Loading...
241 Cedar Creek Rd, DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street . Mocksville, NC 27028 (33G)751-87G0 Account #: 990002784 Billed To: Steven Pope Reference Name: Proposed Facility: Residence ATC Number: 4507 Tax PIN/EH #: 5832-90-6783 Subdivision Info: Location/Address: Cedar Creek Road-27028 Property Size: 1 aac AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLTST BE ISSLJED 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 perrnit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: �,fo CERTIFICATE OF COMPLETION �7 **NO��* The issuance of this Certificate of Completion shall indicate the system described on ImprovemenbOperation Permit ,,�..,� 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. _ � ►c,r� �+-sr� c�, �-� c�9� �7�� `i� � t �7 -► `7 Septic System Instailed By: Environmental Health Specialist's Signature : DCHD OS/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section • •' • P. O. Boz 848/210 Hospital Street ' Mocksville, NC 27028 (33G)751-87C0 Account #: 990002784 Billed To: Steven Pope Reference Name: Proposed Facility: Residence IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: 5832-90-6783 Subdivision Info: Location/Address: Cedar Creek Road-27028 Property Size: 1 aac ATC Number: 4507 **NOTE** This Improvement/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 � #People � #Bedrooms �7 #Baths � Dishwasher: � Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 0 Lot Size Type Water Supply � Design Wastewater Flow (GPD) �� Site: New u Repair ❑ System Specifications: Tank Sizel��6 GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width � Rock Depth /� Linear Ft� 11�1PROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF fi " BELOW FINISEIED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 130 p.m. on the day of installation. Telephone # is (33C►)751-87G0.**** ii�/4x � �'�P�C.0 �� ��C 3 G �� a 1� Environmental Health Specialist's Signature: Date: '2" ,� DCHD OS/99 (Revised) �\ .i i• � s `• �� APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department �� _ �, {� � � � Environmental Health Section ��`� �� � P.O. Box 848/210 Hospital Street , 3 0 2006 w- '� Mocksville, NC 27028 � AUG � (336)751-8760/ Fax (336)751-8786 �_. DA`11E Pemut ❑ Authorization To Construct(ATC) �Both �IMPORTAN2*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed S�('P�h tn ��.� � Contact Person Billing Address % 2,�.�' /- �, -�/ Home Phone S.�� r i� �/c�C S� City/State/ZIP �lI o� (ts�•.� / � i°�� c: Z� U z �� Business Phone � ; � �7 � � ,� � ! � �, Name on Permit/ATC if Different than Above Mailing Address PROPERTY INFORMATION City/State/Zip NOTE: A survey�plat or site plan must accompany this application. (Pernut is valid or 60 months with s�te plan, no expiration with complete plat.) /-y�- Street Address �Q(/ �/��,(Zp�- City /%Jo���tS;,,; /l� Tax PIN# 5� 3�' ��— l�,�Is Subdivision Name Section/Lot# Lot Size ,�, j� �� Directions To Site: F4 �;,, ; n�(�,.._,. 7� -�-v �1��.-)cl ;.� ti �1 ��� r__ 1`2.�� 1 u�'it �; �� c�,� �� t c��i: •- � ��t`(` � . �� %�o �� Zr-�"'� [i.�l ' ��Y`1T J . Date House/Facility Corners„Flagged �"-�� � �� 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? ❑Yes ff�To Does the site contain jurisdictional wetlands? ❑Yes �Io Are there any easements or right-of-ways on the site? ❑Yes �.No ' i: Is the site subject to approval by another public agency? �Yes �No •'� Will.wastewater othet than domestic sewage be generated? ❑Yes �No IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms �... Garden Tub/Whirlpool ❑Yes y�No Basement: Yes �9No Basement Plumbing: ❑Yes �No IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/B�siness 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 ❑Other Water Supply Type:�( County/City Water � New Well ❑Existing Well ❑ Community Well � Do you anticipate additions or expansions of the facility this� ystem is intended to serve? � Yes ❑ No If yes, what type? � /.x�)�).��1 �j� -«irv��.r. /hE�r1 r`•x�,�,, u.n.S�� `�`_s 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 pernut(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 understand thnt I am responsible for all charges incan•red fi-om this applicatio�i. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to deternune compliance with applicable laws and rules on the above described property located in Davie County and owned by > f����i� A,.,��? Property owner's or owner �'' �e� � ��� Date Sign given ❑Yes ❑No Revised 2/06 signature Site Revisit Charge Date(s): Client Notification Date: EHS: Account # �76 � Invoice # �7�`� DEED TRANSFER CHECKE� DAT� `.� -30 - 6 � gy`�'lt��� i� - TAX ADMINISTRRTOr Excise Tax: Gift Deed BK611PG I 81 fILED fOR REGISTAATiON AuQust 30, 2006 11:12 a.m. DATE 71ME ' AND RECOROEOIN BOOK 6�� PAGE is� M. BRENT SHOAF, REGISTER OF DEEDS DAVIE COUMY� NCn A , � BY �,;�c.r.a� �,.�/` JLC�,�,�,ei Asst. • Recording Information Drafted by: Henry P. Van Hoy, II, Attorney at Law, Mocksville, North Carolina Mail to: GRANTEES @ �� ��� �� �dl �/jQ'l�W�� (� � � l.� � V �rL TAX MAP: Part of Parce150.02, Tax Map D-5 WARRANTY DEED THIS DEED made this � day of S�I , 2006, by and between EUGENE L. POPE and wife, PATRICIA SUE POPE, the GRA ORS to STEPHEN EUGENE POPE and wife, ERIKA POPE, the GRANTEES: WITNESSETH: THE GRANTORS, for valuable consideration paid by the GR.ANTEES, receipt of which is acknowledged, have and by these presents do convey unto the GRANTEES in fee simple, all that certain parcel of land situated in Farmington Township, Davie County, North Carolina (the "Property") and more particularly described as follows: TRACT 1 as shown on a Plat recorded in Plat Book 8, Page 385 in the Off ce of the Register of Deeds of Davie County, North Carolina which Plat was prepared by Tutterow Surveying Company, drawing no. 7306-3A and which Plat is incorporated herein by reference. THE GRANTORS acquired the property by instrument recorded in Deed Book 65.6, Page 552 of the Davie County Registry. TO HAVE AND TO HOLD the Property and all privileges and appurtenances thereto belonging to the GRANTEES in fee simple. THE GRANTORS COVENANT with the GRANTEES, that the GRANTORS are seized of the Property in fee simple, have the right to convey the Property in fee simple, that title is y. . � // - :,, BKb11PG 1 88 � , . %-mazketable and free and clear of all encumbrances, and that the GRANTORS will warrant and '' defend the title against the lawful claims of all persons whomsoever, except for the exceptions hereinafter stated. Title to the Property is subject to the following exceptions: 1. Easements and restrictions of record. 2. Ad valorem taxes for 2006 and subsequent years. �, The terms GRANTORS and GRANTEES as used herein include the masculine and the feminine, the singular and the plural, as the context requires, and the heirs, successors, and assigns of the parties hereto. IN WITNESS WHEREOF, the GRANTORS have signed this deed the day and year first above written. GRANTORS ,.,.._.� � • �'�-�- EU ENE L. POPE �r.��l�ri PATRICIA SUE POP STATE OF N TH CAROLINA COUNTY OF Q�(JZ�, I, a Notary Public of the county and State aforesaid, certify that EUGENE L. POPE and wife, PATRIGIA SUE POPE, personally came before me this day and acknowledged the voluntary executio of the f regoing instnunent. Witness my hand and official stamp or seal, this the �� day o , 2006. �����»naai►p� C� i � I v� �, ►' 1 ' ,,,``����iiiti±� �j,,���',r' otary Public �� � : - = OQ ..�H Cj�, ,q4'1e� M ,��S:F'. ' My commission expires:� �� r. d e,� - r � �� + • (Affix Official Seal) '�+�'���LjF ���,•`��` .,, Ct�U� .+ ��+�, u � � �++�0 X:1MyFilesU-Iank Van Hoy�Iteal Estate�Pope, Eugene - Pope, Eugene, L. Gift Deed. mv 10194.8. Aug. 06.wpd existing �ron CONTROL CORNER t from tha vls(on cnd members cA not her now or �provais 3fora any TRACT 2 ��.,4�.�.� � . � << � �� ��. INCLUDES S.R. i�34 R/W iAKEN FROM D.E. 65G, PG. 552 PL.BK. 8, PG. 303 COMPUTED BY D.M.D. ��� new iron existing iron TOTP,L= 300, 00 S 86• 12' 12• E—...s,... TRACT 1 �.�.�� = 1. D 0 3 A C. INCLUDES S.R. 1434 R/W TAKEN FROM - C�. B. 656, PG. 552 PL.BK. 8, PG. 303 COMPUTED BY D:M. : - � -- _ ._.__- ._ .. C300, 6 --�+„_'^ ''' o's 3 total).�.. N 82•33'SB• V �.J �� f '� - . . 1 �. �,��L� �'�' �>8 p ��AN ' �• � 75 or povement �. ' O `r1 j ♦ . cu 0 --new �S v`"- '' . iron i� 0 25.00 I rn : : j� . ti mwest �eldge �r ! of pavement , , . ,� � � N f � �� b' � y ... ... � � • : � existing iron � 25, 00 `�" � � � steel nail near C-►.1 �` west edge �"a� ^ of pavement � � � i � , � `1 ��� � d � c c �s � �g� �� � CORNER z `�/ � ��1 ex�sting --- � iron � � � �� 1 • �. �` '--- -� � e;-�" ri� �T �� �� 1 __ . � �-Ci �- � � �a � �, .�e ��.�.. ` • ��`.�.�.�.�'.,e;�-,;� , ' — _ � _� ��y �� Zr � '�- � � . 3' <3 �+ o,e _..:�_ .,_�� I _ 6�� °i�:�"''d�r a.:,a�-•,,�. m.�k�+�����s„';�"��s wi;n t,�.i i �. 'M-...'��F""'arh?p��e�',Sn^a, ::�a�`� � . :...�+'� ...;�m� ����i�,��� 9�:; i �?, °`,"f ,� r, i,� y7 z�:r s Y� i� � f � ,� tw a f.. :a.:;. g ?°� � :i��� � E r,;�, �a x �r�« i�:^t+,�..¢'� w w; vdt 3b�� "'S� �k �.l `"�,.�. inr . i"�• �L '�n � r�"� � �� +i �5.;" �,��.'�?., � ����;"a. �.��fi r�„ "" � ':.-v fitl� tr �.�^�Tqa * ?.Y+�nr��" �m �: �:4. T' ' w `� ���,I�'��� 1 � t� *. �.�,-a=, i �i a� � �. k�it...� e,are± '�. �41 Itli`a . .#� . I � � �sJ�.,v` -°�'` , a4 � =:.�A ^c� i�i� �opq� �m, ',a"� x�,�� ;p i,�,t;���I � � 7 � a ,� 9h i �;�� i���."aln� v � a , q� a"^",..µ4*�� .,,,.:"�t` �' s:: ¥ '� �,�, i�r: " iii��i� �m„ " 'i ,d��''. i s "�.�i"&4 ��:��p _'�,�'�� w�p�,h�'.,,��',�r�s* .1�.. 3 e' - k� ' �.4, `� a ,�' p � rw � p ..�L�'� t��'*�y�il� 3 ��:��°�r ' �I) �����k��' y W'��«..il� A����Mti�W,�° 1 nR..P.��?_� ' . e" �c�.'�r�.. f �p '� , i i4q�p 4 a � "l� ' ,i� s� ,�s�-' r" d'� ' � �y iH iv �°'�"'f d Fd t � 5��. y"���''S�_���. �i��a'� . "^� � a,y„� �t� � # �� V J. rr i : �`i � ir.�'�� » '�p", �5�..n,3 �+Yn������"�� M� +� ''�n �[.. i ' �.,^�z 3,.c "�° � a����i1t�� � a 13e� :-v"E �, ,a� .$�a �k,�n e a� � :� � � ��g d i i s � � .. s��.u � t q�t i:�f.: �', i�h"� �w i � `; ��� i �� p ��4�J� � ,�n,.x ��w mn'# �- , x<�y�j�.�� �° ,/� u Rx1 � ti I `� �� i I E, ��` k �-• � ��� P k �,�;�,� ++�ci �i�,'��'�A � � �eer '� � .,N�Yitl '�J�'T`�'� � 'q,�,.'� � �...� ,�. t '°,�Ittl� �:, ; a ir s., ���' �is q,„'� W�y�e. :� .. . w�t e. �d» .�n�d::���'i�° ��.' v ��.� w �wk rv.. ��� a���. �, ��1� � �p "a � � rb" N'"���y �`� � ���,��..����^ �� � r�p � �iy ,s,� � a�e t�:��`K m� °��» '� .... ;��r v t 3�e� a , a. s ``h�,' ��� a � �� �4�' �M°� .� �r"'i � M °� � �t�,� � � � "�- r����� ��� �a_ �� �� ��� � ��i� �� � �"�� � � ���� ��" � �� � � ti � �'�'$ . � L �� - u^ I P �..A � 7� � � "�� t �d� �.+Y �� �,���� �� �p� � �� i ��ti �� � �, w � � � � � p�i �`!S�u S" a�'+.. � ir o� �� `���� "� . � � � �� '� � r� ��c d� ' ' �":��"'` :,k,��°�%"s n � q "�`@�, w�,�� I 4 h�`��`z,�'f� '� ° b ��� 9� �W� � d,� � ���. � Y��' � n.`��� �' ��8� i �m;�'ri �, �� `��z�?i�qe�" �, � a � °'�� I ,� i l�t ,�� r��'� ' �1�� � � p .�d n 4 w�"4 I P�, p i � "� r�" '�'� � '�'� � � �� t p, �'�.-a��, � � a. ° "G � �"�,u r. "4�it«w� ��?*a ��; � `� a �F'� c r�t � tN J�it� ';q.rvlp�,�� ���� ��� a a >**.,�^.,�y 1 �� i i n"5 N '". ^� i 1a`"�'�k�� „� "� e '�" �`�" ��'z �i, t � E '. r �";"� �'`"� P fi��w�;..�� M � ,� �, �. � '�. > ��`�,a ..: ' �,� "l� � � v a ��a ��rr ' �� r�w � ��. r�ii�` �� ,'� ��":� �,�� ��rs '; a a�� s�e�,� i� a�,�� ��. ,�� �k � "`� d.�«� �» y " r�m� �'6�� F�i*. � r� ,3�" ,�"1 c a �� a+ °: „�� �, $'��^ ;� 2 a}us� a �'' '� �� � . '-.'.+x.�. ��a <�` t�ra v.. `�" �. �.�'` 't 3 � 3�.� � ' � 4 �`,�9� .� �., ry(�� ,� ' _ 'a . s . ,,� � ;c i°�'����" , '� s���t4s,+��r '«a�a�`�,�u`� ���5 '..« � p,.., � �IY � � IPo'���c.a� a�l 7 ���t���.a�.,.� r z 4��,Nr IpA d �� �� �� ��.�?a'�iU � ,: j ��6 � ' �ra .�� fi r' i �� iti} �� �'"�"�ii� tr� � �����(��i � �.���� �� s��c� � -�7` ������i �°. �H� �, "�� 9�M s,� ��. �� �i x�-.y��n 's �•e„ .�.,, '�'. ,nro �,{�, ae, .,a4?.. '�; �a�. Y '� °a"�✓g �;, �,' � °°�i ,a°"' . Ta'h�`�k.�aF' �P 4"� ��bs,', k�k�'L,y',mi°a�' :� F '� � �,� � � �"� A�� ' '� �.:� �°tr r^y � i i�r����� :��i . �� B 9 �,�;�a " "�� � �� � �w ro��..� �,�I � ����w�+��a!�i���F. a s � � ����'����� � � K , '� �_^��� � ��'�� ,�i o `�� > � �� � s. � u. � � � � . � � `���' �� � � ` • � °�;� .� � � � ���: �`� � d� ,�,� � '' �:� ��� �' -� � l` a. g�i� au �:, .iu 1` �� ���a � a i �� . �, gu��y '..�.v -' � , ` .� : r�* 4::� a'�ai , w,:�' . � �:�a '^�. ,.�d' F� . 'ti'��"�t ° '" � �. s: �m ., : � � G � � �^ � �� � � ��� � � � � �'��° m�� ?�t��ffi���`u�� i�:^au� � 4�� "� r(a� .: ,� � i �,1.�'`� r i��,7 �s �. pp�� �;��� �� �����N�� � �����T W, e �n �� . ` �'� ° i^w���i.,. � °ai� �"� �� 'i.���r "� »y�'�I�r�" �� ��''�, �a.' m� li ( � ��i� '� � Eii 4�'. �, `a � ,�r��;s y�, ��'�''`"�� q '�1`� �, �t� � �d � d �. � y� � � �dw � �"€�', �y�"�,v��,� a+� �i.����`��k +�a�S"�.i ' �}�.:, �,;� y ��. � � a. � " ��� `��,s � ���` �� ry ¢�C �I�, 9 .� � �"� �,"'� h�, (� � {� ��2.� � ., � � °l�' �� � t ' fl I � � d�� �� �""'�1{;��+ � �� r�� i� ��" s��' � iq " ��� � � �+d i'��rv� t ;�r �ki�u����2 9�5+`M �, dY�H�kr"",,�' �a r `�'« "� , 4y &� a § r,���h 9 7.�" � �'. � n w �2,sN�"n � : � � ��s���� � ' i N° � �a" �yi��n�l���o�'�� ..� �' � � ���`P�t ':.�w�!'u'v�@I�i���r'i��y 8a. ,.M�*�, � � � � ��� � ,`�. ��:. � '� ' ,. �� �7�r,� ��. i�; ��'� a������ �'� �� �'� w,�"�a�,,s ��' a�' ,��i��. ;R������� �����k� � --��� �� � "3��y9!�„�i�' .�� � �, i �,Pt, '� � T"a s� e„"��' 'ti�`a �r �^ . s : y 6� i� rr��S *: -� . y, M 'Ug. � �. Aii� �i,ah.wi :. r4e .'A �¢�d? � �? C o Y�.��� a , i{ �i ""�" -� ��� .,s ",� n��> �����v i �� � �a�. , a E i i�: ��N�i�tlidC.�TM�i'^x�. �����`�� � � �+'". `a . � � �� YPo�ti.; ,�"`k °. i �'`� rowY t�.rt ;�li� a�� �. ��CR, uP �, �.a , . � ;� . � ro,�i4�i �K d��.. �d +, a I x F a� � � ��� �� i, 5�, .�� �.�� n�' ��?���� � �si �I� , �i� 1�, � � e, �� �. + °+i r."' ��.�yr�a�.xa� ���a�^ Mt i di� �.. ��;.c�'� h��, �'���� ^*, �,�� r ��.:� �' a� ;°t�`7 ziC �" � _ v R 96i�q` �'y�'�fi � '� a�S � �: „� r i"�*�^� ,�,x �@4 ���f�° �' n'Ssa � (P�ii 5���. � � � ' . �^ � - s. fy� � " �v` �.� �`� `�'.r. i,, . E �9� �i�,� ,��,'u d �t��� ��e�,�" �"�° � �� i G i i�Jw+i �; �t�t � r �. ,.. �, l �iu�i��'.� t �m�i�J��r��h���� �� �>t�rr��r�r., ��"�"• a � y:� ..9 �,� ���'��. �� `�,, ,���li��^ ���� li� i�ii�4at�im a�'1a�;yy`�"a jal�t��'k�,'r a: � 'fi � ,i�e ' ���� p � r.� � �q�kl k� ; � .�µ � ��. .�^ � ;�N�t�:��q�l��ml�;.� °'" °�t� �r .� er��'. �� � �'. r ���'�`�,+� �� , ,'°- �t a ��q��"'I'� -o � .a4 � ' .i' � "�,�,M_' �.�s � � �d� °': < � � ��a� � �a ha � � � 'S 'in � -�,* �, � �a� � "h"��`S t �"'�'��� �� ���;�Gli�l��w- �,j _:.,� .:"4 x.> �r.. ����y: .��,�� �,����i.�� i��,�e . y�-��. �� �"��� -` ^������FH� �� � � �x',� � � ��� *� a�°� � µ� � � �� g i '���,�,".�.�u� �i �' e t �i� '.�5�� .,�«�; il�ifi`�t�� "�� `� ��ka�s�ls'��� �,; ��N w��� ��t�,�t� "�'� °��G .} � : � ."'�'w's 9 .�r ,9 m tn �P � '� �� � �!�'� a. � �4M�=; A,�n'ti m, r� "�°.�e�dy�`�,�� , �s ,� J�i � . �'�'g , r' ���I��� � . � '� �"a�& ��.��'�m`'��. �"�" ;. ��:� ,*;r� s�.�kc�� i r � � �.,' n ��lit ihi �' �. ��� �* x �s� . � �� � �. _ ..,� _ ��. �.- ; . .. � �, J� • � �� � ��r�, �,a i��i��a��''�, �� � ���"���4��� � s��:�t ^ � , ;u„ ��� �� � I �� �� � ��� �� . �� i � �� �� �� �" �� � ��i � v �" � ,� � a �+ � .v as� �� �-� � � � n ��r � ,�.x i T �&P�'�"k 3! ��' "�. �,,`r� r'�""��A �a,,,� �" :.- � �k��«� ""�r,. ��� � �'�'a�w^�r � � ' , �'� `- . �. ^r n s� �j��R��ta ISn � �. �'"�-+.� ''a .. t �""� � . �Y'a ��a � �"..:. y�: s�s'"' �q + a � �,� '�. d i ,P' " 3 . N �"� �,�t�� . 9d �„�re�w:.- ac r�,r s xrx � i z �q" n�rc '�� r�'�``��,,�� ��. .: s' w'.,a � I I�P '��'`�<nu� �� r :: f g � �..« �;, ;.. ,,... M Si�li�� ���,p � 4�._ Ti��. ili'���d� .��S � d ..dl�i� �°�� � � "e� `t, :x 6 � �:<��< 0.�k��'� . �. �:�'� a��,� i ' w P� ��`.� �.s:. J�*.e �' a� � a�� �z��,a��� �� �' �`� �e�:;'� �' �c��'�;"� µ t���, yu,.�C =,�-r .;�� �k'.':. � }�{+����{��°Ik,� P &x'€�.�..; ` 5i"a �' e' a �`°�,'."�1��1',t'i`p�' .it i �i @M1i� �-raa<a :.R� � '� � "`�*" �r�a4s � a +y�N���e�.� ;�a r J�a 47 rc�. �'." `.w �.& E ��`a - � : � i�� i� u��aa s�aa ,� � � 3 � � ..� ��«�m�� � ��� �� ���r�� � ����" rr I �;�..t > ,F:� 7�(r���ih�wi:a��x�,�� vas'�� � ��� ���,i'd' s�:Lm �i w�5�`� �ro�"� �,-��,� i,�t+ ,. ���_.. �.'�"�0�hz"m+a��`� �";..,�.r �. �.��* 's� ��: '�� j -, .ti� x w .:.. � k�x'�+�* . ���� ��i.*.=',. t;^i ti��!Hi��2"��� �.��:"^ a '�' „k�( I�;%3 a � '� � n��,'`"�°�'�.rt.�'��'s�,.� �� �'j"��, ��. ��a r'; �c �. 'i . ,� �*�e�a^�+��,�*5��� r s � �'� ,, �, �1.'�8 7p '�t �g n ,; 9°" �..;� '+ri�:M�a\`�,�P"��� �� g�F•2 "i� r!�`�� �« �$ t� �::��'� �p��.i v�� ..�..�y,i �# E�.�'�� �t �*�, 'i�:' ' €.(�i�";,��� �itri i j`x T�-�"?'� ,xs��S°' "���h��t�,� �� .�.�=:�k.. 9r &��-"t�, ;��ry.i �i�" ':?t`�'�. "�#"}'������ .�� �" .,� � a r� �. �,^�n ��qi�i W ,�„ . �'� '� � �� � v � �a..�'�� �x�0 N� *.�* ,� % t �a � . .:°,.��� n ,` � .. i� (�. � ��e'z� �e�, � ��°�... r���, .s� � . ���� 9` . -„y '� i ic M1ti ,�s"�""�.�..���'' . � ai iv'Y�^".��„�. � ��°�w��;� 'r '"' � �-, , � - ,��� °� a r m d:i�4�a 7 �'��� ��t 6 a�"�^'�,.,�'s �yt�, � � `�n*�� ���.'� i c���`�a`�.�z�°'�' �;.; � y" 7 ��� -k, ,�i}g ::Gi�i R F :i`�-��a'��"� �e i' �"�... `�. �%�'"�,4�...; �a����'.pq��� �°�^� '. x"'� '� �._, �� - t �` S� e°i�h h , ;:� � � v b �" �' � �!.+���r"��� �r ��;{, � �3.M �� �G a � ��t�"�3�4�i"�5,�t� a� tya a �� '\..r,i °^' s���t��,l a� ` ���.„,.���..��,� r�'"�''�+�'*a iw " MSr�. �'� rM a� ;�, �"�,- . 1 1 �k,;�'i�� ' ,�ry�'t;�i �. .i "Fw �'� .0 t� ����; �` � i`"'i��I���"�, �",k ' 1«'��E �y �. �� .���a,� ro i a � F i �..a �s �h^;:�„a �;'s s `.�.. �l � � ,��."� k�;-� ' ;. R , , �"a'�v i� rc �' �'���.� a�,� elli ' '� > .� (i� iPi�i��' m2 + ' , � p S i J fi i"��A'"�^r�" iy�^�a�,�y �s4 R�C � � ���D�i�l. �, ���''' Y�'���N�pl�Gq �1,��;o h�`�i����q`� � �� , 5 fi t ` �.�. '.'""�"�a Yx"m;��i'w�i� �, g v�.� � '�'�.'�,�1�4,��,"y��s���`�. . ,�. � �.�� �'�� �� `5!c-�` �• 'a u "' ��1�xti� ��." `� � i. ,,"w. . � i��^�����zy�, *'��x ':�^�::+c = ��a�y� ��'"��i���s �s�t �s;�.�u��'�� �a� �'�t�>:�R��:,,. �� '. „�y's� K 4 � I i `^a" e�.�" ry�,' 3 �t ��":� a ., r .. NpS� �,' �"�`�k�Y �I �*. ,.A � xr ''. t�i �, r� � � ,,:` �yr,'a� � ' '*4��?. � .�. F �r: k � '�� �a���&.: . 1�. 6 ' .� i$ 4� '. � 4 � � y:,:N� i��, � c�.,d'�� �����s '*, ��"kit»! �'9a ,:e,.rl.x ��4* .� '��� �'��' `�e, � �1 j�'"�`, � a �� �L�. �. �� niP . �ki -�' k � i �y �i �.� x � �, i `t'�' "'� � 1�'_� m A�.;. �i re u a ' �� �' � '^�� ^�;`"X�-�r•,'�' I .� .,�'`� ��� �`9� �a� ,w � i���d�+�'�,r � �'� ��4�,� . �v� p� ' hi���y���" � �r� �«��. I _� : ' ..�:, �� ' y � � ; ,��� - ��� s '��' ������'��4�'�� �.� ������� � �' ."� ,� o ��� x'.. _ ��w. �a ��� 4 � � I �.„;. d,,� ���i(� � � �.',�C P ° �,:;�l[*� ,s a 4`n�'Hr`�,� ^ a� � 'k d'� � �e*� � � � , _ -�6,�<�R'�'�"� :r�' � "�, � �, ..__ �� ui�a .s rA� a �'`' ��"'� "� .�� .�„t , � I � � � � � . � 3 �� � � � � � �� �� � .. a � ar i ': „ � i .:;.� il�l � . .y u�l°�''�pv, i ti w� a ���a!�„� � '. � � � � ��p �� �h�� 7 rc �� - � , �, � a.�.: ,� ' � p � p u�'�s�l,�„I� �.� � *��. � �:a �> �.i `�;�' � i " � �, �v ,4 _',a�w,y9 . »..�aa,v,.�, e � ����'�A�� ,� �.. A x��.�;�aMM �,�. '7!3t Y a;�'` �k Pt;��,ti�'G +� �: g� � .�"��{ r a � s""_�. "��. °'*s. , , � �'R�Nd 4 . � t�� �` �{j �..ea u r�;� . ��( '".w� re �f N a �f x �° P w � i4m b "� 0 1 R^�@ '�R."'� � #.�Wb'��p. "�� � �y . �ru` f +� . .,db.. �" �;' �x i � " � � "�w��„ h v���� �r� ��a1 �i r� � � �� , � �9� ���^ '" �a� � �� � i �' x ,� � t°t �, a d°� � a gti , .6r � .. ;' � 3 „ � n�...� � i9riui ii�p�w : � ��i ,i , ���;�� .�",� ����..,��� � i� �' �..�,�� � � �� �"19 t F�.���,�,�,� �' ��ki�'ii����. �ik�e.��" � � . � �i� .� r fi�'v'w � q �j�in i a 2.;r t � #�: �� �� q r' h x � . , �r� ..�: � T� ��,�� I� 41�"t.: � . u �i�11.��d � �,�t i.� �1 �t;^�; ���9 e� ��i � '� ; � � a . i.� .: " t.,��� i ��.w s. � a�K �" ��. C ����r�M, �..� � °�'���:�i"' w `c w,�'ai� ':i i� d'� � '; �� I � �' � �.� 1 '� � �� eur t4 ,. Y � ` " �d� �' ' i i t -�U �' '�>��� � �k�°'�A. . .t � .�� � � r �; a c� � ' �^�� � '�l �;� � � ^s � �a� a��r�i� e �k��S� ��'���SI,�� ,���t� a U � J�a ��"` "`�,��,� � � I � � '�t 4a "4 s �. •, ii�� 'y.i7 a��. „�..,� � *^'��� i ,�:� u�'���� �r��a�� � "���"� � '�.a�� Rk����. *+, '� � £ "-^ r` i ��;.q = �arc� ,wa*`,Saa �" �g�k'�t�4;, �io.�.,��,,^'�i�:�� ,.��,"m�' x„3�' T�a. , � i a � ia i "*,' w i �;, '"" C ` �,. �a5.�m��r�P�'�jq��{�r�"�� � �I�;�a. ���+��,ry� ��.� ,�sz �.�'�: ''���,��}��$P ;..� ��� I :h+� �� t ������������i��t.� ,z� � ^���,. iPiLi� ,�#y � ,�+p�� 3q �.d a���yiP,s�-q � �""' � e � i�,n,„ � 1� � �� � '�t r ��1��» ��N tp i �, �a���� � I���i i��� � �r° � �' I ' � � �',,# ��� � �°�� E !.�r���a^u �a��"^'k��,��� w ��µ�x � t��i1� �»`�'' �E. � nf� °�`��' ;'�, . o=!� r�i;7``� ��o a�� � �'��t�� �ii i��"� i`�� "a �a�u���; � P t�k''^�^�h�r`�:uC ti���'p P��i���G9����5�, , � %�'�`w����a4„i�p� +„ s��g;� �"'�,.��."f�p „'�.�� ��..�-:�, i u� � a i., � v s � �,�i����"".2��h�d''�'�.S S�" ii i k��,a� 7.�i�R ":�h �L�Pw�,�^., .��* ,.�=� . � R � :9 ,C t � i��� �i, §{ .`'v"p%3� '�P �� '������k�\ �``4�� � '� ' t d� � e�: u g'�w. ,, i�rP'�'�r� -^ e�s t � � , � t: . � ii � F c '�F eqaf�41'�k lra�a�;� i _ �"t��°;'r��l ir�" �` �i .m � ` na� i , �a i t i+ '��. � .;c �, �y� .. N���..�� ����... 1�'g� II��ti tt��'�' q� �y��'� am��'� � h, ��� .�p���. �, ";� �,*r'>�:, :i�..� , ± �d�a E�°° '�h.,,��" � �i - , 5� _ �,., . .. . .,.,.....,a. ._ . �..mc, w�£� i .. _ . � . . :. 1...� ` I_ 554 �� ' � 'ii, , � �ioiJ.,6Wi� � ,iul��-� iPU��hI�`�. � 4y W _ � I . _, I , . . . � '. � . .. . . � � iC ... ... . . .. ... ....�, . . . .. ... .. .. .. ..... . ..i . . . .. ... . . .. . .. .;I i . . �i .. :� �� �.ii � (�i�hil(�i ��M����, i i� ���.�� �\ c 7� 70 � I a ��, s . � � Yf,� 11 1 . . .I� 1 II . i����� � ( er'���o-� I�I I� I I �j' , � � � thilu i j}�����I� ��III������� i� i � ' � �i � �' �, � �idll�d�����������r� � � , � i�i�,. � ' � � � � � �' ,�� � u �. �� ��� � � � � � . � �]��'�� ,. '„i a�i� { �u� �iQ,p������I�G�. ' , �� ��; �� � °�� � � � �i' �� I � ' � ���� � � �. , �. �� � ,�; � ' " �'�, ' ��� �� �� ' ` �!��� �� ���������I���III �ii�i6nr �� = �a�iio���61�F'�� , � 7 � �i�� i � J` �T,Vq � � 1H rm� � ,., O 81�'(t� a I��� oii � �r ��_ � ��i.. � � �1.77A} � � � ^liiuili '� - ii� ».' !.I) i i; i C� ii � ��. : dii ? �'N�uYii�PkOii$�i i i iiii : „ (� �. r.<y � � P '� ���. �x,. , �i�ilii�ii� �� � � s �° � , ii� j� ( IUi�ai i ` , �i�� (jj i ti��i�.` �� "_ ' i-a d "' p���.. �i�i����Nl' '�` �� `:: � I � � � 7849 �'�' �,� ��� � �� ' N � ' � p(y �'I � l�l� '� ' ��(�������i ,.���V �. .� ,d�i;'u?`6�II���������6f�"d�Wi��+il6��inv�.- � ��� ����id�:° � ��� � � itlNV �� � Ip� � n�i ni� �I i� i� h, ��O�GI II'. '� � : 291 �h. ,,, tY� � � d , °� ���u�,����i 6 . s,; ,������,�. ��il@i�/���' �30Qrv�'�� ������H�i�r,� /+'�� /�/�����91NI� �� �'� � � � ���� � � .�.�t>- I 1.J11�.4w ��) �� �.��..i��L �U�'I. � I`����`i,4����� � '� ;� I ; �� 1( i ' � �a . '�� . � �, �, �i iu._ i i : � ilUiVp i". � a II�hUIVPiili.y���u ° `-�' .. .�i u °, �i v��i�l�id '� . �i � � � ... ,, . . ��) , a ��'-y{ //� V� � :���r;�� �d�� � � q � , �.: �� \J � LJL.� . t,�, .... ,,,�� .: i � � d, I �� � ' ���,��i .���� �,. �d������� ` � I"u>. � �� v,a� � �a . ����� ,.a , , ��yi ^ ,,; . < .. - .,. � ;„������ p � � �; �A� ^` i , �: � Vi��liii�� � i��lii�a �r � � � � �"���� iEs,e �; � � i4ti nit� ��i����l�h c Y'\ . r iu inti ��� �� ����i I ��h��i �� i� � ` � }, 78�� r� I�� � �� ,` ' � � �, � � ( ��;, ; '_ ;. ���.� � � � � �_' ' � � ' � � t�i�l�`-�/"►� `�`:��i ; i`�li�l��il � r 'i.* �� ��i uV lif � i � � �, � G i E � � ' ( I �7 , �) � (ls`��i�iil �,It��,."�,I�� .Tal�„'"�.���i � I s I� � I I u ;i : �ro: � � , : . �i , � � il ,u,, � , o ' I � , cv � � u�.;� �.. , „_.: : _ e t. _• ' ' ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil / Site Evaluation APPLICANT INFORMATION Account #: 990002784 Billed To: Steven Pope Reference Name: Proposed Facility: Residence PROPERTY INFORMATION Tax PIN/EH #: 5832-90-6783 Subdivision Info: Location/Address: Cedar Creek Road-27028 Property Size: 1 aac Date Evaluated: Water Supply: On-Site Well Community Evaluation By: Auger Boring Pit HORIZON II DEPTH HORIZON III DEPTH SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: Public Cut OTHER(S) PRESENT: REMARKS: LEGEND L�ndscape Pnsition 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 T�Ctur� 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 .ON�IST .N .E a'IQ1St . VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely frm � 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 Mineralogv 1:1, 2:1, Mixed 1Y� Horizon depth - In inches Depth of fll - 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 - gaUday/ft2 DCHD OS/OS (Revised) , ' � , . Y ,� � ' �iT �� � ^���J D t�AR — 3 2a06 1 _ � SITE EVALUATION/IMPROVEME� Davie County Health Department Environmental H�alth Section P.O: Box 848/210 Hospital Street Moc {s '1 e, NC 27028 ( 36)751-8760/ F x (336)751-8786 For: ite Evaluation/Improvement Permit TANT*** THIS APPLICATION TION IS PROVIDED. Refer to_ APPLICANT INFORMATION �i ATC 4 �G� Authorization To Construct(ATC) ❑ Both PROCESSED UNLESS ALL OF THE REQUIRED �TION BULLETIN for instructions. Name to be Billed� ��� ���`{-(� 5 Contact Person a.J�. �'�y ��Ii✓1��� Billing Address ;� c ,� .9� C�L C� � Home Phone �j �`i ��,�"�� City/State/ZII' �5 �LL� C Z70Z�� � Business Phone Name on Permit/ATC if Different than Above Mailing Address PROPERTY INFORMATION City/State/Zip NOTE: A survey plat or site plan must accompany this application. (Pernut is valid for 60 months with site�lan, no expiration with c mplete plat.) '/ Street Address � �� �' L= j�f}�j� � � � �� City ; -✓ � LL Tax PIN# �k � Z '�I � �Z�7 Subdivision Name Section/Lot#,� Lot Size To Sit�,: L— �Xir � Date House/Facility Corners �'lagged ,3-3 U(o If the answer to any of the following questions is "yes", supporting documen�ati�on �ust be attached. Are there any existing wastewater systems on the site? ❑Yes ❑No Does the site contain jurisdictional wetlands? ❑Yes C'(�10 Are there any easements or right-of-ways on the site? ❑Yes C�o Is the site subject to approval by another public agency? ❑Yes B�o Will wastewater other than domesric sewage be generated? ❑Yes �o IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms Garden Tub/Whirlpool ❑Yes C4�d'o� Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑No IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of FacilityBusiness 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 Typesystemrequested: ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Oth�r Water Supply Type��1 County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes �l No 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 understand that any pernut(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 understand that I am responsible for all charges incurred from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to detern�u 1e complia with applicable laws and rules on the above described property located in Davie County and owned by �J 2/2..(.1 �I��.S "� ? '—'�� Site Revisit Charge P pe owner' o owner's legal representative signature Date(s): � U " Client Notification Date: ,�,�_� . Date EHS: Sign given ❑Yes ❑No Account # U/V Revised 2/06 Invoice # � � � M � N (4.30A) 3099 D50000005002 5832818204 (51.35A) 8204 2032 (11.32A) 4101 (��48) 'I ��� l� �(�v !�� � ��S' - / l� j��a�.t� a�. ��a���U;� �,� �'/d � �� }'� �' D50000004902 N M (3.94A) 7490 � D500000049 N (3.74A) 7170 D500000049411.77A) 0 � " 7849 291 300 Tot /. _ ( 8576 S�SL v � Q' M � w U � � 2s� � � o (1.00A) � " 2888 v � . -� . .`• �, �•— o ' . , r • . . � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil / Site Evaluation APPLICANT INFORMATION �c�-( � � 4v��c� �i� �%ll�� �� � ����� �'a�/�s P�aose�'����/�� - ��sic�e<i�P � � Water Supply: On-Site Well Community Evaluation By: Auger Boring Pit FACTORS 1 2 3 Texture group Consistence Structure 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 SAPROLITE CLASSIFICATION LONG-TERM ACCEPTAN SITE CLASSIFICATION: � LONG-TERM ACCEPTANCE RATE: � REMARKS: PROPERTY INFORMATION %r DIN� ��32 ��r-�Z�� ��l'r�iOY� - ���Q � C���ee,� �'d: 4 EVALUATION BY: Cut 5 6 7 OTHER(S) PRESENT: LEGEND L�ndscaue 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 T�cturg 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 .ONSIST .N . . aZ41Si VFR - Very friable � NS - Non sticky NP - Non plastic FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm SS - Slightly sticky S- Sticky VS - Very Sticky SP - Slightly plastic P- Plastic VP - Very plastic ,�tT]1sL11� SC - Single grain M- Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic J Mineralogv 1:1, 2:1, Mixed lYQtr� 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 - gaUday/ft2 DCHD OS/OS (Revised) ■��■■■���■��■■■�■■■�■■■■■■■�■�■■�■■■■■■■■■■■�■■■������■■■■■■�■■�■■ ■■■��■■■��■■■■■�■�■�■■�■�■��■����■��■■�■����■■■��■��■■■■���■����■ ■��■�■■■�■���■■�������■���■�■�■■ ■■■�■■■■■��������■■�■■■��■■■■�■■ ■��■�■■■■��■■��■���■■■■���■■�■�■��■�■■��■■����■�■��■����■�■�■■■■■■ ■■�■�■■��■��■��■■■�■�■�■■�������■■■■■��■■■■■���■■■������■■■������■ ■■�■�■■�■��■�■������■■��■�■�■■��������������■���■■��■■■�■�■■■■���■ ■��■�■■■■��■�����■■��■■�■�■�■�■����■�■���■�■■■���■�������■�■��■��■ ■���■�■��■��■��■■■���■��■\�■■�■�■�5���■��■��■����■�■■■■■��■■■■�■�■ ■��■��■�■■�■����■�����■�■�■■■■■�■�����������■■■�■■■■■�����■■■■■■■■ ■��■■■��■■������■�����������■�����■�■■■■��■■■��■■�■■���■■�■■■�■�■ ■����■���■�■����■��1�����■�■����■ ■��■��■�����■■■�■■■■�����■��■■■■ ■���■■��■■���■����u�■■■■■■■■����■�������■■���■�����■■����■���■�■■�■ ■■■�■■��■��■■■�r.�����■��■��■��■�■��■�■■■■■■�■��■■�■■■��■������■■�■■ ■■���■���■�■■■��u■��■■�■■■�■■�■�■�����■�������������■��■■�■■�����■■ ■��■�■�����������■■�■■■�■��■��■■�■�����■�■■�■■■■��■■■�■■■■�������■ ■■�■■■���■■,►���►���■■■■�■■■�■����■■■■■■■�■�■■�■■■■■■■■�■�■������■■�■ ■■�■�■����r,�a■n�■�■■■�■������■�■■■�■�■■��■■��������������■�■���■�■ ■��■■■■�■■n■�.�:���■�■■�■■■■■■■■�����■��������■■■■■��■��■�■�����■�■ ■��■����■�u����a�■�■■�■■■■■■■■�■■ ■������■��■■��■���■■■■�����■■■�■ ■��■■■�■■■���■��������■■�����■�■■�■�■���■��■■■■■�■■�■���■��������■ ■■■■■��■�����■■■►.��1�■�����■��■■■��■■�■�����■�■���■�■��t■�■��■■�■■ ■S■■�������■■�■�■\L'li��■��■��■■■■�■�■■■■■�����■■���■���■■■�■■��■��■ ■��■■�■�������■■■�\�■�■��■■��■�■��■��■��■��■��■����■��■�■�■■■�■��■ ■��■����■����■■■■■\\■������■����■�■■■���■■■■�■■■■■■���■���■■■�■�■■ ■��■�■■����■�■��■■�\�������■����■�■■■■■■■�■■�■■�■■�■■�■■■��■■�■■�■ ■���■■�■■■■����■�■�■\■�■■■■■�����■�■�■���!■���■■■■�■�������■■�■�■ ■�■■■��■■■■���■■�■■■\�����■�■��■ ■�����C:�I1�■����■■�■■�■■■■�■��■■■ ■����■��■■�■���■���■■\�■�■��■�■■■■■■■■�■%rM■■�■�■��■■■�■�■������■■ ■�■■■��■■�■■���■�■�■■■\■�■■■■■�������■�LIJ����■��■■�■■������■�■��■ ■■■�■��������■■■■■■■■����/�i%�■����■��I����■��■���■��■�■�■���■■■■■ ■�■�����■��■■■�■�■�����ri�������CC�����==1��■■■■■����■■■■■■■�����■ ■■■■■�■�������\■�■■�■�■■■�■�■■�■�■�������■I■����■■������■���■�����■ ■■■�■■■■■■■��■■■��������■�■������■��������I����■��■��■��■���■■��■�■ ■��■�■��■■������■���■�■������■�■ ■����■�■I■����■�����������■�■■■�■ ■���■�■■�■��������■�■■■�■����■�■ ■�■���■�I■■�����■��■■��■■��■■�■■■ ■■■�■��■���■��■�■�■�■■■�■��■�������■��■�■�I■■�■■���■��■��■�■�■�■■�■ ■�����������■�■�■�■�■�■����■���■■■■���■�■�I■■■■�■��■��■■�■�■���■�■■ ■■\���■■■■■��■■���■���■�'������������������I�■���■��■■�■■■■����■�■�■ ■■■�■��■���\����■�■■��■�;.��..�������������I■■��■�■��■■�■��■�����■�■ ■�����■■�■■■■■■■■■■■■■■��■■■■■�����■I�■�■��������������■■�■�������■ ■■■■■■�■�■��■�������■�■■�■�■��■���■■I�■■■■■■■■■�■■■�����■�■■■�■�■�■ ���������������������������f�►��' ��I�������������������������� ■■■■■■■■�����■■�����■��■��■����fl�■��'��■���■��■��■��■����■�■�■��■�■ ■■■���■��■■�■��■■�■�■��■�■■���■■■�■�■■■�■■■■■���■■■��■■��■■������■ ■�■■■■�■�■�■■���������■■�■��■���■■��A��■�■■■■■���■���■�■■�■�■�■�■■ ■��■■■■�������■■��■■�■■■�■■�■■��■■��i/��■������■■■■■■■■■�■�■■■■■■■■ ■■■�o��■����■�■�■��■■■■■■■■■■■■■■�■r:a��■�■�■■■��■��■��■�■�■■■�■��■ ■�■■�■■■���■�������■��■��■���������u�i.i�■��■��■■■��■■■�■■�■■��■■■ ■■�■��■�■��■�■�■�■■■■■�■��■���■■��r,��■■��■�����■■��■������■�■�■�■ ■■��■�■■■�■■�■���■��■�����■����■ ��%a■��■��■�■��■■�■■�■■�■��■���■■ ■��■�����������������■��■■■�■��■�c�■■■■����■�■���■��■■��■�■�■■■�■■ ■����■��■�■■■■■■■■■�■■■■■■■�■■��■■■■■�■�■��■�■■■■�■■■����■��■�■�■■ ■��■■■��■�■■�■�■■■�■■���■�■��■��■����������■�■��■�■■■��■�■��■�■��■ ■■��■■�t■��■�■�■■��■��■��■���■������■�����■����■��■����■���■���■�■ ■■■��■■■���■����������■■������■■�■���■�■�■■�■■�■�■■�■��■�■�■�■�■■■ ■��■�■■■�■�����■��■�■■■�����■�■■�����■��■■����■■�■��■�������■■�■�■ ■�■��■■■������■■■�■■■■■�■��■■�■���■■■�■■■■■������■��■����������■■ ■��■�■�■■■�■■�■�■■■■■�■■�■■�■��■ ■■■■���■■■■■����■■■■■�■�■�■■■�■■ ■�■�■�■■�■�����■��■��■��������■��■■■�■��■�■■■������■�������������■ ■������■■�■��■■�■�■■�������■��■��■��■����������■���������������■�■ ■■��■�■■■��■■�■■■■■����■■��■■��■■■■■��■�■■■■■■■■■■�■■�■■�■�■���■�■ ■���������■■■■■■■■■■�■■�■■����■■■■■����■■■������■��■�����■���■���■ ■■■�■■�■����■�������������������■�����■��■�■■■■�■■■�■��■■�■�����■■ ■■��������■■■■■■■■�■■■■■■■■■�■■■��■■■■■■■■■■�����������■��■■�■�■■ ■■����■■��■�■��■■■���■■■■■■■■■■■ ■��■■�■�■■�■����������■�■■��■��■ ■���■�■■�■�����■�■■��■������■■��■■�■■��■���■�■■����■��■��■��■��■�■ ■�■�■■■■■■���■■����■��■■���■�■�■��■�������■■■■�■■�■■■�■■��■����■■■ ■���■��■�■�������■■■■■�■��������■■■�������■■�■■■■���■��■�■��■��■■■ ■���■■■�������■■��������■■■�■■■■■�■■�■�■�����������������■■■�■�■�■ ■■��■■�■■■��■���■�����■��■��■�����■��■■�■■�■■�■■■■■�■■����������■■ ■��■��■�■■■■�■■■�■��■���■�■■■�■�■�■■�■■■■■■�■����■■��■■���������■■ ■�■��■��■■■■■■■■■■■��■��■��■��■■ ■��■����■■�■■�■�■■■■■�■■��■�■�■■ ■��■����■��■��■■�■��■��■���■�■■■ �■�■����■�■■■��■��■����■■■■��■��■ ■■�■��■������■■■��������■���������������■��■�■��■�■���■■�■�■■�■�■■ ■�������■■■■■��■�■■��■■■■��■■■■��■���■�■■�■■■�■����������■■■■■�■�■ ■�■��■���■�■■■■■�■■�■�■�■���■�■��■■������■�■�■�■■���■■■■■�■������■ ■��■��■����■�■■■■■��■■■�■��■■�■■�■■■�■�■�����■■��■��■����■�■�■���■ ■�■������■�■■■���■��■�■■■���■■■■�■�■��■�■���■����■��■■■��■�■■■�■■■ ■■■■■�■■��■■■■���■��■■■�■����■■��■��■���������■�■�■�■■�■■�■�■����■ ■■�■��■����■■��■■�����■■�■�■�■■��■���������������■��■■■■�■���■��■ ■■■■■■���■■■���■�■■����■■■■���■■ ■�■■■■■��■���■�■���■■�■■�����■�■ ■��■�■��■��■�■���■■■■■■��■��■���■■�■�����■■■■■■■���■�����■���■■�■■ ■■■■■■���■����������■�����■■■�����■��■��■�■��■■�■��■���������■�■�■ - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil / Site Evaluation APPLICANT INFORMATION Account #: 990000810 Bilied To: Jerry Banks Reference Name: Jerry Banks Proposed Facility: Residence PROPERTY INFORMATION Tax PIN/EH #: 5832-81-8204 Subdivision Info: Location/Address: Cedar Creek Road-27028 Property Size: 150 x 250 Date Evaluated: Water Supply: On-Site Well Community Evaluation By: Auger Boring Pit FACTORS 1 2 3 4 Slope % HORIZON I DEPTH Texture group Consistence Structure 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 SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: Public Cut 5 6 OTHER(S) PRESENT: LEGEND L.�ndsca�e 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 IYIQIS� VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Ex[remely frm � 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 - Granulaz ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic 7 MineralQgv 1:1, 2:1, Mixed LY41�S Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gaUday/ft2 DCHD OS/OS (Revised) 9 Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 _ March 10, 2006 Mr. Jerry Banks 309 Cedar Creek Road Mocksville, NC 27028 Re: Cedar Creek Road Tax Pin #: 5832-81-8204 Dear Mr. Banks As requested, a representative from this office visited the above site March 9, 2006, to perform a site evaluation. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this offce 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 or the intended use change. Improvement Permit System To Serve: ��1,� Wastewater Design Flow: ��� System Type: [�t;onventional ❑Accepted ❑Innovative ❑Alternative ❑Other System Location: C,%�C/fftZ �i2 E� K(i�. Valid: C�'S Years ❑No Expiration Site Modifications/Permit Conditions: ps-i.p.letter 2/06 � � � Specialist �/ Date