152 Live Oaks Road Lot 4Davie County, NC Tax Parcel Report Thursday, October 20, 2016
Parcel Number:
NCPIN Number:
Account Number:
Listed Owner 1:
Mailing Address 1:
City:
State:
Zip Code:
Legal Description:
Assessed Acreage:
Deed Date:
Deed Book ! Page:
Plat Book:
Plat Page:
Building Value:
WARNING: THIS IS NOT A SURVEY
Voluntary Ag. District:
Parcel Information
E715OA0004
Township:
5861878508
Municipality:
82530155
Census Tract:
FRYE BENJAMIN W
Voting Precinct:
152 LIVE OAKS RD
Planning Jurisdiction:
ADVANCE
Zoning Class:
NC
Zoning Overlay:
Land Value:
Total Assessed Value:
27006-0000
Voluntary Ag. District:
LOT 4 BEACONS OAKS
Fire Response District:
2.06
Elementary School Zone:
9/2008
Middle School Zone:
007720207
Soil Types:
0008
Flood Zone:
193
Watershed Overlay:
277880.00
Outbuilding 8r Extra
Freatures Value:
53980.00
Total Market Value:
358940.00
Farmington
37059-803
SMITH GROVE
Davie County
DAVIE COUNTY R-20
DAVIE COUNTY QD
SMITH GROVE
SHADY GROVE
WILLIAM ELLIS
GnB2,GnC2,GaD
DAVIE COUNTY
27080.00
358940.00
No
pv r �{{ All data is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the j
9 u 6 Davie County, implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the
�e
I
County of Dawe Norio Carolina, its agents, consultants, contractors or employees from any and all claims or causes of action due to j
NC or arising out of the use or inability to use the GIS data provided by this website.
'
OPERATION PERMIT
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r
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: Ben Frye
Address: 152 Live Oaks Road
City Advance
State2ip: NC 27006
Phone #: (336) 940-3782
Address/Road #:
152 Live Oaks Road
Advance NC 27006
Structure: SINGLE FAMILY
# of Bedrooms: 3
# of People:
'Water Supply: PUBLIC
'CDP File Number 139511-1
County ID Number:
Evaluated For: HDR/WWC
Township:
/ Property Owner: Ben Frye
Address: 152 Live Oaks Road
City Advance
State/Zip: NC 27006
Phone #: (336) 940-3782
lerty Location & Site Information
Subdivision: Beacon Oaks
'IP Issued by.
'CA issued by: 2140 -Nations, Robert
Design Flow: 3 6 0
Soil Application Rate: 0 - 2 7 5
Nitrification Field
No. Drain Lines
Total Trench Length:
Trench Spacing:
Trench Width:
Aggregate Depth:
Phase: Lot: 4
Directions
Hwy 158 East turn right n Gun Club Rd. turn right on
Live Oaks Rd. to house is a the end of the street
'System Classification/Description:
TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS)
Saprolite System? OYes ONo
'Distribution Type: GRAVITY -SERIAL Pump Required?
OYes QNo
=Pre -Treatment:
Drain field
1 3 0 9 Sq. ft.
O 7 ft.
Oinches O.C.
Feet O.C.
Inches
Feet
inches
Minimum Trench Depth:
Inches
'System Type: INFILTRATOR QUICK 4 STANDARD
Installer: Brian McDaniel
Certification #:
'EH S: 2140 - Nations, Robert
Date: 0 8/ 0 8/ 2 0 1 4
Minimum Soil Cover. Inches Approval Status
Maximum Trench Depth: Inches ❑ Approved ❑ Disapproved
Maximum Soil Cover: Inches _
CDP File Number 139511 - 1
Manufacturer.
STB:
Gallons:
Date:
*Filter Brand:
ST Marker: ❑ Yes ❑ No
nforced Tank: ❑ Yes ❑ NO
1 Piece Tank: ❑ Yes ❑ No
Manufacturer.
Countv ID Number:
tic TanK
Lat.
Long:
Installer:
Certification #:
*EHS:
Date: / /
Approval Status
❑ Approved ❑ Disapproved
Pump Tank
Installer:
PT:
Certification #:
Dosing Volume:
Gallons:
—
Gal Certification #:
*EHS:
Date:
/
*EHS:
/
Date:
Riser Sealed ❑
Yes
❑
No
❑
No
Riser Height: ❑
Yes
❑
No
(Min.6 in.)
Approval Status
Check -valve
nforced Tank: ❑
Yes
❑
No
PVC unions
❑
Approved ❑ Disapproved
No
1 Piece Tank: ❑
Yes
❑
No
No
\ Anti -siphon Hole
❑ Yes
❑
No
Sunnly Line
/ Pipe Size: inch diameter
Pipe Length: feet
*Schedule:
Pressure Rated ❑ Yes ❑ No
Approved fittings ❑ Yes ❑ NO
Installer:
Certification #:
*EHS:
Date:
Approval Status
❑ Approved ❑ Disapproved
/ Pump Type:
Installer:
Dosing Volume:
—
Gal Certification #:
Draw Down:
Inches
*EHS:
*Chain:
Date:
Valves Accessible
❑ Yes
❑
No
Flow Adjustment Valve
❑ Yes
❑
N o
Check -valve
❑ Yes
❑
NO
Approval Status
PVC unions
❑ Yes
❑
No
❑ Approved ❑ Disapproved
Vent Hole
❑ Yes
❑
No
\ Anti -siphon Hole
❑ Yes
❑
No
,CDP File Number 139511 - 1 County ID Number:
Electric Eauir)ment
NEMA 4X Box or Equivalent
❑ Yes
❑
NO
Installer:
Box 12 inches Above Grade
❑
Yes
❑
NO
Certification #:
Box Adj.To Pump Tank
❑
Yes
❑
No
Conduit Sealed
❑
Yes
❑
No
*EH S:
Pump Manually Operable
p
Yes
❑
NO
*Activation Method:
Date:
Approval Status
Alarm Audible
1:1
Yes
❑
No
❑
Approved ❑ Disapproved
Alarm Visible
❑
Yes
❑
No
2140 - Nations, Robert
*Operation Permit completed by:
Authorized State Agent: �� Date of Issue: 0 8/ 0 8/ 2 0 1 4
This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for
Sewage Treatment and Disposal, 15A NCAC 18A.1900 et. Seq., and all conditions of the Improvement Permit and
Construction Authorization. This property is served by a TYPE a A. sewage septic system.
Rule .1961 requires that a Type TYPE It A. septic system meet the following criteria:
Minimum System Review ByThe Local Health Department: N/A
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency By Certified Operator:
N/A
Reporting Frequency By Certified Operator: N/A
Rule .1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract
with a public management entitywith a certified operator or a private certified operator forthe life of the septic system.
Rule .1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid contract with a
public management entity with a certified operator for the life of the septic system.
Rule. 1961 (2) (e) requires a contract shall be executed between the system ownerand a management entity priorto the
issuance of an Operation Permit fora system required to be maintained by a public or private management entity, unless the
system ownerand certified operator are the same. The contract shall require specific requirements for maintenance and
operation, responsibilities of the ownerand systems operator, provisions that the contract shall be in effect foras long as the
system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of
the Operation Permit that subsequent owners of the systems execute such a contract.
01 -land Drawing Olmport Drawing
**Site Plan/Drawing attached.**
OPERATION PERMIT 139511-1
Davie County Health Department CDP File Number:
210 Hospital Street
P.O. Box 848 County File Number:
Applicant:
Address:
City:
State/Zip
Phone #:
CONSTRUCTION
AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Ben Frye Property Owner: Ben Frye
152 Live Oaks Road Address: 152 Live Oaks Road
Advance City: Advance
NC 27006 State[Zip: NC
(336) 940-3782 Phone #: (336) 940-3782
Address/Road #:
152 Live Oaks Road
Advance NC 27006
Structure: SINGLE FAMILY
# of Bedrooms: 3
# of People:
"Water Supply: PUBLIC
Subdivision: Beacon Oaks
27006
Phase: Lot: 4
Directions
Hwy 158 East turn right n Gun Club Rd. turn right on Live
Oaks Rd. to house is a the end of the street
�i
Minimum Trench Depth: a 4
Site Classification: ProvisionallySuttable Inches
Minimum Soil Cover. 1 a
Saprolite System? QYes @No Inches
Design Flow: 3 6 0 Maximum Trench Depth, 3 6 Inches
Soil Application Rate: 0 a 7 5 Maximum Soil Cover: 2 4 Inches
'System Classification/Description: 'Distribution Type: GRAVITY - SERIAL
TYPE 11 A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank:
"Proposed System: 25% REDUCTION
Nitrification Field .
No. Drain Lines
Total Trench Length:
Trench Spacing:
Trench Width:
Aggregate Depth:
1 3 9 9 Sq. ft.
Gallons
1 -Piece: QYes QNo
Pump Required: QYes QNo QMay Be Required
Pump Tank: Gallons
3 1 -Piece: QYes QNo
3 a 7 6 ft GPM—vs— ft. TDH
Inches O.C.
9 Feet O.C. Dosing Volume: _ Gallons
3
@Inches
Feet Grease Trap: Gallons
inches Pre -Treatment: O N SF QTS -1 OTS -II
Septic Tank Installer Grade Level Required: O I 011 0111 OIV
o
CDP File Number 139511 1
Repair
epair System
'Site Classification:
Design Flow:
Soil Application Rate:
*System Classification/Description:
*Proposed System:
Nitrification Field
No. Drain Lines
County ID Number:
uirea:V T Cb V lvt) \,Jlvu, but nab Aveinduit: J
Total Trench Length:
ft.
❑ Open Pump System Sheet
Trench Spacing:
Inches O.
— Feet 0. C.
Trench Width:
0 inches
— O Feet
Aggregate Depth:
inches
Minimum Trench Depth:
Inches
Minimum Soil Cover.
Inches
Maximum Trench Depth:
Inches
Maximum Soil Cover:
Inches
Sq. ft.
*Distribution Type:
Pump Required: OYes ONo OMay Be Required
Pre -Treatment: ONSF OTS -1 OTS -11
'Site Modifications
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department.
7!
'Permit Conditions -
The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements.
2(
This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit not
to exceed five years, and maybe issued at the sametime the Improvement Permit issued (NCGS 130A-336(b)y If the installation has not been
completed during the period of validity of the Construction Permit, the information submitted In the application for a permit or Construction
Authorization is found to have been incorrect falsified or changed, or the site is altered, the permit or Construction Authorization shall become
Invalid, and maybe suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance
with the laws, rules, and permit conditions regarding system location, installation, operation, maintenance, monitoring, reporting and repair
(1938(b)).
Applicant/Legal Reps. Signature Required? Oyes ONO
Applicant/Legal Reps. Signature: Date:.
*Issued By: 2140 - Nations, Robert Date of Issue: 0 7 / 1 5 / a 0 1 4
Authorized State Agent: Malfunction Log Oyes
&Hand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
Pann 7 of Z
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Drawing Drawing Type: Construction Authorization
41 c
CDP File Number. 139511-1
County File Number:
Date: 07/15 /a014
0Inch
Scale: 0 Block
0 N/A
n, LI, 11,
MMIMMM MMM. - - M M
a
/11
Page 3 of 3
P1 P2
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
CDP File Number: 139511 - 1
County File Number:
Date: .0.y./,1 5 / . 0 14
Click below to import an image from an external location: Drawing Type: Construction Authorization
Page 3 of 3
P1 P2
Davie County Health Department
0,9186Vjc Environmental Health Section '
PAI P.O. Box 848 �a
,��—( �... • 210 Hospital Street r,�l
Date, 10 t Courier #: 09-40-06
Mocksville, NC 27028
Phone: (336) - 753 - 6780 Fax: (336) - 753-1680
ON-SITE WASTEWATER CERTIFICATION
(Check One) Replacement Remodeling Reconnection
Name: ✓1 t ft
Phone Numb = me)
L
/ / �1
Mailing Address: L (- x Oc,ks U . c3 �� " 7 -c��(0 - fw )
Detailed Directions To Site: 1 D r-,14 4",,,x rjt k+ 01A 4 "PI C /+t 0 ju fu rr'•` Ci h
Property
6aDOO
Please Fill In The Following Information About The EXISTING Facility:
E7-ira-Ao --0
Name System Installed Under: A-eyk FI`I—C Type Of Facility: N0115 -c.-
1
Date System Installed (Month/Date/Year): 0-0-09 Number Of Bedrooms: 3 Number Of People: /
Is The Facility Currently Vacant? YesTll�o If Yes, For How Long?
Any Known Problems? Yes Qo If Yes, Explain:
Please Fill In TheFollowing Information About The NEW Facility:
Type Of Facility: (54/c �hM ' %3 Poo) Number Of Bedrooms: Number of People
Pool Size: I S" A J Garage Size: Other:
Requested By: Date Requested: (Toa G 06. aL?fV
For Environmental Health Office Use Only
Approved Disapproved
Comments:
Environmental Health Specialist Date:
*The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee
(extended or limited) that the on-site wastewater system will function properly for any given period of time.
Check Money Order #.
Paid By:
Amount: $
Received By:
Account #: l-2951 t Invoice #:
Date: (D -
U
Account #: 990002390
Billed To: Ben Frye
Reference Name:
Proposed Facility: Residence
ATC Number: 4895
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 Fax # (336)751-8786
OPERATION PERMIT
Tax PIN/EH #: 5861-87-8505
Subdivision Info: Beacon Oaks Lot # 4
Location/Address: 152 Live Oaks Road -27006
Property Size: 2.03 Acres
**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 takep as a guarantee that the system will function satisfactorily fora y given period of
time. &N r—�,j .� e�1
System Type: S.T. Manufacturer S�Oa� Tank Date. l
Pump Tank Size
System Installed By: La k tL4 6 AN o-e� E.H.
1
Tank Size
✓/�5
Date.
DCHD 11/06 (Revised)
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax (336)751-8786
Account #:
990002390
IMPROVEMENT P Tax PIN/EH #:
5861-87-8505 .
Billed To:
Ben Frye
Subdivision Info:
Beacon Oaks Lot # 4
Address:
4110 Hwy 158
Location/Address:
152 Live Oaks Road -27006
City:
Advance
Property Size:
2.03 Acres
Reference Name:
Proposed Facility: Residence
t,
**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: R+ 'Years ❑No Expiration
Residential Specifications: # Bedrooms 3 # Bathrooms 3 # People Y Basements Basement plumbing
Non -Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
DesignFlow(GPD): 34.6 Type of Water Supply: 015-unty/City ❑Well ❑Community Well
As stated in 15A NCAC 18A.1969(5)
Site Modifications/Permit Conditions: accepted Systems may also be used
Environmental Health Speci
Date U _ / J —d U
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 Fax # (336)751--8786
ATC Number: 4895
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 #Bathrooms 3 # PeopleJ_ Basement[e Basement plumbing❑
Non=Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Lot Size :y Type of Water Supply: 21 ounty/City ❑Well ❑Community Well
C/
System Specifications: Design Wastewater Flow (GPD) 3�6 Tank Size �, (� GAL. Pump Tank /%t GAL.
u �(� r
Trench Width -3u ax. in �}, D h 3 e th .jh Linear Ft. J r�'
— As'stated in I A A8-4fit# 1�J � P
Site Modifications/Conditions/Other: accepted Systems may also be usc as
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30 — 9:30a.m. on the day of installation. Telephone # 336 751-8760.
I^tl
Environmental Health Specialist
nr,4n 1 1 /(1F fR rvi.cPrll
X3LJ��S D
51Cy ou'1
Date: .".—,�11
I
AUTHORIZATION
FOR WASTEWATER SYSTEM CONSTRUCTION
Account #:
990002390
Tax PIN/EH #:
5861-87-8505
Billed To:
Ben Frye
Subdivision Info:
Beacon Oaks Lot # 4
Reference Name:
Location/Address:
152 Live Oaks Road -27006
Proposed Facility:
Residence
Property Size:
2.03 Acres
ATC Number: 4895
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 #Bathrooms 3 # PeopleJ_ Basement[e Basement plumbing❑
Non=Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Lot Size :y Type of Water Supply: 21 ounty/City ❑Well ❑Community Well
C/
System Specifications: Design Wastewater Flow (GPD) 3�6 Tank Size �, (� GAL. Pump Tank /%t GAL.
u �(� r
Trench Width -3u ax. in �}, D h 3 e th .jh Linear Ft. J r�'
— As'stated in I A A8-4fit# 1�J � P
Site Modifications/Conditions/Other: accepted Systems may also be usc as
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30 — 9:30a.m. on the day of installation. Telephone # 336 751-8760.
I^tl
Environmental Health Specialist
nr,4n 1 1 /(1F fR rvi.cPrll
X3LJ��S D
51Cy ou'1
Date: .".—,�11
I
• G
oak! 10. OG 0
;e •
APPLICATION r
ASG
�ts'J1Q.pPV �� A t S`t
e county onvhtatlth 33G 751 0706 p.2
EVALUATIONAMPROVEMENT PERMIT & ATC
I 'c County Hcalth Acnartment
E uoamealw Hredth Section
P. . Vox 84Ò R0xPibk Street
Mocksvillc, NL 27038
(336)751-87601 Fax (336)751-87116
F;valualion/linFrovestsem Pcmit U Authorizer. ion To Constrtact(A I Q 0 Witt
•4•IMPORTiMP" THIS APPM A LION GINNt: m PROCESS0 U 411M ALL OF Tim' REQUIRED
INFORMATION].'; t'ItOV1131-D. toles to the (MVOKMATION SULL87 tN for instructions.
APPLICANT IM'O_ _RMATION_
Namc tq tic Billcnl �✓ �2 Cor tact Person��✓
Dilling Address —/O S- Hrrrne Phare
City/Ctate/7.IP _, p - ,✓� �G, IOOG: Business Phone _
Name on I'elmi✓ATC if Dlfj'erentihan Above _ •,,,, _ __
Mailing Address City/Ct:1e//rip —_
NUM; A survey plat or site plait mist accompany this application.
(Permit is valid for 60 man0:s with site plan, no expiration with Icw
Street AddresslS.� 6VJC Xt:; .,.4 . _ C;ty.- vh
Subdivision Name == X11 )�4j OArC��•� SecttoNLot#
Directions'I'otiite:�4,rir� pig_ �
elm J(
Date lfousdr-aeility Comers Flaj;-pl� . O
If the answer to any orthe following qui stiom is "yes", supporting documenla lieu must be attached.
Are there any existing wastewater systems an the site?
I )Yc:
Do" the tine contlain jwisdiai mal wetlands?
UYe 1.9,
Are there any eas;mrnts or right-of-ways on the site?
nYc @INo
Is the site subsea to approval br another public ugency?
CIYe: ow",
Will wastewater other than domestic sewage be genets ted7
OYc: QW.-
IF RESlDENCR17ILLOUTT};E BOX BF.I.OW _
K People _ 0 DedwYms 3 N Aathrooms .. Gardcn Tub/WlMpewi IJYes L1 0
m
Dastent: ec I1No_ _ 8s&:mentPlumbing: 0Yes Baso
IF NON -RESIDENCE TILL O1J 1' THE BOX BELOW
I'ypc of facility/Business - Total Squarc Fbotai;c of Building__ R People
N Sinks N Commodes N Showers ,- N Urinals -
imatcd Water Usage (gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY N Seats
Type system rc"ted. l7Cenventiwut nAeeeptat nianovative UAllen,ative 130ther_ — — -
Waw Supply Type; '4<owrty/City Water U New Well DExis•ing Well C Cmmm nityy Well
Oe you anticipate additions atexpruiats of the faaittty oris system is intende d Ie, serve? O Yea t!fFna
If yes. what type? _ -- —
This is to certify that tho ritfomiatinn :xovided can this application is true sod .:onect to the best of my knowledge. 1 understand that
any pererit(s) or ATQs) issued hens ie. - are subject to taspension or revocal-)n if the site is alloyed, the intended we changes, or if
the infonrnatien wbmined in this applta tion is falsified or ehnapd. 1 *mdws'rrwd #bar foss responriiLJor nN tiar=as incurred
)Tram this applicadast. r bcrcby groat nebt orentry to rhe Authorized kcreaerrtative of the Davie County Health D pirtment to
conduct necessary intpoctions to H with applicable laws and rules on the abovu described property located in
Davie County and own
Site K ' i Charge
erns t g
Nope awne 'a or ten's rerte:rntalive stgaature
�f Client Notification Date:
Date EIIS:—_.
_. 0
Sign given !] Yes LINO lccount M _
Revised 2/06
Invoice N
in
P. 1
N
zi
u. McBRA YER
�! 15--418
562
r' '0
•
r�
RAUL A. FOSTER
D.B. 175 , PC. 862
ZONED R--20
GAR.I LD H. DAVIS
D.B. 180 PG. 813
P. B. 4 PG. 51
REF. D.B. 15.1 PG. 870-87
Z01NIED R-20
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TOTAL A
PRELINilt,
B—E-A- C
OWNER --••---•
Ad
(3
rARMIN
DAVIE COUA
TAX MAP RI
Mar -31 04 US:26a davie county envhealth 336 751 8786 P.3
AITL:C7IlON FOIL SIM EVM U' 'nON/WPIIOVEM&1T l'!• WIT & ACC
Davie County Health Department
' En✓lroolne�:a/fee/iii Section
P.O. Dat C40/210 lroapital Street
Yockavilla, NC 27038
(336)751-0760
**,Xk1POR'_ i2TTars TRIS : PPLIC.1:ZOl cmwoT ,IlL PaccaSED MMESS ALL TtIE lzrQUI1:L1i _..—._. .
INFORMF.TION IS PROYMM. Refer Lc the XMItMJTION bULLITZtI for inotl uctiona.
� , 1 J.
f. Noma to be 2sllad f'7�lfL: C'ii t�-<t<< ��,�� contact Parson
x:ilia? Addrasa/n/C I14r,-) J � t 7tosw Y non.
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2. Nano on Pasnl.t/ATC 11 Dilto:aaL a.n AL.va
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i. Appli:atiDn For. ® site zyaivatloz 0 Irprcvamant: Pemuil/ATC 0 IloCb
1. *eton to service, U Sadao, 17 %04ilc Homo ❑ Bcaiaetn ❑ Induz;try D 0";Iac1'
y
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5. Type oystao rcquortad: 4r GIaveatloaal ❑ conventional swd111ed ❑ faacvacivu
i
1. If Lteaidoacn: / People A Backe= 3 1 BaLLrouut:;
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T. 11 nuniaeas/Imeduatry /Othae: verttr typo p Yaopla
1 Coaaasdea 1 Shawers 1 Orinaln A Itiatoc Cocicra
IF IOODSMVICE: C. smal:s Eatimated Water Usage taallouc par day)
D. Typo o1 water supply: County/City 17 Well O Couuir4njLy l-___
Y. Do you aatlaiData adds ticao .or erparsians of the racu:ty this Sys (un Ls Qticaded lu scrva! 13 Yes e<'
If yes, ulml type'
t'alAMORT/tXIvIt CLI-1vin AmsTc0A;PLGTL"rut: ak-21DIRCD PROPLiCI INF'OIiYIA-110N Itt mms'l VD
UCL01V. Ely era P A7' orS:7'I; Pi #%N A1UST6ESVIi'AI?/'ED by the ctlen( it1ith 1'111S AITUCATION.
Properij Vimensio:ts: � ,1 /. 'l y�it /L/` 1 mafrz :1tlCl'IUnS;frwu Mucholdc) lu l'1:U1'lilrl'1%
Tu OMCC 111N:
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PropertyAddress: Road Nzme 64'x% (C. ee„/J �•U.)`e-u9
C1ty2)p'i.�/%lrf��.C%(%LY'L
7l In a Subl:ivisiorl ,provide infarn al iol:, :s Mims;
f r �7 r�
C'r' —i -g Name: _!✓G' (y �Ya� �,j,•,
Section: •' �G� BtocIc: /,_ Lot: •
Dote bomc coracrsrlaggcd: J- Z) r / ld y
This 13 to certify that the Information providcu is correct to the best of tuy lumvIcdga I u:lderstand (Instan), perutil(s)
issued hcrear(cr aro subject to stupors:on ar revocmiea, If the Meplans or hamided use chauge, ov it 1Le btfurutalion
submitted in tI:is applicaliol:Is L•dsirml or cltacged. !, j6o, aisdersrand dratl ca: res;)unsIblefur a/Jcharyca IncurrrdPram
thk dpplicuriwl I, I:c: Cby, gis'c co:uea! to lite Autl:urizcd Rcl meatative of Ule D:rric Couu(y 11cal,I: t)cpu rluu,a
Iv cider upon above described p: uput:' located III Davie Ccunty sud un•ucd by
to con dset�aii�les(irg protcCyl's s net essary to dc(enuiuc the si(e suitabtY.l •.
DATL �lll%f/C�''!
� f 1
THIS AR£AllkY BE USED MR DR-.WLNG YOLK SITZ, LAN (Include aN of Ike tuiimiug::Silsful cad lu opust c
property lines 2nd dimcasioas, struuu:'es, setbac;t,, aad septic Io;zaoas;.
Site liars: t C:lw—gc I
I Ualc(s):
lllj
• i Cliatlt Nuli)iculina Ju ler 1
siengiraD A=omltNo.
— lteeisedDCHD(i15133 ;,,.^I N.
APPLICANT INFORMATION
Account #: 989900635
Billed To: Wayne Frye
Reference Name:
Proposed Facility: Residence
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
SoiVSite Evaluation
PROPERTY INFORMATION
Tax PIN/EH #: 5861-87-7983.04
Subdivision Info: Gun Club Lot # 04
Location/Address: Gun Club Rd -2700
Property Size: see map Date Evaluated: / v
Water Supply:
On -Site Well
Community
Public
Evaluation By:
Auger Boring
Pit
Cut
FACTORS 1 2 3 4 5 6 7
Landscape position
Sloe %
HORIZON I DEPTH <I
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence
Structure G L
Mineralogy<<
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: �h'/ ✓ ®1 EVALUATION BY: �f
LONG-TERM ACCEPTANCE RATE: i L OTHER(S) PRESENT:
REMARKS: alAl YNT
LEGEND
Landscape Position
R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope
CC - Concave slope CV - Convex slope T - Terrace FP - Flood plain H - Head slope
Texture
S- Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt
SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam
SC - Sandy clay SIC - Silty clay C - Clay
CONSISTENCE
Moist
VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm
Wet
NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky
NP - Non pladtic 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)