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252 Bean Road Lot 6Davie County, NC Tax Parcel Report Thursday, November 3, 2016 WARNING: THIS 1S NOT A SURVEY - Parcel Information Parcel Number: N600000096 Township: NCPIN Number: 5745923737 Municipality: Jerusalem Account Number: 82529529 Census Tract: 37059-807 Listed Owner 1: HEWITT ROBERT DONALD JR Voting Precinct: JERUSALEM Mailing Address 1: 252 BEAN ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: DAVIE COUNTY CZOD Zip Code: 27028-0000 Voluntary Ag, District: No Legal Description: LOT 6 BOXWOOD ACRES Fire Response District: JERUSALEM Assessed Acreage: 5.22 Elementary School Zone: COOLEEMEE Deed Date: 7/2010 Middle School Zone: SOUTH DAVIE Deed Book / Page: 008310839 Soil Types: PaD,PcB2,PcC2,ChA Plat Book: 0005 Flood Zone: Plat Page: 137 Watershed Overlay: DAVIE COUNTY Building Value: 226860.00 Outbuilding & Extra 0.00 Freatures Value: Land Value: 48040.00 Total Market Value: 274900.00 Total Assessed Value: 274900.00 Davie County, data Is provided as Is without warranty or guarantee of any Idnd either expressed or implied Including but not limited to the Implied warranties of merchantability or fitness for a particular use. Ati users of Davie County's GIS website shall hold harmless the E01All Nr 1. County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to or arising out of the use or Inability to use the GIS data provided by this website. Account M 990002166 Billed To: Melvin Reid Reference Name: ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ,�26-Z 800P Pd, Tax PIN/EH #: 5745-92-3737.06 MR Subdivision Info: Boxwood Acres Lot # 6 Location/Address: Bean Road -27028 P. Proposed Facility: Residence Property Size: 5.22 acres ATC Number: 2735 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 CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Aeaqe.6n�A' Date: 4-1_ CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. a Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: :�e .,j d - % 2 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ' P. O. Bos 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #. 990002166 Tax PIN/EH #: 5745-92-3737.06 MR Billed To: Melvin Reid Subdivision Info: Boxwood Acres Lot # 6 Reference Name: Location/Address: Bean Road -27028 Proposed Facility: Residence Property Size: 5.22 acres ATC Number: 2735 **NOTE** This Improvement/Operation Permit,DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People_ #Bedrooms 2 #Baths 2_ Dishwasher: El -----Garbage Disposal: ❑ Commercial Specification: Facility Type Washing Machine: El ----Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ #People #People/Shift #Seats Industrial Waste: ❑ Lot Size d Type Water Supply Design Wastewater Flow (GPD) G o Site: New ft --Repair ❑ System Specifications: Tank Size%O ° ° GAL. Pump Tank ' GAL. Trench Width36 Rock Depth / Z 1� Linear Ft3 J O / 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 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.**** 14 Environmental Health Specialist's Signature: DCHD 05/99 (Revised) �u Date: O DAVIE COUNTY HEALTH DEPARTMENT **Ni3TE'ibinprovement/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 #People _ #Bedrooms r_ #Baths Dishwasher: d Garbage Disposal: ❑ Washing Machine: d Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size A Type Water Supply Design Wastewater Flow (GPD) ,r'� Site: New Repair ❑ System Specifications: Tank Size % GAL., Pump Tank GAL. Trench Width Rock Depth Linear Ft. 0?4 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 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.**** it des tit 9S Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) Environmental Health Section . + P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 ' (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001623 ��5� Tax PIN/EH #: 5745-92-3737.06 Billed To:T�mmp Cop�7Subdivision Info: Boxwood Acres Lot # 6 Reference Name: '%e�V4v liN1J Location/Address: Bean Road -27028 - Proposed Facility: Residence Property Size: 5.22 acres **Ni3TE'ibinprovement/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 #People _ #Bedrooms r_ #Baths Dishwasher: d Garbage Disposal: ❑ Washing Machine: d Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size A Type Water Supply Design Wastewater Flow (GPD) ,r'� Site: New Repair ❑ System Specifications: Tank Size % GAL., Pump Tank GAL. Trench Width Rock Depth Linear Ft. 0?4 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 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.**** it des tit 9S Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001623 Tax PIN/EH #: 5745-92-3737.06 Billed To: Tommy Cope Subdivision Info: Boxwood Acres Lot # 6 Reference Name: Location/Address: Bean Road -27028 or.,.,o.+., Qin- 8. 99 aeras Proposed Facility: Residence. - ATC Number: 2735 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 WASTEWA CONSTRUCTION IS VXFOR 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 Improvement/Operation Permit has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: DAVIE COUNTY HEALTH DEPARTMENT •�` IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE`Issued in Compliance With Article 11 of G.S. Chapter 130a S nit ry S wages stems // Permit Number Name �l� DateN2 6.770 Location - (,�.� ,��~/ ✓ �����1�:�i v� �- ,.�T �,��,�/�� Subdivision Name rl.- Lot No. Sec. or Block No. w Lot Size — House 4Z Mobile Home __.._._. Business Speculation No. Bedrooms_, No, Baths No. in Family. Garbage Disposal YES 0 NO 2r" Auto Dish Washer YES NO 0Specification�sofor System: Auto Wash Maohine YES NO Q Type Water Supply APPLICATION FOR SITE EVALUATION/IMPROVEMENT PEIIMIT & { Davie County Health Department Enviro17menta/HeaX1Secti0n P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Me ,li 1 'EL&r -e 9 i�Z_ Contact Person Mailing Address h( %(f �OJGX/1 / C. Home Phone % P �.i 31-14 q 4 City/State/ZIP S / t S KLA+ .�Q 1 ��f Business 76 Y -� Z/4 -41 Z 2. Name on Permit/ATC if Different than Above sPPhone ( JC.Cic T d �" 3 Mailing Address City/State/Zip 3. Application For: 9� to Evaluation @/Improvement Permit/ATC Both 4. System to Service: U /House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People .3 # Bedrooms # Bathrooms ^3 �shwasher 4-6krbage Disposal &,Wa'shing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes S_ # Showers # Urinals 3 # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? 'IMPORTANT' CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: cj. L 2• Tax Office PIN: #-S%,S-% Z- 3 ? 3 ? Property Address: Road Name N /Lo City/zip If in a Subdivision provide information, as follows: Name: WRITE DIRECTIONS (from Mocksville) to PROPERTY: 661-A-1600% iV $2,4A.1 RI) 4u 2n/ 11.1', kt X41 o wf Y6u-t- g1UGIG f Doul -t •2tlS w, -a- ISL Du,t,�e Section: Block: Lot: Date Property Flagged: / `-5, / 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 1 an: 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 to conduct all testing procedures as necessary to determine the site suitability. DATE 2 /i. d 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). Cie_ Revised DCHD 07/99 u— V Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. -5 2► Invoice No. INDEXED ON 5745 I 306 I 228 I 223 1 517 039 039 60000009 i.12A C) co 0841 5.22A 5.18A 3737 5.05A co 8793 6721 126 S R 1202 340 353 200 260 BEAN ROAD 205 205 Q1 gyp` 6936 5.08A 2727 BEPN '0 301 50 ,99 250 039 0 400 8442 0 9209 0 1231 356 9155 0 9091 400 o- 0 (2.78A) 0759 039 S R 1202 q00 039 N � 1532 (1.11A) 200 400 a 2 8314 n �J (3.24A) O !i 2311 200 m (16.78A) N� (2.98A) a29 STATE PROJECT #8.1810201 SHEETS #22,23,24,& 25 •' DAVIE COUNTY HEALTH DEPARTMENT - Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990002152 Billed To: Melvin Reid Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: On -Site Well Property Size: PROPERTY INFORMATION Tax PIN/EH #: 5745-92-3737.MR Subdivision Info: Location/Address: Bean Road -27028 5.22 acres Date Evaluated: Community Auger Boring 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: EVALUATION BY: 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 DCHD 05/99 (Revised) ' - APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT &ATC � Davie County Health Department d Environmental Healfh Section P.O. Box 848/210 Hospital Street FEB 2 7 2001 Mocksville, NC 27028 (336) 751-8760 ENVIRONMENTAL HEALTH DAVIE ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed r7W If% % C e /O Contact Person Mailing Address c20P e PW, Home Phone �,} / � City/State/ZIP &�iS(�/ l/G � C �Q� p Business Phone 2. Name on Permit/ATC if Different than Abo� e^--� Mailing Address City/State/Zip 44,rrLb w i/—, 3. Application For:-' -mite Evaluation Improvement Permit/ATC ❑ Both 4. System to Service: House ❑ Mobile Home ❑ Business ❑ Industry 0 Other S. If Residence: # People c # Bedrooms .3 # Bathrooms Dishwasher ❑ Garbage Disposal ( Washing Machine O Basement/Plumbing O Basement/No Plumbing 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 A Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes XNo 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: 30 X 7G 5- S, as a r. Tax Office PIN: # 57415, 9 g-3 731, Property Address: Road Name leal, Rte____ city/zip 1%l0c k3y,'%/ C /V G If in a Subdivision provide information, as follows: Name: A X lived' ZD � 6 Section: Block: Lot: 6 WRITE DIRECTIONS (from Mocksville)to//PROPERTY: Pah �n� ;S, #e iL"P�<�e .l�PG/ h iKda�• Date Property Flagged: . 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 C'oy to conduct all testing procedures as necessary to determine the site suitability. DATE- SIGNATURE 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). Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. —A 3 Invoice No. CP—/ 6 (P . 274 1. 26 I 2 3737 5.05A 6721 toe// 260 205 I 228 Njk e u APPI (CATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department D /*/ E Environmental Health SbWon P.O. Bos 848/210 Hospital street DEC - 9 10 Mocksville, NC 27028 v, 1336) 751-8760 ENVIRONMENTAL HEALTH nevir enuem ***n,ZPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PR(1. //OVIDEDJ/ I a G . -Rafeer to the INFORMATION BULLETIN for instructions. 1. Wame to be Billed i n 4 a t, l b r o o k= cc/ntaat Person h -)' n C�a !T a a lb e -o o k Mailing Address EO Bo x HOLE T Bo oe Phone X944 -a D - O O City/State/ZIP Co o l ee m e.e+ NL a -701 y Business Phone 75-1 --5-75 Z. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: site Evaluation 4. system to service: House 0 Mobile Home s. If Residence: # People City/State/Zip 0 Improvement Permit/ATC 0 Both 0 Business 0 Industry ❑ Other # Bedrooms _ # Bathrooms 0 Dishwasher 0 Garbage Disposal 0 Washing Machine 0 Basement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/other: Specify type # Co®modea # showers # Urinals # People # Sinks # hater Coolers Ir FOODSERVICE: I Seats Estimated hater Usage (gallons per day) 7. Type of crater supply: ❑ County/City 9 Well ❑ coma►unity s. Do you anticipate additions or expansions of the facility this system is intended to serve! 0 Yes ❑ No If yes, what ype? ***IMPIDRTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. Pmperty Dimensions: yaJ ;d WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax OMce PIN: # 514 5 a - 3 `7 374ODo,�� a ke � o I s � ba 55 S o l Property Address: Road Name Lai' 4 (o Bean Rd. i n fec -se-c,+ i o rt 0 CCP p r O X r(e-s . City/Zip � � � r'1 � d • 1 � 0 `� j�,2. u �' t0 �GtS�" If in a Subdivision provide information, as follows:' °Zg k a u ; � on r i � h f ) Name: Section: Block: Lot: _ Date Property Flagged: /,2 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 responsiblefor all charges incurred form 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,;„�a ({hro ok JRck�e Gvmaaer to conduct all testingprocedures as necessary to determine the site suitability. DATE /-2 ' 0 G� 0d 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). Revised DCHD (07/98) Account No. 30Q Invoice No. r 'DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P,PPLICANT INFORMATION Soil/Site Evaluation PROPERTY INFORMATION Account #: 989900300 Tax PIN/EH #: 5745-92-3737.000E Billed To: Linda Haulbrook Subdivision Info: Reference Name: Location/Address: Bean Road (Site 6)-27006 PROPOSED FACILITY: W DATE EVALUATED: PROPERTY SIZE: �S✓�� Water Supply: On -Site Well Community Public Evaluation By: Auger Boring ✓ Pit 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 Ali 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 Landscane Position EVALUATION BY: zeaezl OTHER(S) PRESENT: 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 tructure 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 (Revised 11/98) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ I■■mss■ss■■s■■■�_■_.:.■■■■s■�:::i■■■■��I•/..�::�■ ■ ■ ■ ■■■.•■■E■ME■ ■■■■■SMMMME■ ■■■■■`■iii■ii ■■■■s■■■M■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ice■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■/■■■■■■■■■■■/■■■■■■■■■■■■■■ ■EE■■■ ■ ■ ■ ■■mons ■■mons ■E■■E■ ■■■■n■ ■E■■n■ ■soon■ ■■■■n■ ■■■■■■ ■O■ME■■EME■ ■EMEM■■MM■■ ■MEMOMMEME■ MEMO ■■ ■ Environmental Health Section P. 0. Box 848/210 Hospital Street Courier 09-40-06 Mocksville. NC 27028 January 8, 1999 Linda Haulbrook P. O. Box 1104 Cooleemee, NC 27014 Re: Site Evaluation Bean Road (Site 6)/5.22 Acres Tax Office PIN: #5745-92-3737 Dear Client(s): As requested, a representative from this office visited the aforementioned site on January 6, 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 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, Ae� Robert B. Hall, Jr., R.S. Environmental Health Specialist RH/wd Enclosure(s)