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4343 NC Hwy 601 North Lots 4-5r Davie County, NC Tax Parcel Report Wednesday, December 28, 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: WA"JLNG: '1'iiii S 1S 1VU'1' A bUKV.LY Parcel Information C30000009503 Township: Clarksville 5822172803 Municipality: 82522255 Census Tract: 37059-801 HENNESSEY JAMES J Voting Precinct: CLARKSVILLE 4343 HWY 601 NORTH Planning Jurisdiction: Davie County MOCKSVILLE Zoning Class: DAVIE COUNTY R-20 Land Value: Total Assessed Value: NC Zoning Overlay: 27028-0000 Voluntary Ag. District: No LOT 5 FOSTALL DEVELOPMENTSECTION 1 Fire Response District: WILLIAM R. DAVIE 0.47 Elementary School Zone: WILLIAM R DAVIE 2/2004 Middle School Zone: NORTH DAVIE 005370088 Soil Types: Mnl32 0004 Flood Zone: 127 Watershed Overlay: DAVIE COUNTY Outbuilding 8r Extra Freatures Value: Total Market Value: 1:01 All data Is provided as Is without warranty or guarantee of any Idnd 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 Countys 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 NC or arising out of the use or inability to use the GIS data provided by this website. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003058 Tax PIN/EH #: 5822-17-2803 Billed To: James Hennessey Subdivision Info: Fostall Development Lot # 4 &5 Reference Name: "M02=117�t . • I Location/Address: Fostall Drive -27028 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 T eatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONS I VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: DDate: --2)17/;-t/ 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 taken as uarantee that the system wi fun 'on satisfactorily for any given period of time. t4 C ` d 121 � T .32' rl Septic System Installed By: w '� CL > 9 Environmental Health Specialist's Signature: D e: DCHD 05/99 (Revised) 1. APPLICATION 1:011 SITE EVALUATION/INIPHOVEAIENT PE-111MIT & Davie County Health Department Environmenia/Hea/111 Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 EUt, FEB 1 0 2004 ENVIRONMENTAL HEALTH DAVIE COUNTY ***IDSPORTANT*** TI1IS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED - INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. Name to be Dilled `IC+� ' �-S i' 65gfj�;e'ontact Per:;on %TAj42.e C , Mailing Address IM&C / 110111C Phone 3.3� _.V-573,-2_.. . City/State/ZIP _(�D�lJO�JW ee /(/Lc'`V 4 Dusiness Plwnc 2. Name on PcrmiL/ATC if Different than Above Mailing Address City/SLate/Zip _._.... 3. Application For: ❑ Site Evaluation &--�mprovemcnt Permit/ATC L=1 Moth 4. System to Service: ❑ House ❑ Mobile Home ❑ Ilusinets ❑ Industry ❑ Othcr �s. 5. Type system requested: Conventional ❑ conventional modified ❑ innovative 6. If Residence: it People. It Bedrooms 3 11 Bathroom:; ishwasher ❑Garbage Disposal 030ashing Machine ❑Basement/Plumbing ❑basement/No Plumbing 7. If Dusiness/Industry /Other: verify type It People It Sinkc # Commodes it showers It Urinals It WaLer Coolers IF FOODSERVICE: #1 Seats Estimated Water Usage (gallon:, per day) _. 8. Typo of water supply: 1H-County/City ❑ Well ❑ Community 9. Do you anticipate additions or CXpal1Si011S Of the facility this S31S(Clll is ill tell ded LoServe? ❑ YeS � If ycs, wliat type? ***IAIPORTiIM" CLIENTS MUST COfl1PLETE THE REQUIRED PROPERTY INFORMATION REQIJESTE'D BELO1V. Ligler a PLAT orSITE PLAN AIUSTIIESU11b11TTBD by the client ivilli THIS APPLICATION. I'roperty Dimensions: V-1 / `S; Tax Office PIN: # a 1- 0 3 Property Address: Road Name 6 264 // 000 city/zip f acl�s vlWt /l/G a70o? If in a Subdivision provide iinformation, as follows: Nan lc: Section: Block: Lot: I ivrL DIRECYIONS (from Mocksville) lu 1'ItUI'lil('l'1': ijo 1 N .Eo Routu-u 14 — le� Date Ilomc corners !lagged: Catf 46MC14 A This is to certify that the inforruation provided is correct to the best of illy knowledge. I understand plat any pernlit(s) issued hereafter arc subject to suspension or revocation, if the site plans or intended use chane, or if tlic informalioil submitted in this application is falsified or changed. 1, also, understand drat 1 uur responsible fur rrll Charges illcru-rrrlPruni !tris application. I, hereby, give consent to the Authorized Represcutative of the Davie Comity IIcaltil Deparluu:nl to enter upon above described 1lroperty located in Davie County and oivrled by _ to cunduct all testing procedures as necessary to determine the site suitability. DATE 0 —/0 ^ L/ SIGNATUItj THIS AREA MAY BE USED FOR DRAWING YOUR SITE e lclude all of ole following:Existilib and proposed property lines and dimensions, structures, setbacks, and septic locations). Sign given Revised MID (05/03 1 Site Revisit Cluu•ge Datc(s): Client Notification Date: MIS: Account No. Invoice No. 70 �0 . I I 0 l • 1,., aIAL APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-6760 9 MAR ?� Zoo? At— ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE , INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for inst/Jruction 1. Name to be Billed !t L Contact Person 9tdZ - {ss�'11 Mailing address Home Phone _ � ✓y City/state/ZIP 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: Site Evaluation 4. system to service: House 0 Mobile Home 5. If Residence: I People Business Phone City/state/Zip 0 Improvement Permit/ATC 0 Both 0 Business 0 Industry n Other # Bedrooms # Bathrooms II Dishwasher II Garbage Disposal II Washing Machine II Basement/Plumbing II Basement/No Plumbing 6. If Business/Industry/Other: specify type I Commodes # showers I Urinals # People # sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City 0 Well 0 Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes 0 No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETII E REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either as PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: 0 Jif13 Property Address: Road Nume� City/Zipl�,(',�`5d�� If ina Sub ivision provide inforination, as follows: Name h)zt-o Lwal Section: f Block: „_,0 Lot: WRITE DIRECTIONS (from Mockcville) to PROPERTY: Date Property Flagged: CJ •c26 -OA 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 susp+.rasion or revocation, if the site plans or intended use change, or if the information submitted in this application is false. Ged or changed. I, also, understand that I am responsible for aft charges incurred from this application. I, hereby, give consent to the Authorized Representative of theD ie ounty Ilei th epartme t to enter upon above described property located in Davie County and owned by Q J to conduct all testing procedures as necessary to determine the site suit ' ' � DATE _e�tS �� SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (0799) Existing and proposed Site R vis t Charge Datc(s): DZ— Client ification Date: E Account No. �,e 5 00 -:� /�, Invoice No. a alter • .•' r DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil,/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900216 Tax PIN/EH #: 5822-17-2913 Billed To: Paul Willard Subdivision Info: Lo-r Reference Name: Location/Address: Fostall Drive -27028 Proposed Facility: Residence Property Size: see map Date Evaluated: k. - 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 p • - 2 Texture group Consistence F' Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence ; Structure L Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE r SITE CLASSIFICATION: EVALUATION BY: !'J1q!L_P 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 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 05/99 (Revised) ME No ME ME NEON ■■N■ MEMO ■■N■ NONE ■■■■ ■■■■ ■■N■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■s■■NOON■■■■■■■■■■e■■e■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■NOON■■■ ■■■■■■■■■■ NOME■■■■ ■■MEMO■■ ■N■E■■M■ ■E■■■EMM ■■iii.:: ■■■M■M■■ ■■■E■■E■ ■■■M■■M■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ NOON■■■■■■■■■a■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ME MENNEN mommomONMEME ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■SII■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■Moa■■■■■ NOON■■■■N■ NOON■■■A■1■■■■■■■ ■■■■■■■■■■■ NOON■■■I■■■■■�1/Il� ■■■■■■■■■■■ ■E■■■■■I■■■■■wee■■ ■■■■■■■■■■■ NOON■■■I■■■■■■�■lwM I■■■■■■■■■f11■ NOON■■■I■■■■■■1�'1�:�. I■■■■■■■■■■■ Ili■■■■■■■■■■■■�I�i!. II!■■M■■ 'AMMEN■ flmmm■ ■EE■■■ ■EM■■■ ■E■■■■ ■ENNE■ ■EM■■■ ■E■■■■ ■■■■■■ ■E■■M■ i ■ ■ ■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ NOON■■■■a■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ NOON■I■■■■■■■■■■■■■■■■■■■ MONON imommummmmomm NOON■I■■■■■■■■■■■■■■■■■■■ NOON■I■■■■■■■■■■■■■■■■■■■ NOON■I■■■■■■■■■■■■■■■■■■■ NOON■I■■■■■■■■■■■■■■■■■■■ NOON■I■■■■■■■■■■■■■■■■■■■ NOON■I■■■■■■■■■■■■■■■■■■■ NOON■I■■■■■■■■■■■■■■■■■■■ NOON■I■■■■■■■■■■■■■■■■■■■ NOON■I■■■■■■■■■■■■■■■■■■■ NOON■I■■■■■■■■■■■■■■■■■■■ NOON■I■■■■■■■■■■■■■■■■■■■ NOON■I■■■■■■■■■■■■■■■■■■■ NOON■I■■■■■■■■■■■■■■■■■■■ NM■M■■M ■M■■MMI■■■ Iii■■■■■■MME■MI■■■ JI■MEME■■EM■■MI■M■ ■■MMM■■■M■■■■I■M■ ■■M■■E■■M■■■MI■M■ ■■■■■EM■■■■E■I■■■ ■■■E■■M■■■■■■I■■■ ■■■■■■■■■■■■■I■■■ ■■■■■■■■■■■■■I■■n ■■ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section o_�1_0 V P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT G<< I a8 s Account #: 990003058 Tax PIN/EH #: 5822-17-2803 Billed To: James Hennessey Subdivision Info: Fostall Development Lot # 4 &5 Reference Name: Location/Address: Fostall Drive -27028 Proposed Facility: Residence Property Size: see map **NOAI *'This improvemeent/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. r #Baths Residential Specification: Building Type �1�L #People � #Bedrooms 2 Dishwasher: M"' Garbage Disposal: ❑ Washing Machine: G?*' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size fAC. S Type Water Supply &n7TDesign Wastewater Flow (GPD) 0 D0 Site: New Oe" Repair ❑ ,f 1 System Specifications: Tank Size C0GAL. Pump Tank GAL. Trench Width Rock Depth 17 Linear Ft.L60 Other: Ll'D151 Q16QTI Required Site Modifications/Conditions: PSF4- L d5%,3 C-'G'-Sroo _ I�- � t 3, �."�1' 19, a( -r IMPROVEM ENT/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. t 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is ( 6)751-8760.**** IBJ' A PP2oX F 8 °g Environmental Health Specialist's Signature: Date: R. D. 13 DCHD 05/99 (Revised) r•�.er♦ NO. /83A.11X17 y^ 1 . U- 5 04 4., FiP_ 4 W 17(o.59 J ri _ N.w lair v WT-:r�tt. 243.7G) Y t ?r.03. Z _ LIP -. ,j power 1me� __ L { G 3 to ..�. - .^ t r,•D.I1 �. gravel dive bldg, •* L t J 1 — r- cement I� brick ----�---. wall _ _ 1104.6) (� 1 23.3 / Ln t rG n overhang (� 1. Ct J tat Dorch a. LLtm -� i Q(�'ak;ir: `jdrive � carport r' • - ' a; o nt i EIP E LN GS-7.00_0 25 , 47„ E t 29.89 E1F 199.31 — U.S. I --WY 14 1 •+:=,:.'i L ry i ^tC.. u is!Ci'', { foo ;t`: i„ i;, Irl t:;r,i 60 Raw AGIRE5 sSEQ IQ, 7411 {} , survey for DEFOY SHOAF 8 wife\ WONGDUEN SHOAF SCALE: Irr = �Ur APPROVED BY DRAWN BY R£V13Ev 2\2`.93 Q DATE: 5 t ? CLT I.v 11 �" tl I^I�1L iCJr {%! �)"{�-TTJ�IMiiY v-F��l :-'J. t±l i'�J.-i1 i *ct,.. Z:. 4f i`C' `t..�tt:+iJ L-'�1UV !Al T+'•= i.l..jtl. i�G')1! _ir DDRAWING11Ut•ABERTA - 10,5 `f . 5, 14: F ` ir`a.y _..�.. r -r , 3 P n. DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PE iIT Date Jiwner/Occupant To : � , Address � S �� ` Address .,( Building Contractor Address �5 Cal. — Manufa urerIs Name Address No. of lines �_ Width L36in. Total length j„� j ft. No. sq. ft. 3 'Type of filter material �� " Total tons used 3�3 Minimum REquirements: House Trailer Tank cap. 800 Sq. ft. line 400 Two-bedroom house 800 600 Three-bedroom house 900 900 No one shall install a septic tank in Davie County without a permit from the Health Offic or his agent. Date of Final Approval Signed: Sanitarian I hereby certify that the above septic tank has been installed according to specification Signed: ✓ c G 'tr14 pt an on ac or 6117 Note: Make sketch of disposal system on back of sheet and mail to Davie County Health Center, Box 57, Mocksville, North Carolina 27028. �0 .� I t t 1 �. i f !. W � �. W • � �� :. '�" 1 (�r� `� ` ,J -. ti� �� 0 ��' � � ti f� `d -, '.`,' I APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMI 6, (` Davie County Health Department Environmental Health Section MA P.O. Bou 848/210 Hospital Street Mockaville, NC 27028 , 2002 (336)751-8760 ENVIRpNM£NTq IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL T INFORMATION IS PROVIDED. Refer to the /INFORMATION BULLETIN for inst�r,.,uc�tio 1. Name to be Billed Contact Person QU/w Mailing Address 7J v Home Phone 2iill 4 City/state/ZIP Business Phone 2. Name on Permit/ATC if Different than Above Nailing Address City/state/Zip 3. Application For: P<Citie Evaluation ❑ Improvement Permit/ATC ❑ Both 4. , system to service: P(,House 0 Mobile Home ❑ Business n Industry ❑ Other 5. If Residence: It People II Bedrooms t Bathrooms Z_ II Dishwasher 11 Garbage Disposal II washing Sachin II Basement/Plumbing II Basement/No Plumbing 6. If Business/Induatry/Other: specify type II People M sinks % Commodes I! showers M Urinals # water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: �( County/City ❑ Well a. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? ❑ Community ❑ Yes ❑ No ***IAIPORTANT*** CLIENTS MUSTCOMPLETETIIE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Eitb.!r a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property I1imensions: / I 7 `C X cP16 •I X 41 X. V�.TTE DIRECTIONS (from h kcville) to PROPERTY: Tax Office PIN: # 5 r 2 2) `10 963 ``-'& Property Address: Road Nam e4y(--�- "JQV � p / / 02 City Zip /. 3 J_ (%e --C% s �P If in a SuHivision provid- information, as follows: Name: Section: Block; n Lot: Date Property Flagged: a, 5 r •Doff. This isoo ertify that the Infora stion provided Is correct to the best of my knowledge. I understand that any permit(s) issued heI eafter are subject to st spension or revocation, if the site plans or intended use change, or if the information submitter' in this application is f; Isified or changed. I, also, understand that I am responsible for all charges incurred from this appli, ation. I, hereby, give c 7nsent to the Authorized Representative of thevie ounty IIe. th D partmen to enter u )on above described pi operty located in Davie County and owned by ^ L to conduc ; all testing procedures as necessary to determine the site sui ' ity. DATE 6 2-- SIGNATURE THIS AR :A MAY HE USED FOR DRAWING YOUR SITE PLAN (Include all of the fo ng: Existing and proposed property Ines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: 1 EHS: Revised DCHD (07/99) Account No. FffO 0 -4 6 Invoice No. Q 7 aL APPLICANT INFORMATION Account #: 989900216 Billed To: Paul Willard Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5822-17-2803 Subdivision Info: LCA i S Location/Address: Fostall Drive -27028 Property Size: see map Date Evaluated: Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit — _7 Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L. Slope % HORIZON I DEPTH 0-1 Texture group 01 S C Consistence ' Structure Mineralogy ' i HORIZON II DEPTH Texture groupr Consistence r_`_50 Structure Mineralogy ,` HORIZON III DEPTH 14h i4q Ob Texture group Gf Consistence ; Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE ne SITE CLASSIFICATION: 1 " EVALUATION BY: sz1.� LONG-TERM ACCEPTANCE RATE: O' OTHER(S) PRESENT: F�ftQ,Z EDOJ_Vp�. REMARKS: J.M� t � M41'� Z�tS', 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 " h CONSISTENCE Moist VFR - Very friable ' 'cFR - 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`: t Restrictive horizon z Thickness and inches from land surface Saprolite - S(suitable),` 1(6psuitable) Soil wetness - Inches froAO 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) ME on ■■MM■ ■MEM■ ■M■■M■■MM■■■■■ ■E■M■ME■ME■EM■ ■E■MMEM■ME■ME■ ■EME■EM■MME■E■ ■MEM■ME■■MEMM■ ■■EMEMME■■E■M■ ■MEMMEMME■ME■■ ■MME■M■M■■MO■■ ■■■E■M■■E■■E■■ ■■■M■M■■M■■ME■ ■M■E■MEM■M■MM■ ■EEE■■■■■■■■■■ ■■M■M■■O■■OMM■ ■■MMMEMEM■■■M■ ■■■EME■ME■■■■■ ■EENNOMM■■■E■■ ■■■■■■■WSZENN■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ EWE ■ N■ MEMO MEMO ■■■■■■■ ■■■■■■■ ■■■■■■■ ■■■E■ ■E■E■ ■■EM■■ ■■■■■■ ME■■E■ ■■■■■■ ■E■■E■ ■E■■E■ ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■ ■■■■■■■■■■■■■■■�■■■■■■■■■■■■■■■■■■■■■■■■■■■Mee■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■OSEM!I ■■■■■■■ ■■M■ME■ ■O■■■E■ Davie County Health Department Environmental Health Section PO Box 848 / 210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 April 18, 2002 Paul Willard, Jr. PO Box 1109 Cooleemee, NC 27014 Re: Site Evaluations - Lots 4&5-Fostall Subdivision Tax PIN: 5822-17-2913(Lot 4) 5822-17-2803(Lot 5) Dear Mr. Willard: As requested, a representative from this office visited the above site(s) on April 17, 2002. The two lots that were evaluated are part of the Fostall Subdivision off Highway 601 North. According to your application(s) each site is to serve a three-bedroom residence with a design wastewater flow of 360 gallons per day. The evaluation(s) were done in accordance with the laws and rules governing wastewater systems in North Carolina General Statute 130A-333 and related statutes and Title 15A, Subchapter 18A, of the North Carolina Administrative Code, Rule .1900 and related rules. Based on the information provided on the Applications) for Site Evaluation and after the evaluation(s) were completed, Lot #5 was found to be provisionally suitable for the installation of an on-site sewage disposal system. It should be noted that area for the septic system is limited, which may limit placement of house Lot #4 was also evaluated April 17, 2002. Based on the criteria set out in 15A, Subchapter 18A, of the North Carolina Administrative Code, Rules .1940 through .1948, the evaluation indicated that the site is UNSUITABLE for a ground absorption sewage system: Therefore, your request for an improvement permit is DENIED. A copy of the site evaluation is enclosed. The site is unsuitable based on the following: Rule .1941(a) -Soil Characteristics, Rule .1945(a) -Available Space. These severe soil or site limitations could cause premature system failure, leading to the discharge of untreated sewage on the ground surface, in surface waters, directly into ground water or inside your structure. The site evaluation included consideration of possible site modifications, and modified, innovative or alternative systems. However, this office has determined that none of the above options will overcome the severe conditions on this site. A possible option might be a system designed to dispose of sewage to another area of suitable soil or off-site to additional property. For the reasons set out above, the property is currently classified UNSUITABLE, and an improvement permit shall not be issued for this site in accordance with Rule .I948(c). However, the site classified as UNSUITABLE may be reclassified as PROVISIONALLY SUITABLE if written documentation is provided that meets the requirements of Rule .l 948(d). A copy of this rule is enclosed. You may hire a consultant to assist you if you wish to try to develop a plan under which your site could be reclassified as PROVISIONALLY SUITABLE. You have a right to an informal review of this decision. You may request an informal review by the environmental health supervisor with this office. You may also request an informal review by the N.C. Department of Environmental and Natural Resources regional soil specialist. A request for informal review must be made in writing to the Davie County Health Department, Environmental Health Section. You also have a right to a formal appeal of this decision. To pursue a formal appeal, you must file a petition for a contested case hearing with the Office of Administrative Hearings, 6714 Mail Center, Raleigh, N.C. 27699-6714. To get a copy of a petition form, you may write the Office of Administrative Hearings or call the office at (919) 733-0926. The petition for a contested case hearing must be filed in accordance with the provision of North Carolina General Statutes 130A-24 and 150B-23 and all other applicable provisions of Chapter 150B. N.C. General Statute 130A-335 (g) provides that your hearing would be held in the county where your property is located. Please note: If you wish to pursue a formal appeal, you must file the petition form with the Office of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER. The date of this letter is April 18, 2002. Meeting the 30 day deadline is critical to your right to a formal appeal. Beginning a formal appeal within 30 days will not interfere with any informal review that you might request. Do not wait for the outcome of any informal review if you wish to file a formal appeal. If you file a petition for a contested case hearing with the Office of Administrative Hearings, you are required by law (N.C. General Statute 15013-23) to send a copy of your petition to the North Carolina Department of Environment and Natural Resources. Send the copy to: Office of General Counsel, N.C. Department of Environment and Natural Resources, 1601 Mail Service Center, Raleigh, N.C. 27699-1601. Do NOT send the copy of the petition to Davie County Health Department. Sending a copy of your petition to Davie County Health Department will NOT satisfy the legal requirements in N.C. General Statute 150B-23 that you send a copy to the Office of General Counsel, NCDENR. enc(s) If you have any questions, feel free to contact this office at (336)751-8760. incerely; Jeff G. Beauchamp, R.S. (� Environmental Health Section V) N 35' 28 34,,. W Q - 176 . 59 4J, 11 26, 92 SIF E _ (f prJ� 14a+ v' r IN 1T':ij{ 24^.7G) Lip ll \J Power a gravel drive (� bldg. N— 1 cement. back 3 ---�--- 1 wall (104.6).._. --- a 23.3 LOT �r^ t well` overhang ; ^'i• (` 16 l o 0 porch ✓ N 1 P ! -- I :;L= :drive- _ t1; E(H + cn �To �:-.:_ t1� 7n) z ;moi c .'�O• /"�„ F Jt 2 E5 + Zj 14 survey for DEFOY SHO SOIL I � _ !( ; L,;5 WONGDUEN 3 SCALE: I.. _ at]+ APPROVED BY �.iYt:'� REVISE 2\2\9, DATE: 5 .'..A a rl� ' i� z r,:''iif a•_s ,ti . pf :I... ff .- / `L ` r �� ,J �.�,�,��lc .!! . _ _._w__ ►Q� ��, , �Ft:. :�>z, �-- •-�-�--r j TAS AF �' C � _ c i + NO. ISSA-11X17 - LAWS AND RULES FOR SEWAGE TREATMENT AND DISPOSAL SYSTEMS 15A NCAC 18A.1900 Rule .1948 .1948 SITE CLASSIFICATION (a) Sites classified as SUITABLE may be utilized for a ground absorption sewage treatment and disposal system consistent with these Rules. A suitable classification generally indicates soil and site conditions favorable for the operation of a ground absorption sewage treatment and disposal system or have slight limitations that are readily overcome by proper design and installation. (b) Sites classified as PROVISIONALLY SUITABLE may be utilized for a ground absorption sewage treatment and disposal system consistent with these Rules but have moderate limitations. Sites classified Provisionally Suitable require some modifications and careful planning, design, and installation in order for a ground absorption sewage treatment and disposal system to function satisfactorily. (c) Sites classified UNSUITABLE have severe limitations for the installation and use of a properly functioning ground absorption sewage treatment and disposal system. An improvement permit shall not be issued for a site which is classified as UNSUITABLE. However, where a site is UNSUITABLE, it may be reclassified PROVISIONALLY SUITABLE if a special investigation indicates that a modified or alternative system can be installed in accordance with Rules .1956 or .1957 or this Section. (d) A site classified as UNSUITABLE may be used for a ground absorption sewage treatment and disposal system specifically identified in Rules .1955, .1956 or .1957 of this Section or a system approved under Rule .1969 if written documentation, including engineering, hydrogeologic, geologic or soil studies, indicates to the local health department that the proposed system can be expected to function satisfactorily. Such sites shall be reclassified as PROVISIONALLY SUITABLE if the local health department determines that the substantiating data indicate that: (1) a ground absorption system can be installed so that the effluent will be non-pathogenic, non-infectious, non-toxic, and non -hazardous; (2) the effluent will not contaminate groundwater or surface water; and (3) the effluent will not be exposed on the ground surface or be discharged to surface waters where it could come in contact with people, animals, or vectors. The State shall review the substantiating data if requested by the local health department. History Note: Authority G.S. 130A -335(e); Eff. July 1 1982 Amended Eff. April 1, 1993; January 1, 1990.