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1508 County Home Rd (2)� � � DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 ,Account �: 990005515 Bille�� io: Chad Fuller R�fer�r�ce �la���: Chad Fuller f�ro�t�s�c9 F��:i€ity: Residence f�TC f��a�b�r: 5092 OPERATION PERMIT �'�x �'i�I.��H #: 5728-61-2978 Su�t�i��i�ior� inffc�: LocationrAddr�ss: County Home Road-27028 �'rt���r�y Siz�: 30 Ac **NOTE** 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. System Type: S.T. Manufacture`��j64� Tank Datea � Tank Siz�d�� Pump Tank Size E H ecialist: �te: Z ZL Zol< . System Installed By:�1Gm�� eY� .. sp —�� (�d0 (,r.. �. C�tRw��2h5 � DCHD 11/06 (Revised) . � a, 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 �ccc�u�t #: 990005515 "��x f�l�€%EH #: 5728-61-2978 8i!!c� ic.�: Chad Fuller Su�idi�fi�ior� Irif�: f�efer�r�ce P�an7�: Chad Fuller LacationiAddr�ss: County Home Road-27028 F�rn�c3s�;c9 F,��,�iEity: Residence �'co��r�y Six.e: 30 Ac f�T'C i�1u[t�b�3': 5092 Site Type: P1�Vew ❑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 Specitications: # Bedrooms� # Bathrooms �. �# People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size �� 4,C. Type of Water Supply: LK�ounty/City ❑Well ❑Community Well �� System Specifications:. Design Wastewater Flow (GPD) �Q Tank Size� GAL. Pump Tank GAL. ' Trench Width �� Max. Trench Depth� Rock Depth� Linear Ft. �� GUO � . / •� � � �/�,— Site Modifications/Conditions/Other: /l(,�/� . �G�t, �QDT/l ,3�0 �� z`S�b �'""'- Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the dav of installation. Telephone #(336)751-8760. �� f�l�r,�,.._� ;-., � �;,� . J � � � / ! � � � Environmental Health Specialist � �" Date:� z � � DCHD 11/06 (Revised) 'J � Account # Billed To Address: City , i Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680 IMPROVEMENT PERMIT 990005515 Tax PIN/EH #: 5728-61-2978 Chad Fuller Subdivision Info: 108-2 Friendship C�urt Location/Address: County Home Road-27028 Mocksville Property Size: 30 Ac Reference Name: Chad Fuller 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: ❑New ❑Repair ❑Expansion Permit Valid for: @� Years ❑No Expiration Residential Specifications: # Bedrooms� # Bathrooms # People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):_�� Type of Water Supply: jZfCounty/City OWell ❑Community Well �t� �,tt;tcti tn 15A NCAC la,�.�,� ;�j�y` Site Modifications/Permit Conditions: �CCe�tc:d Systems m�y oirp �� �„_. .�° Site Plan 0 Environmental Health Speciali i.p. l l -06 . �"4 -`� ` `� /' � � r( . ` �� ` � � � \ ` ��` � •' ; . � � � ' � ♦ � ��, _ �. � . , � ,, ' ' s _' �, � ♦ r .-. 1 � ,., � • •, - \ c,v c�c�-- �"`��. Date� l,��p le� �� , �. APPLICANT INFORMATION Account #: 990005515 Billed To: Chad Fuller R f�rence Name: Chad Fuller Pro osed Facility: Residence K � '� ".'l; � DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section Soil / Site Evaluation - PROPERTY INFORMATION Tax PiN/EH #: 5728-61-2978 Subdivision Info: Location/Address: County Home Road-27028 Property Size: 30 Ac Date Evaluated: �%l/t ?� l ! Water Supply: On-Site Well Community Evaluation By: Auger Boring Pit � 1'� FACTORS 1 2 3 Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure HORIZON IV DEPTH Texture group Consis[ence Structure Mineralogy �-'"`°- SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE , - �■� � : r�rr�■�n ■i■���.�■��r����� �-��� ��--� _---� ��'��r���«��Ii�. ���r��■r%r��v� s���s��sr� ar��� _�i/����i�V's�� r��� �������-r�� _�.. . �i,�r��i''.�'��f���I/�il t���'!"�L:r '� n7�'li�� ��►t�1��.►�l��?�� �r� .��c��r: ������� �-�-� _---� _---� �--�� �_--� ����� C:LAJJ1r1CAl'lUN - LONG-TERM ACCEPTANCE RATE ; ��" SITE CLASSIFICATION;'�' � � S ; � LONG-TERM ACCEPT�NCE RATE: -�� �. _. REMARKS: ' Public Cut 4 5 6 7 Z S' EVALUATION BY: OTHER(S) PRESENT: LEGEND i.�ndsca�e 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�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 '. AN4IST N . , �i'1415� . : � � VFR - Very friable FR - Friable FI - Firm VFI - Very �rm % 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 S r > >r SC - Single grain M- Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic 9 Mineralo�v 1:1, 2:1, Mixed LY�� 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 soii colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) TTAR _ T.nnv-tPrm arrPntanrP ratP _ aal/�a��/ft7 T/�T7T hCll1G ir,__.:__�� C ■�■■ ■��■ ■��■ ■ ■ ■�������■ ■�■����■■ ■���■��■■ ■/������■ ■�■�����■ ■�������■ ■�������■ ■��■��■�■ ■�������■ ■■������■ ■��■����■ ■�������■ ■�������■ ■����■�����■■■ ■���■■�■�■���■ ■������■���■�■ ■\�\���������■ ■���■�������■■ ■��������■���■ ■��■■����■��■■ ■■�����������■ ■������������ ■���■ ■���■■ �����������.Y�� ��������������� �����������.�� ■ ■ ■ 1 � ■ Ili ■ ■ ■�������■ � � ■�■���■�■■ ■���■���■■ ■��■��■��■ ■■�������■ ■�������■■ ■■�����i■■ ■■��■■���■ �� ■■ ■■ ■����■ ■����■ ■■���■ ■����■ ■����■ ■����■ ■����■ ■■���■ ■����■ ■\���■ ■����■ ■����■ ■■���■ ■�■������������������■ �������������������� ���������������������� ���������������������� ���������������������� ���������������������� ���������������������� ���������������������� ���������������������� ���������������������� ���������������������� �������� .������������� ���������������������� ���������������������� ���������������������� ���������������������� ���������������������� ■�■��■��■■�■�■�■�����■ ■�■����������■��■■���■ ■��������������������■ ■�����������■��■■����■ ■��■�����■���������■�■ ■����■�����\���■�����■ ■���■���■��■���■�����■ ■�/�������/����������■ ■����■�������������■�■ ■��������■�■���������■ ■��■�����■���������■�■ ■■■■����■��������■�■�■ ■����■��■■�����������■ ■���■����■��\■�������■ ■��■�������������■��■■ ■■���■���������������■ ���������������������■ ■■��■■���■���������■■■ ■��������■�����������■ ■�■■�������■�■���e���■ ■�������■��������■���■ ■����������/��/������■ ■������■�������������■ ■�■�■���■��������■��e■ ■��������������������■ ■���■��������������■�■ : .. , a���ic `r�� � ��� �-- '�; 1�� '�_. --- � �. � � � �Y {� 1 ITE EVALUATION/IMPROVEMENT PERMIT & ATC � Davie County Environmental Health ��� P.O. Box 848/210 Hospital Street � 2��� � Mocksville, NC 27028 :' '` ti�A� 2 '� � (336)753-6780/ Fax (336)753-1680 , LN��TH Appli�Cation� E�a �, �Si.tC� � al{�tio ovement Permit ❑ Authorization To Construct (ATC) � Both Type f Application� ystem ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility *� *IMPORTAN7*** THIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFO MATION Name � .. � �-- � AddYess � � �-- City/St / IP /� f f J � � Z d�/���c Name on ermit/ATC if Different than Mailin� Address � ffr Contact Person CiL�� �-C.. !/� — Home Phone — '% % � OZ�usiness Phone �"_j 'j�S— $ g�,� ii� , /State/Zip 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? Yes �o Does the site contain jurisdictional wetlands? Yes �o Are there any easements or right-of-ways on the site? Yes l/I�o Is the site subject to approval by another public agency? Yes ,�il�o Will wastewater other than domestic sewage be generated? Yes� IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms Basement: OYes,�10 Basement Plum ing: ❑Yes �No IF NON-RESIDENCE FILL OUT THE BOX BELOW Garden Tub/Whirlpool ❑Yes ❑No 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 � ., Water Supply Type�County/City Water ❑Accepted ❑Innovative ❑Alternative ❑Other ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this sysfem is intended to serve? ❑ Yes CJ( 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 les. nderstand at I a responsible for the proper identification and labeling of property lines and corners and lo a a i 'n se �' location, proposed well location and the location of any other amenities. roperty owner's or owner's legal representative signature Site Revisit Charge Date(s): _�Z �- / b � Client Notification Date: Date EHS: Sign given ❑Yes ❑No Revised 11/06 Account # Invoice # J�/�j � �. �'� �,�� •''�''t` ��'ta� � °: � a l �.. .�-�r��itr �'� s `' , � x ,� � f,,Y Y� ,�T� t ��� � :' fu � I .. . 7. 3�:t .,�. 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NCGS "JOYNER" N: 780046.05' �: 1524974.66' �� � �S Highwoy 64 1 _ . I cra N 3p'''3o�E� _ 8� ronu 5, & wife, 13arbara G, Green � � T e��e 678�- ,, ,Q pIN; 5�2851��9q � North Ref: DB 619 PG 599 m Phicoll _ o 1 y � S _ � k ' m�SreA e enfed to fit ��� �y� � nC� 128 pG � � � m�p- � � o a SITE � 1�on�{ 5, & wife, [3arbara G. Green —N°�2�'�s' ,s`7_ � a '1 pIN; 5�2851��9� I + �` � � � County Home Road � n13128 pG � i 4"oP 1 uP � VICINITY MAP NTS � � � Wood rad fence � rown I.ake, �YIC, ' g I encroaches 4.3'. -e� � I �L,�c��. N?6.33� pIN; 5�28632�05 � o I � �� nC� 88 pG 2�0 � o � 9?0. 1 _ _ � � �, � navid Wa�ne Anderson � — �—z ° � pIN: 5�28610�8� ,�•EIP AT STONE � � n6 51� pG YOZ n, o�oo•oo-E o I z se �. 1 � � � ( 53.37) LP Proposed tiouse 9f"g� N I N � � a°. � m � � � al .03' 123.33 �LT m � 1r, � � �a� _ � o � n- rn O � Q Ot��j��— o ;o '�,� � 30.868 Acres o��;�' �---- fi � ,� �P Q`i��i \ '�'`'�`s �: � ^ \ R * � 1' � � �O `� �i l/------`_ -_ Culvert - ✓ �F � ' �/ ' -�, �9 � � �� �� � �� ' � ������� �?). 1 11 � UP � o\ � \ ____-_ � �// \`����`��` � � � � ,� o, :'� ��\`roposed ��;,;__--' �This portion not located by suniey. ���:�. 1 ` � � �` � Dr�veway �� �� �.�. Chain "gate" N ,� � � �� �� � � / 1 � � 4 ^ ' ' �'/ \`�\� --- ` 1 � � _ �� �e�ay `�\�� , __. __ � � i.',� , C,ca�e���� �, ,� -�__----^----' � � � ,'_-- - , .V � � �O � --��' I d' Gravcl Driveway �a�` ' O ,� �� Gulvert ` \ .`.\ � � � � � ' . i i �.`. 1 RRSPK �� . ���`. ii � . ` ,� �i \3/4"EIP AT STONE � h� �^ ' '� 1�own I.ake, Inc, „ 1 ��''�ry ` ' ;%� o��'c�, pIN: 5�28632�05 '/ .. , ;;;,�P . �°g� s n� 88pG210 RRSPK .5 EtP UP � �`ti � � s ���,9 744_44• ,�Q \Q `1 �!. � � 2�2r��26'�s• � " , , ���ti°6� �� �h�k�Q �� 9$ , , s.2s• o E Q � ��. ?g9 ,�6A,. ��Ei� S � 1753.12333.35' ��4j� � ` 6' ��'IG' CO��G'��G' COt�O�"�IOt1 �9 5 Z 1$ � 05 05 126.85' � F. pIN: 5�28�10963 tis � � 141.45• �` n(3105 pG 228 °'F� 11�e Coll ette Corporation �1 331.7g� � pIN; 5�28�10963 n6 I05 pG 228 '"�'P .\ .\ .\ NOTES: � I . Tax Parcel Identification Number: 57286 I 2978 2. Deed Reference: DB 6 I 9 PG 599 3. Current deed's Exhibit A description contams errors cawsing a mathemat�cal misclosure of 475 feet. PrOpOSed HOUSe Loeation Plan for 4. I O' 6ravel drive is used by Town Lake, Inc. for access�o their property. 5. A grid coordinate was not established on the property because NCGS "405 JA5", the match for"JOYNER", has been destroyed. l.�h a d F u 11 e r 6. Raw traverse error of closure is I :40,I 94. Angular er�ror is 55 seconds in I 6 angles turned. Town of Mocksville — Davie County NORTH CAROLINA LEGEND 120' 60' 0 120' 240' 360' EIP F�(ISTING IRON PIPE ESI EXISTING SOLID IRON BOLT EXISTIN6 BOLT ECM EXISTING CONCRETE MONUMENT SCALE DATE JOB � DRAWN TBAR EXISTING IRON 'T' BAR WITH CAP SET BY GRADY TUTTEROW, PLS L-2527 P R E L I M I N A R Y P LA T ���_�20� 05�06�10 0060 JCA RRSPK RAILROAD SPIKE SET �� #5 REBARSET N OT FOR RECORDATI ON , NS NAIL SET NCGS NORTIi CAROLI NA GEODETIC SURVEY C 0 N V E YA N C E S, 0 R S A L E S (� RM/ RIGIIT-OF-WAY 1VS PIN PARCEL IDENTIFICATION NUMBER —_ —• —• —FENCE LAND SURVEYING �o OVERIIEAD UTILITY Allen Geomatics. P.C. C-3191 ^UP UTILITY POLE � � LP LIGhT POI� PO Box 89, Advance, NC 27006 (336) 782-3796 www.Al IenGeomatics.com