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161 Elberon Ct Lot 9 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account #: 990004403 Tax PIN/EH M 5758-03-1393 Billed,To: Pro-Built Homes, Inc. Subdivision Info: Marbrook Lot#9 Reference Name: Mike Miller Location/Address: Elberon Court-27028 Proposed Facility: Residence Property Size: 1.004 ATC Number: 4799 **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:JWP' S.T.Manufacturer SleaF Tank Date 2,e7 Tank Size Pump Tank SizeW System Installed By: Roar is ,tiy E.H.Specialist: Date: ily 1 A 1 3 30 v a y EL3 CONR,\ VCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 'V AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004403 Tax PIN/EH#: 5758-03-1393 Billed.To: Pro-Built Homes, Inc. Subdivision Info: Marbrook Lot#9 Reference Name: Mike Miller Location/Address: Elberon Court-27028 Proposed Facility: Residence Property Size: 1.004 ATC Number: 4799 Site Type:�Iew ❑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 #BathroomsZ'r'#People Basement❑ Basement plumbing❑ Non=Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size A Type of Water Supply: County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD)::�3teOTank Size kTCUL.Pump Tank GAL. Trench Widtth Max.Trench Depth�Z ©R,occkk D,epMth� tLinear Ft. 3.-ro Site Modifications/Conditions/Other: 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. -15'o�>7rtrci �l�' S• �:N►4r5� k�) ce p, Environmental Health Specialist te: a �/ DCHD 11/06(Revised) Ty�.�re F63�'t':-� '1"b.,4 4 RY.. '}•K4• ,.!r� ❑qw�+", py :j;., .cam '4 P,. u as § ren Y TI � r r ter. 4 ' r" 7`411 .-?r {. {` e kA V. t2a Spy ' � P ,..,• fit. a ,.! r d VV ICAT O F ITE EVALUATION/IMPROVEMENT PERMIT & ATC v 2 a avie County Environmental Health P.O.Box 848/210 Hospital Street ZP��FA`ZN 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 Name to be Billed_(_�,��� E-:?-i A- 17Q.ye Contact Person W- .4 n2'v &-J-Z- / Billing Address $ Hoy S,„'J-h Home Phone City/State/ZIP ��; .4 4. 2—aVJQ 2 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 v l �-.p ., Phone Number ��J�•- C� Owner's Address go/ Sc, l., City/State/Zip 4 mac'-e-e- n JT Z 7Zy(o Property Address G,c•� C fa ��1- City 4-'70,- V, l� Lot Size c5e-e-In AP—ax PIN# Subdivision Name(if applicable) ,.o k Section/Lot# Directions To Site: Htsl! (o({ 1^ �k-- �'vtir+ �✓v ��. �� �,� rev Sc� C� `2 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 ❑No Does the site contain jurisdictional wetlands? ❑Yes Olgb- Are there any easements or right-of-ways on the site? ❑Yes-moo Is the site subject to approval by another public agency? eE�I' s ❑No Will wastewater other than domestic sewage be generated? ❑Yes R3q-o� IF RESIDEN E FILL OUT THE BOX BELOW #People #Bedrooms -7 #Bathrooms I 'L Garden Tub/Whirlpool Byes []No Basement: ❑Yes ❑No Basement P'luurrobing: ❑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: ❑'Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: (J- ounty/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes B-N If yes,what type? This is to certify tha a 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 owno legal representative signature Date(s): 4Z. ,2 -,- Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# ?173 Revised 11/06 Invoice# F � � 1 T S 1 D sao� 4763 a N7, RO - s eat V`• 1`ni—Fiir r` t y� + C1331 i OL .,� as i✓ r 1 Nd co µ j' i `... k•. bL x, .,{�4r �,y,. } .'A nF'� � '. } y:' •�N u`�'�"L..' � l� 1\. � e' 'P 7rw� a..' `y, ,1•, I a+'�'r. Fr�l .' -4 t x 'sv _--. t 7 §� ,. C I - M a 1 n !f,; • e M 3' p JA � .,, tY�+� w.ysy r,� I�"� � ..'�'...�xr NNN1 �• r" ` $ x � :. x :rY� •. � d i' ;. �. i-w� N �' � :f f"x -r. �.. � ` -.1i ->tA xtTy' ; ' .k''w S .r "r # 4 Th.�� - ... -{► a -.� H+' ,_..� 5 Y.. �'� +r '...:,,� r(r Q _iO�,. r .. 1 ' S y� +1�� � - '" � M` �•` `le " I.AIA 6.3 4 � . 1 t Y:�� r K �7if $►+-'., �i.L z �Y.ey� ��."� ��1"9�I ,� C,w_ I v �� �' 3 ���. t��`d,lW ��v� � r .7tiT�'�`�111� � ��r•��-1� r .�,�1 � �r'� lis x - I r ta: .160' ';k t ss� "� •� '`r?u� vC�r �"f � �A. 1�^1 ,d t �._ ..._' __ ,,.�'�`�.W..�..-.�______�:.2'_ _- _ �_...._. - / a f ti9G6A Q0 *�'�X ,' �ti'. :�\ _ /fid• rf' - �•, t Y t F a , .E Pit=�,�', ,�.�' �� �i - •ti -� F h �r -1 i - _ �t - .... �o «2i JOHN CROTTS RD rznl ` (520) 4763 RAD 89 16U2 ,pHNCFCTTSP]AD 1 • �a� 4 7645 . 8091 076i a� i aei L (3.03 A) co 5132 Pa D G n B N (.i 97A) H 7110 c S682A c9 \ 6149 (820A) (aB GA) 0181 _ 9141 CeB2 Q //� l go 1 \ 8061) (1.81 A 63 00 � PcC2 � �- X64 GaD CeB2 0 1 N 1 W Q (16.98.1) 1 6144 yyy�g 7Z$A GnC2Lo l d GnB2 g187G 34 \ s t \ n;2o1 7 (L 67 A) t52 - 7617 bu p �z1J 1 (1069 t61d ry 9543 l d t1s�� ;zap? 3B ¢ ^ h C1. `.An J .. f �.VA Pncol te =kM tp r -c I �• 0 z tp -CID �� � �.t► Jc�c1� I \ rN`. \ '{ jib24 :9 r_ 2S' 125' .23 ,L, -1tn _ l"% r !' ��, i Irl p DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #:.,990004173 Tax PIN/EH#: 5748-83-9141.09 Billed To: Land First Development Subdivision Info: Marbrook' Lot#09 Reference Name: Rodney Bailey Location/Address: John Crotts Road-27028 Proposed Facility: Residence - Property Size: see map Date Evaluated: A lolo"? i Water Supply: On-Site Well Community Public Evaluation By: Auger Boring 'L41-1/60 Pit Z D Gut n FACTORS 1 2 3 5 6 7 Landscape position (. L V L. Slope% Op HORIZON I DEPTH —S O p= Texture group 0-L C— Consistence -rS /_ Structure C1L Mineralogy `1Z rl HORIZON II DEPTH S -2 Texture group G t Consistence f-4-1;P pl-li-V 4 �v I i Structure n31< Mineralogy HORIZON III DEPTH U9 A,�4 Zi -42 Texture groupG-F S Consistence ` ; Structure Mineralogy5.. HORIZON IV DEPTH. Texture group Consistence. Structure . Mineralogy SOIL WETNESS — — RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 5 S LONG-TERM ACCEPTANCE RATE 0. s t SITE CLASSIFICATION: EVALUATION BY.- I k7 47 �) LONG TERM ACCEPTANCE RATE. OTHER(S)PRESENT: REMARKS TC/N " +�-V�c� 1� (� eta t_ LEGEND I; 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 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 l y 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 M 990004173 Tax PIN/EH#: 5748-83-9141.09 Billed To: Land First Development Subdivision Info: Marbrook Lot#09 Address: 228 NC Hwy 801 North Location/Address: John Crotts Road727028 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. PennitType: 71ew ❑Repair ❑Expansion Permit Valid for: 05 Years ZKo Expiration Residential Specifications: #Bedrooms-�/--#Bathrooms2.#People Basement Basement plumbing Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): _ Type of Water Supply: County/City ❑Well ❑CommunityWell Site Modifications/Permit Conditions: Pomp I&—Q0)�Y SystenLType LTAR Initial – , Repair Site Plane 1 *� Li Environmental Health Specialist ate )000000 i.p.l l-06 1 APPL R SITE EVALUATION/IMPROVEMENT PERMIT & ATC 4'1 Q Davie County Environmental Health . P.O.Box 848/210 Hospital Street , '`� �01 Mocksville,NC 27028 (336)751=8760/Fax 336)751-8786 i 6 A i on For: ua ' mprovement Permit Authorization To Construct(ATC) ❑ Both T e of �tem ❑Re air to Existing System ❑Ex an ion/M d' � y p g y p s o ification of Existing System or Facility 0 ** PO 7***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INF&RlaATIONIS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed &-O•Pa i�A.,y ITne. Contact Person /,I,,/ Billing Address �' �, -,g J. Home Phone -�, V City/State/ZIPS ? ��.,r,;(�t /�� Z j G G Business Phone 2-6'�Z?`l Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged I&A0=7 NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valif�for 60 months with site plan,no expiration with complete plat.) Owner's Name_ r1-y-gwl k Ac", Th t, Phone Number -336--?,F2-e'7-?7 Owner's Address 3_3.2 2-0 , _ LG/ 1, City/State/Zip TLi�.-,crvi//l L 2;%C) Property Address L o J - 1 ehe/ON City A-Ll•f�; Lot Size 4 t3(�4 Tax PIN# �?, kA3-/L-?q Subdivision Name(if applicable) 4 Section/Lot# 9 Directions To Site: lell. . ' (��� �✓ X, 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 Cyto Does the site contain jurisdictional wetlands? ❑ es 00Are there any easements or right-of-ways on the site? 2s J]No Is the site subject to approval by another public agency? ❑Yes F,}3-0 Will wastewater other than domestic sewage be generated? ❑Yes V10 IF RESIDENCE FILL OUT THE BOX BELOW #People . #Bedrooms 3 #Bathrooms Z rz Garden Tub/Whirlpool Vres ❑No Basement: ❑Yes EkKo . Basement Plumbing: ❑Yes 4X 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:. 96onventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: V/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 Wo 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 staking the house/facility location,proposed well location and the location of any other amenities. I k Site Revisit Charge Pr perty o er's or owner's legal representative signature Date(s): lj31Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# �b�, Revised 11/06 Invoice# W I Qp- r" ' § a 311 •'err � q� •, -7 Y •� s :x i fpm �. .� � � •� a 4