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154 Shannon Drive Lot 6 .. :., ,_::, y :.. 4;„ � .:..._ro._,.'r s...v , . . ,f, . ,.! .:oar,• .,. ..w,t•;�, - t ... . . -, ' aC AUTHORIZATION NO: 1955 DAVIE COUNTY HEALTH DEPARTMENT 'Environmental Health Section PROPERTY INFORMATION Permittee's'---� ,� P.O.Box 848 Name: lroc �.. mow— Mocksville,NC 27028 Subdivision Name: t•�1► t-a'= ^"-=L , ) Phone# 336-751-8760 Directions to property: i'..�`�� jy � � Section: Lot:. \ AUTHORIZATION FOR 1 „lrrrL2Y Lel L�L' L� WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION 77` /+ 1r.r.Jr-!c ..� �-rJ l?� C': ' Road Name: IANI Ri'd l st ip: , c'7 4 E **NOTE**This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building-Permits.This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 1 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION 4DATISS Ail IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONI, L H ALTH E LIST - 1955 DAVIE OUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION PertrritteSeps . r 1- - 'NarEe . fi� r -t+x�t �; r^ .." ; ?-�' �� ;± Subdivision Name: Direptions to property: f,: Lk 'it" trj Section: Lot: '= IMPROVEMENT VI L f'', . -1 PERMIT Tax Office PIN:,,t` yr.g- Road Name. Zip: �. ?o r, **NOTE**This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system.An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the constructiordinstallation 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) ***NOTICE***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE.YOUR WASTEWATER ENVIRON�GIEN"I AI" ALTH SPECIALIST DA ISS ED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE ti INSTALLING THE SYSTEM. �N ECIFIC _ .,. ,,. RESIDENTIAL SP j (j o) BUILDING TYPE'-JA BEDROOMS _#BATHS-�'5 #OCCUPANTS GARBAGE DISPOSAL:Yes o No COMMERCIAL SPECIFICATION: FACILITY TYPE (,/ #PEOPLE #PEOPLEISHIFT r, #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY Ur�+DESIGN WASTEWATER FLOW(GPD) g NEW SITE 'V'/ REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE A99Q GAL. PUMP TANK GAL. TRENCH WIDTH J' ROCK DEPTH� LINEAR FT, OTHER r1 !®�,�T�LI fjV-Po REQUIRED SITE MODIFICATIONS/CONDITIONS; I Kk'ZTAl L o rj wr" oui , I'-YI— is vf�f IMPROVEMENT PERMIT LAYOUT D5 co x 7QI4ri: =- iCV- "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 A.M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS (336)751-8760. OPERATION PERMIT \© �tSL� YSTEM INSTALL f` M (� L) ` C1 S'Ib rJ l� rX �"� f -Tn�a NSP' H OJS8, i A►J �aT� 9 -2$ o r-ez-jT- AUTHORIZATION NO. OPERATION PERMIT BY: DATE: Z �� I T **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE S DESCRIBED ABOV BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS",BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 05/96(Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERM Davie County Health Department /� tll 7 15 Environmental Health Section /�v R O.Box 848 �. WR 2 5 PA Mocksville,NC 27028 / fi, (704)634-8760 (1 �Y I l I Et1TAt .AI.TH ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSE ES "11 Mul} Y ALL THE REQUIRED INFORMATION IS PROVIDED. R�661% S-4 ro cQ �- 1. Name to be Billed �C�Vl a.l CQ Contact Person c1 Mailing Address �0 g :DaU 1e- RCacu Wl(/1 A, Home Phone 'yO/a - 75<9v2 City/State/Zip LnckSu i* l� f A C 3 70a-z� Business Phone ! ` OV- 2. -2. Name on Permit/ATC if Different than Above 4 m f Mailing Address City/State/Ziv �}..a, I 3. Application For: >( Site Evaluation �$. mprovement Permit&ATC Both 4. System to Serve: y4 House ❑ MobileHomel ❑ Business ❑ Industry ❑ Other 5. If Residence: # People �� # Bedrooms # Bathrooms .Z. 4 Dishwasher ❑ Garbage Disposal Washing Machine Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage(gallons per day) 7. Type of water supply: I'` County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes No If yes,what type? PROPERTY INFORMATION REQUIRED: ***IMPORTANT***A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: 5I 9 -A 41 /9 A 5,55- WRITE DIRECTIONS(from ocksville)TO PROPERTY: Tax Office PIN: # 5-77 fir - - • �� 3q gcVes -I (DA ec'sk 46 201 A Property Address: Road Name ��Yr`1 ✓�-2 C+-N L x - city/zip oty,U- x-700 ' ' T- l.c �- a-I t"Ic1• 0-E tlti �' If in Subdivision provide information,as follows: 'r ��y 1 , -1 CvI- CU - S9-c — ✓� Name: V Y' � rU f� S I rr Section: eP'[R Co moi- G 3`� Lot #: lO 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.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 5Ok 5� a- ack h I'C P nu-)C n of S to conduct all testing procedures as necessary to determine the site suitability. DATE of S SIGNATURE Revised DCHD(06-96) � � 7 I ' N (D 0 26.80 Q I ' " w 9 10 I 12 1 ; found vI S06'36'E _ 5.775 A David L. Doby � 4, MorkTond_ 1 D.B. 159-4 0' w }-fOUS� r en IE�� �,5 - _ W , o� �o a C 5 ~W 1p o�- v 1 O P v 3 - _ 60- 0 z v M o�M _ m 7. 000 AC. 6.730 AC. � � 6.703 AC. 3 ^ 6.369 AC. f ' h j 1 „ Q'� 0 0 � .N � N jr r U Ua o0 2 o Mo M Jomes R. Owings 1 CO N 41t05-30" E 4 z 2 z a w I Z M Ch. 76.62 Y _co ni 110 VCh. r�� N 81°-05' E_-� a 6 �. S880 56'00564 t RLQ m `ID o II — _ p c CD 508.73' -- � � � to �� o vy 0 AJ --=5Q.1JSgss�o§ement= � `;Q: _ _ 2 -.-3SS gs8 � m v� J N 43'35'-05" W - ) 8g'56r=b� O ;BT- 2g, S m f) fU Cts. 56.88' 11 ]� Ch. 188.2813. �n _\� Te°Sg,t o Total 873.22' I t0 u��l�y eosemer�t 1 5 '� 3� 3 SSfL p4•_14„W - /8� 9 f N89g13 ��} N77°-23-47” E �p S010 40'-10"E 7 Qm ;° Irl '� 50.78 �8v �`' qT5 �Q- - Ch. 185 4t0 - X77.-26'_. - - ---- -- ia.7Q' --- �� 50.92' .i ar c -'� °��_ t9'r - - __ 56 - 277.2- . +< - / � W - _ - = -- 1-57.26 10 sight easement m Cot IJ �t o cov o,r,� �� Totof 5 - _ +'"y_A 1 t 5`- 5 -40' - - - - - - - 62 - - ' !o Q h �r t.V „ tr t0, $ - n cD co v stn, 8 26' - - - m to cr t - 50994. ' _ y ° �; E.028 ACRES / e Sag 1 Totol 663.56' h m m cD ase = 3_-44 . W `�ro node Bose w '� enr / / Ch 2p6 O S77 -23 U ! Oj a) 3 2 -20' 20, 6' r X t o `b 6.244 ACRES 0D drO'no9e ease 5.355 AC. Q N _ 6.408 AC - 8 o M W w & '09;30„ �,, I! Q cD o rn - c1- iron faun y�00 u, 54j W ' 0 ro - v James R. Owings o S 0 1 1 o 1 0 0 Hp LU z 0 5.084 ACRES S880- 5 3 5E� �/ 0 493 3?' CD rn r; I� 0. -;j �� o I 0 o '"� N S7 0llor, found \ ' rn 19 W ! 4 N �' O° s�,, S OS•�\ �'� 9 \\ I - 5,42.15- 5. 759 ACRES � \ /, .• 0 5 uir (rtres� / �,,`C, s y �(/461 \ s 74 LJ v / S v'9 E'S '2 0 7. 566 ACRES pr) o , 0 ,,\ s.\ .�Z o (D �. O y _iii%\ p 4i S S 6&\ . 5 CURVE NO R A co O ;y 0 D rc. 502.46 230-39- 55 207. 56 �50 ;s ��Si; \ 2 542.38 I9°-59'-27" 189. 24 N 89 42� � F; `y 3 25.00' 48°- II'- 23" 21. 03' o Q, x 36. k 4 50.00' 680-52'- 03" 60 10' 74 72°-15'-56 JV 5 50 00' 69°- 19'- 55" 60-50' > / a- 6 50.00' 100°- OI'-25" 87.29' g6o-2 Mory Ann Barnhardt - . 7• 50 .00' 3 8°-09'-30" 33 .30' D 9. 72- 494 8 25. 00' 4 8 - 11'- 0 I" 21 . 02' S74°-23'-56"W 9 592 38' 19° -59'-27" 206. 68' 174-16' NOTE PORTIONS OF BOUNDARY WAS TAKEN FROM MAPS BY OTHERS . l0 45 2 46' 230 - 39'-55" 186 . 88' SOUTHERN PHOTO PRINT COMPANY INC .. — DAVIE COUNTY HEALTH DEPARTMENT r ' Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME I41.O 73WAJO DATE EVALUATED / PROPOSED FACILITY �/ PROPERTY SIZE . CSrS A SUBDIVISION MUT I &V ROAD NAME �� L Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L_ L Slope% u HORIZON I DEPTH Texture group SGL SG(— Consistence S S SS Structure C17— Mineralogy 2Mineralo I :/ HORIZON II DEPTH Texture groupG SC Consistence / S S /9�1 S Structure L Mineralogy : 1 HORIZON III DEPTH - Texture grouC Gd Consistence 5n, sk, 58 Structure S A61G Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATED �• SITE CLASSIFICATION: ` EVALUATION BY: LONG-TERM ACCEPTANCE RATE- ©• OTHER(S)PRESENT: C.4_..o-r REMARKS: EGEND 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 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 DCHD(O1-90) ■...■t.■■t■■■■t■■■■..■■t■■■t■■■■.■■■t■■■■■..■t■■e■■■■■.tet■■tt■■.■ ■.■tttttt■■■■t■■t■■■■■■■■■■tt■■■11■■e■■■■■■■e■■■t■■■ett■■■■■e■■■e■ ■■■1111■e1111■■■t■■1t■■■11■■■■t■■■■■■■■■■■■■■■■■■■■t■■■■■■■■■■■■■■ ■■■■t■■t■■■■t.■■■■■t■■■tt■■■■■t.l�t■.tttttt■■■■■■■■■■■■t■■■■t■■tt■ ■■..■ttt.■■ttt...■■tt■■■t.■■■t■■t■■■e.ttt..ttttttt■■.■t■.ttttt.tt■ ■■1111■■■111e■■■t■■■■11■■■■11■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■t■■■e■ ■■■■■■■■t■■■t■■■■■■■■1111■■■t■■■et■■11■■111■■■tttttttt■tt■■■e■■tt■ ■■t■■■■■t■■■■■■■■■■ttt■■■111■■■■et■■e■■■11■■■■■t■■■■■■■■te■■■■■■e■ ■■1111■■■t■t■■t■t■■■t■■t■■■■■■t■�■■■■■■■■■■■■■■■■1t■■■t■■■■■■■11■ ■■■■■■■■■■■te■■■■■■■■■■■■■■■■t■■■■■■e■■■1.111.■■■■■■■■■■e■■■■■.■t■ ■■t■..■■t.■■ttt■■tt..■■■■■ttt■■ttt■■■■tt■■1111..1■■■■■■t■■.111.1■■ ■■t■■■■■t■■ttt■■■■■■■■t■■■■t■■■■�■■■■■tt■■t■■■■■■■tt■t■t■ttt■t■e■ ■■■■t■t■■■■■t■1tt■tttt■■1tt■■■■■ ■tttttt■■111■■t1t.■■1111■■■■ttt■ ■■■■■tt■■tt■■■■1t■■■■■■■■■■■■tt■■■■■tt■■■t■■t■■■tt■■t■■t■■■t■■■■■■ ■■■■tt■■t■■■tt■■t■■■■1■■t■■■■tt■■■■■■1■■tt■■■■1t■■■t■■■■1111■■t■t■ ■■.■■■■.■■■■.■■■■■■■t.■■■..■■t■■t■■■tt■■t■■tt.■■1.111■■■t■■■■■■.t■ MEMNONMEMNONiinaffin ' �iiiiiiMENNENMENNENMONSON ■■1■■■■■■■t1■■■t■■■■■■■■t■■tt►�■tt■ttt■tt■■t■tt■ttt■■■■■tt■■tt■■tt■ ■■■■t■■■t■■■tt■■■1■■■t■■■■■■■a�■■■■�■t■■t■■■t■■t■■■■■t1■■tt■tt■■1t■ ■..■1■.■■■.■■t.■■■..■■■.■■.■t■►ae�r��t.t■.■t■■t..t■..■■.t..t.■ttttt.■ ■■■■■■t■■■1111■■■■t■■t■■tt■■111111■■ttttttttt■t■■■■■t■■■1111■■■■t■ ■■■■■■■■■t■■■■■■■t■■■■■■■■■t1t■■�■■■t1■tt■■■■■tt■■■■■■■t■1111■■t■ ■■■■..■■t■■■t■■■.■■.■■■.■■.■■■.■ n■■■■tt1■■■■.1■.t■■■.■t.■■.■t.t■ ■■t■■■■■■■t■■■■■■■ttt■■■t■■■t■■t�;t��■■11111■■t■■1■■■tt■ttt■lttt■■■ ■.■■■■■■■■■■■■■■■■■■■■■t■■■■ttt■■■tr:�t■■■■t■■t■t.t■.ttt■■■■tt■■t■■ ■■.■■.■■■.■■t.■■■■■■.■■.■■■■■■.■■■■■■.■.11.11.11■■■■■■.■t.tt■■■■t■ ■1.111.■■..■■■■■1111■■■tltt.tt■tttttt■tt■■t■■■11.11.11.11.■■.■t1t■ ■..■.....■■■.■..■...■......a1.■■■��l�iL>■.1.11■■...■..■■■.....■■■■■.t■ ■■■1■■1■■111■■■■1111■■■■t11�11t■n��W1■11t1��t1■tt■11t111■111■11t■■t■ ■t1■■t■■t■■tt■t■■t■■t■■t1■tai■■liii■iiiu�il■■■■ia■■t■■ttt■t■ttt■■t■tt■1■■ ■■■t.■■.■■■■t■■t■■■■1111■tt■ttr+rt*■tt■t■■i■ttttt■■1111■ttttt■tttt■■ ■tt■1tt■1tt1■tt■ttt■tttttt■�■■■ti■■ttt■■t■t■■■■ttt■■t■■■■t■■tt■■■■ ■■■■■■■■■■■■■■■■■■■■■■tt■■t■■■■■■t■■■1111..1■■■t■■■■■■■■■■tt■■t■t■ ■■tlltttltt■■t1t■■■tttt■■■■■■_e••■_■_eases_•.1t■■t■■.t■■■111.11■■ttt■ ■■t■■t■■■■t■■t1t■■■■t■■1■■tt■■t■■c�■■■■■t■■t■t■■■■■1tt■■tt■■■1■■1■ ■■■■■■t■■■■■■■■■■tt■■■■■■■■■■■.■■gar■■t■■1t■■tt■tt■■t■■t■■■■ttt■tt■ ■■■e■■■■.■■..t■■■■■1.■■■11.11.1■ ■.■t.1.■■.■.1■■■..1..t.1..■.1..■ .................................................................. ,,■■■■ Davie County Health Department • y s W'02 99a andHome-Come Health Agency pNpMG 6 P� o Agency ��33 �5�.a� Environmenta(Health Section P.O.Box 848/ 210 HosarrnL STREET COURIER#09-40-06 MOCKSVILLE,N.C.27028 PHONE:(704)634-8760 April 21, 1995 Donald Stroud 808 Davie Academy Rd. Mocksv i l l e, NC 27028 Re: Site Evaluation Merrybrook Acres/Lot 6 Tax PIN: #5778-15-1409 Dear Client (s) : As requested, a representative from this office visited the aforementioned site on April 13, 1998. Based upon the information provided on the application for site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for installation of an on—site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely Jeff G. Beauchamp, .S. Environmental Health Specialist JB/wd Enclosure(s) otor 1. 304 � � -- , �0 41 7P8 , N Quo- 0 6 IsleZ AM" O00 o D �+ 10 � � W at rn mrn ♦^ 30 3q° -7 g 8 3000 Solo ,•.____ O tO I .01 �O--- (31a0 -A 03 to ,o