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996 Cornatzer Rd (2) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street • Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account #: 990005100 Tax PIN/EH#: 5758-99-7439 Billed To: Stewart Howell Subdivision Info: Reference Name: Location/Address: 996 Cornatzer Rd-27028 Proposed Facility: Residence Property Size: 11 .5 Acres 880 AT(;*Vlflf#The issuance of this 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. OR kP Cz 2 / System Type: I' S.T.Manufacturer_ Tank Date --t G 3 Tank Size`_�G Pump Tank Size System Installed By: c E.H.Specialist: 4� �Q Date: • I I tJe� G r C4 DCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH • P.O.Box 848/210 Hospital Street Mocksville,NC 27028 Qdj• a (336)751-8760 Fax#(336)751-8786 nI�D AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION 11 Account #: 990005100 Tax PIN/EH#: 5758-99-7439 Billed To: Stewart Howell Subdivision Info: Reference Name: Location/Address: 996 Cornatzer Rd-27028 Proposed Facility: Residence Property Size: 11 .5 Acres ATC Number: 4880 Site Type: C31 ew ❑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 change. Residential Specifications: #Bedrooms c-#Bathrooms2-,f#►f#People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size Type of Water Supply: 2160unty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD)�36Tank Size OG GAL.Pump Tank X 4GAL. / I► �� / Trench Width Max.Trench Depth_3 6 Rock Depth Linear Ft. Site Modifications/Conditions/Other: As stated in 15A NCAC.18A.1969(5) accepted Systems may also be use roTact 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. p t �� 0; //► 4Z Of / Environmental Health Specialist Date: 3o — i DCHD 11/06(Revised) Davie County Environmental Health P.O.Bog 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990005100 Tax PIN/EH M 5758-99-7439 Billed To: Stewart Howell Subdivision Info: Address: 1032 Cornatzer Road Location/Address: 996 Cornatzer Rd-27028 City: Mocksville Property Size: 11 .5 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: 2Keew ❑Repair ❑Expansion PermitnValidfor: [13"Years ❑No Expiration Residential Specifications: #Bedrooms #Bathroomsd'Jdf#People _Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):3(GU Type of Water Supply: ❑County/City ❑Well ❑Community Well As stated in 15A NCAC 18A.1969(3) Site Modifications/Permit Conditions: accepted Systems may also be use i System Type LTAR Initial eenr&P ,e0 6. Repair Site P an 1 9e \ l Environmental Health Specialist i.p.l1-06 �7 4 10 SITE EVALUATION/IMPROVEMENT PERMIT ATC Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 a� d p�PQM (336)751-8760/Fax(336)751-8786 � � � F &ON rued Ap licatio For:'i.S fri v u ion/Improvement Permit ❑ Authorization To Construct(ATC) G�Both Typ of Application ew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***I ORTANT***.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 ffd int Contact Person 5-(e.Warl t Billing Address JD3� Com 'Ae - Home Phone City/State/ZIP_'Mr2e eW i ( /`l.0 Business Phone 3 J9 Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged b 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 Phone Number Owner's Address /D 3z City/State/Zip /�(ocKsvSl(2 Property Address o.- ¢.v X04 City Lot Size J(.sctc-rei Tax PIN# A –'1JV Subdivision Name(if applicable) Section/Lot# Directions To Site: 1,7y r. Mi WA� PDX RM l2S ()IV If the answer to any of the following questions is"yes",supporting documentation must be attached. Are there,any existing wastewater systems on the site? WYes ❑No Does the site contain jurisdictional wetlands? OYes j8No Are there any easements or right-of-ways on the site? ❑Yes tgNo Is the site subject to approval by another public agency? ❑Yes tallo Will wastewater other than domestic sewage be generated? ❑Yes RNo IF RESIDENCE FILL OUT THE BOX BELOW #People ,2 #Bedrooms 3 — #Bathrooms ,2, Garden Tub/Whirlpool 5dYes ONo Basement: OYes No Basement Plumbing: ❑Yes ®'No 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:. %Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: XCounty/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes No 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 sta ' g the house/facility location,proposed well location and the location of any other amenities. ,,� � Site Revisit Charge Property owner's or owner's legal representative signature Date(s): IO/3•-O$ Client Notification Date: Date EHS: Sign given OYes ONo Account# /Ov Revised 11/06 Invoice# GaMAPS -Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping System 4�aic�fi Click Here To Start Over Quick Search:(County-ID c • , D /" ��! � Ou Active Layer. Huse.Map nips GiS [Vt 0 PARCELS(Map Tips Available v' } ' Map Layers Results JONES C MENT DAVIS 105 I600000 0 6.947 AC CORN ER RD Anil 1032; 158 1013 1018 fli 9494 SS- RO 980, V N I In� o 95$� i� .902ji :r 0 015611 http://maps.co.davie.nc.us/GoMaps/map/Index.cftn?maimnapservice=gomaps&CFID=412... 6/13/2008 • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation t3 769-qq-'?q ij APPMAilt3T#NFAII Q3Xl(IDN Tax PIN/EH#: 5758001 OPPTY INFORMATION Billed To: Stewart Howell Subdivision Info: Reference Name: Location/Address: 996 Cornatzer Rd-27028 Proposed Facility: Residence Property Size: 11 .5 Acres Date Evaluated: ._ 3 ,0r ::::� Water Supply: On-Site Well Community Public ✓'��, Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% + HORIZON I DEPTH n — Q fsg Texture group SG G Consistence lr t/ M Structure �q Mineralogy HORIZON H DEPTH I Texture groupG Consistence (� Structure MineralogyQ HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION lj LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION:_� S EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT- &_%1_ V 1 6_(\L1 C vt. 1 REMARKS: ,)��2t�1 fW� I1 Owe LEGEND 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 Moist 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 StrLcture 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 ]votes 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 05/05 (Reviced) I ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■t■■■■■■■■■■■■Ott■■■■■■■■■■■■■■■■Ott■■■■■■■■■■■■■■■■■■■■t■■■■■ iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii■■iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii ■■■■■■■■t:d.■rid•■■■■■■■■■■■■■■■■■■■■■■e■■■■1■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■i�■cori*�e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■��i.��■■.�■■■■■■■■■■■■■■■■■■■■■■e■■s■■■■■■■■■o■■■■Moe■■■■ ■■■■■■■■■■■■■■■■■■■■■■��a■■■Gr2'=1•lwww!�■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■ ■E■■E■ ■■■■■■ }i■■■■■tt'i■■■■■■h==!""■ ■■■■■■ ■■■■t■ ■■■■■■■■■■■■■■■■■■■■■■■■■1■■■■■■■■■■■■■■■I,■■■Ott■■■■■■■■■■■■■■MESO■ ■■■tttt■■tO■■■■■■■tt■t■■1�■■■tO■■ ■■■tO■i■■■■O■O■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■1►'�■tit■■■■■■■■tl/■■■■■■■■■■E■■■■■■■■■■■■■■ ■■■■■■■ttttt■■■■■Ott■■■■■1�■1■■1191! _ ' ■■■■■■tl■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■11■■■�%■ISL■■■■■■■■1■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■Ili!OOSOG�1\■■■■■■■'■■■■■■■■■■■■■■■■■■■■■■■■■