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1794-1804 Hwy 801N (2)Account #: 990004409 Billed To: Tim Snyder Reference Name: Proposed Facility: Residence ATC Number: 4741 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Tax PIN/EH #: 5853-31-2262.01 Subdivision Info: Location/Address: NC Highway 801 N-27028 Property Size: 1 Acre **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. 10 i � 't(oTank iz eSystem Type. S.T. Manofacturer Tank Date Pump Tank Siz ,l System Installed By: &*, Ar 1t +C' E.H. Specialist: , Dater ,Al DCHD 11/06 (Revised) lod r DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street • Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 . 1 - AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004409 Tax PIN/EH M 5853-31-2262.01 Billed To: Tim Snyder Subdivision Info: Reference Name: Location/Address: NC Highway 801 N-27028 Proposed Facility: Residence Property Size: 1 Acre ATC Number: 4741 // Site Type: M<ew ❑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 1-1 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'ehange. Residential Specifications: #Bedrooms # Bathrooms d—# People l Basement❑ Basement plumbing[i Non -;Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size • (l C 'C Type of Water Supply: &eounty/City R101 ell ❑Community Well System Specifications: Design Wastewater Flow (GPD)9-40 Tank Size &r GAL. Pump Tank GAL. rr J. Trench Width3 �v Max. Trench Depth a% Rock Depth Linear Ft. ©Li, • c Site Modifications/Conditions/Other: As stated in 15,4 NCA!Q 18A.1969(5) Q duuejpAed Systems-63Tcay r31Ti 5 e�UZ %OVI Contact the Davie Cc 8:30.— ironmental Health,Section for final -inspection, of this system between �n'the d11nv n.f installation. Tel6hone # (336)751-8760. I (. Vt art i6®/ I Environmental Health Specialist DCHD 11106 (Revised) TV LICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax(336)751-8786 For. Site Evaluation/Im rovemeii Authorization To Construct(ATC) Both ilicatio . New Syste , Repair to Existing System Expansion/Modification of Existing System or Facility AN7- THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED kTION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed —rl Contact Person - VYI. S Y14 aXV- Billing Address Home Phone -7 8 R - U-11 O City/State/ZIP Business Phone 4413- OI o i -7 •- Pp 1 _ Name on Permit/ATC ifDifferent than Above Mailing Address City/State/Zip PROPERTY INFORMATION 'Date House/Facility Came NOTE: A survey plat or site plan must accompany this application. Included: ite Plan (Permit is valid for 60 months with site plan, no expiration with complete plat. Owner's Name J O 4 S d Phon Owner's Address O i e City/State/Zip ` Property Address w 4 �-O ( N . City AkQ Lot Size a S Q c✓c5 Tax PIN# 5 5 9.3 1 (0 2, 0l Subdivision Name(if applicable) a- Section/Lot# t Directions To Site: (fie • 4 - wiles w If the er to any of the following questions is "yes'. supporting documcmatio must be at Are there any existing wastewater systems on the site? Yes No Does the site contain jurisdictional wetlands? Yes o Are there any easements or right-of-ways on the site? �Yi' No Is the site subject to approval by another public agency? Yes iia, Will wastewater other than domestic sewage be generated? Yes o IF RESIDENCE FILL OUT THE BOX BELOW O# People I # Bedrooms _3 # Bathrooms Basement: Yes o Basement Plumbing: Yes (:R'p / IF NON -RESIDENCE FILL OUT THE BOX BELOW P )Plat(to scale) timber oiI VIC z86-7 la - 'fir o ate✓ 6>� Garden Tub/Whirlpool "e , No 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 r Type system requested:onventio Accepted : Innovative Alternative Other Water Supply Type County/Ci 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 an"agging quaking the house/facility location, proposed well location and the location of any other amenities. Site Revisit Charge o is or own 's legal representative signature Date(s): Client Notification Date: Date J EHS: Sign given Yes No Revised 11/06 Account # Invoice # Q Se "tJ APPLICANT INFORMATION Account #: 990004409 Billed To: Tim Snyder Reference Name: Proposed Facility; Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5853-31-2262.01 Subdivision Info: Location/Address: NC HWY 801 N.-27028 Property Size: 1 dffi& Ac. Date Evaluated: j$" )4- — 0 :7�7 Water Supply: On -Site Well V Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position t-1 Slope % 14 HORIZON I DEPTH 0-15 0 G I-$ Texture groupC, ConsistenceP q4., ' StructureX 49'kY44' Mineralogy /.7 HORIZON H DEPTH ' Texture rou ConsistenceStructureMineralo PIT M HORIZON III DEPTH - Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATIONr LONG-TERM ACCEPTANCE RATE 5 SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS; LEGEND EVALUATION BY: K C-., % 'UC.I 1 OTHER(S) PRESENT: 2"::c A 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 oamSC - Sandy clay SIC - Silty clay C - Clay . r��inrnmr�trr.. Sim _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 -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 05/05 lRevkedl Map Frame Davie County, NC - GIS/Dapping System Page 1 of 1 r Ods Click Here To Start Over Quick Search: (County ID t -tiwe Layer. DP5 GIS OultiS c� ° PARCELS (A4ap Tips Available) f�9a Layers j Results http://maps.co.davie.nc.usIGoMaps/maplmapframe. cfm?CFID=4129&CFTOKEN=61640881 8/6/2007 X15-' z, • ( 7 .y rpt n � GoMaps GIS of --- A3 t Pap kD Ln ,:::5 T- VJ a http://maps.co.davie.nc.us/GoMaps/map/map.cfin?CFB3--4565&CFTOKEN=82887446 6/.' ti v A3 t Pap kD Ln ,:::5 T- VJ a http://maps.co.davie.nc.us/GoMaps/map/map.cfin?CFB3--4565&CFTOKEN=82887446 6/.' WEBBINVESTMENTS, LLC, r INA LIMITED LIABILITY COMPANY A NORTH CAROLINA 690, PG. 199 v txI511NG 50' EASEMENT ! (DESCIBES SOUTHEAST LINE) i SEE D.B. 690, PG. 190 — vE BEARING DISTANCE 309.14 1 159.62 178..33 1 r I .I I I 1 I I I I I I 1 i I. I WA YNE WEBB 1 JENNIFER WEBB I D.B.547, PC. 414 I .'R SF ^:E HWY SO1 Ire -,R PEAR C 'L JOHNSON A. D• B• 580, McBRIDE PC. 55 +C= UNMARKED POINT OF EASEI>,iENTS FXI;T'IG j,R%...IlTE\ tXIS(lr.c _c 100 �0 ��1 100 20D _ -A L' I \ -`L_ -- N: � C -LE VICLVITY MAP DONNA M. FR YE D. B. 130, PC. 47 PRELIMINARY I, -�RADY L TUTTEROW, CERTIFY THAT UNDER MY GIRECTION AND SUPERvISION, THIS MAP WAS DRAWN FROM AN ACTUAL FIELD SURVEY MADE BY TUTTEROW SURVEYING COMPANY. PROFESSICNAL LAND SURVEYOR L-2527 TUTTEROW SURVEYING COMPANY 107 NORTH SALISBURY ST. VOCKSVILLE, N.C. 27023 36) 751-5616 -ED IR(:N T `TAIL PLAT OF SURVEY FOR, TIMOTHY MARK SNI DER REID .JAMES SNYDER, Jr. :ALEj — TI )0, O APPROVED BY, DRAWN BY. FILE NAME, SN',—TIM kTEI AUG -9-2007 ;.L. TI-I-EPOW I J mom NANEWEBI380' —? i BEIN,S 27 803 AC. TAKEN FROM THE JOE K. W&)CWARD PROPERTY D.B. 144, PC. 546) LriNG IN THE FAPMiNGTON -C'NN")HIP DAYIE COUNTT NORTH ':APO—INA TAX GAAP F _- c � ii liaoc:a(: 2 -latraacaa 1$afladl' ,� c; i` z r .r N: � C -LE VICLVITY MAP DONNA M. FR YE D. B. 130, PC. 47 PRELIMINARY I, -�RADY L TUTTEROW, CERTIFY THAT UNDER MY GIRECTION AND SUPERvISION, THIS MAP WAS DRAWN FROM AN ACTUAL FIELD SURVEY MADE BY TUTTEROW SURVEYING COMPANY. PROFESSICNAL LAND SURVEYOR L-2527 TUTTEROW SURVEYING COMPANY 107 NORTH SALISBURY ST. VOCKSVILLE, N.C. 27023 36) 751-5616 -ED IR(:N T `TAIL PLAT OF SURVEY FOR, TIMOTHY MARK SNI DER REID .JAMES SNYDER, Jr. :ALEj — TI )0, O APPROVED BY, DRAWN BY. FILE NAME, SN',—TIM kTEI AUG -9-2007 ;.L. TI-I-EPOW I J mom NANEWEBI380' —? i BEIN,S 27 803 AC. TAKEN FROM THE JOE K. W&)CWARD PROPERTY D.B. 144, PC. 546) LriNG IN THE FAPMiNGTON -C'NN")HIP DAYIE COUNTT NORTH ':APO—INA TAX GAAP F _- c Davie County Environmental Health P.O. Box 848/210 Hospital Street A Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990004409 Tax PIN/EH #: 5853-31-2262.01 Billed To: Tim Snyder Subdivision Info: Address: 2335 Almond Street Location/Address: NC Highway 801 N-27028 City: Winston-Salem Property Size: 1 Acre 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 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: Kkw ❑Repair ❑Expansion Permit Valid for: Years ❑No Expiration Residential Specifications: #Bedrooms DL # Bathrooms "k- # People f Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD): �L4 o Type of Water Supply: XCounty/City WWell ❑Community Well As stated in 1.5A NC.94C 18A.1969(5% Site Modifications/Permit Conditions: 9ccopted Sr^tfstils' e41a . lre b2 HSS. System Type LTAR Initial 6. 1 Repair ey. 0 i.p. 11-06