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164 Emily Dr Lot 17-18 Davie County,NC Tax Parcel Report Tuesday,November 22, 2016 I I EMILY DR 1 r , 152 - ---164 — ----- ------------------------- -------- -- ----- ------- -- --------------- WARNING: THIS IS NOT A SURVEY Parcel Information Parcel Number: E6040SO017 Township: Farmington NCPIN Number: 5861174518 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: LOT 18 COUNTRY COVE Fire Response District: SMITH GROVE Assessed Acreage: 1.01 Elementary School Zone: PINEBROOK Deed Date: 8/2000 Middle School Zone: NORTH DAVIE Deed Book/Page: 003440137 Soil Types: MrB2,EnB Plat Book: 0005 Flood Zone: Plat Page: 012 Watershed Overlay: DAVIE COUNTY Building Value: 247900.00 Outbuilding&Extra 23580.00 Freatures Value: Land Value: 30000.00 Total Market Value: 301480.00 Total Assessed Value: 301480.00 161 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 shalt hold harmlessthe 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 DAVIE COUNTY HEALTH DEPARTMENT Qd- —7- 1 Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001280 Tax PIN/EH#: 5861-17-4518.17818 Billed To: Tamara Fleming Subdivision Info: Country Cove Lot#17&18 Reference Name: Tamara Fleming Location/Address: Emily Drive-27006 Proposed Facility: Residence Property Size: See Map ATC Nurrlbr: 2483 **NOTE** This Tmprovement/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 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 J# #People 3 #Bedrooms�? #Baths Dishwasher: IZf Garbage Disposal: ❑ Washing Machine:2f Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type /y #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow(GPD) %:?a Site: New 0"'Repair❑ System Specifications: Tank Size. A9 GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft.4�Z Other: Required Site Modifications/Conditions:. IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this 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(336)751-8760.**** 0 U)V �� 1rJ Fqc �C,rllpxbe F Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001280 Tax PIN/EH#: 5861-17-4518.17&18 Billed To: Tamara Fleming Subdivision Info: Country Cove Lot#17& 18 Reference Name: Tamara Fleming Location/Address: Emily Drive-27006 Proposed Facility: Residence Property Size: See Map ATC Number: 2483 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED 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 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATE ONSTRUCTION IS VAL FOJZ A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: U CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall.indicate the system described on Improvement/Operation Permit 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. 0% ),-&.(y- 100 1 -1001 00' S Septic System Installed By: Environmental Health Specialist's Signature: te: /0 /17/6 DCHD 05/99(Revised) 1 ti APPLICATION FOR.SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Health Department Environmental Health Section t 2000 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ***IIWCRTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS AIM THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed A'm a t a A. r/e m;n L/ Contact Person ' V V a if n e, y Mailing Address T�►7 C v u✓ Shu 4 re, Home Phone Q q 8 2 3 y [G city/state/zip M Dr-kr✓,'1le , NG 2 16 Z Is Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: M Site Evaluation Improvement Permit/ATC ❑ Both 4. system to service: H House 0 Mobile Home ❑ Business ❑ Industry 0 Other S. If Residence: # People _ # Bedrooms 3 # Bathrooms Dishwasher ❑ Garbage Disposal JR Washing Machine ❑ Basement/Plumbing ❑Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons:par day) 7. Type of Water supply: 11 County/City 0 Well 0 Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes No If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMI77ED by the client with THIS APPLICATION. Cree {face/¢or, 4195-.04 Property Dimensions: 2 2 5 . 2 L X 19 s. (.X 2 a 3S WRITE DIRECTIONS(from Mocksville)to PROPERTY: 57&61 -7- yS'I Tax Office PIN: #-5-V 61 .Z /e-4 f n•1 Property Address: Road Name A rave- 5-h a//e,,., !3r d o% D r;mer ' r City/Zip PAVunC.2_, If in a Subdivision provide information,as follows: I-f-5 on r'L 4h� Side- d Name: Gd CA n+V y G D v e. ,{f-rGGf o f en.d o-P S f-r'=e* ?'/hF-b -y `Aer7 Section: Block: Q Lot: 1'1 4' g Date Property Flagged: 7 �G> P13 S/ey 12- This 2This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation,if the site plans or intended use change,or if the information submitted in this application is falsified or changed I,also,understand that I ant responsible for all charges incurred from this application. I,hereby,give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by_ W;11 a •Sone) i e+ LAX to conduct all testing procedures as necessary to determine the site suitabili . DATE 1-12 - 60 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. Revised DCHD(07/99) Invoice No. �CJ a i b0 Op � � .♦ 10 4 10 �L 1 \ ol '� \ -%60 fyD Zip. • 3 \ `bd I rid�\ ,o ��d o b�°�, � � •a Olol It oa S o' Q Z r S s o �o• 10yrP ld .0 CD G j 0 W f: �0 2z� 0tilllos 0 "� S F`t R -.�h '� �+c�. k, F ``td♦ y�� ]d'1�`�'+..Eflc 9:\s� } `'ft'yd'l '� ^a� �iL •'� :wy.s'd4 r(-y::, al ,tyr�,y�,y�a-,' �����j�d':;�ai i / FS i,t � � t rx ',, J •r•' ! r. l i S .• .1 ✓ 'Y 7'.• ±, i 'k -tom` 1 aI .!' !G d `� x- ! ` t ra 3 .� w'� n' r !• § M � ! r` '. fGt (�, yJf^ '� '.;I ) J .S .. 1� tiM °IF J t�lt. •O :p_/ q" " T Y � i"}l'� �:t" an iaW t`, Vti, y�. k j w ' ,^f C%/' .• !�''�''l 1 'h t.+,7"` i 10� �. z l �N •�it� a6c,{. •�j� .�trrn .t n,.;.., •^t � `:aea�lt � �g.;. ' OM luatll,t14V1 :Ltj r:In� A7 rel Ld.;y.a �• \ � � 1 1 i Z4'W. 231' a tj el da t— 110.35--' _�_ IIOi — _ ._Ito — —_ _ _ --1'lA_ _ —•-- ---'110• —'1 — � � .' I�a;S M 1l0' ' t Ito' 'G'IZ, r .a E M i VY on IV E N.$ 110 'It 24'vJ. -Ito, I l o' 110' < < y '. � 18'S.Sf!! 110' 1101 X:N .y r'I...LZ- ai i^ ++ 1 f +h.i.vd V t 1 1 t```-��-•'M". 3S li 1L". f� 1 S t } � }1`l� �i� -nK�'.3#err '+ ,•� �{�F�#��rrt ' � �, yX' � . f u . tiny'C���a ,w,,�.,� r�! I r t' •��� �,yYs Y .. tej4� �1 x u�r r�,tip tytpj Tarr Sl i 1 y Y>f 4'!1 SOV 7 4-4 tSWY�r'.TY. J Ivi lat'tn .ny ``� m'•�r I I ale x"";��C?dyvffr f e*� i y r°`z4-v.; - Nib • ,t 1 rtil`t j ;;�,q, 1� nAr j ^t !M 1 ao DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTE:Issued in Compliance With Article II of G.S.Chapter 130a /S�a,,n�itaryy Szew/a�e Systems Permit Number Name �1/ /� �`t���/i' ���� �S-�� Date No- 7755 Location Subdivision Name Lot No. ZZ LZ-,,L Sec. or Block No. i Lot Size .21iQ--'/,435- House �/� Mobile Home — Business -- Industry No. Bedrooms i2 No. Baths P� No. in Family_c _ Public Assembly Other Garbage Disposal YES ❑ NO 2-' Specifications for System: Auto Dish Washer YES LTJ NO [3 Auto Wash Ma shine YES NO ❑ ^/ Type Water Supply _ 14� *This permit Void if sewage system desc ' e ow is not ins d within 5 ears f om date Otis ue. This permit is subject to revocat. site pl a intended usB chang i Imp r vements permit by 'Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985. Final Installation Diagram: System Installed by— Certificate of Completion Date '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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT V Davie County Health Department RE(CIF �ME Environmental Health Section P. O. Box 665 U C i _ 3 1994 Mocksville, NC 27028 1. Application/Permit Requested By - _'1 Mailing Address ^ Home Phone " �-�— J i ? Business Phone 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation tR Septic Tank installation Permit 4. System to Serve: House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown �7 5. If house, mobile home:Subdivision '_ 1 Section�_ Lot#LL.�L ❑ Basement/Plumbing No.of People ❑ Basement/No Plumbing No.of Bedrooms 3 ® Washing Machine No.of Bathrooms JXI Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No.of People Served No. of Sinks No.of Commodes No.of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: I& Public ❑ Private ❑ Community 8._Property Dimensions 220 X Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes No If yes,what type? 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation,if site plans or the intended use change. Effective October 1, 1989. Directions to Property: El c Lr This is to certify that the information provided is correct t he best of y kn�ed e, fi "understand I am responsible for all charges incurred from this application. 9- '2 �/- `i�� ' r, DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BED NE-QN ABOVE DESCRIBED PROPERTY MUST CHECK ONE: P 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2,the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Davie ounty ealth Departm�jent t enter upon above described property located in Davie County and owned by L a r i a� (✓)n'q- �I to conduct all testing procedures as necessary to determinesai site's suitability for a ground absorption sewage treatment and dispos I syst m. DATE SIGNATURE DCHD(1193) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ��l�L�`11 DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTY LOCATION OF SITE < Oiir✓"Zf Water Supply: On-Site Well Community Public [1__/ Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L Sloe Z HORIZON I DEPTH Texture group 6_� Consistence. Structure Mineralogy HORIZON II DEPTH p7 .S7/• Texture group Consistence Structure Mineralogy / J HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION \ S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATED BY: 2 77 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 ;lay loam• SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR--V2-y 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(01-901 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section. P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATIO Name o Date 1 �� Address Lot Size FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S S S PS PS PS U U U U 2) Soil Texture (12-36jmjqwWy,, S S S S Loamy, Clayey, (n(o 2:1 Clay) ..�S PS PS PS C U U U 3) Soil Structure (12-36 in.) S S S S Clayey Soils � PS PS PS < i U U U 4) Soil Depth (inches) S S S S PS PS PS U U U 5) Soil Drainage: Internal S S S S PS PS PS PS U U U U External S S S S S PS PS PS U U U 6) Restrictive Horizons K/ ) 7) Available Space S S S PS PS PS U U U 8) Other (Specify) S S S S PS PS PS PS U U U U 9) Site Classification S U NSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: Described by - Title Date SITE DIAGRAM OCHO(b 82) s J. ._rrl ( L'T..'Mr M:.. t„L Il Y. :�^.r . .. y •y+., ... : _ if+ti '4” i . . ♦rr fa.:..... ,ra ,ft ^ra;�rx=..i;"r• t� '4j°,. t�,m:w r�f,,,f�y,,j;,ar}«�.r, 30 {:,., r..^�. f ;._ Q Iia .�� DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION ' :*NOTE:Issued-in Compliance With Article 11 of G.S.Chapter 130a Sanitary Se ,e/S'stems 4 7Perm-it Number Name- / �1�ri' 7��� �� 1�/ Date �"/�'�'� N2 t 7.5 Location + /1i°r / �� �dAry•OIOo.0 /f �Dli-) e/qy, Subdivision Name ©u�>%� w P Lot No. �'l�` /, Sec. or Block No. f Lot Size a:E XZ.,;�S _ House �� Mobile Home —___— Business —_ Industry No. Bedrooms. No. Baths _off_ No. in Family_ _ Public Assembly Other Garbage Disposal YES, ❑ N6:2-o': Specifications for System: Auto Dish Washer YES NO ❑ Auto Wash Ma^hine YES .g NO 'E] 14 Vim, DSI- S� Type Water Supply a *This permit Void if sewage system desc a ow isnot instajlgd within 5 years fromda:teo:)ue. This permit is subject to revocat' site pl a intended chang dr;� e Im r vements permit b P P Y *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M. or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985. Final Installation Diagram: System Installed by _ Certificate of Completion Date '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. DAVIE COUNTY-HEALTH DEPARTMENT t IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION `NOTE:[ssued-o Compliance With Article 11 of G.S.Chapter 130a - Sanitary Sewa a Systems ",-Permit Number. r ,j� / Date Name .. ""•�, '�'� No 77 5 5 ~ Location lir `�' OtIP Al / �r� �/lF��c��•J/Go.l" /� �Orc��j�,'�lf Subdivision Name (l�L��> � Lot No. , �` Z Sec. or Block No. Lot Size7�X/�_ Housey� Mobile Home — "" Business -- Industry No. Bedrooms �� —.No: Baths No. in Family _— Public Assembly Other Garbage Disposal YES ❑ NO p-''' Specifications for System: Auto Dish Washer YES NO,[:] Auto Wash Ma^hineYES u NO ❑ _. ,1 �Dasl- SAX Type WaterSGppty 'This permit Void if sewage system desc ' e ow is not instgJgd within 5 years f om date o is ue. This permit is subject to revocat site pl a intended;Chang F f wC!�7Imp F vements permit by — I �. *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M:, 1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985. Final Installation Diagram: System Installed by _ F c Certificate of Completion Date '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. ) ,S 11 Would [ -�o p lac-c- "1 u x 'l`/ cry- oT- -� i Y. i t � }- o USP_ �fE •APPLICATION FOR SITE EVALUATIONAMPROVEMENT Davie County Health Department Environmental Health Section yq P.O. Box 848 - SEP 8 1997 ` n q, Mocksville,NC 27028 (704) 634-8760 77-7 ***IMP,)RTANT**** THIS APPLICATION CANNOT.BE PROCESSED,UNLESS ALL t` THE REQUIRED INFORMATION IS PROVIDED. 1 Name tc be Billed L CC \ ,� .)care_, Contact Person� �,-� i �M, ;Comes Mailing Address q e9 ���\\© �� K c�S`�1� �C Home Phone q Q= og ao I n n • City/State/ZipA�(Qn.� "-- a70 G76 Business Phone i i 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3 A fl "'n For: Site Evaluation pp �] [ ]Improvement Permit&ATC [.]Both 4.°System to Serve]House [ ]Mobile Home [ ]Business [ I Industry]Other 1' 5: .If Residence: #People _ #Bedrooms #Bathrooms �+]Dishwasher`[ ]Garbage Disposal : [a]Washing Machine [ ]Basement/Plumbing [ ]Basement/No Plumbing 6: If Business/Other:Specify type #People #Sinks #Commodes #Showers #Urinals #Water Coolers ' If Food:ervice:#'Seats Estimated Water Usage(gallons per day) 7. Type of ater supply[�]County/City [ ]Well [ ]Community, 8 Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes' [ ]No. +� If yes;.what type? isf EITHER A PLAT OR SITE'PL4N' I ROPERTY INFORMATION REQUIRED:***IMPORTANT***)X-)KyAyT OF THE PROPERTY MUST BE �q ,— �GIt�� i-o SUBMITTED WITH T"APPLICATION. Property Dimensions: �'[ S — 113. L� ��. - WRITE DIRECTIONS from Mocksville TO PROPERTY 1` i aC 17.5 8 4,1 _ 1 rl r Tax Office,PIN: # 1-dt 1 G8(o t- Irl Property Address: Road Nam,, E MA LA v� k Y• M s City/Lip d�lc`� s If m Subdivision provide information,as follows: Name•`°O-c-w4'C La HCl COLO Section: Lot#: i; This is to certify that the information provided is correct to the best of my knowledge.I understand that any pennit(s)issued hereafter are' subject to suspension or revocation,if the site plans or intended use change,or if the information submitted in this application is falsified or t ; changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authonied� �` Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned ' 1 A keAIe to Gond ct all stir roced s as essary to deteniiine the site suitability '. SIGNATURE a Revised DCHD '0X-96) z1 THIS AREA MAY BE USED AOR DRAIVINC7 JOUR SITE PLA #' 1�� oeQ'1',b� Zit �$4 �r a.�l} "• b ��Vt1t••••&& � r ' •' ���,1.:, ,>a'd�tr��M I 'y �� a � �Isi.:�t YC�S. ���.. m a r � - r • . IPS ;`' r � } �' 4 �,` ,� to o r 11°' 9 ( d • , O Q 1 V E — 4 0 • c LT.4KCT i Y` ��j�ry`.. ACV, 1 t Oil � R{'yNil '`. r 1 .� o _ Y� r�Yl;l,, A C J _ 1 i�J •'LC` N G , c Y .�•d\ 1 (J1 f•I (J a V � rry �i � r � Mu 11Y1`J�tr r 4P xi M ,`• . ul 8 •'( M d � h� x��1. Ir fv 1 \ TZi 1,O 11,0 2A, _...v 1ka �V +I ".) A e.. i� '� ,�u :• '� � � ) 0 I � � <,� rig " , N �i, � o < � � � • �� Q •i P '-. FJ [(j� f'�" � r tatiy.�'" �-' y T�4 .j' 4 \� M ( y Gt rt 7 �V ' 1 '�'rl. dVeS•F ,k -�S } r', .,, N. N 1 `� ,(t . � 17,<,aw r,C��. � 't•" � .� v.C7.hvy, "iL�rt4�. r. . �' 1 .. . 1 �. Y: `�ry IN l °b ,e,,, � y )i• �.('�� I 1 W a ,:x:r r�,;;trl�•. r;r,�i'Ciiiitr'..r`y ic':+�>V �.. �'�; ,� ,��,i} t Q > t ''i3iN,•v' ,i� Vl,J7s k'+ P£ Y ',L f i 1 �`tom `,,pV � � APPLICATION FOR SITE EVALUATIONAMPROVEMENT PEI Iwo= a 2 . Davie County Health Department D ? G LE 15 Environmental Health Section GAJ P.O. Box 848 SEP 81997 Mocksville,NC 27028 (704) 63 4-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed tsky,C� Contact Person Cm Mailing Address a a11Q Home Phone 9 —n og ( City/State/Zip A d V c3X_VZ.•e Q Q 07400 Business Phone C°AV'-- 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For:"N]Site Evaluation [ ]Improvement Permit&ATC [ ]Both 4. System to Serve'J,]House [ ]Mobile Home [ I Business [ ]Industry] Other 21 5. If Residence: #People _ #Bedrooms 0 #Bathrooms -P]Dishwasher`[-Q]Garbage Disposal Washing Machine [ ]Basement/Plumbing [ ]Basement/No Plumbing 6. If Business/Other: Specify type #People #Sinks #Commodes #Showers #Urinals #Water Coolers If Foodservice:#Seats Estimated Water Usage(gallons per day) 7. Type of water supply: [e]County/City [ ]Well [ ]Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve?[ ]Yes [ ]No If yes,what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED:***IMPORTANT***)XVfI'OF THE PROPERTY MUST BE I r7 I V-0 ­& 1 QS, 10 SUBMITTED WITH THIS APPLICATION. Property Dimensions: L0,H S — WRITE DIRECTIONS(from MocksviIIe)TO PROPERTY: Tax Office PIN: 16#17594;, _ 1' _aZ30S y wy m S kc — Lo�t Property Address: Road Dame E M 1 LL 1 City/Zip If in Subdivision provide information,as follows: Name: Q OLUr&(w Cp\i !R Section: Lot#: I ri i �Q ;��o �� ' This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s)issued hereafter are subject to suspension or revocation,if the site plans or intended use change,or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by'Mf pt.5',alp �C kla yam' to cond ct all stin roced s as essary to determine the site suitability. DATEQ—rl— Qr SIGNATURE Revised DCHD(06-96) THIS AREA MAY $E USED FOR bRAWINC� YOUR SITE PLAN: APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department R IE C!E D V IE Environmental Health Section 4r ' ; P. O. Box 665 O G I - 3 1994 Mocksville, NC 27028 1. Application/Permit Requested By Mailing Address 11! I Home Phone / Business Phone 2. Name on Permit if Different than Above 3. Application for: ❑General Evaluation N1 Septic Tank Installation Permit 4. System to Serve: ;K House ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision C7�� �/ �D(fe_ Section__Z — Lot # ❑ Basement/Plumbing No. of People ❑ Basement/No Plumbing No. of Bedrooms -3 Washing Machine No. of Bathrooms 2�: ] Dishwasher Dwelling Dimensions 70 X 0 ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: R Public ❑ Private ❑ Community 8. Property Dimensions 0 X 1�5� Sewage Disposal Contractor 9. Do you anticipate additions/expansion of the facility this sytem is intended to serve? ❑ Yes No If yes, what type? 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: SM h aro-e- v, �«� �e ❑ G l � C� ti 0 0 Dr- This is to certify that the information provided is correct t he best of kno Jed e, tl understand I am responsible for all charges incurred from this application. 42 /— 9�� % r DATE SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: h7 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Davieounty ealth Departr�ent t enter upon above described property located in Davie County and owned by L a I Z AXa /✓ 2,161-la^nI to conduct all testing procedures as necessary to determine sal site's suitability for a ground absorption sewage treatment and dispos'I syst m. DATE SIGNATURE DCHD(1193) ' DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section Soil/Site Evaluation NAME+ V � DATE EVALUATED ADDRESS PROPERTY SIZE A� PROPOSED FACIILTY LOCATION OF SITE V2i 69t _ Water Supply: On-Site Well Community Public- ,,--, Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 Landscape position L Sloe % — `— HORIZON I DEPTH « Texture group 1"4 Consistence Structure Mineralogy HORIZON II DEPTH Texture group /7C C Consistence Structure S 1/ Mineralo / /.'/ , HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 777 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATED BY: 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 (:lay 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-Fim1 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(01-901 ■/..■/■■■■■.■/...■■■/.■.■/...///..■■.............■E.EEEO.ii ■■M.� ■/■.■.■../■.....■...■..../.■■///■/.../.■//SSSS.../.../...■■■■S■ ■■ ■.■.■/....■...■...■■■.■...■........■E.■..E.EE■E.E.i■E■E.■■E■iE■E■■ ■■.iE■■..■■EE■iii■■■EOEE.■EE.■E.■■■■■iE■.■.■Eii■i■■■■V.■■i.EE■■.■■ ENO ■/.■./.■...../.■■/......■��■.....�.■EE.OEEEEOEE■EE...■.EE■ESE■EEE■ ........................... ...................................... ■■■■..EEE■..■....■....■■.EE.i■■■..■...... ..EE:■■■ ..■■:■SSSS■N■■ ■■■EE■■■■EE■ii■.E.EE■EE■..■■■.■■■■■E..E.�i■ii■■i■:■■■■MEMS.■.iii■ ■■EE.S.E■■.......■EiiE.EEiiiE/.■ ■MESE■..i.■..■■/e■■■■■■■i.i■■■■■ ■.■.■■■■■■ESE■■■■E■O.EE■EEE■■■■ ■■......■.0...E►7.OEEEEE■■.i■...■ ■■...■■■.E■..EEEE■EEEEE■■EE.■■E..■■.....■i...■■.Old■i.■■■■.i.■■iii■ ..................................■N.....E..■i..■.■.---.■OMEN.NMI ■■...■..E�■..■■■■■■■.E...■..EE...E..O....■E.....■■ N...■ SSSS.. ■ ■■..■...■■■■.....■/lE......E.E...EEE...............■■■......■..■EEN ■■SEEMiii■■■.■■■■■■■...■��.■...■■�i.■..E.E....i.�l■.E■...E..E.E..E■ onommomommom .■...........E■■EEE■■E..��E.■EE..i......E ■■....■■■.■■■......■■.... .■..........■..■i■.■■■..�I■..■■■.■i.■ii■■.■■.■.■■.■MMMMM■..■. ■i■■.iii .Ei:::�i.=i:::::: :::u:'i:::::: �:'i: �i::: :::::a■o.::::::■' I■ ■.........■■uE■...■....r�■.........■■i.■.C.■..■i■ r.e....■:..■■■..■ ■..........EE..eE...E■.Ei�.■���. ■..... mom noise o:..■■■■■■■■■..■ ■E.....E.■■.....■■...0■ L.i■■i■■:iiD::...:C� ■■ ■ ■i ■■..■i .........■.............:........ ■.E. ■■...��■lla■■ ■:..: MESO.. :mo:m':':::Mm,mgEMO ■■■■.■■..■■I.■■E ........... .... ■....E....■■■.......■■....■.■....■Er..:■i�. 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P. O. Box 665 Mocksville, N.C. 27028 Q� SOIL/SITE EVALUATIO Name— Date! �� Address Lot Size U FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S S S 41B PS PS PS U U U U 2) Soil Texture (12-36 ' S S S S Loamy, Clayey, (n to 2:1 Clay) _eS PS PS PS (I U U U 3) Soil Structure (12-36 in.) S S S S Clayey Soils _eS PS PS PS <dj U U U 4) Soil Depth (inches) S S S S PS PS PS U U U 5) Soil Drainage: Internal S S S S PS PS PS PS U U U U External S S S S S PS PS PS U U U 6) Restrictive Horizons 1 7) Available Space S S S PS PS PS U U U 8) Other (Specify) S S S S PS PS PS PS U U U U 9) Site Classification S U NSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: Described by \ - Title Date SITE DIAGRAM FC4 DCHD(6-82)