119 Dreamscape Ln OPERATION PERMIT or Ice se n v
CIO
Davie County Health Department *CDP File Number 121741 - 1
� PMO
t 210 Hospital Street
ti Count
P.O.Box 848 Y ID Number:
�.
Mocksville NC 27028 Evaluated For: NEW
Phone:336-753-6780 Fax:336-753-1680 Township:
Applicant: M.G. Cranfill, Sr. and Patsy T. Property Owner: William R. Ratledge
Address: 140 N. Niklick Ct. Address: 4832 Vienna Dozier Road
City: Advance City: Pfafftown
State/Zip: NC 27006 State/Zip: NC 27040
Phone#: (336)940-6885 Phone#:
1111,q? CA Proper1y Location & Site Information
Address/Road#: Subdivision: Phase: Lot:
'( Dreamscape Lane
Mocksville NC 27028 Directions
Structure: SINGLE FAMILY 601 N. right on 801 left at four Corners left on
#of Bedrooms: 3 Dreamscape. Property on left
#of People: 2
*Water Supply: PUBLIC
*IP Issued by: 2244-Daywalt,Andrew *System Classification/Description:
TYPE III B.SYSTEM W/SINGLE EFFLUENT PUMP
*CA Issued by: 2244-Daywalt,Andrew
Saprolite System? 9 Yes O No
Design Flow: 3 6 0 *Distribution Type: PUMP TO GRAVITY Pump Re uired?
(�Yes No
Soil Application Rate: 0 2 7 5 *Pre-Treatment:
Drain field
Nitrification Field Sq.ft' *System Type: INFILTRATOR QUICK 4 STANDARD
No. Drain Lines Installer: sherman dunn
Total Trench Length: 3 a 7 ft. Certification#:
Trench Spacing: _ Inches O.C. *EHS:
8 Feet O.C. 2244-Daywalt,Andrew
Trench Width: _ O1 0 / .2 / .2 0 1 3
Feet
O Feet Date: a
Aggregate Depth: inches
Minimum Trench Depth: 1 8 Inches
Minimum Soil Cover: Approval Status
Inches
Maximum Trench Depth: 1 8 Inches EX roved❑ Disapproved
Maximum Soil Cover:
Inches
Page 1 of 4
CDP File Number 121741 - 1 County ID Number:
Septic Tank
Manufacturer: shoat Lat.
STB: Long:
Gallons: 1000 Installer:
Date: / Certification#:
*EHS: 2244-Daywalt,Andrew
*Filter Brand:
D
ST Marker: E] Yes El No ate: l 0 / a a / x 0 1 3
Approval Status
Reinforced Tank: El Yes ❑ No ® Approved ❑ Disapproved
, Piece Tank: ❑ Yes ❑ No
Pump Tank
Manufacturer: Installer:
Installer:
PT: Certification#:
Gallons: 1000 'EHS: 2244-Daywalt,Andrew
Date: / / Date: 1 0 / a a / .2 0 1 3
Riser Sealed ❑ Yes ❑ No
Riser Height: ❑ Yes ❑ No (Min.6 in.)
Approval Status
Reinforced Tank: ❑ Yes ❑ No ® Approved❑ Disapproved
1 Piece Tank: ❑ Yes ❑ No
Supply Line
Pipe Size: a inch diameter Installer:
Pipe Length: a a 0 feet Certification#:
'Schedule: ao
'EHS: 2244-Daywalt,Andrew
Pressure Rated ® Yes ❑ NO Date: 1 0 / a a / .2 0 1 3
Approved fittings ® Yes ❑ NO Approval Status
❑ Approved❑ Disapproved
Pump Requirement
rDosing
ump Type: Installer:
Volume: - Gal Certification#:
raw Down: Inches "EHS:
*Chain:
Date:
Valves Accessible ❑ Yes ❑ No
Flow Adjustment Valve ❑ Yes ❑ No
Check-valve ❑ Yes ❑ No Approval Status
PVC unions ❑ Yes ❑ No ® Approved❑ Disapproved
Vent Hole ❑ Yes ❑ No
Anti-siphon Hole ❑ Yes ❑ No
Page 2 of 4
CDP File Number 121741 - 1 County ID Number:
Electric E ui ment
NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer:
Box 12 inches Above Grade ❑ Yes ❑ NO
Certification#:
Box Adj.To Pump Tank ❑ Yes ❑ No
Conduit Sealed ❑ Yes ❑ No *EHS:
Pump Manually Operable ❑ Yes ❑ No /
*Activation Method: Date:
Alarm Audible ❑ Yes ❑ No Approval Status
Alarm Visible ❑ Yes ❑ No ❑ Approved❑ Disapproved
j)
2244-Daywalt,Andrew
*Operation Permit completed by:
Authorized State Agent: ZDate of Issue: 1 0 a s l a 0 1 3
This system has been installed in compliance with applicable NC General Statutes:Article 11,Chapter 130A, Rules for
Sewage Treatment and Disposal, 15A NCAC 18A.1900 et. Seq.,and all conditions of the Improvement Permit and
Construction Authorization.This property is served by a TYPE III B. sewage septic system.
Rule.1961 requires that a Type TYPE III B. septic system meet the following criteria:
Minimum System Review By The Local Health Department: 5 YRS.
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency By Certified Operator:
N/A
Reporting Frequency By Certified Operator: N/A
Rule .1961 requires that a Type IV and V septic systems designed for a home/business owner must maintain a valid contract
with a public management entity with a certified operator or a private certified operator for the life of the septic system.
Rule.1961 requires that Type VI septic systems designed for a homelbusiness owner must maintain a valid contract with a
public management entity with a certified operator for the life of the septic system.
Rule. 1961 (2)(e)requires a contract shall be executed between the system owner and a management entity prior to the
issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the
system owner and certified operator are the same. The contract shall require specific requirements for maintenance and
operation, responsibilities of the owner and systems operator, provisions that the contract shall be in effect for as long as the
system is in use,and other requirements for the continued proper performance of the system. It shall also be a condition of
the Operation Permit that subsequent owners of the systems execute such a contract.
Hand Drawing O Import Drawing
**Site Plan/Drawing attached.**
Total Time:(HH:MM)
Activity Code: S-19 3Q4-OP issued NEW Type III Quick4 0 1 Hours 0 0 Minutes
Page 3 of 4
• OPERATION PERMIT 121741 - 1
Davie County Health Department CDP File Number:
210 Hospital Street
P.O.Box 848 County File Number:
Mocksville NC 27028 Date: / /
0Inch
Drawing Drawing Type: Operation Permit Scale: , OO N�Ak - ft.
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Page 4 of 4 P1 P2 P3
CONSTRUCTION For Office Use Only
f AUTHORIZATION " *CDP File Number 121741 - 1
Davie County Health Department County ID Number:
f 210 Hospital Street Evaluated For: NEW
P.O.Box 848 Township:
Mocksville NC 27028 PERMIT VALID UNTIL:
on . 6-753-6780 Fax:336-753-1680 0 6 1 1 4 / 2 0 1 8
Applicant. M.G. Crani .Sr.and Patsy T. r
erty Owner. William R.Ratledge
fill
Address: 140 N.Niklick Ct. ress: 4832 Vienna Dozier Road
City: Advance y: Pfafftown
State0p: NC 27006 State2ip: NC 27040
Phone#: (336)940-6885 Phone#:
Property Location & Site Information
FCess[Road #: Subdivision: Phase: Lot:
e Lane
NC 27028 Directions
Structure: SINGLE FAMILY 601 N. right on 801 left at four Comers left on
Dreamscape. Property on left
#of Bedrooms: 3
#of People: 2
*Water Supply: PUBLIC
System Specifications
Minimum Trench Depth: � 8
rSaprolite
ssification: PS Inches
Minimum Soil Cover.
System? OYes @No Inches
Design Flow: 3 6 0 Maximum Trench Depth: 1 8 Inches
Soil Application Rate: 0 - 2 7 5 Maximum Soil Cover: Inches
*System Classification/Description: *Distribution Type: PUMP TO GRAVITY
TYPE II C.CONY.SYSTEM WITH SHALLOW PLACEMENT Septic Tank:
1 0 0 0 _ Gallons
*Proposed System: 25%REDUCTION 1-Piece: OYes (j)No
Pump Required: @Yes ONo OMay Be Required
Nitrification Field Sq. ft. Pump Tank: 1 0 0 0
Gallons
No. Drain Lines 1-Piece: OYes ONo
Total Trench Length: 3 2 7 it GPM—vs— ft. TDH
Trench Spacing: _ 9 QInches O.C. Dosing Volume: _ Gallons
_ _ 8Feet O.C. g
Trench Width: Inches
3 6
8Feet Grease Trap: LGallons,
Aggregate Depth: inches Pre Treatment: ONSF OTS-1TS-11Septic Tank Installer Grade Level Required: O( OII OIII
Page 1 of 3
✓CDP File Number 121741 - 1 County ID Number.
❑ Open Pump System Sheet
Repair System Required:OYes ONO ONO, but has Available Space
rDesign
System
Trench Spacing: Inches O.
ification: PS Shallow Placement — 9 � Feet O.C.
Trench Width: Q Inches
w: 3 6 0 — 3 . 6 (�Feet
Soil Application Rate: 0 - 2 7 5 Aggregate Depth: inches
Minimum Trench Depth: 1 g Inches
'System Classification/Description:
TYPE III B.SYSTEM W/SINGLE EFFLUENT PUMP Minimum Soil Cover.
Inches
'Proposed System: 25%REDUCTION Maximum Trench Depth: 1 8 Inches
Nitrification Field Sq.ft.
Maximum Soil Cover.
Inches
No. Drain Lines 'Distribution Type: PUMP TO GRAVITY
Tota(Trench Length: 3 2 ft Pump Required: Yes ONo OMay Be Required
Pre Treatment: ONSF OTS-I: OTS-II
'Site Modifications
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department.
'Permit Conditions
The issuance of this permit by the Health Department in no way guarantees the issuance of other permits.The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements.
This Authorization for Wastewater System Construction shall bevalld fora person equal to the period of validity of the Improvement Permit,not
to exceed five years,and may be Issued at the sun etime the Improvement Permit Issued(NCGS 130A-336(b)}If the installation has not been
completed during the period of validity of the Construction Permit.the Information submitted In the application for a permit or Construction
Authorization Is found to have been Incorrect,falsified or changed.or the site Is altered,the permit or Construction Authorization shall become
Invalid,and maybe suspended or revoked(.1937(8)).The person owning or controlling the system shall be responsible for assuring compliance
with the laws,rules,and permit conditions regarding system location,Installation.operation,maintenance;monitoring,reporting and repair
(1938(b)).
Applicant/Legal Reps. Signature Required? OYes ONo
Applicant/Legal Reps.Signature- Date:
'Issued By: 2244.-Daywalt.Andrew Date of Issue: 0 6- 1 4 2 0 1 3
Authorized State Agent: Malfunction Log Oyes
OHand Drawing Olmport Drawing Total Time:(HH:f1M)
**Site Plan/Drawing attached.**
Page 2 of 3 0 1 Hours 0 0 u inutes
S-8-CKS issued-new
CONSTRUCTION AUTHORIZATION 121741 - 1
Davie County Health Department CDP File Number:
210 Hospital Street
P.O.Box 848 County File Number:
Mocksville NC 27028 Date: 0 6 / 1 4 / 2 0 1 3
O inch
Drawing Drawing Type: Construct ontMorization Scale: OBlok -°
__1 J
L-L
F-T
__P
I i I I I I rb'"'I �rs t�•d-I I
Pane 3 of 3
IMPROVEMENT.°PERMIT For office use only
CDP File Number 121741 -1
.-- Davie County Health Department
t< 210 Hospital Street County ID Number.
. .. . P.O. Box 848 Evaluated For: NEW
�._...•
Mocksville NC 27028 Township:
Phone:336-753-6780 Fax:336-753-1680 PERIJIT VALID UNTIL: 6/14/2018
"NOTE TO INSPECTIONS DIVISION: Building Permits cannot be issued with this Improvement Permit.
Applicant: M.G. Cranfill, Sr. and Patsy T. Property Owner: William, R. Ratledge
Address: 140 N. Niklick Ct. Address: 4832 Vienna Dozier Road
CdY: Advance City: Pfafftown
State2ip: NC 27006 State2ip: NC 27040
Phone#: (336)940-6885Phone#:
Proeerty Location & Site Information
Address/Road#: Subdivision: Phase: Lot:
Dreamscape Lane
Mocksville NC 27028 Directions
Structure: SINGLE FAMILY 601 N. right on 801 left at four Corners left on
#of Bedrooms: 3 Dreamscape. Property on left
#of People: 2
*Water Supply: PUBLIC
System Specifications
nitial System*Sit6 ai iocatan PS
Minimum Trench Depth: 1 8 Inches
Saprolite System? QYes QNo Maximum Trench Depth: 1 8
_ _ _ Inches
Design Flow: 3 6 0 Septic Tank: 1 0 0 0
Gallons
Soil Application Rate: 0 2 7 5 1-Piece: QYes QNo
Pump Requited: QYes ON O May Be Required
*System Classification/Description:
TYPE 11 C.CONY.SYSTEM WITH SHALLOW PLACEMENT Pump Tank: 1 0 0 0 ` Gallons
'Proposed System: 25°l°REDUCTION 1-Piece: QYes QNo
Repair System Required:OYes ONo ONO, but has Available Space
Repair System
'Site Classification: PS Shallow Placement Minimum Trench Depth: 1 8 Inches
5 Maximum Trench Depth: Inches
Soil Application Rate: 0 2
*System Classification/Description: Pump Required: QYes QNo Q May be Required
TYPE 11 C.CONY.SYSTEM WITH SHALLOW PLACEMENT
•Proposed System: 25°I°REDUCTION
Pagel of 3
'CDP File Number 121741 - 1 County ID Number:
*Site Modifications p open Fill Sheet
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department.
*Permit Conditions
The issuance of this permit by the Health Department in no way guarantees the issuance of other permits.The permit holder
is responsible for checking with appropriate governing bodies in meeting their requirements.
Site Plan The tmproven ent Permit shall be wild for S years from date of issue with a site plan(means a drawing not necessarily drawn to
sale that shows the existing and proposed property lines with dimensions,the location of the facility and appurtenances,the
site forth*proposed Wastewater system,and the location ofwater supplies and surfacewaters).
Plat The Improvement Permit shag be wild without expiration with plat(means a property surveyed prepared by a registered land
surveyor,drawn to a sale of one inch equals no morethan 60 feet,that includes:the specific location of the proposed facility
O and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters. Plat
also means,for subdivislon lots approved by the local planning authority and recorded with the county register of deeds,a copy
of the recorded subdivisions plat that Is accompanied by a site plan that Is drawn to scale).
The Department and Local Health Department may Impose conditions on the Issuance and may revoke the permits for failure of
the system to satisfy the conditions,the rules,or this article This permit Is subjectto revocation if the site plan,plat,or intended
use changes(NCGS 13OA-335(Q).The person owning or controlling the system shall be responsible for assuring compliance
with the laws,rules,and permit conditions regarding system location,installation,operation,maintenance,monitoring,
reporting,and repair(.1938(b)}
Applicant/Legal Reps. Signature Required? OYeS ONO
ApplicanVI-egal Reps.Signature, Date:
*Issued By: 2244-Daywall.Andrew Date of Issue: 0 6 / 1 4 / 2 0 1 3
Authorized State Agent: OValid without Expiration?
O Create CA?
QHand Drawing Olmport Drawing
**Site Plan/Drawing attached.** Total Time:(HH:1.11.1)
0 1 Hours. 0 0 6l1nutes
Page 2 of 3
Activity Code: S-4-IP'S issued:new,valid for 60 mos.
IMPROVEMENT PERMIT 121741 - 1
Davie County Health Deportment ; CDP File Number:
210 Hospital Street
P.O.Box 848 County File Number:
Mocksville NC 27028 Date:
Q Inch
Drawing .Drawing Type: Improvement Permit Scale: Qelock
QN/A
1
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Tj-
1 45%1
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Page 3 of 3
)Iav tns yz,
�� Sm;�)-? s047L
. AA'rarfesss�tafU1'm�att�rn E '
304 Breckenridge Court,Lexington,NC 27292.Phone 336-596-7585
Fax 704-788-2253
71=7�011
Job#CEC-191-S 1
Wdliarrr and Gale Radedge
182 Bridgewater Dr
Advance, NC 27006
Re: Soil suitability for an Approx.2.7 acre tract on Four Corners Rd—Davie County,
NC
Carolina Environmental Consultants(CEC)has performed a preliminary soiUsite )
evaluation on an approximately 2.7-acre tract on Four Comers Rd in Davie County NC
northwest of Mocksville,NC.
SCOPE OF WORK
The scope of this project was to evaluate an approximately 2.7-acre tract located on Four
Comers Rd in Davie County,NC.The evaluation was performed to identify areas
potentially suitable for subsurface wastewater disposal systems. This evaluation is an
opinion,and due to the subjective nature of soil suitability,it is always recommended that
financial commitments should not be made on a property until all permits from the Heatth
Department are final (if applicable).
'£ r-psope.TV Baas evaluawd;taking wAee of.the land(slope,dsam7 age patterns,past Ise,
etc.) as well as soil conditions(depth,texture, structure,seasonal wetness,restrictive
horizons, etc.)through auger borings. From these observations an evaluation of the site
relative to subsurface lVatstewater disposal was developed. The soillsite evahmtion
criteria used was that contained in 15 A NCAC 18A.1900"Laws and Rules for Sewage
Treatment and Disposal Systems".
4Dick Barnes
Broker REALTOR*
i €
ROMMPremier Group
1100-C S.Stratford Road,Ste.106
/ Winston-Salem,NC 27103
Cell:(336)408-8768
Fax:(336)768-6648
•' Main:(336)768-1600
,�re� Email:DickBamesCremax.net
LiL 0 Each Once is tdepwxw*owned and opiated 13
I'f1WEYGS
The majority of the soils identified on the property were most similar to the Enon soil
sues. '"Yt5z soils contained a imm surface ower a clay subswA. Tb?,clay Kayer viz%
expansive and unsuitable for subsurface septic systems. During wetting and drying
cycle's expansive clay shrinks and swells limiting the hydraulic ability of the soil.
Dowever an area was identified on The noribwesiern porfJon of]be property(please see
map for size and location). This area contained potentially suitable depths of 24 inches or
more and has the potential to support at grade and shallow septic systems. Depth to
restrictive horizons(j.e. soils wetness,expansive clay and rock,etc.)determines%*at
kind if any septic system can be supported on the property. The attached map is not a
survey. Data was used from the Davie County NC GIS to create the base map. Soil
borings were approximately located via CIPS technology.
GENERAL 7Vi'ASTEZYATER CONSIDERA77ONS
The utility of a potential useable soil area for a subsurface system is most accurately
deteV P-d by ab on-g Mnd layout of the proposed septic system. Thz total area u�,e&d
for system and repair areas will depend upon the system type,the layout of that system
and the total design flow(factors mentioned above). For example,a typical area
aee&O for a 3bMroom home producing 360 gaHons per day is approyimatAy
10,000 to 12,00W(could be more or less depending on site features). These
estimates reference Laws and Rules for Sewagre Treatment and Disposal Systems for
North CardUna-and use aLTAIR of 03gpolfj 'for conventional.septic systems. 'T'he
required soil area estimates do not include area for a well setback,drive or house
envelope. The health department will determine the design LTAR after their evaluation,
wA ch was determined in coordination with CEC during oar site meeting.
In general,if potentially usable areas are identified,the next consideration is the
'rnnrzrmta1 extent tza=e o€those areas. '£lie size and configuration of the usab&--soil area
dictates how many systems an area can support. The size of a subsurface septic field is
determined by; 1)the design flow(120 gallons/bedroom/day in residences), and 2)long
tem acceptance Fate(LIAR)of the soil(based on the hydraulic canduciivlly of the cnil,
a function of the soil's texture,mineralogy,structure,porosity,etc.). The configuration
of the soil area must be such that an efficient layout of drain lines (on contour)is possible
and not contain unsuitable topography. An additional consideration is the required
setbacks for the system from various elements such as wells (100'),streamsand ponds
(50' or more depending on watershed regulations),property lines (10'), top of
embankment(15'),etc.
A site plan for any lot must ensure that adequate soil area for system and repair is
unaffected by site elements(house/building placement, driveway,parking, wells,patios,
dreks, rfr_)_ The area idlhnately designated by the health department far the septic
system and repair must remain undisturbed (no mechanical clearing,excavation,
heavy traffic or other significant site disturbing activities) until authorized by the
health department. A lot with adequate usable soil area may be rendered unusable as a
result of improper site planning andlor disturbance.
RECOMMENDATIONS
CEC recommends.meeting the Davie County Health Department onsite to review our
findings.If the county approves our soil area,a layout of the septic area may be required
to deterrn:me if enangh line can fit into the poten ially-usable area. 7o perform the above
mentioned layout CEC'my have to perform some hand clearing(so not to disturb the
area). We recommend no further financial commitments be made on the property until a
septic pew:nit is granted. Please contact our office if you have questions abort report:
Best Regards,
Eric Bailey
NC Licensed Soil Scientist
NC Septic System Inspector
ny ••••NOTA SURVEY
A�
••••LINES NOT LOCATED
'0• " ° ••••BASE MAP CREATED FROM COUNTY GIS
`G ••••ACTUAL ALIGNMENT IN FIELD MAY VARY
E ` SLIGHTLY FROM MAP REPRESENTATION
� e
� � R
Dreamscape LN
m n
a
N7,700 Sq. Ft. �0
O
n
ar 3
LEGEND
Area contain soils with 24 inches or
®tee of useable material and hos potential GRAPHIC SCALE
for conventional type septic system (at—grode
and shallow. 1 _ '�00`
FIlLD WONC
Neosr)ypically gonsidered unsuitable for 00 00 200
subsu oce septic systems.
r«rr NOTA SURVEY
ot��.� rrar LINES NOT LOCATED
•
e ►«'► BASE MAP CREATED FROM COUNTY GIS
raaa ACTUAL ALIGNMENT INFIELD MAY VARY
' SLIGHTLY FROM MAP REPRESENTATION
L
Dreamscape LN
4W
vow
a
QJ
• � O
a'
L
. R
a eRRi
dlr
�0
ran ,
g8'
dello*, .
'
glue 10 riot
R
Pink 13 Rea ,10g' 09r Re o�<
1
Layout 1"=40' view
GRAPHIC SCALE
. q
1" = 80'
m
' FIFID P'OPi
FB 80 0 80 160
ttatledge
Project No.CEC-191
layout for a 3 bedroom home Dec-11
FLAG FLAGGED
LINE# COLOR BS HI FS ELEVATION LINE LENGTH
TBM 1.0 100.0
INSTR.1 101.0
SYSTEM
3 Yellow 6.10 94.9 88
4 Blue 7.80 93.2 109
5 Pink 9.60 91A 130
Total 327
Repair
1 Red 2.80 98.2 48
2 Orange 4.10 96.9 70
6 Red 12.00 89.0 109
7 Orange 14.20 86.8 109
TOTAL 336
LINE LTAR SYSTEM INNOVATIVE TRENCH
LENGTH GPDIF 2 TYPE TYPE DISTR.IBUTIOD DEPTH
System 327 0.275 Shallow 25% TBD 18"
Repair 336 0.275 Shallow 25% TBD 18"
Notes:
**TBM is assumed to be 100'
**All measures in feet
**Nitrification lines are demonstrated on contour via colored pin flags
**BS and FS indicate rod readings
rrsr NOT A SURVEY
rWcn „
.� rrss LINES NOT LOCATED
W ■ ars BASE MAP CREATED FROM COUNTY GIS
rrrs ACTUAL ALIGNMENT IN FIELD MAY VARY
' SLIGHTLY FROM MAP REPRESENTATION
� s � o
Dreamscape LN
4W
a
:::7 o
m 0
)qE
0
�, 48' Re QIr r
Re:a►/
—0, 0
8a
Yellow
-Blue AQ
pink 13
ea 109 e
R �p9 R
Layout 1"=40' view
GRAPHIC SCALE
F»
1" = 80'
UMW
en
FIFJD 1RlR■
FB 80 0 80 60
9CUE
� •M
12atledge
Project No.CEC-191
layout for a 3 bedroom home Dec-11
FLAG FLAGGED
LINE# COLOR BS HI FS ELEVATION LINE LENGTH
TBM 1.0 100.0
INSTR.1 101.0
SYSTEM
3 Yellow 6.10 94.9 88
4 Blue 7.80 93.2 109
5 Pink 9.60 91.4 130
Total 327
Repair
I Red 2.80 98.2 48
2 Orange 4.10 96.9 70
6 Red 12.00 89.0 109
7 Orange 14.20 86.8 109.
TOTAL 336
LINE LTAR SYSTEM INNOVATIVE TRENCH
LENGTH GPD/FT= TYPE TYPE DISTRIBUTIO> DEPTH
*System 327 0.275 Shallow 25% TBD 18"
Repair 336 0.275 Shallow 25% TBD 18"
Notes:
**TBM is assumed to be 100'
**Alt measures in feet
**Nitrification lines are demonstrated on contour via colored pin flags
**BS and FS indicate rod readings
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Environmental Health
P.O.Box*848/210 Hospital Street
Mocksville,NC 27028 '
(336)753-6780/=To
680 .
Application For: ❑ Site Evaluation/Improvement Permit Construct(ATC) oth
Type of Apolication: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System cility
***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPI;IC:ANT WFORMATION -
Name M, , I a,41 ' Sr• S ,. Contact Person &
Address C� #' Home Phone(33D
City/State/ZIP D Business Phone
Email C '
Name on a it/ATC if Diffent than Above
Mailing Address ,5aMe as aljo,./ City/State/Zip
PROPERTY INFORMATION *Date House/Facility Comers Flagged
NOTE:.. A survey plat or site plan must accompany this application. Included: VSite.Plan ❑Plat(to scale)
(Permit is valid for 60 months sit p no expiration with complete plat.)
Owner's Name' " Phone Nu b r
Owner's Address City/State/Zip Lv 27
Property Address City
Lot Size, & Tax PIN#
Subdivision Name(if applicable) Se io ot# ,9—
Di ctions To Site: i (' C
�. L4 6A1 4-10
If the answer to any offthe following q estions is `Yes",supporting documentation must be attached:
Are there any existing wastewater systems on the site? Yes ./No
Does the site contain jurisdictional wetlands? Yes ✓No
Are there pny easements or right-of-ways on the site? Yes V,'No
Is the site:subject to approval by another public agency? _Yes _✓No
Will wastewater other than domestic sewage be generated? Yes ZNo
TF RF,SIDF.NC;F,FII T,OI 1T THR BOX BELOW
#People #Bedrooms #Batyrooms ai Garden Tub/Whirlpool ❑Yes KNo
Basement: ❑Yes 31io Basement Plumbing: ❑Yes to
.IF NON-RESIDENCE F111,OUT THE BOX BFLOW
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 ❑Alterative ❑Other
Water Supply Type:V�County/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 comers and locating and flagging
or staking the house/facility location,proposed well location and the location of any other amenities.
ix
Property owner's or owner's legal representative signature Site Revisit Charge
Date(s):
Client Notification Date:
ate ; EHS:
Sign given ❑Yes ❑No Account# eD
boo
Revised 11/06 Invoice# �
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ParcelNumber NCPinNumber AccountNum6er Namel
Name2 Addressl Address2
830000004103 3823345924 City
82523673 RATLEDGE WILLI RATLEDGE AUDR RATLEDGE FAMIL 4832 VIENNA DO FAFFTC ---.
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parid=B30000004103
5/12/2p i-
APPLICATION FOR SITE EVALUATION/IMPROVEMENTPERMIT
Davie County Environmental HealthIlk 11(
(� t P.O.Box 848/210 Hospital Street
v Mocksville,NC 27028
UG `to�� (336)753-6780/Fax(336)753-1680
AApplication For: Site Evaluation/Improvement Permit ❑Authorization To Construct(ATC)
Type of on. kffilew System ❑Repair to Existing System ❑Expansion/ModiScation of Existing System or Facility
gV sssIMPORTANT•s•THIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
Name to be Billed=>CW* Contact Person
Billing Addre t ` Home Phone
City/State/ZIP .C. -nP2:n usinessPhone—2 - J h,4-1
Name on Permit/ATC if Dierent than Abova&§ r .\t
Mailing Address 4 City/State/Zipt
PROPERTY INFORMATION *Date House/FacilityComers Flagged $'1 u'201
NOTE: A survey plat or site plan must accompany this application. Included:J<Site Plan ❑Plat(to scale)
(Permit is valid for 60 months with site qan,no expiration with complete at.)
Owner's NarnA-%C Phone Number
Owner's Address 3 2 -�r City/State/Zip tr. . r.-
Property
Property Address Con+ U City K0tx3a , 1u Z 1V10%k1!Z
Lot size Tax PIN# '5b2a3KS'QZy -y�tJud
Subdivision Name(if applicable) Se ion/Lot#
Directions To Site- Xs0\ tJ n —
If the answer to any of the following questions is"yes",supporting documentation must be attached.
Are there arry existing wastewater systems on the site? ❑Yes&o
Does the site contain jurisdictional wetlands? ❑Yeso
Are there any easements or right-of-ways on the site? ❑Yes o
Is the site subject to approval by another public agency? ❑�'es No
Will wastewater other than domestic sewage be generated? ❑Ye No
IF RESIDENCE FILL OUT THE BOX BELOW
#People _. #Bedrooms -77 _ #Bathrooms__ GardenTub/Whirlpool❑Yeskuo
Basement:Dyes4No Basement Plumbing: ❑Yes o
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:XConventional ❑Accepted ❑Innovative ❑Alternative ❑Other
Water Supply Type:Xounty/City Water ❑New Well ❑Existing Well ❑Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve?❑YeslVo /
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 arty 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
E
and Hiles. I understand that I am responsible for the proper identification and labeling of property lines and comers and
d fl i r taking hous acili I iortip posed well location and the location of any other amenities.
perry owner's or owMr'slcgal representative signature Site Revisit Charge
Date(s):
Client Notification Date:
Date EHS:
Sign given ❑Yes❑No Account#
- Revised 11/06 Invoice# �
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i DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION F&RTY INFORMATION
Account #: 990 05 Tax PIN/EH#: 5823-:r.1('
Billed To: Scot Smith Subdivision Info:
Reference Name: Location/Address: Four Corners Road-270.8
Proposed Facility: Res dentia) Property Size:, 2.7+Acres Date Evaluated:
Water Supply: On-Site Well Community. Public
Evaluation By:. Auger Boring Pit Cut
FACTOR S 1 2 3 4 S 6 7
Landscape position
HORIZON I DEPTH v
Texture grow
Consistencef �F j� tr • .
Structure
Mineralogy I I i I /.'! (-
HORIZON H DEPTH
Texture group tx ri� Mre C_
Consistence
Structure
Mineralogy 7,-t '?_�f
HORIZON III DEPTH l — l•
Texture group L' 'K O 011
Consistence P r F1r
Structure ffil
,
IVA
Mineralogy ?
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION LA.
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATIO EVALUATION BY: I`" J=jQ6&ja
LONG-TERM ACCEPT NCE RATE: ER(S)PRESENT:
REMARKS: "0
LEGEND
Landscape Position
R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope
CC-Concave slope IV-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 F Z 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 _
,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
LY9IeS
Horizon depth-In inches
Depth of fill-In inches
Restrictive horizon-Thickness and inches from land surface
Saprolite-S(suitable),U( nsuitable)
Soil wetness-Inches fron k land surface to free water or inches from land surface to soil colors with chroma 2 or less
Classification-S(suitable i,PS(provisionally suitable),U(unsuitable)
TTAR -T nnv-term anent nre rate- oal/Aa%,/ftp nc1nc m__.:__�
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DAME COUN'rY HEALTH DEPARTMENT�
�����- ENVIRONMENTAL HEALTH SECTION �
P.O. Box 848/210 Hospital Street
Courier #09-40-06
Mocksville, NC 27028
Phone #: (336)753-6780
September 2, 2011
Mr. Scott Smith
113 Fostall Drive
Mocksville,NC 27028
Re: Four Corners
Tax PIN: 5823345924
Dear Mr. Smith
As requested,Andrew Daywalt,Environmental Health Specialist with this office evaluated the
above-referenced property at the site designated on the plat/site plan that accompanied your
improvement permit application. According to your application the site is to serve a
{DESCRIPTION,ex:3 bedroom,residence} with a design wastewater flow of 1360 GALS.}
gallons per day. The evaluation was done in accordance with the laws and rules governing
wastewater systems in North Carolina General Statute 130A-333 and related statutes and Title
15A, Subchapter 18A,of the North Carolina Administrative Code,Rule .1900 and related rules.
Based on the criteria set out in 15A, Subchapter 18A,of the North Carolina Administrative
Code,Rules .1940 through.1948,the evaluation indicated that the site is UNSUITABLE for a
ground absorption sewage system. Therefore,your request for an improvement permit is
DENIED. A copy of the site evaluation is enclosed. The site is unsuitable based on the
following:
- • .1943 Soil Depth
• .1941 Soil Characteristics
I
These severe soil or site limitations could cause premature system failure,leading to the discharge
of untreated sewage on the ground surface,in surface waters,directly into ground water or inside
your structure.
The site evaluation included consideration of possible site modifications,and modified,
innovative or alternative systems. However,this office has determined that none of the above
options will overcome the severe conditions on this site. A possible option might be a system
designed to dispose of sewage to another area of suitable soil or off-site to additional property.
For the reasons set out above,the property is currently classified UNSUITABLE, and an
improvement permit shall not be issued for this site in accordance with Rule .1948(c).
However,the site classified as UNSUITABLE may be reclassified as PROVIONALLY
SUITABLE if written documentation is provided that meets the requirements of Rule.1948(d).
A copy of this rule is enclosed. You may hire a consultant to assist you if you wish to try to
develop a plan under which your site could be reclassified as PROVISIONALLY SUITABLE.
You have a right to an informal review of this decision. You may request an informal review
by the environmental health supervisor with this office. You may also request an informal review
by the N.C.Department of Environment and Natural Resources regional soil specialist. A request
for informal review must be made in writing to the Davie County Health Department,
Environmental Health Section.
You also have a right to a formal appeal of this decision. To pursue a formal appeal,you must
file a petition for a contested case hearing with the Office of Administrative Hearings, 6714 Mail
Center,Raleigh,N.C.27699-6714. To get a copy of a petition form,you may write the Office of
Administrative Hearings or call the office at(919)431-3000 or from the OAH web site at
www.deh.ennstate:nems. The petition for a contested case hearing must be filed in accordance with
the provision of North Carolina General Statutes 130A-24 and 150-13-23 and all other applicable
provisions of Chapter 15013. N.C. General Statute 130A-335 (g)provides that your hearing
would be held in the county where your property is located.
Please note: If you wish to pursue a formal appeal,you must file the petition form with the
Office of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER. The
date of this letter is {DATE}. Meeting the 30 day deadline is critical to your right to a formal
appeal. Beginning a formal appeal within 30 days will not interfere with any informal review that
you might request. Do not wait for the outcome of any informal review if you wish to file a
formal appeal.
If you file a petition for a contested case hearing with the Office of Administrative Hearings,
you are required by law(N.C. General Statute 15013-23)to send a copy of your petition to the
North Carolina Department of Environment and Natural Resources. Send the copy to: Office of
General Counsel,N.C.Department of Environment and Natural Resources, 1601 Mail Service
Center,Raleigh,N.C.27699-1601. Do NOT send the copy of the petition to Davie County
Health Department. Sending a copy of your petition to Davie County Health Department will
NOT satisfy the legal requirements in N.C. General Statute 15OB-23 that you send a copy to the
Office of General Counsel,NCDENR.
Please call or write this office if you have any questions or need any additional assistance,as
follows: Telephone number: (336)753-6780
Davie County Health Department
Environmental Health Section
P.O.Box 848
Mocksville,NC 27028
Sincerely,
Andrew Daywalt
Environmental Health Specialist
Ericlosure(s): Soil-Site Report
Rule.1941 and 1943
Invoice
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TAX_E6PERVIS()R
Excise Tax .e. ltecordini Time.Book and Pan
TaxLot No..............................:........................................................... Parcel Identifier No.........................:.........................,................... .. ;
Verifiedby......................................................I.................County on the................day of.........:..............................................,1f.........:..
by ...........................................................................................................................................................................................................................
Mall after recording-to .:N11,11. ►L.R.r..RAt,leti9E.......... �.3�.....yeR��.eta.�Ptev. ..y.� Isnlr.'�.�e...........
:...........................................:............................... .......... ./..................................................................
a�iw-ytf•s
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This Instrument was prepared by...
Brief description for the Index
NORTH CAROLINA GENERAL WARRANTY DEED
THIS DEED made this......�o......day of...AP.ri1.............................................10.911.....,by and between
GRANTOR GRANTEE
1
A. C. RATIEDGE (WIDOWER) WILLIAM R. RATLEDGE and wife,
AUDREY G. RATLEDGE
Entre In appropriate block for eaeb party:name,addr"%and.1t appropriate,ebaroeler of#Duty.#4 eerperstlot,or prtne,abtp.
The designation Grantor and Grantee as used herein shall Include said parties,their heirs,successors,and assigns,and
shall include singular,plural,masculine, feminine or"neuter as required by context.
WITNESSETH, that the Grantor, for a valuable c6naideratlon paid by the Grantee, the receipt of which lo.hereby
gckn"w•ledged,ha's and by these presents does grunt,bargain,sell and convey unto the Grantee In fee simple, all that
rrrtain lid"r panel of land situnted In the City of_ .. , -Clarksville ..... Township. i
Davie Voto,ty.North C'tirolinu and more particularly described us follows:
TRACE ONE: BEGINNING at an existing iron pipe, A.- C. Ratledge's northwestern corner
Oee Book 27, Page 206) and a common corner for C. H. Ratledge Deed Book 61, Page 496x1
thence South 840 29' 26" East along C. H. Ratledge's southern boundary 710.98 feet to
a new iron pin; thence.South 840 29' 26" East 31.38 feet to a nail and cap in.the center-
line of -N.C.S.R. 14251 thence along, the centerline South 220 33' 30" West 122.22 feet
to a nail and cap; thence North 850 00' 20" West along a new line for A. C. Ratledge
and crossing a new iron pipe at 31.37 feet, .a total distance 'of 710.23 feet to a new
iron pipe. in C. H. Ratledge's eastern boundary (Deed Book 27, Page 208); thence with
his line North 070 131 020 'East 123.29 feet to the point and place of BEGINNING, con-
tai ni ng' 2 acres, more or less, -as shown on a plat prepared by Grady L. Tutterow, R.L.S.,
dated 9/16/83.
TRACt TWOS BEGINNING at a nail and cap in the centerline of N.C.S.R. 1425, said nail
and cap being located South 840 29' 26" East 31.38 feet from an iron located in C. H. ;
Ratledge's southern boundary (Deed Book 61, Page 496)1 thence South 840 29' 260 East
175.61 feet to a point in the centerline ofN.C. Highway.8011 thence South 430 431 00"
West 465.16 feet to a nail and cap,. the intersection of the centerline of N.C. Highway
801 and the centerline of N.C.S.R. 14251 thence North 220 33' 300 East 382.30 feet along 1
the centerline of N.C.S.R. 1425 to the point and place of BEGINNING, containing 0.737
acres, more or less, as shown on a plat prepared by Grady L. Tutterow, R.L.S., dated .
9/16/83.
N.V.hat A,w.Form Nw]Ole7%.Rotted 0I"1-•..,,..wa#a,wl..ar t,t.MlN.n,1.N.a r,[M i
0584 ,
•0332„ BK58bPG332
OWCHEpKo 011042
FILED FOR REGISTRATION
�/—t15- 0� wvjl It( Ihdrr DECEMBER 20, 2004 12:05 P.M.
�r TAXAOMIP01I MTOR DATE TIME
AND RECORDED IN BOOK 586 PAGE 332
NO TAXABLE COS=ATED M.BRENT SHOAF,REGISTER OF DEEDS
DAVIE COUNTY,NC
BY .
ASST.
SPACE ABOVE THIS LINE FOR RECORDER'S USE
QUITCLAIM DEED
EXCISE TAX: $0.00 EXEMPT
After Recording Mail To: Mail Tax Statements To: Prepared By:
American Family Legal Plan William R.Ratledge Stamey,Foust&Dwyer,LLP
5009 High Point Rd. Audrey G.Ratledge Richard R.Foust
Greensboro,NC 27407 4832 Vienna Dozier Road 204 Muirs Chapel Road,Ste.300
Pfafftown,NC 27040 Greensboro,NC 27410
(Without Title Exam or Opinion)
r
THIS DEED OF GIFT made this /Tn day of 4 �— ,2004,by and
between William R.Ratledge and Audrey G.Ratledge,hereinafter called GRANTORS,
and William R.Ratledge and Audrey G.Ratledge,Trustees of The Ratledge
Family Trust,dated lb-/9—0 V- ,hereinafter called GRANTEES,WHOSE
address is 4832 Vienna Dozier Road,Pfafftown,NC 27040:
WITNESSETH:
That the GRANTORS,as a DEED OF GIFT,have bargained and sold,and by these
presents does bargain,sell,remise,release,and forever uitclaim unto the QRANTEES,
their heirs and/or successors and assigns,premises inownship, i
Davie County,North Carolina,described as follows:
See Exhibit"A"attached hereto and incorporated herein by reference.
Prior Recorded Doc.Ref.:Warranty Deed:Recorded April 24,1990 in Book 153 Page
865 in the Davie County Registry.
Subject to: Restrictions,Conditions,Covenants,Rights,Rights of Way,and Easements
now of record,if any.
°0586' •BK-58bPG333
• 0333. . .
TO HAVE AND TO HOLD the above described premises and with all the appurtenances
thereunto belonging,or in any wise appertaining,unto the GRANTEES,their heirs and/or
successors and assigns forever.
When reference is made to the GRANTOR or GRANTEE,the singular shall include the
plural and masculine shall include the feminine or the neuter;
IN WITNESS WHEREOF,the GRANTORS have caused this deed to be executed the
day and year first above written.
William R.Ratledge. Audrey Ratledge
ACKNOWLEDGMENT
STATE OF, 6 CW
County of(
f ii!_ _
I, do hereby certify that William R.Ratledge and Audrey
G.Ratledge personally appeared before me this day and acknowledged the due execution
of the foregoing instrument.
Notary stamp/seal WitnessDiy band and official seal
day of 6—A.D.,
2 04
jMels Harris
North Carolina
20041530139 Ivy
Pu c
Notary Public
6.7.09
Commission
Expires:
JEtK6L HARR S ..
e Notary Public
01 for County
St ata of North Carolina
Comm►ssfon ras 9' '2009
STATE OF NORTH CAROLINA; DAVIE COUNTY
The foregoing certificate of Jewels Harris NP of Guilford County, NC
is certified to be correct. This the 20th day of December, 2004.
M. BRENT SppHOAF REGISTER OF DEEDS
BY: c�ltuia, c�Vi�Xlir/].a� ASST.
• , ' 10334, . BK58bPG334
TRACT ONE: BEGINNING at an existing iron pipe, A. C. Ratledge's northwestern corner
Deed Book 27, Page 206) and a common corner for C. H. Ratledge Deed Book 61, Page 496);
thence South 84' 29' 26" East along C. H. Ratledge's southern boundary 710.98 feet to--
a new iron pin; thence South 84' 29' 26" East 31.38 feet to a nail and cap in the center-
line of"N.L",.R; 1425; thenee a onjMFie cen er ne SoJ 12'.'331 30" West22.22 feet
to 'a' nail and capi thence -North 85' 00' 20" West, along a new line for A. C. Ratledge
-and crossing a new iron pipe at 31.37 .feet;. a total distance of 710.23 feet to a new
iron pipe in 'C. H. Ratledge'seastern boundary (Deed Book 27,. Page 208); thence with
his line North 07' 13' 02" East 123.29 feet to the point and place of BEGINNING, con-
taining 2 acres, more or less., as shown on a plat prepared, by Grady L. Tutterow, R.L.S.,
dated 9/16/83..
TRACT TWO: BEGINNING at a nail and cap in the centerline of N.C.S.R. 1425, said nail
ani cap being located South 840 29' 26" East 31.38 feet from an iron located in C. H.
Ratledge's southern boundary (Deed Book 61, Page 496); thence South. 84' 29' 26" East
175.61 feet to a.point .in the centerline of N.C. Highway 801; thence South 43' 43' 00"
Nest 465.16 feet to a nail and cap, the, intersection of the centerline of N.C. Highway
801 and the centerline of N.C.S.R. 1425; thence North 22' 33' 30" East 382.30 feet along
the centerline of N.C.S.R: 1425 to the point and place 'of BEGINNING, containing 0.737
acres, more 'or less, as shown on a plat prepared by Grady L. Tutterow,' R.L.S., dated
Y
' i