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178 Nellwood Court Lot 2CONSTRUCTION AUTHORIZATION •a Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Address: City: State/Zip: -Phone#: Neil Townsend/Wishon & Carter Builders PO Box 1719 Yadkinville NC 27055 (336) 469-2290 / For Office Use Only "CDP File Number 232629-1 County ID Number: 5748538919.02 Evaluated For: NEW \.Township: 1 VALID UN I IL: 1 a/ a 0/ a 0 a 1 Property Owner: Neil Townsend/Wishon & Carter Builders Address: PO Box 1719 City: Yadkinville State2ip: NC 27055 Phone #: (336) 469-2290 Address/Road #: Subdivision: McAllister at the Oaks Phase: Lot: 2 Nellwood Court .Mocksville NC 27028 Structure: _2 SINGLE FAMILY # of Bedrooms: 3 # of People: *Water Supply: PUBLIC to Directions Hwy 158 right on Sain Rd. Right into McAllister Park, right at Stop sign at end of street on right Donn 1 ^f'A Minimum Trench Depth: 3 6 \ Inches Site Classification: Provisionally Suitable Saprolite System? OYes QNo Minimum Soil Cover. a 4 Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 2 7 5 Maximum Soil Cover: a 4 Inches *System Classification/Description: *Distribution Type: GRAVITY -SERIAL TYPE III G. OTHER NON -CONY. TRENCH SYSTEMS Septic Tank: 1 0 0 0 _ _Gallons *Proposed System: 25% REDUCTION 1 -Piece: OYes QNo Pump Required: OYes QNo OMay Be Required N itrification Field 1 3 0 9 Sq. ft. Pump Tank: Gallons No. Drain Lines 3 1 -Piece: OYes ONo Total Trench Length: 3 a y GPM—vs— ft. TDH ft Trench Spacing: — 9 gFe t O.C. O.C. Inches Dosing Volume: _ Gallons Trench Width: 3 Inches @Feet — Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: OI J Oil OIII OIV Donn 1 ^f'A CDP File Number 232629 - 1 County ID Number: 5749538919.02 ❑ Open Pump System' Sheet Repair System Kequlrea:v t rs vrvu vrvu, uuL ndb rivduduic QNdUU *Site Classification: Design Flow: Provisionally Suitable ick.;rl boll Appilcation Rate. 0 a 7 5 *System Classification/Description: TYPE III G. OTHER NON-CONV. TRENCH SYSTEMS *Proposed System: 25% REDUCTION Nitrification Field 1 3 0 9 7.. Sq. ft. No. Drain Lines- Total inesTotal Trench Length: - -- _ 3 a 7 ft. Trench Spacing: _ 9 Inches 0. t O.C. Trench Width: 3 Inches 2 Feet Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover, 2 4 Inches Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: a 4 Inches *Distribution Type: PUMP TO GRAVITY Pump Required: @Yes ONo OMay Be Required Pre Treatment: ONSF OTS -1 OTS -11 *Site Modifications T 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 bythe Health Department in no wayguarantees 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 valld fora person equal to the period of validity of the Improvement Permit, not to exceed five years, and may be Issued atthe sametime 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 applicatlon fora permit or Construction Authorization Is found to have been incorrect, falsified o' charred, or the site is altered, the permit or Construction Authorization shall become invalid, and may be suspended or revoked (.1937(g)). 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, maintenancA monitoring, reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature: Date: , • / , / 'Issued By: 2140 -Nations, Robert Date of Issue:._1 a / a 0 / a 0 1 6 Authorized State Agen : Malfunction Log Oyes @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Construction Authorization -11I »RRutT-5 County File Number: 5749538919.02 Date: l a/ 2 0/ 2 0 16 Q Inch Scale: QBlock QN/A CONSTRUCTION AUTHORIZATION Davie County Health Department , 210 Hospital street CDP File Number: P.O. Box 8485749538919.02 Mocksville NC 27028 County File Number: Date: la/a0/a016 Click below to Import an Image from an external location: Drawing Type: Construction Authorization IMPROVEMENT PERMIT Davie County Health Department aid 210 Hospital Street P.O. Box 848 Mocksville NC 27028 For Office Use Only 'CDP File Number 232629-1 County ID N umber: 5749538919.02 Evaluated For. NEW i,Township: Phone: 336-753-6780 Fax: 336-753-1680 PERMIT VALID UNTIL: 12/20/2021 "NOTE TO INSPECTIONS DIVISION: Building Permits cannot be Issued with this Improvement Permit. Applicant: Neil Townsend/Wishon & Carter Address: PO Box 1719 City: Yadkinville State2ip: NC 27055 Phone #: (336) 469-2290 Property owner: _Neil Townsend/Wishon & Carter Address: PO Box 1719 City: Yadkinville State/Zip: NC 27055 Phone #: (336) 469-2290 Address/Road #: Subdivision: McAllister at the Oaks Phase: Lot: 2 Nellwood Court .Mocksville NC 27028 Directions Structure:- - _ -SINGLE FAMILY- Hwy 158 right on Sain Rd. Right into McAllister Park, # of Bedrooms: - 3 right at Stop sign at end of street on right # of People: "Water Supply: PUBLIC -bite L;lassmcaian: SaproliteSystem? OYes QNo Design Flow: 3 6 0 Soil Application Rate: 0 a 7 5 "System Classification/Description: TYPE III G. OTHER NON -CONN. TRENCH SYSTEMS *Proposed System: 25% REDUCTION Minimum Trench Depth: 3 6 Inches Maximum Trench Depth: 3 6 Inches Septic Tank: 1 0 0 0 Gallons 1 -Piece: OYes (QNo Pump Required: OYes Q No O May Be Required Pump Tank: Gallons 1 -Piece: OYes ONo Repair System Required:@Yes ONO ONo, but has Available Space r. Repair System 'Site Classification: Provisionally Suitable Soil Application Rate: 0 a 7 5 'System Classification/Description: TYPE 111 G. OTHER NON -CONN. TRENCH SYSTEMS "Proposed System: 25%REDUCTION Minimum Trench Depth: 3 6 Inches Maximum Trench Depth: 3 6 Inches Pump Required: @Yes ONo O Maybe Required Page 1 of 3 CDP File Number 232629 - 1 County ID Number: 5749538919.02 *Site Modifications ❑ Open Fill Sheet 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 H ealW Department in noway guarantees the issuance of other permits. The permit holder is responsible for checking -with appropriate governing bodies in meeting their requirements. The improvement Permit shall be valid for 5 years from date of Issue with a site pian (means a drawing not necessarily drawn to Site©,lan- scale that shows the existing and proposed property lines with dimensions, the location of the facility and appurtenances, the site for the proposed Wastewater system, and the location of water supplies and surface waters). Flat The Improvement Permit shall be valid without expiration with plat (means a property surveyed prepared by a registered land O surveyor, drawn to a scale of one inch equals no morethan 60 feet, that Includes: the specific location of the proposed facility and appurtenances, the site for the proposed Wastewater system, and the location of water supplies and surface waters. Plat also means, for subdivision lots approved by the local planning authority and recorded with the county register of deeds, a copy of the recorded subdivisions platthat is accompanied by a site plan that Is drawn to scale). The Department and Local Health Department may Impose conditions on the issuance and may revoke the permits for failure of the system to satisfy the conditions, the rules, or this article This permit is subject to revocation if the site plan, plat, or intended use changes (NCGS 130A -335(f)). 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 (A 938(b)). Applicant/Legal Reps. Signature Required? OYes (; No Applicant/Legal Reps. Signature; Date: 'Issued By: 2140 -Nations, Robert Date of Issue: 1 a/ a 0/ a 0 1 6 Authorized State Age OValid without Expiration? g OCreate CA? alland Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Improvement Permit CDP File Number: 232629 -1 County File Number: 5749538919.02 Date: Q Inch Scale: QBlock QN/A r�___ n Asn .._.._..........► , _ : � __ ; _ i _____ _ _1 _ � I ! � _ :_ ... .2 is I I _._ r � i " � t i ` 1 f ' " r�___ n Asn IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street on B 848 CDP File Number: 232629-1 . . Ox 5749538919.02 Mocksville NC 27028 County File Number: Date: 1.1 .10 /2016 i Click below to import an Image from an external location: Drawing Type: Improvement Permit AP0ICA , N FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC 4 Davie County.EnvironmentaliHealth . P. Box 848/210 Hospital Street ; W. Mocksville NC 27028 i.•. ' ..:-i --(336)753-6780/Fax (336)753 1680 Application For: ❑ Site valuation/Improvement Permit ❑ Authorization To Construct (ATC) Ygoth Type of Application: RNew 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 /��;i i"e L, s.eK�� W;�t`n� 1 Cw Qv;1c Contact Person AL ;1 I Address Po Be )-713 Home Phone -t'3(ay (aq- z -L 9 o - 040 G . lr City/State/ZIP yu d c; „,,; I 1 f , nJ c _ 7-7 c s's- Business Phone ; 3 - (0:Jq - zo 3 1 Email A. ► To w o- s w,.A ra Q,- c.as k-..1- . C 0 W.- Email: Name on Permit/ATC if Different than Above %..r �3t,_1 �,. r s Mailing Address 54,ti, ,e. 1` City/State/Zip .N 1 0 PROPERTY INFORMATION ! ' '*Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany thisl application. ' Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name 1Jj,4,r. s, Cc.rl.. r C�.,;`e��s _Kc ; Phone Number Owner's Address go City/State/Zip Vu E:.�,,, <<.r , PJ e- z70 fs- Property Address City --Mm k, Lot Size . X31- 4Tax PIN# 5 yyq- Subdivision Name(if applicable) M c All.%L, &,I Section/Lot# Z. 1/' ge 0S15 .1 r Directions To Site: 11w4c 1!!ru . c 2d P-iIL4- I wt< A11.11 L ��y4.•� � sl:o p ��,, �.G? � Kit o F ' s� o „� If the answer to any of the following questions is "Yes",supporting documntation must be attached: Are there any existing wastewater systems on the site? _Yes -✓lel Does the site contain jurisdictional wetlands? _Yes _ o' Are there any easements or right-of-ways on the site? Yes ./ o Is the site subject to approval by another public agency? _Yes�o s o Will wastewater other than domestic sewage be generated? Ye TTI "T10Y7lTATd" 1r L'TT T 11T TT TLTL' U/lV UL'T MIT IF X%L01"JU IN% -1 111L11 Vv 1 1111: vy . i # People # Bedrooms 3 kBathrr. ms. 2 yZ. Garden Tub/Whirlpool ❑Yes Ao Basement: ❑Yes o Basement Plumbing: ❑Yes 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: VA/ccepted ❑Innovative ❑Alternative ❑Other --- i' Water Supply Type: SI/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 0 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 permit(s) IP(s) or CA(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. Permits issued will expire 5 years from the date of issuance. 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 staking the house/facility location, proposed well location and the location of any other amenities. Applicant's Si nature Property owner's or owner's legal representative signature Date Revised 11/16 Site Revisit Charge Date(s): Client Notification Date: EHS: /3 Account # Invoice # ellk 11061 -�3«� iJ/ 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 #: 5749-53-8619.02 Billed To: Cool Spring Builders, Inc. Subdivision Info: The Oaks at McAllister Park Lot # 02 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: eNNew ❑Repair ❑Expansions Permit Valid for: 05 Years/el'go Expiration Residential Specifications: # Bedrooms 3 # Bathrooms 3 # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats 2 `` Square Footage(or Dimensions of Facility) Design Flow(GPD): 3&0 Type of WaternSupplly:County/City ❑Well ❑Community Well Site Modifications/Permit Conditions: S stem T e LTAR Initial - • Z Repair - 2 Site Plan i laroj $rO*Z*k* 14,E6ksk a 10 role �'�' �c�`�C� r�'� • rye 'WMWGP� V- 0 40 t-O/ti Environmental Health Specialist i.u.11-06 a M Date r; . y TE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street tJOV 2 7 2005 Mocksville, NC 27028 - (336)751-8760/ Fax (336)751-8786 Appli ation Forlt E' 'j�e ' �afga��on/Improv ment Permit ❑ Authorization To Construct(ATC) ❑ Both Type f tion`=`+ ewspg em epair 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 ��'�' % jam%� �'�j � �� �r'� i , n Contact Person ff di -o f l t- Acle 'Pl-0 Billing Address /JC► Au,Vf o Home Phone 41 7, ..-OS City/State/ZIP r,:Sgc /14 C. Business Phone .34,,- 3'i-9 (Cdl Name on Permit/ATC if Different than Above Mailing Address PROPER"1'Y 1NF0RMAI'lUN tate/Zip *Date House/Facility corners NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan,J (Plat(to scale) (Permit is ,alid) for 60 months w'th site plan, no expiration with complete plat.) Owner's NameLs/W/ ,i)tr e4 _?" tic i��S Pho e umber Owner's Address SW dle�� W, Yom' Property Address Sart RoQs Lot Size Tax PI Subdivision Name(if applicable) Directions To Site: /.5'V . 'T2aA11 12,t .4Z City/State/Zip'%' 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 40Ko­ Does the site contain jurisdictional wetlands? ❑Yes QNo Are there any easements or right-of-ways on the site? ❑Yes EKo Is the site subject to approval by another public agency? ❑Yes I No Will wastewater other than domestic sewage be generated? ❑Yes CTNo IF RESIDENCE FILL OUT THE BOX BELOW # People 1_? # Bedrooms # Bathrooms Garden Tub/Whirlpool es ❑No Basement: ❑Yes ❑Nok Basement Plumbing: C -0No A/ A 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: VConventional ❑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 �o 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 oraking 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 DtO• Date Sign given []Yes ❑No Revised 11/06 ae. 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: PROPERTY INFORMATION Tax PIN/EH #: 5749-53-8619.02 Subdivision Info: Black Forest Lot # 2 Location/Address: Sain Road -27028 see map Date Evaluated: i Water Supply: On -Site Well Community Public / Evaluation By: Auger Boring Pit Cut SITE CLASSIFICATION: PS LONG-TERM ACCEPTANCE RATE: 27S REMARKS: LEGEND EVALUATION BY:S=6F:e I OTHER(S) PRESENT- Landscape RESENT- i, n s ape 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-t 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 1Yntes 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) Consistence BEI 119APM KAM= OF -451011 1110000111111101111111111110110 Mineralogy16-�►/A�llA1IM#A1=1 RUM 11111011111111111111110 11111110 HORIZON 11 DEPTH &-J;02MTexture iti�.��%�i��---- group Consistence 'S0MRMWL� 111101111111111111111110 HORIZON III DEPTH I M EMMA 1111111111111111111111111110111101111111111111011111111 Texture group Consistence HORIZON IV DEPTH Texture gmup Consistence Mineralogy SOIL WETNESS SAPROLITE CLASSIFICATI• SITE CLASSIFICATION: PS LONG-TERM ACCEPTANCE RATE: 27S REMARKS: LEGEND EVALUATION BY:S=6F:e I OTHER(S) PRESENT- Landscape RESENT- i, n s ape 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-t 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 1Yntes 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)