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198 Timber Trails Lane Lot 12DAVIE COUNTY ENVIRONMENTAL HEALTH ' P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax #(336)751-8786 Account #: 990002755 Billed To: Clifton Burke Reference Name: Proposed Facility: Residence ATC Number: 4627 OPERATION PERMIT Tax PIN/EH #: Subdivision Info: Location/Address: Property Size: p� v^J\o� 5812-00-7353 Timber Trails Lot # 12 Timber Trails Drive -27028 4.98 **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: S.T. Manufacturer t -o {� Tank Date Tank Size 140 c, Pump Tank Size System Installed By: old %N P`5 E.H. Specialist: �o(o AlcXo p, 5 Date: JI Cc, Kd C � -CA-1 (r,- %4 (�! No Ct Kbi f Q� DCHD 11/06 (Revised) Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville NC 27,028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990002755 Billed To: Clifton Burke Address: 181 Greenfield Road City: Mocksville Reference Name: Proposed Facility: Residence Tax PIN/EH # Subdivision Info Location/Address Property Size: 5812 -OD -7353 Timber Trails Lot # 12 Timber Trails Drive -27028 4.98 **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: t<ew ❑Repair ❑Expansion Permit Valid for: 95S'ears ❑No Expiration Residential Specifications: # Bedrooms 4f # Bathrooms_ # People a Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD): 7gd Type of Water Supply: 8'County/City ❑Well ❑Community Well Site Modifications/Permit Conditions: has stated in 15A NCAC i8A.1959 (5 � eeept€dSysterts-rimy af=,,tr uo ubuu Initial Site Plan Environmental Health Specialist i.p.11-06 tem Type LTAR C. Z • Date �il l��d 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 #: 990002755 Tax PIN/EH #: 5812-00-7353 Billed To: Clifton Burke Subdivision Info: Timber Trails Lot # 12 Reference Name: Location/Address: Timber Trails Drive -27028 Proposed Facility: Residence Property Size: 4.98 ATC Number: 4627 Site Type: 2New ❑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 or the intended use change. Residential Specifications: # Bedrooms_ # Bathrooms # People Z Basement Basement plumbing Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size 17�. ��iCce•� �. Type of Water Supply: 2'County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD)1't d Tank Size I/ sCr) GAL. Pump Tank GAL. Trench Width3 G `r Max. Trench Depth _311L Rock Depth �.i Y Linear Ft.� Site Modifications/Conditions/Other: As stated in 15A NCAC _18A.10959(5) 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. T�c�S O�yrad��Cr/+�rt�t'r 7 k e, 1rKC Le 5 p 0'55 0 61.e im CL (CUw -1d, H Oa66 Q icl%t�C3i u Environmental Health Specialist �-�' — Date: DCHD 11/06 (Revised) • 0 1 a ',- SITE EVALUATION/IMPROVEMENT PERMIT & ATC -- Davie County Environmental Health ;1 P.O. Box 848/210 Hospital Street FEB 2 6, 2067 Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 provement Permit ❑ Authorization To Construct(ATC) C4Yoth El 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 C[- • 1— 10-S Lc r 1< e Contact Person L— / u` 1rN Billing Address 1ISt Pia Home Phone( 3>4-/ 4 -0? -)---5617 City/State/ZIP IK c ky tt c' N C- 7-70.4$ Business Phone A/-,#, F Name on Permit/ATC if Different than Above Mailing Address Sane PROPERTY INFORMATION *Date House/Facility Corners Flagged c2laQIO7 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 Ian, no expiration with complete plat.) Owner's Name j> o.� P %` C v�2-: 3 �'(�.r S L C. Phone Number Owner's Address (4 Jk k- City/State/Zip fiIC- Property Address r, h 7 tS 4 aAe- City -AL, % Ly: Lot Size Tax PIN# 6Y/Z- 06 - Z3u53 Subdivision Name(if applicable) Section/Lot# 1,.2 - Directions To �- DirectionsTo Site: C9ri Oe— (l4 Oe,.,C%tom-rc 134P If the answer to any of the following questions is "yes", supporting documentation st be attached. Are there any existing wastewater systems on the site? ❑Yeso . Does the site contain jurisdictional wetlands? ❑Yes (k.- Are there any easements or right-of-ways on the site? ❑Yes I -Ko':- Is the site subject to approval by another public agency? ❑Yes Zh<o Will wastewater other than domestic sewage be generated? ❑Yes , o IF RESIDENCE FILL OUT THE BOX BELOW # People a7, # Bedrooms 4- # Bathrooms 2 Garden Tub/Whirlpool Bles ❑No Basement: ❑Yes W-116 Basement Plumbing: ❑Yes 0315 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: R<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 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 staking the house/facility location, proposed well location and the location of any other amenities. PrPr peo -rty wner's or owner's legal representative signature ,Z-2G--v`� Date Sign given 'QYes ❑No Revised 11/06 Site Revisit Charge Date(s): Client Notification Date: EHS: Account # 55 Invoice # �/� Arc1wi viewer r r � httn-//rnans.co.davie.ne.us/website/maDviewer/MaDFrame.htm rage i ui i 2/9/2007 �` � ' ��` �t _,.�,•-�'yJ� �'� ��i��J�� / -� •k' kid ' ;do 1%•AJN� ! LOT 12 �' i� 0 14,9 LOT 6 . i RE 5. Qti n l t C f' S •`" LOT 9 LOT 7 LOT06Lo L _ f� AREA ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION Account #: 990002755 Billed To: Clifton Burke Reference Name: Proposed Facility: Residence Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5812-00-7353 Subdivision Info: Timber Trails Lot # 12 Location/Address: Timber Trails Drive -27028 Property Size: 4.98 Date Evaluated: 3 _QL <n) Community Evaluation By: Auger Boring / Pit Public Cut FACTORS 1 3 4 5 6 7 Landscape position C_Mucr Sloe % t HORIZON I DEPTH Texture group 5 L 1— 4 1— Consistence Consistence p La . Structure , o.,, v:, - Mineralogy t : ( JiL e HORIZON 11 DEPTH 2 _ 1 t —Q — q Texture group S c. G Consistence Structure y lee- ea,.Mineralo Mineralogy t 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: (L7 a 1 si lD LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: `Cab V V Ll t) 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 CONSISTENCE Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm 3i'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)