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121 Veach Ln i DAVIE COUNTY ENVIRONMENTAL HEALTH ` P.O.Box 848/210 Hospital Street Mocksville,NC 27028 , (336)753;6780/Fax#(336)753-1680 OPERATION PERMIT ��ct�u�t #: 990005869 '��x:�i�€.%�H#: L5100A0008A Bilie;+�Ta: Tracy O'neal Siaf�iii�i�iar� info: : }��fer�r�ce �t�€�i�: Locat�onrAdc�r��s: 121 Veach Lane-27028 . F�ropc�s�c9 F�:.�ility: Residence ��o��r�.y��iz�: 200x252 . E�TC Nurnber: 5934 **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. Qfb�l System Type: b S.T.Manufacturer�� Tank Date� aS Tank Size avo Pump Tank Siz� Bedrooms: 3 System Installed By: �t(�t C t (%n Installer# Date: � �o Z GPS Coordinate: . � - . �� , �� r ��u � � �tl� 5 �'`�� . �, � � - � �� - `�' `�E ZS I �� 1 � � �g� , �� ' 1 �'v' � � � � r-\ �' �l�].Z,. I._____-.____. _- _ • Environmental Health Specialist {/� ��C C Date: 7 DCHD I 1/06(Revised) , , 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 �cC+�u�t �: 990005869 ,. '��x PI�€:EH�: L5100A0008A Bille� To: Tracy O'neal �. . 5ut��iEfi�iar� I��t�: Re�fer�E�ce Nar��e: . : LacationrAd�r�ss: 121 Veach Lane-27028 f�raposQc� Fa�;iEity: Residence . . . . �cop��.y Siz�: 200x252 N�TC Numb�r: 5934 . Site Type: �'New ❑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� Basement0 Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size � Co�J� Type of Water Supply: ❑County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD),��Tank Size�GAL.Pump Tank_�GAL. t< <' � Trench Width�� Max.Trench Depth�� Rock Depth� Linear Ft.G��j�y Site Modifications/Conditions/Other: �P�(,l(�(�� Contact the Davie County Environmental h�Section for final inspection of this system between — a.m.on e a o m a a ion. e e one . `� � F--- Ibb �� C��-C': o° � ,• �- j �'xlp�` Q 1 � Environmental Health Specialist Date: � � D�Z r��un i�m�ruP�,;�P�i . ,. _ ' Davie County Environmental Health P.O.Box 848/210 Hospital Street � Mocksville,NC 27028 � r �I1v (336)753 6780/Fax(336)753-1680 ,I,''� t� IMPROVEMENT PERMIT Account #: 990005869 Tax PIN/EH#: L5100A0008A � Billed To: Tracy 0'neal Subdivision Info: Address: 121 Veach Lane Location/Address: 121 Veach Lane-27028 City: Mocksville Property Size: 200x252 � 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: [�1ew ❑Repair ❑Expansion Permit Valid for: ❑5 Years ❑No Expiration y� Residential Specifications: #Bedrooms � #Bathrooms 2 #People 2 Basement0 Basement plumbing� Non-Residential Specifications: Facility Type � #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):�lp� Type of Water Supply: ❑County/City �Well ❑Community Well � Site Modifications/Permit Conditions: S stem T e LTAR Initial ` � R ir � � Site Plan _ '� `J ( � .�----��, ) � . �� .� : � � � . z`� -" � . . ��`� ,• - - k . " .. � (�f�� , a�,r (�t`� -�` Q ; t ,� ; - � : . � , Environmental Health Specialist � Date� i.p.l 1-06 �.. , " � � 'A�'PLICATION FOR SITE EVALUATION/IMPROVEMENT PE IT & ATC � , ,.. , �� .�. . ... . . .,.,_� „ ' ��, Davie�County Environmental Health � � ,��',,� P.O.Box 848/210 Hospital Street / �� :2a�'� Mocksville,NC 27028 �1 ' �, ,� , � F �P Z � I1�b (336)753-6780/Fa (336)753-1680 �1;' r!'%? q , , _ .. .��5-17-I Z a�- ♦ Ap i �io • ite Evaluation/Im provement Permit Authorization To onstruct(ATC) � Type� ' pplication: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or ility ***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name T�.C �/ (��ci l' (� � ('JPr.,� Contact Person Address /,.� / ��L � ,� Home Phone 331�- �/G 9- q'7.3� City/State/ZIP�j�c I;s v, I I e /1 0?7a a � Business Phone 3:� (,- '�S )- G.23� Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged � �p Zr 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 Jo n U C..0.G� s S c , Phone Number .336'o�fl�/ �S�y Owner's Address I► ( �/P!'i C�. ( � City/State/Zip�ksv�Ue n[, ,��02 � Property Address____'2� V 2QCh l-,n City oCk s�i ll� Lot Size_o�do 1� a S� Tax PIN#�Sr15�� l y 9�j�C L�1 vD,4 bb0� A' Subdivision Name(if applicable) Section/Lot# Directions To Site: � b O -�o U e� :�-� -2 If the answer to any of the ollowing questions is"Ye ',supporting documentation must be attached: Are there any existing 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? �[1'es 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 �1'�i'es ❑No Basement: ❑Yes �No Basement Plumbing: ❑Yes No IF NON-RESIDENCE FILL OUT THE BOX BELOW : Type of FacilityBusiness Total Square Footage of Building #People r #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 ❑Innovative �Alternative ❑Other Water Supply Type: ❑ County/City Water �New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Q'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 the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I und rstand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging or s in e u�e`facility locatio ,proposed well location and the location of any other amenities. � � Site Revisit Charge r----,, � operty owner's or owner's legal representative signature Date(s): .�'070 f� Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# 1f1� Revised 11/06 Invoice# � � ,� . 252 �'i' ., f . � 30 FT OF LINE . PROPOSED WELL AREA . 45 FT OFF LINE 75 FT OFF LINE HOUSE BACK 94 FT OFF LINE . HOUSE SIDE 200 FT 200 FT 100 FT OFF LINE HOUSE HOUSE SIDE 28X58 D R I 97 FT OFF LINE 10 FT OFF FRONT V HOUSE OF HOUSE E FRONT SEPTIC AREA W A Y 252 ft �� Rep�rts . • Page 1 of 1 . �. . s`� Davie County, NC Tax Parcel Report . • � l / l V ~ r \ ' 7A1,�; ' l'2Z22� ' �� 223�J� 1 f ' � r / �� ' 1 \ ,. ` rti. � � � � ., �, 223�1� ' t ` " �i r .. � �`�, t 22�5�, ,� t,- ,, 'v, �23F�� "� .� �,/ _ �23d� �2242�� 2255� `� � ,, .G, l ,Y az� ,,�� . � " , f- � ! 'h.� � r h� �� ,,:: . ''' � J . t �� ,/' F ' �� . . ( 225�� ! ��i J ' �` � \ ' �� --V�ACF('"LI��-""�''"_...�...,�-„_. '.,�,:' t ;, � � I +� a � �� '�w]'�, L1 1'�,� �� , ,:��s,.�'�-12��,*f��,p� �,�;��`-�� .:�-m,.,�--.�- rt.. . _.� ..�....,�.. �'�� 4 i 0 0 70ft t � *WARNING:THIS IS NOT A SURVEY!* Wednesday, 4/25/2012 Parcei Number: L5100A0008 A This map is prepared for the inventory of PIN Number: 5746149225 real property found within this �p�i ccount Number: 2518071 jurisdiction,and is comp(led from �.�,� . recorded deeds,plats,and other public �.y �;�° yy' Listed Owner#1: EACH]OHN RAY SR records and data. Users of this map are , Q��RC Listed Owner#2: hereby notified that the aforementioned - public primary Information sources should Mailin Address 1: 111 VEACH LANE be consulted for verification of the Mailin Address 2: Informatfon contafned on this map.The i : MOCKSVILLE County and mapping company assume no State: NC legal responsibility for the information ZI Code: 27028-0000 Contained on this map. Legal Descriptlon: . �P�O LOTS 31-39 Notes: DANIEL crea e: 3.22000000 Deed Date: 2001 Deed Book and Pa e: 03870562 Plat Book: 0001 Plat Pa e: 035 Buildin Value: 25660 Outbullding and Extra Features 23530 alue: Land Value: 27590 otal Market Value: 6780 otal Assessed Value: 6780 http://maps.co.davie.nc.us/GoMaps/reports/report.cfin?CFID=13 3126&CFTOKEN=79031... 4/25/2012 �_ ' � • " ' � DAVIE COUNTY HEALTH DEPARTMENT , � ' � �" Environmental Health Section Soil/Site Evaluation � APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990005869 Tax PIN/EH#: L5100A0008A Billed To: Tracy O'neal Subdivision Info: Reference Name: Location/Address: 121 Veach Lane-27028 Proposed Facility: Residence Property Size: 200x252 Date Evaluated: ��Z___ Water Supply: On-Site Well Community Public Evaluation By: Auger Boring � Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e sition L Slo e % � p , HORIZON I DEPTH Q- —3G Texture grou � Consistence / Structure � �5 L Mineralo HORIZON II DEPTH . Texture rou $_ Consistence � f� Structure ,- Mineralo ; HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE � CLASSIFICATION S" LONG-TERM ACCEPTANCE RATE . �'� SITE CLASSIFICATION:_ �� EVALUATION BY: � G�wL''� A LONG-TERM ACCEPTANCE RATE:_�"Z_ OTHER(S)PRESENT: REMARKS: LEGEND i, n s e Position R-Ridge S -Shoulder L-Lineaz slope FS -Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope Textul'g 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 .ONSI�T .N • . �Q1S� 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 S r> >r . SC-Single grain M-Massive CR-Crumb GR-Granulaz ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineraloev 1:1,2:1,Mixed LYs.t�S 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-gaUday/ft2 DCHD OS/OS(Revised)