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1400 Yadkin Valley Rd r _ _ ._._.__.__.. _.. _ t . � DAVIE COUN�I,Y ENVIRONi�9EV�I'AL ITLf�I,�l f I i P.O. T3or �48/2�10 3(ospital Street Mocksville, NC 270?� ��3���si-���o��Y#�33���s1-��b� Account #: 990000758 OP�;KATION PERi1�t.�� PIN/EH #: 5863-35-5150 II Billed To: Ronnie Foster Subdivision Info: � Reference Name: Location/Address: Yadkin Valley Road-27006 Proposed Facility: Residence Property Size: 7 Acres ATC Number: 4839 **NOTE**The issuance of this Operation Permit st�all indicate the system described on the ATC has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .7900"Sewage Treatment and Disposal Systeins," but shall in I�TO WAY be taken as a guarantee that the system will fimction satisfactorily for any given period of time. � J} �7� System Type:��_S.T.Mamtfacturer �hO C'� Tank Date� Tank Size_�, �1 CGG Pump Tank Size � �t,+ �� �'-- ��' �� q� � ��l , � ���� - ��-- D� �� � System Installed By: �� ,!G'��:� ����z`` E.H�Specialist: �-�'��' Date: ��� � / I �Ih , i� ; / / / / -- —— ----- � �D� _ I .___.___ .__ �� / I ���� , � a� / �a-j c��'° � ��4 1 � � , � I r � � � � ti � v � � �r � -Z � � \ � � � � � , �. �� � ' � �, � ; �' , � , lu° i , � � � _ ; ' — --- - -�--"�— �`-`�` [� �-� -{ -- 7 :��u�c�f��/ - , ..i.rrr� � � rn� in'_--�__�� �v ��� �� K(H�.POr/df�l • ����', �, � - i);1V11�. COT�V��1�Y1_:�\�'11:0_���11�:A�� �Lf(i::�l ��i ;i ��� � • !'.0 F3o��-��/?1(i I-Iospitai St:ee: ���� vt�>c�:svi11�, NC 2702� � r_��6)7�1-8760 Fax# (336)7�1-�786 1li'fHO121%;�'1�I0V� 1�0121V.�S'1'E�1'_1"1'F;R SYS't'FM CO'�STIZtiC'TIOi� Account #: 990000758 Tax PIN/EH #: 5863-35-5150 i Billed To: Ronnie Foster Subdivision Info: �I Reference Name: Location/Address: Yadkin Valley Road-27006 Proposed Facility: Residence Property Size: 7 Acres ATC Number: 4839 I �ite"I yp�: �i�ew i-:Repair l iEYpansion � �*NO"I�E*� This Authorization to Constnict(ATC)ivfUST I3E ISSUED by tbe Davie County Lnvironmenta] �Iealth Section prior to issuance oF any building permit(s), (in coinpliance with Article 11 of G.S. Chapter 130A �� Wastewater Systems, Section .1)00 Sewage Treahnent and Disposal Systems). �i'HTS AIJ'1'HOIZIZA'I�10N TO CONSTRUCT IS VALID POR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if sife plans, plat � or the intencled use chan�e. Residential Specifications: #Bedrooms �#Bathrooms__� �People � BasementfJ Basement plumbing�7 I \ot�-Residential Specifications: Facility`I'ype_ _ #People__ #Seats__ � Syuare Footage(or Diinensions of Facility)___ _ Lot Size_/ �C G1�7 '1'ype of Water Supply: GK;ounty/City �Well ❑Commutiity Well I ' � System Specifications: Design Wastewater Flow(GPD) ��L' Tank Size � ��U GAL. Pump Tank��_GAL. _J-__ � ' � �� � 7 ' rI'rench Width__7[�_ Max."1'rench Depth 3L• Rock Depth_ �:� _ Linear Ft. �_,� �—,(/� I Si,e Modifications/Conditions%Other: ___ _ _.�� 3(t r��7(QIC�p�4��,a� Contact the Davie County Environmental Health Secfion for final inspection of this system betrveen �� 8:30—9:30a.m. on the day of installation. Telephone# 336)751-8760. - _ _ _. . _---- —�--- _- �`' { ,� Io'�'�r���� y,� �;r� � � 5 ��-� �c�,�� ���� I C ' 1 — r ` c,� (�I) � �'� � . � � �r h,e5 P r _� .�' �Cn 0� � Q— �- �t p�i� 7G .! �r-��i ! 9 �� T - , � � � �� � a = � � �• I �uc i � t�(,' t'�1�11�Q� � � / � � � - � - / —s�- ----.._---- -----�- — --- ---�� i ----- ' -- -- I;m�ironinental Health Spccialist—_ T)ate: —�� DCHD 11/OC(Revised) I i . Davie County Environnicntal Hcaltli P.O.13os S48/210 Hospital Street Mocksville,NC 27028 (336)7�1-87fi0/ Fax(336)757-8786 Account #: 990000758 IMPROVF,MENT FEI���IN/EH #: 5863-35-5150 Billed To: Ronnie Foster Subdivision Info: Address: 363 Harvest Way Location/Address: Yadkin Valley Road-27006 I City: Mocksville Property Size: 7 Acres Reference Name: Proposed Facility: Residence **NO'1'L**This Improvement Permit DOES NOT authorize the constniction of a wastewater system. An Atitlaorization To Construct a wastewater systern must be obtained from this office prior to the construction/installation of a wastcwater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). Ttiis Improveme�it Permit is subject to revocation if site plaiis,plat or the intended use change. ...._._.�._..._._.__.._..._. _..._�.4._..._____..,�._..._...�._..�......_........m.�.� ._..�.,..�._._,_....._.._.., Permit Type: rew I 1Repair ❑Expansion Permit Valid foi: — Ycars�[-�No Expiration Residential Specifications: #Bedroonls_�_ #Bathrooms j #People� Basement❑ Basement plumbing_: Non-Residential Specifications: Facility Type #People _ # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):_�C �� Type of Water Supply: f�l�Ounty/City f7Well ❑Community Well Site Modifications/Permit Conditions: I System Type LTAR Itutial � .�� 7 j Repair �e� t <-e� . 7 Site Plan C/ � �� P��� N���-�. IQ4� pG / t��+5`� -,--` � f n"� � ��} � � O ,_b 1 �� � � .��,,,� �� �L° �� � � `� ���' ,,o � � � �� � � '� �� -- ���t� �.\�,..� 'R _ -----._ Lnvironmental Health Speciali t � .0 ���ate i I :.ii_ni • � l I I _ � � � � �APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health '� '��,'� � � P.O. Box 848/210 Hos ital Street � � ��`x•.,'��,, , Mocksville, NC 27028 . (336)751-8760/Fax(336)751-8786 Application For: Site Evaluation/Improvement Pernlit � I Authorizatiott To Construct(ATC) � '�� Both Type of Applicati� =�New System �� �Repair to ExistinQ Systein IEx ansion/Moditication of Existin�S stem or Pacilit � P � Y Y ***l�4PORTANT�`*�THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION �-- Namc to Ue Billed T� i -, E� ��, r E' �I��, �:, �c=�>� Contact Person �\l�:��-. ., ,'.. �. , f�, Billing Address ��. � i-/cr�:>>_ .;, � �:'�:�r Home Phone `/�/ -�Z r; (.:;� � Eity/State/ZIP ;'����-�: �,,,. /I,, �� ; _ �� j �t c_' � Business Phone `i�'; �- _; ;�=';_ � Name on Permit/ATC if Differerat than Above Mailing Address City/State/Zip PROPERTY INFORMATION *llate House/Facility Corners Flagged ,3� Ia -a� NOTE: A st�ivey plat or site plan must accompany this application_ Included: '_1 Site Plat� ' IPlat(to scale) (Perinit is valid for 60 rr�ntl�s with site plan, no expiration with complete plat.) Owner's Name��>,�� � f���� �.� Phone Number �'S �� � Ov�n�cr's Address Cit /State/li � ��� ��� l��l ►�: �L�1 �.�n_. i�.�.�._ _ �C?c�c�, )' I� � Property Address City Lot Size �/ ;-1, �- Tax PIN#SS�i .�S S/SU Subdivision Name(if applicable) Section/Lot# DIl'f.'Ct1017S TO Slte: �� e� ( *C �i �cC<n 4[.���� + <':.;�.t2^ [y�.itil ttu/�'-� �i���' I �t, � . �i n-r i �t.; �4 h c�.� -� l f � � xsL�1 �n ��..-• �� �i I�the answer to any of the followiug questions is"yes", supporting document�ation must be attached. � Are there any existing wastewater systenzs on the site? � IYes ❑No � Does tlle site contain jurisdictional wetlands? lYes I �No Are there any eascments or right-of-ways on the site'? � 1 Yes ❑I�To Is the site subject to approval by another public agency'? I IYes ❑No Will wastewater other than domesric sewage be generated'? I !Yes ❑No IF RF,SIDENCE FILL OUT THE BOX BELOW #Pcople l� #Bedrooms � #Bathrooms _� Garden'I'ub/Whirlpool Yes 'No Basement: Yes nNo I3asernent Plumbing: Yes `�No IF NON-RESIDENCE FILL OUT THE BOX B�LOW Type of Facility/Business Total Squarc Footage of Building _ #People � # Sinks #Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of siinilar facility water consumption) FOODSF,RVICE ONLY: # Seats Ty�e system requested: i�Conventional �_lAccepted :��:Innovativc �. ;Alternative �� ��Other Water Supply Type: �ii County/City Water C New Well ' �Existing Well Community Well Do you anticipate additions or expansions of the facility this system is intended to serve'? I � Yes IX No If yes, what type? e, This is to certify that the information provided on this application is true aild correct to the best of i��y knowledge. I understand that any pern�it(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is alCered, the intended use changes, or if the information submitted in this application is falsified or chaugcd. I hereby grant right of enh-y to the Authorized Represe»tative of the Davie County Health Department to conduct necessary inspections to deternune compliauce with applicable laws and tules. � I undeistand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging or s� g the house/facility cation,proposed well location aiid the location of any other amenities. � � "i , , �� .�, r ��� i� � ��- Site Rcvisit Cl�arge roperty owner's or owner's legal representative signature I � Da�e(s): _��j'� � "�' Cliciit Notification Date: _ __ Date E�IS: Sign givcn Yes ❑No Account t� I � � Reviscd 11/O6 Invoice# � � I . � �dx a�ar�ei rceporc ' - � � !'r — ��';'a . . • • � �� � I � ' _ I �1 ���`� ;� � .4 i � � I �.�P � C� �� \ 1.;_:t,� �'�/"/ y� �9�n SL��.� , ��� � , ,.�, , n� �� � J y_.�-- 5 1 - � ��� _ - _ - � t _ _ -- ti Kt� ��'L��_Y �� _ _,�� / R _-_ ~� , _��' ��. �i i, l � � , _ - - i� y �'� v"� ~ i :���-�� _��~ � �I _-"�" � �ti, s r``I ti � � �t����'s 77ft � , �r' � �, i, *WARNING: THIS IS NOT A SURVEY!* WLdCIeSd�jy, ?_/?._0/2008 Parcel Number� -- This map is prepared for the inventory of Number. 5863355150 real property found within this Ky����� jurisdiction, and is compiled frorn ccount Number: 000082514545 recorded deeds, plats, and other public C, `�;- '�� RIDDLE]ERRY WF records and data. Users of this map are QU �.t Listed Owner #1: R hereby notified that the aforementioned Listed Owner #2: public prirnary infarmation sources should 1366 YADKIN VAL be consulted for verification of the Mailing Address 1:�ROAD information contained on this map. The , County and mapping company assume no Mailin Address 2: leyal responsibility for the information Cit : DVANCE contained on this map. State: NC Notes: Zi Code: 27006 Legal Description: 7.00 AC YADKIN i VALLEY RD Acrea e: 7.43000000 Deed Date: 020000307 Deed Bookand Pa e: 003280150 Plat Book: Plat Pa e: �— Buildin Value: 0 Outbuilding and Extra Features � Value: Land Value: 95100 otal M<�rket Value: 95100 http://maps.co.davie.nc.us/GoMaps/reports/report.cfm?CFID=4363&CPTOKEN=84588107 2/20/2008 GoMAPS - Davie County NC Public Access Page 1 of 1 , . Davie County, NC - GIS/Mapping System ����t�` Click Here TQ 5#art Quer Qs�i�k �e�ar+ch:(C€�unty ID c I! u. , _ f�, � ��i • � .,�� � � l � � �� �c�iw� ����r: 0i}�se��� �r�s GIS � � , � � - �'U"N� � � � ;�" � �, PARCEL� (M�p Tip�Av�ilable} � ' ���p L���rs � 3����It� � � ' �,`'�:�`--- �; � �;' •Fi:�� ��-.Y �� �� � �I �� �, ,�� (�-ti.3,5� �` � .,__} i i .-�' _=�� i � �. ��'7 �` � a i� � � I -� _ t �.� `� � � � '� `-� C: 1, , � � + !� "., n' i ? 1-=' �' ,.�i r r��_ — — �'� "��t � � � � +1{ � Y��.�1 }��]?� ' — � � _�r���Y��_ �~y�t��r rlrr =f�� _ , M � � I �' � �.;r—--m_ n y' i �t t�.� w _ f r. ` I� �I �� �� fr ��~- _ "_-- 4 5 f�r I y ,r �r y � � � s��R�cs�o �� � i ` �� — �� —(" � �� � �� ', ? ' i � � � 1 ` i �.`��_ _ � � a__- ^, m I ��:1� ~ ~~~�y�t '�I - n�J I, �t�7��,�1_ St � � I 7 + 5� i e t L�.,��'(}a 1j 5t {r = 5--� _ ' _ — � J ���'� .y) �} � `n y u �t t� � � �IF � t � � � �' O �� 4 ( I I - ' 1I �� i� �� � ���i� ( I I . �O� UIL I I � a- � � http://maps.co.davie.nc.us/GoMaps/map/Index.cfm?mainmapservice=gomaps&CFID=412... 3/14/2008 • . ' i . • • ' DAVIE COUNTY HEAI TI-f DEPARTMENT Environmental Health Section Soil/Site Evaluation APPI PC�d�'�'tI�:F�B.�OQ��I Tax PIN/EH #: 586B1�$6�Y INFORMATION Billed To: Ronnie Foster Subdivision Info: �'s!�<.�_:��`�f�j�� Reference Name: Location/Address: Yadkin Valley Road-27006 �� Proposed Facility: Residence Property Size: 7 Acres Date Evaluated: �=���' �, i � Watcr Supply: On-Site Well Community _ !'ublic � II Evaluation I3y: Auger Boring_ Pit _ Cu[ _ FACTORS 1 2 3 4 5 6 7 Landscape positio�l (,,_ �- �.---- � Slope % f � r HOR17.ON I DEP'1'H �_ : ' C% — L; Tcxttuc grou ' � �. �+ — , Consis[ence ;,;i ;� ,;/ � Sfructure �' �� � 1�� �� � Mineralo� ! _ n � -�, , �� ' I ]iORI"/.ON iI DEl'TH �I�GXCUI'C �I'OL]. ' . �'.011S1SLCIICC SII'UCLll["C MIIICI':1�04!}� NOR110N ili DEPTI�� Texturc �rou� � Consistcnce � I Structure Miueralo* �� l101t►'T.ON IV llEI'TH � Te�turc �rou � i Consistencc I� Structure Miner�ilo� � I SOII_,VVETNESS ..—�� KES'I'RICTIVI?HORI"1-ON ��" � SAPROLITE �� CI.ASSIFICAI'ION � ` � LONG-TERM ACCEP'TANCE RATE . � ` — ) i ' ` ) ^ f i SI`l'E CLASSIFICATION:_ `� J EVALUAT[ON BY: ���f1 ..�I/����f[;�1 � _ ' _ . LONG-'1'�;RM ACCTP`I'ANCE IZATF_: �' ��-� O'I'H�R(S) PRESENT: �O�'1 f"�s F �(����� I RLMARKS: -- -- LEGEND -- --- — L�t1d��pe P��sitiori � R - ltidgc; S - Shoulder L- Lincar slope FS - Foot slope N - Nose slopc CC - Cuncave slope CV -Convex slope T-T'errace HP- }�lood plain I-I - Head slope Ts�stllrs� S - Saucl LS - Loamy sand SL- Sandy loam L- Loarn SI- Silt SICI_,- Silty clay loam S1L- Silty loanl CL- Clay loam SCL-Sandy clay loam SC - Sandy clay SIC - 5ilty clay C - Clay S;S2I�,�1STt�:NCL 1,1� VI�R -Vcry friable FK - Friable FI - Firm VFI - Very f�irrri EFI-Extremcly firm �YsI NS - Non sticky SS - Sligh[ly sticky S - Sticky VS -Very Sticky NP- Non plastic SY- Slightly plastic P-Plastic VP- Very plastic Strustu►•e SC - Singlc grain M - Massivc CR- Crumb GR- Granular Af3K -Angular blocky SBK - Subangular blocky Pl,- Platy PR - Prismltic �'Iincr.�l�ig�� 1:1,2:]. Mixcd \c�tc� Hurizon cicE�th - ln inches Depth ��f fill - ln inches Rcstrictive horixon -Thickness and inches from land surface Saprolitc - S(sui�able),U(unsuitable) Soil wetness - Inches from land surfacc to free water or inches from l�nd surfacc to soil colors with cl7roma 2 or less Classification - S(suitable),PS(provisionally suitabfe),U(unsuitable) LTAR - Long-term acceptance ratc- gal/day/ft2 r�rUr�n�inc iv,...:....a� ������������■��������■■���■■■���■����■��������■�������■��������■�� ������■�����■�����■■■■����������■�������■���■�������■����■■�����■� ��■������������1■����■����■■���■ �■���■�■��■�■�■��■■�����■������� �������/������������������0���������������■�������■����■�■■��■��■ ���������/����������■������■��■����■■■�����■■�■��■�����■■�����■��� ����■�������������������■�������■���■��%!��C�C�����.�����■�����■■� ■�■���■�■����■■��■����■�����■����■�%��/���■■■����■■��������������� ■��������■■����■�■�■��■��■��■■�i����■��■���■�■����■�;■�■����■�■■��� 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