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375 Harper Rdt DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Account #: 990004327 Tax PIN/EH #: 5851-99-7647 Billed To: Sonner Land Company,LLC /Ed Hard Subdivision Info: Reference Name: Tom Gavin Location/Address: Harper Road -27006 Proposed Facility: Residence Property Size: 59.15 acres ATC Number: 4706 **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. Manufacturer 6G P Tank Date Tank Sizel© C.v Pump Tank Size —� System Installed By: E.H. Specialist: V Al kikliate: 3 —U 5 GI.— f) .�. --SPU r .575 Ily- n � r � DCHD 11/06 (Revised) {rb -7 C f -1 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004327 Tax PIN/EH #: 5851-99-7647 Billed To: Sonner Land Company,LLC /Ed Hard Subdivision Info: Reference Name: Tom Gavin Location/Address: Harper Road -27006 Proposed Facility: Residence Property Size: 59.15 acres ATC Number: 4706 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. Residential Specifications: # Bedrooms # Bathroomsa25 # People 1, Basement❑ Basement plumbing Non -Residential Specifications: Facility Type # People # Seats. Square Footage(or Dimensions of Facility) Lot Size 66 4c✓t5 Type of Water Supply: County/City ell ❑Community Well System Specifications: Design Wastewater Flow (GPD) 3 If 6 Tank Size IO -CJ -0 GAL. Pump Tank Q f&G,AL. Trench Width 36'Max. Trench Depth Rock Depth % Linear Ft. `r A1Q yv, I htfcack D"fl', 3(e " - Site Modifications/Conditions/Other: As statow accepted Systems may ..1Ishr usP n 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. 3G,I q t5 -y t7-e&A thd %1..c.,.- J\e Q Environmental Health Specialist_. DCHD 11/06 (Revised) Date: "l� �� IqA� APR242001 R SITE EVALUATIONAMPROVEMENT PERMIT & ATCV 30! JW Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 E,� EA1ZH Ap 'cap to Ev mprovement Permit ❑ Authorization To Construct(ATC) ktoth Type of A t 0 ew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed 44149JzA s6r/ Contact Person %o M Uii✓ Billing Address/ Y4 L8- Home Phone 33 (0-q y0 - y So3 City/State/ZIP NS— — N C- Business Phone 33 G - 39 q—�.�5r a7/off Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners 7, NOTE: A survey plat or site plan must accompany this application. Included: NSite Plan at(to scale J�. �S �r�G� (Permit is valid for 60 months with site plan, no a piration ' h mplete platy v�T�T�e rv(,� p 1 Owner's Name f Z (S(�! Phone Numller Owner's Address xoiio, Citv/State/ZiD Property Address l Lot Size 06Qai Subdivision Name(if applicable) Directions To Site: H-76Pg1 Section/Lot# 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 Wo Does the site contain jurisdictional wetlands? ❑Yes [moo Are there any easements or right-of-ways on the site? ❑Yes 6Wo Is the site subject to approval by another public agency? ❑Yes CTo Will wastewater other than domestic sewage be Generated? ❑Yes M o TF RESiDF.NCF, FTTJ. OT TT THF.ROX RF.T.OW vaAle e- v 700 # People # Bedrooms �� # Bathrooms -1 Garden Tub/Whirlpool ❑Yes Basement: ❑Yes o Basement, Plumbing: ❑Yes C 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:. 216onventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ❑ County/City Water ,XNew Well El Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 4-110 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 corners and locating and flagging or staking the house/facility loc on roposed e ll location ands the location of any other amenities. -.-012�MIAFIKIV IVAI�Obair �"�2.��?1yl Site Revisit Charge Pro9wner s or owner's legal representati a signature � Date(s): a Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account # Revised 11/06 Invoice # EXHIBIT "B" BEGINNING at a point, an iron pipe, C. Leroy Ellis' Southwest corner in L.S. Bowden line, being the Northwest corner of the within tract, runs thence with.C. Leroy Ellis' line and continuing with C. Wayne Ellis' line South 87 deg. 55 min. East 2117 feet to a point,'---. and iron pipe;;common corner of C. Wayne Ellis and W. G. Smith; thence with said Smith's line South 78 deg. 34 min. East 646.4 feet to a point, and ironrod m Northern right of way line of service road next to Highway I-40; thence with said service road .South 54 deg. 41 min. West 111.8 feet to a point, a�'gramte ngltt ofway marker; thence South 35 degs. 19 mins. East 4.8 feet to a point, a gran to right .af way `marker in North edge of right of way of said 140; thence with .I-40 South 51 deg. 15 min. West 1117.5 feet to a point, a'granite-right ofway marker; thence with said I-40 South 48 degs. 10 min.West 810 feet to a point,,-a,gramte;right oiway marker,•,thence with said I-40 South 54 deg. 25 min. West 234 feet to a point:­`graruteiglit of::way marker; thence South 83 degs. 25 min. West 285 feet with said I-40 right of way to'a point, an iron pipe, LS. Bowden's corner; thence with said L.S. B.owden's line the -following calls: North 2 degs. 35 min, East 430 feet to a stone.North 86 deg. 50 min. West 102 feet to ani ron:pipe, North 0 degs. 45 min. West 306 .feet to a stone. North 85 deg. 30 min. West 643.5 feet to a stone, North 1 deg. 00 min. East 890 feet to the BEGINNING, containing fifty nine and fifteen hundredths (59.15) ACRES, more or less, as taken from a survey of said tract by J.C. Comer, Davie County Surveyor, dated July 15, 1970. For Title seethe following instruments recorded in office of Register of Deeds of Davie County: (1) Deed recorded Book 38, page 725; (2) Deed -recorded Book 76, page 116; (3) Deed recorded Book 81, page 635. PQ 9 M,&4� Dives -Al (12 25A) m CQ50A1 n 03 E673 4.40 CS.�'Jk"CD 5ar��) B'E4�4E r� �28 33D t HARPER RD E�g �. )� I (,"£ 877 7Ei7 n 43 (42162 2162 ®� iinJ ELT M8.1]31503 91-E Ef ki�� `• 26 V1 s �m gy%p, - *"+ �" - i12 [ 54I ki „„_ 'k5 -:a? t 3 T37382, _ - 4540 e a � C _ .v FA ..�f.E NT be �. ... 33aJ - „- HARPER RD - p 1 (56.82A) ( 7647 a F. - 2162 r. 44 " ..i. ., ,�:..,. �.. "•._surer ., DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION Account #: 990004327 Billed To: Ed Harrison Reference Name: Proposed Facility: Residence PROPERTY INFORMATION Tax PIN/EH #: 5851-99-7647 Subdivision Info: Location/Address: Harper Road -27006 Property Size: 59.15 acres Date Evaluated: -,/0,? , 07 Water Supply: On -Site Well —G Community Evaluation By: Auger Boring Pit FA c&/. Public Cut FACTORS 1 2 3 6 7 Landscape position C_ Slope % '.-- HORIZON I DEPTH — Texture groupC C_ Consistence Structure /( Mineralogy} HORIZON II DEPTH _ (� Texture group 's L L Consistence r Structure { kq Mineralogy HORIZON III DEPTH _ 2 Texture group Consistence �.� Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE --;b CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: ' ` f C''3. 51, .4-M 110k LONG-TERM ACCEPTANCE RATE: 3 REMARKS: EVALUATION BY: OTHERS) PRESENT: liy iy1 LEGENIi 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 ANSI TEN .E Moist VFR - Very friable FR - 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 LYQies 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 05105 (Revised) ��let Davie County Environmental Health P.O. Box 848/210 Hospital Street Mo&sville NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990004327 Billed To: Sonner Land Company,LLC /Ed Hard Address: 125 Sugar Maple Court City: Winston-Salem, Reference Name: Tom Gavin Proposed Facility: Residence Tax PIN/EH #: 5851-99-7647 Subdivision Info: Location/Address: Harper Road -27006 Property Size: 59.15 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. Permit Type: Ndew ❑Repair ❑Expansion Permit Valid for: N-YYears ❑No Expiration Residential Specifications: # Bedrooms # Bathrooms oL # People2•5 Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): 8 &6 Type of Water Supply: ❑County/City ?'yell ❑ Community Well Site Modifications/Permit Conditions: As stated in 15A NCAC 18A.1969(5) accepted 5ys ems may'sJJ '; USUC Svstem Type LTAR Initial .E c-0 , Repair wu y Environmental Health i.p.11-06 Date ,lo