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190 Redwood Dr . . , • , , � DAVIE COUNTY HEALTH DEPARTMENT �"!yq/e �� � ' . Environmental Health Section P.O.Boa 848/210 Hospital Street ' Mocksville,NC 27028 (33G)751-8760 , Account #: 990003718 Tax PIN/EH#: 5747-32-2930 Billed To: Paula O'Rorke Subdivision Info: Reference Name: Location/Address: Redwood Drive-27028 Proposed Faciliry Residence Property Size: 10+acres ' ATC Number: 4185 As stated in 15A NCAC 18A.19$�� accepted Systems may also be us AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION � **NOTE** This Authorization for Wastewater System Construction MUST BE ISSLJED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 bf G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATE S IS V F PERIOD OF FIVE YEARS. � Q Environmental Health Specialist's Signature ' Date: U� � • CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis ertifi te ofCompletion shall indicate the system described on ImprovemendOperation Permit has been installed in ompl ance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"b t sha in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. � ` �l� � � i I� ���TU� •� `�ti �'�'A ��'g �' N� u� . , .d `7QrJ�c � �,�.�`si� R'"-� � - � " �i-z�- _ �z�� � � - _ , .}� �o_z_ Septic System Installed By: �� Environmental Health SpecialisYs Signature: � Date: �2- Zg O• DCHD OS/99(Revised) , " . , DAVIE COUNTY HEALTH DEPARTMENT z,'�-o � Environmental Heaith Section , • . P.o.Boz 848/210 Hospital Street �/�-�lo � • Mocksville,NC 27028 '� (336)75]-87G0 IMPROVEMENT/OPERATION PERMIT Account #: 990003718 ,:�x PIN/EH#: 5747-32-2930 • Billed To: Paula O'Rorke - Subdivision Info: �4� Reference Name: � Location/Address: Redwood Drive-27028 Proposed Facility Residence Property Size: 10+acres ATC Number: 4185 **NOTE**This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AiTTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type �Ol7S� #People � #Bedrooms 3 #Baths �•� Dishwasher: � Garbage Disposal: ❑ Washing Machine: � Basement w/Plumbing: ❑ Basement/No Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: � Lot Size �� L�CQ�%SType Water Supply W��— Design Wastewater Flow(GPD) 3� Site: New� Repair❑ System Specifications: Tank Size(fAOGAL. Pump Tank ��"AL. Trench Widt�i��n k1�?&p��.i�§�'���l`�r �ate � ���g Jn� � accopted Systems may also be use Other: Required Site Modifications/Conditions: �r.TsTo.t,.�. D•� C�TOu`l�_ �-�P ��o� �5��`'�J+. Y—i=�=� ��1 �"^��� '�z�EIQ . IMPROVE ENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6"BELOW FINISHED RADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system betw en 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-87G0.**** y � � �S� '�Mo►x T��.���H �,� � P� ���� s � � � � � O �'��� a.$• � � �" � � Z�� p �' � lP� t'_ Environmental Health Specialist's ature: ate: l�� DCHD OS/99(Revised) . �Z�i:�� �,P , � , c • � • ' : / n (� (�� V • � APYL[Cn710N FOR SITE EVALUATION lhft'Ii0VCM11CNT PCRht lFr� v � � . , Davie County Health Department - Environmenta/Hea/t/i Section � P.O. Box 848/210 Hospital Street AUG 2 6 20� Mocksville, NC 27028 � • (336)751-8760 pyy����� A ***Il'tPORTANT'*** THIS APPLICATION CANNOT BE PROCESSED UNL�SS ALL THE RLQ , INFOR2•I1ITION IS PROVID�D. Refer to the INFORhiATION BULLETIN for inatructionu. r /� 1. Namo Lo ba Dilled C_� Contact Peraon � Mailing Addresa � `` Iiomo Phone y I � ,`7��J(J�`� City/Stato/ZIP I Y I�C-�JV , I C �� ��lJ�� BusinQsa Phone �.. )� " Vq`7 —���� 2. Namo on Permit/I►TC if Difforent than Abovo Mailing Address City/State/Zip 3. Applicaeion For: ❑ Site �valuation ��mprovement Permit/ATC ❑ I3oth 4. Sysl•em to servico: �IiouBa ❑ 22obi1a Homo ❑ I3uainess ❑ Induutry ❑ Other 5. Typo oyatem reque�tod: � Convontional ❑ convantional modified ❑ innovativo p ac Cep ted 5. If Rnaidence: I� People � � nedroom3 � _ � Bathrooms a t s �ia2iwa3har ❑Garbago Dinpo�al �7ashing 24achina �Dasement/Plun�ing ❑Bauement/210 Plumbing • / . 7. If Buoinesa/Znduatry /Othar: verify type # Peoplo N Sinkn S Commodoa R �howora # Urinals IE WaL•or Coolors IF FOODSERVICE: �� Seatu Ea�imated Water Usaga (galions por day) 8. Typo of water aupply:. ❑ CounCy/City �,Well ❑ COmmunity / •� 9. no you anticipato additions or exp:msions of tl�c facility tliis systciu is iiitcndcd to scrvc? ❑ Ycs �tYo If y�cs,tit�1�1t typc? ***IAIPORT'fINT'"�**CLIL:IYTS hcUST COdlYLCTL•TII� REQUIItED PROPGRTY INrOR11�IATlO1Y RI:QUGSTLD BCLON. �itl�cr a PI.AT or SITC PLAN MU.ST BESUIIhfITTED bv tl�c clicnt �vitli TI[IS APPLICATJON. I'roperty�Dimcnsions: I O� ��-�5 1VRITC DIRGC'I'IONS(from 11•locltsvilic)to PKOP['sKTY:.' T�x orr,��rrN: �� 5�� � -3 a � ��t 30 ��� Sc)C�� �v 1�a1/�rr1�Y� Property Address: Ro�d Namc �'e��� v� �--� I '_ v� �G�G� m�n-- c;cyiz,n �YI a c�v i 1 le a7o,�$� j 5� ��P7� i S 7�'1C�/� ��W� , If in a Subditi�ision providc information,as follotivr. (il�q Namc: �✓'.P_P_T Q�C)� ��D� i/� i U�� Scction: Blocic: Lot: Datc tiornc corncrs!]aggcd: ����� � � TGis is to ccrtify il�at tl�c informatioii providcd is coi•rcct to tl�c best of c»y I:notivlcdgc. I undcrstand tli�t any peri2iil(s) issucd I�crcaftcr are subjcct to suspcnsion or rcvocation,if thc sitc plans or intcndcd usc cl�augc,or iC tl�c informalion submittcd in t(iis application is falsiCcd or clianged. I,also, ttnrlcrstrtnrl llrat!nn1 res�ousiGlc for nll cl�nrgcs iucurrcr!froui t/ris applicn�io�r. I,I�crcby,givc consc��t to tl�c Autl�orizcd Rcpresctitati�•c of tlu.B,a��}c Couut� � calllt Dcpartu�cnt to cnicr upon abovc dcscribcd pi•operty locatcd in Davic Cowity and o�vncd by -f��lc` O �oYLo , to conduct all testing procedures as»ecessary to determiue tlie sit ility. DAT� �� � �S SIGNAI'URL: ��✓`-Q��� (�� , G c - TIiIS AI�A A1AY BE US�D FOR DRAWING YOUIt SITL PLAN(Includc all of tlic folloiving: Lsisling and proposcd property lines and dimensions, structures, setbacks, and septic locations). � n�� j�� _,� �� � �+ t f G�$p Sitc ltcvisit Chargc �' . Datc(s): �� G/G� � � �( . Clicut NotiGcatioii Datc: � ` �I-IS: C� !z � � , � Sign givcn � l ,c� :� Account No. � �`� �' ,,,Q�,,,� ,�- . ��,� _ Reviscd DCIiD(OS/03 ' � � Lrvoicc No. � � �,•�� / �- � / .`� -- - . � . � � � Ga � C .. ;_� . �, p • � API'UCATION FOIi 817E L•V�ILUA�lON/Ih1PIiUVI:h1GVI'I'L•II11 ' -C , � Davie County Health Department �AN 1 5 2�04 E�yironmenfa/Hea/th Section P.O. IIox 84II/210 Ho�pital Street rrock3vi11e, NC 2702II EN�RONMENTALHFJIl.TH DAVIE COUMY _ (336)751-II760 � ***ItSPORTANT*** TIiIS APPLICATION C1INNOT DE PROC�SS1?D UIdLI;SS ALL TIIL R�QUIItLll . ' . .I INFORMATION IS PROVID�D. Ret•or L-o tho INI'ORMATTON DULL�TIN tor in�LrucL•ion�. 1. Name to be Dilled � �]y'���'� ContacL- Per�on ______..__. t•Sailing Address ���✓ ` S Itd:n-c �honc ae�a ___`�.C�� _... City/Statc/ZIP � L llunincaa Yl��iic '] � �. /..._.,. —LL.<-�•-�- 2. ltamo on Pcrmit/ATC if DiL-ferent than 1lbove � Mailing 1lddress City/3tatc/Zip 3. Application For: �Site �valuation� � ❑ ImprovemenL- PenniC/ATC ! IJ IloL-1� 4. System to Service: �t Hou3e ❑ t•iobile Home ❑ IIu�ine�s ❑ Indu;,L'ry ❑ OL'licr ____ ___ ,;, S. Type aystem requested: t� Conventional ❑ conventional modiiicd ❑ iunovaL•ivc G. If Residencc: 11 Pcoplc �_ il IIcdroom� _�_. I! 1laClirooiu:� � _ C7Diahwaaher ❑Garbage Dispo�al i�Washing Diachino ❑Da�e:nenL-/Plwnbing "�Ua�emenC/t7o Pluwbin� 7. If Du�inea�/Indu3tiy /Other: verify L•ype 11 i�cople If :,'iul:� _._____.___ 8 Commodca 11 Showcr� �! Urinalo 1{ WaCcr Coolur� IF FOODS�RVICE: �� SeaLa �atimated WaLer U�agc (�ailon� per �lay) V_^ ..__ . e. Ty�o oi water 3upply: 'CJ County/City , ❑ Well ❑ COmnluniL"}• • ' 9. Do you anticipatc additionn or CXI):lI1SlO11S Ur 111C r1l'111Iy fI11S S)'SlClll 1S 111�CI1(�C(� lU Sl`1'1'C�: ❑1�l'S �'PC�� jj)'CS�l�'�l�<<)'i)C� ' ***lAIPOIZTi1N7�**CLiLNTS�IIUSTCOAI!'LBTL•TE1G 1t1:QUlItGU PKOI'LR'1'Y 1NI�O1tBIA7'IpN ltt:(lUl'sS'1'I;U _I I3CLOIV. Iii(licr a PLA7'or SIT�PLr\N r1fUSTl1L•SUI3�1II77'ED by tl�c clicnt n�ilh'1'1IIS�1PPLIGl7'ION. 1't'operty'Dimcnsiu��s: ��. �py ,� llrlt('TL ll11Zl:C'1'IU�S(i'ruiu Blod:s��ilic) lu 1'IZUI'lilc'1'1': t•:►x orr►«rtN: � 574�7- 32 � z 9'3v Cr�C��s -�c,�,r�v 1��- c��_ � Property Address: Road Na►»�P��� o o .� �/e- � ` � , � �lJ�}��� � ���y,Z►n mc� � ,�1��ra?8 -����,�P��-��N r�� � If lfl a SUli(I1Y151071 fll'OV!(IC lllrUi'7211L1011�1S fUIIU}yS: �'aII1C: _ Scctiou: Bloclt: Lot: Datc Iiomc cocircrs IIabbcd: 1" ,���� Tl�is is tu ccrtify that tl�c iiifoi•matioii providcd is corrcct to thc bcst of iiiy lc�iotivlcdga ! uiidcrs(aiid lli:i(:ii�y pc►•iiiil(s) issucd I�crcaftcr are subjcct to suspcnsion or rcvocatioli,if tlic sitc plans or ii�tcudcd usc clianbc,or if tl�c inforivation subn�it(cd in ll�is:ipplication is falsiiicd or cl�angcd. I,�lso,ru�dcrslan�111rn!I«�n rc�/�unsiLlc jui•al!cha�3�cs iircrn•�•c•r!fr��ui • I/ris�rpplicaliv�r. I,I�crcb�•,bi�•c coiiscnt to tlic Autt�orizcd Rcpresculativc of tlic ll:ivic Cu�iu�,j•Ilc:�ltli 1)cp:�r(u�ciit tu cntcr t�pon ab��•c dcscribcd properly lucalcd iii llavic County arid oti�•iicd b����p�(`��.����e ,�` lo cunduct:ill tcstiiig proccdw•cs as ncccss:iry tu dctcru�inc fl�c sifc suitabilil��. DA7'L; l— �c�3 O�1 SIGNATURL' , TIiIS AIt�A D7AY 13E USLD FOR DRAtiYING YOUR SIT�PLAN(Icicludc all uf Uic fullosviiib;.Lxisliiib:uiQ pruposccl � property lincs atid dimciisions, structures, sctbaclts, and scptic loc:ttions). . - � " • , Sifc 1Lcti�isil Chai��;c ' ll�itc(s): -- — . • Clicnl Nolil'ic:itio�i ll:itc: � �IIS: Sign gi��cn � Accouut 1�'0.�.�-� � Rcviscd DCI�In(OS/03 ' Livoicc No. ��✓ ,, � �� , . , DAVIE COUNTY HEALTH DEPARTMENT � � ' • • Environmental Health Section • ` Soil/Site Evaluation APPLIC�ANT INFORMATION PROPERTY INFORMATION � . Account #: 990003031 Tax PIN/EH#: 5747-32-2930 Billed To: Johnny Sheets Subdivision Info: Reference Name: Location/Address: Redwood Drive-2702 Proposed Facility: Residence Property Size: 10.64 ascres Date Evaluated: 1� v Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca osition L � Slo % �Za ' 'HORIZON I DEPTH �W (O � O- Texture rou � Consistence � $SS`r' SS S -f �' � Structure CSZ Mineralo �; I� ��1 -� HORIZON II DEPTH - �- � Texture rou G C G Consistence ; - .S Structure c SQa1< < - Mineralo 1: � �� :1 1: � HORIZON III DEPTH -�t � — p " -4 Texture rou ' �tS L�iS ° G�. Consistence ; -� "�S Structure 1c.. Mineralo ' 1 1'• t'• � HORIZON IV DEPTH ' Texture rou ;Consistence Structure _., � Mineralo - SOIL WETNESS �"" RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION y LONG-TERM ACCEPTANCE RATE . -E�.'�� 0:3-C''y� � � /' SITE CLASSIFICATION: � � EVALUATION BY: ���1 � _ / - LONG-TERM ACCEPTANCE RATE: �' � �'� OTHER(S)PRESENT: ' REMARKS: A�l ,�t�� �"�-,Crvqerz 3&"�- ,�. A �2 l�.Tz��a4"f � q�y �1�.� `1 t,~� � ��-lc-�2 ��t��c� 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 i SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm , Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky Y-�� NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic � ,� , tructure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic � Mineraloev 1:1,2:1,Mixed 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-gaUday/ft2 DCHD OS/99(Revised) ■■�■���■�l���■����������■���■�■��■�■■■���■�■��■�����■����■�■ ■���■ ■■��������������■��■�������\■����■��■�■����■��■����������������■�■ ■�■��0�������■�������\■��■��■�■����■��■��■�����������■��������■�■ ■����■��������■��■����������■��■ ■��■��■��■���■��■�����■����■��■■ ■�■������■�■■�������■�■���■������■�■�■�■■\�■������■�����■����■■��■ ■����■���■�����■��■�■��■��■■�■�■���■�����■������■�■■����■����■���■ ■����������������������������������������������������������������■ ■������i■■��■�������■�■■����■�■��■■�■■�■■■�■��■■��■�■■��������■��■ ■�■����■���■�■�■�■��■��■��■���■��■■■���■■�■■■�■■��■�■��■���������■ ■����■�■■����■����■�■��■������■���■■�������■����■��o�■■����■s���■■ ■�����������■��■��■���������������■■■���■������■�����■�■��������■ ■�����■�����■���■��■�■��■������■ ■�■o■��■���■��■��■■����■�������■ 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Environmental Health Section PO Box 848/210 Hospital Street Mocksville,NC 27028 Phone: (336)751-8760 /Fax: (336)751-8786 February 12, 2004 Johnny Sheets 2238 HWY 6015 Mocksville,NC 27028 Re: Site Evaluation- 10.64 Acre TractlRedwood Dr Tax PIN#: 5747-32-2930 Dear Client(s): As requested, a representative from this office visited the above site February 11, 2004 to perform a site evaluation. Based on the inforrnation provided on the Application for Site Evaluation and after the evaluation was completed,the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. It should be noted that house location and complex topography may necessitate the use of a pump station for the initial or repair system installation. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct,the appropriate application must be completed and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, feel free to contact this office at 751-8760. Sincerely, JeffG. Bea amp, R.S. Environmental Health Section Enc(s) � , . � t - � ' � DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section PO Box 848/210 Hospital Street . Mocksville, NC 27028 a � Phone: (336)751-8760 /Fax: (336)751-8786 ,.V.�.,. �. , �. .-- � September 3, 2003 Roger Buzby PO Box 30117 Winston-Salem,NC 27130 Re: Site Evaluation- 10.64 Acre Tract/Redwood Drive Tax PIN#: 5747-32-2930 ' � Dear Mr. Buzby: . . As requested,a representative from this office visited the above site August 27 and September 2, 2003 to perform a site evaluation. Based on the information provided � on the Application for Site Evaluation and after the evaluation was completed,the site was found to be provisionally suitable for the installation of an oversized, modified on- site sewage,disposal system.� �- Due to soiUsite conditions a french drain or other interceptor drain will be required. Sizing rate of the system is approximately 1601inear feet of tail line per bedroom. Additionally, a pump station may be required based on topography andlor house location. ti Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct,the appropriate application must be completed and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, feel free to contact this office at 751-8760. Sincerely, _ �-� � <E � - ..ci ! Jeff G. Beauc amp, R.S. 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�q �«� ILu" dow �swr� Q�y� �o w!ooa v�u!}»� e-Z U0"�0$ Pu,/,� \ ro� 6ui�nS P�ol �S �Q PoZ!�43� �I� W3iwwd ai NOIS.Iaad S32l�d QOOMH1flOS '� toet as Ra �wco�o � �up �u� �1 l3 „t/�� �1 //�� / a aoa�„o�o,N,o puo Auu�p �o dou, .i� � !3o�Wt D�+o �4i -, � �- �/, n«Lou (Q�oewd a4� �1 Po4awny�o quawnxp ----- -� � � ' j' $ P�.� IIoN Mb�£►.Ll.6�N .LZ'ltl \ / � � � / '•3aP alµl �o co poyciwn� � •ya�oae �I�3 a3oin�o puo IR+{ o �Q P�o1��lD ��S � ' ;uau�anod -/+.�Zi M�� �!Iq�d ��9 oQ �Cow 7�41 c��o� �(uo 03 }oafqns a �Cotins ry41 '�+nc �-------� �.�� Q Do} a�4i lp� !i!�l�� ��14 �u JIOPul �� •�}du�ea�d � J(IbJD Ui �AD /CDW O M 10 YOI %O Uf10 /O UMO o�C,' P��a � � '}rno� W �}»I� '�paoQ jo ,.�.�e.a ay} jo ao�o •:�� w p�ooai — �/� a r�2.,cQ p o o rrt.p a� �o �o�ddo �tow �woc �y; so •�Cuo +} 'cluawcpaso puo c � �w — � • '¢�CoM-lo-i46u 'cwawocoa po ol �afqne c� iCyadwd cly� _ , . � � - �.��. �' �,�, �� ;.�LON �M ' � /.' _.a�ciX�� , . � : . u, . , . . . �,.e.. .. , ,�x,. .�. . . .. .a��� � . � _ . _ . . . � . ..._�. � : . . , Davie County, NC Tax Parcel Report Thursday, October 6, 2016 WARNIAU: THIS 1S 1VUT A SURVEY Parcel Information Parcel Number: K50000000401 Township: Mocksville NCPIN Number: 5747322930 Municipality: Account Number: 82523861 Census Tract: 37059-805 Listed Owner 1: O'RORKE PAULA Voting Precinct: SOUTH MOCKSVILLE Mailing Address 1: 190 REDWOOD DRIVE Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27028-5434 Voluntary Ag. District: No Legal Description: 11.208 AC DEADMON RD Fire Response District: JERUSALEM Assessed Acreage: 11.19 Elementary School Zone: CORNATZER Deed Date: 7/2005 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 006170850 Soil Types: GnB2,PcC2,RnD Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 141490.00 Outbuilding 8r Extra Freatures Value: 0.00 Land Value: 76440.00 Total Market Value: 217930.00 Total Assessed Value: 217930.00 101 All data Is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the Davie County, Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to NC or arising out of the use or Inability to use the GIS data provided by this website. APPLICATION f011 SITE EVALUATION/1hIP11OVUIENT PE111111-I' ' Davie County Health Department EaYironmenta/Hee/t/� Section P.O. Box 848/210 Hospital Street blocksville, NC 27028 (336)751-8760 D t AAUG I 2003 �q 1'1�C0� yl yf ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE RLQUIlaa INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for insLrucLion:1. 1. name Lo be Billed `D f� i '! h-/ �Y CorrLacL Person Mailing Address 1'�0,P%� �DI 17 llanc LI� 7 City/SLate/ZIP �ii 1'vr 5 i 7fY1 r� �C d` lVl� Business Plrorre 2. Name on PeriniL/ATC if Different than Above Mailing Address 3. Application For: ❑ Site Evaluation 4. S}stem to Service: ;� house erg City/SLaLe/Zip ❑ Improvement- Permit/ATC \�IIoL-11 ❑ Mobile Home ❑ Businenn ❑ Industry ❑ Other S. Type system requested:�Conventional []'Conventional modified ❑ innovaLi.vc 6. If Residence: 11 People _ it Bedrooms _ 11 Batllroorw� SDiehwasher yaGarbage Disposal Pilashing Machine RBasemeht/Plumbing ❑Ilacemerut/llo I1l11uibi.uu 7. If Business/Industry /Other: verify type It - People 8 Commodes 0 Showers ,I Urinals G VlaLer Cool ni IF FOODSERVICE: 11 Scats Estimated Water Usage (gallons per day) 8. Type of water supply: 14 County/City ❑ Well ❑ CouununiLy 9. Do you anticipate additions or exp:ulsious of the facility this systcul is iuteudcd to serve? ❑ Yes lXNo ,lf ycs, what type? ' ***It111,0RT11tYT*** CL1E TSd1USTC0M1'L 'TE THE REQUIRED PROMRTY INFORMATION 1t1.Q1JJ,1'S 'I;U-- 13EL0\V. Eitlicr a PLAT o ITE PLAN h1UST ESU1h11ITlED by the client witll'11115 APJ'LICA'1'ION. Property Dimcllsious: lax Office PIN: 11 5 �q •7 52 Property Address: Road Name 4 J ti✓oAd 01- City/zip 6 c &S v--;Le4 4 Lop If in a Subdivision provide infornlatioll, as follows: WRITE DIKGCTIONS (1'ruin Alocksville) lu 1'It011'V1%-J 1': r_ � -�a Ke 601 S IZ/ Ga1�F.<rl icd � ,r rx '+A4 P-nf-U �a.cclia�n feel � Z'�aC � �d �/ v�•+� rev �� ��.vr Name: 01, fkCPfS S OIi �• yet" �GfC�z 1icu5rt !Jh �K�_c�o 5-e c Section: Block:+ Lot: Date home corners 11ab6Lc1: This is to certify that the hiformatiou provided is correct to the best of my knowledge. I understmid that any peruli((s) issued hereafter arc subject to suspension or revocation, if the site plans or intended use cll:ulbe, or if Ute iufornlaliou subulitted in this application is falsified or changed. 1, also, tulderstaud that 1 aur responsible for all chart; cs incur -d li-om this application. I, hereby, give couscat to (Ile Authorized Represeutalive of the llavic CO 11111)' 1IcalIII 1)ep:1 -luu•1 II to elite• upon above described property located in llavic County :uld owucd by to conduct all testing procedures as ucccssary to detel•Illille the site Suitability. DATE g ,149 3 SIGNATURE TRIS AREA MAY BE USED FOR DRANYING YOUR SITE PLAN (Include all of the following: Existing; and proposed properly lines and dimensions, structures, setbacks, and septic locations). —fl �A, & -4- Sign given / Revised DCI (05103 l e, CGCIti? c s� 0 /2-? Site Revisit Charl,c Date(s): Clicnt Notification Dale: _ E1 -IS -. Account No. -2--- Invoice No. 3 $o/ 8139 2 ?07 0 8008 M N ti 5666 5383 0P� "30 1395 907N -----► 1632 1 0 2642 0 3651 " m 9237 90 59 0601 ; t o"---' 7597 2 200 8505 ,,Q05 N'V 0 +7431 m ' 2 0 b o ; (1.33A)—J 6486 _ r a1 3 1 1GL SFV 5475 273 285 Z! 0 0 0430to 0 0 2411 81 344 ' 100 ; 208 ; 100 { , 1.00A 8145 ' 5162 256 0 0 9191 206 104 1 104 45.58 10OWzo0 612 788 86 w 4Mo" )9.40 ' ; rn ; • 49' a ' irtA1 • 5333 (2.105A) 4684 31 3 99 202 111 77 4973 Od'0 4872 4679A :Ln (19.79A) 8616 333 7258 31 8139 ?07 0 8008 M N 200 5383 0P� � 0342 (0 1395 7997 -----► 7897 13 � 9237 90 59 273 285 Z! 0 0 0430to 0 0 2411 81 344 ' 100 ; 208 ; 100 { , 1.00A 8145 ' 5162 256 0 0 9191 206 104 1 104 45.58 10OWzo0 612 788 86 w 4Mo" )9.40 ' ; rn ; • 49' a ' irtA1 • 5333 (2.105A) 4684 31 3 99 202 111 77 4973 Od'0 4872 4679A :Ln (19.79A) 8616 333 7258 31 8139 ?07 0 8008 M N 200 O 7997 -----► 7897 13 0 ----y 7797 200 0 7697 200 o"---' 7597 2 200 100 ,,Q05 N'V 0 +7431 0 843Q 273 285 Z! 0 0 0430to 0 0 2411 81 344 ' 100 ; 208 ; 100 { , 1.00A 8145 ' 5162 256 0 0 9191 206 104 1 104 45.58 10OWzo0 612 788 86 w 4Mo" )9.40 ' ; rn ; • 49' a ' irtA1 • 5333 (2.105A) 4684 31 3 99 202 111 77 4973 Od'0 4872 4679A :Ln (19.79A) 8616 333 7258 31 ► 1 •1r 'APPLICANT INFORMATION Account #: 990002892 Billed To: Roger Buzby Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5747-32-2930 Subdivision Info: Location/Address: Redwood Drive -2702 ^� Property Size: see map Date Evaluated: CJ On -Site Well Community Auger Boring Pit Public ✓ Cut • •Landscape 0®�®0©00 position Lei g VAG)Texture group Consistence MineralogyTexture group MONWITINSWARNMEFIN MNA�M Consistencew•L{MrM afffm ff A WINre.0sr�:rr�� AFMMineralogyo HORIZON III DEPTTextumgrqup Consistence Mineralogy HORIZON IV DEPTH Texture group Consistence Mineralo • a; = �ras���rar+� � � CLASSIFICATION SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: • Z ` ©2-� RVAC4 EVALUATION BY:La"/'t��'-r�� 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 SV_ - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P -.Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS (provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/99 (Revised) ■■■Me■■EM■ME■■M■■ ■EM■■EEMEMEMEM■■■ ■E■EM■MO■M■M■E■■■ ■e■■e■MEM■■■MME■■ NONE M■e■E■■■■■■■■■■ ■■■■■■■■■■■E■■■ ■O■■■■■■■■■■■E■ ■■■■■■■■O■E■■■■ ■ ■■ ■ ■ ■/■■■/■■■O■■l111■fly■11■■■■■■■■■/■//■■11■■■■■■■■■■■■■■■■■■■ ■/■■■■■■■■■■■■Ile/■e■i�E■■■■M■E■■E■■■e■■■M■■■■■■■/■■■■■E■ ■■■■■■■■■■■■■■11■■■■■ISE■■■■■■■■EE■■Ee■EEM■■E■■■■■ME■■■■■ ■■■■■■■■■■■■■■■■■■■[�\111■■■■■11■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■ ■■■■■ ■■E■■ MEMO ■■O■ N �3 3,651 o m `� 641 t , , 2 i1 ...� .. . . .. ....... .... ... ..c ...:: ,.. .. . ,, t 20 0 AOp / t 5475 co 94 O a� 1395 1 (3342 �v 5333 co O, to s a' 'a$9 QA 172 613 1 � / 5 a GnB2 8008 COPcC2 M cv _ _ 00 I 1 l n Do)Co j co is 'n .,. p1 - ----- 200 sa o 0 t------- 7797 1p� 200 3 11 (2.1 05A) 4 333 `-- �- 75712? . . . . . , ,. "° G n B2 313 100 inn VIA 6 100 0 273 285 297 %,5 tO a 17431 ca 843P `" 943Q 24.1 3441; t; o 24 1 "loo loblo� 10 4 i � 1 I 1 t _ _ i __ IOWROAD 2 4 i 21�p 7258 W 0 ; t 208 ; X00 � 0 100 1 1 30 1 , 1 F3 1g0A,'; '4 4143 ?W3 o 2141 cr jr 208 , 104 104 131 c� o 100 10 99 101 202 � - -------- ----100 100 T 111 77 4973 ---G* -- CD0 A 7887 86 y '2 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 / Fax: (336)751-8786 1 X . September 3, 2003 Roger Buzby PO Box 30117 Winston-Salem, NC 27130 Re: Site Evaluation - 10.64 Acre Tract/Redwood Drive Tax PIN#: 5747-32-2930 Dear Mr. Buzby: As requested, a representative from this office visited the above site August 27 and September 2, 2003 to perform a site evaluation. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an oversized, modified on- site sewage, disposal system.. - Due to soil/site conditions a french drain or other interceptor drain will be required. Sizing rate of the system is approximately 160 linear feet of tail line per bedroom. Additionally, a pump station may be required based on topography and/or house location. b Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct, the appropriate application must be completed and submitted to this office. The location of the facility the system is to serve must be staked off. Enc(s) If you have any questions, feel free to contact this office at 751-8760. SincaBeauc Jeff p, R.S. Environmental Health Section