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210 Oak Meadow Lane Lot 10DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: Billed To: Reference Name: Proposed Facility 990001715 Tax PIN/EH #: Wishon & Carter Builders Subdivision Info: Douglas & Marg. Bordner Location/Address: (Residence Property Size: ATC Number: 3811 5716-99-9062.W C Hunting Creek Lot # 10 Oak Meadow Lane -27028 10acres 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 Treatpent and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATE NST V I A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: CERTIFICATE **NOTE** The issuance of this Certificate of Completion shall inditake the has been installed in compliance with Article 11 of G.S. ChaN I Disposal Systems," but shall in NO WAY be taken as a guarant given period of time. 2i Faox —JI lzf cN LPS OLD) -- Septic System Installed B n Environmental Health Specialist's Signa _ DCHD 05/99 (Revised) TION Mn ibe S 'on, I t Sys u I on Improvement/Operation Permit 1900 "Sewage Treatment and i will function satisfactorily for any �U )i t� Dat : li DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section P. O. Boa 848/210 Hospital Street f •' Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001715 Tax PIN/EH #: 5716-99-9062.WC Billed To: Wishon & Carter Builders Subdivision Info: Hunting Creek Lot # 10 Reference Name: Douglas & Marg. Bordner Location/Address: Oak Meadow Lane -27028 Proposed Facility Residence Property Size: 10acres ATC Number: 3811 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type HOOSE #People L4 #Bedrooms Ll #Baths q Dishwasher: Ge Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: M Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size ID 4C -V- S Type Water Supply EAA— Design Wastewater Flow (GPD) LNO Site: New e Repair ❑ System Specifications: Tank Size 1CM GAL. Pump Tank GAL. Trench Width Zl� Rock Depth W Linear Ft. Other: -�t.A,J �/Au/� �15TQ1�rJT tctiJ!i'S Required Site Modifications/Conditions: lr-1bTaLyJ e c L, (, kLW 1S O' lj(X i. V4 -0—f jpp IMPROVEh1ENT/OPERATION PERh11T LAYOUT - APPROVED EFI FINISHED GRADE. ****NOTICE: Contact a represen ative of the Davie system between 8:30 a.m. to 9:30 a.m. or 1:00 p to 1:30 p.m. on the day of 1� 0wdt I y CAF S it'l� int �t,�� u►� to o�� X33 Environment th S st's S• re: DCHD 05/99 (Revised) V LTER. RISER(S) IF 6 " BELOW �t th Department for final inspection of this Telephone # is (336)751-8760.**** --T-0 LS oFpr-;-= 04ov- `tn �aN1lJ� 1,i5UQi� � /Da .77/7k� Jun 29 04 02:07p davie county envhealth 336 751 8786 p.2 APPIICArION FOR SRE EVAUATION/IMPROVEMENT PERM & ATC Davie County Health Department EnvhVnmenta/Health Sedyon P.O. Box 648/210 Hospital Street Mockaville, NC 27028 (336)751-8760 * * *IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLBSS ALL THE REQUIRED o t INFORMATION IS PROVIDED. Refer the INFORMATION BM-LETZN for instructions. I. Nam to be Bll2ed ! i l�.,r f .N �r„/c%ei5 Contact Person �C1[� Nailing address ;70�,.k /7/9 Nome Phone City/stats/ZIP V a lkr"n V !I e Ak Z 70 5� Business Phone 33 Cn • G 79' Zt7 I I 2. Name on Permit/ATC if Different than above QQU�/yt Nailing address Z-75 CCLc/i Scl K Qca, City/state/Zip 410C k 4:36 II _ AlI 7702-4R 1. Application For: 53 iite Lvaluation t Permit/ATrC ❑ Both 4. stem to service: House C3Mobile Some Business E3 Industry ❑ Other S. Type system reiuestedi LY Coo•rontionol ❑ Conventional modified ❑ innovative 6. I— �fResidence: i People y,,// i Bedroo_ms y B Sathroo®s 6115/h.asbsr ❑Garbage Dispcsal Mashing Machine OJSasemsnt/Plumbiag ❑Basement/No Plumbing 7. If Bueiness/Industry /others verity type i People 1-- i Sinks # Commodes i ioarars i Urinals i water coolers IF FOODSEMCB: # Seats Setimateed Water Vx&ge (gallons per day) S. Type of rater supplys ❑ County/City I�YWell ❑ Community 9. Do you anticipate additions or expansions of the facWty this system is intended to serve? Q Yes GYNa If yes, what type? •"IMPORTAN7-- CLIENTS MUST COMPLETETH E REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PIAT or Srf E PLAN MUST AE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: to d c r c S WRITE DIRECTIONS (from MacksWIle) to PROPERTY: Tax Office PIN: # 571C 9990 Z s Sir; cV.o Lt.. lZc\_ Property Address: Road Name ngk M,,a n t. I n . Lr --C 1- O v. Sr, . c : O V%- City/Zlp -6 c k s v �1 Io- � g If in a Subdivision provide htforma6m, as follows: i- n om= r D CV- rvX.a a A n L,2 Name: K �rs w.. S Rrnp.o r! - Section: Block: Lot: 10_ Date home corners !lagged: % - 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 l ant responsiblefor all charges hicurreel jronr this AppUcaddon. I, hereby, give consent to the Authorized Representative of the Davie County Ileaith Department to enter upon above described property located in Davie County and owned by D ,.c•/a s f /+�� .� �. i L�i•rc%, r.1- to conduct all testing procedures as necessary to determine the site suitability. ' DATE o X SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed rty lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge \y" Date(s): N CUent Notification Date: EHS: Sign given Account No. _ 0 O Revised DCSD (05/03 InvoiceNo. / �_-IT. •� '.'�� a 'tib r•� =w WON ";9 "v UME %P PON • , , O•�A EX.ST 4 1 t_XISTING IROk M 10 iN SET. AT 4- a0 CI 1 TREE g a . AREA = 10 oo. AC. N g AREA i o.000• AC. TAKEN FR M ' �' 473 . TAKEN FROM ? n,8, 310, PG., B . 310 , p G . 473 tIXISTING IRON ''1NG IRON `•� �, '+f '+ ,� .lr `, .�' •. • �'�,---._._ '�12.5 ' ' i. �. 414 2.1 dVh '� ted' i . •„� r .. • S' � � � ., t .�'Fy• � � , � ':, . . 4510, 0 : `" • ' :+ '1A �' `Y A . i '� �;. . • .. .__ ,111; N `rte„ ('. ] � •' ,Zs' .��.'' ft ` ``' �; tri • • .� .; ., t fes„• + s , _ - � . ,. '�.� ` Apr 06 04 181111M4111 davie county envhealth 336 751 8786 R _.I p.2 ,-/ —/,- T=aY APPLICATION FOR SITE- EVALUATIONJIMP1tOVEA111M' 11011111'1' S ATC / yl,.1, Dav'IC t w 4k n tm t ---7 -7! ' ' c oun y ca epar en C En�i�dni»entalffea/th Section -,/ P.O. Box 040/210 _� Hospital Street b1tr- Mocksville, 11C 27020 (33G)751-07GO ( �� ***Xb1P0RTANT*** THIS 11;?PLICATION CANNOT J32 PROCESSED UNLLSS ALL THE REQUIRED INFORMATION IS PROVIDED. Refor to tho INFORMATION BULLETIN for inoLxucLiouu. 1_ -Mine to be billed tv 2 d� Contac L' 11cruca Mailing Address ` + City/SL•ato/2IP llome Phone berd4.,,- ,j/ llamo on Permit/ATC it Diflorault than Above !�24S ____..... .. Mailing Address ;2 �� � !N p. N�/ City/StaL•o/'Lin /4 04,)1,1( / g! Application For:aitc RvaluaL-ion 13IlnproveincnL- Pcru►i•L/ATC lJ 11oL•h --4-Systcal to Service: IOUs(: 11 Mobile Home E -I Business ❑ Industry EJOLhcr � f $, Type system requested:* ❑ conventional modifiedc� ❑ ilwuvULivL y� ,r/C If Rcsidonce: R Peop] c Q Bedrooms / I( 13aLllroomw ! `�Lahwashcr ❑carbago Dial,oaal 01anhing Machina -it'DasomonL•/Pluahing ❑Daeomont/tlo pluwbinU 7. IL Duaiaoas/Induatry /Other: verily type a people u :;intra 1 Commodes tl Showers Q Urinals 11 WaLor Cooler:, IF FOODSERVICE: # Soat,3 Estimated Water Usage (galloun per day) ....... `�. Type of water supply: ❑ Cot.aty/Ci Ly Well ❑ Colwauni.ty Do you anticipate additions or eXpallsiolls of the futility this systcpl is hAeuded to Serve: ❑ Yes No if yes, what type? •*t1A11'oR' TL�lO17on1PLLTv'rut: xLQU11(GD rROPLlt'1'Y IMOltMATION Itl QUE-STI- i) �...! BELO . Eitl(era PLAT or SITZ; PLAN USrB-rSU11d117T13D by the client wiffi T IS APPLICATION. -�Irroper(y llinuusions: �� Q.c > ;.. . tln w1wCI'I0NS (1'r11111 A•lucl;svillc) lu 1'1tUPlilt'1'�': Tax office YIN: li CX perty Address: Road Nene _L /1? 1Q-via— ��a. r/YL City/Zip 464w, ��� XJC 42.2d, Y !M e .-tin a Subdivisioll provide hirornlalion, as follows: �'' '" 0-- Nanlc: %� ��c�-� S e, Section: Bloch: Lot: k-Pite house corners flagged: 7 This is to certify that the illfortuatiou provided is correct to the best of my icnowledbe. i understand that any llcrrllii(s) issued hereafter arc subject to suspeus. an or revocation, if the site plans or intended use (Mange, or if (lie iul'urm.,iiuu subulitled in this application is L'dsifica: or chaiiged. 1, also, aarlersland !ball (fill respoilsiblejul' all clrru5cs illcul-1-1 /i unr this application. 1, Thereby, give colucal to (lie Authorized Rcpresenla(ivc or the Davie CutuU 1; Ilc:ll h DeparUuerll to enter upon above described prupert;' located in Davie County and uyt'ticd by ✓� i'o%a�.rs _ _ to conduct all testing procedures as neci:ssary to deteruliue the site suitability. DA•rt; y ISIGNATURE 'Z& THIS AREA MAY BE USED FOR MMING YOUR SITE PLATY (Ltclude all of tllc fullowhig: Existing and prop used properly lines and dimensions, structures, setbacks, and septic locations). Site Revisil Charge Received Time AP 7:48AM Sign gtvcn Da(c(s): -- — Client Notification Date: EI1S: Account No. a r 7 3 AUG 1 4 2001 ENVIRM!'' ENTAL HEATH APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERRIIT & ATC Davie County Health Department EnvifonmentaiHeai i Section I 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. Name to' be Billed '� Q V e /gyp 6 rQ 0"( Contact Person / 2 -4 Mailing Address rt/ Lca4 09d Home Phone _ City/State/ZIP Name on Permit/ATC if Different than Above Mailing Address 3. Application For: 4. System to Service 5. If Residence -1-N Dishwasher Gls�ltl Evaluation LA ouse ❑ Mobile Home # People Business Phone 3 54 --7-1-/- a2Z2 City/State/Zip ❑ Improvement Permit/ATC II Both ❑ Business fl Industry II Other # Bedrooms # Bathrooms 2— ❑ Garbage Disposal `- Washing Machine asement/Plumbing II Basement -/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals 11 Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City ell I1 Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? CI Yes I I No If yes, what type? _ ***1AI1-'0RTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUI?STED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTF.D by the client with THIS APPLICATION. Property Dimensions: ! 0 4CAW Tax Office PIN: # S%2ka— 9 (oQ/( Property Address: Road Name 00,(e- me-aA w IiN City/Zip W dcs''i 111 A) (— . If in a Subdivision provide information, as follows: v Name: 1J t7'n t1u,,L --)0i/ Section: Block: Lot: WRITE DIRECTIONS (from Atocl6%,ille) lu PRUPI',WIT: c - �-tX RSO Q_Ar'1 t�Q�A 2 Date Property Flagged: A/r This is to certify that the information provided is correct to the best of my knowledge. I understand that any permil(s) issued hereafter arc 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. 1, also, understand that I ani responsible fir all charges incurred froin this application. I, hereby, give consent to the Authorized Representative of the Davie County IIealill Departill ell t to enter upon above described property located in Davic.County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE - l I q / SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the fo owing: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. Invoice No.L FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 2 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: As LONG-TERM ACCEPTANCE RATE: REMARKS: LV LEGEND Landscape Position EVALUATION BY: / ' "6/ 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 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) DAVIE COUNTY HEALTH DEPARTMENT y►• .. Environmental Health Section • AL. Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001880 Tax PIN/EH #: 5726-98-6129sr Billed To: Steve Robertson Subdivision Info: Hunting Creek Lot # Reference Name: Location/Address: Oak Meadow Lane -27028 Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: On -Site Well Community Public ' Evaluation By: Auger Boring t,-, Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH 2 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: As LONG-TERM ACCEPTANCE RATE: REMARKS: LV LEGEND Landscape Position EVALUATION BY: / ' "6/ 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 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) ■ ■ ■ ■■RM■■■ ■PAPE■■ MKIZUR■■ ■E■■■■M ■E■■E■■ M■M■EE■ ■■EMME■ ■■■M■M■ ■■■■■■■ ■■E■EM■ E■■■■■■ ■■■EMM■ ■■MME■■■■E■E■■ ■■M■E■M■■M■M■■ ■■E■E■E■■E■M■■ ■■MNEME■■M■ME■ ■■EME■EMMEMME■ ■■M■M■M■■M■M■■ ■■■MEN■■EM■■■■ ■■■MM■■MMMMMM■ ■■■■E■■■■■■■■MM■ ■■EM■■E■E■■M■MM■ ■■■M■■E■■M■M■MM■ ■EMMEME■■■■■■■■■ ■■■EM■■■■EM■■■E■ ■■■M■■E■■EME■■M■ ■■M■■■E■ME■■■E■■ ■■■M■■EMMEMEMME■ ■■M■E■E■■E■■■ME■ ■■MME■E■ME■■■ME■ ■■EME■■■EME■■EE■ M■M■EM■EMEM■MEM■ ■MMEM■■MEMEMEMM■ ■■■■■■MEM■■■■■■■ ■■MEM■■ME■EMMEM■ ■■EMMME■EMEMMEM■ ■■M■■■■M■MEM■■E■ ■M■MMM■MMMM■M■■M ■■MMME■M■■E■■ME■ ■■■MEMMEMEMEMEM■ ■■■■■■MEMS ■EM■■E■■M■ ■MM■■■■ME■ ■■E■M■MEM■ MMEEMEMMEM ■E■ME■■■ ■■■M■■EMS■ MEMMEMMOMM MEMEMEMEME ■■■■■■■■■■ ■■■■■■■■■■ ■E■EMME■■■ ■EM■■EM■ ■■E■EM■■ MMEMMEMMEM MEMEMMEMEM ■■■M■EMM■■ ■MEMEM■MEM ■EME■■M■■■ ■ESSEE■■■■ HEMM■■■M■ ■EMEM■M■ ■ ■E■S■ ■EN■■ ■O■■■ ■E■E■ ■E■EM M■■■■ ■E■■■ ■O■■■ ■E■E■ ■MME■ ■E■E■ ■EEE■■ ■EMM■■ ■■■N ■OE■ ■■M■ ■■E■ NONE ■EM■ ■EM■ ■ON■ ■OO■ ■ME■ ■EM■ NE■N V <1 O0. NEW iRON SR AT BEEC" TREE AREA = N� 89 51 • � Se !r 10 y S/ 6 /S °g. Ex SitNG IRON O ✓ / O � o o W. MICHAEL MEBANE PLAT BK. 6 Pg. 180 % i` i Pf Y qZ r� O cp AREA = N� 89 51 • � Se !r 10 y S/ 6 /S °g. Ex SitNG IRON O ✓ / O � o o W. MICHAEL MEBANE PLAT BK. 6 Pg. 180 % i` i Pf DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003173 Tax PIN/EH #: 5716-99-9062 Billed To: Steve Robertson Subdivision Info: Hunting Creek Lot # 10 Reference Name: Location/Address: Oak Meadow Lane- 7028 pp Proposed Facility: Residence Property Size: see map Date Evaluated: Y �3 Water Supply: On -Site Well / Community Public Evaluation By: Auger Boring Pit V/ Cut 5ZI. tin ^ SITE CLASSIFICATION: (-5 LONG-TERM ACCEPTANCE RATE: f? . -Z,— REMARKS: LEGEND Landscane Position EVALUATION BY: 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 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) Landscapeposition Mff NOWA A HORIZON I DEPTH Texture group Consistence off SWUMM HORIZON II DEPTH onsistence Mineralogy HORIZON III DEPT�Ga'��s7G",Mw� 10 0 HORIZON ��®®1li7� M, Textgroup_ Consistence --- i�'`�--- • SAPROLITE SITE CLASSIFICATION: (-5 LONG-TERM ACCEPTANCE RATE: f? . -Z,— REMARKS: LEGEND Landscane Position EVALUATION BY: 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 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) ■ ■ ■ ■ ori■ ■■■■■■■■■■��■■■■■■■■■■\�■ MAN" MEN■E■ ■NAME■ ■■■O= ■■mom■■■■■■■■■�ieM■■■■_..m■■■ ■■Moo.■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■11,1■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■E■ ■o■■■m■■ ■E■■NEE■ ■M■NEE■■ ■o■■■■m■ ■E■■■EE■ ■■EE■■M■ ■■■E■■■■ ■E■■■■■■ ■■■■NEEM ■■■■NEEM ■■■■■■■■ mmmom■■■ m■■■■■■■ ■■■■■■■■ ■;-.■■■■ ■v■■■■ A■A■■■■■■■■■■■■ ■RSEE■E■EE■■■■■ mzm■m■m■■■■■■■■ MEWME■■■■■M■E■E WHEN■■■■■■■■■■■ ■u■■M■M■■■■■■■■ r.■■■E■■■■■■■E■■ A■■■■■■■■■EE■E■ ■■■■■■■■■mommom ■■NEEM■■■■■E■■■ NESE■■■■■■MM■■■ ■E■■■■■■■■■E■■■ ■■■NEM■EE■■■■E■ ■■MME■■■■■■■ME■ ■■EM■EME■■■■■E■ ■■■E■■■E■NEEME■ ■■EE■■■E■EE■■■■ ■EEM■EEMEMM■ME■ ■■■m■■m■mm■■m■■ NEEM■■E■N■■EEM■ ■■ENE■■■■M■ENE■ ■N■■■MENME■■■■■ ■■ENE■■EMEMENN■ ■■■■EMENNE■■■M■ ■M■■M■■E■MEME■■ ■EE■■■■■■■■M■■■ ■■E■E■N■ ■m■mm■■0 ■NEEM■■■ ■■EM■■E■ ■■mm■E■■ ■■■■moms ■■m■■mm■ ■E■E■E■■ ■ommmo■■ ■mmommo■ ■■mmo■o■ ■MMM■m■■ ■M■E■E■■ ■moo■■m■ ■o■■■■m■ m■■mmm■m ■o■■m■■■ ■Ammo■■■ mmmm■mm■ ■ENE■■N■ ■■mm■■m■ ■Ammo■■■ ■■m■■m■■ ■NNNEM■■ ■m■■■■o■ ■omm■m■■ ■m■■mm■■ ■■■m■oo■ ■E■■EE■■ ■ommo■■■ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 /Fax: (336)751-8786 April 29, 2004 Steve Robertson Douglas Bordner PO Box 1147 Mocksville, NC 27028 Re: Site Evaluation - 10 Acre Tract/Oak Meadow Lane Tax PIN#: 5716-99-9062 Dear Mr. Robertson and Mr. Bordner: As requested, a representative from this office visited the above site April 23 and 29, 2004 to perform a site evaluation. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an oversized, modified on-site sewage disposal system. Due to rocky soil conditions, exploratory backhoe pits will be required in the area designated for the septic system prior to its construction. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct, the appropriate application must be completed and submitted to this office. The location of the facility the system is to serve must be staked off. Enc(s) If you have any questions, feel free to contact this office at 751-8760. Sincerel Jeff G. Beauchamp, Environmental Health Section 06 &7 9 I j f Aoue- ,p g cj I.96*106L99C6 831NU3 WOHSIM aoc:co so sa idu Phone: (336) - 753 - 6780 rax: (336) - 753-1680 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement !" Remodeling ,' Reconnection Name: �-1c,���E-� �t is=�.e a��- . cQ,'L Phone Number L?`` i .� Home Mailing Address: D, g.,C 17 19 (cC i'' (Work) yea � Ns, lt� ty L. Z"iOSS n Detailed Directions To Site: .) e.r.-c �d C Ir. �-•� Ck .-na NN��rcP.� (� ,,� ^p l�a 3, A44 r -,j Ott 1*- Al ea >> Pin t r il w" -J L9 t, f Z 10 6,41e 1A*- Eaw JA- t_ Property Address: Z % O OAk Ae..- c , LR^-- L - Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: De, 1 A �k ffj R re k -9w' ^.r -L -r'" Type Of Facility: Date System Installed (Month/Date/Year): C /3v /® y Number Of Bedrooms: Number Of People: Is The Facility Currently Vacant? Yes N� If Yes, For How Long? Any Known Problems? Yes No If Yes, Explain: 13 Please Fill In The Following Information About The NEW Facility.: t. Type Of Facility: Number Of Bedrooms: Number of People Requested By: Date Requested:. ,.Z L -161 (Si a e) For Environmental Health Office Use Only ApprovedDisapproved Comments: ©�, G 1'✓1 Q � � 5� a ((Q f ,t6j LJO 5 e � 6,j rj u� i (.t � to � (i► � h � � aK �y a 3 6 ckrA V\ &N Environmental Health Specialist f Date:_ *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash Check Money Order Paid By: Account #: Amount:$ ived By: Invoice #: Davie County Health Department ,a Environmental Health Section P.O. Box 848 F r A n 210 Hospital Street "'NE„ Courier # : 09-40-06 1 Mocksville, NC 27028h; ,r Phone: (336) - 753 - 6780 rax: (336) - 753-1680 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement !" Remodeling ,' Reconnection Name: �-1c,���E-� �t is=�.e a��- . cQ,'L Phone Number L?`` i .� Home Mailing Address: D, g.,C 17 19 (cC i'' (Work) yea � Ns, lt� ty L. Z"iOSS n Detailed Directions To Site: .) e.r.-c �d C Ir. �-•� Ck .-na NN��rcP.� (� ,,� ^p l�a 3, A44 r -,j Ott 1*- Al ea >> Pin t r il w" -J L9 t, f Z 10 6,41e 1A*- Eaw JA- t_ Property Address: Z % O OAk Ae..- c , LR^-- L - Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: De, 1 A �k ffj R re k -9w' ^.r -L -r'" Type Of Facility: Date System Installed (Month/Date/Year): C /3v /® y Number Of Bedrooms: Number Of People: Is The Facility Currently Vacant? Yes N� If Yes, For How Long? Any Known Problems? Yes No If Yes, Explain: 13 Please Fill In The Following Information About The NEW Facility.: t. Type Of Facility: Number Of Bedrooms: Number of People Requested By: Date Requested:. ,.Z L -161 (Si a e) For Environmental Health Office Use Only ApprovedDisapproved Comments: ©�, G 1'✓1 Q � � 5� a ((Q f ,t6j LJO 5 e � 6,j rj u� i (.t � to � (i► � h � � aK �y a 3 6 ckrA V\ &N Environmental Health Specialist f Date:_ *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash Check Money Order Paid By: Account #: Amount:$ ived By: Invoice #: GoMAPS - Davie County NC Public Access hA z i ROWAN ?+ Ls --ILL LG'lPT RD 1 Do462ft I I WATERSHED -STRUCTURES L WATER_BODIES 71 COUNTY -BOUNDARY , STREETS DAVIE COUNTY RAILROAD _CENTERLINE L—I PARCELS CITY -LIMITS ***WARNING: THIS IS NOT A SURVEY!*** This map is prepared for the inventory of real property found within this jurisdiction, and is compiled from recorded deeds, plats, and other public records and data. Users of this map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on this map. The County and mapping company assume no legal responsibility for the information contained on this map. 71 mall other values> Wednesday, July 12009 BERMUDA RUN COOLEEMEE , DAVIE COUNTY MOCKSVILLE nccounttcs Z{ DAVIE ***WARNING: THIS IS NOT A SURVEY!*** This map is prepared for the inventory of real property found within this jurisdiction, and is compiled from recorded deeds, plats, and other public records and data. Users of this map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on this map. The County and mapping company assume no legal responsibility for the information contained on this map. 71 mall other values> Wednesday, July 12009