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133 Drayton Court Lot 20 P/O 19It OPERATION PERMIT Davie County Health Department �y 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: RS Parker Homes LLC Address: 502 Hickory Ridge Drive City: Greensboro State2ip: NC 27409 Phone #: (336) 267-8812 *CDP File Number 123669-1 N5.200-AM020 County ID Number. Evaluated Far: NEW Township: �roperty owner: RS Parker Homes LLC Address. 502 Hickory Ridge Drive City: Greensboro State/Zip: NC 27409 \ Phone #: (336) 267-8812 Property Location & Site Information Address/Road #: Subdivision: Mcallister Park the Oaks Phase: Lot: 20 133 Drayton Court Mocksville NC 27028 Directions Hwy 158 right on Sain Road I think its on the left Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: *Water Supply: PUBLIC 'System Classification/Description: *IP Issued by. TYPE 11 A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) *CA issued by: SaproliteSystem? QYes ONo Design Flow:GRAVITY-SERIAL 4 $ 0 Pump Required? *Distribution Type: O Yes (Q No Soil Application Rate: 0 a 7 5 *Pre Treatment: Drain field N irification Field 1 7 4 5 Sq. ft. *System RD Type: INFILTRATOR OUICK 4 STANDA No. Drain Lines 4 Installer: Frranktransou Total Trench Length: 4 3 6 8• Certification #: 2771 Trench Spacing: _ g Inches O.C. Feet O.C. *EH S: 2140 - Nations, Robert Trench Width: — 3 Inches Feet 0 3/ 1 3/ 2 0 1 4 Date: Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. 2 4 Inches Approval Status Maximum Trench Depth: 3 6 p Approved Q Disapproved Inches Maximum Soil Cover: a 4 -14 Inches CDP Fite Number 123669-1 Manufacturer. shoaf- STB: 760 Gallons: 1000 Date: 09/ 1 0/-2 0 1 3 'Filter Brand: POLYLOK PL -122 With Pipe Adapter ST Marker, ❑ Yes 0 No Reinforced Tank: ❑ Yes 2 No 1 Piece Tank: ❑ Yes El No Manufacturer. PT: Gallons: Date: / / RiserSealed ❑ Yes ❑ No RiserHeight: ❑ Yes ❑ No (Min.6 in.) nforced Tank: ❑ Yes ❑ No 1 Piece Tank: ❑ Yes ❑ No Poe Size: inch diameter Pipe Length: feet *Schedule: Pressure Rated ❑ Yes ❑ No Approved fittings ❑ Yes ❑ No County ID Number: H -200 -AO, -00201 c TanK Lat. Long: Installer. Frank Transou Certification #t: 2771 *EHS: 2140 -Nations, Robert Date: 0 3/ 1 3/ 2 0 1 4 Approval Status n Approved ❑ Disapproved Pump Tank Installer, Certification #: *EH S: Date: Approval Status `0 , Approved ❑ Disapproved Supply line Installer: Certification':: *EHS: Date: Approval Status ❑ Approved ❑ Disapproved Pump Type: Installer: / Dosing Volume: - Gal Certification #: Draw Down: Inches *EHS' *Chain: Date: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ NO Check -valve ❑ Yes ❑ No Approval status , PVC unions ❑ Yes ❑ No ❑ Approved ❑ Disapproved Vent Hole ❑ Yes ❑ No \ Anti -siphon Hole ❑ Yes 0 No CDP File Number 123669-1 Electric Equipment County ID Number: H5-200-AO.0020 NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer: Box 12 inches Above Grade ❑ Yes ❑ No Certification #: Box Adj. To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No `EHS: Pump Manually Operable ❑ Yes ❑ No *Activation Method: Date: / Approval Status Alarm Audible ❑ Yes ❑ NO ❑Approved ❑ Disapproved Alarm Visible ❑ Yes ❑ No 2140 - Nations, Robert *Operation Permit completed by: Authorized State Agent: 77 Date of Issue: 0 3/ 1 3/ 0 1 4 Owner/Applicant Signa This system has been installed in with applicable NC General Statutes: Article 11, Chapter 130A, Rules for Sewage Treatment and Disposal, 15A NCAC 18A .1900 et. Seq., and all conditions of the Improvement Permit and Construction Authorization. This property is served by a TYPE 11 A. sewage septic system. Rule .1961 requires that a Type TYPE 11 A. septic system meet the following criteria: Minimum System Review ByThe Local Health Department: PIA Management Entity: OWNER Minimum System Inspection/Maintenance Frequency By Certified Operator: NIA Reporting Frequency By Certified Operator: NIA Rule .1961 requires that a Type IV and V septic systems designed fora homelbusiness owner must maintain a valid contract with a public management entity with a certified operator or a private certified operator for the life of the septic system. Rule .1961 requires that Type VI septic systems designed for a homelbusiness owner must maintain a valid contract with a public management entity with a certified operator for the life of the septic system. Rule. 1961 (2) (e) requires a contract shall be executed between the system owner and a management entdy prior to the issuance of an Operation Permit for a system required to be maintained by public or private management entity, unless the system owner and certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibilities of the owner and systems operator, provisions that the contract shall be in effect for as long as the system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. (S)Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC Drawing Drawing Type: Operation Permit CDP File Number: 123669-1 County File Number: H5 -200-A0-0020 27028 Date: J J 4 0Inch Scale:. OBlock ON/A i F-, t/ i t ........ r i -- :--- _ a.... { I ! i iI I t V ! i Applicant: RS Parker Homes LLC Address: 502 Hickory Ridge Drive City: Greensboro State/Zip: NC 27409 Phone #: (336) 267-8812 � For Office Use Only *CDP File Number 123669-1 County ID Number: H5 -200 -AO -0020 Evaluated For: NEW �, Township: PERMIT VALID UNTIL: 1 0/ 1 6/ x 0 1 8 Property Owner: RS Parker Homes LLC Address: 502 Hickory Ridge Drive City: Greensboro State/Zip: NC 27409 Phone #: (336) 267-8812 — Property Location & Site Information /'Address/Road #: 133 Drayton Court Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: *Water Supply: PUBLIC Subdivision: Mcallister Park the Oaks Phase: Lot: 20 Directions Hwy 158 right on Sain Road I think its on the left ons Minimum Trench Depth: IN Site Classification: Ps � 4 Inches SaproliteSystem? OYes XNo Minimum Soil Cover: Inches Design Flow: 4 8 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 .2 7 5 Maximum Soil Cover: Inches *System Classification/Description: *Distribution Type: GRAVITY - SERIAL TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) S t. -r_ k' *Proposed System: 25% REDUCTION Nitrification Field No. Drain Lines Total Trench Length Trench Spacing: Trench Width: Aggregate Depth: 436 ft. up Ic n . 1 0 0 0 Gallons 1 -Piece: OYes (9 No Pump Required: O Yes ®No O May Be Required Sq. ft. Pump Tank: Gallons 1-Piece:OYes ONo GPM --vs-- ft. TDH Inches O.C. Feet O.C. g Dosin Volume: Gallons – O Inches O Feet Grease Trap: Gallons inches Pre -Treatment: O NSF OTS -1 O TS -II Septic Tank Installer Grade Level Required: 01 O II 0111 O IV , Page 1 of 3 ' CONSTRUCTION AUTHORIZATION ..nMo t Davie County Health Department 4 s I "r 210 Hospital Street •�� .• P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: RS Parker Homes LLC Address: 502 Hickory Ridge Drive City: Greensboro State/Zip: NC 27409 Phone #: (336) 267-8812 � For Office Use Only *CDP File Number 123669-1 County ID Number: H5 -200 -AO -0020 Evaluated For: NEW �, Township: PERMIT VALID UNTIL: 1 0/ 1 6/ x 0 1 8 Property Owner: RS Parker Homes LLC Address: 502 Hickory Ridge Drive City: Greensboro State/Zip: NC 27409 Phone #: (336) 267-8812 — Property Location & Site Information /'Address/Road #: 133 Drayton Court Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: *Water Supply: PUBLIC Subdivision: Mcallister Park the Oaks Phase: Lot: 20 Directions Hwy 158 right on Sain Road I think its on the left ons Minimum Trench Depth: IN Site Classification: Ps � 4 Inches SaproliteSystem? OYes XNo Minimum Soil Cover: Inches Design Flow: 4 8 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 .2 7 5 Maximum Soil Cover: Inches *System Classification/Description: *Distribution Type: GRAVITY - SERIAL TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) S t. -r_ k' *Proposed System: 25% REDUCTION Nitrification Field No. Drain Lines Total Trench Length Trench Spacing: Trench Width: Aggregate Depth: 436 ft. up Ic n . 1 0 0 0 Gallons 1 -Piece: OYes (9 No Pump Required: O Yes ®No O May Be Required Sq. ft. Pump Tank: Gallons 1-Piece:OYes ONo GPM --vs-- ft. TDH Inches O.C. Feet O.C. g Dosin Volume: Gallons – O Inches O Feet Grease Trap: Gallons inches Pre -Treatment: O NSF OTS -1 O TS -II Septic Tank Installer Grade Level Required: 01 O II 0111 O IV , Page 1 of 3 CDP Bile Number 123669 - 1 County ID Number: H5 -200 -AO -0020 ❑ Open Pump System Sheet Repair System Required: (9 Yes ONO ONO, but has Available Space /Repair System Trench Spacing:O Inches O. *Site Classification: Ps — _8Feet O.C. Trench Width: Inches Design Flow: 4 8 0 _ Feet Soil Application Rate:0 a�5 Aggregate Depth: inches . a *System Classification/Description: Minimum Trench Depth: 4 Inches LESS)TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR Minimum Soil Cover: Inches *Proposed System: 25% REDUCTION Nitrification Field Sq. ft. No. Drain Lines Total Trench Length: 4 3 6 ft. Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: Inches *Distribution Type: GRAVITY - SERIAL Pump Required: OYes ®No OMay Be Required Pre -Treatment: O NSF OTS -1 OTS -II *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. *Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit, not to exceed five years, and may be issued at the same time the Improvement Permit issued (NCGS 130A -336(b)). If the installation has not been completed during the period of validity of the Construction Permit, the information submitted in the application for a permit or Construction Authorization is found to have been incorrect, falsified or changed, or the site is altered, the permit or Construction Authorization shall become invalid, and may be suspended or revoked (.1937(8)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, installation, operation, maintenance, monitoring, reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? O Yes (& No Applicant/Legal Reps. SignaturP7 Date: *Issued By: 2244-�D'aaywalt, Andrew Date of Issue: 1 0 / 1 6 / a 0 1 3 Authorized State Agent: ( _ Malfunction Log Oyes Hand Drawing O Import Drawing Total Time:(HH:MM) **Site Plan/Drawing attached.** 0 0 Hours 3 0 Minutes Page 2 of 3 S-8 - CA'S issued - new 1 • CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Construction Authorization CDP File Number: 123669 - 1 County File Number: H5 -200 -AO -0020 Date: 10 / 16 /x013 O Inch Scale: O Block O N/A Page 3 of 3 P1 P2 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 CDP File Number: County File Number: 123669-1 H5 -200 -AO -0020 Date:.1.0. / 16 / .2 0 13 Click below to import an image from an external location: Drawing Type: Construction Authorization Page 3 of 3 P1 P2 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC RECEIVED Davie County Environmental Health P.O. Box 848/210 Hospital Street OCT �Q�� Mocksville, NC 27028 u� (336)753-6780/ Fax (336)753-1680 APGaaWT4 o LT1FAte Evaluation/Improvement Permit WAuthorization To Construct (ATC) ❑ Both Type of Application: ❑New System El Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***1MPORT4NT*** THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name R5 10a-iKe r axe z -e -c Contact Person GI��C.� Ar�Q LSCS Address 562 H,'c_Kpry Home Phone 33G- 2767 -PP / Z City/State/ZIP � �� Y Business Phone 3 3G - W Z -S 8 / Z Email U1fc-T e � Paan%/rhOwtg.'5. C-c3w` Email: a Wk.Q__ Name oV Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners 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 l Po,• Ke -r Hny,.,e S LLL Phone Number 336 ZG 715-81 Owner's Address /qeE City/State/Zip Property Address 3 1 rc. 4rn% C City_oe-K-6ci i t Jit.-.,, Lot Size I Tax PIN# Subdivision Name(if applicable) Ali: -}tom s Section/Lot# a C Directions To 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? L Ko Does the site contain jurisdictional wetlands? _Yes _Yes Are there any easements or right-of-ways on the site? _Yes Is the site subject to approval by another public agency? _Yes ✓< Will wastewater other than domestic sewage be generated? Yes � o TT " . C1TTTILTd"1r,1 TTT T /-%T TT TTTn n/lV nUT !1717 it nr 31"JP 114%.JP1 rii.i. vU i 1 iii: ,>vZV vv # People # Bedrooms y # Bathroom 3 V2. Garden Tub/Whirlpool Ples []No Basement: []Yes wo Basement Plumbing: ❑Yes Ev o 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: onventional ❑Accepted ❑Innovative ❑Alternative ❑Other. Water Supply Type: FV1 ounty/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? C0 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 Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understan th tnselil: Spon*ble for th o r identification and labeling of property lines and corners and locating and flagging or stakin�ty/I�cation r sed well location and the location of any other amenities. Site Revisit Charge Property owner's or owner' legal representative signature Date(s): l Client Notification Date: Date EHS: Sign given ❑Yes ❑No Revised 11/06 Account # Z Invoice # 1[ 3 HOME DIMENSIONS NTS DRAYTON COURT 50' R/1P (PUBLIC) GRAPHIC SCALE 30 0 25 50 100 ( IN FEET ) 1 inch = 50 ft PRELIMINARY PLOT PLAN FOR: RS PARKER HOMES LOT 20 OF THE OAKS AT McALLISTER PARK 133 DRAYTON COURT P.E. 9 PG. 318 Rming 61imirm"ag, enc. 700 Camegle Place Greensboro, NC 27409 Phone: 3364852-9797 . Fax 33645241766 NCBELS C-0950 DATE. 09-27-13 REF: PRDJ\1831—D1\dwg\McAWSTER.dwg Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990004186 Tax PIN/EH #: 5749-53-8619.20 Billed To: Cool Spring Builders, Inc. Subdivision Info: The Oaks at McAllister -Park Lot # 20 Reference Name: Michael Moorefield Location/Address: Sain Road -27028 Proposed Facility: Residence- Property Size: see map ATC Number: 0 **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. Pem7it Type: /New ❑Repair ❑Expansion Permit Valid for: 0 Years,^o Expiration Residential Specifications: # Bedrooms_! ( # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats �J Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply:ef<ounty/City ❑Well ❑Community Well As stated in 15A NCAC 18A.t989(51 Site Modifications/Permit Conditions: ame to ed Systema r;�v 111!1n t!� ug,p;i Site Plan +h O A 00 System Tvve LTAR Initial Repair -Z ? ` \ �d SO% ~ 1, \9 � I +-� �tt�trla� Qp.� X41 ' 4 'x Environmental Health Specialist Date i.p. 11-06 C IL� SITE EVALUATION/IMPROVEMENT PERMIT & ATC S' 1� „ Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 � a 336)751-8760/ Fax (336)751-8786 App ication For Zllim�� valuation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both Typ pplication:.XNew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS_APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed CO3' 1�y�y'� !1 j f� �i('t ► , :Tir= Contact Person ff 'd)zq el I - IV6 e Billing Address Pia Home Phone City/State/ZIP zS i. �PS'�. /%� /v �. ._�' 7-2z&Business Phone 3-3&-,3-j5 - S �- Name on Permit/ATC if Different than Above Mailing Address YKUF.tX1 Y 1N1'UFMA1IUN City/State/Zip *Date House/Facility Corners NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan,,�`Plat(to scale) (Permit is alid for 60 months w'th site p n, no expiration with complete plat.) Cy? s ) a Owner's Name we, U(k %S Phone Number Owner's Address � r ,-2- City/State/Zip L,&ia k - 61 22 Property Address S71d !'4ac( C* Lot Size Tax PIN#-`� �'(o / i �� %�: Df_ rx mer', Subdivision Name(if applicable) bja&lf t, Directions To Site: /5'V 'Ti7u/1) %7iC/4 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 4C -N- ­ Does the site contain jurisdictional wetlands? Dyes ©No Are there any easements or right-of-ways on the site? ❑Yes PNo Is the site subject to approval by another public agency? Dyes nNo Will wastewater other than domestic sewage be generated? Dyes M140 IF RESIDENCE FILL OUT THE BOX BELOW # People 1—:?— # Bedrooms # Bathrooms Garden Tub/Whirlpool es ❑No Basement: Dyes ❑No/y Basement Plumbing: C E}No ?V41 . IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of FacilityBusiness 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: Vonventional ❑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 Cho 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. 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 Representative 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 and flagging or aking the ouse/facility location, proposed well location and the location of any other amenities. --A' 4-1 x!At, Site Revisit Charge Property owner's orner's legal representative signature Dt / . /-,,Z r e,6 Date Sign given Dyes ❑No Revised 11/06 a e(s). Client Notification Date: EHS: Account # Invoice # DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION Account #: 990004186 Billed To: Cool Spring Builders, Inc. Reference Name: Michael Moorefield Proposed Facility: Residence Property Size: Water Supply: Evaluation By: On -Site Well Auger Boring PROPERTY INFORMATION Tax PIN/EH #: 5749-53-8619.20 Subdivision Info: Black Forest Lot # 20 Location/Address: Sain Road -27028 see map Date Evaluated: 6 Community Pit Public Cut FACTORS 1 3 4 5 6 7 Landscape position L Slope % & HORIZON I DEPTH 0- b r-) Texture grow SGe_ CL Q,4 1 Consistence�'q C S 5-V 'Structure G G Mineralogy HORIZON II DEPTH 69 Texture group Consistence " Structure Mineralogy HORIZON III DEPTH Lig Texture group1- S� a Consistence r Structure s Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS — — RESTRICTIVE HORIZON — - SAPROLITE -' CLASSIFICATION LONG-TERM ACCEPTANCE RATE -O.�IJ SITE CLASSIFICATION: V S LONG-TERM ACCEPTANCE RATE: 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 Moist 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 Mineralogv 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) Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990004186 Tax PIN/EH #: 5749-53-8619.19 Billed To: Cool Spring Builders, Inca Subdivision Info: The Oaks at McAllister Park Lot # 19 Address: PO Box 2040 Location/Address: Sain Road -27028 City: Advance _ Property Size: see map Reference Name: Michael Moorefield 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. Permit Type: ,Kew ❑Repair ❑Expansion Permit Valid for: 0 Years Peo Expiration Residential Specifications: # Bedrooms `7l # Bathrooms --3 People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): `/90 Type of Water Supply:,2'County/City ❑Well ❑Community Well Site Modifications/Permit Conditions: Rome '-'L Q'PA'12 System Type LTAR Initialri ©•Z%S- Re air OrQ110,�A1. 0•7— Site Plan. Ir (0l 1 1 � , 4? 4 C-2 3a � 1 Environmental Health i.p.l l -06 S io Date ����% VFW" -&I F ITE EVALUATION/IMPROVEMENT PERMIT & ATC Qavie County Environmental Health P.O. Box 848/210 Hospital Street ., Mocksville, NC 27028 r E;�HFAL�N (336)751-8760/ Fax (336)751-8786 � co. ry Appli ation Fore tte )✓valuation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both Type fApp ation: 'KNew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS, APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed e'c' i -SP''� nom} ju ��'�'� i n Contact Person %�� �Z1�/e� - I%4�'y�'/t'P%if Billing Address P® ! A o Home Phone City/State/ZIP N C 7-2-z i�, Business Phone . 334,i' - Name on Permit/ATC if Different than Above Mailing Address rKUYr,K1 Y 1NPUK1N1A11UN 'Date House/racility Uorners NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan (Permit is alid for 60 months with site p n, no expiration with complete plat.) Owner's Name y i 'SI) iwt _. Gt�� :'S Phor Owner's Address e? City/State/Zip Property Address :SQ;,1 , --,C4X Lot Size Tax PIN# Subdivision Name(if applicable) , Directions To Site: /,6-V '�2Lr'A) ,Crl9f 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 4OK6-. Does the site contain jurisdictional wetlands? ❑Yes E3No Are there any easements or right-of-ways on the site? ❑Yes RNo Is the site subject to approval by another public agency? ❑Yes nfr o Will wastewater other than domestic sewage be generated? [I Yes [llo scale) .s` gC IF RESIDENCE FILL OUT THE BOX B LOW # People __ # Bedrooms # Bathrooms Garden Tub/Whirlpool B`Ves ❑No Basement: ❑Yes ❑No/y Basement Plumbing: No /j/.I1 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: Vonventional ❑Accepted ❑Innovative ❑Alternative ❑Other. Water Supply Type: County/City Water ❑ New Well El Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes If yes, what type? C -N—O' . 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 Representative 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 and flagging or aking the ouse/facility location, proposed well location and the location of any other amenities. Site Revisit Charge Property owner's or er's legal representative signature Date Dme(s). Client Notification Date: EHS: Sign given ❑Yes ❑No Account # Revised 11/06 Invoice # DAVIE COUNTY HEALTH DEPARTMENT 10 4` j Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION Account #: 990004186 Billed To: Cool Spring Builders, Inc. Reference Name: Michael Moorefield Proposed Facility: Residence Property Size: PROPERTY INFORMATION Tax PIN/EH #: 5749-53-8619.19 Subdivision Info: Black Forest Lot # 19 Location/Address: Sain Road -27028 see map Date Evaluated: Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1353 01 135if4 5 6 7 Landscape position Lr L�_ Slope % S b HORIZON I DEPTH _ 0— Texture groupSGG cLfQtxa SGt>' Consistence Structure Mineralogy SC HORIZON II DEPTH - L 7 ` 21 Texture group C C, Consistence Structure_- c k Mineralogy HORIZON III DEPTH Texture group�.� Consistence [� Structure 1G Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogyi SOIL WETNESS �-- RESTRICTIVE HORIZON _ �- SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE O, Ul N SITE CLASSIFICATION: r LONG-TERM AC EPTANCE RATE: ( '2!5 REMARKS: LEGEND OTHER(S) 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 CONSISTENCE 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 Mineralogy 1:1, 2:1, Mixed 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)