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123 Fox Run Drive Lot 24Davie County, NC ITax Parcel Report Thursday, December 29, 2016 WAK ING: '1'Mh 1J 1VU'1' A SURVEY Parcel Information Parcel Number: E611OA0024 Township: Farmington NCPIN Number: 5851830572 Municipality: Account Number: 82523155 Census Tract: 37059-802 Listed Owner 1: BELCHER DONALD S Voting Precinct: SMITH GROVE Mailing Address 1: 283 PARK AVE Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY QD Zip Code: 27028-9501 Voluntary Ag. District: No Legal Description: LOT 24 FOX RUN Fire Response District: SMITH GROVE Assessed Acreage: 0.61 Elementary School Zone: PINEBROOK Deed Date: 8/2004 Middle School Zone: NORTH DAVIE Deed Book / Page: 005640502 Soil Types: GnB2,PcB2 Plat Book: 0005 Flood Zone: Plat Page: 182 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding 8r Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: 101 Davie County, NC All data Is provided as Is without warranty or guarantee of any ldnd 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 website shall hold harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to or &rising out of the use or Inability to use the GIS data provided by this website. ►Pertnitte4'9� DAVIE COUNTY HEALTH DEPARTMENT f t L" o.,r�� .rr Name: , Environmental Health Section PROPERTY INFORMATIO P.O. Box 848I Directions to property: l Mocksville, NC 27028 Subdivision Name: G Y U 0 f / Phone #: 336-751-8760 ,� j� �` C:' �� t.ry 1 != t •�� U !1 � . Fox /C, �i � Lot: cS 4-1 Section - - AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION -" AUTHORIZATION NO: 002723 A Road N 23 % t Y iv r') I')/ Zi -'"7C. **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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ?' ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE _ # BEDROOMS 3 # BATHS I( # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) - NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE �X i SGAL. PUMP TANK —Or GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. OTHER lJ D -P 1 r©(O C b - REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT A '�-- Lrs�v� �00�5 are Ho fe m4• 7!=vt5tir dl s� u i c.rj •S ¢ u u cyl oN i � S il.s pyo,>r✓ �� �� � � rN o• (1s3gS 14 oi1'1 �n:+x r •t �( 1I �,,S a ( 5 w�lck.•a ttNS`r' Jo<� ,N# ,lei v� lict d1 116' a P 1; Z G t y �.► no c9 r� rtO.�r b.a c•► 34 " t 4 110 pAuie SAC# Ito._ , kat4 LAi4t17 PVC- S��P�autiS W�,�✓r Nr�,r 95dte /YtUia�a�n 0t rte.•+ Adk* Vi0 t /c"t+OrG rvy FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: Cl m %- �e G� i ♦t -0 4 l� C(r t� �tNT ,.1�3 F6-t12t�h t I � � t r0� r AUTHORIZATION NO. OPERATION PERMIT BY: 1-s' l : ----A-,/1 **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIB VE 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. DCHDoyoz (Revised) ���� # 7Zt -!A) MCC sT(O1 ,S i . ° ) DAVIE',OUNTY HEALTH DEPARTMENT Nam'C�L Environmental Health Section PROPERTY INFORMATIOIk r\ ._ . ! �„' , �,j'Ga P.O. Box 848 I Directions to property: �r ' Mocksville, NC 27028 Subdivision Name: ' Phone #: 336-751-8760 bX �ll�i ) Lot: � �� � � _ Section: *-- AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION 2 - { AUTHORIZATION NO: 002723 A Road�am 1 ,r v 'd �) �/� Zip:.' **NOTE**- This Authorization for Wastewater System Construction MUST BE ISSUED by thl D�V'iC .ounty Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should bePresenteei to the Davie County Building Inspections Office when applying for Building Permits. !f� (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatme t and Disposal Systems) xj` �} �; ***NOTICE*** THIS AUTHORIZATION FOR W STEWATER CONSTRUCTION �' <• ��'r}� �f_a Je-pt V 7 IS VALID FOR A PERIOD OF;FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED /' r RESIDENTIAL SPECIFICATION: BUILDING TYPE _ # BEDROOMS # BATHS 4 # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE'--- _ # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW,SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE e x i hGAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. OTHER'1 ' f> (6c, <> �i r - REQUIRED SITE MODIFICA70NS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT , p"5 G� �t �ur 7F ►tSt+r t ! A 4- + VUIUt'. d7�W • eki'S?ir(cf � , r . �)Q.cv�r'� , E �� Gl 1. be U( �J • 7 �► &A °'^ i S Y P7,p at�titow 110 N+&t -e S�+c, IIorti. :l LA 01A ALV- ILA S&N4j PVC- �j11 ficivusy5 1,v��✓r Htc,r y5st • /J'taie'�a+n 'j'S r��ias i4.n 1+a1 e 'l lC1 t /G��i'c, try FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT 1) SYSTEM INSTALLED BY: J Q m l << Q' a n� �1 4 ll (C1J rNr TO i c, x•54, � i a 1 AUTHORIZATION NO. OPERATION PERMIT BY: /' �' s "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCI WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND.DISP( GUARANTEE THAT THE,SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERI( ED_ABOVE HAS BEEN INSTALLED IN COMPLIANCE LL SYSTEMS", BUT SHALL IN NOWAY BETAKEN ASA OF TIME. DCEIDO?102(Revised) &4e{ �Z � i �JUtlie� Skill , 1Na 1 DAVIE COUNTY ENVIRONM TAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME__ Zora13) '1W AU_ PHONE NUMBER (M- 54151 ADDRESS ' Um' :br�Ve- SUBDIVISION NAME Fri Furl K\YL\LO L.%ti.L LOT # 7 -q - DIRECTIONS TO SITE l:S - • 6f4 oy,6 `R,uvx - VuJ- jzt W. 1&+ 7BLy r_ ry , �b ►,� DATE SYSTEM INSTALLED q-ZY'go NAME SYSTEM INSTALLED UNDER NQ.u)Fnlis . (y- TYPE FACILITY Ptte,- NUMBER BEDROOMS Oe NUMBER PEOPLE SERVED TYPE WATER SUPPLY Cb • SPECIFY PROBLEM OCCURRING DATE REQUESTED 1-3-01 INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge. and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1/93 APPLICANT INFORMATION 12,3 Mx /Z(c,J Water Supply: On -Site Well 'DAVI$ COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation Community Evaluation By: Auger Boring Pit PROPERTY INFORMATION Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence rr Structure $ Mineralogy HORIZON H DEPTH 314 -Kg Texture group Consistence rr 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: &O . ): 'y eu e w Sc..lti d �� LONG-TERM ACCEPTANCE RATE: Q REMARKS: LEGEND EVALUATION BY: K O 6 OTHER(S) PRESENT- Landscape RESENT: I, n s ape 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 Moist VFR - Very friable FR - Friable FI - Firm VE - Very firm EFI - Extremely firm 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 lyote� 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 ✓�� IMPROVEMENTS PERMIT AND CERTIFICATE .OF COMPLETION *NOTE: Issued in Compliance With Article II of G.S. Chapter 130a Sanitary Sewage Systems i _ / Permit Number Name � a_ �� �% f f t", —Date ?. �c�/f�'',�� N2 6092 Location Subdivision Name Lot No. Sec. or Block No Lot Size —&ZK— House Mobile Home _ Business Speculation No. Bedrooms No. Baths s. % No. in Family — Garbage Disposal YES ❑ N0 Specifications for System: Auto Dish Washer YES NO ❑ �DG�C�� /�' 'f Lf ,/ Auto Wash Machine YES [� NO ❑ U Type WaterSupply *This permit Void if sewage system descr bed below is not installed within 5 years from date of issue. This permit is subject to revocation if�flepfans or the intended use change. MI Improvements permit by *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 day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by Certificate of Completion 1Q Date 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. LJ Improvements permit by *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 day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by Certificate of Completion 1Q Date 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. 0. Box 665 Mockaville, NC 27028 1. Application/Permit Requested By Iv Mailing Address Home Phone 2. Name on Permit 3. Property Owner Business Phone 915—q �c q a3— 4c 3.2 if Different than Above if Different than Above 4. Application/Permit For: 0 General Evaluation )(S/Tank Installation 5. System to Serve: ,House u Mobile Home 0 Business 0 Industry u Other 0 Unknown 6. If house mobile home: Subdivision Z.OX Sec. _ Lotv�� No. of People Dwelling Dimensions,O k / No. of Bedrooms if Basement/Plumbing No. of Bathrooms % 7 Basement/No Plumbing Washing Machine ; Dishwasher 0 Garbage Disposai 7. If business, industry, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers S. Type of water supply: Public 9. Property Dimensions 10. Sewage Disposal Contractor 0 Private 0 Community 11. Do you anticipate additions/expansions of the facility this system is intended to serve? 0 Yes e No If yes, what type? *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. This is to certify that the information provided is correct to the best of my knowledge, and I understand I am r.sponsib a for all charges incurred from this application Date Signature Directions to Property: DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION SITE EVALUATION CONSENT FORM 1. Complete the form below and return to the Davie County Health Department, 2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin." NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO: Davie County Health Department, Environmental Health Section, P. 0. Box 665, Mocksville, N.C. 27028 Davie County Health Department Environmental Health Section Site Evaluation Consent Form LOCATION OF PROPERTY: DATE RECEIVED fl oi 6�, S , J nc� v e- (office use only) i, S 1. 1 am the ownerno'f the above described property. oes� yes no 2. I am not the owner of the above described property, however, I certify that I have consent from I lUec�1 �-o�-77s,owner to obtain a owner's name site evaluation by the Davie County Health Department for the purpose of determining the suitability for a ground absorption sewage treatment and disposal system. no 3. I hereby give consent to the authorized representative of the Davie County Health Department to enter upon the above described property and conduct all testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE 4. I hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: caner only vb- wners designated representative _Anyone requesting results _Only those listed below DATE DCHD (11 /84) 'S SIGNATURE NAME ADDRESS DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPOSED FACIILTY DATE EVALUATED -7` PROPERTY SIZE LOCATION OF SITE Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position Slope % �t HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy J. 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: _ !/91/' >� LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD(01-901 EVALUATED BY: A& OTHER(S) PRESENT: 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 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 ■.■...■u..■....■e..■.Ali.■....■.. .■.....■■■....■■■■...■.■■■■.�■■■ ■.■■■■■■.■..■■■.■...■■■■...�_�.epi.■...■■....■■■■■.■.■■■■...■■■■.■■ ■■■.■■ ■■■■■■ ■■■■■■ ■■■■■■ MUMMER M■■■■■ ■■M■e■ ■■■■■■ ■.■■.■.■.■■....■■.■.....■■■■■■.■�i■..N■.■■..e..■■■■■...e.■■■ MEMO ■.....■...e.■.■.■■■■■■e.......■.■■.....■■■■■■■ ■■ ■■■■■■■ ■■.■■■.■ iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii■�■iiiiiii�iii.i�ii= ■■■■■...■.■■■■■■.e..■■■■■M■e.e■....■ ■■■MM...■�i ■■■■■.■Mee.■■■■■■■ NEEMMMEM iii■iiiiiii�iiiiiiiiiiiiiii=iiiiiiiii■i=iiiiiiiiiiii�ii ii ■■■■■■■ ■.■�i■■■■■■■■■■.■tM.■■■■■■■■■■.■■■■■■■■.■■■■.■.■.■■■■■■�■■ ........................................... ................. ... .................................................................. .................................................................. ......................................... ........................ a I 0 1� f A 71 77 r a b ie �a. _9"N" Ft 9WI&OW"s - _ - ii�2tL F� itEND:EIJ� CN/IRLIE G1lAN�S - - RAY C_ HANES- L HOWAAU &.-HANES CHARUE CHANES AL IL 9.2."Pa. 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W*. owopmft "drw _ - - _ • PC -pow d ewwwbm rf owrei ow[ ump of Tam _ _ _ = = _- L _ - - _ _ _ - - - - - _ _ - • /r& sm&4@WMMPL'FMQM= - - ■ LC -LMBC0md �M_numb is% - -•C8• - - --- -- _ - ltus ea - _ # - - _ _ _ Scala �4 P� �4t - EEra«swta, of SOL- - Woft-oMvy eE raCarf, ap-- mw _ Po of on ptrmwk Prior t6 "to of Asa Pial` E - - _ MOO "F E RENCE flRB-40 Frr.Slo- _ w- com rawt tt�ty tr A" tU FlLbvn 10 MIO S aF U&Lbear = N of Pa L t3 O .J t� a QE 0-= M 1 .•� - _ lCERTFfYT"TON — - _ "L__ WE SLWMUM TK PROPEWY SFfOVIfM ON TKM PLAT; ALL_OF vfiv(�t Ku mm t mom bm =STAB- CORNATZEE -SCALE•= --MWKSMW - -STATE -_ 4WS& = - -PAWS' CTA A. JONES - — = _- --_ fr+sir_rasst ab = - = araltrolFs�tel. a.t -JOB tom- - - INAPPEW ' _-=1 i Si •3 1BEA?4ir—E FL DWI&OIA15 HAZEL H= HENDRIX � � CNARLIE CHANES � RAY G_ HANES I HOWARD G HANES CHARLI C= HANES ! - D 6 91 Pt's -277 D.8 -9Z PCP -2-73 � - EE B- 91- PCP 275 � 08-92 PC._3.7t � 0-2. 91 rG 269 D 8-_46 it's Gat t ,• VANCE DUNN i \ N. - ` D. & 45 P& Z G 7 r ` ` L_ L_ BROWN INC7 JR • � — � i ` � L D8 64 Prr 5-28 J. {lek 4 - - LL_ 8ROWNING JR- Ul 0 B- 93 P& 54+- t i i f 100, / co f s1 - ..Of A,- f a 4c, f f ul F _ CLINrON C_ CORN^rzrR _ " j p�//-I- k D•8-86 P6,:-548 ! -Tag E Z E c, — `-�e�.�aa•e�eea rw s.•ra•r. eae� vee Legend • EM - Emb" tea P" • 11,11. P upwQ Lar — 0Xra17 GtLFI-RENCE = D.8 40 F6%510 90- CDN rOUR INTERVAL p��Lt f�1 t w1 had/ M.Lrvty FIZDm L7f`<:QS L]F 2,EL en 1W40i s:O tL OC.&0%,4Ls O C2_Q%cL4% a0 /tT\e .•� `� u� e u tZ u .� G_ti T AaLt..-► t�¢� m L3 S CrS C26U Ab V-^ Ar 9 % _ -L CERTIFY THAT ON _ 19-- - WE SURVEYED THE PROPERTY SHOWN ON TMtS PLAT: ALL OF WH" WAS DONE UNDER MY - SUPERVISION FORSTACY CORNATZER . MIP - Mea taw Pipe • RAN - RW1r-eetaF - _ • EPs- Ems" Pm Draw • i - Cawim-h" _z 100 • MPI - New Pill;haw • EP Edge of Pam • C■cawnele ■ewawew/ • FC fad i Ces - • w" - MaOwafa MeM • PC - Pam, , Canaealaw aar a,awae esed IW • PT - ►ear of Tangswr JOB NO. 1351-3 • Rwa aria wvwftd w • LC - Lmn Cbwd • am 9~ Drat • c» clwr Note- this plat Is subject to any Graphic SCale Easements_ Agreements, or 100 6a / 0 300 Rights -of Way of record. ap- parert on premises_ prior to date of this ptaL - 0Xra17 GtLFI-RENCE = D.8 40 F6%510 90- CDN rOUR INTERVAL p��Lt f�1 t w1 had/ M.Lrvty FIZDm L7f`<:QS L]F 2,EL en 1W40i s:O tL OC.&0%,4Ls O C2_Q%cL4% a0 /tT\e .•� `� u� e u tZ u .� G_ti T AaLt..-► t�¢� m L3 S CrS C26U Ab V-^ Ar 9 % _ -L CERTIFY THAT ON _ 19-- - WE SURVEYED THE PROPERTY SHOWN ON TMtS PLAT: ALL OF WH" WAS DONE UNDER MY - SUPERVISION FORSTACY CORNATZER -SCALE- -TOWNSHIP-1 -COUNTY- 0 -STATE- I -DATE- _z 100 FARM#JGTON DAVIE N -C- SURVEYED, OTISA-JONES SURVEYING CO, INC. MINW FIRST ST We1STOMSALMMC JOB NO. 1351-3 rAPPEo- dl'ssG Tax Map: Address: ! a'6 Fay jf c. ,j Installer: C)C"n;r 6Ct"t'-cs EHS: R ,!/ Date: 1- lb -40 -1 Operation Permit Inspection Checklist Location and Separation Distances 1. Distance from septic tank/pump tank to foundation/basement 'e-)cr SI#I s feet 2. Distance from system to well if applicable C cj u t y ,A, U f-ey- feet 3. Any other setback (.1950) requirements v --- Supply Supply line h'Q`diameter 1. Material supply line is constructed of inches 2. Length of supply line (2' min.) 3 , 3. Amount of fall in supply line (1/8" per foot min) 3(f 4. Distance from ST/PT to the nitrification field/dist. device) i feet -s Septic Tank/Pump Tank 1. Visually inspect top of tanks(s), interior & exterior walls, baffle wall and bottom e K!S 0f'` 2. Any honeycombing or exposed rebar present? Circle: YES or NO 3. Visually inspect sanitary tee, lids, and air vent for proper installation and sealant 4. Tank Serial Numbers: STB PT 5. ST w/in 6" finished grade? Circle: YES or NO 6. Date of manufacture: ST PT 7. Liquid capacity of tanks ST PT 8. Effluent filter type 9. Pipe penetration seal present? Circle: YES or NO 10. Riser(s) present? Circle: YES or No Riser Type 11. Pump Tank riser 6" above finished grade? Circle: YES or NO 12. Riser approved? Circle: YES or NO Nitrification Field 1. Septic Tank outlet elevation 2. Trench Depth Readings (inches) 3 4 - 3 t `� 3. Number of Trenches 3 Distance between trenches 4 ' dr R-��-- 4. Trench Width J 5. Aggregate material type and size 3 4 5 6 57 (Circle) 6. Aggregate Depth (inches) 7. Nitrification lines installed on contour? Circle: YES or NO 8. Innovative system typeL Q `( ki Installer certified for installation? Circle: -E0 or NO 9. 2' earthen dam between ST (or d -box) and beginning of nitrification line? Circle: YES or NO 10. Stepdowns a. 2' undisturbed earthen dam(s) Circle: YES or NO b. Proper rise over stepdowns? Circle: YES or NO c. Solid pipe used? Solid, Corrugated or other? d. Elevation of each stepdown e. Are all stepdowns lower than the ST outlet elevations? Circle: YES or NO Distribution Devices 1. Type ecv c r e `t e Is the device watertight? -e -5_ Is it level? IP -r S 2. Distance from Dist. device to trenches 3 ` J T, feet 3. Record elevations: Inlets Outlets DAVIE COUNTY HEALTH DEPARTMENT .cif Environmental Health Section Soil/Site Evaluation NAME jZ -4, 4A 'Ve ADDRESS PROPOSED FACIILTY�U� { DATE EVALUATED PROPERTY SIZE LOCATION OF SITE > CIyY Water Supply: On -Site Well _ Community Public Evaluation By: Auger Boring Pit Z_� Cut FACTORS 1 1 2 3 4 Landscape position L Slope HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH F Texture group Consistence Structure L & s /'/ Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 775 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: �EVALUATED BY: Ike 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 :lay loam- SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR- V+ ---y friable FR -Friable FI -Finn 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 3C -Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky SBK-Subangular blocky PL -Platy PR -Prismatic Mineralmy 1:1, 2:1. 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