129 Alexandria Court Lot 12Davie County. NC Tax Parcel Report Tuesday. November 29. 2016
Parcel Number:
NCPIN Number:
Account Number.
Listed Owner 1:
Mailing Address 1:
City:
State:
Zip Code:
Legal Description:
Assessed Acreage:
Deed Date:
Deed Book / Page:
Plat Book:
Plat Page:
Building Value:
Land Value:
Total Assessed Value:
WARNING: 'PHIS 1S 1VU'1' A SURVLY
Parcel Information
H806OA0012 Township: Shady Grove
5789247656 Municipality:
39390000 Census Tract: 37059-804
IRWIN JOE DARRYL Voting Precinct: EAST SHADY GROVE
129 ALEXANDRIA COURT Planning Jurisdiction: Davie County
ADVANCE Zoning Class: DAVIE COUNTY R-A,R-20
27006-7315
LOT 12 COVINGTON CREEK PHASE TWO
0.69
6/2004
005580772
0007
139
Zoning Overlay:
Voluntary Ag. District:
No
Fire Response District:
ADVANCE
Elementary School Zone:
SHADY GROVE
Middle School Zone:
WILLIAM ELLIS
Soil Types:
WeB,PcC2
Flood Zone:
Watershed Overlay:
DAVIE COUNTY
Outbuilding 8r Extra
Freatures Value:
Total Market Value:
101 All data is provided as is without warranty or guarantee of any Idnd either expressed or Implied including but not limited to the
Davie County, implied warranties of merchantability or fitness for a particular use. All users of Davie Countys GIS website shall hold harmless the
County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and ail claims or causes of action due to
NC or arising out of the use or inability to use the GIS data provided by this websge.
`Permittee'sDAVIE COUNTY HEALTH DEPARTMENT
Name: `a CL t.L.�h 44,1
L � � LRS i Environmental_Hgalth Section :iPROPERTY INFORMATION
P.O. Bok -848 �f
j
Directiors to rvperty; --�'.`0.411'.'�i' , w Mocksville, NC 27028 Subdivision Name:
r / ?Phone #: 336-751-8760
JIT, I^ LST Section: Lot: i "-
AUTHORIZATION.FOR
WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION -
AUTHORIZATION NO: A Road Name: i;.� �ii~c't�Z;P:
*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 ForirdAuthorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits:
(In compliance with -Article 11 o ._G.SrEha"ter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
R6N 'TA E LTH SPECK DATE ISSUED
RESIDENTIAL SPECIFICATION: BUILDING TYPE# BEDROOMS # BATHS .2.5 #OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUIPPLY�/otjly DESIGN WASTEWATER FLOW (GPD) LAW NEW SITERE PAIR SITE
SYSTEM SPECIFICATIONNS`:�oTH RTANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH 1 ROCK DEPTH to A LINEAR FT. ,
Z iS7Q i8t)Tto..S ' S, At t_/1�.h`t �„?(c� Ft.t�„J Jam%, i�/1oJt
REQUIRED SITE MODIFICATIONS/CONDITIONS: V— wt;t V-t!:Off vjl� Of � � , 00t or N40WAY
"CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760.
OPERATION PERMIT Nor W
.:21
n
AUTHORIZATION NO. ERMIT BY: WENINSTALLED(IN
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABCOMPLIANCE
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.
DCHD 01!02 (Revised)`
h2o S(o o
V
-D
AVIE COUNT'V"RE-ALTH DEPARTMENT
Envir6nmentaLHealth Seefion =PROPERTY INFORMATION
►1�'P.O. Bo`0 48
OertY:' (/�
Subdivision Name: A -11
MillNC 27028ocksve,
Phone #: 336-751-8760
Section- Lo' t:
AUTHORIZATION FOR
W-ASTEWATER
SYSTEM . CONSTRUCTION Tax Office PIN:# 7
to
AUTHOPAZATION NO.. -2539 A Road Name ' ZIP.
**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 Pen -nits.
-le I I 6f.G.S-Chapter 130A, Wastewater Systems, Section. 1900 Sewage Treatment and Disposal Systems)
(In compliance wit�iArtic I
F.
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
�,FNVIR6NPENTA'L',—Ji—EALTHTPECI�ALlSt DATE ISSUED.
RESIDENTIAL SPECIFICATION: BUILDING TYPE QLYC # BEDROOMS # BATHS "' '4 OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE #PEOPLE-, #PEOPLE/SHIFT_ # SEATS ikUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPID) ;NEW SITE.� REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE _�GAL. PUMP TANK -----GAL. TRENCH WIDTH ROCK DEPTH LINEAR -FT.
OTH R,.<
C
REQUIRED SITE MODIFICATONS/CONDITIONS:
IMPROVEMENT PERMIT I,Xyg�
U
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:3U.M. ON THE DAY OF INSTALLATION. TELEPHONE# IS (336)751-8760.
Uuto Vauz (Kevisea)
Perniittee's f SDA I COUNTY HEALTH DEPARTMENT
"kla,m »' . i"PA Environmentat.ff ealth Section PROPERTY INFORMATION
Direetionsto o e ra� j c: P.O: Box 848
prop rty: Mocksville, NC 27028 Subdivision Name:
/n J Phone #: 336-751-8760 _ \
t r j tt Section- Lot: i -
AUTHORIZATION FOR
0AP0 a,kr,yj(,'.C-1A C -r WASTEWATER Tax Office PIN:#
SYSTEM CONSTRUCTION
AUTHORIZATION NO: 2426 A Road Name: !� "`�C��J�?'Z1p: CX, ct
**NOTE** .This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie Countv.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.
(n cco_mpliange with Article 11 of GS..Ctaapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
y L� t1 t IS VALID FOR A PERIOD OF FIVE YEARS.
E IRC) M TAL'HEALTH S ECI IST DA ISSUED:
RESIDENTIAL SPECIFICATION: BUILDING TYPE r # BEDROOMS # BATHS 2 # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS ' INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY�J r DESIGN WASTEWATER FLOW (GPD) � NEW SITE REPAIR SITE Y
A C:�
; �
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DE H LINEAR FT. �
OTHER
I STPI Tt0J`IL
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT
All
�,� vi11' jou% CG G �i-�4
10
lam
t '�r" c htanti: :54+'ST A lj R >jU1
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30,P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760.
... - !
AUTHORIZATION NO. `OPE TION'PER�vIIT BY:' r ! 4":V
%*THE ISSUANCE OF THIS E ON PERMIT SHA EM DESCRIBED ABO HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I I 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.
DCHD 02/02 (Revised) -'I JON
}'�� -7s
,� l .r -:_ •, F "Y .�nsv Wli �, t�tb +i 1y Y �"tel j yFlS - _. • 4 -'{' v
4' • exniii4ee's ,j . DANI COUNTYHEALTH$DEPARTMENT4 1 d S
011 t4Eironmentpl,.kealth:S'ction PROPERTY INFORMATION
«,
P.O. Box 848
•_4" �rectlons to•property:Mocksville, NC 27028 Subdivision Name:
' Phone #: 336-751-8760
Iv Section: ry
Lot:
\ AUTHORIZATION FOR
I r ...
' Office WASTEWATER Tax OPIN:#
� SYSTEM CONSTRUCTION - -
n�j r/' )A
2*
AUTHORIZATION NO: 2 A Road Name. Zip: x
**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 11 of GS -Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
***NOTICE*** THIS AUTHPRIZATION FOR WASTEWATER CONSTRUCTION
r p i IS VALID FOR A PERIOD OF FIVE YEARS.
VIR9N
"—IiNMtNTAL HEALTH S ECIACIST DATE ISSUED
RESIDENTIAL SPECIFICATIONr BUILDING TYPE { {0 5. # BEDROOMS # BATHS ' # OCCUPANTS GARBAGE DISPOSAL: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT(� Q�`} # SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY L -fl My rDESIGN WASTEWATER FLOW (GPD) NEW SITE ` REPAIR SITE �I
t
SYSTEM SPECIFICATIONS: TANK SIZ . GAL. PUMP TANK GAL. TRENCH WIDTH' Iv'� .
ROCK DEPTH , LINEAR
-
OTHERS . ,L�I s T k=t vT1�.1 iW v(/� D►t!! �{/j ILA
REQUIRED, SITE MODIFICATIONSXONDITIONS:
IMPROVEMENT PERMIT. LAYOUT /� 1
kt�!"'rX:
f1i lot,
ilk -
w•
1
=V,
CUT
Al
&t4r.v�ic
(
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30 - 9:30 A.M. OR 1:00 - 1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. '
� s
OPERATION PERMIT
SYSTEM INSTALLED BY: ----- (` I `t ., 1
t'i c1
AUTHORIZATION NO. OPER TION PEI&IT BY.
%� rF
**THE ISSUANCE OF THIS OPEdON PERMIT SHAL M DESCRIBED ABO HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I 1 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.
DCHD 02/02 (Revised)
' DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990001296 Tax PIN/EH #: 5789-247656
Billed To: Michael Myers Subdivision Info: COVINGTON CK Two Lot # 12
Reference Name: Location/Address: Alexandria Court -27006
r l VPV0Vu 1 -0%, Illy. G.71u6111r0
ATC Number: 2769
r1upulty JILL. 'CC
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 I 1 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTE WA ON-STIRUCTION IS VALID FOR A PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: �`'� t Date: el
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 I 1 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:
1 1
DCHD 05/99 (Revised)
?l
Date:
Ir
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section ��- S- a �" IV
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990001296 Tax PIN/EH #: 5789-247656
Billed To: Michael Myers Subdivision Info: COVINGTON CK Tvm Lot # 12
Reference Name: Location/Address: Alexandria Court -27006
Proposed Facility: Residence Property Size: see map
q�� b r: 2769
**NOTE*'iis fmprovement/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.
#Baths . S
Residential Specification: Building Type IV #People #Bedrooms
Dishwasher Garbage Disposal Washing Machu 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) 4z Site: New ❑ Repair ❑
System Specifications: Tank SizalaP GAL. Pump Tank GAL. Trench Width 2jL Rock Depth -d' 1 Linear Ft3W
Other:
Required Site Modifications/Conditions:
IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 K 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.****
Environmental Health Specialist's Signature:
Date:
DCHD 05/99 (Revised)
' r
,�- 2 H-8
OCTERT H. MKON
wFE AL C. DIXON
oa 't ids PG 5jo
1
UP„
.�` TOTAL 382.30' S--87” 45' 11'' E
" 118.00' 52.90` 130.00' 200.00'
r
I r
13 IN �co r
I1 r CD
con
r`" r rA°10�
I�
195
of
r ,
• jSRR
2 10 05' G�' ./ �'. �,, , )156 .
N 87 31 31
CYTO 50' R/W ON
j R ,
. . 103.05'
POO I
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department
Envirwnmenta/ Heia/ffi Section
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336) 751-8760
p JP[OM[
#
2 2 n
ENVIRONMENTAL HEALTH
DAVIE COUNTY
***1W0RTANT*** THIS APPLICATION 0=0T BE PROCZSSED UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
1. Name to be BilledH�/j/,/ ,�-H,y.i Contact Person�raL ;
Mailing Address7
��f� •� Home Phone %%/ ✓iC
City/State/ZIP —A§Y 7 /,,F /111' J�—W� Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address
3. Application For: ❑ Site Evaluation
iI/
City/State/Zip
ti/Improvement Permit/ATC ❑ Both
a. system to Service: use ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People # Bedrooms _ # Bathrooms
.dishwasher la Garbage Disposal U -hashing Machine U Basement/Plumbing O Basement/No Plumbing
6. If Business/Industry/Others Specify type
#! People i Sinks
# Commodes # Showers # urinals # Water Coolers
IF FOODSERVICE: # Seats �Estimated Water Usage (gallons per day)
7. Type of water supply: I'County/City ❑ Well ❑ Community
e. Do you anticipate additions or expansions of the facility this system Is intended to serve? ❑ Yes YN
If yes, what type?
***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: l IX �hXl�,r1'�%y%r
Tax Office PIN: #
Property Address: Road Name
City/Zip�Vi�/��(%
If in a Subdivision provide information, as follows:
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
�Vwy 9014, QP:7X/)ffX&CF
FU
Name: Lx�
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 I am responsible for all charges incurred from
this application. I, hereby, give consent to the Authorized Representative of the Davie County Health De artment
to enter upon above described property located in Davie County and owned by
to conduct all testing procedures as necessary to determine the site sulta bili
DATE Y SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inc)4e all of the following: Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
,SCS Ifrj? C' �, � I Site Revisit Charge
Revised DCHD
Date(s):
Client Notification Date:
I EHS:
Account No. rrI 9
Invoice No. vim! 0 w
111 )eA: L' J•„i. �. v..��✓il .. X11..i i11.i_: '. Ivl
" Date
ed lard surveyor, licensed number 3513, certify that
at creates a subdivision of land within the area of
-,at bas an ordinance that regulates Frarce!s of land.
Date _
LOT 20.02, MAP H-8
ROBERT H. DIXON &
WIFE JILL C. DIXON
DB 1,38, PG 553
133.0,
200.00'
1
J /G
r �
r \ 5 / / ,•
A �,,�"d �JJ N F i R E
S 87. 3;. 3, J�,�� 1 w'YnRANT
s { ( 8
/
T V - l l
t
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT
• Davie County Health Department D C@ Q
Environmental Health Section
P.O. Box 848
JAN. J
Mocksville, NC 27028
(704) 634-8760
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL
THE RE UIRED INFORMATION IS PROVIDED.
1. Name to be Billed r+^ a Contact Person
Mailing Address ?Ln , R o >e -L,3 d e') Home Phone
City/State/Zip .! �0,110 Le N( . ; 706 Business Phone �l�''' �i�%%.Z 9/3-3919' rAfAI I. �
2. Name on Permit/ATC if Different than Above
Mailing Address City/State/Zip
3. Application For: ite Evaluation [ ] Improvement Permit & ATC [ ] Both
4. System to Serve: [ ] House [ •] Mobile Home [ ] Business [ J Industry [ ] Other 02 ZZ 10+ Lt L41 iv is /nn1
5. If Residence: # People # Bedrooms # Bathrooms [ ] Dishwasher [ ] Garbage Disposal
[ ] Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing
6. If Business/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_
If yes, what type?
L;1 1111-R ,l PLA I OR S 1 I 1: PLAN
PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***-Ac FLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: A>ar + o� 4.6 ac, pAv-c e WRITE DIRECTIONS (from Mocksville) TO PROPERTY:
Tax Office PIN: # 78`3 - 9-4/-- _�/ 3 ; � cJ_�lS I �Sa �r� �. �� 064 V ci )u e,e
Da
Property Address: Road me 8101 C a ; _D�.mmP 4 % m I — L20-14 S'IdP- 14
Citymp �AA • 27004.
If in Subdivision provide information, as follows:
`� •-awl re e,
Name: b 7 / rorao SzcC
Section:
PL 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
of the Davie County Health Department to enter upon above described property located in Davie County and owned
Revised DCHD (06-96)
all testing procedWs as negessary to determine the site suitability.
THIS AREA AfAl/ LIE 11SEL) rOIZ bIZAIVINC I10111Z SITE PLAN:
DAVIE COUNTY HEALTH DEPARTMENT
: Environmental Health Section SECTION- LOT-,
Soil/Site Evaluation
APPLICANT'S NAME �i i' 6� DATE EVALUATED
PROPOSED FACILITY PROPERTY SIZE
SUBDIVISION
Water Supply: On -Site Well
Community
Evaluation By: Auger Boring Pit I:�
ROAD NAME 3:22 Z
Public L�
Cut
FACTORS 1 2
3 4 5 6 7
Landscape position
Slo e %
HORIZON I DEPTH
p -.
Texture group
Consistence
Structure
Mineralogy
HORIZON II DEPTH ' " F `'
• 5
Texture group
Consistence
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: EVALUATION BY:
LONG-TERM ACCEPTANCE RATE: i OTHER(S) PRESENT:
REMARKS: J
Landscane 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
is
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 - ME ssive CR - Crumb GR - Granular ABK - Angular blocky
SBK - Subangular blocky PL - Platy PR - Prismatic
MineraloU
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 (0(-90)