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335 Dalton RdDAVIE COUNTY ENVIRONMENTAL HEALTH , P.O. Box 848/210 Hospital Street �' Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 Account #: 990004182 Billed To: Cynthia Dalton Reference Name: Proposed Facility: Residence OPERATION PERMIT Tax PIN/EH #: 5757-07-8569 Subdivision Info: Location/Address: Dalton Road-27028 Property Size: 2 Acres ATC�,FN 4752 * 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. _ � � � '�J'"� �� . J �� � cs ✓ c3 a System Type:� S.T. Manufacturer� Tank Date� Tank S�ze � U r � Pump Tank S�ze �� �� �� � ` � �y System Installed By: � " "` ��' ` - -E.H. Specialist: �1/ � �� Date:�O� 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 i AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004182 Billed.To: Cynthia Dalton Reference Name: Proposed Faeility: Residence" ATC Number: 4752 Tax PIN/EH #: , Subdivision Info: Location/Address: Property Size: 5757-07-8569 Dalton Road-27028 2 Acres Site Type:�lew �Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MC1ST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building pernut(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 FNE 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:� F`'acility Type # People # Seats ` Square Footage(or Dimensions of Facility) Lot Size '2 � � . � Type of Water Supply:.�'�ounty/City ❑Well OCommunity Well System Specifications: Design Wastewater Flow (GPD) � Tank Size6ial,�GAL. Pump Tank ��GAL. ,i ��� ,i � Trench Width� Max. Trench Depth Rock Depth )� Linear Ft. ��� Site Modifications/Conditions/Other: �IV� i,.� �l �%�(/�C ���� Ci�7'C l��e:� , ` , �� � s LI�.Jr:. Contact the Davie County Environmental Iiealth Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telephone #(336)751-8760. As st�ted In 15A NCAC 18A.1969(51 �ccepted Systems rriay also bQ used _ ��C,. i3c�' �. ��� s a+ �� /���-� -�s' .- Environmental Health � DCHD 11/06 (Revised) �� r ; . . y .•' • ' DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 i AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004182 Billed To: Cynthia Dalton Reference Name: Proposed Facility: Residence ATC Number: 4752 Tax PIN/EH #: 5757-07-8569 Subdivision Info: Location/Address: Dalton Road-27028 Property Size: 2 Acres Site Type: �Iew ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MCTST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building pernut(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 FNE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. �, .�' Residential Specifications: # Bedrooms � ##,Bathrooms 3# People � Basement0 Basement plumbing0 Non-Residential Specifications:� Facility Type # People # Seats � Square Footage(or Dimensions of Facility) Lot Size � . , Type of Water Supply:.�ounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) �� Tank Size{���GAL. Pump Tank �a�GAL. � ► , I� i Trench Width�� � Max. Trench Depth 2� Rock Depth )� Linear Ft. �'j� Site Modifications/Condirions/Other: �IV�' ��.L � ��%U(/t, /�� � �� r7Yl��L'�/ Contact the Davie County Environmental Health Section for final inspection of this system between 8c30 — 9:30a.m. on the day of installation. Telephone #(336)751-8760. As str�ted }n 15A NCAC 18A.19S9(S) ��cepied Systems may atso bQ ured � � r k' N � -M��.10' Environmental Health Speci ist � Date: �� �2. fl% DCHD 11/06 (Revised) � : •• � ITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental I�ealth � P.O. Box 848/210 Hospital Strcet Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Appl ation For: ❑ valuation/Improvement Permit ❑ Authorization To Construct(ATC) �oth Type�f'A ' ion: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** 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 � 1J ., Contact Person Billing Address Home Phone City/State/ZIP _ 1 Business Phone Name on Permit/ATC if Different than Above Mailin;,> Address PROPERTY INFORMATION City/State/Zip *Date House/Facilitv Corners � ZTd1� NOTE: A survey plat or site plan must accompany this application. Included: Q'Site Plan ❑Plat(to scale) (Pernut is v� for 60 onths ith site plan, no expiration with complete plat.) 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"x^a-���.a»: k;iE >'.�_ '+� i :r4� �,d��4 �.:..� �.: � http://maps.co.davie.nc.us/GoMaps/map/index.cfm?Extent=1548018.68992609,777022.06... 8/27/2007 � •• • DAVIE COUNTY HEALTH DEPARTMENT a , , �' • Environmental Health Section � Soil / Site Evaluation APPLICANT INFORMATION Account #: 990004182 Billed To: Cynthia Daiton Reference Name: Proposed Facility: � Residence -�.. � :i PROPERTY INF�RMATION Tax PIN/EH #: 5757�0 5 y Subdivision Info: ,,, Location/Address: Dalton Road-27028 Property Size: 2 Acres Date Evaluated: � 1� � Water Supply: � On-Site Well Community Evaluation By: Auger Boring � Pit FACTORS 1 2 3 ,� Landscape position , L _ , � , �--� Slope % � HORIZON I DEPTH Texture group Consistence Structure Texture groi Consistence Structure HORIZON III DEPTH Texture group Consistence Structure �4i[�i.�`�, ���r.��z� ��I��L� ����re��� ���.�r����%��� ' , � ��L��������' ��� � . ��.�[�� ►���'. '���.�C� �'�,�i�!J�`��� �������J r��� �'�Jl��a�� ���'�if"�i�G�'l�J HORIZON IV DEPTH Texture rou Consistence S tructure � Mineralo SOIL WETNESS �^-- RESTRICTIVE HORIZON SAPROLITE ^- CLASSIFICATION LONG-TERM ACCEPTANCE RATE o. Z7 � SITE CLASSIFICATION: Q� / LONG-TERM ACCEI'TANCE RATE: C� •�� � Public � Cut 5 6 � 7 .___ „� 4� � t — ,.. J .3 •2 J rO .3 ' EVALUATION BY: � OTHER(S) PRESENT: REMARKS: LEGEND I.andscane Position R- Ridge S- Shvulder 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 �ONSIST .N .E MQi�� 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 Structure 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 , Notes 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 [o soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/f[2 DCHn �5/(15 (RPvicP�ll � i ■ : . ■ ■ ■ ■ ■ ■ ■ ■■�■■��■ ■�����■■ ■��■�■�■ ■�����■■ ■■�����■ ■■■�■��■ ■���■�■■ ■■�s■��■ ■�■�■�■■ ■■�����■ ■������■ ■��■�■�■ ■����■�■ ■������■ ■��■���■ ■������■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■��■■�■��■�■ ■���■����■�■ ■�����■����■ ■����������■ ■�■������■�■ ■■��■■��■��■ ■����■�o�e�� ■�����■ ■r�< ■�■■��■ ' ■�■ ■�����■����■ ■■■��������■ ■�������■■■■ ■��■■ ■��■■ ■ ■ ■�����■ ■ ■ ■���a■�■�■ ■■�����■�■ ■������■■■ ■���■����■ ■���■����■ ■■�■�����■ ■�����,r.e!�■■��■�■���■�����■����������■ ■�����Il1►111>����■�����■�� ��������������■ ■■■��■f������■�����������■����■■■����■ ■���■ ■■■��■ ■�■�■■ ■�■��■ ■����■ .....� ......�......i�......�...... ......�..�� ........................... ■■����I��iv■�l����■���������������■S��■ ■■��■�I����■��ii�■������■■��■���������■ ■�����I��■■�������■�����■��■���■���■�■ ■��������■���■ ■ 7 I ■ ■ ■ ■ ■■ ■ ■�■ ■�■ ■■■ ■�■ ■■ ■ ■�■ ■�■��■ ■����■ ■����■ ■�■■�■ ■■���■ ■�■■�■ ■■���■ ■�■��■ ■�■■■■ � , J "^� . � � Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 - (336)751-8760/ Fax (336)751-8786 Account #: 990004182 Billed To: Cynthia Dalton Address: 246 Dalton Road City: Mocksville Reference Name: Proposed Facility: Residence � � � IMPROVEMENT PERMIT Tax PIN/EH #: 5757-19-0454 Subdivision Info: Location/Address: Dalton Road-27028 Property Size: 2 Acres **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. Pemut Type: ew ❑Repair OExpansion Pernvt Valid fo�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):«� Site Modifications/Pernut Conditions: Site Plan Type of Water Supply:�unty/City OWell �Community Well /�s stated In :tSA NCAC 1E3�i.19S9(5) accepted Systems r►�ay also ba u.sed '7s` Environmental Health Specialist i.p.l l-06 �r.,�I �l � � - Date