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320 Merrells Lake Road Lot 6N 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 #: 5768-62-1630.06 Billed To: Rodney Bailey Subdivision Info: Hayes Hills Lot # 6 Reference Name: Jeff Hayes Location/Address: Merrells Lake Road -27028 Proposed Facility: Residence Property Size: see map ATC Number: 4566 **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. Qq System e: ' `' S.T. Manufacturer Tank Date I "'�� Tank Size a d ys �'p ..� Pump Tank Size GFS DCHD 11/06 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH - Jf P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004007 Billed To: Rodney Bailey Reference Name: Jeff Hayes Proposed Facility: Residence tr'1. CA ATC Number: 4566 Tax PIN/EH #: 5768-62-1630.06 Subdivision Info: Hayes Hills Lot # 6 Location/Address: Merrells Lake Road -27028 Property Size: see map **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. Residential Specification: Building Type #People #Bedrooms #Baths Basement w/Plumbing: ___. Basement/No Plumbing Commercial Specification: Facility a #People #People/Shift #Seats Lot Size Type Water Supply esign Wastewater Flow (GPD�Q Site: New. R pair• System Specifi tions: Tank Size 1000 GAL. Pump Tank — GAL. Trench Width--Aou Trench Depth `(o) I OA's Rock Depth 14 Linear R.a'!0' ,•- C�)'-as �1 , Required Site Modifications/Conditions: 1t��T�U t� CD,)0 0 p LI Contact the Davie County Environmental Health Section for final inspection s system between 8:30 – 9:30a.m. on the day of installation. Telephone # (336)751-8760. L c Dt i 31 t S (A \v PSP, u a� eco Environmental Health Specialist Date: to O DCHD 11/06 (Revised) tom' 918 bed(oo nv� ON) PPLICATION FOR SITE EVALUATION/IMPROV)8MENT PERMIT & ATC .20(� Davie County Health Department JVD 2 Environmental Health Section P.O. Box 848/210 Hospital Street TAt H - • Mocksville, NC 27028 ENS �p�j 011Nn(336)751-87601 Fax (336)751-8� . Application For: at/a-Evaluat,iordimprovement Permit i%nuthot ti To Construct(ATC) 0 Both 1UPORTAIV7'"" THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Rcffr to the INFORMATION BULLETIN for instructions. Name to be Billed ,'e� Contact Person Tit �E Uo.. t/ Billing Address w L To J 1 S, home Phone City/Stittearp vu Business Phone -D D Name on Permit/ATC if Different than Above Mailing Address City/State/Zip NOTE: A survey plat or site plan roust accompany this application. (Permit is valid for 60 mpnths with site pla no expiration with complete plat.) Street Address v 11. %'A, .ce City v. vljg Tax PIN# ;S' iia Z Subdivision NauuHI/Is Section/Lot# Lot Size S— ,Tmc. a-�ti 7 +A c Directions To Site: 1± e. 4., 2 n CA -e"11, t- Date House/Facility Comers Flagged If the answer t9 any of the following questions is "yes", suppotting documentauo nst be attached. Are there any existing wastewater systems on the site? DYes Does the site contain jurisdictional wetlands? ❑Yes LJ Are there any casements or right-of-ways on the site? ❑Yes t o Is the site subject to approval by another public agency? Dyes 96 Will wastewater-othcr than domestic sewage be generated? Dyes p'l�o IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms . .!�( — # Bathrooms _ Garden Tub/Wb rlpool &Yirs ❑No Basement: es ONo Basement Plumbing: D es CNo IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of FacilityBAsiness Total Square Footage of Building 0 People # Sinks # Commodes # Showers # Urinals estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: t,}Gonventional OAccepted Olnnovative ❑Alternative 00ther Water Supply Type: al K-11City Water O New Well OExisting Well 0 Community well Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes algl 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. [understand that any permit(s) or ATC(s) issued hercattcr are subject to suspension or revocation if the site is altered, the intended use chnngts, or if the information submitted in this application is falsified or changed. I understand that I 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 wij� aPplicat�le laws and rules on the above described property located in Davie County and owned by _& It 0 1 ,/ (61 + e..5 ) e`� Property cr's oro ier's legs presentative signature Date Sign given QYes ONo Revised 2106 Site Revisit Charge Date(s): Client Notification Date: EHS: r �] Account # 1 Invoice p .,AAITAAr:& -I 1,,,IMM11- -T-1I AIAA AAA AAA I-1AL.TT 0"11 AAA„/1,11A Op;a7a �• . p U Norlh Carolina Cllck on the Map to: Hor7iQ ;:,lrit:ift 1•lClli Find_Adjoidng Par-mls. j • County/O:J700000059 • Account Number.0000119511000 • PIN. 57686211630 • Legal 1:14 AC MERRELLS LAKE RD • Owner Name: BYERLY GLEN HEIRS 1 • OwneNAddress f: BYERLY GLEN HEIRS • OWnedAddress 2.' • Owner/Address 3: % BETTY HOCTOR • City. State Zip: WALDICK ,NJ 07483 - 0038 • Land Value: $86,950.00 • Building Value: $0.00 • Land Unit/Typa: :/AC • Dasd aooklPaga: 00042/0495 • Deed Date: 1944101131 • Sales Price: $0.00 • Property Address: • County Zoning: R•20 �,v) • Census Coder • City Code: o Fire District: FORK • Flood Zone: ZONE X • Flood Community: 370308 • Flood Panel: 0100 C • Flood Map Date: 12-17-1993 Map L; :.;.: •Oraw.L• Draw select [� Census Tra City Bound ❑ County Zor Multi Sy1 E011 Fire 0 ❑ Flood Pane Flood tone [] Parcels settooi 0151 Multi Syl ❑ soils [j Town Zonit Townships MUM Syi voting Pre( Driveways Q Rall Lines ❑ street cent Q U31NC Higi Multi Syr U N ❑ Aerial Phot 3hyelcal [� Creeks and E911 Addrt ❑ Fire Depart ©3chools ;Draw L MAP C -t i his map Is prep; Inventory of real 1 within thisjurisdic conipeed from rat plate, and other; and data. Users e hereby noti0ed 1n 900/9000 dOd MUM OWN 6d80 866 9££ XVd WIT QdM 9009/99/I,0 iso I 336.00 ' E too ro 7— CO 0", 70 LOT I ru ch 5.46 ACRES 14 N 88*17'07' W �4 CD LJ LOT 2 5.46 ACRES rn 71— Jai— — -------------- IN 87'28,59, W BFJ 7-0— W LOT 3 5.46 ACRES kD ct� -------------- :N LOT 4 .5.46 ACRES OD 1&0 'N (A LOP 5 (7\ j 5,46 ACRES' CD 336.o(i NA Z- 1B8.00 N 86-00loo, W 301,00 .3 2, N 86#Q0,00- V 70 A 0 - 2.04 ACRES 0 cz lou Na0ao MEL C C 11 274YER J tfo - 1 DAVIE COUNTY HEALTH DEPARTMENT • Landscape position Environmental Health Section Slope % Soil/ Site Evaluation co 70 APPLICANT INFORMATION HORIZON I DEPTH PROPERTY INFORMATION Account #: 990004007 Tax PIN/EH #: 5768-62-1630.06 Billed To: Rodney Bailey Subdivision Info: (unknown) Lot # rj Reference Name: Jeff Hayes Location/Address: Merrells Lake Road -27028 Date Evaluated: 3 Proposed Facility: Residence Property Size: HORIZON II DEPTH ` 3 Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit 1'_*1 Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % co 70 —77o HORIZON I DEPTH ©- o Texture group Consistence SS Pr S Structure D4 C.4 Mineralogy HORIZON II DEPTH ` 3 Texture group Consistence Structure C Mineralogy HORIZON III DEPTH Texture grou C—t- a Consistence r SP -, Structure Mineralogyrj ^� HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION V LONG-TERM ACCEPTANCE RATE 0.27, 49.27] SITE CLASSIFICATION: �S -\ LONG-TERM ACCEPTANCE RATE: V • Z> REMARKS: EVALUATION BY: v� &::�ALUA­P OTHER(S) PRESENT: '-"� k[.'C�C�6 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 1 oki 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 Mineralog 1:1, 2:1, Mixed NQies 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: 1 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: k--5( 'Wastewater Design Flow(GPD): 360 Valid: Q5 Years ❑No Expiration System Type: ❑Conventional .BAccepted []Innovative ❑Alternative ❑Other. Site Modifications/Permit Conditions: I Site Plan w � 0 0 SD i.p.letter 7/06 r� . P -M � 1'(� � _ L -AIL.:. o . z�- 0, 2� } f• w.. V ENSi��h'��`ZN ��'dIRO� ECOUN Z5 06 03;44a davie countd envhealth 336 751 8786 P.2 A?PLICATION FOIL SITE EVALUATIONAMPROVEMENT PERMIT &- ATC Davie County Health Department Lmv&onmenra1 Health Section P.O. Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-87601 Fax(336)751-8786 Application For: /She Evaluation/lenprovemcnt Permit D Authorization To Construct(ATC) D Both "'I,NP0RTAY1*'* THIS' APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED MORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. Narne to be Billed -9 W_ s Contact Person Billing Address _?. Z me Phone City/State/ZYP —pvm_ 1$'t,Business Phone Name on Permit/ATC if Different t.tan Mailing Address NOTE: A surveYpvt or site plan rMA accmV&n this application. (Permit is valid for 60 months with site plan, no iration with complete plat) 57&3& 21030 Street Address_ 2o4IA4sz r.- t; City lt.,:=t- Tax PIN# Subdivision Name_ j 0114 Section/Lot# 2 Lot Size 1 R Directions To. Site: _ �T Ep, q 1 r� h vtir sy..K19 4, &. ow Date House/Facility ComemPlagged If the answer to any of the following q.u.stione is" yttC. supporting dorimitatioamvst be attaebed. Are then any cxistimg wasicvater systems on the site? Oyes eNo Does the site contain jurisdi(tonal wetlands? 17Yos C190— Are there any easements m rittht of --ways on the site? DYes 0,90 Is the site subject to approval by another public agency? U V as ETA Wall wasaewnterorl+etthamdcztteatiesewagebegeneratcd? OY:aDFio IF RESIDENCE FILL OUT THE BOX BELOWOirJ"�) wo #'People _ / . _ It Bedrooms # Bathroom.; Gardw Tub/Whirlpool u . OND . Basement: rdYes nNo Bwntent Plumbing: QYes ONo V NON -RESIDENCE FILL 01 IT THE BOX BELOW Type of Facility/Basincss Total Square Focnage of Building,_ _ At People # Sinks ii Commodes # Showers _ . # Urinals Estimated Water Usage (gallons per day) (Attach do:umentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested:onvcmimul OAcceptcd Olmovative DAhcmative 00ther Water Supply Type: e -c- tmty/City Water 0 New Woll DE.isting Well t Community Wcll Do you anticipate additions or cxpaa:ions of the faeflity this system is irate aded to verve? 0 Yes rgo- lfyes, what type?. TWs is to=* that the information provided an this application is true gad correct to the best of my knowledge. I understand that any pcm*dt(s) or ATC(s) issued beret fter are subject to suspension or revc:ation if the site is altered, the Intended use changes, or if the infotmution submitted in this application is falsified or ehaaged. I unrerstand that I am tesaonsible for all charges incurred from this appikatton. i hereby grant right of entry to the Audtorized Reptescatative of rho Davie Co=ry Health Department to conduct necessary inspections to deb:rMine compliance with applicable I" and rules on the above deactibei property located in Davie County and owned by - —0 1 J Site Revisit Charge roperty wner s or or r's lc represent tive signature, ignature Date(s):,, Client Notification Date: Date r EHS:! Sign given UYesONo Account* Revised 2/06 Invoice # Z00/Zq UUM HIM IE 6680 866 9££ IM IS. -II M 900VU/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 3ra, 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,-K.S. Environmental Health Section Enc(s)