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737 Ben Anderson Rd • � . ' DAVIE COUNTY ENVIRONMENTAL HEALTH , �,�,? P.O.Box 848/210 Hospital Street (�� I Mocksville,NC 27028 2�10� (336)751-8760 Fax#(336)751-8786 � ' � OPERATION PERMIT Account #: 990004324 Tax PIN/EH #: 5803-50-1395 Billed To: Oakwood Homes Subdivision Info: Reference Name: Location/Address: Ben Anderson Road-27028 Proposed Facility: Residence Property Size: 3.42 Acres ATC Number: 4682 **NOTE**The issuance of this Operation Pernut shall 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 WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. ,��,�,, �.� O� System Type: , �'Z� S.T.Manufacturer�.�-'— Tank Date '��3 Tank Size�, o[�� Pump Tank Size System Installed By: ..p E.H. Specialist: �� Date: ���4 �� � --. ���c � ���� �� -� .�• ��. .� �� 1 N � f ��' � � � R ,`3 9� �-- r � s-� a � \ � DCHD 11/06(Revised) , . � . , DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street . Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCT'ION Account #: 990004324 Tax PIN/EH#: 5803-50-1395 � Billed To: Oakwood Homes � Subdivision Info: Reference Name: ` Location/Address: Ben Anderson Road-27028 Proposed Facifity: Residence Property Size: 3.42 Acres 1 ATC Number: 4682 ! Site Type: QNew ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site p11ns,plat or the intended use change. Residential Specifications: #Bedrooms .3 #Bathrooms�_#People 3 Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size 3,Y�. Type of Water Supply: ❑County/City �'Well �Community Well System Specifications: Design Wastewater Flow(GPD)3�i o Tank Size�,6�6 GAL.Pump Tank�GAL. r �� �� Trench Width 3 L Max.Trench Depth 3!� Rock Depth l� Linear Ft. DO_ l.!� StaYed in 15A NC,�,C 18�1.i963�5� Site Modifications/Conditions/Other: �CCepted Syste�s may �I� b� used Contact the Davie County Environmental Health Section for final inspection of this system betwee� 8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760. '� '� +. �� � ' � _ ,� � 1-�����0.�� ' , � ��L���� � D�5`�r�� � . v I 5� `.� � �n �.��a ��� � �' � `� ��o '�' �,Y:i M ♦�ca jcy � � M � ' � sc � t : � 4'�4 Envuonmental Health Specialist Date: '�� � l/ � DCHD 11/06(Revised) � -� � • � , • � � ❑ �(� �a 07 10:52a davie oouhty enuhealth 3�6 �51 R786 p.p � � �� v D + � 2001 APPL�CATION FOF.SITL�VALUATION/IMPROVEMEN7'PERMIT&A7`C p,P� � . Xlavie Couiaty Esvir�nmei�ifai iieatth �'.O.Bux 848lZ10 IIosptts�l Serccc n���:j^L�{[}\LSH � I�4ocksvule,NC 27028 fjy�I1R0�\ �Y C,����Zy • • (336)7Si-87601 Fax(33�:'51.A786 pp:i_ � • � / Abpiiearion For. Ef Site valuationryn�p�ovement Permic kSAuthoriza�ipn To Gt�nstnrce(A'fC) ' ��'Eotl: Type ot'Applicatiort� �Iew Systam TJRepair ta Existios System qExpiosioniModifieation uf T:xistiag System or Fnciliry «'"'1MPOR7'ANI"•'THIS APPL[C;�TION CANNpT 8�7'ROCL•'SSCD l'7N[,ESS AL.1.OF TTiE it�'QC1TR1'+D � [NFORMATIOId IS X'ROVTDfiD. F,eferto the INFORMATION BULLCTIN for instructinns. APPLICANT INFOItMATiOi� Namc ta be Bitkd ��t� � i�1�n�c�� Cnntuct Person o : C,�e�'_Z(llL.l Billing Address,,,�2 re,��" }Tome Phone� T 'City/ScatdZTJ' ./ .G- „?���siness Phonc -�C9 c ca... Name on T'ermidATC ifDrJJermt.han Above lviailin Address � ` `L'iry/Statd'Li F�22Q�'�I2.TY WFpRMq'1'LON ^ ''Iiate x-Tou;xlt'acilit Corn��rs�'ta ed, -��� NOTE: A survey plat or site plan m�st accampany qd�applicnCion. Xndiuled: ,,ite Plan L Plu(to scale) (PeRnitis valid for bU xnontl�:with site pien,sw eyq�iration wiU�complece piat.) Owner's Name ,�qMe �j,,,�e[��,NJ phorte Numbet a.�L=oZ�S�-yl v7 l�wner's Address ' J �d►�hl� CitylStatc/Zip��'cf'•,✓;l�q P�operry Address_ .,i��t� �. Ciry ��c.�K,il'Il�, T.or Si2c 3,�{Z Tax PIIVt3 ��4n 350 J 3�f S 5ubdivisian a+Jnme(if a�l+c�blel �Sc�tion2ot# Dirtctions To S«t: To 'd • y (;� �� � �tU (�p� ['.,I�eiC_ � '7"0 �,,,�� T'12 9D /_—�$.. 9�t��ti�� e+'+ 1sF'C If tl�e answu.to any o[We following questionc is'yts",aupportin�docume�rtadon mwt Ee efiacl�ed. Are there any exisGng wastev��atEt aystuna on 1he sitc? 4Yes�1�So Does lhe site contein jurisdic s�ro►i wctlattdsl U Yes G7'1�fa Are d�erc�ny casements or ri�,;tit-af-ways on the site? ClYes id9�fe ts tht�itt subject to approval 6y annthet public ageacy? OYcs pNo Wtl!wustawatec othei then d��mestic sewage be e�cntcd? OYr,9�1C0 _�_ `r��^� YF ItESIDF.NC��TT,L OUT I'�iE BOX BELOW . i�Peopk N Acdr>oms #Bathroocru c� Ciardrn Tubl�Vhirlpool L1Yos (]No - Basement:OYes o Bast�mcnt Plumbing: 1]Ye9 i�iQo I�IUN-[iESLUENCC F'T�.,L OUT xFIE DOX B�AW _ --...____w-_.—. 't�pe oiFaGility/Basiness Total Square Poo�age af IIuildingM�_..,,,�„#People � #Sinks #Commodes �t.Showers � #Urin�ls, Estimated 1�Jater LJsaga(gallons p+:r day) (Attach dnr.umcntation of similar faciliry woter cansumption) I FOODSERV[CEONLY: #Seats. ,J Typesystemrequested:. �Coavencioml OAcccp[ed Uinnovativo qAlccrnac7vo I'tOther�__.,._.�, V'J'SlerSupplyTypo:O Counry/City V1'atar 4Y�Iew Wo11 ❑Gx(stinE Well, !7 Camnmqiry Wolt • Do you antieipata•rdclIlions nr expyns.�ra uf the CaCility Ihis aystein IS intcu:led ta servo?A Yas �o Yf y�s.wlut type? _ �...,, .��__-.,--,� ,__....�_..__�� • Thi:is to eer6fy that d�e informz!ian 3�ravidedoa Siis npPli:a:ioa's x«a an�:co.^.ect t.:J�e oe.t uf�ny icnowtedge. I unckrstand that apy ptrnut(S)or ATC(e)issueJ he�uplter ate subjttt to tutPCpfiOn or revo�ation if 1he&1tC is nit�Ytd,thc intrnded use changes,ot i! t90 iafotmation aulmilteed in thia epplication is f�isifiod or changed I hcrel:y�nt right of cnny to tho Ausherited Jiepresenmtiva oldteD�vie CouncyHealthDepamnent to couduct aecessary inspcedons to determine corriplia�xe with applicrblc Uwa and nilcs. I undcrstsnd that I sm responsible for thc proper identitieauon and labeling��f propetty lines and comers and loc�fing and Aagging ` oE suking the housdtaeiliry lontien,�:•roposeJ weil locntiaa aod tlu Jocat;tn of auy ozher a+ner�itics. J.�'�""`� �.dl.�.�. Si�t Revisit Chargc Ptapertyom+er't nr owner's lesai re�,�emative signamre Aate(s):T i ��C�� Clicnt Nobfication Da�c: .` Duc £HS:__._ .�..._ Sign gircn.t7Ya pNn Account M ,�J� Reviced 11/06 ' '�..-:"'" ilL 'd 0985'oN ttl�6p�966 WV9t�tl L�OZ '�"i�� i . - �1'�e �..��/OU� �f3�'i'�1 - �. � �o� ; �A�� � : t I � � � ��� � 5 z ��� � f � I ; , , . . ; � . i -;� I a � d S ��,� � � � � . y � _ � � ? � 0 � � � (��� C�k �h" 'Pd .�-- /.y rn;l�s -�' CQ � �-'"i'- ('ce t�1 y� � f iLG � PtE,4S'��LABEL�ALL 1TEMS � t � 'f. Roads t�at tiorder proper�y 9. �lectrical Meter j 2. Driveway ? 3. Septic �ocation ' 4. Septi.c Lines (!f needed) � ` 5. Wa�er ta,p or Well locat;on � � � 6. Water lines � 7. Heat Pump �lacement j 8. Steps or Decks:{pr.aw arrow for which way sfeps wil! come off stao�) i L/l 'd 098�'�N ' ZLlZ6tiZ9£E N�dSl : ll t00Z 'Ol' add GIS Daca Print Page Page 1 of 2 �avie Coanry Oriline CXS Print Page � ��.. 1 ': � , , • .:My F _ �,Y / , �` • ..... . - I�ti .... � .' � � \ . .�ir. 1 • ' \,: . �~' `� , , � ` ' '"'-'- " . ... . ..y .\ '"� :£.; ,:, �....„, 1 � � �� � , •1 ��.1 \ . x�' ... . , '�I{N.T!r:°(I:HIji:L.C'Y,: 4U�';)'4(Si!iMd41li1S ,(p' 11r�� '�**"»WAftNTNo:THtS iS NOT A SURVEY! Date: 4l11/2007 �� � �***� �e��� 20000000502 "I7iis map is prepared fox'the inventory of real N�mtxr property found wi�}uir��Ais jurisdiction,and is N m�� 5803501395 compiled from recorded deeds,plats,and othcr co�r,t public¢'ecords and daca.C1ser5 ofthis map are Number ooszs�sago hereb ''notiticd�hac ihe afore►nentioned ublic ��s«d Y P NDERSON JAMES E�WARD pri�»ary ir�fonnation sonrces should be consulted for wner tti verification of the infotmatioa Gonlained on ihis �isted Owner ii2 map.The County a55urnts no lega!rtsponsibility Ma'�'^9 1543 MAIN CHURCH ROAO for che information containod on this map. ddress� h�admg ddress 2 Cit MO KSVIILE tate NC ; Code 27028 - Le`�� 3.550 AC B�N ANDERSON R Oescri t�on , re e 3.42 oced oa�o oz0000zoa Deed BooK 03250490 nd Pa e Plat Book Plal Pa e u�lding p elue Utnu�idin nd Extra ��350 FCatU�Qs 31ue �and vaNe t9880 htL/£ 'd.ta;.,098�'�N.nc:.ti.is/�vch,itc/m<invi.��•ccfn�trccirnint.:imt ZLlZ6trZ9EE WtlSl � ll LOOI 'Ol' 1dy GIS Daia Print Page Page 2 of 2 � ote� larket 32230 alue otat ssessed 32230 � alue - �eteapd alue Sales orice � hcl/tr 'dn�.�0985��N.�,�.v<i�vcbs�tclm<tpvi-.wc���i�srcclt»ic�c.;ttrrt ZL l Z6tr�9EE wb5� : < < <ooa �oa� a tly. 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INFORMATION PROPERTY INFORMATION Account #: 990004324 Tax PIN/EH#: 5803-50-1395 Billed To: Oakwood Homes Subdivision Info: Reference Name: Location/Address: Ben Anderson Road-27028 Proposed Facility: Residence Property Size: 3.42 Acres Date Evaluated: !i�—��—lJ7 Water Supply: On-Site Well ✓ Community Public —Q 7 �.a Evaluation By: Auger Boring ✓ Pit ✓ Cut h� FACTORS 1 2 3 4 5 � I � Landsca e osition LL Slope % ` HORIZON I DEPTH — ! � — — U'` Texture grou y. � t � Consistence y� ' i'U Structure l' � ; f-��� �.:' ��.� (' Mineralo i�^I ?l �� HORIZON II DEPTH � Texture rou ' Consistence � � Structure Mineralo HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE -��a �� p CLASSIFICATION —`t<S O� r'c LONG-TERM ACCEPTANCE RATE — O� � SITE CLASSIFICATION: �C�.1 \O��l'2 -- EVALUATION BY: �n��) ,� �r'1l�i nsn� � LONG-TERM ACCEPTANCE RATE: �' � OTHER(S)PRESENT: � ^ �1�n ��L�f 4ZM- REMARKS: LEGEND T,andscape 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 T.extui� 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 ONSIST .N . a'IQ1St 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 , r> > SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic _ Mineraloev 1:1,2:1,Mixed �9S�S 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 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� � Davie County Environmental Health � P.O.Box 848/Z10 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990004324 Tax PIN/EH #: 5803-50-1395 Billed To: Oakwood Homes Subdivision Info: Address: 828 Piedmont Drive Location/Address: Ben Anderson Road-27028 City: Lexington Property Size: 3.42 Acres Reference Name: 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. Pernut Type: fl�Tew ❑Repair ❑Expansion Permit Valid for: �'S'ears ❑No Expiration Residential Specifications: #Bedrooms�_#Bathrooms�_#People .3 Basement0 Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): 3�� Type of Water Supply: ❑County/City ell ❑Community Well A� stated in 15� NC�+C 1�A.1983(5� Site Modifications/Pernut Conditions: �„�,� �,a+�,.�-i� �l������� n� IISP System T e LTAR Initial G• Re air d.S n s,�, J� �� �� J �n_ � 1 ,�'1�IGc�L G- �, ��P�+,- ��� � _" . , � "� 'M' : -�n,�!'�/sy4� , � �' � .F W ('�1. 4'� I � I � ���` l.C� � `� Environmental Health Specialist Date � ��-� C ' i.p.11-06