168 Dreamscape Ln;permfttee;s e--"- DAVIE COUNTY HEALTH DEPARTMENT
Name:--moi.-i'rIL�1 "'' 'r'";-1� Environmental Health Section PROPERTY INFORMATION
A —1 L) P.O. Box 848
Directions to property: Mocksville, NC 27028 Subdivision Name:
r' I1,,;�; rJL, �.; �.'� J Phone #: 336-751-8760 Section: Lot:
.. AUTHORIZATION FOR
I i'.tis c:� 1. !`I Cirly(j WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION j4 -_ -
AUTHORIZATION NO. 002704 A Road Name: fr , 1- 11"� Z�'C /� - �
.,
P� ,
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Pen -nits. This Fonn/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Bt itdhi'g`Permits.
(In compliance with
,Miele I I of G:S. Chapter 130A, Wastewater Systems, Section.] 900 Sewage Treatment and Disposal Systems)
" ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
>< �I IS VALID FOR A PERIOD OF FIVE YEARS.
fTA611690f H SPECIALIST'S DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE =1� P � s, # BEDROOMS _ # BATHS ::- # OCCUPANTS 2- GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE men T�PE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE GAL.+ PUMP TANK ^� .GAL. TRENCH WIDTH --<, ROCK DEPTH LINEAR FT. ,
OTHER ko--�1r1'ft{ G��� i"Ccr1�1X`T1Vj
REQUIRED SITE MODIFICATIONS/CONDITIONS: , N SS�t {" 1 c, u3 Fi-,�V' n ,-
IMPROVEMENT PERMIT LAYOUT
�x
GW
404/, r�tS�►�v
01
fA. 4)t`"
f
-, WM H
'1 U
FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
SYSTEM INSTALLED BY: ` �'�`v N 0 1
' VG
UW )A t}
Th -6 -JT
y
Qoib4L)
AUTHORIZATION NO. JIV�*A OPERATION PERMIT BY: DATE: II b
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE STEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 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) h e C
I '
DAVIE COUNTY HEALTH DEPARTMENT ��
Name `�-'�- r F " `I" �_3 Environmental Health Section PROPERTY INFORMATION
,, —�+ P.O. Box 848
% ections:to'property: �- - 41~_• Mocksville, NC 27028 Subdivision Name:
3t ,kr._`it• ., t ,) t �.r,�: iia. �`�.� s:': Phone #;'336-751-8760
Section: Lot:
AUTHORIZATION FOR 1
NN, V-, E F c �-..ij _ � $ yy.c°:fi ``' e10 C WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION - -
AUTHORIZATION NO: 002704 A Road Name: �{ r' I��` r�'Zip: . .
**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 FomVAuthorization 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 130A, Wastewater Systems, Section.] 900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONptE T'AL;HEALrFH SPECIALIST,, DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE 1_I^.W J # BEDROOMS ' `> # BATHS Y = # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY,TYPEi # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE )L PE WATER SUPPLY 1i�t: i L. r DESIGN WASTEWATER FLOW (GPD) " l NEW SITE REPAIR SITE
*✓
J
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH — ROCK DEPTH LINEAR FT.
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
,f
IMPROVEMENT PERMIT LAYOUT �� ',
R --
=t
�z�►
.� � , I �.�
fA
�f
OR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760.
a ATIO IT +"
SYSTEM INSTALLED BY: 1 lrLl:
tt
}i
�a
(2,q
,q
T2cJ T
OoQW u
AUTHORIZATION NO. 2_Iby OPERATION PERMIT BY: DATE: J,'
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE STEM DESCRIBE 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) !f) F I - — /
`\ (' It, C
Pe 6�-,)
.. ,',�i '`-iY-�v.-�, .sus.. `i' Nr•C'+'t;.td .;alt ..r x,. �. a-.. .7.v
! UNTY HEALTH DEPAR
ironmental Health Section
O Box 848/210 Hospital Street 0
Mocksville, NC 27028 `
Phone: (336)751-8760 Nov
96
f l
�'S . a AS TER CERTIFICATIO R
( ckOne) -PREP NT e--' REMODELING ❑ N ❑
+�Name:��f �' P -W L� Phone Number: ome)
Mailing Address: 9 M2.1`Aw 1536A,per G.4 7 (jol!j I,,, (Work)
Detailed Directions To Site:
Property Address: I!� b 12 F11_MjeC19Q /OAA,
Please`Fill`Yri The Following I/nformation About The Existing Dwelling.
Name System Installed Under:fe Y2 gn ►Y��0 Type Of Dwelling: ��r
Date System Installed(Month/Day/Year): Number Of Bedrooms:C-�, —Number Of People:_
Is The Dwelling Currently Vacant? Yes ❑ No B"/ If Yes, For How Long?
Any Known Problems? Yes ❑ No Q,,**' -If Yes, Explain:
Please Fill In The Following Information About The New Dwelling;,
D 0
Type Of Dwelling: umber Of Bedrooms: Number Of People:
Requested Date Requested: A-29— 6
(Signature) 1
For Environmental Health Office Use Only
Approved ❑ Disapproved ❑j, �% n
Comments: f1[�1�l1� ►t%1'h 17'----1S�t/LZ% �� la lD(� 7C� E�i�l'ii�/�JI) S
Environmental Health
*The signing of this form by the Environmental Healffi Staf min 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 ❑ # "'1I/ 5d Amount: $ 0 Date: 41- -Q
Paid By: I Received By: I limit,r Q/i1
Account #:�3�? Invoice #:
�3
0 DAVIE COUNTY HEALTH DEPARTMENT _
Environmental Health.Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028 i
(336)751-8760
Account #: 990003528 Tax PIN/EH #: 5823-125-1418.03
Billed To: Stephen Stromko Subdivision Info:
Reference Name: Location/Address: Dreamscape Lane -27028
ATC Number: 4316
As stated in 15A NCAC 1SA.1969(5)
accepted Systems may also be usepd
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTE NS IS V ID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signatur . Date:
J
CERTIFICATE OF COMPLETION
**NOTE**. The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation 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.
_:2
3 3 �T
•Fa 5--. T
•
(24 %AL
Septic System Installed By:
Environmental Health Specialist's Signator(� I/ r —
Date: O
DCHD 05/99 (Revised)
'10 DAVIE COUNTY HEALTH DEPARTMENT
_.
If
• Environmental Health Section
P. O. Boa 848/210 Hospital Street 'Q IO G
Mocksville, NC 27028 a I
(336)751-8760
Account #: 990003528
Billed To: Stephen Stromko
Reference Name:
ATC Number: 4316
Tax PIN/EH #: 5823-125-1418.03
Subdivision Info:
Location/Address: Dreamscape Lane -27028
As stated in 15A NCAC 18A.1969(5)
accepted Systems may also be uses
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to
the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTE NST IS"ID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signatur . Date:
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation 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.
i ask ��-y
Q1i►C.l� 1-{ 5TH Gin^
Septic System Installed By:
Environmental Health Specialist's Signaturl6:
DCHD 05/99 (Revised)
S 3 ST
to
1—
Date:- O
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
:r P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990003528 Tax PIN/EH #: 5823-125-1418.03
Billed To: Stephen Stromko Subdivision Info:
Reference Name: Location/Address: Dreamscape Lane -27028 .113
Proposed Facility: Residence Property Size: see map
**NOTE*"This Improvemeent/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 I 1 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 M. RL -)M 1:-: #People #Bedrooms Z #Baths 7—
Dishwasher:
Dishwasher: 21"" Garbage Disposal: ❑ Washing Machine: 123" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industriall Waste: 13Lot Size ,�� Type Water Supply ALL Design Wastewater Flow (GPD) 2-419 Site: New M --Repair ❑
System Specifications: Tank Size ILCOGAL. , Pump Tank GAL. Trench WidthI Rock Depth /,2 1) Linear F)t�'
G, 01 Other: 2%s RIP_�o'N ACPs accepted SystemsNmay alAC so be use5d
Required Site Modifications/Conditions: O C�tJTOOr?, �� Y xF –. � ' prr �'P
T i .✓r
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW
FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this
s Stem between 8:30 a.m. to I3g P.L9r 1:00 p.m. to 1:30 p.m. on the day of installation. Telepho e # is (336)751-8760.****
Y tom= _
,v lY1 • N-o1� E
c
7
Nom
V,
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
3S!
�k 1�bX • 'f�1=1.511 I �'
Date: L
TA VoiCE 57�
JAN -31-06 09:12 AM SLromko 19109476103 P.01
i
2:oviv cavi• aownty anvhealrh 336 761 6k7•
APPUCATU oat: c«�tArf� OM o at t►tc �N 3 1 2006
�;;�, ,!�/ � altn�rottwtdrlLel�Ii/INi�Mn -
P.jy
O. tlou M/210 R"Piw luvot �NiR
koot[s*iile. 1te Slott QNtij
-
{f Z>rIQRTlttf:*tt Un 1JIMM" canto as mveimi► QItLM/ 1►LL 'lO IIiQ7TUD ,}'
r
dt tt�T20Y it 'PROVIM. Ufor to the 2�Y9tat 21WA ttltSL><Yilt for Mot/uotaen/.
-
i;i;� " Vol. sto• to be a/ltd OMKO C.Amctet ver.mi
✓lt.tlwtdi, 4,46" Phu$
- -filytsate/sat^uoil C'rOn/ .�3 •�i.•s,.:• soca• 9/O —e- 9-
I t. 11toa of fame/= sjDittW&S tits mora ,�pAfeN f'TAIn�n
��fr►tss/ tiir•aa aglanu/sta � -
je/pitsatiaa t'oe.,t` 04" tivaluatioe Qzwpre"seena f.stWATO f.
t..•. q•t.a q e..41aa: 0 ileus* )( "Ohile som O Iwminua O iaatotrr t7 dues
slo• q.►.. rquuysu, D tu...aaetta•1 Q eaalreatlo.ai ssMteLN D Lommov.ttve
� ir � ,►w. tut� aulatuo„ f fea�in i f+fdroasfar � t 1/Wsoow/ __�_,__ - .
a ••• 1tis1•tirttttu 5tl.tssea "*sea *, lunor washime - v1sstesatlll"imf O/atsotae!/a tnlirablm
I. m th.•la Asoluota /#Uwe. wsUt %foo a p•otla 1 /i.t.a T_
F t coommasat a ttsenra • Vrteala / flatsr ct••Sara
'. �+ if TOOtltpNt;C/• R scala ietis•atad trat.r cfaaf. fsa11•aa r• tyrf �_�.� .
--"t. Im d alas /s/fil" a CRAMr/ettYItai1 O t7tr.uettr
so nu at•lossate aeatbt•as lit apaetau /ttho haty thw listemis attndod to mol D Yos e :
MMlr A►T'•' CLWTSMMIr LMTlttt ABQCIAAD FROMM iN/0tt1MATM Af'QUD ZD
Q •r a t•LATor/t tL i lD M ttiset wbf T11U1 ►L1CATtaM.
4"Icroterlyalarm)eAe:—1Plutearnscsfa[ta[tr.wtM.ctn,pWettit0r RM
t a.�htQQtetllN[ S�rir.S����
: „imp"Ado-W Letanue.001 N HwYkpl
/ �Wtt► ro�tatutm�laon,tt:.u.� hod o l T Corn r: �S r
Cast, cr Left-OKe� on Drtvc`
torttuu ,r„..�_ •btlt r,,_ Lot: t-Witk Rome toratri ttafee. OA ♦ ,
• . - ' .
Wile to corttty 1181 the luror[uad•a Ksrtded Y tarred to thew d Aly k/ewtedpe. I un darstatd dot t4Y p 1(s)
41ttdttsrntter are tubjmtosupt/Wonocts woot.vim dteytctr•rkwoma.444MWuao
A6ddttN ie thta opRitgdea is hittMa sr *Elia;td. 1r.4.. tru�twsnnl tlf.rl aw.vtr�o�dXiJ�rMeAnln hrui ���:: . ':
ak4wtewt w, L WAY. Ovo moist m We Amberml Nepdvt 016 O'rit comity Ishii, 0 A petit
M 4OW upon above ieoortttd peri,:Oy iecale0 is Davis County sad owad by {
- • : M tllthret t11 tccR/ psoetd/rtt u ttetecttt)r q itttt'miae td tiq Tutt tt7. - -
t.+�AAT7< rstSirny'u � .
"M ARSA MAY U vow" rns D"WM Tom /Ili PLAN Qitdads to sift plbww Er<kttes idp�yoNC
lrowly WIN mm N naval N, mclurol, eetbacUN MW ssplkltsattat).
. til � !tq 1loNt1[ C►a ' a .
clk"t NIotmesum Dots:_
. ...r..+ r.e•un n..,a� Lvalre N..
.JAN -31-06 08:13 AM Stromko
ie County, North Carolina Spatial Data Explorer
19109476103
S+rzarn*�o
P. 02
Page l oft
. Y -
Spai
aI Dd- ?,a [2K :-:,t>r'er
no �.�� rl�m caro4na i `;
f
Click on the Map to: Map U s'
t - -
Ioomin C' Zoomout r Recenler Map r Identify:
Parcels - ;
� Draw select -
oam Factor. 2X 'vr Radius Search (feet)10 Boundary
census Trat
c % City Boundt J
t hvttne St-reS h Gve ,�,eE'n�1cc�� ti ".i } rCot,rttyzortl ;. s
1.
:14t '1414r C ` Multi Syt
• County 11): 8300000037
• AccountNumber825i5SD9
• PIN_5823261418
• Legs) 1:28.907 AC 14WY 601
• NxerName.' RATLEDGE A C JR ETAL
• OwnerlAddress 1_ RATLEDGE A C JR ETAL
• OwneNAddMSS 2.-
•
:• Owner/Address 3: 4402 NC HIGHWAY 801 NORTH
• City,State ZW MOCKSVILLE ,NC 27028 - 0000
• Land Valus:292,970.00 ,
• Building Value: $0.00
• Out t3miding/Ertra Features Value: 30 00
• Assessed Valine: 992,970.00
• PrQQerty Reoofd Card
free
i�
(— Creeks and
1
Land Unit /Type.: B300000037 :1 AC
oras
?
-
` r.
•
.i1fi.
Flood Zone!
t
Firs Os
r ?,!te
e
I✓ Parcels
,
school D" 7
-- .-^-�
i
Multi Sy► t..
. �� . ;
SSW
.. i
? t
• County 11): 8300000037
• AccountNumber825i5SD9
• PIN_5823261418
• Legs) 1:28.907 AC 14WY 601
• NxerName.' RATLEDGE A C JR ETAL
• OwnerlAddress 1_ RATLEDGE A C JR ETAL
• OwneNAddMSS 2.-
•
:• Owner/Address 3: 4402 NC HIGHWAY 801 NORTH
• City,State ZW MOCKSVILLE ,NC 27028 - 0000
• Land Valus:292,970.00 ,
• Building Value: $0.00
• Out t3miding/Ertra Features Value: 30 00
• Assessed Valine: 992,970.00
• PrQQerty Reoofd Card
free
(— Creeks and
Flood Panel
Land Unit /Type.: B300000037 :1 AC
oras
?
-
` r.
•
.i1fi.
Flood Zone!
Firs Os
r ?,!te
e
I✓ Parcels
,
school D" 7
-- .-^-�
i
Multi Sy► t..
. �� . ;
lr 3ct+ools . J.
? t
•
Property Address.
i
r Town Zonble
i
i
r Townshlp'll
County Zoning:
•
Census Code:
:Fla
seers. i i
r Voting Prat 1
_ t
uaa
a i924 '
IflfraslfUChlrt
j;
•
Fire District: COURTNEY
r Driveways }:.
This map is prepay
swoR
•
Flood Zone: ZONE X
r Inventory of real pt .'
within this jurisdid
tr
rstreet conic
A
t�
! a>R•. i
[� USINC Nlgk
sae
Multi Syn
....,
Parcel Data
1
r A.r1et phOtt
Find Adjoining Pariml�
physical -
. '
• County 11): 8300000037
• AccountNumber825i5SD9
• PIN_5823261418
• Legs) 1:28.907 AC 14WY 601
• NxerName.' RATLEDGE A C JR ETAL
• OwnerlAddress 1_ RATLEDGE A C JR ETAL
• OwneNAddMSS 2.-
•
:• Owner/Address 3: 4402 NC HIGHWAY 801 NORTH
• City,State ZW MOCKSVILLE ,NC 27028 - 0000
• Land Valus:292,970.00 ,
• Building Value: $0.00
• Out t3miding/Ertra Features Value: 30 00
• Assessed Valine: 992,970.00
• PrQQerty Reoofd Card
• Flood Commun/ty.
• Flood Panel.'
• Flood Map Date:
• Soil.. MnC2
• Township. CLARKSVILLE
• Town Zoning:
Compiled from yea .
Plats. and other pu
data. Users of this ;
noGfied that"a4
public pnmary into ;
should be Consulfir .
verification of ther. -
contained on this r
r
(— Creeks and
•
Land Unit /Type.: B300000037 :1 AC
E911 Addrat
` r.
•
Deed BooWPage: 00344/0466
'
Firs Os
r ?,!te
e
•
peed Date. 2000/08/28
•
Sales Price! $0.00
lr 3ct+ools . J.
? t
•
Property Address.
i
!
•
County Zoning:
•
Census Code:
MAp C�
•
City Code:
•
Fire District: COURTNEY
This map is prepay
•
Flood Zone: ZONE X
r Inventory of real pt .'
within this jurisdid
• Flood Commun/ty.
• Flood Panel.'
• Flood Map Date:
• Soil.. MnC2
• Township. CLARKSVILLE
• Town Zoning:
Compiled from yea .
Plats. and other pu
data. Users of this ;
noGfied that"a4
public pnmary into ;
should be Consulfir .
verification of ther. -
contained on this r
r
i
F; DAVIE COUNTYiEALTH DEk'ART`MEN T ' r
- Environmental Health Section °<
Soil/Site Eva�tza�iohJ
APPLIt✓ANT INFORMATION " ' PROPERTY INFORMATION
,AccoUni #: X990003528 Tax PIN/ H #: 5823-25-1418 ;
Billed To Stephen.Stromko SubdivisiaNnfo:
f/ }
__i Reference''Name $ �' . Location/Address: Highway 801-27 8
Proposed Facility.; Residence Property Size: see map ` Date Evaluated: C
tO
�t
.. Watei Supply On-Site Well Community Public
Evaluation By: Auger Boring - Pit Cut
;.'FACTORS 1 2 3 5 6 7
Landscape position L L
Slo a%-: 5}'
;HORIZON:I DEPTH rte,.., - -
Texture groupv L tc
,
Consistence T737,
Structure
t1'
Mineralogy
HORIZON H DEPTH J A=
..Texture group
Consistence I S ` S �+
Structure 7�1�
' Mineralo SLAC
HORIZON III DEPTH - -
Texture groupj +
Consistence
'Structure
k
Mineralogyr
HORIZON IV DEPTH
Texture group_
Consistence
Structure
,Mineralo
SOIL WETNESS—
RESTRICTIVE HORIZON r
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE yl,
-SITE CLASSIFICATION: 1 EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: ") OTHER(S) PRESENT: Ol C-A
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 t
VFR - Veryfriable FR -Friable FI - Firm VFI -Very firm _ EFI - Extremely firm
NS-. Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky 1
NPr- Non plastic SP - Slightly plastic P - Plastic VP - Very plastic E
Structure t
SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky
SBK - Subangular blocky. PL - Platy PR - Prismatic
_ i
Mineralogy
1:1, 2:1, Mixed ,
LY.otes
V,
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)
■■■■■■■■■e■e■e■■■■■■■■■■■■■t■ase■se■■■■■■■■■■■■■■■■■■■■■■e■e■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
MENNENMESONSUNSEEN MENNENiiiiii�iiiiiiMENNEN
■ee■■■■■■■■■■i■iter■■■■■■■■■■■a�a■■■■■■e■■■■■■■■■ne■■■■■■■e■■■■■■■■■■
■■■■■■s■■■e■■iii■rr■■■■■■■■■n::::��'■■■■■■■■■■■■■u■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■■■Herr■■■■■■■t�:i�e■■e■■■■■■■■■■■e■■■■■■e■■■■■■■■■■■■■■
■■■■■■■■■■■■■rr■tr■■■■■n■■■gat■■■■■■■■■■■■■■■■■■■�■■■■■■■■■■■■■■■■■■■■
■■■■■■■■■■■e■ ■rr■i■�r����NRn�i■■■■■■■■■■■■■■■�i■e■■■■■■■■■■■■■■■■■■e■
===____=====�i��i■e■■■■■■■■■■■■e■ ■■■■■■■erg■■■■■■■■■■■■■■e■■■■■■■■
r��r_.__..■.:Cr■�Cr,■■■■■■■■■■■■■■■■■■e■■■■■■■II■■■■■■■■■■■■■■■■■■om■w■
0
F
MdD
I'
25.6
1418
204
MnB2
N n l-
N
MnB2
9.168A
02
754
210
�-
"
CREAM
"
20 a
1.000A
y ...
_a.
I
m (3.86A)
N
470
� �
N 4003aa.�,
o ;\`< .
4741
(�79 n.
(4.48A)
_
N
m
t7
7566
<
/
N
(13.59A)
4
e434
/
m
209 -
:.:470
677
i
S.00A
R
(5.04A)
4493
^)
o
9420
_
Davie County Health Department
Environmental Health Section
P.O. Box 848/210 Hospital Street
Mocksville, NC- 27028"
(336)75178760/ Fax (336)751-8786
February 8, 2006
Stephen Stromko
5080 HWY 24-27
Cameron, NC 28326
Re: 25Acre Tract/Dreamscape Ln.
Tax PIN# 5823251418
Dear Client(s):
As requested, a representative from this office visited the above site February 7, 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 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 or the intended use change.
Improvement Permit
System To Serve: Wastewater Design Flow: �IO
System Type: 216:o—nventional
❑ Accepted ❑ Innovative ❑ Alternative ❑ Other
System Location: LOWCiz SID;eE7 �Valid: 85"Years ❑No Expiration
Site Modifications/Permit Conditions: bcc) T
ps-i.p.letter 2/06