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981 Farmington Road Lot 2DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 • (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Account #: 990005129 Tax PIN/EH #: 5841-56-9005 Billed To: Anderson & Church Construction Subdivision Info: Hunter Acres Lot # 2 Reference Name: Rob Church Location/Address: Farmington Rd -27028 Proposed Facility: Residence Property Size: 1.059 ATC Number: 4888 **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: 0aq S.T. Manufacturer oa F Tank Date ?-a Tank Size /4W Pump Tank Size &/A - System Installed By: 14 ktti au"., E.H. Specialist: Date: 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 #: 990005129 Billed To: Anderson & Church Construction Reference Name: Rob Church Proposed Facility: Residence ATC Number: 4888 Tax PIN/EH #: 5841-56-9005 Subdivision Info: Hunter Acres Lot # 2 Location/Address: Farmington Rd -27028 Property Size: 1.059 Site Type: 21lew ❑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 I or the intended use change. Residential Specifications: # Bedrooms -0— Bathrooms)-- # People 3 Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Lot Size 5 Type of Water Supply: GXCounty/City ❑Well ❑CCo//mmunity Well System Specifications: Design Wastewater Flow (GPD�gp Tank Size/`GAL. Pump Tank . NNGAL. Trench Width 'J Max. Trench Depth 3 Rock Depth a Linear Ft. UU As stated in 15A NCAC 1SA.1969(5 Site Modifications/Conditions/Other: accepted Systems mtqy Pkzn ba ur6 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. Yob .............. ok ql .J' Environmental Health Specialist l Date: DCHD'11/06 (Revised) . •. C \0 GoMAPS - Davie County NC Public Access Davie County, NC - GIS/Mapping System Page 1 of 1 OP➢U/ Click Here To Start Over Quick Search: (County ID c ray "-� € �,�?�.„ f Viµ' d+" 9 C1�1 Active Layer. ❑d use Map Tips GI£ �� Q v'� � ' PARCELS (Map Tips Available) ,w, -. Map Layers I Results I 0 http://maps.co.davie.nc.usIGoMapslmap/Index.cfm?mainmapservice=gomaps&CFID=412... 12/4/2008 JUL-22-200B 14:12 ERA PREMIER 3369980879 ON FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Boz 848/210 Hospital Street Mock (336)751-8760/ Fax (336)7ville, NC 91-8786 ASite Eva tion/Improvement Permit Authorization To Consauct(ATC) Both .. Tplicatio ystem Repair to Existing System Expansion/Modification of Existing System or Facility LL *1UP0RTAM"*' THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED �•-� ""'r INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. Name to be Billed JAN r #rj O -C64 K J/ CoWbontact Person l�'I t Ohl Billing Address Z N Home Phone 9z- 7-2J91 City/State2lP /4?D /ttt.E Z7 Business Phone�/�3J.1 ls7l� tfGa/2 Name on Permit/ATC if Diff r tAbove Mailing Address2-3 S -D /G,1&WQA lAJ &D CitY/State/Zio PROPERTY INFORMATION *Date House/Facility Corners Fla - Of NOTE: A survey plat or site plan must accompany this application. Included: Sim Plan Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat) Owner's Name_ Tw " A w95 Phone Number u Owner's Address Z,g * fl JA+ utSD.SiP� /Z� City/StatrlZip j4I1—w- , p" /VG Z7/L Property Address Z L City r1mmm hs'aw- A14 Lot Size /. D 53# PIN# ,/d►�11ES. _Tax Subdivision Name(ifapplicable). &&aRZ&A5 Section/Lot# Z- DirectiomTo Site: 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 Does the site contain jurisdictional wetlands? Yes OM Are there any easemeruts or right-of-ways on the site? Yes 42 Is the site subject to approval by another public agency? Yes 02 Will wastewater other than domestic smp be ted? Ya #Bedrooms _ 3 #Bates ms _Z GardenTuWWhiripool Yes Basement Plumbing: Yes IF NON -RESIDENCE FILL OUT THE BOX BELOW 'type of Facility/Business 'fetal 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: Conventian Accepted Innovative Alternative Other Water Supply Type: Conary/ sty Wat 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? 2+ 'Kris is to certify that the information provided on this application is true and correctto 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 changes I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary irnpectiors to determine compliance with applicable laws and rales. I understand that I am responsible for the proper idemifrcztion and labeling of property lines and comers and locating and Ragging or staking the house/facility, location, proposed well location and the location of any other amenities. Site Revisit Charge Property owner's or owner's legal representative signature Date(s): Client Notification Date: Date EHS: Sign given Yes No Revised 11/06 Account # 3129 Invoice # P.003 3 Total P.003 JUL-22-2008 14:12 ERA PREMIER vara �.uuu�r� n�. Tax Parcel Report 3369980879 P.002 *WARNING: THIS IS NOT A SURVEYI* Tuesday, 7/22/2008 This map is prepared for the inventory of real property found within this pa jurisdiction, and Is compiled from recorded deeds, plats, and other public records and data. Users of this map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on this map. The County and mapping company assume no legal responsibility for the information contained on this map. Notes: Parcel Number: E500000046 IN Number: 5841569005 ccountNumber: 000082526796 ted Owner #1: MCAS JERRY 1 ted Owner #2: AKAS SHELIA Iling Address 1: 868 WOODAR ROAD allin Address 2: I : INSTON SALE tate: NC I Code: 7127 Legal Description: T 2 HUNTER CRSS crea e: 1.05800000 Deed Date: 020060809 Deed Book and Page: 1006740170 Plat Book: 008 Plat Pa e:111 08 uikdln Value: Outbuilding and Extra Featuresalue: ndValue: 4320 otal Market Value: 4320 otai Assessed Value: 4320 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION Account #: 990005129 Billed To: Anderson & Church Construction Reference Name: Proposed Facility: Residence Property Size: PROPERTY INFORMATION Tax PIN/EH #: 584 - - Subdivision Info: Hunter Acres Lot # 2 Location/Address: Farmington Rd -27028 1.059 Date Evaluated: Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON H DEPTH Texture group Consistence Structure Mineralogy 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 RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: OTHER(S) PRESENT. 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 u. 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 Mineral= 1:1, 2:1, Mixed LYQte� 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) TTAn T ___ - -..a- --11.3-_./C.n T l .Sep 06 05 11:52a devie countd envhealth 33G 751 8766 p:�1� jf,,, '1'LIU.TION FOR SITE EVALUATION/141111 )VEMENT 6'ERMIT S ATL' Davie County Health Dai artment f,( Envirionmenta/Healtli ;eCV0n P.O. Box 848/210 Hospi al Street �.�, H 1 Mockaville, NC 's'C20 �1O(V110 y f (396) 751-87GG _91�NE _ - �6-os *IMPORTANT*** TRIS APPLICATION CANNOT BE PROCE. GED UNLESS ALL THE itr^,QUIRED 1: :FORMATION IS PROVIDED, Rate= to the INFORHATI,N HL'*.,LETIN for instructions. � Nino Lobe 8311ed ro es k- M. 4u 71 i'e(- --ton tact Person F—rrl i e (/ L , Sailing Address a S f � Phone . 41ty/3tate/ZIP 1� Q�L3\ �, \e- W G y "tusiaeea Phone on Permit/ATC if Ditfero:t than Above �_,lk:.ling Address ,./ CitY/S! rte/Zip AF lication For: ,la Site ]:Valuation G :mp tvemon". Permit/RTC ❑ Both L- r- system to services J21,1ouse ❑ Mobile Homo ❑ Bus: ;ess ❑ Industry O Other 'L.--Ty-s system requested: � conventional ❑ convantiona: a 3ified ❑ innovative =accepted If Residence: a people i Badroc is 3 N SJAa(rthrooma �— ✓-W.ehwaahsr ❑Garbage Disposal W'sabing Machine 121 se«ent/Plumbing iJ{lja2emea:/No Pa:Iabing 7. J: Business/Industry /others verify type # People # Sinks 0 (nsomodee d S -..owners # urin..e # WaL'or Coolers IP ?OCDSERVICE: #l: Seats Estimated Wt :er Usage (gallons For day) Typ : of water supply; W COun!:y/City ❑ We' L ❑ Conmuinity oa anticipate additions or •axpanslors of iLc facility tris cyst, :i is intcuded to serve? U Yes 040 if)' :s,1vl1At typC {**IIPORT' INT"** CLlLNTS, UST COAIPLi;TETHE REQUIRC PROPERTY INFORMATION REQUESTED ;:PsLO . fes irP1 or SIS; LAN MUST DESUDNITTED by V client %VIVi THIS APPLICATION. `--'PropcllyDinicnsions;3Qct-Aa1F*c', /RoK 41R ;IRECTIONS(frontNocl(svillc)tot'IIOPCRTY: 011iccrIN: 1i Sp /660 160 d -1-y � on Proper y Address: Road Nanic -1 r 5 Firm ; n j 4 n G'('OS 5 O V (Lt Ifo C-0 Ahay e trn City2lpJ( ! CJJ%Viile 14C- f illi Ie- pasf Va (cart Sone- Quarry it. c:' ibutrislon provide lntorulauoti, as ioiiows: LWNOCUT70, � e M �(ZJ ,ur Bloctc _ Lot: C—De rltr u^ corners !lagged: ef& /0s 4'his h to . crtify that the Iufurinatioe pr(-vidt:u Is correct to the best of niy 1 ioiviedge. I understand that anY pertnit(s) Issued het: after are subject to suspension or revocation, I site she pians or 7 ttrdcd vs., cljouge, or is the itirorina:iotl subinilted n this appileation Is ralsilled Or clsangcd. 1,1:3'0, undarstrurd th a, "all: rc porzsibleforaif charges;acun-Vdfrvnr tilis applic . tiers. 1, llcrcbv, give consent tot the .author :zsd iicprescittatiti c m ttic Davie Comity Health Dep21,11i.el:t to cnt(:r a)aabove described property Lcaied in Davit Courtly and otvnct by t0 canduc ail tes(Ing proUdUITS aS IICCC-Vary tG deteratitic the Site suita!Ai '. 4--VA'TE _ . J& to 6 "- s -NATURE _ THIS ;1RI k MAY BE USED FOR DRA17ING YOUR SITE PLAN (Includ all of thr fu3ow;ng: Exis(h:g and ,troposed property i ! ics and dimensions, structure: •; setbacks, and scpVc locations). Client Notification Dater EIIJ: W_ 5 v � '`- ------ _- -- f Sign given.. /�l�'`�' �� Account No. �7;), �S V Revised. D( :11) (05/03 Invoice No. _ '55 r- S.. . . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003728 Tax PIN/EH #: 5841-66-0078 Billed To: - Ernest Hunter Subdivision Info: Reference Name: Location/Address: 975 Farmington Rd -2 028 Proposed Facility: Residence Property Size: 1 1/2 acres Date Evaluated: al 23`0 Water Supply: On -Site Well Community Public Evaluation By: Auger Boring / Pit Z3 �i Cut FACTORS 1 2 3 4 5 6 7 Landscape position L_ f✓ L L Slope % 70 -0 h7 HORIZON I DEPTH 0-13 Texture group CIE_ t o L Consistence -,r SS 5V _ , FESS S F, Gr F, VIS W Structure &N -- Mineralogy b --"16 HORIZON R DEPTH - Ig IV Z- 32 1 Is -Z11111,1X - GID Texture group P (2) C_S `t Consistence �S n, Structure /,-- Mineralogy iINP Yr HORIZON III DEPTH 2 - 3 Texture groupti Consistence l 1• �• �� Structure Mineralogy1� t "YaD HORIZON IV DEPTH - n Z Texture groupS C& Consistence rSIP Structure k'__ Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 0,5 LONG-TERM ACCEPTANCE RATE 'U. • 7�' SITE CLASSIFICATION: P� EVALUATION BY: LONG-TERM ACCEPTANCE RATE. OTHER(S) PRESENT: REMARKS: tcX/d �rD 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 Moist VFR - Very friable FR - Friable FI Firm VFI - Very firm EFI - Extremely firm 33_et' 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 Notes 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) ■■■■■NESS■■E■■E■■E■■■MMM■■■M■EM■M■■mmM■■■ ■■■■■OME■■■■■■■■■OOEM■■■MMM■■E■■■E■■■■M■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■m■■■■■M■■■■■E■OEM■■■■■■■■■■■M■EE■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■E■■■■M■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■M■■■■■■■■MEM■E■OE■■■■M■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■O■■■O■■■■■■■■■M■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■O■M■■O■M■■■■■■■■M■■■OO■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■MO■■M■■■■■EM■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■MMM■■■M■■■■■■■■■■■■■■ME■E■■■■ ■■■■■■■■■■■■■■■■■■■■O■■■■M■■M■M■■MM■■■■■■ M■■■■M■O■■■■■■■M■■M■E■■■■■O■■MMM■■■■■E■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■i■■■■■■O■■■■■M■■■■■■■ME■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■OE■■■E■■E■■MEM■■■■■■■■ ■■■■■■■ ■■■■■■■M■MM■■■■■M■■■■■■-------------- - ■■■■■■■■ no ■ ■■NOMI MEMO ■E■■■ ■E■■■ ■EO■■ NONE EMMENEME MEMEMEE M MEMMEMEMEMMEMENMEMEMMEMMEMEMEMMEMMOMMEMOMMEMESOMMEMEMEMMEMMENEEMMEMEMOMEMMEMEMMEMEMEMEMEMEEMEMMEMEMEMEMEMMMMEMEMEMMEMMEMMEMEMEMMEMEMEMESEEMEMEMEMEMEMEOMMEMEMEMEMOMMENEEMEMEMEMEMEMESOMEMEMEMEMMEEMENMMMMMMMMMMMMMNEEMEMMEMMENMEM ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■■■E■■■■■■E■■SMS■M■■■ ■■■■■■■■EMs■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ■O■E■O■M■■■■■■■■■■M ■■ ■EEE■■■■MM■■ ■■■■M■■■■■O■ ■■■■E■MME■■■ ■M■■■■■■■■E■ ■■■M■■■■■E■■ ■■■■M■■■MMM■ ■■■MMM■M■■E■ ■■■MMM■MMM■■ ■■■M■■■■■■■■ ■■■M■■■■M■■■ ■■■O■■■■■M■■ ■■M■■■MM■M■■ ■■■M■■■E■■M■ ■MMM■MM■MMM■ ■■■■E■■M■■M■ ■■EMM■■■EM■■■M■M■ ■■■■■■M■■■■M■■■■■ ■■■■■M■■■■■■■M■■■ ■■■■■■■■■■■■■■■■■ ■■■■O■M■■M■O■■M■■ ■■■■E■■■■■■■■■E■■ ■■■■E■■■■M■■■■■■■ ■■■■■■M■■■■M■■M■■ ■■■■■MMM■■■M■■■■■ ■■■■M■■■■M■■■■M■■ ■■■■■M■M■M■M■■■E■ ■■■■M■■M■■■■■■M■■ ■■■■M■M■■■■■E■■M■ ■E■■M■M■■M■M■■M■■ ■E■E■E■■E■E■■E■■■ ■■E■■■■■■EEE■■■M■