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129 East Knoll Brook Drive Lot 74,L DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Account #: 990001309 Billed To: San Filippo Companies Reference Name: Proposed Facility: Residence ATC Number: 2940 P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 1Z.q c �,Ndll�mol�• Tax PIN/EH #: 5749-53-1994 Subdivision Info: Meadow Ridge Sec I Lot # 7 Location/Address: East Knoll -27028 Property Size: see map 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 O STRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature:ate: Y-0-6( 0(%d I I 2 S, CERTIFICATE OF COMPL **NOTE** The issuance of this Certificate of Completion shall indicate the has been installed in compliance with Article 11 of G.S. Chatei Disposal Systems," but shall in NO WAY be taken as a g "{� given period of time. ° n41 f� f• Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) spibed on Improvement/Operation Permit ion .1900 "Sewage Treatment and system will function satisfactorily for any Date://' DAME COUNTY HEALTH DEPARTMENT _ Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001309 Billed To: San Filippo Companies Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5749-53-1994 Subdivision Info: Meadow Ridge Sec I Lot # 7 Location/Address: East Knoll -27028 Property Size: see map 2940 **N6E*N�ibm.proveme 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 eLl #People _4;�-- #Bedrooms #Baths �!1 Dishwasher: 11"Garbage Disposal Washing Machine-A' achine; Basement w/Plumbing:.12"" Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply_ Design Wastewater Flow (GPD) _Ze Site: New0""Repair ❑ System Specifications: Tank Size,60 GAL. Pump Tank reiC�lt11 Required Site Modifications/Conditions: GAL. Trench Width,:Ze5�� Rock Depth Jt Linear FrW IMPROVEMENT/OPERATION PERMIT LAYOUT - APPR( FINISHED GRADE. ****NOTICE: Contact a representative of system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on LUENT FILTER. RISER(S) IF 6 " BELOW Zounty Health Department for final inspection of this installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department y EnvirwmwtaiHealth Section C� .._--• d P.O. Box 848/210 Hospital Street i Mocksville, NC 27028 fi"� C AW 2 nMI i (336) 751-8760 V�+*** w T** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED iyVIRO IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed`Contact Person .+ Mailing AddressP�'�. ZZ� Home Phone City/State/ZIP _V�� Z�/Q6D� -Business Phone � Lio 2. Name on Permit/ATC if Different than Above WL0 b -r Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation Improvement Permit/ATC ❑ Both 4. System to Service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People �� / p 21 # Bedrooms # Bathrooms � Z WDishwasher rt' bags Disposal U4ashing Machine C4-`Basement/Plumbing 11 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 1-11 7. Type of water supply: (YCounty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 119 If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMI7TED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # - rZ L% 5 V,%3 - riq Y_ Property Address: Road Nameo' City/Zip f-�='=y i llf-e-- WRITE DIRECTIONS (from Mocksville) to PROPERTY: (� ICK ��s+ VJ If in a Subdivision provide information, as follows: � �= o to Name: "%A.. Q _17 Section: Block: Lot:_ Date Property Flagged: v Lo yly 16 -OA' 9,000-1 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 to conductall testi g procedures as necessary to determine the site suRabili . DATE SIGNATURE 44? THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN elude all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. Invoice No. 2� APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Enidr vnmental Health Section gtP.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 CD (E) D OCT i.9"nq ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED., Refer to the INFORMATION BULLETIN for instructions. (/r 1. Name to be Billed Contact Person Mailing Address I&///���,'//�,,,1//�,� �s. y Home Phone qc City/State/ZIP "47 VA' /�/ '9-200(0 Business Phone t•/Z�/,o 2. Name on Permit/ATC if Different than Above ?3&- 03 T .a$-2 k�?-) Mailing Address City/State/Zip 3. Application For: ite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: VmHouse ❑ /Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: # People cy # Bedrooms 5 # Bathrooms IVb/ishxasher VGarbage Disposal Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. I£ Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: M County/City ❑ Well ❑ Commun__it,,,,yy� a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 1�+�tvo If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # ow- T3 —$�70F Property Address: Road Name City/Zip If in a Subdivision provide informaltion, as follows: Name: 2eai 1 -0G't2 Section: Block: Lot: l WRITE DIRECTIONS (from Mocksville) to PROPERTY: sem,? � P� Date Property Flagged: ) �"/- C, "7 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 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 to conduct all testing procedures as necessary to determine the site suitabil• . DATE �D "26 -6)0 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS: Revised DCHD (07/99) Account No. 40 Invoice No. O.N _ wwu -_ wNu i a" 11 , _... 1 •.. _ � -•..V MY a q a as rbr �[tmr wt rawu w 4p, (wauuna rales.•' ,.nw..a'auo ..o n�u, n wu Q„[ .•+na cr"nc - SCJKY .— 1 I Z S2t&W IAD, s /9l1 ae 1.99 OO'MIY[lli, I01 uRralaNf iQ al[ w0r.l Krwr 9R R[VnR.q N aK ariCi d aC aysR� Y�yans. n wn _.. w.rR I $' sl ,,.aw w4.r ,.•....,� ..., r.w..r•.,.. wa w 1% vl of �valmunc[mc=.,._ ...•oao u 9„ncv... n [,'•, 1 [RYmvaJUTE tiuBv�BR �xm[aln Mrs x 'v Ml..�iz w `+cllns� a'[ oon„ticla a ocCu•..tr• . /.191 Anes (dmlll �L11xffiYK1171ilaSllale,u ar • ,� aut E �. IRa, rN wrtya . ~ I 3y se• 306 w- j° o+rnal 90c,rn,la[ n,aaa,G 1 I I i I I s14 i u 4I 7 Drzo B1OK 1B�➢Wr 19 I tECE 110 1 Fd7 Acres (Oh♦// _ I I I Nr rmerfl+ wnu R.r uK 'c ---1 I w .�{!'.-�• Gf('RG9 LlrnANIFI h Nur o- OOA FoFoM. IAORK /r rw a rarw41L7 'Z -J ' 3 I• 1 I -- . __. ._N 72A • C'• - .-dna - �'•a1S1 97 E IAARY si HOLDER K e :�` i Q Uo la/ 1•\, SJ I Reber Foul �, tl i,u W'K I EawNwrN N 0073'06 E 970.7a' _1 _ —E rr 90Wb,E NIl9a.N 96,wK1 I l _ CGNI RJI GARNER N W7Y06 E , � � M / Refiq- Fmmd 771.70- 2w.uo' i0o a0 1aR33' ! Ir l Iwl•,: wl .uiM4 1 I e z ,t 's KF NNfl11 L. F > r c ,•[..oN x, l •C' , . , 1 ! FOSTER ro.n (., vawcvw pl sal 7 F•G 857 Ix I-.—= 21 = r h~In..~i•sn •v I i" Irr ` K �.i .. ?!1� 2 /.Z/I AVe1 (dmdl uanr, sl '/.v f '•tatr. GSErcNI (Ir➢c,y) ;. 2n /- 1.397 Anes (dmdl � L =1-I-Aff Alt"XE I t, L '• - •n' r 1 i 1.. 59 Ades /dm Yl vJ i 2% ! `6. 12 1 Wn .Olr I 1 {-- NOCI:7y'E 4'1 G„ Ia- 701 oe. �HFFT OF i - ex .a 60'. V N!L31. S OB•1y00 Ir _ � M I v � / J/ EFU� 401MEADOLY/DGE �f s t'8 L R a�wcta C M, P"&'r R'9" [H Q/j/LC $ °^s/s6 / V �',. ua•� k 476J Auas (dmd,' ,ef • •. • `. °j. G_ \\ \,� .l' e y sT ` a,,�♦ '' f' \•\•tiTr L\'➢�\r�d•'� 1atl.9j. ( R I I.� •-�'e'E iUW 75 .- °R _� •` J.y \\ /��.• w•�. ET 1 � ./ �. 7R, `e .-i 5%g3'' +' - ''9i:)%•• 1.9/.;.,(,;ier (a4nJJ1 • \ \, i' - _-_. - - . ♦� L5911 Aeier (a9rrdl m�n / / i., / 7/ilrX yw..1•^L ' o..� - • \ �, fY \.�� 7s. y�� S1 / / p u-' 0a 11j7 /-�• ARIUGEI�VEN PUCE /'`' C • Bye �9n' (. _'e ^ , , , 3 /. •- . Na .."„ / �'` / A i 'o ` Co `'0pn. i 1 e - �..d/(..!/� 1, 4/ / • .I �( ' n\\ �. , uo .l`0.0 u�Erlr rASllpa _ � � � � � l \ a�..N\7� n •`y' O�Va'Utl'-,.�-'[,7.91• ```�N S \ ` I9 uanr rasewn �s -\ SH `� - �•-' --- °its .� 1.y ty. �g� Sl OWNE y` f rva a Eew+cow' 'f I KENNETH L w; /So7 Rues (ihrrlJ n '1 E ••""•" (\�^ ('•� 186 1M n /.Ifi Aars (dmdJ S• N.�,^.. m/ .�• •'/ MOCK s cow" + 'ae'•• E,••� M=/ 8i i SURVEYE 114. uw,-lal atz1.,7' z oaoow • BY KENR $N1 HOLLHNO s 1.1 la• Regia% r(a,„ l P•1 3t 1•tl• ca[rlol cci,NER CcMertirw Cur" Data(N R NOMS- Y BK, 4 pN•r„E IP,O ctl'mg TOTAL AREA c-1 INCLUDING _IV Ii,If.IN-F-fTfY10 Snm 1 7) VC T O S -r Bx L ES A E I TT lYL ( a2�A ' 1 11� ENaHri arloar 7a].•i• 2a0.a7' N 7a7s•, �I (7) SVC ,iAO sEr B.IX LPrtS ARE rs•hPIC..E ( $IR(ET ss Zy 1 - •73.00' ,. 7 0.•. . / • .TOTAL' : 3 6 a9' 3T5 7a' 13.J3' S ,7`0'^ (3) REM 'fMD SET Bao[ tA1ES ME "TITC.IL C-7 i66.Oo' 7r 00. n• aa'OB': r ' �•'^^ a ww t ta)w' aJ' all LOTS ARE w ll" u Or 0.000 SO(LME FM -- -+ + 00- M, d7.a3 v19'.7 c / AVERAGE.' LOT G••`•• • boar 7919R' 'BO SQ' N 3B'Oa31 (]t nIE cURRENr zo-4 a PRoVERrc rs m r-'• MI ra• ' r B•S r IA oR• BEING PART..OF T/ c-� 3.69' 7aa yl• a tTvr7 fat 111E LO[S i1[f TO eE ERCRO BY ➢VBLIC 1uTCR arq ➢i 5[➢ilc SY51EN5 53 al• GRAPHIC SCALE vl asJ. ulunEs ARE ,RnERurotR,o c-7 wJ.a9' ,a7 �. 1 '•a• IQ16'7a � DEED 8K' i c_1 wy.ev, aaae K o.a. e =e (BI U A+M1w5 $+vu Bf Lou7B wm.N b iEC7 a <ET-Rc,iOr wrfkSER' MOCKSVILLE TWSP•, C-9 KENNEI- L. FOSTER' & DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990001461 Billed To: R.A. Hewitt Bldg. Reference Name: Proposed Facility: Residence Water Supply: Evaluation By On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5749.43-5798.07 Subdivision Info: Meadow Ridge Lot # 7 Location/Address: Sain Road -27028 Property Size: see map Date Evaluated: Community Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH ' Texture groupS Consistence Structure Mineralogy HORIZON II DEPTH u Texture group Consistence r 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: `/� / t' ✓ A J �lC�F' EVALUATION BY: LONG-TERM ACCEPTANCE RATE: 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 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) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■e■■nc■c■■■c■■ec■■■■■■■■■■■■eec■■■■■■■■■■■■■■■■e■c■■■■■■■■eee■■ ■■■■■■1�■c■ecce■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■c■■els■■■■■■■■■■■c■■■■■■■■■■■■■c■■ccc■c■c■■■■■■■■■■■c■e■■e■■e■■■ ■■■■■■ei�■■■■■■■■cc■■■■c■ccc■■e■■■■■e■■■■■■■■■■■eee■■■■■■■■■c■c■■■■ ■■■■■■erg■■c■■■c■ci■■■■■a■■■c■■■c■■■■■eec■■■■■ee■■■■■■c■cc■■■■ec■■■ ■e■■ee■■eee■e■ecce■■■■■■■■■■■■■■�leec■■ec■■■■■■ecce■■■c■■■■c■■■■■■ ■■■■■■11■■■■■�1■■■■■■■■■■■■■■■■■■■■�■■■■eee■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■�■ur.�rire■■e■■■■■■■■■■■■■■■■■�■■■■■■■■■■■■■■■■■■■■■■■■cc■■■■■■ ■■■■■■■�1Je■■■■■■■■■■■■■c■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■eee■■■■■■ ■■■■■■■/1■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ecce■■■■■■ ■■■■■'1 ■■■■■■ ■■■■■■ ■■■■■■■■■■■■ ■■■■■■ ■■■■■■ ■■■■■■ ■■■ccc�■■■■■■■■■e■■■■■■■■e■■■■■■■■■■■cc■■ecce■■■■■c■■■■■■cc■eec■■■ ------------ ■■ce■■■►t■■■■e■eee■■■■■■■■■■■■■■c■■■■■■■e■■■c■■e■■■■■■■■■■■■■■■c■e■ ■■■■erg■■■e■■■■c■■■■■■■■■■■■■■■■■■■c■■■■■i■■■■■■c■■■■■■■■■c■■■■■■ec■. ■■■■■■■■■■■ec■■■■■■cc■■■■■■■■■■■■�■■■■■■■■■■■■■■■■■■e■■■■■■■■■eee■ ■■■■eee■■■■■■ec■■c■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■eee■■■cc■■■■■■e■■■■c■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ 77 777:17 LTH D ENVIRONMENTAL HEALTH SECTION P.O. Box 848/210 Hospital Street Courier #09-40.06 Mocksville, NC 27028 Phone #: (336)751-8760 November 1, 2000 R.A. Hewitt Building Co., Inc. 119 Highway 801 South Suite A-400 Advance, N. C. 27006 Re: Site Evaluation: MeadowRidge Lot 7 Tax PIN: 5749-43-5798 Dear Client(s): As requested, Robert B. Hall Jr., Environmental Health Specialist with this office on October 31, 2000 evaluated the above -referenced property at the site designated on the plat/site plan that accompanied your application. According to your application the site is to serve a 5 bedroom/3 bathroom House with a design wastewater flow of 600 gallons per day. The evaluation was done in accordance with the laws and rules governing wastewater systems in North Carolina General Statute 130A-333 and related statutes and Title 15A, Subchapter 18A, of the North Carolina Administrative Code, Rule .1900 and related rules. Based on the criteria set out in 15A, Subchapter 18A, of the North Carolina Administrative Code, Rules .1940 through .1948, the evaluation indicated that the site is UNSUITABLE for a ground absorption sewage system. Therefore, your request for an improvement permit is DENIED. A copy of the site evaluation is enclosed. The site is unsuitable based on the following: .1945 Available Space These severe soil or site limitations could cause premature system failure, leading to the discharge of untreated sewage on the ground surface, in surface waters, directly into ground water or inside your structure. The site evaluation included consideration of possible site modifications, and modified, innovative or alternative systems. However, this office has determined that none of the above options will overcome the severe conditions on this site. A possible option might be a system designed to dispose of sewage to another area of suitable soil or off-site to additional property. For the reasons set out above, the property is currently classified UNSUITABLE, and an improvement permit shall not be issued for this site in accordance with Rule .1948(c). However, the site classified as UNSUITABLE may be reclassified as PROVIONALLY SUITABLE if written documentation is provided that meets the requirements of Rule .I 948(d). A copy of this rule is enclosed. You may hire a consultant to assist you if you wish to try to develop a plan under which your site could be reclassified as PROVISIONALLY SUITABLE. You have a right to an informal review of this decision. You may request an informal review by the environmental health supervisor with this office. You may also request an informal review by the N.C. Department of Environmental and Natural Resources regional soil specialist. A request for informal review must be made in writing to the Davie County Health Department, Environmental Health Section. You also have a right to a formal appeal of this decision. To pursue a formal appeal, you must file a petition for a contested case hearing with the Office of Administrative Hearings, 6714 Mail Center, Raleigh, N.C. 27699-6714. To get a copy of a petition form, you may write the Office of Administrative Hearings or call the office at (919) 733-0926. The petition for a contested case hearing must be filed in accordance with the provision of North Carolina General Statutes 130A-24 and 150-B-23 and all other applicable provisions of Chapter 150B. N.C. General Statute 130A-335 (g) provides that your hearing would be held in the county where your property is located. Please note: If you wish to pursue a formal appeal, you must file the petition form with the Office of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER. The date of this letter is November 1, 2000. Meeting the 30 day deadline is critical to your right to a formal appeal. Beginning a formal appeal within 30 days will not interfere with any informal review that you might request. Do not wait for the outcome of any informal review if you wish to file a formal appeal. If you file a petition for a contested case hearing with the Office of Administrative Hearings, you are required by law (N.C. General Statute 15013-23) to send a copy of your petition to the North Carolina Department of Environment and Natural Resources. Send the copy to: Office of General Counsel, N.C. Department of Environment and Natural Resources, 1601 Mail Service Center, Raleigh, N.C. 27699-1601. Do NOT send the copy of the petition to Davie County Health Department. Sending a copy of your petition to Davie County Health Department will NOT satisfy the legal requirements in N.C. General Statute 150B-23 that you send a copy to the Office of General Counsel, NCDENR. Please call or write this office if you have any questions or need any additional assistance, as follows: Telephone number: (336) 751-8760 Davie County Health Department Environmental Health Section P.O. Box 848 Mocksville, NC 27028 Sincerely, o Robert B. Hall, Jr. Environmental Health Specialist RH/di Enclosure(s): Soil -Site Report Rule .1945 LAWS AND RULES FOR SEWAGE TREATMENT AND DISPOSAL SYSTEMS 15A NCAC 18A.1900 Rule .1948 .1948 SITE CLASSIFICATION (a) Sites classified as SUITABLE may be utilized for a ground absorption sewage treatment and disposal system consistent with these Rules. A suitable classification generally indicates soil and site conditions favorable for the operation of a ground absorption sewage treatment and disposal system or have slight limitations that are readily overcome by proper design and installation. (b) Sites classified as PROVISIONALLY SUITABLE may be utilized for a ground absorption sewage treatment and disposal system consistent with these Rules but have moderate limitations. Sites classified Provisionally Suitable require some modifications and careful planning, design, and installation in order for a ground absorption sewage treatment and disposal system to function satisfactorily. (c) Sites classified UNSUITABLE have severe limitations for the installation and use of a properly functioning ground absorption sewage treatment and disposal system. An improvement permit shall not be issued for a site which is classified as UNSUITABLE. However, where a site is UNSUITABLE, it may be reclassified PROVISIONALLY SUITABLE if a special investigation indicates that a modified or alternative system can be installed in accordance with Rules .1956 or .1957 or this Section. (d) A site classified as UNSUITABLE may be used for a ground absorption sewage treatment and disposal system specifically identified in Rules .1955, .1956 or .1957 of this Section or a system approved under Rule .1969 if written documentation, including engineering, hydrogeologic, geologic or soil studies, indicates to the local health department that the proposed system can be expected to function satisfactorily. Such sites shall be reclassified as PROVISIONALLY SUITABLE if the local health department determines that the substantiating data indicate that: (1) a ground absorption system can be installed so that the effluent will be non-pathogenic, non-infectious, non-toxic, and non -hazardous; (2) the effluent will not contaminate groundwater or surface water; and (3) the effluent will not be exposed on the ground surface or be discharged to surface waters where it could come in contact with people, animals, or vectors. The State shall review the substantiating data if requested by the local health department. History Note: Authority G.S. 130A -335(e); Eff. July 1 1982 Amended Eff. April 1, 1993; January 1, 1990. APPUCA110N FOR SIZE EVAUlAT10N/IMPROVEMENT PERMIT do ATC M 0 W% I Davie County Health Department D Envfronmenfal Heafth SmHon P.O. Box 848/210 Hospital Street JUL Mockaville, NC 27028 13361751-8760 ***IMP0RTANT*** THIS APPLICATION CANNC)T BE PROCS;SSSD UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Mame to be Billed KEN a E T N L . ro S t E R . Contact coraco K'�15 N aE T H L, FosTe2 Mailing Address t $ (o m A Pt..E TgeC L14NE Bane Phone 704 - 54,(o- -7 7 2� 8 City/state/LIP _ f4t0CKS,J11LC , .2702e Business Phone 33Co--(Z3-8850 Z. Name on Parsit/ASC if Different than Above Nailing Address City/state/Lip #. Application For: It Site Evaluation 0 IWrov==nt Pesmit/ATC 0 Both 4. system to service: Er"House 0 Mobile Home 0 Business 0 Industry 0 Other s. Ims t Residence: # People 7 # Bedroom � # Bathrooms w6ishrasher 0 Garbage Disposal t]4tashing Machine 0 Basement/Plumbing 0 Basement/Ito Plumbing S. if Business/industry/other: Specify type # People # Sims # Caa®odes # shoxers # Urinals # Rater Coolers IF rOODSERVICE: # Seats Estimated Nater Usage (gallons per day) 7. Type of water supply: 0'-'County/city 0 Well 0 Caaawnity s. Do you anticipate additions or expansions of the facility this system Is Intended to serve! 0 Yes 0 No If yes, what type! ***IHP0RTAN7*** CLIENTS AIUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBIIIITTED by the client with THIS APPLICATION. Property Dimensions: ?54-Y, 1 g 3 X 385)(2&3 Tai Office PIN: # 5? 49 - 43- S -I 9 8 WRITS DIRECTIONS (from Mocksville) to PROPERTY: I= AST O N V s "L,34 1 S g Property Address: Road Name -6A'" Roac-> To Ruao (SP, lb4 Tu Rtil City/Zip AGC..KS.) t Ila 91yZ8 9,1 G NT o N 5 A i a - A P P "jc 0, 5 M 1 L G - If in a Subdivision provide information, as follows: Name: McAnowPuDGE CPtopo D� Section: Block: Lot: -7 Tem S tTE n e-1 R\ L t4 T Date Property Flagged: 6 . a 0 - 94 This is to certify that the information provided is correct to the best or 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 ibis application is falsified or changed. I, also, understand that I ant nponsible for all charges incurred from this application. 1, 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 %S�wN&-7W - L. F4'5T E R; to conduct all testing procedures as necessary to determine the site suitability. DATE (- - Z 8 - 199'1 _ SIGNATU THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/98) Account No. asy Invoice No. Xzc APPLICANT INFORMATION DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Account #: 989900654 Tax PIN/EH M 5749-43-5798.07 Billed To: Kenneth Foster Subdivision Info: Meadowridge Lot # 7 Reference Name: Kenneth Foster Location/Address: Sain Road -27028 Proposed Facility: Residence Property Size: 1.52 Acres Date Evaluated: I �� Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group c l_ Consistence SS S Structure G� Mineralogy; I HORIZON II DEPTH - 1 Texture group C, Consistence t✓ - S P Structure 5 k Mineralogy` HORIZON III DEPTH 3 Texture group Consistence S Structure Mineralogyl = I HORIZON IV DEPTH 2 + " Texture group Consistence Structure Mineralogy t ; SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE U . SITE CLASSIFICATION: QS EVALUATION BY: —3� �Ci AnrP LONG-TERM ACCEPTANCE RATE: 0- 3 OTHER(S) PRESENT: REMARKS: _ P#i TAt_C-koc_I(, I/W J W14 LEGEND Landscaae 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 is 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 Mineralo¢v 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 DCHb (Revised 05/99)