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144 Elberon Court Lot 5 DAVIE COUNTY ENVIRONMENTAL HEALTH 01 P.O.Box 848/210 Hospital Street Mocksville,NC 27028 OI (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account M 990003628 Tax PIN/EH M 5758-03-5240.05 Billed To: R.A.Freeman Construction Subdivision Info: Marbrook Lot#5 Reference Name: Location/Address: Elberon Court-27028 Proposed Facility: Residence Property Size: 0.69 ATC Number: 4725 **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. -ry ��` X11 / �� J System Type: S.T.Manufacturer Tank Date Tank Size Pump Tank Size System Installed By: 1. H.Speciate CS� 11 QUI IC4-4 S�rb N� �i ►�1Ct,td r r �6 :',t T i JL s DCHD 11/06(Revised) rrr. DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 AD (336)751-8760 Fax#(336)751-8786 -'4 % i AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990003628 Tax PIN/EH#: 5758-03-5240.05 Billed To: R.A.Freeman Construction Subdivision Info: Marbrook Lot#5 Reference Name: Location/Address: Elberon Court-27028 Proposed Facility: Residence Property Size: 0.69 ATC Number: 4725 Site Type:�tew ❑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 Ll #Bathrooms 2 #People q Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size �- 1—"" ' "Z Type of Water Supplyrunty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD) 160 Tank Size 1060GAL.Pump Tank GAL. r• ,� r Trench Width Max.Trench Deptnh� Rock Depth_ Linear Ft.'1 0 Site Modifications/ onditions/Other: 1�) 6 U is 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. ' j Vf� t-ln�c .lO' Environmental Health Specialis Date: DCHD 11/06(Revised) • APPLICATION F TE EVALUATION/IMPROVEMENT PERMIT & ATC �n avie County Environmental Health Q V P.O.Box 848/210 Hospital Street Mocksville,NC 27028 Q \ 36)751-8760/Fax(336)751-8786 Applic n r: Celle Evaluatio roveme t Permit ❑ Authorization To Construct(ATC) ❑ Both Type of p tion: OR ' o Existing System ❑Expansion/Modification of Existing System or Facility ***IMP RTANT* T PLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFO TIO ROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be BilledA4, A4fh h!2 Contact Person Billing Address 17,5- SIMS nr. Home Phone y36 City/State/ZIP L"iSdi1TA)C, 2_&q3 Business Phone 336 - -tra�96 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 isv id for 60 months with site plan, o expiration with complete plat.) Owner's Name r-e—e vt Phone Number 7io�-lo q� Owner's Address City/St e Property Address pt C City. 5 (e_ Lot Size - o�S X IS-4 Tax PIN#� �d 3 S�go Subdivision Name(if applicable) h b n o Sect' ot# bo Directions To Site: 61 1,15 c7 1^ C�otkl If the answer to any of the following questions is"yes",supporting documentatio must be attached. Are there any existing wastewater systems on the site? ❑Yes Zlo Does the site contain jurisdictional wetlands? ❑Yes Ao Are there any easements or right-of-ways on the site? ❑Yes500 Is the site subject to approval by another public agency? ❑Yes6 Will wastewater other than domestic sewage be generated? ❑Yes IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms #Bathroomsarden Tub)Whirlpool es ❑No Basement: ❑Yes o Basement Plumbing: ❑Yes 5R16' 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:. [)Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other s- d 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 U-N 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 staki_ th 7%A_XP4Z_AMa_ /facility location,proposed well location and the location of any other amenities. �& Site Revisit Charge Property owner's or owner's legal representative signature Date(s): -7 7 Client Notification Date: _ Date EHS: Sign given ❑Yes ❑No Account# 4110 Revised 11/06 Invoice# l j"CROT'f8 RD SITE X ILL MWftR DR i+D U3 64 i VICINITY MAP NO SCALE ie2 ` JOHN CROTTS ROAD SR 1602 PAVED NEGATIVE ACCESS EASEMENT _ S 34.37' 42" E ALONG JOHN CROTTS ROAD 125.00 125.00 6 5 4 0.69 AC. 0 m � ai N ��1✓ M N 3 w o � � N N jn � � �2o�ooslti0 In co O I Z M 50.0 `d — — 125.02 — — _ _ — _ 125.00 F N 34.33'57*' W ELBERON COURT PAVED SURVEY FOR RICK FREEMAN CONSTRUCTION MOCKSVILLE TOWNSHIP DAVIE COUNTY NORTH CAROLINA 1 e TAX REFERENCE J5170A0005 PIN #5758035240 JULY 23,2007 vf.`'�i`�`r�,��r"''�� LOT 5 � V. MARBROOK I f g P.B. 9: PG. 152 A , ,� 4• O EXISTING IRON PIN qr 1 p•�";�,o AREA BY COORDINATE METHOD 460§21040 RATIO OF PRECISION 140,000. MICHAEL D. HODGE SURVEYING 31 VANCE CIRCLE ,4, _3 y76 7-2S-+07 0 IO 25 50 loo LEXINGTON.NC 27292 336 - 243 - 7480 DRAWN BY: I"=50' DRAWING " 2444 t o ICAT�gN F ITE EVALUATION/IMPROVEMENT PERMIT & ATC. avie County Environmental Health P.O.Box 848/210 Hospital Street N�o Mocksville,NC 27028 01 Oh�� _ (336)751-8760/Fax(336)751-8786 Applic n or: 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 n Name to be Billed ( .r, v..� 1-:r,A- 1)cz,/e v 0,w�}' Contact Person p<b�n _y �J-Z_y Billing Address Hoy J'_1 / 6&,,1-h Home Phone City/State/ZIP f4&!4: 4 � 2- Business Phone C/6 -� 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: ite Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name Phone Number 001 - Owner's Address Sol City/State/ZiJC. Z 7yy�, Property Address___ G,h C., a ;KX►. City !1 O,_ Lot Size X22, �Tax PIN# Subdivision Name(if applicable) W r,r >r..)k Section/Lot# Directions To Site: Ht-5y (04 L 'k— T-kms he�, — 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 ❑ o_ Does the site contain jurisdictional wetlands? ❑Yes [moo Are there any easements or right-of-ways on the site? ❑Yes o Is the site subject to approval by another public agency? es ❑No Will wastewater other than domestic sewage be generated? ❑Yes BN`66_ IF RESIDEN E FILL OUT THE BOX BELOW #People #Bedrooms T #Bathrooms Garden Tub/Whirlpool D Yes ONO - Basement: ❑ es Fl Basement Plumbing: ❑Yes ❑No , 4 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: M76nventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ounty/City Water ❑ New Well ❑Existing Well ❑ Community Well i Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes G-N-0 If yes,what type? f This is to certify thal"fhe 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 staking the house/facility location,proposed well location and the location of any other amenities. Site Revisit Charge Property er' or owne s legal representative signature Date(s): l`- ;2 !�=�� Client Notification Date: Date EHS: Sign given ❑Yes ❑No /L Account# 73 Revised 11/06 G( Invoice# CROTTS R 44 ', 1� N 1 • 1� µ {Q� r 31 �b 7210 I a ' e i Y t 4" � . ; r2• b' � � .� 4i SSS.. n. � � .qo �p�� 3'. ynFi'A •'� r 6149 a+'.1 . V�. �, .• �,4 Ski or 'it l•T q,„r �j'r A •4 � x ,r .-� K r a 14, •} .. 3+. "�R#. .d r r r p �It 10 1 •+ � qf' F"� "ria, � '' '"b _ b -. 5 (l 81A 41_ J �+�ay,41 st hot y n� �_ r 'w Ar r �r�vr w se•i ._. .. 1l�g I;..�1 ♦' •. �','_.� 4,�r .�� +7 f�•�tYi-�� 3x 'vi Of Y rto Yr !� y ,..� � � a• � 3 X1543 c,J; _ i y •. JOHN CROTTS RD � 520, 4763 ao :.,;., ._ [6621 ' ... X21602 ,PHNCFDTTS MAI) 40 s� & 764$ FOPD ... . ail 0 P B) 1176)UP-54 291 6]31 u s E 417 Co 03 Pa D GnB Ca 97 A) H 7210L°9 9682A \ 6149 �� o (H 20 A) (e5494) bpi 0181 9141 CeB2 loa;) a y (1.81 A 0M) (/�\163 W v 1" .3 e@ PcC2g, 2564 GaD CeB2 l3J0) (iS \ SR 00 M } N r-- 1 160 (16.984) 1 6144 2 27Z2gA GnC2 ,�, GnB2 I Ltl Y s4 usioi �z (Z67A) 7617 (20 50 is�d f9^546 e 1 AW r i C I I �7 c] T d LP z rt �. � .Pi N jN • - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004173 Tax PIN/EH#: 5748-83-9141.05 Billed To: Land First Development Subdivision Info: Marbrook Lot#05 Reference Name: Rodney Bailey Location/Address: John Crotts Road-2702 Proposed Facility: Residence Property Size: see map Date Evaluated: 1 t 07 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% Seo - HORIZON I DEPTH p r I O O (o Texture group 5 G CIL S i L Consistence Structure 5Sk < S31 Mineralo s� HORIZON R DEPTH t o- ) - 21 IV,-14-7 Texture group S;CL•+ S;C S c±+ Consistence P Structure 55k -C-13k Mineralogy HORIZON III DEPTH 3�l�r 5D 21 - Texture groupSl S;CL+S�► Consistence r a Fr S Structure k Mineralogy F) HORIZON IV DEPTH 4t>-LA Texture group 9;L Consistence Structure Mineralogy SOIL WETNESS — - RESTRICTIVE HORIZON 34 40 - SAPROLITE 0 L) - CLASSIFICATION ps LONG-TERM ACCEPTANCE RATE EO.275 O• 1•17 7S SITE CLASSIFICATION: 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 1l�ist 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 dotes 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) • Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990004173 Tax PIN/EH M 5748-83-9141.05 Billed To: Land First Development Subdivision Info: Marbrook Lot#05 Address: 228 NC Hwy 801 North Location/Address: John Crofts Road-27028 City: Advance Property Size: see map Reference Name: Rodney Bailey 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: Aew ❑Repair ❑Expansio/nPermit Valid for: 05 Years o Expiration Residential Specifications: #Bedrooms 71- #Bathroomsz--�r#People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): �' Type of Water Supply: ounty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: System Type LTAR Initial Repair �D SitePlan o V ILI Environmental Health Specialis Date 7 i.p.11-06