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149 Shallowbrook Dr Lots 55-56-57 Davie County,NC Tax Parcel Report Tuesday,November 22, 2016 135 173 yy/166 4177_ l t11 ,4} 0s,16 0 �7 L L L 161 --15 2 �� •', Y., �� Or ,! f 144 1419 ,fJ _ U�-•-' '•5 ^--I 138 ter � --128 4155 4147 41-r L 41.11 , �p 5 I Y 125, -' 163 Y , 412 WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: E605OA0004 Township: Farmington NCPIN Number: 5861066800 Municipality: Account Number: Census Tract: 37059-802 Listed Owner 1: Voting Precinct: SMITH GROVE Mailing Address 1: Planning Jurisdiction: Davie County City: Zoning Class: DAVIE COUNTY R-20 State: Zoning Overlay: DAVIE COUNTY QD Zip Code: Voluntary Ag.District: No Legal Description: LOTS 55-56 COUNTRY COVE Fire Response District: SMITH GROVE Assessed Acreage: 2.44 Elementary School Zone: PINEBROOK Deed Date: 6/2006 Middle School Zone: NORTH DAVIE Deed Book/Page: 006680843 Soil Types: EnB,MsC Plat Book: 0005 Flood Zone: Plat Page: 012 Watershed Overlay: DAVIE COUNTY Building Value: 177990.00 Outbuilding&Extra 11880.00 Freatures Value: Land Value: 60000.00 Total Market Value: 249870.00 Total Assessed Value: 249870.00 9!• �F 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 Illness 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 ag claims or causes of action due to na U N NC or arising out of the use or Inability to use the GIS data provided by this website. h- -• DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION- *NOTE: Issued in Compliance with G.S. of North Carolina _Chapter 130 Article 13c Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name t ) ( � l ri�>r. ,,�f" Date '%/i Location Subdivision Name > 3j_j:S7 , �� \� Lot No.?'> �? Sec. or Block No. r Lot Size• -. House �� Mobile Home _ Business Speculation No. Bedrooms - No. Baths No. in Family _ Garbage Disposal YES ❑ NO ❑ Specifications for System: . =-- -Auto"Dish Washer YES ❑ NO ❑ ! =- Auto Wash Machine YES ❑ NO -F-1 Type Water Supply *This permit Void if sewage system described-below is not installed within 36 months from date of issue. 1 i I Improvements permit by *Contact a representative of the Davie County Health Department for final Inspection of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. �^ ` Final Installation Diagram: System Installed by /l L, r,i I`4 / Certificate of Completion l— ''�" Date 0 �' *The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. V F-:: �a . US, 158 0 3' m �tGo L)ri-r2y G>0� � 40 �r�o�nt-rl2l/ Lovas Id DI?"L1r.le,.11a.vrrun 4G. r � m Or . J -e •�--_ N Z S� op• Zo•• W ssssstrr strrq� �+y=�C.�r O . Q � 7 : Z • _ SEAL' L-2499. = Note:Thla plot is subject to any C Easements,Agreements,or Rights This prt4wrh• Is rx+t (neural In 641 l ••�'4N UV��o•• zArd arra as Q : ply which wasdM IIDN at lM prior to date of this rlPtruslxrmiixal IrIn. the,Drpartmeril if ••.•• SU••••.'P� , time of my Inspection. HuuxinR :md Urhen Ih velrgxanettt. '% Ge • Graphic Scale ♦D K• uF.� LEGEND •PP•Power Pole •UP•Light Pole FMAP •EIP•Existing Iron Pipe •Pfl.•Property Line —• J2N•NIP•New Iron Pipe •RAN•Righl•o!We;•EPI•Existing Iron Pin •It•Centerllne TOWNSHIP COUNTY STAtE DATE NPI•New Pin Iron •EP•Edge of PavingCM Concrete Monument �FC�.Fesa o fCxr � tcor2-/T/-I 6•-C- 6^ZZ-87 •CA-CO&JTW-t. ACCESS / 9 CERTIFY THAT ON Jii,�[C LOTS 55's SG "Gouy.t-qzf ✓%" D,6, 1• `gam WE SURVEYED THE PROPERTY SHOWN ON P.+SE•ar O!3 "r4,r41r"0 Be, MAP 4L. ->D7 SURVEY 0:.; ALLIED LAND SURVEYING CO. Joe NO.THIS PLAT., hlC7� A DIVISION OF MAPPED; LARRY L.CALLAHAN SURVEYING CO. INC ... ME.MOUNTAIN ST..SUITE H.KERNERSVILLE.k.C.2im 37>4m_ I 86Wx1aTT I•nl IW2771 • w APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT ® Davie County Health Department y�� Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 ! - { CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 99 9 S� q 7 1. Permit Requested By e� Business Phone q98 SY 9 7 2. Address 1 1 7152:-, a-7006, 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair b) Privy Conventional Other Type Ground Absorption c) Sub-Division C:2:�Q�t� Sec. —Lot No. 5. System used to serve what type facility: House L Mobile Home Business IndustryOther b) Number of people 91- 6. f6. a) If house or mobile home, state size of home and number of rooms. House Dimensions---3,0 1 4 (b + Bed Rooms—Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes - urinals ""-- garbage disposal lavatory showers OL washing machine dishwasher sinks 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes�No 9. a) Property Dimensions ' b) Land area designated to building site c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? V-17- What type? This is to certify that the information is correct to the best of my knowledge. D to Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: 3. + q L DCHD(6-82) Davie County Health Department Environmental Health Section Site Evaluation Consent Form LOCATION OF PROPERTY: DATE RECEIVED SC, a-s7 amu- (office use only) yes no 1. 1 am the owner of the above described property. yes no 2. 1 am not the owner of the above described property, however, I certify that I have consent from , owner to obtain a owner's name site evaluation by the Davie County Health Department for the purpose of determining the suitability for a ground absorption sewage treatment and disposal system. yes no 3. 1 hereby give consent to the authorized representative of the Davie County Health Department to enter upon the above described property and conduct all testing procedures as necessary to determine its suitability for a ground absorption sewage treatment and disposal system. 4-11 Klk7 D� ATE t SIGNATURE 4. 1 hereby authorize the Davie County Health Department to release site evaluation results from the above described property to the following: —Owner only — Owners designated representative Anyone requesting results —Only those listed below 3- aV7 SIGNATURE DCHD 01/84) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name �cCr2��t�r"�SL('f`' Date Address Lot Size�, FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position /S S CSS U S = U PS 2) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey (note 2:1 Clay) f y�� PS PS ,r PSS PS U U U U 3) Soil Structure (12-36 in.) � S S S S Clayey Soils 4 A 3 A/lej- PS PS , /�� PS PS U U U U 4) Soil Depth (inches) S S S S PS PS PS PS U U U U 5) Soil Drainage: Internal S S S S PS PS PS PS U U U U External � PS PS PS S U U U U 6) Restrictive Horizons 2 ��,� �� .� /i p; �.� 7) Available Space —PS PS PS —PS U U U U 8) Other (Specify) � � qp§) U (�PjSP 9) Site Classification U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: Described by Titled Date SITE DIAGRAM / `jai 3 27- Ab" '-Z� ddte rf IA/ 1 //0 /10 DCHD(6-82) P � APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section F� P. O. Box 665 f Mocksville, N.C. 27028 'Q CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone`1 1. Permit Requested By Business Phone 2. Address s 3. Property Owner if Different than Above Address 4. Permit To: a) Install-LZAlter Repair b) PrivyZ Conventional Other Type Ground bsorption *hgtow I / c) Sub-Division J�– . i SecLot No��e-6(P 5. System used to serve what type fa ility: House Mobile Home Business IndustryOther b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions AY )k 60 l Bed Rooms Bath Rooms—Den w/Closet_ b) If Business, Industry or Other, State: Number of persons served What type business, etc. want Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes urinals garbage disposal lavatory ' showers washing machine 1 dishwasher sinks 8. a) Type water supply: Public s° Private Community b) Has the water supply system been �ov es/ No 9. a) Property Dimensions O- /0 X b) Land area designated to building site A L c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? U What type? This is to certify that the information is correct to the best of my knowledge. ate Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: 1 `2 �- 1/ DCHD(6-82) �Fc APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department F� Environmental Health Section 19 R 0. Box 665 A Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone �11Q-CQ-Sa3-/ 1. Permit Reques d By Business Phone 2. Address e O 3. Property Owner if Different than Above Address 4. Permit To: a) Install ✓Alter Repair b) Privy-Z Conventional Other Type Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: House `Mobile Home Business IndustryOther b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions .3b x',O Bed Rooms` Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes - urinals O garbage disposal lavatory ' showers washing machine dishwasher sinks 13 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes✓ No 9. a) Property Dimensions V f 7� `�� 7/C 10� b) Land area designated to building site c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? b What type? This is to certify that the information is correct to the best of my knowledge. - /I(/- 6� . Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS. Allow 5 days for processing Directions to property: Sr DCHD(6-82) APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department C� Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 � Sal 9fop- So/� CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone KO 7 �-� 1. Permit Requested By. Business Phone 2. Address C. d 3. Property Owner if Different than Above Address 4. Permit To: a) Install✓ Alter Repair b) Privy �Conventional Other Type Gro nd bso ption C) Sub-Division W Sec. - Lot No. 60 5. System used to serve what type facility: Houses Mobile Home Business IndustryOther b) Number of people 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions ff)L60 Bed Rooms Bath Rooms Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes urinals garbage disposal lavatory showers a washing machine dishwasher sinks 0 8. a) Type water supply: Public Private Community b) Has the water supply system/been approved? Yes --*'*'No9. a) Property Dimensions /i' a 4,'�g b) Land area designated to buildin site c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? O What type? This is to certify that the information is c 11rPct to the st of my knowledge. Zd' d Date 0Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: �' /� �� D�/// � DCHD(6-82) Paiiie ( auntU Pealth Pepartment ttn� �QmP �Pttltl� �I�PnC�1 P. O. BOX 665 Aarksville, �urth Carolina 27028 OFFICE OF THE DIRECTOR TELEPHONE October 22, 1984 17041 834.5985 Ms. Pat Newman Rt. 4, Box 240—A Advance, N.C. 27006 Re: Lot # 55 and 569 Country Cove Davie County Ms. Newman: As per your request, please note below the soil conditions and/or the landscape positions which cause the aforementioned lots to be classified as unsuitable for any type of ground absorption sewage treatment and disposal systems. These findings were found by this office, with the assistance of our State Soil Specialist from our Raleigh office in August of 1979. Should you have any questions, feel free to contact my office. Lot & 55: Examination of a soil test boring at the back portion of the property indicates that approximately 0.4 feet of topsoil overlies an olive and brown massive subsoil to a depth of approximately 2 feet. below existing grade. This subsoil is relatively impermeable and has a high shrink—swell potential. Below the subsoil at a depth of 2 Feet, a basic, massive, saprolite (rotten rock) was encountered. Borings at the front portion of the property indicates that approximately 0.5 feet of loamy topsoil overlies a blue, gray, and brown, sticky plastic very slowly permeable clayey subsoil to a depth of approximately 1.5 feet below the existing grade. A massive, basic, saprolite (rotten rock) was encountered from a depth of 1.5 feet. Lot # 56: This property has some wet weather gullies that diagonally dissect the property. Soil borings located in the northeast corner of the property indicates that approximately 0.8 feet of topsoil overlies a saprolite that is massive and slowly permeable and exist from a depth of 0.8 feet to at least 4 feet. At the upper end of this subsoil, the material, when disturbedt is a loamy clay with some sand and varies to a sandy silty loam near the bottom of the boring. Examination of soil borings on the lower landscape position out of the gullies towards the eastern end of the property indicates that approximately 0.5 feet of topsoil overlies a massive, plastic, sticky, slowly permeable olive and brown, clayey subsoil to a depth of approximatley 2 feet below the existing grade. At a depth of 2 feet, a massive, basic saprolite was found. 'ncerely oe Mando, R.S. Env. Health Coordinator s STATE North Carolina Department of Natural Resources &Community Development James B.Hunt,Jr.,Governor James A.Summers,Secretary October 23, 1984 Ms. Pat Newman Rt. X64, Box 240-A Advance, NC 27006 Subject: NPDES Application Davie County Dear Ms. Newman: As per your request please find attached the appropriate form(s) to be used in applying for the subject permit. To apply for a permit you should complete, sign and return three (3) copies of the NPDES Discharge forms __-_ along with a map marking the proposed location of the discharge or non-discharge Before your application will be considered by this Office, it will be necessary to demonstrate that all feasible methods of on-site wastewater disposal methods have been explored. Therefore, it is requested that you submit a letter from the local County Health Department which will indicate the following: A. The location has been evaluated and determined unacceptable. B. The reasons for not allowing on-site disposal. C. List the alternative methods considered (low pressure systems; mound systems; pumping to another nearby location, etc.) The County's letter should clearly indicate the full consideration given to conventional, as well as, non-conventional means of on-site wastewater disposal and present specific reason why the location has been determined to- be unacceptable. The letter should be signed by the Environmental Health Supervisor or Health Director. It is our understanding that this application will be fora proposed private residence and that, at present, you have no wastewater treatment facilities. This being the case, it will be necessary for you to construct treatment facilities that will insure that the environment .will not be degraded and it will be necessary for you to submit design plans and specifications for the proposed treatment facilities for .our review. Winston-Salem Regional Office 8003 North Point Boulevard,Winston-Salem,N.C.27106-3295 Telephone 919/761-2351 An Equal Opportunity Affirmative Action Employer ,. Page 2 The plans and specifications may be prepared by you for the discharging system if you feel that you have the necessary expertise. For your consider- ation, we have attached a copy of a type of treatment system commonly called the subsurface sand filter system. (Note: that a septic tank, subsurface sand filter system may not be adequate treatment.) However, it has been our experience that most individuals find that it is necessary or advisable to seek the assistance of a registered engineer with experience in designing wastewater treatment facilities. This is especially true if a non-discharge system is proposed. For this reason, we have attached a partial listing of registered engineers in sanitary engineering. You may contact one of these engineers or any other engineer which you may prefer, whether their name is on this list or not. When we have received your application and location map, a technical review will be initiated to determine any limitations that may apply to your specified treatment facilities. When the technical review has been completed, it will be forwarded to you so that your treatment facilities can be designed to meet your requirements. If you have any questions regarding these matters please contact Mr. L...L..-Anderson_or me at (914) 761-2351. Sincerely, M. Steven Mauney Regional Engineer MSM/rb cc: Mr. Forrest Westall Mr. Gil Vinzani WSRO Davie Co. Health Dept. F{ �; �tt�1iE (1�ouu#�1 �E�II#� �E�ttr#mPrt# �Ttti� �r QtttE �PtSC#� �1.�EItC�T P. O. BOX 665 locksu le, North ( arolina 27028 OFFICE OF THE DIRECTOR TELEPHONE 17041 834.5985 January 20, 1983 Rick Stanley . .Route #1, Box- 318 Advance, North Carolina 27006 'Dear Mr. Stanley: This letter is in regard to lot 56 in the Country Cove sub- division in Davie County. In August, 1979, this office conducted a detailed soil/site evaluation on lot 56 and at that time the lot was classified unsuitable by Steve J. Steinbeck, State Soil Scientist. Please note the 'findings below: Lot 56 is bounded along the road, which is to the east, ;by a property line 110 feet long, to the west by a property line 110 ;'feet long, and to the north and south by property lines 200 feet deep. The average percolation rate, as determined. by the-Davie County Health Department, was 65 mpi. Examination ,of a. perk test hold at the front portion of the property indicatesthat water is standing at a depth of 1.4 feet below the existing grade. This property has some wet weather gullies that diagon- ally dissect the property. Soil boring located in the northeast corner of the property indicates that approximately 0.8 feet of topsoil overlies a saprolite that is massive and slowly permeable and exists from a depth of 0.8 feet to at least 4 feet'. At the upper end of this C.horizen, the material, when disturbed, is a loamy clay with some sand and varies to a sandy silty loam near the bottom of the boring. Examination of .a soil test boring on the lower landscape position out of the gully towards the eastern end of the, property indicates that approximately 0.5 feet of topsoil overlies a massive, plastic, sticky, slowly permeable olive and brown, clayey subsoil to a depth of approximately 2 feet .below the existing grade. At a depth of 2` feet, a massive, basic diorite-saprolite was encountered. Based on the above severe soil and site limitations, this property is classified unsuitable for the installation of a ground absorption sewage disposal system. If you would like for us to re-evaluate the above mentioned lot please complete the enclosed forms and return them to this office. If you have any questions feel free to call. Sincerely, Robert B. Hall, Jr. jh Sanitarian DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 Account #: 990005056 OPERATION PER11JU PIN/EH#: 5861-06-7603 Billed To: Daniel Lawrence Subdivision Info: ShallowBrook Lot#Country Cove Reference Name: Location/Address: 139 Shallowbrook Drive-27006 Proposed Facility: Pool House Property Size: 1 r r ATC Number: 4855 f **NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. L� System Type:----C S.T:Manufacturers Tank Date Tank Size �Q Pump Tank Size C �c�e,IC U w1C• -— �j G1 a (u uo �a�r E:� System Installed By: �— E.H. Specialist:�,�J� {�10 P 16 t��a1, ;.+ of Ti17 11106(RPvknd) Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990005056 Tax PIN/EH M 5861-06-7603 Billed To: Daniel Lawrence Subdivision Info: ShallowBrook Lot#Country Cove Address: 149 Shallowbrook Drive Location/Address: 139 Shallowbrook Drive-27006 City: Advance Property Size: Reference Name: Proposed Facility: Pool House **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans,plat or the intended use change. Permit Type: ❑ ew ❑Repair ❑Expansion Permit Valid for: Years ❑No Expiratiioon Residential Specifications: #Bedrooms / #Bathrooms ' #People BasementRI asement plumbing?---- Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) DesignFlow(GPD): Type of Water Supply: ounty/City ❑Well ❑CommunityWell As stated in 15A NCAC 18A.1969(5) Site Modifications/Permit Conditions: accepted Systems may also be used System Type LTAR Initial 10. 15 Repair b, Site Plan god v � S u 0, h Environmental Health Specialist Date (/ i.p.l l-06 ' DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-.:8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005056 Tax PIN/EH#: 5861-06-7603 Billed:To: Daniel Lawrence Subdivision Info: Shallowl3rook Lot#Country Cove Reference Name: Location/Address: 139 Shallowbrook Drive-27006 Proposed Facility: Pool House Property Size: ATC Number: 4855 Site Type: ew ❑Repair ❑Expansion **NOTE** This Authorization to Constrict(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s),(in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. } Residential Specifications: #Bedrooms 1 #Bathrooms l #People Basement asement plumbingD' Non=Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size ,H 5-6 a c r-,P . Type of Water Supply: ounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD)a�[� Tank Size CAU GAL.Pump Tank AL. ,r n Trench Width 3 G Max.Trench Depth_ Rock Depth I2 Linear Ft. 7 As stated in 15A NCAC 18A.1969(5� r �� Site Modifications/Conditions/Other: _er: acep tod ystPms may also he u�sr /7O 1 6:1 Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the day of installation. Tel phone#(336)751-8760. Ik3 7 T A�� n .X T' ^ - v V e -ill 1� Ale u f� w Environmental Health Specialist Date: _— DCHD 11/06(Revised) �P ON FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Environmental Health P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 q OPQ� 00 'Lo (336)751-8760/Fax(336)751-8786 Application Fo ite Ev on/Improvement Permit Authorization To Construct(ATC) Both Type of m' epair to.Existing System Expansion/Modification of Existing System or Facility L pF+ ••THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED TION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed 1 L LEE JAWaaX9!5ContactPersonhAPj9L- Billing Address / G Home Phone 336• /Zc�O City/State/ZIP Business Phone Name on Permit/ATC ifDifferent 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 i valid for 60 months with site plan,no expiration with complete plat.) Owner's Name LU33 Phone Number 33 6- • Z 0 Owner's Address City/State2ip W Property Address O City _ 77p 0(o Lot Size Tax PIN#_;dS- 0 _,_ Subdivision Name(if applicable)~ _Section/Lot#—i�il � �7 Directions To Site: If the answer to any of the following questions is`ryes",supporting documentation must be attached Are there any existing wastewater systems on the site? Yes Does the site contain jurisdictional wetlands? Yes o Are there any easements or right-0f--ways on the site? Yes o Is the site subject to approval by another public agency? Yes o Will wastewater other than domestic sewage be generated? Yes V401 IE IF RESIDENCE FILL OUT TBOX BELOW T� s #People 2 #Bedrooms _� Bathrooms 1 Garden Tub/Whirlpool Yes o Basement: es No Basement Plumbing: es No IF NON-RESIDENCE FU4k OUT THE BOX BELOW Type of FacilityBusiness Total Square Footage of Buildin #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested: Conventio Accepted Innovative Alternative Other Water Supply Type: County/City Water New Well Existing Well Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? Yes 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 I' g and fl g or staking use/facility location,proposed well location and the location of any other amenities. 717/ L�(�� Site Revisit Charge Property 6;-,Wes-or owner's legal representative signature Date(s): AA LI Z p p Q Client Notification Date: Date EHS: Sign given Yes No Account# 57b%, Revised 11/06 Invoice# uoMAPS -Davie County NC Public Access Page 1 of 1 ' Davie County, NC - GIS/Mapping System OPsfA Click Here To Start Over Quick Search:(County ID c A I� .�� Active Layer. ❑Use Map Tps GIg �00 1%K. ` 11�1 1 PARCELS(Map Tips Available) " Map Layers ( Results I lfiwt 152 i 144 i 14 Q t r� <O 4147* 4111 0� \ . � �O 4142 try 1 40994 4 Or 79ft 4085, 5 1 http://maps.co.davie.nc.us/GoMaps/map/Index.cfm?maimnapservice=gomaps&CFID=4129... 4/8/2008 t , l l i P°o L Soar 3 to c f r�o Pool M I�9 S l�ccoW�2oaK DR. GoMAPS -Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping System Qt. Click Here To Start Over Quick Search:(County ID c Ott � l Active Layer. RUseMap 7 ps GIS A. ' ' PARCELS (Map Tips Available) R11 Map Layers I Results I ! r 1 1 1524 r 1444 149, 138 i ! 139,y �0 4147,6 4111 ! f91 0O� \ �0 t \ 4142 Qct ,ti 40996 1 Oo7$ft 40851 \\ 1\ http://maps.co.davie.nc.us/GoMaps/map/Index.cfm?mainmapservice=gomaps&CFID=412... 4/10/2008 . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ' Soil/Site Evaluation APPLj9dh6 itINFCNM9N Tax PIN/EH#: 586A INFORMATION Billed To: Daniel Lawrence Subdivision Info: ShallowBrook Lot#Country Cove Reference Name: Location/Address: 139 Shallowbrookk Drive-27006 Proposed Facility.: Pool House Property Size: Date Evaluated: (v Water Supply: On-Site Well -�Communit Public C y Evaluation By: Auger Boring Pit , Cut FACTORS 1 2 3 \ 3 7 Landscape position Slope % HORIZON I DEPTH Texture group G 56 ' sle "G S Consistence V „( 0 1!fv J`r fl iv- Structure V. k 1- SPk Mineralogy ryt HORIZON II DEPTH L(- - i , Texture group $(_ L L L- Consistence Q (y' Structure 14 Mineralogy /t! HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE y ' CLASSIFICATION $ LONG-TERM ACCEPTANCE RATE (� , SITE CLASSIFICATION: ✓ EVALUATION BY: Gt&!4 LONG-TERM ACCEPTANCE RATE: 1 3 OTHER(S)PRESENT: REMARKS: tel- r\tw- 14-T 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 1?'In1S� 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 Miner�alo�v 1:1,2:1,Mixed 1 nim 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) LIAR-_Long-term acceptance rate-gal/day/ft2 r)r,un ncrnc r Or �ttiriP fl�nun#� �ettl#I� �e�txr#men# Unb Pnme pealth Ageneu P. O. BOX 665 �iatksbille, �ar#1j flLttralintt z7ltz8 , OFFICE OF THE DIRECTOR TELEPHONE • 17041 634.5965 November 5, 1983 Raymond J. Markland Route #2, Box 401 Mocksville, North Carolina 27028 Mr. Markland: This letter is in regard to 2 site evaluations done by this office on lots 55,56,57 in the Country Cove subdivision in Davie County. Based on the heavy 2:1 clay and shallow soil depth this office classifies these lots as unsuitable for any ground absorption system. If an easement is provided to the stream behind said lots there is a possibility that a sand ,filter could be installed. This office recommends you contact Steve Mauney or Larry Anderson at the Environmental Management Commission, 8003 Silas Creek Parkway Extension, Winston-Salem, N.C. phone 919 761-2351 in order to explore the possibility for a sand filter permit. If I can be of further assistance, please feel free to call. Sincerely, jh Robert B. Hall, R.S. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone i974'– y 1. Permit Requested&BJ§ �� Business Phone .515Z/L1 L- 2. Addresslc� 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair b) Privy Conventional Other Type Ground Absorption c) Sub-Division 11941 ' Sec. Lot No. 5. System used to serve what type facility: House Mobile Home Business pi P/11Z--P IndustryOther b) Number of people 6. a) If house,or mobile home, state size of home and number of rooms. House Dimensions Bed Rooms�i— Bath Rooms yen w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes =3 urinals garbage disposal lavatory - showers washing machine dishwasher sinks 8. a) Type water supply: Public Private Community b) Has the water supply system been approved? Yes_j_ZNNo 9. a) Property Dimension 67-- //D X zo5Vle7'-,5Z.- l oX.7e) T•�"7- 1�l X,2-'de - - b) Land area designated to building site c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? What type? This is to certify that the information is correct to the best of my knowledge. Date Owner ignature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: DCHD(6-82)