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604 John Crotts Rd• DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street • Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 t OPERATION PERMIT Account #: 990004403 Billed To: Pro -Built Homes, Inc. Reference Name: Phillip & Drema Morris Jr. Proposed Facility: Residence 9 a ATC Number: 4722 Tax PIN/EH #: 5758-12-0460,01 Subdivision Info -*,(00 Location/Address: John Crotts Road -27028 Property Size: z,i3Zj a� **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. v GZ� Li i! System Type: S.T. Manufacturer �X U`f- Tank Date Tank Size_, 6_o_c> Pump Tank Size 7 ` r&_j dk I — el System Installed By: C) P ` )V�o ca d c E.H. Specialist: U 1 ate: Pct, LL Ae_d allm 111.( , y 1 I.� ..-� DCHD 11/06 (Revised) ,1,,, .jy o"..,:,. 7Geg; Ile 54, 1 04 fGce.T. CC; - 41` e-7 �w 4 3 s � G 14 e V ��O a a DCHD 11/06 (Revised) ,1,,, .jy o"..,:,. 7Geg; Ile 54, 1 04 fGce.T. CC; - 41` e-7 �w 4 3 s I,\IC T4IOIi FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC ------ --'`�!' Davie County Environmental Health f P.O. Box 848/210 Hospital Street JUL Z 3 2007 Mocksville, NC 27028 _ (336)751-8760/ =1-8786 Aplifiifli°" �i �jH I rte Eval 'on/Improvement Permit ion To Construct(ATC) ❑ Both ion: ❑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 Name to be Billed (V ,/f ",I 4'e. Contact Person ��'lt`yN Billing Address 2 t utir� Home Phone 4i7 y— gf�-X— City/State/ZIP 273,CO T prat tl s & /✓Lf- Business Phone _ 382 - C 2 3 `I Name on Permit/ATC if Different than Above . h •.l Dore,"•t Mailing Address City/State/Zip YKUYEK1 Y 11Nt'UK1V1A11U1N ^ Date House/t aclltty Corners Nagged 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 lei - 1 ,��, d�r,� Phone Number Owner's Address City/State/Zip Property Address lot / _To4., 020/ �,�� City Lot Size Tax PIN# Subdivision Name(if applicable) Section/Lot# Directions To Site: l'q C /,.fl r- loPkl 7i, f _%.0 leX 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 PRRo Does the site contain jurisdictional wetlands? ❑Yes PNo Are there any easements or right-of-ways on the site? ❑Yes [31f Is the site subject to approval by another public agency? ❑Yes a, wo Will wastewater other than domestic sewage be generated? ❑Yes QNo IF RESIDENCE FILL OUT THE BOX BELOW # People _4 # Bedrooms 4_ # Bathrooms 3 Garden Tub/Whirlpool p�cs ❑No Basement: VYes ❑No Basement Plumbing: &�es ❑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; [?60nventional []Accepted ❑Innovative ❑Alternative ❑Other. Water Supply Type: VICIounty/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? M 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 pern it(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 location, proposed well location and the location of any other amenities. i&✓ /f ,(' Property owner's or owner's legal representative signature Date Site Revisit Charge Date(s): Client Notification Date: EHS: Sign given ❑Yes ❑No Account # �►!33 0 Revised 11/06 Invoice # __� / (416.64') L-31 Total L-+2 L_�] bnled Stone free L_ •-t-NMP In SR 1603 Roadway _. Wilnm von t� V7 Proposed 30' Joint ' \ Access; Easement � 1 r' a. IA Part of` - %�'L!' Tax kta I 5.489 Acr +/ Lot 5 Lot 4 (Inclusive of area within R. 1603 R/W) N Proposed 30' Joint Part of Tax Lot 2 ty o Part of Tax Lot 2 Acorn Easement I Tax Map J-6 + LS Tax Map J-6 ws c°ni a cit ".r 1► L-34 Total +w 5.242 Acres +/- - 5.222 Acres +/- (8211.88)1 NI4P M SR 1603 RONwq (Inclusiveof area within (Inclusive of -a within U.S. HWY 64 R/W) Lot 3 1� 1 U.S. HWY (50.x) 64 R/W) Part of Tax Lot 2 IRs Plea°° M Une I q� Tax Map J-6 6.653 Acres ,tL Control Comer (Inclusive of area within U.S. HWY 64 k S.R. 1603 R/W) Irt61 i e /IRS Pbc.d M Line Proposed 30' Joint 001 / (30.70') Property Une = Approximate 1 .1 Accep Eoesment t6o' in Un• ._ Center Line of U.S. Hill 64 Property Line = Approximate v MIS placed ! - - NCGS Monument "Burgess" Corder Une of U.S. HW( 84 '-L-7 _ N: 238257.014 m -L_d ` E: 472823.773 m 1 -CF. 0.9999058 -NMP acL+/- mac- p76•, , U.S. Highway 64 Lot ry 9 J Tax 2.02 i .I I Tax LMotop J-6 CL 4- 60' Public R/W claimed by NCDOT '= '�" z \iNMP Inhna/er 8 O PG 273 us er 64 SR 160328'+/- Pavement g 1/2" EIR Fnd ER � Tax Lot 1 = \ / Map J-8 FJR nred 1 \\ \ John R. Sheek a f and wife I \ Lynn F. Shook Part of Tax Lot 2 \ DB 152 O PG 143 DB 181 O PG 788 Tax Map J-6 \\ \ I Lot 11 1 \ PS 273 � \ � 1 \ J __ _j �\ . \ t \ P� NCGS Monument "Foster" N: 237772.163 m E: 473192.803 m cF:0.9999033 Div \ PROPERTY LINE CALL TABLE B COURSE BEARING DISTANCE COURSE BEARING DISTANCE L-1 N59°16'48"W 137.70' L-20 N 24'00'58"W 121.97' p, L-2 N 65012'59 & "W 148.46' L-21 S 89.14'00"E 425.00' L-3 N 71'28'53"W 113.46 L-22 S 89°1400E 444.07' I (..) In Is, a.nRy that i am (w. are) tr. ewn.r(.) Of u. yracarty L-4 N 71'28'53"W 51.68 L-23 S 89°14'00"E 278.93' ae.cribea hereon, wNch 1. ioaotec In the .lodi isim 7vdedlauon or L-5 N 78°34'00"W 130.84' L-24 N 02°57'29"E 265.53 t3aw. eo..ty and that I h.raby adapt tine subdiAslon plan with rr y pre. L-6 N 78'34'00W 48.21' L-25 S 87'58'38"E 375.35' sent, .atobli.hed mlNmum building f.tba.k It.. and dedicate all L-7 N 85.46'42"W 202.06' L-26 S 33°28'41"E 316.06' sante. alley.. walk., parts and other cues oN easements to Pabfio or L -B S 87°19'15W 123.65' L-27 S 19'35'49"E 99.10' P6ats, uen as nates. L-9 S 81.46'46"W 234.12' L-28 S 09.03'25"E 99.00' Total Area L-10 S 79'56'32"W 129.62' L-29 S 03°45'07"E 82.28' (Inclusi L-11 S 79'56'32"W 275.00' L-30 S 03'45'07"E 250.97' $ .\5 _o Owners/Heirs Srar L-12 N 23°41'57"W 127.52' L-31 S 00'37'52"E 128.38' Dae etgn.e rpt )'`J Barbara F. Beane L-13 N 13°54'39"W 47.17' L-32 S 06°30'09"1N 97.03' '-•moo /J Albert L Foster 1" = 150' 50 L-14 N 46'45'49W 32.61' L-33 N 88.48'38"W 563. 2 28' r O�iWrL Lynn F. Shook L-15 N 30.52'03W 112.96' L-34 N 88.48'38"W 900.08' '.23-06 rgnw L-16 N 03'55'53"W 43.52' L-35 N 00°46'00"E 264.30' bol. SURVEYED: S SC L-17 N 21°42'57"W 54.91' L-36 N 00046'00"E 270.00' Address: ,DB L-18 N 01.47'14"E 64.89' L-37 N 07°24'30"W 601.33' 1420 U.S. HWY 64 E. ��` L-19 N 09036'33"W 98.87' 8 iS D b a.g lJ M..ville, NC 27028 GRS alt. I, eeora. R.an elan., aaneiona Lona sww.,ar, L -31st. cnnity t. on. a u. I.Ibewg o. I,MkelW ma., ® w �� STATE OF NORTH CAROLINA COUNTY l)F' DAME Fn.a r.r r.D 1.n. then ar m•,k°care w mal°�e°a°b- aM a Ibl ba John Crotts Road3a- 2 r.a a a,My rc munkiPogly on oralmrca Uwl rpNoln parch a bM. ' / Officer of Davie County, I, I�.th R 1 ma mu i. a ua i. baaue m l or ceeerrr}TTlllryry that the alt to plat to which this certification is meets of totutory requirements for recording. S •+ " • i b Plof eo.w .. as o w"y aKn partbn aro wwty a munklpalla tai . w,.qukl.. u to an a,alnoM. ewl n,,.at... 'Is.r am: offlxed 60' "Public R/W claimed by NCDOT n �. pial i. a . W oI on ..611 mal u..611, rq pemw or pwmb Review Officer: ` 22'+/- Pavement FII Ino F.. Pe �d ❑° a. ma ants P. k a ...mer a o,Mbr a.t.a.rr..van o. u» 1n, �I, \ � 4i✓ / ncambMoron a w. p.rc.... oow,-or - .aner .r ou« ....aron u, a.nnswn.r wedbwon: "NO APF EOUIRED, THE CO PLANNING DEPARTMENT" ., NMP near Mtanectton of or DE�YiieHMP p k Cl °/- of SR 1603 ., me m. krm 1 . oaaaw to ods e.,nyo, I..,,m -11 om ..,.u. is moa . an snassn to u.. e..e w my n.r.sknal Plano ng Director 1/2" EIR Fnd in J.. ' ouey - to 0,-ainsa In (o) Ill (d) ab.n. �[ [ G Planted Stone Fnd by w;uleea Iran Da (336.x6, Call �6 Total Road George R. Stone /< S.R. Lot 1 1602 Lot 1 Is on exempt minor subdivision. Lots 2-5 ora exempt due to the ores being 5 Acres +. Part of Tax Lot 2 \\� Tax Map J-6 \ NG E ,. Tax Lot 14 �� 2.825 Ac 'r 1' 2. Tax Map J-5 C r (Inclusive n/f Land First Development, LLC RS 660 0 PG 100 11'' "+� of area w 1603 R/W) >, Property floe = Approximate Center unit of U.S. HWY 84 3' ,n Dns g ,•� IRS Pixatl in Lin. \ (416.64') L-31 Total L-+2 L_�] bnled Stone free L_ •-t-NMP In SR 1603 Roadway _. Wilnm von t� V7 Proposed 30' Joint ' \ Access; Easement � 1 r' a. IA Part of` - %�'L!' Tax kta I 5.489 Acr +/ Lot 5 Lot 4 (Inclusive of area within R. 1603 R/W) N Proposed 30' Joint Part of Tax Lot 2 ty o Part of Tax Lot 2 Acorn Easement I Tax Map J-6 + LS Tax Map J-6 ws c°ni a cit ".r 1► L-34 Total +w 5.242 Acres +/- - 5.222 Acres +/- (8211.88)1 NI4P M SR 1603 RONwq (Inclusiveof area within (Inclusive of -a within U.S. HWY 64 R/W) Lot 3 1� 1 U.S. HWY (50.x) 64 R/W) Part of Tax Lot 2 IRs Plea°° M Une I q� Tax Map J-6 6.653 Acres ,tL Control Comer (Inclusive of area within U.S. HWY 64 k S.R. 1603 R/W) Irt61 i e /IRS Pbc.d M Line Proposed 30' Joint 001 / (30.70') Property Une = Approximate 1 .1 Accep Eoesment t6o' in Un• ._ Center Line of U.S. Hill 64 Property Line = Approximate v MIS placed ! - - NCGS Monument "Burgess" Corder Une of U.S. HW( 84 '-L-7 _ N: 238257.014 m -L_d ` E: 472823.773 m 1 -CF. 0.9999058 -NMP acL+/- mac- p76•, , U.S. Highway 64 Lot ry 9 J Tax 2.02 i .I I Tax LMotop J-6 CL 4- 60' Public R/W claimed by NCDOT '= '�" z \iNMP Inhna/er 8 O PG 273 us er 64 SR 160328'+/- Pavement g 1/2" EIR Fnd ER � Tax Lot 1 = \ / Map J-8 FJR nred 1 \\ \ John R. Sheek a f and wife I \ Lynn F. Shook Part of Tax Lot 2 \ DB 152 O PG 143 DB 181 O PG 788 Tax Map J-6 \\ \ I Lot 11 1 \ PS 273 � \ � 1 \ J __ _j �\ . \ t \ P� NCGS Monument "Foster" N: 237772.163 m E: 473192.803 m cF:0.9999033 Div \ PROPERTY LINE CALL TABLE B COURSE BEARING DISTANCE COURSE BEARING DISTANCE L-1 N59°16'48"W 137.70' L-20 N 24'00'58"W 121.97' p, L-2 N 65012'59 & "W 148.46' L-21 S 89.14'00"E 425.00' L-3 N 71'28'53"W 113.46 L-22 S 89°1400E 444.07' I (..) In Is, a.nRy that i am (w. are) tr. ewn.r(.) Of u. yracarty L-4 N 71'28'53"W 51.68 L-23 S 89°14'00"E 278.93' ae.cribea hereon, wNch 1. ioaotec In the .lodi isim 7vdedlauon or L-5 N 78°34'00"W 130.84' L-24 N 02°57'29"E 265.53 t3aw. eo..ty and that I h.raby adapt tine subdiAslon plan with rr y pre. L-6 N 78'34'00W 48.21' L-25 S 87'58'38"E 375.35' sent, .atobli.hed mlNmum building f.tba.k It.. and dedicate all L-7 N 85.46'42"W 202.06' L-26 S 33°28'41"E 316.06' sante. alley.. walk., parts and other cues oN easements to Pabfio or L -B S 87°19'15W 123.65' L-27 S 19'35'49"E 99.10' P6ats, uen as nates. L-9 S 81.46'46"W 234.12' L-28 S 09.03'25"E 99.00' Total Area L-10 S 79'56'32"W 129.62' L-29 S 03°45'07"E 82.28' (Inclusi L-11 S 79'56'32"W 275.00' L-30 S 03'45'07"E 250.97' $ .\5 _o Owners/Heirs Srar L-12 N 23°41'57"W 127.52' L-31 S 00'37'52"E 128.38' Dae etgn.e rpt )'`J Barbara F. Beane L-13 N 13°54'39"W 47.17' L-32 S 06°30'09"1N 97.03' '-•moo /J Albert L Foster 1" = 150' 50 L-14 N 46'45'49W 32.61' L-33 N 88.48'38"W 563. 2 28' r O�iWrL Lynn F. Shook L-15 N 30.52'03W 112.96' L-34 N 88.48'38"W 900.08' '.23-06 rgnw L-16 N 03'55'53"W 43.52' L-35 N 00°46'00"E 264.30' bol. SURVEYED: S SC L-17 N 21°42'57"W 54.91' L-36 N 00046'00"E 270.00' Address: ,DB L-18 N 01.47'14"E 64.89' L-37 N 07°24'30"W 601.33' 1420 U.S. HWY 64 E. ��` L-19 N 09036'33"W 98.87' 8 iS D b a.g lJ M..ville, NC 27028 GRS alt. 1EACPJjIq'ISITE EVALUATION/IMPROVEMENT PERMIT & ATC r- ! Davie County Environmental Health f 2oQi �� P.O. Box 848/210 Hospital Street � ��l ^ Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 l IiROPlh9Er nt HEALTH pplicatio\'t 'Sita`'liyaluati© rovement Permit ❑ Authorization To Construct(ATC) ❑ Both icahon Clew 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 Name to be Billed A;"I�/� F. MofY�'s J r. Contact Person Billing Address 6ht S. v`� G'sb�n, Sq- Home Phone (33 4) 7t5-,? - 03 9 2 City/State/ZIP 1V( 1 J — oc(cs v�' e IVC"' 2*629 Business Phon<&,_Q 92y-6$40 Name on Permit/ATC if Different than Above Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged ?L yJ0 7 NOTE: A survey plat or site plan must accompany this application. Included: CVSite Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name 73—r�ara 31 gi Q l Phone Number Owner's Address ep C v_ City/State/Zip Mde.(c6&, Ile AIC. Z�o2B Property Address 70;% Cry Lo'r Y City lqe C-1<Svi'll e Lot Size 2. 6 Z /.1c+res Tax PIN# 5-F 5-49 120 K60 Subdivision Name(if applicable) Section/Lot# Directions To Site: 14 &,L v✓4.4 Cy CAsr. 1 ".rr., ,Tvhvs G►rolfsPei 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 51No Does the site contain jurisdictional wetlands? ❑Yes NNo Are there any easements or right-of-ways on the site? []Yes IgNo Is the site subject to approval by another public agency? ❑Yes ;lNo Will wastewater othei than domestic sewage be generated? ❑Yes ONo IF RESIDENCE FILL OUT THE BOX BELOW # People y # Bedrooms S # Bathrooms 3. S Garden Tub/Whirlpool VY' es ❑No Basement: Yi'es ❑No Basement Plumbing: VYes ❑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:.,lConventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: EYCounty/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes C3—IQo 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 st ,l iN OifAuse/facility location, proposed well location and the location of any other amenities. Site Revisit Charge Property o is or owner's 1 resentative signature Date(s): NI'LlIo 7, Client Notification Date: Dae EHS: Sign given []Yes ❑No Revised 11/06 Account # Invoice # �f lUr APPLICANT INFORMATION Account #: 990004291 Billed To: Philip Morris Reference Name: Proposed Facility: Residence Water Supply: On -Site Well DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5758-12-0460 Subdivision Info: Location/Address: John Crotts Road -27028 Property Size: 2.62 Acres Date Evaluated: :3 — D_':'' �—d -7 Community Public SITE CLASSIFICATION: 2 U-�0Iuc`�.� �rP EVALUATION BY. a.� ,�J CORth-4 LONG-TERM ACCEPTANCE RATE. �, `�� OTHER(S) PRESENT: REMARKS: c' -t" C(y i U IC4 --7 LEGEND ,� / , f f Landscape Position ' ' 5 dk ldf lV ICv+�" 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 mDiq VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm W NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structtire 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 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) FACTORS 1 2 3 4 Landscape position C tL L v k0 Sloe % 01 �-- ry HORIZON I DEPTH 0 ` 0 — 1 0 Texture group G G Ci C Consistence ,7 ti Structure 116, 57h k-- Mineralo =Ir HORIZON H DEPTH - Lf — 3 Texture group C. Consistence Structure L Z70 y 4;1 Mineralogy1:1,A HORIZON III DEPTH Texture group Consistence I Structure Mineralogy r"Y HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS 7 46'/2- 2 RESTRICTIVE RESTRICTIVE HORIZON Z.,/ SAPROLITE CLASSIFICATION I V`' • 1 Pr el Lj -5- �6' LONG-TERM ACCEPTANCE RATE , a 5 b 2 -W6 �' 55- SITE CLASSIFICATION: 2 U-�0Iuc`�.� �rP EVALUATION BY. a.� ,�J CORth-4 LONG-TERM ACCEPTANCE RATE. �, `�� OTHER(S) PRESENT: REMARKS: c' -t" C(y i U IC4 --7 LEGEND ,� / , f f Landscape Position ' ' 5 dk ldf lV ICv+�" 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 mDiq VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm W NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structtire 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 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) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MENNENiiiiiiiiiiiiVJ� MUNROE iiiir■iiiiiEMNON MENNENli�l ■■■■■■■■tee■■■■■■■■■■■■■■■■■■Ile■■■■■►e�e■■ee��■rl■■■■■■■■■■■■■■■■■e■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■i��■�■■celi.�■■■■e/e■■e■■e■■■■■■■■■■■■■ ■■■■■ri■■■■■■■■■c■■■■■■■■■■■■n■■i■■■■er�■■■■■■■ell■■■■■■■■■■■■■■■■■■■■ ■■■■■e■■■■■■■■■■►-s■■■■■■■■■■11■n■■■■■!a■■■■ice■1l■■■■■■■■■■■■■■■e■■■■ ■■■■RI/J■■■■■■■■■■■E*'/.7■■■■■■■■1l■r/!A■■■■eJ■■■■KINUUM■e■■e■■■■■■■■■■■NONE ■■■■■■■■■■■■■■■■■J■■G�Ii11:\roe■11■I�■■■■■■■■■■�!�■/,■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■6■\`■\\■11■i■■■■■■■■■■!7■■■lee■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■C/l\\1\tl■■■■■■■■■edli��■11■■■■■■■■■■■■ecce■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■:11■►\■\\I■■■■■■■■■■■Ill'!■It■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■\■its\■■■■■■I■■■■■■■■■■■■■■■■■■■■■■ N. Davie County GIS Online a 4 Yi 'i RO<Tasr a., lx- rerty44xT C) 13"132.2515; J'40000000 2o5 2• d2$- 3�n� c3 E -7 -AL sip Tax PI N:c ,S �5-8120 Y66 Legend �.� arrests N MASTAT€ RA#ia 1% PR NATE Pjax A= ARZA Property O nsions Property Lines r, .,i Strerrrm ��fj4 X x R SITE EVALUATION/IMPROVEMENT PERMIT & ATC 12 2006 Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street/, L;�'—mn—mmMl��HEAITN - Mocksville, NC 27028 7s oAv►EcouNn (336)751-8760/ Fax (336)751-8786 Application For: Aite Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both 'IMPORTANT " THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Bill Billing Address City/State/ZIP Name on Permit/ATC if Different than Above Mailing Address PROPERTY INFORMATION Contact Person _)t-JOBElZ-1' S`rO"a _Home Phone Business Phone 3 3 (e - �J 9 8- y 7 3 3 City/State/Zip NOTE: A survey plat or site plan must accompany this application. (Permit is valid for 60 months with site plan, no expiration with complete plat.) Street Address t �, 1 OH tJ Ci/lo 1-rS 1140 City v G 1LJik/j U-( Tax PIN# S 7 S 8 o 1-T L 55 Subdivision Name I- ,-2 F-4 r' SHt-c K Section/Lot# I Lot SizeZ � 6 Ae '-+' Directions To Site: 0 5(, ((_; 4 5 T "T o -1 o )A )� C o T'T r,/ 5 e ( J K i ko 3 S 1 T'c 1 S Li T- ► U 1-,1 -3 v)4 to G 2v ?%S" ,2/J go O L 7= P,/c v .� �— Date House/Facility Corners Flagged t 7- /0-0& If the answer to any of the following questions is "yes", supporting documentatioj� must be attached. 70 Are there any existing wastewater systems on the site? ❑Yes Does the site contain jurisdictional wetlands? Dyes V�qo Are there any easements or right-of-ways on the site? [Yes ❑No Is the site subject to approval by another public agency? &(Yes ❑No Will wastewater other than domestic sewage be generated? Dyes 51No IF RESIDENCE FILL OUT THE BOX BELOW # People .3- # Bedrooms a 3 # Bathp°oms Z Garden Tub/Whirlpool ❑Yes EtNo Basement: ❑Yes &&o Basement Plumbing: ❑Yes [Wo 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: ❑Accepted ❑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 [II 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 understand that 1 am responsible for all charges incurred from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with a plicable laws and rules on the above described property located in Davie County and owned by (- V N W sl f r- f le C t ad - Site Revisit Charge Proper er's or owner's legal representative signature Date(s): D 6 Client Notification Date: _ ~' Date Sign given Dyes eNo Revised 2/06 EHS: Account # '�_ _ Invoice # APPLICANT INFORMATION Account #: 990004037 Billed to: Lynn Sheek Reference Name: Proposed Facility: Residence Water Supply: On -Site Well Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiySite Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5758-01-7255 Subdivision 75 - - Subdivision Info: Foster, Bean, Sheek Lot # 1 Location/Address: John Crotts Road -27928 / Property Size: 2.8 ac Date Evaluated: Community 1. Auger Boring ✓ Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % 6 HORIZON I DEPTH Texture grou 4- Consistence, Structure / C� Mineralogy /14 HORIZON II DEPTH Texture group Consistence Structure S Mineralogy . / ' HORIZON III DEPTH 'IyXII Texture group G�14.1 AP Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: /"y 6A M n D �f �EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: 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 oist 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 MineraloU 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 I ID 05199 "Revisr!(f ....�e.�................CC� ::C::C::::C::C:CC:::::::��oC:: ... .0 ................ � �.. ..................� .............................. . . 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H. ,., .. ... _.. _..x-:�.,., �,. _. . ...,.z._,. . . « ... . , �. .:..i.�,�Y+k ...........s...si �..Cf- _ .._...,....5�� ..'k&a�:.._�.,..Ys-y. gr: . ...Lt+�_ _.an_sw_.<a-:,�`�.s,,. ..se.�.. ....,�.�a a�.. .e..,_..�..n.. .._ ...+.. .. .._ ._ . ......,..,... .._. .... . , . . . .. -�. .. .. .n._ fi,. . .. � , .. r.,. .. . . .�. _ ,�v,.,...a� n +!...�L§�_ �.�.,. ....tss�.��f;`.� .. ...:a:NrGCNk:�r_. .�S,�rnelw�.�.._,.. :�a,x..,..._.�eC��2+ �i�g*isx.��.'T�i."6�'�� ...;'�:+�.:_'t.w��:w�.,-., ...a . _.,;�'�fr'T ... .��e��'y.��''.is.+�..w ... . . Davie County Health Department Environmental Health Section P.O. Box 848/210 HospitalStreet Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Improvement Permit July 27, 2006 Ms. Lynn Sheek 1420 US Highway 64 East Mocksville, NC 27082 Re: John Crotts Road Tax PIN# 5758017255 Dear Ms. Sheek 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 or the intended use change. System To Serve: ��—Wastewater Design Flow(GPD): Valid: RI—Y--ears ❑No Expiration System Type: ❑Conventional /A*ccepted ❑Innovative ❑Alternative ❑Other Site Modifications/Permit Conditions: .i / }�� As stated in 15A NCAC 18A.1989(5) may a Environmental Health Specialist Date i.p.letter 7/06 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 #: 990004403 Billed To: Pro -Built Homes, Inc. Reference Name: Phillip & Drema Morris Jr. Proposed Facility: Residence ATC Number: 4722 1'3�ag 3•$0 Tax PIN/EH #: 5758-12-0460 Subdivision Info: Location/Address: John Crotts Road -27028 Property Size: 2.825 Site Type: ewl❑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 q- # Bathrooms 3 # PeopleA BasementB'Basement plumbingpl� Non=Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size Type of Water Supply: VCounty/City ❑Well ❑CommunityWell �OOd % Dam System Specifications: Design Wastewater Flow (GPD)'I/� 0 Tank Size / GAL. Pump Tank GAL. C. (r 1I // u Trench Width 3 (-" Max. Trench Depth'14 Rock Depth Linear Ft. 6 LT 0 Site Modifications/Conditions/Other: As stated in 15A NCACX*6"Ar, i5� fications/Conditions/Other: r <Ipms ma n1so be use � c.n C�0 a66�'�'3tG'd ��C. ;r �, V c C•7 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. .. CL #. rvr4 w/ <-JPI 1- 9- , e- (-) 6, t) " \ U __Tv7 Eavir�=Atal Health Specialist_T y� �i/i/ Date: % — _67 DCHD 11/06 (Revised) Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Account M 990004403 Billed To: Pro -Built Homes, Inc. Address: 3321 Lower Lake Road City: Thomasville IMPROVEMENT PERMIT Tax PIN/EH M 5758-12-0460 Reference Name: Phillip & Drema Morris Jr. Proposed Facility: Residence Subdivision Info: Location/Address: John Crofts Road -27028 Property Size: 2.825 **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: �w ❑Repair ❑Expansion Permit Valid for: P ' Bears ❑No Expiration Residential Specifications: # Bedrooms # Bathrooms 3 # People 1 BasementCasement plumbingt]� Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD): 'l aU Type of Water Supply: 91e6unty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: As stated in 15A NCAC 18A.1969(5) ZQv�C�� ,Si lan System Type LTAR Initial AGC c a 6 - eJ Repair c9 C) • <7 Health S-oeciali C> - T 4AI Date /X—I (—"D-7 M-4 � � C SJ`l e� Ho L -C d� afag501401),e 61 / ICJ Zp S !l�G�.� —�(J % G r — !'l r/ ( �j g� CPO -e l .. 3 _ ® I Environmental Health Specialist �Date:. DCHD 11/06 (Revised) any permit(s) or kMs) issued hereafter;aze subie�t " + 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 #: 990004403 Tax PIN/EH #: 5758-12-0460.01 Billed To: Pro -Built Homes, Inc. Reference Name: Phillip & Drema Morris Jr. Proposed Facility: Residence ATC Number: 4722 Subdivision Info: Location/Address: John Crotts Road -27028 Property Size: ;Z,61f Rd - Site Type: �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 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 to # Bathrooms 3 # People BasementVBasement plumbing Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size Type of Water Supply: (Sunty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) '7 I'O Tank Size / 0 GAL. Pump Tank GAL. Trench Width r Max. Trench Depth 3 Rock Depth_Ll_ Linear Ft. As stated in 15A NCAC 18A.1959(5 �� :r -o Site Modifications/Conditions/Other:stqms u tea* p vi c o� Contact the Davie County Environmental Health Section for final inspection of this system between S -t'1 8:30 — 9:30a.m. on the day ofjnstajUation. Telephone # (336)751-8760. h 5 Environmental Health Specialist ;%i'�i�`.�C _. Date: —e- 7 DCHD 11/06 (Revised) u 1ti7r3� _-------- Trc:.At > 5-e ;. pfu -ez` Pr�G IN D 3 ,� c.e.a u; f Environmental Health Specialist ;%i'�i�`.�C _. Date: —e- 7 DCHD 11/06 (Revised) Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville NC 27028 (336)751-8760/ Fax (336)751=8786 IMPROVEMENT PERMIT Account #: 990004291 Tax PIN/EH #: 5758-12-0460 Billed To: Philip Morris Subdivision Info: Address: 649 S. Salisbury Street Location/Address: John Crotts Road -27028 City: Mocksville _ Property Size: 2.62 Acres 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: ❑New ❑Repair ❑Expansion Permit Valid for: F5 Years ❑No Expiration Residential Specifications: # Bedrooms# Bathrooms �, 5 # People Basement0'Sasement plumbing<;i— Non-Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD): Ile 0 O Site Modifications/Permit Conditions: Type of Water Supply: -915ounty/City ❑Well ❑Community Well As stated in 15A NCAC 18A.1959(5) accepted Systerns-may al&o ba used System Type LTAR Initial Re airGe •1� Environmental Health Specialist i.p.11-06 Date —3—a4 U-71