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124 Lost Farm Dr CONSTRUCTION ." For Office Use Only AUTHORIZATION 'CDP File Numtier 19!1W8--1 Davie County Health Department County ID Number:ssso5�ss25 210 Hospital Street Evaluated For.,,,, NEW .,, ,. P.O.Box 848 Township: Mocksviile NC 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax:336-753-1680 0 a /' 1 8 / a 0 a 1 Applicant: Isenhour Homes, LLC Property Owner: Isenhour Homes,LLC Address: 3411 Healy Drive Address: 3411 Healy Drive City: Winston-Salem City: Winston-Salem State/Zip: NC 27,103 State/Zip NC 27103 Phone#: {336)659-821.1 Phone# .(336):559-8211 Property Location � Site Information Address/Road#: Subdivision: Knoxs Farm Phase: Lot: 2 124 Lost Farm Drive Advance NC 27006 Directions Structure: SINGLE FAMILY Hwy 158 East right on Hwy 801 left on Peoples Creek Rd. right on Southern Magnolia, right on Tulip Magnolia Dr. #of Bedrooms: 5 left on Twisted Hill Drive. to end Knoxs Farm #of People: *Water Supply: PUBLIC System Specifications Minimum Trench Depth: � 4 CF[ow: Provisionally Suitable Inches Minimum Soil Cover 1 a QYes *No Inches 5 0 0 Maximum Trench Depth: 3 g Inches Soil Application Rate: 0 2 7 5 Maximum Soil Cover: 2 4 Inches "System Classificatian/Description: "Distribution Type: GRAVITY-SERIAL TYPE III A.CONY SYSTEM>480 GPD(EXCLUDING SFD) Septic Tank: 1 Ij 5 0 Gallons 'Proposed System:;25%REDUCTION 1-Piece: QYes QNo Pump Required: QYes NoO May Be Regtiired` Nitrification Field a 1 a a Sq.ft, Pump Tank: Gallons No..Drain Lines 5 1-Piece:QYes INo Total Trench Length: 5 4 5 ft. GPM vs— it. TDH Trench Spacing: 9 10 Inches O.C• Dosing Volume' _ Gallons r Feet O.C. ' . Trench Width: QInches 3 Feet Grease Trap: Gallons Aggregate Depth: inches Pro-Treatment: ONSF OTS-1 OTS-11 Septic Tank Installer Grade Level Required: 01011 0II1 ,OIV` Conn 4 nfl CDP Fite Number 198858 - 1 - County ID Number: 5880519525 ❑ Open Pump System Sheet Repair System Required:@Yes ONO ONO,,but has Available Space epa(r System Trench Spacing: 9 Inches O. . *Site Classification: ProvisionallySuitabie — Feet O.C. Trench Width; Inches Design Flow: 6 _ 3 Feet Soil Application Rate: a a s Aggregate Depth: inches . W Minimum Trench Depth: a � *System Classification/Description: Inches TYPE III A.CONY SYSTEM};480 GPD(EXCLUDING SFD) Minimum Soil Cover I Inches' Maximum Trench Depth: 3 6 Inches *Proposed System: 250%REDUCTION , Maximum Soil Cover: � 4 Nitrification Field a 6 6 inches Sq.ft. No. Drain Lines 6 *Distribution Type: GRAVITY-SERIAL TotatTrench t.ength; tS 6 � � Pump:Required: OYes QNo QMay Be Required Pre-Treatment: C7NSF OTS-I CATS-II Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. cA *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 bevaild fora person equal to the period of vaiidity ofthe improvement Permit,not to exceed five years,and mays be Issued at the same time the Improvement Permit issued(NCG5130A-336(b)�If the installation has not been completed during the period of validity of the+Construatlon PermI%theinformation submitted ln'the application for a pe mit or Construction Authorization Is found to have been incorrect;falsified or changed,or the site Is altered,the permit or Construction Authorization shall became lnvalid,and may besuspended or revoked(.1937(8)).The person owning orcontroiling the system shall be responsible for assuring compliance. with the laws,rules,and permit conditions regarding system location,installation,operation,maintenancA monitoring,reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps.Signature: Date: *Issued By: Date of Issue:2140-Nations,Robert 0 2 / 1 8 / .2 0 1 6 .. - - Authorized State Age Malfunction Log Oyes @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number: 210 Hospital Street 5880519525 P.O.Box 848 County File Number: Mocksviile NC 27028 Date: 0 / 1 8 / 2 0 1 5 Q Inch Drawin; Drawing Type: Construction Authorization Scale: . pBiock QN/A _i r T V 4 } r C C. o •j _ od 00 i r A .a_ 77 1 I CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: P.O.Box 848 5880519525 Mocksville NC 27028 County File Number: 021Date: 2 1 1 8 / 2016 Click below to import an Image from an external location: Drawing Type:Construction Authorization IMPROVEMENT PERMIT Forofticeuse only "GDP Fite Number 198858-1 dr4 Davie County Health Department 210 Hospital Street CounVID N6mber5880519525 P.O.Sox 848 Evaluated For. NEW` Mocksville NC 27028 Townst>ip: Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID UNTIL 2/18/2021 "NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit Applicant: Isenhour Homes, LLC Property Owner. Isenhour Homes, LLC Address: 3411 Healy Drive Address: 3411 Healy Drive City. Winston-Salem o Y. Winston-Salem State/Zip: NC 27103 State/Zip: NC 27103 Phone#: (336)659,-8211, Phone#:: (336)659-8211 PropertyPropeay Location &. Site Information r ress/Road#: Subdivision: Knoxs Farm Phase: Lot 2 4 Lost Farm Drive vance NC 27006 Directions Structure: SINGLE FAMILY Hwy 158 East right on Hwy 801 left on Peoples #of Bedrooms: 5 Creek Rd. right on Southern Magnolia, right on Tulip #of People: Magnolia Dr. left on Twisted Hill Drive.to end Knoxs "Water Supply: PUBLIC Farm System Specifications nitial S stem ' `Site Classification: Provisionally Suitable Minimum Trench Depth: a 4 Inches Saprolite System? Oyes @No Maximum Trench Depth: 3 6 Inches Design Flow: 6 0 0 Septic Tank: i a 5 0 Gallons Soil Application Rate: 1-Piece: QYes ®No `—' Pump Required: QYes, ®No,OMay Be Required *System Classification/Description: TYPE III A.CONY SYSTEM>480 GPD(EXCLUDING SFD) Pump Tank: Gallons "Proposed System: 25%REDUCTION 1-Piece: QYNew s ONo Repair System Required:QYes ONo ONO, but has Available Space Repair System 'Site Classification: Provisionally Suitable Minimum Trench Depth a 4 Inches Soil Application Rate: 0 _ S Maximum Trench Depth: 3 6 Inches *SystemClassification/Description: Pump Required: QYes Q No O May be Required TYPE III A.CONV SYSTEM>480 GPD(EXCLUDING SFD) "Proposed System: 25%REDUCTION Pagel of 3 CDP File Number 198858. 1 County ID Number. 5884519525- *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 by the Health Department in noway guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. , Site Platt The tnprovement Permit shall be valid for b years from date of Issue with a site plan(means a drawing not necessarily drawn to scale that shows the existing`and proposed property Tines with dimensions,the location of the facility,and appurtenances,the e site forthe proposed Wastewater systemy 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 60feet that includes:the specific location of the proposed facility 0 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 the county 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,or this article.This permit Is subject to revocation if the site plan,plat;or Intended use changes(NCGS 130A.335(f)).The person owning orcontroiling thesystern shall be rWonsiaefor assuring compliance with the laws,rides,and permit conditions regarding system location,installation,operation,maintenance,monitoring, reporting,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 a / 1 8 / a 0 1 6 01" Authorized state ...... � `- OVald without Expiration? O c reate CA? @Hand Drawing Olmport Drawing .� **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT 198858- 1 Davie County Health Department . CDP File Number: 210 Hospital Street 5880519525 P.O.Box 848 County File Number: Mocksville NC 27028 Date: / / Q Inch Drawing Drawing Type: Improvement Permit Scale: , peiocic QN/A — {{ � l �y 4= . i . i -- _: IMPROVEMENT PERMIT Davie County Health Department 210 Hospital street CDP File Number: 198858 - 9 P.O.Box 848 5880519525 Mocksville NC 27028 County File Number: Date: 8 / Ili/ 2 0 1 6 Click below to import an image from an external location:Drawing Type: Improvement Permit APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC Davie County Environmental Health Mwqm 1/u P.O.Box 848/210 Hospital Street Mocltsville,NC 27028 (336)753-6780/Fax(336)753-1680 Application For: ❑Site Evaluation/ImprovementPermit 0 Authorization To Construct(ATC) Both i< Type of Application: ❑New System ❑Repair to Existing System OExpansion/Modification of Existinystem or Facility ***IMPORTANT***THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION 11 Name to be Billed S Yon ay.'i( C ontact Person 7 Y'D Y1(\(K n Billing Address 1 k H QA.I Y)r Home Phone City/State ;V-\!5�o h S� �A �n N �— Business Phone 'i 1,6 'L S I --pa �-^moo P- Name on Permit/ATC ifDierent than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility House/FacilityComers Flagged 1 a S NOTE: A survey plat or site plan must accompany this application. Included:O Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name S Phone Number Owner's Address City/State/zip- Property Address t a, is S ar vv1 0-r City V ok C-C, Lot Size %. o.t.rp— Tax PIN# S 4'f S Cr K 10.54 Subdivision Name(if applicable); L ^o F Section/Lot# Directions To Site:k4w o o �a Z �v�y n �'o Sn t��►e yl Mo.a)y�bl�a3 r o "'ru\ r 0)ywcA,n()1;4. k IEV o n -Twp 1 , ( + 0+1 L•S ;M cif If the answer to any of the following questions is"yes ,supportinEr documentat'on must be attached. Are there zany existing wastewater systems on the site? Oyes No Does the site contain jurisdictional wetlands? Oyes No Are there any easements or right-of-ways on the site? ❑Yes No Is the site subject to approval by another public agency? Dyes No Will wastewater other than domestic sewage be generated? ❑Yes No IF RESIDENCE FILL OUT THE BOX BELOW #People. #Bedrooms -L4— #Bathrooms Garden Tu /Whirlpool Eres ❑No Basement: ❑Yes o Basement Plumbing: ❑Yes ❑No IF NON-RESIDENCE FILL OUT THE BOX BELOW Type offacilityBusiness Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested:)#onventional ❑Accepted ❑innovative ❑Alternative ❑Other Water Supply Type:Xounty/City Water ❑New Well OExisting Well O Community Well f Do you anticipate additions or expansions of the facility this system is intended to serve?❑Yes 00 If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site it altered,the intended use changes,or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie Cou Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I unders I m responsible for the proper identification and labeling of property lines and comers and to in an ing�s in a houselfacility location,proposed well location and the location of any other amenities. ro rty own r r s al representative signature Site Revisit Charge (-Z/1 Client t p iG Date(s): Client Notification Date: Date EHS: (� 0 0 G •� tm _ j .I N 01d l8'6'E 30166—► __ KV to 5r"5ID.7�► W 0 0 / SEPTIC. v (am) �1 i Poa. 77!I ---- -- -- ' . o'KAM& R I I � � y ' I W PROPOSED SEPTIC .;. AREA(#1) �-- &r' 45• •IU 336 ' �SITEE PLAN LOT 02 GI SCALE, I'. I ON o t104d 10'5'E 30166'—>^ N 0 o 6 E. 500'—► MWM w — 30'-0'NANRAL EIFFER i�� -=1 I I Z O O ` - - - - - - - -- - - - - - - - WO RAM&BVFER 6.07d 46'WILL 336D4' N ri--NSITr= PLAN LOT 02 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health-Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME !"�L /Z�P� DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE SUBDIVISION ROAD NAME ✓ Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit j/' Cut FACTORS 1 2 3 4 5 6 7 Landscape position L— Slope% HORIZON I DEPTH Y Texture group G Consistence Structure Mineralogy HORIZON II DEPTH Texture group 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 Vj LONG-TERM ACCEPTANCE RATE //�� SITE CLASSIFICATION: Aj EVALUATION BY: 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(01-90) i 44W v APPLICATION FOR SITE EVALUATION/IMPROVE&iENT PERMIT&ATC Davie County Health Department C p� Environmental Health Section P.O. Box 848/210 Hospital Street Jl`© Mocksville, NC 27028 (336)751-8760 ***IhIPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE H INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed L �. ['Z= ��l-fJQ j�c'2 Contact Person92 Mailing Address Z7 3 G+C�L, L-L 1 2/A 1 L✓ Home Phone 33 - 6- q 7 3 3 City/State/ZIP AWA'J t✓' N •Z70Ob Business Phone 33 7 2. Name on Permit/ATC if Different than Above Mailing Address � City/State/Zip W( 3. Application For: 1-1fSite Evaluation ❑ Improvement Permit/ATC [IBoth 4. system to service: 13 /House ❑ Mobile home ❑ Business ❑ Industry ❑ Other 5. Type system requested: (Conventional ❑ conventional modified ❑ innovative 6. I 2 .f Residence: # People �/ _ # Bedrooms # Bathrooms GDishwasher taarbage Disposal ERWashing Machine &Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: #,_S/eats Estimated Water Usage (gallons per day) 8. Type of water supply: LSE County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes ❑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. Property Dimensions: zse (�L WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # 5� S -� 7 .� + OZ- -+c-Y0 (:A$"}' 70 WC�w8c)], r')c 1-I vv 801 Property Address: Road Name i-c s-r ►%tL eYt , TL A&'4 )c t� n)CT LT,O)'J +�O61tr'S C(z fe0 Ci City/ZIPAQ A:�Gv, WC Zx�b LY, t.�N S, i'l1A L0VtI1 ►0e+t 2?, ON If in a Subdivision provide information,as follows: Jt.i p r'Y1Qy n1C(-1°� �'2� , LT ON Tw IS•Tr io Name: p Vy� �7 `-�� ILL D"K 715, 0 kqLc1.5T 1�/a2✓Y� 0+2, its Q a 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 hereafter 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 I an: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 to conduct all testing procedures as necessary to determine the site suitability. r' DATE 1 d '(� -G SIGNATURE; X21 I-�:� k Llf THIS AREA MAY BE USED FOR DRAWING YOUR SITE PL A1V(Include all of the following: Existing and pr posed property lines and dimensions, uctures, setbacks, and septic locations). Site Revisit Charge i Datc(s): Client Notification Date: EHS: r �S Sign given Account No. Revised DCIID(05/03 Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental'Health Section ' Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001852 Tax PIN/EH#: 5880-51-9731.04, Billed To: Jeanette Cornatzer Subdivision Info: a 2 Reference Name: Location/Address: Lost Farm Drive-27006 Proposed Facility: Residence Property Size: see plat Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit 1_� Cut FACTORS 1 . 2 3 4 5 6 7 Landscape position Sloe% 6 HORIZON I DEPTH Texture groupG' Consistence Structure Mineralogy HORIZON II DEPTH r f f i Texture group Consistence Structure /L •� 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: EVALUATION BY: 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 slopeT,=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!■■ee■et■■cee■■■■■■c■e■t■■■■tee■■■ee■■■■■e■e■■c■■■!e■■■e■■■te■■■ ■e■e■■■■■e■■t■■■e■ecce■■■■■■■■■■I�Il�eee■ee■■■■ee■■e■e■■e■■e■e■■■■■■ ■■e■t■e■■■■tee■■■■eeeeeee■■■■■eeeei■■■■■■■se■e■eee■e■■■e■■■ceee■ee■ ■■e■■■e■■■■■e■ecce■■■■�■■■■■■■■■■■i■■e■■■■■■■■■■■■e■e■�r�■e■ee■e■■■ ■■■■Bee■■■■■■■■■■■■■■■■■■■e■■■■■■■�■■■ece■ee■e■■■■■ee■■■■■ec■■■■e■ ■e■ecce■■■■■■■■■■■■■■e■■■■■■■■■■■■��■■■■■■■■■c■■e■■■■■c■■■■■■■■■■■■ ■■e■e■■ecee■■■■c■ec■■■■c■■s■■■■■ 1�■s■e■■c■cee■■ec■■■■■■s■■Bee■■■■ ■■■■■■ce■■■■■■■■e■■■■■■■c■■■■■c■■■I■s■■■■■c■■■c�a■■■■■ece■■■see■e■■■ ■■■■■e■■e■■■■■■■■■■■e■s■■e■■■ee■■■i■■Bee■■■■■ecie■■t■■ee■■■e■e■■ec■ ■■■■■■■■■■e■■ee■■■■■■eee■■■■■■c■■■■■■■■■s■■■ecce■■■se■■■e■■■se■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■e■■■■■■■■■■■■■e■■ec■■■c■■■e■e■ceeec■■■■ce■e■e■■■ecce■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■Vii■■■■■■■ii■DIY■■■■■■■■■■■■■■■■ ■■eece■ee■!■■e■■c■erans■■■■Bun■■■c■■e■rr■■c■ec■■■■■i■■■e■■c■cec■■■■■■ ■■■■■cc■c■■■■■■■■■�■■■Bee■■i■■■■c■s■■■I■■■c■■■■■■■1�■■■■■■■■■■■■■es■■ ■■■■■■■■c■■■■■■■■r,■■■■■■■err■■■■■1�■■■u■■■■■c■■c■I�■■■■■■■■■■■■■■■■■ etc■Bee■■■■■■■■■■■■■■■■■I/■■■■■■■■■■tl■■■■■■■■■■�!!■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■e■c■t■■■■■■■■■■■■■ecce■■e■■■■■e■■■■ I CAL.L TABLE COURSE BE�RING OtSTANCE L-1 S 02°45'03"W 13.26' L-2 S 84•33'�.5"E 198.00' L-3 S 83�3'31 "E 188.60' L-4 N 8Z•25'15"W 74.88' L-5 S 18"32'50"W 125.59' L-6 N 06°18'21 "E 87.78' L-7 N 79•10'46"W 127.38' L-8 S 06•07'28"W 84.54' L-9 S OZ•�.3'24"W 219.00' L-10 N 64•31'S2"W 134.00' L-11 N 02'14'40"E 181.50' L-12 N 52'38' f 4"E 134. 75' L-13 N 69"58'OD"E 81.55' L-14 N 59'13'40"E 87.,3' L-15 N 69°42'33"E 72.49' L-16 N 56°17'17"E 84.22' L- l 7 N 53'02'32"E f 55.89' L-18 N 43• 11 'S8"E 270.16' L-19 N 43°40'11"E 268.90' L-20 N 61 �8'20"E 117.35' L-21 N 80•48'33"E 126.41' L-22 N 74°16'19"E 93.79' Tox Lot 3 erock e Tcx Mop G-8-5 n/f Douglos Ray Markfond D8 88 O PG 325 Zoning: R/A TOX LOt 2 ero�k e Tax Map �-8-5 n/f Robert E Jomes and wife Carol 8. Jcmes DB 123 O PG 126 Zoning: R/A ,�O ____ �6 __�� 5� �� /',Ri� r L - �� \\ ' �G� 0`°�Gr' I I \, �� - t �,t_ . , � �J I �� I � \\\�. �— / '- - 8��' �� - __ Tax Lot 62 I __-_�� Tax Mvp G-8 n/f Gro�ory D. Phillipa I OB 192 O PG 448 I � Zoning: R/A Tox Lo! 63 Tox Lot G-8 n/f Jlmmy E Robertaon, Sr. ond wife �j 1 � PauM Robertaon DB 146 O P6 277 Zon�ng: R/A / Property line Follows 8ronch -� / �� / \ / / ` � . / Tax l.ot 64 Tax Alc� �-8 n/f Dodd Ziitke4 !tl D8 i78 O PG 2�9 Zoning: R/A f :' , '� � Tax Lot 71.01 � � � Tax Map G-8 / .\ _\ � - - - -- - I n/f Kennon A Whfte �r - - _ and wife I � ' Helen S. White � �� DN 190 O PG 149 , �� Zoning: R/A I `� '� �� jl �\ i � � G / � �� , � �I ; � ; / --` `_ / --- — i� —.--► L' �e.so� - L�2� ��i 3}.19. � �g41 �� / O --0 � 96.99' � r \ �� h�l � I i �� `iR�___.j � r / "35. 46, 47, dt 48" / , f'�9 / O -' / � \ �' � ------ - -------- � . ,��'""__ �15y7 . / � � /1602 %! x y� x � � x �,so� � � / �.�.. - 1160J /1598 V "49 � 50" � / �. . I_ _ I /] 33 � �15J4 x Tax Lot 5 r � Tax Map G-8 � � n/f Brock R. 8aitey, IN " � � �___ and wJls � �"'- �.,` Judkh C. Bcilsy I aB 82 � PG 48 _Peoples Creek Road — - -' ZonFn9: R/A ____.. � � — �. ` 9.sJ. : __ _ __ �'..�. 1650 ._. _ _ ______ ' :--�--=. e ' 3 '� �"W 60' Public R/W �'tmrne.�_ by NCDOT — '� ""—" — — ___., � � _, � 20'+/— Povement `- J _ ` '� 8QQ _ _ _ - IFGEND re//w - aq�►t-a-way � - c� u�"'n. � � EP - Edq� a Pawm�nt � - fC - oa o�CwE �- �=�� 72�� H= 1� PJ� - Prop� tb» p��y I�GP - RdMoro�d�Cqrror�t� Pfp� � � �t t ��.p.. 1p9�0�� 9N"'de'y _ - «+a -X- FM�oi� � �k Cw'b 5' Contour Intervol Verticat Dota Obtained fr-om Davie County Zoning Office �20 0 120 240 360 �Hie s�u.E - f,EEr e . "� �� . .. . a ... .. ' . � _ �� . . . . . . 50' I Ri1M � � � ,,4- � �� p�r toot — . w Terrain Max. Slope Level 2 : I Ro I I i nq 2: I Hi I ly I.5 : I conrng: R/A Tvx Lot 79+ Tax Mop G-8 n/f Nelen C. Snipes DB 61 0 PG 1 ZO Zoning: R/A Tax Lot 85 i� � I Tax Map G-8 n/f Ceorge L Bomhordt and wife �""------''__-� Mn H. Bamhardt . � 08 56 O PG 38 Tox Lot 4 �� Zoning: R/A Tax Map G-9 - I �-\ n/f Ne!! Lee Philips DB 80 O PG 237 �.� � �- --- Zoning: R/A /_-`' � - � �� , ,- � � , I � ; ., � , � ` � - `� -� �"E 75 ,pp� 1 � \ �c>>.o' a."-- � L-1 �A6' '�""��' '�.� \ � , ,z, 3,- ---.. . i � �— i � �.Xo� 15 /iSfil — — � -------- , Z — �� \\_ 10 ��4 �_� ,� r 1 /v i ' _ ?*9.39 • ��( /' �.�2� ��I � � �.� � � � ♦ Peo�les Creek Road s.R. 1 s�a 60' Public R/W Claimed by NCDOT 20'+/— Pavement Tox Lot 8 7ox Mop G-9 n/t Jay Afintr DB 143 1 PG 426 D8 148 O PG 674 DB 195 O PG 87 Zoning: R/A Owner. Jeanette O. Cornotrer 1646 Peopt�a Cr+eek Road Advance, N.C. 27006 (336) 998-7894 NOTES: 1. ZoMing: R/A 2. Waterehsd cloasificotion: WS-N Protected 3. Total Acreoge of Subdivisron: 43.7 Acres +/- (Note: This Acr�aqe was d�termined from deed dvta � GIS data and does not mflect an ortuol survey) 4. Number of propossd bta: 35 1. Averoge lot size: 1.Z4 Acroe +/- 8. The aubject porce! is not located in a Special Flood Hozard Aroa os determined by sccling HUD/FEAW Mops doted: 12-17-93 Community-Pane! No.: 370308 0100 C 7. The subJect par�cel is prodominantly wooded 8. A!! bta to be served by public water 9. AN lots to be served by privots septic tank systems PHASE 1: Lots 1-23 PHASE 2: Lots 24-35 PRELIMINARY NOT FOR RECORDATION. DEEDS, OR BUILDING Preliminary Plan for: "�A GNOLIA A CR.�'S" 7ax Lot 6, Tax Mop G-9, Record 800k 321 O Poge 44 Record Book 322 O Poge 624 Tox Lot 65, Tax Map G-8, Deed 800k 61 O Poge 120 46.000 Rcres +/-- by Daed dc GiS Plot Computations (lNcludes House Lot Area) SG1LE T'OWlISMP CaIMRY STATE QATE 1" = 120' Shady Grove Davie North Carolina 5-20-2001 �„�; Stone Land Surveying Company ,,� �,,�. MT,BL O�orq� Rob�t 9tons. P4S L-310T S17800C IAAPi+EO; 713 Drum Lorte Phone (336} 998-4733 ��• GRS Mocksville. N.C. 27028 St780� .-A mer.k*�--*wr +�+wa" `_�r #" y� � �s�>�""a•mm t v..�a �r.'��; - ,� u,�wa �eb`w aY-�.k b°�:k 4,p�� o�+ Environmental Health Section P. 0. Box 848/210 Hospital Street Courier 09-40-06 Mocksville, NC 27028 TT' A+�.a r r":1 `a7717111'r-MM" 1 "'" (336)751 8760 , x ;V51 g rt , Y y, + November 16, 2004 Jeanette Cornatzer 273 Orrell Trail Advance, NC 27006' Re: Site Evaluations/ Lots 1 and 2 Lost Farm Drive Tax Office PIN: #5880-51-9731 Dear Client(s): As requested, a representative from this office visited the aforementioned sites on, November 10,2004. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the sites, they were found to be provisionally suitable for the installation of on-site sewage systems. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions,please feel free to contact this office. Sincerely, Robert B. Hall,Jr.,R.S. Environmental Health Specialist RBH/dlf Enclosure(s) / APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT PDavie County Health Department v Environmental Health Section ,� P.O. Box 848/210 Hospital Street. �/ Mocksville, NC 27028 410V (336)7151-8760 ``'Z 2004 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for ins 6 1. Name to be Billed J GAG ( W 60,'L A T�(=/2 Contact Person ko Ca? Mailing Address Z-7 -6el Ql= L.(_ T2� 1 L Home Phone 336 - 998- q733 City/State/ZIP i40 Aro c, lAr 270CAD Business Phone 33 7 3? 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: Ui Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: ED/House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. Type system requested: (Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People _ # Bedrooms # Bathrooms 2 GDishwasher L^lGarbage Disposal QWashing Machine MBasement/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: 12(County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes ❑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. Property Dimensions: 1. ('" WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # 58 8 015/ 5731,o 2C-YO e;ALE 70 W C 14Wt 801. tJ C H v M Sol Property Address: Road Nam I-0-STPL:/)�l �Q , Tis AOQ.IAPJ Ct 1 N C, LTA Otil i0C-"U10Li S 0Z 40� '7AY—LUT 6,01 MAPCity/Zip A r�G.:, A C Z'it�Olp LT, ONS, VAA�NO C 1 A �Q, , G - 5 If in a Subdivision provide information,as follows: I O L I p og4NoLIA '02, , L'7; 0,�1 -rVJ 17r Q Name: V l� H ILL 02.A.i a4 LLQ S?r 1 AizvA ,0d, ?moo c-NQ„ Section: Block: Lot: _� Date home corners flagged: /0 - 0 This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter 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 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 to conduct all testing procedures as necessary to determine the site suitability. DATE I G 'C) '� SIGNATURE l THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLX&(Include all of the following: Existing and p posed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS: Sign given Account No. Revised DCHD(05/03 Invoice No. �0 y DAVIE COUNTY HEALTH DEPARTMENT Y Environmental Health Section L Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001852 Tax PIN/EH#: 5880-51-9731.02- Billed To: Jeanette Cornatzer Subdivision Info: O t Reference Name: , Location/Address: Lost Farm Drive-2700 Proposed Facility: Residence Property Size: see plat Date Evaluated: r1f/D y Water Supply: On-Site Well Community Publicy 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 ' ' Texture group 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 LONG-TERM ACCEPTANCE RATE , SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: � 1,1�/ 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) ■■■■■■■s■■■■■■■■■■■■■■■■■■■■■■■ire■■■■■■■■■■■■■■■■■■s■■■■■■■■e■■■■■ ■■■■■■■■■■t■■■■■■■www■■■■■■■■■■1�1�■■■■■■ww■■■■■w■■■ww■■we■■e■■■■■■ ■■■■■■s::�■■■■■■■■iii:::�o■■■■■■�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■thew......1.■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■t -■■■■e■■■■■■■�.met_w■■■■■■■re■■■■■■■■■■■■■■■■■■■■■■■■e■w■■ww■■ ■■■■■tw■■e■■■■■w■■ei-.■e■■■■■w■■■ ■www■■■■■■■w■■www■■■sww■■■e■■■■■ MENNENiiiiii iiiiiiiiiiiiiiiiiiiiiiiaiiMENEM ■■■■■■tot■■■■■■■■■■■■■■■■■■■■■■i■■■■■■■■■■■■■■■■■■■■e■■■■e■■■■■■e■■ ■■■■■■■■■■■■■w■■ee■■■■■■■■■■■■■■1�■■■■■■■■■e■■■■■■■■■■www■■■■■■■■■ ■■■■■wwwww■■■■w■■■■■■www■■■■■■■■■■■■■■■■■■■ww■■■■■■■■e■■■■■■■■ee■■ ■■■■■■wew■■■■ww■■■r�■■www■■■■■■■w■■■■■■■■■■■■■wwww■ww■■■■■■■■■■■wt■ ■■■■■t■■■■■■t■■■■■IJ■■■.!l■■■■�I■www■■■■■■■■■■■■■■■■■■■wwwww■■■■■■■■■ ■■■■■■■■■e■e■■■■w■■■■■■■www■■■■■ ■■■wwwwwwww■■■■■■■■■■■■■■awwwww■ ■■■■■■■■■■■we■■■■■■■wwwe■s■■■■■w■■■■■■■■■■■■■■■■■■■■■wwwwwwee■■■■■ ■■■■■■■■■■■e■■■■■■■■■■e■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■t■ww■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MENEM ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■w■■wwwww■■■■■■■■■■■■■■■■■■■■■■■■■■w■■■■■wwww■wwwwww■■■ ■■■■■■■■■■■■■■■■■■■■■■Ile■■■■■\/I■ ■■■tl■■■■■■■■■■■■■■■■■■■■■■■■■■■■ i r l Davie County Health Department Environmental Health Section Payment Due Now. PO Box 848 (210 Hospital Street) Please Return a Copy of the Bill with Payment. Mocksville, NC 27028 Your Check is Your Receipt. (336)751-8760 Jeanette Cornatzer Account No: 990001852 273 Orrell Trail Invoice No: 4488 Advance, NC 27006 Billing Date: 11/16/2004 Sry Date Service Code ID/ATC# Description Sry Cost Quan. Extended Cost 11/16/2004 SITE EVAL-PS Lost Farm Drive-27006 $150.00 1 $150.00 11/16/2004 SITE EVAL-PS Lost Farm Drive-27006 $150.00 1 $150.00 Balance Due Now: $300.00 � b Environmental�Health Section P. 0. Box 848/210 Hospital Street Courier 09-40-06 Mocksville, NC 27028 - _ ,F h� h rix .,�� e6 ale. .' � a t"� s ,�'1✓ .A a«:# m� w� r 3.r rot z{ w rv� q;J d 'b m` S� 'fid:&�a � � � t �^`" .vwa'^✓� w.w.�.w'",C.4:au�:w,.�:.. `� aka"x November 16, 2004 Jeanette Cornatzer 273 Orrell Trail Advance, NC 27006 Re: Site Evaluations/ Lots 1 and 2 Lost Farm Drive Tax Office PIN: #5880-51-9731 Dear Client(s): As requested, a representative from this office visited the aforementioned sites on, November 10,2004. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the sites,they were found to be provisionally suitable for the installation of on-site sewage systems. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions,please feel free to contact this office. Sincerely, Robert B.Hall,Jr.,R.S. Environmental Health Specialist RBH/dlf Enclosure(s)