The URL can be used to link to this page

128 Drayton Court Lot 21Davie County, NC Tax Parcel Report Wednesday. February 8. 2017 WARNING: THIS IS NOT A SURVEY 161 All data Is provided as Is without warranty or guarantee of any kind 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 County's 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 NCor arising out of the use or inability to use the GIS data provided by this website. Parcel Information ` Parcel Number: H520OA0021 Township: Mocksville NCPIN Number: 5749537195 Municipality: Account Number: 48186500 Census Tract: 37059-805 Listed Owner 1: MCALLISTER CHARLES M Voting Precinct: NORTH MOCKSVILLE COUNTY Mailing Address 1: 178 POPLAR STREET Planning Jurisdiction: MOCKSVILLE City: MOCKSVILLE Zoning Class: MOCKSVILLE OSR State: NC Zoning Overlay: Zip Code: 27028-2226 Voluntary Ag. District: No Legal Description: LOT 21 THE OAKS MCALLSITER PK Fire Response District: MOCKSVILLE Assessed Acreage: 1.12 Elementary School Zone: MOCKSVILLE Deed Date: 3/2016 Middle School Zone: SOUTH DAVIE Deed Book / Page: 010130165 Soil Types: GnC2,GaD Plat Book: 0009 Flood Zone: Plat Page: 318 Watershed Overlay: MOCKSVILLE Building Value: 113360.00 Outbuilding & Extra Freatures Value: 0.00 Land Value: 22500.00 Total Market Value: 135860.00 Total Assessed Value: 135860.00 161 All data Is provided as Is without warranty or guarantee of any kind 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 County's 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 NCor arising out of the use or inability to use the GIS data provided by this website. OPERATION PERMIT ✓,moo Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Wishon and Carter Builders, INC Address: PO Box 1719 City: Yadkinville State/Zip: NC 27055 Phone #: (336) 469-2290 Address/Road #: 128 Drayton Court Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 2 # of People: *Water Supply: PUBLIC *CDP File Number 202022 -1 H520OA0021 County ID Number: Evaluated For: NEW �ownship: e"'Property Owner: Wishon and Carter Builders, INC Address: PO Box 1719 City: Yadkinville State/Zip: NC 27055 Phone #: (336) 469-2290 Subdivision: The Oaks at McAllister Phase: Lot: 21 *IP Issued by: *CA issued by: 2140 - Nations, Robert Design Flow: a 4 0 Soil Application Rate: 0 2 7 5 Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: Directions Hwy 158, right on Sain Rd. right on Hanford, Left on Chandler Right on Madera *System Classification/Description: TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Saprolite System? O Yes (9 No *Distribution Type: GRAVITY -SERIAL Pump Required? O Yes W No *Pre -Treatment: 8 9 a Sq. ft. a .1 3 ft. 9 Q ® Inches O.C. Feet O.C. — 30 Inches Feet inches e *System Type: INFILTRATOR QUICK 4 STANDARD Installer: Darrell Salmons Certification #: 2652 *EHS: 2399 - Eldridge, Tiffany Date: 1 a/ a 9/ 2 0 1 6 Minimum Trench Depth: a 4 Inches Minimum Soil Cover: 1 Inches Approval Status Maximum Trench Depth:3 6 Inches ®Approved ❑ Disapproved Maximum Soil Cover: .2 4 Inches Page 1 of 4 CDP File Number 202022 - 1 Manufacturer: shoaf STB: Gallons: 1000 Date: 1 0/ a 7/ a 0 1 6 "Filter Brand: POLYLOK Dual PL -122 With Pipe Adapter ST Marker: ❑ Yes ® No Reinforced Tank: ❑ Yes ® NO Yes ❑ No I— ❑ KiPieceTank: ❑ Yes ® NO Countv ID Number: H5200A0021 Lat. Q rump l ann Manufacturer: Installer: PT: Certification #: Gallons: *EHS: Date: / / Riser Sealed ❑ Yes ❑ No Riser Height: ❑ Yes ❑ NO (Min. 6 in.) nforced Tank: ❑ Yes ❑ NO 1 Piece Tank: ❑ Yes ❑ No I— ❑ Yes ❑ / Pipe Size: Pipe Length: *Schedule: Pressure Rated ❑ Yes Approved fittings ❑ Yes Date: Approval Status ❑ Approved ❑ Disapproved Supply Line inch diameter Installer: feet Certification #: *EHS: ❑ No Date: / ❑ No qpp ❑ Approve / Pump Type: Dosing Volume: - Draw Down: Inches *Chain: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ NO Check -valve ❑ Yes ❑ No PVC Unions ❑ Yes ❑ No Vent Hole ❑ Yes ❑ No Anti -siphon Hole ❑ Yes ❑ No Installer: Gal Certification #: *EHS: Page 2 of 4 / al `Status , ❑ Disapproved; Date: / / Approval Status L F Approved ❑ Disapproved CDP File Number 202022 -1 County ID Number: H5200A0021 NEMA 4X Box or Equivalent ❑ Yes ❑ NO Installer: Box 12 inches Above Grade ❑ Yes ❑ NO Certification #: Box Adj. To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ NO *EHS: Pump Manually Operable ❑ Yes ❑ No *Activation Method: Date: Alarm Audible ❑ Yes Alarm Visible ❑ Yes El No Approval Status 'Approved "Disapproved ❑ ❑ No 2399 - Eldridge, Tiffany *Operation Permit completed by: IL Authorized State Agent: I Date of Issue: 1 a/ a 9 / a 0 1 6 Owner/Applicant Signature: 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 ii A. sewage septic system. Rule .1961 requires that a Type TYPE 11 A. septic system meet the following criteria: Minimum System Review By The 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 for a home/business owner must maintain a valid contract With a public management entity with a certified operator or a private certified operator for the life of the septic system. Rule .1961 requires that Type VI septic systems designed for a home/business owner must maintain a valid contract with a public management entity with a certified operator for the life of the septic system. Rule. 1961 (2) (e) requires a contract shall be executed between the system 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 owner and certified operator are the same. The contract shall require specific requirements for maintenance 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 O Import Drawing **Site Plan/Drawing attached.** Page 3 of 4 OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC Drawing Drawing Type: Operation Permit CDP File Number: 202022 - 1 County File Number: H5200A0021 27028 Date: 0 Inch Scale: . O Block 0 N/A Page 4 of 4 P1 P2 P3 i OPERATION PERMIT Davie County Health Department 210 Hospital Street CDP File Number: P.O. Box 848 H5200A0021 Mocksville NC 27028 County File Number: Date:. . ./. . ./. Click below to import an image from an external location: Drawing Type: Operation Permit Page 4 of 4 P1 P2 P3 System Final Inspection Log: 'Charaders Drain Field: Remaining 4000 Septic Tank: Pump Tank: Supply Line: Pump Requirements: Electrical Equipment: P1 P2 P3 Characters Remaining 4000 Charaders Remaining 4000 Charaders Remaining 4000 Charedera Remaining 4000 Charaders Remaining 4000 Address/Road #: Draxton Court Mocksville Structure: # of Bedrooms: # of People: *Water Supply: NC 27028 SINGLE FAMILY 2 PUBLIC Subdivision: The Oaks at McAllister Park Phase: Lot: 21 Directions Hwy 158, right on Sain Rd. right on Hanford, Left on Chandler Right on Madera CONSTRUCTION - Minimum Trench Depth: a 4 Inches For Office Use Only AUTHORIZATION Saprolite System? QYes ®No *CDP File Number 202022-1 40 Davie County Health Department Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 a 7 County ID Number: H5200A0021 Maximum Soil Cover: a 4 Inches *System Classification/Description: 210 Hospital Street *Distribution Type: GRAVITY -SERIAL TYPE II A. CONV SYSTEM (SINGLE-FAMILY Evaluated For. NEW P.O. Box 848 _ _Gallons *Proposed System: 25% REDUCTION Township: 1 -Piece: QYes QNo Mocksville NC 27028 PERMIT VALID UNTIL: Nkrification Field 8 Phone: 336-753-6780 Fax: 336-753-1680 0 3/ a 3/ a 0 a 1 Applicant: Wishon and Carter Builders, INC Property Owner: Wishon and Carter Builders, INC Address: PO Box 1719 GPM—vs— ft. TDH Address: PO Box 1719 City: Yadkinville City: Yadkinville StatefZip: NC 27055 Aggregate Depth: inches State(Zip: NC 27055 \ Phone #: (336) 469-2290 Phone #: (336) 469-2290 Address/Road #: Draxton Court Mocksville Structure: # of Bedrooms: # of People: *Water Supply: NC 27028 SINGLE FAMILY 2 PUBLIC Subdivision: The Oaks at McAllister Park Phase: Lot: 21 Directions Hwy 158, right on Sain Rd. right on Hanford, Left on Chandler Right on Madera Donn 1 of Q Minimum Trench Depth: a 4 Inches Site Classification: Provisionally Suitable \ Saprolite System? QYes ®No Minimum Soil Cover. 1 a Inches Design Flow: a 4 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: _ _Gallons *Proposed System: 25% REDUCTION 1 -Piece: QYes QNo Pump Required: QYes QNo OMay Be Required Nkrification Field 8 7 3 Sq. ft. _ Pump -Tank: Gallons No. Drain Lines 3 -------1-Piece: QYes ONo Total Trench Length: a 1 8 ft GPM—vs— ft. TDH Trench Spacing: — 9 Olnches O.C. Dosing Volume: Gallons QFeet O.C. g — Trench Width:3 Inches gFeet _ Grease Trap: Gallons Aggregate Depth: inches - Pre Treatment: ONSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: 01 OII 0111 01V Donn 1 of Q CDP File Number 202022-1 • -County ID Number: H520OA0021 ❑ Open Pump System Sheet Kepawbysiem Kequired:V res vlvv k lN0, ou[ nos MVdIIdDie 0Pdce /Repair System Trench Spacing:Inches O. *Site Classification: Provisionally Suitable 9 Feet O.C. Trench Width: 0 Inches Design Flow: O A A _ 3 Feet *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 wayguarantees 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 same time the Improvement Permit Issued (NCGS 130A-33G(b)). If the Installation has not been completed during the period of validity of the Construction Peri; the information submitted In the application for a permit or Construction Authorization Is found to have been incorrect, falsified or changed, or the site is altered, the permit or Construction Authorization shall become Invalid, and may be suspended or revoked (.1937(8)). 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)). Applicariftegal Reps. Signature Required? OYes; ONO Applicant/Legal Reps. Signature: Date:. / / *Issued By: 2140 -Nations, Robert Date of Issue:. 0 3/ a 3/ a 0 1 6 Authorized State Agent: Malfunction Log OYes OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 Depth: Soil Application Rate:Aggregate 0 .1 7 5 inches Minimum Trench Depth: a 4 *System Classification/Description: Inches TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS, Minimum Soil Cover. 1 a Inches Maximum Trench Depth: 3 6 *Proposed System: 25% REDUCTION Inches Maximum Soil Cover: � 4 Nitrification Field 8 7 3 Inches 5q. ft. No. Drain Lines 3 *Distribution Type: GRAVITY -SERIAL Total Trench Length: a 1 8 Pump Required: OYes @No OMay Be Required ft \ Pre Treatment: 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 wayguarantees 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 same time the Improvement Permit Issued (NCGS 130A-33G(b)). If the Installation has not been completed during the period of validity of the Construction Peri; the information submitted In the application for a permit or Construction Authorization Is found to have been incorrect, falsified or changed, or the site is altered, the permit or Construction Authorization shall become Invalid, and may be suspended or revoked (.1937(8)). 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)). Applicariftegal Reps. Signature Required? OYes; ONO Applicant/Legal Reps. Signature: Date:. / / *Issued By: 2140 -Nations, Robert Date of Issue:. 0 3/ a 3/ a 0 1 6 Authorized State Agent: Malfunction Log OYes OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Healih Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Construction Authorization CDP File Number: 202022 -1 County File Number: H52"A0021 Date: 0 3/ 2 3/.1 0 1 6 () Inch Scale: ()Block ()N/A _a L1.5 ( I ! LIlip 14 i T1i 31 - I _ _...... I Fr I f L7L_ I s `'G =ZZ 1--------------- _.... 3 r j { r � I _ � I CONSTRUCTION AUTHORIZATION' Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 CDP File Number: County File Number: 202022-1 H520OA0021 Date: .03/a3/-2016 Click below to Import an Image from an external location: Drawing Type: Construction Authorization APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health PAIS P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/ Fax (33 )753-1680 ,on or: 7 Site Evaluation/Improvement Permit uthorization To Construct (ATC) ❑ Both Type of Application: 94ew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name W ; v L � , F C,4 -,r Qr, : 14.Lt Contact Person A e ; I Tc Lo +1 I .< 4-A Address PO 13^,r ' 1719 Home Phone 33r, - u (o e(— ZZ q r2 City/State/ZIP AIL 7 -70S -S Business Phone 33(0-(079-2031 Email w Sa 1 co; gb�tir c r l,: w r . Cc,..,Email: n) c� I T L .. w- Name on Permit/ATC if Different than Above Mailinl; Address _ _ _ City/State/Zip PROPERLY IN VO MAIIUN "Date House/Factl NOTE: A survey plat or site plan must accompany this application. Included: L-rSite Plan LIPIat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name "J 6f .; lel �sy •TLC Phone Number 33(0-fo79-703/ Owner's Address PO (jos- 1119 City/State/Zip )U k: A V 1 t. _ A/C Property Address Lo•f- 2-1,- —15rck�- vr. C--- City_Lt.(pCI r y .144 /�/O Lot Size 1.07 Acr.a s 1"ax PIN# 00 Z I .1 Subdivision Name(if applicable) -9 e OaPi a�Fca//sF c.J'(3ection/Lot# Z/ r / Directions To Site: /5V fv:a...A,_;w-4- ,&- Se.:... Z.YLA- c, P s- a d scc- 1 L' u! F L-• If the answer to any of the following uestions is "Yes",suppo ing documentation mus be attached: Are there any existing wastewater systems on the site? _Yes vli o Does the site contain jurisdictional wetlands? — es ✓�Io Are there any easements or right-of-ways on the site? ✓ Yes No Is the site subject to approval by another public agency? _Yes Will wastewater other than domestic sewage be generated? Yes X0 IF RESIDENCE FILL OUT THE BOX BELOW # People Z # Bedrooms Z #p5hW21ras ZXt Garden Tub/Whirlpool I [Yes INo Basement: 7Ye ❑Noi Basement Plumbing: �Ye 3No 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: 3tonventional ❑Accepted ❑Innovative ❑Altemative ❑Other Water Supply Type: U&Iunty/City Water ❑ New Well ❑Existing Well 7 Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? C Yes If yes, what type? Md. 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 corners and locating and flagging or staki2p1he house/fac' k location, propo well location and the location of any other amenities. Site Revisit Charge Property owner's or owner's legal representative signature Date(s): 5-22- I(, Client Notification Date: Date EHS: Sign given I Yes ❑No Revised 11/06 Account # Invoice # C IOWZv Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account M 990004186 Tax PIN/EH #: 5749-53-8619.21 Billed To: Cool Spring Builders, Inc. Subdivision Info: The Oaks at McAllister Park Lot # 21 Address: PO Box 2040 Location/Address: Sain Road -27028 City: Advance . Property Size: see map Reference Name: Michael Moorefield 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: Xew ❑Repair ❑Expansion Permit Valid for: 05 Yearso Expiration Residential Specifications: # Bedrooms '?> # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD); Type of Water Supply: Xounty/City [I Well ❑Community Well Site Modifications/Permit Conditions: S stem Type LTAR Initial 7 Re air c"2-7y- Site .2"7– Site Plan "Ilk — r 1 1 2:5 io l 41b, t �.890 Environmental Health Specialis Date 2 i.p.11-06 ITE EVALUATION/IMPROVEMENT PERMIT & ATC avie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Appl a�CTfion For: 0IY ite Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both Type of Application: 5qlew 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 INFORMATION Name to be Billed ` "' Sy19%' /19 -' � '�'' i , -1/1 Contact Person Zi./ t ele1��'�-�? U�� ,-5 Billing Address PC)J��c �C% Home Phone � `� � �j JS3 `' City/State/Zip City/State/ZIP cS�e4aPS't. ,veer N` v� �' 7�2�' c� Business Phone .33& 3 - 5,�4-3 (61ell Name on Permit/ATC if Different than Above Address PROPERTY INFORMATION "Date House/Facility Corners nagged_ NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan*lat(to scale) (Permit is alid.for 60 months w'th site p n, no expiration with complete plat.) Owner's Name) 1 r ) I-ivei -. U�� ,-5 Pho e umber Owner's Address - Z City/State/Zip Jh Property Address �'ac c Ci� Lot Size Tax PIN# Subdivision Name(if applicable) 1 0fZ S -P Section/Lot�#/ Directions To Site: /5S' %i2Gr/Ll �2r�-i11 f e/l1 XeraW If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes-RIdo Does the site contain jurisdictional wetlands? ❑Yes ENO Are there any easements or right-of-ways on the site? ❑Yes RNo Is the site subject to approval by another public agency? ❑Yes QNo Will wastewater other than domestic sewage be generated? ❑Yes ffllo IF RESIDENCE FILL OUT THE BOX BELOW # People_ # Bedrooms # Bathrooms Garden Tub/Whirlpool ErKs []No Basement: ❑Yes ❑No/L/ f f Basement Plumbing:[ e--'s� {;}No IV/4 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: onventional []Accepted ❑Innovative []Alternative ❑Other Water Supply Type: ffC- ounty/City Water ❑ 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? M. 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 corners and locating and flagging 0aking the ouse/facil/ity location, proposed well location and the location of any other amenities. -�` ) Site Revisit Charge Property owner's or k�wmer's legal representative signature Dt Date a e(s). Client Notification Date: EHS: Sign given ❑Yes ❑No Account # Revised 11/06 Invoice # - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990004186 Billed To: Cool Spring Builders, Inc. Reference Name: Michael Moorefield Proposed Facility: Residence Property Size PROPERTY INFORMATION Tax PIN/EH #: 5749-53-8619.21 Subdivision Info: Black Forest Lot # 21 Location/Address: Sain Road -27028 see map Date Evaluated: 3 Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 13441 4 5 6 7 Landscape position J (, l /-- Slo e % Slope (010 HORIZON I DEPTH $ CL - R Texture groupG Consistence IG , Structure F.5 k Mineralogy ' HORIZON II DEPTH I O - 11-49, Texture groupC--,,Sco Consistence /� . Structure - C MineralogyS'v HORIZON III DEPTH Texture groupS, Consistence N Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 32, — RESTRICTIVE HORIZON 3 Z SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE Z77.:--. 0 '" SITE CLASSIFICATION: Il > EVALUATION BY: LONG-TERM ACCEPTANCE RATE: �• 2�� OTHER(S) PRESENT: nF�renTrc• V;.(.le, ntiofTLJ 1. xgy0 t tr 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 3yd 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 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 05105 (Revised)