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197 Dare Ln DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account #: 990004360 Tax PIN/EH#: 5857-67-8960 Billed To: Ken McDaniel Subdivision Info: Reference Name: Aaron Walker Location/Address: 197 Dare Lane-27028 Proposed Facility: Residence Property Size: 4.77acres ATC Number: 4689 **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. 5�loy� � 'o System Type: S.T.Manufacturer Tank Date -(0 Tank Size Pump Tank Size System Installed By: Y�ctv► ��1� � CN;jf,E.H.Specialist: Date: o` 75-cY 1 t4C , yQ. A s 4 DCHD 11/06(Revised) �- S DAVIE COUNTY ENVIRONMENTAL HEALTH � . P.O.Box 848/210 Hospital'Street �� f Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account M 990004360 Tax PIN/EH#: 5857-67-8960 Billed To: Ken McDaniel Subdivision Info: Reference Name: Aaron Walker Location/Address: 197 Dare Lane-27028 Proposed Facility: Residence Property Size: 4.77acres ATC Number: 4689 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 change. r� Residential Specifications: #Bedrooms #Bathrooms#People a Basement❑ Basement plumbingO Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size L1,'7 3 -Type of Water Supply: ❑County/City M<ell ❑Community Well System Specifications: Design Wastewater Flow(GPD) 2lq O Tank Size GAL.Pump Tank GAL. Trench Width 3(A Max.Trench Depths Rock Depth I Zo Linear Ft. Wo As stated in 15A NCAC 18A.196M) Site Modification s/Conditions/Other: sEceote i Systems may-QIFQ hg us— 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. -eta `y J4 t� y .-M as1 e ;r Environmental Health Specialist DCHD 11/06(Revised) R.e t! end d APPLIWIO R SITE EVALUATION/IMPROVEMENT PERMIT & ATC gyp`( 3 Davie County Environmental Health P.O.Box 848/210 Hospital Street V1R0�1T"91�191AINEA��t1 Mocksville,NC 27028 pPV�EC0Uf1� _ (336)751-8760/Fax(336)751-8786 Application For: Q Site aluation/Improvement Permit /Authorization To Construct(ATC) ❑ Both Type of Application: kNew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTAN7***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 "Zp Contact Person Billing Address L Home Phone City/State/ZIP .c C Z Business Phone Name on Permit/ATC if Different than Above . Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged 2 0� NOTE: A survey plat or site plan must accompany this application. Included: Erl§ite Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name Phone Number S Owner's Address City/State/Zip C Property Address City N C z7oz� Lot Size Tax PiN# Subdivision Name(if applicable) Section/Lot# Directions To Site: t I D W 2 N If the answer to any of the fol owing questions is"yes`,sup orting docume tion must be attached. Are there any existing wastewater systems on the site? es ❑No Does the site contain jurisdictional wetlands? ❑Yes 1�<o Are there any easements or right-of-ways on the site? ❑Yes 9<o Is the site subject to approval by another public agency? ❑Yes C� Will wastewater other than domestic sewage be generated? ❑Yes 20 IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms,_'7, #Bathrooms Garden Tub/Whirlpool es ❑No Basement: ❑Y�o Basement Plumbing: ❑Yes 64o" IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of FacilityBu-siness 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: ❑ County/City Water ❑New Well Z xisting Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes �- o 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 comers and locating and flagging or staking the house/facility loc 'on,proposed well location and the location of any other amenities. Site Revisit Charge roperty owner's or owner's legal representative signature Date(s): Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# tf<� Revised 11/06 Invoice# I /'(County, North Carolina Spatial Data Explorer. i - J NoM Carolina Click on the Map to: Zoomin O Zoomout 0 Recenter Map 0 Identify: Parcels . #' _ .........._..._..... _.�... Zoom Factor:;2X i . 0 Radius Search(feet) w NP (1.98A) pan 3 'I 363 I-td � X33} F M 43 to > 60 Q CW ��'TI GDU��� " to 9547i Parcel Data Find Adjoinin _Parcels • Land Unit/Type: :/AC • Deed aook/Page:00507/0931 • Deed Date:2003/08/22 • County ID:E600000053 • Sales Price:$68,500.00 • Account Number.*000082521377 _ DE ly E 0 11 E 1 CATION FOR SITE EVALUATION/IMPROVEAIENT PERMIT&ATC - Davie County Health Department G leo EnvironmentalifeaithSection L lel 2003 P.O. Box 848/210 Hospital Street (- �_ o 3 Mocksville, NC 27028 ENVIRONMENTAL HEALTH (336)751-8760 PPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Oa the INFORMATION BULLETIN for instructions. W 1. Name to be BilledAelro&i Q /P1-- Contact Person h7roo Mailing Address s N 14w�/ Re>/ Home Phone 99T 6 " (o 1?9 ?9 1 City/State/ZIP 1'flfzz6nCe lVe- �70� Business Phone co/l % ^ /J--361,9 2. Name on Permit/ATC if Different than Above '� n tt;l ✓`f'�S Mailing Address City/State/Zip 3. Application For:*ASite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: YHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other -5. Type system requested:)W Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People 3 # Bedrooms C— It Bathrooms �--- ❑Dishwasher ❑Garbage Disposal Washing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People tt Sinks # Commodes # Showers # Urinals It Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 8. Type of water supply: ❑ County/City Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑Yes gNo If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY 1NFORMA711ON REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTE•D by the client with THIS APPLICATION. Property Dimensions: 1VRITE DIRECTIONS(from Mockwille)to PROPERTY: Jx Office PIN: it ��S /� 789( 0 , J S��ra� / r Property Address: RoadNamc terry ��SIS /s8•�f-'uYry ��Tp�0T1/ '00 4'140,0 VC). 'ss City/zip C f8y over— b r;d e (900- If 900-If in a Subdivision provide information,as follows: Yate r,i oN T1 Name: Section: Block: Lot: Date home corners flagged: ! V This is to certify that the information provided is correct to the best of my knowledge. I understand that any pernnit(s) issued hereafter are subject to suspension or revocation,if the site plans or intended use change,or if the information submitted in this application is falsified or changed. 1,also,understand that 1 ann responsible for all charges incurred from this application. I,hereby,give consent to the Authorized Representative of the Davie County Iley�lth Department to enter upon above described property located in Davie County and owned by JQm e.S /' V64r L e-i,c� to conduct all testing procedures as necessary to determine the site suitability. DATE JUNG 2 Z Of 3 SIGNATURE -6 THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Datc(s): Client Notification Date: —' EIIS: V d� Sign given Account No. —7s Revised DC)ID(05/03 Invoice No. '-2_ a _ : 754.20 7429 t 4.74A r N n 0055 4.754A V., . ___ \ 7020 1'J <.K.. 1378) _______________ _ i' yk 341.38 F 975 418 l `w . . N (22A) 776417 148 .__________ �t 1653 - 1 (1.91A) 4-1- 7555 1 , ------------- 7354 ------� -- (1.07A) 7254 ------mm 363 -- 323 a! (733) - p. rr �r r � x .399 1 v Ui L (6.66A) ^ v cx 8960 Y 0 5: 530 � 5DA. 1 '17 ' 5.89A 8294 r o A0. (1406) ' 7.35A)., DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002785 Tax PIN/EH#: 5851-67-8960 B Billed To: Aaron Walker Subdivision Info: Reference Name: Location/Address: Strawberry Hills-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: 6*4`la tel 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 a U Texture group Consistence Structure Mineralogy HORIZON II DEPTH Vol 41 Texture group Consistence Structure 1 Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: k5 EVALUATION BY: LONG-TERM ACCEPTANCE RATE: 0, a OTHER(S)PRESENT: V REMARKS: �1��I`S�ti1�e2� /Nle/,9 yol� 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 ois VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm Wet 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 Mineralogy 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 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 05/99(Revised) ■■rr■r■see■■■■■■■■c■■■ecr■■■■it■■■■■��■■■■■e■■ee■■■■■■■■■■■■■■■■■■ ■■■■■t■■■■rt■■■r■r■eee■■c■■■r■■■�■■■��rcec■■cc■■e■■ee■■rcccr■■■cc■ ■■■r■rrc■r■■r■er■■r■■■■■■■■�■■■■ ■■■��■■e■t■■■■■■■■■■■■■eeeee■■■■■ ■■tc■■ecce■■■■■■■■■■■■■■■■■��■■■■■■■■■►�■c■■r■■r■e■■■■■rrcet■■■■■ce■ ■■■■■■■■e■■■■■■■cccr■■eee■eee■,■■i�■■■■reerr■cr■■c■■recrtecrrcrrrc■ ■tee■ecce■■tcrttetttrcet■■tt■■uti�cate■■tc■t■e■tr■tt■■tr■■■t■■ttt■■ ■ertcrrr■rrceerr■tet■■■t■■rr■■�irncrrer■■cr■ee■■■■■rrerrr■r■■errcc■ ■■rr■tot■■■■■■■t■■■r■■■■■■■■■■■■S�■■er■r■■■t■r■■■e■rc■rrcrrr■rrec■ ■e■et■eet■■et■este■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■cr■■r■■■r■r■r■t■■ ■■■■c■■rcr■■■r■rcerr■■■ec■etc■■■■�■■■r■■■rrr■rrr■■■■■rr■■■■■■■■■■■ ■■■■■s■■■etc■�cr.w■�uii�ti■■■■■■■■■■■■i■■■■■r■■■■r■■■r■■■■■■■■■■rc■■■■r■ ■■rt■r■c■■r■sir■■c■■r■■■r■c■■■c■■■n■■■r■■■■■■■t■■■■■■■■■■■■■■■■■■■■ ■tctcttre�t■cttrctetcer■■tr■■r■hitt■■c■■■c■■t■c■t■■■■■■■■■■■■■■■■ ■■rtr■■e■■rr■■■■■tercet■■■■■c■■■c■■■ere■ttr■c■■r■■■r■■c■■trr■■tr■■ ■■■■■■■■■■■■■tri!:=■■■wn■■r■■r■■e■■r■■■cc■■c■■■■tr■■ctrtrcra■■rte■ Emotion MINiiiiMEMNO i ' �MENNENMENNENMENNENMENNEN ■■■■■■t■■■t■e�i■■■■t�i■t■�e■■■■■■■ern■■rt■ctt■t■■t■■■t■■■■■■ttcse■t■ ■■■■■■tte■e■■■ia■■■ei■■■■t■■■r■■rte■��■err■c■■■crrr■■rrcrt■■■crr■rtc■ ■■rrrcrr.Derr■�i■■■■■■r■■rrer■■rr■■■�t■cr■■t■■■■■■■■■■r■■cr■r■■■■■rs■ ■■■■■■■■ a■■■v■rte■■■■■■■■e■■■■i■■■■■rr■■■■■r■■rr■■r■cr■■cr■rtcrrc■ ■ter■crcic■_e■■r■■■■tee■■■■■■■■■i■■■■■■■ctc■■r■■rr■■rr■■rr■■■cc■■r■■ ■c■eeeee■thea■■t■■■ccr■tc■■rrenrrri�rrescre■r■■rte■c■■■tcrerccrtt■ ■■■rc■rrcrr■ce■tett■e■c■rc■■trr�irtr��ce■err■■■recce■cc■rrc■■■■■■■e■ ■r■■e■■■e■■r■■rr■r■erre■rrreerr■ir■■i�■■rrrrrrrr■■e■■rerrrcrer■t■te■ ■■tt■■rtc■trctttttttrrrcttr■cr■�i ■i�■■■tc■■ccr■tc■ct■■ctr■tt■tttc■ ■■■■■■■■c■■■rr■r■■■r■■■■■■■r■■■n�irn■sec■■■r■■rcc■■r■■rc■■r■s■■■r■ ■■rrcrrereecrrettrtterrrrrrcr■■��erci■rrerrrcerrcerrtrttttrrrrcctce■ ■■■■■■■e■■■e■■■e■■■■■■t■■t■■te■n ■■et■■■r■■■rrtctr■e■rtcrrt■■err■ ■■rtect■■c■■err■■crerrrertrrrc■■■■■r■■■r■■■r■■■■■■■sc■■cr■■e■■■rr■ ■■tectrtttttrttettttettrctrt■■src■tt■■tc■■■ctrr■ct■■tt■■c■■■■cert■ ■crrcr■ttr■rrr■cert■■■r■■■■■■■■■■■■■■■■■■e■■■■■ee■e■■■■■■■■■■t■■t■ ■■■■■■■■■■■■■■■■■■■■■cr■■■■■trier■■rrcr■■r■■■■■■t■■■■r■■rerree■■r■ ■e■core■■rr■■rr■■■■■■■■r■■■■■■■■■■■■■t■■■■e■■■■■■■■a■■■■■■e■■■t■■■ ■■■e■■■rt■■e■■■■ct■■■r■■■■rr■err■■■■eeer■e■rerrctrtrterteeeettrec■ ■r■■■■c■■rr■■cc■■■■■■srcr■■err■■ ■■■■■■■rt■■rr■t■■r■r■■■■rr■■■r■■ ■■■■■■■■■■■■cr■■■■■■■■■err■■■■■■■■■■■■■■■r■rrr■cr■■■■■■r■crrct■■r■ �IIECOUNTYREALTHD PAR ENT,,— ENVIRONMENTAL NT ENVIRONMENTAL HEALTH SECTION P. 0. Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NC 27028 777 Phone # (336)751 8760_... June 12,2003 Aaron Walker 351 N C Highway 801 N Advance, NC 27006 Re: Site evaluations Tax PIN: #5851-6708960 A&B Strawberry Hills Dear Client(s): As requested, a representative from this office visited the aforementioned site on June 11, 2003. Based upon the information provided on the application for site evaluation and after an evaluation was completed,the site was found to be provisionally suitable for.the installation of a modified, oversized on-site sewage disposal system. Before a representative of our office will revisit the site to issue an Improvement Permit/Authorization to Construct the appropriate application must be completed in full and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, please feel free to contact this office. Sincerely, Robert B.Hall,Jr.,R.S. Environmental Health Specialist RH/df Enclosure(s)