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324 Seaford Road Lot 8,. - r - .n.ry.4 ^�-.. _.V=Y"h �u�r!"m:j aW,y.;iA.r.'?;,rv�/�.:��,1v�•cco-r:`YV:n'iy:�TL'.�,+.v�+,..#,'w�irr�y�. 7'„+:..ra �-fir, ti..�. _... (� AUTHORIZATCON No; ` Q Z 9 DAVIE COUNTY HEALTH.DEPARTMENT ;�� J4 Environmental Health Section PROPERTY INFORMATION Permittees / P.O. Box 848 Name�tSwJi✓q/ Mocksville, NC 27028 Subdivision Name. Phone #:,704-634-8760 ,' S 7�— . 0Y Directions to propertySection AUTHORIZATION FOR - WASTEWATER Ta ice PIN:#��- SYSTEM CONSTRUCTION < ax n RoadName: \@fi r , zip: **NOTE** This Authorization forWastewater 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 FIVEYEARS; ARS ENVIRONMENTAL HEALTH SYJECIALIST DATE ISSUED . :H�'� �� .. :'✓'>.- ..-w^r"' ���..i?e0`Kr,�-�h,�� rA.tY.`"''�'1 s.i xj`i jy ♦k n.. w.r.: n�'. -;.[ i..��.. y.... f. ....� !DAVIE COUNTY HEALTH DEPARTMENT r - . ,IMPROVEMENT AND OPERATION PERMITS . PROPERTY INFORMATION IQfa Subdivision Name:' J `. DIrecdons to property T f ' i� 'Section: IMPROVEMENT PERMIT Tax 91fice PINy.# `_� Road Name \<C2fd. ip: **NOTE** This Improvement Permit DOES NO p pro T authorize the construction or installatioh of a septic tank system or any wastewater system. An AUTHORIZATION•FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the constructionlmstallation 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) `� j 7 / ***NOTICE***.THIS PERMIT IS SUBJECT TO REVOCATION IF SITE �` i` �' %j f/f i' l PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER r vr- A/ . r' .r; �'G ENVIRONMENTAL HEALTH PECIAI,IST DATE ISSUED SYSTEM CONTRACTOR MUST SEE' THIS PERMIT BEFORE' ' INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE #BEDROOMS #BATHS,-#OCCUPANTS GARBAGE DISPOSAL Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE -#PEOPLE # PEOPLE/SHIFT ' # SEATS INDUSTRIAL, WASTE: Yes or No LOTSIZE;�A(� TYPE WATER SUPPLY. DESIGN WASTEWATER FLOW (GPD) NEW SITE ✓ REPAIR SITE .SYSTEM SPECIFICATIONS: ;TANK SIZE GAL. PUMP TANK GAL: TRENCHWIDTH CFV "ROCK DEPTH 7 LINEAR Fr.. ADD OTHER - - .,REQUIRED SITE MODIFICATIONS/CONDITIONS: **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. DCHD 05N6 (Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT Davie County Health Department D IE O w Ls Environmental Health Section P.O. Box 848 MAR _ 61997 Mocksville, NC 27028 (704) 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed Contact Person m o cj Mailing Addres� Home Pho City/State/Zip Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/zip 3. Application For: [ ] Si Evaluation mprovement Permit & ATC [ ] Both 4. System to Serve: House [ ] Mobile Home 5. If Re deuce: # People # Bedrooms Washing [ ] Business [ ] Industry [ ] Other 3J # Bathrooms [/, Dishwasher [ ] Garbage Disposal i Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes — # Showers # Urinals' # Water Coolers If Foodservice: # Seats Estimated W r Usage (gallons per day) 7. Type of water supply: [ ] County/City Well [ ] Community i 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes No If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:*** IMPORTANT **OkELAT OF THE PROPERTY MUST BE 3 t2/illaiL. SUBMITTED WITHIIJIS APPLICATION. Property Dimensions: i WRITE DIRECTIONS (fro Mocksville) TO PROPERTY: Tax Office PIN: # $ % % �F _ ✓� c/ Property Address: Road Name City/zip If in Subdivision provide information, as follows: Name: i Section• / �'� Lot#: 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 Cou ��c Health Department to enter upon above described property located in Davie County and owned by , 1 A /� n > � Q to co tic `all testing pro edures as necessary to determine the site suitability.: DATE 3 (p 7 SIGNATURE Revised DCHD (06-96) THIS AREA MAY BE USEb FOR bRAWINy YOUR SITE PLAN: r j'' f0% to be conveyed to '_2.32"Domes Robert Not iron plocW gond Leo Ann Total 552.80 PM 1 y 3.000 %ACRES �! 30.43 �I °f, co: ,ran laced LO Q I �; LL/dm To.: N 030-03'. Lu CO �3 RES �l U / i ran plo d 680-22' 50 E Total 710.65 3.000 ACRES 710.98, ) m N 03., 03 '5.0"E M 30.43 Totol 741.41' ACRES i//11niii APPLICATION FOR SITE EVALUATION/EUPROVEMEN7 y. Davie County Health Depar Environmental v 1 B1� P.O. B, Mocksville; 70 n 5 (704) 634 ****IMPORTANT**** THIS APPLICATION B CA ESS L THE REQUIRED INFO N IS PROVIDED. Q 1. Name to be Billed -2e—A/I/Contact Person /SCOT -s k Mailing Address P D Home Phone City/State/Zip P ZV Business Phone 2. Name on Permit/ATC if Different than AboveOI.C= �i Y✓�� �� �£5`Yi20i2 �'//�9 Mailing Address City/State/Zip 3. Application For: [" Sie�te Evaluation [ ] Improvement Permit & ATC [ ] Both a. S 77� 4. System to Serve: �yq use [ Mobile Home [ ] Business [ ] Industry�i[ ] Other -£� :3 # e- 4- ` 5. If Resid nce: #People Bedrooms # Bathrooms .Y i [ Dishwasher [ ] Garbage Disposal [ aching Machine [ asement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes — # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [ ] County/Cityell [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [AI'No If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A FLAT OF THE PROPERTY MUST BE L, 5 est SUBMITTED WITH THIS APPLICATION. Property Dimensions: D /�� • / P_ )9C.A T, WRITE DIRECTIONS (from Mocksvine) TO PROPERTY: T Tax Office PIN: #f%%� Property Address: Road Name S B T �O•'"f� City/zip p,R7Cdf' ; If in Subdivision provide'nformation, as follows: Name: Section: KJ Lot#: Q 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 H. th De/partment to enter upon above described property located in Davie County and owned Q �,�/- by/� induct all testir> �erinrec as necessary to etermine the site suitability. Revised DCHD (06-96) / �g 4- 7'/'Ac-7 742 I/ i awl* o-� SC3'-24-30 W— 95700' 10.002 ACRES 942 46 —.1 03•_32-10 •'E G 1.433-56 N 02. - 51 E 2 - 0.608 ACRES J E l to � J.k.ItSIJ C 't Jl1 c.+�t.1 � •�''°•� - - _-- i-... —�7-GSE._ —S 24 wPvr- . •';( 44 446 61 SOS. 57 - -- 4 _ �S i 's 3v. - - - - _16^ v5_ ` d 523'.32 -40E— 61.Oa 50 4a' . CSla'_18-30W _-_._ S_S 9E\ O 3248 vy 1�J 08 ae.,� 536•-16. a0 E 1474 — _26937500_'41-50 C 32.3, a./.�.� Sao - o —2o 0, -`,O7--59.mw - -- -- SO O. Ss 6, v0 '. \gs C / 550 39-20 E-23.76 T''2 .� f `.B E 3 38 89 g j JM`� 557'-00-25 E— 57.80 S / � 8 5j i / 68'-11 -20 E— 56-27 • 3 .� 58-30 E 67 46 574'.— CO 29.039 ACRES to E S. R. 1813 E 'L 30 EASE.) =r-115.047 ACaveRE g f i1o1� ( to S 1 j o - � J 1 ,7' /—N j"_. N B6•-35;30 W 1Oj 32.77 IO1. 10 (r" Qi 1 1 w ` 1 1 i t � � � •v«.q f �� u moi. .Q a 9a5 ., 1v0 Oc a.b S53 79 396 52 t 7.089 ACRES ( to S. R.1813 8 44I'( --SEE D B � UT - 226 a. 1 �2' 23 - P. Ot I I s ,70 24-2 0.608 AgREc- ;\ 0 w found 30' EASE.) �[ 30 eosement- s 100 S S0 So ` ---297.3 50.44 "S 14°- 18 -30 W - _ - tr 269.37 SOO°-41_50 W ~ x point pow -------- --- `4/00 '/8• E\ F0 59'- 2D W S ' S � gO •- SS 38.899, c' S�� F� 3 \ / 66, S8 S) 16,91 29.039 ACRES ( to t S.. R. 1813 8 �— 301 EASE.) 86°-35 , 30"W 32.77 C/ 7 p 5' E pont overheod po-er-- S 5°- �.— x it Poi- l58 -.� _;— nsl X10°_44-40 E— 61767-- I . 57 X017 S �6 45'; f�UPosrit' ° S 23° 32-40 rE— 61.04, 3.0,9,- .0g' _ v x S360- 16 - 40 E -- 32.48 Point Poynr/'� S 4 4° _ 44,- 4pp„ E— 14.74 , / S 44 - 44- 40 E— 20.00 S 50° 39-20 E— 23.76 J S 57°-00-25, E— 57.80 / / S 68°- I1- 20" E — 58.27 point S 740 - 58'-30"E — 67.46' "pol t CO C6 25125. 1' 00 Q 0 N W r� I co oI Q l LLJ11 15.047 ACRES ( to i S. R. 18t3 T'` ✓ yu 1 '4 i!X y i �'r 4F, '%1 h T r t r•ht� ,1�"` > . �a^ „r•�; � 4yd�' N, ,' la ;'p ` :lA • ..�G k, i ,Sys! L + T � ,� `2. � ,rr -'��' f�,+ �'�+f' .) iE �'k `�wP i :G'.. 'I, •M1 •`c.,. MIM v.{i �����'" ` 'i"7M.G�i. �• � ��r t :: rd � }. *r4�1 ., rr 1.9��f v i � � - v i 111 f'. w. Yi.��li � J�'• �! "1` •R i RrJ t ra '°;. ,k a'i� � ,�,� �), Ea W f , � §� "� X71 .i(�a��Z';a.y, F r�'� r .� r,�F.a �;��.t �r y,f �;hi`, e ���•k FT.'� it 1, y d - .:. _ e �''�`• � 5f. ,. � t .valur�t,'I�- +t � why 4 it -.., ' J � t 4 ;+n .,,t ��, L�'Y� t7h t )I .,4� � , � �'L.�11R'" .a,'• .i: A.. ��: �� i '�� �'��'S�a� �'� '�as���5.';J• S� _-•90. .,�'� � � {�-� f y�Yi+ M r� ^�i•,rC-, sx{',�, 1 f, frTi..+.�p/rG _, ydy @' �e i i ♦ . 'Ri`. (N'.�'1 F ..4 l.Wv�, •�s'k_o.1's^iwi .M, aur' I{Y -. tr, " « � as � t "• � t �. � �� 4.�� #' ,, r� '�� + .. d�-'^♦�1/µ.jt 1 �� }�y { ,?.M. 7. TR•y�' ,� ♦ f.J' yS$: of RI .,V�. is + r �l i �5 �; iDi�.•, r .dkEAe•i4a� . �; Yr �,AWWA r r ♦ INN 44 a. � f ••yJ (yy�Il� �. , '"'fir} Sr ty Y q k � , 't. ��t ,�•�4 1 r rl yd yqa 'F�'t r2. �,>�J h�`C�{�"Ygy}�'1r y�����k"'.< .::. rr,h •,� ?N .'$%�a1.+r} a. �,+4.+w! �'.a. t3+,, ''!i, +?'� f.. it � ' ti �`. .ni'¢ryL9 +. l•Px7`#'��,� :d5, 1";; � s ,�+f�a r,x,a aS".�'�`.v-rsp. .fit ,V �� ♦: ,•,,e j/ �'� 5 � �:� >• � ,.. • r'+L k, R �' ° .fir` *+ O riia� ' APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC-' Davie County Health Department Environrnenad Health Section / P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 ""IMPORTANT"" THIS APPLICA'T'ION CANNOT BE PROCI+;SSED UNLESS ALI, ,rim T? REQUTIZED INF0101A`C'ION IS PROVIllED. I. Name to be Billed �-, Ce- `Y4 -4j--Z,,,�/l% Contact Person i� J G /r•.\ Mailing Address CJ �� _ Home Phone City/State/Zip �y %a It:' • _ Business Phone—ff ,X_,.4— L Gl^ 2. Mune on Permit/ATC if Different than Above Mailing Address _ _ City/State/zip _- 3. Application For: [ Site Evaluation I I improvement Permit & ATC [ I Both 4. System to Serve: [ use [ Mobile Home [ I Business ( J Indussttry I I Other 3 C 5, If Residence: # People__ # Bedroorns_�_ # [3athruum5.:-�l' (�6'�Dishwasher [ I Garbage Disposal I All' ashing Machine I, Basement/Plumbing [ I Basement/No Plumbing 6. If Business/Other: Specify type # Puuple A #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [ I County/City V-t"�VeII [ I Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve'? [ ] Yes IAT -1I0 If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions; U Tax Office PIN: Property Address: Road Name -�U,E`��C� City/Z,ip n licz ✓t-cz N: i ;� If in Subdivision provide (formation, as follows: Name:__ Section:_*x _ I..ot #: WRITE DIRECTIONS (from Mocksville) TO PROPERTY: 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 ain responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representq,t))ive of the Davie /Davie County He th Department to enter upon above described property located in Davie County and owned by `i �' - t/ / r c c inductall t in edze�Las necessary to determine the site suitability. DATE, /--�J7SIGNATURE__ 29' Revised DCHD (06-96) 4 4 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Sectio SECTION ' LOT_ Soil/Site Evaluation APPLICANT'S NAME DATE DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE �/�C . SUBDIVISION ROAD NAMES4d. Water Supply: On -Site Well Community Public Evaluation By: Auger Boring_ Pit Cut HORIZON I DEPTH . Texture group FACTORS 1 2 3 4 5 6 7 Landscape position Z7L Slope % (� HORIZON I DEPTH . Texture group Consistence Structure Mineralogy HORIZON II DEPTH YF r Texture group 0 Consistence 0 Structure Mineralogy/ HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION I LONG-TERM ACCEPTANCE RATE I V Ir SITE CLASSIFICATION: EVALUATION BY: /I LONG-TERM ACCEPTANCE RATE: l OTHER(S) PRESENT: 1 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 clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE Moi 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(01-90) Davie County Health Department and Home Health Agency Environmenta[Health Section P.O. Box 848 / 210 HosRrru STRiU ` COURIER #0940-06 MOOKSVILLE, N.C. 27028 PHONE Q04) 634.8760 Lee & Jim Rolan c/o Potts Realty P. 0. Box 11 Advance, RC 27006 Dear Clients: January 29, 1997 As requested, a representative from this office visited the aforementioned sites on January 24, 1997. Based upon the information provided on the application(s) for site evaluations) and after the evaluations were completed, the sites were found to be provisionally suitable for the installation of on-site sewage disposal system on each site. Before any permit(s) can be issued the appropriate application(s) must be filled out and the house/mobile home location(s) staked off. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Rall, Jr., R.S. Environmental Health Section RH/wd Enclosure(s) cc: Jesse Boyce, Zoning Officer APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. O. Box 665 Mocksville, NC 27028 1. Application/Permit RequuSested/B &)^e 71f -y V- eS 1&`'k /�-`( Mailing Address �� t/ r r�� r %U Home Phone Z/ O' �Qs( I NCIP , 2W7 Business Phone 2. Name on Permit if Different than Above 3. Application for: 4. System to Serve ❑ Business ❑ General Evaluation House ❑ Industry 5. If house, mobile home: Subdivision No. of People No. of Bedrooms No. of Bathrooms t�2 Dwelling Dimensions ❑ Septic Tank Installation Permit ❑ Mobile Home ❑ Place of Public Assembly ❑ Other 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Commodes .aa: 1P No. of Lavatories J No. of Showers 7. Type of water supply: 8. Property Dimensions ❑ Public No. of Sinks No. of Urinals No. of Water Coolers Water sage Figures Private Sewage Disposal Contractor ❑ Unknown Section Lot # ❑ Basement/Plumbing _... ❑ Basement/No Plumbing ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes ❑ No If yes, what type? ❑ Community *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. Directions to Property: Tax Office PIN: PROPERTY ADDRESS, as follows: Road Name: City: SUBMIT A PLAT WITH THIS APPLICATION. Revisions effective October 1, 1995. This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: 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 said site's suitability for a ground absorption sewage treatment and disposal system. SIGNATURE DCHD (1183) V� O �oOp�PP TI N FOR a County EVALUATION/lAIP MENT PERNUT & ATC oHealth e Eli virolimei7taiHeaith9ection M F .,..Box 848/210 Hospital Street ^ ' Mocksville, NC 27028 (336) 751-8760 Y d� An( *** THIS APPLICATION CANNOT BE PROCESSED UNLESS,ALLTIiE REQUIRED INFOXIATION-IS PROVIDED. Refer �I1'to the INFOPMATION BULLETIN for instructions. h1. Name to be Billed on6ie. '1'r)s+6 ink Contact Person Mailing Addressx/39 i -1J- O 'l,"1(tf31-7-)G •7 Home Phone 350 - 11-<'- 7- q 4.5 City/State/ZIP T or f Cn'6 r J L 177 G Business Phone - 2. Name on Permit/ATC if Different than Above - Mailing Address - City/state/Zip 3.`Application -,For: R --site Evaluation ❑ Improvement Permit/ATC - ❑ Doth 4. system to service: l -House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. Type system requested: 0"Conventional ❑ conventional modified ❑ innovative - 6. If Residence: �� �� If People 3�� If Bedrooms _ It Bathrooms a Va (3bishwasher, htiarobage Disposal aching Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /other: verify type If People If Sinks - 8 Commodes If Showers If Urinals 8 Water Coolers IF FOODSERVICE: t) Seats Eatimat–eed Water Usage (gallons per day) 8. Type of water supplye '❑ County/City -®'Well ❑ Community - 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes W410 If yes, what type? ***IAIPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Elther a PLAT or SITE PLAN MUST EESUUMITTED by the client ,with TIIIS APPLICATION. Properly Dimensions: 17 S X 9 11 7 1gg 7( i 4g WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: �#� R0O0O0oa0.or1� 'Z+h`l 3e nY —P ro crt Address: RoadName a r_� X0.08 CQe Q.Q City/Zip M(ccl j- Ale LIC F� en Seatoi�..t-� If in a Subdivision provide information, as follows: �n S Name: . P/t- r 10 9 G -le., A &% -S i SO . Section: Blocic Lot: Dates lioJni%c corners flagged: 3LDL-3 1 0 Tills is to certify (fiat the information provided is correct to the best of my knowledge. I understand ilia( any permits) 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 Imo responsiblejor all charges iscun erl jroin this application. I, hereby, give consent to the Authorized Representative of the Davie County IIealth Department to enter upon above described properly located in Davie County and owned by to conduct all testing procedures as necessary to determine tlne s . c suitability. DAT) 3 -ZS -0rj SIGNATUR); s� -• nun TIIIS 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). Site Revisit Charge Datc(s): Client Notification Date: / Account No. Invoice No. / / DAME COUNTY HEALTH DEPT TMENT Environmental Health Section Soil/Site Evaluation' . APPLICANT INFORMATION PROPERTY INFORMATION /�C,frount #: 990003553 'Tax PIN/EH #: 5776-58-5550.05 Billed To:, Donnie & Kathy Link Subdivision Info: Seaford Acres Lot # 05 Reference Name: Location/Address: Seaford Road-27028/fI Proposed Facility: Residence Property Size: 'see maps Date Evaluated: Water Supply: On -Site Well __k__- Community - - Public Evaluation By: Auger Boring' ✓ Pit Cut : FACTORS I . 2 3 4 5 6 7. Landscape position L 1 -- -Slo e% Slope % HORIZON I DEPTH ci S n Texture group Consistence Structurer Mineralogy HORIZON li DEPTH Texture group Consistence Structure Mineralogy�• HORIZON III DEPTH Texture group Consistence . Structure I Mineralogy I HORIZON IV DEPTH Texture group Consistence Structure ' Mineralogy SOIL WETNESS .. RESTRICTIVE HORIZON I SAPROLITE . CLASSIFICATION r nw,n �UDAA ACCFFTANUF BATF. SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKSi LEGEND ' Landscape Position L o n , 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 MSS! VFR - Veryfriable FR - Friable FI Firm VFI - Very firm EFI - Extremely, firm Wet Non sticky Slightly SS - Sli till lucky ` S - Sticky VS Very Sticky N NS . Veryplastic P -Non plastic SP -Slightly plastic P - Plastic VP - r lure SC - Single grain ! M - Massive CR Crumb GR - Granular ABK - Angular blocky. SBK Subangular blocky PL - Platy PR - Prismatic Mineralo2y 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(suitablc), PS(provisionally suitable), U(unsuitable) '. LTAR - Long-term acceptance rate - gal/day/ft2 IX9ill 05/99 (Revised) VN� Environmental Health Section P. O. Box 848/210 Hospital Street Courier 09.40-06 Mocksville, NC 27028 (336)7,51,§76Wsa V April 11, 2005 Donnie & Kathy Link 23917 Oak Tree Drive Sorrento, Florida 32776 Re: Site Evaluation/ Seaford Road Tax.Office PIN: #5776-58-5550 Dear Client(s): As requested, a representative from this office visited the aforementioned site on, April 8,2005. 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 on-site sewage system. Before an Improvement PermitlAuthorization 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, '04� Robert B. Hall, Jr., M. Environmental Health Specialist RBH/dlf Enclosure(s) , •4q ' APPLICATION FOR SITE EVALUATION/IMPROVEME� �jJ n1 Davie County Health Department D /� �} Environmental Health Section 5 � IUl /t P. O: Box 848 d J Mocksville, NC 27028 (704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PRO' UNLESS ALL THE REQUIRED INFORMATION IS ROVIDED.�`' 1. Name to be Billed_ R,44 e Zj tge,. Contact Person Ao- Mailing Address Home Phone City/State/zip /96 /4/ez� IV—�f Business Phone 9h�a�/DO 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: City/State/Zip Site Evaluation ❑ Improvement Permit & ATC 4. System to Serve: O'�House ❑ Mobile Home ❑ Business ❑ Industry 5. If Residence: # People # Bedrooms 3 21 ishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing 6. If Business/Other: Specify type # Commodes If Foodservice: # Showers # Seats # Urinals ■ :., ❑ Other # Bathrooms ❑ Basement/No Plumbing # People # Sinks Estimated Water Usage (gallons per day) # Water Coolers 7. Type of water supply: ❑ County/City zr-We11 . ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 2 --No If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: WRITE DIRECTIONS (from 1 Mocksville) TO PROPERTY: Tax Office PIN: # Property Address: Road Name Af7 e ' City/Zip If in Subdivision provide information, as follows: C� Name: Section: 8 Lot #: 1 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 as necessary to determine the site suitabilit / DATE /'�-s - t� Revised DCHD (06-96) to conduct all testing procedures - 0.608 ACRES � ••Vc Z69 S Oa�_OT � E� _ .. ,,,,. /ti J_K.IijIJ t 't C.>�t. l' GSE°` 26_x. k 10 JU ,7- SOS. i<7. - 24 ., , 4 .✓ !,O'_a4 .40 x.061 7 SO$. 297.33 S r6 a5._ <�3/`/521.32-aO E12 48 i-�/.• SJa. _i9 E.`>3 08 _C,`536•. E_ 50 44 - 4` 77" p .Sts`i8-3O,w SJ v=c -J . 5aa•-aa._gg'£-2000 — t4T4 SC3•_2s'_30"w wr.«e �__ __26937 500_-41-50 �+�-.w••<---�_•�� 2, 5. �o �5aa•_aa - _ E� 0��� 50•-39-20E-23.76 - c $ / / / / 55 57.80 —' 957.00 /l,�i��•i0T 59-� M' .. SO2• 36E,\ 0 E� S.J9. 5T•25 E� / O ti^ 38 89 ''2 -,,, ce ss 59 $) i / 5 68'- - 20--E.— 58.27 1 S74--58- 67 46 7a'-58-6746 � .n r FO 10.002 ACRES �� l✓ �/� r� <1 "� p47 ACRES N 29.039 ACRES 0(� �,;J ( to E S. R. 1813 i 30 EASE.) (1 rL S R. 8131 i < �0 942 46* - ..<w —.N03'-32 -1O"E .. ..«. t o V LI 1 ! Q, 1 i 1 � `• rah' 1H-Zb is 9 65 / ;, ., 40 00 396.52 1.433.56 . Davie County xeaftk Department and,Lome Heath Agency Environmenta[Healtk Section ` - P.O. Box 848 / 210 Hmpff& STREET ' COURIER #0940-06 MOCKswIxE, N.C. 27028 - - PHONE: (704) 634-8760 January 29, 1997 Lee & Jim Nolan c/o Potts Realty P. 0. Box 11 Advance, NC 27006 Re: 2 Site Evaluations/Seaford Road Tax Office PIN: #5776-59-3496 Dear Clients: As requested, a representative from this office visited the aforementioned sites on January 24, 1997. Based upon the information provided on the application(s) for site evaluation(d), and after the evaluations were completed, the sites were found to be provisionally suitable for the installation of an on-site sewage disposal system on each site. Before any permit(s) can be issued the appropriate application(s) must be.. filled out and the house/mobile home location(s) staked off. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr., R. S. Environmental Health Section RH/wd Enclosure(s) cc: 'Jesse Boyce, Zoning Officer I y' t be ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT_ Soil/Site Evaluation APPLICANT'S NAME 16 �� DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE ®��G SUBDIVISION - ROAD NAME Water Supply: On -Site Well 1"-, Community Public Evaluation By: Auger Boring L"_� Pit Cut FACTORS 1 2 3 .4 .5 6 7. Landscape position IL L Slope % HORIZON I DEPTH Texture group Consistence Structure . Mineralogy HORIZON II DEPTH p f Texture groupG` Consistence 4i I 11i i Structure 5-4 Li- 6< Mineralogy f. /, I V HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION d ,. LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: �So EVALUATION BY: 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 clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam 6 - 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 Mineraloev 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 DCH6I(01-W) MEME y Davie County Heath Department and Home Health Agency EnvironmentafHeafth Section l P.O. Box 848 / 210 HosRRu STREET ! - COURIER #09-40.06 MOCKSVILLE1 N.C. 27028 PHONE: (704)634-0760 January 22,'1997 Potts Realty, Inc. P. 0. Box 11 Advance, NC 27006 Re: Site Evaluation/Seaford Road Tax Office PIN: #5776-59-3496 Dear Mr. Potts: As requested, a representative from this office visited the aforementioned site on January 21, 1997. Based upon the information provided on the application for site evaluation and after the evaluation was completed, the site was found to'be provisionally suitable for the installation of an on-site sewage disposal system. If you have any questions, please feel free to contact this office. P: Sincerely, Robert B. Hall, Jr., R.S. Environmental Health Section RH/wd Enclosure(s)