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129 Hawthorne Road Section 1 Lot 1Davie County, NC ; f Tax Parcel Report Tuesday, January 17, 2017 WAKNIING: TMS 151VU'l' A JUKVEY Parcel Information Parcel Number: J6050F0001 Township: Fulton NCPIN Number: 5757894597 Municipality: Account Number: 82524714 Census Tract: 37059-804 Listed Owner 1: HARRIS JOHN ERIC Voting Precinct: FULTON Mailing Address 1: 129 HAWTHORNE ROAD Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag. District: No Legal Description: LOT 1R HICKORY HILL SECTION 1 Fire Response District: FORK Assessed Acreage: 1.98 Elementary School Zone: CORNATZER Deed Date: 9/2009 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 008060021 Soil Types: GnB2,MsC,MsD Plat Book: 0010 Flood Zone: Plat Page: 120 Watershed Overlay: DAVIE COUNTY uildin& Extra Building Value: FO eatures Value: Land Value: Total Market Value: Total Assessed Value: 91 All data is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the Davie County, Implied 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 �7 TUU N� l� C or arising out of the use or Inability to use the GIS data provided by this website. ASep 14 05 11:34x, 1 , 04V f� 1 davie caunttl envheal'•h 336 751 €3706 p.2 �APPUC-11 ION FOR SITE EVALUATION/M11111[ JEMENf PERMIT M' ' Davie County Health Depi ltment Envlronf C17tal Hcalfli S' Worn SEP 74 2005 P.O. Box 848/210 Hospit..l Street 0 Mocksvi.11e, NC 27:+28 ENVIRO (336) 751-8760 NM TAC y DA�fCntm:,,,TH ***ZMF0R7ANT*** THIS APPI,ICATICN CANNOT BE PItOCES:.ED UNLESS ALL THE REQU*iRBD RM INFOATION IS PROVIDED. negar to the INFORMATICS'[ BULLETIN for instructions. �r rName to he Billed _c�C��.�v _Eie rr n/14,rr, s &o tact Parson ice s (/ L'Pxling Address 1 /ft,' 0,701 -Z- 7e-& H e Phone /t/C 9'760C1 R- Business Phone t2O'j LF . 14-.520 - '— �—e on Perriitl= it Differe:.t than Above J /;,- -A wiling address Ste^ _ City/St teJZip �! Application For, Site Evaluation ❑ Imptavement Permit/ATC th System to Service: h�ou�se Mobile Home ❑ }3usi.),ese 13 industry O Ot 4_ �'I) system roqueted J Cunv entianal ❑ conventional ai:.311:e8� �❑ innovative Maccepted ✓d. If ft031don0418 q People _ _ # Badroo, is -1 =-�' d Bathrooms' Dishwaobar Moarbage Dispoval Uwsshing machine ❑Pcsement/Plumbing ❑Casementimo Plumbing 7t./if business/Industry /Other: verify type # People # Sinks /vr0 Co=odes tt Showers A urini,[.s # water tossers IF FOODSERVICE; 4 seats Estimated Stir: tier Usage (galionu per day) _ (--�'ir Typo or water supply:'-iS Country/City Cl we:.:t 13 community 4„-9!'Do you anticipate additions or expansions of the facility this syst, :n Is Intended W serve? C1 Yes �o Irycs,1vl:at typc9 ***1 1P0R7AN2-** CLIEvT.; UST COMPLETE THE RCQU11i?.:1 PROPERTY INFORMATION REQUESTED [ST°.LO - tttr rt.AT or Si I,4LAN hfUST BE SVB,4f[TTLD by t ,n citont with TINS APPLICATION. OdiF�ac� i S 54c 'roperty Dimensions: t a o Y Z -- e 11'79 (1YAf3T, DIRECTIONS (frons Mucksville) to PROPERTY: .S�'7 c) - q .5-917 max Office 1'!N: It 7S 17 - g'9 - C 6 7 �ff �ti s� yew �lautl►oe.-� ,iso( --'-F-r�operty Address: Road Name rr%7�>, a� R �R.. c /lar, 1/� //,•� . _ 'C o f / �„�t city/zipNQZ Cs a k If in a Subdivision provide Inforuisfiatt, as follows: Section: Block: .— Lot: l + 2 c `y mete corners flanged: _,'hQ _ This is to certify that the Information provided is correct to the best of nr; ihnoivledge. I understand [lint any perrii((s) issued hereafter are subject to suspension or revocation, if the site plans or intended use cliatsbe, or if the information submitted in this application is falsified or changed. I, also, understand M �I I aur resronsible for all charges incurred,7v)n !Arts applicadvn. I, licreby, glvc consent to the Authorized .Representativo : f the Davie County Health Departinent to enter upon above described property located in Davie County and own: d by�'� Z— to conduct all testing procedures as necessary to deterntirc the site suitabi ity. ATE U s '--K NATURE si � ..o, /P D THIS AREA MAY BE USED FOR DR!'MING YOUR SITE P ' (Include all of (lie followbig: Existing and proposed property ilncs and dimensions, structu.•es, setbacks, and septic locations:, n auc nevwu r.i,:c� be ' Datc(s): Client Notification Date: I EMS: Sign given N� Account No. _ Revised DCHD (05/03 \ Invoice No. 6p &fry - M "Ir IV d6 � (,titkj- 6 J i . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMA Account #: 990003742 Billed To: John Harris Reference Name: Proposed Facility: Residence Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5757-89-4597 Subdivision Info: Hickory Hill Lot # 01 Location/Address: 129 Hawthorne Road -27 i Property Size: see map Date Evaluated: �� OS Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % !v HORIZON I DEPTH <- ./ Texture group C Consistence v -� Structure n r - Mineralogy HORIZON H DEPTH <� y Texture group Consistence Structure J Mineralogy/ HORIZON III DEPTH r- 7 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:/ LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: (-1—k-1 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 13 M VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Kit 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 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) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■m■■Ile■■neon■■■■■e■■■■e■■e■�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■111\■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■111/s■s■■nem■■■■■e■■mn■■n■o■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■1111■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■11/Innen■■■■■■e■oe■e■■■■■■s■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■1111e■■■■■■■■e■eee■■e■n■n■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■1111■■■■■■■■■■■■■■■■■■■■■�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■1111■■■■■■■e■e■■■■■■■■■■■■■■■■e■■n■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■n■1111■■■■■■■e■■e■e■■■e■■■■n■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■111/■e■■e■■e■■■■e■■■e■■■■nn■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■Ilse■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■ ■■■■■■■■■Ile■e■■ee■■■e■■■■■■■e■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■w■i■■nen■I■■ee■■e■■■n■■■■e■�:�a■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■:�■■■ I■■■ee■ ■■■■e■ 11■n■■■ '■■mons ■e■■■■ ■■■■■■ ■■■■■■ ■■■■■■I■■■■I■■no■■61■�nosoe■■■■e!■■■■■■■■■■■■■■■■e■■■■■■■■so■■moo■■■■ ■■■■■■ISI■■■I■■■■■■i■sn■■■■wII■■�le�■■e■a■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■iil■s■I■■■■■■ilr�rea'7i.1 �fv=re■'ivll;�■i■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■Ie■■■■■11r�fi■■■in■■�n�7■■■n■■■■■■n■■■■■nn■■■nn■n■non■■■■■■■ ■■■■■■■■■■i■■■e■■c:::::::::.■■■■■■■■■e■eenne■■■■■■■■e■■■■■■■■■■eee■ ■■■■■■■■■mime■eee■■■■■■■■■■■■■■■■■■■■■■■■n■■ee■■■■■■■■■■■■■■■■■■■ ■■e■e■nen■■■■non■■■o■e■■■■nee■■■o■■■■■■■n■■■I■■sno■■s■■■so■■■■■■■■■ ■■■■■■■■e■■■■■■■■■■n■■e■■■■■■■■■■nee■■eon■■■�■■■e■■eon■■■■■e■■■non■ ■■Doomo■■■■■■■■■■■■■no■■■■■■■■e■e■■■■■■soesnl■sn■■■■■■■o■■■no■e■o■■ ■■■■■■■■■■■■■■■■■eno■e■■■■■■ns■■�■■■■eon■■■I■o■■■o■■on■■■■o■■■■■■■ ■■■■■■■e■■■■■■■■■■■■■■■■e■n■■■■■ ■memo■■■e■I■■o■■■■e■■one■■■■■■■■■ ■■■■■■■■e■■■■■en■■■■■n■■■nee■■■n■■n■■non■eenl■e■■■■■■■e■■■■eee■■■■■ ■■■eee■■■■�■■o■o■ono■e■■■■■n■■■■nem■■■■■■o■■I■senoe■■■n■■■■e■n■neo■ ■■■o■■■■■■■■■■■o■■■s■■■s■■■■■■■■s■■■meso■■n■I■o■■■■■■■■■mese■o■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■e■■■�����I���m■■■■■■■Ion■■e■■■■■■■■■■■■n■■11■ ■■■■■■■■■iiiiiiiiiiiiiiiiii.■■■■■t■■�s■■■e■nl■■■■■1■■■■■■■■■■■■■■■■ii ■■■■■neo■ens■■■■■■■■■■■moo■■■■■■■■■■■■■■■■■■■■■Deco■■■■nen■e■■■■■■ ■o■■■■■■■■■■■■■■■once■■■■■■■e■Dome■■■Den■e■■■■■■■■nnoeo■■■■■■■■■e■ ■■■■■■■■■■■■■■■■■■■■■eee■■■■■■■■■■■■■■■■■■enc■■■ss■■■■■■■■■■■■■■■■ ■■■■■■■■■me■■■■■s■■■■■■n■nem■■■■■■■■o■e■■■■■■o■■■■■■■■■■000n■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■m■■ ■■■■■■■■■■■■■■■■■■■■■■■■nn■■■■■■■■■■■Donn■■eons■■seen■■es■■■■neon■ ■■■■■■■■■■■■■e■e■■■■■■■■■■■■■■eo�,1■■■one■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■oe■se■■■■■e■n■■■■■■■eon■■■■■■■■■■■■■■■■■■■■■e■■■■■■■m■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■e■ono■■■sn■■■■■■■■s■■■noes■■■■■■■■Dee■■moo■■no■■o■■■e■■■o■o■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ October 3, 2005 John Eric Harris, MD 129 Hawthorne Road Mocksville, NC 27028 Re: Site Evaluation/ Hawthorne Road Tax Office PIN: #5757-89-4597 # 5757-89-4667 Hickory Hill lots 1 & 2 Dear Client(s): As requested, a representative from our office visited the aforementioned site on October 3, 2005. Based on the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, it was found to be provisionally suitable for the installation of an on-site sewage system. Before and Improvement/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 F'�5E r .OP�uj�t, Pay 69Q.s _ fir n vie County Health Department MAY 3 0 20 1,. •� nvironmental Health Section BY: 00- P.O. Box 848 210 Hospital Street Courier # : 09-40-06 Mocksville, NC 27028 Pl►one: (336) - 753 - 6780 ON-SITE WASTEWAT ERTIFICATION (Check One) Replacement Remodeling ' Reconnection Fax: (336) - 753-1680 Name: T� q '�T—r-L Q her - / Phone Number 225--306 0 (Home) Mailing Address: 12!j %L�l pl h.� I�•9 - (Work) ml k s U0 /Gr- Email Address: Property Address: 1 �&Z h1,01�>� Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: Type Of Facility: f& S �n Date System Installed (Month/Date/Year): "(� Number Of Bedrooms:____,3 _Number Of People: Is The Facility Currently Vacant? Yes No Any Known Problems? Yes Please Fill In The Follow ng If Yes, If Yes, For How Long? rmation About The NEW Facility: Type Of Facility: 1? --q �IaC-g -4-3 o 11 M 121- Number Of Bedrooms: 0 Number of People Pool Size: Garage Size: 3 5—)C tLjr Other:10-171A5,R lh 1,14-0 Requested By: o nam Date Requested: s�1 JI/z ( ignature) Cm—ments- Environnfental proved, For Environmental Health Office Use Only Health *The signing of this form by the Environmental Health Staff is iWno way intended, nor should be taken as a guarantee (extended or limited) that the on -s' astewater tem will function properly for any given period of time. Payment: eck Money Orde # -;?' Amount:$ 100.00 Date: 5-3U-12 Paid By:,t Received By: �%M //-- /W,� Account #: 3-1q Z Invoice #: 06 1 27,2009 12:53 Jan 27 09 03`.42p Da W, 13369986098 Environmenta 3367518786 AWE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 rAx 33& 7-5'1-,Y796 page 1 P.1 ;.. `;- IT q1 SE K'ASTEWATER CERTIFICATION FOR DWELLING ck One)EPLACEMENT D REMODELING RECONNECTION D � Name: . 11)i f'} JG&I *%M'rI f Phone Number:,tl� IL 1/01-444'(Home) Mailing Address: /Z9 r1 A VA CC4 G p/ 3� l d ��%iL .(Work) Detailed Directions 1p Site:- laq D-1&koIZI! 0/0 C la—o/ I sf �/i/�lf9N�Pi Property Address:- _a ,lJ! l&�I t f `'{! - /i JO �FdV�r'.e! XZJ 4 Please Fill In The Following Information About The Existing Dwelling: Name System Installed Under:_' Tvpe Of Dwelling: DGao _ Date System Installed(Month/Day/Year): Number Of Bedrooms: -3 Ntunber Of People: _ Is The Dwelling Currently Vacant? Yes 0 No D If Yes, For How Long?, Any Known Problems? Yes f-1 No 0 If Yes, Explain: Please Fill In The Following Info�QrDmation About The New Dwelling: � K _ �cevi � p Type Of DweWng:�Gd/ //7 8-- t reo nr N Requested B�(Signature) For Environmental Health Office Use Only Approved u Disapproved ❑ ober Of.People: Requested:.-,� Comments --__ _ — /"-oZ�` -�-/ -I'llie signing of this form by the Environmental Health Staff is in no %vav intended, nor should betaken as a �-l uarantee(extended or limited) that the on-site wastewater system will function properly for any given period of time. I Payment: Cash 0 Check 0 Money Order 0 # Amount: Paid Bv- ? Received By:__ �� Account il:_ _�✓ ----._--- —Invoice k:_ 70 JAM JAM 27,2009 12:90 3367518786 page 1 Permitte.e's DAVhE COUNTY HEALTH DEPARTMENT Names' r ` "' Environmental Health Section PRO P.O. Box 848 ;Directions to property: "t �''..I'1 Mocksville. NC 27028 Subdivision Nai l Phone #: 336-751-8760 f Section: AUTHORIZATION FOR "WASTEWAT!E:R Tax Office PIN: SYSTFM CONSTKUCTION NO: 002916 A : AUTHORIZATION, Road Name ,. **NOTE** This Authorization for Wastewater Svstem Construction MUST B'E'ISSUED by the Davie County I to issuance.:of any Building: Permits. This Form/Authorization Number should be presented to the Di Office when applying forBuildirg Permits. (In comphancewith A ticle .l I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment an ***NOTICE*** THIS AUTHORI7ATION5P At IS VALID FOR A PERIOD ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED ;RTY INFORMATION Lot: a 7 nvironmental Health�Seetion_prior ,ie County Building"' Inspections Disposal Svstems) UASpT€€EW�AkTER�C STRUCTION 4KE— YEARS. RESIDENTIAL SPECIFICATION -BUILDING TYPE F7f # BEDROOMS '" #BATHS —# OCCUPANTS 1� GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT, ` # SEATS _ LOT SIZE TYPE WATER SUPPLY CO' DESIGN WASTEWATER:FLOW (GPD) y g� NEW SIT] -2 �r SYSTEM SPECIFICATIONS: TANK SIZF-1000 GAL. PUMP TANK i GAL. TRENCH WIDTH J (D ROCK nT14PQ 2 S /' 1a P UC+bjk REQUIRED''SITE GIODIFICATIONS/CONDITIONS: IMPROVEMENT- PERMIT LAYOUT 1� FOR FINAL INSPE CATION PERMIT INDUSTRIAL WASTE: Yes or No REPX_IR1SIrTE EPTH LINEAR FT. ( `� s k -d- ? 21 Q• EttMS� lo Y 4IGt F+hirtt dl; OF THISSYSTEMPLEASE CALL BETWEEN 8:30 9 30 A.M ON THE DAY OF INSTALLATION TEL SYSTEM INSTALLED BY. .. �4 AUTHORIZATION NO. OPERATION PERMIT BY: I "THE ISSUANCE OF THIS` OPERATION. PERMIT SHALL INDICATE THAT THE SYSTEM DES: IBED.ABOVE HAS BEEN WITH ARTICLE 11 OF G.S. CHAPTER 1,30ASECTION 1900: SEWAGE TREATMENT AND�DISPOSAL SYSTEMS", BUT SH GUARANTEE THAT THE SYSTEM WILL FUNCTION, SATISAALYf0k ANY GItVEN,PERI,©D OF TIME. DCHD 02/022(Revis d) lot _ DATE AV'v INSTALLED IN COMPLIANCE 4LL IN NO WAY BE NKEN AS,A a t- °.� ' vw9 -' "`. �'" t''3�•i `� L�,i� �a':"` d+'.mµYtw �sv :,q � +si �^''�1F s. v. Pe DAVIE C°OUNTY HEALTH tteg s DEPARTMENT[ kms` "f' *"�' PROPERTY INFORMATION �p game; 'Environmental Health Section I 1 P O: Box 848 ;,LJ ", _,Directions to property:, Mocksville; NC 27028 Subdivision Name: t t Phone #: 36-75-760Fr ti. Section: Lot: 43 - AUTHORIZATION FOR � WASTEWATER Tax Office :X 3 h SYSTEM CONSTRUCTION g ?AUTHORIZATION NO: A Road Name ti 4>=.� � �""'�, �' t Zip:. s **NOTE** Tfiis Authonzation for Wastewater System.`Construction MUST BE ISSUEI7by the Davie County Environmental Health Section pnor ; Section- to issuance of any Building, Permits. �T'his-Fonn/Autho nation 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 1.30k, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) i; ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION "--ft I x -r ' r IS VALID FOR A PERIOD OF FIVE YEARS. ENVIIiONMENTAL HEALTH SPECIALIST DATE ISSUED 'RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL Yes or No COMMERCIAL SPECIE ICATION: 'FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE. Yes o"r.No".„<, LOT SIZE TYPE WATER SUPPLY ' DESIGN WASTEWATER FLOW (GPD) NEW SITE _ KIR SITE R�'�FIR SYSTEM SPECIFICATIONS. TANK SIZE°. !i rg fJU "GAL: PUMP TANK I Ytr,1 ' .G,AL. `TRENCH WIDTH J � ROCK DEPTH LINEAR FT # � � (47 5, C its OTHER 471). 1Gt et'NF Lcnw fl REQUIRED SITE MODIFICATIONS/CONDITIONS IMPROVEMENT PERMIT LAYOUT i { 4,�.t., Ci i 1�A ii M a res f eh• ((i� ,tF "'• ti :o C ri '"a i fUt i r+t,' r "`'+ 3 '.. Ott t r Af ,�r� fv 1&r r- � _7 P,41 ... ` 1 1" ���.....-� t 10 i 4 I"t {.�j. B r TELEPHONE # IS (336) 751-8760 ay ¢" FOR FINAL INSPECTION.OF"THIS�SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. g � OPERATION PERMIT` SYSTEM INSTALLED BY: K :rlG�t�l '!yl r%%r(% 7et t'�kit,I'ls ,, zJ {N S SAAUTHORIZATION NO. OPERATION PERMIT.BY`. .� DATE: / / **.THE ISSUANCE OF THIS OPERATION PERMIT,SHALL.INDICATE THAT THE,SY,STEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I OF G.S. CHAPTER 130A, SECTION 1900`1`. SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BETAKEN AS A GUARANTEE THAT THE`SYSTEIv1 WILL FUNCTION SATISFACTORILY FOR.ANY GIVEN PERIOD OE`TIME. C DCHD • - .. .. . - � to Permittees; DAVIE COUNTY HEALTH DEPARTMENT NVme: .(—) f' �GZ Imo, I� Environmental Health Section PROPERTY INFORMATION P.O. Box 848 Directions to property:t ' ISt'Y lj Mocksville, NC 27028 Subdivision Name: �/� CSCAll r t r Phone #: 336-751-8760 Section: Lot: .� y AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION AUTHORIZATION NO: 0 Q 2 'y' 12. A Road Name: f Zip: r �)i **NOTE** This Authorization for Wastewater 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 1 I 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 FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPEi # BEDROOMS �_ # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) 76 y NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH �?� ROCK DEPTH IV LINEAR FT. C OTi-1FR 2-J REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVIMENT PERMIT LAYOUT i;151r�1I0�i�y�, , re rine k/ut,t . i F i�lz ly v FS, t15t C t ��."��IISWt I (';/l�110.4 oo? �(J Irkf'S / old I i n�-S--�� •- � i ` nflN'�"' FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEENN:30 - 9V0 A.M. kN THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT AUTHORIZATION NO. OPERATION PERMIT BY: IBY: N u� DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. DCHD 02/02 (Revised) Pe rttee{sem; `,4 � �: DAME COUNTY HEALTH OEPARTMENT PROPERTY INFORMATION ' 4;;Envlronmental Health Section V. _� P.O'.-Box 848 ^ r' Subdivision Name # Nocksvile, NC 27028Directions to pro erty l ,t r. l tnr 1 r°..:# Phone #: 336-751-8760 , Section: Lot: 'Y AUTHORIZATION FOR . WASTEWATER T SYSTEM CONSTRUCTION - f ax. O fiveIN.# P • AUTHORIZATION IVO; Road. Name: r'F.: sI'tfrt.ritLip: .' ` **NOTE** This Authorization for Wastewater System Constructibn MUST BE ISSUED by the Davie County Environmental Health Section prior °i to issuance of any Building Permits. This Fonil/Authorization Number should be presented to the Davie County Building Inspections Office'when applying for. Building, Permits. p p y ns, Section .1900 Sewage Treatment and Disposal Systems) (In com liance;with Article 1 l of G"S: Cha*ter130A', Wastewater • . X� ' ICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION r ' AA IS VALID FOR A PERIOD OE FIVE YEARS. ENVIRONMENTAL HEALTH ,SPECI ALIST-DATE ISSUED9W LL =° RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS ff # BATHS # OCCUPANTS GARBAGE-DISPOSAL Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS' INDUSTRIAL WASTE. Yes or N`- `LOT SIZE. TYPE WATER,SUPPLY ? DESIGN WASTEWATER FLOW (GPD) "Y NEW SITE REPA+R SITE t SYSTEMSPECIFICATIONS. TANK SIZE . )GAL. PUMP TANK GAL. TRENCH WIDTH) ROCK DEPTH LINEAR FT,7I` �1 OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVE ENT PERMIT LAYOU_ T .. Al be ye k ro VA W Se _ t� d. 1 r } r � 'i { j iE, . -..,�..•.-,.."., �...�„ f_........�..n.:..,,.._.�.. f k�, �4 � �� � �#"�" �k1'I t � ��. � f'� �.'• l: 'y� ._ i}• y 1 1 i ftpout .. �. l��. F�YR�"�--..���"'t �. 30".,r't� �:-�s •t}�_( 2 ,r^�fff;,,. g( ,qp ' •G r- h 7 ` , }a FOR FINAL INSPECTION OF THIS SYSTEM CALL.BETWEEN :30 - 930 A:M. THE.DAY OF INSTALLATION. TELEPHONE # IS (336) 751=8760. t' II OPERATION PERMIT SYST INS ALLED BY: + E4 _ Y - ... a N a 11 , *! M1. w AUTHORIZATION NO, OPERATION PERMIT BY: DATE: - _ **THE ISSUANCE OF THIS OPERATION. PERMIT SHALL•INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE,,-," 'WITH F = } `�V THATSYSTE OTH.1WILL FUNCTION SATISFACTORILY FOR -ANY GIVEN PERIOD OF TIME. , A, SECTION-A900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NOWAY BETAKEN ASA DCHD 02102 (Revised)' 4 go + ' . DAVIE COUNTY HEALTH DEPARTMENT ' IMPROVEMENT PERMIT and OPERATION PERMIT IMPROVEMENT PERMIT lbtr(i S �Ntfvj DuJNVL /,0 D **NOTE** This improvement permit DOES NOT authorize the construction or installation 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) NAME i �/' �I �fi l/// /tel PROPERTY ADDRESS M C ko r h V i lI -r L,� oc�— Z f!7 DATE LOCATION SUBDIVISION NAME11 K16''fl-4 LOT NUMBER ? 7' 'i/ SEC. /BLOCK NUMBER 94cx-F RESIDENTAL SPECIFICATION: BUILDING TYPE # BEDROOMS S # BATHS # OCCUPANTS I GARBAGE DISPOSAL: Yes COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No LOT SIZE � = TYPE WATER SUPPLY h DESIGN WASTEWATER FLOW (GPD) NEW SITE 'I--' REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIIE �2d GAL. PUMP TAME( Z&,L) GAL. TRENCH WIDTH ROCK DEPTH � ` LINEAR FT. OTHER oC___ REQUIRED SITE MODIFICATIONS/CONDITIONS: ***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PIANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. IMPROVEMENT PERMIT BY &int' // 7 w` nD 4ull Au" �G,-t� tq! **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. OPERATION PERMIT SYSTEM INSTALLED BY x l=w 4�P r. �y oql l2ox 3 xl2'" AUTHORIZATION NO. 0/0.3 OPERATION PERMIT BY a-,; f4 in Blu 1-0- - &L co -5 L-P-\Jcc� 5e-Que,�C-z 41f r#Z q3 � DATE **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. DCHD 10/95 - ✓, Davie County Health Department ENVIRONMENTAL HEALTH SECTI AUTHDRIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (Issuen Compliance with Article 11 of ` B.S. Chapter 130A, Wastewater Systems) ***This Authorization For Wastewater System Construction oust be issued by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Numbe16 prese!#jW } oo Yea ounty Building Inspections Office when applying for Building Permits.*** / J / U✓ T/ ►(J � AUTHORIZATION NUMBER MWME �DATE r,0 /, ?/r'r�C NAME ON IMPROVEMENT PERMIT (If different than above) SITE LOCATION 41, Mpg a ,��i� —J, -q-- / .�� ASS �r / v COMENTS/CONDITIONS ON AUTHORIZATION TO CONSTRUCT WASTEWATER SYSTEM APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PE Oil I �� f Davie County Health Department t,NOVA C 9� Environmental Health Section N U" U 66 - I I G lj 4 P. O. Box 665 DI�O^ Mocksville, NC 27028 EOUNT WITH ��� D 0AV1EC 1. Applicn/Permit Requested By rr JJCtI Mailing Address -49q tiT11 :Zda d Home Phone qqq- 191 961 YA,� .2191-)6 Business Phone lyo"q"5-,3.3 2. Name on Permit if Different than Above 3. Application for: ❑ General Evaluation ❑ Septic Tank Installation Permit 4. System to Serve: Q'House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry El Other ❑ Unknown q , 5. If house, mobile home: Subdivision 'r I i i Section I Lot # 3t— ► O �3 ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms r CA'Washing Machine No. of Bathrooms 2 Dishwasher Dwelling Dimensions 17 Xj tP 1,1560 6. If business, industry, place of public assem ly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers No. of Sinks _ No. of Urinals No. of Water Coolers Water Usage Figures ❑ Garbage Disposal 7. Type of water supply: [public ❑ Private ❑ Community 8, Property Dimensions ZOO X q00 Sewage Disposal Contractor (A 1 f, &(,yA �f�KP 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes M40– If f o If yes, what type? ► '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. PROPERTY INFORMATION REQUIRED: Directions to Property: &L1eve 5--h `�v /- e iO- 4 a7- &�Ad2 ye prD?:;i erk D/-) L e -,` 0-4/,P,,n /'�Qulron¢ %fid / J&5 -F3 %�a� been S-x,�'d, d 4gc Tax Office PIN # Road Name Box # (if available) City /% OC k Sy 2 .� 7S 7 9 - 4/8a 7 J z u yi n�hD >// 1dAr r 7Gi' 1"e si )e-, This is to certify that the information provided is correct to the best of my knowledge, and incurred from this application. DATE SIGNA I am responsible for all charges CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: N? 1. I 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 Coun y Health Department to enter upon above described property located in Davie County and owned by rine r a c- (Z to conduct all testing procedures as necessary to detid site's suitability f r a ground absorption sewage treatment and disposal system. C DATE DCHD (1193) ,TUBE DAVIE COUNTY HEALTH DEPARTMENT ' = Environmental Health Section Soil/Site Evaluation NAME ADDRESS PROPOSED FACIILTY Anq� i( DATE EVALUATED A�' PROPERTY SIZE /0� LOCATION OF SITE /,` `�, lZ Water Supply: On -Site Well _ Community Public ✓ Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L L.4— L. Slo e % Slope HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH "f Texture group e" CC Consistence Structure /l 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: AlAot an rr- k& fnC LONG-TERM ACCEPTANCE RATE: REMARKS: �n DCHD(01-901 EVALUATED BY: ,A 4 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 ;lay loam• SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR- V? ---y friable FR -Friable FI-Fiml 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 3C -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/fu ". APPLICATIQN FOR SITE EVALUATION/IMPROVEMENTS PERMIT / Davie County Health Department Environmental Health Section JUL 3', P. o. sox 665 RECEIVED V'Mockaville, NC 27028 id i1. Applic ion/ ellrm Mailing Address _ / oc e_ Irt, oll 7J 05 d Home Phone Business Phone'- 3lD Q 2. Name on Permit if Different than Above &nrte-l� 3. PropertyOwner if Different than Above In na ' QJ �� 4. Application/Permit For: 19 General Evaluation S/Tank Installation S. System to Serve: 5 House J Mobile Home (] Business ❑ Industry u Other 0 Unknown 6. If house, mobile home: Subdivisiona�11�, sec.- Lot#_ No. of People Dwelling Dimensions No. of Bedrooms Basement/Plumbing No. of Bathrooms Basement/No Plumbing Washing Machine Dishwasher 0 Garbage Dlspusai 7. If business, industry, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers S. Type of water supply: Z Public 0 Private 0 Community 9. Property Dimensions 10. Sewage Disposal Contractor 11. Do you anticipate additions/expansions of the facility this system is intended to serve? 0 Yes X No If yes, what type? *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plane or the intended use change. Effective October 1, 1989. 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 ��cren� C or t e �IL 4z •rho Directions to Pro ty : V. DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION SITE EVALUATION CONSENT FORM 1. Complete the form below and return to the Davie County Health Department. 2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin." NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO BEGIN THE REQUESTED EVALUATION. DETACH HERE AND RETURN TO: Davie County Health Department, Environmental Health Section, P. O. Box 665, Mocksville, N.C. 27028 Davie County Health Department Environmental Health Section Site Evaluation Consent Form LOCATION OF PROPERTY: DATE RECEIVED / (office use only) Dye no 1. I am the owner of the above described property. yes no 2. 1 am not the owner of the above described prope`rC,ty, however, I certify that I have consent from L u G� �1, , owner to obtain a owner's name site evaluation by the Davie County Health Department for the purpose of determining the suitability for a ground absorption sewage treatment and disposal system. es no 3. 1 hereby give consent to the authorized representative of the Davie County Health Department to enter upon the above described property and conduct all testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE 4. 1 hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: 'Owner only Owners designated representative Anyone requesting results — Only those listed below �- 0�4?- Zj -L�� L-� - DATE SIGNATURE DCHD (11 /84) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME l/U.�,f ADDRESS PROPOSED FACIILTY DATE EVALUATED PROPERTY SIZE LOCATION OF SITE �l .�— Water Supply: On -Site Well Community Public L� Evaluation By: Auger Boring / Pit Cut �- L Sloe�- FACTORS SITE 1 2 3 4 Landscape position �- L Sloe�- HORIZON I DEPTH Texture group ft, SL S�- Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence - i ! r/ Structure v2�6/rl 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'—T7_'-,r— ATE , SITE CLASSIFICATION: 1" !� EVALUATED BY: A6. LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: tl 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 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/ftz DCHD(01-901 . Dame County Yfealfff Deparfinenf and .Moine . Alealliff .fyency 210 HOSPITAL STREET / P.O. 80% 665 MOCKSVILLE. N.C. 27028 PHONE: (704) 634-5985 August 10, 1990 Johnny R. Williams Rt. 4, Salisbury Rd. Mocksville, NC 27028 Re: Site Evaluation Hickory Hill I/Sec. F -Lot 4 Dear Mr. Williams: As requested, a representative from this office visited your site on August 9, 1990, to determine the soil/site suitability for the installation of a ground absorption sewage system. Unfortunately, due to the reason(s) noted below, we must classify this site unsuitable: 1) Shallow soil to saprolite. 2) 2:1 clay. We sincerely regret this classification and are more than willing to discuss this matter further, upon your request. Sincerely, &V2.X�v Robert B. Hall, Jr., R.S. Environmental Health Section RH/wd Enclosure • (Davie County Nealtk Department altI A en and .1�ome �e y cy 210 HOSPITAL STREET I P.O. BOX 665 MOCKSVILLE. N.C. 27028 PHONE: (704) 634-5985 December 7, 1995 Stacy & Brett Lavery 499 Griffith Rd. Advance, HC 27006 Re: Site Evaluation Hickory Hill I/Lot 3 & 4 Dear Mr. & Mrs. Lavery: As requested, a representative from this office visited the aforementioned site on November 21 and 27, 1995. Based upon the information provided on the application for a site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of a modified, oversized on-site sewage disposal system. If you have any questions, please feel free to contact this office. RH/wd Enclosure Sincerely, ;0eW� Vis. Robert B. Hall, Jr., R.S. Environmental Health Section