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397 Speer Rd , • . l��N Nis ` ' ' � DAVIE COUNTY ENVIRONMENTAL HEALTH •'. - P.O.Box 848/210 Hospital Street �R�-�I�Z ' Mocksville,NC 27028 '� � (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account #: 990004355 Tax PIN/EH#: 5812-64-5574 . Billed To: Dennis Sutton Subdivision Info: ��9�]' Reference Name: Location/Address: Speer Road-27028 Proposed Facility: Residence Property Size: 3 acres ATC Number: 4707 **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 Treatrnent 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. � � /\ 1..� ' y I� . . System Type:�S.T.Manufacturer� Tank Date Tanlc S' �1�� Pump Tank Size . � System Installed By: �'��'��""' E.H.S cialist: � ate: � Z� �� lm i� {. a ; tb �lG�,� �, �-� C�-�'-�.�,Pa�Q� ,� � � ��;� � i=�7 yu� � � � a` �i �. ro U�- �S � � �� 'IB'� �3 C��.a�-� � o-- • C� �Z �a 1� C � �� f��2 l�/ �� . ��o �U� �2s Q f� O �`-�' , �g, , t ��1' � �. � � G T� _� � I� � �� p � DCHD 11/06(Revised) � � � . � . �' . 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 #: 990004355 Tax PIN/EH#: 5812-64-5574 Billed To: Dennis Sutton Subdivision Info: � Reference Name: Location/Address: Speer Road-27028 Proposed Facility: Residence Property Size: 3 acres ; ATC Number: 4707 ? Site Type: �w ❑Repair ❑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 FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms � #Bathrooms' � #People�Basement❑ Basement plumbing� Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size ��L� Type of Water Supply: .l7c:ounty/City ❑Well ❑Community Well System Specilications: Design Wastewater Flow(GPD)� Tank Size �o�GAL.Pump Tank GAL. t� i' . Trench Width� Max.Trench Depth� Rock Depth N Q Linear Ft. �Ol� Site Modifications/Conditions/Other: � !� � �+�T'4u- � � — l � — 5' � Contact the Davie ounty Environmental Health Section for tnal inspection of this system between 8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760. �� Q•o•tir�(. —�� ` Ss' � � �• , � `� �s ' ss� � v '1� ,a;. . � �. � ,�.2�Pa,�fZ 40' �. ,�. '�`�-7� ` � � `� � � � M� s ��' � � 4 � � �� - / Environmental Health Specialist Date: � � �� DCHD 11/06(Revised) 1 �..i . � � . � . . ' - ��-� �� TE EVALUATION/IMPROVEMENT PERMIT & ATC f avie County Environmental Health ` D $ 20�� P.O.Box 848/210 Hospital Street � �� Mocksville,NC 27028 ^jA`�� (33�751-8760/Fax(336)751-8786 �tiRoc�M� N�+ Applic tion For: SSt�� ion/Improvement Permit �uthorization To Construct(ATC) ❑ Both Type o A n: ❑New System ❑Repair to Existing Syst`�m �]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 � C�NN� S C , S i�l T'T'� N Contact Person Billing Address �LLS � p,.q �c ►�<<l�,o � z' Home Phone �j(j� U 7 g' t�.!� ��' City/State/ZIP j�J �y��;�,�,,;� � � Z yl�.Bus�ssPhone g�� _Sl- (� < - 11-' � S� .� . cP�/ Name on PermitlATC if Different than Above Mailing Address City/State/Zip . PROPERTY INFORMATION *Date House/Facility Corners Flagged .� Q NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) � (Permit is valid for 60 months with site lan,no exp}�ation with complete plat.) Owner's Name >�C.U,V� S � ; ,�f��pN Phone Number Owner's Address City/State/Zip � - Property Address . City Lot Size � ��r�5 Tax PIN# Z– Subdivision Name(if applicable) Section/Lot# �/ Directions To Site: S.I.��u r a — L. - 'i-- �-r-- f–�/D � ,� 1�'P� If the answer to any of the following questions is"yes",supporting documentarion must be attached. Are there any existing wastewater systems on the site? ❑Yes �fNo Does the site contain jurisdictional wetlands? ❑Yes �10 Are there any easements or right-of-ways on the site? �Yes�FTo Is the site subject to approval by another public agency? ❑Yes�TNo Will wastewater other than domestic sewage be generated? ❑Yes �To IF RESIDENCE FILL OUT THE BOX BELOW • #People #Bedrooms _� #Bathrooms .� Garden Tub/Whirlpool ❑Yes o - Basement: ❑Yes o Basement Plumbing: ❑Yes o 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:, �nventional ❑Accepted ❑Innovative �Alternative ❑Other �' \ Water Supply Type: � 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 �o 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 D �(ie County Health Department to conduct necessary inspections to deternune compliance with applicable laws and rules. I unders a�1d that I am responsible fo the proper identification and labeling of property lines and corners and locating and flagging or sta g e house/�'a�ility v�ation proposed well location and the location of any other amenities. � / L G�� Site Revisit Charge Pro e owner's or owner legal representative signature Date(s): �� Client Notification Date: , Date � ��l ,�'� EHS: Sign given ❑Yes ❑No Account# � Revised 11/06 Invoice# _��/ �" , ; � j�Z � �r� • _ I j . . � (�0� y • . , pEPt11Y-ASSISTANT , . \,\C�F' . _ �___ _ , , . � �F��F,� ��._ � . ��QK : � f . 0 (�/� • . . , . . . ,y�'l1 � �7 V �� , (�.� � . �',�u q � . . . . , . ' . ., p ', . � � , , � . � ,� ; �. �, ti DAYI.3 . , , � �.8. 149, �� a''`'' . � � � ! 6�/ ' 1y � POINT IN �' ROAD J�.c��S 17. SFEER ; �j '/'c''`'� c� . .� .c -�----- � YI.�. '993—�-5 � `'t . � .d--..__ � .x� zoNeo Rn � c � . � � . � � � ---_'__'---- __ o AREA = 3.000 AC. o � ,�05'0 � �' '/�� AREA BY DMD `/'� �A � ..�-� a p'�6�:3� o �`� INCLUDES S. . �� $252 !/ . PEN ID� 5872645574 � � �� . '� ZONED RA $ � . , ., . . . � y . . " i' . � ;y. � . � . `'� �/!'. / �! � .� l� . ,..., : ' . . . . � . . � ' ✓� �e � " • � � �' . � . � . NEW . � ; . . ;�- <, 'i,'^ < <;� . .. IRON �(/ ` - .�-,., _ . � ��J . :1 � d.r ''f�+.ta ,.;,,_..f .-��- . . DDUG.J,1��_�.. .�':� ✓,r±-'.�7� �,,, t� EXISTiNr. � � �. � ,3 , �� :33 , ""......, , .-.,.. lR�;.� �'' � .U:tJ. e :,�, r'�. �,. 2 _ � , � ` .�+rora�� 3ss,30 ` � 80'19'34• � EXISTING (� � �'� , 201.55 IRON {� �' �� . V - � � •9[1� ' �, 30. p MA� NAI� G i � . • • W �'J GARAGe ' I �N R0. , ,(� (\ . ��, AREA = ;?.5,�:6 �E. ev Lo CRAVEI ORIyE I 'o �� -- - ► /� � , � �° �en �,� �►�� M I o � v�a� o�NEAk b� J,A.RRY E. �0'NEAL � z D.B. 472, PG. �78 '"d ' � . $� D.B.449, PG.. 924 26.bo � PEN 1D� 5812647441 � �/ c�c� '1 ---- - - - _ _. 1) 2 _~"_25 � �:�--_„ N Q0;'��330,95 j!/' �� ' ,� N J 2) PRIVATE 2,9� r�2 C• v � . t , l /9 f ^ �4, � 3 N O N C • DAVIE COUNTY HEALTH DEPARTMENT ' + ' Environmental Health Section Soil/Site Evaluation APPLIC�N��JN Tax PIN/EH #: 5812�-��TY INFORMATION Billed To: Dennis Sutton Subdivision Info: Reference Name: Location/Address: Speer Road-27028 /�1 -1 Proposed Facility: Residence Property Size: 3 acres Date Evaluated: ��C��(� I b �/��A� � Watcr Supply: On-Site Well � Community Public � Evaluation Bv: Au,_c: Burinc Pit Cut fAC"PORS I '_ 1 4 5 6 7 Land�cape position [_ Slape 90 3 HORIZON I DEPTH - I (� U - �a a -�� o - - - ( 1 Texturc erou � ( Consititence , � $IrtICWIY �{� �< ' L /'. � �� Miner:due�� y 5�= Cl:= - : I�IOIziZON II DEI'I�11 !O• ! E�� I . L - Zo � �L 9'cxturcerou G - .� ;(rt.�. Lr��- " C • iGY. Con�istence - �-.� �e ��`,� Strurturc i' �� >k �Alineralu„c . i! �- . h, �. r HORIZOti III DEP�I�H � �� .� .�� Z- _ y _ l�exiurc erou ' C�r. Cr�.,n Cuntis[cnce -� � �i . Structure �->i Mincr.doev 5 - I IUR 'V.ON IV DEPI'H N Z 'lixture cruu S.. Cun.�isitnct Svucturc � l� Mincraloe�� SOILN'F.TNESS - - - -LI�c�S - - -� RI:SIRICTIVE FIOR "V.ON �3 � Z - 3' 3"L "(L SAPROLITE �.� V �/ - CI.AtiSIFICATION �� S LONG=CtiRMACCBI'1'ANCERAT6 U �L � ��' 7- Q��-L7� � ."LLa (l E ��) r� SI"�E CL.4SSIFICATION: 1 S Lb'ALCA"CIO��' RY: - �-�- ��'uh—� IANG-1'ERM ACCEPTANCE RATE: �'Z� OTHER(S) PRESENT: REMARKS: LEGEND t.•`ndscape Position R - Ridge S - Shouldcr L- Linear slope FS - Foot slope � - Nose slop� CC - Concave slope CV - Convex slope T-Tertace FP- Floal plain H - I Irn� �lope ,fexturc S - Sand LS - Loamy sand SL- S.mdy loam L- Loam SI - Silt SI('I. - Sil�y clay loam SIL- Silty loam CL- Clay loam SCL- Sandy clay lu.im SC - S:mdc clay SIC - Silry clay C - Clay �oxsisrH vice illuist VFR - Very friable FR - Friable FI - Firm VFI - Veq� finn EFI - Extremclp firm IYcI NS - Non sticky SS - Slighdy sticky S - Sticky VS - Very Sticky NP- Non plastic SP- Slightly plastic P- Plastic VP- Very plAstic Str�cl�re SC - Single grain M - Massive CR - Crumb GR -Granular ABK-Angulnr blocky SBK - Subaneular blocky PL- Plary PR - Prismatic 111incralogy I:I, 2:I,Mixed L�lulss Horizon dep[h- In inches Dcpth of fill - In inches Restrictive horizon -'thickness and inches from land surface Saprolite- S(suitable), U(unsuitable) Soil wemess - Inches Gom land surface to free water or inches from land surface to soil colors with chroma 2 or less Cl�ssification- S(suitable), PS(provision.dl}� suitable�. l��unsuitablel ILTAR - Long-term acecptance rate - eal/da}dit2 DCHD OS/OS (Revisedl . , �� b�' � I t^` I� � � `''" pfl`' �� 3 / 5 'r,;> .h�r 'OIoI � �1 �1� �ol � ^N � � I � ;.�y �I c��`� x ,- t , o� o ; � , - ;- � Y � � - . � � �� i�� r � � � `'� — i � Q �� AR � „ '� �, o p _'II/ � p,REA Bl' DMD N I :'�`~?� 7�' � .. !/_ - __- . .. ' :: / IVCWDES 5�,645574 w �� - PEN ID- 5 �.��% , _ _ . ____- ��,y�' _ .__--��— _ ,�'I ZONED R!+ � �ll � � � � . I '�, _ g��- -� "'�j , " � b ��_ > ;��r� - �, � . .. - — �_rorA�. 3es.so � � (` N f70•19'34' V Ex15-�.,; � � � 201.55 ,FOV ' G � �� 30. p � I � �� i .I 9PV . I �'!� _ I :f I '��" LA.RRY E. 0'NEAL o I D.B.449, PG. 924 I PEN ID- 5�12647441 � _ � f e 6 S , � Davie County Environmental Health � P.O.Bog 848/210 Hospital Street � Mocksville,NC 27028 - (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990004355 Tax PIN/EH#: 5812-64-5574 Billed To: Dennis Sutton Subdivision Info: Address: 1481 Oak Ridge Drive Location/Address: Speer Road-27028 .'y City: Summerton �,. Property Size: 3 acres Referenca�ame: Proposed�F_�ility: Residence Y � **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 ❑Repair ❑Expansion - Pemut Valid for:�Years �No Expiration Residential Specifications: #Bedrooms�#Bathrooms Z #People�Basement❑ Basement plumbing❑ Non-Residential SpeciGcations: Facility Type #People #Seats Square Footage(or Dimensions of Facility) • Design Flow(GPD):�� Type of Water Supply�unty/City �Well ❑Community Well Site Modifications/Pemut Conditions: ' S stem T e LTAR Inirial le� 0.2�5 , ' _ Re air GC�. t� O. 2S � ite Plan ��j� , S�-�� •o•�' , 3°� � , — �° . � . . � � � �,J►-r��,�. ,--2o�T A�� 2 N��= � � � �� ,��.�� - � <L\ � � a�.. Environmental Health Spe 'alist Date f "0� �� .� i.p.l l-06 , r � � . • ', ' , DAVIE COUNTY ENVIRONMENTAL HEALTH /��I • P:O.Box 848/210 Hospital Street � Mocksville,NC 27028 �1Z��U� . (336)751-8760 Fax#(336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004355 Tax PIN/EH #: 5812-64-5574 Billed To: Dennis Sutton Subdivision Info: Reference Name: Location/Address: Speer Road-27028 Proposed Facility: Residence Property Size: 3 acres ATC Number: 4707 Site Type:,.H'�iew ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MIJST 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 Z#People .� Basement� Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats . Square Footage(or Dimensions of Facility) Lot Size �QL Type of Water Supply:�County/City OWell ❑Community Well System Specifications: Design Wastewater Flow(GPD)�� Tank Size ��C'AL.Pump Tank GAL. Trench Width?'J�, Max.Trench Depth Z2� Rock Depth� Linear Ft. �o(� Site Modifications/Conditions/Other: {n+ST'.�,� n--� !�?.��'n� �� D� P� �.)n�v� � , 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# 33 751-8760. . .S�t�� Rae�> >?-�•�Nl• Sc�' . � � � s' , . �o' �� rP-cc��i ss' 5c�� e�� ,� 4to' ��+� a � . � `�� - o� �`�� 'ti �M�a.S' k��'� �., io• ,� `'v�- ��,12 �, �.o�, � Environmental Health Speci ist Date: / �7 DCHD 11/06(Revised) • � • � . � r¢` � '�� .a�';:, ;:.:� � F'�^Yj � , ,, .>+ �.t wr �z;� � � r ; � : �. � '> ,_s ��r y�` pw- j c_ l S • � ei .., c.�;r�. = , �4 - ' +a..� . . ' � z '. ' : �' • • .f . � � . 1 ?i� � ' F c ;F x ; Wd :, �.. rd �' . . , s . k � i : � � � .y ��r�`� u�i�y,1��i �,�a1 `� �.:;7&��"�.. •:�- � q i I �. �',.r.�,w�:... � / .�• , , . .. � . . � . ,:c:. . � _ r":'- -_ ,,r�. �.=�: �. . # �C � . . �. �5.- ' ".�,t, _ i ,� -�:,e ciFi�- � 'S '-� w ^J�� sL��`$�y�� . _ . _ . �� f ;:�`�' . . . .rti+c.s