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159 Marbrook Dr Lot 24 . "'••. DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Pd. Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004443 Tax PIN/EH #: 5758-02-2470 Billed To: The Solid Source Subdivision Info: Marbrook Lot#24 Reference Name: Location/Address: Marbrook Dr- Proposed Facility: Property Size: 125x240 ATC Number: 4761 C Site Type�w ❑Repair ❑Expansion nzatio **NOTE**This Authon 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�#Bathroom57'<PeopleL/ BasementO Basement plumbingo Non=Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Siz "30e 00C4V Type of Water Supply�County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD) M41Tank Size AL.Pump TankVI GAL. Trench Width Max.Trench Depth d Rock Depthj*Linear Ft. •4.P � Site Modifications/Condi 'ons/0 er: Idegr02'Y. L --wV Contact the Davie County Environmental ealth Section for final inspection of this system between 8:30—9:30a.m.on the day of installation. Telephone#(336)751-8760. As stated In 15A NCAC 18A.t969(5! accepted Systems may also be use •Lt,J� M►�• ry%N ,'may^J Environmental Health Specia ' t Date: 11CHD 11106(Revised) Ir • �'.' "' 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 M 990004443 Tax PIN/EH M 5758-02-2470 Billed To: The Solid Source Subdivision Info: Marbrook Lot#24 Reference Name: Location/Address: Marbrook Dr- Proposed Facility: Property Size: 125x240 b ATC Number: 4761 Site Type.Z<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.. �f� s Residential Specifications: #Bedrooms #Bathrooms'�' #PeopleL/ Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) i Lot Size�' c50i � Type of Water Supply-156ounty/City ❑Well ❑CommunityWell I System Specifications: Design Wastewater Flow(GPD)�ank Size/6kDQ'jAL.Pump Tank GAL. �i `'l'^ Trench Width _I Max.Trench Depth�q RockDepth Linear Ft. 4NO Site Modifications/Condit '/Ot er: �►`l��W, Ll� Contact the Davie County EnvhTon-mentilllealth Section for final inspection of this system between 8:30—9:30a.m.on the day of installation. Telephone#(336)751-8760. As stated in 15A NCAC 18A.i969(5) accepted Systems may also be use pd d I' (. QtE P'a�2 i-R ' 1vE �f N Environmental Health Specia ' t Date: DCHD 11/06(Revised) I u • o F� "� ct- vayst ootant•.� Cnv�,ea.w, •.+...., ._.. ,..._.. ,.. _ V � O LAPP AT N FOR SITE EVALUATIONJIMPP.OVEMFtiTPERNETBc ATC S� ASN 'Davie County Enviroorrtental Health P.O.Box 848/210 Hospital Street ES\ pPd\E Mocksville,NC 270214 (336)751-8760/Fax{330751-6786 M Applicatioa;or. =Site£v lautionilmpru,cment Pcrmit El Aur iarizAt_'ou To Construct(ATCI olF. Type of App',iar.!*n: ew Symcm .1R:,pair to:Justin,^•System t?Expan disa/Modillcation of i%isting System or Fa6lity ■3■11dPOATi'N7"•'THIS APPLICATION CANNOTBB PROCESSED UNLESS ALL OY'I':il REQUIRED INFORMATIUN IS PROVIDED. Refer to the INFORMATION BULLETIN lot itttstructiors. APPLICANT INFORMATION' ".,474x.. Name to be Billed � O i9 if r C'�r.'.;t Pers;r: 4_r�rls4dBilling Address ar•:e Phona. ,9 .. City/State/?SP-4 ewi el//r__/ �1 Busiricss Phone� ;1'! P __•_,--- 1 Name or Pwndtl lTC if Differnit d:nn AL:,-c Maili,-Address 6ty.'Statealp PROPERTY_INFORMATIbN =Date Hous h':..ilit Carries FF. ?.ed Ni7TE: A survey plat or Site plan must ac:ornpany t"-applicatitin. Inckdect itc Plan '-4iF1 (to scale) (Pemtit is valid for 60 mw.-hs%id si a plan,no expiration with coniplc'%:plat.) Oavaer's Natre ZZO z .__—____.. __ Ph na Nan'.1 Owner's Address Q C:ty.•atac/Zips-� tit�iMf��� Peoperty Addicts __ Cit O Lot Sizc j215L a7'� PL � a 0 Subdivision Nsttu(iltcabk) Mir 4Secti,tt ��_ Uttr i:i r.s Tu S:tcrez lf the answer to any of the following gpc•tic os is•des support doct:menntion Hurst be an_chcd. I Are th-reany existing wastewatct iystenw on the sir-? 'Yes tell I� Docs the site contain jurisdictiona wetlands. Oyes t-eo { Are them any easerneats or right-m'•ways on the site? OYes!t� Is the sitc rtbject tc approval by at:Esther public agcncy? OYcs tlrj� i Will wmicwatcr other than dormw r 4 sewage be generated? L Yes' .to •K _ _J IF RESIDENCE FILL OUT THE_B U BELOW _ Pcoplc #Bed== _ #Batlu wins Oardcrr Tils/Vairlpool Pfes `Nc 1 Basement`OYes Wo Base:rient Plumbing: uYes - -_ J i EF NON-RESIDENCE ML'0U1 'l'HE BOX BELOW 1 Type of F'acility/Business__. Total Square Footage c f Buk.ing— #Pcople 1#Sinks #Corwaodes___ #Showers 4 Urinal; _ t t Estirmkd Water Usage(gallons per dr.�­ _(Attach documentation of sirdlar facility water consuniptior.) FOODS ERVICE ONLY: *Beats Turin iVMtAnGalp,..iti. iir.,._....t:---t r' ..._s 811--d.. ..t.�.. Water Supply Type: �Iun /City watzr ;,New We:1 =Existing Neil f,:;,etrtn:uni; W c11 Dv yeu itstitiyate additions Q;expnrtaians of the facilit:r rtis systetu N but nJcti'u.;rsae.' Yes -- This ii to certify that:he infoiTrstion ptov:dt if on this rpl:li.a:ion is true Grid contut:o the beat os my know:.;gc. 1 understand that .t-►y permit(&)or A'1•C(t)issL-td h,!..aP.. •bjCtt:.�SuSNtaiiiuA t,t t.tx:aiiva is ti:e sits:is OitC!et:.:tn!iltteuded cie cl:a:,g:,s,or it the in'ormi ion submittcd in this appticatv,n.s fouiiit3 or 4,2%:d. i lu-5oy ons t iRhc of cy:, 'tt lu,�uL'.crizcd tieprc�-�.tait�r Zd WdZZ:b0 z00Z £T 'daS 8PZZ£Z69££ : 'ON Xtid JNI So2n0s tII'10S SHl W08 iii v �r �_ .. iiU1� .-•.�_....__..._._..-• - -. -.....-•'y':^ SiteRev���•ChncgC � P pex"y owner s or owners legal represpttwive si, atucc 8 8n. t D&tL PHS: t Si$ngiven LYr..c L:Ya Accousit qV3 Revised 11106 if M �le- bd Wd£Z:b0 LOOZ £1 'day GVZZ£Z69££ 'ON XUA ONI 33anoS QIlOS 3Hl WO2ld I i Solid Solid St Irtare C;auntef Tops TONY LAWHON 0ftic a33&9P3=2247 P.O.Box 713 Fax 336-9232248 Lewiswme,NO 21023 © �2 q r' � t o- N. 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DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT" /5q NIafl2mok Dr. Account M 990004443 Tax PIN/EH#: 5758-02-2470 Billed To: The Solid Source Subdivision Info: Marbrook Lot#24 Reference Name: Location/Address: Marbrook Dr- Proposed Facility: Property Size: 125x240 ATC Number: 4761 u **NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any give period of time. cv� 20 System Type:_-S.T.Manufacturer Tank Date r Tank Size./--,<,2 Pump Tank Size A X P System Installed By: (l E.H.Specialist: ��rmif 4 BedromS rKAV 6roo kva t g,�� •111( y� a 1 I� ii r I 1 DCHD 11/06(Revised) ICAT Oti F ITE EVALUATION/IMPROVEMENT PERMIT & ATC 2$ V J avie County Environmental Health P.O.Box 848/210 Hospital Street �MENZP�yA�jN Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 Applic 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 i 5 n Name to be Billed_L c,v`� 1-:r,tA7 t,)Q•ye t, Contact Person p< 2V &J.'— / Billing Address Ht,., X FJ f 6b,7-h Home Phone { City/State/ZIP f �.,� A/.r 2�_7L,Qk_Business Phone 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 Owner's Address Ro City/State/Zip Akkc, e- /U C• Z w 0 Cr, Property Address - •J ,G,k% C.•n f��_ City l d-7oC- �"I Lot Size (5—ple-In 0 Tax PIN# 6S Ok� Z5/ Subdivision Name(if applicable) k Section/Lot# Directions To Site: HL.-sy (04 L '1-_ T,,L Y, v S )eJ. S �IF 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 03q0 Does the site contain jurisdictional wetlands? ❑Yes Ogo Are there any easements or right-of-ways on the site? ❑Yes o Is the site subject to approval by another public agency? ErYes ❑No Will wastewater other than domestic sewage be generated? ❑Yes Bl oo IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms #Bathrooms t Garden Tub/Whirlpool (mss ONO Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ONO �f 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: CrCon`ventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: Dunty/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes D-N—o If yes,what type? Wag This is to certify thate 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 owneOllegal representative signature Date(s): ! Client Notification Date: Date EHS: f' Sign given ❑Yes ❑No ` Account# q173 Revised 11/06 Invoice# �—/ - I.r)i e;t rp n-rTC RD (5201 X763 `Za t r Nco , 081 AC oi t P,yI .arl ge d f .ti 01 or -3 c 5 i yea. 14 .( 74 UAg i 5 s �F r� t t .s 3� w �, 4 ••• , OR�t � 'N 4 �fi + JOHN CROTTS RDMAD {` �4a° y4t502 PHNCFOTTS FdO.AU 1 'P 6° "28) (219) (17fi) P3 11. li 543z> PaD - GnB L( (d g7A) 7210 U s \ o �i 6149 O� Y 181 920A1 _ M484) 0181 1 0 /J� 1 g CeB2 1 /�1 1081] a �J 63 co s. � PcC2 �� � X64 GaD CeB2 �u I15 00 � 1 160 W .P 6144 272 22 3 A GnC2 i GnB2 L25 TL 94 \ X52 JJ�3 R 61 7 d 7617 su (I C%6 9545 s0 t � (D in r 32 B r n. • r IQ U7 v j vi Ln C►? rt1 nm i 1 l r a.l 1, - r of • v' \20 225'017) i 1 ' x rN 2,„aVF 'IN F 1 _ 'rte ?` 7- • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004173 Tax PIN/EH#: 5748-83-9141.24 Billed To: Land First Development Subdivision Info: Marbrook Lot#24 Reference Name: Rodney Bailey Location/Address: John Crotts Road-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: O o7 i Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 71 Landscape position Slope% I HORIZON I DEPTH O-7 D 1 I I Texture groupI I Consistence $ P f Structure CjL CO ! Mineralogyf 1 HORIZON II DEPTH Texture group SIG C�_ i I Consistence I I Structure I Mineralo If W 1 HORIZON III DEPTH I Texture groupII Consistence 1 I Structure I i Mineralogy 5, 1 ' HORIZON IV DEPTH 1 1 Texture groupI ; Consistence I -Structure I Mineralogyd i SOIL WETNESS '— 1 RESTRICTIVE HORIZON _ I SAPROLITE -- ! CLASSIFICATION I vs 1 LONG-TERM ACCEPTANCE RATE nn ! SITE CLASSIFICATION: ►V S EVALUATION BY: LONG-TERM ACCEPTANCE RATE: ?'�� OTHER(S)PRESENT: REMARKS: LEGEND 1 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 t 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 �'�4lSt i VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm 3�t NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structure i SC-Single grain M Massive CR Crumb GR Granular ABK-Angular blocky I SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1 i 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/fU DCHD 05/05'(Revisedl I : 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#: 5748-83-9141.24 Billed To: Land First Development Subdivision Info: Marbrook Lot#24 Address: 228 NC Hwy 801 North Location/Address: John Crotts 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: ew DRepair ❑Expansion Permit Valid for: 0 Years o Expiration Residential Specifications: #Bedrooms #Bathrooms2*.T#People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply:�unty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: System,Ty2e LTAR Initial - O. Repair CL' /K Site Plan --- ' ` 4 W Jf1 tea.+. r 1 Ln af l Environmental Health Specialist Date 7 f i.p.11-06