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656 Pudding Ridge Rd "01SERATION PERMIT or thce Use n v Davie County Health Department *CDP File Number 161865-1 210 Hospital Street E4-000-00-046-11 P.O. Box 84$ County ID Number Mocksville NC 27028 Evaluated For. NEW Phone:336-753-6780 Fax:336-753-1680 Township: Applicant: Nina Scherer Property owner. Nina Scherer Address: PO BOX 813 Address: 120 O'hara Dr City: Mocksville City: Salisbury State2ip: NC 27028 StatefZip: NC 27028 Phone#: (336)462-2647 Phone#: (336)462-2647 Property Location & Site Information Address/Road #: Subdivision: Phase: Lot: 656 Pudding Ridge Rd Mocksville NC 27028 Directions Structure: SINGLE FAMILY 140,east exit on Farmington Rd, left. go Pudding #of Bedrooms: 3 Ridge On left property on right #of People: *Water Supply: PUBLIC *IP Issued I *System Classification/Description: TYPE II A CONV SYSTEM(SINGLE-FAMILY OR 480 GPA OR LESS). *CA issued by: 21ao-Nations,Robert SaproliteSystem? QYes ONo Design Flow: 3 6 0 * GRAVITY-SERIAL Pump Required? Distribution Type: OYes ONo Soil Application Rate: 0 - a a 5 *Pre Treatment: Drain field rNo. on Field 1 4 a 0 Sq.ft. *System Type: INFILTRATOR QUICK 4 STANDARD n Lines 3 Installer: FrankTrdnsou Total Trench Length: 3 5 4 ft. Certification#: 2771 Trench Spacing: 9 Inches O.C. ()Inches O.C. *EH S: 2140-Nations,Robert Trench Width: 3Inches &Feet Date: 1 a / 0 4 / a 0 1 4 Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 Approval Status Inches Maximum Trench Depth: 3 6 ®:Appy©ved O Disapproved Inches Maximum Soil Cover: 2 4 Inches a CDP Fite Number 161865 - 1 'County ID Number_-E4.000.00.046.11 y Septic Tank Manufacturer. Shoaf Lat. STB: 760 Long: Gallons: 1000 InstallerFrank Transou Certification#: 2771 Date: 0 6 / a 4 / a 0 1 4 'EHS: 2140-Nations.Robert "FilterBrand: POLYLOK PLA 22 With Pipe Adapter Date: 1 a / 0 4 / .1 0 1 4 ST Marker. El Yes El No - Reinforced Tank: ❑ Yes ® NO Approval Status 1 Piece Tank: ❑ Yes ® No ® Approved❑4 DisapprovJ7 7 ed Pump Tank Manufacturer, Installer. PT: Certification#: Gallons: 'EHS: Date: / / Date: RiserSealed ❑ Yes ❑ No RiserHeight: ❑ Yes-- ❑ No (Min.6 in.) A iroval Status pp Reinforced Tank: ❑ Yes ❑ No p Approved❑ Disapproved 1 Piece Tank: ❑ YeS ❑ No yy ,. ,. , =., _ . ,.N,.; - Supply Line Pipe Size: inch diameter Installer. Pipe Length: feet Certification#: *Schedule: 'EHS: Pressure Rated ❑ Yes ❑ No Date: Approved fittings ❑ Yes ❑ No =- Approval Status - f, D Approved❑ E7lsapproved,. Requirement Pump Type: installer Dosing Volume: — Gal Certification#: Draw Down: Inches 'EHS: 'Chain: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check-valve ❑ Yes ❑ No Approval Status PVC Unions ❑ Yes ❑ No ❑ Approved❑ Disapproved Vent Hale ❑ Yes ❑ No Anti-siphon Hole ❑ Yes 0 No CDP File Number 161865 - 1 County ID Number: E4.000-40.046.11 Electric Equipment CNEA4XM Box or Equivalent (:1 Yes ❑ No Installer. Box 12 inches Above Grade ❑ Yes ❑ No Certification#: Box Adj.To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No *ENS: Pump Manually Operable ❑ Yes ❑ NO *Activation Method: Date: s Approval Status Alarm Audible. ❑ Yes ❑ No ❑ Approved❑' Disapproved Alarm Visible ❑ Yes ❑ No 2140• axons.Robert 'Operation Permit completed by: Authorized State Agent: Date of Issue: 1 2 / 0 4 / 2 0 1 4 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 et. Seq.,and all conditions of the Improvement Permit and Construction Authorization.This property is served bye TYPE a A. sewage septic system. Rule.1961 requires theta Type TYPE 11 A septic system meet the following criteria: Minimum System Review ByThe Local Health Department: NIA Management Entity: OWNER Minimum System InspectioniMaintenance Frequency By Certified Operator: WA Reporting Frequency By Certified Operator:NIA 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 entity with a certified operator or a private certified operator for the 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 entity with a certified operator for the life of the septic system. Rule. 1961 (2)(e)requires a contract shall be executed between the system owner and a management 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 owner and systems operator,provisions that the contract shall be in effect for as tong 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. OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT 161865- 'I Davie County Health Department CDP File-Number: 210 Hospital Street E4000-04.046-11 P.o Box 848 County File Number: Mocksville NC 27028 Date: ! / 0Inch Drawin Drawing Type: Operation Permit Scale: . ON/A = ft. 1 i I � I Ind I I CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 161865:- 1 a*- -. Davie County Health Department County ID Number: E4-000-00-046-11 210 Hospital Street Evaluated FNEW 5 P.O. Box 848 �Townshi�p. � Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax: 336-753-1680 1 1 / 0 7 a 0 1 9 Applicant: Nina SchererProperty Owner: Nina Scherer Address: PO BOX 813 Address: 120 O'hara Dr City: Mocksville City: Salisbury State/Zip: NC 27028 State/Zip: NC 27028 Phone#: (336)462-2647 Phone#: (336)462-2647 Property Location & Site Information Address/Road#: Subdivision: Phase: Lot: 656 Pudding Ridge Rd Mocksville NC 27028 Directions Structure: SINGLE FAMILY 1-40,east exit on Farmington Rd, left. go Pudding Ridge On left property on right #of Bedrooms: 3 #of People: *Water Supply: PUBLIC System Specifications Minimum Trench Depth: a 4 Site Classification: Provisionally suitable Inches Minimum Soil Cover: Saprolite System? (&Yes O No 1 a Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 a a 5 Maximum Soil Cover: a 4 Inches *System Classification/Description: *Distribution Type: GRAVITY-SERIAL TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons *Proposed System: 25%REDUCTION 9-Piece: O Yes ®No Pump Required: O Yes ®No O May Be Required Nitrification Field 1 4 a 0 Sq.ft. Pump Tank: Gallons No. Drain Lines 3 1-Piece: OYes ONo Total Trench Length: 3 5 4 ft, GPM--vs— ft. TDH Trench Spacing: Inches O.C. — 9 Feet O.C. Dosing Volume: Gallons Trench Width: — 3 gate Depth: 2Inches ®Feet Grease Trap: Gallons inches Pre-Treatment: O NSF OTS-1 OTS-11 Aggregate Septic Tank Installer Grade Level Required: 01011 O III 01V Page 1 of 3 CDP File Number 161865 - 1 County ID Number: E4-000-00-046-1i ❑ Open Pump System Sheet Repair System Required:®Yes O No ONO, but has Available Space CDesign System Trench Spacing: 9 O Inches O. . fication: Provisionally suitable — ®Feet O.C. Trench Width: Inches w: 3 6 0 — 3 Feet Soil Application Rate: 0 a a Aggregate Depth:5 inches Minimum Trench Depth: a 4 *System Classification/Description: Inches TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR Minimum Soil Cover: 1 a LESS) Inches Maximum Trench Depth: 3 6 *Proposed System: 25%REDUCTION Inches Nitrification Field 1 4 a 0 Sq.ft. Maximum Soil Cover: a 4Inches No. Drain Lines 3 *Distribution Type: GRAVITY-SERIAL Total Trench Length: 3 5 4 ft. Pump Required: OYes (&No O May Be Required Pre-Treatment: O NSF OTS-I OTS-II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. Remainme 750 *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. Characters mairmg 2000 This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit,not to exceed five years,and may be issued at the same time the Improvement Permit issued(NCGS 130A-336(b)).If the installation has not been completed during the period of validity of the Construction Permit,the Information submitted In the application for a permit or Construction Authorization Is found to have been incorrect,falsified or changed,or the site Is altered,the permit or Construction Authorization shall become Invalid,and may be suspended or revoked(.1937(g)).The person owning or controlling the system shall be responsible 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? Oyes ONO Applicant/Legal Reps. Signature- Date: *Issued By: 2140-Nations,Robert Date of Issue: 1 1 / 0 7 / a 0 1 4 Authorized State Agent: !:�*_ko 4.0.o* �„_� et --= Malfunction Log Oyes ®Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number: 161865 - 1 210 Hospital Street Count File Number: E4-000-00-046-11 P.O.Box 848 y Mocksville NC 27028 Date: 11 / 07 / ,2014 0Inch Drawing Drawing Type: Construction Authorization Scale: . O Block O N/A I i t , -- -- --- --- ------------- --- ------------------ -------- ------.---- ------------- ------- -------------- -- ' ------ - ---- C _ ----------------------------------------------- r - - - ................ - _ ZS --- ---- - --- ---I I - --- I i - -_ _ . ....... _-............ ............ ........__........... - __ - --._. Page 3 of 3 P1 P2 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital street CDP File Number: 161865 - 1 P.O.Box 848 E4-000-00-046-11 Mocksville NC 27028 County File Number: Date: .1.1./.0.y. /...0.1.4. Click below to import an image from an external location: Drawing Type:Construction Authorization Page 3 of 3 Pi P2 APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC Davie County Environmental,Health_ . P.O.Box 848/210 I3ospif Street Mocksville,NC 028 (336)753-6780/F 753 ax 36) -1680 plic.ion For: In Site Evaluation/Improvement Permit Authorization To Construct(ATC) ❑Both ype or applicaflowONew System ❑Repair to Existing System ❑Expansion/Modifrcation of Existing System or Facility ***IMPORTANT"**THIS APPLICATION CAMMOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed �J i t1b. SU^erer Contact Person RiCK S40,&(2V Billing Address O1�-O1C 813 Home Phone City/State/ZIP /-gag 'Ui ge -A1Q1 21078 Business Phone L XY7 Name on Permit/ATC if Different than Above Mailing Address City/State/Zi PROPERTY INFORMATION *Date House/Facility Comers Flagged NOTE: A survey plat or site plan must accompany this application. Included:❑Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat) Owner's Name A oD, Se,lze et' Phone Number Owner's Address Ile) O'InoM Dt" City/State/Zip 'S .0&F Property Address Gn City , eJ Su�l� Lot Size '7acres ax P Subdivision Name(if applicable) Section/Lot# Directions To Site: If the answer to any of the following questions is'yee,supporting documentation must be attached. Are there any existing wastewater systems on the site? Oyes Flo Does the site contain jurisdictional wetlands? Oyes Cd'110 Are there any easements or right-of-ways on the site? Dyes EfNo Is the site subject to approval by another public agency? Dyes trio Will wastewater other than domestic sewage be generated? Dyes o IF RESIDENCE FILL OUT THE X BELO #People 2 #Bedro _ Bathrooms 2'(l Garden Tub/Whirlpool es []No Basement:Dyes PNo Base nt Plumbing: ❑ es 990 IF NON-RESIDENCE FILL OUT 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 ❑Alternative ❑Other Water Supply Type:U- ounty/City Water;" ❑New.Well OExisting Well 0 Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?❑Yes A7 No 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 that I am responsible for the proper identification and labeling of property lines and comers and 1mg `c�ging o c hopse/facility location proposed well location and the location of any other amenities. Property owner's or owner's legal representative gnature Site Revisit Charge Date(s): - - N Client Notification Date: Date EHS: Sign given Dyes ONo Account# Revised 11/06 Invoice# jf •, •• .J 'i I ,.�'! I ........... ...... -- .,,.t,;'�,,',,,•''',, , , N , .. n ��- ' ^ M l,Ir �S Ji \ ♦•` , , ' rte•' Q : t ,1 � `,' •' , , , 1 a Trac.•. •, � t_1, ; , • I _ r I -------------- ... , .' ♦•• , \ r, , �O ,•1 �,-'••,..r.^Lr 'I Q t'"�.:. _ _,/Y ro� 1 e _- 06 30 • .......... •---- -. o ;+��; 'fir �^_�•_-�-- _ "C:lD�1R C:Rlal;-RD-.;-_=----- =�•-__:�__ , • Davie County Environmental Health P.O.Box 848/210 Hospital Street � Mocksville,NC 27028 00 1 �I (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT Account #: 990005555 Tax PIN/EH#: 5831-98-3825 Billed To: James Clark Subdivision Info: Address: 6968 Culler Road Location/Address: Pudding Ridge Road-27028 City: Clemmons Property Size: 6.37 Acers 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: %New ❑Repair ❑Expansion Permit Valid for: U,5 Years ❑No Expiration Residential Specifications: #Bedrooms I— #Bathrooms_ISI#People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):600 Type of Water Supply: IRCounty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: .S stem Type LTAR Initial Repair 5 Site Plan �l r L �Ali� dr Environmental Health Specialist Date i.p.11-06 P� 1r OC IO R SITE EVALUATION/IMPROVEMENT PERMIT & ATC , Davie County Environmental Health P.O.Box 848/210 Hospital Street �r� ��u q 0 Mocksville,NC. 27028 0 �VIRONMENT�-H (336)753-6780/Fax(336)753-1680 51- q jgg OpV1EC0 pplic Site Evalujtion/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both ype of Application: 11New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT***THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION/ Name Z 4;_ 1 BS 0_l a r `C Contact Person Jq,tVVP_s [Qr•��' Address to 9!0 e 1A e Home Phone 336— 'd-S�t— 9/J$9 City/State/ZIP aev�v%--a"e NC 'L r? a Vz- Business Phone 336— IkSt 91d 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: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site Ian,no expiration complete plat.), , i�.rrt Owner's Name o r i r T wit 6Q1i01cA0 Phone Number Owner's Address ( o U, OdLru City/State/Zip V01AJ-,J dc a?0 019 Property Address r1 city MJ WC NG Lot Size (p,3 4r rp r Taxq4N# i Subdivision Name(if a plicable) Section/Lot# ti Directions To Site: vSS u� r If the answer to any of1he folfRving questions is"Yes",supporting doc„unjentation must be attached: Are there any existing.wastewater systems on the site? _Yes `yNo Does the site contain jurisdictional wetlands? _Yes No tJtl�KN�tr.rrS Are there any easements or right-of-ways on the site? V,Yes Nn Is the site subject to approval by another public agency? Yes �2hlo Wil I wastewater other than domestic sewage be generated? Yes VNo IF RESIDENCE FILL OUT THE BOX BELOW #People C-A #Bedrooms 6 #Batyooms 25 Garden Tub/Whirlpool Yes ❑No Basement: DYes [I-No Basement Plumbing: ❑Yes ©No 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: 21ffonventional []Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: 2<ounty/City Water ❑New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No 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 charges,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 house/f ' ' Location,Irrop ed well location and the location of any other amenities. —} x--Je q4L 6 200-t6 Site Revisit Charge Property owner's or owner's lega r re at' e ature Date(s):__ _ /Zho Client Notification Date: X Date /— EHS: II Ear'/ C"dcAs Sign given :.Yes [ No Account# N fJ Revised 11/06 Invoice# GRANTORS till", GARY WlkD/E'G>ROCE LA&DAW. GR E . RICHARD EARL GROCE JUS,,' TA H, GR 16 CE DIANA GROCE VUICH RUSSELL T.VUICH C OK84bPPJ5b8 STATE OF NORTH CAROLINA COUNTY OF DAVIE I certify that the following person personally appeared before me this day, each acknowledging to me that he or she voluntarily signed the foregoing document for the purpose stated herein and in the capacity indicated: GARY WADE GROCE, individually LINDA ry GROCE, indivichially RICHARD EARL GROCE, indiviclually JUANITA H. GROCE, individually DIANA GROCE MICH, indiviclually RUSSELL T. MICH, individually This iL day of�: ,2012. Of 16a Signature of Notary 51 � T' ;Notary's printed or typed name,Notary Public H My commission expires: X:\MyFiles\Hank Van Hoy\Real Estate\Groce,Richard Earl -Deed,Nina Scherer,July 2012.wpd . � agbPG5bq Exhibit "A" BEGINNING at a railroad spike at or near the centerline of SR 1435 said railroad spike being the corner of Peter E. Parker(Deed Book105, Page 509)thence from the beginning with or near the centerline of SR 1435 following courses and distances:South 64 deg. 34 min. 34 sec. West 185.87 feet to a point; thence South 65 deg. 17 min. 20 sec. West 113,56 feet to a point; thence South 67 deg.3 min. 30 sec. West 60.32 feet to a point;thence South 70 deg. 02 min.20 sec. West 69.51 feet to a point;thence South 72 deg.26 min.51 sec. West 71,78 feet to a point;thence South 75 deg. 16 min 08 sec.West 67.44 feet to a point;thence South 79 deg. 24 min.22 sec.West 56.68 feet to a point;thence South 83 deg. 22 min.45 sec. West 115,71 feet to a railroad spike at or near the centerline of SR 1435;thence South 83 deg. 16 min 03 sec.West 211.59 feet to a point;thence South 84 deg. 05 min. 56 sec. West 9.90 feet to a point, the Southwestern corner of the within described tract;thence North 12 deg.7 min.23 sec.East 31.55 feet to a new iron pin in the northern right of way margin of SR 1435;thence continuing.North 12 deg.7 min.23see. East 298.88 feet to a new iron pin; thence North 44 deg. 24 min. 06 sec. East 384.51 feet to a new iron pin; thence continuing North 44 deg. 24 min, 06 sec, East 15 feet to a point in Bryan Branch the northwest corner of the within described tract in the line of Peter E.Parker(Deed Book 105,page 509);thence with said branch as it meanders the following courses and distances: South 66 deg.29 min.34 sec. East 376,79 feet to a point;thence South 48 deg.37 min.49 sec,East 295.51 to the point and place of Beginning containing 7.351 acres, as shown on a survey prepared by Tutterow Surveying dated January 23, 1991, drawing number 1391-4. The above described Tract is a portion of that property described in Deed Book 56, Page 422 to which reference is made. For further back reference see the Will of Wade I.Groce filed in the office of The Clerk of Superior Court of Davie County. This property is also designated as parcel 46.11 of Davie County Tax Map E-4. TE/1-1VH, File No. 26516.1 Davie County Environmental Health P.O.Box 848/210 Hospital Street '71 I`l�} Mocksville,-NC-27028 !r (336)753;6'180/-Fax(336)753-1680 -tIMI'ROVFIYIENT PI;RIIIIT Account ft: 990005555 Tax PIN/EH M 5831-98-3825 Billed To: James Clark Subdivision Info: Address: 6968 Culler Road Location/Address: Pudding Ridge Road-27028 City: Clemmons Property Size: 6.37 Acers Reference Name: .Proposed Facility: Residence **NOTE**This Improvement Pen-nit DOES NOT authorize the constntction 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. Pennit Type: W1ew ❑Repair^❑Expansion^y^~ Permit Valid for: Gas Years ❑No Expiration Residential Specifications: /I Bedrooms#Bathrooms 9 People Basement❑Basement plumbing❑ Non-Residential Specifications: Facility Type H People 0 Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):LOO Type of Water Supply: IRCottnty/City OWell ❑CommunityWell Site Modifications/Permit Conditions:' S stem Type LTAR Initial Repair qvti Site Plan c 41 EuvironmentaLHealthSpccialist _ Date _ p.11-06 �1 ►� goP� S65 03794 11LE0 FOR REGISTROON JULY 16, 2012 3:21 P.M. Davie County,North Carolina DATE TIME Excise Tax Paid is 0 0 AND RECORDED IN BOOK 896 PAGE., M.BRENT SHOAF REGISTER OF DEEDS DAVIEOU ,N A021 �� I_ r_r. r� DEPUTY lri"AFOti Excise Tax Due:$120.00 Recording Information Drafted by:Henry P.van Hoy,11 ivtail to:GRANTEE a 120 O'Hara Dr.,Salisbury,NC 28147 TAX MAP: WARRANTY DEED THIS DEED made this ' day of July,2012, by and between: GARY WADE GROCE and wife, LINDA W. GROCE (123 Valley Oaks Way, Advance,NC 27006), RICHARD EARL GROCE and wife,JUANITA H. GROCE (154 Valley Oaks Way,Advance,NC 27006),and DIANA GROCE VUICH and husband, RUSSELL T. VUICH, (4604 Janet Place, San Diego, CA 92115), collectively the GRANTORS TO NINA CELESTE SCI-IERER (120 O'Hara Drive, Salisbury,NC 28147), The GRANTEE Primary Residence Information:The Property described in Exhibit A does not include the primary residence of any of the GRANTORS. WITNESSETH: THE GRANTORS,for valuable consideration paid by the GRANTEE,receipt of which is acknowledged, have and by these presents do convey unto the GRANTEE in fee simple, all that certain parcel of land situated in Farmington Township, Davie County, North Carolina (the "Property") and more particularly described in the attached Exhibit"A". THE GRANTORS acquired the property under the will of Wade 1.Grace,a copy of which is filed in the Office of the Clerk of Superior Court,Davie County,North Carolina,Estate File 2009 E 239. The Property is part of a 247 acre tract acquired by Wade I. Grace by a deed recorded in Deed Book 56, Page 420 in the Office of the Register of Deeds of Davie County, North Carolina. TO HAVE AND TO HOLD the Property and all privileges and appurtenances thereto belonging to the GRANTEE in fee simple. THE GRANTORS COVENANT with the GRANTEE,that the GRANTORS are seized of the Property in fee simple,have the right to convey the Property in fee simple,that title is marketable and free and clear of all encumbrances,and that the GRANTORS will warrant and defend the title against the lawful claims of all persons whomsoever,except for the exceptions hereinafter stated. Title to the Property is subject to the following exceptions: 1. Restrictions of record,particularly the Restrictive Covenants recorded in Book 154, Page 391 in the Office of the Register of Deeds of Davie County,North Carolina. 2. Easements of record including the fallowing easements: A. Yadkin Valley Telephone- DB 74, Page 72; B. Board of Transportation-DB 93, Page 414;and C. Dutchman's Creek Watershed for stream maintenance-DB 135, Page 339. 3. Ad valorem taxes for 2012 and subsequent years. 4. Boundary Line Agreement-DB 99,Page 417. The terms GRANTORS and GRANTEE as used herein include the masculine and the feminine,the singular and the plural,as the context requires,and the heirs,successors,and assigns of the parties hereto. IN WITNESS WHEREOF,the GRANTORS have signed this deed the day and year first above written. 1 5v, DAVIE COUNTY ZONING PEI RIMT tt 172 Clcutcilf,SL,Alocltsv1110,Kc 27020 NOTE, No nppllcnilou sl)nll ho cousitlorctl t►0ntplolo utiles till filo followhlc lnrorntn(lon is n(laclted.Tiro ZAtd►tg Adtulutsh•nior luny%volvo Ally of(110 millfromcnis,0xcop( fees,null luny require nddiftoual luroruuttion ns noecssm•y for pi-aper cousidorntlmt of this request, A copy of n son 61 thawing%V11 loll shotes Ilio sltalt0 n11d dimemlou of 1110 10 1 to ba Usctl,1110 shttpo and dit►tenslon oral[types oroxisling And proposed Uses null sitim,iet,mid oho Iocnllon orrigltts-or--Tay,on filo 101.Tho dlmtving must Also shove the location orNxisting or proposed pnrldng mud laudsenping requited At well ns enough dolnil to lildlento(ho intent(t)comply with Ali opplieablo deilgo and use. slnndnrds, , 011ier" t' PZlSit8R,P2?1A1 fhe,Jolkju'lltgh1formal ml elerrrly. S'r on'll AlARUSS fiUUD11�lSION t.o'r11 Purpose rAppllcallou;, i gt,J 5�� f fnes_ oet C, Appraxl non'h•ontodolutl sgnnt'a fantngos_ '2-3�Q.__ _ __ Sl�a 01):,111;�{ at:rGs ,r)lx Mill)Vowel Numhorl Vii`=� _t(�. f f Znuht({Uich•lct: �'� lluslacss Nnnlct A'A Cull S ►cac :l a rltollo Il.Q? (IG:L 1 7 Properly 0tvaot•'sNttutc: 1JiA%,, a krcr- 111touolll`10 "73'tl 76; 7 Addressl flfrll(etentthunnhot+a) j 20 ~ e:fo— 1r._ Simb tic r d ?.P.(t{7 Appilenitt'sMom,((ftl ffererflthanab0►C) Addrasst f{�djff•rcurlhmrnba)�e) 1'houolll [rax!t: l;-ulnll; 1 heraby car[U3,Ant Ilm h jmmaila)p�oAkilheronn Lv;to the heti rtfrnyknntrledgu,cmraarn,trf cnt+tltlelo,I lnularalnnrt llrnl ll)rtJding jrrlse+u•hrcnu►plere hlforlrnllost or vinlnthp;an nppr Over!7unh)g lrcnrrl!muy by gminrL• for resocallml ojlLa))0111111 and n)ol cntnrot cover nl! eats by au Any Id wilLyllbuoqulrar/tonteclollappltcnblclocalnudstRecodes. h. _ <} A tttcnnks_.S ,n0tur nto �hhADb NOT XyttlICABELow'f(ttsI l ghk** Bute+ upm)r ra br nru1R1 n)t prlu+ u'lT1i.t np1) cal nn,1 ra tvnr nt proposed rn►►als l nt rognlrernwtls o lire zouh)g unlbrmrco. ArlilNlo)1al Roa1n►'kslCondillolls; xoning Adntlnlsiralor ^'Dato ' Rand 11/174114 Paso)012 DAY-1h, COUNTY p RE1SIDrNTIALMLDING 4�ies 1� rl,X2.11rIIT APPLICATION Dab Colully A0Y01011111e111'�SOrYiOCS ''' Y� .�, 172Clemclit 8(to ct,1Aockwl11aWC27028 O tai Tolouhouc:336.753,6050 Pax:336,751,7669 A dr • �4c- Aso App1 cnllon is for the ollo►vb►gJwlsdictlonl IdDavle counly Q Alocksvllfe t'ropetty 0lvncr's Nnn10 1'ro)lttty Owner's Address Prapttly 0v,ner's Tolepl►ono lt.jl� 5c4t;r�t 120 dq,� {�s�ury' r ) - IYonta ��t; A�� 2`��t�l7' ��t1-�)'15r1 -_7L2�Cal1 Pto)eclNanle ProJcal AJdress!(.ocatiost(if Mmvn) Zo 11ny Dlsiricl ' �U�d,� R��� Ind• �_=--��_. Subdivlsl0u Haw(If appllcablo); Loll! App►lcaul'sNow(Ifdlffutnl) AppllcoaftAddrtss(IPdiffercnl) Applicout'sTciaphuno (L0 Ot',( ' "Ou D I ) - Zlaluo $'c,J,Acjr JJCr,2PW1 ` 4'Me l Contractor's Hama canlraclor'sTefephone Ocneral Contractor's License No. 'R.A."S (336 Wig Z-7.G4I7 CO3 I contractor's Address Water Supply: 4203 1-- & . W p' MC 1 10OG Vpt'ibllo ❑Prlvalu(Woll) ❑14M )Ir1clL'rolt t pcscr►tUlan: t'lcil Pornlit It Se►verSupply: 'f•roarSlruch►ror 8ouudnQonTypo; ,� NcsY SPA; 1losenunt: ❑ Q 1,6110bq sepllo ❑N/A Addfllon: ❑ •Vented ctmvlspace: ❑ Setsllo Peh111t 111?�OS S J`t Renovallon: E) Stated crnlvls aco: Q . Pbe ilestorollon: ❑ Slab on 01nde: ❑ AccessotySkuctwo: Q Conslruclloncost;$ -,ZUo0G TolalSquasoPeett'156 3 I lit Icby nuesi 1110 infotmallon provided an Ibis oppitealion end any addlltouni h►fonunlion submilled pettolnlog to chis eppltcnllon Is Ime and'acournl0. Should 1110uso olllte property andlor slructur04 chango,t understand oddiilcual permits may be rttlultcd, lu uddltton,I undelsleud plan ravlew comet cover all aspects of consRuctions and[lit iePofaart lvork done tvlll be re abed to meet ail a s dioable Iocol and sla10 codes. Api+ticonl's Signahrra: Owner's Signattue: Appllcool's Nnmo(Pdul), <~40A 0►Yner'SNn1110(Pr1111): Nn�+✓ �c e-rt�' halo: — • 0iflct Use e i Poral 11 �QQ 06 �� 'fax ID 11 so-I 82_-_S_ Zoning 1A _ T>xes �A,Irrored ❑betted List upbud 11/4/09 1 ort NIP porch • NORMAN W. ELIQNS NIPON . • . r oP' / fL 1 AREA 2,001 ACRES 6,►'z ata w. iNIP S7 oP .�'� kD ''' _ 15.00 DETAIL R�6 NIP p0, Q N IP 31g 0.. g,f �- I�I = 201 C2 ? ° N hlyp O ahs AO�P� ��•�+ El P 1 3 , {po R/R SPIKE d5 .93 29:93 ,; l►. �• °)' G, 191,14 � 7-4 � NIP Q 3 AREA = 7.351 ACRES „ IZ' Walnut r v! y. kis WADE L GROCE A o D5.56 PG.422 + a 1 W . , 4 Od HM +'0+-0 Z ' ,y + NONE c NIF? o.�" •r G F E r< E Q 131. +� O O v 3705 \ NIP .., p `J � o �--RR P �+ �i R/R / SPIKE \ A-B = S 64° 34 34 W IE547 N m L. SPIKE 0; 8-C = S 650 17' 2C{' W 11356 R/R WADE I. GROCE •— C- D = S 67° 03' 30" W 60.32 (. SP1 K E D- E - S 700 Or� 20" W 6951 3RADLEY B. MOORE E- F c S 720 26' 51" W 71.78 F-G = S 750 16' 08" W 67.44 D6. 15 7 PG.664 G- H = S 79°24' 22" W 56.68 JERRY R. WEBB H - 1 = S 830 22' 45" W 115.71 D.B. 154 PG. 390 1 - J = S 830 16' 03" W 211.59 J - K = S 840 05' 56" W 134.00 TOTAL K- L - S 840 41' 27" W 228.15 TOTAL L- M - S 820 47' 47" W 107.09 M- N - S 790 02' 13" W 40.36 0- P = S'740 53' 10"' W 394.99 TOTAL P-0 = S 740 40' 31" W 211.66 Q-R = S 740 23' 59" W 205.38 TOTAL R-S - S 740 47' 40" W 101.58 S-T - S 750 56' 16" W 118.55 T- U = S 77° 33' 45" W 57.10 U-V = S 770 28' 37" W 134.20 V- W ° S 80" 27' 50" W 82.48 W-X = S 830 00' 06" W 126.33 X- Y = S no 30' 09" W 124.79 EIP = EXISTING IRON PIN SURVEY FOR NIP = NEW IRON PIN PIP = PLACED IRON PIN WADE I. GROCE * UNMARKED POINTS IN CENTER 1, GRA+.DY L TUTTEROW. CERT&Y THAT UNDER OF ROAD -OR- CENTER OF CREEK. SCALE: I" c 200' APPROVED BY DRAWN BY AN.' SUPE'RV:S'ON.THIS 1AA;P RLVISED 10-24-91 REVISED 10-15-91 'A� -"'� " 1 8�` t!! ti.?U F;C v SURVEY DATE: 1 - 23-91 GRADY L. TUTTEROW D. WATKINS (ELKINS) REVISED 12-30-91 REVISED 9-11- 91 F v41�r_ I:Y TU;TEROW 5URVLYiN-13 CC;. REVISED 1/4/93 REVISED 4-14-92 REVISED 2-14-92 REVISED 6-5 - 91 BEING 112.357 ACRES, A PORTION OF WADE I. GROCE PROPERTY i (D8: 56 PG. 420) LYING IN THE FARMINGTON TOWNSHIP, LitaLt, Rsrviqs:n Atmvwx.REVISED /14/94 REVISED 6-2-92 .7lITTER;.W SURVEYIflo Co. DAVIE COUNTY, NORTH CAROLINA REVISED 9/14/94 REVISED 6-22-93 ROUTE 6 BOX 129 F I DRAWING NUMBER DAWIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990005555 Tax PIN/EH#: 5831-98-3825 Billed To: James Clark Subdivision Info: Reference Name: Location/Address: Pudding Ridge Road-27028 Proposed Facility: Residence Property Size: 6.37 Acers Date Evaluated: 0 d)/.o Water Supply: On-Site Well M Community Public Evaluation By: Auger Boring Pit - Cut FACTORS 1 . ._2... <.3 4 5 6 7 Landscape position ,Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group4 Consistence Structure Mineralogy HORIZON III DEPTH _Texture,group rou Consistence Structure p MineralogyJ; HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE157 CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: 144 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 Wei 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) T TAR T fT Q-tPrfl9 �rrnetn�no.wtn ....1 l.te�tc.1 — -•-- --." . APP OR SITE EVALUATION/IMPROVEMENT PqWT & ATC Davie County Environmental Health ,q APR 2 3 2012 P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 �Y! • :­01� q (336)753-6780/Fax(336)753-1680 Application For. ❑ Site Evaluation/Improvement Permit ❑Authorization To Construct(ATC) Both"`;g Type of Application: -Aew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT'**THIS APPLICAPON CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION-BULLETIN for instructions. -APPIJCANT INFORMATTON -` IA161 i�- Name / /lGt Sctierer' - Contact Personn/6,�/ Address O O'F/oao. Home Phone City/State/ZIP Business Phone 336'X162 26UZ Email—. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged / 2 NOTE: A"survey plat.or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name` �affi� SaMS Phone Number Owner's Address Sqb Cctnlinc;LAxle, City/State/Zip 4bAb,%V1JJt JJC Z-JOZ Property Address o&k ` Lake,2 City. Moctrbllk Lot Size__8,21, Tax PIN# 940000001(0 Subdivision Name(if applicable Section/Lot# D' ctions To Site: 2 'A 6 , I e answer.to any of the following quest ons is"If&',supporting documentation must be attached: Are there any existing wastewater systems on the site? Yes :/No Does the site contain jurisdictional wetlands? Yes ✓No Are there any easements or right-of-ways on the site? Yes /No • � oN f0�Is the site subject to approval b another public agency? —Yes �No .: Will wastewater other than domestic sewage be generated? Yes ✓No TF RESIDENCE FTIJ,nT IT THF.BOX RFI,0W #People 2 #Bedrooms 3 #Bathrooms 2- Garden Tub/Whirlpool ❑Yes Ao Basement:. Yes. A0 Basement Plumbing: ❑Yes AO TF NON-RESMENCE FTIJ,OUT THE Box13ELOW 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 ❑Alternative ❑Other Water Supply Type: O"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 ✓No 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 underst pxyhat I am responsible for the proper identification and labeling of property lines and comers and locating and flagging ors phonacXacili ocation,proposed well location and the location of any other amenities. Site Revisit Charge Property owner's or owne ' egal representative signature Date(s): V-43-/L- Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# J D Revised 11/06 Invoice# _ l Y ; PIPE ' + ir CD ' POND a) vu1 ��! { m fib? l r� -j I F iC�ZV-- Cxl: tilde 3/4- SOLID -�; EXsrG.. N 2 TRACTNO, ,3 `q�q . C14 2; ass . C-5 .4 8.919 Acres dmd f : INCLUDES AREA WITHIN FLIGHT RF WAY' EYISl OG 0497 Acres t Right Cif Way 21 .� 7/2; PIPE to d� OLD t10Li 1J�� :HED PIPS N-•v f i w WliP! cS O 0 � b r, t 60,00' o- IOU . {t 08'12'59 DB 41 NEW 1?0t1 SET S UTILITY LINE __ ..., C �, EYlsrnvc t!r n"p i/r PIPE NEw IRON sir GoMAPS Davie County NC Public Access 14 WATERSHED STRUCTURES of -- WATER—BODIES COUNTY—BOUNDARY STREETS rn RAILROAD CENTERLINE PARCELS CITY LIMITS BERMUDA RUN x COOLEEMEE r �'• DAVIE COUNTY hSOCKSVILLE i' nccounties c DAVIE F7 <all other values> lr °i , Tuesday,April 24 2012 ` Y o 2089 ***WARNING:THIS IS NOT A SURVEY!*** This map is prepared for the inventory of real property found within this jurisdiction,and is compiled from recorded deeds,plats,and other public records and data.Users of this map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on this map.The County and mapping company assume no legal responsibility for the information contained on this map. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990005867 Tax PIN/EH#: B400000016 Billed To: Nina Scherer Subdivision Info: Reference Name: :Location/Address: Bonkin Lake Rd.=27028 Proposed Facility: Residence Property Size: 8.92 Acres Date Evaluated: 2 O Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit_ Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH -t Texture group t_ Consistence Structure 4.��- t'�►+r.,to Mineralogy1 - , HORIZON II DEPTH 7 p737Z7 1°n-71 r Texture group :« Consistence Structure ' r - till ito 1 cP Mineralogy �;- HORIZON III DEPTH Texture group Consistence Structure !a°'an .:•_fit Mineralogy HORIZON IV DEPTH Texture group Consistence _ Structure - — - - >. •,.; • ralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: � EVALUATION BY- LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: ` 1� YJl _ 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 �'�41St 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 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) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O. Box 848/210 Hospital Street Courier#09-40-06 Mocksville,NC 27028 Phone#:(336)753-6780 Fax#:(336)753-168.0 June 21,2012 Bill Sams 540 Carolina Ave. Yadkinville,NC 27055 Bonkin lake rd Parcel id#-B400000016 Dear Mr. Sams, As requested,Andrew Daywalt,RS;Environmental Health Specialist with this office on {May 218`of 2012),evaluated the above-referenced property at the site designated on the plat/site plan that accompanied your improvement permit application(s). The evaluation was done in accordance with the laws and rules governing wastewater systems in North Carolina General Statute 130A-333 and related statutes and Title 15A, Subchapter 18A,of the North Carolina Administrative Code,Rule.1900 and related rules. Based on the criteria set out in 15A, Subchapter 18A,of the North Carolina Administrative Code,Rules .1940 through.1948,the evaluation indicated that the site is UNSUITABLE for a ground absorption sewage system. Therefore,your request for an improvement permit is DENIED. A copy of the site evaluation is enclosed. The site is unsuitable based on the following: Rule.1941 soil characteristics 3.(b) Rule.1942 soil wetness These severe soil or site limitations could cause premature system failure,leading to the discharge of untreated sewage on the ground surface,in surface waters,directly into ground water or inside your structure. The site evaluation included consideration of possible site modifications,and modified, innovative or alternative systems. However,this office has determined that none of the above options will overcome the severe conditions on this site. A possible option might be a system designed to dispose of sewage to another area of suitable soil or off-site to additional property. For the reasons set out above,the property is currently classified UNSUITABLE,and an improvement permit shall not be issued for this site in accordance with Rule.1948(c).However, the site classified as UNSUITABLE may be reclassified as PROVIONALLY SUITABLE if written documentation is provided that meets the requirements of Rule.1948(d). A copy of this rule is enclosed. You may hire a consultant to assist.you if you wish to try to develop a plan under which your site could be reclassified as PROVISIONALLY SUITABLE. LAWS AND RULES FOR SEWAGE TREATMENT AND DISPOSAL SYSTEMS 15A NCAC 18A.1900 Rule .1948 .1948 SITE CLASSIFICATION (a) Sites classified as SUITABLE may be utilized for a ground absorption sewage treatment and disposal system consistent with these Rules. A suitable classification generally indicates soil and site conditions favorable for the operation of a ground absorption sewage treatment and disposal system or have slight limitations that are readily overcome by proper design and installation. (b) Sites classified as PROVISIONALLY SUITABLE may be utilized for a ground absorption sewage treatment and disposal system consistent with these Rules but have moderate limitations. Sites classified Provisionally Suitable require some modifications and careful planning,design,and installation in order for a ground absorption sewage treatment and disposal system to function satisfactorily. (c) Sites classified UNSUITABLE have severe limitations for the installation and use of a properly functioning ground absorption sewage treatment and disposal system. An improvement permit shall not be.issued for a site which is classified as UNSUITABLE. However,where a site is UNSUITABLE,it may be reclassified PROVISIONALLY SUITABLE if a special investigation indicates that a modified or alternative system can be installed in accordance with Rules.1956 or.1957 or this Section. (d) A site classified as UNSUITABLE may be used for a ground absorption sewage treatment and disposal system specifically identified in Rules .1955, .1956 or.1957 of this Section or a system approved under Rule.1969 if written documentation,including engineering, hydrogeologic,geologic or soil studies,indicates to the local health department that the proposed system can be expected to function satisfactorily. Such sites shall be reclassified as PROVISIONALLY SUITABLE if the local health department determines that the substantiating data indicate that: (1) aground absorption system can be installed so that the effluent will be non-pathogenic, non-infectious,non-toxic,and non-hazardous; (2) the effluent will not contaminate groundwater or surface water;and (3) the effluent will not be exposed on the ground surface or be discharged to surface waters where it could come in contact with people,animals,or vectors. The State shall review the substantiating data if requested.by the local health department. HistoryNote: Authority G.S. 130A-335(e); Eff.July 1 1982 Amended Eff.April 1, 1993;January 1, 1990. y You have a right to an informal review of this decision. You may request an informal review by the environmental health supervisor with this office. You may also request an informal review by the N.C.Department of Environment and Natural Resources regional soil specialist. A request for informal review must be made in writing to the Davie County Health Department, Environmental Health Section. You also have a right to a formal appeal of this decision. To pursue a formal appeal,you must file a petition for a contested case hearing with the Office of Administrative Hearings,6714 Mail Center,and Raleigh,N.C.27699-6714. To get a copy of a petition form,you may write the Office of Administrative Hearings or call the office at(919)431-3000 or from the OAH web site at www.ncoah.com/forms. The petition for a contested case hearing must be filed in accordance with the provision of North Carolina General Statutes 130A-24 and 150-B-23 and all other applicable provisions of Chapter 150B. N.C. General Statute 130A-335 (g)provides that your hearing would be held in the county where your property is located. Please note: If you wish to pursue a formal appeal,you must file the petition form with the Office of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER. The date of this letter is {DATE). Meeting the 30 day deadline is critical to your right to a formal appeal. Beginning a formal appeal within 30 days will not interfere with any informal review that you might request.-,Do not wait for the outcome of any,informal review if you wish to file a formal appeal. If you file a petition for a contested case hearing.with the Office of Administrative Hearings, you are required by law(N.C. General Statute 150B-23)to send a copy of your petition to the North Carolina Department of Environment and Natural Resources. Send the copy to: Office of General Counsel,N.C.Department of Environment and Natural Resources, 1601 Mail Service Center,Raleigh,N.C.27699-1601. Do NOT send the copy of the petition to Davie County Health Department. Sending a copy of your petition to Davie County Health Department will NOT satisfy the legal requirements in N.C. General Statute 15OB-23 that you send a copy to the Office of General Counsel,NCDENR. Please call or write this office if you have any questions or need any additional assistance,as follows: Telephone number: (336)753-6780 Davie County Health Department Environmental Health Section P.O.Box 848 Mocksville,NC 27028 Sincerely, Andrew Daywalt Environmental Health Specialist Enclosure(s): Soil-Site Report Rule .1948 Invoice