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281 Pepperstone Dr Lot 23 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 990004489 Tax PIN/EH#: 5820-75-8365 Billed To: ERA Premier Realty c/o Norma Johns Subdivision Info: Pepperstone Acres Lot#23 Reference Name: Location/Address: 281 Pepperstone Drive-27028 Proposed Facility: Residence. Property Size: 1.2 Acres ATC Number: 4808 Site Type;,,9New ❑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 #Bathrooms:0-5#People BasementO Basement plumbing❑ Non=Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size Type of Water Supply: Z-6410unty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD)--3LPV Tank Size 10W GAL.Pump Tank GAL. Trench Width - Max.Trench Depth:;N Rock Depth VZ Linear Ft. E-C1/ Site Modi cations/Conditions/Other: u% QA W� OW Contact the Davie County Environmental Health Section for final inspect on of this system between 8:30—9:30a.m.on the day of installation. Tele hone#(336)751-8760. �s 13o2� 1vironmental Health Speciali Date: allQ DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account #: 990004489 Tax PIN/EH#: 5820-75-8365 Billed To: ERA Premier Realty c/o Norma Johns Subdivision Info: Pepperstone Acres Lot#23 Reference Name: Location/Address: 281 Pepperstone Drive-27028 Proposed Facility: Residence Property Size: 1.2 Acres ATC Number: 4808 **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. O o System Type:_ _S.T:Manufacturer �v a I Tank Date1 �Tank SizeQ� 0 Purrmp Tank Size �f 8 System Installed Ey: �R y E.H.Specialist: O Date: letZ { A �kti_ lJ rr .Y , ; Q DEC-10-2007 1 `ERA PREMIER 3369980879 P.002 y APP ON FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC Davie County.Environmental Health Q2Q01 P.O.Box 849/210 Hospital Street O�C 1 Q (336)751-8760/Fax(6) -8986 ir Sit o/Improvement Permit Authorization To Construct(ATC) Both New System Repair to Existing System Expansion/Nlodifwation of Existing System or Facility ••1MPORTAM "THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED DWORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFHRUATi)N Name to be Bt7tedr` KkktAContacr Person Na �Q 9 -ZZQ e Billing Address .Home Phone City/StateMP usiness Phonei`i'1-I f Name on Perntit/ATC if D!„(Jereru than Above l'Mailing Address City/State/2i PROPERTY INFORMATION *Date HouseMacility Comers Fla ed NOTE: A survey plat or site plan must accompany this application. included: Site Pian Plat(to scale) (Permit is valid for 60 months with sit plan,np expiration wM complete plat.) Owner's v+ Phone Nrunher Owner's Address City/Stats/Zip Property Address AV a /Y City e •<,• Lat Siae Tax PIN# z(� s Subdivision Name(if licabl ) { Section/L.ot# D. .Outs•( •tC: i Al . r t! , If the answer to any of the following questions is"yes',supporting documemai ustbe attached. Art there a tryezistingw�astewatersystemsoathesite? Yes Does the site contain jurisdictional wetlands? Yes Are there any easements or right-of-ways on the site? Yes Is the site subject to approval by another public agency? Yes o Will wastewater other than domestic sewage be eneratcd? Yes /�/ IF RESIDENCE FILL OUT THE BOX`B L W �/ t)? p GYN /V��l/m__a #People #Bedtoottts #Bat�goms GardenTub/Whirlpool Ye No Basement: Yes Basemen�Pl in : Yes tl_gY bNl� IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage ofBuilding_ #People g � #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system tequesu Conventional A-opted Innovative Alternative Other Water Supply 7yp<§unty/C.7v 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? 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 petmit(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 Depanttxnt to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that 1 am responsible for the proper identification and labeling of property lines and corners and lowing and flagging or staking akthe house/facility location,proposed well location artdthg location of arty other amenities. Site Revisit Charge Property owners or owner's lege representative igaaarre Date(s)- ory Client Notification Date: Date f EHS: Sign given Yes No Account# Revised I V06 Invoice# Total P.002 DEC-10-2007 14:53 ERA PREMIER 3369980879 P.002 +G a 3p IN 1 Total P.002 F' T f 44- s � 4� 280.0 5,,,��0 - - �,2 55 (014 70 -�� 23 g s gs 7,5, N 8800910511 E Q 741.361 v .CR k 2t 1 FePPE-725 ro vF D L-Or 23 *-FAt I*b3 �3vponZ3 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 990004489 Tax PIN/EH M 5820-75-8365 Billed To: ERA Premier Realty c/o Norma Johns Subdivision Info: Pepperstone Acres Lot#23 Address: 228 NC HWY 801 S. Location/Address: 281 Pepperstone Drive-27028 City: Advance Property Size: 1.2 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: 2Tfew ❑Repair ❑Expansion Permit Valid for: 215Years ❑No Expiration Residential Specifications: #Bedrooms 3 #Bathrooms�• #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): OU0 Type of Water Supply: Zounty/City ❑Well ElCommunity Well Site Modifications/Permit Conditions: 010-12SAW I,JTrY1C.1rf'�t�R 1At�f System Type LTAR Initial ow Ve7j T 0.'1 Repair Ovl4 �•ZS Site Plan 'IQ � I tTtAL o v� 30 oe . L1rJ 1 Environmental Health Specialis Date / i.n.11-06 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ' �DT'1�/ DATE EVALUATED ADDRESS PROPERTY SIZE PROPOSED FACIILTYLOCATION OF SITE ��/�/I�r Water Supply: On-Site Well Community Public ✓ Evaluation By: Auger Boring I-liq Pit Cut FACTORS I 2 3 4 Landscape position .L Ws Slope R =-" HORIZON I DEPTH p — - (v n -Z Texture group Consistence SSW -rS Structure Mineralogy - HORIZON II DEPTH - -2 24--` Texture groupC' �L Consistence i - Structure Mineralogy l•- < L- HORIZON III DEPTH -� Texture group Consistence Structure S' S Mineralo HORIZON IV DEPTH 40 F Texture group Consistence Structure - Mineralogy SOIL WETNESS RESTRICTIVE HORIZON - 3 40 + SAPROLITE -- -- -- CLASSIFICATION S LONG-TERM ACCEPTANCE RATE 10.Z7Z5 o./Z SITE CLASSIFICATION: EVALUATED BY: LONG-TERM A CEPTANCE RATE: 4 OTHERS) 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 Moist 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 Mineralogy 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 DCHD(01-901