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147 Finn Hollow Lane Lot 2TnPa 14'7 �hV/F FII data is provided as is without warranty or guarantee of any kind either expressed or implied including but not limited to the implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS webei e shall hold harmless the County of 0115 Davie, North Carolina, Its agents,consultants, contractors or employees from any and all claims or causes of action due to or arising out of ,.1 Pnnted.00t 02, 2013 the use or Inability to use the GIS data provided by this wabalte. 14'7 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION ` PROPERTY INFORMATION Account #; X237/3 Tax PIN/EH #:��QO QQ—Qv�-OS' Billed To: _Rbba/-.tSU41 Subdivision Info: Reference Name: Location/Address: erw(144p Proposed Facility: pn. Property Size: Date Evaluated:_T2c s Water Supply: On -Site Well Community Public Evaluation By: Auger Boring OC Pit Cut SITE CLASSIFICATION:, EVALUATIONBY:41al"�j c��Gk�uJGur LONG-TERM' ACCEPTANCE RATE: 3 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 Tell= S - Sand IS - 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'ONSTSTF,NC . , D44JSY VFR - Very friable PR - Friable FI - Firm VFI - Very firm EFI Extremely firm li'et NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastid P - Plastic VP - Very plastic Structure SC - Single grain M = Massive CR - Crumb OR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralo¢v 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) LIAR - Lone -term accentance rate - nal/dav/ft2 nr [rn papa Consistence HORIZON 11 DEPTH Texture group HORIZON III DEPTH Consistence moo—®tea® • RESTRICTIVE HORIZON SITE CLASSIFICATION:, EVALUATIONBY:41al"�j c��Gk�uJGur LONG-TERM' ACCEPTANCE RATE: 3 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 Tell= S - Sand IS - 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'ONSTSTF,NC . , D44JSY VFR - Very friable PR - Friable FI - Firm VFI - Very firm EFI Extremely firm li'et NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastid P - Plastic VP - Very plastic Structure SC - Single grain M = Massive CR - Crumb OR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralo¢v 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) LIAR - Lone -term accentance rate - nal/dav/ft2 nr [rn papa DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street, Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004165 Tax PIN/EH #: G8-000-00-005-08 Billed To: Robert Sutton Subdivision Info: Address:. 153 Finn Hollow Lane Location/Address: 147 Finn Hollow Lane -27006 City: Advance Property Size: �6.820 Ac - Reference Name: Site Type: New ORepair Expansion Proposed Facility: Office Space . **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_ # People BasementO Basement plumbingO " Non -Residential Specifications: Facility Type Fa -C # People 3 # Seats i Square Footage(or Dimensions of Facility) O Lot Size Type of Water Supply: ffCounty/City O Well OCommunity Well System Specifications: Design Wastewater Flow (GPD) Tank Size e GAL: Pump Tank GAL. e� Trench Width 5& Max. Trench Deppth I� Rock De th( Linear Ft _l J As stated In 16A1tSA.19F3(�. Site Modifications/Conditions/Other: accepted Systems may also be use Contact the Davie County Environmental Health Section for final inspection of this system between l A•2n _ o.zn. m nn A. dw nF "Tnlnnhnnn 11 (2261741 A76a r . . Environmental Health Specialist ///���%id/C//i%�// Date:1/02 114, DCHD 11/06 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 /Fax # (336)753-1680 OPERATION PERMIT Account #: 990004165 Tax PIN/EH #: G8-000-00-005-08 Billed To: Robert Sutton Subdivision Info: Address: 153 Finn Hollow Lane Location/Address: 147 Finn Hollow Lane-27006 City: Advance Property Size: 6.820 Ac L6Tk42_ Reference Name:. Propos#e* O J t ;i usuan a otethis Operation Permit shall indicate the system described on.the ATC has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAYbe taken as a guarantee that the system will function satisfactorily for any given period of time. System Type;.. S.T. Manufacturer Tank Date Tank Size 'Pump Tank Size Bedrooms: System Installed By: Installer# Date: GPS Coordinate: Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/ Fax (336)753-1680, IMPROVEMENT PERMIT s; Account #: 990004165 Tax PIN/EH #: G8-000-00-005-08 Billed To: Robert Sutton Subdivision Info: Address: 153 Finn Hallow Lane Location/Address: 147 Finn Hollow Lane -27006 City: Advance Property Size: 6.820 Ac !L# Reference Name: f . Propos �� I t 1 hOf�imprSpace ent Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Constructs. wastewatersystem must be obtained from this office prior to the constructionAnstallation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change: Permit Type: Wlew DRepair DExpansion Permit Valid for: X Years DNo Expiration Residential Specifications: # Bedrooms # Bathrooms I # Peoplei Basement0 Basement pluribing❑ Non -Residential Specifications: Facility Type & ce, # People' .' # Seats_ Square Footage(or Dimensions of Facility) �gL DesignFlow(GPD):MCI Type" of Water Supply: CCounty/City ❑Well ❑Community Well , Site Modifications/Permit Conditions: p3sn a9q osle te61 suialsig Peldaooq l5)69bT;;'170VUN V5 ti ul Pa383s §V S stem T e LTAR Initial -.__� �'? Repair 6, 2 7 R y %!�%% Date Appraisal Card DAVIE COUNTY NC Page 1 of 1 12/3012013 10:04i22 AM UTTON ROBERT D SUTTON STACEY J Return/Appeal Notes: Parcel: GB -000-00.005-08 153 FINN HOLLOW LN - PLAT: 0010/005 UNIQ ID 11590 2526063 NO PICTURE ID NO: 5870935913 COUNTYTAX (100), FIRE TM (100) GRD NO. I of I 0.eval Year: 2013 Tax Year: 2014 LOT 2 SUTTON & MARTIN 6.820 AC SRC= Inspection ralsed by 19 on 10 14 2008 07002 MOCKS CHURCH TW -07 Cl -FR -01 EX- AT- LAST ACTION 20110712 CONSTRUCTION DETAIL MARKET VALUE DEPRECIATION CORRELATION OF VALUE Oundatim-3 Standar) GOWO 5.00USE ER. BASE RCN INS AYB REDENCETO MARKET Up Floor stem ub Floor Sys[em • 4 MOD Area UA BATE OS 14,2 61 128 89.603]86492007200]%GOOD 99.0 DEPR. BUILDING VALUE - CARD 35593 I o00 6.00 OS Mor Walls -l0 TYPE: Single Family Residmeal Single Family Real OEPR. OB/XF VALUE -GRD lummumPfinyl S[d;rxQ 29. MARKET LAND VALUE -GRD 61,78 baling Sonature-03 STYLE: 2-1.5 Stories TOTAL MARKT VALUE -GRD 417,71 able 8.0 Cover oofiRotel hotel TOTAL APPRALSED VALUE -GRD 417,71 5. nteriof Wall ConatruOlOn - $ TOTAL APPRAISED VALUE - PARCEL 417,71 all Sheetrock 26.0 nterlor Wall Construdion - 6 OTAL PRESENT USE VALUE - PARCEL ustom Interior 0.0 OTAL VALUE DEFERRED - PARCEL Merlon Floor Cover -12 OTAL TAXABLE VALUE - PARCEL 417,71 afriW00ri 10.0 PRIOR nterior Floor Cover• 14 BUILDING VALUE 397,21 front OR: B%F VALUE eating Fuel - 04 ANDVALUE 61,78 IeRrk 1.0 RESENT USE VALUE eating Type - SO EFERREO VALUE Heat Pump 9.0( 'OTAL VALUE458,99( U Conditioning Type - 03 antral 9.0 rooms/Bathmoms/Haif-BaUVxr s +12 16.000 I F O G 1310 I I PERMIT Bedrooms 3 3 CODE I DATE I NOTE I NUMBER AMOUNT AS -2 FUS -2 LL -0 S S Ihrooms ++ + I ] -2 FUS - ILL -O ++++ ... +12 OUT: WTRSHD: -Bathmoms 2 F U S 16+ 2 SALES DATA -OPUS-DLL-O 3 +16+ 3 FF. INDIGTE ++# RECORD DATE DEED SALES ce++++ ++ + BOOKPAGER;LPOINTVALUE 116.00 vlll 820 9 00 Q< C IBUILDING ADJUSTMENTS +32-1 ++8+ 0659 223 3 00 WD E Vll [AS IFGD4++ ++--35--+ ++ 0626 786 9 00 WDv % V9 4 ABAVG 1.200 1+FOP+19+++13 121•++21+6+13 a Desl 4 FAR0R9 1.050 S 6BA5 + 6UBM 4 x 3 51Je 0.87 I +8+ + ++ ++ AL ADJUSTMENT FACTOR 1.10 +32 -+PIP 7 1 7 AL QUALITY INDEX 12 2 9 +71 9 ++ HEATED AREA 3,227 1 +1418•+14 8 +14+18+14+ +----61---•-} NOTES BM ADDED 08 SUBAREA I ORIG% SIZE ANN DEP % OB/IIF DEPR. GS OD UA DESCRIFTION OUN LTH HUNK PRICE CON. BLDG# FAR Y R KATE VN COMO VALUE TYPE AREA %RPL CSTOTAL Ol XF VALUE BAS 2 OD l 17946 GD 77 4 31091 FOG 42 8 3198 FOP 1 12 3 3530 FUS 8 9 6487 BM 200 2 3593 FIREPLACE I - None SUBAREA 71278,64 TOTALS BUILDING DIMENSIONS BAS=ES FOP=NBE$N2ESN2E852ESS2E355BW13N2W6S2W21N4W454W14$ E16N4E4$4E2LN2E6S2E1355W157WIS5W2S7 OP=SIBW6IN26E8S19El4SlEl8NlE14NllE7$ W7511W14S1W18N1W14N19WBN36$ FGD=N14W22S35E22 N21$PTR=N60 $.S23W559W4N4WSNSW16S5W559W4N4WSN23ESN4E459E5S12El6N12ESN4H54ESSS60E100 BM=E21N4E4S4E21N2E6S2E13SSWISNIISSW25JW7511W3951WIBNIWIdN19WBNlfi W100E95Nfi0 FOG=N35E32535W13 W45560. LAND INFORMATION XIGNEST THERADJUSTMENTS LAND TOTAL AND BEST USE LOLL FRON DEPTH / LHD COMB ND NOTES ROA UNIT LAND UHT TOTAL ADJUSTED LAND OVERRIDE LAND SE CODE ZONING TAGE EPT SIZE MOD FAR RF AC LC TO OT TYPE PRICE UNITS TYP ADIST UNR PRICE VALUE VALUE NOTES URAL AC 0120 0 0 1.2200 4 0.7500 F10-15+00+Oo+00 RT 9900.0 6.82 AC 0.91 9,08Z01 6177 TOTAL MARKET LAND DATA 16.82 61,78 TOTAL PRESENT USE DATA http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parcel=G800000005O8 12/30/2013 G C��Af APPLICA6ION FOR SITE EVALUATIONAMPROVEMENT PERMIT &ATC �%�� t'' Davie County Environmental Health e� 1 2� P.O. Box 848/210 Hospital Street Date: `b 2 Mocksville, NC 27028 Z /3 (336)753-6780/Fax.(336)753-1680 'i—!-; db Application For: 0 Site Evaluation/Improvement Permit 0 Authorization To Construct (ATC) 0 Both ' Type of Application: ONew System ORepair to Existing System OExpansion/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. Name Address Email' Koloe-T @ -JPhAJ Com Name on Permit/ATC if Different than Above Mailing Address I S3 17,A- i4mu.._4 t' Contact Person !2a pex-+ Home Phone 32,6 - Business Phone _33b • �I -� -� lq FROFERTY INFORMATION *Date House/Facility Corners Flagged 51 NOTE: A survey plat or site plan must accompany this application. Included: 0 Site Plan OPlat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name -Ro ESIFAZ 1" Phone umber Owner's Address /S 3 r?Ne/ {•lobLOu/ 1-N City/State/Zip HDy4*ZE Property Address.n1 Ft I LN City AtLx/. &E Lot Size Tax PIN# " Subdivision Name(if applicable) Section/Lot# Diiebtions To Site: If the answer to any of the following questions is "Yes",supportm documentation must be attached: Are there any existing wastewater systems on the site? Yes ' No Does the site contain jurisdictional wetlands? V90 Are there any easements or right-of-ways on the site? _Yes _Yes Is the sitesubj Rt to approval by another public agency? Will waste wafe'r other than domestic sewage be generated? _Yes _ Yes o IF RESIDENCE FILL OOT THE BOX BELOW # People # Bedrooms # Bathrooms Garden Tub/Whirlpool OYes ONo Basement: ❑Yes ONo Basement Plumbing: OYes.ONO Ir NUN -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/BWinessOFF1Ce,SPAC4 Total Square Footage ofBuilding o7$t Q #People 3 # Sinks I # Commodes # Showers I # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: L onventional OAccepted':❑Innovative OAltemative ❑Other Water Supply Type: M County/City Water 0 New Well ❑Existing Well 0 Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? 0 -Yes If yes, what type? This is to that any p changes,i Represent laws and: loca�r Property 10 -2 Date Pay to Order ProTek Home Cleaning 66a6/53i 131 Finn Hollow Ln- - - Advance, NC 27006. 20L3 Davie County Environmental Health 1: 0 5 3 10046 5 1: 1000 13 31,69 54 3 Signgiverr-Ti-xes-uiw— -- -- Revised 11/06 N'No /SO.GJ 215 ' - nderstand i use Authorized th applicab e iers and Cities. ] �ilars 12 r 0215 Invoice # 0 Improvement Permit Robert Sutton 122 Pennsylvania Avenue Winston-Salem, NC 27104 'Re: 7.639 Acre Tract / Beauchamp Road Browder/Sutton Division -Lot 2 Tax PIN: 5870442211 Dear Client(s): This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans or the intended use change. System To Serve:440J&5wastewater Design Flow(GPD): Valid: J�Years ❑No Expiration System Type: ❑Conventional ;?9ccepted ❑Innovative ❑Alternative ❑ Site Modifications/Permit Conditions: i.p.letter 7/iJ6 �I.lrr►AL. � uX/A.n a ?-.?5 2, f (Z W0 ►-IWs c_TA,2 Date N�� &d U j DAME COUNTY HEALTH DEPARTMENT Environmental Health Section Pd P. O. Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990004165 Tax PIN/EH #: 5870-44-2211.02. Billed To: Robert Sutton Subdivision Info: Browder/Sutton Div Lot # 2 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: 5.07 ACRES ATC Number: 4547 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type 0c� #People 3 #Bedrooms #Baths Z.: Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: E Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats . Industrial Waste: ❑ Lot Size Type Water Supply t�f Design Wastewater Flow (GPD)_ Site: New i� Repai�r/❑��, . System Specifications: Tank Size/0095AL. Pump Tank � GAL. Trench Width Rock Depth N Q Linear Ft. 7`P-�� Other: AC:t: Li� LF 5/o LSF---7/Onl ls�E 11 S. -4 z5w &101�F Required Site Modifications/Conditions: k%L IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 « BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:3 . ip.m. on the day of installation. Telephone # is (336)751-8760.**** wlz I 7 M4�(TRraktl D IN- ASer tCO2�zLtI' i G inmental Health Specialist's Sign pec Date: DCHD 05/99 (Revised) 1 DAVIE COUNTY HEALTH DEPARTMENT ,. Environmental Health Section " P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990004165 Tax PIN/EH #: 5870-44-2211.02 Billed To: Robert Sutton Subdivision Info: Browder/Sutton Div Lot # 2 Reference Name:. Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: 5.07 ACRES ATC Number: 4547 P -C AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION 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 S e Trea ent and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA S CTIO S ID FOR A PERIOD OF FIVE YEARS. ital Health Specialist's Signature: Date: �hDa-P I.QCItjc,.l: <I -1R - 07 7v CEF/TIFICATE OF COMPLETION ©� 3 2'1 The issuance of this Certificate of Completion shall indicate the system described on Improtrinent/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. R2D M Septic System"Installed By: Health Specialist's Signature: DCHD 05/99 (Revised) Laui- q-/0-G% a`_8"xL Ex i s -n N G SAyzt-i - a x q l 3o scA�F. LecTR1G EX'ISTi�1Cr, 1 PA -NEL 1 aon APP I� Ot:F1c E EX Is, I tjcG VJA-C.L �.' . '71 1.OPT'31 u�W r C OPT Q 1 LquN�ay I SHwR QUO. .1.31 EQutPnFnlr Sf'oYUt� log WA -MF- HyD9A-PJr liy7 I�rNI�I �OLLOW LAS NCNl ftCoW WALL. r.iD rr:InlAr_ 80 As , I1x `� •11 is �K. c'�- 0�. .f�.. 7 sy as ,1 �� � � •� 1 t . '�. }. F:� � an.',i}� i. SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie.County HealtifDepartment Environmental Health Section P.O. Box,848/210 Hospital Streef, . Mocksville, NC 27028' (336)751-8760/ Fax (336)7514786.. . aprovement Nimit 0 k6thorization To Construct(ATC) Both ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETfor instructions. J f APPLICANT INFORMATION V IPWdS/TC, 1 11M _5ik er p0 , /Yeo E6YlfplaxYOl1/�fePLtPU� Name to be Billed _FoI3Eccr_ > • _SLJT�/J Contact Person T;buEi r T) 50-7 D71 Billing Address (2P Fr&SVrLVRe r -o AU. Home Phone 336- 76 o• o $S7 City/State/ZIP In)-idftorl SAL6N I NL ;17104 Business Phone 9Y/ 9�0 -SSS Dyes BNo Will wastewater other than domestic sewage be generated? Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION NOTE: A survey'plat or site plan must accompany this application. (Permit is lid for 60 mont .ri s' e plan,po eXp a 'on wit omplete plat.) `/ Street Address . C�06d x{6^t, ity f/dWca Tax PIN#6S/ 704V— 2Z! Subdivision Name Y e /. �ctiW/Lot#___o2 .Lot Size ./RESIDENCE FILL OUT THE BOX BELOW # People 3 # Bedrooms # Bathrooms ,S Garden Tub/Whirlpool Rqes ONo Baserrtent: )(Yes ONo Basement Plumbing: OYes ONo I II�C�]�9:7ol.YI�7�1�(�151�1i11[�Ii111II1I:1� Z�):� 7�III�YdI 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 ,�Typesystem. requested: 3 onventional ❑Accepted ❑Innovative ❑Alternative ❑Other ,,,Nater Supply Type: 0 County/City Water 0 New Well ❑Existing Well . /0 Community Well /Do you anticipate additions or expansions o the facility th system isaintended to serve? H Yes 0 No If yes, what type? % ZI;3�/1, to itt(T jAIiJ�IPGC. dia This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that ariy 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 understand that I am responsible for all charges incurred from this application. 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 on the above described property located in Davie County and owned by Site Revisit Charge Proper owner's legal representative signature Date(s): IJ -3-o6 Client Notification Date: ate EHS: Sign given Dyes ONo Account#Artra Revised 2/06. Invoice # �� Date House/Facility Comers Flagged /6 -/R DO 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? Dyes Ciro Does the site contain jurisdictional wetlands? Dyes 0300 Are there any easements or riglit-of-ways on the site? Oyes UNo Is the site subject to approval by another public agency? Dyes BNo Will wastewater other than domestic sewage be generated? ❑Yes C-YNo ./RESIDENCE FILL OUT THE BOX BELOW # People 3 # Bedrooms # Bathrooms ,S Garden Tub/Whirlpool Rqes ONo Baserrtent: )(Yes ONo Basement Plumbing: OYes ONo I II�C�]�9:7ol.YI�7�1�(�151�1i11[�Ii111II1I:1� Z�):� 7�III�YdI 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 ,�Typesystem. requested: 3 onventional ❑Accepted ❑Innovative ❑Alternative ❑Other ,,,Nater Supply Type: 0 County/City Water 0 New Well ❑Existing Well . /0 Community Well /Do you anticipate additions or expansions o the facility th system isaintended to serve? H Yes 0 No If yes, what type? % ZI;3�/1, to itt(T jAIiJ�IPGC. dia This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that ariy 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 understand that I am responsible for all charges incurred from this application. 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 on the above described property located in Davie County and owned by Site Revisit Charge Proper owner's legal representative signature Date(s): IJ -3-o6 Client Notification Date: ate EHS: Sign given Dyes ONo Account#Artra Revised 2/06. Invoice # �� 869* t/6£9'L L g \ dzcz ` jJ GaD GnB2 N113 3� CD 12.16A) co 436 $ 56 SM Sheet 2 of 2- Tax.4QP 0-6 +i - ` See Sheet 2 of 2 F, . ?az Loi 5.43 - Tar Mop 0:5 MCI -a - - - .ilt (:1. z • n/f Angelo B. S obaoh .. - cM�2t comer 3.. {� •b� and hucbond - . � Gcry F. Sia6och DE 166 0 PG 732 Pat di Tax Lot 11.07, Tax li6p 4-8 ` p 9:557 AOre9'V/- h� Shd J ' Pott of v Tac L,ot 6,07, Tdfc Map G-8 mmCn, 4 ,i . Pond If, Center.Uriaof--� li �\ seRf 50' Mceee Fosemeni is \ (25' each 'aide if aentbr I 33 _ --to Ketal — \ 49T Fort of lot 2 : 1$365 1" Eh'rM fmropa� h u� 371.. LW rmIRS \1 F'Ort of 1 ; Tax Lot Pop.G- 4 Pop Tax Lot 5.07, Tpx Mop G -H - n/f Plwl Emory ry Co,-natzar t lumye3.4Q4 ,if oe ,wit _ c ❑B Ind _-- -`— - and'Afe 1 l In Ipeire if wca `ti,lhin Kgthyy_Ftya' Comotter tD. SR 616 & 5R 3621 ft/1Y,_ - .> DB 96 a pt� 761 - c,:a nitfryn Soadlem Ii-a11Way R/1N, dt per. aroa SOL.lh M SR 1616 & Sputhc•n Rallaay' /y Tax Lot z 1\s ` P' Y x1v �n� — 1.withiri.20o0' of *It*. .. Tax Map -G--43 ■■■■■OE■■■■■■M■■ ■M■■M■■■■■■■E■MO ■■MM■M■■M■■■■MM■ ■OO■M■O■■■■■■■O■ E■■E■OMO■■■■■E■E ■■■■■■MOM■■■■■■■ ■■■■■■■M■■M■■■■■ ■■■■■OE■■■■M■O■■ ■■O■O■M■■■■■M■■■ III ME ■i ■ p iii ME ■■■MEMO■ ■■O■OM■■ ■■■■■E■■ M■■O■■■■ ■■ ■ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation ' APPLICANT INFORMATION �� �- PROPERTY INFORMATION Account #: -9989697-23 gg000 41W Tax PIN/EH #: 5870-44-2211.02 Billed To: is utton Subdivision Info: Browder/Sutton Div Lot # 2 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: 5.07 ACRES Date Evaluated: Water Supply # On -Site Well / Community Public �- EvaluationBy: Auger Boring ✓ Pit Cut FACTORS ,:' 1 2 3 M_4 .5 6 7; Landscape position :r slope 90 e.to .. .. ;.,HORIZON I DEPTH ^7©, Texture rou Consistence' Structure .,:..Mineralogy.:S S ,,HORIZON II DEPTH V I ? -`3 (0 12 - -,Jexture groupr ,•. C�. + a . Consistence O - Structure 5 Mineralo :'.i i HORIZON III DEPTH - -OX rou 5 ai Consistence Structure Mineralogy HORIZON IV DEPTH Texturegroup Consistence Structure Mineralogy `SOIL WETNESS ,'. RESTRICTIVE HORIZON SAPROLITE — — CLASSIFICATION S — LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: D ` OTHER(S) PRESENT: REMARKS: 44r POcect. DF BXP n 2o'14, 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 ' Textuis, S - Sand LS Loamy sand SL,- Sandy loanoi : .L - LoamL 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 . ONSISTFN .. ' Mas VFR Very friable . ' i FR Friable FI'- Firm, VFI - Very fnm EFI - Extremely firm . NS Non sticky SS - Slightly sticky: S - Sticky VS - Very Sticky' i 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 ..:..., Minerelo� 1:1, 2:1, Mixed -... ; blQu 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 05105 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001995 Tax PIN/EH #: 5870-44-2211 Billed To: Robert Stone Subdivision Info: Browder/Sutton Div Lot # 02 Reference Name: Location/Address: Cornatzer Rd 270 Proposed Facility: Residence Property Size: see plat 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 %A0p HORIZON I DEPTH i Texture group; Consistence Structure, , Mineralogy_. HORIZON H DEPTH >L / Texture group Consistence Structure Mineralogy HORIZON IH 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 4,1 EVALUATION BY: I_. LONG-TERM ACCEPTANCE RATE:,OTHER(S) PRESENT REMARKS: LEGEND: T.andscaoe 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 1 H - Head slope Texture S - Sand ' LS - Loamy sand ., .SL - Sandy loam L - Loam SI - Silt; i SICL - Silty clay loam' SIL - Silty loam CL - Clay loam, SCL - Sandy clay loam SC - Sandy clay.,. ,SIC - Silty clay' "C -Clay_ CONSISTENCF , f VFR - V friable` ' , FR - Friable FI'. Finn VFI -.Very fum Very EFI '.Extremely fum 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, . , Mineralaev 1:1, 2:1: Mixed I_ Horizon depth - In inches Depth Restnctivelhorizoninches Thickness and inches from land surf ' ace 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 05105 (Revised) . x APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERtDftEeo �`- Davie County Health DepartmentD Environmental Health section2005 P.O. Box 848/210 Hospital Street Mocksville; NC' 27028 (336] 751-8760 EALTH ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. Name to be Billed RICNAKS)Su'CTorJ Contact Person Rd23>r R.'l" Ljow Mailing Address 37 11- If 9 -fl, S"i W, Home phone ,t City/State/ZIP ,�PRD�NT'O)J - 1=C 3't{oZtO Business Phone 33&-995 `4`► 33 Q� t- %- 2. Name on Permit/ATC if Different than Above Mailing Address - city/State/Zip 3. Application For: Site Evaluation [3rm Improvement Peit/ATd. - - ❑ Both _ 4. System to Service: -House ❑ Mobile Home _ ❑ Business ❑ Industry. iJ Other S. Type system requested: Conventional ❑ conventional modified ❑ innovative 6. If Residence: N People,�.,,// # Bedrooms -S-4 Bathrooms _ ISIDishwasher ❑Garbage. Disposal l lWashing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People. # Sinks 4 Commodes' # Showers - - # Urinals # Water Coolers IF FOODSERVICE: $ Seats - .'Estimated Water Usage (gallons per day) S. Type of water supply: WCourity/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Imo If ycs, what type? '**IDIPURTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either PLAT or SITE PLAN MUST BESUBgI1rTED by the dicnt with THIS APPLICATION. P' crI r Dimensions: •mac= �' �'"'WRITE DIRECTIONS (from Mocksv(llc) to•PROPEICI'Y: Tax Office PIN: f! '1 O 144 z Z.1 1 . V S (o q 7b Fo rt -ie • � �X C3�1 /Zig Property Address: RoadN2me2&49 C'oizi4A-ItEi2-,& -oA 0( aU 2t,%' -7 City/zip,401/ANu: I td C. (fo" AGo12AJA7'z1=rz, tZJ z-lo0b If in a Subdivision provide information, as follolvs: 6eAV e d'i m po /n4 ✓.%. Name: 13 4a W49'(1 /S V TTOtJ )Ol tr'tS) 0 4,J .-,45-17Z I S AT NLA) T Section: Block: '^^ Lot: Date home corners Ragged: I 0S This is to certify that the information provided is correct to the best of my knowledge. I understand that any perni)t(s) Issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information ; submitted in this application is falsified or changed. Jr, also, understand that I am responsihlefor all chaires i icurred froln this aliplication. I, hereby, give consent to the Authorized Representative of the Davie County Ilealth Department to enter upon above described properly located in Davie Comity and owned by to conduct all testing procedures as necessary to determine the site suitability. 2 ,DATE _� Z �� SIGNATUR); TIIIS 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). Sign given Revised DCIID (05%03 i Site Revisit Charge Datc(s): Client Notification Date: . ERS: Y7 AccountNo. Invoice No. Q?? . -'j ?Gel 0 -OIL I -k • 1�0 vo\ S 4110-.00, J ,I' °5y t k sig 4'f, ^A •¢ 1 5 x_I „ sdpy ,, `3 'w <^ Un, a ,� •.. w ° ,y', i� kr� }t r %anis+"'° M 3 q v . a^ V� l r ,OWN - ' yif a a�k d pTnv 'fj �`�� gy r If h 1 I :7 rk "'c'.j{ x.r a; n�"n�rr �` k J, r^ *' ' r /t . t`: 110 a G. TA PAS W i %Rq man ip i ( i *11 wstb�s ' 4-� ' �r~aa s, tp2a f zI��k + 41A NN, .� �tiw.�a', a vi NJ 40 s v a \^I \ u .A aredi Vw, ft N�la� MYNA �. �. ✓ / u k 6 ; �,^w R �i' rbp��,.,� ;/ E'fr� �� #j '.� �, s.l .-B"` .. �''^`, / x ✓ ,dp� a G�; °aJ",4�d� k h+ +," i i$, �a. y "imp A No r S, a 5• "A"V f a d v �. EA Ax s <`�i J' �'LOLA '- " M. • r `N m - a { A I r �� � ���,wA � ,•�� �� � IIs � �,.; � �� ���'„ai r i _ 3 F p A 1 f i 1 �l J eI 14 ie lk s 1 ; Y a y� i .i' ����� .,� dh+ 'k'r` \5� mN�• �� e\ \�Xrr#iT � .s T '�ptW �.i� .@ �E f � �b�� ���/ t 4;w ^.`4 ..q �"^�.W ,\. \ �� Jij� + �' �y A •.o� 1 $ . '4 .y', «a:4`.^ •? �:.. .r” «i',;;s ,,',".^