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137 McGee Court Lot 4Davie County, NC Tax Parcel,Report Tuesday, November 8, 2016 1 137 WARNING: THIS IS NOT A SURVEY Parcel Information:.._._ Parcel Number. C7130A0004 Township: Farmington i NCPIN Number: 5872064820 Municipality: l Account Number. 82529459 Census Tract: 37059.802 Listed Owner 1: ANDREWS EDWARD M Voting Precinct: FARMINGTON I I Mailing Address 1: 137 MCGEE COURT Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAME COUNTY R-A,R-20 State: NC Zoning Overlay: DAVIE COUNTY OD Zip Code: 27006.0000 Voluntary Ag. District: No Legal Description: LOT 4 BUTNER CENTURY Fire Response District: SMITH GROVE Assessed Acreage: 0.53 Elementary School Zone: PINEBROOK jt Deed Date: 4/2008 Middle School Zone: NORTH DAME, Deed Book/Page: 007520560 Soil Types: PcB2,PcC2 Plat Book: 0005 Flood Zone: Plat Page: 181 Watershed Overlay: DAVIE COUNTY Building Value: 170950.00 Outbuilding & Extra 3750.00' Freatures Value: Land Value: 31500.00 Total Market Value: 206200.00 Total Assessed Value: 206200.00 5;vldtAll data is provided as is withordwamanty or guarantee of any kind either expressed or Implied Including but not llmbd to the Davie County, Implied wamnllesormerchantability orlitnessform paNlwlaruse.Adusers 0Davie Courdy'sGIs webaiteshellholdhamlanthe County of Galls, Noll Carolina, its agents, consultants, contractors orempkoyees from any and all claims or causes of echo" due to �o NC or arising out ofthe use or Inability to usethe Gla data provided by this webaft AUT PUZATION NO:,.0984, : DAME COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION 5At/ P.O. Box 848 /s� Mocksville, NC 27028 Subdivision Name:' L47t� _// Phone #-704-634-8760 Directions to property/ �C/!� Section Lot: AUTHORIZATION FOR ''<.. WASTEWATER SYSTEM CONSTRUCTION Tax Office PIN:# !OZ ©6 Road Name: Zip: 1706 **NOTE'** ThisAuthorization for Wastewater System Constriction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any. Building Permits. This Form/Authorizatich Number should be presented to the Davie County Building Inspections.' Office when,applying for Building Permits: (In compliance with Article 11 of O.S., Chapter 130A, Wastewater Systems, Section .1900 Sewage. Treatment and Disposal Systems) OTICE THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION . ***T *** IS VALID FOR A PERIOD OF FIVE YEARS. - ENVIRONMENTAL HEALTH SPECIALIST - DATE ISSUED - - DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street ' Mocksville, NC 27028 (336)751-8760 Fax #(336)751-8786 **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC has been installed L in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," 7 but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time���W System Type:S.T. Manufacture OQTank Date I6 "�� Tank Size�j�0� Pump Tank S�zZ System Installed By: V GYI-1 CJE.H. Specialist: LbINNI POM j3ate: — � 1 DCHD 11/06 (Revised) �h L ffOM3 OPERATION PERMIT Account #: 990004402 Tax PIN/EH #:5872-06-4820 Billed To: Darryl Hayes Subdivision Info: Butner Centurty Place Lot # 4 Reference Name: Location/Address: McGee Court -27006 5 Proposed Facility: Residence Property Size: .05a6re y ATC Number: 4734 �3 **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC has been installed L in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," 7 but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time���W System Type:S.T. Manufacture OQTank Date I6 "�� Tank Size�j�0� Pump Tank S�zZ System Installed By: V GYI-1 CJE.H. Specialist: LbINNI POM j3ate: — � 1 DCHD 11/06 (Revised) �h L ffOM3 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street' Mocksville, NC 27028 (336)751-8760 Fax # (336)751=8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004402 Tax PIN/EH #: 5872-06-4820 Billed To: Darryl Hayes Subdivision Info: Butner Centurty Place Lot # 4 Reference Name:' location/Address: McGee C6urt-27006 Proposed Facility: Residence Property Size: .05acre ATC Number: 4734 Site T e: yp ef1New ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications:, # Bedrooms. # Bathrooms ,Z # People_ BasementO Basement plumbing Non -Residential Specifications: Facility Type # People_ # Seats_ Square Footage(or Dimensions of Facility) Lot Size '/Z&CRE Type of Water Supply:e(5unty/City ❑)Nell ❑Community Well System Specifications: Design Wastewater Flow (GPD) aL>Tank SizeAL. Pump Tank_ GAL., Trench Width& Max. Trench Depth 4t�;) Rock Depth N A Linear Ft. Site Modifications/Conitions/Other: A` CiY t 'w,� L It'bz , rJV� KEEP 1 a oFF CGnAe�l . Icu—t. 17' F a Z, i�STat� C®niTi91A Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telephone # (336)751-8760. Maio E—>T C10117 CQIVE 17(0' (00' F&P Cts . Environmental Health Specialist Date: DCHD 11/06 (Revi'sed) '. I i f ATION SITE EVALUATION/IMPROVEMENT PERMIT & ATC j t} 2007 Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ENNRONMENTAI NFALIiI (33 751-8760/ Fax (336)751-8786 DAVIECOUNIY - A mcanon For: O Site Evaluation/Improvement Permit Authorization To Construct(ATC) D Both Type of Applicaiion: ONew System ❑Repair to Existing System OExpansion/Modification of Existing System or Facility ***ILIPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPL CANT INFORMATION Name to be Billed ) 6- e C 1 -`zs Contact Person BillingAddress r Home Phone City/Soto/ZIP N C. i Business Phone 131 KY 9 41 Namen mi I Pert/ATC if Different than Above Mailinir Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: O Site Plan OPlat(to scale) Owners (Permit is valio for 60 months with si`e p no expiration with complete plat.) Name �� Ery �v -aCf L. L C, Phone Number t Owner:s Addresssccnl� ov-ai City/State/Zip 6o-r ProperlyAddress LfA &c.k-- City /k4v0-WC=A-/dtear Cam Lot Size s -5 a e Tax PIN# 5 a - U7 9" Subdivision Name(if applicable) V &C� Sectio ot# Directions To Site: Q61 go r raAn_ --1-4 q0, 1 MII-Q- 1-t) cOnl 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? O Yes i V o Does the site contain jurisdictional wetlands? OYes)eNo Are there any easements or right-of-ways on the site? DYeswo Is the site subject to approval by another public agency? O Yes $14o Will wastewater dther than domestic sewage be generated? OYes',HNo IF RESIDENCE FILL OUT THE BOX BELOW # Peop1e # Bedrooms .3 # Bathrooms Garden Tub/WhirlpooLY4Yes ONo Basement:$Yes ONo Basement Plumbing: Wes ONo 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,,)zConventional ❑Accepted ❑Innovative OAltemative ❑Other Water Slhpply Type:(County/City Water O New Well DExisting Well O Community Well Do you Inticipate additions or expansions of the facility this system is intended to serve? O Yes ,ndo If what type? yes, This is �o certify that the information provided on this application is true and correct the best of my knowledge. I understand that any perm rit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if ---------- - —1-1— —.....w.........o ..m.m..---..—... .e .. ... ........g.............,,y S...uu.g...... 1—y w uw �u.u.vau.w .wYwuwnuur� 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 comers and locating and flagging or staking the hoAe/fggility location,Qroposed well location and the location of any other amenities. or owners iegam representative signature Date I Sign given OYes ONo Revised 11/06 Site Revisit Charge Date(s): Client Notification Date: EHS: t Account # Z�Iqv-L Invoice # 4.11& 9 r APPLICATION FOR SITE EVALUATION/IMPROVEMENT PE I1T AfC� t Davie County Health Department, D Env1*11017mentaiHealth Section Nov - P.O. Box 848/210 Hospital sires - 1,12004 Mocksville, NC 27028 (336) 751-8760ENVIRONgO{ MgyrgLL1fr (***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED. UNLESS ALL THE Ut INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. �`7� 1. (Name to be eilied ,6COW <_ � C.t t�,OQFf-Li/�� - Contact Person 5Y�(�kCMLt. &ddaAJ p Mailing Address (O`(O' ki!lktowtd Ceo�.% ��� Mom, Phone -`:a'{ -(037 -7&q City/State/ZIP SrdALAN N L - cAs—J - Business Phone 33t'.0-403 -"IlnlD - C4 II 2. Name on Permit/ATC if Different than Above 0, 4t,1 OL(k Mailing Address /�City/State/Zip - 3. Ipplication For: 0 Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. ystem to service:H,.ousee 13 mobile Home 13 Business El Industry 13 other S. -�IW'3'Pe.system requested: M t-.`nventiona�l.1 ❑ conventional modifie1d 13 innovative S. If Residence- #People 3 -1 # Badrooma-._6 -# Bathrooms _ .Dishwasher 40arbage Disposal_ yawashing, Machine - Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other; verify type - - # People # Sinks ,Commodes- '.# Showers # Urinals - # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day). - S. Type of water supply: Onnt 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? ***IMPORT4NT*** 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: 130M -X I S, VP WRITE DIRECTIONS (from Mocksvilie) to PROPERTY: .Tax OfficePlN: # 5i517D(uy �ciO,^ r+i '%o Ton`,l / Pro pertyAddress: II Road Name mc6ce �i _GflsSS btl� at F�� SU TrII(.(l; City/ZipAo�U"CR- 1211 If in a Subdivision provide information, as follows: /V1 t 6�' Cour Name ax (Gi co_ "'�'"-I -L -.._�11_ '/1lLI, Utx !:IP4 ` SectiI n Block A O Lot: W ' -Date home corners Ragged: i l I aa�a y This is to certify that the information provided is correct to the best of my Imowledge.I understand that any permits) 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 amt responsible for all charges lucurred froom this application. I, hereby, give consent to the Authorized Representative of the Davie. County Health Department to entcr upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE oil ( Lo 10!1 SIGNATURE t (X�UI t i THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions,. structures,, setbacks, -and septic locations)... _.---___ . . _, .. __. ___ ...._ ... ...:.. Site Revisit Charge . Datc(s) Client Notification Date: EHS: I Sign giv n � Account No. Revised DCHD (05/03 Invoice No. / �/ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site, Evaluation APPLICANT INFORMATION PROPERTY INFORMATION 'Account #: 990003414 Tax PIN/EH #: 5872-06-4820.SG Billed To: Scott & Stephanie Goddard Subdivision Info: Butner Centurty Place Lot # 04 Reference Name: Location/Address: McGee Court -27006 Prol,osed Facility: ResidenceProperty Size: see map Date Evaluated: If 1;6)94 Watei Supply: _ On -Site Well Community Public, Evaluation By: Auger Boring Pit ✓ Cut FACTORS 1 2 3 4 5 6 7.. Landscapeposition Slo l% HORIZON I DEPTH -7 b Texture group '5r- CL Consistence Structure S Mineralogy HORIZON H DEPTH ^ 2Z 1 Z Texture group Consistence Structure Mineralogyl HORIZON IH DEPTH2 ' Texture group Consistence r Structure Mk 1C Mineralogy tty HORIZON N DEPTH 140 1 9 - Texture grouL p( Consistence Structure ' Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE O• -0. SITE SSIFICATION: Qo�23 �"EVALUATION BY: LONG-TERM ACCEPTANCE RATE: l OTHER (S) PRESENT: ^�'` REM RKS: 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.:. VFR - Very friable FR - Friable FI - Firm' VFI'- Very frm 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 Structur 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 DCI 05/99 (Revised) ■■■Es■■■ 31 z O -•i m o� 0 �z o� mV Zr" r" m� N D r r N 00•/4'04'f-+ S9/.TO' --- 130 04 '--- - -- 130.04 ' 8 -- 130.04' i .30 Alm JVL � ` I �• dm W,a c w w e p ® x, w � 1•� a � � m 7 VIN 130.00', 130.00 /30.00' T9. -4—s 0/1030'30" w ,E COURT (PUBI.iC) N 01 630' 5.9 \Ilk 130.00 I IT, 132F Zlo OIL UP I /� � �y SO -0�.I� `I4 -- 04,8.4,9' c mm r a�ZZ i2y m i� ice•* my.. .r _ 14 - .,- . q. i . - ,, \ 1 DAVIE COUNTY'HEALTH.DEPARTMENT s. IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Names �Gi!/.�e1.�ifr'QN_ Subdivision Name Direction to property; r 4 Section r ,�j�r/q Lat. / BVIPR Rry ffr T a 6 !ice D /O PERMIT Tax Office PIN:(# L Road Name: ! r 1t . kip/ g7ge **NOTE**This Improvement Permit DOES NOT authorize the construction or installation of aseptic tank system or any wastewater system An - AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department rior to the constructionlmstallation of a system or the issuance of a building permit. (In comp 'ance with Article ii of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOT'ICE***THLSPERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRONMENTAL: HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THLS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTiALSPECIFICATIOMBITILDING TYPE /;0`— # BEDROOMS 1.?: # BATHS --# OCCUPANTS V GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPEA # PEOPLE _ # PEOPLEISHIFP #. SEATS _ INDUSTRIAL WASTE: Yes or No LOT SIZE �.Y TYPE WATER SUPPLY e! DESIGN WASTEWATER FLOW (GPD) NEW SITEL � REPAIR SITE SYSTEM SPECIFICATIONS: TANKS DD/) GAL. PUMP TANK GAL. TRENCH WIDTH , ?e ROCK DEPTH Z-) LINEAR FT., 1�oO . .: OTHER. _ REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT:- **CONTACT' PRESE ATNF OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BEMn E 8:30 -.9: A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. - - DCHD 05196 (Revised) ,� • DAME COUNTY'HEALTH DEPARTMENT "� IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION Name d44 .VY!-J,,f;�CrE�' .y Subdivision Name rt i •r Direc of s toproperty:f/✓ +!7 ' Section:Lot ffyy IMPROVEMENTPERMIT Tax Office PINA::11 rr)l -- Road Name: _ r(, -/41 -r{ frf **NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the constmction/installation of a system or the issuance of a building permit. -f (Incompliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOVICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE 5; �i• 71 F'//27 PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ENVIRON ENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDEN7 SPECIFICATION: BUILDING TYPE g_ # BEDROOMS L.? # BATHS_ # OCCUPANTS GARBAGE DISPOSAL: Yes or No (_ r COMMERCIAL SPECIFICATION: FACILITY TYPE ': # PEOPLE _ # PEOPLFJSHIFT # SEATS _ INDUSTRIAL WASTE: Yes or No ,+. s„ LOT Sl!-Y//3fIZE TYPE WATER SUPPLY /A DESIGN W6'STEWATER FLOW (GPD) NEW SITE REPAm SITE SYSTEM SPECIFICATIONS: TANK SIZE�—/L-121i GAL, PUMP TANK:- GAL. TRENCH WIDTH 7% ROCK DEPTH �.i , LINEAR Fr. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS- ! / - c IMPROVEMENT PERMIT LAYOUT Ll • r i **CONTA*8:30 ES ATIVE OF THE6gVIE COUNTY, HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS S B - 9: A.M. OR 1:00 - 1:30 P.M. ON TF�E DAY OF INSTALLATION. TELEPHONE # IS (704) 6348760. l PERMIT INSTALLED AUTHORIZATION NO. OPERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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 gPrAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIM. +j DCHD 05/96 (Revised) [J AP1?LICATI QN FOR SITE EVALUATION/IMPROVEMENT Davie County Health Department Environmental Health Section J/ n� I , G( P.O. Box 848 - �� L /' Mocksville, NC 27028 (704) 634-8760 THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 'AL 2 2199T 1. Name to be Billed �- F `= �r-� Contact Person a`t\`= Cc a (=r N �< Mailing Address \ CY\ w C' Home Phone Cit}/State/Zip A c1J a�^r� t C . oli o o (� Business Phone 2. Name oItt Permit/ATC if Different than Above 3. Applin f 4. System 5.' If Res. [ WE 6. If Bus # Shol If Foo 1 7 .Type c oyo PH yes, Prope Tax0 n, if Sec This is ..i Repres by DATE• Revised THIS Address City/State/Zip ion For: [ ] Site Evaluation XImprovement Permit & ATC [ ] Both o Serve: House [ ] Mobile Home [ ] Business [ ] Industry [ ] Other ,nce: # People # Bedrooms_ # Bathrooms 2•\h- b(Dishwasher [ ] Garbage Disposal ing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing ass/Other: Specify type # People #Sinks # Commodes rs # Urinals # Water Coolers ,rvice: # Seats Estimated Water Usage (gallons per day) water supply: [County/City [ ] Well [ ] Community mticipate additions or expansions of the facility this system is intended to serve? [ ] Yes KNo hat type? S:T'4F-9 .4 1-64;: Bti S#T£+ A64H PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** ATIMOF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. f Dimensions: \-r S.-T4RT ] 'R,W WRITE DIRECTIONS (from Iocksville) TO PROPERTY- ce PIN: #537,? D6 CH82o� Address: Road Name 'M2--G� Cat- o} , city/zip Ra tam, i.1 G. a-roo16: division provide information, as follows: Lot #: 1 S 4 a ^ 5 aoo a 1 4t 1 ! rtify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are ispension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or also,:understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized ive oftheDavie County Health Department to enter upon above described property located in Davie County and owned Q', c,G�� Get` tto/oo� conduct all testing prof1dures as pecessary to determine the site suitability. r - n- C4 r I D (06-96) EA hIAJ 13L USED FOR DRAIVINC JOUR SITE PLAN: a Name Address FACTORS DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 665 Mocksville; N.C. 27028 . SOIL/SITE EVALUATION AREA 1 AREA 2 Date '1hPJS'7 Lot Size ARFA 3 "ARFA d 1) Topography/ Landscape Position S' S S PS PS PS PS U U U >) Soil Texture (12-36 in.) Sandy, S S S Loamy, Clayey, (note 2:1 Clay) PS U PS U PS U I) Soil Structure (12-36 in.) S S S Clayey Soils PS PS U PS U PS U I) Soil Depth (inches) L /� f i,.l/ PS S PS S PS S PS U U U U i) Soil Drainage: Internal S S S S PS PS PS U U U External PS S PS S PS S PS U U U i) Restrictive Horizons Available Space S PS S PS S PS U U U 1) Other (Specify) S PS S PS S PS S PS U U U. U i) Site Classification U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recomme dations/Comments:m��a wle Described ibyTitle Date SITE DIAGRAM DCHD (6.82) - : l Sp a ' er Av . K - - _ 150. 04 ---- - -• 13D .. ._..� _ .... _: ..:,. . • _ r_� �Qui - rJ�T�•7L Y. �k �- lift Rr- a 0/ 030 150#1W e s / ` Jow 00 • E IROR Nm W se 00 � 00 W W dl �M S� W 0000 C3 ; yajjuma O W o0 t W i s0' PIP J9 W All HAI - fa DEED ,aI_WAI Hep N 'H BUT kR UTN 9p� 9 e3, PAGE 144 NOTE : IRON PIPE AT ALL LOT CORNERS POO. 1 �►ly DAVIE COUNTY_ Nf Ascended 7/2 / T9 I hereby, certify th, HEALTH DEPARTP ssreNvlebn enlilNd with respect to crime by state law or W, the some it fm" and condthot,s Ex( Hol tylion. For M s,h0otio.s see the sold Department IMPORTANT NOT1C^ CONSTITUTE A PE— INDIVIDUAL LOTS INSTALLATION OI /,•. 2 / Date Co ry Hewth of— The foregai" certificote NOTARY„,PUfdUC a certif This _..I ',� day of Ll Probate fee / L pas J. K. SMITH Register am by 1� IROR Nm W se 00 � 00 W W dl �M S� W 0000 C3 ; yajjuma O W o0 t W i s0' PIP J9 W All HAI - fa DEED ,aI_WAI Hep N 'H BUT kR UTN 9p� 9 e3, PAGE 144 NOTE : IRON PIPE AT ALL LOT CORNERS POO. 1 �►ly DAVIE COUNTY_ Nf Ascended 7/2 / T9 I hereby, certify th, HEALTH DEPARTP ssreNvlebn enlilNd with respect to crime by state law or W, the some it fm" and condthot,s Ex( Hol tylion. For M s,h0otio.s see the sold Department IMPORTANT NOT1C^ CONSTITUTE A PE— INDIVIDUAL LOTS INSTALLATION OI /,•. 2 / Date Co ry Hewth of— The foregai" certificote NOTARY„,PUfdUC a certif This _..I ',� day of Ll Probate fee / L pas J. K. SMITH Register am by DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. 0. Box 848/210 Hospital Street Courier 09-40-06 Mocksville, NC 27028 (336)751.8760 October 15, 2004 Larry McGee 151 McGee Court Advance, NC 27006 Re: Site Evaluation/ Butner Century Place, Lot 4 Tax Office PIN: #5872-06-4820 Dear Client(s): As requested, a representative from this office visited the aforementioned site on, January 13, 1987. 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 for the installation of an on-site sewage system. 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. This was perked for a three bedroom, two bath home. 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) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760/ Fax: (336)751-8786 November 30, 2004 Scott and Stephanie Goddard 1040 Highland Creek Dr Salisbury, NC 28147 Re: Butner Century Place -Lot #4 Tax PIN#: 5872064820 Dear Client(s): As requested, a representative from this office visited the above site November 29, 2004. Based on the information provided on the Application for Site Evaluation and after evaluating the site, the lot was classified unsuitable for the proposed four-bedroom residence. A prior evaluation(Jan. 13 ,1987) classified the lot provisionally suitable for a three-bedroom residence design. 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, Jeff G. Beauchamp, R.S. 1 Environmental Health Section