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3518 Hwy 801Sr Davie County"Environmental Health P.O. Box 8481210 Hospital Street Mocksville NC 27028 (336)751=8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account M 990004380 Tax PIN/EH M 5788-02-6049 Billed To: Trent Young Subdivision Info: Address: 3535 NC HWY 801 South Location/Address: NC Highway 801 South -27006 City: Advance 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: QXew ❑Repair ❑Expansion Permit Valid for: &6 Years ❑No Expiration Residential Specifications: # Bedrooms_3 # Bathrooms_Q # People ( Basement Basement plumbing Non -Residential Specifications: Facility Type # People # Seats . Square Footage(or Dimensions of Facility) Design Flow(GPD): 3be-0 Type of Water Supply: ❑County/City ❑Well ❑Community Well Site Modifications/Permit Conditions: As accepted Systems May System Type LTAR Initial7` c . a"7 Repair Ae ev O. D-7 Site Plan I �4 IU 14� '� �rv�l� 141)y�P > Environmental Health Specialist i.p.11-06 Date Z (f 7 DAVIE COUNTY ENVIRONMENTAL HEALTH N'r P.O. Box 848/210 Hospital Street -71:31107 31107 Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004380 Tax PIN/EH #: 5788-02-6049 Billed To: Trent Young Subdivision Info: Reference Name: Location/Address: NC Highway 801 South -27006 Proposed Facility: Residence Property Size: 1 Acre ATC Number: 4715 Site Type: [4New ❑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 3 # Bathrooms # People Basement❑ Basement plumbing❑ Non=Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size a� Cc Type of Water Supply: ❑County/City'@""ell ❑CommunityWell System Specifications: Design Wastewater Flow (GPD) 3 (¢O Tank Size �� o c)0GAL. Pump Tank _,U &EiAL. Trench Width '3 (-N Max. Trench Depth 3& Rock Depth 0 " Linear Ft. y 3 G Site Modifications/Conditions/Other: As stated in 15A NrAr 18AI969(fil accepted ystems may also bo use Contact the Davie County Environmental Health Section for final inspection of this system between Environmental Health DCHD 11/06 (Revised) Date: o9 —.21 (/ DAVIE COUNTY ENVIRONMENTAL HEALTH ' P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 Account #: 990004380 Billed To: Trent Young Reference Name: Proposed Facility: Residence ATC Number: 4715 OPERATION PERMIT Tax PIN/EH #: 5788-02-6049 Subdivision Info: Location/Address: NC Highway 801 South -27006 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 sy$ m will functio satisfactorily for any given period of time. `�• �G< l t1� System Type: S.T. Manufacturer Tank D to Tank Size 00C Pump Tank Size System Installed Byre (>,e R �>&0 "-L-E.H. Specialist: C) C$ JvMDate: cv-� �i U.,( 0 1 QV I-7 CI - L rk'L — !"o C ' �C) y1,4 DCHD 11/06 (Revised) RJNe SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 lionprovementPermit Authorization To Construct(ATC) �Both�Repair to Existing System Expansion/Modification of Existing ys sTem or Facility ANT*•* THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED RMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. Name to be Billed -f" Cntact Person Billing Address pjrf LT, Home Phone City/State/ZIP Buaness Phone Name on Permit/ATC if Different than Above, Mailing Address PROPERTY INFORMATION *Date NOTE: A survey plat or site plan must accompany this application (Permit is valid for 60 monthswith site plan, no expirptQn M Owner's Name 7:Me t A - Owner's Address_ S j l' I-rzrnj . FS"I <A1 (nh Property Address 21(p Lot Size pf)-Tac PIN# 6'18%_ 021- CtCrr? c- Subdivision ame(if plicable) Directions To Site: rronrn (o4 -t-c.tVr, l o If the answer to any of the following questions is "yes", supporting documedL, Are there any existing wastewater systems on the site? Yes Does the site contain jurisdictional wetlands? Yes Are there any easements or right-of-ways on the site? Yes Is the site subject to approval by another public agency'? Yes Will wastewater other than domestc sewage be generated? Yes Corners Flagged e Plane Plat(to scale) hae Number -3B0 I -QJ7 Ciel �) aP 4r1t/A_rkro . AIC o2761Yn �1L-::) to_Ar rerif javiu-l) J8000M2Z dict6V�I.GfD ast T is C P,�irFc are n r, I& , nt be attached. a7n h n 3535 �L 3521 (acios M20 IF RESIDENCE FILL OUT THE BOX BELOW # People 1 # Bedrooms ' # Bathrooms 2— Garden Tub/Whirlpool Yes No Basement: Yes (RZo3 Basement Plumbing. Yes o IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Taal 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=Conventi..-.lAccepted 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 If yes, what type? No This is to certify that the information provided on this application is true and correct to the best of my knowledge. 1 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 rightof entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rales. t 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 Vocation, proposed wet location and the location of any other amenitim / J� - Jf Site Revisit Charge Property owners or owner's legal resentat signature Client Notification Date: Date EHS: Sign given Yes No Revised 11/06 Account # c�0 Invoice # 7r -Z r �51' 4,0 Genf Youn3 a- I Co acres s �- i�-a�s.e Tw, 31 4 46 co a X ti @ q ` a W Y v9 � " 1. 2613 \ 3464 CA.738A ' �A \ 233 0 34 \ 34,34 1790 - ` s1 1.30A AF 7901 ry l \ �.SII1A PcC2 PcB2 6049 � vr, (td3R 35 owl r� 5503 469 D y 4 �o n 13.117A \ 1284 (17.83A) 2168 f APPLICANT INFQHM&PN —�ciIIctnr�. Billed To: Trent Young Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil /Site Evaluation Tax PIN/EH #: 5788 .8- 119RTY INFORMATION Subdivision Info: Location/Address: NC Highway 801 South -27006 Property Size: 1 Acre Date Evaluated: (o On -Site Well Community Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L 4�_ Slope % Z_ HORIZON I DEPTH Texture group Consistence D Ow C PIP. Structure <Ip S & K 5 13A Mineralogys HORIZON H DEPTH ok — ( — Texture group Sc .5 C_ —1 Consistence r & r&p Structure A MineralogyC 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 1 A-17517 SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: ®.. a 7 REMARKS: LEGEND EVALUATION BY- %7 / 1, nL" (on OTHER(S) PRESENT: IJ Landscape Position R - Ridge S - Shoulder L -Linear slope FS - Foot slope N - Nose slope CC - Concave slope CV - Convex slope T - Terrace FP - Floodplain 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 DZo1St 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 r . 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) iii■■■■■■e■■■■■■/■■■■■■■■■■■■■■■■s■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Uiiiiiiiiioiiiiiiiiiieiiil' iiiiiiiiiiiiMEMNONiiiiii ■■■■■■■■■■■■■!.c Ali■■■■■■e■■■■■'■■■■■■■:�'At■■■■■■■■■■■■111■ ►1�'ll■■■■■■■■■■■■■ �_ ■■1�.,��/�F�■■■■■■■■■■■■■■111■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■,■il.� I i1■!I■I��il�//�J■■Ile■■■a■■■■■■■�\■ISI/I/■■■■■■■■■■■e■■■ ■■■■■■■■■■■■/■■It■■it'%i■■■■Cily■■■■■11■■■■■■■■■�■L;1l/I■III/e■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■11■■■■■■■■■11■■■�!:file■■■■■■■■■■■■■■%'�■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■glee■s■■■■■■■■■■■■ae■r:JI■■■■■■■■■■ilr,■■■■■■■/■■■■■■■■■ ■■■■/■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■e■■■■■■■e■■■■■ee■■■■■■e■■■■ ■■■■e■ ■■■■e■ ■■■■■■ ■■■■■■ ■■m>•■■■■■u■■o■ ■■e■■■e■■ ■■■■■■■/■ ■■■■■■e■■