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459 Wyo Rd , ,. � . :, .. , � ' DAVIE COUNTY HEALTH DEPARTMENT , • Environmental Health Section P.O.Boa 848/210 Hospital Street Mceksville,NC 27028 (33G)751-8760 Account #: 990003906 � Tax PIN/EH#: 5833-93-6042 Bilied To: Larry McDaniel Builders Subdivision Info: Reference Name: Location/Address: Wyo Road- ATC Number: 4341 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 Disposai Systems). THIS AUTHORIZATION FOR WASTEWATER CONST CT N IS VALID FOR A PEWOD OF FIVE YEARS. Environmental Health Specialist's Signature: � Date: ��/Y/�� CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis Certificate ofCompletion shall indicate the system described on ImprovemendOperation 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. .� .�� � �,����� � � � - � � � ?�� C� � �a` � � �� l�� �� ��� Septic System Installed By: r lZ,� f Environmental Health Specialist's Signature: i�V'�v/ Date: • 7 aZ v1� DCHD OS/99(Revised) • DAVIE COUNTY HEALTH DEPARTMENT � �' , , Environmental Health Section • ' ^ P.O.Boz 848/210 Hospital Street �� 6 . D Mocksville,NC 27028 € .f �DI� (336)751-87C0 ` Ll�l .� IMPROVEMENT/OPERATION PERMIT Account #: 990003906 Tax PIN/EH#: 5833-93-6042 Billed To: Larry McDaniel Builders Subdivision Info: Reference Name: Location/Address: Wyo Road- Proposed Facility: Residence Property Size: 7.703 acres **NO"T��*�Th�is�Impro4ement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AiJTHORIZATtON 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 � #BathsG�� Dishwasher:� Garbage Disposa� Washing Machinej� Basement w/Plumbin� Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: � Lot Size � ��� Type Water Supply BV/ Design Wastewater Flow(GPD)� Site: New�Repair❑ System Specifications: Tank Size�fl�GAL. Pump Tank GAL. Trench Width�Rock Depth�Linear Ft�� Other: �r.v'� l�u[ ���d'� � �� b`J �!S Required Site Modifications/Conditions: IMPROVEMENT/OPERAT[ON PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF G "BELOW FINISHED GRADE. ****NOTiCE: Contact a representative ofthe Davie County Health Department for final inspection ofthis 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.**** ���,yt �a u� � ���� � ,��- F � ����� ��y��' �(� � �v���� G ' C�� �� . � �d . �. :t� ���o Environmental Health Specialist's Signature: � ��.q-l� Date: ��/V� V DCHD OS/99(Revised) � . :03a davie county envhealth 336 751 8786 P• 1 ' �••� � 4 �� �td" ` ��-�''l.. /` �� � � �' D � 9 2�0� ' APPUCl�TION FOR S1TE EVAIIJATION/161PROVEAtENT PERhfIT&ATC �/ f C��-.� ��pR 1 Dav10 County Health Dopartmont `�t1� Environmenta/Hea/th Section � y'/��� /�� � r -�--. �'�?� P.O. Hox 84B/210 Hospital 3treot 1,.�;[y '/'EJ UL� r `��1Q�,� Mocksvilla, NC 27028 U V �rr�•�p�� C (336)751-8760 ��r ,/�� t..(�� ^�j •�*ZMP�TANT�+►• THIS APS�LxCA�N CAHI�OT BE PROG6SS6D IINLBSS ALL TSE REQIITRED "��/�_/��J/ 1�/ IXFORMATION xS PROVZDED:"'Itefer to the INFORDSATSON IIUI.LETZN for inatructiona. ..[ � L � �,�Q v2. Xamo to bo Hlllad _�.�Q,L��S Co�Gact ?eraa� � � �HIailing bddreaa!%� �� I �6'►Ylwae aw�► h� e �CiGy/State/ZIp �,��j,(,li� 1 f� ����„ aueineea Pnoa• /S„�.����1 �� ` �W� � `����� `E� W , ./J. Aam� oa Aermit/11TC 1L DiS�ozer.: tl�an Abova �Q.r()11 �` ��� ��Mal,llag Addroo� Cit,y/stxu/Ziy e,��� �� '�i� � `�. ayplicatioa Fors C1 Site EvaSuation ImprovomattC Permit/ATC ❑ Both �.Y �[ � c�. sy.eam � s.rvicu� I�(House ❑ Mobilc Homo ❑ IIuminess ❑ Induetry 4 orher �� � 5. 1ypo ayntem =equasC�di�Conv::ntSonal ❑ convenGioaal moditlad ❑ innovative •�� �, �/� .�e. It &eaidaace: � Paople �_ w Bedrooms �,,. A Bathrooma �O ,__Cyy � A�a�, �/ Q�sLvaohor L�dubaye Dieposnl !lkasAinp lcachlne aeemeae/plumbiuq Claaae+wnt/xo Y1�mLing � 'C;� 7. , I� IIY�IAOOO�Ii1dW�l�'/O[hYit t'ariLy typa 1{ p�opla � ainka �� i Coomodu � Sb:+wara � Urlaala 1 Nates Coolors ��� I! p00DS88VICE: Ik saste _. Eatimatod watar Vnaga (gallona por d►y) �Y. sype ot xac.r suyply: ❑ Count;��/City , I�ell ❑ Commuaity �9. no you anetcip.a additious or txpautions of t6c facllity Utis systcnt Is intcndcd to scrvc?O Ycs �l�6 Ifycs,�vliat typc? ••+IAf�J�1PT"'�"��:�d!USTCOAfPLETBTIIE RGQUIRC•D 1'ROP6RTY IIVPORh1ATI0N REQUESTGD ••• !tE[A Elthcr a P_L.�,w E f'LAN b1UST6ESU/IAll77'ED by tdc cllent wlth TltlS APPLICATION. ✓PropCrly Dimecuious: �� v1VRITE DIIiECI'fOIYS(Crom 111ucksvWe)to!'ROPERTI': r�orac�rtH: u�� Z,�.23.�,�_�'�"D� ����_.�--�'1 �nnT ✓Property Address: Road Na�uc w1� vCi y�("QG C�.�.__ Citq/Ztp,�� �. l�(Q, r If in a Sutxlivision proridc Infomu4un,as follo�vs: - _.------- �Vamc: � • . �cctioa: Block: Lot: .�9Tc l�omc corncn flu�cd: � Thls is to ccrltfy tuat thc inforu�aliou provldcd'u corrcM!o tbc best af my knowlcvlgc. I uudentand t4at any pernut(sj IuucJ lurestfter are subjcct W suspcnsion a r rcvocatla�,if tl�c sltc plans or intcndcd usc cLangc,or!C cLc IufortuaUot► subnilttccl In this applicalion!s fals[fic�i or chapgcd. I,also,«irdcrrraud llra�t anr rrspousiG/e jur a!1 diar�cs iiiu�rrad jrurn lhis applicatfo�i. I�hcrcby,glvc cousc►it tu L ic Authorized Rcpresciriativc of tlu Daric Caunty IlcaltL Departmcut lo cntcr upou abovc Jcscribcd pro��crty loc,�tcd ia Davic Coanly and o�rncd by to couducl aU icstfn�procedures as ucccss�ry to datcraduc tlic silc sullabil!!�•. DATE ,�^!v ���/ �.SIGNATUI Z � ✓ y TliIS AItEA MAY BE USL�D FOR DItAW1KG YOUR SITE 2'LAN(Lre c all oC thc faIIo�rtug: Ezlsting and praposcd property lincs and dfuuauions, structures, �:etbacla, and scpdc locaGons). . Sitc Rcrisit Clu►rgc Datc(s): fClicnt Notification D�tc:��„ IsFIS: ,. $Igq�YC� /�+v ACCOUp�N0.�� Rcvtscd DCIID(05/03 Involcc Na � �� NOTE. This property is subject to oil eaesawt►, right-of-way, 1"InsV1116 ltd W streets and ossesemsntw, i1 ary, as the some may app°+ar of R/W record in the officeRe of the gteter of rSee4s, Clw* of Court, Tax Lot 4.02 R Town or County Tex Office or which may have been ocyuirsd by r w i 6�T. _ •...,, l 1 Tax Map C-5 proscriptive use. This survey is subject to any facts that may 1 i n/f William H. Seats, Sr. be disetosed by a full and accurate We seeach, NOT furnished rgler re► t� as of this dote and wife 01161$ t , '�1ts . ` Ola Mae Seats Tax Lot 4.03 1 DB 126 O PG 248 T This map rx re fur i and any a person(%) r pax Map C-5 documents are fumishsd to the persan(sj purr+ed rrtn ♦ kttt frJ 1 ' , Tax Lot 4 n/f Amy M. Campbell thereon and no afterotions nr use by nth.rra idyf� sur,, ir,+ 1 s permikted unless autrorrzed ?tone tar,d `„u,*rrng .., sox Tax Map C-5 DB 207 O PG 569 Tax Lot 4 lav, 1 riff William H. Seats jr. Existing 30' Access & Utility Easement Tax Map C-5 Certified copies of this survey map will nt,f to :estsa DB 126 0 PG 242 Reference DB 126 0 PG 242 ' n/f William H. Seats, Jr. beyond nmety(g0; day of tru. arTq,naf a,�«y fats Reference DB 126 0 PG 246 DB 126 O PG 242 Reference DB 126 0 PG 248 VOL) net for ecardatnn Reference DB 207 0 PG 569 I Prerieiar t °oca+ 1 1 ------ � (N1rA tr, Sr 71A ------ trait. M ) IRS 1 � JIc y �p 1 1,3 t” E1P Fnd in Line A r---� �- - - _ 3�4' EiP Fnd PK--Nasi Set .n SR 1429 Roadway- i 3' ', � IRS Placed in Line +9C.6 - - Tax Lott Tota• - -� -- Tax Map C-.5 112" EJR Fnd n/f Richard G. ;rater Tax Lot 3 and wife Brenda S. Crater rJ Fnd DB 126 O PG 244 `ax Map C-5 `-7 3/4" P n/f Lauro Lee Seats Campbell and husband 1 t r- 1 L 8'-` 1&112" ElpFnd D8 127 O PG 474 Roger Campbell DB 96 0 PG 272 1 1 ` N PK-Noi! Set :n SR 1429 Roadway- + 4T 1 QRS ar Tax Lot 8.02 °oe Tax Map C-5 ! C in n/f Patricia Peyton Petree a ftp geot/Fnd �e RB 627 O PG 567 c V 1!� N 1 ee PROPERTY LINE CALL TABLE u V 0. S (Y' COURSE BEARING DISTANCE fn µMQ Ire Ce ¢�g�4 Htck i� L-1 N 8456'19"W 558 .19' L L-2 N 84 56'19'W 113.02' Dance Hall Road -�—T-= �"s r°fa� 3 i L-3 N 10'56'45"E 211.31' L-4 N 10°56'45"E 382.70' S.R . SQ• 680.90' r l L-5 N 20.52'54"E 292.26' ' .1 t~ . 14 0 1 , �� urp/ L-37 Total O' L_6 N 20°5254"E 265.73' 50' Public R/W 18' 4-/-- _1'avemerlt B�Ff / IRS / _J Y _ \ L N 254E 230.70' / f------ ` L-8 N 20°50'29"E .33' L°r..\i - - r7. Natural uffer _ -_ L-9 S 58°46'26"E 115'50 L-10 N 87°10'04"E .80' 1 _ - _ IRS36 11 L N 87°10'04"E j3.57' . _ -- ----"-`-- L-12 S 70°55'33"E r�.90' L-13 S 27 04 54 E 4.47 Tax Lot 6 ` ►__-____-- -- 2" EIP Fnd L-t t e �� � • 7' L-15 Map C-5 -- ---_.`-- �R-12 L-14 S 34°53'52"E .84' � _____---- NMP CL +/- Cedar Creek riff Elizabeth S. R©bertscr; L-15 S 14e39'00''W 91' nB 92 ® PG 694 _ _---_-- _-_ .-.- L-16 5 12°09'47'W - L-17 S 26 11'40 E A4' � L-18 N 61°33'54"E .07' 1 L-19 S 81 009'37"E 48' 1 1 L-20 N 87045'44"E 1.4;' i Property Line PL-21 N 80.23'56"E 1_8 'oliows /,�° L-22 S 01°24'54'V 2 6.00' Center Line Cedar Creek �r - a --- -- �l L-23 S 77035'06"E 3 6.00' R-16 R-15 L-24 S 13°01'03"W 1 7. -- .- L-25 S 16°39'51'V X Cenotes Nonmonumented Ports LOcatea 1 + p, ' L-26 S 22008'44'V L n the SR 1429 Roadway -27 5 26057'02"W 30'L-28 S 30.30'09"W {.63' L-29 S 33°53'56'W 3.12' L-30 S 36031'14"W x.73' ":'S'' 1 Tax Lot 8.01 Tax Map C-5 s L-31 S 38°52'39"W2 .90' E1F Fnd I n/f Adelaide Peyton Hamilton L-32 S 38052'39'W 1 .13' RB 627 0 PG 564 A Denotes Nonmonumented Points Defining the _33 S ° \� Random Line Describing the Center Line +/- L-34 S 30°36'19"W 90' of Cedar Creek as Located on 8-15-2005 L-35 N 38°31'17"E 4 .78' 1 Tax Lot L-36 N 09.17'05"E 2 .56' Tax Map C-5 4 L-37 N 0991 7'05"E 7 .90' 7703 A; res } coo L-38 N 72°02'20"W 6 .37' Tax Lot (in( t,sive of area w thin 'SR 1429 & SR 143C R14) �0\ Tax Map C n/f Troy Robertson. 1 and wife o A t C NMP CL +/- Cedar Creek Mary Robertson � � DB 124 O PG 551 ,1r `�. , �� / \ o Proposed r 1 S Pte 50 '� TIE UNE CALL TABLE = P o cr+� Area in Question: GAP 22 Tota IR ced Tax Ma B-5 1 1 I Nouse Site � 00 l� to un p 1 1 1 215 IRS Placed n/f Thelma S. Plemmons COURSE BEARING DISTANQf in Line 5000' DB 77 O PG 425 T-1 S 79°02'02"E 36 5' 0 220.00' �--NMP CL +/- Cedar Creek R ! 1 2" EIP Fnd N t 2°24'5_4"E 270.00'Total T-2 N 20049'25"E 236, 3' T-1->--� �� 6' T-4 S 67°06'55"E T-3 N 85°41'01"W 34, 6' 8 ^- r PK-Nail Set * Approximate T-5 N 05°28'11"E 3� 1' nd Nair & pop F ___._-__ _ ,, intersection SR 1429 & SR 1430 Q+ T-5 N 05028'111"E 3Q, 6' -- -- r_p T-7 N 85050'52'W 3Q.21' R/W '- ' T-8 N 83°35'37'W 32.93' �- - --�. N% 1510� T-9 N 85040'58'W 36,47' s 4 _..- gcr �. ` \ Tax Lot Jackie D. Harrison and wife <, Linda K. Harrison �2 r DB 141 0 PG 807 --t � o l T Bpr Denotes Nonmonumented Points Locatedw�Ooo,c L 0 the Approximate Center Line of SR 1430 PK-Noil Set CL +/- SR 1430 Wyo Road 3o _ - - --_ "' -- -•-- - - _ 2" EIP Fnd In Lint w R qrt cr-w,y LEGEND I F ce t 1430 ` ?g - 23°62' — [J_ - E shr..a r:De 6j ; - BC k. •f '.urb S.R . `�` ♦1 -- -- — ) c•R Ex ,n, .r'. Pet,j, PP - N wer Goorge RoGert Stone. P. fesa+ona' - Tnd S,,; eyor �_-3' certdy fo ane �I(p L`28 - SR 1430 _-----.- — "----' PK`Nail Set CL + _ of ire fdroriny a i .^rioted ,us i .✓ — - - 60' Public R/W 20'+/ Pavement L-27 _ M :< ete Mmurnen• MH - M 1 �o- r }lc .,.o ebar Set CH - t,..1 Js ur.,r •, iha. hs ^iat 's�.t - survey "or ea e.,.,euDdrr,sior of land •ithin r-•80r' r L`26 —.-' _ _ �"• - R/W Site Plan for: F - -- P �,t y L,ne P,0 - Port ui - the o a of o au ty a m rn_ipo:ay that has or o•dinarx:e that w�Cop F��+ L-25 L-24 J . �. ,.• Deed 'e arotea on.ers ai lard: rid +� .� ...,.��, „� _ •.,�•� _ _ - — Ca Fnd M �c tugota a �es.Y UB - pe-lo B' q p ---- T-bar w/cap Larry McDaniel Builders or-rete P'p PB - Flu, B oor MP - r- ..'ugcted Meta f-fie R6 -- Re�erd E+vok b That the plots a',, survm rho! :e ia:cred in sac^porta^of a I P �orruggte� Ostic Pipe PC - Poge county or munfr,palRy that n un•-eauwted os to an ortlinin<e Tax Lot 12 _F- 'DO rear Fioo3 i3ourdor,. +rat re9wates hof- V ;md CE - (.-it Bonn Tax Ma C-5 vverhe0j Utilities V Seale Line twat th•s peat s of a waver o`nr east"' P Tax Lot 8 `0,�ye1ee�i��r�s n/f Anita S. Hording, et al TOx Map C-5 K - Fent., 'wM - water Meter '±i - 9 p^_a porc e,x p p rid C,,Und NVV �- water Ya1vC of land � DB 136 ® PG 828 t No „ Formedy BM -- Bench Mart. ��� ee,�pt ' ' I� Tax Lot 12.01 NMP -- N"nmonument9d pDol; TBM - Tem oro B_n^n !Hark. (._ ;i '"",u. tris p,r sof wrvev of ono he, oteg„ xvct os he 1e` s ,.R'q �I Tax Ma Ci-5 P ry J - r gnat'°n "t'n` 'r"" �°' `�" 'a� i n f Terry S. Spillman, et al Record Book 645 0 Page 613 enter Line RRS Pali Rood ,v,kr �� r%wY/ ' / ry P 7.703 Acres +/- by coordinate geometry e+ceptc t� fh de.-.n: f Q��+,„.,��n. x Denotes Nonmonumented Points Located DB 190 0 PG 219 (Inclusive of area within SR 1429 & SR 1430 R/W) _P Edge of Pcvern-nt �T,: - cable Teiewsor• Pedest.,� a • r 'afepMone Pedestal ETB Electric Tr nsforme Bu, . i vJ watu ��ne Cts Sonitory leave ..Ie�r Cut 't- ,he nforrn t .. adDle > khs S� to h [>xTt om ! dCCiore that tr1 .4 ,. - t < 2� 0 the Approximate Center Line of SR 1430 A r r SCALE TOWNISMiP COUNTY STATE DATE :'•1'N!+o poke Oeter'n 3tro” tr, he xst prpfess,on C! • • ,r „t, a,,; r„•4,a.° -,rife"''., ^ ^ ,nrwGr ,, ate.' we surveyed the prd'�f3rtyL stQ�,f� o�. w R 1'' 60' Farmington Davie North Carolina 3-09-2006 >`J 0 60 12C, 18Q this plat: • , O; .c George R Stonew GRAPHIC SCALE - FEET _ - - -- - Stone Land Surveying Com an «� eye 3+E: �,� SURVEYED: Y 9 P Y roe No. °edesaoesr`•ssse SC,D6,DT George Robert Stone, PLS L-3162 4006 MAPPED: 113 Drum Lane Phone (336) 998-4733 MAP NO. GRS Mocksviile, N.C. 27028 4006 � . : . .� , � 1 e,1 /�� /,.��� . ,, , � APPLICATION FOR SITE EVALtJATION/1M1IYROVChfENT PERhfIT&ATC �� �/LJp� Davie County Health Department�, ,����� ��6/ S �a � (}'� �( � Environmenta/Healt/�Sectioi��� /� �� oZ/�U�� D �, V u P.O. Box 84E3/210 Hospital Streat��`G� ���yWw'w' Mocksvilla, NC 27028 JA� _ � 20�6 i (336)751-8760 � **Il�PORTANT*** T IS PLICATION C.�NNOT BE PROCESSED UNLESS ALL THE REQUIRED �,��ROVID� . Refer to the INFORMATION BULLETIN for instructions. ��pAVIEC0UN1 `_ _ \ v `' • 1. e Dilled ,V� �3— Contact Yer�on �`o�y�_' �lV�,�pn.s` Mailing I�ddYes� ��t..� � D�.� Iiome Phone��i iJ +�`. ���`p cic5•/�tate/ZIP �,J;�c��;� -Sa���.*�C���� Husinesa Phone'3'�b =1 Z� �.�_ S1j 2. Nama <�n Permit/2�TC if Different than Above MailincJ Address City/State/Zip 3. Applicution For: ,� Site Evaluation � Improvement Permit/ATC ❑ noth 4. syste�n to service: � Houffe ❑ Mobile I�ome ❑ IIuainess ❑ Industry ❑ Other 5. Typa n}•c�L'em reque�tod: � Conventional ❑ conventional modified _ ❑ innovutiva pac�epted 6. If �Re:�idence: 11 People � # Dedrooms � #� F3athrooms 3 �Di�lnaasher ❑Garbage Disposal �Washing Machina ,�Basement/Plumbing ❑Ua�ement/No Plwnbing 7. If liu�inesn/Industry /Other: varify type ' # People R Sinka # Conunodou � Showera �► Urinals 1� D7aCor Coolera IF FOODSERVICE: �# Seata Estimated Water Usage (gailons per day) 8. Type of water aupply: ❑ County/City � Well ❑ Community 9. Do you anticipate adclition� or expansions of thc facility tl�is sy'SfC1l1 IS II1tCt1(IC(I t0 SCI'VCZ ❑Ycs � No IC��cs, ti��hat typc? ***I;il1'ORTANTk**CLIGN'1'S�11UST COdfPLETETIIC RL•QUIKED PROPLRTY IlV1�ORNIATION 12EQULSTC:D I31:i.f�\V. �ithcr a PL.AT or SITG PLAN hfUST 13G SUB/t11TTED by il�c dicnt with THIS APPLtCA'TiON. Properiy lliii�ensions: �q��,� '�/ — �VI21T�DIRGCTIONS(frum Mocicsvillc)to PItOPGR'I'1':` —�— z�:�.orr,«riN: t� V�3�-�f�'��yZ Property Address: Road Name �_1,����_ Co+wz2� .. i� �v� R's�c�—��,i��� �� City/Zip�D�jj��T_'��-=,�. ��b��Sv�.��i��Jr.� '�`�p�� If iti a Subcli��ision providc infoi•tiiatiot�,as follo�vs: " Namc: Scction: I3locic: Lot: llatc I�omc coi-ncr•s flaggcd: �"' �"�(,� '1'his is to ccrtif'y tl�at tl�c infoi7118tI0t1(]COVI(IC(� IS C01'YCCt IO tI1C�CSt Of Ill)�kno�vlcdgc. I undcrst:lll(I �Il:lt ail)'rCI'lill��5� issucd I�crcaflcr are subjcct to suspcnsion m•rcvocation,if tl�c sitc plans or intcndcd usc cLangc,or if ihc information submitted iu tl�is applicatio�i is falsiGed oi•cl�anged. I,also, iuiderstafrd tliat 1 ani resporisiGle for al!ckarges incru•recl jra�i t/ris applicalian. I,hereby,fiive consent to tl�e Authorized Represeutative of the Davie County I-Iealtli llepartment to ecitcr upou abovc dcscribcd property locatcd in Davic County and o�vncd by to conduct afl tesli��g proceelures as necessary to delermine tlie site suitabil� � � x u,�,�,vne- �l c�co DA1'E_�� _'�jj., � S SIGNATUI2� '�,GZ�.,,r �t.c.t�i..�, t/.��� TFIIS AItI;A I�IAY B�US�D TOR DRAWING YOUR SIT�PLAN(Includc all of tlic fullotiving: I;�isting and proposed property lirics znd dimensio�is, structures, setbacics, and septic locations). Silc Rcvisit Chargc . Datc(s): Clicnt Notificatiou Datc: rTis: Sign bivcn '. 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' ' i-� �b„;t'.'}'I'�41 . � I v ��� ���I�+;iYi3{ �' '� �, "',1q;'4('' I . � ',, ' , ; ��•� 1 �.,';;�.:,��4 � �' �'��iY�;I��� , , ' :I';"ny� . ., .. , ,��•S y?�� . �� ,�!q, ; ' ' � �. � , `,,;;;;'f,y�9 i�,�sy� I . .. , ,,.J.,.�;?,�,;,,',� ���1)i��11�.4�Y��i�}� � i'�,�����IrV}�/� �� • . . : .� � r.�.,,��,''�;%1R,n;..� + , . ^ . ,' V�',II`� s• 1 , .� '� 'f'�, t•�.�e �. .1 f�,�r:��j'aJ��Sqi ' . � , � � ����;�J� ��;�i������� �� � � - . . . . �ii���aIH�, r � , DAVIE COUNTY HEALTH DEPARTMENT � 4 �. r ,• Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003839 Tax PIN/EH#: 5833-93-6042 Billed To: Cathy Moore Gene Veach Subdivision Info: Reference Name: Bobby Jones Location/Address: Wyo Road-27028 Proposed Facility: Residence Property Size: 7 Acers+ Date Evaluated: ����� Water Supply: On-Site Well Y Community Public Evaluation By: Auger Boring � Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e sition L �- Slope% HORIZON I DEPTH �' � �� Texture grou -�L Consistence 1/� � }y Structure / j Mineralo I„' L ' HORIZON II DEPTH � ' '' Texture rou � G Consistence .' ;` Structure (� �, Mineralo HORIZON III DEPTH Texture rou � Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE � " SITE CLASSIFICATION: �� EVALUATION BY: �"� LONG-TERM ACCEPTANCE RATE: � � OTHER(S)PRESENT: REMARKS: LEGEND i,andccane 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 C'ON�I TF.N . . aZ41S� VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm � � NS -Non sticky SS -Slightly sticky S -Sticky VS -Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic �tr� �r SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic MineraloQv 1:1,2:1,Mixed � 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 DCHD OS/OS(Revised) . , •4 . � . � ��._. ., .r.�.�.. .�.,..w� . .o,��, ,,... _- _.. ,,. _, �,�... . ., � ...._.. . .. ... .....__,_ . .._.... . .�. _ . ....,, � ..,. ;,,,,.�/�����S��R.d�.�@m��les5"�F��� �����lm�bl`5��6 3 . . ... .. . ..._. ' .,,.., .� m � � � _. w _ . ...: Environmentai Health Section P. 0. Box 848/210 Hospifal Street Courier 09-40-06 Mocksville, NC 27028 ; �' ��(336)751-8760 � i , � � � ; ; _.__�� _..� ,_��._��,� .,s_ �.�w�.....�,m� _��__�... __._� ._�__�.�� ____.,�wa� _ n_ .n_...,wn ._� .� u m.. .� _.�_�-.w� January 19, 2006 Cathy Moore &Gene Veach 6050 Blue Bonnett Lane Winston-Salem,NC 27103 Re: PIN#: 5833-93-6042 Wyo Road Dear: Cathy or Gene, As requested, a representative from our office visited the aforementioned site on January 18, 2006. Based on the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, it was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement/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, �a�'���i��, Robert B. Hall, Jr.,R.S. Environmental Health Specialist RBH/bml