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117 Tyler Court Lot 63Davie Countv. NC Tax Parcel Report Tuesday, December 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 ADVANCE Parcel Information SHADY GROVE 9/2014 Middle School Zone: F803OA0063 Township: Shady Grove 5870633691 Municipality: 388 Watershed Overlay: 8304091 Census Tract: 37059-803 BAIR DANIEL FRANCES Voting Precinct: EAST SHADY GROVE 117 TYLER COURT Planning Jurisdiction: Davie County ADVANCE Zoning Class: DAVIE COUNTY R-A,R-20 NC Zoning Overlay: 27006 Voluntary Ag. District: No Land Value: Total Assessed Value: LOT 63 ESSEX FARM PHASE 1B Fire Response District: ADVANCE 0.69 Elementary School Zone: SHADY GROVE 9/2014 Middle School Zone: WILLIAM ELLIS 009671022 Soil Types: GnB2 9 Flood Zone: 388 Watershed Overlay: DAVIE COUNTY Outbuilding & Extra Freatures Value: Total Market Value: Fo- Davie County, NCor All data is provided as Is without warranty or guarantee of any Idnd either expressed or Implied Including but not limited to the Implied warranties of merchantability or fitness for a particular use. All users of Davie CouWa GIS website shall hold harmless the County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to arising out of the use or Inability to use the GIS data provided by this website. OPERATION PERMIT Davie County Health Department f ¢ 210 Hospital Street P.O. Box 848 1r � Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: RS Parker Homes / Joy Springer Address: PO Box 5967 City High Point State2ip: NC 27262 Phone #: Address/Road #: 117 Tyler Court Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: *Water Supply: PUBLIC *IP Issued by. *CA issued by: 2140 -Nations, Robert Design Flow: „ Q M Soil Application Rate: Nitrification Field No. Drain Lines Total Trench Length Trench Spacing: Trench Width: Aggregate Depth: *CDP File Number 136572-1 F8 -030 -AO -063 County ID Number: Evaluated For: NEW �ownship: Property owner: RS Parker Homes / Joy Springer Address: PO Box 5967 City High Point State2ip: NC 27262 Phone #: ierty Location & Site Informatio Subdivision: Essex Farm 0 . 2 7 5 Phase: Lot: 63 Directions Hwy 64 East left on Cornatzer Rd. Left on Essex Farm Rd. just past Beauchamp Rd *System Classification/Description: TYPE 11 A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) SaproliteSystem? OYes QNo *Distribution Type: GRAVITY -SERIAL Pump Required? OYes QNo *Pre Treatment: Drain field 1 7 4 5 Sq. ft. 3 4 3 6 ft. 9 Inches O.C. Feet O.C. 3 Inches (j)Feet inches Minimum Trench Depth: a 4 Minimum Soil Cover. 1 a Maximum Trench Depth: 3 6 Maximum Soil Cover: 1 a Inches Inches Inches Inches *System Type: INFILTRATOR QUICK 4 STANDARD Installer: Frank Transou Certification #: *EH S: 2140 - Nations, Robert Date: 0 7/ 1 0/.2 0 1 4 Approval Status Approved D Disapproved CDP File Number 136572- 1 1 Manufacturer. Shoal STB: 760 Gallons: 1000 Date: / / *Filter Brand: POLYLOK Dual PL -122 With Pipe Adapter ST Marker: ❑ Yes 0 No Reinforced Tank: ❑ Yes 0 NO I'l1 Piece Tank: ❑ Yes 0 No Manufacturer. PT: Gallons: Coun tv ID Number: F8 -030 -AO -063 c TanK Lat. Long: Installer: Frank Transou Certification #: *EHS: 2140- Nations, Robert Date: 0 7/ 1 0/ 2 0 1 4 Approval Status ❑ Approved ❑ Disapproved Pump Tank Date: / / RiserSealed ❑ Yes ❑ No Riser Height: ❑ Yes ❑ NO (Min.6 in.) Reinforced Tank: ❑ Yes ❑ No 1 Piece Tank: ❑ Yes ❑ No / Pipe Size: inch diameter Pipe Length: feet *Schedule: Pressure Rated ❑ Yes ❑ No Approved fittings ❑ Yes ❑ No Installer: Certification #: *EHS: Date: Approval Status ❑ Approved ❑ Disapproved Supply Line 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 ❑ No Check -valve ❑ Yes ❑ No Approval Status PVC unions ❑ Yes ❑ No ❑ Approved 11 Disapproved Vent Hole ❑ Yes ❑ No Anti -siphon Hole ❑ Yes ❑ NO I CDP File Number 136572 -1 NEMA4X Box or Equivalent ❑ Yes Box 12 inches Above Grade ❑ Yes Box Adj. To Pump Tank ❑ Yes Conduit Sealed ❑ Yes Pump Manually Operable ❑ Yes "Activation Method: Alarm Audible ❑ Yes Alarm Visible ❑ Yes County ID Number: F8 -030 -AO -063 CICGUIG CUUM1111CI7[ ❑ No Installer: ❑ No Certification #: ❑ No ❑ No *EH S: ❑ No Date: ❑ No Approval Status ❑ No ❑ Approved[] Disapproved 2140 - Nations, Robert 'Operation Permit completed by: Authorized State Agent: Date of Issue: 0 7/ 1 0/ a 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 11 A. sewage septic system. Rule .1961 requires that a Type TYPE 11 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 operatoror a private certified operator forthe life of the septic system. Rule .1961 requires that Type VI septic systems designed fora homelbusiness owner must maintain a valid contract with a public management entitywith a certified operator for the life of the septic system. Rule. 1961 (2) (e) requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit for a 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 formaintenance and operation, responsibilities of the owner and systems operator, provisions that the contract shall be in effect for as 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. ®Hand Drawing 0Import Drawing **Site Plan/Drawing attached.** OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC Drawing Drawing Type: Operation Permit 27028 CDP File Number: 136572 - 1 County File Number: F8 -030 -AO -063 Date: /./.. Davie County Health Department CDP File Number: f . 210 Hospital Street P.O.Box 848 County Fife Number: F8-030-AO-063 Mocksville NC 27028 Date:. 0 3 / 1 4 / .2 0 1 4 Q Inch Drawing Drawing Type: Construction Authorization Scale: . OON/A k ft. .......... .r l � Paae 3 of 3-- CONSTRUCTION AUTHORIZATION Davie County Health Department Y� 210 Hospital Street P.O. Box 848 Mocksville NC 27028 / For Office Use Only *CDP File Number 136572-1 County ID Number: F8-030-Ao-063 Evaluated For: NEW Township: nrnafi. .I . n . Phone: 336-753-6780 Fax: 336-753-1680 0 3/ 1 4/.1 0 1 9 Applicant: RS Parker Homes / Joy Springer Address: PO Box 5967 City: High Point State2ip: NC 27262 Phone #: i Address/Road #: 117 Tyler Court Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: 'Water Supply: PUBLIC Property Owner: RS Parker Homes / Joy Springer Address: PO Box 5967 City: High Point State2ip: NC 27262 Phone #: Subdivision: Essex Farm Phase: Lot: 63 Directions Hwy 64 East left on Cornatzer Rd. Left on Essex Farm Rd. just past Beauchamp Rd *Proposed System: 25% REDUCTION 1 -Piece: QYes (2)No Pump Required: QYes QNo OMay Be Required Nitrification Field 1 7 4 5 Sq. ft. Pump Tank: Gallons No. Drain Lines 4 1 -Piece: QYes ONo Total Trench Length: 4 3 6 ft. GPM—vs— ft. TDH Trench Spacing: _ 9 Onches Fe t O C.0 Dosing Volume: _ Gallons Trench Width:Inches 3 Feet Grease Trap: Gallons Aggregate Depth: inches Pre -Treatment: ONSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: 01011 OIII OIV Pagel of 3 Minimum Trench Depth: a 4 Inches \Site Classification: Provisionally Suitable Saprolite System? QYes Q Minimum Soil Cover.No 1 a Inches Design Flow: 4 8 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 . a 7 5 Maximum Soil Cover: a 4 Inches 'System Classification/Description: *Distribution Type: GRAVITY -SERIAL TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons *Proposed System: 25% REDUCTION 1 -Piece: QYes (2)No Pump Required: QYes QNo OMay Be Required Nitrification Field 1 7 4 5 Sq. ft. Pump Tank: Gallons No. Drain Lines 4 1 -Piece: QYes ONo Total Trench Length: 4 3 6 ft. GPM—vs— ft. TDH Trench Spacing: _ 9 Onches Fe t O C.0 Dosing Volume: _ Gallons Trench Width:Inches 3 Feet Grease Trap: Gallons Aggregate Depth: inches Pre -Treatment: ONSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: 01011 OIII OIV Pagel of 3 CDP File Number 136572:1 County ID Number: F8 -030 -AO -063 ❑ Open Pump System Sheet Required:OYes ONO ONo, but has Available S - Trench Spacing:Olnches 0. *Site Classification: Provisionally Suitable — 9 Feet O.C. Trench Width: Inches Design Flow: 4 8 0 _ 3 - Feet 4 Total Trench Length: 4 3 6 ft. Pump Required: QYes ONo OMay Be Required PreTreatment: ONSF OTS -1 OTS -II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department *Permit Conditions The issuance of this permit bythe 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. 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)� If the installation has not been completed during the period of validity of the Construction Permit; the Information submitted In theapplication for a permit or Construction Authorization is fount to have been Incorrect, falsified or changed, or the site is altered, the permit or Construction Authorization shall became 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 Authorized State Agent: Date of Issue:. 0 3/ 1 4/ a 0 1 4 Malfunction Log Oyes OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 C•, 7° 2( Aggregate Depth: Soil Application Rate:la a 7 s - inches .� Minimum Trench Depth: a 4 *System Classification/Description: Inches TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover. 1 a Inches *Proposed Maximum Trench Depth: 3 6 System: 25% REDUCTION Inches Maximum Soil Cover: a 4 Nitrification Field 1 7 4 5 Inches Sq. ft. No. Drain Lines 'Distribution Type: GRAvrrY-SERIAL 4 Total Trench Length: 4 3 6 ft. Pump Required: QYes ONo OMay Be Required PreTreatment: ONSF OTS -1 OTS -II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department *Permit Conditions The issuance of this permit bythe 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. 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)� If the installation has not been completed during the period of validity of the Construction Permit; the Information submitted In theapplication for a permit or Construction Authorization is fount to have been Incorrect, falsified or changed, or the site is altered, the permit or Construction Authorization shall became 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 Authorized State Agent: Date of Issue:. 0 3/ 1 4/ a 0 1 4 Malfunction Log Oyes OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 C•, 7° 2( CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number. 136572-1 210 Hospital Street F8 -030 -AO --063 P.O. Box 848 County File Number: Mocksville NC 27028 Date: 03/ 14/ 2 0 1 4 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 % (336)753-6780/ Fax(336)753-1680 % Application For: /Site Permit /Authorization To Construct(ATC) '✓Both Type of Application: 1 Kew System ❑Repair to Existing System CExpansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed S Q Contact Person \J Q� �I/ r Billing Address Home Phone City/State/ZIP Business Phone Name on Permit/ATC if Different than Above 1n I o, Mailing Address City/State/Zio rmurr,KI T t1VrVKN1H11V1V -Late tiouse/t acnity corners ria¢ ea NOTE: A survey plat or site plan must accompany this application. Included: = Site Plan _ lat(to scale) (Permit is ali for 60 m nths w' site plan, no expiration with complete plat.) ,. Owner's NamePCir (T Phon Numbe Owner's Address City/State/ ip 1 Property Address i City01 C.X Lot Size Tax PIN# Subdivision Name(if a1p�licable) Sectionot# Directions To Site: 1H U A 1c t 1 "Til l/1 �Jinl/t a! cza If the answer to any df the following questions is "yAs", suppeftitig documentation must be attached. ✓ Are there any existing wastewater systems on the site? Yes .� y Does the site contain jurisdictional wetlands? CYes t'N. Are there any easements or right-of-ways on the site? ❑Yes >s3V�0 Is the site subject to approval by another public agency? C Yes 10 �( -,Yes F4- 'AQ;7- 0 Will wastewater other than domestic sewage be generated? GNo U�0 t(� IF RESIDENCE FILL OUT THE BOX BELOW # People 0. , # Bedrooms 4 # Bathrooms Garden Tub/Whirlpool CYes o Basement: Yes %%No Basement PI bins: []Yes LtK-0, IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: 't'Conventional ::Accepted Clnnovative CAltemative COther, Water Supply Type: U, ounty/City Water' New Well 'Existing Well C Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? C Yes TyIVo 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 f the Davie County Health Department to conduct necessary inspections to determine compliance with applicable la and rule understand that I am responsible for the proper identification and labeling of property lilies and corners and 1 ca ' n Il M -in or staking the house/facility location, proposed well location and the location of any other amenities. Pr p rty wn is owner's lega epresentative signature Site Revisit Charge Date(s): V • Client Notification Date: Date EHS: a Sign given _Yes =No Account # Revised 1 U06 Invoice # R-20' SETBACKS: FRONT: 45' SIDE: 15' SIDE: 25'(STREET) REAR: 30' 6,2 )V.92028'00* W 131.91' / E wistow Asa N� cx�f g5, S82.28' 00"E 9.65' TYLER COURT 50' RIW (PUBLIC) GRAPHIC SCALE 40 0 20 40 w (INS) 1 inch = 40 & HOME DIMENSIONS NTS PRELIMINARY PLOT PLAN FOR: RSP BUILDERS LOT 63 OF ESSEX FARMS, PHASE 1 P.B. 9 PC. 388 Rmial En111=ng, enc. 700 C"Ie Place Gnsenebom, NC 27409 Phone: 3364M.0791 * I= 336, -BM NCBELS C-0950 DAM 02-17-142 REF: PR0D\1831-01\dwg\ESSEXFARM.dwg A PLICA Q � 2 3 2001 PSG SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Sita uation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both tion ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT Name to be Billed ASC eocr ya",P tn" r Contact Person 72KIPRy Bz47c ur Billing Address A.o 3f0 Home Phone City/State/ZIP _&vcr� rrG Z 7018 Business Phone 7S/ - 7300 Name on Permit/ATC if Different than Mailing Address PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: 0 Site Plan &Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name �D jC A��y�copriFi�+i cc s iAG Phone Number 7S/ - 73-10 Owner Address eO4X City/State/Zip Property Address Cit Z�'- Lot Size d , Tax PIN# - - Subdivision Name(if applicable) 49 Sectio ot#Q Directions To Site: Cf 4e�Pl'Z %f- Z&&� hbil S G .t? W Cc r f the answer to any of the following 4uestionsfis "yes", supporting documentatio9 must be attched. 9 Are there any existing wastewater systems on the site? Dyes Does the site contain jurisdictional wetlands? Dyes 13No Are there any easements or right-of-ways on the site? &%es ❑ o Is the site subject to approval by another public agency? Dyes Will wastewater other than domestic sewage be generated? Dyes l3No IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms - 1-C # Bathrooms Garden Tub/Whirlpool Dyes ❑No Basement: Dyes ❑No Basement Plumbing: Dyes ❑No IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested:<nventional ❑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 ❑ No 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 ofthe 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 locatinglocating an ging or staking the house/facility location, proposed staking the house/facili location, proposed well location and the location of any other amenities. Site Revisit Charge Prope Tt or er's legal represents re Date(s): Client Notification Date: Date EHS: Sign given Dyes ❑No Account # Revised 11/06 Invoice # -�� 73 DAVIE COUNTY HEALTH DEPARTMENT y Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004425 Tax PIN/EH #: 587D=b4=2Zbb-6 Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot # 63 Reference Name: Brad Coe Location/Address: Cornatzer Rd -2700 Proposed Facility: Residence Property Size: 0.689 Acre Date Evaluated: I /0--) Water Supply: On -Site Well Community Public / Evaluation By: Auger Boring Pit Cut FTTI I DEPd-�-- -HORIZON Texture • .Consistence ®---- HORIZON 11 DEPTH UJIMMA 19=01 VA WX&". -- • r�Kautr�elsa�������� HORIZON III DEPTH Texture group Consistence Mineralogy HORIZON IV,DEPTH Texture group Mineralogy SOIL WETNESSRESTRICTIVE ®oca����s���■ HORIZON SAPROLITE CLASSIFICATION«�r�w�ri■�������® SITE CLASSIFICATION: EVALUATION 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 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 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 0 Mineralogy 1:1, 2:1, Mixed Nblu 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 -arm acceptance rate - gal/day/ft2 DCHD 05/05 (Revi. Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Account #: 990004425 IMPROVEMENT PERNkTPIN/EH #: 5870-64-2265.63 Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot # 63 Address: PO Box 340 Location/Address: Cornatzer Rd -27006 City: Mocksville Property Size: 0.689 acre Reference Name: Brad Coe Proposed Facility: Residence **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: �Tew ❑Repair. ❑Expansion Permit Valid for: 05 Years XT5o Expiration Residential Specifications: # Bedrooms—q—# Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):_q4eb Site Modifications/Permit Conditions.: Type of Water Supply�County/City ❑Well ❑Community Well I I Svstem Tvne I LTAR I Initial 0 Si fn 3 .�W•