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147 Brookdale Drive Lot 8 Section 2. DAVIE COUNTY ENVIRONMENTAL HEALTH h P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/Fax #(336)753-1680 OPERATION PERMIT Account #: 990005420 Tax PIN'IEH #: 5871-84-5459 Billed To: Edward Bolton Subdivision Into: Greenwood Lakes 5 Lot # 8 Reference Name: LocationrAddress: Brookdale Drive -27006 Proposed Facility: Residence Property Size: .85 Acres ATC Number: 5049 ' � koddale— **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. !� System Type:�� S.T. Manufacturer'sRTank Date ?' Tank_ Sized Q �% d Pump Tank Size System Installed By. (5 �'1-RIrWLl�:1 � E.H. Specialist: 440#��Date: -�d N �>15d 5~8.785- ago DCHD 11/06 (Revised) DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION Account #: 990005420 Billed To: Edward Bolton Reference Name: Proposed Facility: Residence Water Supply: Evaluation By On -Site Well Auger Boring Property Size: PROPERTY INFORMATION Tax PIN/EH #: 5871-84-5459 Subdivision Info: Greenwood Lakes 5 Lot # 8 Location/Address: Brookdale Drive -27006 85 Acres Date Evaluated: I L Community Pit Public / Cut FACTORS 1 2 3 4 5 6 7 Landscape position L. L Slope % 1 j HORIZON I DEPTH 6 - y - 3 - Texture group G C_ Consistence Structure 5 k b $ k Mineralo p s HORIZON II DEPTH , tY Texture grou2 Consistence Structure g 1 Mineralogy 3y1p HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE iAT 1 12,,1-7!2.a z(2,p,734 SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: 7 7 REMARKS: LEGEND EVALUATION BY: OTHERS) PRESENT. 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 - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay ►j =1 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 Mineralogy 1:1, 2:1, Mixed rJotes 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) T TAR - T nna_tPrm arrentanrP ratr - aai/rinu/ft7 rWIrtrN ■ ■ ■ ■■■■■■■■■■■■■■■ ■M■NNENM■NNMNO■ ■■■■■■■■■■■E■■■ ■■EM■M■■EM■ON■■ ■■■■■■■■■■■E■■■ ■■■O■■N■■■■■■■■ ■■■■■NEN■■■M■■■ ■■E■■■■■■■■■■■■ ■■N■■■■M■■■■N■■ ■MNO■■■■O■■M■M■ ■MEN■OOMO■NMMMM ■S■ ■ ■N■■N■■■■■■ ■N■N■NN■■O■ ■E■MMMUMME■ ■MEMM■■MEM■ ■MEMEMMEME■ ■■MENU■■■■■ ■M■■M■MEME■ ■ ■ ■9:=E■_r ■N■■■O■■■O■■■ ■■ENE■■NN■N■■ ■■■■NMN■■■■■■ ■N■OU■O■■■■M■ ■■EO■■■■O■O■■ ■■■O■O■O■N■O■ i ■ ■EN■ NONE ■ ■ ■ ■ ■■■■O■ ■■NN■■ ■ENN■■ ■EMNON ■■NNE■ ■■ON■■ ■O■■ NONE ■■N■ MONO ✓ - 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 Account #: 990005420 Billed To: Edward Bolton Reference Marne: Proposed Facility: Residence ATC Number: 5049 Tax PIN!' WH #: 5871-84-5459 Subdivision lnfo: Greenwood Lakes 5 Lot # 8 r LocationiAddress: Brookdale Drive -27006 QK'� Property Size: .85 Acres 441241 �� ►►►"`"`" """" Site Type: ew ❑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: # Bedrooms3 # Bathrooms -J # People ,Z Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People _# Seats Square Footage(or Dimensions of Facility) Lot Size �• Type of Water Supply: ounty/City ❑ Well ❑Community Well System Specifications: Design Wastewater Flow (GPD31t Tank Sized AL. Pump Tank GAL. Trench Width 3M Max. Trench Depth_ Rock Depth_/0 Linear Ft. 3 ? p a 5' 'p,ot"A N n Site Modifications/Conditions/Other: A stated in 15A NCAC 16'.156 -?;5} �wsy.e� I ' accepted.:ysterns may : C) :11 Unca 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. V1 16ft r-749 IW MM -ql ` UJ Ft \ . r ,^l ,Q �+a , X59 nvironental Health Specialist CHD 1 /06 (Revised) 1� AI r Date: /^ /3—/6 Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax (336)753-1680 IMPROVEMENT PERMIT Account #: 990005420 Tax PIN/EH #: 5871-84-5459 Billed To: Edward Bolton Subdivision Info: Greenwood Lakes 5 Lot # 8 Address: 161 Brookdale Drive Location/Address: Brookdale Drive -27006 City: Advance Property Size: .85 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 p�s, plat or the intended use change. Permit Type: 6New ❑Repair ❑Expansion Permit Valid for: Fl5 Years ❑No Expiration Residential Specifications: # Bedrooms # Bathrooms 177 # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): 3 (,10 Type of Water Supply: e ounty/City ❑ Well ❑ Community Well Site Modifications/PermitCo ditions: As stated in 15A NCAG 18A.19 a J erns may also be use LTAR I / Initial / 05 Zd el-A.-Atu-7 I O. '.. -75 I Site Plan Environmental Healh Specialist i i.p. 11-06 Date APP ' SITE EVALUATION/IMPROVEMENT PERMIT & ATC GDavie County Environmental Health S P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/ Fax (336)753-1680 AP icatio For _G atio rovement Permit ❑ Authorization To Construct (ATC) Both T of A tcfa� ype�, pp • t�•pd� ystem ❑Repair to Existing System ❑Expansion/Modification of Existin System or Facility ***1}if TTRTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. A DDT TO A ATT TATT7nD AA A TTn7%T �r Name to be Billed =��� l� ° Contact Person Billing Address _ /r'i / /L o al�,r%¢Z [J" /j,� Home Phone City/State/ZIP //,{-r✓G Gr_ it/ 2-7cy-) B�ne Name on Permit/ATC if Different than Above Mailing Address 5110" �65' 33 G — sway— 75/y7 YKUYhK l Y 1Nf UKMA llUN 'r Date House/Facility Comers Nlaeeed 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 -, Ac c-'rrr" Phone Number 3?c --Kiri —r-Z,S� Owner's Address !4l r� ,& pLf G cam/%,_ City/State/Zip 4 ,�Gc-- Property Address a.o o Al- Orj2c/ City ^L�t/f�,✓� �r Lot Size Tax PIN# Subdivision Name(if applicable) 4!,'/l L ,✓wU�� G�ICEr�. Section/Lot# Directions To Site: T�f t<Ll /s-�° /Zl`v� gc (,LNj� 1, - Directions , //_ 7a /A/cee rLt T j VA / 2I a-., M(Z c_ e.,Lc-.r T Ta /Lc . ,� A't"0, 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? _Yes )(No Does the site contain jurisdictional wetlands? _Yes kNo Are there any easements or right-of-ways on the site? _Yes XNo Is the site subject to approval by another public agency? _Yes _kNo Will wastewater other than domestic sewage be generated? _ Yes filo IF RESIDENCE FILL OUT THE BOX BELOW # People 2. # Bedrooms 3 # Bathrooms Z S Garden Tub/Whirlpool ❑Yes A<0 Basement:&es ❑No Basement Plumbing: ❑Yes ,F to 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 (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 If yes, what type? �No 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 Representatives of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating an. 'fla in * r staking t e house/Facility location, proposed well location and the location of any other amenities. tet' .— Site Revisit Charge Property/owner's or owner's legal representative signature lU Client Notification Date: Date EHS: Sign given ❑Yes []No Account # 15Wo Revised 11/06 Invoice #�� GoMAPS - Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping System 40 Click Here To Start Over Quick Search: (County ID or Owner Ni Active ! a ' 1: Use `la�� fps V baa �V PARCELS(Map Tips Available) Pt, A d dre. ti t- r r '1 �� 'r �i , _ % \ r `� I � i� r 7c Jj�� `rte _ 71 i •_ . � � 41 j Of�Ki�R e� _1 rtr, —BKOOKL)KLL P `J 1 ti RR Lh: titi1� tl t�ti O t P4f I http://maps.co.davie.nc.usIGoMapslmap/Index.cfm?mainmapservice=gomaps&CFID=4129... 1/6/2010 GoMAPS - Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping System Click Here To Start Over Quick Search: (County ID or Ot+aner Ni - u Active l-ayei. ZUse"'Ii ° Ties �rf tip . 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