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166 Abbey Ln '/ i ` . . � . • � , • . � DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PE Account #: 990005099 ��a�c PIN/EH#: 58�3,35-5185/Site 1 Billed To: Mary Zimmerman Subdivision Info:� �� Reference Name: Location/Address: �.,,,..y Lane-27028 � Proposed Facility: Residence Property Size: 6.47 � ATC Number: 4876 **NOTE**The issuance of this Operation Permit sfiall indicate the system described on the ATC has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems," but shall in NO�AY be taken as a guarantee that the system will function satisfactorily for any given period of time. � System Type: S.T.Manufacture��d��Tank Date� _ (" Tank Size��(/ Pump Tank Size__��- � � �� , �a -�� System Installed By: �llV�,+—Q E.H.Srecialist: /�k SDate: / � � I �� \� ---�� '� ,�, � � �� R � .� Q� � � ��yy✓ .J' i \ . i �� rvv�� I � �c` � �,o �tia I I � /� �> �� G�6�► -''� �c Y.�.r v�/�-%�� . nr.Hn i i m��uP�;�P,�� \ ' _ • ' �� , • • ' i Davie Coun Environmental Health • ' � • P.O.Bo 848/210 Hospital Street �`�I� Mocksville,NC 27028 � (336)751-8760/Fax(336)751-8786 ��(_ � �1 IMPROVEMENT PERMIT Account #: 990005099 Tax PIN/EH #: 5843-35-5185/Site 1 Billed To: MaryZimmerman Subdivision Info: � �. Address: 240 Manhattan Lane Location/Address: Abbey�ane-27028 City: Advance Property Size: 6.47 Reference Name: Proposed Facility: Residence **NOTE**T'his 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. Pernut Type: ew ❑Repair ❑Expansion Pemut Valid for: 5 Years ❑No Expiration Residentiat 5pecifications: #Bedrooms�_#Bathrooms � #People�Basement❑ Basement plumbing� Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): `� a� Type of Water Supply: County/City ❑Well ❑Community Well Site Modifications/Pernut Conditions: l2� St�ted i� g ' ^`-�'E'tC 1�'b �.�;;�f�a{� t+ L ��Y.. L .�. iil�uj U �.l�:J{.�1 S stem T e LTAR Initial � r• � � Re air 'J-t�P � SitePlan �__ Q ifI C(/� �{' _ r � � ^� v�� 1 � a � � �Qi _ � ► �, \ - ��I . �► �s �a 4 �,� � u �' '� \v ` \� �-� � � � ' �� h � � � ? �, Environmental Health Specialist ' �%�!��/ Date '" �i i.p.l 1-06 � . ' � DAVIE COUNTY ENVIRONMENTAL HEALTH 1 , ' ' , , P.O.Box 848/210 Hospital Street ' ` Mocksville,NC 27028 C� (336)751-8760 Fax#(336)751-8786 - � Y � �` �` I AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005099 Tax PIN/EH #: 5843-35-5185/Site 1 Billed To: Mary Zimmerman Subdivision Info: Reference Name: Location/Address: Abbey Lane-27028 Proposed Facility: esidence Property Size: 6.47 ATC Nu er. 4876 Site Type: e�ew ❑Repair ❑Expansion ; **NO�' **This Aut ization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health�' �__ pnor to issuance of any building pernut(s),(in compliance with Article 11 of G.S.Chapter 130A „ Wastewater Systems,Section.1900 Sewage Treahnent and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms � #Bathrooms �#People � Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size�<<l7ct.-r�y Type of Water Supply: �}County/City ❑Well ❑Community Well System Specif cations: Design Wastewater Flow(GPD)3�� Tank Size��GAL.Pump Tank�GAL. � r �i � �! / Trench Width� Max.Trench Depth��•A Rock Depth � Linear Ft. � Q Site Modifications/Conditions/Other: �s�:. :�.�.e.}d--L'��n 15� N��C 1��2�,'�.1�u?;:�� l•v+ILliiA �'fJL:.T11J��U1J�af Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760. � �P��< <�.� �2 a• � �/�1,�6 K 3 � � ►�y-� s � � �. . �hb�. �� . I °y i �`�� ' ,� 3� F, � I j� ►�p,n'1 �� r�, � f � I`Q � I.�� \ ?�B� � �'��i uo a��y ST � d ` �b � ,, .�� o' r:�* / _ �i ^'.�J �Vt% Environmental Health Specialist � Date: DCHD 11/06(Revised) .�ur� a,� uu u.�. � •a ✓.- ...o..�� .......�..o o�.....�a� .... .�..... . ...� ._. . _.._.. � - - , � ..-R�� .,� '�, `'v `�j �t.•'1'�� • '� � APPLQC`ATTON`�� 2 t��ITE EVALUATION/IMF'ROVEMENT PERMIT &. ATC ��c� 1 Davie County Eiiviromment.il Hcaltl� �U�\ +� `�; �-�U ^� P.O.Bos 848/210 Hospital ;�treet �r '� Mocksvillc,NC 2702'r.� ' _-•.:��-�� (336)751-8760/Fax (336)75:1-8786 � `- /�t«,�� 1 �--` nc.,��{':- � / Applic�io}t Fo��.{�-y�e,;'� �an/I�npi+�vemeut Pem�it G Autl�orizat.ion To ConsU�uct(ATC) I✓i3Oth Type ofAp�licaQb��i�-� ew System i7Repair to Exiscing SysYem OExpansion/Modification of Existinr�Systcm or Facility * * RTiiN7"`**THIS APPLICA7'[ON C.4NNOT 6F PROCESSED iJT�:[.E;SS ALL OF THE REQUIRED INFORMATION IS PROVIDED. I:ef.:r to thc INFORMATION BLII,I.FTI:`J for instructions. APPLICANT INFORMATION Name to be Billed- (n��_�Ilh�M14N' Contuct Person ��`M �C.KVIW � Billing Address o��lp M11A,►�1 Nd►�N_ r-WN'L H��me Phone ,33b� qQ$^C76'70 City/State/ZIP �d.lr{h1G2 � dNC. ,;].�0�(,, Busii�ess Phone 334.� q�l�- q<3o3 Name on Pcrmit/ATC iFDiJfer-e�rt chaii Above �� "" • ��D� Mailing Address Cicy/State/Zip PROPERTY INFORMATION _ *Date House/::�acility Corners Fla ged �`��d� NOTE: A siuvey plat or site plan must.�ccompany this application. Inclttdr.�d: O Site Plan ❑Plat(to scale) (Permit is'valid for 60 month_�:w :h site plan,no expiration�vith complete plat.) Owner's Name �O�(s�R S K- C��:a1L1 L Phone Number 3.3�s'��6�" �� Owner's Address_ �1�1 /��$Gl� �4fJ� Cit:,�/State/Zip rM�.�� Bx�ol?Ch�� Property Address QO /�fi�t.ti/ �}N Ci�:y %1�p�,(�S�Ij� Lot Size (.�..i,17 �LR� Tax PIN# SE34 3355/�S / Subdivision Naine(if applicable)__ S�cti•:�n/Lot# oS/r� � Directioiis To Site: �1- i1C1Z�}l( y� Qi^ ON�%�U RoR� �(ZfpO•l Q��ll�%i1l� �D� lZ�f 0�.1 %�148�y�/`4/�1�- _ _ � If the ansi�ec to any of tlie following quesr.ons is"yes",supporting documentati<�n�ust be nttached. Are there any existing wastewater systems on Yhe site? ❑Yes I:i'No Does tl�e site contain jurisdictior�al wetlands? ❑�s C� Are there any easements or ri�ht-of-ways on the sile? GaYes f.:�Ny Is the site subject to approval by another public agec�cy? ❑Yes I:��f Will��astewatGr ocher than dome.iic sewage be generated'1 ❑Yes I:✓No IF IZ�SIDElY�'E FILL OUT THE f30X ELOW - �`Peopte #Bedroor.is #Bathrooms Garden Tub/Whiripool es ONo Rasement: ❑Ycs lp3d'o Base�ne:it Plumbing: t7Yes i>No IF NON-RESIDENCE F7LL OtJT THE BOX BELOVJ Type of Facility/Business _. Total Square Foota�e of Building #People #Sinks #Commodes #Sho�vers #Urinals Estimated Water Usage (gallons pe�•d;�y) (Atiach documi:ntation of similar facility wdter consumption j FOODSERVICE ONLY: #Seats T}�e system requested:. �Gonventionaf I]Accepted Uliuiovative C]Altemacive ❑Uther Water Supply Type: l�C:ounty/City W.+[er U I�Iew Well C7Existinz;WeII ❑ Communiry Well Do you anticipate additions or expansions .�f Yhe facility diis system is intended :•� sCrve'? U Yes Ci!'No If yes,what type? _ _ . This is to ccctify that the information provi.ted on this application is true and co�rect eo the best of nry kztowledge. I understand tlzac any pemiit(s)or A7'C(5)issued hereafter ai�subject to suspension or revocation.if the site is altered,thc intended use changcs,or if the information suhmitled in tl�is applir.itic:i is falsiFed or changed. I hereby gr.int right of entry to the Authorized Representative of the Davie County Health Departnieut to ronduct necessary itispeetions to detcrinine complianee�vitli applieable laws and ru]es. I understand that I an�responsible for the Froper identification and labeling of property lines and corners and Iocating and flagging or staking the house/facility location,pro�c��sed well location and tl�e location of uny other amenities. � Site Revisit Charge r'Y opCt'ty o� er's wnec's legall-epresenrative si�nah�re Date(s): � � Client Notification Date: ___ Date �� EHS: Sigii given I IYes flNn Accvunl/f V✓�� _ Revised 11/06 Invoice# _/ � 1�-- ��-`^ � � ,�4 � � �� .� � M -�- , r-+ � M t c� �m , �._._....,__. 0 Q� 8 9 i _ �3 �, 9 T �,.,: $� .�".�" � ._.-...... � r�, . +� _.._._ � � ��95 � �� =f�> TF � .:. ��`�'J(� � y �•1 SHc.� �l � . � � f) �.i� 1,,,� _ `S l.�e'�a- Q' � � ��ap,� � t�� 1-�� r- ' /. �,� �� _ '�a��n� ` ,._.. ._...�,..�__'��„�'._�?N� p......�. _._. A _ �.� 8 a �� v -.��; . � �d� � . . ... . - . .. w:K...._. w. �� ,�o .. . __ �.. ... _._ ....,... . � , r�`� -as�oH �''1 . � �� Q �^� �,: � . , `S�e� � .�►�. � — _�L9 �� . ��' �� .�:� � �'� _ 'r• � ` � ` ` C.4� �t�� ' � • � v0503 Q � � . MiilTo: _Gr�21t�� 3it 5� Bw[--1?9-� nrksv-�11a�_ Ur ry7n�R �i'rw��Mf��c� � This instrument was prepared bX= Jenni£eY' D Broc „ �ROGK & BBOCK, P_A_ � P_ O_ Itox �47� Mocksville. NC 27C QUI7CLAIM DEED—QD-1 Printed and for sale by lames Williams&Co.,Inc.,F'.O.Box 127,Yadkinville,N,C.27055 STATE OF NORTH CAROLINA, Davi_e County. ' TH�SDEEU,Madeandenteredintolhis dayvf SeptemUeT ,�9�,,byandbetween DQbb__?_z�p I,_�Coim •i 1 o( County and State vf Nortli Carolina,hereinaftercailed Granlar,and _ bou�].ag Hugh Gouncil of Davip County anJ State of North Carolina,Nereinaher cal�ed Grantee,whose permanent mailing address is Rt 5a Box 1z9-1 riorksvi L, N� 97n?£i , ' W17NE5SETH: � t . � . ''::.�: . r ....., . ...� ' , NO 7AXq8LE C0IVSIDERAtiON STATED ' � t,,..,..�.. . �- . . . -1 9�...._.._ . l �u.....__. �.. . .�.�. .. :. .,� Thal said Granlor, for and in cansideralion of the sum of Ten Uollars (S10.UU) lo him in hand paid, lhe receipt of which is hereby acknuwledged, has remi�ed and released a�J by these presents dues remise,release,tonvey,anJ forever quitclaim unlo the Grantee,his heirs andlor successors and assigns, all right, tide, claim an� interest of lhe Granlor in and to a certain lot or parcel of land lyi�g and being in Fazmington Township, bav�e County,Nonh Carollna, and more pahicularly described as(ollows: TRACT ON�: B�GINNING aC an iron stake in the line of T. T. Lawrence, SoutheasC corner of the wiYktin descriUed tract and Northeust corner of Douglas H. Counci]. 4.00 acre xract ' • and zunning thenca with Councll line North 83 degs. 16 min. WesC 172.53 fest to an I iron in the line of B. C. 13rock, Jr.; thence with Brock line Nortli 07 degs. 16 min. East 532.07 feeC to an i.ron in the 5outhern right of way margin of SR 1431 (comtnonly known as Pineville Road); thence with the Southern Tight of way margin of said SR 1431 the following 2 courses and distances: Sonth 39 degs. 15 min. East 119.38 feeC, Soutti 31 degs. 09 min. East 130.62 feet: to an ,iron, Nortliwest corner of T. T. I,awrence; Chence with Lawrence line South 06 degs. 27 min. 25 sec. West 344.99 feet TO TIiE POINT ANU PLAC� 0� BEGINNING, conCaining 1.79 acres, more or less, and being � a porti.vn of thoae lands described by deed recorded in Ueed Book 115, page 527, Davi,e County Registry. The above lands are subject to aJ.l easements, reservaCions and restri.ctiions v£ record and particularly Co any easemenCs of ingress and egress liezetofore conveyed Co pouglas Ilugh Council and wife, Debbie Lee Council. '1'IiACT 1'WO: BEGINNING at a new iron, the Northeast corner of Che w3Chin described txact in the line oE Frank McClaurin (UB .63, p. 286) new corner of J. K. Miller; said iron pin being locaCed 5outh 06 degrees 44 minutes West 761.45 #eet from a conerete monument found in the Miller — McClsurin line; thence from the beginning Soutl� 06 degreea 44 � minuCes West 761.k5 feeC to an axJ.e, Che Southwest corner of Trank McClauri.n, Northwest corner of William P. Brock, 5r. (AB 100, p. 250) ; ttience South 05 degrees 55 minutes 5k seconds West 376.16 f'eet to an iron pin, the Sou4heastern corner of the wiChin described tract; thence Nortih 86 degrees 23 minutes 50 seconds West 200.58 feet to an iron pin, the 5outhwest corner of the within described Cract, Southeastern corner of B. C. IIrock, Jr.; L•tience with Che line of B. C. Srock, Jr., North 07 degrees 16 minuCes Ease 1,148.58 £eet to a new iron pin, the Northwestern corner of the within described txacC, new Southwestern corner of J. K. Miller; � thence Stiuth 83 degrees 16 minutes Esst 184.34 £eet TO TF1G POINT AND PLACE OF B�GINNING, conCaining 5.00 acres as surveyed by C. Ray Cates, Marcli 1, 1983. TOGExHER WITH A NONEXCLUSIV� EASEI�ENT for puYposes of ingress, �gress attd regress; said easement being 30 feek in width, Che Tiastern boundary running from the beginning point of the above described 5.00 acre tract NorCh 06 degrees 44 minutes East 401.58 £eet to a conereCe monument; thence North 06 degrees 27 minutes 25 ' seconds East 916.79 feet to an iron pin, being the Noztheastern carner of J. K. Miller described in Deed I�ook 115, page 527, and being further located in the Southern righC of way margin of SR 1431. � T have and to hold the aforesaid lot or �arcel o(land and all rivile es thereunro belon in to him,the Grantee,his heirs and/or successors 0 1 P K 8 8 and assigns, (ree and discharged from all right, title,daim��r inlerest of the Grantor or anyone claiming by,through or under him. The designation Grantor and Grantee as used lierein sliall include said parties,their heirs,successors,and assigns,and Shall inelude singular, plural, masculine,feminine or neuler as required by context. � � � M' � ' . " ' . ,. DAVIE COUNTY HEALTH DEPARTMENT . , Environmental Health Section Soil/Site Evaluation �',-.�E� APPA�I'c�Iff'�NB9�5�OB�N Tax PIN/EH#: 5843�3{{��t¢�FORMATION Billed To: Mary Zimmerman Subdivision Info: Reference Name: Location/Address: Abbey Lane-27028 PrQposed Facilify: Residence Property Size: 6.47 Date Evaluated: � �� —� � Water Supply: • On-Site Well Community Public �I Evaluation By: Auger Boring ,� Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape posi[ion • Slope % � "�j HORIZON I DEPTH � p -- � — Texture grou G ;G Consistence -f;� / r S[ructure K � � Mineralo �' /) '' ' HORIZON II DEPTH � — �f� Texture rou � $o�jG Consistence f Structure � K Mineralo HORIZON III DEPTH � Texture rou Consistence Structure Mineralo � HORIZON IV DEPTH Texture rou Consistence Structure � Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE Z ,�. SITE CLASSIFICATION: � EVALUATION BY: G � '') � LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: ��'j �� r o xEM�cs: . J.� .� ,..� 4 /y L�GEND i,andscane Positian • . , 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 T�xtur� • 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 l�i�� 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 Str�ct�re SC-Single grain M- Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-S�bangular blocky PL-Platy PR-Prismatic lYlineraloQv ' 1:1,2:1,Mixed Notes Horizon depth-In inches Dep[h 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 DCHn O5/(15 (Revise�ll