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870 Markland Rd Lot 6 i r DAVIE COUNTY ENVIRONMENTAL HEALTH . y P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 1 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION (� Account M 990005085 Tax PIN/EH M 5779-95-8731 Billed To: Scott Millien /79i1/CYL Subdivision Info: Stonemoon Lot#6 Reference Name: Location/Address: Markland Road-27006 Proposed Facility: Residence Property Size: 4947 ATC Number: 4864 Site Type: B'New ❑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 -7 #Bathrooms #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats /� Square Footage(or Dimensions of Facility) Lot Size ."1p-1 l acr e 5 Type of Water Supply: 13 ounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD)I id—Tank Size GAL.Pump Tank"/GAL. Trench Width 3& Max.Trench Depth A Rock Depth 1 Linear Ft..L__s . Site Modifications/Conditions/Other: As stated in 15A NCAC 18A1969(5) asGep=ed-SYSteflis mt'7 C15040c; UzJflu Contact the Davie County Environmental Health Section for final inspection of this system between 8:30-9:30a.m.on the day of installation. Tele hone#(336)751-8760. J ,01A •� P o I T:pow v 1 c� /.5" �. c's "a-� 4 0 ,i 'D` 7 Environmental Health Specialist Date: —d(T DCHD 11/06(Revised) �! SITE EVALUATION/IMPROVEMENT PERMIT & ATC DDavie County Environmental Health `+SAY 2 P.O.Box 848/210 Hospital Street Mocksville,NC 27028 A�NEp11t1 (336)751-8760/Fax(336)751-8786 ENVIROHM�pUN1V � Ap lication For: valuation/Improvement Permit LtYAuthorization To Construct(ATC) ❑ Both Typ p ication: ❑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 �Go -� /yf t u.�-,� Contact Person o024114 L✓t L/cc�5 Billing Address /-76 6-v c, S r,zf=-e; Home Phone -7©V- 66 a City/State/ZIP /,Ll o orc,�f,�,Lc1c, iv` 2$/i- Business Phone 336 Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged Z! 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 plan,no expiration with complete plat.) Owner's Name /''ti-cen~ Phone Number__ Owner's Address /76 64sl, -Sr. City/State/Zip/4°c',I✓-r:,'/cry IV6 Z9i1 7 Property Address �?7o /Lj- yr ,,,., f'L.o City !�J .,•'�� Lot Size y.25j�J Tax PIN# -!5r-7-?c 1i j h:7 3 / Subdivision Name(if applicable)- Section/Lot# Directions To Site: Cr - 2 o„/ 6vl O j 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? Dyes �k Does the site contain jurisdictional wetlands? Dyes QI0 Are there any easements or right-of-ways on the site? ❑Yes It< Is the site subject to approval by another public agency? Dyes B<o Will wastewater other than domestic sewage be generated? Dyes GN5 J. IF RESIDENCE FILL OUT THE BOX BELOW..­.X b Z O? 0Oe, InP1,s 0u) 6gglarolftY #People _ 13 #Bedrooms _7 #Bathrooms q Garden Tub/Whirlpool es ❑No Basement: Dyes RX6— Basement Plumbing: ❑Yes @�ro- 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:. Si onventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: 6LCounty/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yeso 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 respon ible forpe proper identification and labeling of property lines and corners and locating and flagging or staking the house cility oc io proposed well location and the location of any other amenities. Site Revisit Charge Prope wne s or owner's legal representative signature Date(s): 21 0 g Client Notification Date: Dat EHS: Sign given Dyes ❑No Account# db✓ Revised 11/06 Invoice# _ Reports http://maps.co.davie.nc.us/GoMaWreports/report.cf n?CFID=266... Davie County, NC Tax Parcel Report -MA RKLA WQ 1 RQ 8244 846 � ` r tf ago 1 1 i i Zv 8`J2� i 0-7911 *WARNING:THIS IS NOT A SURVEYI* Tuesday, 5/20/2008 Parcel Number: H8070A0006 This map Is prepared for the Inventory of MV/ PIN Number: 5779958731 real property found within this jurisdiction, q ix R -- and Is compiled from recorded deeds, - Account Number: 000082526004 plats,and other public records and data. c, MILLER JOHN SCOTT Users of this map are hereby notified thatpU�.� Listed Owner#1: SR the aforementioned public primary Listed Owner#2: MILLER MARGARET Information sources should be consulted - - - -- -. -- — -- --.- for verification of the information contained Mailing Address 1: 11312 BIXLER DRIVE on this map.The County and mapping Mailing Address 2: company assume no legal responsibility for CI GARDEN GROVE City: the Information contained on this map. state: CA Notes: Zip Code: 92840 Legal Description: LOT 6 STONE_MOOR Acreage: 4.94700000 Deed Date: 020060303 Deed Book and Page: 006510435 Plat Book: 0008 Plat Page: 269 Building Value. 0 Outbuilding and Extra Features 0 Value: Land Value: 99000 Total Market Value: 99000 Total Assessed Value: 99000 1 of 1 5/20/2008 6:56 PM ATION FOR SITE EVALUATION/141PROVEMENT PERMIT Sc ATC Davie County Health Department > > 2005 Environmental Realtly Section ,b P.O. Box 848/210 Hospital Street 1 HEALTH Mocksville, NC 27028 EfdV!FONMEflTAL (336)751-8760 �,, .E COJrlTY ***IFfPORTANT*** TIiIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORI•IATION IS P`R[OVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name tv ba =Ten Sc�h„ S�v tk 1 �I �`ClS r' Contact Person V CCJ6 Mailing Address `�?n & e r ;�)Y, Home Phone _ c4 O Z 7( l City/Stato/ZIP l.7'CZ rr-" lJ r&,/e., C A �� � Businoss Phone DC1 S 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: )6 Site Evaluation ❑ Improvement Permit/ATC ❑ Doth A. System to Service: EX House ❑ Mobile Homo ❑ Business ❑ Industry ❑ Other 5. Typo system requestod: A Conventional ❑ conventional modified ❑ innovative r3acCepted 6. If Residence: U People 4 Bedrooms 11 Bathrooms 3 •� kDinhwashor ffCarbago Disposal washing Machina lDasament/Pluming ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People ti Sinks 9 Commodos tl Showers tl Urinals 0 Nater Coolers IF FOODSERVICE: ll Seats Estimated Water Usage (gallons per day) 8. Type of water supply: 0 County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of(lie facility this system is intended to serve? ❑Yes ❑ No If yes,what type? ***IA1I'OR7'iINT***CLIENTS AIUSTCOUPLETETHE REQUIRL•D PROPERTY INFORMATION REQUESTED Ill''LONV. EiMer a PLAT orS,IrT,�E�PLAN AfU.ST BESUBA,11TTED by(lie client with,rius APPLICATION. Property Dintcusions: yl j DIRECTIONS(from htodcsvilic)to I'KOPER 1'1':' Tax Off cc PIN: fi J� l�q 1�07 5 W C Property Address: Road Nantc /' Ia r0a n Ci feel !� Get Ab r k- (&W4 P--j CitylZip Adu ice, IVC 2 700 4 Y4 I C..-+"1— If in a Subdivision provide information,as follows: Name: (� 1 / Section: Block: Lot: O T Date liome corners flagged: 1 6 S Tliis is to certify Mat the inforinatfon provided is correct to the best of my knowledge. I understand that any permi((s) issued liercafter arc subject to suspension or revocation,if the site plans or intended use change,or if the information subnii(ted in this application is falsified or changed. I,also,understand that I air responsiblefor all charges incurred from this applicatiuir. I,ltereby,give consent to tlic Authorized Representative of the Davie County Ilealtli Department to enter upwi above described p:-operti,located in Davie County and otvnedby to conduct all testing procedures as necessary to determine the site suitability. Drl'I'Is 12-Z6 jds SI6NATURE_ 1/►^ a. a. TIIIS AREA MAY BE USED FOR DRAIVING YOUR SITE PLAN(Include all of(he following: Existing:lnd proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge / Dntc(s): d Client Notification Date: t Y 4V / EMS: � l rSign given C/ 'Account No. Revised DC11D(05103' Invoice No. DAVIE COUNTY HEALTH DEPARTMENT _ Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003811 Tax PIN/EH#: 5789-16-0725.06 Billed To: John Miller Subdivision Info: Reference Name: Location/Address: Markland Road-27028 Proposed Facility: Residence Property Size: 5.25 acres Date Evaluated: i Dix, Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH 0_ d- Texture groupSC Consistence Gf S 'PrS150 Structure (�p P= G Mineralogy L, HORIZON H DEPTH 13 L 1 P,I -ZJ Texture group5 C Consistence S V Ff-S Structure eal Mineralogy HORIZON III DEPTH Z —(, q Texture group Sc.+ SLS Consistence i=r S ;S Structure SI1C 83 Mineralogy HORIZON IV DEPTH Texture group �. Consistence V:i--ASa Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE l9 .735- P5SITE CLASSIFICATION: f 5 EVALUATION BY: LONG-TERM ACCEPTANCE RATE: O_ �� OTHER(S)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 Tertius 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 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 tY.o1s� 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) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■s■■■■■■■■■■■■■■■■■■pie■■■■■■■■■■■■■■■■■■s■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ MEMNON iiiiiii iiiiiiiiiiiiiiiiiiMEMNON ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Mal ■■■■■■■■■■■■■■■■■■■■I■■■■■■■■■■■■ t:Sal■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ y DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 /Fax: (336)751-8786 January 23, 2006 John Scott Miller 11312 Bixler Dr. Garden Grove, CA 92840 Re: Site Evaluation- Stonemoor Subdivision-Markland Rd. Lot#6—5.25 Acre Tract Tax PIN#: 5789160725 Dear Client(s): As requested, a representative from this office visited the above site January 10, 2006 to perform a site evaluation. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. House location and size, soil conditions, and other design criteria may necessitate the use of a pump station and/or an alternative/innovative system. System design will be determined at the time an Improvement Permit/Authorization to Construct is applied for and issued. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct,the appropriate application must be completed and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, feel free to contact this office at 751-8760. Sincerely, Jeff G. Beauc p, .S. Environmental Health Section Enc(s) • DAVIE COUNTY ENVIRONMENTAL HEALTH • P.O.Box 848/210 Hospital Street L Mocksville,NC 27028 06 (336)751-8760 Fax#(336)751:8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990003810 Tax PIN/EH#: 5789-16-0725 Billed:To: John&Suzette Miller Subdivision Info: Stonemoor Lot#4/5 Reference Name: Location/Address: Markland Road-27006 Proposed Facility: Residence Property Size: 10.05 Acres ATC Number: 4851 Site Type: Ellew ❑Repair ❑Expansion **NOTE**This Authorization to Constrict(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 3•S #People`3 Basement❑ Basement plumbing❑ Non=Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size 0-f'e5 Type of Water Supply: ❑County/City ❑Well ❑Community Well 1 ���� System Specifications: Design Wastewater Flow(GPD) '�60 Tank Size dLY/GAL.Pump Tank, -{a-GAL. / Trench Width 36' Max.Trench Depth 3 G 1/ Rock Depth �. Linear Ft. /-'36. 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. e�Rv �C, L .I Environmental Health Specialist Date:_ DCHD 11106(Revised)