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277 Harvest Way (2)Account #: Billed To: Reference Name: 990000815 Doris Delli-Santi Doris Delli-Santi Proposed Facility: Residence ATC Number: 2254 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5749-03-9153 Subdivision Info: Location/Address: Harvest Way 27028 Property Size: ZPAcre AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: CERTIFICATE OF COMPLETION Date: / // 7 �7 7 **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. L— �`� bwe 30 9 aa0 3a 6P, Septic System Installed By: E40JU / Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: r DAVIE COUNTY HEALTH DEPARTMENT %fid 1pai--9% Environmental Health Section / P. O. Boz 848/210 Hospital Street ' Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000815 Tax PIN/EH #: 5749-03-9153 Billed To: Doris Delli-Santi Subdivision Info: Reference Name: Doris Delli-Santi Location/Address: Harvest Way 27028 Proposed Facility: Residence Property Size: 27Acre ATC Number: 2254 **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 ck 1C -- #People #Bedrooms #Baths Dishwasher: � Garbage Disposal: ❑ Commercial Specification: Facility Type Washing Machine:/l Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ #People #People/Shift #Seats Industrial Waste: ❑ Lot Size "2 r` res; Type Water Supply 4 Design Wastewater Flow (GPD) Site: NewRepair ❑ II System Specifications: Tank Size OD0 GAL. Pump Tank Z6 GAL. Trench Width 11 Rock Depth" Linear Ft. Other:—L1?-xl�/�9 �t �.��su W6)�<l L Required Site Modifications/Conditions: ` clf �y /Ql-7 •11 �J�o� L' rlr� IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 K BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** Sc7,1 5A.9 N/P'l (` ,) I �p Environmental Health Specialist's Signature: Date: / L-1712 DCHD 05/99 (Revised) APPUGAMON FOR 3111 EVAWATION/IMPROVEMENT PERMR A Alp L5 � � 0 W R 'r Davle County Health Department Eni attmentsl Meu/th Seatton (T I" P.O. Box 868/210 Hospital Street Mookaville, NC 27028 (336) 751-8760 ENVIRONMENTAL HEALTH DAVIE COUNTY w**zWCRTAW** THIS APPLICIITI(M can= Be IP==88= muss ALL Tisa nQuum SNi'OTM210H 18 PROVIDeD. Refer to the IM1'O94=10M SM322111 for instructions. 1. =a= to b,& :wed rVol2 /S P 6 L L -94 &4 % contact sereon -J c2,, 5 ck4 t teeiunq Address -3-5--o a G�J� /7'I �C,C�L 441v lqotr am* stma 33e - ?7,v- P raz- cuty/state/:ip W1 t)5 told _ C 44 Er» IV (f ; 11a6 stain.*• anon. r 3. Mase on perait/wm it Diffewmt than *boyo liaiiinq ledrese 3. Applioation >ros: Xilite evaltnation m o P(,i,L/9/Z •. a=ntes to sertioe: 0 House �L-N nw Home a. if Residence: ! People ^� city/stat./sip Al Improvement pewit/ATC 94ath 0 Business 0 Industry 0 Other ! Bedrooms - ! Bathrooms �- Dishwasber D awamms, Disposal Maahi+sag 9Gwr�BLigae ®2` esent/plvvebinq 0 aasesent/t:o pinsbinq a. 22 Staines•/2ndastry/other: specify tzyo ! aeople ! sinks ! commodes ! showers ! urinals ! Maur Coolers It 1=89MCa: # Seats estimated hater Osage (gsuons par day) 7. Type of water supply: X County/City 0 Well a. Do you anticipate additions or expansion of the facility this system is Intended to serve? If yes, what type? 0 Community 0 Ya 0 No ***IMPORTANT*** aMXM MUSTCOMPLEMTHE REQUIRED PROPERTY INFORMATION REQU£Si'ED BELOW. Elther a PLAT or SITE PLAN Ml8T BESIIBMITTED by the client with THIS APPLICATION. Property Dimensions: —� �WRrFE DiRECf10NS (from Mocksville) to PROPERTY: LW Tax 081ce PIN: 0 . 7.O - 63 - %/ ,�;- 3 Property Address: Rad Name ///4p -)/C -t5 T W/9 Cityalp M d C 1 : � � E /1/. (f - -27 A ly U In a Subdivision provide Information, as follows: Name: h ►,r �- r>7yR� Section: Block: Lob Date Property Flagged• /o -// ^ 9� This is to certify that the Inebrmadon provided Is correct to the bat of my knowledge. I understand that any permit(i) Issued hereafter are subject to sapension or revocation, U the site plans or intended we change, or if the information submitted in this application is fiisilled or changed I, also, understand that I an rcapouffik for aU charges Incurred front this appUcadom I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located In Davie County and owned by :- uvdu:: a- ifiting procedures as necessary to determine the site suitabtUty. DATE l0 �lt*— / SIGNATURE LI w -i , THIS AREA MAY BE USED FOR DRAWING YOUR SrM PLAN (include ell of the following: Eslsting and proposed property flues and r"13mensions, structures, setbacks, and septic locations). Site Revisit Charge Client Notification Date:' �2-74e^c-e S $-76' 9 Revised DCHD (07199) Account No. Involee No. / ��� SOB SOB WOB ---- PcC2 PcB2 PcB2 w9c X1836 w y c� f� fir: f. s This map is for PERC TES' and BUILDING PERMIT pu only. The Davie County Pa Tax Administrator's Office assumes no liability for an information contained on 1 RnD r' iNOB COUNTYID:H500000 October 11,199911:52 Parcel Identification Nui 5749-03-9153 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • Soil/Site Evaluation APPLICANT INFORMATION Account #: 990000815 Billed To: Doris Delli-Santi Reference Name: Doris Delli-Santi Proposed Facility: Residence PROPERTY INFORMATION Tax PIN/EH #: 5749-03-9153 Subdivision Info: Location/Address: Harvest Way -27028 Property Size: 1 Acre Date Evaluated: Water Supply: On -Site Well Community Public l�� Evaluation By: Auger Boring �/ Pit Cut • vo©e®tea position HORIZON I DEPTH groupLandscape Texture �rv�■��rv��r��� • ' �fAF,W 'J�'I writlm�llll__ NO 13M IW, 2. WA WA20MWo Consistence F:� T'yWr HORIZON Texture group �Lff Ir r� ., r�irs��r����r����■i■r� QjM'F 1210 Consistence lip, g�= FO�W 1001% ME W""V ®MWOMIMMIM Mineralogy HORIZON IV DEPTH Consistence ------- SOIL WETNESS SAPROLITE OWED R NO SITE CLASSIFICATION: (/� EVALUATION BY: ��17c o LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT• — / _ REMARKS: LEGEND -- Landscape Position R - Ridge S -Shoulder L - Linear slope FS - Foot slope N - Nose slope CC - Concave slope CV - Convex slope T - Terrace FP - Flood plain H.- Head slop Texture O'1SC4Y' 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 oist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/99 (Revised) Davie County Health Department Environmental Health ; PO Box 848, Mocksville NC 27028 336-751-8760 Doris Delli-Santi 3502 Wimberly Lane Apt. K Winston-Salem NC 27106 Dear Mrs. Delli-Santi, As requested, a representative visited the property referenced below on Oct. 28th 1999, and performed a soil site evaluation. At that time the property was found to be unsuitable for the installation of an on-site sewage disposal system for the following reasons: a. Rule 1942(a) Soil Wetness conditions b. Rule 1941(3) Massive soil conditions c. Space limitations At this time, this office knows of no alternative system that would properly function on this property. You do have the right to an informal appeal of this decision by the Environmental Health Supervisor of this office and also by regional staff of the Dept. of Environment and Natural Resources. You may contact this office to arrange for this further review. You may also wish to contact a private consultant to collect site specific data and submit this to our office for review. A site may- be reclassified` to provisionally suitable if the written documentation including engineering studies, hydrogeological, or soil studies show that a system can be reasonably expected to function satisfactorily. The data must show that: a. The sewage will receive proper treatment b. The sewage will not contaminate any ground or surface water Finally, you have the right of formal appeal of this decision if you file a petition with the Office of Administrative Hearings, PO Drawer 27447, Raleigh, NC 27611- 7447. A copy of the petition must be received by the Office of Administrative Hearings within thirty days of the date of this notice. The hearing may be held in Davie County. If you file a petition for a hearing, you must send a copy to Mr. Richard Whisnant, DENR, Office of General Counsel, PO Box 27687, Raleigh, NC 27611- 7687. If you have any questions, please feel free to call me at 336-751-8766. Re: lacre- 281 Harvest Way 5749-03-9153 Y7E�. truly, C Environmental Health ou •gip •«, w,•, -• « •�� 2006 • D6 177. P"448 • WS 2006-E-49 COURSE •RS 3220PD on DISTANCE R. Stave �tN CNtp` �i �ie2 =0.�0tESS/0k'�•-A. .nun. � w 13.28' 12.10' EASEMENT TE LRE E-{ E-5 L-3152ar rwnpl wbdMWm G•e°"'M"ouo" r way.b)• HCA^ Mmumwl WOLFE N: 2424OC346 m C 47ODS6.795 m CF: 0.9999096 • '"i•r•4�rkF�®moi. wwWi.�w+�' ❑::�:^:.: Gag. R 51m. 1/A.t AM/{A �.....r.. ww ACOS Mam.na t WOLFE AZ 1t 242063.954 m C 470050.778 m aAW/hr�m nlwAle —A 6e.4r TaM A l e \ _ _ ie1/r oP r.d�-1x1/2• aP eaM=r ^\ _ — - - — - - — - I TM u 0* S Or19.51'E 190.50' I Tar tee 12 Tor Yap N -S n/T./aM Y. tcwntr IP.m K tr DB 111 • PO 662 SEI nM SY51E11 EASEMENT GALL TABLE COURSE BEARING DISTANCE E-1 N B4'34'44'E 10.9V EASEMENT TIE LINE E-2 E -J N84'S4'N'E N 54'S4'44"E 13.28' 12.10' EASEMENT TE LRE E-{ E-5 S 0r36.10"W N 84'5V4,VE 79.3Y 32.39' E-6 E-7 N 02.38'10'E 3b4 '44V 79.3{' 32.39' E-8 E-9 N46.14'29" R N 03'40'26"8 146.94 4.61' E -f0 N 49.3 5'Y7 111.90' E-11 E-12 S 70'17'25'Ty 5 61.117rE 77.33' 17752' E-13 E-14 N 0740'26"E 5 46't4'29"E 2154' 129.75- I NMP deflMrq oar w. of wp0p ry.l.m 9—ts PA-N.rwua P,9-w1r w-ooa Yw"�r�w. Bea. n - G(m NM Tar ler /0I / Tm AAP N-5 n/TYr FF./ Yarya.l Margaret Dellisanti 60 0 60 120 iiiiiiiir_ GRAPHIC SCALE - FEET f� Y VAT: d ipRlll U' BOlR1A COUNr7 M MNE , AJ..6.a.E..A.. allr r o.A. ara wmlry Wr.. 77raGrl�k•%e ew4. omw 6.r Ti P. do.. M a.M...Cd,Ya, —). le 0 Two d INcbAM 6AMn Orrnsw. DOME PW -V Dk..br Harvest Way S.R. 1498 (Old U.S. Highway 158) /-60' Public R/W per NCDOT 18'+/- Concrete Pcwemant X 6QrtiM 911495 7 Y 1. Zmirq: Open Span Rwld.ntlW (OSR) k Flood Plan (FP). 2. TM wb).et IM I- w . d thg Wp ry, . . 3. Th. M). t p -M Is not W.M.d .Nhln Oi. 100 y.r Rood a Pl.rd l 0 Revised Tax Lot 10.01 r-} 1.000 Aar' E..rn.4 s.o� b110 s.. feu Tao. 208.72• N O nliev e.rna 11w tat 1h. 7- Lr 10 7 Yap N-5 N4 Md.W F. DME.mtl Map.e Di ff DD 177 • PG 446 NAD 83 M h P.Pab d.vEM Msn r4ch Y 1..a1r N h wbefrlan }.bdcllen M OP- fb.dY sr tlW I hPr.bx' .d.N e4..eerYa, Pw., Mn rq h.. o.wrd, .M.bWwd mH..n brig rMbeok saw .r s.e..t. a w..la aILR w.y oar aW otlr MW tM wr,rtb l PE6e a PrkM. uw G•LI•oL ih�1;d� T1AAr 2 7�'r a, -,i a°� .qss 12'01 Y«L. .a6 «r..... 100 Yv fled Nerve Zai. w Swld from FDA Wp DdW 12-17-93 C---r.)•-PaW No. 3703W 0075 C lwrwd� yky�R7 y.p (Nr b Sm1a) enf/-r Me 1498 1 I N o5V5•,ev _ _ 184P N E9.lio Cl.ak / b.. PaaM Mtn SaWrn L T. tot 1001 / V / T- tee to im Yap N-5 / n/Y Weh w F. D.ebantl and Fwntl DO 177 DND,1 / oa toe' Pc 446 —100 Yw P1aad Ibxmd Zaw w S -W cpm FEMA WP DatW 12-17-93 / Ca lty-PaW N.. 370308 0073 C / W / U / YI Recombination. Survey for. Michael F. Dellisanti Tar ler /0I / Tm AAP N-5 n/TYr FF./ Yarya.l Margaret Dellisanti GB+wnN DB 177 • PG 446 / 7 Y 1. Zmirq: Open Span Rwld.ntlW (OSR) k Flood Plan (FP). 2. TM wb).et IM I- w . d thg Wp ry, . . 3. Th. M). t p -M Is not W.M.d .Nhln Oi. 100 y.r Rood a Pl.rd l 0 Revised Tax Lot 10.01 r-} 1.000 Aar' E..rn.4 s.o� b110 s.. feu Tao. 208.72• N O nliev e.rna 11w tat 1h. 7- Lr 10 7 Yap N-5 N4 Md.W F. DME.mtl Map.e Di ff DD 177 • PG 446 NAD 83 M h P.Pab d.vEM Msn r4ch Y 1..a1r N h wbefrlan }.bdcllen M OP- fb.dY sr tlW I hPr.bx' .d.N e4..eerYa, Pw., Mn rq h.. o.wrd, .M.bWwd mH..n brig rMbeok saw .r s.e..t. a w..la aILR w.y oar aW otlr MW tM wr,rtb l PE6e a PrkM. uw G•LI•oL ih�1;d� T1AAr 2 7�'r a, -,i a°� .qss 12'01 Y«L. .a6 «r..... 100 Yv fled Nerve Zai. w Swld from FDA Wp DdW 12-17-93 C---r.)•-PaW No. 3703W 0075 C lwrwd� yky�R7 y.p (Nr b Sm1a) enf/-r Me 1498 1 I N o5V5•,ev _ _ 184P N E9.lio Cl.ak / b.. PaaM Mtn SaWrn L T. tot 1001 / V / T- tee to im Yap N-5 / n/Y Weh w F. D.ebantl and Fwntl DO 177 DND,1 / oa toe' Pc 446 —100 Yw P1aad Ibxmd Zaw w S -W cpm FEMA WP DatW 12-17-93 / Ca lty-PaW N.. 370308 0073 C / W / U / Recombination. Survey for. Michael F. Dellisanti / and urife Margaret Dellisanti / Pak of T. Let 10 Ta. Map N-5 0'.1 Bwk 177 O Pap. 448 / k Purl of Tm Lt10.01 Toa Wp M-5 / MTI Baok 2006-E-49 R.cad Book 322 O Pa9. 836 Told Mo for Rwiwd Ta. Lot 10.01: toxo Orn. f/- by cmminat..omPuletln (InclWw A- riNin S.R. 1498 R/W) svu lawWlP cq.4n PAVE Our 1• . 60' M -b ". DaW. No h Coro- 5-19-2006 Mom"aMF.D.B.au ,,ETM Stone Land Surveying Company waytl SC.DIDT 6-" erb.l Ela.. NS W142 8806 2E1��rv..t Moclada.. N.G 27028 WrPER ,J Pun ,a.. Pm... (aae) ane-4xJJ 6o C,pg k..W...c, ttaxe