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985 Hwy 64W Davie County,NC - Tax Parcel Report a35 Tuesday, September 27, 201( I , r I 1t I I 950 i -944 — 64 r 913 I lr 933 945. .---123 O WW F— U) WARNING: THIS IS NOT A SURVEY ParcelInformation Parcel Number: 1400000056 Township: Mocksville NCPIN Number: 5738064646 Municipality: Account Number: 27667000 Census Tract: 37059-806 .Listed Owner 1: FREIBERGER JAMES ' ': Voting Precinct: SOUTH MOCKSVILLE Mailing Address 1: 985 US HIGHWAY 64 WEST Planning Jurisdiction: MOCKSVILLE City: - MOCKSVILLE Zoning Class: MOCKSVILLE OSR State: NC Zoning Overlay: Zip Code: 27028-0000 Voluntary Ag.District: No Legal Description: 3.60 AC HWY 64 Fire Response District: MOCKSVILLE Assessed Acreage:, 3.74 Elementary School Zone: MOCKSVILLE Deed Date: 10/1996 - Middle School Zone: SOUTH DAVIE Deed Book/Page: 001900454 Soil Types: GnB2,MsC Plat Book: Flood Zone: Plat Page: Watershed Overlay: MOCKSVILLE Building Value: 137630.00 Outbuilding&Extra 18670.00 Freatures Value: Land Value: 39890.00 Total Market Value: 196190.00 Total Assessed Value: 196190.00 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 ooUN� NC or arising out of the use or Inability to use the GIS data provided by this website. . . �� -� �y Permittee's D IE COUNTY HEALTH DEPARTMENT Name +��� '' � "� '` Environmental Health Section PROPERTY INFORMATION P.O.Box 848' • Directions to property: t v5K La`I Mo`cksville,NC 27028 Subdivision Name: Phone#:336-751-8760 -'N'L ;A 'n � _ (:L-L n^11,� Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - - AUTHORIZATION NO: . 2357 A Road Name S }}iXMO D: �-76Z�) **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 Form/Authorization Number should be presented to the Davie County Building Inspections. Office when applying for Building Permits. (In compliance Vijh Article,I I of G.S.Chapter 130A,Wastewater Systems,,Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ON N T`4RlB H SPECT IS-. DATE ISSUED RESIDENTIAL SPECIFICATION:BUILDING TYPE 'kms' =�sEDROOMS #BATHS #OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE J- 'NC E WATER SUPPLY L DESIGN WASTEWATER FLOW(GPD) I_C)C' NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH 3L ROCK DEPTH IZ. LINEAR FT. \ OTHER SfiQ LTi l o+� Y� i REQUIRED SITE MODIFICATIONS/CONDITIONS: ��l, li!L-"-01%) 60JTOX IMPROVEMENT PERMIT LAYOUT lea- T baa **CONTACT A REPRESENTATI E OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 M.OR 1:00 1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS (336)751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: rN V V Io f�i' p;•3 p nu c � 1 AUTHORIZATION NO. OPERATION PERMIT B DATE: �. **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT T SYSTEM 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 MM(Revised) A TION FOR SITE EVALUATION/IMPROVEMENT PERh11T&ATC : Davie County Health Department dam✓ !,JAY Z7 Environmental Health Section — �✓ P.O. Box 848/210 Hospital Street � Mocksville, NC 27028 , — UMRDMI��ECAl11`MY (336)751-8760 0-1k ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Contact Person / y /• r Mailing Address ,��vi/, �'�i/t'✓! LSV, Home Phone City/State/z IP rw�� C �?7oa s� s3 s Phone 09-/2-rl . ame on Pe than Above ' Mailing Address �D��J/� /,7 6vCs� City/State/ZiprtT�,:��L /y C, c�'d2O 3. Application For: R'Site Evaluation ❑ Improvement Permit/ATC � ❑ Both 4. System to Service: ❑ House ❑ Mobile Home 13 Business ❑ Industry El/Other 5. Type system requested: ❑ Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People # Bedrooms # Bathrooms ❑Dishwasher ❑Garbage Disposal ❑Washing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers ,IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 8. Type of water supply: ❑ County/City 6d Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve?❑Yes B No If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Properly Dimensions: 3_7 7 Y WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Offlc PIN: # 39t)6 Li6 Cly Property Address: Road Name / 1 City/zip��1 "4., ,iilr.t ��t� 0 1 i•...z,� — l If in a Subdivision provide information,as follows: L-P—A Name: Section: Block: Lot: Date home corners flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued bereafter 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 changed. I,also,understand that l a/n responsible far all charges i//curred f/•on) this application. I,hereby,give consent to the Autliorized Representative of the Davie County Ilcaltli Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitabilit DATE - -U Y SIGNATURE THIS AREA MAY BE USED FOR DRANVING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Datc(s): Client Notification Date: EHS: i Sign given Account No. 0 2260 / g Revised DCHD(05/03 Invoice No. I •' ' 0.- `•� ht y1+9' .�$ .�y1Z 6�+C`aY i•1 -y!i'r ''r:ji k C y � � a p '.fi•.yn �.S ,.�w<,.vi.r; .i.i. TWA In lax Lot 6Q Tpx i11aP.1 n/f James.Wesley Wooten :Qnd wife , ilessk S Wooteft �, 1 � DB 146';P,PG 463 7. ' t ll p 02.08'45'E 6 502.84' ti + mayI 1 ertwdeied y r r+' Pad In J-. r O VIVO MeU ti Rack Walk - �. .U Lbolvy ioundal_1an / .. �t ., .• �• for rw"e / ' Crovet Drive t t \ \ \ 1 Drive ------- 1 nd &1/5" OP F s DAVIE COUNTY HEALTH DEPARTMENT ENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900158 Tax PIN/EH#: 5738-06-4646 Billed To: Richard Hendricks Subdivision Info: Reference Name: Location/Address: Highway 64 West-2j028 Proposed Facility: Bathroom Property Size: 3.744 acres Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slo % HORIZON I DEPTH Texture group "C-L- . Consistence Structure Mineralogy -HORIZON II DEPTH Texture group C_ Consistence Structure Mineralogy HORIZON III DEPTH 1 Texture groupSG1 Consistence Structure l� MineralogyS HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION PS LONG-TERM ACCEPTANCE RATE I qM SITE CLASSIFICATION: EVALUATION BY: �^`k ' 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 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 DCHD 05/99(Revised) ■■■■■e■■■■■eee■■■■e■■eeeee■■Mee■eee■■■■■■■■■M■■■■■■E■■■M■■■■■■■■■■ ■e■■e■e■ee■■■ee■e■■E■e■■teE■e■e■t�■■■Mee■■■■■■E■■■■e■■■■■■■■■■■■■■ ■■■■ee■ee■■e■■e■e■■■■■e■e■■■EEE■ ■■■eeE■■■Ee■EE■eeeteeE■■e■eE■■■■ ■■■■■■e■■■■■eee■■e■e■■e■■e■■■■e■■ee■■■■■■Mee■■EE■Me■■■eEE■■■e■■e■e ■e■■■■e■■e■■■■■e■■■■e■■■■■e■e■■■■ee■■E■ee■■■t■ee■■e■■etee■■e■■■■■■ ■■ee■■■ee■eee■■■■■■e■■■e■■■e■e■e■■■■ee■■ee■■Ee■ee■E■■■■EM■■ee■■eE■ ■■■■e■■e■■■■■e■■■■ee■■e■■■■■e■■■ee■■■■■■■tE■■e■■■■■e■■■■ttee■e■E■■ 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Per nittee's 1 G ( 11 COUNTY HEALTH DEPARTMENT Name:"�!j��`+� �' f 'I"14 �° "•''-'' Environmental Health Section PROPERTY INFORMATION P.U. Box 848 Directions to property: Mocksville,NC 27028 Subdivision Name: E' Phone#:336-751-8760 Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - - AUTHORIZATION NO: 2357 A Road Name: **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 Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance wi Article,II of G.S.Chapter 130A.Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. �NVIIION N 1104EA H SPECIA'LIS'E_' DATE ISSUED r�i RESIDENTIAL SPECIFICATION:BUILDING TYPE.(,A—k`#BEDROOMS N A#BATHS I #OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE 1 nu�R Y<PE WATER SUPPLY DESIGN WASTEWATER FLOW(GPD) )(Do NEW SITE REPAIR SITE ✓f rr..-�� ,I SYSTEM SPECIFICATIONS: TANK SIZE 1w GAL. PUMP TANK GAL. TRENCH WIDTH' ROCK DEPTH � - LINEAR FT. OTHER REQUIRED SITE MODIFICATIONS/CONDITIONS: �� �( l. �� G hots+ � 6n4 4&c IMPROVEMENT PERMIT LAYOUT r 0 V VSt: wq LG AQ i l i ! ! **CONTACT A REPRESENTATI E OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30-9:30 .M.OR 1:00-1:30 P.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS (336)751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: I r J 1 N AUTHORIZATION NO. OPERATION PERMIT BY: DATE: a **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED 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 02102(Revised) { f; ' A TION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Health Department AY 7 2004 En vironmenta/Health Section ` — • P.O. Box 848/210 Hospital Street Cr Mocksville, NC 27028 EiVVIRBEAL pAf�ECOUEN'AtM`( (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS .PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billedi( 1 �'•C� Contact Person / Mailing Address v�.�>bl/�9i/t'q LN, Home Phone p city/state/ZIP i1�i� �� AIC 22d-R Business Phone 2. Name on Permit/ATC if Different than Above_ JK_ me e;/J � JA s Fr i'���.-,- Mailing Address �D�S� X/ Ivo City/State/Zip r;FT�,r'/�L 3. Application For: O'S'it`eEvaluation ❑ Improvement Permit/ATC ❑ Both 4. system to service: ❑ House ❑ Mobile home ❑ Business ❑ Industry IJ Other 5. Type system requested: ❑ Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People # Bedrooms # Bathrooms ❑Dishwasher []Garbage Disposal ❑Washing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type It People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) a. Type of water supply: ❑ County/City 2 Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve?❑ Yes lid NO If yes,what type? ***IA1POItTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUES'I'Ell BELOW. Either a PLAT or SITE PLAN MUST BESUBAfITTED by the client with TI ITS APPLICATION. . 7 Properly Dimensions: '37 yy i9r%e1 WRITE DIRECTIONS(froni Moclisville)to PROPERTY: i':lx orfie .PIN: // S73Fo6 V6y-W Property Address: Road Name, City/Zi /X6, nn {{ If in a Subdivision provide information,as follows: Name: Section: Block: Lot: Date home corners flagged: 'Phis is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued.11creafter arc subject to suspension or revocation,if the site plans or intended use change,or if the information submitted in this application is falsified or changed. I,also,understand that lam responsiblefor all charges incurred front this application. I,hereby,give consent to the Authorized Representative of the Davie County Iiealtli Department to enter upon above described property located in Davie County and owned by to conduct :111 testing procedures as necessary to determine the site suitability Q DATE _ G� SIGNATURE h TRIS AREA MAY BE USED FOR DRANVING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Datc(s): CIient Notification Date: EHS: Sign given Account No. ( 6 2 Revised DCIID (05/03 Invoice No. �� Permittees- I to, ,`� DAVIE COUNTY HEALTH DEPARTMENT a Name: =-'� ;Y� =-' - Environmental Health Section PROPERTY INFORMATION V` C P.O. Box 848 !1 Directions to property: Mocksville,NC 27028 Subdivision Name. Q& Phone#:336-751-8760 - ��� LVA Section: Lot, AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - AUTHORIZATION j/- NO: 0 2 A Road Name: L) -� �vp�" **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 Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Artic1611 oLC S.Chapter 130A,Wastewater Systems,Section.]900 Sewage Treatment and Disposal Systems) �Y I� \ r ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION all / _,� . IS VALID FOR A PERIOD OF FIVE YEARS. `„_.EON 13 T L SALT SP 'ALIST DA E 1 SUED RESIDENTIAL SPECIFICATION:BUILDING TYPE jjU_L61E#BEDROOMS #BATHS 2 #OCCUPANTS GARBAGE DISPOSAL:Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE � 1,.#PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No W LOT SIZE�'� TY E WATER SUPPLY CL DESIGN WASTEWATER FLOW(GPD) 5U0 NEW SITE REPAIR SITE ✓ SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTHLINEAR FT..-�L�i OTHERr \�_�� tr".1� �S� F-t:-1���.�7 C7..� 4S `�TL.:� REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT CA GUS% ix�1 u�I►J�1 i 4t�c� (!� _ . fr u sT F1 LLt-�LL� wF-LL U Tr� + 22" FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760. OPERATION PERMIT rte+-1►�It) I L"�Z SY�SiEOM INSTALLED BY: PO&L, fF AUTHORIZATION N0.2/"Z14 OPERATION PE **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SY TEM DE BED ABOVE HAS N IN TALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S.CHAPTER 130A,SECTION.1900"SEWAGE TREATMENT ND DISPO AL SYSTEMS",BU SH IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GI N PERIO OF TIME. DOW 0=2(Revised) a faao 06/ , y ti-�„s +.fes n !^'- i.rt,. +'�'•tif... 't-»r�.,: ,T.a -r.s. r ..s:u��.-Y._.:.:.:a. :•4�:�. .i_.1 r-.f.'� ,. .. 4-u. 1, .t r..,..,-- � --P�r DAVIE COUNTY HEALTH DEPARTMENT .. hlartre, r" .1� Environmental Health Section PROPERTY INFORMATION 6 P.O. Box 848 "mons to property Mocksville,NC 27028 Subdivision Name: �. Phone#:336-751-8760 Section: Lot: T AUTHORIZATION FOR r WASTEWATER Tax Office PIN:# - SYSTEM CONSTRUCTION AUTHORIZATION NO: 002802 ,%A Road Name: F �`� **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 Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Artic)e 1 I of-CLS,.,Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems) ***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION , -7 (, IS VALID FOR A PERIOD OF FIVE YEARS. w ENVII� NI"4NT L E-ALT SPECIALIST DA E 1 SUED RESIDENTIAL SPECIFICATION:BUILDING TYPE } � #BEDROOMS �� #BATHS `�” #OCCUPANTS / GARBAGE DISPOSAL:Yes or No COMMERCIAL/SPECIFICATION: FACILITY TYPE , #PEOPLE #PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE:Yes or No LOT SIZE TYPE WATER SUPPLY W - "� ELL DESIGN'WASTEWATER FLOW(GPD) '��G NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH_��kINEAR FT. OTHER 1 REQUIRED SITE MODIFICATIONS/CONDITIONS: iL�r UZ ' I`'�Ykie 1L)W ATt+f` t CII i IMPROVEMENT PERMIT LAYOUT { tyt�JN ' G I F FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30-9:30 A.M.ON THE DAY OF INSTALLATION.TELEPHONE#IS(336)751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: zoo F I P0o60 Io' , (q -Z3) I , PCO L r _j 'j N Gh2A(aE 20, '---- T AUTHORIZATION NO. 02&Z 2V OPERATION PE **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYS EM DES ED ABOVE ASB N IN ALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S.CHAPTER 130A SECTION.1900"SEWAGE TREATMENT D DISPO L SYSTEMS",B SHAL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIV PERIO OF TIME. DCHD 0=2(Revised) Gj a gip_ - /75_1 .- - �� DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) r rIER NAME �P/HI �Ic� /�L 17O ADDRESS + 6� SUBiDIVISION NAME LOT# DIRECTIONS TO SIT /2� SL f'�P'/ v� DATE SYSTEM INSTALLED !-0 NAME SYSTEM INSTALLED UNDER TYPE FACILITY � NUMBER BEDRQ MS—­2 NUMBER PEOPLE SERVED TYPE WATE SUPP Y SP CIFY PROBLEM OCCURRING P V3J6,Z V 1 DATE REQUESTED 4011 INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge,and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev.1193 GoMAPS -Davie County NC.Public Access Page 1 of 1 (930 . 8 85 m ri a n i� ti# ?L 317,1a http://maps.co.davie.nc.us/GoMaps/map/print.cfin?CFID=4141&CFTOKEN=64238063 8/6/2007 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION / 697 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture groupL Consistence F;` Structure Mineralogy HORIZON II DEPTH Texture groupG Consistence Structure MineralogyY� 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 D. SITE CLASSIFICATION: EVALUATION BY-._9:=-)P 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 slope Texture S -Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt 'V11 . 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 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 Mineraloev - 1:1,2:1,Mixed LYQte� 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)