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152 Paw Paw Ln � . � i���� ' DAVIE COUNTY ENVIRONMENTAL HEALTH � ' P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account #: 990004430 Tax PIN/EH #: 5755-90-3927 Biiled To: Patricia Ebright Subdivision Info: Reference Name: Location/Address: Paw Paw Lane-27028 Proposed Facility: Residence Property Size: See map ATC Number: 4760 **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 Treahnent 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. O Q , a� . System Type: ,�-1-�✓ S.T.Manufacturer ��a� Tank Date �� Tank Size� Pump Tank Size /D� �(7 , V Sons j'���� / System Installel Zy: ,Q E.H. Specialist. Date: lP � � — � � � � � � �S� � R�4a:�: n.r 4/Ar �� �. � � �1 � �� w P�� � t� �e�� � ,,�, Rs'�a�w.�, � `�°�(r d ��°°� � u6 � � � � �� Q �nSh ov►y � � � V '�,� 'SP$e� �' ��t �`f � �------s�4'�'�. p G�` G 1 3 � `4'�'� e � s —�b�� V �- -� tbc.w � ��� tr ► Q��u�t �r.c S 3 `' � � �a Ck..�r r�i�l: l l Q�►� DCHD 11/06(Revised) . ,_,,,.....�.. DAVIE COLJNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street . Mocksville,NC 27028 �� (336)751-8760 Fax#(336)751-8786 �\�\ � AUTHORIZATION FOR WASTE�VATER SYSTEM CONSTRUCTION Account #: 990004430 Tax PIN/EH#: 5755-90-3927 Billed To: Patricia Ebright Subdivision Info: Reference Name: Location/Address: Paw Paw Lane-27028 Proposed Facility: Residence Property Size: See map ATC Number: 4760 ��✓' Site Type: C3RVew ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MLTST BE ISSUED by the Davie County Envirorunental 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 �1 #Bathrooms�#People�Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size f '��Lf'� 5 Type of Water Supply: CCounty/City C�'Well OCommunity Well System Specifications: Design Wastewater Flow(GPD) ^1gV Tank Size ��ov°GAL.Pump Tank�AL. � !,p� Trench Width� Max.Trench Depth�(.D j Rock Depth /�.�� Linear Ft. J O asn �q os�e �tew swals,(S paaciao�� Site Modifications/Conditions/Other: ���• . . ,,,� , . , �,, Contact the Davie County Environmental Health Section for final inspection of this system between :30—9:30a.m.on the da of inst llati n. Tele hone# 336 751-8760. ` - .� ca�:�Q��d,� ,��� a I � U��-�'� �� � .c�v��� . �� � �-� �`� `� o I� �NS �� �� 1JZv� �oo � ( �� I � � � � 7,r a�� �,h < < �t,`w � Y 5 t�t � a� � ry. �T '�✓L'H 1 � � G , ( f \ � 1� •���'�— /(, L � c�r�l.Pa (.J-�" i � �C G / C�'�� � .1 .Q�'CJ�I C> J --- . _ Environmental Health Specialist Date: I ��� d 1 DCHD 11/06(Revised) •:d" . , - Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMTT Account #: 990004430 Tax PIN/EH #: 5755-90-3927 Billed To: Patricia Ebright Subdivision Info: Address: 149 Paw Paw Lane Location/Address: Paw Paw Lane-27028 City: Mocksville Property Size: See map 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: �'�Iew ❑Repair ❑Expansion Pernut Valid for: 5 Years ❑No Expiration Residential Specifications: #Bedrooms ( #Bathrooms 3 #People�Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): ��v Type of Water Supply: ❑County/City OWell ❑Community Well ��s stat�d in 15/� NCr�C 1£3A.3968(�) Site Modifications/Permit Conditions; arr����� �T��e���,����.,,�5a S stem T e LTAR Initial �.,,e c3� '7 , Re air � Site Plan � �'A- U i/ !'\/`„�'"� --. - ��^ � c �cC,l �.._�_l". ��I G h� �-- _� �� a' � � r0��y_• s �1t ��w� � � � �w���� ���- �t�a �6 S Q Q 3 (�.,-C..�F i r �/�-e�; �Q . � 7C7 3�l S � — ��� Environmental Health Specialist Date (.}� 7 :_ii_n� �f a0��7 ,��UC!�117� 1 v" . � �F�I�A OR SITE EVALUATION/IMPROVEMENT PERMIT & ATC �/�`�� D �`' Davie County Environmental Health 1 /�� r � ��'� � P.O.Box 848/210 Hospital Street i ,UL � Mocksvi11e,1vC 27028 � � (336)751-8760/Fax(336)751-8786 N�I�N � Applicatird'�rl�i E, '�' uation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both Type of ion: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTAN7***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 �K�r 1 C�UJ 1— �l ' �� Contact Person�C�����1�'�'Y� `� ��� � ��' Billing Address 'v�J � i.+� --G�i L1L.� Home Phone � ��� - ` -L�}���— City/State/ZIP � �� -e � � _� BusinessPhone�j ���• �Cii-�3�(-.� 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) (Pernut is valid for 60 months ith site plan,no expiration with complete plat.) Owner's Name �i�� a�� �(;�.f���.�% Phone Number. Owner's Address G`�.�J �u, City/State/Zip �oCJ'C�Ji � J (_ 1C�L S Property Address �t t` City Lot Size `�..<JCjleS Tax PIN#__.-1'j `7�5.�90, .��,2�� Subdivision Name(if applicable) _ Se tiQn/Lot# � ) Directions To ite: /tl !1`cJ ��-� ���� / Gt 1 d If th answer to any of the following questions is"yes",suppo ing documentationj�ust be attached. Are there any existing wastewater systems on the site? ❑Yes C�N� Does the site contain jurisdictional wetlands? ❑Yes [3�No Are there any easements or right-of-ways on the site? ❑Yes C]�o Is the site subject to approval by another public agency? ❑Yes C1�� Will wastewater other than domestic sewage be generated? ❑Yes O3Qo IF RESIDEN -E FII,L OUT THE BOX LOW #People #Bedrooms #Bathrooms � Garden Tub/Whirlpool es ONo - Basement: es ❑No Basement Plumbing: +�P`es ONo IF NON-RESIDENCE FILL OUT THE BOX BELOW � Type of FacilityBusiness 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 systemrequested; onventional ❑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 ❑ 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 pernut(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 subnutted 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 detemune compliance with applicable laws and rules. I under:;tar.3 that I am respcnsible for the proper identification and labeling of property lines and corners and locating and flagging or 'ng the house/facility locationyp=o}��sed well location and the location of any other amenities. � �, � � Site Revisit Charge Property owner's or owner's al representative signature Date(s):_ ''1 j �� Client Notification Date: � Date �� EHS: Sign given ❑Yes ❑No Account# ��J6 Revised 11/06 Invoice# G�_3� i ; ��.-, �J�rl�� : �1�����1,�� 1Vi''��'i � `�'� — ,., � ,y.. 1�"`-i��� �'v�,V V �;/',!-:l ����� ' � ��� � � � +�`'�� -' .��G�.���i ��.��r, � �� 3��0. ��-�-����� Z�q ,�� ��\ � � v� � ���� , P , � � � �do , , o � N � . i N 9 � � : , � � � � �P�sec4 ---- � �3 ; �� � �1 ��OI.�S-e dr�„ewa.,.i ' � � �S a �� � � �� � , � #� r� ��,� ��r , r �r� � rh� _ ___,_. � .....___._...._------_._.--�._.._... . ------__..____�_.�, ..�`_' � --�------_.�.,w__.___ __._ __...u�...�_�,_ a .. .. _,_ _ -_____ ___._______. _ ._ n. --�-� ._ �S/N� _ __. � L L=7"��✓ . _ . /2/�, ._�_.._..__..__..�..__�____-__.�.._ _ ._r._ . _ _� -�: � _ , �d � GoMAPS - Davie County NC Public Access Page 1 of 1 , ' Davie County, NC - GIS/Mapping System �i �'�''°�'� �lick H�reTo St�rt �ver Qa�i�� 5���r�h:�C:r�ur��� I€� e k . ,k, S��}'i �~:] .,�� 1,,,,,,���bbb 4 C"� f 4 7 � � �� ,��� � r a. a � ���i�� ����n ��s�,'+?�aa a��.� c�is � ����� , �5 � � .:� � �. 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I I �,���' �, ��N!��io�fl�4u�bCi�y�����o�u�i� � .�:. � . � ., I (i���N������N���o�� :, ��F � �~ �:-�� � :� ��A�h�� �� c a��� ��` , ` _l ,: � , ,;,�, ( � ,����� �� i�l�i��i � �� � �� � W �q are.t� A�k � \Y�� N1 "' r y� -.W�,'i �4 f ,fiy� t M1 --��1 i�1��t�"r'� �����' � � ( ���i .C�����i�` .i"U._.. .. ..N��� ��: . . �� ��, �� �IN��IIO���i � . � ! _� �_���� — � �m��o��i�l�!��I .. . ��d�� n �� - —�� ��i�����������,�������au�,����� � �_ � i ~---�� ���! �..,. � r. _�4�.'-',i�SQ. `S7'�'� �`', ���'e: � � � �i5��� . .:::t�.' ....._.e... ........ :.. .._ . �—1 �0.3��.�'�?� ���� � http://maps.co.davie.nc.us/GoMaps/map/Index.cfm?mainmapservice=gomaps&CFID=4129... 9/5/2007 � . , DAVIE COUNTY HEALTH DEPARTMENT , Environmental Health Section ' Soil/Site Evaluation APPLICANT INFORMATION P�Z QP_ERTY INFORMATION Accoun . Tax PIN/EH#: 5r5��=`35� Billed To: Patricia Ebright Subdivision Info: Reference Name: Location/Address: Paw Paw Lane-27028 �Proposed Facility: Residence Property Size: See map Date Evaluated: _ � � a�[ ` d� Water Supply: • On-Site Well ✓ J Community Public ' Evaluation By: Auger Boring ..�� Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position (..._ Slope % � '�- HORIZON I DEPTH p •'-Cg Texture grou � �'fi Consistence �l ,�,� Structure �' k 5 Mineralo -� D HORIZON II DEPTH � Texture rou • - Consistence Structure Mineralo HORIZON III DEPTH Texture rou Consistence Structure Mineralo � HORIZON IV DEPTH Texture rou Consistence Structure • Mineralo SOIL WETNESS RESTRICTIVE HORIZON .�' SAPROLITE CLASSIFICATION '�, („ k• LONG-TERM ACCEPTANCE RATE .�7 p. , SITE CLASSIFICATION: �u �l'4b� EVALUATION BY: P ri�b J��'c�r�''� S LONG-TERM ACCEPTANCE RATE: G•��� OTHER(S)PRESENT: l/V�4�� �l�e.� d 4 n rx wr,� � REMARKS: LEGEND J_.andsc�pe 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 C'ON�IST .N . . M4iS� VFR-Very friable FR-Friable FI-Firm VFT-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 Mineralo�v ' 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 accep[ance rate-gal/day/ft2 DCHT�OS/(15 (Revi�eril I � �� � l�YlEllf QFf10ER�i CE�TiF1G�TE,_ iihd for r D.B. 136, FG. 163 � ���K REQlHREO �r T� �pwtrotion � o'ciodc N. I, . ww..� .Nic« of o.w. ca,�q►. oMNE ooW+rr vu�+www� oFJ��+R►/EwT. tn.t M�. Mav « vIQ to Whid+ w� o.rtiAcotio� . 2007 and rsoor+/.d in y� �..b �1 .blwr,► �.�.�I. t., wo�f , p,�� Wot pook . Poq� � n�nby c�rtiy that � om a. o�w�.r a u�. prov�+r •�wWn ond �c�ii�d I�so�, �I�iol� Ioo�W in th� COuw M Do� Md � h�r �t Mis � d «�IM wiyh �ay Hw oona�r�t. �1M M'ICE� OAIE �w i•• f rW. Y. w�a s►nlr - ow�[ c.. Mqw► a a.a• NtOMY�11�d 111illllllulq 14i1�11� �/�M:k w1N M1d �b� OM �P7�� �11�{� M►�MI/� /M11� �11� �IK �MM M� MM►��M1� � �IIb�O Or Y t �M� 1� 4! 11��. /N/MIpflNlr. ( M/+� ��� � ��ry � �, N o Mr b IM C�IMwI M Orlib � ���� � : O�E �` �,� ,.ir.���,,,.� �.� _ �� � �' '�' � � SINGEf i)N RD. MNI.L�MI 11. �Q�pMNqt � '" — -� ` �", � � � , � � ' O �N I�0 SCALE ��Z�� � � - _ _ - _ _ �.�. �`; �Ro.�,�,�r �' �� V ICII�TI7'Y MAP _ , C. � '' — � ,� '�+�w�r�Y �,co �s3 rvr w 4�� � q. , \ ` �� (u,,.�__rAREjy�r �CT �A{,y�W,�Q EA��EMEr�T � �h ��\� ` ' \� 1•�u� � �E1�'�� AUG��2 2�)07 I � � ' v� � �., \ i � r� `� �, � \- � \ `, � �1�� � \�� _ _ _ q' �._.._ ��� ! �� - - - - -_____ _ _ -- - � � __'_— - ' 1 i�'" �.� -- - ' -- - - -___ ._ _ _M 1 � �, `� �� � PF.W PFW LANE - 10' GRAL'EL �.PRIV��TE _ �215� y I z .__ zi _� " `_ DRIVEWAY _"-- ` y�e7, y ��� a5 `- --- _ � ._ . �� 1 ,___i. --� .._""��_ ---_._ ��\ � ' -_,.,� K • � \ � Y \._L� � �� _ � 3-DGE OF � -• �--- _ �,� \�� � MO�r ' � ` ��. EASEAnENT - •..... ����� ` �,�rI � � � �, � � ` N � � � � � �=NT f,t,`����'�`- -�. 1 P•EW 45' � ��\ GF \ \ I !�, � � Er+SEMt NT E� � TRACT t �UC-�2�?OU7 \ ��MFNT , d� NEw JFASE4ENT � ��. �J iu��i►�`i� i.c�8 i .��'. \� y � � � � � /� NOTES: � j � N �� `i� ��T 2 1. TOTAL TRACTS� 2 � , '�I F I��'11= 1.J�Q� //�i. � 2. TOTAL A�C.� 3.3i7 AC. � � ✓ � SUBJECT TO S.R. 11{21 R/W. ~ � 3. X� UI�WARKED POINT OF C/L OF NEW �5' EASEQIENT � �• � ��� � � ` • , �L � � 4. TRACT t HAS AN EXtSTING DWELLING .4ND SEPTIC ' �r SY'STE�I. TRA�CT 2 NAS iEEN EVALUATED Bl' THE � ""_ �s ��` � i�C1lJNp TO��ETMSI��A�t�.E iOR��E�IC SYSTE�I. � � '�f . j ty �' S. THIS PROPERIY IS LOGATEp WITHW A WS-IV � �. IMATERSH�p. 1 '�"' � •� , � K�� . i -�- � PLAT I�AP: i �Z � TITILLIAII d H. BR OAD 1�'A Y ► �� ! � �Ill J� � \�� OWNER ------------------ DEVELOPER I ������������ �•,�� �`��' A' � IAMWAII N. NlOADWAY � ��•J,,'�N�O�••,� 's,' p(i"� ���S / 1 SZ �AW 'AW LANE I :����+'' �i8� ��.`q, ;I gs I �; IIOCKfVILL[� N.C. 2702i ` � (i3t) ON-2343 . f � • = s� �� = 1 0 : �_2�� ' : � " MOCKSVILLE TOWNSHIP ,G� s<.�� oe,� ; � DAVIE COUNTY, NORTH CAROLINA � • �(� SII,,�",�r CrtYio.iio. f�r - �.i. C�ueW. Yr,. r.n.lh. ' �9OL••°suRv�r � I ��I / •�� ������, � ♦ . a • �, c�v � r�, �a.r.�+ �.�r s�Mwo., w.+�w �-� ',, (. TU .•• UATE: AUG-2-2007 cuWy b en� a m�w � IM ti�My • Wloiw Ir � Ik ������������N �,hw+by c«ti thot th� Davi� Ca�y I�a�th O�p�rim�nt TAX l[AP REF.: N-6, P�0 77.1)5 A hos th� aubdivtsion .�o, TM�t 1Mir M • /bt N a MM �w�ty � Ni�A�Ma N MYtI�: 1M'ILWY M. �OADMYIY Iw/ �rIW� M �r.� d a w�w � sw��M�r �M�t 1� w I. 0►aiy l. TuM�row. oaWY Mwt tIw pbt wM dr�ow� riM r+NP�d M orM�ri� end oonditionr s�tobWh�d SURti'E1fED BY: .,�„�. n,� ,.�„�. �..� � ,.� � �, �,�,�, �,,,,�, �, � �y ,� y, .yti �, « �,,.�,K,�t,.� w.�d„ .� �+. �,n,. TUTTEROX SUR�EYING COMPANY b. lAM Mb 1� r d . w�Ar M�t r 1w1r M �M o �nMr �► �rMM'�'1�iM (M�1 rwa+rM M� M Ioun/ t� wr+og► WIIM wN� arNnM w/ �KiMr 107 NORTN SAUSBURY STREET -- �Me� �ri a win�► �► ,�, Mrt Y w��11MM M b • �� �� �. NM► IM tlIC�T aa M! h�rih i� aumh rrak�sti�►. For d�Wl� NOCKSVILLE. NC 27028 �+a�w aN! wMi1r rwi�r i N�ic d U►b �wI11�bn �nd /�r � wrNlr� Nr�rt _c. 11rt IM� pMl b �1 • ��t d � MYW�� /�+�M M ��� �' �� r ��^ M tlV �t MM �MMwMt• UNE BEARING DISTArJCE �3�36� 7$1-561 B ' � Y�1�n�Y�n h�w+� M� �� !d A�it tli �Y Y d � �ww�r d MeMr . wN� • IM MI�t 1M e� �f /Irci�iM b M1�111�� /� rM�O�'fANT Mq�-. TTW�i_CERTMHGI'E D�ES NOT L 1 N 21'49'08" E 22.ti6 d arrl- rMr. M M�t Mlb �I�t � M� �OMNa�M� �rW� A OR �pw�, p�' wp�� � N 21'40'08' E 5d.03 !�ir"�O�M���.�� �7�-d0 N rIMrM �ar M�MM1 �iwM�, lai� � wRM.►.�lOM 0� u N 22'sc'a3" E s�.o� 50 2 5 �) 50 100 1 S 0 __�. � � «�� v � y � W � �� � L� N 1 T 16'28' E 34.57 IAd I w� ww • 4�rini��n�Mr Mrt M aN Md Mi� .,,_,_ � N ��'� ���" LS N 10'S3'30' E 6�.2a �,r M �, �y�� i�. � L6 N OS'20'�5' E 37.25 " �� SCALE IN FEET �� �� �) «r � �{�11 My��f DA� AA� CaM111� I�A1.1M 01�I,i R � �: COORO N�M/E: DRAWINO NUAASER: W-BWAY WILLBWAY-E 1 13507-3