Loading...
161 Nikki's Way OPERATION PERMIT or. ice use Only Davie County Health Department *CDP File Number 196705-1 210 Hospital Street 5842426095 P.O. Box 848 County ID Number, Mocksville NC 27028 Evaluated For. NEW Phone:336-753-6780 Fax:336-753-1680 Township: Applicant: Nicholas Edward Martyak Property Owner. Barry Lynn Sechrest Address: 3651 Midddlebrook Drive Apt G Address: 207 Pepperstone Dr City: Clemmons City: Mocksville State2ip: NC 27012 State/Zip: NC 27028 Phone#: (215)720-9121 phone#: Property Location & Site Information �1 Address/Road #: 10 Subdivision: Phase: Lot: 2 1 Nikki's Way Mocksville NC 27028 Directions Structure: SINGLE FAMILY 601 North get on 1-40 East exit Farmington Rd left to Hubert Road right Staya Way to Nikki's Way #of Bedrooms: 3 #of People: *Water Supply: NEW WELL *IP Issued by. 21ao-Nations,Robert *System Classification/Description: TYPE 11 A CONY SYSTEM(SINGLE-FAMILY OR 480 GPO OR LESS) *CA issued by: 2140-Nations,Robert Saprolite System? ( Yes QNo Design Flow: 3 6 0 *Distribution Type: GRAVITY-PARALLEL(eq.d-box) pump Required? OYes ONo Soil Application Rate: 0 a *Pre Treatment: Drain field N7knificationld 1 8 0 0 Sq.ft. *System Type: INFILTRATOR QUICK 4 STANDARD N 4 Installer: Ronnieoverbee Totarencength: 4 5 0 Certification#: 1143 Trench Spacing: — 9 Olnches O.C. • Feet O.C. 'ENS: 2140•Nations.Robert Trench Width: — 3 Olnches Date: 03l as / 2016 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 Inches ApprovatStattis Maximum Trench Depth: 3 6 ®.'Approvetl tO ;Disapproved Inches Maximum Soil Cover a 4 Inches 196705 - 1 ID N � W42426095oss CDP File Number County umber: Septic Tank C Manufacturer. WMs Lat. STB: 62 Long: Gallons: 1000 Installer Ronnie Overbee Certification#: 1143 Date: 0 2 / 1 9 / .2 0 1 6 *EHS: 2144-Nations.Robert *Filter Brand: 1 6 ST Marker: ® Yes ❑ No Date: 0 3 / .2 .2 / .2 13 Reinforced Tank: ❑ Yes Q NO Approval Statusxt Piece Tank: ❑ Yes ® No LE Approved❑ �Disapproved� Pump Tank Manufacturer. Installer. PT: Certification#: Gallons: THS: Date: / / Date: RiserSealed ❑ Yes ❑ No Riserheight: ❑ Yes ❑ No (Min.6 in.) ` Approval Status Reinforced Tank: ❑ Yes El No ❑ Approved❑,Disapproved 1 Piece Tank: ❑ Yes ❑ No Supply line Pipe Size: inch diameter Installer. Pipe Length: feet Certification#: *Schedule: THS: Pressure Rated ❑ Yes ❑ No Date: Approved fittings ❑ Yes ❑ NO Approval Status ❑ Approved© Disapproved Pump e e PumpType: Installer Dosing Volume: — Gal Certification#: Draw Down: Inches THS: *Cham: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ NO Check-valve ❑ Yes ElNo ApprovaljStatus` PVC unions El Yes ❑ No ❑ Approvetl Drsapprovetl Vent Hole ❑ Yes ❑ No Anti-siphon Hole ❑ Yes 0 NO CDP File Number 196705 .1 County ID Number: 2426095 Electric Equipment NEMA 4X Box or Equivalent ❑ Yes ❑ NO Installer. Box 12 inches Above Grade ❑ Yes ❑ NO Certification#: Box Adj. Pump Tank ❑ Yes ❑ NO Conduit Sealed ❑ Yes ❑ NO *EHS: Pump Manually Operable ❑ Yes ❑ No I I *Activation Method: Date: Approval Stafus - Alarm Audible ❑ Yes ❑ NO Approved❑ Disapproved Alarm Visible ❑ Yes ❑ No 'Operation Permit completed by: Authorized State Agent: Date of Issue: 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 18A .1900 of. Seq.,and all conditions of the Improvement Permit and Construction Authorization.This property is served by a TYPE 11 A sewage septic system. Rule.1961 requires that a Type TYPE 11 A. septic system meet the following criteria: Minimum System Review ByThe Local Health Department: N/A Management Entity: OWNER - Minimum System Inspection/Maintenance Frequency By Certified Operator: NIA Reporting Frequency By Certified Operator:N/A Rule.1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract with a public management entitywlth a certified operatoror a private certified operator forthe life of the septic system. Rule.1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid contract with a public management entitywith 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 ently prior to the issuance of an Operation Permit for a system required to be maintained by a public or private management entity,unless the system ownerand certified operator are the same. The contract shall require specific requirements formaintenance and operation, responsibilities of the ownerand 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 condition of the Operation Permit that subsequent owners of the systems execute such a contract. @Hand Drawing OlmportDrawing **Site Plan/Drawing attached.** OPERATION PERMIT 196705 - 1 Davie County Health Department CDP Fite Number: 210 Hospital Street 5842426095 P.O.Box 848 County File Number: Mocksville NC 27028 Date: ! / Q Inch Drawing Drawing Type: Operation Permit Scale: . ON A k i s o i I�i I I I I I I I I I 1 _ _ l a I I _ I—ILI f ! t I CONSTRUCTION For office Use Only AUTHORIZATION F,!CDPFite Number 196705-1 Davie County Health Department y ID Number 5842426095 210 Hospital Street Evaluated For. NEW P.O. Box 84$ ' Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax:336-753-1680 0 9 / 1 5 / a 0 a 0 Applicant: Nicholas Edward Martyak Property Owner. Bary Lynn Sechrest Address: 3651 Midddlebrook Drive Apt G Address: 207 Pepperstone Dr City: Clemmons CRY: Mocksville State/Zip: NC 27012 State0p: NC 27028 Phone#: (215)720-9121 Phone#: Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: 2 Nikki's Way Mocksville NC 27028 Directions Structure: SINGLE FAMILY 601 North get on 1-40 East exit Farmington Rd left to #of Bedrooms: 3 Hubert Road right Staya Way to Nikki's Way #of People: "Water Supply: NEW WELL System Specifications Minimum Trench Depth: 2 4 Site Classification: Provisionally Suitable Inches Saprolite System? ®Yes ONO Minimum Soil Cover. 1 a Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 . a Maximum Soil Cover: 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 Gallons 'Proposed System: 25%REDUCTION 1-Piece: OYes (g)No Pump Required: OYes @No 0May Be Required Nitrification Field 1 8 0 0 _ Sq.ft. Pump Tank: Gallons No.Drain Lines 4 1-Piece:OYes ONO Total Trench Length: 4 5 0 ft. GPM—vs— ft. TDH Trench Spacing: Inches O . _ _ 9 . g Fe t O.C. Dosing Volume: _ Gallons Trench Width: Inches _ — 3 _ gFeet Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS-1 OTS-11 Septic Tank InstallerGrade Level Required: 01 011 0111 OIV CDP File Number 196705- 1 County ID Number.'584242605, s ❑ Open Pump System Sheet Repair System Required:@Yes ONo ONO, but has Available Space epair System Trench Spacing: 9 E613- lnches O. . 'Site Classification Provisionally Suitable — Feet O.C. Trench Width: Inches Design Flow: 8 — _ 3 - Feet Soil Application Rate: Aggregate Depth: 1 8 0 0 inches Minimum Trench Depth: a 4 "System Classification/Description: Inches TYPE ii A.cow SYSTEM(SINGLE-FAMILY OR 484 GPD OR LESS) Minimum.Soil Cover. 1 a inches "Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: a 4 Nitrification Field 1 8 B 0 inches Sq.ft. No. Drain Lines 4 *Distribution Type: GRAVITY-PARALLEL(eq.d•box) Total 1 rench Length: 4 5 0 Pump Required: +(Ayes @No OMay Be Required Pre Treatment: ONSF OTS-1 OTS-II "Site Modifications 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. 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 1130A-336(b)}!f the installation has not been completed during the period of validity of the Construction Perml%the information submitted In the application for a permit or Construction Authorization is found to have been Incorr-%falsified or changed,or the site ls,attwid,the pirmlt orconstruction Authorization shall become Invalid,and may be suspended or revoked(.1937(g)).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,installation,operation,maintetance6 monitoiing reporting and repair Applicant/Legal Reps.Signature Required? Oyes ONo Applicant/Legal Reps.SignatureDate:, ! - 2140-Nations, rt 0 9 / 1 5 / 4 0 1 5 Issued By: Date of Issue: - Authorized State Ag t. Malfunction Log OYeS @Hand Drawing Olmport Drawing **Site Pian/Drawing'attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION 196705- 1 Davie County Health Department CDP File Number: 210 Hospital Street 5842426095 P.o.Box 848 County File Number. Mocksville NC 27028 Date: 09 / 1 5 / ,2 0 1 5 pinch Drawing Drawing Type: Construction Authorization Scale: pN/A ON .ft. ....................L—J-1 I r I WA* CONSTRUCTION AUTHORIZATION - Davie County Health Department 210 Hospital Street CDP File Number: 196705- 1 lG(' w P6�\j o.Box 848 �"�V.Q� ` _ s4242soss a'ja \ County File Number: 1, Q Mocksville NC 27028 —�L') �,./ Date:2 tick below to[Import an image troJm an external location: Drawing Type: onstruction uthorization 1'I 4Ud u' UV � a APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATP E C E I VE D Davie County Environmental Health AUG Z Z�15 P.O.Boz 8481210 Hospital Street Q MwUvMe,NC 27028 (336)753-6780/Fax(336)753-1680 DG HEALTH E ATi 'i'H I Application For. i Site Evaluation/Improvement Permit -(Authorization To Construct(ATC) Both L':I f7 Type of Application: :New System Mcpair to Existing System : Expansion/Modification of Existing System or Facility "*MPORT.IMs"nO APPLICATION GNNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refcr to the INFORMATION BULLETIN for instructions APPLICANT INFORMATION -� �, Natne �DIrLS LSX�1 �fiiVc Contact Person Address 3&y i cd fP 1Z� fir,&,e- i- Home Phone City/Srat,emp c l r,�urn�r,< 1U��7o1� Business Phone�-- --.---- F.noaii Z`)Y�7Ctr i � V QMaZld Coro Email Name on Permit/ATC if Dffferenr than Above MailingAddress PROPERTY INFORMATION 'Date House/Facility Comets Fla NOTE: A survey plat or site pram mutt accompany this application_ Included Site Plan lat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat,) Owner's Name v-r 4-q/7 n c -,4- Phrnpe Number Owner's Address t •-% r City/State/Zip Mock SvJ l l t ?7 V Pmpe ty AddtessNi 'ik 's W Z City iVo ck.5 a yl Lot Size Tax PIN# 5: (jO SubdivisionName(tf applicable) A-1 AE SectiotnJLot# DirectiomToSitmT4oE -ip NiK&-,0 la% If the answer to any of the following gucstiow-is-'Yar supporting documcntstion smut be attached: Are them any existing wastewater systems on the site? Yes_XNo Does the site contain jurisdictional wetlands? Yes YNo Are therm any easements or right-of-ways on the site? YYes No -.Sr e w „:�ru y11ey.- Is the site subject to approval by another public agency? `Yes)LNo (/ Will wastewater•other than domestic sewage be generated? Yes o IF RESIDENCE FILL OUT THE BOX BELOW_ #People 016 #Bedrooms 3' #Bathrooms a- Carden Tub/Whirlpool I.Yes )lo l Basement xYes No Basement Plumbing:'e!Yes !;No _ r-Qur fF NON RESIDENCE FILL OUT THE BOX BELOW Allh Type ofFacility/Basiness Total Square Footage of Building #People-__ __ #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day)_ (Attach documentation of similar facility water constmmption) FOODSERVICE ONLY: #Scats Type system requested:XConveodonal LAaxpted _Innovative -*Alterative _Other War Supply Type JCounty/City Water ,�i'<—Well ;Existing Well Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? Yes A40 Ifyes,wbattype? --- - —.__-- -, This is to certify that the information provided on this application is tme and cornet to the best of my knowledge- I understand that any pemit(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 an 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 ndes. I understand that I aro responsible for the_woper identification and labeling ofpropetty lis and cornets and locating and flaming g the well location and the location of any other amenities Site Revisit Charge RSFWY17 T, 's or oven's legal representative signature Datc(s):-_ o I I1�_ Client Notification Date: Date `T EHS: Sign given Yes ONO Account# ..�06, Revised 11106 Invoice# YT--,1077 i H 00'5556' r _N V 'S56'E. 34`54'�`1v..�•. N01.11'33'E =^ 92125' 1 wr plea N OLD SAW WE R1rw15 W OLD RMOOm W TRACT NO. 2 = 19.217 ACRES `, N 5 n 1zo a l9 z 837,104 sq.Fk S9P17189 acres N 02'12'16•E 385.00' fJO5IM16 SipE 1 *1i NJ �"' —•• -�. . AERIN..FOVER LDJE y N,� T z - Carpal CURVE RADIUS I LENGTH I CHORD i REARING C-1 123.24' 35.12' 35.00' N 76'32'31' V ra and \. CONTROL CORNER san - 30.0 yr piy ENO PKD?5'Pniaft*cess foumw moa C-1 � Bd C-Z U } ((rt Dom 64 w4w TOraI 1�"� 25.00' J C47MNF SLS£ . • \ ra4(SEt A9 9/O PC 218 Ev (txlsTlnG sm m"D) 1/I'Kim 0 Rw (acv SROM SET) R 0 PMM(w0 wWas"Thimm sElr - mama w.shm A w=mwum wo ucrl AN 580-12-.0795PK MR.WT p0n"s ED57Uc "�1° OJ?3 EnVIV G IEI smwt OB X!A1 /•ppE Qy VATER METER J K1, UTSITT POLE 0 l.WA rms. \ Q %M"WT SEVER Wawl1U / w ❑ Ci(GTga 14W 1 I1M%$EO IS'1'riroM AttYSp fQSNne7f / 0 Ca(SEVER tUm-WI 11 _/ \ M.W-Ii )ELE%VW ME i PED NIKKIS WAY / \ 119 121 P r((Ic"C"ra/D() E:lcpE bV V'AwWo Acus E'aswwl / \ VATEA VALVE / ,.IMPROVEMENT PERMIT For Office Use Only t •_ + • - I 'CDP File N umber 123016- 1 -.' Davie County Health Department County ID Number: D `5.000-00-01 Sale 2 210 Hospital Street r� P.O. Box 848 Evaluated For: NEW Mocksville NC 27028 Township: Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID UNTIL: 911312018 "NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit. Applicant: Jonathan A. Sechrest Property Owner: Clara Jo Munday Shore Address: 207 Pepperstone Drive Address: 2017 Brittany Oaks Court City: Mocksville City. Yadkinville State/Zip: NC 27028 StatefZip: NC 27028 Phone (336) 940-8649 Phone;:: Property Location & Site Information Address/Road 1": Subdivision: Phase: Lot: Off of Nikkis Way Mocksville NC 27028 Directions Structure: SINGLE FAMILY 1-40 East , exit Farmington Rd. turn Left, then Left on of Bedrooms: 3 Hubert Rd. right on Staya Way , then right on Nikkis of People: 3 'Water Supply: NEW WELL �Glassificauon: System S stem Specifications PS i:tinimum Trench Depth: 3 6 Inches Saprolite System? QYes ONO t:taximum Trench Depth: 3 6 Inches Design Flow: 3 6 0 Septic Tank: 1 0 0 0 Gallons Soil Application Rate: 0 2 1-Piece: QYes QNo Pump Required: QYes ONO Of:1ay Be Required 'System Classification/Description: TYPE III B.SYSTEM%V/SINGLE EFFLUENT PUI61P Pump Tank: Gallons *Proposed System: 25°b REDUCTION 1-Piece: QYes Q N o Repair System Required:OYes ONO ONO, but has Available Space rERepair System 'Site Classification: Ps t:linimum Trench Depth: 3 6 Inches Soil Application Rate: 0 2 t:taximum Trench Depth: 3 6 Inches 'System Classification/Description: Pump Required: QYes ONO Q May be Required TYPE II A.CONV SYSTEM 1(SINGLE-MMILY OR 480 GPD OR LESS) "`Proposed System: 25°o REDUCTION Page 1 of 3 f:D,P File Number 12.3016 '.1 — County ID Number: D5-000.00-018Site 2 'Site Modifications ❑ open Fill Sheet No grading or construction activity is alloyed in areas designated for system and repair without approval of Health Department. "Permit Conditions The issuance of this permit by the 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 shalt 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 site for the proposed Wastewater system,and the location of water supplies and surfacewaters). 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 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 13OA-335(Q).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,installation,operation,maintenance monitoring, reporting,and repair(.1938(b)). Applicant/Legal Reps, Signature Required? QYes ONO Applicant/Legal Reps. Signature: Date: 'Issued By: 2244-Daywalt.Andrew Date of Issue: 0 9 / 1 3 2 0 1 3 Authorized state Agent: 4Valid without Expiration? 4Create CA? UHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Total Time:(HH:1.1ht) 0 1 hours 0 0 Minutes Page 2 of 3 Activitv Code: S4-IRS issued:now,valid for 60 mos. IMPROVEMENT PERMIT • -Oavie County Health Department CDP File Number: 123016 - 1 210 Hospital Street D5.000.00-018 P.O.Box 848 County File Number: Site2 hlocksville NC 27028 Date: l Q inch Drawing Drawing Type: Improvement Permit Scale: ON/AOBlok NI •ft. 1b2- s o _ S zi -- �--> r r Page 3 of 3 Davie County,NC -GoMaps Advanced Page 1 of 1 77, � 7 1 R 1 - i CedY-07rl� A Cedar ��� '.-Creek k' 20 1 I I #8 F ON \NIX 1 300 m l 1000 ft L.tit u:e, 35' Or 13.1 ` Lan;itue=( -SC' 3231.QS' http://maps2.roktech.net/davie_gomaps/index.html 9/12/2013 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC- Davie County Environmental Health PAS P.O.Box 848/210 Hospital Street Mocksville,NC 27028 Dau: Z 3 RECEIVED (336)751-8760/Fax(336)751-8786 e Date: _n. 3 Application or:,,FVSite Evaluation/Improvement Permit ❑ Authorization To Construct(A Type of Application: ❑New System ❑Repair to Existing System DExpansion/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 �� '��n,-:l A. gec hk-o,- Contact Person 3)� Y Billing Address a ett o i�s k :; Home Phone `3`31, Y,o- �4�Q/ City/State/ZIP_A Business Phone Name on Permit/ATC if Different than Above .. Mailing Address ''° City/State/Zip PROPERTY INFORMATION *Date House/Facility.Comers Flagged �'a Y o�`013 NOTE: +A survey plat onsite plan must accompany this application. Included: ©'Site Pla OiPlat(to scale) (Permit is*valid•for 60 mo the with si a plan,no expiration with complete plat) .J/'�'(X� f7 Owner's Name P111o > a o R 2_ Phone Number Owner's Address" Ali -City/State/Zip Q Property Address i s W City 10.61<5VOIlG o270 � Lot Size f —QV Y%-f Tax PIN# `��:D Subdivision' ame(if applicable) Section/Lot# Directions To Site: i If the answer to any of the following questions is"yes';supporting documentation must be attache . Are there any existing wastewatersystems on'the site? ��es rNo Does the site contain jurisdictional wetlands? Are there any easements or right-of-ways on the site? so, Is the site subject to approval by another public agency? ❑Yes Ilio Will wastewater other than'domestic sewage be generated? DYes fro 1 IF RESIDENCE FILL OUT THE BOX BELOW #People _ #Bedrooms 3 #Bathrooms Garden Tub/Whirlpool-E�es ❑No Basement: 01 es 01l— Basement Plumbing: ❑Yes ENV' 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:. ❑Conventional ❑Accepted ❑Innovative UAltemative ❑Other Water Supply Type: ❑ County/City Water ew Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 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 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 thatkm responsible r the proper identification and labeling of property lines and corners and locating and flagging or staking 7tse/fac' ' t' n,proposed well location and the location of any other amenities. g Site Revisit Charge Prop .ty owner' or er's legal representative signature Date(s): gClient Notification Date: Date EHS Sign given C,Yes ❑No 30 - Account# Revised 11/06 ' Invoice# Davie County, NC Tax Parcel Report Monday,August 19, 2013 _2 Jk'l eor- �f •J_ $ TON �.� J i 1a„ oancy Buttons In- N WARNING:THIS IS NOT A SURVEY DAVIE COUNTY HEALTH DEPARTMENT s- Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION ,.1"AQPFIiTkIN1nORMATION Account #: 990006151 Tax PIN/EH#: D5-uov=v&%qj:� Billed To: Jonathan Sechrest Subdivision Info: Reference Name: Location/Address: Off of Nikkis W - 7028 Proposed Facility: Residential Property Size:. 49 Ac Date Evaluated: 3 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit X Cut FACTORS 1 2 3 4 6 7 Landscape position Slope % o p e HORIZON I DEPTH .Texture groupC__ c� Consistence Structure Mineralogy HORIZON II DEPTH ?•12 p ..2q —S Texture group C C ` V ConsistenceOr StructureINA Mineralogyr HORIZON III DEPTH 40-y N_ 6 43F_,S_W51 Texture groupT Consistence Structure sk Mineralogy HORIZON IV DEPTH T Texture group 'Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LAI (�. LONG-TERM ACCEPTANCE CRATE o SITE CLASSIFICATION: 2S EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS �b �P��f� - '7� ! wW 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 CONSIST .N _F. Dist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm NS.-Nan,sticky `' SS-Slightly sticky S-Sticky VS-Very Sticky -Non'plastic, SP-Slightly plastic . P-Plastic VP-Very plastic t Structure`, SC-Single grain' :!' M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK`=Subangular blocky.. PL-Platy PR-Prismatic Mineralonv 1:1,2c 1 Mixed lY9tcs '. . Horizon depth-In inches' epth,of.,fill-.In inches trictive horizon Thickness,and inches from land surface rolite-S(suitable),U(unsuitable) etness-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less cation-S(suitable),PS(prov sionally suitable),U(unsuitable) nnv-farm acrantanra rate_ aal/riati/ftp �` T!`)iT AG/Ae m__.+._ .+ *Wed A w '• Y Z r + or u y • � s f ' �. i ..Y i •:2��� � �1 a'�5�4 R.-ta'�.'",F'i�Y '�yPyC�nY'�.� •M, a Am is Google-earth • • • ' . ,11 a _ �P•tea +4 niQ t '4 ei sA�y� � x � `$r t i �'° '� , ..� 6�iz'Sda a,t'J".s• ��-�.c,Yom,' d, y= '.D' a� :f. r - � :.�.a't i 4� Google earth • I � � oil L .+. rw =♦ 'r c K Y Google earth r j kr } � •Y, L r so 41..x^ . � •. �• •: J7'r7, , 4its' ig CI x < 1 wdw L'^ r�ti ��•.! '� r Lk. t =.. a "' ytgC"5� �+F7 '� s 9, ,�•du,l W (.000le earth i. t' C a � '-+�': .�y'_�.✓. a.4` tl '-*: .. � y�.��-may ai. :fp R 'f a:- i. ,5 1 aGoogle54 -earth. ' all to