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1061 Duke Whitaker RdDAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Strut — - Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 Account #: 990005291 Billed To: Owen Bovee - Address: 295 Timber. Trails Lane City: - Mocksville Reference Name: OPERATION PERMIT 'ac) Tax PIN/EH #: 5811-08-7113 76 Subdivision Info: Location/Address: Duke Whitaker Rd -27028 Property Size: 7.00 Acres Proposed Facility: Residence **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. Ink System Type: �� S.T. Manufacturer00 Tank Date �l � Tank Size_�/,�C) C Pump Tank Size System Installed By: ��! in S� (�� E.H. Specialist: Date: I cid DCHD 11/06 (Revised) ", a '` JG 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 Account #: 990005291 Billed To: Owen Bovee Reference Name: Proposed Facility: Residence Tax PIN:EH #: 5811-08-7113 Subdivision info: i-ocationiAddress: Duke Whitaker Rd -27028 Properly Size: 7 -.0 -Acres f Lg ace -e5 ATC Number: 5065 Site Type: 9<e`w ❑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 I # Bathrooms 3 # People -3 BasementErg-a—sement plumbing❑ -- Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Q GfG� Lot Size yiv_ Type of Water Supply: 2IC-o'unty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) r �Q Tank Sized GAL. Pump Tank GAL. it it, Trench Width 3 G Max. Trench Depth 3 G Rock Depth Linear Ft. 711 As stated in 15A NCAC 18x1.1969(5 G� 6_3 3'Q Site Modifications/Conditions/Other: optGd Sy, Wms may. ►. � ,� Contact the Davie County Environmental Health Section for final inspection of this system between -T- �('j-Pam C lc C l K,4,1 I-) L K� _w v. � % d-0_. II. Le Environmental Health Specialist '% C� Date: DCHD 11/06 (Revised) +. ;• Davie County Environmental Health • • P.O. Box 848/210 Hospital Street P01 Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990005291 Tax PIN/EH #: 5811-08-7113 Billed To: Owen Bol/ee Subdivision Info: Address: 295 Timber Trails Lane Location/Address: Duke Whitaker Rd -27028 City: Mocksville _ w _ Property Size: 7.00 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`odiice 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: B<ew ❑Repair ❑Expansion Permit Valid for:. Years ❑No Expiration -- - -- -..._,_. � Residential Specifications: # Bedrooms—3—# Bathrooms -al# People �BasementEOI Basement plumbing[] -W Non -Residential Specifications: Facility Type # People # Seats - Square Footage(or Dimensions of Facility) f/ 1 Desigx Flow(GPD): -3 (A Type of Water Supply:ounty/City ❑Well ❑Community Well � d Site Modifications/Permit Conditions: As stated in 15A NCAC s may 11150 be use System Type LTAR InitialJftCC--C-taA---C-qJ J Repair Site Plan 0°1 u&- foo Environmental Health Specialist i.p.l 1-06 .e'v 71- 0 J- W mak(J uJ' I V1 L I.t 5 ITE EVALUATION/IMPROVEMENT PERMIT & ATC �y avie County Environmental Health P.O. Box 848/210 Hospital Street \� �p Mocksville, NC 27028 �N (336)751-8760/ Fax (336)751=8786 App lic tion or: ltb� G uation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both Type o pplicat' ❑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 Contact rsonMa('-V, c)c Billing Address _24 `j 1� m b TrcxilS 1_r� Home hone 31.) 14 City/State/ZIP L1�S?5�41�►1e . lUc aiU�g EF�ss hone (o Name on Permit/ATC if Different than Above Mailiniz Address Citv/State/ZiD YKUYhK I Y 11V V UXN 1 IUN "Date House/Facility Corners NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid60 months with site plan, no expiration with complete plat.) Owner's Name 'Jerj2.2y Phone Number Owner's Address_ or- C k (kj , nc_, City/State/Zip Mcq,csville , OC-, RgC5'd8' Property Address -DL0 ,-p— Wh; c, h tet— Cityymc%c�Q Lot Size Tax PIN# 5�81r? W6 Subdivision Name(if applicable) Section/Lot# Directions To Site: o c\'h Cr reek,-- 0—V1, _,- rin 2di ) l.6' -cm (`L alb e Xyye-4n.r..k - Su roey If the answer to any of the following que ns is "yes", s pporting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes.QNo Does the site contain jurisdictional wetlands? ❑Yes Colo Are there any easements or right-of-ways on the site? ❑YesVNo Is the site subject to approval by another public agency? El Yes NNo Will wastewater other than domestic sewage be generated? ❑Yes RNo IF RESIDENCE FILL OUT THE BOX BELOW # People 3 #Bedrooms �� # Bathrooms Garden Tub/WhirlpoolRYes ❑No Basement: (,Yes ❑No Basement Plumbing: AR`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:<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 br-No If yes, what type? Qr)() 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. iLXut, baA-f— _ Property owner's or owner's legal representative signature mo"a9 q Date Sign given ❑Yes DNo Revised 11/06 -�( Sire UiSi� Site Revisit Charge Date(s): Client Notification Date: EHS: Account # 6-Z / Invoice # • �GbU"S -.Davie County NC Public Access Davie County, NC - GIS/Mapping System Click Here To Start Over Active La er. +� y ❑ tise map irps oU �� PARCELS (Map Tips available) Page 1 of 1 Quick Search: (County ID or Owner Ni M. Addre or----_-n105ft U C C336q C), bttn://maDs.col daviemc.ustGoMans/man/Index.cfm?mammapservicL=gomaps&CFID--412... 5/21/2009 O _ APPLICANT INFORMATION Account #JI 990005291 Billed To: Owen Bouee Reference Name: Proposed Facility: 'I Residence D ' Water Supply: Evaluation By: On -Site Well DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5811-08-7113 Subdivision Info: Location/Address: Duke Whitaker Rd -27028 Property Size: 7.00 Acres Date Evaluated:�7/�l� Community Public Auger Boring Pit �\ Cut _ FACTORS 1 2 3 4 6 7 Landscape position V L Slope % APPLICANT INFORMATION Account #JI 990005291 Billed To: Owen Bouee Reference Name: Proposed Facility: 'I Residence D ' Water Supply: Evaluation By: On -Site Well DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5811-08-7113 Subdivision Info: Location/Address: Duke Whitaker Rd -27028 Property Size: 7.00 Acres Date Evaluated:�7/�l� Community Public Auger Boring Pit �\ Cut _ FACTORS 1 2 3 4 6 7 Landscape position V L Slope % y HORIZON I DEPTH o _ Texture group S' T G �, C Consistence - ,/ Structure .f g(;V- 5 CMineralo k HORIZON H DEPTH 3 4 Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texturegroup Consistence 'Structure Mineralogy i HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS �-- RESTRICTIVE HORIZON J SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE C) , . -.)-)-5- 1 a SITE CLASSIFICATION: J EVALUATION BY-.. 6 ka/ZC1 ! LONG-TERM ACCEPTANCE RATE: / OTHER(S) PRESENT: 1, L 4Y REMARKS: LEGEND, Landscape Positio 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 Tex S - Sand LS - Loamy sand SL- Sandy loam L - Loam SICL - Silty clay loam SIL - Silty loam CL - Clay loam SC - Sandy clay SIC -Silty clay C - Clay lZ'141Sf VFR - Very friable NS - Non sticky NP - Non plastic SI - Silt SCL - Sandy clay loam FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm SS - Slightly sticky S - Sticky VS - Very Sticky 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 1Ys21:� Horizon depth - In inches Depth of fill - In inches Restrictive horizon I 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) T TAR - I.nna-term nrrP.ntanrP'ratP - anIlrbulftp ter Tir% ncinc