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157 Sawgrass Drive Lot 290CONSTRUCTION For Office Use only AUTHORIZATION *CDP File Number 136435-1 r Davie County Health DepaftfAXIED County ID Number: E9-000-00-290 t l 210 Hospital Street bats:t �/�� Evaluated For: NEW P.O. Box 848 ` �� Township: Mocksville NC 27028 PERt.11T vAUD uN71L: Phone: 336-753-6780 Fax: 336-753-1680 B a/ a 7/ a 0 1 9 Applicant: Isehhour Homes, LLC Address: 3411 Healy Drive City: Winston-Salem State2ip: NC 27103 Phone #: / Address/Road #: 157 Sawgrass Dr Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 5 # of People: *Water Supply: PUBLIC E Subdivision: Sawgrass Property Owner: Oak Valley Associates Ltd. Address: PO Box 10 City: Bethania State/Zip: NC 27010 Phone #: Phase: Lot: 290 Directions Hwy 801 to Oak Valley blvd. left on Seay Drive, right on Silverod, left on Sawgrass Dr. system specifications Pump Required: QYes ONo OMay Be Required Nitrification Field a 1 8 a Sq. ft. Pump Tank: 1 a 5 0 Gallons No. Drain Lines 6 1 -Piece: QYes ONo Total Trench Length: 3 6 4 ft. GPM—vs— ft. TDH Trench Spacing: _ 8 OInches O.C. Dosing Volume: _ Gallons Feet O.C. g Trench Width: Inches a - 8Feet Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: OI OII 0111 OIV Page 1 of 3 Minimum Trench Depth: 3 6 Site Classification: Provisionally suitable Inches Saprolite System? QYes QfNo Minimum Soil Cover. 1 a Inches Design Flow: 6 0 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0.1 7 5 Maximum Soil Cover: a 4 Inches *System Classification/Description: *Distribution Type: PRESSURE MANIFOLD TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP Septic Tank: 1 a 5 0 _ _Gallons *Proposed System: 50% REDUCTION 1 -Piece: QYes ONo Pump Required: QYes ONo OMay Be Required Nitrification Field a 1 8 a Sq. ft. Pump Tank: 1 a 5 0 Gallons No. Drain Lines 6 1 -Piece: QYes ONo Total Trench Length: 3 6 4 ft. GPM—vs— ft. TDH Trench Spacing: _ 8 OInches O.C. Dosing Volume: _ Gallons Feet O.C. g Trench Width: Inches a - 8Feet Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: OI OII 0111 OIV Page 1 of 3 CDP File'Number 136435 - 1 County ID Number: E9-000-00-290 Repairbysiem Kequifeo:viCS LJINU IJIVV, IJUt1Id,/1Vd11C3L)1C O *Site Classification: Provisionally suitable Design Flow: 6 0 0 Soil Application Rate: 0 - a 7 5 'System Classification/Description: TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP 'Proposed System: 50% REDUCTION N itrification Field a 1 8 a Sq. ft. No. Drain Lines Total Trench Length: 6 3 6 4 ft. ❑ Open Pump System Sheet Trench Spacing: — 8 8Feet Inches O. O.C. Trench Width: Inches — a 8Feet Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. 1 a Inches Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: a 4 Inches *Distribution Type: PRESSURE MANIFOLD Pump Required: OYes ONo OMay Be Required Pre Treatment: ONSF OTS -1 OTS -11 'Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. " 7; 'Permit Conditions The issuance of this permit bythe Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. 2( This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit, not to exceed five years, and may be Issued at the same time the Improvement Permit issued (NCGS 130A -336(b)} If the installation has not been completed during the period of validity of the Construction Permit, the information submitted In the application for a permit or Construction Authorization is found to have been incorrect, falsified or changed, or the site is altered, the permit or Construction Authorization shall become Invalid, and may be suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, installation, operation, maintenance; monitoring, reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature, Date: *Issued By: 2140 -Nations, Robert Date of Issue: 0 a a 7 2 0 1 4 Authorized State Agent: d77� Malfunction Log Oyes ©Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION 136435-1 Davie County Health Department CDP File Number: 210 Hos ital Street V E9-000-00-290 P.O. Box 848 County File Number: Mocksville NC 27028 Date: 0 a/ a 7/ a 0 1 4 Olnch Drawing Drawing Type: Construction Authorization Scale:. OBlock = ft. ON/A pill C._ �76 pte cl APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health`9 j P.O. Box 848/210 Hospital Street Q Nd`rC1✓� Mocksville, NC 27028 (336)753-6780/ Fax (336) 753-1680 Application For: ❑ Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) Both Type of Application: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing ystem or Facility ***IMPORTANT*** THIS APPLICATION CANNOTBEPROCESSEDUNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. II\t�1�J►��IJJi�J�I Name to be Billed N blM@ S . LLC Contact Person R 60 M fN C _llpM 1'\A Billing Address 3 Li t( Home Phone City/State/ZIP w, v. S-A' 6n Nn N C -&-1103 usiness Phone ?, t, to 5i - s 1X— Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION 0 1 1 (f J Lj *Date NOTE: A survey plat or site plan must accompany this application. (Permit is valid for 60 months with site plan, no expiration w Owner's Name 0 0 V 011 m (J S S d L. L.{- c Owner's Address P 0 Go X J 1 O Property Address 1 c& —1 6 4SS f Lot Size Tai IN# £.,I O O Subdivision Name(if applicable)51 C�l Directions To Site: RW CI -VQ a)ILIJ le s i l o %-M O ) e f -r n h S os If the answer to any of the followi g questions is `yes", supporting d< Are there any existing wastewater systems on the site? Does the site contain jurisdictional wetlands? Are there any easements or right-of-ways on the site? Is the site subject to approval by another public agency? Will wastewater other than domestic sewage be generated? Corners Flagged_ e Plan ❑Plat(to scale) complete M ime'htation must be attached. ❑YesNo Invoice # ❑Yes No ❑Yes No ❑Yes No ❑Yes No IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms Garden Basement: No Basement Plumbing: Yes ❑No Yes ❑ IF NON -RESIDENCE FILL OUT THE BOX BELOW Amt -q � C ,Z O10 Vhirl000l` .Yes ❑No Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: Xconventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: [County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes If yes, what type? YIo This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and comers and ing and flag, ing or staking house/facility location, proposed well location and the location of any other amenities. St, ti,,,- Site Revisit Charge Property owner's or owner's legal represe tati signature a l Client C ): Client Notification Date: Date EHS: Sign given ❑Yes ❑No Revised 11/06 Account # Invoice # 2 OOS 59 ul< SEPTIC T", 6ET BACK 2eO .59.5 I (2[West.F�i Course Drive —6rlvat 6� 33,278 Sq. Ft. I ra►nag 5r—' h St. Andrews Golf Villas 10. Section 98, Phase II, Section 2 30,894 Sq. Ft. Q`Q � I103 150 �o Plot Book 8, Page 21 ,SIS ��P s tae Q ' q.33,42F, rq. F t. P•`pP "1 N F ( 35,081 Sq. Ft. 34,-156 Sq. Ft. 35,486 Sq. Ft. GO 0 (Y!e1N 01 14 j s?*?• O� O � ~Ct- N 1 d- N _Cv Q) O 75 bt m Z C14Qa c� a 96\ �'� , 148 — — 145' 142' '1 243' rr —22i'— (04 N 015 � 100' 33,897 Sq. Ft. ;� 0 —• N M 228' 30,488 Sq. Ft. i 30,080 Sq. Ft. >P 7 �T / A 27o'"------- - ��t� / 2 7 rOw) CcpCA 33,(69 Sq. Ft. (i O Robert John Kassel ;�� and Tracy Ann Kassel N I Ned Book 548, Page 859 30,(50 Sq. Ft. PIN:5871-23-4327 4 t n O iv 30,078 Sq. Ft. J I N I 30,060 Sq. Ft. 227, I , r: O 30,078 Sq. Ft. let 30474 Sc . Ft. 7 r 4ttP 40 2040.01 30,040 Sq. Ft. ` r0� 30,37 Sq1. Ft. 7 la NCSR 162 W, p a d N 6 ubl is Rr9`—�� 1 .i 1, 10 7 Sq. Ft. 1 at Bend--------- Iirit (As Shown) -on Pin Set (3/4" conduit) xisting Iron Pin (As Shown) 100 200 300 111als 100' til Notes 1. All distances shown on this plat are horizontal around distances, unless otherwise noted. 2. All bearings shown on this plat are based on deed or plat bearinjs, as noted. r�•vo Notes 1. All distances shown on this plat are horizontal around distances, unless otherwise noted. 2. All bearings shown on this plat are based on deed or plat bearinjs, as noted. 1 53, 1133 Sq. F O CU O �p Q N d- N C p X Q) O 00 $,p m a� >>e 7 x c.5L t4 _ P-1) ) Z) MAP +6Qb le ITS P Robert John Kassel and Tracy Arin Kassel Deed Book 348, Page W59 PIN:5871 73 -4.52 % 3q -w s'-CA3y f ---SP curse Dr St. Andrews Golf Villas Section 98, Pluse II, Section 2 P ' P r Plat Book B, Page 21 �!h P\Q e Fp,4» P 9r FSP' FSA � co I 2,i 0) 10 0'j37 Sq. Ft. )o t 60' NOS` 1626 6W�de pub IV 26 tic ;g�' s,l� t 0 f W �1 _ Le ------------------------end o Pt. Paint (As Shown) 0 T.P.S. Ir.•on Pin Set (3/4" conduit) A Q.I.P. Existing Iron Pin (As Shown) 100 0 100 200 300 GRAPHIC SCAL:', r 1" L' a c;s 100' xZ N 1h 34,c"6 Sq. I t. 35,486 Sq. Ft. 145' 142' ti —+ ---r-- s i 22i, i� 3� to ' t 30,080 Sq. r r� 1 r> r� r 27 r 30,078 Sq?Ft. a 30,0713 9q. Ft. 27 i � 9 r 30,040 Sc F t. 2 7 440. � 1 .51, 10 7 Sq. Ft. 5!Q .:p„llllll.lti .,, Butes t. .All distances shown on this plat are hurizontai ground distances, unless otherwise noted. 2. Ali bearings shown on this plat are based on deed or plat bearings, as noted. Preliminary Site. Playa SAWGRASS_ at Oak Valley tti Seaon 13, Phase II Oumer / Developer: Keller — Caudle 7'7 -acts Oak Valley Associates, Limited Partnership 2110 Cloverdale Avenue Winston-Salem, NC 27103 MID WORK BY CHECKED BY. CS ci DAW rKcz /Lot PIN. Deed Book/Page _ E-7 5871-25-2468 A.B. 172, Pg: 158 148 & 14801 6871-24-2264 D.B. 184, Aige 700 TOWNSHIP, CITY: _ COUNTY.• Farmington Davie STATE: DATE: SHEET NUMBER: North Carolina Jan, 25th, 2006 of JOB NUMBER DRAWN BY.• 05210 dw BEEBBU EDOIDEER1110 I11C. ENGINEERS SURVEYORS PLANNERS 508 HIGH STREET WINSTON—SALEM, NC; 27101 TELEPHONE. (536) 748-0071 ruurw. be—OS ons 1 t •.. ,. .'r%.I�\- 1 .. si 3i-^si 'O �091Af'� 1' g / u �, y.' ` (puno;) _ — — de lu a uauinup _____ - \ M,16� Ig G .SON I \ 1 uOJ DLII S&g _ \ �, I\ �'lY t 11! Z!, 10 ,Ott ; 0 4 t t . 1 I ``, •• 1, 0 l ,�7` to C ot Ota t \ 4. .Y ?52 o q - Q2 p, a G LZ V. Op • \ � `\ ��ZJ �i:.i: � .,-•�r ' •� �y 3t \ \ .. .� � N �'"4 � �) 5.6 ..r'�: `2+,�_..'^` -p_ `(, � L„ i�. \ �_ �_ `\ ___ N __ -_ -� - _ --�_.'-_------ I O' CD 4'�`v' F'O.'- m irYIw7 ( f r • 1 -Ql \ r 1, �X� fff, i� t,�� -- --- -- — \ - — _ v i I \ T F • # i : U Y .w f • r I sl: .. CJ 7�• ��0 aif : L�� _ A. CA o ,uo D9 t I , � _ i ,0 I tY G� (� 'R..•.•.r.�V��\- ' ! \ IN L l q sa= i ; ` ' fi t- I � It see Z 9 b� \ \ 417 az IS if F,i '�, i ti, oo, t I . CD CIA 41 - fish 17 r; • - l;. -','' {}/;� cv C!41 5 4 � `er'' -.; -.-- .. r 7 ti" 1••• -. " ,''"°"'w•(a '%t•'.' 1 49 -1;1j-17,OZ.� n� •�= 0 t 6d 31 vLL t dv t ID/1 DO l�\ \' T Day sal}l.l,}�� I S... 0. .�6 f._.� 11 E -�.- �• _ _ —_'. `I�� 6 ' •.� �\ _ �_� I Q \\ L89– d SL 8D L, - ; ,5� !Q u� U. N1' , `c�=' CF—' mow' sJauf e XC -110 vD , fib' b� ,, T7}`si >� \ Q It, s �• g .i0 •IWII / D';37�a7UD�_1a,�U:Dw �� \ +.a . 1 / � .�%`�. \ ms's': . .,'� R Er _ � �.:;-rte I . 7,T`' - yjQ "`. U�� ` �\. 1p \ •`\\ i /, �' \ � `\ \ \--� rn `� u) ; ,,: / � S UO \ I � t i iWK-419.9, arr r- ,aJ` .ns M / d1 r F i \ d S 1 r' S O: r y _ y ) _ tJ J . wl • - •� �� , � 1 � 1 i �';,,. ,.,, ,,�� b }• � `\� \ , . 4 .,. } ,// ��: -._ ..r► f i•' nr I ' kyr, .... .. L' ��'-,• � +wL'hti,Gx�..:. ..:?` '.. '\ S' , � - \ \ .\. \ I ___,__- - ... / 01 16 Y .9100 H - � l[{ ' � . � � / \\ `\ \, .. n - .. - `` � \... `` •\ \ \\ \ - //`/. ' 'G"'.:' 2 OOS 59 ul< SEPTIC T", 6ET BACK 2eO .59.5 I (2[West.F�i Course Drive —6rlvat 6� 33,278 Sq. Ft. I ra►nag 5r—' h St. Andrews Golf Villas 10. Section 98, Phase II, Section 2 30,894 Sq. Ft. Q`Q � I103 150 �o Plot Book 8, Page 21 ,SIS ��P s tae Q ' q.33,42F, rq. F t. P•`pP "1 N F ( 35,081 Sq. Ft. 34,-156 Sq. Ft. 35,486 Sq. Ft. GO 0 (Y!e1N 01 14 j s?*?• O� O � ~Ct- N 1 d- N _Cv Q) O 75 bt m Z C14Qa c� a 96\ �'� , 148 — — 145' 142' '1 243' rr —22i'— (04 N 015 � 100' 33,897 Sq. Ft. ;� 0 —• N M 228' 30,488 Sq. Ft. i 30,080 Sq. Ft. >P 7 �T / A 27o'"------- - ��t� / 2 7 rOw) CcpCA 33,(69 Sq. Ft. (i O Robert John Kassel ;�� and Tracy Ann Kassel N I Ned Book 548, Page 859 30,(50 Sq. Ft. PIN:5871-23-4327 4 t n O iv 30,078 Sq. Ft. J I N I 30,060 Sq. Ft. 227, I , r: O 30,078 Sq. Ft. let 30474 Sc . Ft. 7 r 4ttP 40 2040.01 30,040 Sq. Ft. ` r0� 30,37 Sq1. Ft. 7 la NCSR 162 W, p a d N 6 ubl is Rr9`—�� 1 .i 1, 10 7 Sq. Ft. 1 at Bend--------- Iirit (As Shown) -on Pin Set (3/4" conduit) xisting Iron Pin (As Shown) 100 200 300 111als 100' til Notes 1. All distances shown on this plat are horizontal around distances, unless otherwise noted. 2. All bearings shown on this plat are based on deed or plat bearinjs, as noted. r�•vo Notes 1. All distances shown on this plat are horizontal around distances, unless otherwise noted. 2. All bearings shown on this plat are based on deed or plat bearinjs, as noted. 1 53, 1133 Sq. F O CU O �p Q N d- N C p X Q) O 00 $,p m a� >>e 7 x c.5L t4 _ P-1) ) Z) MAP +6Qb le ITS P Robert John Kassel and Tracy Arin Kassel Deed Book 348, Page W59 PIN:5871 73 -4.52 % 3q -w s'-CA3y f ---SP curse Dr St. Andrews Golf Villas Section 98, Pluse II, Section 2 P ' P r Plat Book B, Page 21 �!h P\Q e Fp,4» P 9r FSP' FSA � co I 2,i 0) 10 0'j37 Sq. Ft. )o t 60' NOS` 1626 6W�de pub IV 26 tic ;g�' s,l� t 0 f W �1 _ Le ------------------------end o Pt. Paint (As Shown) 0 T.P.S. Ir.•on Pin Set (3/4" conduit) A Q.I.P. Existing Iron Pin (As Shown) 100 0 100 200 300 GRAPHIC SCAL:', r 1" L' a c;s 100' xZ N 1h 34,c"6 Sq. I t. 35,486 Sq. Ft. 145' 142' ti —+ ---r-- s i 22i, i� 3� to ' t 30,080 Sq. r r� 1 r> r� r 27 r 30,078 Sq?Ft. a 30,0713 9q. Ft. 27 i � 9 r 30,040 Sc F t. 2 7 440. � 1 .51, 10 7 Sq. Ft. 5!Q .:p„llllll.lti .,, Butes t. .All distances shown on this plat are hurizontai ground distances, unless otherwise noted. 2. Ali bearings shown on this plat are based on deed or plat bearings, as noted. Preliminary Site. Playa SAWGRASS_ at Oak Valley tti Seaon 13, Phase II Oumer / Developer: Keller — Caudle 7'7 -acts Oak Valley Associates, Limited Partnership 2110 Cloverdale Avenue Winston-Salem, NC 27103 MID WORK BY CHECKED BY. CS ci DAW rKcz /Lot PIN. Deed Book/Page _ E-7 5871-25-2468 A.B. 172, Pg: 158 148 & 14801 6871-24-2264 D.B. 184, Aige 700 TOWNSHIP, CITY: _ COUNTY.• Farmington Davie STATE: DATE: SHEET NUMBER: North Carolina Jan, 25th, 2006 of JOB NUMBER DRAWN BY.• 05210 dw BEEBBU EDOIDEER1110 I11C. ENGINEERS SURVEYORS PLANNERS 508 HIGH STREET WINSTON—SALEM, NC; 27101 TELEPHONE. (536) 748-0071 ruurw. be—OS ons 1 t •.. ,. .'r%.I�\- 1 .. si 3i-^si 'O �091Af'� 1' g / u �, y.' ` (puno;) _ — — de lu a uauinup _____ - \ M,16� Ig G .SON I \ 1 uOJ DLII S&g _ \ �, I\ �'lY t 11! Z!, 10 ,Ott ; 0 4 t t . 1 I ``, •• 1, 0 l ,�7` to C ot Ota t \ 4. .Y ?52 o q - Q2 p, a G LZ V. Op • \ � `\ ��ZJ �i:.i: � .,-•�r ' •� �y 3t \ \ .. .� � N �'"4 � �) 5.6 ..r'�: `2+,�_..'^` -p_ `(, � L„ i�. \ �_ �_ `\ ___ N __ -_ -� - _ --�_.'-_------ I O' CD 4'�`v' F'O.'- m irYIw7 ( f r • 1 -Ql \ r 1, �X� fff, i� t,�� -- --- -- — \ - — _ v i I \ T F • # i : U Y .w f • r I sl: .. CJ 7�• ��0 aif : L�� _ A. CA o ,uo D9 t I , � _ i ,0 I tY G� (� 'R..•.•.r.�V��\- ' ! \ IN L l q sa= i ; ` ' fi t- I � It see Z 9 b� \ \ 417 az IS if F,i '�, i ti, oo, t I . CD CIA 41 - fish 17 r; • - l;. -','' {}/;� cv C!41 5 4 � `er'' -.; -.-- .. r 7 ti" 1••• -. " ,''"°"'w•(a '%t•'.' 1 49 -1;1j-17,OZ.� n� •�= 0 t 6d 31 vLL t dv t ID/1 DO l�\ \' T Day sal}l.l,}�� I S... 0. .�6 f._.� 11 E -�.- �• _ _ —_'. `I�� 6 ' •.� �\ _ �_� I Q \\ L89– d SL 8D L, - ; ,5� !Q u� U. N1' , `c�=' CF—' mow' sJauf e XC -110 vD , fib' b� ,, T7}`si >� \ Q It, s �• g .i0 •IWII / D';37�a7UD�_1a,�U:Dw �� \ +.a . 1 / � .�%`�. \ ms's': . .,'� R Er _ � �.:;-rte I . 7,T`' - yjQ "`. U�� ` �\. 1p \ •`\\ i /, �' \ � `\ \ \--� rn `� u) ; ,,: / � S UO \ I � t i iWK-419.9, arr r- ,aJ` .ns M / d1 r F i \ d S 1 r' S O: r y _ y ) _ tJ J . wl • - •� �� , � 1 � 1 i �';,,. ,.,, ,,�� b }• � `\� \ , . 4 .,. } ,// ��: -._ ..r► f i•' nr I ' kyr, .... .. L' ��'-,• � +wL'hti,Gx�..:. ..:?` '.. '\ S' , � - \ \ .\. \ I ___,__- - ... / 01 16 Y .9100 H - � l[{ ' � . � � / \\ `\ \, .. n - .. - `` � \... `` •\ \ \\ \ - //`/. ' 'G"'.:' uu: •rap • a t ( OJo - r J'T -J A V a AYPG GYftON FOR SITE EVALUA710.Y/IAfI7tOV0tWC YEnSEIT S ATC Davie County Health C Ipartment Sn riranDzerrW 1fwlt. i Section P.O. Box 848/210 Roar.1tal Stxact Mocksvillo, NC 27020 (336)751-8710 ***I1IPORTAM711* 17IIS J )PLICATION CAIMOT BE PROC.?SSED tWLESS ALL I= IIEQUMMQ MIFORKATION IS VXOVIDCD, lieler to tho MfrOANAT�:ON DDLLEIIN for UotluctiouD. 1. Naso to Yo DL11ed l%r,%4 (01`,kt"1 HSS O:i�•�t (-y,{• �4ifA�sa .."'set Parson ��` (�CV:S naLling Address •� �1 /' i ' � Z"'� ! • Rom phone CLAY/!:tato/'.ZP trt( `+"•1Gf-L y, tNt,. 'II J•7lt)((s //Di�ualnos..bone /i 1. Mas3a Mase oo Feut/ATC it Diff6l"t tbsa Above _ 1 �t t 7� !J'G rte{ xalling Aadraaaiv.-e City/::tnta/ZSp 1. Application For: �dsite Evaluation Q In:•rovewumt Permit/ATC ❑ Doth 6. System to Servlca, 6d 110USe ❑ Mobilo am* D Dui Lneaa ❑ 2:oduSlry O owtor S. Typo or*tas awtu•otad: Ld Cw:rentioml ❑ coavoatlonal :mdlflcd ❑ lnnovatIve �l. acCcptad 6. It Venidenea: 6 Peopl:: tel) a Dedm:xa q naaroo16 tdDlsAwaaLar f/carbage Dispa3al 7ANashing ;d�eLlbo Id:taseaent/rIuubing Qbaaoentpro Plumbina 7. It nsolAeaa/Iaduatry /Ot1or: verify type 6 people I sinks / Coa.dee I ::hovers q oc1a.:Is / Hator Coalere IF roaDMERVICE: D Soata Eatim ted W ter lfaage toailona per dart t. Typo of voter rarLIya Q(Coanty/City a Ho.11 rJ Cotrmunity S. Do yo., ewticipate addttLaos or ezp•Jn3ionS ortbC taa7ily fW337so-l"isialcuded foserve70 Yes A. If )•es, irltal type •••113/P0Rf,fA7"** CUENT1 )fW7COfifPLETZ'I*IIt RL•QUIM; rROPEILTY INFORMATION ILFQUYSPE13 ` HELO\Y. rMcra MAT or SlTli PLAN AftMrJICSURAfl77F.h D hr t. tlieni ultlt THIS APPU CATION. Properly Dimensions: _ rLtr 7D 1i3.� WRITE 31R£CTIO:NS (rruruAloctisyMc) to PROPERM. Tac Office I'M: c Properly Address: Road Name_ Ute:1. 1.L=. UQ I AV j -Z CityrLip ]fin a Subdivision provide infortnatiar, as follo37s: Natnc Section: Black: _ Lot: o'- L Date ho a corners nae fed: This is to eerfiry tltal Ute infuct Won provided is correct to the best oris} k otvlcdge I understand that any perntit(s) Issued bercaffer arc subject to suspension or revocation, it Ute site plats or I. fatded use ehaagc, or if the waruration subntitled in Hits applitaliun it fakiTcd of ehanCed. /, also, fradersrondrher: run raponsibic for all damilmsiueurred from rhirapplicafion. I, hereby, give cousent to Ute Authorized Repraattative of . %e Davie COanq• 11ralllt Department to enter Npua m above described properly located in Davie County and at 7F►ui ; tagi- jJ. fs to conduct all tcsling procedures as nnzssary m deterntino the site suitafritit� t DA7I "l Z J _ SIGNATURE - i�. an /CaG L/i G't. THIS AREA ALLY BE USED FOR DRAINING YOUR SITZ; PLAN (Include all of the following: ElisEing and proposer) properly lines and dlnlenslotts, strutturrs, setbacks, and septic locations). Site Revisit Charrc Datc(s): G7icut NotlBratiou D21c: EILS: Sigu given Itevised DClill (05103 �AccounlNo. � �^ J Invoice Na. r. �14 4 kL �) ? A ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION Account #: 990003765 Billed To: Oak Valley Associates Limited Partne Reference Name: Proposed Facility: Residence Property Size: Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH M 5871-25-2458.29 Subdivision Info: Oak Valley Lot # 29 Location/Address: Oak Valley Boulevard -27028 see map Date Evaluated: Community Evaluation By: Auger Boring Pit / Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % HORIZON I DEPTH Texture group 04— Consistence Structure Mineralo HORIZON II DEPTH -7-7-? Texture group Consistence Structure S 564 - Mineralogy HORIZON III DEPTH Texture group Consistence G $ Structure Mineralogy HORIZON IV DEPTH Texture group ei'o i Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: PS x.2,1 J EVALUATION BY:�-�L 52_W&4' -f 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 mdq VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogy 1:1, 2:1, Mixed 1YflS�S Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05105 (Revised) I 0452 I 157 l tom' �tf 3 4450 i ,15G ---__- , 134,' t ,, >v Phrase 2�1' 7,180 836C 1 � 4257- 1I 622 ��++ �LJ t. 4175 . kl"�0�� Fib49 135 f FIT f �= Cit 1 All data is provided as Is without warranty or guarantee of any kind either expressed or implied including but not limited to the implied (W warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to or arising out Printed :Jun 09, 2015 �.' of the use or inability to use the GIS data provided by this website.