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546 Amber Hill Rd
Dave County,NC r t Tax Parcel Report Wednesday, February 15, 2017 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: B10000001601 Township: Clarksville NCPIN Number: 4893984522 Municipality: Account Number: 8305542 Census Tract: 37059-801 Listed Owner 1: ELDRED JEFFERY B Voting Precinct: CLARKSVILLE Mailing Address 1: 546 AMBER HILL ROAD Planning Jurisdiction: Davie County City: YADKINVILLE Zoning Class: DAVIE COUNTY R-A State: NC Zoning Overlay: Zip Code: 27055 Voluntary Ag.District: No Legal Description: 4.586 AC AMBER HILL RD(2.03 AC) Fire Response District: LONE HICKORY Assessed Acreage: 2.01 Elementary School Zone: WILLIAM R DAVIE Deed Date: 10/2015 Middle School Zone: NORTH DAVIE Deed Book/Page: 010020310 Soil Types: GnB2,GnC2 Plat Book: 12 Flood Zone: Plat Page: 82 Watershed Overlay: DAVIE COUNTY Building Value: 135620.00 Outbuilding&Extra 0.00 Freatures Value: Land Value: 17470.00 Total Market Value: 153090.00 Total Assessed Value: 153090.00 161 All data is provided as Is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Davie County, implied warranties of merchantability or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the County of Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to NC or arising out of the use or inability to use the GIS data provided by this website. OPERATION PERMIT F,1CDP,Ffle.Number, ice use ny Davie County Health Department 192834.1 210 Hospital Street P.O. Box$48mber;: '' •'' Mocksville NC; 27028; Evaluated.For NEW Phone:336-753-6780 Fax:336-753-1680 Township: Applicant:, ,Jeffery B. Eldred Property owner. Melissa Steelman Eldred Address: 530 Amber Hill Road Address: 530 Amber Hill Road City: Yadkinville CRY: Yadkinville Staterzip: NC 27055 State2ip: NC 27055 Phone#: (336)492-6242 Phone#: (336)492-6242 Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: Amber Hill Road Yadk7inville NC 27055 Directions Structure: SINGLE FAMILY Hwy 601 North Turn Left on Liberty Church Rd, turn #of Bedrooms: 3 left beside church, turn 1st road on right. #of people: 'Water Supply: NEW WELL 'IP Issued by. 2140-Na►ians,ttotiert *System Classification/Description: TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *CA issued by: 2140-Nauons,Robed Seprotite System? QYes ONo Design Flow: 3 6 0 *Distribution Type: GRAVITY.PARALLEL(eq.d-box) POYes ? No Soil Application Rate: 0 a 7 5 *Pro Treatment: Drain field rNkndficationField 1 3 0 9 SQ•8• *System Type: INFILTRATOR QUICK4STANDARDn Lines 3 Installer: Tony Hall Total Trench Length: 3 2 7 ft. Certification#: Trench Spacing: 9 Inches O.C. • Feet O.C. *EH S: 2140-Nations.Robert Trench Width; 3 Inches &Feet Date: 0 1 / 0 5 / .2 0 1 6 Aggregate Depth: inches Minimum Trench Depth: 3 0 . Inches Minimum Soil Cover. 1 8Inches Apprcnral Status = Maximum Trendy Depth: 3 6 Appy ed( Qtsappr�oved ; Inches Maximum Soil Cover. a 4 Inches CDP File Number 192834 - 1 Septic Tank County ID Number: ' Manufacturer: Shoat Let. STB: 760 long: ,__,_, • , Gallons: 1000 Installer: Tony ball Date: 0 9 / 0 1 / x 0 1 5 Certification#: THS: 2140-Nation.Robert "Filter Brand: POLYLOK PL-122 With Pipe Adapter ST Marker. El Yes R No Date: 0 . 1 . / 0 5 / a 0 1 6 Reinforced Tank: ❑ Yes ❑ NO AppravalStafus 4 1 Piece Tank: [I Yes [i] No a Approved❑�Dlsapprored Pump Tank Manufacturer, Installer: PT: Certification 4: Gallons: THS: Date: / / Date: Risersealed ❑ Yes ❑ No RiserHeight: ❑ Yes ❑ No (Min.6 in.) ApprovatStetus Reinforced Tank: E3 Yes ❑ No �` a �App�oved®SDlsapproved 1 Piece Tank: ❑ Yes ❑ No Supply Line Pipe Size: inch diameter Installer. 1 Pipe Length: feet Certification#: *Schedule: *EHS: Pressure Rated ❑ Yes ❑ No Date: Approved fittings ❑ Yes ❑ No Approval Status = _ 2 ❑ Approved©1 �isapproyed� Pump Requirement CDosing p Type: Installer. Volume: - Gal Certification#: Draw Down: Inches THS: *Chain: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check-valve ❑ Yes ❑ No - App"raval Status=` , PVC Unions ❑ 'Yes ❑ No ❑;Approved 13 Disapproved Vent Hole ❑ Yes ❑ No R Anti-siphon Hale ❑ Yes ❑ No 'CDP File Number 192834- I County ID Number: Electric Equipment NEMAT or Equivalent ❑ Yes ❑ No Installer. Box 12 Above Grade El Yes ❑ No Certification#: Boo Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No *EHs: Pump Manually Operable ❑ Yes ❑ No "Activation Method: Date: Approval Status Alarm Audible ❑ Yes. ❑ No ❑ Approved❑ Disapproved;: Alarm Visible ❑ Yes ❑ No 2140•Nations,Robert *Operation Permit completed by: ,ow Authorized State Agent. -. J�-- Date of Issue: B 1 0 5 2 0 1 6 Owner/Applicant Signature; This system has been installed in compliance with applicable NC General Statutes:Article 11,Chapter 130A,Rules for Sewage Treatment and Disposal,15A'NCAC 18K.1900 et. Seq.,and all conditions of the,Improvement Permit and Construction Authorizatio n.This property is served by.a TYPE I1 a sgyyage'LLseptic system, Rule.1961 requires that a Type TYPEIIA. septic system meet the following criteria: Minimum System Review ByThe Local Health Department: NIA Management Entity: OWNER Minimum System InspectioniMaintenance Frequency ByCertified Operator: NIA Reporting Frequency By Certified Operator.NIA Rule.1961.requires that a Type IV and V septic systems designed for a homelbusiness owner must maintain a valid contract wRh'a public management entitywtkh a certified operatoror_a private certified operator forthe life of the septic system. Rule.1961 requires that Type VI septic systems designed for a home/business owner must maintain a valid contract with a public management entity with a certified operator for the life of the septic system. Rule.1961,(2)(e)requires a contract shall be executed between the system owner and a management entity prior,to the issuance of an aperatioh'Perm'rtfar a System required to be maintained bya public_or private management envy, unless the system ownerend certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibilities of the owner and systems.operator,provisions that the contract shall be in effect for as long as the system is in use,and other requirements for the;continued proper performance of the'system, 'it shall also be a corrdion of the'Operatiort Permit'that subsequent owners'of the syst6ms`execute such a contract. @Hand Dravving OlmportDrawing **Site Plan/Drawing attached.** �'� OPERATION PERMIT Davie County Health Department CDP File Number: 192834 " '1 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: j f Q Inch 1ock Drawing Drawing Type: Operation Permit Scale: . ON A k ft. j �.. r �v k f C t ..r Davie County Health Department Training Log Employee Name: Tiffany Steelman Department: Env. Health Year: 2015 Date of Title of Training Cont. Ed. Hrs Cert./License Place of Training Training Earned Yes/No 1/22 PC 101 Training 5 No Raleigh 2/10-2/12 SOP Food Service Plan Review 16 Yes Black Mountain Regional Food Protection Mtg 4/20 #1 4.75 Yes Statesville 4/27-4/28 NACCHO Site Visit 12 Yes Raleigh NC Annual Preparedness 5/20-5/22 Symposium 14.25 Yes Asheville 6/22-6/24 ICS 300 18 No Lexington 6/29-6/30 ICS 400 14 No Lexington Foodborne Outbreak& 9/16-9/17 Response 15 Yes Pittsboro Regional Food Protection Mtg 12/10 #3 4.5 Yes Lexington w CONSTRUCTION For office use Only AUTHORIZATION *CDP File Number 192834-1 r Davie County Health Department County ID Number. 210 Hospital Street Evaluated For NEW P.O.Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753.6780 Fax:336-753-1680 0 9 / 3 0 / 2 0 2 0 Applicant: Jeffery B. Eldred Property Owner: Melissa Steelman Eldred Address: 530 Amber Hill Road Address: 530 Amber Hill Road City: Yadkinville CRY: Yadkinville State2ip: NC 27055 State2ip: NC 27055 Phone#: (336) Phone#: 492-6242 (336)492-6242 ' Property Location & Site Information Address/Road 9: Subdivision: Phase: Lot: Amber Hill Road Yadkinville NC 27055 Directions Structure: SINGLE FAMILY Hwy 601 North Tum Left on Liberty Church Rd, turn left #of Bedrooms: 3 beside church, turn 1st road on right. #of People: *Water Supply: NEW WELL System Specifications Minimum Trench Depth: a 4 Site Classification: Provisionally Suitable Inches Minimum Soil Cover Saprolite System? QYes ®No 1 a Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches SoilMaximum Soil Cover: Applicatan Rate: D a7 5 a 4 Inches *System Classification/Description: *Distribution Type: GRAVITY-PARALLEL(eq.d-box) TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons *Proposed System: 25%REDUCTION 1-Piece:. QYes QNo Pump Required: QYes ®No OMay Be Required Nitrification Field 1 3 0 9 Sq.ft. Pump Tank: Gallons No,Drain Lines 3 1-Piece:!(QYes QNo Total Trench Length: 3 a 7 ft. GPM vs— ft. TDH Trench Spacing: _ 9 Inches O.C. Dosing Volume: _ Gallons Feet O.C. Trench Width: Inches 3 . Feet Grease Trap: Gallons p _ _ Aggregate Depth: inches Pre Treatment: ONSF OTS-1 O:TS-11 Septic Tank InstallerGrade Level Required: 01 OII 0111 OIV CDP File Number 192834 - 1 County ID Number. 'D Open Pump System Sheet Repair System Required:@Yes ONO ONo, but has Available Space rDesign System Trench Spacing: 9 Inches O. ification: Provisionally Suitable — 0 Feet O.C. Trench Width: QInches w: 3 6 0 _ 3 . @ Feet SoilAggregate Depth: Application Rate: 0 - 3 a 5 inches Minimum Trench Depth: 2 4 *System Classification/Description: Inches TYPE 11 A.COW SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover 1 a Inches Maximum Trench Depth: 3 6 Inches *Proposed System: 25°!o REDUCTION Nitrification Field 1 3 0 9 Sq.ft. Maximum Soil Cover: a 4 Inches No. Drain Lines 3 *Distribution Type: GRAVITY-PARALLEL(eq.d-box) Total Trench Length: 3 a 7 ft. Pump Required: Oyes eNo OMay Be Required Pre Treatment: ONSF OTS-1 OTS-11 *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. i *Permit Conditions The issuance of this permit bythe Health Department in no wayguarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. ; This Authorization for Wastewater System Construction shall be valid fora person equal to the period of validity of the Improvement Permit,not to exceed five years,and may be Issued atthe'same time the Improvement Permit issued(NCGS 130A-338(11)�If the installation has not been completed during the period of wlidity of the Construction Permit,the information submitted In the application for a permit or Construction Authorization Is found to have been lrwAxTect,falslfled or changed,or the site is altered,the permit or Construction Authorization shall become Invalid,and may be suspended or revoked(.1937(g)).The person owning or controlling the system shall be responsible forassuring compliance with the taws,rules,and permit conditions regarding system location,Installation,operation,maintenance,monitoring,reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? OYeS ONo ApplicanVLegal Reps. Signature: Date:. *Issued By: Date of issue: 2140-Nations,Robert 0 9 / 3 0 / 2 0 1 5 Authorized State Agent Malfunction Log OYes Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 t6NSTRUCTION AUTHORIZATION 'Davie County Health Department CDP File Number: 192834- 1 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: 0 9 / 3 0 / .1 0 1 5 Q Inch Drawing Drawing Type: Construction Authorization Scale: . QBlock =_ ft. QNJA ! .w d o 3 i I L 0 Vi''`i' CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: 192834 - 1 P.O.Box 848 Mocksville NC 27028 County File Number: Date: .0 .9 1 3 0 12 0 1 5 Click below to Import an image from an external location: Drawing Type:Construction Authorization Well-Construction Permit For Office Use only e,�s""Fe Davie County Health Department *CDP File Number 192834 210 Hospital Street PIN Number: P.O. Box 848 �'"�'"` Mocksville NC 27028 Tax Lot#: Tax Block#: Phone: 336-753-6780 Fax: 336-753-1680 Evaluated For: WELL PERMIT VALID UNTIL: 9/30/2020 Property Owner: Tiffany Nicole Eldred Applicant: Tiffany Nicole Eldred Address: 530 Amber Hill Rd FAddress: 530 Amber Hill Rd City: Yadkinville City: Yadkinville State/Zip: NC 27055 State/Zip: NC 27055 Phone#: Phone#: Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: Amber Hill Road *Proposed use of Well: Yadkinville NC 27055 If Other: Latitude Longitude Directions Site Address:Amber Hill Road Directions: Hwy 601 North Turn Left on Liberty Church Rd,turn left beside church,turn 1st road on right. Well Contractor Information Drilling Contractor Driller Registration , , , , , , , , , , Permit Conditions *Permit Conditions Charactaro Remaining 4000 Well location,construction and protection must meet all state and local regulations and must be inspected and approved by an authorized representative of the Local Health Department.The permit may be revoked at any time for failure to comply with existing regulations.The siting of approved well construction area(s)by the Health Department is to provide protection from the known possible sources of contamination.The approved well area(s)may not be changed without written permission from an authorized representative of the Local Health Department.No volume of quality of water is guaranteed by the Health Department. *Issued By: 2140-Nations, Robert *Date of Issue; 0191 / 13101 / , a , 0 , 15 . 5 Authorized State Agent: ®Hand Drawing OlmportDrawing Owner/Applicant Signature: **Site Plan/Drawing attached.** Page 1 of 2 WELL CONSTRUCTION PERMIT 192834 Davie County Health Department CDP File Number: 210 Hospital Street _ P.O. Box 848 County File Number: Mocksville NC 27028 Date: 0 9 / 3 0 / .1015 5iwn�' Olnch Drawing Type: Well Permit Scale: , O Mock O ft. J----- -- -- --- ----------- - -------- ------- ------ __------------------------------- ----- ------- . -- ------ - ----- --- i - �— _ ... ........ _ _ ....._...... .................... f _--..............._ �...,.._ `_.._1..................._ __.-............-... _._. _l._.._......_.._ _1 -._... �' •�-' — ................... ....___ .... _ I ;L_ _. .................._ ' z-`u -- ................. ... _.... ......._._ _ i __ __ ........ ____ - ........- -- - - --------- . -- - _ ...- _ _ r- ---t-- - _ _ -- --- a _ ........ . L ...... - .. ... . .........i--._.... ............ ---- _.. ..... r . ............ ----. _ .......... ....-- ......-- ---- _._ _ __. --- _ _.. _ 1 --. - ---- ---- - _ _... __. ---- _----- ----- ---- _.. -- .- ----- ---. - .._ L _..._! _. -- ... --------------------- ------------ ---------------------- ... .. --..................... ............... - __................. i -----1 - ------------......._------------ ----------- _ __--------___ __ ----- -__ ------------ _ i------------- _ .. Page 2 of 2 P1 P3 APPLICATION FOR PRIVATE WELL PERMIT TD Davie County Environmental Health p P.O.Box 848/210 Hospital Street Vat6 J Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 'IMPORTANT " THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. APPLICANT INFORMATION Name NkC Contact Person'NKL-\, Address Home Phone City/State/ZIPBusiness Phone Email Name on Permit if Different than Above Mailing Address5�� City/State/Zip Q j I I D M C `105j PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A surve plt r site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) Owner's Nam k Phone Number&&&— gZ-53 MI5 Owner's Addres City/ tate/Zip wy—j U i it 0. O C a`'() Property Address-!t3 City V _ Lot Size (-1Cy- Tax PIN# Subdivision Name(if applicable) Section/Lot# Directions To Site: N f , 1"I" o Y) � VQ, +0— cxwwway r DEVELOPMENT INFORMATION Permit Type: New Well Well Repair Well Abandonment Other(specify) Facility Type: Residential Food Service Church Commercial Other Are There Any Septic Systems Currently On The Site? YES NO Do You Intend To Install A New Septic System On This Site? YES NO TERMS AND CONDITIONS: This application must be accompanied by a plat or site plan of the property that includes the existing and proposed propertylines with dimensions,the specific location of the facility and any existing or futureappurtenances,the location of any existing septic system,sewer lines,water lines,any existing water supplies and any surface waters. The applicant is responsible for idenifying and marking the property lines and corners. The applicant is responsible for making the site accessible. By signing this application,the applicant signifies that they understand the terms and conditions and that they give permision for Davie County Environmental Health representatives to perform necessary field evaluations and procedures deemed necessary to determine the best location for a well. PAA 1A as .Sig d Dat 7/30/09 Account# Invoice# r �� I ��Ck IMPROVEMENT PERMIT For.oftice use only *CDP File Number 192834- 1 ~ 6 Davie County Health Department 210 Hospital Street County ID Number . - ' , _ P.O. Box 848 Evaluated For. NEW Mocksville NC 27028 Township: 4 Phone:336-753-6780 Fax:336-753-1680 , PERMIT VALID UNTIL' 7/21/2020 9�c• �7 INSPECTIONS DIVISION: Building Permits cannot be Issued with this ImprovementPerm[t. Applicant: Jeffery B. EldredProperty Owner. Melissa Steelman Eldred Address: 530 Amber Hill Road Address: 530 Amber Hill Road City: Yadkinville City: Yadkinville StatefZip: NC 27055 State/Zip: NC 27055 Phone#: (336.)492-6242 Phone#: (336)492-6242 Property Location & Site Information rddess/Road#: Subdivision: Phase: Lot: mber Hill Road adkinville NC 27055 Directions Structure: SINGLE FAMILY Hwy 601 North Turn Left on Liberty Church Rd, turn #of Bedrooms: 3 left beside church, turn 1st road on right. #of People: *Water Supply,." NEW WELL System Specifications nidal S is_tem *Sita asst Icatio-n: Provisionally Suitable Minimum Trench Depth: a 4 Inches Saprotite System? QYes j}No Maximum Trench Depth: 3 6 Inches Design Flow: � 3 6 0 Septic Tank: 1 0 0 0 Gallons Soil Application Rate: 0 . 3 1-Piece: QYes *No Pump Required: QYes Q No QMay Be Required *System Classification/Description: TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR Pump Tank: Gallons LESS) *Proposed System: 25°lo REDUCTION 9-Piece: (QYes ONo Repair System Required:*Yes ONO ONO, but has Available Space Repair System *Site Classification: ProvisionallySuitable Minimum Trench Depth: a 4 Inches Soil Application Rate: 0 - a ,7 S Maximum Trench Depth: 3 6 Inches *System Classification/Description: Pump Required: QYes QNo O Maybe Required TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25%REDUCTION Pagel of 3 CDP File Number 192834 - 1 County ID Number: t *Site Modifications ❑ Open Fill Sheet No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of this permit bythe.Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. Site Plan The Improvement Permit shall be valid for 5 years from date of issue with a site plan(means a drawing not necessarily drawn to scale that shows the existing and proposed property lines with dimensions,the location of the facility and appurtenances,the w site forthe proposed Wastewater system,and the location of water supplies and surface waters). Plat The Improvement Permit shall be valid without expiration with plat(means a property surveyed prepared by a registered land surveyor,drawn to a scale of one inch equals no morethan 60 feet,that Includes:the specific location of the proposed facility O and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters. Plat also means,for subdivision lots approved by the local planning authority and recorded With thecounty register of deeds,a copy of the recorded subdivisions plat that is accompanied by a site plan that Is drawn to scale). The Department and Local Health Department may Impose conditions on the Issuance and may revoke the permits for failure of the system to satisfy the conditions,the rules,"this article.This permit Is subject to revocation If the site pian,plat,or Intended use changes(NCGS 13OA•335(t).The person owning orcontrolling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,installation,operation,maintenance;monitoring, repord4g,and repair(.1938(b)). Applicant/Legal Reps. Signature Required? OYes ONO Applicant/Legal Reps.Signature: Date: "issued By: 2140-Nations,Robert Date of Issue: 0 7 a 1 a 0 1 5 Authorized State A Agent: OValid without Expiration? g O Create CA? (Nand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 ' IMPROVEMENT PERMIT Davie County Health Department CDP File Number: 192834 - 1 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: / / Olnch Drawing Drawing Type: Improvement Permit Scale: , OBiock ON/A L. e I �w p �w _ 8 �.._ ._.. ... :..___. _._ µ......_.we �_�... .... ..�. �__. _.�_.�_ I � I IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street CDP File Number: 192834 - 1 P.O.Box 848 Mocksville NC 27028 County File Number: Date: L02 a 1 a 0 1 5 Click below to import an Image from an external location:Drawing Type: Improvement Permit Surveyors Certification for Subdivision PIC KENNETH L FOSTER L-2552 certify to one or more of the dram by me from X l Professional Land Surveyor, Number following as indicated by an X: Shown A. That the plat is of a survey that creates a subdivision of land within the area of a county or municipality e 1:10,000 feet That has an ordinance that regulates parcels of land; This I B. That the plat is of a survey that is located in such portion of a county or municipality that is unregulated Dmk as to on ordinance that regulates parcels of land; C. That this plat is of a survey of an existing parcel or parcels of land; -2552 D. That this plat is of a survey of another category, such as the recombination of existing parcels, a court that ordered surveyp or other exception to the definition of a subdivision; rev nse Number E. That the information availableto this surveyor is such that I am unable to make a determination to the best f my profession I ablo as to provisions contained in A. through D. above. This tl Signatu L-2552 Professional Larfid. Surveyor License Number IREDELL COUNTY—NORTH CAROLINA CAR "", 0 e ESS101 � C e C 0� E A L 2552 �'•, ,,: SUrn- R , fiLr� 1s m JERRY W. ELLER FAMILY LLC 0 � PIN # 4893 99 0363 DB 2214 PG 160 JERRY W. ELLER FAMILY LLC � I� TRACT 6 PB 5 PG 62 (DAVIE COUNTY) ` PIN # 4893 99 5233DB 912 PG 103 TRACT 6PB 5 PG 62 I .--•� _ — I — CONTROL CORN _ — 30' EASEMENT DB 912 PG 103 EXISTING NAIL ASEMENT DB 2214 PG 160 S 8303'39" E O BE IRON 782.77' 0 6K` W�p ONE COIS LOT 2 8 5 PG 327—..tRMfj0 2.56 +/— Acres IREDELL. f DFI�) 2.03 +/— Acres DAVIEo G 4.586 Acres Total (dmd) o I 380.6,9. S9-1I 03230•F PIN # 4893 88 9438 I - o DB 784 PG 526 0'N N SET 1/2-IRON PIN # 4893 98 4522 I �I JERRY I DB 148 PG 457 I PI 4SS 466�S. I I T 1 � LOT 3 OT 1 2.58 +/— Acres IREDELL I NEW IRON SET 2.00 +/— Acres DAME 5 Acres 0.156 Acres R/W ' 1/2" REBAR Acres R/W 04 eras Total (dmd) 4.582 Acres Total (dmd) zo I i I J. O) N �• I � �-.r--- 30.00' C/L pow •LINE ��MErvr LOT 2 \ 327 (IREDE••3 2.56 +/— Acres IREDELL. ,(_ �) Acres DAMEp I 4.586 Acres Total (dmd) L t �U 12 I PIN # 4893 88 9438 I I 0 DB 784 PG 526 { �, N N SETI C >2EBAR PM # 4893 98 4522 I �I. JERRY_W. El I DB 148 PG 457 I PIN # 51 DB 9121 836 4 �5'I I TRACT 5 58.46' II I LOT 3 I 2.58 +/— Acres IREDELL I NEW IRON SET iv 2.00 +/— Acres DAME I 1/Y REBAR 0 U 56 Acres R/W N i° 4.582 Acres Total (dmd) 1 n I NCo •. I 30' W EASEMENT PB 5 PG � ? ••� I I Oo I M \''neo/ }} "Po we °wet 1 z I \ •� 1 ET •. I CONTROL CORNER N 8700'5Y W I I EXISTING IRON p — 1' SOUD(BENT) r. 485.03' N _ II EXISTING IRON 1/2- REBAR d Alf qT•R / ,Mar.2,6.20'15 '07:36 AM 'Je'sse McEwen & Sons Gradi 3364634151 PAGE. 1/ 2 C I � Date.. . 4a q) APPLICATION FOR SITE EVALVATIONAMPROVEMENT PERMIT&A O Davie County Environmental Health P.O.Boz 8481210 hospital Street Mucksville,NC 27028 (336)753.67801 Fax(336)753.1090 Application For: n Site Evaluation/lmptovementPermit Of Authorization To Construct(ATC) n Both 7y06 of App11d61l0n' JTNew System iaRepair to Existing System OlixpetlSlon/Modiftoation&f Exiatlttg SyStcm or Facility --JMP0RT4N7`t**THIS APPLICATION CANNOT BR PROCESSED UNLIiS.S ALL OF THE REQUIRED INFORMATION IS PROVIDED. RrAr to the INFORMATION BULL913N ft instructions, APPLICANT INFORMATION %Name to be Bilictl Y(,-0 'Cantact Person Billing Address Horne Phone City/StatwzlP �1 BusincsePhane • Narne on Permit/917C ifDll)"erenf than Above , Mailing Address City/State/Zip PROPERTY INFORMATION 'Date House/Faeilit Comers Fla cd NOTE: A survey pest ut site plan must accompany this application. Included:Je Site Plan i.IPlat(to scale) (Perm"is lid toy 60 m the with site plan,no expiration with completeplat.) Owner's Name Ph c Number - y Owner's Address City tate7,it�5f5 Property Address City f t i..ot Size Tax PIN$ Subdivision Namc(if applicable) Section/Lot# Directions To Site: Q If the answer to any of the following questions is"yes",au Ring documerustion must be attaehed. Arc there tory existing wastewater systems an the slit? klYcs 11No Does the site ebrtttin jutisdiedonsi wetISA41? Byes 2140 Are there any casements or tight-of-ways on the site? fdYes ONo Is the site subject to approval by another public agencyll I.tYcs IANo _Will wastewater other than domestic sewage bagenerated? Utes QNo IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms' #Bathruorm Gardt,'n Tub/Whirlpnol tYes ONo Basement:Ives nNo .Basement Plumbing: DYcs XNo IF NON-RESIDENCE FILL 011 'THE BOX BUM Type of Facility/Business Total Square Footage of Building #People. #Sinks #Commodes #Showers_ #Urinals Estimated Water Usage(gallons per d'ay)� (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system iotluostcd: rlConvcntional I I t cepted rllrnnovative nAltemativc 1'10ther Water Supply Typo;rt County/City Water jll'New Well UExisting Well U Community Well Po you anticipate additions or expansions of the facility this system is intondcd to serve?n Yes NNo Iryes,what type? ' This is to certify that the infbrmatlon provided on this application is true and correct to the best of my knowledge. 1 undcraland that any permit(s)or ATC(s)issued hercatlet are subject to suspension of revocation if the site is aitcred,the intended use changes,or if the information submitted ht this application is falsified or changed. I hereby grant right of entry to the Authorizcd Ropmaentative of the Davic County Heolth Department to conduct necessary inspections to determine compliam:e with applicable laws and rules. I understand that I am responsible for the proper idcntifkatfon and labeling of property lines and corners and M ,y�t�ing and Fl ging or�t the house/til iljty ocatt ,proposod well location and the location of airy other amenities. `�i01"'��— Site RevisitChargc Property owner's or owner's legal representative signature Uatc(s): Client Notification Date: Ih, BHS: Sign given nYes[]No Account N Ituvised 11/06 Invoiced ,Mar.•6.2015 '07:37 AM ' Jesse McEwen & Sons Gradi 3364634151 PAGE. 2/ 2 c� 10 r 0 � � � P 37 I J� F DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION jjpe'( w(d A -yw iy- qZ 6393 q,5 Ae ra5 Water Supply: On-Site Well / Community Public Y Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position ( [_ Slope% HORIZON I DEPTH d qd Texture group C" G Consistence 'T P- Structure t Mineralogyi HORIZON H DEPTH 4 — 441 ,49 Texturerou C C L- 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 5 LONG-TERM ACCEPTANCE RATE n 15 2 7 SITE CLASSIFICATION: l�' S / EVALUATION BY: LONG-TERM ACCEPTANCE RATE: �' , 27 t) OTHER(S)PRESENT 1 V IGI(: q _ 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 CQNSTSTENCF Moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm 3yet 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 dotes 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 chroman or less Classification-S(suitable),PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate-gal/day/ft2 DCHD 05105(Revised)