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951 Cedar Creek Rdr DAVIE COUNTY ENVIRONMENTAL HEALTH � �� P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 OPERATION PERMIT Acct�unt �: 990005693 "��x F�if�:EH #: 5842-06-4307 Biilc� ie: Brian and Kathryn Spach Su��di�ri:.,iar� lr�fo: �;;: ' , Re�er�E�ce €�ani�: LocaiioniAd�lr��s: Cedar Creek Road-27028 f�ropc��sci F�ci€ify: Residence . Pro��r�y �iz�: 2.625 Acres t�TC Nurnbe��: 5785 **NOTE** The issuance ofthis Operation Permit 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. ' � t �, ,: � p ' System Type: � S.T. Manufacturer�'�pGl,i Tank Date %� Tank Size'%�O � Pump Tank Size � � System Installed By: �(,1.1�vU�,� Q(�ilL.� E.H. Specialist: � � ate:_�� %Z GPS Coordinate: DCHD 11/06 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fa�c # (336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Accc��a�t #: 990005693 "��x Pi�€.�EH #: 5842-06-4307 Biiics� iQ: Brian and Kathryn Spach Su�aciivi:.,iar� Ir�f�: �., Refer�r�ce �la��: : LocaiioniAd+�r�ss: Cedar Creek Road-27028 F'ro�c��c9 F;��:i€ity: Residence . �ro��c�.y �iz�: 2.625 Acres a�TC N�amb�r: 5785 Site Type: �New ❑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 plans, plat or the intended use chan�e. " Residential Specifications: # Bedrooms� # Bathrooms.( `� # People 2 Basement� Basement plumbing� Non-Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size .�_ Type of Water Supply: �County/City ❑ Well ❑Community Well - System Specifications: Design Wastewater Flow (GPD) �Q�Tank Size_� GAL. Pump Tank / GAL. Trench Width ��` Max. Trench Depth�i �� Rock Depth� Linear Ft. `i ��t C�� %D Site Modifications/Conditions/Other: ��' �� ' ` " il dr`"��b, �,`OK�-I Contact the Davie County Environmental Health Section for final inspection of this system between ,��t,vPrt Ssj$��? 8:30 — 9:30a.m. on the da of installation. Tele hone # 336 751-8760. ,'� �a- � � 5' �Q�,K shcG(ou� Q; �t� � ' � �� > „ ��t � -�br �'�� r Q�� Environmental Health Specialist Tlrur� � i in� �uP�,;�P�� ,:- —� � , � �`��, , c.� ---�: - - _ _.; • DAVIE COUNTY ENVIRONMENTAL HEALTH `', P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/Fax #(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION � Accnu�t #: 990005693 "i�x PI�€i�H #: 5842-06-4307 Biile;� ic.�: Brian and Kathryn Spach Su��di�i4ion i��c�: � Re��er�E�ce Rla��: Loc�iioni4d�ir�ss: Cedar Creek Road-27028, f�rnpc�sec9 F,�ci€ity: Residence ,, ;�fc��eriy S�iz�: 2.625 Acres Site Type: [�lNew ❑Repair ❑Expansion a,TC Number: 5785 **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat on the intended use change. �• Residential Specifications: # Bedrooms J # Bathrooms �•✓ # People 2 Basement� Basement plumbingf$ Non-Residential Speciiications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Lot Size —8"�.,�" Type of Water Supply: r�.County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) -2�Tank Size�Q� GAL. Pump Tank GAL. Trench Width � Max. Trench Depth� Rock Depth�_ Linear Ft.��a�� . - I �t 9 �j�� Site Modifications/Conditions/Other: �T h(�,('��1 �2 11vu`.r11 M.l,cv►1�/� ��n �� Ils.l L� � �f�� Contact the Davie County Environmental Health Section for final inspection of this,system between 8:30 — 9:30a.m: on the day of installation. Telephone #(336)751-8760. _ �- ` �j�.� �: Environmental Health Specialis � Date: 6 DCHD 11/06 (Revised) � ' Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680 IMPROVEMENT PERMIT Account #: 990005693 Tax PIN/EH #: 5842-06-4307 Billed To: Brian and Kathryn Spach Subdivision Info: Address: 157 Pinewood Lane, Unit 101 Location/Address: Cedar Creek Road-27028 City: Mocksville Property Size: 2.625 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. Permit Type: ~�lNew ORepair ❑Expansion Permit Valid for: �5 Years ❑No Expiration Residential Specifications: # Bedrooms �# Bathroom �Z # People_� Basementl� Basement plumbing� Non-Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD)�� Site Modifications/Permit Conditions: Type of Water Supply: l�.County/City ❑Well OCommunity Well z- E�Er4(NPt TION FOR SITE EVALU�ITION/IMPROVEMENT PERMIT & ATC Davie County �nvironmental Hc�ltl� 1I q 2011 P.O. Box 848/210 Ilospital Strcet JU�� 0 1 Mocksville, NC 27028 ' � (336)753-678U/ Fax (336) 753-1G80 BV:•-�'� pplication For. C; Site Evaluation/Improvement Permit i-'� Authorization To Construct(.ATC) E3oth Type of Application: i,New System ': ]Repair to Existing System CiExpansion/Modrtication of ExisUng System or Facility *•'IMPORTANT"** TH1S APPLICATION CANNOTl3E PROCESSED UNLESS ALI, OP THE REQUIRED INFORMATION 1S PROVIDED. Refe� to the INFORMATION BULLETIN for in�tructions. APPLICANT INPORMATION Name to be Billed (�rj� ��Nn �Contact Person j�� Billing Address �7' 1((x°��cl �'i � 10 r Home Phone 3�— City/State/Z,[P ,/��J Git�Cp Nc, a7vo6 I3usiness Phonc�__ Name on PermiUATC if Differen[ than Above_ Mailin� Address Ci ['KVYCKIY 11Vt'VKN1H11VN 'uateriouseiraciu[y�ornersriaggea NOTE: A survey plat or site plan must accompany this application: Included: .! Site Plan '' Plat(to scale) (Petmit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name�g� � �,� �-,enS Phone umber336--`%yo G3� Owner's Address r �� I City/StateiZip� YtnG� �l PropertyAddress City Moc'�l�i��\\�, Lot $ize a• G a� CiL:�1(.� Tax PIN# 53 �i� �l y.� 67 Subdivision Name(if applicable) Section/[.ot#� Are there any existing wastewater systems on the site? Does Ihe site containjurisdictional wedands? Are there any easemen,s or right-ot=ways on the site? Is the site subject to approval by another public agency? Will wastewater other than domesdc sewage be generated i�Yes P1f�lo [ I Ycs '.�'(Jo !✓�es ONo —�'e C-��e,C'.��. MG� C;Yes G3�i�o ? i ,Yes C�o IF RESIDENCE FILL OUT THE BOX BELOW # People o2. # Bedrooms �_ # Bathrooms Garden Tub/Whirlpool XYes 'No Basement: X%es i7No Basement Plumbing: XYes �7No IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footagc of Building _# People # Sinks # Commodes # Sho�vers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: �ventional ''Accepted f'Imiovative I' Altemadve ''Other. Water Supply Type: IVC,'ounty/City Water !: New Well �:Existing Well ' Community Well Do you anticipate addi[ions or expansions of the faciliry this system is intended to serve? '' Yes � If yes, what type? ._ This is to certify that the information provided on this application is true and correct to the best oFmy knowlydge. I understand that any permit(s) or ATC(s) issucd 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. 1 hereby grant right of entry to the Authorized Representative ofthe Davie Counry Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. 1 understand that 1 am responsible for the proper identification and labeling of property lines and corners and ��I ting d Flaggin or staking the house/facility location, proposed well location and thc location of any other amenities. �"'' �� '�C'�� 5ite Revisit Charge Property owner's or owner's legal re esentative signature � Date(s): �%` � ►— ( � Client Notitication Date: Date E:}IS: Sign given f=:Yes ONo Revised I I/06 Z Account # 1�1L�� Invoice H �J�� , � I ��'1'%�j�f �f %� �a��j�' � �';:, . � . ., � � - "MAG' NAIL SET IN THE PAVEMENT C/L INTERSECTION COMPUTEO DEED CORNER INSIDE- �; OF C�AR CREEK ROAD WRH N.C. HWY. 801 (A TIE POIN'� A 30" CEDAR TREE, THE N.E. � CORNER OF EDWIN L SPACH a/w ANGELA S. SPACH'S PROPERTY '� (1 st TRACT� N � (2nd TRACT� RECORDED IN DB. 126, PG. 808 ! ` ! � � w _ —� \- — — w �� + c� 0 �:f � ��w EDWIN L. SPACH a/w ANGELA S. SPACH '` �\ � DEED BOOK 126, PAGE 808 (TWO TRACTS) '\�O N TAX PARCEL D50000000102 TAX PIN #5842065856 f PER DEED ` , (SEE DEED BOOK 115, PAGE 766 FOR A BACK REFERENCE FOR) ' 808 � � THIS PROPERTY AND HAS A MAP ATTACHED TO THE DEED i ��.uv� � m\ ' "'NAIL SEi PER DEED � 126. PG. 808 43"59'40"E . � 100.00' SEi 1N ROAD PER DB. 126, PG RNER OF NEW LOT 1 �`\ OV�H� s � _uNES `% PP sos � ��OQ �Q 6�0� 35.08' �s.. �',� 4, �� ' CAR pxLE �-- N 89°27'29" w^ �t! 6'st s'� ��5,'R y� FOUND � — — � n► 1 �i 9�" S� �' � <a W^ o \'�, O00 �,C�' R`�R `� N 4 o N '� S� � J c ;n ��i o O'_ � ,�^ 2 a o 3 �s�`i' ,%�;�� J' N � r- � � N ``►� � ` � O�q ,, � '� I 3 '`1J r N 86°02'S5"W- 71.88' 3/8" REBAR q � IRON Fd. I N w o � o I c,, 00 0 0 w m W 198.00' � AXLE REPL �� IINSIDE � '4 �9\ �a � L.N. �YEST '. 30 WIDE ACCESS dc 11i1LIiY W� ENT TO SERVE NEW LOT 2 N�P COMPtlTEp � � � POINT ONLY Q `" � �, AREA� N z 4, a (O.Z76 OF / � m ROAD R/W � N � a �- _ � /� a � ^ O � - . � � �o _ �� _ o s � �� ^ W y � � 0.30' 901 \`\\ LOT 1 i25 ACR E INSIDE 0 �l , z � 333.72' NEW IRON PIPE SET-� (A NEW CORNER) [S.W. CORNER —� N� NEW CORNER WD ANDREAS 'Sf"�`%�— WIRE FENCE � �Z � �� oo\ �x oi� � WIRE � FENCE --S 88°58' 11 "W 364.02' �roTr�) (NEW PROPERTY L1N� COMPUTED POINT ONLY ` NE1P LOT 2 AREA= 3.375 ACRES (PROPERTY UNE RUNS BEfYVEEN TWO WIRE FENCES) � N 88°57'09"W �387.85' ANDREAS KAZAKOS , DEED BOOK 491, PAGE 573 TAX PARCEL D5000000�2 DEED BOOK 44, F TAX PARCEL D5Di TAX PIN #5842C �'MAG" NAIL SEf TO REPLACE THE \ S.E. CORNER OF EDWIN L SPAC �AUGELA S. SPACH'S PROF ERTY ( DEED BOOK 126. PA�E 808 � . \ \ � \ \ 9�\�-� NEW IRON PIPE SET `'P '� (A NEW CORNER) P x �I x „ w � � 3 (� � � � M L.N. WEST HEIF DEED BOOK 42, PAGE : PARCEL No. D5000000a TAX PIN #5842068461 �3/8" REBAR Fd. AT THE PREVIOUS S.E. CORNER OF DWIGHT W. SPACH'S PROPERIY DESCRIBED IN DB. 440, PG. 364, THE COMMON S.W. CORNER OF LN. WEST HEIRS PROPERTY � � � , , , , .- � � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section . Soil/Site Evaluation APPLICANT INFORMATION Account #: 990005693 Billed To: Brian and Kathryn Spach Reference Name: Proposed Facility: Residence Wa[er Supply. On-Site Well Evaluation By: Auger Boring ✓ FACTORS 1 HORIZON I DEPTH Texture group Consistence HORIZON II DEPTH Texture group Consistence scructure � Mineralogy HORIZON III DEPTH Texture group Consistence Structure HORIZON IV Texture group Consistence Structure Property Size: - �, PROPERTY INFORMATION Tax PIN/EH #: 5842-06-4307 Subdivision Info: Location/Address: Cedar Creek Road-27028 2.625 Acres Date Evaluated: ��SI �U�� SOIL WETNESS ,5"� — RESTRICTIVE HORIZON �� SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE � SITE CLASSIFICATION: �� LONGTERM ACCEPTANCE RATE: • �-� EVALUATION BY: Public �� ; � ... ... ��.�: � ., ::, � 0 OTHER(S) PRESENT: < ' � � � l.. � / i� ' ' REMARKS: � ` � � LEGEND L ndcc e Position . R- Ridge S- Shoulder L- Lineaz 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 CONSIST .N _ . 11541� VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFT - 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 - Granulaz ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralo�v 1:1 > 2:1, Mixed otes 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) � TTAR - T.nnv_trrm arrPntanrP ratP _ oal/rlav/ft� T/'�TTTl�C/!�G in__.:__�� ■��0��■ ■��/��■i��■�l��■��■��■�■ ■��/��0��■ ■��/��■ ■��■■��■��/��0�■��/��■ ■��■�■��■��0��■ ■��/��/��■��■ ■��/��■��■��■ a��s��■ ■��e��■��■�■��■��o■��■ ■��t��■ ■�■��■ ■��■��■��■��■ ■��/�/�i��0■ ■��■��■��\��■��■��■0��■ ■�■��\��■��■��■■��■ ■��0��\��0��0��i��■ ■��■��■��■��■ ■��a��o�s��o��■ ■��■��■t��t��■��t��■ ■��■ ■��s��o��■ ■■��t��■�o�t��■�o��■o�■ ■��v��■ ■��■��t��s��■��■��■��t��■ s��■��■��s��■ ■��■ ■��■��■��t��■��o��■ ■��e��■ s��■��■ ■�o��t��■ ■��t��t��t�t��■��t�■ ■��■��v��o��■ ■��.��■ ■��■��■��■��■��.��■ ■��o��.��.��s��■ ■��■��■��/�%p1G�\��■��\��■ ■��i��■��/�R��wV�i��\��■��■ ��%��l�'J"s_��■ ■��0��■ ■��i��/��7G%��■��■i��\��■ ■��/�5��nf��;i�:y�/��/��I��iO��/��■ ■��■��%■fil:�✓��A��I��\��■ ■��%��n�i��',��/�/��I��/��i■ ■��■��rfi��:lrn��L�v��1��/��■��■ ■o��►�n��n�i��i��■ �iiiiii�Gi��i�i�iiiii iii�ii::::��iiii�ii�iiiiiii�iiiiiii�iiiiii� ■��i��o��_v.�s��■ ■��■��■��tl�e��l��yv��J��1��■��■��■ ■��t��n�i��siii��■ ■��i►a��■�■��■��i��■�■��■ ■��o��t��a��ti��o��■ ■��■��■��i��■��■ ■��/��Ilkil��\��O��I��■��■��■ ■��■��Ul��■■ ■\��I��■��\��■��ll��■ ■��■e�ll!!'��0��■��I��■■/�■ ■��e��cti��i��■ ■��■��■��t��i��■��■ ■��e��r��i��■ ■��t■��o■��i��o■��■ ��t��t��e�r��t�� ■��■ei��■ ------ �....�l��a��s��■ ��r.::::.�....------------ ■��o��■��■��■��■��■ ■��■��o��■��■��■��■��e��■��■��■ ■��■ ■��■�■��■��■ ■��s��t��■ ■��■��■��■ ■�■��■ ■�■��i��■ ■��■��■��.�■�■��■��■��■ ��o��■ ■��■��■��■��■��■��■��■ ■��■ ■��■■��■��■��■�■��■�■■��■ ■�■��■�■■��■��■ ��. t��■t��■ ■��■��■��■�■ ■��■��■��■ ��■ ■��■��■��■ ��s��s��w��t��■ ■�v��e��■��■��o��■ ■��so�■��o��v��o��■ ■��■■��v��■��e�� ■��■�■��■�v�� ■��v��■ ■��st��■ ■��■��■��■��■��■��■ ��o��t�� 1 � �,�i `� � � � � —+ � �" 1..� .. � ,...�.- .. . - .. . _ .._��._.. dt! _ . � _ ., �� 1� \�`� , ,� r" �'. �:�:� , ��l - __ � ►-� -Q � - ` �f ,� �c , �-��--�`�-� - . � , ;, ; : . ._ , /fi � `' �1 -� ' � i i� � ��'s � - � I �� - zi ,f C ? 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