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192 Woltz Ln . ` •• � � . DAVIE COUNTY HEALTH DEPARTMENT n � ' ' � Environmental Health Section 1' 11��� P.O.Boa 848/210 Hospital Street 3 i Mocksville,NC 27028 (33G)751-87G0 /4� Account #: 990003837 Tax PIN/EH#: 5788-99-7537 Billed To: Helen Butner Subdivision Info: Reference Name: Diane Foster Location/Address: Woltz Lane-27006 ATC Number: 4335 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION � **NOTE** This Authorization for Wastewater System Construction MLTST 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 of G.S.Chapter 130A,Wastewater Systems,Section.1900 S wage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CO TR ION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: � Date: � ����d�� � CERTIF����T�E O�C�1)✓IPLE�N_( ��� e_4�:!r�51��yt/• **NOTE** 'The issuance ofthis Certific e ompletion shall indicate the system described on ImprovemendOperation Permit has been installed in comp ' wi �cle 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but sh AY be taken as a guarant that he,system will function satisfactorily for any p,1;..t given period i time. 70 - 9 `�.r t � �.s� �� /' S��I/ L�, ��� � ���� ���/ Ui� Ll �/�'' � � ��a f � � � ��! ����c � J �� /�� � F �_ . �_ . Septic System Installed By: ' / l�� ��� Environmental Health Specialist's Signature: �����/��, Date: ����,`�I� c.�� DCHD OS/99(Revised) , DAVIE COUNTY HEALTH DEPARTMENT � • ' ' ' Environmental Health Section � , P.O.Boz 848/210 Hospital Street � � Mceksville,NC 27028 . (33G)751-87C0 IMPROVEMENT/OPERATION PERMIT Account #: 990003837 Tax PIN/EH#: 5788-99-7537 Billed To: Helen Butner Subdivision Info: Reference Name: Diane Foster Location/Address: Woltz Lane-27006 Proposed Facility: Property Size: **NOTE�*�Thislmpro4eme5nt/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION 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 PERMTI'IS SUBJECT TO REVOCATION IF STI'E PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People � #Bedrooms� #Baths Dishwashe�Garbage Dispos�Washing Machine�Y -1�Basement w/Plumbing: ❑ Basement/No Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply� Design Wastewater Flow(GPD)_17�� Site: New� Repair❑ ��/� 1 System Specifications: Tank Size/�'�"�GAL. Pump Tank GAL. Trench Widtt� Rock Depth� Linear F _ ��v v Other: ssa accepted Systems may also be use Required Site Modifications/Conditions: IMPROVEI�IENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF 6 "BELOW FINISIiED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 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(33O751-87G0.**** Environmental Health Specialist's Signature: Date: `� Y DCHD OS/99(Revised) � Jan 03 �16 03:32p davie county envhealth 336 751 8786 p. l o� .� � �` � � I . . . � d � I � t � APYlJ:.ATION�-0fi SITL'EllAlUAT10N/IM1ft'IiOVEM1tENT 1'LliM1f(7&A7C O(����b� . Davic County Heaith Dl�partment /� � � � Nu` � Environmenta/Hea/t,r Section / \ \ P.o, eox 848/210 Hosp:.tal Street \ Mocksville, NC 27028 (336)751-87E:1) � +**I11POR1'ANT;+* THIS l•PPLICATION C�iNNOT BL• PROG.3SSED QNLESS ALL TI� REQUIRED �I� I' �/7lvN ZNFOIud1�TION ZS pROVZDf:D. Refer to tha Z2tFORMASCON BULLETIN for inetructiona. \ 1. Namc to be DSlled��r���1 �J . �(L )�,/�' . ConGact Yeraon���Q�(J� 'Tr/$�fir r JO/�` f��� q �,/ /v Hailing �ddrene �S. �O�S�!/K/ �/ , 1lome Phons _ 7 �6 �JO 9�Z107'7 ��/� rt � � �3� �CiCy/9tatu/ZIP _�c+y(�S�/i`��t _, Busineas Phono � �—� 2. Name on Ye[wit/ATC iL Diff[cent than�o�� : �h�n �!J/ rn�� C, �•- . Hailing I�ddross Ci[y;Stata/Zip 3. Applicat3oa Fori Sit; Svaluatioa 0 I::�provement Permit/ATC �� r �`���' / 6. syite�n eo sarvice, �Hc•ue:e ❑ Mobile Home ❑ IIuainesa ❑ Induetry ❑ Othez S. Sypo uynLau�r�quoatad:�t[onventlonal ❑ convantiona?. modified ..❑ innovalivu (�aC � //� ^ v �� D s. IL itesidence: 6 PeoF�le � fF IIedr�oma N IIathrooma v � �Sahvaatur ❑Cnrbaga Dispoaal �uhing ttacLino �Basemaat/Y1vnUing ❑llaaemenc/tto 1 _/�� ` � V � T. if Guelnens/2nduetry/Othor: verify type�_,� N Pwple 4 Sinka �� � � / Cowaodua 1 Showera p Ux�nala M Wator too ere ��6 % IF POdDBERVICE: 11 SeAt:a EBtisnatod Wster VBagfl (g�llons por day) ����1�1F/�l 8. lypo uf vater aupylye ❑ Cauaty/City �I�7e11 ❑ COinmunity D��/f���N�Y'��TH �. no yo� �.1cscip.�. aaai�so.0 or cxpsnsiocu o[Uic f•rcilitp t�is spslcm is iutcudcd to scrvc?O 1 cs �Ko If ycs,i�•I�at typc? _ - •'�*I,jfPORTilNT't`CI.IL V7'S AIUS7COAfPLETC•THG REQL:'HL•D PROPERTY IIYRO[tMATION RLQU�ST(:D ItL•'LO�V. E(thcr a PLAT or St7'C PLAIV AfU.CT ULSUUAfJ7TLA by tl�e clicnt widi TFItS APPLICATION. Property lli�ucnsiwu: 1YRt"fL OIRCCTIONS(trom Alodcsvillc)tu PROPERTY:: •r�x otr��rrn: n �7�g�j9�'_�'_ � _ r�f'D/ S -�D /�evo�r �s C►�'� Property Address: RoaJ Nanu,. C�f1�7�Z ��N�i � �J� �/1 �D L- CitylZip—�itrtP� /�C l�t. �B��Z �L I[in a Subdivision providc iafa•niation,as foito�OD� _, J�� WL Qi0 Gz�G�J Gt� Namc• �. Scction: Iilocic: `_ Lot: Da:c ]�ameeorncrslla;gcd: ' �Q � Tl�is ts lo ccrlify lhat 1Lc infonnatiatt providcd'u corrcct to thc besl ol my kao�ricdgc. I undcrstand tliat any permil(s) issaed Lcrcattcr are subject lo suspensfon or rcvoCat'tot1,if the sitc plaus or intcndcd usc cl�angc,or iC tLc iufonnatiop subnutted in ltiis application Is L•�Isi(�ed or clsinged. I,also,u�+derstan,l that l�m res/iousiGle jorall cGarges incrrrred jrom fl�is applicafiar. I,liereby,give consent ro tlu Authorized Kepresenta:ive o[the Davlc Coimty HcatU�lleparlment lo enier u��ou abovc dcscribed property located in Dnvic Couaty and t�v d 6y to conJuct:d!icsting procedures a:ucccssary to dcicrnunc thc sitc su;ta '1 ty. DATE I— _� � [�G SICHATURE TH[S AR�A Ir7.iY BL USCD FOR DRAWING YOUR SIT'E PLAN(.ndudc all ot tLc fullowing: Existing and proposcd property lincs and dimcnsioiu, structures, sctbacks, an�scptic locatiuns). Silc Rcvisit Chargc ���113.F J��e 4L GVCi�� /5�7'C Datc(s): ��� Clicut PIolification Datc: I?I3S• Sign givcn . Account PIo.�3�3/ � {� Revisccl DCIID(OS/03 ���n� ���,�� Iuvoicc l�Io. � U f��a��y �e��n �r6�er�i�s �rn��-�.�N�/��Ce� �3 CK �v 3fn0 - __ _ ___ ___ __ ___ __ _ _ __ _ ___ _ _ _____ _ _'I � � �F . .. �. -t � ' - i '�. �e:;�.�� . .�:,�s -t :, . .— . .�` �.F���'��,. �,' . �;� ��,.i �;'�ra'`s"'��_ $ � ' •'+4�w�� A>�. 46 .,�� ��r.. 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' ��� I O ��, c�' > > � �:�� � � ��� �'p .� hJ��r1Y� Caroliria i U �t i Click on the Map to: M8p L I r Zoomin � zoomouc r RecenterMap � ider,t�sy: Parcels - Draw L I Draw selec Zoom Factor: 2X � � Radius Search(feet)� i.e§;C9 6;"'�f I -� � Census Tra :;.,�; City Bound � County Zor �I � MU�tI S) � E911 Fire� r Flood Pane � Flood Zone _ � Parcels " � School Dis� _ _ - MU�tI S) �I � I 5788997337 � � Soils II ir Town Zonii i ', �, '�_ __ _ r Townships ' MU�tI S) �Voting Prec 1;;i.;.i:F1 i '� Driveways li ' � Rail Lines � r Street Cent � US/NC Higl MU�tI S) , � I Parcel Data I l��ind fldjc�inin� Parcels �aer�ai Pr,ot I ,:� • Land Unit/Type:1900000005 :/AC � � Creeks and • Deed Book/Page:00539/0337 E911 AddrE • Deed Date:2004/03/09 • County ID:1900000005 • Sales Price:$56,500.00 (- Fire Depart �, • Account Number000080537880 • Property Address: � Schools I • PIN:5788997537 �CaW � ' • Legal 1:12.100 AC OFF BURTON RD • County Zoning:R-A • Owner Name:WOLTZ HOWELL WAY • Census Code: • Owner/Address 1:WOLTZ HOWELL WAY • City Code: M�I� ��� • Owner/Address 2:WOLTZ VERNICE CHAITAN • Fire District:ADVANCE This map is prep� • Owner/Address 3:255 WOLTZ LANE • Flood Zone:ZONE X inventory of real� • City,State Zip:ADVANCE,NC 27006-7644 • Flood Community. within this jurisdic compiled from re� • Land Value:$73,990.00 • Flood Panel: plats,and other F , • Burlding Value:$0.00 • Flood Map Date: and data.Users c ' hereby notified th � http://71.16.185.125/servlet/com.esri.esrimap.Esrimap?name=Davie&Cmd=sParcel2&PIN=... 1/3/2006 _� � � �,� �� DAVIE COUNTY HEALTH DEPARTMENT � , . � Environmental Health Section ' Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003837 Tax PIN/EH#: 5788-99-7537 Billed To: Helen Butner Subdivision Info: Reference Name: Diane Foster Location/Address: Woltz Lane-27006 Proposed Facility: Property Size: Date Evaluated: j"'�/�—�� Water Supply: On-Site Well � Community Public Evaluation By: Auger Boring V Pit Cut FAC'TORS 1 2 3 4 5 6 7 Landsca e sition � Slo e% � L .6 HORIZON I DEPTH � ' " Texture grou S C L SC,(_, Consistence -/`✓ 1//�/ Structure /' .�'y Y Mineralo /,' HORIZON II DEPTH *'� '� Texture rou L' - G Consistence � - / Structure /C S' � Mineralo ,`( '.` HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE � �- . SITE CLASSIFICATION: �j EVALUATION BY: �'// LONG-TERM ACCEPTANCE RATE: r / OTHER(S)PRESENT: REMARKS: LEGEND L�ndscape 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 ON�I�T�.N . D�41S� � VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firtn � � NS-Non sticky SS-Slightly sticky S-Sticky VS - Stic NP-Non plastic SP-Slightly plastic P-P 'c , -Ve lasti �u�t� SC-Single grain M-Massive CR-Crumb GR-Gr lar ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismati,� Mineralo�v M,;1 1.1,2:1,Mixed �. ` � H�ongz e th-In inches � �� � on d p L� Depth of fill-In inches Restrictive horizon-Thickness and inches from land surface Saprolite-S(sui[able),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-gallday/ft2 DCHD OS/OS(Revised) ■�■�■■�■��■■■■�■■���■�����■����■�■■��■�����■■■■��■�������■���■■■�■ ■����■■■�■���■��■■■■■■��■����■�■ ■■�����■�■■�■■���■��■���■����■�■ ■���■■■■�■■��■�■■■�■■�■�■■■■■■■■�■���■■■���■�■■■��■�■■■■����■��■■ 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P. 0. Box 848/210 Hospital Street Courier 09-40-06 Mocksville, NC 27028 � � ��`,�� (3�6)?51 $7f0 " � , � " ` � , ' ,� � � E X 7' u . � �i: r j� � ��� r i � � '� ����. � �w,.rra..uaam�w...�,k,v„<.4.,.: ..,,...,_,..� ..,.�,.,N�sm,.�a.� ��r✓!�»;...w..a.,�:..,»,w,yeFx. ............._,�w.,,,s.a:...:��k,,..,�...-.. .>,.._ ,,,, ..z.�«� �.,as,.�a�sm�Aw,.z,..,�_»,.,mn_.,.. ..�...,n.,;.�w.,..,,,.. �. January 17, 2006 Helen S. Butner 135 S. Salisbury Street Mocksville,NC 27028 Re: T�Pin: 5788-99-7537 Woltz Lane Dear Ms. Butner: As requested, a representative from our office visited the aforementioned site on January 17, 2006. Based on the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, it was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions,please feel free to contact this office. Sincerely, �,���� �-���..��. Robert B. Hall, Jr., R.S. Environmental Health Specialist RBH/bml