131 Finn Hollow Lane Lot 1DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 Fax # (336)751-8786
OPERATION PERMIT
Account #: 990003857 Tax PIN/EH #: 5870-44-3226
Billed To: David & Joanna Martin Subdivision Info:
Reference Name: Location/Address: Finn Hollow Lane -27006
Proposed Facility: Residence Property Size: 1.7 Acres W+ 1 4S
ATC Number: 4890
**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 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.
SystemType:AG Q`r S.T. Manufacturer Sheaf' Tank Date o1-2- Tank Size o00
Pump Tank Size AM -
System Installed By:` ee Bet- 1aelGkre_ E.H. Specialist: Date: Z -S
uwx \e."a = 436' C?JUA
toot cA.,.bcy
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 M 990003857
Billed To: David & Joanna Martin
Reference Name:
Proposed Facility: Residence
ATC Number: 4890
Tax PIN/EH #:
Subdivision Info:
Location/Address:
Property Size:
�kk� *SJR
�6Wk�.
4
587044-3226
Finn Hollow Lane -27006
1.7 Acres
Site Type: ❑New ❑Repair ❑Expansion
**NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental
Health Sectionprior 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_ BasementOBasement plumbing❑
Non=Residential Specifications: Facility Type # People_ # Seats_
Square Footage(or Dimensions of Facility)
Lot Size1J96/'-rV Type of Water Supply:ounty/City ❑Well ❑Community Well
G
System Specifications: Design Wastewater Flow (GPD) Tank Sizee GAL. Pump Tank GAL.
Trench Width 3G Max: TrenchDepth__31L Rock Depth Linear Ft. �ga
SiteModifications/Conditions/Other: �Beatated In 15A NGiC tBA.19G9(5)
Contact the Davie County Environmental Health Section for final inspection of this system between
R-10 — 930a.m. on the day of installation. Telephone # (336)751-8760.
Environmental Health f
Mun i i Ing
• 57- r
H6
r
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax (336)751-8786
IMPROVEMENT PERMIT
Account #: 990003857 Tax PIN/EH #: 5870-44-3226
Billed To:. David & Joanna Martin Subdivision Info:
Address: 2669 Comatzer Road Location/Address: Finn Hollow Lane -27006
City:Advance Property Size: 1.7 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 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.
Peanit Type: 2New_ ❑Repair ❑Expansion ` Permit Valid for: e Years ❑No Expiration
Residential Specifications: # Bedrooms 'I # Bathrooms 3 # People_ BasementO Basement plumbing[]
Non -Residential Specifications: Facility Type # People_ # Seats_
Square Footage(or Dimensions of Facility)
DesignFlow(GPD)✓: Type of Water Supply: 1 unty/City ❑Well ❑Community Well
Site Modificatigns/Pennit Conditions:
System Type LTAR
Initial ae �„z� e�l 0- a
Repair a a 7
Plan
5
A
Environmental Health
i.p.11-06
rt92/ZBa2B02 \ 49965b5 bUIIUN GKUUP - PAGE 01
2 (� TAPL CAT N FOR STrE EVALT UATIONMI1MOVEMENT PERMIT & ATC
DRvia County lavirolatnental. Health
E�+ P.O. Box 848 10IlotpftalStreet "
p1E11jP��� NockirwMe„IC 27028
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Typeofwp0ilcadom�htewSYsasm GRepaUm Er:fafng Syetmn OBxpmsiaJMOGiEwdoo ofExistbg 9ystcmwFar.Miry
"•"IMPORTANT"""7170 APPLICATION CANNOTBBPB0Cg8980 MM ALL OF TIM REQORtEO
INFORMATIONISP)kOVMZD. RcfamdtefNPORMATIONBULLETINfkimouWwa. -
APiaLICArt WFQ�MATION �JS f i N l�1(
Name m be Billed Ja�1�) Z , �. MTl n Contact person J%A, [ pn [in"� CO-
`. Bating Adams �l,Glf(.(oAAi+ye[' 14A Homephone -e `
' Citylstd9 [P 2l.sa_Lancp nl(_ �t,]JtXa HnsinazaPlmrre -
Nzmc on FormittATC If Dl ew" Then Above
0
NOTE: A sumyplat w site plan mutt accomps y foie epplieatiwi.
SimPleni]Pl dQu scale)
(Fendt is wlidfw 60 rroadr vridasfte plen,no Hrpiiptionvri$ eonrplem
Owner's Name �.i2 '0,�7elryto. M.
NNAr lin Phone NmabwA L(9ei•gJ-Le
wner
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Subdivision Nante(iPapplicable)
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DwI711eeden3TO $112: CIM 4lulla.r Larry 1 iuowp
l ab!r 14S annatCk-.�
fel
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If theinswer m any of Ne Ibllow* quesdom is'yes", supporting dac mrnt■tion mastte amehcd _ -
- Are 1146 coy exisline westswater systmns on the site?
CYesxxo -
Does die site coutainjurisdictional wetlands?
CYcl XNQ -
Ate these any euetma; or right-ofwer an the situ?
RYa ONc
It doe she subject to approval by arsmhorpub0asgepey?
GYes wo -
Wid Waste" rodw 4an domcade smgo be gsueroadl
ayesmio
IF RESIVENCF, FILL OUi THE sox BELOW
X NON-LbjEBDOBNC E FILL OLTP THE BOX BELOW
Type ofFaeiliryBdsiness Total Squirm pootagc of Building #People_
w %nits 11 Commode 0 Showers is Urinals
Estimated Water Usage (gallons per day) (ARwh docnnlrntation of similar faeilitywater eonsumption)
FOODSERVIM ONLY. #Sea"
type mumcaquosted: OCanvemionet DAccepted Olonavvow 93Atcvn■tive GOdr e -_
O.. PT(JJ a aP t ,!
Water Supply Type: J(Coomylchy Warer :A)1b el: - Mining Well 0commoniW well
All
Do you andeipamaddidonswexpuuiom of the facdigddc svalemn fateaded tosarve? D Yee XNo
Yves. wheetype?
This is to artily tbat de informatiao provided anthia application is true end correct m debut of my knowlcdgc. landerstsudtbat '
any pemth(s) of ATC(s)issued hoea:ers ase Nbject to snrpm6oaorrcvoutioo if ibe site l"Itored, me fnmoded= changes, w if
the ia[oanafioa mbtrotie4 iemit applicaetoa is AlFiRM wehmgrl, ihaebygmmtlgbtafenvymthe AsstaarimdRepreeeantfve
of the Davie County HealdtDepattme rt to eonduer neceasuy, inspaetim be ddemtoe ampdanee wimapptirable ism sun cNas
I widcrsmad Opt I am its little lbr die properidewigation and labet(ag ofpmpww tines and comers and locating and flagging
w sulci a howl{ 01 lacadon, pmpoaM�ag lx�adon mdtlre Loudon ofany othrr ameoddee.
L./.LY ��n LI SfrR«iotowge
Propca3r— nc s w a tentative signature -
%/�gieMNotiEution Dlte: .
Desk EHS:
FVan AVi"vaa DYca ONo •. Accamels �,
1Leviscd 11/06 Invoice 1l
rd wQL9= - tquounmilAu3 Auno9 GIAaO RM:90 20 ZZ Inf. .
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
., Soil/Site Evaluation.
APPLICANT INFORMATION
Account #: 990003857
Billed To: David & Joanna Martin
Reference Name:
Proposed Facility: Residence Property Size:
PROPERTY INFORMATION
Tax PIN/EH #: 5870-44-322
Subdivision Info:
Location/Address: Finn Hollow L -27006
1:7 Acres Date Evaluated:
Water Supply: On -Site Well L/Community
Evaluation By: Auger Boring ✓✓✓ Pit
Public C
444
Cut
SITE CLASSIFICATION: l^^
LONG-TERM ACCEPTANCE RATE:' L. 7
EVALUATION BY:.--) '22 ams
OTHER(S) PRESENT:
REMARKS:.' \ n 1?" O' �1 �-e (�b5 ed J P 'I QCcY�i,
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
Texture
S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt
SICL - Silty clay loam . . SIL - Siltyloam CL - Clay loam SCL - Sandy clay loam
SC - Sandy clay SIC - Silty clay C - Clay
CONSISTF.NCF.
MQiat
VFR - Very friable FR.- Friable FI - Firm VFI -Very firth EFI - Extremely firm
3yd
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
Mineraloev
1:1, 2:1, Mixed
LY4IeS
Horizon depth - In inches
Depth of fill - In inches
I Restrictive horizon - Thickness and inches from land surface
Saprolite S(suitable), U(unsuitable)
_ Soil wetness - Inches from laid surface to free water or inches from land surface to soil colors with chrome 2 or less
i Classification- S(suitable), PSSprovisionally suitable), U(unsuitable)
HORIZON I DEPTH
won, M- r&4aw&T�A
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•
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•
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SITE CLASSIFICATION: l^^
LONG-TERM ACCEPTANCE RATE:' L. 7
EVALUATION BY:.--) '22 ams
OTHER(S) PRESENT:
REMARKS:.' \ n 1?" O' �1 �-e (�b5 ed J P 'I QCcY�i,
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
Texture
S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt
SICL - Silty clay loam . . SIL - Siltyloam CL - Clay loam SCL - Sandy clay loam
SC - Sandy clay SIC - Silty clay C - Clay
CONSISTF.NCF.
MQiat
VFR - Very friable FR.- Friable FI - Firm VFI -Very firth EFI - Extremely firm
3yd
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
Mineraloev
1:1, 2:1, Mixed
LY4IeS
Horizon depth - In inches
Depth of fill - In inches
I Restrictive horizon - Thickness and inches from land surface
Saprolite S(suitable), U(unsuitable)
_ Soil wetness - Inches from laid surface to free water or inches from land surface to soil colors with chrome 2 or less
i Classification- S(suitable), PSSprovisionally suitable), U(unsuitable)