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185 Timber Trails Lane Lot 3y , DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Sheet Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERNPT Account #: 990003425 ax PIN/EH #: 5812-01-5250.03 Billed To: Paul & Wendy Olinger Subdivision Info: Timber Trails Lot # 03 Reference Name: Location/Address: Timber Trails Drive -27028 Proposed Facility: Residence Property Size: 5 acres ATC Number: 4842 **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. _ d6 System Type: S.T. Manufacturer �� d Tank Date Z i Tank Size__ / _wlj Pump Tank Sine A� %/ D e System Installed By: (�G�y , �` ` �l r E.H. Specialist:`'P O Date: a �I to _ I ro; ( 5 �1 3 3( 3q 3f 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 #: 990003425 Billed To: Paul & Wendy Olinger Reference Name: Proposed Facility: Residence ATC Number: 4842 Tax PIN/EH #: 5812-01-5250.03 Subdivision Info: Timber Trails Lot # 03 Location/Address: Timber Trails Drive -27028 Property Size: 5 acres Site Type: ew ❑Repair DExpansion **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 or the intended use chance. Residential Specifications: # Bedrooms "1 # Bathrooms 3# People "1 Basemente'i Basement plumbing2rl Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size G 4C S Type of Water Supply: County/City DWell DCommunity Well System Specifications: Design Wastewater Flow (GPD)w Tank Size OG GAL. Pump Tank GAL. 2 t� � Trench Width 36c( Max. Trench Depth 3� Rock Depth -Linear Ft. 74 Site Modifications/Conditions/Other: As stated in 15A NCAC 16A.1969(ri) _ U y M1 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 Specialist. DCHD 11/06 (Revised) r M;,J Date: 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 #: 990003425 Tax PIN/EH #: 5812-01-5250.03 Billed.To: Paul & Wendy Olinger Subdivision Info: Timber Trails Lot # 03 Reference Name: Location/Address: Timber Trails Drive -27028 Proposed Facility: Residence Property Size: 5 acres ATC Number: 4842 Site Type: BNew ❑Repair ❑Expansion **NOTE** This Authorization to Constrict (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 or the intended use change. Residential Specifications: # Bedrooms1 # Bathrooms 5 # People BasementYgasement plumbing Non -Residential Specifications: Facility Type# People # Seats Square Footage(or Dimensions of Facility) Lot Size C` Type of Water Supply: ❑ ounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) �14�1 Tank Size 01' rAL. Pump Tare-'— `"AL. r, Trench Widthle Max. Trench Depth 3 4- Rock Depth Linear Ft. _ Site Modifications/Conditions/Other: 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. E Zt (5) 116 " X 3 04,11A C -s Environmental Health Specialist DCHD 11106 (Revised) Sure irj xfm i 4 � � I Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 .(336)751-8760/ Fax (336)751-8786 Account #: 990003425 IMPROVEMENT PE1 IT'IN/EH M 5812-01-5250.03 Billed To: Paul & Wendy Olinger Subdivision Info: Timber Trails Lot # 03 Address: 4125 Lakewood Glen Drive Location/Address: Timber Trails Drive -27028 City: Winston-Salem Property Size: 5 acres Reference Name: 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: (mew ❑Repair ❑Expansion Permit Valid for: CC'S Years ❑No Expiration Residential Specifications: # Bedrooms # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):� Type of Water Supply: Z ounty/City ❑Well ❑Community Well a09 Site Modifications/Permit Conditions: '. CCV V W„�� L'ms�n�Ja`rZVcy stated in 15A NCAC 18A.19�7�� Site Plan 0 4 �o5 S System Type LTAR InitialG. Repair . ? n. ti -F i y,'�r_ 54 sy5 OS�I'�N'- y Environmental Health Specialist CAP" A��u�� u Date /–/— —69 Q� Applica .\ ICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 r: Sit E luation/Improvement Permit Authorization To Construct(ATC) Both icatio • ew ys a Repair to Existing System Expansion/Modification of Existing System or Facility TANT*** THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED TION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Oa // X hlzs bC2fQZ4? /11/L 01'&j;1-1 like Name to be Billed RJ -t we,. j 1 i h Contact Person P,,,,/ Billing Address X11 ,J L -4t ✓6c -/l»y!• Home Phone City/State/ZIP W ;.�.i - Sir... iL C --;7/0-7 Business Phone 2ZZ -5 Q O 0/ Name on Permit/ATC ifDifferent than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Comers Flagged NOTE: A survey plat or site plan must accompany this application. Included: Site Plan Plat(to scale) (Permit is alid or 60 months miith site plan, no expiration with complete plat.) t -c,. wt^,`i Owmer's Name ✓ I -i d f!; ^c ti Phone Number Owner's Address L4 13 S 0,- City/State/Zip / Property Address T i r, - 7f - s City A o c 1,j , ., //r Lot Size S Tax PIN# /,2490/1/k? Subdivision Name(if applicable) ; �+, r� i«,'/s Section/Lot# 3 Directions To Sitg: t` O/ N a L e - f f C., L; A er y Ch -1,4 � L e f 'i a., g Pty Char, -1 a -F:, R;Shl o., T;M1. -rl.. I, 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 o Does the site contain jurisdictional wetlands? Yes o 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 sewave be venerated? Yes o IF RESIDENCE FILL OUT THE BOX BELOW # People 11 # Bedrooms H # Bathrooms Garden Tub/Whirlpooles No Basement--/M—No Basement Plumbing: es No 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: Conventional Accepted Innovative Alternative Other Water Supply Type: 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 No 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 comers and locating and flagging or staking the house/facility location, proposed well location and the location of any other amenities. Site Revisit Charge Property owner's or owmer's legal representative signature Date(s): Client Notification Date: 7� Date EHS: Sign given Yes No Account # 37 Revised 11/06 Invoice 9 7 C/PE' 4 GoMAPS - Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping SystemZoom To Scale: Click Here To Start Over Quick Search: (County ID or Owner Name) Active Layer. ❑USe map -rips GIS Dent Home Page I Contacts I Department I Inf U �� � � � .49 � � °�' PARCELS (Map Tips Available) vj Map Layers I Results I Address/Name/Parcel Search I Tools http://m«ns.co.davie.ne.usIGoMaps/map/Index.cfm?maimnapservice=gomaps&CFID=4129&CFTOKEN=61640881 &initializem... 4/3/2008 Now 15 04 12:04p daviO count3 envhkealthk 336 75 w !/ 6� GA1 [ON FOR SITE EVAWA'iION/iMt'ROV MEW PERMr A 3 O 1,t Nov �� APP i`u i nz Davie County Health Department 204 f 'AliV1nvnM�enta/t/eWIth SkICU00 �����GY" .0. Box 848/210 Ho=pitai Strawt 3' `� Mookoville, KC 27028 &%RONMENtALNW� ��<< �� 33�� Z� (336) 751-8760 DAWECOUIM ***IMPORTANT*** TUX3 "VX.ICATSOW CANNOT BS PROCSSSSD UNLESS ALL T= RL►QVZRFD INPO2VAATI01:7 XS pROVIDSD. Refer to the XXr0VMATI0N STYLLET:rN for inetrtsctiona. 1. Name to be Billed e01 'f Wend0/ o4t�Contact Parson P4u / 0 "T - ?tailing Address a iS G Ieh s�or, a ?/y%I �¢.�. 8 xosa. mane 3 6 `% - / 3 91' City/state/Zit' Hi o�n 1<T�C %��S Sutainess !hone 3 3• �s 9- & o% 2. Name on Permit/ATC It Differs -it than Above Sv►t a 4s 4 r70NQ Mailing Address City/State/zip 3. For Aluatlon ❑ ItuproVement i>errn3t/ATC ❑ Both 4. System to service: ouse ❑ Mobile Hoare ❑ Business ❑ Induatry O other- 3- therS- Type system requested& 12"CV.veational ❑ conventional modified (3 innovative 6. x€ Ttasidences 0 ?eopl.s. 3 a Bedroom& $athroms 11�* i&hags Di&ossa! ishwMachine MS.-.;.t/Plumbing ❑8asement/7Po Plumbing 7. Zf Nosiness/industry /otberi: verify type a people I sinks Y Cammodea N ,9howera a Urinals N Nater Coolers YF ro=fi2SVICS11 #Ss Batl=ated Water Usage (gallons per day) a. Type of water supply: County/City ❑ Well ❑ Conwa=:Lty 9. to you anticipate additions cr expansions of the facility this system is Intended to serve? ❑ Yes 04. If yes, what type? ***IMPORTANT*** CLIEN'T'S MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT orstt,rc PLAN MUST BSSUBhl1TTCD by the client with THIS APPLICATION. Property Dimensions: X ` ` WRITE DIRECTIONS (from MoocJ 1 cksville) to PROPERTY. Tax Office PIN: fF SO ,S 0 O�-Te P 5") I—�- 7 O /' 6 All / ) Property Address: Road Name _. / e rk74er � •/s �/ L n Li t�t� jt CA., -c4 li'W -Ap CityMp /hoL^LsL,,'// bC L /OA Be..- Crrek CA,,� RV If In a Subdivision provide Information, as follows: looA -74/-/Ir 1T enp,- 7, -,,'Is S ; �► Name: Tih, 7r4; �s jus7� 175 / Section: Black: Lot: 3 Date home corners nagged: This is to certify that the information provided Is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site pians or intended use change, or if the information submitted in this application Is falsifi iA or changed, 1, also, undeWund that l am responsible jar all charges i ersrred frons Ilsis 4pilcallon. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property Iocated In Davie County and owned to conduct all testing procedures as mccessary to determine the site suitabil D r DATE SIGNATURE THIS AREA MAY DV USED FOR E RAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). 4Q� KV Sign give / Revised D HD (o5/03 Site Revisit Charge Date(S): Client Notification Date: EHS: Account No.�' _ Invoice No. 4. SfAq .>.1 i ,✓ 1 1Mvnlin OrrM>.tl�r+ fl�rafwt cwwavklbm M !�•AM.n .,, ..» . w.. a .. 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I ; l� �1 r _ - �awsrw•� •rrrrr »r r wrs wf ..s w +�r� A latr r.. ss .1 OVA" r 0ILt7R VM@N I[. r 17M DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION Account #: 990003425 Billed To: Paul & Wendy Olinger Reference Name: Proposed Facility: Residence Property Size: PROPERTY INFORMATION Tax PIN/EH #: 5812-01-5250.03 Subdivision Info: Timber Trails Lot # 03 Location/Address: Timber Trails Drive -27028 5 acres Date Evaluated: 12 '? Water Supply: On -Site Well Community Public Evaluation By: Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L_ Sloe % (77V-1 to HORIZON I DEPTH (5-- I Q — Texture grou '(�-'�S-f C -L- ` C1- $" L Consistence 1F 10 PA - Structure C b i &_ Mineralogy 1L HORIZON II DEPTH Texture group C_ t Ck Consistence �• �S - _� SS Structure L� Mineralogy S -.AR HORIZON III DEPTH 7q- 4'2- Texturerou S; CRS i `C _ '' t 15,S'« Consistence (-{SS>P S S(-' Or Structure c. c Mineralogy��. c' HORIZON IV DEPTH qck 4 -"A - k 2 Texture groupS L. L Consistence Vr Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION ki _ LONG-TERM ACCEPTANCE RATE a 3 • _ t .� "T o SITE CLASSIFICATION: EVALUATION BY: �-- LONG-TERM ACCEPTANCE RATE:U i OTHER(S) PRESENT: ` �'•�� Aad ems ; iZZ REMARKS: 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 Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet 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 05/99 (Revised) i i i ■■ ■■ on No so ■o■ ■■■ ■■■ ONE ENO ■■■MEMO■ ■■■■EME■ ■■■■MMM■ ■E■■■■■■ ■E■■■■M■ ■s■E■■■m ■■■■■■E■ NONSENSE ■■E■E■■■ ■■■■mm■■ ■■■■■■■■ ■■■■■E■■ ■E■■■■■■ ■■■■E■E■ ■E■E■M■■ ■EE■■M■■ ■■■■■■■■ ■E■E■M■■ ■E■■■■■■ ■E■■■■■■ ■■■E■■■■■■e■■■■ ■■■■■■■WEEMMEM■ ■■■MEMEMM■■M■■MEM■M■ ■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■ ■■ ■E m Emmoommorg m■m■ummitem M■■MUNALWAN MENNNEREME ■EERSHME■■ ■■■m■■■■E■ ■■s►■■■■M■ ■EMMOMM■■■ ■M■■MOM■■■ ■E■OO■moss ■■■■■■■■ a■ ■MMM■■■■■N ■■M■M■OMEN ■■NEEM■■E■ ■■■■■MM■M■ ■■■■■■MMM■ ■■■■■■MMM■ ■■■■■MMM■■ ■■■■■MMM■■ ■■■■■■M■■■ ■■■■mons■■ ■■■■E■■■■■ ■■M■■■■■■■ ■■m■■■■■■■ mn■■■■■m■■ WME■■■■■■■ ■■■NESE■■■ ■■■■M■■■M■ ■■■■■■■■■■ ■MMM■■■■M■ ■■■■■■NEEM ■■■■E■■■M■ ■■■■■■■E■■ ■■E■■■■■■■ ■■EEE■■■■■ ■■M■■■M■M■ ■■EE■E■■■■ ■ t '•' � 'moi � �� `' _''• _� •_'-,=.\ , �; --- r � . " .. 4J Y '•. lam,, � �/� �t r�J�� � � � �, � � � ��, � ��• �1 � l , .�/ -�-�" - • M � • j •' � .' •,moi 1, " ' � � / .�r �,/�! % . � � � ,i `' �.. , r (r� fl ' • •� /f , �.�`• fi ` t{ 1fr �ri .��w,. ^` . y:y��l,!/ J 1, f� / 7i1`.'..� (�. ••rte. .~ i .� `' , /'�. � �rC �, •'��� f �•J� i' '-'.L.�`,''` � - /�'i � , r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO,Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 /Fax: (336)751-8786 December 8, 2004 Paul and Wendy Olinger 1215 Glenstone Trail Apt. 2B High Point, NC 27265 Re: Site Evaluation - 5+ Acre Tract/Timber Trails-Tract#3 Tax PIN#: 5812015250 Dear Client(s): As requested, a representative from this office visited the above site December 7, 2004 to perform a site evaluation. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. Before a representative of this office will revisit the site to issue an Improvement Permit/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. Sincerel Jeff G. Beauchamp, R.S. Environmental Health Section Enc(s)