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169 Browder Lane Lot 11Davie County. NC ,� — • Tac Parcel Report Wednesday. October 19. 2016 - I 26822,110 412 0 5 170 109 j 335 i24:�f 190. I �p 153 t / 163 303 % ff ' 1249 ( 206 183 S ---1263 _---= ( 199 - -- f! 319'I 197 200 9, ', f210 109 t_1292X108 16 _11y 1318��� 1332 ' 134 0 wq till, .� �i ��UN� Eel 7T,A 1". E NG: TETHS 1S NOT A SURVEY n r Y:a r'f��l ITI 11 \Tt Tl til �f\TI Parcel Number: G707OA0011 Township: Shady Grove NCPIN Number: 5860632218 Municipality: Account Plumber: 82526699 Census Tract: 37059-803 Listed Owner 1: WITTLINGER DAVID Voting Precinct: WEST SHADY GROVE P:'lailing Address 1: 169 BROWDER LANE Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27006-0000 Voluntary Ag. District: No Legal Description: LOT 11 BALTIMORE TRAILS Fire Response District: CORNATZER - DULIN Assessed Acreage: 12.12 Elementary School Zone: SHADY GROVE Deed Date: 112016 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 010091153 Soil Types: GnB2,GnC2,EnB,RnD,MsC,ChA Plat Book: 0008 Flood Zone: Plat Page: 277 %.'atershed Overlay: DAVIE COUNTY Building Value: 402820.00 Outbuilding & =xtra Freatures Value: 17540.00 Land Value: 81680.00 Total Market Value: 502040.00 Total Assessed Value: 502040.00 wq till, .� �i ��UN� Eel T� Davie County, NC Ali 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 merchantahility or fitness for a particular use. All users of Davie County's GIS we.,site stall hold harmless the of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to c: arising out c'. the use or inahii y to use the GIS data provided by this website. o. Account #: 990003970 Billed To: David Wittlinger Reference Name: ATC Number: 4411 DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5860-33-5745.11 B Subdivision Info: Baltimore Trails Lot # 11 Location/Address: Baltimore Road -27028 I&Meo&d&7Z, tAg4J AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONST IS V LID OR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: **NOTE** The issuance of this Certificate of has been installed in compliance v Disposal Systems," but shall in M given period of time. M Q \"' 'indicat t e s em ibed on Improvement/Operation Permit G.S. ter OA ion .1900 "Sewage Treatment and as a tha a system will function satisfactorily for any 60 -jq) Sep Environmental Health DCHD 05/99 (Revised) 's Signature : IDA,j 1 ' Account #: 990003970 Billed To: David Wittlinger Reference Name: ATC Number: 4411 DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5860-33-5745.11 B Subdivision Info: Baltimore Trails Lot # 11 Location/Address: Baltimore Road -27028 I&Meo&d&7Z, tAg4J AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONST IS V LID OR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: **NOTE** The issuance of this Certificate of has been installed in compliance v Disposal Systems," but shall in M given period of time. M Q \"' 'indicat t e s em ibed on Improvement/Operation Permit G.S. ter OA ion .1900 "Sewage Treatment and as a tha a system will function satisfactorily for any 60 -jq) Sep Environmental Health DCHD 05/99 (Revised) 's Signature : IDA,j DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ,,,,// P. O. Boz 848/210 Hospital Street 606 Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003970 Tax PIN/EH #: 5860-33-5745.11 B Billed To: David Wittlinger Subdivision Info: Baltimore Trails Lot # 11 Reference Name: Location/Address: Baltimore Road -27028 Proposed Facility: Residence Property Size: 12.26 acres ATC Number: 4411 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 Typ#People C #Bedrooms #Baths S - Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: 12"'--Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply WEW_ Design Wastewater Flow (GPD) LCO Site: New 21"� Repair ❑ >k to -7 { System Specifications: Tank Size 175D GAL. Pump Tank GAL. Trench Widths' a Rock Depth 4—A% Linear Ft. r �� Other: ff }To) �� T[c�J cS Y lt7✓\- , aLTU2 � u✓!a FLn tN ✓,�L V - Required Site Modifications/Conditions: je.3S17j.1..L Co� J're� GZ KL—E CO��►�pM WELL M IMPROVE NT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISERS) 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 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** 55 1 ID YAZiJ1T t 010r, 90� -� � /R `� �1STI E � DOI AA-k� �' 30. Environmental Health Specialist's Signature: Date: 125' c �ta►f 125 DCHD 05/99 (Revised) a Ju1;17 2006 3:46PM _ FRED BEANS PARTS 18888223267 P.1 t P, n _ - PRELIMINARY r - n _ a 4� 0 LOT 5 AREA = 18.604-1- ACRES 0%. 36 W %0 LOT 6 a cr. 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Box 848/210 Hospital Street Mocksville, NC 7028 �1V1RGtatnENjP����� (336)751-8760/ Fax 6)751-8786 pAV1ECGUt1iY pplicat' Site Evaluation/Improvement Permit Authorization To Construct(ATC) U1Both ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed Co Contact Person`Fv, bmo o -p Billing Address u uv Home Phone 9y� — 3 $'$O City/State/ZIP UA✓C� , AVC --J 2-oo G Business Phone 7Q3 -- !U1q Name on Permit/ATC if Different than Above Mailing Address PROPERTY INFORMATION City/State/Zip NOTE: A survey plat or site plan must accompany this application. (Permit is valid for 60 months with site plan, no expiration with complete plat.) Street Address City Subdivision Name AL- L1Mf6- 2,4tLS Section/Lot# Directions To Site: /. �4S r°- !(�, m1,7� �i /'� ,u L- Tax PIN# Date House/Facility Corners Flagged q _ p 6 L-0 7- -Itf- ! l 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 leo Does the site contain jurisdictional wetlands? Dyes CJNo Are there any easements or right-of-ways on the site? Dyes Gi <o Is the site subject to approval by another public agency? ❑Yes 0,Ko Will wastewater other than domestic sewage be generated? ❑Yes U?Zo IF RESIDENCE FILL OUT THE BOX BELOW # People q # Bedrooms _q # Bathrooms 3 Garden Tub/Whirlpool [;Kes ❑No Basement: [mss ❑No Basement Plumbing: ❑Yes WXo 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: Reonventional ❑Accepted ❑ Innovative ❑ Alternative ❑ Other Water Supply Type: ❑. County/City Water Pfew Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes If yes, what type? • This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I understand that 1 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 law�gnd rules on the above described property located in Davie County and owned by SCQ- t Property owner's or o�� er's legal representative signature �A -I ;Z0 oG Date Site Revisit Charge Date(s): Client Notification Date: EHS: Sign given Dyes ❑No Account # V-/5/ Revised 2/06 Invoice # DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section **N0 ffQ-1i4M f(prJ9Wnt/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 BEFOREN�STALLING SYSTEM. Residential Specification: Building Type 1 EENC #People � #Bedrooms cJ.� #Baths �~ Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 12 •ZL AaOF > Type Water Supply Vj 1�--L- Design Wastewater Flow (GPD) �000 Site: Newell" Repair ❑ System Specifications: Tank Size 12SOGAL. Pump Tank GAL. Trench Width ,Rock Depth N a Linear Ft. Other: �i-\ T I tU �� � Q�YLat— M , AL71) 1 rk9 )O 1%G Required Site Modifications/Conditions: 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 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** } QO Cot $,1©� T. E0 W pomp Fei�- �C Yp,urE IT7C: *BOLDZS R-�M�a�r ern 1 Environmental Health Specialist's Signature: WIM'1" Date: AS 41ImH AS PpzS18L-t. DCHD 05/99 (Revised) P. O. Boz 848/210 Hospital Street Mocksville, NC 27028ej (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003970 Tax PIN/EH #: 5860-33-5745.11 B Billed To: David Wittlinger Subdivision Info: Baltimore Trails Lot # 11 Reference Name: Location/Address: Baltimore Road -27028 Proposed Facility: Residence Property Size: 12.26 acres **N0 ffQ-1i4M f(prJ9Wnt/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 BEFOREN�STALLING SYSTEM. Residential Specification: Building Type 1 EENC #People � #Bedrooms cJ.� #Baths �~ Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 12 •ZL AaOF > Type Water Supply Vj 1�--L- Design Wastewater Flow (GPD) �000 Site: Newell" Repair ❑ System Specifications: Tank Size 12SOGAL. Pump Tank GAL. Trench Width ,Rock Depth N a Linear Ft. Other: �i-\ T I tU �� � Q�YLat— M , AL71) 1 rk9 )O 1%G Required Site Modifications/Conditions: 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 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** } QO Cot $,1©� T. E0 W pomp Fei�- �C Yp,urE IT7C: *BOLDZS R-�M�a�r ern 1 Environmental Health Specialist's Signature: WIM'1" Date: AS 41ImH AS PpzS18L-t. DCHD 05/99 (Revised) FROM :YEjNY WITTLINGER • ;,,MAY.. 20062 3': SbPM CBT TQ FAX NO. :16097309346 May. 04 2006 11:44RM P1 D 998 4492nvh--Ith ass 751 a;N0.1767 P. 1./ip.2 EVALUATION/1NPROVFINPNf PERMIT & ATC County Health Department nv onmental Eealt4 Sectfon P.O. ox 8481210 Hosplial Street ocksville, NC 2.1028 (33-8760/Fax (3361751-8786 1� oveweat Poanit ;luthoritation To Conshnct(ATC) 0 Botts ilA ac. TMS APPLICATION CANNOT BE'PAOCBSSID UNLESS ALL OF THE REQUIRED IS PROVMED. Refrx to the Tt-tFORMAXION IIULLI.-M for imtiucaoas. Name to be Billed zavi d C;Dart Person IDt u i !� Billing Address 1 5letre `�a `-'-"Or 1I=Photic =a City/State/ixP Ti uS yr %% iV 3- O 5'6 0 Business phone 2.15 -763 - 0 l� Name on Permit/ATC if Dgerert than Above Mailing Address City/S=teiTp - rKvrmj T 1VCVKrAA11VJV NOTE: A survey plat or site plan rtr<st accompany Ws appllcatiom (Permit is Vali foz 60 mombi With site plan, no expuav'on with w kte plat.) Street Address La zZ i chi-AlAvore- T/W1 City ;).c V040e TazPIN# Subdivision Name__. a /_f /_mere 7?z?,1S Sgction/Lot#_ f/Lot Size 7Z, / 47C' Date House/Facility Comers Flaa:d 7 ej- If the answer to any of the following questions is "yes". supporting documentation rto t be attaehrd. Are tbcro any existing wastewater systems on the site? 13YO UNo Does do site eentain jurisdieionat wodands? OYasxgo Are there any easearoau or rijbi-oFways on the sitz? Em sf4o Is the site sibjcet to tpprovul ry a wdier public agenry? OY4t Allo Will wastewater other than do-mestic sewage be generated? OYi s $Fro IF _ #Bedrvmts - -1;l _.. #Bathrooms i Garden Tubt(Whitipool OYes ISNo ')No Basetoen Mmbing. VYos_ LINO_ IF NON -RESIDENCE FILL OUT THE BOX BELOW ripe of Faeihty/Busintuts _ Total Square Footr.ge of Building_ # People # Sinks # Comarodes # Showers # Urinals - Estimated Water Usage (gall ms per day) (Attach dos mentation of similar facility water cowunV tion) FOODSERVICE ONLY. # Seats Type tystcmrequested: )qbnveatiorui. OAccepted Ohmovative AAltertative OOthe, Water Supply Type: 0 County/City Water RVew Well OExistiaa Well O Community Well Do you anticipate additiow or expausimu of the facility this system Is intend :d to serve? 0 Yes 'Flo If yes, what type? — -- Trus is to certifythat the information lut:vided on this application is hue and :ouect to Ila best ofmy knowledge. I understand dart any permits) or ATC'{s) issued herealle: are subject to suspension or revoavon if die situ is altered, the intended use changes, or if the information submitted in this appbcr tion is fakiSrd or changed. l wrtderr'and that lam rawmaible for au charges taeurred from this appitcarton t baeby grant tight of entry to the Autharizcd Reptosentative of the Davie County Health Deportment to conduct accessary ht pections to determine compliance with applicable laws :md rules on the above described property located in Davie unty and owned by _ URV Site Revisit Charge ropm owner's UMW apret:entative Signature Datc(s):�i / z tilt?% Client NoriLcation Date: Dat / EHS: Signgiven QYas ONO Accoutit# Revised 2/06 Invoice 9 --0 sari-+ � el APPLICANT INFORMATION Account #: 990003970 Billed To: David Wittlinger Reference Name: Proposed Facility: Residence Water Supply: On -Site Well Evaluation By: Auger Boring DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation Property Size PROPERTY INFORMATION Tax PIN/EH #: 5860-33-5745.11 B Subdivision Info: Baltimore Trails Lot # 11 Location/Address: Baltimore Road -27028 12.26 acres Date Evaluated: Community Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND EVALUATION BY: OTHER(S) PRESENT: 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 uI VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm 3ye>t NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogy 1:1, 2:1, Mixed 1YQteS 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) APPLICATION FOR SITE EVALUATION/IMPROVEMENT Davie County Health Department Environmental Health Section JUS P.O. Box 848/210 Hospital Street 5 � Mocksville, NC 27028i�oti (336)751-8760/ Fax (336)751-8786 t7q�Mjgl.H�-I._ Application For: ❑ Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed Am 411; W4 0'L Contact Person l Billing Address q sloge p4o Home Phone City/State/ZIP QY5 Q Business PhoneZ,/5" 1 X3- 0/16 Name on Permit/ATC if Different than Above 90 Mailing Address City/State/Zip PROPERTY INFORMATION NOTE: A survey plat or site plan must accompany this application. (Permit is lid for 60 montl with ite plan, no expiration wit c mplete plat.) Street Address �{%/YI0 City 1` Tax PIN# 59&0--33 5 %it's•1J Subdivision Name ection/Lot# Lot ,�Size L AEYG 0 SO Directions To Site: Ad/ i.•v►n/P dCI o 9Atgmol't' owAls . G1QGf_a D 11A!ea Date House/Facility Corners Flagged ..7--45-0 & If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes Flo rv' Does the site contain jurisdictional wetlands? ❑Yes Crlo Are there any easements or right-of-ways on the site? ❑Yes RNo Is the site subject to approval by another public agency? ❑Yes B<o Will wastewater other than domestic sewage be generated? ❑Yes C<o TF RF-gMF.NCF, FILL OUT THE BOX BELOW # People # Bedrooms # BathroomZ s 5— Garden Tub/Whirlpool ❑Yes 011 o Basement: des ❑No Basement Plumbing: l-4'es []No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: ❑�entional ❑Accepted ❑Innovative ❑Alternative ❑Other. Water Supply Type: ❑ County/City Water [*- ew Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes�o If yes, what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I understand that 1 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 tdetermine ��}�pli nce with applicable laws and rules on the above described property located in Davie County and owned by �liVr Wf ��ll(/Q��7C. Atjiiz- W1,q1,;A)I &-P--1 IV Property owner's or owner's legal representative signatures Date Site Revisit Charge Date(s): Client Notification Date: EHS: S' n iven ❑Yes Cho Account # `-' IV g 7%11 Revised 2/06 O(Q�� QSF- Invoice # S IJZp 14A) it Gni 4VA0,00 �'si e �'/a yra PA APPLICANT INFORMATION DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation Account #: 990003970 IBilled To: David Wittlinger Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: PROPERTY INFORMATION Tax PIN/EH #: 5860-33-514b.11 (new si e Subdivision Info: Baltimore Trails Lot # 11 Location/Address: Baltimore Road -27006 Property Size: 12.26 acres Date Evaluated: Y On -Site Well Community Auger Boring Pit Public Cut • MLandsca2e position HORIZON I DEPTH Y" APPLICANT INFORMATION DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation Account #: 990003970 IBilled To: David Wittlinger Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: PROPERTY INFORMATION Tax PIN/EH #: 5860-33-514b.11 (new si e Subdivision Info: Baltimore Trails Lot # 11 Location/Address: Baltimore Road -27006 Property Size: 12.26 acres Date Evaluated: Y On -Site Well Community Auger Boring Pit Public Cut • MLandsca2e position HORIZON I DEPTH Consistence Mineralogy Consistence Mineralogy Texture group Consistence Mineralogy HORIZON IV DEPTH Texture group ConsistenceMineralogy •1919N ai7������ •0--�---- • Uhl ►����-�� SITE CLASSIFICATION: EVALUATION BY: JL;5W— t,)C*0.L,-7 LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: LEGEND Landscape Position R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope CC - Concave slope CV - Convex slope T - Terrace FP - Flood plain H - Head slope Texture S - Sand LS - Loamy sand SL - Sandy loam L - Loam 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 of VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm wet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure 'SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land 'surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 `)CHD 05/99 (Re-` 'n APPLICATION FOR SITE EVALUATION/IMPROVEAIENT PERMIT A 'E • Davie County Health Department Q �/ Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 OCT 1 g 2005 t (336) 751-8760 ***IFIPORTANT*** TIiIS APPLICATION CANNOT BE PROCESSED UNLESS A i��7 EA Illi INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructi 1. Name to be Billed 7, f� 4- - Contact Person r""t'' I A Nailing Address �s. t"4p, %"i� Y'f�r'k Boma Phone ��O City/State/ZIP U �DGI�i Business iness Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: U/Si�tc Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: FIouae ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. Typo system requested: ❑ Conventional ❑ conventional modified ❑ innovative I=laccepted G.. 6. If nesidence: II People 8 Bedrooms � It Bathrooms L2 Dishwashar []Garbage Disposal Washing Machine ❑Basement/Plumbing ❑Basement/1to Plumbing 7. If Dusiness/Industry /other: verify type # People It Sinks II Commodes It Showers tt Urinals It Water Coolers IF FOODSERVICE: it Seats Estimated Water Usage (gallons par day) G. Typo of water supply: ❑ County/City Cf P7ell ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intcndcd to serve? ❑ Yes ❑ No rI If ycs, what type? ***Il4IPOR74ANY*** CLIENTSBiUSTCOMPLETI. THE REQUIRED PROPERTY INFORMATION REQUESTED IIELOIY. Either n PLAT or SITE PLAN .4tU.4T IIESU11,H=7-.D by the client with THIS APPLICATION. Property Dimensions: —<:fO--O• 1-M I'd -Y-" / -2 - 0-" `` VRITE DIRECTIONS (1'rwu hiod(sville') to 1'ROI'GRTY:' Tax Office PIN: it 3 g 6 o - 3 3 -5�7 Ys. 1l •-0 I'roper(yAddress: RoadNamc&/i-?nG/'e?- City/Zip If in a Subdivisiou provide hiformation, as follows: Section: _ Block: Lot: ! / Date ]tonic corners flagged: This is to certily that the informatiou provided is correct to the best of my knowledge. I understand that any permil(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if tl►c it►forma(ion submitted in (his ipplicatiou is falsified or changed. I, also, mtderstand thatl am responsiblejor all charges incurred from this application. I, hereby, give consent to the Authorized Rept•esentative of the DiN,ie County I-Iealtlt D�e1,)artni/eat to enter upon above described property located it► Davie County and oivneclby / y'I �% d-6111; Y�e� LC-;, "' to conductall lcsling proccdut cs as accessary to dela mine the site suits /ility. DATE / q SIdNATURh TIIIS AREA MAY BE USED FOR DRAINING YOUR SITE PLAN (Iiicludc all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). 2/!1 /L sign given Revised DCIID (05/03 CJ Site Revisit Charge Datc(s): Client Notificatiou Date: EhIS: '.Account No. 775 - Invoice No. I/ / --�-