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601 Liberty Church Rd Lot 2 r DAVIE COUNTY ENVIRONMENTAL HEALTH .' P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account #: 990002706 Tax PIN/EH#: 5811-58-6107.02 Billed To: Jeff Hayes Subdivision Info: ftgmLo /�ANec9�mE)V� "Z Reference Name: Location/Address: Liberty Ch Rd-27028 Proposed Facility: Residence Property Size: see map ATC Number: 4592 **NOTE**The issuance of this Operation Permit shall indicate the system descnbed on the ATC 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. System Type Or � S.T.Manufacturer-6 Tank Date 'Tank Size ©C U Pump Tank Size System Installed By: E.H. Specialist: JV ai-lai-gDate: a OG x ad t(7 cG t O DCHD 11/06(Revised) 0 I " DAVIE COUNTY ENVIRONMENTAL HEALTH r P.O.Box 848/210 Hospital Street 1 Mocksville,NC 27028 �r y (336)751-8760 Fax#(336)751-8786 51�Ca AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990002706 Tax PIN/EH#: 5811-58-6107.02 Billed To: Jeff Hayes Subdivision Info: PAQ-0 tv'\Cqa 'lT Lar 2 Reference Name: Location/Address: Liberty Ch Rd-27028 Proposed Facility: Residence Property Size: see map ATC Number: 4592 Site Type:.2<ew ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms :E> #Bathrooms 2— #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size f7 Type of Water Supply: 015o"unty/City []Well El Community Well System Specifications: Design Wastewater Flow(GPD) Tank SizeI DOOiAL.Pump Tank GAL. Ilk Trench Width� Max.Trench Deepth_2Rock Depth Linear Ft. qM1 Site Modifications/Conditions/Other: '�>✓�1w 2-So Kl DOC TIt1J sgSTtK F G—s LH q ►J C,2�t2��� ICt-CP IO oFF ¢�P. = - 19 So' F-2-6m Clemlj,$DRitawLL-l_ Contact the Davie County Environmental Health Section for final inspection of this system between f installation. Tele hone#(336)751-8760. t.►a std' 6- tTRAc lC Gea.1TALT`THIS ai rl� 5 -G.1�1 �S wa.l_ 'q�loNNI WA -2. �� ,� viol a►� � - �N rA1,5.5 �Z c� � ►3 � (` Sr�sCw^^ Sr 3 .. t -f1-1 1 4 ,_. mstx 5 TIVE { o� S1r1C I IOp' \ �AS�\AEN ST-75 Environmental Health Specialist ate: l7� DCHD 11/06(Revised) . APPLICATIO SITE EVALUATION/IMPROVEMENT PERMIT & ATC • n FEB - 2807 Davie County Environmental Health IU 1. • + P.O.Box 848/210 Hospital Street ENvIRONMENT ALHEALTN Mocksville,,NC 27028 1E COUNTY' (336)751-8760/Fax(336)751-8786 Application For: ,Q Site Evaluation/Improvement Permituthorization To Construct(ATC) ❑ Both Type of Application: ❑New System ❑Repair to Existing System . ❑Expansion/Modification of Existing System or Facility ***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed �' c� l '`' Contact Person Billing Address -S Home Phone City/State/ZIP ry 0�_ / Business Phone — Name on Permit/ATC if Different than Above Mailing Address , City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: t-5it Plan ❑Plat(to scale) (Permi is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name Phone Number Owner's Address f City/State/ Property Address 1/L, City 6 Lot Size 1071/ Tax PIN# Subdivision Name(if applicable Section/Lot# Directions To Site: If the answer to any of the following questions is"yes",supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes lq o Does the site contain jurisdictional wetlands? ❑Yes ZNo Are there any easements or right-of-ways on the site? �s ❑No Is the site subject to approval by another public agency? ❑Yes BN6 Will wastewater othei than domestic sewage be generated? ❑Yes qNo IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms '3 #Bathrooms Garden Tub/Whirlpool 6Yes ❑No Basement: ❑Yes Basement Plumbing: ❑Yes EJ>d'- IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business 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:. gleonventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: [-County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes "0 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 pemut(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is 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 County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging or staking the onus f cility location roposed well location and the location of any other amenities. Site Revisit Charge Proper; er's o wner's legal reg sentative signature Date(s): Client Notification Date: Date EHS: X70(o I IQ-242 Sign given ❑Yes ❑No Account# Revised 11/06 Invoice# -Oct 1:58a davie county envhealth 336 751 8786IO�Q _-Jr I 5 [� A 'LI ATION FOR SITE EVALUATION/IMP ROVEMENT PERMIT&ATC Davie County Health Department ► \ Environmental Health S'eetion P.O.Box 848/210 Hospital Street � IpLNEA�IN Mocksville,NC 27028 li Rpp EC011�� (336)751-8760/Fax(336)7'.1-8786 Application For: Site Evaluation/Intptovement Permit D Authorization To Construct(ATC) D Both */MPORTAN7""•THIS APPLICA7TON CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION 1S PROVIDED. Ref--r to the INFORMATION BULLET[14 for instructions. APPLICANT INFORMATION Name to be Billed i� Contact Persons Billing Address Imo'/ Home Phone. City/State/ZIP' MaJ)lr_y JLH _Business Phone rip Name on Permit/ATC if Dii erent than Above 1 I Mailing Address_ _ City/State/Zip PROPERTY INFORMATION NOTE: .A survey plat or site plan must,.-.company this application. (Permit is I'd for 60 mo the h site fan o piration with complete plat.)/ Street Address r ,L` City. GUI l>°Tax PIN#591159M7 Subdivision Name Spction/Lot# o Size_ Die, o Site:_ (.� t Date House/Facility Comers Flagged_ � If the answer to any of the following questions is"yes",supporting documentation must be attached. Are there any existing wastewate:-systems on the site? Dyes E-Mo Does the site contain jurisdictional wetlands? DYes fl-No Are there any easements or right-J--ways on the site? Dyes t'?fQo Is the site subject to approval by another public agency? DYes M0 Will wastewater other than dome:itic sewage be generated? Dyes EtNo IF RESID CE FILL OUT THE E OX B LOW #People _ /#Bedroon:s #Bathrooms Garden Tub/Whirlpool es No Basement: Yes E G- BasentenPl tumbing: DYes @moo IF NON-RESIDENCE FILL OUT'."HE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes_ #Showers #Urinals_ Estimated Water Usage(gallons per d:,y) (Attach documc:ntation of similar facility water consumption) FOODSERVICE ONLY:�#Se-eats Type system requested: QConventional [IAccepted Dlnnovative DAltemat.ve DOther Water Supply Type: County/City Water D New Well DExistinz Well D Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?D Yes iY1Qo If yes,what type? _. This is to certify that the information provi-led 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 is altered,the intended use changes,or if the information submitted in this application is falsified or changed. I understand that!am responsible for all charges incurred from this application. 1 hereby grant right:if entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to tramme °'�pliance with applicable s and rules on the above described property located in Davie County and owned by Z40 N ASS &tve rlleA ` �V/`"' _ Site Revisit Charge Propefty owner's or owner's legal representative signature Date(s): 1 A0-1'--06Client Notification Date: Date EHS: 2 IqSign given DYes DNo Account# ✓5 Revised 2/06 Invoice# f 1'aa y ���' �,g �� ,yam � " s y •Rp 1 �, f ia� a, � � ;',:, rC+�.�. Si'a� �f.f' T�."Y�l��✓.Y � 'k.A< �+ q e� •s��'�, �" '� T f"�,yw.�* € :s" , ' '�' '.x- ��'�kb:R ,.�..£� 'tom_. k8 v a `a •tf, �..� .t�y� {� H' �•�.��4. � ,. �,'�.�}�+g�'�,»�. fib'� �, �'� •� � � � ,..� Lv T OP - e It 7 "it=s s r . ! y $ •t. � :. • fig,d y�. ` .pia � p 'e .3� •�.' may, M 4 f yam. Y� S z x_ 45,�, � r,'>t. ` �+F 4 _,'S.J ?�k+�.�` '4�F•a.'«�.s b�" :S aMi .f" ro ;`� � ���✓ €` �"�� T r'�� a• • OrrT9 71- ',7 OWN A?'`" , !. _ ,{ •...moi. :sp Y;B• 1 Yw 7 '.. w frT •XIP:. ➢•L- k ,Yi:' •�. .J" aA, "� �$.' ",;,,y K�Y S - 1d'r .'°{' T" § 'u� S • �� e.'. w w !RM •fi ''➢x5 ..� `t,��,,. v a��,�y'a..KJeF�T 7 r�`��W _ ,� �� • i ;�;'; 1� �,"��::v � � � Sy. � 7.:_ '*.% � _,.. a;�n 3 ry�Ta ,fir, _ a..C"� t�._ y yr ,^, k.F .�• �..'b :+y .1 r`{r" �' ! 1i" � �� ^,?b, , • T'���. y 'L a. K,,i�.. � N A'� ,��ixS+y � g�v �'�^�� a' � �., 2 S"•;�. 'S - ^4 ry` �, VIA fit - .t: . '.a ; t8 '., s i` + ..:• 77 ri sj. �'x.� 4, '�➢ � i• ` 'it t �"fi, � c 15y� Z ,',y_•: .. 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"v •a 9r i�� _ ' 'A�= y�� _�'. � lib.• w .{., ^�€� 9I �, ,p'""�`5 e., ».;ws,�BA w'y` `�' � G r y V R „� �i+•' �.�,. � 'n, v .�' y,cr' TO4-. �� +if'ti"+f £ ➢ ,• •.(,: gut�fR `x: � � ,� � w si "" °� y� �a'y 'fit' ��•,�T"' ..�v 9 �, :tiY 4 '� �� co % a ?s (408) co C) Mn B2 O ' 3 5512 122 130 184 NnB2 , s 1321 3 1 . 000A W 3-2 1 o 1 . 361 A CN4 2334 N �.5 r 4385CD Ulm) � ' t 58 . 98 _ _--100 _ _ 140 4 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001933 Tax PIN/EH#: 5811-58-6107,OL Billed To: Martha Rollins Subdivision Info: Reference Name: Location/Address: Liberty Ch Rd-27028 Proposed Facility: Residence Property Size: 0.898 ac Date Evaluated: 1I et Water Supply: On-Site Well Community Public / Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 7 Landscape position L L Sloe% 20 4 Zo HORIZON I DEPTH p - 15 O - 0-to 0-40 O D Texture group C ` L 4�G S;(-L S CL Consistence r F: S $ Structure 53 Mineralogy HORIZON H DEPTH Z 42 •Z p.- Texture group S;L 540 L Consistence F t S —1 S Structure S S!Ac t f (L Mineralo 5 M 6, HORIZON III DEPTH 04- Z - ZZ- 40 Texture groupe__';C' 5,4 1r 4. Consistence 5 -� Structure A!Sk- Mineralogy HORIZON IV DEPTH Texture group Consistence F; Structure Mineralogy SOIL WETNESS — 101 C U L — P�'ta�li,•�. RESTRICTIVE HORIZON — y SAPROLITE -- — -- CLASSIFICATION SPS i P S LONG-TERM ACCEPTANCE RATE ZS o 2 D.Zs 0•7. 0.225✓ SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: gt�ye_ M,y rJ& 241 4'kw 2 LEGEND N✓� 14 JS 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 MOW 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 Mineralogy 1:1,2:1,Mixed 1YQLes 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) DB. 65;9 �c . 933 _..w,.. s r r 9 Sz:, -} C r y e { d - rj'f r` L f�N i LJ _ No Lil E.Ci fD'� II z WM' FiiW D.B. 115 PLG. 2'05 7rES:EN Fk31. D.B. ll:: F%. 205 D.R. iia PG. _1q 70S.R. 1--20 F../W) . (SUBJECT (="3JEC7 10 S,P,. I..20 P,-K) d `tet E'er kv„ 155.69 r�0� 35.83 _ N 88'40'30` W w KOta 7GTA.L= 192.52 � ^s ARITAI:= 0,870 AC. r, D.C. 18$ PG. 4r0 u' 'ON �,� SUG,11CT TO S.R. 10302 & t 1D P/tit ;V cD I. r<TH OF CIL .v...,....,.,•..,,,�,- �q o r _ NEW .c' ED _RTH C;F CIL hi-�z $121 RON i t L 'z CSC `CAD I, Gr DY L. TUTTEROW, CERTIFY THAT UNDER MY DIFEC-iION AND SUPERVISION, THIS HAP ,'AS D�AVN FROM AN +CTUAL FIELD SURVEY DE Y lopow ROW R 4'iNG GMPANY. HA. c 659 I B. 1d� I I S " E 93 130.44 ....� - .._ , I{{ tL I Oq . f a fl1 � h v? e - -- fi 1'15 PG. 2Q5 v 1 1.0` tt j 12 69 Evisilr G .8 �r 7cc / t °, rOGp s T , "Oa CrF tF o .C:Fce t , -7 TO s%R- 1002 LP, CD o \` t IRON 5.x.7 I C' 1 BEAR CREEK CHU J; % k RCH RD. o 3 P NO SCALE 1L� VICINITY MAP EXISTING IRON _ i W%D � cs C3 NOL 0 1�1afvAG�mEwr 100 f I _ - - gab D8• 659 _ 20' PAVED S 85'57'24• E �--�. TOTAL= 4NEW IRONPLAC99.84 S 85.53,386.9EIRON EXISTING 22.38 NEW IRON IRON 130.44 IRO 154.630M� Z•ON NEW w1 � Li Frc��' ZD AR A— � o • 4 T N B. 115 PG 205 N CD (' W Cu W � D.B 23 PG_ 319 j L o L BJECT S.R. 1002 RIW) O Fy I c v � - - OD C4 In o AREA= 1.000 AC. oZ _AREA= 1.000 AC. 0. c) Z TAKEN FROM D.B.- 115 PG. 205 ~ TAKEN FROM D.B. 115 PG. 206 � & D.B. 123 PG. 319 - & D.B. 123 PG. 319 - c F (SUBJECT TO S.R. 1320 R/Mn _ (SUBJECT TO S.R..1320 R/W) H o f� 155.69 IRON EXISTTNG 36.83 • IRON N 88.40'30' W W / TOTAL= 192.52 a 1 �vi o RAkROAD t y ; SPIKE a AREA= 0.870 AC. 3 NEW TAKEN FROM D.B. 188 PG. 490 In I IRON P` (SUBJECT TO S.R. 1002 & 1320 RIW) tt1 C : 1 I`WL 0.3' 99.94 / o j NORTH OF C/L .t—N 84.52'22' W NAIL 1.3 .6 I; 16' PAVED NORTH OF C/L 5121 / IRON 77- , 4 `{o{{11 BEIDD�g 7`1774 2 S4- � 0. 9 w `. I in Cew�C�MA' OOryyJ 1(f o r _ 6 sur lb cq r Mqc < •� �'� I, GRADY L. TUTTEROW, CERTIFY THAT UNDER MY DIRECTION AND SUPERVISION, THIS MAP WAS DRAWN FROM A CTUAL FIELD SURVEY MADE TUT ROW YING OMPANY. -------- PROFESSIONA LAND SURVEYOR L-2527 TUTT SURVEYING COMPANY 107 NORTH SALISBURY ST. ,: . MOCKSVILLE, N.C. 27028 (336) 751-5616 PLAT OF SURVEY FOR+ ROSCOE JONES X= UNMARKED POINT IN C/L OF ROAD REVISI04 Ste, 1• - 50• BRAWN RVs ME NAM, RO-BUCK DATE, FEB-22-2002 G.L.TUTTEROW JOSHUA ODDRD. wj0 BUCKJONE-68 - 50 25 0 50 100 -150 BEING 4 TRACTS TOTAUNG 3.768 AC.-TAKEN FROM ROSCOE JONES,(DB. 307. PG.' 561) .. ,. v. do NANCY do ROSCOE Jr. JONES (OB. 188. PG. 490)(DB. 123. PG. 319)(D8. 115, PG.. 205) LYING IN THE CLARKSVILLE TOWNSHIP, DAME COUNTY. NORTH CAROLINA :. SCALEIN T FEE ..��,. ...�.,�.. TAX MAP REF.: E-2> PARCELS 31, 31.01, & 32 �`'��� x�Frr •• X57 _ _ - � •I: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation • APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001933 Tax PIN/EH#: 5811-58-6107.02 Billed To: Martha Rollins Subdivision Info: Reference Name: Location/Address: Liberty Ch Rd-27028 Proposed Facility: Residence Property Size: 0.898 ac Date Evaluated: DCa Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit / Cut _._.____.-_-FACTORS------____._-_--__ .-____.1__.___ - - 2.- 3 4 5 6 7 Landscape position L_ L Slope % ?10 HORIZON I DEPTH U - 1 p- 7 0- Texture group _ 'C ConsistencePS-SP Structure Mineralogy HORIZON lI-DEPTH 13-20 5 e7— Texture group S Consistence f=r Is V F; 5 Structure MineralogyS HORIZON III DEPTH 2p- V 22 Texture group Consistence ;S Structure Mineralogy L HORIZON IV DEPTH Texture group Consistence Structure L Mineralogy SOIL WETNESS ZS '3ael 3-5 RESTRICTIVE HORIZON SAPROLITE 0 CLASSIFICATION S U LONG-TERM ACCEPTANCE RATE ©.Z'S SITE CLASSIFICATION: EVALUATION BY: �Jl. �� I�►vt� LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT- REMARKS: L sly `, Z� �P'113 REMARKS: (-I Q ?_Z_ fi r �� , I Sr rZS P A Z, 3 3 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 MQidt VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm 3y-et 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 05105(Revised) ■■ecce■■e■■■■■■■■■■■■■■■■■■s■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■ ■■■■■■■■ee■■■■e■■■■e■■■■■■■■e■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■e■■■■■■■■■■■ee■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■e■■■e■ ■ ■�G��iG��ii�iG�iiiii�����iii�iii�iiiiiiiiiiii��iiiiC�7i�iGii��Gi������,■■ ■■>•ell■■■■e■■■■■■■■■■■■■1■■■e■■e■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■tl■■ ■■■■Ile■■■■■■■■■■■■■■■■■■e■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■11■■ ■■cell■■■■■■■■■■■■■■■■■■ee■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■11■■ ■e■ell■■■■■■■e■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■I�e■ ■■■■Ile■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■■u■■ ■■■■Ile■■■■■e■■■■e■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■1N■■ NEWSiiMMMMiiiiMONS iiiiii�iiiiiii�iiiiiii� ■■■■Ile■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■i�■■ ■■■epee■■e■■■■■■■■■�■■■■■■■■e■■■■■■■■■■■■■e■■■■■e■e■■■■■■e■e■■■i■■■ ■■■ell■■■■■■■■■■■■■uii■■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■e■■■�■■ ■■■■11■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■Ile■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■tl■■■ ■■■ell■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■I■■■ ■e■ell■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■11■■■ ■■�■11■■■■■■■>Ce!■■■■■■■■e■■■■■■■■�■eee■e■■■■■■e■■■■■■■■■■■■■■■■■u■■■ ■■■■11■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■uet.eeiiiiiii■iiii■a■■ea■■■ ■■■■11�������5'.i■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■GCS■■ ■■e■11■■■■■e■■ee■e■■■■■■■e■ecce■■■■■■■■e■■ee■■■■■e■■■■■e■■■■■■>ue■■■ ■■■■11■■■■■■■■■■■■■e■.■■■■1■e■■■■■■■.■■e^■e■■ee■■■■e■■■■■■■■■eerie■■■ ■■■■ue■■■■■■■■■■■■■■gee■r,■ne■■■■■■r�■■:r■■er■ei■■■■■■■■■■■■■■■e■1■e■■ ■■■■Ilea■■■■■e■■■■e■�1\'i■f�`L'J■■■■e■�1\ie�:■■■l!�I■■■■■■■■■■■■■■■■ell■■e■ ■■■X117■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■U■■■■ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Water Supply: On-Site Well Community Public Evaluation By: Auger Boring V/ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH 04 _ - Texture group S i '•L. S., ' 5 i CG'SAi' i CIL S L Consistence Structure r SBIC ar Qr MineralogyP HORIZON II DEPTH Texture group G i C. 507b S i G Consistence f F; Structure 5 IC Sr3K. - K Mineralogyt= P - t XP nj' SE�cP . HORIZON III DEPTH ?_q7 Lt Lq-3a' Texture groupSSG �b a S1Ct51 ' Consistence ; S Structure SWAM B r_ Mineralogy5� HORIZON IV DEPTH a Texture groupS�1 cS Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: • LalaM LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: \�• R�/ti t C��v,l1J REMARKS: A2._ Z<<-<<G~ cd i C_ 4 LEGEND Landscape Position ��}n rj � �'�-s• 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 lope Mule 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 CONSIST+.N .E 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 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 05105(Revise DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 / Fax: (336)751-8786 December 13, 2006 Martha Rollins 1201 Wagner Road Mocksville,NC 27028 Re: Site Evaluation- 0.898 Acre Tract/Liberty Church Rd. Lot#2 of"Roscoe Jones" subdivision Tax PIN#: 5811586107 Dear Client(s): As requested, a representative of this office visited the above site to perform a site evaluation. Based on the findings of the evaluation,the site is classified unsuitable for the installation of an onsite wastewater system for the proposed three-bedroom residence. Therefore, the request for an Improvement Permit is denied. However, further investigation of the site determined that the classification may be changed to provisionally suitable by abiding by the following: 1. An existing onsite wastewater system that serves the residence at 130 Bear Creek Church Road encroaches on the evaluated property. An easement for this existing system must be established, surveyed and recorded with the Register of Deeds, and 2. An easement on the adjoining lot(Lot#3)for the onsite wastewater system to serve the proposed residence on the evaluated lot must be surveyed and recorded. Specifications for this easement are shown on the attached map. Documentation of the easements must be provided prior to the issuance of an Improvement Permit or a change of the unsuitable classification. If you have any questions, feel free to contact this office at 751-8760. Sincerel , Jeff G. Beauchamp, R.S. Environmental Health Section Enc(s) NORTH OF ` LWAItD LOT 3 iSEPTIC EASEMENT AND SOUTH OF NORTHERN LOT LINE = 0.998 AC. AREA BY DMD I S 856 038' E )ES SEPTIC EASEMENTS) I 30' W :cT TO S.R. 1002 R/W) I~� N VI CIN. or, TAX MAP E-2, PARCEL 32 I NEW SEPTIC EASEMENT I cv L 659 , PG. 933 (tract 1) I sl (B) TO SERVE FUTURE W o 0 LOT 2 SEPTIC REPAIR o c ZONED R-20 I Nlc AREA. EASEMENT AREA IZo �o REQUIRED BY THE DAME olcu H o COUNTY HEALTH ui o 20' PAVED -__--_- I � DEPARTMENT FOR ONSITE %olc ----_� zl WASTEWATER SUITABILITY. .4 �y Filed for registration at -oil 38' W89.63 control existing 65.00 comer iron 29.48 TOTAL= 184,11 2007 and ri S 85.53'38' E�� existing iron Plat Book Page _ Filing fee # paid. M. BRENT SHOW by DEPUTY- ;EPTIC EASEMENT 1 SERVE EXISTING ACHMENT OF LINES FROM p1 NPROPERTY 34-90o� rvlN� W o,v Lor 2 .�aL ZD CU j MAREA= 0.898 AC. ,, >;4AREA BY DMD N o S 7 (INCLUDES.SEPTIC EASEMENT A) O C� (SUBJECT TO S.R. 1002 R/W) N TAKEN FROM TAX MAP E-2, PARCEL 31 z ZONED R-20 Q z IMM��yy N ^ FX 7—7U7NMARKED POINT 0i u cu U � ui NOTES: 1. 3 LOTS TOTALING 2.766 ACRES (AVERAGE L, 2. NO NCGS MONUMENT WITHIN 2000' OF THIS 3. LOT 1 HAS EXISTING DWELLING AND SEPTIC C 192.52 total ) F_ N 88.40'30' W existing 4. WATER IS SUPPLIED BY DAVIE CO. WATER.S' 155.69 iron 36.83 5. LOT 2 & 3 WILL HAVE PRIVATE SEPTIC SYS existing iron 6. THIS PROPERTY AND ADJOINING PROPERTIES WELL tj EQ OUSE W 7. LOT 3 IS AN EXISTING TAX MAP PARCEL. N Davie County Environmental Health P.O.Box`848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990001933 Tax PIN/EH#: 5811-58-6107.02 Billed To: Martha Rollins Subdivision Info: Address: 1201 Wagner Road Location/Address: Liberty Ch Rd-27028 City: Mocksville Property Size: 0.898 ac Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans,plat or the intended use change. Permit Type: ew ❑Repair ❑Expansion Permit Valid for: 0 Years o Expiration Residential Specifications: #Bedrooms 'J #Bathrooms Z #People 7 Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply:..8'6ounty/City []Well ❑Community Well 21 ' Site Modifications/Pe ' t Conditions: �t System Type LTAR Initial Repair ,�CCe c� •2 �, Site Plan. � A> Q I TI&L- 2 '0' aeL i i� too' 3-7 L i P�L4ZTY C'40&-H 29az� - 2R Environmental Health Specialist Date 0 — i.p.11-06 exis,mg iron ( a - _ LO NANCY M. JONES a � o D.B. . 86, PG. 80 y G r I placed I SITE #o° i° iron l Crj i--------- 407.19 S 85•ssf21• E -(433,03 t tal I oOoc' 0 I ___ existing BEAR 30' I MINIM --- — ------ non REEK y ------- ----- . ..—_._UM — BUILOMIG SETBACK LMES C _CHURL Q i W , 01 i 25.8 ' ��A�3FOR IN INGRESS/EGRESS _ ^rwt "awl o j LOT 3 I 500 OF SEPTIC EASEMENTµp `ted OF NORTHERN LOT LINE, �, AREA= 0.998 AC. I AREA BY DMD I -5!339- z E S e5 NO SCALE i� ;- NO APPROVAL REQUIRED BY THE (INCLUDES SEPTIC EASEMENT B) I 30' w i (SUBJECT TO S.R. 1002 R/W) j SAME COUNTY PLANNING DEPT, I EXISTING LOT, TAX MAP E-2, PARCEL 32 I � � Cu I SEE D.B. 659 , PG. 933 (tract 1) I ,. NEW SEPTIC EASEMENT I F'i VI CINI T Y MAP (o�TO SERVE FUTURE W --- _ MINIMUM BUILOlNG SETBACKONES 20NED. R-20 i ;ol LO 2 SEPTIC REPAIR NIS AREA. EASEMENT AREA I •" REQUIRED BY THE DAME $I� y il CAME COUNTY PLANNING DIRECTOR eronng 99.89 existing' __---- — -------__,___— I �` COUNTY HEALTH 20' PAVED Iron 22,38 �; -- ••:....._, I gI DEPARTMENT FOR ONSITE N 85.5724' w 130.44 --J zl WASTEWATER SUITABILITY. ly N e5•53138 i gt<ietir,g I Filed for registration at _o'clock M. = iron N 85.53'38' M 69.63 REVIEW OFFICER'S CERTIFICATE I control existing Iron 9 6s.00 -1?9,48 TOTAL: s Ss•53'3884,11 existing 2007 and recorded in I, Review officer-of _Davie .County, ___. - -- requirements g I E—a. Iron P P " certify that the ma or lot eq which this cer tification I Plot Book Page ' t:z affixed meets all statutoryuiroments for recordin . I I I I Fling fee : paid. M. BRENT SHOAF — DAVIE Co. Register of Deeds REVIEW OFFICERby CERTIFICATE OF OWNERSHIP AND DEDICATION ( I Q I o — ANT _ I hereby certify that I am the owner of the property shown _ EPLiTY ASSIST NEW-SEPTIC EASEMENT and described hereon, which located in the County of Davie I I A) TO SERVE EXISTING that I hereby adopt this plop of subdivision with my free content, ENCROACHMENT OF •�/, __..__. --..•.._ . .._ ._. .. ___..... . .-------..__-- __---.__.. . establish minimum building setback lines and dedicate all streets, I I SEPTIC,LINES FROM N 7tg H olleys, walks, parks and other sites and easements to public or I 0 I MURPHY PROPERTY 34- private A private use as noted. Furthermore, I hereby dedicate all sanitary W fewer and water lines to the County of Davie. I co I Sl5� 1 2S 6 DATE I I EA 0LOT 2 co �" I I 9 r . AREA= .898 .AC. 4'.14 �l b A' 1M (INOWDES SEPTIC DMD A) a LO ROWNS ( CORP.) I I r1 (SUBJECT TO S.R. 1002 R/i� UA\ w. IMI �O o TAKEN FROM TAX MAP E-2, PARCEL 31 O �j ---- w " M ROWNS I I z ZONED R-20 Q W CO N eV ko x UNMARKED POINT . CERTIFICATE OF APPROVAL OF PRIVATE SEWAGE DISPOSAL SYSTEMS I I, hereby certify that the Davie County Health I is I m NOTES: Deportment has evaluated the subdivision entitled : PLAT MAP FOR MARLO CORP. 1. 3 LOTS TOTALING 2.768 ACRES (AVERAGE LOT SIZE 0.922 AC.) with respect to criteria and conditions established I I V + '' b by state law or promulgated thereunder and the • 2. NO NCGS MONUMENT WITHIN 2000' OF THIS PROJECT. name is found to comply with such criterto and i i� I ' conditions EXCEPT as set forth in such evaluation. iO4 3. LOT 1 HAS EXISTING DWELLING AND SEPTIC SYSTEM, WITH PUBLIC WATER For details of this evaluation and for limitations, e� I A t 192.52 total )�— N 88.40'30' W existing a-se the written report on file at sold department. i I 155.69 iron 4. WATER IS SUPPLIED BY DAVIE CO. WATER SYSTEMS. IMPORTANT NOTICE: THIS CERTIFICATE DOES NOT I _-- I Biro Ing 36.83 5. LOT 2 do 3 WILL HAVE PRIVATE SEPTIC SYSTEMS. CONSTITUTE A PERMIT OR APPROVAL OF INDIVIDUAL I Wftj'' W 6. THIS PROPERTY AND ADJOINING PROPERTIES ARE ZONED R-20 LOTS IN SAID SUBDIVISION FOR INSTALLATION OF SEWAGE FACILITIES. � I � � � 7. LOT 3 IS AN EXISTING TAX MAP PARCEL 190 I a� Vl C) TE DA ER w ! BUI�i� � 2w 2.5 SPIKE P I EAST LAT MAP' FOR: ,,URVEYOR'S CERTIFICATION I OF C/L RD. I, Grady L Tutterow, certify that this plat was drown I A MARL 0 MAN AGEMENT CORPORATION under my supervision from on actual survey made I c under my supervision deed description recorded In h Book 659 Page , etc.) (other);that the ttrr�rr,, I z s OWNER ------------------ DEVELOPER boundaries not surveyed are clear) indicated as •drown .t�N CAR�s fr-am information found in PL Book , Page �� 20 PAVED that the ratio of precision is calculated as 1: +20.000 ; �� Q' •••��j�i c in MARLO MANAGEMENT CORPORATION that this plat was prepared in accordance with G.S. : f•ESS/O •,ti 47-30 as amended. Witness my original signature, �:•QQ' -yr�.�'9�: I g 1201 WAGNER RD. license number and seal this�� day of SAIL MOCKSVILLE, NC 27028 --- --_ A - - -- - �- -"-- .. _ - aD. 20 z L 2527 = _ existing '" AREA= 0.870 AC. 336-492-7505 SuryOr . :�yy OQ� control lAev ° AREA BY DMD (!i (Seal or tamp % ••,O Q• (SUBJECT TO S.R. 1002 Ar 1320 R/N� CLARKSVILLE TOWNSHIP Ucense Number ��9Or•suRV•,,,� ,�� s S >2, p� TAKEN FROM TAX MAP E-2, PARCEL 31 DAME COUNTY, NORTH ' CAROLINA ��i "� �� Kf 42• t� ZONED R-20 THIS IS A MINOR SUBDIVISION �s�sisr�tNtt X0,71 fes,` �, : ` W TAX MAP PARCEL.: E-2, PARCELS 31 & 32 Suryor Certification for Subdivision Doyle County. North Carolln UN • I, Grady L Tutterow, Professional Land Surveyor, Number L-2527 C/CEb aO�M , DATE: JANUARY 10, 2007 certify to one or more of the following as indicated by an X: �� N SURVEYED BY: _L.._a. That this is a plat of a survey that creates a subdivision of rn TUTTEROW SURVEYING COMPANY land within an area of a county or municipality that hos on 107 NORTH SALISBURY STREET ordinance that regulates parcels of land; A3 b. That this plat is of a survey that N located in sect, a • �►�. �R1 N 6e, 2,gs _ _. . MOCKSVILLE, NC 27028 Pte+ of a count/ or rraa+lelpotity that Is unregulated as to an Z� <7,it ea, (336) 751-5616 �l`9 W ordinance ti+ot requlaEss tsa+o.t. of londr �� b SCALE: " , a. That " plot Is of a sunny a1 an owsul parcel or + E. 1 = 40 d. T1�tlrN of �� r. , �. ' PW b of a.r WVW of a+e1Mr category, such as the 40 20 0 40 80 120 rsooR+binolsa+ of ♦ es�e!—aefen� eurvay, or � . other sumpitlon to )lies of • tsbAMso�; t co —0. Treatthat I tt+e iMor�+dlMt 11� 19 Mfr y n�ch �L �s: �C N fie+ Profam vr+oele !s psMl4► r r11MrM+sww host of m N otic) oe anew +r above. '.! °�� SCALE IN FEET Rianatu t i V i i ' y COORD NAME: FILE NAME: DRAWING NUMBER: ' 23506-3 8 CwyQ� E I t BUCKJONE-68 MARLO .._......... --