� � liY�` ]'3��`. ' . •• .�^��� �. �.�� \ t' 86W�� . v�s FlY �+ � ', t (214,� � .,/��r( 4 �091H) ��O S� 2`'�L ' �48$ -^�\ / �a �_ ,l. �t 4 • �• •� V a�3 5 ..�• l290241 � -�.>- � A �, fsz�l 3373 ;��i� �7 � a � _� ' � 021s �' R � � � �7 ��� ' � 2 � � ��� t+ � - DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section PO Box 848/210 Hospital Street � Mocksville, NC 27028 � Phone: (336)751-8760/Fax: (336)751-8786 � � June 24, 2004 Spencer Lane Construction 630 W.Ridge Road Salisbury,NC 28147 � Re: Site Evaluation-Greg Shuler 10.56 Acre Tract/Saddle Up Trail Tax PIN#: 5755-37-6212 Dear Client(s): • As requested, a representative from this office visited the above site 7une 23, 2004 to perform a site evaluation. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed,the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct,the appropriate application must be completed 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 751-8760. Sincerely, F V JeffG. Beauchamp, R.S. Environmental Health Section Enc(s) 07/23/2004 22:43 7046338759 SPENCERLANECONSTRUCT PAGE 02 � . �' • � a . � � . � ' , � l � 1 , 1 . i � t � , 4 t { � \ I . .� -� � 4 ` .��f �- ��8j. . \ !�� • ( r.Or���1 �tc.res � � � ; � j�r. 4 H � � � r v��r�` - ��_p � . 1 � � cl> ' m . � � � _ r. .., _ �J i � � • - : — �' .. � - ���� � � � �� �s3.3z� � �"� I � i � � t {4 � � �� w � . �7�Ec l�`7�vt//t/' 7zn.4I� - ---- ...__._._..__..____._...._..__.,�.._��. QWivck:�'.�.Si�ut,� C�oNT'�A[TD2: S�GNGE� 1-�N'� T x�3Rp T�F• M-�, P/° �8 Oz