297 Brangus Way Lot 28-29**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article I 1 of G.S. Chhtpleer`130A. Wastewater Systems. Section. 1900 Sewage Treatment and Disposal Systems)
// ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
O 7 IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONw1�N AL'HEALTH$PECIALIST DATE7SSUED
_.�.r / 11
RESIDENTIAL SPECIFICATION: BUILDING TYPE ll)1,� # BEDROOMS # BATHS # OCCUPANTS LL GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE
__ # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/or No
W
LOT SIZE E TYPE WATER SUPPLY J>JT�ESIGN WASTEWATER FLOW (GPD) ' NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE'S GAL. PUMP TANK GAL. TRENCH WIDTH '-f ROCK DEPTH -- LINEAR FT.
REQUIRED SITE MODIFICATIONS/CONDITIONS:j��`IAL U �QJQ V't^c'- (�W l'��L}
IMPROVEMENT PERMIT LAYOUTVT'
--nLt,�
�X1ST
IrJU
EK,4-SI T,
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF
OPERATION PERMIT
�
S�TIC_
TELEPHONE # IS (31b) 751-8760.
SYSTEM INSTALLED BY: ►�ANz)W ' " `1 L.•L &z
rv\ >J
AUTHORIZATION NO. , 7 1 OA OPERATION PERMIT BY: �,� DATE: 0--)
COMPLIANCE
*THE WITH ARTICLECE OF I I OF G.SSCHAPTER 130A, OPERATION SECTION 1900 "IT SHALL "ICATE THAT SEW GE TREATMENT AID DIS I�E[�43"�SHAEL N NO WAY BETAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD O7M2 (ReA,W) A,,1 -r<+- (! 6 3
Permittee's
) { t~ ^)
DAVIE COUNTY
�'�-
HEALTH DEPARTMENT
Name —y L�
Environmental
Health Section
PROPERTY
INFORMATION
!� L'r
!J i L -f1NQ
P.O. Box 848
��� �'
Directions to property:
Mocksville. NC 27028
Subdivision Name:
i
Phone #: 336-751-8760
Section:
-
LoCD__
AUTHORIZATION FOR
WASTEWATER
SYSTEM CONSTRUCTION
Tax Office PIN:#
-
-1V
NO:
OO2%%O A
Road Name:.-
t�Az:vAUTHORIZATION 11
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article I 1 of G.S. Chhtpleer`130A. Wastewater Systems. Section. 1900 Sewage Treatment and Disposal Systems)
// ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
O 7 IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRONw1�N AL'HEALTH$PECIALIST DATE7SSUED
_.�.r / 11
RESIDENTIAL SPECIFICATION: BUILDING TYPE ll)1,� # BEDROOMS # BATHS # OCCUPANTS LL GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE
__ # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/or No
W
LOT SIZE E TYPE WATER SUPPLY J>JT�ESIGN WASTEWATER FLOW (GPD) ' NEW SITE REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE'S GAL. PUMP TANK GAL. TRENCH WIDTH '-f ROCK DEPTH -- LINEAR FT.
REQUIRED SITE MODIFICATIONS/CONDITIONS:j��`IAL U �QJQ V't^c'- (�W l'��L}
IMPROVEMENT PERMIT LAYOUTVT'
--nLt,�
�X1ST
IrJU
EK,4-SI T,
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF
OPERATION PERMIT
�
S�TIC_
TELEPHONE # IS (31b) 751-8760.
SYSTEM INSTALLED BY: ►�ANz)W ' " `1 L.•L &z
rv\ >J
AUTHORIZATION NO. , 7 1 OA OPERATION PERMIT BY: �,� DATE: 0--)
COMPLIANCE
*THE WITH ARTICLECE OF I I OF G.SSCHAPTER 130A, OPERATION SECTION 1900 "IT SHALL "ICATE THAT SEW GE TREATMENT AID DIS I�E[�43"�SHAEL N NO WAY BETAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD O7M2 (ReA,W) A,,1 -r<+- (! 6 3
- r- � f Y . � s ..., ` .. --+..-.�'.L,p '•9�'P�rv�"n��r�s�.,,-6!NV''s+` %1J�, fi_tf.ia"'%M,� •5i } k . `� J- ' - .,.r .'u ^, : . , n_'.. . , .. ,
Permittee's DAVIE.CO.UNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION.
rl (P.O. Boz 848Ty-,4%vd4 t �►�!
.. , Direction 0 property:Nlocksville; NC 27028. Subdivision Name:
r Phone #: 336-751-8760
Section: Long�
�.
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION q�- - a
AUTHORIZATION NO: 002770. A Road Name:2- %
**NOTE** This Authorization for.Wastewater System Construction MUST BE ISSUED. by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Form/AuthorizationNumber should be presented to the Davie County Building Inspections
Office when applying for.Building Permits.
(in compliance with Article 1 l o G.S. C4a=r 130A. Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
.
***NOTICE*.** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
A VIAL DATE WS6ED
RESIDENTIAL SPECIFICATION: BUILDING TYPE NBEDROOMS # BATHS #OCCUPANTS -7 GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE ��"'�"`� PE WATER SUPPLY ESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE ✓
n �
SYSTEM SPECIFICATIONS: TANK SIZE GAL. -PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. 2 7
OTHER
L
REQUIRED SITE MODIFICAONS/CONDITIONS: D) N
TI `
IMPROVEMENT PERMIT LAYOUT
�'• , � Mei `r� �-�
ST r -j
EX IST I hjcq
S af >T i c
,
�. FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTAL TION. TELEPHONE # IS (3 ) 751 -8760 -
OPERATION PERMIT
51-8760.OPERATIONPERMIT
'416. 6) SYSTEM INSTALLED BY:
AUTHORIZATION NO. 21 O_` OPERATION PERMIT BY:
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT T4 AB S
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND,DI Wig' ;
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTO$II.Y FOR ANY GIVEN PERIOD OF TIME.
DcHD OM (Reraeo
DATE:
-LED IN COMPLIANCE
NO WAY BE TAKEN AS A
_ Permittees , , 4 _ DAME COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
_ P.O. Box 848 r
Directions to property: f 1 f? • t r 'F d. `�' ` "" Mocksville, NC 27028. Subdivision Name:Z-
�, Phone #: 336-751-8760 Section: Lot
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION - -
AUTHORIZATION NO: 002770 A Road Name r 17
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any Building Permits. This Forrn/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance with Article 11 of G.S. Chaple„r 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
1 ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
r?` 4 XZI J � IS VALID FOR A PERIOD OF FIVE YEARS.
" ENVIRONMENtAL HE'AL'TH SPECIALIST DATE ISSUED
rf
RESIDENTIAL SPECIFICATION: BUILDING TYPE f its, %`C:# BEDROOMS # BATHS —4—# OCCUPANTS 1" GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE t V � TYPE WATER SUPPLY -- .'upjl �ESIGN WASTEWATER FLOW (GPD) Lt NEW SITE REPAIR SITE ./
SYSTEM SPECIFICATIONS: TANK SIZE 40 GAL. PUMP TANK GAL. TRENCH WIDTH - '^ROCK DEPTH —^--LINEAR FT.
OTHER�`�t
REQUIRED SITE MODIFICATIONS/CONDITIONS: of-)
IMPROVEMENT PERMIT LAYOUT '( I
--.m. ;✓moi _�...r"""'!:La�.Id
FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALL TION. TELEPHONE # IS (3 ) 751-8760.
OPERATION PERMIT
SYSTEM INSTALLED BY:
AUTHORIZATION NO. v" ` OPERATION PERMIT BY: 1 / (:' f! �
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT T iE SySTEM L RIBEQ AB E H,, BEEN
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DI % S",`BIIT SH
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 02/02 (Revised)7 (l o . /1 / j 3
FlMIMA
'-LED IN COMPLIANCE
NO WAY BE TAKEN AS A
" AWWAVI SITE EVALUATION/IMPROVEMENT PERMIT & ATC
'- Davie County Environmental Health
3 o 2007 P.O. Box 848/210 Hospital Street
Mocksville, NC '27028
(336)751-8760/ Fax (336)751=8786
ENVIRONPJ�ENTAIHAIR1-
:ion Fb�'� provement Permit ❑ Author* ation To Construct(ATC) ❑ Both
Application: Z3<ew System ❑ Repair to Existing System EJ-Expansion/Modification of Existing System or Facility
11, Z,
'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
Contact Person
Billing Address 1 _-,?-S--7 u s
C,-) L J � ,-i-
Home Phone
City/State/ZIP /'✓%
v .��s 1 �.
,�J . L . 27 o z %
Business Phone 7 `f 5-- Z v v b
Name on Permit/ATC if Different than Above.
Mailing Address
PROPERTY INFORMATION *Date House/Facility Corners Flagged 3 / 1 `4 l o —7
NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale)
(Permit is valid for 60 months with site plan, no expiration with complete plat.)
Owner's Name Sc. a -0- r L. S , 4 ['� 4r_ • L �_ 1 � Phone Number 5 - 67 4 y
Owner's Address Z 5 -7 p - 4 , " , (_J _ �, City/State/Zip
Property Address S„ — - City S - —
Lot Size I b .. s Tax PIN#
Subdivision Name(if applicable)_ ty 1` p - o - w : t 1 Section/Lot# 2 �,__D
Directions To Site: e—'u , 2 A
��
3 iT J i — o .-- I- C
If the answer to any of the following questions is "yes", supporting document tion must be attached.
Are there any existing wastewater systems on the site? F�'fes ❑No
Does the site contain jurisdictional wetlands? ❑Yes ❑No
Are there any easements or right-of-ways on the site? ❑Yes ❑No
Is the site subject to approval by another public agency? ❑Yes ❑No
Will wastewater othei than domestic sewage be Generated? ❑Yes ❑No
IF RESIDENCE FILL OUT THE BOX BELOW
# People L # Bedrooms f # Bathrooms Garden Tub/Whirlpool El Yes ,gKo
Basement: ❑Yes PN6- Basement Plumbing: ❑Yes 9N -T-
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:. Ne6n`ventional ❑Accepted ❑Innovative ❑Alternative ❑Other.
Water Supply Type: "oun/City Water ❑ New Well ❑Existing Well ❑ Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes cxo
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 corners and locating and flagging
or staking the house/facility location, proposed well location and the location of any other amenities.
Pro rty o er's or owner's legal representative signature
_311z �a -7
Date
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Sign given ❑Yes ❑No Account #
Revised 11/06 Invoice #
aeons !or DAVIE county and , if applicable. Thal a
rf approval has bean issued by thn Division of I lighways pursuant to
haplor 135 of (ho General Slatules, State of North Carolina
..................day of.....................................................19..................
.... .
DIRECTOn OF PLANNING
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control cornor 82+05'23'
ita.uiutas ui UIIUr........... 11..1 .................................................. i'�)r)p ..': •l a.....
that the boundaries not surveyod are clearly indicated as drawn from inforn
Book ........................'......................... Page .........................: tlhal the ratiot
calculaw'd is 1: ......... 30,000. ......... ; that this plal was prepared in accord.,
47-30 as amended. Witness my original signature; registration number and.
day of ....O:c.MiPUR ..........................A.D., 19 —5.0 ...............
Surveyor
( Seal or Stamp) Ilegistrauon M:)mher'
WHi
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22' 28' 51' E
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control cornor 82+05'23'
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that the boundaries not surveyod are clearly indicated as drawn from inforn
Book ........................'......................... Page .........................: tlhal the ratiot
calculaw'd is 1: ......... 30,000. ......... ; that this plal was prepared in accord.,
47-30 as amended. Witness my original signature; registration number and.
day of ....O:c.MiPUR ..........................A.D., 19 —5.0 ...............
Surveyor
( Seal or Stamp) Ilegistrauon M:)mher'
WHi
A LAND
D. f3.
—S D1+
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22' 28' 51' E
1-
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1•��.0
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228.95
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D. a. 61 Pg 498
I\IOTES
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION
Water Supply:
Evaluation By:
On -Site Well Community
Auger Boring Pit
ROPERTY INFORMATI
�l
2 -lo -7
Public
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
O— 1
Texture groupSG
Consistence
Structure
Mineralogy
HORIZON H DEPTH
Texture group
_<eZ -
Consistence
n!5 N
Structure
ze—
Mineralogy
HORIZON III DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
--
RESTRICTIVE HORIZON
SAPROLITE
S
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
Q LS
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
REMARKS:
LEGEND
EVALUATION BY. -__\t
OTHER(S) PRESENT:
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
MWA
VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm
NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky
NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic
Structure
SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky
SBK - Subangular blocky PL - Platy PR - Prismatic
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 05105 (Revised)
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Account #: 990002768
Billed To: Kelly Crosby
Reference Name:
Proposed Facility: Residence
ATC Number: 3473
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
a17 /3rauqus WIgq
Tax PIN/EH #: 5832-08-8155/5832-08-7539
Subdivision Info: Whip O Will Lot # 28 & 29 combined
Location/Address: Brangus Way -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 VA F R A PERIOD OF FIVE YEARS.
%
Environmental Health Specialist's Signature: Date: L10
is
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.
Septic System Installed By:
Environmental Health Specialist's Signature Date:
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
�'• P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002768 Tax PIN/EH #: 5832-08-8155/5832-08-7539
Billed To: Kelly Crosby Subdivision Info: Whip O Will Lot # 28 & 29 combined
Reference Name: Location/Address: Brangus Way -27028
Proposed Facility: Residence Property Size: see map
4111
ATC Number: 3473 On
**NOTE** This Improvement/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 I 1 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 #People _-_ #Bedrooms 4 #Baths �, S
Dishwasher: Garbage Disposal: j2" Washing Machine: J2- Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size "I'C Type Water Supply _ Design Wastewater Flow (GPD) -- - Site: NevO Repair ❑
System Specifications: Tank Size/
a GAL. Pump Tank
"61 ff l
Required Site Modifications/Conditions:
GAL. Trench Width _ja Rock Depth /,,? Linear Ft.Zo
IMPROVEMENT/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. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.****
h A,/ t/
Environmental Health Specialist's Signature: ! Date:
P -
DCHD 05/99 (Revised)
MAY -22-2003 13:06 SARA LEE GROUP SALES
336 7440879 P.01iO4
• , APPLIDA•1•ION FOR SITE CVAWATION/3WIFIROVEMENT PCHMIT ak ATG
Davie County Health Department
Elrvlrinnmental h�ea/�h S'ectien
P.O. Sox a4a/z10 Boapital 0treat
• MOCksville, NC 27020
(336)7S1-9760
IF FOODSERVICE: s) Seatt: Estimated Water Unage (9allons par day) ___
L,..—r. Type of ►meas supply. County/City Well Cotrmuniey
Do you anticipate additions or expansions of the facility this System is iutcatletl to scrve? Xe No
r�
If ycs, what type?
***IMPORTANT"h CLIBN'I.S MVST COAIPLL•TET►IB RBQUIlIE13 PROPut-i- ' fNr0RMA'I•I0N ItEQ[IES'i'ED
BELOW. Either a PLAT or SI'M PLAN MUST RESUBMITTED by tttccticnt funis T1tiS r\PPLICATION.
Property Dimensions: S -.. %y--- tz, wttiTG witEC'I'WNS (trunk Nlucksvillc) to PROPLIVI'V:
Tax O tike YIN: 0 .S-8-3� Q it - 1 S3 L A� � �
Yrvperty Addrl i s: Rend Namt T, 4 ty.
city/zip:-'7
If In a Subdivision provide Informallon, sts follows:
Section: ISIocK: Lot*. o2- �atc home corners Il:►ggcJ:7,X�p
?�•�L
Tills is to certify that ilia Information ;..irovldocl Is currcct to Ute Uest of mthat y knowledge. 1 understand thta nrntll(s) �
Issued hereafter are subject to susponiton or revocation, It cite site plaus or Intended use chuuCe. or if the ltifarteuttlon
submitted in this application is falsified or changed. I, also, rrrrrlarstnn./ Mai I rias respust3iblc f<rr all plrarb eN iticurrcrffr•rrnr
this eppliaatiora 1, hereby, give cvetioue to the Authorized Rcprescuttttivc of tilt D•tvle Cot uty 1I :tl It cps Inn r t
to enter upon above described properly located in Davie County and owctcd by "1 11 _
to eanduct all tcs�tlug procedures as uc,misary to detcritilne lite site suit bi itV. 7
DATE �P�~y, SIGNATUR>
THIS AREA MAY BE USED
FOR DPAWING YOUR SITE A Gtclude alof ilio foilu ing: Exisllnl: and pruptrscd
property linea And dimensions, structures, setbacks, and septic ocatlons).
Sltc Revisit cuurgc
Clicut Notification Date:
ZHS.
Sign given El Account No. !/
Revised DCRD (07/99) Invoice No. 5`7 7
a**XMJi012TA1JT***
INHOPIATION IB
Tlt2$ Ane•LICATION CANNOT D$ FitOCESSSD UNLnes ALL THE REQUIRED
DROVIDYD. xaler to the INFORMATION SIILLSTSN !or lnotructiori'.
Name Co U. eA110d
Ttaillna Addeasl
Contacc Y■rzon
01
Nam.Rhona„rJ�.. C%
CLty/Dtate/t:ZP
Dualnep.a rhos■
3.
Wasia an Vormit/ATC i! Dii or■• C than A6ov■ ._ _
Nalllaa addre■■ ��� CLtY/S■sea/�LtZ�
—3.
Apylicatlon Yore
S :valuation ZiopYOvement POrmit/ATC both
..^s.
Syatara to aarvico,
Itl Ro■idaaaa.
oua Mobile Home Businaaa Industry Other _
a peepl.% _ � « Bedrooms xtYBAthXoana ,�--?
el
■hvaohor
��ryQy1�1'1
aQ* DSer,,i �. Na■ttiny Ns.Chla* Da•dweO t/P1u.nta►..a na■ament/No Dlutnbir,p
6.
IL Huslnass/Snduatry/Ocher. Cpaci Ly typo rt P(ropl* 0 slnxG
a CooW,od■■
D 1hovora • urinal■ — * Natog Coolora
IF FOODSERVICE: s) Seatt: Estimated Water Unage (9allons par day) ___
L,..—r. Type of ►meas supply. County/City Well Cotrmuniey
Do you anticipate additions or expansions of the facility this System is iutcatletl to scrve? Xe No
r�
If ycs, what type?
***IMPORTANT"h CLIBN'I.S MVST COAIPLL•TET►IB RBQUIlIE13 PROPut-i- ' fNr0RMA'I•I0N ItEQ[IES'i'ED
BELOW. Either a PLAT or SI'M PLAN MUST RESUBMITTED by tttccticnt funis T1tiS r\PPLICATION.
Property Dimensions: S -.. %y--- tz, wttiTG witEC'I'WNS (trunk Nlucksvillc) to PROPLIVI'V:
Tax O tike YIN: 0 .S-8-3� Q it - 1 S3 L A� � �
Yrvperty Addrl i s: Rend Namt T, 4 ty.
city/zip:-'7
If In a Subdivision provide Informallon, sts follows:
Section: ISIocK: Lot*. o2- �atc home corners Il:►ggcJ:7,X�p
?�•�L
Tills is to certify that ilia Information ;..irovldocl Is currcct to Ute Uest of mthat y knowledge. 1 understand thta nrntll(s) �
Issued hereafter are subject to susponiton or revocation, It cite site plaus or Intended use chuuCe. or if the ltifarteuttlon
submitted in this application is falsified or changed. I, also, rrrrrlarstnn./ Mai I rias respust3iblc f<rr all plrarb eN iticurrcrffr•rrnr
this eppliaatiora 1, hereby, give cvetioue to the Authorized Rcprescuttttivc of tilt D•tvle Cot uty 1I :tl It cps Inn r t
to enter upon above described properly located in Davie County and owctcd by "1 11 _
to eanduct all tcs�tlug procedures as uc,misary to detcritilne lite site suit bi itV. 7
DATE �P�~y, SIGNATUR>
THIS AREA MAY BE USED
FOR DPAWING YOUR SITE A Gtclude alof ilio foilu ing: Exisllnl: and pruptrscd
property linea And dimensions, structures, setbacks, and septic ocatlons).
Sltc Revisit cuurgc
Clicut Notification Date:
ZHS.
Sign given El Account No. !/
Revised DCRD (07/99) Invoice No. 5`7 7
Hay 21 03 10:04a
dava
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336
751 8765 N•'a
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MAY -22-2003 13.10 SARA LEE GROUP SALES 336 7440879 P.04iO4
pewie uounry, NOrM t;arolma tipattat Mata txptorer ray,%: 1 u1 c
Spatial Qala [=Plorer � ®
Q*W
1 Qrolba
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r Zoomin r• ZoomOut r' Racaeta U2P C' Identify: ParC81s liitl}t�
Zoom Factor. lam'.. E' Reidivs Search (feet) - Ora selected layers:
Boundary
NW 'A„ NE [- Census Tracts Q
City /
C{ Dotmdarles"
r Driveways
r Rail Lines
r; SWetCent•rllnes
ry US/NC Highways
Multi Symbol ,i.
US Highway
NC Highway
ri Aerial Photography
r Croaks and Rivers —
E911 Addresses" ra
(� Fire Departments a
C Schools b
MAP Cu -u -r- cy.
This map is prepared for the
inventory of real property round
within this Jurisdiction, and Is
Compiled from recorded deeds.
plats, and other public records
and data. Usere of this map are
hereby notified that the
aforementioned public primary
information sources should be
consulted for verification of the
information contained on this
TOTAL P.04
•
Lend Unit/Type; 5.01 JAC
• County ID; C41 SCA0029
•
Deed 86004009e; 00174 / 0434
• Account Number.C4160A0029
•
Dead Data -,1994/0S101
• PIN; 5832de7539
•
Sales Pdce: $0.00
• Legal VLOT 29 WHIP O WILL
•
PtoWyAddress:
• Owner Name: WHIP -0 -WILL LAND 6 CATTLE LLC
WY
• Owner/Address is WHIP -O -WILL LAND b CATTLE LLC
•
County Zoning: R -A
• owns►iaadress 2:
•
Census Code:
• Owner/Addross3: 571 BRANGUS WAY
•
City Code:
• CIty.Stats Zip: MOCKSVILLF .NC 27028.0000•
Fire District:
• Lend Value: $57.070.00
•
Flood Ione: ZONE X
• Building Value., $0.00
•
Flood Community:
• Out Bullding/Extra Features Value: $0.00
•
Hood Panel: 0025 C
• Assessed Value: $57,070.00
•
Flood Map Date:
• P►oper�Recor Cnrd
•
Soil..
•
TOwnahlp: FARMINGTON
•
Town Zoning:
r Driveways
r Rail Lines
r; SWetCent•rllnes
ry US/NC Highways
Multi Symbol ,i.
US Highway
NC Highway
ri Aerial Photography
r Croaks and Rivers —
E911 Addresses" ra
(� Fire Departments a
C Schools b
MAP Cu -u -r- cy.
This map is prepared for the
inventory of real property round
within this Jurisdiction, and Is
Compiled from recorded deeds.
plats, and other public records
and data. Usere of this map are
hereby notified that the
aforementioned public primary
information sources should be
consulted for verification of the
information contained on this
TOTAL P.04
MAY -22-2003 13:09 SARA LEE GROUP SALES
✓M/lV VVMLL►'� llV1lL ►illi VlLlY U!/YllYl ✓MW 4dAt/1Vl Vl
' v
Spatial Data 13Mplerer
Nofi Carolina
Click on the Map to:
1^ Zoomin r; ZoomOut C' Recenter Map C Identify. Parcels i
Zoom Factor: r2X .9 C Radius Search (feet)
I:�
336 7440679 P.03iO4
. -bv • — r
4
Parcel Data
Find Adjoining Parcels
Map Layers
a�l
Drrw selected layers:
r Census Tracts
Q
•
Land unit / type: 5.77 :1 AC
•
County ID. C4180A0028
•
Deed BooWPsge: 00174 10434
•
Account Number.C4160A0028
•
Deed Dale: 1997/05/01
•
PIN: 5832086i55
•
Sales Price: $0.00
•
Legal f:LOT 28 WHIP O WILL
•
PropsrtyAddrtass:
•
Owner Name: WHIP -0 -WILL LAND 6 CATTLE LLC
(- Town Zoning
WY
•
Owner/Address 1: WHIP -p -WILL LAND b CATTLE LLC
•
County Zoning: R -A
•
Owner/Addross 2:
•
Census Code:
•
Owner/Address 3.571 9RANGUS WAY
•
C8y Code.
•
Cily,Stale Zip: MOCKSVILLE .NC 27028 - 0000
•
Fire D18trict:
•
Land Value: $89,250.00
•
Flood Zone: ZONE X
•
BWiding Value. 30.00
•
Flood Community:
•
Out BuildingExtra Features Value: $0.00
•
Flood Panel: 0025 C
•
Assessed Value: $69,250.00
•
FWd Map Date:
•
Pro _rt Record Card
•
Soil.•
•
Township: FARMINGTON
•
Town Zoning:
Map Layers
a�l
Drrw selected layers:
r Census Tracts
Q
City Boundaries "
r County Zoning
Multi Symbol !i
[� E911 Fire Districts
❑
(— Flood Panels
❑
(— Flood Zones
❑
1✓! Parcels
❑
r School Districts
Multi Symbol ;. .
C' soil.
❑
(- Town Zoning
❑
r Townships
Multi Symbol h
1- Voting Precincts
❑
r Driveways
r Rall Lines
(— Street Centerlines —
r USNC Highways
Mu_1ti Symbol ' .
Us Highway—
NC Highway --
r Aerial Photography C
Physical
Crooks and Rivers
E911 Addresses " it
(— Fire Departments 9=
r S boots
MAP Currency.
t rns map u preparea for the
Inventory of real property found
withln this jurisdiction, and Is
compiled from recorded deeds,
plats, and other public records
and data. Users of this map are
hereby notified that Rte
oforementioned public primary
Informationsources should be
consulted for verification of the
Information contained on this
http://66.209.132.254/scripts/esrimap.dll?name—Davie sdx&Cmd=sParcel2&r.wrpTN=SR'47nRR1 Si:6mo-li.- 9/111rmnl
Vey
APOAPPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMI
Davie County Health Department J
Environmental Health Section AN
N ` 9
P. 0. Box 848
la Mocksville, NC 27028
�1 (704)634-8760 �I
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS
01, ALL1TH/E REQUIRED INFrA,/,Contact
ION IS PROVIDED. Ag
1. Name to be Billed ' /i l t /6%a'�t) Person <;5:,
Mailing Address Home Phone
City/State/Zip t; L%, I t ! a;- � 0 -
,21 2X Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address
3. Application For: Site Evaluation
4. System to Serve: House ❑ Mobile Home
City/State/Zip
❑ Improvement Permit & ATC ❑ Both
❑ Business ❑ Industry
5. If Residence: # People -U q, X -t- T4 !L� # Be rgoms .��
❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing
6. If Business/Other: ecify ty e _ # People _
# Commodes # Showers # Urinals
If Foodservice: # Seats
Estimated Water Usage (gallons per day)
❑ Other
# Bathrooms
❑ Basement/No Plumbing
# Sinks
# Water Coolers
7. Type of water supply: County/City • . ❑ Well ❑ Community
8. Do you anticipateladditions or expansions of the facility this system is intended to s rve? ❑ Yes )< No
If yes, what type?
PROPERTY INFORMATI N REQUIRED *** IMPORTANT ***A PLAT OF THE PROPERTY MUST F''';
rA77 SUBMITTED WITH THIS APPLICAT. V.
Property Dimensions: 5 —�" /-��' 2�S "�7 -Z.� E? le,4/ri (1 WRITE DIRECTIONS (from
Mocksville) TO PROPERTY:
'fax Office PIN: # 1 �'
Property Address: Road Name
City/Zip 6u'0CoC ;J�4�1 VJ141 l t (1�
1
If in Subdivision provide information, as follows:
Name: "' 1
1
Section: ' �N 2vSS Lot #:
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 I am responsible for all charges incurred from this application. I, hereby, give consent to
the Authorized Representative of the Davie County
to enter upon above described property located in Davie County
and owned by / to conduct all testing procedures
as necessary to determi a the site suitability. /
DATE SIGNATURE '
Revised DCHD (06-96)
T
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION ---Z— LOT
Soil/Site Evaluation
APPLICANT'S NAME
PROPOSED FACILITY
SUBDIVISION
Water Supply:
Evaluation By:
On -Site Well
Auger Boring
Community
Pit
DATE EVALUATED -7 -
PROPERTY SIZE
ROAD NAME -f�O_T Lei !A
Public r1�
Cut
FACTORS 1
2
3 4 5 6 7
Landscape position
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture groupC
G
Consistence
f
Structure
A 't
Mineralogy[P4,"f
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 0
SITE CLASSIFICATION: " >"" /`< //-
LONG-TERM ACCEPTANCE RATE:
REMARKS:
DCHD (01-90)
C//
LEGEND
Landscape Position
EVALUATION BY: A&
OTHER(S) PRESENT:
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
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■
f APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT &�/ATCr
�/'i.� Davie County Health Department
`�� � � Environmental Health Section J •
P. O. Box 848 Nr� 9
1 Mocksville, NC 27028
(704) 634-8760
0-1 I i
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS
ALL THE REQUIRED INFO TION IS PROVIDED.
6't✓ /1 P �•':L / l / k "q-�/ .Contact Person t
1. Name to be Billed I
Mailing Address 712 4M &J21 hJAU Home Phone ` G
City/State/Zip isL J_& I (� Business Phone 2 Oq
2. Name on Permit/ATC if Different than Above
Mailing Address
3. Application For:
4. System to Serve:
XSite Evaluation
1, House ❑ Mobile Home
City/State/Zip
❑ Improvement Permit & ATC
❑ Business ❑ Industry ❑ Other
galf W
5. If Residence: #People N �(,�� # Bathrooms
+>�3 `�t—
❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing, ❑ Basement/Nti 'inmbing
6. If Business/Other:ecify te I # People # S::.;..,
Q v ?,,"�- e--
# Commodes # Showers # Urinals # Water Coolers
If Foodservice: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: County/City i ❑ Well
8. Do you anticipateladditions or expansions of the facility this system is intended to sgrve? ❑
If yes, what type?
PROPERTY
❑ Community
Yes 'i No
*** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: —f— A -f C-1 (L0&A II WRITE DIRECTIONS (from -
1 Mocksville) TO PROPERTY:
Tax Office PIN: #
0
Property Address: Road Name 1 i /, m0 (I—owwU
City/Zip
e—
If in Subdivision provide information, as follows: 1 -1
Name: _"' 1
Section: AiF ?(LOSS izz.:71Lot #: / 1
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 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 C
I ! to conduct all testing procedures
as necessary to determi a the site suitability.
DATE I e SIGNATURE
Revised DCHD (06-96)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION LOT
Soil/Site Evaluation
APPLICANT'S NAME ����i� ` 6_� - A/, //
PROPOSED FACILITY
SUBDIVISION
Water Supply: On -Site Well
Community
Evaluation By: Auger Boring Pit
DATE EVALUATED
PROPERTY SIZE
ROAD NAME 0'41fAla al,4
Public t'---'
Cut
FACTORS 1
2 3 4 5 6 7
Landscape position 4.L
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH
Texture group
Consistence 4L
i
Structure
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
SITE CLASSIFICATION: l�J Gf_� �(� '00 7C�
LONG-TERM ACCEPTANCE RATE: ,2 ,
REMARKS:
DCHD (O1-90)
LEGEND
Landscape Position
EVALUATION BY:
OTHER(S) PRESENT:
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
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