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102 Hidden Passage WayDAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990001071 Tax PIN/EH #: 5851-64-3332 Billed To: Joyce Marshall Subdivision Info: Half Moon Lakes Lot # 3 Reference Name: Joyce Marshall Location/Address: Livingston Road -27028 Proposed Facility: Residence Property Size: 6.0067 Acres **NOTE'** Tliibfr provement/Operation Permit DOES NOT authorize the construction of 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 1 I 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 -Q #Bedrooms 1, #Baths. - Dishwasher: 2re Garbage Disposal: ❑ Washing Machine: 0"** Basement w/Plumbing: ❑ Basement/No Plumbing:-�--'- Commercial Specification: Facility Type #People #People/Shift #Seats Industrial este: ❑ Lot Size 4C Type Water Supply &ell Design Wastewater Flow (GPD) Site: New ir ❑ System Specifications: Tank Size/% GAL. Pump Tank GAL. Trench Width IV Rock Depth - Linear Ftfe)6--f' Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATIO PERMIT LA OU - A_PP VED EFFLUENT FILTER RISER(S) IF 6 k BELOW FINISHED GRADE. ****NOTI E: Contact r ve of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. 1:0 0 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** P12allol O rar Cfea� F YK WA Oe fS Environmental Health Specialist's Signature: Date:" DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001071 Tax PIN/EH #: 5851-64-3332 Billed To: Joyce Marshall Subdivision Info: Half Moon Lakes Lot # 3 Reference Name: Joyce Marshall Location/Address: Livingston Road -27028 Proposed Facility: Residence Property Size: 6.0067 Acres ATC Number: 2367 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 WASTEWATE CONSTRUCTION IS VALLIID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 6 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. � X12 eill �( 'p �)90 Septic System Installed By: ` Environmental Health Specialist's Signature: Date:' O DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC �.. �: Davie County Health Department .....,� 9 �av�22, N9g tv Environmental Health Section pN�j P.O. Box 848 Q E�P�6� I {SS Mocksville, NC 27028_ 6 10 (704) 634-8760 �R l EIMR011ME1nAl NEIL H ****IMPORTANT**** I THIS APPLICATION CANNOT BE PRO THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed C -S t-\�Z Contact Person Gr`S kr-k Mailing Address � r' w o 10 j4 Q Home Phon U &,q v City/State/Zip ack on. _✓, e (A c =;-? ao Business Phone '77& • 9V4,0 2. Name on Permit/ATC if Different than Above Ity-7N 1 oL Mailing Address City/State/Zip 3. Application For:, [dSite Evaluation [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: [ `House [ ] Mobile Home [ ] usiness [ ] Industry [ ] Other 5. If Residence: # People_ # Bedrooms # Bathrooms_, �shwasher VfGarbage Disposal Vkshing Machine [ asement/Plumbing B asement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers :If Foodservice: # Seats Estimated ater Usage (gallons per day) 7. Type of water supply: [ ] County/City [ Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [ ] No If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: ***IMPORTANT **SAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions a: WRITE DIRECTIONS (from Mocksville) TO PROPERTY: 5`�SI _ !� 33 3,;2,— Tax; Office PIN `# - Property Address. =`Road ame ` '" L /�Oa�// _. City/Zig l a1 bw Alsl Iel f in 'Subdivision provide 'nformation, as follow /l�X/ u Name �1 D W �6 Q , 12Al1 NCY -Section:��Lfrn Lot #: 3 This is to certify. that the information provided is correct to the best of my knowledge: I understand that any permits) issued hereal'ter`are subject.to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or clianged. I, also, understand that I am responsible for all charges incurred from this application. 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 conduct all to rocedures as necessary to determine the site suitability. DATE >�2Iq Y tSIGNATU Revised DC (06-96) 1 THIS AREA MAY BE USED iOR DRAWING YOUR SITE PLAN: a . � x� M PIP gel b, c AV oP LAKE 1\1 t rCPui I r I �O m0 6.061', ACRES+— co� o _Zb G PRNA�E DRNE' I I , - t 05 NIP � NIP 4 6.6611 ACRES+— S 85°50'49"E 235.04' z (V io � N �� 1 13 C, S 89°51-27"E Q o ;- C NIP 50.00' oPN 10 oc- W 0 z W > w O N \ 1l. Z LAKE / NIP ti 0 �ry ,38 6�• NIP / TOTAL NIP NIP S 89°51'2T'E 1175.76' 191.45' NIP w t7 N M � O :2 z r NIP `3 -�N o fl z t rCPui I r I �O m0 6.061', ACRES+— co� o _Zb G PRNA�E DRNE' I I , - t 05 NIP � NIP 4 6.6611 ACRES+— S 85°50'49"E 235.04' OP cq 4 z (V io � N �� 1 13 C, S 89°51-27"E Q o ;- C NIP 50.00' oPN 10 FOX RUN P.B. 5 PG. 182 W 0 z > w W E OP cq 4 (V io � N �� 1 13 � e S 89°51-27"E Q o ;- NIP 50.00' oPN 10 FOX RUN P.B. 5 PG. 182 i 545.48' N 05°27'53'E I 61@� 62.46' 100 0 4x28 F� _ �-�'�--- PRIVATE EASEMENT N 89 51'NIP 2 ' w. �600 �`� N GRAPHIC SCALE CII E `- klc CY IRON ROD FOUND \ MAP HALF—,A b%A= 1 q FOX RUN 1" _' 100' FAF =' P.B. 5 PG. 182 o DMSI N OF D.B. 62 P' NIP ac°�••��..W 1 •.46 8'CLIN68.40'25"W 80.00'RAYMOND v. MARKLANDe—D.B. 86 PG. 548NETi� „ oP P.O.. BOX 27E TON C. D.B. 174 PG. 261 y\ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME PROPOSED FACILITY SUBDIVISION q DATE EVALUATED % T— PROPERTY SIZE 4'�' ROAD NAME Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L' Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH I/ Texture group Consistence ; 10r 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: e�2 ' /7 o3p/) LONG-TERM ACCEPTANCE RATE: o REMARKS: DCHD (01-90) kv%Y" Pe /EVALUATION BY: OTHER(S) PRESENT: Landscape Position R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope CC - Concave slope CV - Convex slope T - Terrace FP - Flood plain H - Head slope Texture S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay . SIC - Silty clay C - Clay CONSISTENCE Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic . Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 _ti • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME PROPOSED FACILITY SUBDIVISION q DATE EVALUATED % T— PROPERTY SIZE 4'�' ROAD NAME Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L' Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH I/ Texture group Consistence ; 10r 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: e�2 ' /7 o3p/) LONG-TERM ACCEPTANCE RATE: o REMARKS: DCHD (01-90) kv%Y" Pe /EVALUATION BY: OTHER(S) PRESENT: Landscape Position R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope CC - Concave slope CV - Convex slope T - Terrace FP - Flood plain H - Head slope Texture S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay . SIC - Silty clay C - Clay CONSISTENCE Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic . Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 - 0.1 0. FJP LAKE ,%K� nFlSHING HUT ,�OOP�-�64 / `o N 6 NIP w o) ,7 ;., co 04 /z / NIP LAKE_ �ry�• . -46 (��� NIP / NIP MAW W i o, !`� N M o : /10 z NIP I 11 tq O m p Q X I I � I I D 6.0611 ACRES+ -04 i , I , o o V) W E NIP NIP S 85°50'49"E 235.04' pP oP _ 6.0067 C S+— /� \ -p TOTAL NIP S 89°51.27"E 1175.76'NIP 4 SGP cli3 ccQ ' w 6.6611 ACRES+— IRON ROD FOUND FOR —.15 r� SCALET N ' 1 4 FOX RUN 1' = 100' FAF o o P.B. 5 PG. 182 DIVISION OF D.B. 62 PC z N D.B. 83 PG. 610 AND ��5---`' �r 114s. 8 CLINTON C. CORN NIP �% ss� o•2s"w 80.00• RAYMOND .i. MARKLAND D.B. 174 PG. 261 D.B. 86 PG. 548 P.O. Box 27€ N M N 89°51�27"E o i!S NIP 50_00' oPN FOX RUN P.B. 5 PG. 182 545.48' N 05°27'53"EI NI 16.78-,,-_, 62.46' 46 \ 100 0 28 PRIVATE EASEMENT NIP50.00' N 8s°51_27"wN P FOx r Hi I I I so. RU GRAPHIC SCALE — \k/ RDR MAP ' w 6.6611 ACRES+— IRON ROD FOUND FOR —.15 r� SCALET N ' 1 4 FOX RUN 1' = 100' FAF o o P.B. 5 PG. 182 DIVISION OF D.B. 62 PC z N D.B. 83 PG. 610 AND ��5---`' �r 114s. 8 CLINTON C. CORN NIP �% ss� o•2s"w 80.00• RAYMOND .i. MARKLAND D.B. 174 PG. 261 D.B. 86 PG. 548 P.O. Box 27€ my supervision corded in cable): from culated• •.S. 47-30 nd seal: 890 e that at ation of he unable tuber N 15°08'26"E --�^-- • ��.�"""""•n. '••� 490.00' Tie to NCGS Monument "WARD" / H V A r!1 �/� ��•�O.• .O,.STfgr�• M onument found upside down 6P in ground, Location approxirrfe only, o`ti f e 's LIVINGSTON ROADti SEAL = 7.9 L•2890 END OF ROAD AT R/W MONUMENT. • yy••......... •'40A/CHARD •�••, 0 •'rr•@Ur n Wes% I t }7 4~J, fVl�Fy I I Co c, i 1 arO z I cW ct`"il 01 I QI I I 1 i OI 1 �O I V)1 I EIP O i A NIi I I 1 6.2740 ACRES+— ' I I I 1 I 1 �1 OGP` ( • I I 1 1 �6 ti EIP A LAKE�FlSHING HUT %K �o \ 23 S�pP olrr I 1 I 2 I 1Ih~O o 'IAF' I 1 1 ' I I I 1 6.0611 ACRES+— I oR\� - f ' NIP NIP i� '(OSP 3 g4 6.0067 ACRES+— O P LAKE �4- PeP� NIP OP IEIP UP N 36°15'17"F 1717.43' Tie to NCGS A' Monument fo-/ North (Y) 81 P East (X) 155" a I f S 85.5049"E 235.04' S 89°51'27'E' —e• TOTAL / NIP S 89051'27"E 1175.76' .45' � , �_ 4_ 0 6.6611 ACRES+ - 545.48' N 05°27'53"E I "Ii 62.46' PRIVATE EASEMLNT 1p 50.00' N 89°51'27"Wa a? I14 ^ O N 89°51'27"W 1146.18' RAYMOND J. MARKLAND e— CLINTON C. CORNATZER D.B. 174 PG. 261 D.B. 86 PG. 548 Number • 41�- �� �r p6 6� 000% + t! o r Z ++Lv }- :ff 6.0611 ACRES+- ) i + ot� rro /i r o 1"o-01,11 NIP \Gt L6c cn LAKE �o�� FISHING HUT S 85°50'49"E 235.04: SP NP /. _ 6.0067 ACRES+- - . ` 62.46' — P. q 8905 LAKE rami - y - }._. -•`. a, .., ._. - - - ..� r:l-+<'4• c- .xs�.J`•Y.x"'k:n�4iw"k''i+}- - -,.}.a,. TOTAL ,� .. c' : a1 r�"poa` m itPat.., �sb dt+EsrYrl xi..? ca�tirk. -u: tG:E�= s .���p• __• ,.,.. •- ' •--....."�'!1'""-'.' .. - ... -vs tax 7h+.�?�+� ' 'f=: f Davie County Health Department 55� and Come Health Agency P MPS 60 Environmenta(Health Section � P.O. Box 848 / 210 Hosprm STREET COURIER #09-40-06 r MOCKSVILLE, N.C. 27028 PHONE: (704) 634-8760 June 5, 1998 Joyce B. Marshall 216 Talwood Dr. Advance, HC 27006 Re: Site Evaluation Half Moon Lake/Lot 3 Livingston Road/6.0067 Acres Tax PIH: 45851-64-3332 Dear Client(s): As requested, a representative from this office visited the aforementioned site on May 14, 26, and 29, 1998. Based upon the information provided on the application for site evaluation, this tract was evaluated to determine the suitability of installing a ground absorption sewage disposal system. The soil types on this tract were found to vary greatly from provisionally suitable to unsuitable. -There is an area of approximately 150 X 100 feet on this site that contains a provisionally suitable soil type; however, this area is extremely limited due to its size.Due to the lack of provisionally suitable soil on this site, this office'myst limit the design of the septic system to be sized for only a twobedroom home. It is imperative that you and/or your representative work very closely with this office to ensure space is reserved for the septic system. Before a permit can be issued the appropriate application must be filled out and left at our office. Before any construction begins the house location must be staked off; and, this office must meet with your builder or representative to ensure all requirements can be met. Please note that your well must be 100 feet away from any part of the septic system. If you have any questions, please feel free to contact this office. RH/wd Enclosure(s) Sincerely, Robert B. Hall, Jr., R.S. Environmental Health Specialist