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122 Idlewild Rd Lot 4 For office Use onl CONSTRUCTION y -�m G AUTHORIZATION "CDP File Number 139277_=1 Davie County Health Department County ID Number 210 Hospital Street Poo f n ,Evaluated For NEW P.Q.Box 848PTownship: Mocksville NC 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax:336-753-1680 0 1 / 0 8 / a 0 a 1 Applicant: Arena Builders Property Owner: Arena Builders Address: 3445 Wyo Rd Address: 3445 Wyo Rd City: Yadkinville City: Yadkinville State/Zip: NC 27055 State0p: NC 27055 Phone#: (336)388-2586 Phone (336)388-2586 #: Property Location & Site Information Address/Road#: Subdivision: Idlewild Phase: Lot: 4 122 Idlewild Road Advance NC 27006 Directions Structure: SINGLE FAMILY 158 to Redland turn left, cross 140 Idlewild on right #of Bedrooms: 3 #of People: "Water Supply: PUBLIC System Specifications Minimum Trench Depth: (Design ite Classification: Provisionally Suitable Inches Minimum Soil Cover. aprolite System? @Yes ONo Inches Flow: Maximum Trench Depth: Inches Soil Application Rate: Maximum Soil Cover: - Inches "System Classification/Description: "Distribution Type: GRAVITY-PARALLEL(eq.d-box) TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: Gallons 'Proposed System: 25%REDUCTION 1-Piece: Oyes ONo Pump Required OYes ONo OMay Be Required Nitrification Feld Sq.ft. Pump Tank: Gallons No.Drain Lines 1-Piece: OYes ONo Total Trench Length: ft GPM vs— ft. TDH Trench Spacing: _ Olnches O.C. Dosing Volume: _ Gallons ()Feet O.C. Trench Width: Inches 8Feet Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS-1 OTS-11 SepticTank InstallerGrade Level Required: 01 011 0111 QIV Dena 4 of a CDP File Number 139277 - 1 County ID Number. ❑ Open Pump Systbm Sheet Repair System RequiredAYes ONO ONO, but has Available Space rDesign System Trench Spacing: Inches 0. . ification: Provisionally Suitable — 8Feet O.C. Trench Width; Inches w: — Feet Soil Application Rate: Aggregate Depth: inches .� *System Classification/Description: Minimum Trench Depth: Inches TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover. Inches 'Proposed System: 25%REDUCTION Maximum Trench Depth: Inches Maximum Soil Cover: Nitrification Field Inches Sq.ft. No. Drain Lines *Distribution Type: GRAVITY-PARALLEL(eq.d-box) TotatTrench Length: ft. Pump Required: OYes ONo OMay se Required Pte 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. cA This construction authorzation is for the construction or a birm and french drain above the septic system E "Permit Conditions The issuance of this permit bythe 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 bevaild for apomon equal to the period of validity of the Improvement Permit,not to exceed five years,and may be issued atthe same time the improvement Permit issued(NCGS 130A-336(b)}If the Installation has not been completed during the period of validity of the Construction Penmt%the information submitted In theappiication for a permit or Construction Authorization Is found to have been Incorrect,falsified or changed,or the site Is altered,the permlt orconstructbn Authorization shall become Invalid,and may besuspended 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: / * 2140-Nations,Robert Issued By: Date of issue: . 0 1 0 ,8, � a 0 1 6 Authorized State Ag t: Malfunction Log OYes -� *Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 j CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number. 139277 - 1 210 Hospital Street P.O.sox 848 County File Number: Mocksville NC 27028 Date: 0 1 ! 0 8 ! 2 0 1 6 Q Inch Drawin Drawing Type: Construction Authorization Scale: . ON�A k D �T CJ r,i 1 Q S r I _ � s � � CONSTRUCTION AUTHORIZA71ON ' Davie County Health Department . 210 Hospital Street CDP File Number: 139277- 1 P.D.Box 848 Mocksville NC 27028 County File Number: Date: _0 1 / 0 8 / 2016 Click below to import an Image from an external location: Drawing Type:Construction Authorization r �C t �T 1 i t � V � t l 1 � v 1 .� OPERATION PERMITFor Ice Use Only e * Davie County Health Department "CDP File Number 139277- 1 210 Hospital Street P.O. Box 848 County ID Number: Mocksville NC 27028 Evaluated For: NEW Phone: 336-753-6780 Fax: 336-753-1680 Township: -7 Applicant: Arena Builders Property Owner: Arena Builders Address: 3445 Wyo Rd Address: 3445 Wyo Rd City: Yadkinville City: Yadkinville State/Zip: NC 27055 State/Zip: NC 27055 Phone#: (336) 388-2586 )�' Phone#: (336) 388-2586 Property Location & Site Information Address/Road#: Subdivision: Idlewild Phase: Lot: 4 122 Idlewild Road Advance NC 27006 Directions Structure: SINGLE FAMILY 158 to Redland turn left, cross 1-40 Idlewild on right #of Bedrooms: 3 #of People: *Water Supply: PUBLIC *IP Issued by: 2140-Nations,Robert *System Classification/Description: TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *CA issued by: 2140-Nations,Robert Saprolite System? O Yes B)No Design Flow: * GRAVITY-SERIAL Pump Re uired? 3 6 Distribution Type: O Yes KNo Soil Application Rate: 03 *Pre-Treatment: Drain field Nitrification Field 1 a 0 0 Sp'ft. *System Type: INFILTRATOR QUICK 4 STANDARD No. Drain Lines 3 Installer: Joe Le""°" Total Trench Length: 3 0 0 ft. Certification#: 1112 Trench Spacing: Inches O.C. p g' — 9 Feet O.C. EHS: 2140-Nations,Robert pinches 1 a / 1 9 / a 0 1 4 Trench Width: 3 ®Feet Date: Aggregate Depth: inches Minimum Trench Depth: a 4 Inches Minimum Soil Cover: 1 a Inches Approval St:Disap:prov)ed Maximum Trench Depth: 3 6 Inches FENK roved❑ Maximum Soil Cover: a 4 Inches Page 1 of 4 CDP File Number 139277 - 1 Septic Tank County ID Number: ' Manufactureshoaf Lat. r: STB: 760 Long: Gallons: 1000 Installer: Joe Lennon Date: 0 7 / 0 8 / .2 0 1 4 Certification#: 1112 *EHS: 2140-Nations,Robert *Filter Brand: POLYLOK PL-122 With Pipe Adapter ST Marker: ❑ Yes ® No Date: 1 a / 1 9 / a 0 1 4 Reinforced Tank: ❑ Yes ® No ;,e roval Status " 1 Piece Tank, ❑ Yes ®Apd Disapproved ` Pump Tank Manufacturer: Installer: PT: Certification#: Gallons: *EHS: Date: / / Date: Riser Sealed ❑ Yes ❑ NO Riser Height: ❑ Yes ❑ NO (Min. 6 in. t g � Reinforced Tank: ❑ Yes ❑ No {ky ❑ Appro"ved❑ Disapproved 1 Piece Tank: ❑ Yes ❑ No Supply Line Pipe Size: inch diameter Installer: Pipe Length: feet Certification#: *Schedule: *EHS: Pressure Rated ❑ Yes ❑ No Date: Approved fittings ❑ Yes ❑ No Approval Status ❑nApproved ❑ Disapproved , gd Pump Requirement Type: Installer: rDos7ingVolume: - Gal Certification#: rawDown: 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 El Yes ❑ NO Page 2 of 4 I CDP File Number 139277 - County ID Number: Electric Equipment NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer: Box 12 inches Above Grade ❑ Yes ❑ No Certification#: Box Adj.To Pump Tank ElYes ElNo Conduit Sealed ❑ Yes ❑ No *EHS: Pump Manually Operable ❑ Yes ❑ No *Activation Method: Date: Approval`Status q Alarm Audible F1 Yes ❑ No ❑ .Approved® Disapprovetl Alarm Visible El Yes 1:1 No 2140-Nations,Robert *Operation Permit completed by: Authorized State Agent: Date of Issue:. 1 2 / 1 9 / .2 0 1 4 Owner/Applicant Signature: 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 II A. sewage septic system. Rule.1961 requires that a Type TYPE IIA. septic system meet the following criteria: Minimum System Review By The Local Health Department: N/A 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 home/business 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.** Page 3 of 4 OPERATION PERMIT Davie County Health Department CDP File Number: 139277 - 1 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Dra in Drawing Type: Operation Permit Scale: , O Bloc O N/A l I __ , 4 ......_ ! _ ... , ........j _ 1 �C_ ... ........ i I � I � 1 i _ � � _ I i - -- - C[ - --_ - L -- - I r _� ....._ .__ ,._..... .... �3 i_ .. . ..... ... ......... . ..... i _ j -I I- I {_ __....._. ........--..... -r - - .. - - I I ' _ { t I I j I I � ... — ._.. - i L.... ...........................................; _ _.......... ........---- ....... _ .. -- - - ....._.__ ! ._L_ .__ -- _ 1 t �. ................ ........ ........... - - j --. --- I ! I - I — ..-...... __.._.— - _ ........ ` .... . ................. l .�_ - _ _ _ L . . . .. _ ! I I .- �. .__------- _ __ -._-� -----_ ._ .. .. .... __._i___ .__-•. 1i._.....-__._-ry-- .- ..__ ___.. _______- _..._._ _ _ . _ - _ -)-- _ _. ------ Q---- -- - - - --- --- E _ ..1... .__ - I �...... _� __...... I I_..... ...... .......... _- ...................... i..- - _ � �......... 1 ...... _ Page 4 of 4 P1 P2 P3 OPERATION PERMIT or ice se n v Davie County Health Department *CDP File Number 139277.1 210 Hospital Street P.O. Box 848 County ID Number Mocksvilie NC 27028 Evaluated For. NEIN Phone:336-753.6780 Fax:336-753-1680 Township: Applicant: Arena Builders Property Owner. Arena Builders Address: 3445 Wyo Rd Address: 3445 Wyo Rd City: Yadkinville City: Yadkinville State2ip: NC 27055 State2ip: NC 27055 Phone#: (336)388-2586 Phone#: (336)388-2586 PropeLtij Location S Site information Address/Road#: Subdivision: Idlewild Phase: Lot: 4 7 122 ldlewild Road Advance NC 27006 Directions Structure: SINGLE FAMILY 158 to Redland turn left, crass 1-40 Idlewild on light of Bedrooms: 3 #of People: Water Supply: PUBLIC 'IP Issued by. 2140-Nations,Robert "System Clessificatan/Description: TYPE It A.CONI SYSTEM(SINGLE-FAMILY OR 480 GPD+OR LESS) *CA issued by: 2140-Nations,Robert Saprolite System? ©Yes @No Design Flow: 3 6 0 * GRAVITY-SERIAL Pump Required? Distribution Type: Q Yes @No Soil Application Rate: 0 - 3 *Pre Treatment: Drain field (Nitrification d 1 2 0 0 Sq.ft. *System Type: INFILTRATOROUICK4STANDARD 3 Installer: doe Lennon oarencength: 3 0 0 h• Certification#: 1112 Trench Spacing: _ 9 O Inches O.C. Feet O.C. *EH S: 2140-Nations,Robert Trench Width: _ 3 Qlnches Feet Date: 1 a J 1 9 / a 0 1 4 Aggregate Depth: inches Minimum Trench Depth: a 4 . Inches Minimum Soil Cover. 1 a Approval Status Inches a p 3 6 �� 3,�pproried�L7 Dts pprored Inches F Maximum Soil Cover: � 4 Inches CDP File Number 139277 - 1 Se tic Tank County ID Number: ' Manufacturer shoaf Lat. STB: 760 Long: Gallons: 1ODD InstallerJoe Lennon Certification#: 1112 Date: 0 7 / 0 8 / x 0 1 4 'EHS: 2144-Nations,Robert *Filter Brand: POLYLOK PL-122 With Pipe Adapter ST Marker: El Yes O No Date: 1 a / 1 9 / x 0 1 4 Reinforcer!Tank: El Yes ® N o Apptovaf Status* ' Piece Tank: ElYes ® No Approved El,'V* . : Pump Tank Manufacturer. Installer: PT: Certification#: Gallons: 'EHS: Date: / / Date: / RiserSealed ❑ Yes ❑ No Riser Height: 0 Yes0 No (Min.6 in.) *Approval St tus Reinforced Tank: [-I Yes El No Q Approved❑ Qlsappovetl 1 Pere Tank: ❑ Yes ❑ No Supply Line Pipe Size: inch diameter Installer: Pipe Length: feet Certification#: *Schedule: THS: Pressure Rated ❑ Yes ❑ No Date: / Approved fittings ❑ Yes ❑ NoA caval Status y' Approved❑ llsapproved' t s Pump Requlrei�int Pump Type: Installer. Dosing Volume: — Gal Certification#: Draw Down: Inches THS: 'Chain: Date: Valves Accessible ❑ Yes ❑ NO Flow Adjustment Valve ❑ Yes ❑ NO Check-valve ❑ Yes ❑ No x Apprtnraltattis' PVD unions ❑ Yes ❑ No ❑ Approved❑ Disaprovetli Vent Hole ❑ Yes ❑ No � r Anti-siphon Hole El Yes ❑ NO CDP File Number 139277 - 1 County ID Number: Electric Equipment NEMATinches or Equivalent ❑ Yes ❑ NO Installer. Box 1Above Grade ❑ Yes ❑ No Certification#: Bo Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No *EHS: Pump Manually Operable ❑ Yes ❑ No '"Activation Method: Date: AlarmAudible El Yes ❑ No °ApProvatStafus proved �� Alarm Visible ❑ Yes ❑ No s ❑`7pp �Isapproved . 2140•Nations,Robert *Operation Permit completed by: Authorized State Agent: Date of Issue: 1 a / 1 9 / a 0 1 4 Owner/Applicant Signature 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.e TYPE It A sewage septic System. Rule.1961 requires that a Type TYP1:I1A. septic system meet the following criteria: Minimum System Review ByThe Local Health Department: NIA Management Entity: OWNER Minimum System Inspection/Maintenance Frequency By Certified Operator: WA Reporting Frequency By Certified Operator:NIA 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 home/business owner must maintain a valid contract with a public m anagement 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 entry,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 shalt be in effect for as long as the system is in use,and other requirements forthe,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 OlmportDrawing r� **Site Plan/Drawing attached.** OPERATION PERMIT 139277. 9 Davie County Health Department CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: / ! Q Inch Drab in Drawing Type: Operation Permit Scale: . QBbctc = ft. pN/A --------- --J .._K_F T 1 � I Jt ... ... CONSTRUCTION For office use only AUTHORIZATION [Evaluated P File Number 139277-1 = '`' Davie CountyHealth Department p nty ID Number:_ _ 4, 210 Hospital Street For: NEW P.O. Box 848 wnship: Mocksville NC 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax: 336-753-1680 0 8 / 0 6 a 0 1 9 Applicant: Arena Builders Property Owner: Arena Builders Address: 3445 Wyo Rd Address: 3445 Wyo Rd City: Yadkinville Cay: Yadkinville State/Zip: NC 27055 State/Zip: NC 27055 Phone#: (336)388-2586 Phone#: (336)388-2586 Property Location & Site Information Address/Road #: Subdivision: Idlewild Phase: Lot: 4 122 Idlewild Road Advance NC 27006 Directions Structure: SINGLE FAMILY 158 to Redland turn left, cross 1-40 Idlewild on right #of Bedrooms: 3 #of People: *Vl/ater Supply: PuguC System Specifications Minimum Trench Depth: a 4 Site Classification: Provisionally suitable Inches Minimum Soil Cover. Saprolite System? QYes @)No 1 a Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 3 Maximum Soil Cover: a 4 Inches *System Classification/Description: *Distribution Type: GRAVITY-SERIAL TYPE It A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons *Proposed System: 25%REDUCTION 1-Piece: QYes QNo Pump Required: QYes QNo OMay Be Required Nitrification Field. 1 a 0 0 Sq. ft. Pump Tank: Gallons No. Drain Lines 3 1-Piece: QYes ONo Total Trench Length: 3 0 0 ft GPM—vs— ft. TDH Trench Spacing: 9 2Inches O.C. Feet O.C. Dosing Volume: _ Gallons Trench Width: Inches 3Feet Grease Trap: Gallons Aggregate Depth: inches Pre-Treatment: ONSF OTS-1 OTS-II Septic Tank Installer Grade Level Required: 01 Oil 0111 01V ,CDP File Number' 139277 - 1 County ID Number: ❑ Open Pump System Sheet ------ --- ----Repair-system-Required:*Yes--ONO.__ONo,_but has Available.-Space rDesign ystem Trench Spacing: Inches O.C. fication: Provisionally Suitable — 9 Feet O.C. Trench Width: Inches : 3 6 0 — 3 8 Feet Soil Application Rate: 0 3 Aggregate Depth: inches Minimum Trench Depth: a 4 Inches *System Classification/Description: TYPE 11 A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover 1 a Inches *PMaximum Trench Depth: 3 6roposed System: 25%REDUCTION Inches Maximum Soil Cover: Nitrification Field 1 a 0 0 a 4 Inches No. Drain Lines 3 Sq. ft. *Distribution Type: GRAVITY-SERIAL .Total Trench Length: 3 0 0 ft Pump Required: OYes Q)No OMay Be Required Pre Treatment: ONSF OTS-1 OTS-11 *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. 7; *Permit Conditions The issuance of this permit bythe Health Department in no wayguarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. Ntr 2( This Authorization for Wastewater System Construction shall bevaiid fora person equal to the period of validity of the Improvement Permit,not to exceed five years,and may be issued at the sametime 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 may be suspended or revoked(.1937(g)).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: 2140-Nations,Robert Date of Issue: 0 8 0 6 .2 0 1 4 P 01 Authorized State Agent: Malfunction Log : OYes *Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** • CONSTRUCTION AUTHORIZATION Davie County Health Department CDP File Number: 139277 - 1 210 Hospital Street ---------:_—__-_-------_—P.O.-Box-848--_____—. -----------County.File_Number:----- ------ Mocksville NC 27028 Date: 08 / 0 6 / x 0 1 4 Q Inch Drawing Drawing Type: Construction Authorization Scale: OBIock ft. QN/A W" ,J �b A _ --� 10 a fir, APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC 1VSD Davie County Environmental Health ' P.O.Box 848/210 Hospital Street PAID U 1 Mocksville,NC 27028 Dain 7 . 3. 1 y •-= (336)753-6780/Fax(336)753-1680 Received by: IMM Application For: ❑ Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both Type of Application: ❑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 NameL-`V rL6&tS Contact Person �/�11 ('4b GZ Address a '2 Home Phone City/State/ZIP _ vQ p 01,J 0 1 a( r' fJ C 2 a C� Business Phone 33 -3 -Z�'(o Email (ZAg att e- A(UWA i3Jic0t7<icons Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name Phone Number Owner's Address City/State/Zip Property Address �_� L City d 22 Lot Size �.04 /1 Tax PIN#, Subdivision Name(if applicable) ,ilcc LOPLZ Section/Lot# Directions To Site: 157t ou S — (,i)i I d n A;Z' Specify Problem Occurring: IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms 3 #Bathrooms 2 Z Garden Tub/Whirlpool es ❑No Basement: ❑Yes o Basement Plumbing: ❑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:)irconventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: kcounty/City Water ❑New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes �,Ko 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,Ahp D vie County Health Department to conduct necessary inspections to determine compliance with applicable laws anda�nd//ain(o tand that I am responsible for the proper identification and labeling of property lines and corners and locating staking the house/facility location,proposed well location and the location of any other amenities. Site Revisit Charge Prope owner's or owner's legal representative signature Date(s): C /( Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account Revised 11/06 Invoice# U ' :•..134 t 128 na 04 g ; i. ' 7 122 %0 M00 241 317 �o o co t r,, 114 Ln 11f ----------------- 2 _f _ 321 All data Is provided as Is without warranty or guarantee of any kind either expressed or implied including but not limited to the Implied warranties of merchantability or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the County of U N Davie,North Carolina,Its agents,consultants,contractors or employees from any and all claims or causes of action due to or arising out printed:Jun 17, 2014 ��' of the use or Inability to use the GIS data provided by this website. • 1 w S 0?3056 W w W W W Lot 4 2 rn Lot 5 o w W m A r O � M W O N n � d y Lot 3 N CD 3 W 3 Proposed House W -1--. Porch Garage W I 18.3' I I I_ W I0 Ln It I 3 3 3 a9eEase��i R=225.00' ` <aHj Idlewild Road 50'Public Right-of-Way Proposed Layout For Prepared By: ARENA Builders Associates, LLC Autry-Abernathy,P.A. C-2341 Lot Idlewild Subdivision 6601 Skylark Road Pfafftown,N.C.27040 Davie County,NC 336-922-4335 Plat Book 8 Page 192 336-922-4624 Fax Scale 1 inch=50 feet n.r C9 94 101174 devt)vfa lw onvOgltn 779 7161 Y799 P.Z • 1 uruuna wr mccwu:a:aywymllaoit ecwrt.,ne f ' owl.00uMyxw+moplremwt L�r6Damtsr�/Alx/18.A+mfDf i AX MIZI bl iw scat 1 votbvilms,Ic rul i (77iJ711.17r0 ._ .- --wo I ur-,ins 4tJL:CA w CUR u DJdCM mm MA TJ; • TQO>I�SOI u PlDYIDCD, Ida to W TxfDl ilDi xotatrar by itrbiteElbu. :.1 t. w is w OW Cous7•Ruc,JoA Co. ottcac 4114� _ 4'6d'9+�)S r:uu�mut dr. I ��outrJ�t� fF✓d aatJelelha Ylorw-541cm 1 .p03 r�wtt tj9 t 3b•7221 54 L,r to talll/M 1!atk,ot a"Ibn!_ 1. yplt a fat 0 tits xttluda Q Lgaotmot haitl C 1. J►ta9 a attku IlfJaue D xa4iic xoa 0 jalap 01'cduuy J. Q! .tiwcttou. ldl(l+t Q lmontlh 1 i. u Ja,ilebu lheDl9 ' r 1. tt.w„Wa1.tC�locan.lII:r eke hql.,� BLO!' 11 IocYICi1 t IDa4 Lliott4a titer X7699(wsLe!pr a� !t wt.!swim VCauWwr C xo11 0 ceatatnikt, i 1. m tan *mum aapt6st66ItrukG tWt �f 9�mifhd:•xklulan.+OYu K� ` u�,mc gtrt . 1 , ,nicttmmurarccr�uRnu L1utyJrxa^TxKmYDt' Duow.r� tutasrtxuru�arusvr m<aa.�rinurilG'OUT"anuxsluo • ;.r i trtpmJauwmr)I.SfAe 13 to YtturecfxtrnpKSlhnwd9r IntxurDa�: Tiso�ac?lct !Z3 9 P c y Awa 15� esT _ 1!�oDa17A11rm:R67d1Yua h Lefr ON Cbl a� Ir6t361dlrbt66t^ a4aWTtiu t►>me�D�etutr.D � s1ud�S:nN �:. •_� L.r d Dut 16mcarcta� ,. • 1s�10e17�a�Cxiafoa�6a9Jmt�dxm«�ac»De#�� •t�gedOceagnc�pi� eblitYdaWtcpy:Lt�tttwy � �66�t6pl:nrb:aJdwa�nJe,u:rfieflror4aa;,. �., auq�6crL�1,baft erg MWrueA+Lha�fs�wdgPalftr'r9.^�N+ +J.tli<tlutQilQtnt51/Fr� . ttarla6paaLtiSdctclbpl �1p1�Ihee.ICoD�riaGaurfldtLpgn�wuM I. lM9P�!6axdt60tirG CtWytld omml . ` oaudud�DwilDlpvro�n>t�a�todaau�ae(httYclux�t:�".`"—"- �' tnt�Jdl �M'�YOI3tSiliPWlQadede>bortlu2Ctrl¢�gttu;uCy,�P�P�d �ttrlalCl7r�t ' dkrt7hC0auluDcte i too AmiAtr6. 33 4 i0'd £t£SSZt9£E w + ♦ ASH Htl 9C:10 "—Mt-42S DAVIE COUNTY HEALTH DEPARTMENT 5 Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003354 Tax PIN/EH#: 5862-34-9883.04 Billed To: H&V Construction Subdivision Info: Idlewild Lot#04 Reference Name: Location/Address: Gordon Drive-27006 - 1 Proposed Facility: Residence Property Size: see map Date Evaluated: 1I 2 Vy Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit I,,", Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH 1 Texture group Consistence Structure Mineralogy d HORIZON II DEPTH I -" Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group ♦ I Consistence (- Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE bT SITE CLASSIFICATION: EVALUATION BY: Q LONG-TERM ACCEPTANCE RATE: C)'zz� OTHER(S)PRESENT: REMARKS: crA> U Q Z2-" N low LOT Ll' LEGEND 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 CONSISTENCE Moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm Wet 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 05/99(Revised)