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837 Joe RdAccount #: 990005578 Billed To: Anthony Holman Reference Name: Proposed Facility: Residential DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028, (336)753-6780 / Fax # (336)753-1680 OPERATION PERMIT VA, 1�, k 4V 01 ', Tax PIN!EH#: 5767-52-5166 :'Subdivision ',LocationiAddress:-Zedaf-Gfeve-Ghitfelt4Rogd.2ZU8-...,, Property!SizO: 1.033 Acres ATC Number: 5116 **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 Tank Date Tank Size lav Pump Tank Size System Installed By: 6I Specialist: 412,2120to GPS Coordinate: DCHD 11/06 (Revised) 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 :X990005578 Tax PIfr1IEH #: 5767-52-5166 Billed To: 'Anthony Holman Subdivision Info:.; Reference Blame: ?.:::LocationiAddress: Cedar Grove Church Road -27.028 Proposed Facility: Residential prbperty Size: 1.033 Acres ATC Number: 5116 1Site 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_ # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size t t) (— Type of Water Supply: l�County/City ❑ Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) `1 W Tank Size_IM GAL. Pump Tank XA GAL. Trench Width ( Max. Trench Depth Rock Depth Linear Ft uo j iL I -'I'0 t Site Modifications/Conditions/Other: dsolo ku&en Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation—Tilephone # (336)751-8760. MEN Environmental Health Specialist 1 Dater V f 200 DCHD 11/06 (Revised) Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680 IMPROVEMENT PERMIT Account #: 990005578 Tax PIN/EH #: 5767-52-5166 Billed To: Anthony Holman Subdivision Info: Address: 826 Cedar Grove Church Rd. Location/Address: Cedar Grove Church Road -27028 City:. Mocksville Property Size: 1.033 Acres Reference Name: Proposed Facility: Residential **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 Permitis subject to revocation if site plans, plat or the intended use change. Permit Type: flew ❑Repair ❑Expansion Permit Valid for: 5(5 Years ❑No Expiration Residential Specifications: # Bedrooms_ # Bathrooms # People 14 Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply: $CCounty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: Sep, 21 10,11:40a Information Services I. `' • I I APPLI Application For: ❑ Type of Application: TION FOR S Evalu jtionflmprov Jew System OR( I 3367531680 p.2 E C E 0 V E EVALUATIONAMPROVEMENT RMIT & ATC e County Environment 1 Health SEP 2 2 20t , O. Box 848/210 Hospital Street Nlocksville, NC 2702 1ENVIRONMENTP,L HEALtH 36)753-6780/ Fax (336)7 3-1680 DAVIE COUNTY mr Permit ❑ Authorization Td Construct (ATC) lR' Both to Existing System ❑Exp sion/Modification of;Existing System or Facility ***hVPORTANT** THIS APPLICATION AMOT BE PROCESSED LtNLESS ALL OF THE REQUIRED INFORMATION I PROVIDED. Refer to Ce INFORMATION BULL IN for instructions. APPLICANT IN ORMATION GardenlTub� 'hirlpool 5Yes ONO n I AA kcJ Nance Contact Person +c.�OAA re S; J -(A Address a r H me Phone City/'State/ZIP ;lle a Bu iness Phone 33(0- aqr - 7() q1 �G��-ti-o � IT4oN►eS Name on Pennit/A C if Di rcrent than At ove ity/State/Zip Mailing Address i PROPERTY INFORMATION *Date Housa/Facility Corners Flagged NOTE: A survey plat m site plan must acco pang this application. Inch ded:, Site Plan §Vlat(to scale) (Permit is v lid for 60 months with s plan, no expiration with co plete plat.) Owner's :dame_E I n dr Phone Number 33(o -ga (p ` 7yF, Owner's Address IQ ityfState/Zip /VtOcicc cf`llP tVC. a ©a� Property Address „n 'icy t,c lis _ l.ltt= Lot Sizet nc T PIN 5767 ,j 2 Subdivision Name('f applicable) NIAi Se tioniLot# Directions To Site: 4 ro✓.- c4-,gi- tti AL. 7- ro ^n.Pr 6 — o Tc� If the answer to any'of the following question; is "Yes",supporting documentation must be attached: Are there any exi ting wastewater systems on the site? Yes ICN Does the site con iii jurisdictional wetlan s? _Yes ZCN Are there any easements or right -of --ways n the site? Yes �C N Is the site subject o approval by another blit agency? _Yes LC N Will wastewater o her than domestic sewa be generated? Yes YC IF RF.SinFNCF. FILL OUT THE B X BELOW # People # Bedrooms I 4 Bathrooms GardenlTub� 'hirlpool 5Yes ONO Basement: ❑Yes No Basement lumbing: Dyes 1No IF NON-RESID I NCE FILL OUT T M BOX BELOW Type of Facility/B, iness Total Square Foot ge of Building 4 People # Sinks # Commodes i # Showers # Urinals Estimated Water U sage (gallons per day) i (Attach doc mentation of similai facility water consumption) i FOODSERVICEONLY: # Seats Type system request : Ponventional C ceepted ❑Innovative ❑Alt mative ❑Other Witter Supply Type4 County/City Neater 0 New Well ❑E isting Well ❑ Community Well i Do you anticipate ac ditions or expansions of die facility this sysfem is inter ded to serve? 2 Yes ' l(No If yes, what tyT e7 This is to certify ilia the information pTovidt J on This application is true and correct to the best of my knowledge. I understand that any pennit(s) of ATC(s) issued hereaftei are subject to suspension or revocation if the site is altered, the intended use changes, or if the in oimation submitted in 11 is application is falsified or clanged. I hereby grant, right of entry to the Authorized . Representative of t1w Davie County Health epartriient to conduct necessa inspections -to deterinine compliance with applicable laws and rules. I understand that I am respoi sible for the proper identifical ion and labeling of property lines and corners and lot ing and flag itt br staking the house/f iliry location, proposed wellcation and the locatign of any other amenities. '�- � Site Revisit Charge Property owner's or owner's legal represent 've signature Date(s): / o i Client Notification Date: Date i ERS: i i Sign given UYes E No !Account# Revised 11106 Vt�-- ; Invoice 4 7 ' o201�(rmi�rv� 7TL q G 1 o j L 1 Ce.Acti - dr OV AL t,4AwyG Ao' CIA r � i'' 50' w A� n ec Coo' s f 50 -� 0 0 0 \ V Ce.Acti - dr OV AL t,4AwyG Ao' CIA r � i'' 50' I (WE) HEREBY CERDF7 THAT 1 AM (WE ARE) THE OWNERS) of THE PROPERTY DESCRRE➢ IEEEON, "IT IS LOCATED N THE SlIB01VI5CN JURISDICROM OF DANE CIKNIY AND TIMI 1 HERE ADOPT THIS SUBONISKIN PAN ATILT M1' FREE CONSENT. ESTABLISHED MROMIN eunDNc s�aDK "� I��MINARY PLAT DEDICATE ALL STREETS (ROAD). AUETS. WALL'S. PAR/5 AMD ""`Fi9Y' R RECORDATION EASEMENT TO PUBLIC OR PRIVATE USE AS Norm. DAM SKIED OWNERS CONVEYANCES OR SALES R" E/P E/P PT PT. 30-00' Ir OO A PT. I r V W 0 1 I 1/4' REBAR SET r � � PT. Ir LUTHER 0. SHULAR DB 71 PG 407 S 90'00'00'E 210.58' 17940' �L48' TOTAL 1 ,A'7 p DM OO� DEEDS ftAT YON FILED FOR REGETRADCI AT O'COGK M. THIS THE DAY Or . 2019 ANO RRpCE9 N MT BOOR . PINE FEND FEE PAID: M. TRENT WIOIF, RFG6IEA OF DFEDB t 1.333 ACRES PT. o P/O DB 7 6 PG 74 AREA EX USIVE ^ OF RO R/W In I T 776 SPG AIN DB74 f 1.03 ACRES (REMAINDER) y POLE SHED PT. / Fh (to beA renoved) \8 y O 1/4' REBAR PT. �. SET C y / I -O \ 1 it� PP ^ EI FRAME v Vcm D .� o BLOCK SHED1 J e / \... IQ —I PT. PT. — S 90'00'00'V 43417' NELSON JONES DR 732 PG 946 IFCFNO DP COSINO IRON PN PS WON PN SET R/W RONT-OF-WAY DOME or PAVEMENT EA EDGE OF GRAVEL UTE CONCRETE MONUMENT A POWER POLE RRL MINIMUM BAIDNO LINE UP UCIr POLE —E— OVERHEAD SERVICE LINES Fr. PONT THIS PUT IS SUBJECT TO ANY FASEMENIS AGREEMENTS OR RIGNf-OF-WAYS PRIOR TO THE DATE OF THIS PEAT, 1-1/2' IRON -o PIPE FOUND Course Bearing Distance L1 N 14°58'44' W 16.58' L2 N 14'58'44' W t 0.300 ACRES L3 N 12'52'52' W 48,72' IN ROAD R/W N 09'02'02' W 50.43' L5 N 05'32'42' W 1 FL I N 02.16'52' W - 43.68' PT. PT. REBAR R/V FRANCIS SHULAR F , I ISET L9 ➢B 786 PG 1045 47.17' S 89.07'21'V m I I I N 09'02'02' W r N �- 82.69' E/P o R/R SPARE tSEi) R/R SPIKE -�— 5,89.07.21'V (SET) � E/P N 00.30'49' W 70.73' 98'70' —°L➢ TRACT LD+E PRELIMINARY PLAT NOT FOR RECORDATION R/W CONVEYANCES OR SALESL-- 1 CEDARGROVE CHURCH ROAD SR # 1811 20' PAV'T R/W E/P IFCFNO DP COSINO IRON PN PS WON PN SET R/W RONT-OF-WAY DOME or PAVEMENT EA EDGE OF GRAVEL UTE CONCRETE MONUMENT A POWER POLE RRL MINIMUM BAIDNO LINE UP UCIr POLE —E— OVERHEAD SERVICE LINES Fr. PONT THIS PUT IS SUBJECT TO ANY FASEMENIS AGREEMENTS OR RIGNf-OF-WAYS PRIOR TO THE DATE OF THIS PEAT, 1-1/2' IRON -o PIPE FOUND Course Bearing Distance L1 N 14°58'44' W 16.58' L2 N 14'58'44' W 41.60' L3 N 12'52'52' W 48,72' L4 N 09'02'02' W 50.43' L5 N 05'32'42' W 57.63' LIS N 02.16'52' W - 43.68' L7 N 00.30'49' W 71.42' LB I N 00.20'09' E 44.56' L9 N 12.52'52' W 47.17' LID N 09'02'02' W 48.51' L11 N 05'32'42' W 55.86' L12 N 02'16'52' W 42.37' L13 N 00.30'49' W 70.73' L14 N 00'20'09' E 44.51' E W. EEE COATER COMFY THAT THIS TMP WAS DRAWN RIDER MY SUPEIMSION FROM AN ACTUAL SURVEY MADE UNDER MY SUPEXVISCN. DEED DESCRIPTION RECORDED N OED] TOCK (s MIM). PAGE (s MwIW) WTO.: THAT THE ERROR OF CLOSURE AS CUAAATED BY LATITUDES AND DOWITURES 6 1/10,000. FROMTMNFORMATI N FOUND DEED BOOK (m MwIW) PAGE (9P MwiME BOUNDARIES NOT SURVEYED ARE SHOWN AS BROKEN LINES }EDTI TD THIS NAP WAS PREPARED N ADCORDVICE WTM CS {7-70 AS AMENDED. WITNESS MY HAND AND SEA. THIS�1.L' (D_ DAY OF 201OL SEPTEMBER PRELIMINARY PLAT RE, ND' ,SOB NOT FOR RECORDATION CONVE=YANCES OR SALES S FURS EDe MWENn A TION I. W, LEE CORER REGISTERED LAND SURVEYOR. NUMBER 7598 CERTIFY THE FOLLOWING AS NOKATED 11MOW. .1L A TMDTMNATaACDMTLALANIIS�THAM5LANWITHIN THE AREA AA UORNICPALRYTWAN ORDINANCE THAT REGULATES PARCELS OF LANG; SIGNATURE 7598 SURVEYOR REGISTRATION NUMBER STATE OF NORTH CAROLINA COUNTY OF DAVE 4 REVIEW OFFICER OF DAVIDSON COUNTY, CEROFY THAT THE MAP OR PUT TO WHICH THIS CERTIFICATION 6 AFFIXED MEETS ALL STATUTORY REQUIREMENTS FOR RECORDING. R/V E/P NELSON JONES I HEREBY COMFY THAT THE SUBONISION PLAT SHOWN HEREON HAS SEEM FOUND TO COMPLY TRA COUNTY LAND SURVEYING 11 1/2 HEST HAIR STREET THOHASV= N.C. 27360 THOUARVR.T.I'. A (336) 472-9408 LEXINGTON AA (338) 243-7429 WINSTON-SALEMW (336) 788-0703 DR 732 PG 946 WITH ANY. AS � �S IN THE MINIDNISION UTES THE PLAN WITH THE IXBOARDDAiND, TIMOF TR HAS VARIANCES. P APPROVED FOR RECOMNG N THE OFFICE OF THE REWSTER OF GOODS. R 6 HEREBY NOTED PRELIMINARY PLAT THAT SUCH APPROVAL FOR RECORDATION DOES NOT INCLUDE APPROVAL TO INSTALL AND URRE SNIffARYFACErtIFS NOR GOES R IN APPROVAL FOR RE Co167f81LTi0N OR OCCUPANCY OF NOT FOR RECORDATION BUILDINGS OR STRUCTURES. CONVEYANCES OR SALES DIRECTOR DAVIE COUNTY PLANNING DEPARTMENT D"IE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990005578 Tax PIN/EH #: 5767-52-5166 Billed To: Anthony Holman Subdivision Info: Reference Name: Location/Address: Cedar Grove Church Road -27028 Proposed Facility: Residential Property Size: 1.033 Acres Date Evaluated: kr%l) 2 t9 Water Supply: Evaluation By: On -Site Well Community Auger Boring Pit Public X— Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % jb0 HORIZON I DEPTH Texture group Consistence V Structure r Mineralogyl; (; HORIZON II DEPTH Texture groupC e Consistence Structure 150Z 5914 . Mineralogy l; HORIZON III DEPTH < < Texture group- Consistence Structure Ll Mineralogy1 ; HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE • 3 SITE CLASSIFICATION: l LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: 00dKPIA) �DQAJ CL& OTHER(S) PRESENT: 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. CONSTSTFNCR Moist 1 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 IYQt�a 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) I TAR - T n»o_tPrm arrnnronno roto 1/ 7 ../lr 1 ' _-- " - ■■■■■■■■■■MM■■e■■eM■■■■■■■■■■■■■■■■■■■■■ ■O■■■■■■O■■■■■■e■■M■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■e■■■■■■eINIe■■MO■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■M■■■■■■■■■■■■■■■■e■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ -----------••••••••■•■■■■■■■■■■e■■e■■■■��iiiiiiiiiiiiiiiii MEMO ■■MMM■■MMMMM■MMMM=-■■11■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■M■■M■MMM■■■■■MMM■■P....-_--__,�■�\■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MEN ■■■■■■■■■■■MMMMMM■I/■MMM■M■■M■�ll■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■'■e■■■e■■O■■1\■\■■■e■■M■■■■■M■■■■■■■■■■■Me■Mee■ ■■■■■■■■■■■■■■■■■■/■■■■■■■■■■fi:till■MSI ./ 1■■■■■■■■■■■■■■■■■■■■■■■■■■■ i�i■■■■■■ ■■■■■■�111■■■■■�1■■■llMnlftl■o[ �■�IM■■■■o�l■■■■tMl�■■■■M■1� ■■■■■■ ■■■■■■ 11■■■e■ ■M■11►'Fii ■SI ■ MOO■■■ ■O■■O■ ■■■■■■ ■■MEM■■OMEM■■■■■■■It■O■■■■Mee■I�U117■■■ ■■M■■■■■■■M■■■■■■■■■■MO■■■■ ■■■■■■■■e■eMO■O■ell■■e■■■■■M■■■efiMM■■ ■■■M■■■■■■■■■e■■■■■■■■■e■■■ ■■■■■■■■■■■■■■■■Erle■■■■■■■■■M■Mee■■■I II■■■■■■■■■■■■■■■■M■■■■■■■M■ ■■■■■■■■■■■■■■■■■��■■■■■■■■■■■■■■ ■Mil ■■■■■■■■■■■■■e■■■■e■■■■■■■ ■■■■■■■■■■■■■■■■rt■■■■■■■■■e■■■■■■■■■�O�I■■■■■■■■■■e■■■■■■■■■M■■e■■ ■■■■■■■■■■e■■■■■■M■■■■■■■e■■■e■■M■■■■■Mesh■■M■OM■■MMOe■OM■Me■OOO■■ ■■■■E■■M■■Mee■■■■■■■MMMMes■■■■■■■■■■ee■■■■■e■■■■■M■■■■■■■■■■e■ee■■ ■■■■■■■■■■■■■■■■■■■■■a■■■■■■■■■■■■■■■■■■eM■■■■■■MMM■■■■■■■■■■■■■■■ ■MNEMEMMM■■M■■e■■■■■■■■■■■■■■■■■■■■■e■■■■■e■ME■■ee■e■■■■■■■■■■■e■■ ■■■e■■■e■■■■■■■■■■■■■■e■e■e■s■Me■MMM■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■OE■■MEMM■■■M■MMMMMO■■■O■eOMe■ ■■■■■■■■MMM■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■O■■■■■■■■■■■��■■■MMM■M■■■MMee■■■■■■■■■■■.■....