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552 Buck Seaford Rd Davie County, NC Tax Parcel Report Monday, September 26, 201 t 454 I 486.` _-- 495 �"- IL ,,� --- --"`"---------------- 509 75 504 5521 5 r 563 r 528 ~591 r-` 605 !` `{ WARNING: THIS IS NOT A SURVEY Parcel Information� � Parcel Number: K40000004309 Township: Mocksville NCPIN Number: 5726992174 Municipality: Account Number: - 82529952 Census Tract: 37059-801 Listed Owner 1: REYNOLDS DANIEL JOSEPH Voting Precinct: SOUTH MOCKSVILLE Mailing Address 1: 552 Buck Seaford Road Planning Jurisdiction: Davie County City: Mocksville Zoning Class: DAVIE COUNTY R-A State:. NC Zoning Overlay: Zip Code: 27028 Voluntary Ag.District: No Legal Description: 22.077AC TRACT 1 SMITH SD Fire Response District: COOLEEMEE,MOCKSVILLE Assessed Acreage: 21.51 Elementary School Zone: COOLEEMEE,MOCKSVILLE Deed Date: 8/2008 Middle School Zone: SOUTH DAVIE Deed Book/Page: 007660988 Soil Types: GnB2,PcC2,EnB,MsC,ChA Plat Book: 0009 Flood Zone: Plat Page: 378 Watershed Overlay: DAVIE COUNTY Building Value: 1678120.00 Outbuilding&Extra 43010.00 Freatures Value: Land Value: 198540.00 Total Market Value: 1919670.00 Total Assessed Value: 1743850.00 All data is provided as Is without warranty or guarantee of any kind 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 cOUty4 NC or arising out of the use or Inability to use the GIS data provided by this website. DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT �qaI-7y Account #: 990005090 Tax PIN/EH#: Billed To: Dan Reynolds Subdivision Info: 'Sa.. Reference Name: Location/Address: 154—Buck Seaford Rd-27028 Proposed Facility: Residence Property Size: 55 Acres ATC Number: 4905 **NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC 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. L' `�'S'�_ r U Ido�� /,OOv' ale–' �/ 12- " System Type: S.T.Manufacturer ��d Tank Datel/ Tank Size 'Ila cp-' Pump Tank Size:– System Installed By: L-& E.H.Specialist: Date.— � u 00 ec,-Ctti s 0 ,0C) (�a��V� � � �¢ T k-e 1r3 a✓'vt � a'�1 C� �; �U�of 33 1p4 cy �QKu1 G f par � G 0o �O C�uvaj P l DCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848%210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751--8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005090 Tax PIN/EH#: 5726-98-0447 Billed To: Dan Reynolds Subdivision Info: Reference Name: Location/Address: 454 Buck Seaford Rd-27028 Proposed Facility: Residence Property Size: 55 Acres ATC Number: 4905 Site Type: 0<w ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental . Health Section prior to issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. 1 ' ,t( u / Residential Specifications: #Bedrooms -7 #Bathrooms V #People Basements Basement plumbing❑ Non_Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) - loo, Lot Size 5"C",149 Type of Water Supply: 3 ounty/City ❑Well ❑CommunityWell • 34Uv eoo .f. System Specifications: Design Wastewater Flow(GPD)1130 Tank SizeGAL.Pump Tank GAL. 7%A�) y- •Trench Width 3 G Max.Trench Depth Rock Depth*A'Linear Ft. S a d Site Modifications/Conditions/Other: As stated in 15A NCAC 18A.1969(5) aGGe ted-Syster~rr^abse Contact the Davie County Environmental Health Section for final inspection of this system between 8:30-9:30a.m.on the day of installation. Telephone#(336)751-8760. or-AV jo\� 3 b -&roc3'&u 5 '� D-t CatoovAa &A ^1I�►�S � r- r Oriu4C '-to gw� Environmental Health Specialist Date: nrun 71/06MPvicr.d) Davie County Environmental Health P.O.Box 848/210 Hospital Street • Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990005090 Tax PIN/EH#: 5726-98-0447 Billed To: Dan Reynolds Subdivision Info: Address: 183 Woodfern Road Location/Address: 454 Buck Seaford Rd-27028 City: Neshanic Station Property Size: 55 Acres Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans,plat or the intended use change. Permit Type: ew ❑Repair ❑Expansion Permit Vaal/lid for: Years ❑No Expiration Residential Specifications: #Bedrooms (0 #Bathrooms 6 #People BasementE;� asement plumbingln Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): �0 Type of Water Supply: ounty/City ❑Well ❑Community Well As stated in 15A NCAC 18A.1969(6 Site Modifications/Permit Conditions: accepted Systems may . Iso he use System Type LTAR Initial C Repair ? Site Plan -e GrK Irl �GA_O _ fipnr°� �C CA Environmental Health Specialist Date L9 3D i.p.11-06 • � � t( 05/19/2008 HON 7:22 rax ,!Q vivo IDS . MAY-17-2008 1511 From:CB1'R RDVRN CE 3369984492 G -Ta:919083930301 e May 09 us 03: 5 p ,°,. davie county envhealth age's 751 8766 P• ?dq0 . SLI ON FOR`)I VE EV'ALC3ATION/IlVt '.ROVEMENT k'ERMTT&AT �+ DAVIC County EnviroamcutuIllealth 4, Y.U.Boa 8481210 Ru3pftal,3treet . lvlocicskillp,I+IC:270221 ter, t 4 i (336)'151=87601 Rapt(336)79:1.8786 S uplacaG ii-FOr: -1:1 Evaluatioa/hnptovutneot Portnit 0 Authorizaboh•!o.Construct(ATC) f}both Ty{�e oI`Application: ONew System • Oltcpair to Existing System GExpan.ion/Modilication of.Exbting System or Faelli ty F•**IMPORTAN7***T141S APPLICA710N CANNOT 06PROCaSED UNLESS ALL OF THE REQUIPM INFORIV 77IMi IS PROVIDED. It.efur to the NFOa�MAT10N:6ULLET[l�t for inshrucdiooa. APPIMANT INFORRN�f'ATION Name to be Billed Contract Person Billing Address /.?-3 t-jDoh .� Herne Phone 9�n 8 1'3__ �4a.7 trity/State/21P ^/�� 5`S�-aa.Z's,�,� J" Ii�,sir css Fhone �o� — •.z.9 y S�o 7 2 Flame on Pcrmlt/ATC ifDi f ere::t than Above Mailing,Address Cit;JState/Zip PROPERTY INFORMAVON _ *llatt=EiotsrclP Comers-Pira NOIT: A survey plat of site plan tnwA a:compaay this application. :..Iaelu4ei:U,Sito-Ptan at(to scale) (Permit is valid for 60 montlu'wlah slte plan,no expiration with cote ote:plst.) Owner's Namte jlc.fr 2� _ r .T-.f Phone Number Owner's Address es G1� �„E y t >� Cit)/State/zip Tyoperty Address qu�.s�.a. rE2� C,�t}� 7e9 •� - ��/t` Lot.Siza '!'sx>?1Ni! 7f� 3o'if Subslivi5iort amc(ifappiicabfc) Section/Latti Directions'ro Site: J,s_rl., �__� ►�,�� ,� rf�_,Q,,e r� c r~ t` tr— If the answer to any of the following quinti.los is"Yee.supporting docutncutatica I=t be attachod. Arra there any existing wosmw&ter systerm an the site? dyes t Does the sito cantain jurisdietlow I wetlands? Oyes Are titre any casemcats or richt-at=ways on the site? ayes a Is the site subject to approval by a:iodmi public agency? oyes 0.<, Will waatewatrr eget Ulan daaarai:c sewage be generated? pYes.W'Vo IF RESIDENCE FILL OUT THE P OX BELOW People —*Bedroom ,� 11 Bathrooms GQrdca Tub/Whirlpool OYas ONo . Basemosesit. 13No Basomenr.Plumbing! V� ; ONo IF 11 ON-RESIDENCE FILL ou•r ma Box 13BLoW Type of Facility/Biusiness_ Total Square Footage of Building #Pcawle 9 Sittka_ _,+ 4 Commodes fS Showers V Urinals Estimated Water Usage(gallons per da)) (Attach documcriati.on of similar.fociiity.watcr consumption)' FOODSERVICE ONLY: #Seats Type system requested;, 0rK9nventiorsl 0.11►t:etspted Olnnovative UAtternativa OOther Water SUPPLY Typc:W/County/city Water O Now Weft DExisting Well 0 Commututy Well > Dartticipaie additions or expansions of tbo facUity this Pvcinrn�.:�•-.a - o t t 98L8 ZSZ 9�� °1 26bb86695:£ 33Nti�ldd 21183 T2:%T 8002-82-1,tiW ®010/010 • 05/19/2008 MON 7: 22 PAX • . ..—-�..-«..+wwuuW W]e�YC! U iCS 1w„O tY yes,what type? INs is to certify that the information provided on this application itt We and eoae:l to thohcat of nyknowledge. 1 understand that- any permits)or ATC(s)Issued hereafter ore hub/ect to suspen3ion orrevocation it-iho site is altered,the intended use changes,or if the information submitted in this application is falsified or changed r hereby gray:right of entry to the Authorized Representalive of the navitt my Health Department to conduct'necuasary inspections to dctcmL-.c,compliance with applicable laws and rules. un tha qgpofi parAenfificatian and labeling of prol,erty liars and corncY's and locntiug and'flagging r sta ' t {ohs lfac�lijy ci ' n, io oar wt location and the location of arty otber amenitlae. l � • ..q - ' Si:r: Prmpetty tiwncr a rawu c!s cgal rq,reNmtn\.ivs_s' nature Re visit Ci we Date(s): ,. Client Notification Date: Date Sign given 13 Yes ONo Account VV V t;cvised t J/06 Invoice'# 9818 TGL 922:01 26bb8669g£ 30NHt1413 8183:woj3 i2:Li 8002-82-AHW "*, N i :� l''i c. ° r r� j �: '�, r.:i rr s q ro,at;n C �prs�F.i�z ,.,n'✓+ r. - "' < A'S iA ,..•2+.. 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' AND IV.7000A4SiM1• INGf1 R8.73 P0.as, f % A0. �. }�;�.� ... ow.. 1 FeT 1 •T'1�� � ren �m i a � n� � DAVIE COUNTY HEALTH DEPARTMENT., Environmental Health Section Soil/Site Evaluation APP,1`,tErelda #N9QKW1b0EIbN Tax PIN/EH#: 5726-9ft• QTY INFORMATION Billed To: Dan Reynolds Subdivision Info: Reference Name: Location/Address: 454 Buck Seaford Rd-27028 Proposed Facility: Residence Property Size: ` 55 Acres Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % , 2 HORIZON I DEPTH d f " 6 If — Texture group C' G Consistence -1 10 V1 Structure 7:::;JB K 7Z kJ I/,- Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure . Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON l SAPROLITE . CLASSIFICATION gi LONG-TERM ACCEPTANCE RATE =DAZZ , p SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: V �? . 175 OTHER(S)PRESENT: REMARKS: a� LEGEND J,andscape 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 SICU-Silty clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC- Silty clay C-Clay CONSISTENCE a� Moist 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 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 05/05 (Revicerl) ' Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990005090 Tax PIN/EH#: 5726-98-0447.Site 2 Billed To: Dan Reynolds Subdivision Info: Address: 183 Woodfern Road Location/Address: 454 Buck Seaford Rd-27028 City: Neshanic Station Property Size: 55 Acres Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans,plat or the intended use change. Permit Type: ErNew ❑Repair ❑Expansion . Permit Valid for: ff Years ❑No Expiration Residential Specifications: #Bedrooms #Bathrooms #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply: ounty/City ❑Well ❑CommunityWell Site Modifications/Permit Conditions: System Type LTAR Initial (}, ( 75— Repair 5— Re air �� ? 'Z r> Jac: cl'o Ct, ieo .� Site Plan oil �I LA od ZZ, 'StQ�'c r Environmental Health Specialist Date i.p.11-06 07/03/ OOtt •THU 11: 05 FAX 002/003 _ •,J JL1L-03-2008 10: 16 From:C -M ADURNM 3369984492 Tot%900930301 APPLICATION FOR SITE PYALUA'.fI0N/IMFROV9MENTPERMIT& ATC DRY19 Courtty Envirorunlebttal At pith P.O.Box 849/210110801tal Street Modmills,NC 27028 (336)751-87601 FAX(336)751-8786 Application For; A-<Evaluution/laaprovement Permit 17 Atftrizatlun To UnstrucgATC) p 13Dth Type of Applieadon: vNew Syettln rlRepair to Existing Systt:tn t]Bxpanyicn/Madiflaation of Existing Syatam or Faculty :"Z POR7W tM*-MIS APPLICATION E OT AS PROCESSED UNLESS ALL Ole TIE RRQUIRBD INFORMATION IS MOYIZIED. Refer to the Mr-ORMATION BULLL'i'1N for i lmhuctions. APPLICANT INFORMATION Name to be Billed--� .._Contact Pergnn ° 'V- Billing Alclnsss_ ���, ��� .__ Home Phone City/StawZ1P. Business pbotie ¢a ' _SIC ZP— Name on Pcrmit/ATC VDgerent tlttrn Abovb MztilingAddress Cin/Staten p _�s�r�^- PROPERTY INFO. mkrjON Vate House/Facility Corners Flogged NOTE: A sutvcy plat orafte plant ttmsr accampapy this application, Included:rJ Site Plan WALL(to scale) (Permit U valid for 60 mambs with site plan,no expiratino with compinte plot) Owner's Name E,F�,o�ES r _ Phone Number Owner's Address �� A•- eg City/S1,strMp ouSLg;fgV L& Property Addrestt 'i<''q1 City. 0%%A..¢u.,!rfld amool IE Lc t Size s A�c.QQ C Tax PINp, G coo beg 43 o 4P Subdivision Nbme(ifapplicable) .19 Z, Directions To Site: _ if the answer to any of the fallowing quretlobs is"yes",sugporlittg doeumentation must be attached. Are Lhure any existing wi mwater systems cm the site? Mes Ao Dods%a site cont6i juiisdictim ial mdande? r3Yes 6"Po Aro there any casements or right-of-wayson the site? l IYLs Is the trite subject to approval by anothertublic agency? r3Yes 5910 Will wasmwater other than domestic sew c ba geurmtctt? nyes An Y IF RX81 DRNCE FLOUT THE BOX BELOW . fl Xleopla _ 11Dedtooms #Dat}troome_ CardenTub/Whirlpool U1Yas UNo I Beacmeat: r7Yes I Wo BanementPlumbing- t IYcs 0- No IF NON-RES>lDENCR,VML OUT TIM BOX BELOW_ Type of Facllity1Bttziness t _1otal Squam Footago of Building. 0 People A Sinks _ #Commodes_ #Showers _ #Urinals estimated Witter Usahm(gallons pLx day)_• ,_(Attach documentalion of similar 6cility water consumption) FooDS1E RVME ONLY: 1/Seats Type system re:quesrad: 015onventlonal 0 A,ceeptacl 01movative ❑Alternative, notim Watat Supply TVc Wtotttuy/City Water 15 New Well Uli:cming Wall t7 Commuuity Well Do yun anticipate addidom or expansianc of the facility this aymtotn is intended to serva r1 Yes fo<a 1frZ 'dat''96EE 'ON Utt 966 OdINl 189-. WdOZ'E 9002 '� ltl(' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990005090 Tax PIN/EH#: 5726-98-0447. Site Billed To: Dan Reynolds Subdivision Info: Reference Name: Location/Address: 454 Buck Seaford Rd-27028 Proposed Facility: Residence Property Size: 55 Acres Date Evaluated: Water Supply: On-Site Well Community Public J Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position �— Slope% HORIZON I DEPTH o Texture groupG Consistence l,- Structure k k Mineralogy HORIZON H DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION �S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: S EVALUATION BY., LONG-TERM ACCEPTANCE RATE: 7 D� �- -75___-75___ OTHER(S)PRESENT: 6t 0 1A�1 1 T REMARKS: Landscape Position LEGEND 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 �l21St 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 Mineral= 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) T'PA n T .....- •......- ........�•..�..--..•.. -l/J..../hit �..-� ..-..... .� .. PLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC Q r�GI Davie County L-tvironmental Health hi Arc P.O.Boz 848/210 Hospital Street W �, Mocluville,NC 27112$ (336)753-6780/ (33 751 86 r 1 DU 1 U�s App' For. Evaluation/Improvement Permit tion To nstruct(ATC) ❑Both t l O �\� ppli New System ORepair to Existing S ❑Expausion/ModiYieation of Existing System or Facility n V �ccii'" ORTAM�"THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUII2ED o[ t�0 � ORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed 1h A JZ! u t 5 T�L3 t t.q l,ts(r T aC- Contact Person Gv R 1)n,`l W t TJ-Jgr`f Billing Address .o, 2 Home Phone q4o ^(v947 City/StatQtZIPDJAr e-E , IJC 2?OO�O Business Phone 3q5- 3158 Name on Permit/ATC ifDifjerent than Above Mailing Address City/State/Zi PROPERTY INFORMATION 'Date House/Facility Corners F1 ed I D`l NOTE: A survey plat or site plan must accompany this application. Included:❑Site Plan ❑Plat(to scale) (Pem k is valid for 60 months with site plan,no expiration with complete plat) Owner's Name O a t " . Q O L Phone Number QOy'ZQ 4-5-70 Owner's Address I V L 0 J O p V, City/Stat&Zip'�B12A w B tow, N 1 b 9 ?Cp Property Address 1 Je1K -50A Rp O. City MCCKS Vs L(,E N C. Lot Size 3Z 4- Z1 !}GPsh Tax PIN# -572(o9°J0447, 572.1,,gq Z i'74- Subdivision Name(if applicable) Section/Lot# Directions To Site: If the answer to any of the following questions is-yes",supporting documentation must be attached Are there any adsting wastewater systems on the site? Dyes*0 Does the site contain jurisdictional wetlands? ❑Yea$Wo Aro there any easements or right-of-ways on the site? Oyes P40 Is the site subject to approval by another public agency? ❑Yes PNo Will wastewater other than domestic sewage be generated? ❑Yea)io IF RESIDENCE FILL OUT THE BOX BELOW 6 FIA— 2 z- j G #People r- #Bedrooms 7_ #Bathrooms Garden Tub/WhlrlpooIXYcs ❑No Basement:XYes ❑No Basement Plumbing: OYes XNo IF NON-RESIDENCE FILL OUT THE BOX BELOW f 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: ❑Conventional ❑Accepted ❑Innovative ❑Alternative OOther Water Supply Type:g County/City Water ❑New Well Misting Well ❑Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?0 Yea -gNo Myes,what type? 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 permits)or ATC(s)issued hereafter are subject to suspwsion 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 Represea five of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws an les. unders that I omrble for the proper identification and labeling of property times and comers and locatin d ging or the location,proposed well location and the location of any other amenities. Pr , wner's or er's egal reae n ' e signature Site Revisit Charges Date(s): Client Notification Date. D ERS: Sign given ❑Yes❑No Account# Revised 11/06 Invoice# 1 — -- — --- — ------------------- Jo 0-OOLe L 1 ( !) 3 ,S4 ,69°ZO S NV�d 31lS i qs bl �SnEnVf i I ZB'LFL M •64,gii odsa aa0dV3S >fOnB a}D(] I 30NVNIN3 3AI80 - 1V S11vM 3NOlS Mol- 61 L CD > O 00 CA n n i cpm 61 .,o W 4 b0'LLL _� cn �1 C< Q 3AIa0 13AVa0 ' 03NI1 33x1 301M o U) J .7 zn G3dV3S Yl � O Q I Sa300d 313a 00 QCD 39"V9 4* •t ->FZ 1 �I OH Q ( 3SN VW NaVB 01( IIa0 \ 13Ava ONS Q O — .0-,ZL 3 ln3–' ('0'1'N) 100d 3dn1n3 \ COIN) 3an1nj Nave I i 3arun3 �1 ('dAl) 3NI1 j I Ala3d0ad v �I \ I I �i CD � 6'9 njO �!2 t CD �� I I I \ i 0 C_ r (0 0 rN� `° 1 (-4 V) I -,j3 Wv rt I i 3 -Co .£4.40 N Z-D = 68'fi8 E �� ( I 3 „00 ,£4.40 N ,4L'SLS I ALV 3 ,.9Z ,c4.b0 N \ I O � .49'98Z 3 „9Z ,£4.40 N 3 x _7 •9Z ,£4.40 N O I ,9F'86Z O L-A -o I i C _ E t f. i I i o— fv dSn o �o OQO Y w T V MRR 30 2011 7: 23RM HP LRSERJEI aeuu p- g Da ' County Health Department 'ronmental Health Section P.O.Box 848 kj 210 Hospital Street .0 ��( Courier#:09-40-06 Mocksville,NC 27028 Phone(336)-.753=6780 Fa=(326)-7531680 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection NamesDui M�.it x(We-Narme.- Rblvn04� Phone Number —704- - 6-tg 6e9g (Home) Mailing Address: t( w,.�� U4 - 9O —7650 (Work) de Afc— Z ,,677 Detailed Directions To Site: Property Address: r5 Z /14"sr;it. . Atc— Please Fill In The Following Information About The EEMSTING Facility: Name System Installed Under: _N/v � /Vods Type Of Facility: 4(45e.' Date System Installed(Month/Date/Yeark O'%. /0 Number Of Bedrooms:_Number Of People: ((J Is The�Facility Currently Vacant? Yes No If Yes,For How Long? Any Known Problems? Yes (to)If Yes,Explain: Please Fill In The Following Information About The NEWFacility: Type Of Facility: Number Of Bedrooms: Number of People Pool Size: �J6 K '��r Garage Size: Other: Requested By: Date Requested: (Signature) For Environmental Health Office Use Only proved Disapproved Comments: Environmental Health Specialist i *The signing of this form by the Environmental Health Staff is in no way intended,nor should be taken as a guarantee (extended or limited)that-the on-site wastewater system will function properly for any given period of time. Payment: Cash Check Money Order # Amount:$ Date: Paid By: Received By: Account : Invoice# DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Strut — - Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 OPERATION PERMIT Account #: 990001597 Tax PIN/EH ; 5726-99-2174 Billed To: Subdivision info: Reference Name: Dan Reynolds (.ocationiAddress: 552.Buck Seaford Rd-27028 Proposed.Facility: Barn Property Size: 55 AC Z. ATC Number: 5075 **NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC 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. System Type: S.T.Manufacturer 0—f Tank Date Tank Size ! 0 Pump Tank Size ��j System Installed By: Ck k'� �.H.Specialist:J � at r �P• 3 60 yo 6 2.60 ` �o DCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990001597 Tax PIN/EH#: 5726-99-2174 Billed To: Marquis Building Subdivision Info: Reference Name: Dan Reynolds LocationiAddress: 552 Buck Seaford Rd-27028 Proposed Facility: Barn Property Size: 55 AC ATC Number: 5075 Site Type: 4dNew ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms:#Bathrooms #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type n #People #Seats Square Footage or Dimensions of Facility) Lot Size 'S�ar Type of Water Supply: ❑County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD) 11O Tank Size o/ OO GAL.Pump Tank_A�A GAL. Trench Width 3(e_ Max.Trench Depth_j_& Rock Depth /Z Linear Ft.-ma d Site Modifications/Conditions/Other: Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the day of installation. Telephone#(336)751-8760. `OPP i RN"2, {� t c Environmental Health Specialist Date: 2010 DCHD 11/06(Revised) ��ii Davie County Environmental Health P.O.Box 848/210 Hospital Streit. — Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT Account #: 990001597 Tax PIN/EH#: 5726-99-2174 Billed To: Marquis Building Subdivision Info: Address: P.O. Box 2170 Location/Address: 552 Buck Seaford Rd-27028 City: Advance Property Size: 55 AC Reference Name: Dan Reynolds Proposed Facility: Barn **NOTE**This Improvement Permit DOES NOT authorize the constructi(m of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit.is subject to . revocation if site plans,plat or the intended use change. Permit Type: QNew ❑Repair ❑Expansion Permit Valid for: MI'Years ❑No Expiration Residential Specifications: #Bedrooms____#Bathrooms #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People_#Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):/C20 Type of Water Supply: ❑County/City ❑Well ❑Community Well Site Modifications/Permit Conditions: System Type LTAR Initial &&W if Avlo 01g, 3 Repair (9" rAroh Site Plan 4JL r I Environmental Health Specialist Date// 2 /0 i.p.11-06 OR SITE EVALUATIONAMPROVEMENT PERMIT & ATC t Davie County Environmental Health 1y P.O.Box 848/210 Hospital Street MocksAlle,NC 27028 pQR (336)753-6780/Fax(336)753-1680 ppli atiption/Improvement Permit ❑ Authorization To Construct(ATC) Both ype of A tc6 New System . ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility MPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name -.,J Contact Person Ki .' Addressa S�� (c. Home Phone `!4 •-�,,<j¢� City/State/ZIP fL Vi4�1.I f L g.,,! Business Phone 7346— 3 f S%`r Name on Pennit/ApC if DLfferent than Above Mailing Address 7 City/State/Zip � •e_- PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included:XSite Plan ftlat(to scale) (Permit is valid for 60 m�qths with site plan,no expiration with complet pat.) Owner's Name__ � ,.Jy,�4h;._�`7 Phone Number Owner's Address City/State/Zip Property Address .5 5" 0>04:e_ St" ;=vl-6" City &V/J�� i LLQ Lot Size 5.5 A( ,O_e-_5 Tax PIN# 572lo- g-0174 Subdivision Name(if applicable) Section/Lot# Directions To Site: If the answer to any of the following questions is"Yes",supporting documentation must be attached: Are there any existing wastewater systems on the site? %des _No f3 P_ N"J c 5c-- Does the site contain jurisdictional wetlands? _Yes _)�No Are there any easements or right-of-ways on the site? _Yes k No Is the site subject to approval by another public agency? _Yes AtNo Will wastewater other than domestic sewage be generated? Yes-)(No IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms #Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes ❑No Basement Plumbing: ❑,Yes ❑No IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business 1:S Total Square Footage of Buildin ZoeO l #People # Sinks t #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) _ (Attach documentation of similar.facil�ty water consumption) FOODSERVICE ONLY: # Seats Type system requested: QConventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply TypeCounty/City Water 0 New Well ❑Existing Well ❑•C6mmunity Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes XNo If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I uiiderstai-rd ' 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 rule I understand that, a responsible for the proper identification and labeling of property lines'and corners and locating an aggi�or st in � e/facility location,proposed well location and the location of any other amenities. Property owner' or owne s legal repr sentative signature Site Revisit Charge Date(s): Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# Revised 11/06 Invoice# ;y a • • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001597 Tax PIN/EH#: 5726-99-2174 Billed To: Marquis Building Subdivision Info: Reference Name: Dan Reynolds Location/Address: . 552 Buck Seaford Rd-27028 Proposed Facility: Barn Property Size: 55 AC Date Evaluated: 'ZG Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% - cs 0 HORIZON I DEPTH — Texture group Consistence r G Structure 77 — Mineralogy HORIZON H DEPTH U-t/ Texture group Consistence Structure r Mineralogy %g fi .•}( 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 . 7 SITE CLASSIFICATION: EVALUATION BY: '���' .r►'t L r j ,t ' " LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: LEGEND Landscape Positi 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 ONSISTENCE moist 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 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) TTAR -i nna-term arrPntnnrP rate- oal/Aau/ftp nnTrn ncine ■■■■■■■■■■■■■■■■■■■■■EO■■■■■N■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■NONE ■■■■■■/t■■■■/■■■■■■■■■■■/■/■/■■/■/■NOON■//NOON■/NOON//NOON/■■■/■■■■■■■ ■■■■■B■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■/■■■■■■■■■■■■■■■■■■■■/■e■■■■■■/■■//■■■■/■■■■■■/■■/■■■■■■/■■/■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■t■■t■Ott■■t■■t■■t■■■■■■■■■t/t■ ■■■■O■■/■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■tO■■ ■■■■■■■■■■s■■■■■■■■■■■■■■■■■■■■■■■■■t■t■■■■tt■tttt■t■■■■■■E■t■t■te ■■■■■■t/■t■■■■■■■■■■■/■■■t■/■■■■ ■■■■■■■■■/■■/■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■t■■■■■■■■■■■■■NOON■■■■■t■■■■■■■■■■t■t■■■■■■■■ ■■■■■■a■■■■■■■■■■■■■■■■■■■■■/■■■■■■NOON■■■■■■■■■■■■■■■■■■■■■■■■■t■ ■/■■■■/■/■//■■■//■■■■/■■■/■■■/■■■■■■■■/■■■■■■/■■■t■■■■t■■t■■■■■■■■ ■■■■■■■■■■■■■■■/■■///■■■■■■■■/■■e■■■■■//■s■■e■■■■■/■■■■■■e■■■■/■/■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■NOON■■■■■■t■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■t■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■o■■■■■■■■NOON■■■■■■■■■■■■■■■e■■■■■■■■■■■ �iii�iiiiiii�i�ii�ii�iiiiiii�iiiiiii�iiiiiii�iiiiii� ■■■■■■■ e■■ ®E�■■■■■■■■■■■■ ■■Ee■■■■■■■■■■■t/■■■■■■■■■■■■■■■■■■■■t■ ■■■■■■■■cI■t3�r��■�7.ca■■■■■■■■e■■■c���■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■��■i/■■■r�■■■�:::.tie■t■■■■/■■�:���e�.�■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■��■■■■��e� ■■F�■■■■■■■■■■■■/■■■■■■��■a�on■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■e�■■■■■■■■■■■■■ ■■■■■t■E■■■e :■��■■■■t■■t■/■■/e■■ ■■■■■■■■■■■■■//■■■■r�i©�.�■■■■■■■/■■■■■■■■■■■■■■ire:■�i■■■■■t/■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■/■■e■■■■■■■■■/■■■■■■■■■■■■■��■■��■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■/■■■■■■■■■■■■■■■NOON■/■■■ii:.�J■■■■■■■■■/NOON■■ ■■■■■■■■■■■■■■■■■■■■■■Ot■■■■■■t■■■■■■■■tt■t■■■■■■■r,Ey�,■■■■■■■■■■■t■ ■NOON/■■■■■■■■■/■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■/■■■■■■■■■■■■■■■/■ ■■■■■■/■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■/■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■/■■■■■■■■■e■■■■■■■■ ME MEMO■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■s■/■■■t■■■■/■■■■/■■/■■■■/■/■ a� -4 Oji Oo C^ �c� P'� s \div. 91 PROPERTY LINE (TYP.) FUTURE BARN (N.I.C.) FUTURE CABANA (N.I.C.) c FUTURE c` POOL (N.I.C.) j FUTURE 12'-0" ` WIDE GRAVEL \ DRIVE TO BARN (N.I.C.) MAIN 235'- 1• HOUSE GARAGE CONCRETE PAVERS AT FRONT DOOR LANDSCAPED ISLAND I `o in 17'-G" WIDE TREE LINED w GRAVEL DRIVE o 2 7_ j 00„ w 30.30' -•. co ro ~�1^ x_245 rn S 0 1g 19• f '.'�•�. 12 1� W --LOW STONE - WALLS AT DRIVE ENTRANCE 480.11' _ �SUCKs pF S 08.36' 4g" �.. 'D ROAD w 137.82'X _D4•23' 53" W, .24.3! SITE PLAN 9.12' 1'-100'-0" S 02.59' i