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310 Merrells Lake Road Lot 7• - DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Account #: 990004007 Tax PIN/EH #: 5768-62-1630.07 Billed To: Rodney Bailey Subdivision Info: Hayes Hills Lot # 7 Reference Name: Jeff Hayes Location/Address: Merrells Lake Road -27028 Proposed Facility: Residence Property Size: ATC Number: 4567 **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 Tank Date j -� J Tank Size Pump Tank Size 'j y/ System Installed By: S-6,0JE. Speciah ?L L4 c,"Ni3dLs ,r�' 'Sj 9 �z GLl;a-v,�:Q � Z 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 II -vl AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004007 Billed To: Rodney Bailey Reference Name: Jeff Hayes Proposed Facility: Residence �I ATC Number: 4567 Tax PIN/EH #: 5768-62-1630.07 Subdivision Info: Hayes Hills Lot # 7 Location/Address: Merrells Lake Road -27028 Property Size: **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 FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. SBaseResidential Specification: Building Type AU� #People #Bedrooms #Baths Z,5- Basement ment w/Plumbing: T Basement/No Plumbing e - Commercial Specification- Facility Type #People #People/Shift #Seats Lot Size j / Type Water Supply 0,0apesign Wastewater Flow (GPD) 3Q Site: New, Repair System Specifications: Tank Size 1000GAL. Pump Tank — GAL. Trench Width Trench Depth 3L'" AAX Rock Delith_11L Linear Ft. L t 7Q1�1if1© As stated in 15A NCAC 1EA.1969(5) Other: �X-2� accepted Syst(;ms may also be used Required Site Modifications/Conditions: Contact 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. Environmental Health DCHD 11/06 (Revised) /32' � a,qle t JAL 2 6 � 31xd irdoau 0. 0 TION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section ' P.O. Boz 848/210 Hospital Street Mocksville, NC 27028 ENNRppV1EC0 � (33 751-87601 Faz ( 75I-878 �7. Application For: rte EvaluatioMmprovement Pemtit uthorization To Construct(ATC) 0 Both ***1UPORTAk%** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refbr to the INFORMATION BULLETIN for instructions. Name to be Billed Contact Person Tp- Li"-V•es Billing Address 2 wv TO( �.�L Home Phone � City/State/ZIp y[v�,,, r JV ?-?06& i_ Business Phone d Name on Permit/ATC if Different than Above Mailing, Addresa City/State/Zip NOTE: A survcy'plat or site plan trust accompany this application. (Pmmit is valid for 60 n hs with site plexpiration with opluplat.) Street Address w � � Y6, L o Ciry. W.� o: TaxPIN# Subdivision Name �_ Section/Lot# Lot Size S•- $"me a_ T 1 pS.' DircctionsToSite: Q- wig L4 Date Houee/Facility Corners Flagged If the answer to any of the following questions is "yes", supporting documentatio tst be attached. Are there any existing wastewater systems on the site? Dyes Does the site contain jurisdictional wetlands? OYa ppp���jjr�l Are there any casements or right -of --ways on the site? Oyes t3No Is the site subject to approval by another public agency? OYes I11 Will wastewatcr•otlicr than domestic sewage be enerated? �o Oyes rrrvo IF RESIDENCE FILL OUT THE BOX BELOW # people# Bedrooms 41#.,Bathrooms _ Garden Tub/Wbirlpooi 0-Y s` ONo Basement: es ONo Basement Plumbtng: Cres ONo M NON -RESIDENCE FILL OUT THE BOX BELOW Type of FacilityBosiness Total Square Footage of Building if People # Sinks # Commodes # Showers # Urinals l;stimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested onventional OAccepted Olanovative OAltemative OOther Water Supply Type: ol ouaty/Ciry Water 0 New Well OExisting Well O Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes F1'No If yes, what type? This is to certify that the information provided on this application is true and correct to the best of ray knowledge. I understand that any pemiit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use chanW, or if the information submitted in this application is falsified or changed- 1 understand that 1 am responsible for all charges incurred from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance wiplica le laws mid rules on the above described property located in Davie County and owned by _(S I v1 �Jzr l J ((� e•s ) -/ (Cu ) Propc�rty"ncr's oro lws leg presentative signature Date Sign given CJYes ONo Revised 2/06 Site Revisit Charge Date(s): Client Notification Date: EHS: t 1 Account # Invoice # wan ,TanM TA, IWIMA1nIn %—TMTI1 ntnn nnn nnn •I\,!' nL.TT nRU AAA71A41IA -.41 ► t S North Carolina tj Click on tho Map to: ZK 0 zoom►n ;0.700mout �0890 Parcels Zoom F 0 Radi7se�erch ,9..AA, j ua Hi,rriv tt.�,.11., 'SMA Arse exfth. 6761621650 frA. i wyA. I WIV i .. .. • i 3 rtu !tl 1 . AAA. . •�... _ 1 7Ytf .......•.yr.......„.- 1 .2.WA. C Find_Adio..in ng Panne,h i • Courtly 11).J700000059 • Account Number.00001195e000 • P/N. 5768621630 • Legal 1:14 AC MERRELLS LAKE RD • Owner Name: BYERLY GLEN HEIRS • OwnerlAddress 1: BYERLY GLEN HEIRS • OwnerlAddress 2: • OwnerlAddreas 3: % BETTY HOCTOR • City, State Zip: WALDICK ,NJ 07463 - 0038 • Land Value: $86,950.00 j• aulld/ng Value: $0.00 • Land Unit/Typo: a AC • Dead acoklPaga: 00042/0495 • Dead Date: 1944101131 • Sales Price. $0.00 • Property Address: ^ • County Zoning: R•20 • Census Coder • City Code: ♦ Fire District: FORK • Flood Zone: ZONE X • Flood Community: 370308 • Flood Panel: 0100 C • Flood Map Data: 12.17-1993 Map W Draw,L Draw salaet oundary ] Census Tra City Bound ] County Zor Multi Syt ] E911 Fire C ] Flood Pane ] Flood Zone parcels ] settooi DIST MUlti Syl ] Solis ] Town zonir ] Townships Multi Syl ] voting Pre( ifrastructu ] Driveways ] Rall Lines ] Street Cent U3►NC H191 Multi Syi U N ❑ Aerial Phot Physical [� Creeks and E911 Addrt ❑ Fire Depart [� Schools raw L I MAP Ct This map is prep: inventory of real I within thisjurisdit compiled from re plate, and other F and data, Users e haraby notl0ed th Z00/Zq dOd VNI10M URN 6L80 866 9££ YVd WIT OR 900Z/99M -50 6, too 40 CD 7o N z J- 4 15AD Ln 0 A A — Jtc, N @Goo 7i 10W 2.04 ACRES fIT, 0 ;r-;- 3 N ru LOT I 5.46 ACRES 4 1 N 88.17'07' w 843,75 LOT 2 5.46 ACRES IN 813.70 LOT 3 6.46 ACRES LOT 4 5.46 ACRES LOT 6 5.46 ACRES "I --V-R--w-00-v 0 IS? r1l) 0 ID w AIFL Ply C, -D.B. pCCUTffEJ? . 1',0 ao Xr 40 N @Goo .3 2.04 ACRES fIT, 0 ;r-;- 3 N ru LOT I 5.46 ACRES 4 1 N 88.17'07' w 843,75 LOT 2 5.46 ACRES IN 813.70 LOT 3 6.46 ACRES LOT 4 5.46 ACRES LOT 6 5.46 ACRES "I --V-R--w-00-v 0 IS? r1l) 0 ID w AIFL Ply C, -D.B. pCCUTffEJ? . 1',0 APPLICANT INFORMATION Account #: 990004007 Billed To: Rodney Bailey Reference Name: Jeff Hayes Proposed Facility: Residence Water Supply: On -Site Well DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5768-62-1630.07 Subdivision Info: (unknown) Lot # 7 Location/Address: Merrells Lake Roa 7028 Property Size: Date Evaluated: Community Public Evaluation By: Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position i L Sloe % _tfL -;520 HORIZON I DEPTH - to Texture group C, L Consistence jg p Structure Mineralogys HORIZON II DEPTH - 2[,, Texture group 0+-$4 1 L Consistence S Structure Mineralogy HORIZON III DEPTH Texture group C f Consistence Fi Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 1 0. Z7 0 �r J SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: �' Z�S OTHER(S) PRESENT: REMARKS: 1 K TD F A l 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 - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE lu � 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 Nates 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 - gal/day/ft2 DCHD 05105 (Revised) Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Improvement Permit Jeff Hayes 228 NC HWY 801S Advance, NC 27006 Re: I Acre Tract / Merrells Lake Road Lot # Tax PIN# 5768621630 Dear Client(s): 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 or the intended use change. System To Serve: _ CN- astewater Design Flow(GPD): - Cp; Valid: Zb Years ❑No Expiration System Type:�onventional ❑Accepted ❑innovative ❑Alternative ❑Other. Site Modifications/Permit Conditions: Site PlanSO- lt,) I iii. tAc7 to i.p.letter 7/06 29 06 09t44a davie oourtt4 envhealth 336 751 8786 p.2 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT& ATC Davie County Health Department .environmental Health Section P.O. Box 848/210 Hospital Street MocksviUe, NC 27023 (336)751-876w Fax(336)731-8786 Application For: Site EvaluatioNlmprovement Permit 0 Authorintiort To Construct(ATC) O Soft ***1AdP0RTAh1'0•• THISA"UrP,TION CANNOT BE PROC MED a`tI�IIXM ALL OF VE REQUIRED lbo INFORMATION 13 PROVIDED. fer to the INFORMATION SUI:.L.M fN far insancdom. APPLICANT INFORMATION_ Name to be Billed _ S , Contact PersoA ��` Ry A�6g j Billing Address _ a - I t. home Phone _ City/Stafe/71P_� t\t-'�,__HusinessPhone_ _ 4 Name on Pawit/ATC if Different taan Mailing Address _ NOTE: A srtrW01st or site plan rtati:t accnmparty (Permit is valid for 60 months with site plat Street Address 4j, 1mg 0 • a. Subdivision Name N %L4 _ r Q Directions To Sit.t4 i coknplcte plat.) Tax PIN# 57(,4(02 1 to!O 1 _ Lot Size Date House/Facility ComemFlaggvd if rhe arrswa to any of the followb* q-w=om is'•yes", supporting docuu=tation mwt be attached. Are there any existing wastcv-tter systems on the site? Oyes Wo Does the site contain judsdic zonal wetlands? Oyes Are theta any tasernmM or tirt d -of -ways on the site? OY41 dwo Is the site subject to approval by another public agency? U Y es t Will wastewaterothetthan dcmesticravage beYeneratcd? OV -.3 o _ IF RESIDENCE FILL OUT TH E BOX BELOW 0 r 0" 61:3110 (Q r # "People # BLdrootns # Bathroom ; Cratden Tuwwhiripool es . allo . Basement: es ONO Base:mentPlumbing: OYes ONo IF NON -RESIDENCE FILL 011T THE BOX BELOW Type of Facility/Business Total Square Foct:age of Building,.,_,,,_,-,—„ # People # Sinks # Commodes # Showers _ # Urinals Estimated Water Usage (gallons pis day) (Attach do mmentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested:oavcntioual OAcceptcd OInnovative OAhcmative 00ther Water Supply Type: a,611'aty/City Coater 0 New Weil OE4sting Well t Community Well Do you anticipate additions or expaaiions of the facility this system is intexW to serve? q Yes e o If yes, what type?. This is to certify that the information provided on this application is true x3d correct to the best of my Imowledge. I understand that any person(:) or ATC(s) issued hent Iter are subject to suspension or mvo: ation if the site is altered, the Intanded use changes, or if the information submitted in this application is falsif ed or changed I understand that I am responsible jot all charges incurred from this appltcadon. I hereby grant tight of entry to the Authorited Rcpteseotativt: of the Dao is County Hearth Depamncnt to conduct necessary inspections to debarMnt compliance with applicable 1s:vs and rules on the above described propetty located in Davie County anti owned by fiVGr 1./ &n1t2z 94 46 Site Revisit Charge toperty wner s or o er's lcigg-representitive signature Date(s):_. Client Notification Datt: Date EHS._ Sign given UYes ONo Account Ravised 2/06 Invoice # zoo/zooE )UIVHH HIM va 6180 966 9£C 1VJ is -IT au 90oa/69/80 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 /Fax: (336)751-8786 August 30, 2006 Don Byerly C/o Jeff Hayes 228 NC HWY 801S Advance, NC 27006 Re: Proposed Subdivision-Merrells Lake Road Site Evaluations -2 lots, 1+ acre each Glen Byerly Tract Tax PIN#: 5768621630 Dear Client: As requested, a representative from this office visited the above site(s) August 3rd, 2006 to perform site evaluations. Based on information provided on the Application for Site Evaluation/Improvement Permit and results of the evaluations, both lots are classified provisionally suitable for the installation of on-site wastewater systems. This provisionally suitable classification is based on a three-bedroom design. Before a representative of this office will revisit the site to issue an Authorization to Construct, the appropriate application must be completed and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, feel free to contact this office at 751-8760. Sincerely, Jeff G. Beauchamp,7CS. Environmental Health Section Enc(s)