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307 Oak Meadow Lane Lot 6Account #: 990001690 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Billed To: Bill & Teresa Balkcum Reference Name: Proposed Facility: Barn IPA- a/ Tax PIN/EH #: 5726-98-6129.05 Subdivision Info: Hunting Creek 20 Lot # 5 Location/Address: Hunting Creek Farms -27028 Property Size: 20 acres * *NOTES * T i bfinproveeme nt/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 AA #People #Bedrooms _� #Baths j_ Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: 0 Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #/Seeats Industrial Waste: ❑ Lot Size �C Type Water Supply � Design Wastewater Flow (GPD) Site: New Repair El System Specifications: Tank Size ,vv GAL. Pump Tank GAL. Trench Width, -'?Z Rock Depth & Linear Ftp Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) 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.**** NA 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 #: 990001690 Tax PIN/EH #: 5726-98-6129.05 Billed To: Bill & Teresa Balkcum Subdivision Info: Hunting Creek 20 Lot # 5 Reference Name: Location/Address: Hunting Creek Farms -27028 Proposed Facility: Bam Property Size: 20 acres ATC Number: 2800 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: CERTIFICATE OF COMPLETION Date: **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: IVI APR 7 2001 ENV{ROVIENTAL HEAL IN FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department En wivnmental Hea/tfi Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)75;-87.60 - 4-)l It app lefto!Se- LJdZKPt1M 117,0/ gales t-A&tL &a . . do- t rp -lve ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. l 1. Name to be Billed Contact Person Mailing Address =0 Home Phone _11. City/State/ZIP Al. .1-�--_ Business Phone r 2. Name on Permit/ATC if Different than Above Mailing Address City/state/Zip 3. Application For: ❑ Site Evaluation lrImprovement Permit/ATC ❑ Both 4. system to Service: ❑ House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: # People # Bedrooms / # Bathrooms L1 Dishwasher ❑ Garbage Disposal V ashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # showers # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City 94e11 ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETE,THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION. Property Dimensions: D-0 ►' Tax Office PIN: # S%(o - %9 - (o /�.� 5 Property Address: Road Name ,/")/ a A l"ir er'e.lk City/Zip f21at,1'svc`l e NC If in a Subdivision provide information, -aass follows: Name: Ud i't, r1/111 ,f /�tl ill Section: Z - 3 Block: cP6 Lot: "11®r, Date Property Flagged: '�C (� - '14-2-0 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 froirr 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 T' /7 - D / SIGNATURE i&yl- 61', �i% 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) t Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. / (o / 6 -a Invoice No. �- APPUCATION FOR SITE EVAUTATION/IMPROVEMENT PERMIT & ATC v Davie County Health Department D Environments/ Health Section2 6 j�99 f �s B.O. Box 848/210 Hospital Street Mockaville, MC 27028 (336) 751-8760N; ***IMPORTANT*** THIS APPLICATION CANNOT BS PRO=5S]D UNLESS ALL THE REQUIRED INFORMATION IS PROVIDEDRefer. Refeto the IMiPORMATION BULLETIN for instructions. `2R 1. Name to be Billed IC l / i LL Contact Parson AA eP_, 'IL Mailing Address Homs Phos. 3 9 —9 City/state/sIp MSEV L Lis NCI,27:7 Dar ? susiness Phone 33 L %5/ - 57 �5 1_ /_ — ,i JJ -1 . Z. Maas on Perait/ATC if Different than Nailing Address city/state/sip A/061(\ SV;' 7e,2 P 3. Application for: )48its Evaluation 0 Improvement Permit/ATC 0 Both a. systen to service: XBouse 0 Mobile Home ❑ Business 0 Industry 0 Other S. If Residence: i People *2) Bedrooms # Bathrooms _Dishwasher O Garbage Disposal )washing Machina Xnasesent/Plnabing 0 8assmant/No Plumbing 6. If nosiness/Industry/Others specify type # Commodes # people i sinks i shovers ! Urinals f water Coolers IF I=SERIIICE: # Seats Estimated Nater Usage (walons per day) 7. Type of water supply: 0 County/City ,Nell 0 Community e. Do you anticipate additions or expansions of the factiity this system is intended to serve? 0 Yes Ilq'*No V yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: /K P1)A4f1?F M e_7^ WRITE DIRECTIONS (from Mocksville) to PROPERTY: VTa:Office PIN: #5 7a Co 9M& l a e1 :5L�sc�r�2y s� ,, %7 ✓U„%�Q-✓ ®PSL Property Address: Road Name 0A4 "ouJ 14,0r V knll,tfCao CityfLlp1VOPksill Lzz-d /�✓ /1 /��7�Dr�/ TLE�1�C V in a Sa ows: fvisioa provide information, as foll�- Name: TN _F0 14UN�/�l G �F.L-q2, S rw Block. a Lot. DA"k M fDoc� Section: �'"' - 3 •-$ � Date Property Flagged: 3 —9 y, 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 1, also, understand that 1 ane responsible for all charges incurredfrom 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_W4/��[� 1 i � to conduct all tea g procedures as necessary to determine the site suitability. �^ (r DATE 2 1.007� THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inikude all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EAS: Revised DCHD (07/99) Account No. Q Invoice No. / g I APPLICANT INFORMATION Account #: 990000751 Billed To: Harry Hill Reference Name: Harry Hill Proposed Facility: Residence Water Supply: Evaluation By: On -Site Well Auger DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5726-98-6129 Subdivision Info: Hunting Creek Farms L-3, Block 204d-5_ Location/Address: Oak Meadow Lane- 7 8 Property Size: 10.00 Acres Date Evaluated: Community Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % chi 74 HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence ` Structure / i' Mineralogy / ` / P'` 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 S SITE CLASSIFICATION: Z5 LONG-TERM ACCEPTANCE RATE: /1 REMARKS: 1liPcS; LEGEND EVALUATION BY: t?�C� OTHER(S) PRESENT: 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) I ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■BOOB■■■■.■■e■■■■■■■■■■■■■■■■■■■ ■■■■■■SBE■■■■�■■■■■■■■■■■■��-�Nii ■■■BOOB■■■■■■N■■■■■��■■■■■■■■■■■■■ ■■BOOB■■■■■■■■■E■■■■�■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MENEM iMEMNONMEMNONiiiiiim No ■■BOOB■/■■■.■N■■e■■■■■■■■■■■■■■■■ ■■■■■■t1■lrti's■■■■■■■■■■■■iriGiil■■■■■/1 ■■■■■[1■t]■■■■■■■■■■■■■■■Gii■!1■■ ■It ■■/BeeBOOB■■II■■■■■■■■■■■■1!I■■■■■■ ■■■BOOB■■■■G■■■■■■■■■■■■■■�■■■■■C\ no ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ mom ONE MEN iii ■■■■N■ ■■MMES REEME■ MEM■E■ ■OMEN■ ■■MMES ■■■N■■ ■■■■E■ ■■■E■■ SEEN■■ ■■MMES ■■■M■■ ■■■NO■ ■■■■O■ ■E■NO■ ■■MOON ■■MENS ■■MMES ii ME no ■■■■■■■■ ■■■■■■■■ ■■■■■■■■ NONSENSE OMENS ■■N■■ ■E■E■ ■■■E■ OMENS MEMOS SEEMS ■■■E■ ■■EE■ -- OBOE NOME ME No ■■ BE ■■ ii ii no No No No ■■ ■■ ■■N■E■S■ ■ESEEME■ ■■■■■■■■ ■■■■■■■■ ■■■Bosom ■■■■■■■■ ■■■■N■■■ ■■■■■■■■ ■■■ES■■■ ■E■■N■■■ ■M■N■■■■ ■MEMS■E■ ■ONS■■■■ ■■■■■■■■ ■■■■■■■■ ■ENN■■M■ ■O■S■O■■ ■■■■■■■■ ■■■■■■■■ BENNE■M■ OBSESSES ■■SE■■■■ OBSESSES ■E■NEE■■ NONSENSE ■EEM■■E■ A E V E O V E D MAR Z 4 2004 1 2 ENVIRONMENTAL HEALTH !'LIGATION FOR SITZ• L'VALUATION/IMPROMIL•1l•f I'L'IA UT & A•I-C Davie County Health Department EnYironmenta/Hes/i/, Section P.O. Box 848/210 Honpital Street Mocksville, NC 27028 (336) 751=8760 TRIS APPLICATION C1IN2VOT BE PROCESSED UNLESS ALL IIE REQUIRED - I INFORMATION IS PROVIDED. Refor to the INFORMATION BULLETIN for instructions. Name to be Dilled Mailing Address City/State/ZIP ` -,A10'Ck:Q I I 1 0 Y(::: liamo on Permit/ATC if Different than Above_ C,d4yh Q ConL-acL Per::31r/-U1W liomc Phone ' 7 Dusincss PhoucoaL- ' cel Mailing Address City/State/zip „_._..,.. 3. Application For: eSite Evaluation ❑ Improvement Permit/ATC LI Ilotll 4. System to Service: D Housc ❑ I•folgile Home ❑ Busincts ❑ Industry ❑ Other 5. Type system requested: 0 Conventional ❑ conventional modified ❑ innovative G. If Residence: it People IF Bedrooms 4 11 hath ounl:; .. 3..,.5. - l abishwasher %26arbage Disposal %OW"ashing blachino ❑BasomenL-/Plumbing ❑DasomenL/no Plumbing 7. If Business/Industry /other: verify type It People It Sinits # Commodes It Showers tt Urinals It 19aLer Cool.cru IF FOODSERVICE: 11: Seats Estimated 14ater Usage (gallons per day) S. Type of water supply: ❑ County/City Well ❑ Conuiiuni ty 9. Do you anticipate additions or eSpallSlolis Of the facility this systclll is ilitelided to serve? ❑ Yes A10 If yes, what type? ***IhIPORTAJYP** CLIEN'T'S il1UST COili LL•Tt TIIE R iQUIRED PROPERTY INFORMATION ltliQllhS'1'1:U _ I BELOW. Eitbcr a PLAT or SITE PLAN i11UST BESU11Af11'7•I:D by the client iYRICI'I1IS APPLICATION. I'ropc►•ty Dinlcnsiuils: � � ,np (fir t` o , 11^01:�� Tax Office PIN: 11 Property Address: Road Nanie OOK M=c to Ci tylZip rl 1u l 0110 'ply If in a Subdivision provide inforniation, as follows: 71 Nanic: (';1'ay.k $ Section: L.-3 Bloch.: c�,O _ Lot: WRITE DIRECTIONS (frow A-Iocksi•ille) to 1'1 OPLR•1.1': ��a� ► ay�rta S �' 4a Jt n c or -1\-A 4-o '/-I- 11 /a- ►.,�� 111!rv1 %Je��Rel( t11d.v_ I'YIC4 CK Q L f='WS cin ©nK %ado (k) IIJ Datc lionlc corners flagged: L— This is to certify that (lie information provided is correct to the best of illy knowledge. I understand that any perinit(s) issued hereafter are subject to suspension or revocation, if the site plans or iliteiided use cliange, or if (he i ifornw (ion submitted in this application is falsified or changed. 1, also, understand that I ani responslbleforall chagcs hicurrvil•%roul this application. I, Hereby, give consent to the Authorized Representative of the ll: vic Count calth I)cp:Uu u•enl to cuter upon above described property located in Davie County and olvued b}' ` --- to conduct all testing procedures as necessary to determine the site sui ability. DATL _ SIGNAT TRIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Iiiclu Il of flit following: Existing and proposed property lines and dimensions, Structures, setbacks, and septic locations). Site Revisit Charge Datc(s): Client Notification Date: EIIS: Sign given Account No. a Revised DCHD (05/03 Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990003123 Billed To: Douglas & Margaret Bordner Reference Name: Proposed Facility: Residence Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5726-98-6129 Subdivision Info: Hunting Creek Lot # 5 Location/Address: Oak Meadow Lane -27028 Property Size: 10 acres Date Evaluated: rf IA; r' Evaluation By: Auger Boring Li Pit Public Cut SITE CLASSIFICATION: tv, EVALU TIO BY: LONG-TERM ACCEPTANCE RATE: C`�,� OT ER(S) ESENT: REMARKS: f ��7 A/ LEGEND Landscaue 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) Landscape position Texture group Consistence Mineralogy HORIZON Texture group ��wR��r�i� Consistence Mineralogy Texture group Consistence �WHIM NVATURMMineralogy ��■�� IV DEPTH groupHORIZON Texture • Mineralogy SOIL SAPROLITE CLASSIFICATION SITE CLASSIFICATION: tv, EVALU TIO BY: LONG-TERM ACCEPTANCE RATE: C`�,� OT ER(S) ESENT: REMARKS: f ��7 A/ LEGEND Landscaue 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) ■ BEEN ■■N■ W1021m■ ■E■S■ ■■S■■ SEEMS MEMO NONE OMEN ..S■ NOES ■ ■ i ■ ONES MEMO NONE SEEN OMEN moss NESS OMEN ONES NONE ■O■■ ■O■■ ■■■■PA ■■■G■■ SENSES ■■mons ■■■■ SEEN OMEN ■NN■ OMEN ■■S■ OMEN ■NN■ MEMO MEMO ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■E■ ■E■ ■■■■■■■■E■ SEEN■■■■■■ ■■.■.■■■■■ ■■■E.■■■■■ NESE■■■.■■ ■■■■■m.■■■ ■■■■■■■.o■ ■■■■■■■■S■ ■■NS.EN■E■ ■■■■■■��.■■■.■■■■■■■■.■■■.■■■■mom ■MEN mommom CMEMNONi�MEMNON�3SENSES �iMENEM ..................................... ..................................... ..................................... ......��........................ ■ENE■ ■.....l�....■........................ ■��■■■.i■■.■■■SOS■■■■■■■■■■■...■■■.S■■■ SEEMS I■■■■■■■■■ l■■■■■■■■■ I■■■■■■■■■ JAN -10-2005 02 11 PM CENTURY21 3367513931 P,02/02 Jen 10 05 11125a devie county envheelth 33G 751 0766 APPLICtrION ton SRE EYA"Tl6WIMpftnWMEAff P£RMR L ATC Davis County Health Department Elrr/ronn/e►rWIMNI 4 soctlop P.O. Vow 84e/210 Hospital street Mockaville, NC 27028 (3361751-8760 •••I7WORTAIrT•a— • =2 APRICAT20N ctMVOT At pdOcx&SjW V3Mjgss ALL MillRAp IY omaTTOX Z9 1A0v2D$D. Refer to the 17WOttMATION 2=13TIR for iustruc I twpw to be slued -A2A f71 / 19 S F%Li ___ Contact veto" _ M•iltng Adnraaa -50 7 A 1 r/ aawtwo" ^, aoslneaa Phone ^_ a—r.- lents on soreit/ATT: 1r oLffersnt than ,/xelling address CIVY/stete/1119, p ECECV1 E JAN 1 0 E2005 " 10 i%EfUA11L�7H�E/ALTH m 1VIEC0WT a.,fm 1-1). Application Pori Xsite tvaluation O Zvoroveatent Darreie/ATC 13 noth %-4. eyetew to Yervtoo, 11, *owo O Yobils some O Business 13 SAdwtry O other --f. Type crocus eet+•eatee.�Coaw •ewevnel D Detiveational eoditlee 13 iaeovativs t/ I! Aaaidpaat s People a Bedrooms 0 lsathroome 3,_ -� Xaiahaveher Vaernat. Machin IVauxwsent/slunhing 1134aeeent/W P1w4bing 7. It eu■tn•aa/tnduatrf /other: verify typea Bogle `_— s at". e Combo". a enewra - a trriaale 1 water Cooleco 1p FOODglRp2CU1 8 Yeats .,Ratimated Mater Usage (gallees par sort .,-I. ,no of water supply: E3 County/City )'II11111 0 Commmitr r. pa TTOMentlalaats addlttona ea oxparalent of the futility this fysltm Ix intended lu serve? 0 Yce )1d,0 It ytr, what type? •••IM fMUST COMPLETZTilt REQUIASOPROP[RTYINFORRATION RSQOCSTED pELO ltheraPLATsrSh PLANMU.YTAESUAMIITTJW bytheciloni with THIS APPLICATION. c'—property Ditnonoloul: � Aa �lTE DIRECTIONS UMom htuelsvttle) to PROPERTY: ' Tar Olilts PIN: ji C �flj� � Q yt-u - a d e -t QJO J __Yroperly Addr.en LRoad Name ) Q 0. L aA 1) rora- Cuylllp %h . p l�5 ✓/ //� a n L i r If in a Subdivision provide informat(oly as fanows: if x Name: _�G"� r� � (Tr Section: L_ 5 Black: 3 _ Lot: _ Ate home corners flagged: IA O AS This to to c"Illy, that tee Information pri vided Is correct to the best of nity knowledge. I understand that any pormtt(s) issued hereafter are soNeet to suapentlan or revocation, if the site plans or intended Not chants, or It UK haformtlon submitted in this application is falriDed or chaspsd. J, also, ivNdsrtlend shel [am respoorslurjer all charges lncxmdjww shi r epp/lcsrha. 1, hereby, give consent ti- the Autharlrnd Representative of the Davie County Health Deponetonl to enter upon above described property Lxated in Davis County and owned by to conduct an testing prvicedaret of accnrary to determine the site suitability. J. 7 X DATE SIGNATURE THIS AREA MAY BE V3ID FOR DRAWING YOUR SITE P1./yv (Iiarl u e follwabil: Existing and proposed property Ilan and dimensions, struetarer, setbacks. and feptie slims,). Nita Revielt Charge Dsts(s):_ Clitat Notification Date: Exs: / 914#1 given_ Account No. ( � � Revised DCHD (85A3 Invoice No. APPLICANT INFORMATION Account #: 990001785 Billed To: Bobby Grigsby Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5726-98-6129.05 BG Subdivision Info: Hunting Creek Lot # 05 Location/Address: Oak Meadow Lane -27028 Property Size: see map Date Evaluated: ✓`,% 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 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 i SITE CLASSIFICATION: g� > LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND Landscape 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 ist 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) ■ ■ SIMM KM■ ■■■ ■1\■ mum ■■E■■M■M■ ■EME■EMM■ EMMEMEMEM ■E■■M■EM■ ■EMEM■■■■ ■■■■■OMEN ■■EMEMM■■ MMEMEMEMN ■■■MEMME■ ■EMM■E■■■ ■■MEMS■■■ ■E■■E■EE■ ■M■M■■M■■ ■■E■■■■■N ■■■■■■■Eli MMEMOMEMN ■S■■■EME■ ■ ■ ■ ■Moll ■■■Is ■■E■ ■■ ■■■■ME■ ■■■■■■■ ■■M■■M■ ■M■■ME■ ■■■■EE■ ■OMMME■ ■■■■EE■ ■ ■ L,77,777 - Environmental _Environmental Health Section P. 0. Box 848/210 Hospital Street Courier 09-40-06 MnrLawilla WV. 97(19Ja January 12, 2005 Bobby Grigsby 307 Oak Meadow Lane Mocksville, NC 27028 Re: Site Evaluation/ Lot 5 Hunting Creek Tax Office PIN: #5726-98-6129.05 Dear Client(s): As requested, a representative from this office visited the aforementioned site on, January 12,2005. 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 oversized modified 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 RBH/dlf Enclosure(s)