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580 Vanzant Rd , . , • DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 OPERATION PERMIT ,�cct�ur�t �: 990005396 "��x �If�:�N�: 5709-83-6655 BiElc,�Te: Damian Lewis �uE��iE�isiar� ln#U: }��er�r�ce €�a��: LacaiianiAd+�r�ss: Vanzant Road-27028 F'ro�c�s��;c9 F��:ifity: Residence P�o��r�.y Siz�:: 6.27 Acres a�TC Numb�r: 5024 **NOTE**The issuance ofthis 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. � I /� v- System Type: � S.T.Manufacture��Tank Date � Tank Size � �nO Pump Tank Size �( �/fp G // /' S tem Installed B : � "'Y � E.H.S ecialist: !!� �D e: � / ` � YS Y r /� j� � 7 �r O �-1- � �1 �.�C . 23 �1'` 3o c4 ' '�,�� G h � h � f g' � (� �ac � �r �� r � �\ \� I � ' /� �� / �� r ' , , Vav� � G'� �^ � 2c �� '± DCHD 11/06(Revised) � 1 � ! *. .l � DAVIE COUNTY ENVIRONMENTAL HEALTH �C� � P.O.Box 848/210 Hospital Street /L/��/D n Mocksville,NC 27028 7 (336)753-6780/Fax#(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION .��ct�u�3t �: 990005396 �"�x Pl�i�l-�#: 5709-83-6655 �illc,t�Tc?: Damian Lewis St��i�ii�ri�ior� lr3��: ReFeE��E�ce P�a��e: Lac�t�oniAd�t��ss: Vanzant Road-27028 f�ropc�sQc9 Fr��;i€ity: Residence �ro��riy Six.�:: 6.27 Acres �,TC frlu�'tbet' 5024 Site Type: ❑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 � #Bathrooms� #People�Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size V•� Type of Water Supply: �County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD) (t�Tank Size �/d�GAL.Pump Tank,ti7�r AL. � Trench Width�(� Max.Trench Depth_�'�Rock Depth � ��,Linear Ft. (�� r �1s stated in 15A �lC:C�C �$�'�.1�JEQ(5� Site Modifications/Conditions/Other: accepted Systems rn�y alsu ��:; us�-�u 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. � I. QY al� � � �� , � �� - � _► �� a„ � I Environmental Health Specialist /��'/ Date: ! � � �—�7 DCHD 11/06(Revised) � . . � ` Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT Account #: 990005396 Tax PIN/EH#: 5709-83-6655 Billed To: Damian Lewis Subdivision Info: Address: 139 Sterling Drive Location/Address: Vanzant Road-27028 City: Mocksville Property Size: 6.27 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 ar 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 sitc plans,plat or the intended use change. _�_____._�_ _ .M _. _.___._�...._____.�,_. _. Permit Type: a'New �Repair ❑Expansion Permit Valid for: Years ❑No Expiration �_____._.__�__ �___.._____.__----___._.._� Residential SpeciGcations: #Bedrooms #Bathrooms #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) D.esign Flow(GPD): Type of Water Supply: ❑County/City ❑Well �Community Well � As staied in 1:iA NCF,C �Fl;� �.�::�;�f5i Site Modifications/Permit Conditions:��c�f�ted Svstems rna�� ., ,� .�"t . - �.,�f:.-. . S stem T e LTAR , Initial Re air " • S e Plan � , � � �� R �' S � � / � 1 �t � � V � N s . s - wo � ( Environmental Health Specialist �%:�/ Date ��` � �� i.p.11-06 :1 . • -- 4 �' G�'I� E EVALUATION/IMPROVEMENT PERMIT & ATC ft��.. vie County Environmental Health � � 9 2p09 P.O.Box 848/210 Hospital Street ��\ N�v � Mocksville,NC 27028 v� 36 753-6780/Fax 336 753-1680 �R��`M�N�P��N ) � ) Applica �on For: C��it� ion/Improvement Permit ❑ Authorization To Constn�ct(ATC) �'Both �; Type of p li : �New System ❑Repair to Existing System CJExpansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Rcfer to the INFORMATION BULLETIN far instructions. APPLICANT INFORMATION Name to be Billed �,i�-ti,t�i�.� ��v,�� S Contact Person �I��,.r�i�tn Bi11�ng Address 13c1 5�t t�-1►��c� i(��i v� Home Phone 33C:- 2�I -ti'�1�f I City/State/ZIP 1��C k S u ; I l,Z hi( Z 1 D Z�: Business Phone ' Name on Permit/ATC if Different than Above Mailing Address City/State/Zip_ PROPERTY INFOIZMATION *Date House/Facilit Corners Fla ged /��-�g NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Pla�i ❑Plat(to scale) J (Permit is valid for 60 months with site�lan,no expiration with complete plat.) Owner's Name (��m��t� �Anc�i r' Lc�t;�S Phone Number Owner's Address 1'3�1 .S-tr�-1+nct O;i�� City/State/Zip n1G<IC�'; (�,t �(C 7 �1;� Property Address �"��C� ��-lnzCcn� Er� Gity_j�1(`CkS�'��ll.� Lot Size �,, '�`� c,�� Tax PIN# �7Dg. �3-(P(�5S _ Subdivision Name(if applicable) Section/Lot# Directions To Site: �.iL�l,� (cii ��{'.j c,;� U:,na�an-� P�.�� ' , '�.-L.e4�cnr c� � `�� -- If the answer to any of the following questions is"Yes",supporting documentation must be attached: Are there any cxisting wastewater systems on the site? Yes �No Does the site contain jurisdictional wetlands? Yes �/No Are there any easements or right-of-ways on the site? Yes �No Is the site subject to approval by another public agency? Yes �No Will wastewater other than domestic sewage be generated? Yes�No IF RESIDENCE FILL OUT THE BOX BELOW #People � #Bedrooms �_ #Bathrooms^� Garden Tub/Whirlpool�Yes ❑No Basement: ❑Yes No Basement Plumbing: ❑Yes No 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 consuinption) FOODSERVICE ONLY: # Seats Type system requested: FICo�iventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type:�County/City�Vater ❑ New Well ❑Existing Well � Community Well Do you anticipate additions or expansions of the facility this sysfem 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 permit(s)or ATC(s)issued liereafter are subject to suspension or revocation if thc site is altered,the intended use changes,or if the inforn�ation submitted in this application is falsified or changed. I hereby grant right oi entry to the Authorized Representative ot the Davie County Health Department to conduct nzcessary inspections to detennine compliance with applicable laws and rules. I understand tliat I am responsible for tllc propzr identifi�atioii 1nd labelir.b of property li�ies and corners ancl locating and flagging o�st king the house/faci3ity loc��tion,proposed well location and the location of 1ny other amenities. �`-`'-'"� r— Site Revisit Cl�arge � Property owner's or owner's Icgal repr�csentative signature. n�t��s�:___ � � �� Clieut Notification Date: _ D te ----- j Li-1S:-------- � L � , Sign given GYes ❑No Account# _��l�'Z..�p_ Rcvised 11/06 In��oice# -��--� ,\ �� L`�� 2�� ilS C�O� ,��S � �S�c� l� �� C�� , CioMAPs -Davie County NC Public Access Page 1 of 1 � 1 Davie County, NC - GIS/Mapping System r�'`�V j``w,. �' _ - � '',; '�O sae �'� p" Click Here To Start Over ,� �. -�� ,, C)ieic�: "iearch:(County ID arOt�lner N� �' ` � ' 1'cr_tive La}•ea: +�' p �Tr��s �1�, „� ❑Usa�pr� y O ,'L� Pt. ��,�,t��, C'� � � ❑ PARCELS (Map Tips Available} �' ' r��dr-cs _- -, •- ___. _ _ _ _ . __ _ _--� _ _ ___ _ __._ _ � � �.r�r:�zs¢,��NaEs rt�:�_ r ,. + Hzo�oodoi� , = ;r 49J4 At�HtYY 64�'�j rf i r •-• r�:i: 1 =— �J—�� --- /`�. � 1 =- _y{��_ 3 ---��___ -'r' � = -- __ -�r -- 7� �,' V i ��-� ��J R ' �' ,i = ' �� 7�f 1� _�� . . ��' ~"'�� ~ f+r I ' � 1/ .,-�! �/% l' , ' I� .. =�� ,-�hl-� � � 1 .,.1�,`5��it '� � � �,1 '` :� �t�� .x�_ �l 1.�} r�11 _✓��'s� f..- ��.} .� r x r1� � �,�r`h'1� 1 x l � 1 'y''� /�' ,� �' � � 7 � ! f f r `� 5}.5 I � +, ,� � ,-� � I` �1�A �1� � f ��5 I r' 1 f 1 I , II ,� � ' � 1 I � '`5 r + r� � �'t � � � I _ — f'' f I-�� `�� i !� f ' S1 r/� �/ ky__ 11 ._".\ � r f ~�� - _ r'f 1 If =—t1 i 1� 1� �''ti f 11 ; +,, r� ; r x � .,, ' � � � r' �4 '' f� � � _ ''� '�� '� y r (I rI � }r+ t � ,.�J i I ,.r� {- l�i, '� S �0�.��t . +' i ~ I � `� . �� _ - �'� http://maps.co.davie.nc.us/GoMaps/map/Index.cfm?mainmapservice=gomaps&CFID=41... 11/17/2009 " DAVIE COUNTY HEALTH DEPARTMENT � � Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990005396 Tax PIN/EH#: 5709-83-6655 Biiled To: Damian Lewis Subdivision Info: Reference Name: Location/Address: Vanzant Road-27028 Proposed Facility: Residence Property Size: 6.27 Acres Date Evaluated: � � — � �� _L Water Supply: On-Site Well Community Public ,� Evaluation By: Auger Boring Pit Cut FACTORS 1 4 5 6 7 Landscape osition !�' !� Slope % HORIZON I DEPTH rj .� �, � i l .. ( Texture grou C ,s G L Consistence ll � U Structure � Mineralo �� HORIZON II DEPTH o -k ' — �! —�+l Texture rou SG SG �G'�-5" Consistence S[ructure � K Mineralo ' , HORIZON III DEPTH Texture rou Consistence Stntcture Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS �' `' G � RESTRICTIVE HORIZON l' / SAPROLITE CLASSIFICATION S 5 � LONG-TERM ACCEPTANCE RA E O_2 . O �� • .'�� ' ,(. SITE CLASSIFICATION: � EVALUATION BY: /(} �— LONG-TERM ACCEPTANCE RATE: v •� . Z �. �J OTHER(S)PRESENT: REMARKS: LEGEND i.anandscape Position . R-Ridge S -Shoulder L-Linear slope FS -Foot slope N-Nose slope CC -Concave slope CV-Convex slope T-Tenace FP-Flood plain H -Head slope Tgxtut� . S -Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SICL-Siity clay loam SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC- Silty ciay C-Clay (:ONCICT �,N . 1?�is� 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 O .S Horizon depth-In inches Depth of fill-In inches Restrictive horizon -Thickness and inches from land surface Saprolite-S(suitable),U(unsuitable) Soil we[ness-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) TTAR -T.nna_tPrm acrrntanrP ratr_ aal/rlav/fY7 Tl�TTT nc�nc m___:__��