166 Eric Road Lot 11 & 12Davie County, NC -i r Tax Parcel Report Thursday, December 15, 2016
[all
All data is provided ss is withoutwerranty or guaranteeof any kind etiherexpressed or Implied including but not limited to the
Davie County, implied wmrardies of merchamability ortkness for a partiwlar use. All users of Davie County's GIs website shall hold harmless the
l�County of Davie,NorthCarolfm Ns agents, consuhants, contractors or employees from any and all daims or causes of actiondue to
NC or arising out ofthe use or inability to use the GIs data provided by this websha
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number:
J609OA0012
Township:
Mocksville
NCPIN Number.
5757281822
Municipality:
Account Number.
82522741
Census Tract:
37059-807
Listed Owner 1:
MOORE JASON M
Voting Precinct:
SOUTH MOCKSVILLE
Mailing Address 1:
PO BOX 1093
Planning Jurisdiction:
Davie County
City: COOLEEMEEE
Zoning Class:
DAME COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27014-1093
Voluntary Ag. District:
No
Legal Description:
LOT 11 DALTON ACRES
Fire Response District:
FORK
Assessed Acreage:
0.70 Elementary School Zone:
CORNATZER
Deed Date:
5/2004
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
005510262
Soil Types:
ChA,MsD
Plat Book:
0004
Flood Zone:
Plat Page:
099
Watershed Overlay:
DAME COUNTY
Building Value:
Outbuilding 8 Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
[all
All data is provided ss is withoutwerranty or guaranteeof any kind etiherexpressed or Implied including but not limited to the
Davie County, implied wmrardies of merchamability ortkness for a partiwlar use. All users of Davie County's GIs website shall hold harmless the
l�County of Davie,NorthCarolfm Ns agents, consuhants, contractors or employees from any and all daims or causes of actiondue to
NC or arising out ofthe use or inability to use the GIs data provided by this websha
Account #: 989900074
Billed To: Dennis Howell
Reference Name:
Proposed Facility: Residence
ATC Number. 2954
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 1
Tax PIN/EH #:
Subdivision Info:
Location/Address:
Property Size:
166 E12(elm
5757-28-1677.12
Dalton Acres Lot #>
Eric Road -27028
see map
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** Ibis 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 I 1 of
G.S. Chapter 130A, Wastewater Systems, S ion .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWATE STRUCTION IS VAL FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date:
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on ImprovementtOperation 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.
v
Septic System Installed By. A'
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
Davie Countv. NC Tax Parcel Renort Thursday Decernher 15- 7016
i -
161
U �
tr
166 j
[all
All data Is provided as Is withoutwarrantyor guarantee of any Idnd either expressed or Implied including but net limited to the
Davie County, Implledwaman es, of merchantability or fitness for a particular use All users of Davie Countys GIS website shag hold harmlessthe
!+County of Wvla, North Carolina, its agents,consultants, corMchns or employees from any and all claims or causes of action due to
NC or arising out a the use or inability to use the GYS data provided by this website
WARNING: THIS IS NOT A SURVEY
Parcel Information
Parcel Number:.
J609OA0011
Township:
Mocksville
NCPIN Number:
5757281677
Municipality:
Account Number.
82522741
Census Tract
37059-807
Listed Owner 1:
MOORE JASON M
Voting Precinct:
SOUTH MOCKSVILLE
Mailing Address 1:
PO BOX 1093
Planning Jurisdiction:
Davie County
City: COOLEEMEEE
Zoning Class:
DAVIE COUNTY R -A
State:
NC
Zoning Overlay:
Zip Code:
27014-1093
Voluntary Ag. District:
No
Legal Description:
LOT 12 DALTON ACRES
Fire Response District
FORK
Assessed Acreage:
1.00 Elementary School Zone:
CORNATZER
Deed Date:
5/2004
Middle School Zone:
WILLIAM ELLIS
Deed Book / Page:
005510262
Soil Types:
ChA MsD
Plat Book:
0004
Flood Zone:
Plat Page:
099
Watershed Overlay:
DAME COUNTY
Building Value:
Outbuilding 8r Extra
Freatures Value:
Land Value:
Total Market Value:
Total Assessed Value:
[all
All data Is provided as Is withoutwarrantyor guarantee of any Idnd either expressed or Implied including but net limited to the
Davie County, Implledwaman es, of merchantability or fitness for a particular use All users of Davie Countys GIS website shag hold harmlessthe
!+County of Wvla, North Carolina, its agents,consultants, corMchns or employees from any and all claims or causes of action due to
NC or arising out a the use or inability to use the GYS data provided by this website
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section °u
P. O. Boa 848/210 Hospital Street
�- Mocksvitle, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 989900074 Tax PIN/EH #: 5757-28-1677.12
Billed To: Dennis Howell Subdivision Info: Dalton Acres Lot # 12
Reference Name: Location/Address: Eric Road -27028
Proposed Facility: Residence Property Size: see map --
**NOTE* Tfdshnprovement/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 /Z W #People #Bedrooms <-'f #Baths
Dishwasher Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ I
Commercial Specification: Facility Type /� #People 0
#People/Shift #Seats Industrial Waste:
Lot Size A/ee Type Water Supply C D Design Wastewater Flow (GPD) J;W Site: New O'Repair El
i
System Specifications: Tank Size /T GAL. Pump Tank GAL. Trench Width &�C`Rock Depth e� Linear Ft.,
Other:
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 am. 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.****
vll) �t
Environmental Health Specialist's Signature:� Date: �h
DCHD 05/99 (Revised) C �y � �' 1 � a
'-7 a 57 11 S iib / t
FRI
�r
rn E -C E
MAR 2 5 2004
ON F011 SlI'L• MILUAT10N/IMPHOMIMT PL'11MIT & A'('C
Davie County Health Department
Enyironnlenta/Hes/th Section
P:O. Box 840/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
x•*lt•1eUJ4TANT*** TRIS APPLICATION CANNOT 13E pROCESSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1.
Name to be Billed _ nn 15 l a/p //
Contact Person -
MailingAddressf 4"Y' 9
- - _ Home Phone
-
City/State/ZIP MIRLkr ULL O 270n7
.Business Phone
- 2.
Nano on if DiffcrEnt than Above
-
Nailing Address -
city/stat o/Zip
1.
Application For: Site Evaluation `.-
EJ Improvement- Permit/ATC' ❑ 130til
ro
4.
System to service: ❑ House ❑ Mobile Home.
❑ Business ❑ Industry ❑ Other
y
S.
,Type system requested.73,Conventional ❑ conventional
modified ❑ ilmovtltia.o
. G.
If Residence: - if People - I)
0
IIodroom.. /8 1 Bathlounw Z y,
dishwasher ❑Garbage Disposal ashing Machine
jtype
- ❑Basement/Plumbing ❑Basomont/No Plumbing
7.
If Business/Industry /Other: verify
N People U Sinks
N Commodes It Showers
It Urinals 11 Water Coolers
.
IF FOODSERVICE: 0S�eats Estimated Slater Usage (galloon per day)
11/
Type of water supply: L�1 County/City
❑ Well ❑ Conulluni ty1
9.
Do you anticipate additions or Cxpansiens or the facility
tills system is intended to serve? ❑ Yes
. -
If yes, what type?
***I1f1'oRLiitYl*** CLIENTS MUST COMPLCTL• 'rlIE
BELOW. EithernPLATorSITLPLAN MUSTBESUt16f
Property Dimensions:
'las Office PIN: 11,5
-2-& lf, 77
Properly Address: Road Naulc
City/Zip '7 e) i S'
10 PROPERTY INFORMATION RLQIIESTE'l)
the dicot 10(li THIS APPLICATION.
1YRRITE DIRECTIONS (from mud:ssilic) lu 1'RUI'Ek'I'1':
Ar '21 -
If in a Subdivision provide infurmation, as follotivsi
Namc:__2 cL 4•-a n- A E
Section: Bloch: Lot: "F (Z Date honk corners fagged: o S-
This is to certify that (lac information provided is correct to the best of lily knon•Icdge. i understand that any,licrulit(s) .
Issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the iufm•mn(iolt
submitted in this rpplicatial is falsified or changed. r,, also, rrtiders'tand thatl ant reaholtaiblejor till cliatges htcurred,jroot
tbrs tipPlicatiatt. I, hereby, give consent to (he Authorized Representative or the Davic County licnitb Deparpnen(
to cuter "poll above described property located in Davie County and ulvned by
to conduct :til testing )rocedul•es is necessary to determine lire site sui(abili(a•.
DA'Z'E ys d SIGNATURE
TRIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the folio lying: Existing a"d propuscd
property lines and dimensions, structures, setbacks, and septic locations).
V8jl n� Siie Revisit Chargc
llatc(s):
ClimltNDUlI ationDatc:
Sign given v �'
Revised DCIID'(05/03
Account No.
Invoice No.
j y5 /Ie -/Z
-(ta .2 v CATION FOR SITE EVALUATION/IMPROVEMFM PERMIT & ATC
l►p lS Davie County Health Department
EnWronmentaiHealth Section
2001 P.O. Box 848/210 Hospital Street
JUN 2 g - Mocksville, NC 27028
(336)751-8760
***ID>1?d7R
�RMATION IS
H2�APPLICATION CANNOT BE PROCESSED UNLESS ALL
PROVIDED. Refer to the INFORMATION BULLETIN for
THE REQUIRED
instructions.
1. Name to be Billed
!/r nn
i 5 Ot) [A) d l l Contact Person L�p.
y 77-e H
�
9 q8-5-816
Mailing Address
2q'go
T Home Phone
w 4 o h y
City/State/ZIP
M OGJ,-'SV
f f I'e •) C -;�70ajD Business Phone
%L
-
2. Name on Permit/ATC
if Different than Above �N'
/ oC.(4 -5
Mailing Address City/Stat:a/Zip
3. Application For: Site Evaluation p, Imp ent ermit/ATC ❑ Both
4. System to Service: ❑ House q Mobile Home f❑ Business ❑ Industry ❑ Other
S. I£ Residence: # People1� `rr # Bedrooms _ # Bathrooms a
11 Dishwasher ❑ Garbage Disposal uiWashing Machine 1:1Basement/Plumbing 13Basement/No Plumbing
p_
6. If Business/Industry/Other: Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of Water supply: County/City ❑ Well ❑ Community
s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 1VNo
If yes, what type?
***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: �LIL
Tax Office PIN: # -T75-7-R8'-1(p77
Property Address: Road Name
City/zip
If in a Subdivision provide information, as follows:
Name:
Section: Block: Lot: Ov
WRITE DIRECTIONS (from Mocksville) to PROPERTY: 7p
Lg an grime %1J
01yd Lal' oN ieiS47l"
Live, e FI14-5 S
Date Property Flagged: &/30 /U )
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(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. I, also, understand that I am responsible for all charges incurred from
this application. 1, hereby, give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described property located in Davie County and owned by
to conduct all testing procedures as necessary to determine the site suitability.
DATE 6.7-9- O/ SIGNATURE
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).
CaA + 0
Date(s):
Account No. y ra G
7
Revised DCHD (07/99) V/ / Invoice No.
rL �
��V..// I ��,vvv h�C .
I/
II: /I 1 1►YY �Lc_ Y� 1 __:: Yul ►YY
�.
Environmental Health Section
Soia/Site Evaluation
i AiPLICANT INFORMATION
....-. .. .. .:., ... - - -
- - PROPERTY INFORMATION -
Account #::989900074.
Tax PIN/EH #:.'
5757-28-1677.12
Billed To:
Dennis Howell
Subdivision Info:
Dalton Acres Lot # 12,
'Reference Name:
Location/Address:
Eric Road -27028
Proposed Facility::
Residence
Property Size: see map. Date Evaluated:
Water Supply: ' .
On -Site Well
Community'
Public
Evaluation By:
Auger Boring
„ ..
� • . Pit
Cut
: FACTORS
!J--
1 2 3 4 :J
5. 6. 7
Landscape position
/ I— .
Slo %a .
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 . .
Texturegroup
Consistence
Structure
Mineralogy
SOIL WETNESS -
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: \' EVALUATION BY:
LONG-TERM ACCEPTANCE RATE OTHERS) PRESENT;
REMARKS: .
LEGEND
Landscape Position `
CC idge-Concave to eShoulder -Convex slo a slope FS - Foot slope - N - Nose slope
p p T -Terrace FP - Flood plain:. H - Head slope
Texture'
:-
S - Sand LS - Loamy, sand SL - Sandy loam L,- Loam - SI -Silt
SILL -Silty clay loam SIL - Silty loam -CL - Clay loam SCL - Sandy clay loam
SC - Sandy clay , SIC - Silty clay C - Clay
CONSISTENCE ...
:Moist ,
VFR - Very friable:
-FR =Friable FI -Firm VFI -Very firm EFI -Extremely firm
Wet
S' - Stick : "..:
' NS -Non sticky � : SS =Slightly sticky y S = 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
DCHD 05/99 (Revised) ,
1
Q)
u ttE CQjNEALTH 119PAPT
ENVIRONMENTAL HEALTH SECTION
P.O. Box 848/2.10 Hospital Street
Courier #09-40-06
Mocksvilie, NC 27028
July 30, 2001
Dennis Howell
2420 Highway 64 E
Mocksville, N.C. 27028
Re: Site Evaluation: Dalton Acres/ Lot 12
Tax PIN: 5757-28-1677
Dear Client(s):
As requested, Robert B. Hall Jr., Environmental Health Specialist with this office on
July 19, 2001 evaluated the above -referenced property at the site designated on the plat/site plan
that accompanied your improvement permit application. The purpose of said evaluation(s)
was/were to determine the soil/site suitability for the installation of an on-site sewage system. The
result(s) of the evaluation (s) , a copy of which is attached, indicate(s) the site is unsuitable for the
installation of an on-site sewage system for the following reason(s)
.1940- Landscape position
(d) Complex Slope Patterns
(e) Depressions
Due to the limitation(s) on your site, this office is not aware of any modifications or alternative
measures which can be implemented at the present time to upgrade the classification from
"unsuitable" to " provisionally suitable". Your application for an Improvement/Authorization to
Construct, must, therefore, be denied
You have the right to an informal review of this decision by the Environmental Health Director of
this office and also by the regional staff of the Department of Environment and Health. You should
contact this office to arrange for this further review.
You may also wish to obtain the services of a private consultant to collect site-specific data and
submit data and a system design to this office for technical review. A site may be reclassified
provisionally suitable provided written documentation, including engineering, hydrogeologic,
geologic or soil studies indicate to this office that a proposed on-site sewage system or a proposed
alternative system can reasonably be expected to function satisfactorily. The substantiating data
from these studies must indicate that:
A. The effluent ( wastewater) will receive adequate treatment;
B. The effluent ( wastewater) will not contaminate any ground water or surface water, and
C. The effluent (wastewater) will not be exposed on the ground surface to be discharged to
surface waters where it would come into contact with people, animals, or vectors.
Finally, you have the right to a formal appeal of this decison if you file a petition for a,
contested case hearing with the Office of Administrative Hearings, P. O. Drawer
27447,Raleigh NC 27611-7447. A copy of a petition form can be provided to you upon
request. The petition must be received by the Office of Administrative Hearings within
thirty(30) days of the date of this notice. The hearing may be held in Davie County.
If you file a petition for a hearing, you must send a copy of the petition to Mr. Richard
Whisnant,DENR, Office of General Counsel, P.O. Box 27686 Raleigh, NC 27611-7687.
Please call or write this office if you have any questions or need any additional assistance,
as follows: Telephone number: (336) 751-8700
Davie County Health Department
Environmental Health Section
P.O. Box 848
Mocksville, N.C. 27028
Sincerely,
Robert B. Hall, Jr.
Environmental Health Specialist
RH/di
Enclosure(s): Soil -site report
Invoice
APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT &
Davie County Health Department D
1 p�� Env/ronmen[a/Hea/thSecVon
P.O. Bo: 818/210 Hospital Street IAt�
1 /%h�\I �b �1/�►,°t Nookaville, NC 27029 JJMM
V/ rig (336) 751-8760
�.,.1 uceIru
***IMPORTANT*** THIS APPLICATION CANNOT Br PROCESSED UNLESS AL
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
I- Name to be Billed %{ /2Kv Te 4 v. s / eC Contact Person _ %T /r?y 73-4 1.. N r- L
Mailing Address 21 4 i 2; 0� 4T S ^ h ti—
City/state/ZIP _/znC /--; c ,Yje ,/i 2 i Ll r Blooms Phone
S. Name on Permit/ATC if Different than Above /112,1 C/(f
wailing AddressS/�y��, , City/state/zip
3. Application For: 1YSite Evaluation Wimprovemeat Permit/ATC O'Both
6. Bystem to service: L" House ®'Mobile Home ❑ Business ❑ Industry 11 Other
s. If Residence: / People / Bedrooms i Bathrooms
B Dishwasher 'D Garbage Disposal 0 Washing Machine D Basement/Plumbing 0 Basement/No Plumbing
6. If Business/Industry/other: Specify type # People / Sinks
i Commodes f Showers f urinals i Water Coolers
IF FOODSERVICE; if Seats Estimated Nater Usage (gallons per day)
7. Type of water supply: ❑ County/City ❑ well
❑ Community
s. Do you anticipate additions or expansions of the facility this System is intended to serve! ❑ Yes ❑ No
H yes, what type'
"•'IMPORTANT •*" CLIENTS AfUST COAfPLE7E THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the client with THIS APPLICATION
Property Dimensions: % AC WRrP DIRECTIONS (from Mocleville) to PROPERTY:
Tai Office PIN: 0 S 8a Z' 000
W9 le4E — 1 R+ a d CrossRcD,
Property Address: Road Name _/ ¢% s•T !aC ` r,,; F7 rsT Pd—
City/Zip ►ModCSvJ 1. 220LY
If in a Subdivision provide information, as follows:
Name: A2
Section: Block: Lot: //
a�- C..nYle� Lrnt.
Date Property Flagged: I - l 1• - Q �
This Is to certify that the information provided is correct to the best army knowledge. I understand that any permit(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. I, also, understand that! am rrsponsihlefor all charges lncarredfrom
this application. 1, hereby, give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described property located in Davie County and owned by /?OL :5 cTT 7 /3r c /c
to conduct all testing procedures as necessary to determine the site suitability.
DATE 1-12. 9% SIGNATURE %vv.. /, aw z
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).
Revised DCHD (07/98)
Account No. .38
Invoice No.
' r
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section sacTloN
Soil/Site Evaluation
APPLICANT'S NAME J Md Ste/ ��iG� DATE EVALUATED
PROPOSED FACILITY 17L PROPERTY SIZE
SUBDIVISION ROAD NAME (: C �✓
"Water Supply: On -Site Well "' Community Public
Evaluation By:! Auger Boring -- - Pi[ Cut
FACTORS _ ." 2 3 4- 5 6 7
Landscape position
Slope %.
HORIZON I DEPTH v
Texture group
Consistence .
Structure
Mineralogy
i ; HORIZON H DEPTH
Texture group
Consistence'
Structure
Mineralogy
i' 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 1
SITE CLASSIFICATION: �S%�`��` EVALUATION BY:
LONG-TERM ACCEPTANCE RATE:OTHER(S) PRESENT:
REMARKS: LEGEND
Landscape Position
R - Ridge S - Shoulder L - Linear slope FS - Foot slope N -Nose slope
CC - Concave slope CV - Convex slope T.- Terrace FP -Flood plain H.-. Head slope
Texture
S - Sand LS - Loamy sand rSL - 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 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 -tern acceptance rate - gal/day/ft2
n (01-90) -
MEMO
si
R. 1605
DALTON ACRES
P B . 4v P. 99
/
SR, 1605
DALTON ACRES
PB. 41 P. 99
tJ
DAVIE COt&rYHEALTH DEPARTMENT -
ENVIRONMENTAL HEALTH SECTION
P. O. Box 848/210 Hospital Street
Courier #09-40-06
Mocksville, NC 27028
Phone #: (336)751-8760
February 22, 1999
Terry S. Johnson
21 Wright Lane
Mocksville, NC 27028
Re: Site Evaluation/Eric Street
DaltonAcres/Lot I1 (1 Acre)
Tax Office PIN: #5757-28-1822
Dear Client(s):
As requested, a representative from this office visited the aforementioned site on
February 12, 1999. 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 on the ridge 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.
If you have any questions, please feel free to contact this office.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health Specialist
RH/wd
Enclosure(s)
APPLICATION FOR SITE EVALUATION/IMPROVEMFNF PERMIT• JL
•, • �' •�"� Davie County Health Department Environments/Mea/thSection
P.O. Box 848/210 Hospital Street9�M�1 lle, H87607020
ENVIRONME nAVIF OUNTHYLTH
***IIWORTANT*** THIS APPLICATION:CANMOT BE PROCESSED UNLESS A
IRED
INFOMMTION IS PROVIDED. Refer to the INFMUMTIOH BULLETIN for instructions.
1. Name to be Billed
T RR✓
Jh Itih c a L�
Contact person _
T lea
Mailing Address
a/ w
; q kI ,L p N e
Same Phone
City/state/ZIP /jjo c.E S u"11C 2 7 & 74: Business phone
2. Name on Permit/ATC if Different than Above._ goe )3&_ S /1i C
walling Address S.Jg.e' .bt fV'raur City/state/Zip
a. Application For: iR Site Evaluation
fA'fmprovement Permit/ATC 6-Soth
e. system to service: 2 -House eMobile Home ❑ Business ❑ Industry ❑ Other
s. If Residence: / People / Bedrooms b Bathrooms
0 Dishwasher 0 garbage Disposal - 11 Washing Machine 0 Basement/Plumbing 0 Basement/No Plumbing
6. If Business/Industry/other: Specify type 4 people / Sinks
f Commodes i Showers 4 Urinals f Nater Coolers
IF FOODSERVICE: / Seats Estimated Water Usage (gallons per day)
7. Type of water supply: GlCounty/City f3 well ❑ Community
s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No
H yes, what type?
***IMPORTANT*** CLIENTS AIUST COAfpLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESURMITTED by the client with THIS APPLICATION.
/qc
Property Dimensions:�'�
,+fit
Tax Office PIN: Nx rn .S-77-7- _X fl_ i 2
Property Address: Road Name ER c sr-
city/zip mOY ti� Z oa
If in a Subdivision provide information, as follows:
Name: _ Al n &
DIRECTIONS (from Mocksvllle) to PROPERTY:
l�Ra 2;1tr n -r
F:nsr GIFT l2oa0 w7ll 6r l�iRi
Section: Block: Lot: 10,12 Date Property flagged: I- (Z -gt l
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(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. I, also, understand that I am respensibfe for all charges Incurred from
this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described property located in Davie County and owned by /e.2 ;9 e 7 -7 -
to conduct all testing procedures as necessary to determine the site suitability.
DATE 1-1.2- 99 SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Elisting and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Account No. .37
Revised DCHD (07/98) Invoice No.
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION ✓ - LOT✓2
Soil/Site Evaluation ,
APPLICANT'S NAMEDATE EVALUATED
PROPOSED FACILITY PROPERTY SIZE
SUBDIVISION ROAD NAME
Water Supply: On -Site Weil' Community - - Public !/
Edaluation By: Auger Boring �' Pit Cut
FACTORS : ' 12 . 3 4 5 6 7 .
Landscape position FS
Slope %
HORIZON I DEPTH
Texture group
Consistence d
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 r
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE I
SITE CLASSIFICATION: EVALUATION BY:i(t:Gf
LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:
REMARKS: _' n�}LlL i l?lfP� LiITC ^
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 SII, - Silty loam CL - Clay.loam SCL - Sandy clay loam
SC - Sandy clay. : SIC - Silty clay. C - Clay
CONSISTENCE' -
Moist
VFR - Very friable FR -Friable . _. FI - Firm..' . VFI - Very firm . EFI - Extremely 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
DCM(01.90) - . .
^ rz FR. +"""`5 ` •Y`xPF"'�q�q"''�^�'4n"��!?xtr �V•F•':nY..ene-r.'i:<.n,�w.;cT€:f,\'[R.-<�✓�G-.=➢-�Ei`i 'Fr L"•"•'C'^cam ._7
ENVIRONMENTAL HEALTH SECTION
P.O. Box 848/210 Hospital Street
Courier #09.40-06
Mocksville, NC 27028
Phone #: (336)751-8760
February 22, 1999
Terry Johnson
21 Wright Lane
Mocksville, NC 27028
Re: Site Evaluation/Eric Street
Dalton Acres/Lot 12 (1 Acre)
Tax PIN: #5757-28-1677
Dear Client(s):
As requested through your application, Robert B. Hall, Jr., R.S., Environmental Health
Specialist(s) with this office, visited the aforementioned site on January 28, 1999. The purpose of
said evaluations(s) was/were to determine the soil/site suitability for the installation of an on-site
sewage system. The result(s) of the evaluation(s), a copy of which is attached, indicate(s) the site
is unsuitable for the installation of an on-site sewage system for the following reason(s):
Rule(s) .1940 -Landscape Position
(d) Complex Slope Patterns
(e) Depressions
Due to the limitation(s) on your site, this office is not aware of any modifications or alternative
measures which can be implemented at the present time to upgrade the classification from
"unsuitable" to "provisionally suitable." Your application for an Improvement
Permit/Authorization to Construct must, therefore, be denied.
You have the right to an informal review of this decision by the Environmental Health Director of
this office and also by the regional staff of the Department of Environment and Health. You
should contact this office to arrange for this further review.
You may also wish to obtain the services of a private consultant to collect site-specific data and
submit data and a system design to this office for technical review. A site may be reclassified
provisionally suitable provided written documentation, including engineering, hydrogeologic,
geologic or soil studies indicate to this office that a proposed on-site sewage system or a proposed
Page 2
Terry Johnson
February 22, 1999
alternative system can reasonably be expected to function satisfactorily. The substantiating data
from these studies must indicate that:
A. The effluent (wastewater) will receive adequate treatment;
B. The effluent (wastewater) will not contaminate any ground water or surface water, and
C. The effluent (wastewater) will not be exposed on the ground surface or be discharged
to surface waters where it could come into contact with people, animals or vectors.
Finally, you have the right to a formal appeal of this decision if you file a petition for a contested
case hearing with the Office of Administrative Hearings, P. O. Drawer 27447, Raleigh, NC
27611-7447. A copy of a petition form can be provided to you upon request. The petition must be
received by the Office of Administrative Hearings within thirty (30) days of the date of this notice.
The hearing may be held in Davie County.
If you file a petition for a hearing, you must send a copy of the petition to Mr. Richard Whisnant,
DENR, Office of General Counsel, P. O. Box 27686, Raleigh, NC 27611-7687.
Please call or write this office if you have any questions or need any additional assistance, as
follows: Telephone number: (336)751-8760
Davie County Health Department
Environmental Health Section
P. O. Box 848
Mocksville, NC 27028
Sincerely,
Robert B. Hall, Jr.
Environmental Health Specialist
RH/wd
Enclosure(s): Soil -Site Report
Invoice