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323 Rainbow Rd � '" --�`" � DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 ' (336)753-6780/Fax#(336)753-1680 OPERATION PERMIT �ccount �: 990005572 , ' Tax PIN:EH#: 5851-77-6732 . Billed Ta: Richard Carter :� . : � Subiiivi�ion;lnf�;r , .°;; ; Referer�ce N�nie: . . .. _. . . ,:�-:LacaiioniAddr�ss: Rainbow Road-27006 � . . . . � ,. Proposer! �a�iEify: Residential ��:�, . , �. ��, , :•.�Pro�er#y Sii�: 14.808 Acres ;-. .. : = ATC Number: 5115 , . : ;,:;: . : :�� :; • , .. **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:�/� S.T.Manufacturer,�C�2{�_ Tank Date /o/� Tank Size/Z7,S� Pump Tank Size�� talled B � / E.H.S ecialist: kte: %1J �� System Ins y:��/�� p � GPS Coordinate: lV�Zt ` . . / � �'• � ' h � . � i .ti� .. � � • � � �` , � � � ti . � � . !"l� '�� n` � � f ' : ;• � � �""" _ . - ,;.. . . DCHD 11/06(Revised) 4 1 a . • �'. . . � � . DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION �ccount #: 990005572 . _ .. - '��x Pi�€r'EH#: 5851-77-6732 : :� : 6illcd To: Richard Carter -'� � • :: _��uE��i�tisior�Flnfo:: . . � . ; Refer�r�ce Na��e: . , � ;; �"::.-•LocatianiAddr�ss: Rainbow Road27006-� ; . . .. Propnssci Fa�ifity: Residential .�:;.�.., , , ::, >;,�P�o�er#y�ize: 14.808 Acres � ��;�, ,� . . , , �TC Number: 5115 , ., � . . ._. ,:Site Type: P5�A1ew ORepair ❑Expansion . : **NOTE**This Authorization to Construct(ATC)MLJST 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 FNE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: .#Bedrooms�#Bathrooms�.S#People�BasementCg Basement plumbing'6- Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size� Type of Water Supply: OCounty/City 4�31Ve11 OCommunity Well System Specifications: Design Wastewater Flow(GPD) �v Tank Size�� GAL.Pump Tan1dZ.S� GAL. Trench Width 3�o Max.Trench Depth Rock Depth� Linear Ft.�� Site Modifications/Conditions/Other: ��`��a� Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760. � �� a'� � � � 5 � o � . � L� � ,� � � � � �3� � . � � fiti� � � � � � � . � �� Environmental Health Speciali Date: �� DCHD 11/06(Revised) - � � . ' r Davie County Environmental Health P.O.Bax 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT Account #: 990005572 Tax PIN/EH#: 5851-77-6732 Billed To: Richard Carter Subdivision Info: Address: P.O. Box 278 Location/Address: Rainbow Road-27006 City: Advance Property Size: 14.808 Acres Reference Name: Proposed Facility: Residential **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: �New ORepair ❑Expansion Permit Valid for: {�,5 Years ONo Expiration Residential Specifications: #Bedrooms�_#Bathrooms�#People�Basementf�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�Well ❑Community Well Site Modifications/Permit Conditions: S stem T e LTAR Initial o (9 •� Re air o y 4 Site Plan . . �y.�� : � �S6z� 3�' � . 5 ��6, �� , �` � . � /� �v� ��' � � �� Environmental Health Specialis Date D/D i.p.l l-06 • ' a � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Sife Evaluation � APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990005572 Tax PIN/EH#: 5851-77-6732 Bilied To: Richard Carter Subdivision Info: Reference Name: Location/Address: Rainbow Road-27006 Proposed Facility: Residentiai Property Size: 14.808 Acres Date Evaluated: �b 1 ?� 1 �' Water Supply: On-Site Well � Community Public Evaluation By: Auger Boring ''� Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e sition Slope% o HORIZON I DEPTH -� Texture grou L Consistence Structure � Mineralo (; ( HORIZON II DEPTH .-yz Texture rou Consistence Structure Mineralo �:� HORIZON III DEP'TH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence ' Structure Mineralo SOIL WETNESS RESTRICTNE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: "��I �� EVALUATION BY: � LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: b �U !J REMARKS: LEGEND T,�ndsc,,�g 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�.uLe � 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 Nl�i�t ' VFR-Very friable FR-Friable FI-Firm VFT-Very firtn EFI-Factremely firm '3� � � NS -Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky • � - NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic StrLctLre ' SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angulaz blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralo�v 1:1,2:1,Mixed otes . Horizon depth-In inches Depth of fill-In inches Restrictive�horizon-Thiclrness 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) T TAR _T nno_tanr arra�tnnno.�.aro ....1/.7..../F��1 — ---- - ' �� ,.� ': . .'�� ' � . ... •�, t� . .....�.'''4,�a = ,u �_.. .'_ �--%'"�,; ,-� `1 i1 �- t� ,' �� 1,�,L% _r APPLICATIO SITE EVALUATION/IMPROVEMENT PERMIT&ATC +y� � Davie Couaty Environmental Health ' � ,�'j Lv� � ' P.O.Boa 848/210 Hospital Street :,��p Mocksville,NC 27028 (336)753-6780/,Faa(33�753-1680 '•: : "r�.�nhE �N�� ' � t kpplicaUon F�, � mprovement Permit ❑Authorization To Construct(ATC) ❑Both '; Type of A ew System ❑Repa'u to Existing System ❑Expansion/Modification of Existing System or Facility ,j �r •"IMPORTAN7*"THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF Tf�REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BiJLLETIN for instructions. APPLICANT INFORMATION Name to be Billed ' !' ' L(� Contact Person /' Billing Address Home Phone -ro (� City/State/ZIP C Business Phone - - Name on Permit/ATC if D�erent than Above .- - Mailing Address City/State/Zip , PROPERTY INFORMATION *Date House/Facili Comers Fla ed NO'TE: A survey plat or site plan must accompany this application Inciuded:O Site Plan ❑Plat(to scale) (Permit is valid for 60 mo s with site no expiration with complete plat.) Owner's Name � Eve��- 1�A/� Phone Number Owner's Address City/State/Zip Property Address ' City��ryncL Lot Size �y�$O [1 t��'�[ Tax PIN#� 77 7'7� Subdivision Name(if pplicable) --� Section/Lot# —+ D'uections To 'e: T- n r If the answer to any o e following qu stions is`yes",supporting documentation must be attached. , Are there any existing wastewater systems on the site? ❑Yes�No � Does the site contain jurisdictional wetlands? OYes�No � Are there arry easements or right-of-ways on the site7 OYes�No Is the site subject to approval by another public agency? ❑Yes,�No � Will wastewater other than domestic sewage be generated? ❑Yes�QNo ' IF RESIDENCE FILL OUT TI�BO BEL #People #Bedrooms #Bathrooms 3. 5 Garden Tub/Whulpool es ❑No Basement: es ❑No Basement 1 Yes ❑No 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 system requested:�Conventional �Accepted OInnovative OAltemative ❑Other Water Supply Type:0 Counry/Ciry Water �New Well ❑Existing Well �O Communiry Well Do you anticipate additions or expansions of the facility this system is intended to serve?0 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 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 e Davie County Health Department to conduct necessary inspections to dete�nine compliance with applicable iles. I dersta �that�am re ponsible for the proper identification and labeling of property lines and comers and t,g d fla ing�ef' king� /facili ecation,proposed well location and the location of any other amenities. V operty owner's or owner's legal representative signature Site Revisit Charge Date(s): � � Q 1 Q Client Notitication Date: Date EHS: Sign given ❑Yes ONo Account# • ��72 Revised I1/06 Invoice# _%7�/�� ' yJ / . ., �ap Frame Page l of I Davie County, NC - GIS/Mapping System o-'," ,' nr� '� �.t,�� .. . 1J ._ , . , ' - --- � sua �i . rt ii:,�r _ '_.i.. � I. �' [� � .� � PAF.t;EL'=� CTa1:3EiTips?,:�.ii13t71ej ' s � a �� , =I - -1 - � . . , �� - . . - � - �L . ..�. 5.,...' . . ++}}'��,,�� '�� . � y . V� , ` t .��.� ,K�i�' t � � ' �, d . 3r��„ .� >. ^ � ., , � , "� � . �i . � ; * ( � � � 4 i - . . V J� � . . ♦ � ,, y � �f.li�U ��'� 2. �L,. {�' �� , fl �—�-- +� ro �r v '� � � . � ' ' �'� �, ,, � . � ' , 4 �'� • • l \.. � �1 _ �� , � � . F � ��_� . , ��a < ' •� .v}�� cs�^a ' f ^� t r ' � �_'`-'. i ,� ,� _ .'�r" .�` ,d -:' � �} � �..+ ,��'.? .. �� ;` � ,�. . ;..-:� ,;, r - .. ef �.ti. . . � j �. .•. � r. ., U r�� f� u�Z 'Sj Y ir•'4\�, i -1+ � r. � .r:l 0�720ft �. s'r'* ��'� �t'; . :.;4 http://maps.co.davic.nc.us/GoMaps/maphnapframe.cfm7CFID=4129&CFTOKEN—(16408._ 9/10/2010 . ,' ,. • � Davie County Environmental Health ' •` � � P.O.Bog 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 � IMPROVEMENT PERMIT Account #: 990002785 Tax PIN/EH#: 5851-77-4213.03 Billed To: Aaron Walker Subdivision Info: Ward Property Lot#03 Address: 197 Dare Lane Location/Address: Rainbow Road-27006 City: Advance Property Size: see map Reference Name: Prop��e�J��i�i�R�dence is provement 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 �Repair OExpansion Permit Valid for: Years ❑No Expiration Residential Specifications: #Bedrooms� #Bathrooms��People Basement❑ Basement plumbing0 Non-Residential Specifications: Facility Type � #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): ��-0 Type of Water Supply: C�'C;ounty/City ❑Well ❑Community Well Site Modificarions/Pemut Conditions: F�s siated in 15A fV�EkC 18A.1989{5j a�cQp e yg em r ay a�sb � c S stem T e LTAR Initial � • / Re air / � Site Plan . . ��'�= .��`a�Se�o�� (`�cr , �4��- � �e�QeJ'�/'-ca , { - �� Y �d , �- � � � � � �� .. 4 � �PlOx _c � �`40 � 1 Environmental ealth Specialist ate G'/��a.2 y '�9' i.p.l 1-06 � 2-. I. ' . .} ... ' .• ♦ ��, / '` .� . . . � ' . . oA�L��A FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC . _ � � Davie County Environmental Health � �� P.O.Box 848l210 Hospital Street • �cj ��Ca,v�/�� I '� tioo0� Mocksville,NC 27028 � � � t � � � C�� Q (336)751-8760/Faa(336)751-8786 � j 1 : � t �P/ � ��- q `L �, a -t�'`�- r�1` 1Ppplication For. e��valuatio rovement Permit Authorizaiion To Construct(ATC) Both � � i 1 '+� �;. , Type of Appli�atiQi� �ew m Repait to Existing System Expansion/Modifica6on of Eacisting System or Facility U ,/�<<'��'�� t;l� *�,'tt�41�T J '4 THIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF Tf�REQUIRED INFO TION IS PROVIDED. Refer to thc INFORMATION BULLETIN for instructions. ' APPLIGANT INFORMATION Name to be Billed � b C. �E'Y Contact Person T��-(.1�0Y �;�:?t�^ Billing Address Home Phone } City/State2IP� ,�•ct h�_ I�J,e, �.'7 DD Business Phone . ; Name on PermidATC if D�erent than Above Mailing Address City/State/Zip - � ,_: PROPERTY INFORMATION *Date House/Facili Corners Fla ed �� y �. NOTE: A survey plat or site plan must accompany tlus application. Included: Site Plan Plat(to scale) . (Pertnit is valid foi 60 months with site pl no expiration with complete plat) /� t- Owner's Name E e-{-f- I,Ja � Phone Number �t�u'��C.�"J�9�,. Owner'sAddress_�p Sn � lVe� W�lt� City/State/Zip_S4pov 1��41�.eercy,�_ ?eS g' , Property Address City AC/Ue�C P_ Lot Size / �a v Tax PIN# 7 2 Subdivi§ion Name(if applicable) Secfion/Lot# 7 Direc6ons To Site: � . , If the answer to any of the following questions is`�es",supporting documentation must be attached. Are there any existing wastewater systems on the site7 Yes � Does the site contain jurisdictional weflandsl Yes � Are there any easements or right-of-ways on the site7 Yes � � Is the site subject to approval by another public agency7 Yes � , }• Will wastewater other than domestic sewage be generatedT Yes o � IF RESIDENCE FILL OUT'I�BOX BELOW #People � #Bedrooms .3 #Bathrooms r�.. Garden Tub/Nhirlpool �, No Basement .Yes o Basement Plumbing: Yes No IF NON-RESIDENCE FILL OUT Tf�BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentaYion of similaz facility water consumption) FOODSERVICE ONLY: #Seats _4� Type system requested: Conventional ccepte Innovative Altemative Other � ," Water Supply Type: CCo ty/City Water,t New Well Existing Well Commimity'Well ''-'—�---�--_..- Do you anticipate addirions or expansions of the faciliry this system is intended to serve7 Yes (No If yes,what type7 This is to certify that the information provided on this application is true and correct to the best of my Imowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or ievocation if the site is altered,the intended use changes,or if the information submitted in this application is fals�ed or changed I hereby grant right of entry to the Authorized . Representative £the Davie County Health Department to conduct necessary inspections to determine compliance with applicable � laws and . I understand that I am re ns�ble for the proper iden�cation and labeling of property lines and comers and locati flagging or stalcing h acility location,proposed well location and the location of any other amenities. � Site Revisit Chazge , ro erty o er's or owner's legal representative signahue Date�s): . I � 2 v � Client Notification Date: - D EHS: • Sign given Yes No Account# � � Revised 11/06 Invoice# ,� .� � ... << ,' � llavie County, NC Tax Parcel Report � ��G� � � �� a � �� . o-'�� °�`,� � �` ,��.� �G . . _ _ � :d� __�� A �,y.. Z �� Q � � � t o" � .1 ,, , , / i� ` � sa _ r , �� ,r� �—' -- �� :' - �_ �,�� ¢4� � �;� �- .:,�� t �� '+ , tit'� 4�`� �� o�� ,,1A ,�. ti; f /'' • `' ��J �� :, � Ot�� .,.tit� �,'�'� - Oot62ft ,�.`��,P r>�' e<� ., . *WARNING: THIS IS NOT A Sunday,2/8/2009 ;r— � ,Parcel Number E60000005001 _ _.�_._— S��Y�* a�`9��F �PIN Number: 5851774213 This map is prepazed for the ,,� :, . , ___.�,_. _____. _._. _.. _...._._..._ . _. .._ _- inventory of real property found �o��,� Account ,000082529382 within this jurisdiction, and is umber. compiled from recorded deeds, Listed Owner �MARTIN LOiTELLA ; plats, and other public records #1: WARD ---_ _ --_ -- --._ ,._._.. _-._— _ . and data. Users of this map are Listed Owner ' hereby notified that the #2: � ____,_ . . _.. _,_ .. __ . . . _._ . aforementioned public primary `Mailing Address ; 1300 AMY LEE TR information sources should be . 1: consultedforverificationofthe ---- _ ._ �_._... . ._ . _.__. _._ � information contained on this Mailmg Address map. The County and mapping '2' - _ _. �_ company assume no legal City _ KERNERSVILLE � responsibility for the +State: _C_ __ _ . . _ information contained on this Zip Code: 27284 _ __ _ . _. . map. Legal 29.616 AC I-40�� Description: Notes: Acreage:_ 29.62000000 Deed Date: 020080310 , � ,.. t � • ' DAVIE COUNTY HEALTH DEPARTMENT . Environmental Health Section Soil/Site Evaluation ��t�2/3 APELICANT.,IN� AQAT�ON Tax PIN/EH#: 5851-'�4Yi�BIOBY INFORMATION Billed To: Aaron Walker Subdivision Info: Ward Property Lot#03 Reference Name: Location/Address: Rainbow Road- 7 06 /�� Proposed Facility: Residence Property Size: see map Date Evaluated: '- 7- �� Water Supply: On-Site Well �_ Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e position � Slope % ' . HORIZON I DEPTH �� Texture grou � � e.. Consistence S tructure � Mineralo � HORIZON II DEPTH � Texture rou , G '" G Consistence r S tructure �' Mineralo HORIZON III DEPTH Texture ou Consistence Structure - Mineralo � HORIZON IV DEP'TH � ' Texture rou l� � Consistence S tructure Mineralo SOIL WETNESS RESTRICTIVE HORIZON • SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE d.j p►, f SITE CLASSIFICATION: � EVALUATION BY: �� ' LONG-TERM ACCEPTANCE RATE: � � � OTHER(S)PRESENT: �'O� REMARKS: � LEGEND r,�ndscaoe 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 � Textur . 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 CON�I�TEN . lYIQiS� VFR-Very friable FR-Friable FI-Firm VFI.-Very firm EFT-Extremely firm � NS-Non sticky SS-Slighdy 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-Granulaz ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralo�v 1:1,2:1,Mixed No c 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) ' T'i'AR -T.nna-tPrrn arrPntanrP ratP_aa11Aa��lft� � t�nTm�c�ne m__:__��