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241 Hidden Valley Lane Lot 9Davie Countv, NC Tax Parcel Report Tuesday, January 31, 2017 WARNING: THIS IS NOT A SURVEY 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 County's GIS website shall hold harmless the I-& Parcel Information County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to Parcel Number: G314OA0009 Township: Mocksville NCPIN Number: 5729183069 Municipality: Account Number: 82518729 Census Tract: 37059-806 Listed Owner 1: MCCLEAREN KENNETH W Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 241 HIDDEN VALLEY LANE Planning Jurisdiction: Davie County City: MOCKSVILLE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27028-5665 Voluntary Ag. District: No Legal Description: TRACT 9 HIDDEN VALLEY SECTION TWO Fire Response District: CENTER,WILLIAM R. DAVIE Assessed Acreage: 5.16 Elementary School Zone: WILLIAM R DAVIE Deed Date: 5/2002 Middle School Zone: NORTH DAVIE Deed Book / Page: 004230069 Soil Types: WeC,RnD,ChA Plat Book: 0006 Flood Zone: Plat Page: 118 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding & Extra Freatures Value: Land Value: Total Market Value: Total Assessed Value: Davie County, 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 County's GIS website shall hold harmless the I-& NCor County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to arW ng out of the use or Inability to use the GIS data provided by this website. f DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002251 Billed To: Kenneth McClearer Reference Name: Proposed Facility: Residence ATC Number: 3151 Tax PIN/EH #: 5729-18-3069.09 KM Subdivision Info: Hidden Valley Lot # 9 Location/Address: Hidden Valley Lane -27028 Property Size: see map AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: X&K-Z Date: � CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article 11 of G. S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. F A-C�, -3 T- 1,0 m-1+ If o ! q0 quy (Oot- 0--Z- 1Z a St`►-tsi 5� R �, r3 07- t}tJ..��C L`, Septic System Installed By: Environmental Health Specialist's Signature: Da DCHD 05/99 (Revised) 'A -2304 (-70q 3 •SSI In 7- DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Pee- (o_ 7-0Z ' P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002251 Billed To: Kenneth McClearer Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5729-18-3069.09 KM Subdivision Info: Hidden Valley Lot # 9 Location/Address: Hidden Valley Lane -27028 Property Size: see map **NOTIJ** Tliiss proven ent/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type MA: #People I-, #Bedrooms C- #Baths Dishwasher: .21 Garbage Disposal: ❑ Washing Machine:. Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow (GPD) c Site: New ET"" Repair ❑ System Specifications: Tank Size A GAL. Pump Tank dab VGAL. Trench Width " Rock Depth A' Linear Ft.c'�O D J Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - FINISHED GRADE. ****NOTICE: Contact a represen system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 XED EFFLUENT FILTER RISER(S) IF 6 L° BELOW the Davie County Health Department for final inspection of this the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date: -5 "2 ��— DCHD 05/99 (Revised) APPLIctainON FWR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department `1l 4 Environmental Health Section I % P.O. Box 848/210 Hospital Street Arjb Moaksville, NC 27028 `, 7,2 „ (336) 751-8760 ����% ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for innstru S. 1. Name to be Billed �1 16 4C M C (/ (f a r' -e4, Contact Person A f/ Mailing Address u � 0 Pat c -e 41tt YL CZ Home Phone 3Z 6( —c -,t 616 City/State/ZIP (.p trl n a n S 'A J G . rh7f� l �-- Business Phone ✓3 lam- ca 6 iy 6 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: I Site Evaluation 4. System to Service: ❑ House Mobile Home 5. If Residence: # People J ;Cro tvement Permit/ATC ❑ Both ❑ Business ❑ Industry ❑ Other # Bedrooms 3 # Bathrooms Dishwasher ❑ Garbage Disposal Washing Machine ❑ Basement/Plumbing CI Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes (4PNo If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION. Property Dimensions: /l,) WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # 30 4-0 Property Address: Road Name + L �' Il e�Cl e nJ City/Zip D --1-Fi Q- 1 r,,_o s + -i-o If in a Subdivision provide information, as follows: Name: Section: Block: Lot: Date Property Flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified.or changed. I, also, understand that 1 am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suita ility. DATE Gj_ I�- D,�, SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Pll L - 7--0 L Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. / Invoice No. C�- / D.:�AVIE COUNT'�I LTO DEPARTMENT F � ENVIRONMENTAL HEALTH SECTION P. 0. Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NC 27028 Phone #: (336)751-8760 April 23, 2002 Kenneth McClearer 1165 S. Peacehaven Road Clemmons, NC 27012 Re: Site Evaluation/ Hidden Valley Lot 9 Tax Office Pin : # 5729-18-3069.09 KM Dear Client(s): As requested, a representative from this office visited the aforementioned site on April 22, 2002. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, the site was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions, please feel free to contact this office. Sincerely, k�e & C;�ad'o• Robert B. Hall, Jr., R.S. Environmental Health Specialist RH/df Iron :,_ tl:. �...' •+ ' -?T«' r' ,' S 88' 52.17" E 60.05 �Y955.68 total.) ext _gig r.cn 395.63 AREA 5.130 ACRES ;Pf i 60EASEMEN T o. 1 89(;.e9 fit; '")s_ _ 10 " eb:,.� — —�, AREA = 5.126 ACRES n w#y b0.00o \ \ o a 6,01 a _ • \ dy. \ FA -F AREA i • n �•ZCh 1=1 \ •T•!' ��„� Dlacod Irun S•1 33ACRE r ' . AREA ; 5.325 ACRES _ •n' d � 336.6p R ' (1833.5 3 lolcl) ✓ ��• 331.00 ” r_ I �� •/ �' " 86.1'1' j0.. tv alo.2s — 1 I' JAMES CIYI)1 / DB- 71 pr,NUTCHINS. nn L� n l5 AP: LIGATION FOR SITE EVALUATION/IMPROVEMENT 1'ERBi;iT & Davie County Health Department • Environmental Heath Section N 2 9 n .� P.O. Box 848/210 Hospital Street CUUI >� Mocksville, NC 27028 (336) 751-8760 ENVIRD;v',�;ENTAL HEALTH DAVIE COUNTY l,J w ***IMPORTANT*** _INFORMATION IS THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to,be Billed oA ( ko-v 1�Q(C���iQ41 Contact Person flaffu marriaq Mailing Address9/r�/� Home Phone �g(Y�S�f�j�� /�n to�7oe- IVC � - cb-y L(fP{�1//l(� City/State/ZIP-Pd • (�,[IJIJBusiness Phone `7Y D 2. Name on Permit/ATC if`Different than Above Mailing Address Coity/State/Zip 3. Application For: ❑ Site`Evaluation ` J� Improvement Permit/ATC [IBoth 4. System to Service: ouse '\.. ❑ Mobile Home ❑ Business ❑ Industry ❑ Other v� 5. If Residence: # People # Bedrooms # Bathrooms '� ic yDishwasher Ll Garbage Disposal tT washing Machine Ll Basement/Plumbing 1.1 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City � Well LI Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the client with THIS APPLICATION. Property Dimensions: -Se�' 1 Ct�t1 (1 4K. Tax Office PIN: # Property Address: Road Name 9 cLP•- City/Zip If in a Subdivision provide information, as follows: Name: J c �r l Y� ��G `e Y, Section: Block: Lot - 94-/o `-/ o WRITE DIRECTIONS (frmn Mocksville) to PROPIAZ IN: h LJ� 0"-. Lt oc r Date Property Flagged: �'� 3,/ o This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed. 1, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site sui ability. DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). CO- 1— -}-o P Ge- 1- 7�I r i i► d o Revised DCHD (07/99) Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. J c� Invoice No. ...6..1./intr•nuVtMtN1 rPLUNII &AIC ------- 1V• I , Davie County Health Department 1- Envfroamenb/Kea/f6 Suction I (I P.O. Box 848/210 Hospital Street FEB — 5 19N(,•_ '• S Mocksville, NC 27026 1336)751-8760 VIVIROF1�P1EC1(AIITY hLiH TdIS APPLICATION CAMTOr BL PROCESSED UNLESS ALL THE RmLIZAP.1>3`�_. IMPMATIOH Is PROVIDED. Refer to the INrORMATION BULLETIN for instructions. Nam to be Billed -es L , /�- - eoY Contact Persan:3&P e S Hailing AddressO n /y� City/state,LIp 1' • E oa Business photya 3 _5to`(Dkd�-> ��_ Gams on Permit/ATC If Different than Above /10 Mailing Address City/state/Zip 3. Application For:{ S Evalna ass 0 Improvement Permit/ATC 0 Both +. system to service: House ile Home 11 Business U Inft8t3:y R Other a. If aide==:49a People _ i Bedrooms ! Bathrooms Dishwasher Disposal ash! Machine asenient Plu bin '� ng / g [) Basement/No Plumbing 6. If Business/Industry/other: Specify type • Commodes f showers # People # sinks # Urinals / Rater Coolers IP IMDSERVICE: I) seats ^� Estimated slater Usa(gallons per day) 7. Type of water supply: 0 Conn /Ci 0 Cosanni County/City t]T a. Do you anticipate additions or expansions of the facility this system Is intended to serve! 0 Yes o If yes, what type! *•'IMPORTANT'•' CLIENTS AIUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMIITED by the client with THIS APPLICATION. Property Dimensions: WR ITE DIRECTIONS �(from�Mockwille) to PROPERTY: y%TalOlcePIN: gL _ T Fr-uperiy Address: Road Name &4&n ) L &AC 97, Ve,-'tf tA -71 - l City/Zip. �lie nL ���a�� l ig `4-/z GZl ono: - e nz' If in a Subdivision provide information, as follows: C�� GI,SC 0 i1 r I/ Name: Y /e'". Section: _ _ Mock: yak— Date Property Flagged: This is to certhj ghat the Information provided Is correct to the treat of my knowledge. 1 understand that any permit(s) issued hereafter are su!)ject to suspension or revocation, If the site plans or Intended use change, or if the Information submitted in this application Is falsified or Asaged. I, also, anderstaxd Mat I am xloruible for al/ charges lxcurredfrow this application. 1, hereby, give consent to she Authorized Representative of the Davie My H tb Depart ent to enter upon above described property located in Davie County and owned by �.(j ��� to conduct all testing procedures as necessary to determine the site suitability. + DATE (,.l SIGNATURE THIS AREA MAY BE USED FOR Dpi WENG YOUR SITE 'r'(incinde all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). If ,,s /,,/, /x, Revised DCHD Account No. Invoice No. 51,1 Plac ion >• �o� r .— a , _T• j11— — —' o 8. 52. •02s55: .560eG , •y?3..'.`.•.'}�,,��1.M1., , (9553. 96t58,. 6 )3 '! M� na.b e,i,!q ' f rog AREAt5.130 ACRES O&%, EASEMENT O o o O 340.4 ."B96.B9 33965 J AREA=S.f26ACRES �1/�//EwIi o 60.00g `. cri to \ 39• \ `* I f0 2B- W Cj C71 \ CJs �� • \ ti q Ut �•��J \ \ / a AREA ACF3� ARE;; 05133 ACRES / \\\I[t 54r\ Placed lrun • ^ '� � �� a"3(% �Q•y „ fir_,', _ -;_? ACRES, .....................(_ q r� 43 .325 = 5.325 ACRES ti( . N f • 336.60 •-✓ - ? J . • ! (1(333.53 fofcl) _ 33).00 N 86• Iq ,30.. I4, • � ! 410.25 n I 100.00 s JAMES CLYDE NCHIN pe• 71 P6, 176 PAA `JE COUNTYHEALTH��� , . 1 ENVIRONMENTAL HEALTH SECTION P.O. Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NC 27028 Phone #: (336)751-8760 March 22, 1999 James Lonny George 1181 Daniel Road Mocksville, NC 27028 Re: Site Evaluation/Hidden Valley Lane Tax PIN: #5729-18-3069/5 Acres Dear Client(s): As requested through your application, Robert B. Hall, Jr., R.S., Environmental Health Specialist(s) with this office, visited the aforementioned site on January 28, 1999. The purpose of said evaluations(s) was/were to determine the soil/site suitability for the installation of an on-site sewage system. The result(s) of the evaluation(s), a copy of which is attached, indicate(s) the site is unsuitable for the installation of an on-site sewage system for the following reason(s): Rule(s) .1940 -Topography: Landscape Positioning (g) Wetland .1945 - Available Space (a) Installation (b) Repair Due to the limitation(s) on your site, this office is not aware of any modifications or alternative measures which can be implemented at the present time to upgrade the classification from "unsuitable" to "provisionally suitable." Your application for an Improvement Permit/Authorization to Construct must, therefore, be denied. You have the right to an informal review of this decision by the Environmental Health Director of this office and also by the regional staff of the Department of Environment and Health. You should contact this office to arrange for this further review. You may also wish to obtain the services of a private consultant to collect site-specific data and submit data and a system design to this office for technical review. A site may be reclassified provisionally suitable provided written documentation, including engineering, hydrogeologic, geologic or soil studies indicate to this office that a proposed on-site sewage system or a proposed Page 2 James Lonny George March 22, 1999 alternative system can reasonably be expected to function satisfactorily. The substantiating data from these studies must indicate that: A. The effluent (wastewater) will receive adequate treatment; B. The effluent (wastewater) will not contaminate any ground water or surface water, and C. The effluent (wastewater) will not be exposed on the ground surface or be discharged to surface waters where it could come into contact with people, animals or vectors. Finally, you have the right to a formal appeal of this decision if you file a petition for a contested case hearing with the Office of Administrative Hearings, P. O. Drawer 27447, Raleigh, NC 27611-7447. A copy of a petition form can be provided to you upon request. The petition must be received by the Office of Administrative Hearings within thirty (30) days of the date of this notice. The hearing may be held in Davie County. If you file a petition for a hearing, you must send a copy of the petition to Mr. Richard Whisnant, DENR, Office of General Counsel, P. O. Box 27686, Raleigh, NC 27611-7687. Please call or write this office if you have any questions or need any additional assistance, as follows: Telephone number: (336)751-8760 Davie County Health Department Environmental Health Section P. O. Box 848 Mocksville, NC 27028 Sincerely, AkV X • Robert B. Hall, Jr. Environmental Health Specialist RH/wd Enclosure(s): Soil -Site Report Invoice DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION_ LOT • Soil/Site Evaluation APPLICANT'S NAME ��'� rP 2 DATE EVALUATED _ "Pl" -4, PROPOSED FACILITY /V_ PROPERTY SIZE -she SUBDIVISION ROAD NAME Water Supply: On -Site Well Community Public Evaluation By: Auger Boring v Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position IFIP f Slope % 91 HORIZON I DEPTH 4 y Texture group oil Consistence Structure Mineralogy HORIZON II DEPTH 2" Texture groupC_ C Consistence r {� Structure 4i OI t� 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 Ej, SITE CLASSIFICATION: U-� LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD (01-90) EVALUATION BY: A 4 / OTHER(S) PRESENT: 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 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 ■■ME■■■E■■■■■■■MEM■■■■■■■■■■■ ■■■■■E■■■■■■■■■■MMrEE■ ■E■ ■■E■ ■■■■■MMM■■E■■■n■■■E■■E■■ME■■■■■■■■M■■■MEE■■■■■■MEE■■■■■■■■■■■ ■■E■■■■■■■■■■■ri■■■■■■E■■■■■■■■■■■■■■■e■■■■■■■M■■■■e■■■Mee■■■■ ■■MM■M■■■■■■■■��■■■■■■■M■■■■■E■■■■■■■E■■■MMM■■M■■■■■■■■■riEM■■■ ■■■■■■■■■■■■■n■■■■■■■■■■■■■■■ ■■■MEMMME■■■■■■■EEE■■■■►�■■■■E■ ■■■■■■■■■■■■�■■■■■■■■■■■■■■■■■■■■■E■■■■■■■■■■■■■■■■■■MEQ,■■■M■ ■■■■e■■e■t■r�e■■■e■■■t■■t■■tt■ ■■■te■■te■■■t■■te■EM■■■■��■■■■■ ■■■■■■■■■■■■�iM■■■■ME■■■■■■■■M■■■■■EEE■■■■■■■■■EMMM■■MEM��E■■■ ■■■■■■■■■E■■■.•■■■■■■M■■■■■■■■MNEME■■■E■■■■e■■t■■e■■■ee■u■ee■ ■■■■■■■■■■■■■■■tie■■■■■■■■■■■■I�■■■EE■■■■t■■■M■■■e■■tt■ri■■■■■■ ■■■■E■■■■■M■MMM►�■■■■■■■■■E■■■■■■■■■■■■■■■■■■■■■■■■■■■EEri■■■■■ ■■■■■■EE■■ENE■��■E■■M■■■■■■M■■�■■■■■■■■■■■■■E■■■■■■■t■�rttt■■■ ■■■■■■■■■■■■■■�iE■■■E■■■■■■■■■ ■■■■■MMM■■■■■■■M■■■■■■M��■■■■■■ ■■■■■■■�e■■■■��M■■■■■■■■■■■■■■■■■■■t■■tt■tent■■■■■■■■■■■r�■■■■■ ■■■t■■■■M■M■tet■■■■■■■■■■■■■■MMM■■■■■►�Eiv��y■■■■■E■■■■■E■EMM■■■ MENEM iMENNE MENNENMEMEMM��'w"MommammEMEME MEMMME aMEMNON ■■E■EM■■M■tett■■■■■■■■■■■■■■■■■■■■■MMM■■■MMM■■■■■ERS■■�■r�■■■■■ ■■■■■■■■■■■■\■■■■■■■■■■■■■■■■�■■■stet■tee■■■■■■■■■■■■■E■■■■■ ■■■■EEM■■■■■��■■■■■EMEEME■■■■ ■■■■■■■■■■E■■■■■■■E■■■■■r,■■■■■ ■■■■■■■■■■t■■■►�■■e■■■■t■t■■■e■ee■■■■t■ee■t■t■et■t■■■■t■�■■■t■ ■■■■■■■■■■■E■■��■■■■■■■■■■■■■■■■■■■■E■■■■■■■E■EO■■■■■■Of1■E■EE■ ■■■NI■■■MM■E■■■ ■■■N■EE■■■■■E■ ■■R■■E■■■■M■■■ ■■EMMEE■■■■■E■ ■■■■E■■■E■■■■■ ■■M■E■■■■■■E■■ ■MUME■ME■■■E■■ ■EIS■M■■ME■■E■■ ■■I■EM■■ME■ME■■ ■■n■■■■■■■E■■■ ■■"MEMME■■E■■■ ■■UMMEM■■EM■■■ EMEMEMEMEM ■■■EEE■■■■ ■■■■ME■t■■ ■■■■EMME■■ ■■■■■E■t■■ soon ii MEMO MEMO i ■ ■■EM■M■■B■ ■■■■E■■■EM ■■■■■■■■ME ■■■■■■■■EN ■■■■■E■■E11 ■■■■■■■■■" ■■■■■■ME■A ■■M■■■MEMS ■MM■M■■■WM ■E■■■■■OMM ■■■MEE■■UM ■■■■■■MERE MEMEMEMERM ■■E■■■■EWN ■■■■EME■E■ ■E■■■■ME■E i ■ i HE ;1J APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERM T RECEIVED Davie County Health Department 1 , Environmental Health Section JUL - 6 694 "✓ I P. 0. Box 665 Mocksville, NC 27028 _ _ _ _ _ _ _ _ _ _ �u �7 IOVI /s Gr1e 1. Application/Permit Requested B Mailing Address 0,41v,*% -Z67 /� Home Phone %2?' 5/3'9 7 L I�t,. Nr G. 2 ;,oz b' Business Phone 2. Name on Permit if D Verent than Above 3. Application for: General Evaluation ❑ Septic Tank Installation Permit �� ., �� 4. System to Serve: 0� ousex- �Cs6�G= 0 Mobile Home - ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision �� Section Lot # U pa ko,�4 4. 11-14 U[' gofa N a .46AZO ,L O i s ❑ Basement/Plumbing -.0 9,e S 4'vJV h.,S PLc� s I4C�$�i?,0c „� 7-�.�cTs No. of People ❑ Basement/No Plumbing No. of Bedrooms No. of Bathrooms Dwelling Dimensions ❑ Washing Machine ❑ Dishwasher ❑ Garbage Disposal 6. If business, Industry, place of public assembly, other: Specify type No. of People Served No. of Commodes No. of Lavatories No. of Showers 7. Type of water supply: 8. Property Dimensions ❑ Public 9. Do you anticipate additions/expansion of the facii If yes, what type? No. of Sinks No. of Urinals No. of Water Coolers Water Usage Figures ❑ Private Sewage Disposal Contractor sytem is intended to serve? ❑ Yes ❑ No ❑ Community "NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions to Property: �-- 0) This is to certify that the information provided is correct to the b t of my knowledge, and I u erste Incurred romt s application. Q DATE SIGNATURE I am responsible for all charges CONSENT FOR BT EVALUATION ZQ BE DONE QN ABOVE DESCRIBED PROPERTY MUST CHECK ONE: ❑ 1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD (1103) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAMEDATE EVALUATED ADDRESS PROPERTY SIZE 1h /! l PROPOSED FACIILTY y/ / iY � /` .PI LOCATION OF SITE am ,�✓ X ll tj / Water Supply: On -Site Well f/ Community Public Evaluation By: Auger Boring Pit I-/ Cut FACTORS 1 2 3 4 Landscape position L L = Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group ell Consistence Structure i /7 Mineralogy HORIZON III DEPTH 1 1 Texture groupI 1 Consistence I Structure Mineralogy' HORIZON IV DEPTH Texture group Consistence Structure 1 MineralogyI SOIL WETNESS RESTRICTIVE HORIZON j SAPROLITE CLASSIFICATION I PSI - LONG -TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATED BY: LONG-TERM ACCEPTANCE RATE: OTHERW PR SENT: REMARKS: D r�� 40 LE ND Landscape Position R -Ridge S -Shoulder L -Linear slope FS -Foot slope N -Nose slope CC -Concave slope CV -Convex slope T -Terrace FP -Flood plain H -Head slope Texture S -Sand LS -Loamy sand SL -Sandy loam L -Loam SI -Silt SICL-Silty +:lay loam, SIL -Silty loam CL -Clay loam SCL-Sandy clay loam SC -Sandy clay SIC -Silty clay C -Clay CONSISTENCE Moist VFR-Very friable FR -Friable FI -Finn 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 3C -Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky SBK-Subangular blocky PL -Platy PR -Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water' or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD(01-901 rDai ie. _County Neall§ De arlment ' and XOh7e Jfealtl yency 210 HOSPITAL STREET/ P.O. BOX 665 MOCKSVILLE. N.C. 27028 PHONEt (704) 634-5985 September 23, 1994 James Nance 1568 Cornatzer Rd. Mocksville, NC 27028 Re: 2 Site Evaluations Hidden Valley/Tracts 9 & 10 Dear Mr. Nance: On September 15, 1994, this office evaluated tracts 9 and 10 in Hidden Valley off Allen Road in Davie County. Soil borings on tract 9 revealed a provisionally suitable soil on the upper left side; however, it appears that part of the tract lies in a flood plain. Before specific approval can be granted the house or mobile home placement must be estalished and that immediate area evaluated. Soil borings on tract 10 revealed a provisionally suitable soil. It appears there is room for two septic systems to be installed on tract 10. Before specific approval can be granted.the house or mobile home placement must be established and that immediate area evaluated. If you have questions, feel free to call. Sincerely, A4vs,4,�; ' , �2' � <--SI Robert B. Hall, Jr., R.S. Environmental Health Section RH/wd Enclosure cc: Jesse Boyce, Zoning Officer DAME COU Y SIE_ LTH ENVIRONMENTAL HEALTH SECTION P. O. Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NC 27028 Phone #: (336)751-8760 April 23, 2002 Kenneth McClearer 1165 S. Peacehaven Road Clemmons, NC 27012 Re: Site Evaluation/ Hidden Valley Lot 9 Tax Office Pin: # 5729-18-3069.09 KM Dear Client(s): As requested, a representative from this office visited the aforementioned site on April 22, 2002. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, the site was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr., R.S. Environmental Health Specialist RH/df North Carolina - Department of Environment and Natural Resources - Division of Water Ouatity - Groundwater Section 1636 Mail Service Center - Raleigh, N.C. 27699 -1636 -Phone (919) 733-3221 WELL CONSTRUCTION RECORD WELL CONTRACTOR: WELL CONTRACTOR CERTIFICATION #: 252? STATE WELL CONSTRUCTION PERMIT#: 1. WELL USE (Check Applicable Box): Residential ❑ Municipal ❑ Industrial ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use: 2. WELL LOCATION: (Show sketch of the location below) Nearest Town: Mocksville County: Davie Alan Road Agricultural ❑ Monitoring ❑ (Road Name and Numbers. Commu ity, or Subdivision and Lot No.) Kenneth MCC earer DRILLING LOG 3. OWNER From To Address Hidden Valley Lot From To From To Mocks `ile rr u e o. NC in. in. 0-42 City or Town State Zip Code 42-125 4. DATE DRILLED 7-11-02 5. TOTAL DEPTH 12 5 Depth 6. CUTTINGS COLLECTED YES ❑ NO© Material 7. DOES WELL REPLACE EXISTING WELL? YES 0 NO® B. STATIC WATER LEVEL Below Top of Casing: FT. FL (Use -+- 9 Above Top of Casing) 1 9. TOP OF CASING IS FT. Above Land Surface' -Top of casing terminated attar below land surface requires a variance in accor- dance with 15A NCAC 20.0118 10. YIELD (gpm): 12 METHOD OF TEST air 11. WATER ZONES (depth): 50 an 12. CHLORINATION: Type 13. CASING: DEPTH Formation Description clay/sand rock Amount If additional space is needed use back of form Wali Thickness Depth Diameter orWeighUFL Material From 0 T04 Ft. 6.25 sch40 pvc From To Ft. From To FL 14. GROUT. Depth Material Method From 0 To 20 Ft. concrete gravity From To Ft. 15. SCREEN: LOCATION SKETCH (Show direction and distance from at least two State Roads, or other map reference points) Depth - Diameter Slot Size Material From To From To Ft in. Ft. In. in. in. From To 16. SAND/GRAVEL PACK- ACKDepth Ft. in. In. �. Depth Size Material From To FL From To Ft. 17. REMARKS: 1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT ACO�� I � COEEN PROVIDED TO THE WELL OWNER. FOR OFFICE USE ONLY Quad No: Serial No. SIGNATt3AE OF PERSON CONSTRUCi1NG THE WELL DATE Submit original to Division of water OuaGty. Groundwater section within 30 days GW 1 REV. 12199