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482 Cana Road Lot 1Dav 0 !016 I rd,� Is provided as Is willicifivamrafflyorguarantee of any kind afthereximonsed or Implied Including but not limited to t:h lon " I * Davie County, C p1ladvat an an ofinerchantablifty, orfitness for a particular uss. All users ofDavle Countys GIs website shall hold ham a.. th.] . ty9 tm� , Davie, North Carolina, its agents, constiftents, contractors or employees from any and all claim or causes of Neu.. due to NC or , alg out at the use or Inability to use the GIS data provided by this webstite. WARNING: THIS IS NOT A SURVEY Parcel Number: G400000060 Township: Mocksville NCPIN Number: 5830042449' Municipality: Account Number. 4 8301564, Census Tract: 37059-806 Listed Owner 1: RABY NICHOLAS J Voting Precinct: CLARKSVILLE .Mailing Address 1: 482 CANA ROAD Planning Jurisdiction, Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27028 'Voluntary Ag. District: No Legal Description: LOT 1 CANA ACRES Fire Response District: WILLIAM R. DAVIE Assessed Acreage- 4.00 Elementary School Zone: WILLIAM R DAVIE Deed Date: 1/2016 Middle School Zone: NORTH DAVIE Deed Book I Page: 010100651 Soil Types: GnB2 Plat Book: 0009 Flood Zone: Plat Page: 062 Watershed Overlay: DAVIE COUNTY Building Value: 186900.00' Outbuilding &Extra 5400.00 Freatures Value: Land Value: 23100.00 Total Market Value: 21540 0.00 Total Assessed Value: 215400.00 I rd,� Is provided as Is willicifivamrafflyorguarantee of any kind afthereximonsed or Implied Including but not limited to t:h lon " I * Davie County, C p1ladvat an an ofinerchantablifty, orfitness for a particular uss. All users ofDavle Countys GIs website shall hold ham a.. th.] . ty9 tm� , Davie, North Carolina, its agents, constiftents, contractors or employees from any and all claim or causes of Neu.. due to NC or , alg out at the use or Inability to use the GIS data provided by this webstite. DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street ,Pdr Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Account #: 990002706 Tax PIN/EH #: 583X0-04-2225.01 Billed To: Jeff Hayes Subdivision Info: Cana Acres Lot # 1 Reference Name: Location/Address: Cana Road-27028 Proposed Facility: Residence Property Size: 4.074 ac ATC Number: 4680 **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. System Type; �`' S.T. Manufacturer 5� Tank Date I7,47 Tank Size 111" Pump Tank Size NW* System InstalledBy:&-ef" foot. t*je E.H. Speciali Date: Z" Z 'OY 3 3dl` s s �Ar jVb A ck- Y ,. jJe N _ Il r uI C« 1:.W5 <y��► -N- t v 24 C� 3 IAF C� DCHD 11/06 (Revised) C DAVIE COUNTY ENVIRONMENTAL,HEALTH ° P.O. Box 848/210 Hospital Street Mocksville,NC 27028'����c4 (336)751-8760 Fax # (336)751-8786 I- AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account M 990002706 Tax PIN/EH #: 5830-04-2225.01 Billed To: Jeff Hayes Subdivision Info: Cana Acres Lot # 1 Reference Name: Location/Address: Cana Road-27028 Proposed Facility; Residence Property Size: 4.074 ac ATC Number: 4680 Site Type:,,�Kew ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 1-1 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 ,3 # Bathrooms Z # People_ BasementO Basement plumbingO Non-Residential Specifications: Facility Type # People_ # Seats_ Square Footage(or Dimensions of Facility) Lot Size �/.aAS Type of Water Supply:.E<ounty/City ❑ Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) ank Size f 1000AL. Pump Tank_ GAL. T �r' n Trench Widtlh eU Max. Trench Depth � Rock Depth. I Z Linear Ft. Lib' Site Modifications/Condit(gns/Other:- 19 STALL. Q,l �IJ 6 �'G , �� (� 1 tit .• (/ Ja S Contact the Davie County Environmental Health Section for. final inspection of this system between 8:30 — 93`0' n the da" of installation: Tele 'hone # 33 751-8760. UV.� As stated in 15A NCAC 18A.lM(5) i accepted Systems may also be uae i 3aR i n�2 —7©' Eovuonmental Health Specialist Date: O tc DCHD 11106 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account M 990004350 Tax PIN/EH #: 5830-04-2225.01 Billed To: Robbie Mills Subdivision Info: Cana Acres Lot # 1 Reference Name: Location/Address: Cana Road -27028 Proposed Facility: Residence Property Size: 4.74 acres ATC Number. 4880 V �y61 SiteType:,Wew ORepair ❑Expansion **NOTE** This Authorization to Construct (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 '-f # Bathrooms 2 # People_BasementO Basement plumbingO Non -Residential Specifications: Facility Type # People_ # Seats_ Square Footage(or Dimensions of Facility) Lot Size l}•Ip-T AC Type of Water Supply: County/City ❑Well ❑CommunityWell System Specifications: Design Wastewater Flow (GPD) 4eQ Tank Size GAL. Pump Tank GAL. i /1 , Trench Width Max. Trench Depth 6� Rock Depth 61 4 Linear Ft. 5� Site Modifications/Conditions/Other:=F'1��+Tlo.� 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. r� � 1 10o —Minato 15'1'., f 75' Environmental Health Specialist ate:',- XI-ID.11/06 (Revised) . b1\ \u Cori L-j:krspe t m �Amlica� I Name to be Bi Billing Addres City/State/ZIP Name on Pem TION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax -8786 Site E luation/Improvement Permit uthorization To Constru (ATC th Ne System Repair to Existing System Expansion/Modificatio xistin st ,Facility '** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. - Home Si Phone PROPERTY INFORMATION *Date House/Facility Comers Flagged NOTE: A survey plat or site plan must accompany this application. Included: Site Plan Plat(to scale) (Permit is valid for 60 months wi siteplan_ngexpiration with complete plat.) Owner's Name -r'Yef - Phone Number3 Owner's Address -" _ City/State/Zip n If the answer to any of the following questions is'yee, supporting documentation ust be attached. Are there any existing wastewater systems on the site? Yes Qlo� Does the site contain jurisdictional wetlands? Yes Are there any easements or right -of --ways on the site? Yes Is the site subject to approval by another public agency? '`Yes try Will wastewater other than domestic sewage be generated? - Yes Basement: IFN Type # Sin Basement # Seats Type system requested: l, Conventional Water Supply Type: GardenTub/Whirlpool 'Yes . Yes Square filar facility water consumption) Accepted Innovative Alternative New Well Existing Well Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? Yes If yes, what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and comers and /\ llo-c. g and flagging or staking the house/tacility location, proposed well location and the location of any other amenities. Pr��"'� f Site Revisit Charge perty owner's or wner's legal representative signature Date(s): / G �7 Client Notification Date: Date / EHS: Sign given Yes No �/�(\�� - Account# Revised 11/06 v - Invoice # - 71-17W iml, I4e, ■■■■OE!'modow■■■■■...■■■■■ I■ ,■■■■■■ �■ •�■■■■■ wo..o.mo ■■■■■■■■■■■■■ ■■■■■�" ■.■■■■■■■■■■■�I �■■■■■ ■■■■■■■ t■■■.■■■■■■■■■ ■.■.■ ■■■■■■■..I■■■■■■■.■■■■M I■■■■■■■. ■■■■.M■.■IVENN.R'C:� ■ENE■ 1■■■■.■■. OE�1w1��■■■■/1■■■■■■■■ ■■.■.17■■■1 mMmmoEmmomummmom19. ■■■■■■■e■ e■e�._ .■....�...■■.■■ MMEM 1i .■■■■■M . ■■e_■e ■■■...iN■■■■■■■■ ■■■■■■■M■■ ■...■�■■....i�.■e■■■■. .■■■■■■■■ ■■.■■ ■■■■■.IS■■■■■■■■ .■■■■■.■■ ....■....■■■�■..■.... ■■■■■■■■■ ..■■O■■.■■■■�E■■■■■■■■ .■■■.■■■■ OMEN m��■��i�.■...■■■ ..■...■...ee..����■�i.�e■.■■■■■■ ■..■..■■■■■■■■ee ■■■■■■■.■■■■■■ ........■......■■........ ■■■■.. ■ev��°tea■.....■a■..■■....■.s■■.s.. ■i■i■■■ii■■i■■si:■iii�e.■■���OEM S 06.35'22' W (total = 558.24 w/tle) GEORGE A. MEBANE IV D.B. 602, PG. 820 m.v IrAn. n_A DAPVFr 1.17 oo-- 0 ❑ m o 8 a DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APP QPJT4j NjgAbMON Tax PIN/EH #: 5830-41MIb TY INFORMATION Billed To: Robbie Mills Subdivision Info: Reference Name:', Location/Address: Cana Road -27028 Proposed Facility: Residence Property Size: 4 acres Date Evaluated: i 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 Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence . Structure Mineralogy HORIZON IH 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: " EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT:' REMARKS: LEGEND ~ ' Landscape Position . :- .. ' .' :'.; :. •, i- 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 - ... - .. .. ... CONSISTF.N ....:. _ •. VFR Very friable' FR - Friable FP- Firm VFI - Very firm EFI - Extremely fum 3Yet . Very `. NS -Non sticky'.. SS -Slightly sticky...;.... S -Stick .yVS - Ve Sticky ' NP - Non plastic. L SP - Slightly plastic" P.- Plastic ; ; VP,. -Very plastic Structure SC - Single grain M - Massive • CR - Crumb GR Granular ` ABK - Angular blocky • _ SBK w Subangular blocky . PL - Platy PR -Prismatic Min raloev; ... 1:1, 2:I, Mixed ' Nato. 'Horizon depth - In inches : " ' •.. :.. i 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 -Lon-term a Long-term cceptance rate gal/day/ft2 DCHD 05105 (Revised) n **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 o£G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: ZNew ❑Repair OExpansion Pemrit Valid for: 0 Years 214o Expiration Residential Specifications: # Bedrooms 3 # Bathrooms Z # People_ BasementO Basement plumbingo Non -Residential Specifications: Facility Type # People_ # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD):2YQ Type of Water Supply: Btrunty/City ❑ Well ❑Community Well Site Modifications/Permit Conditions: Davie County Environmental Health P.O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990002706 Tax PIN/EH #: 5830-04-2225.01 Billed To: Jeff Hayes Subdivision Info: Cana Acres Lot # 1 Address: 130 Hwy 801 S Location/Address: Cana Road -27028 City: Advance Property Size: 4.074 ac Reference Name: Proposed Facility: Residence n **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 o£G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: ZNew ❑Repair OExpansion Pemrit Valid for: 0 Years 214o Expiration Residential Specifications: # Bedrooms 3 # Bathrooms Z # People_ BasementO Basement plumbingo Non -Residential Specifications: Facility Type # People_ # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD):2YQ Type of Water Supply: Btrunty/City ❑ Well ❑Community Well Site Modifications/Permit Conditions: r APPLICAT ffn i lg 6 L u U SEP - 6 2006 !I� E SITE EVALUATIONAMPRO VEM. Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC27028 (336)751-8760/ Fax (336)751-8786 pp icahonor: rte va uanoi mprovement Permit ❑Authorization To Construct(ATC) 'D Both ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. ADDT TO AATT TATT7nD K A TTr NT - - Name to be Billed Contact Person Billing Address'' Home Phone City/State/ZIP ess Phone - Name on Permit/ATC if Different than Above D (' Mailing Address City/State/Zip PROPERTY INFORMATION NOTE: A survey'plat or site plan must accompany this application. (Permit is valid for 60 months with site plan, no expiration with complete plat.) Street Address City Subdivision Name' S -tion/Lot# Directions To Sits: r 1 n/ul in 14e 1 M .LL A- A .— Date House/Facility Corners. -Flagged If the answer to any of the following questions is "yes", suppo Are there any existing wastewater systems on the site? Does the site contain jurisdictional wetlands? Are there any easements or right-of-ways on the site? Is the site subject to approval by another public agency? Will wastewater othet than domestic sewage be generate Tax PIN# Size mentation 4 must be attached. Dyes Epivdo Dyes t3No gYes DNo—WaIc C� �j D Yes SNo Dyes Cho IF RESIDENCE FILL OUT THE BOX BE # People # Bedrooms # Bathrooms _ Garden Tub/Whirlpool El ❑No Basement: Dyes' DNo . Basement Plumbi g: ❑Yes 0No II' 1V V1V-iCCJLJt'.N l:t✓ PILL UU I 1HE BUX BbLuw Type of Facility/Business - Total Square Footage of Building # People # Sinks I I # Commodes # Showers # Urinals . Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY:. # Seats I Type system requested:Xonventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type.,10County/City Water D New Well ❑Existing Well D Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? D Yes AIo 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 pennit(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 understand that I am responsible for all charges incurred from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to det n ce witp ble laws a rules on the above described property located in Davie County and owned by -15 6 q dpi Site Revisit Charge Property o er's or o is legal repffsentative signature Date(s): / V Client Notification Date: Date EHS: Sign given Dyes DNo Account #� Revised 2/06 Invoice # .lv e -c Jl I'- L 159.03 130. _ eis LOT r� i I i I / LOT 4 786 AC. / /AREA= 0. I > ' / 34,226 SQ - .6 x, \ ' ,\ \ fl 9b o ?� \ f I \ 1 / I A=21.03 A-39.43LOT 5 I \ 4REA=0.691 AC.1 0,100 SQ. FT.I 9y I I I )\ I \ I \ AXLE i 7 LOT —0.6:11 Al"'. AREA— 30, 100 SQ. FT. �> y / Lu1' AC. 69 1�=0.1 S Q FT i / 30,100 • LOT 3 'AREA= 0.778 AC -1, 33,895 SQ. IT/ _ eis LOT r� i I i I / LOT 4 786 AC. / /AREA= 0. I > ' / 34,226 SQ - .6 x, \ ' ,\ \ fl 9b o ?� \ f I \ 1 / I A=21.03 A-39.43LOT 5 I \ 4REA=0.691 AC.1 0,100 SQ. FT.I 9y I I I )\ I \ I \ AXLE Uy TIII 19: GZ Rk 33ti M UM LI(A YKN...6K KP.ALI I z., •, i. dd i + } fl 52 Z byR1 ..,� ...c l��cr. c• .�.— -sac ±f+J,� q_ �_ y '� _ '•�. moi, �nvR t y- - ^M'�rJ> Y..1" '?^K bT,i 'TT- [a.`�,�.Y�y"Y'^�+�y.•� Id, `' �f r C 4 —1Y v u. � T use i �,�'� tr r '� "]• � .`d'.;{�������`�' • i7 t,,,a`�Rr 5 y � � >. ` • p� � ,4.: "ll r - • ° ' it�:.l.If:4a�e+�n}4i, �a<h a.•..'+r�t .«'.:38]1��c+e� ,2��,f.. t� .f. a [ vc$_ ..� _., ,«. N 495 O A 3s 8749, N n 117 n 179' (23& m N � N n N h GnB2 D 75 98 N N 495 O A 3s 8749, N n 117 n 179' (23& m N � N n N h GnB2 D 75 98 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002706 Tax PIN/EH #: 58366dY22ff 530 04 11tS. 0l Billed To: Jeff Hayes Subdivision Info: Jeff Hayes Lot # 1 Reference Name: Landscape position Location/Address: Cana Road -27028 I Proposed Facility: Residence _ Property Size: 0.691 ac Date Evaluated:Z/�7(Q_ L 070 / Water Supply: On -Site Well Community Public - I Texture group / G Evaluation By: Auger Boring Pit Cut FACTORS I 32 33 S4 35 6 7 Landscape position L k GG, t -- Slope % L 070 c HORIZON I DEPTH C) - 1 37 0 - I Texture group S7 t! G u S Consistence Cr SSWS f ScC_ Structure AAk C Mineralogy SA ra HORIZON H DEPTH Z-] 3 Texture group C' r Consistence F ' Structure S S Mineralogy tM HORIZON III DEPTH 5 - J-5422 - Texture groupC S Consistence S Structure Mineralogy HORIZON IV DEPTH Texture group Consistence F. V Structure M Mineralogy Fi SOIL WETNESS S RESTRICTIVE HORIZON 5 2 SAPROLITE CLASSIFICATION l S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: C, EVALUATION BY: C Yi 1— aA'A-1' OTHER(S) PRESENT: I 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 ,M, V FR - Very friable FR - Friable FI - Firm VR - Very firm EFI - Extremely firm }Yet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Struchirg 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 Mates 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 - ial/da�/ft2 wra p5/7 51114flil