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244 Timber Trails Lane Lot 10r Account #: 990004322 Billed To: George Snyder Reference Name: Proposed Facility: Residence ATC Number: 4670 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Tax PIN/EH #: 5812-01-8121 Subdivision Info: Timber Trails Lot # 10 Location/Address: Timber Trails Drive -27028 Property Size: 4.86 acres **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. -7`��_lt� System Type: 04 S.T. Manufacturer Tank Date Tank Size IM Pump Tank Size System Installed By: �� E.H. Specialist: Date: 10' / WHO DCHD 11/06 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax 4 (336)753-1680 ATC Number: 4670 Site Type: ( w ❑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. IN '� Residential Specifications: # Bedrooms # Bathroomsi -- # People aLn Basement0�asement plumbing Cr I Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) J1 Lot Size / •IJ ��C/'�iS Type of Water Supply: Ztounty/City ❑Welt ❑Community Well .t r�K p System Specifications: Design Wastewater Flow (GPD) Tank Size_ZD6 GAL. Pump Tank J S GAL. t Trench Width 3& rMax. Trench Depth( Rock Depth Linet Ft. 41OLI O -f As stated in 15A NCAC 18A.1969,5)asp c.n_G dh Site Modifications/Conditions/Other: accepted Systems may also be used Contact the Davie County Environmental Health Section for final inspection of this system between nn --8:30 – 9:30a.m. on the da of installation. Telephone # (336)751-8760. 0 °�' y SYz- Environmental Health Specialist 01 DCHD 11/06 (Revised) Date: —e AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account M 990004322 Tax PIN/EH #: 5812-01-8121 Billed To: George Snyder Subdivision Info: Timber Trails Lot # 10 Reference Name: Revised Permit 01/07/2010 LocationiAddress: Timber Trails Drive -27028 Proposed Facility: Residence Property Size: 4.86 acres ATC Number: 4670 Site Type: ( w ❑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. IN '� Residential Specifications: # Bedrooms # Bathroomsi -- # People aLn Basement0�asement plumbing Cr I Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) J1 Lot Size / •IJ ��C/'�iS Type of Water Supply: Ztounty/City ❑Welt ❑Community Well .t r�K p System Specifications: Design Wastewater Flow (GPD) Tank Size_ZD6 GAL. Pump Tank J S GAL. t Trench Width 3& rMax. Trench Depth( Rock Depth Linet Ft. 41OLI O -f As stated in 15A NCAC 18A.1969,5)asp c.n_G dh Site Modifications/Conditions/Other: accepted Systems may also be used Contact the Davie County Environmental Health Section for final inspection of this system between nn --8:30 – 9:30a.m. on the da of installation. Telephone # (336)751-8760. 0 °�' y SYz- Environmental Health Specialist 01 DCHD 11/06 (Revised) Date: —e • DAVIE COUNTY ENVIRONMENTAL HEALTH N'r P.O. Box 848/210 Hospital Street %, %7 10.7 Mocksville, NC 27028 (�!/ r (336)751-8760 Fax # (336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004322 Billed To: George Snyder Reference Name: Proposed Facility: Residence a 3 P ATC Number: 4670 Tax PIN/EH #: 5812-01-8121 Subdivision Info: Timber Trails Lot # 10 Location/Address: Timber Trails Drive -27028 Property Size: 4.86 acres Site Type:Xew ❑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 �,5 # Bathrooms5s# People2- Basement❑ Basement plumbing Non -Residential Specifications: Facility Type # People # Seats // ��ff //�� Square Footage(or Dimensions of Facility) Lot Size -t'a- &"z-_5 Type of Water Supply:/TCounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) Tank Size /La00GAL. Pump Tank GAL. Trench Width1--,�,/, ' Max. Trench Depth Z� Rock Depth N & Linear Ft. �'71S Site Modifications/Conditions/Other: O► L -P t eb ZS a Zi T�'�'7 T� — , J' 1ST LL— 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) Apr 05 07'04:25p Martha Rollins C E O V E %U APPLICATION F APR 10 2001 ENVIRONMENTAL HEALTH DAVIE COUNTY ApplicaticnFor: 0 Site Evaluation/] Type of application: NNew System 336-492-5757 p.l TE EVALU7ATIONIAMPRO`rEMENT PERMIT & ATG Davie County Environmental Health P.O. Box 848,'210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 arovement Pernii} L'. Authorization To C'onstruct(,ATC) X Bot'., ❑Repair tc Existing System :]Expansion'Modification of Existing System or Facility '**IA!?OJUAA,Y*** TH :; .0PLICA; IO\ C.3r'N0T BE PROCES',SEL UNLESS ALL OF THE RPQI JTRED 1 FORM A'1'lCyN 1S l'k0`ti`iliGD. l:efar to the INFOF1bLa'' iON B L.LETIN Far urs it coons. APPLICANT 1N"F0'-314ATI0N J _. ltilanl(' tohe '� Contact Person _ :' 1.c1 R}1lLCi 1f1 — $illit:; Address � ..�*t, [��'31d Rome Phone �� + Business Phone City/State, ZIP AN,,,"� 14anre or. PcrmA/AT C% if L'ijf _r- rtt than Ab ve `7 �j ` �',l� r✓!ailing Addie s % .�'!'� : C��f�s i�l � ity/State/Z:ip PROPERTY LN ORiNIATfM4f *Date House/Facility Comers Flagged 4Z— AP � 7 NOTE: A suivey plat or sitz plan must accompany this applicr:tion. Included: A Size Man UPlat(to scale) (Permit is valid for K rnorths with site plar-, no e\jiiratien with complete plat.) � j Owner's1`.amePhoneNutnher�/'/"/ Owner's Address_? &,P4 -Aa.417L4 CitylSlriie/7,rt _V496Lire-1 Proaerty Address Lot Size^, - _ Trx T'1Ttin 5- Z 019zz S:tl?divisinti Nurnc(:f al lt';icu rlc) _�. Cc rat SectiorL'Lot# �fL�• Dircctiorrs To Site:6t•/ N T• le,41- Z: &.4 -I 'Z YV — . b/Z Z�a-� If the answer to any of the follo vir-g c uestiens is "yes", supporting documentation must be attached. � Fine there any existing wastewater systems on the site' Yes FNn Does the site coz:zirt iuris&ctioaal wetlands': Are there ani, easerre:its or right-of-ways on th site? J Yes XNo Is the site subject to approval by another public agency? C Yes j No Will wastewater other- tlraa domestic sewage be ger cratd? Dyes X.10 IF RESIDENCE .ELL OUT THE BOX BELti1: ,,1'�G People _ ? # Bedrooms 4� �,V 13atnrocrrw _ � Garden TubM lrirlpool Yes ❑No Basencent: )Yes GNo BasementPlutrhing: )(Yes F,No IF NON-RESIDEN CE FILL OUT THE BOX BELOW Type of Facility/Business _ Total Square Footage of Buildinp People 4 Sinks _ k Cormnodes ;t Shativers .. _. _. Urinals Estimated lvrater Usage (gallons per day) _ (Attach documentation of similar facili v ,vater consumption) FOODSER'VICEONLY: Type:syste.nraquested: t1k-w.ventiunal =-Accep cd Olnnovative GAlternati-,e ❑Other Water Supply Type: `1%CountyrCity Water Q 14cw Well ❑Existing W61 ❑ Community Well Do you anticipate additi.orl. or expar:sioas of,lit facili y Jiis system is iutcndcd to serve? :1 Yes AND If yes, what t'pe^ --- - This is to certify that the inforrra�ion provided on this application is tnue and correct to the best of my knowledge. 1 t.nderstand that any prnuit(s) o. ATC(s) issued h.creaftcr are subject to suspension or revocacion if the sire is altered, the intended use cl inges, or if the infotmatioa submiacd in this application is falsified or charged. I hercby grant right of entry to the Authorized Represen-ativc of the Davie County Health Department to coriduct necesszry inspections to dete.-mine compliance wish applicable laws and rules. I uadcrstaod tlwl I am responsfinle for the proper identification and labelin, of property lines and corners and lacar;ng and flagging or staking the housc/facility location, proposed well location anc the location of any other anten.it:es. .14 i Site Revisit Charger o', u VA * I leg .it t�-rrt.,rnitative sirmwllre Client Notification Da-c:. Da-e EHS: `1`5`0 7 Sign ,rgiven -.',!Yes :]No Account Revised 1 Invoice rt npr 05 07iO4:27p Martha Rollns 51in 6% 336-492-5757 p.4 GIS Its DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section R Soil/ Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION " Account #: 990004322 Tax PIN/EH #: 5812-01-8121 Billed To: George Snyder Subdivision Info: Timber Trails Lot # 10 Reference Name: Location/Address: Timber Trails Drive -27928 Proposed Facility: Residence Property Size: 4.86 acres Date Evaluated:i a� Water Supply: Evaluation By: On -Site Well Community Auger Boring / Pit Public --� Cut FACTORS 1 2 3 4 5 6 7 Landscape position t— Slope % „ _01 21 HORIZON I DEPTH - 1 C9 — 0 '1 �'; — 2. d Texture group ci— GL: SC -C. C_ Sc_L_ 6Z_ Consistence S i V -r- S' -S Structure < e,2 , Mineralogy S HORIZON II DEPTH (o -' 1 Z - 2 ii Texture group G G f-S C Consistence S oc`$ 5i Structure AP k - Mineralogy rtn t HORIZON III DEPTH r• Texture group '#-,e Consistence . �5 F- `:97rS Structure 1 S K Mineralogy / Hn% )c,<'+ 1/�- tic ` . P HORIZON IV DEPTH -- LIZ — - Z r v -t el (o � Texture group &YO LS a L Consistence Structure Mineralogy SOIL WETNESS Lt C_ 2 -h4 - f -RESTRICTIVE RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE o. r- �'- �'4.rKui SL3v SITE CLASSIFICATION: �s LONG-TERM ACCEPTANCE RATE: REMARKS: , LEGEND EVALUATION BY: "t`' 1 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 Mohl 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 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 riQtes 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 05/05 (Revised) i ■■■■■■■■■■■et■t■t■■t■■■!■■■tt■t■■t■■■tl■■!■■■■eft■■rte■■!■■■t■ttt■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■ttl■■t■■t■t■■■■lt■■t■tt■■■■■■t■■e■■■■■■e!t■t■■■l■ttt■■■!■t■ ■■■!■■t■■■te■t■■�►�t■tt■■■■tt■t!■■■■■r�►e■��e■■■■■■■■■■et■■■■■e■ ■■■■■■■■■■■■■■■■i■ace■■■■■■■■■■■■�i■■■■il■I�r�JI ■■ell■■■■■■■■■■■■■■■■■■■ '■■■■■■■■■■■■■■■■11■ell■■lt■■t!■■■■■■■■111■!■!!t■■11■■■■■■■■■t■■!■■■■■■ ■■■■■■■■■■■■■■■■�I■■■\■■■■■■■■■■■■■■c7;%■■■■■e■■Ile■■e■■■■■■■■■■■■■t■ ■■■■■■ ■■■■EN ■■11M■■M■■■■■ ■■NM■■■■■■IIE■EM■■MMEM■EM ■■■■■■■■■■■■■■■■■Il■■L 1■■■e■■■■MEN ■■■■■■■■ ■■tt■l■■■■■■■tt■■11t■■e1�e3�.[i�i>:i7�l:�J�■ee■ee■■■e■■11■ere■■e■■■■■■■■■■■■ ■■■■■■■■■■■t■■■■■Ir■■Gf■`�'!!�9■r�■!t!t■a■■t■t■e■■11■■!e■!!■!■■■■t■■t■■ ■■■■■■■t■■■■■■■■■II■ce■■■!■■■■■■■■�■ie�a■t■t■■■■■II■■■e■■■■■■■■■■tt■e■ ■!■■■■flee■■ll■■till/t■t■t■■ttetltt=C:a■t■11>•�A'll■■■t■■t■■■■■■■■t■■■ ■■■■■■■■■■■■■■■■■II/ii�r�i:. i� :iic=�■Icr`7:oiT.itl�ll�■■■■■11■■■e■■■■■■■■■■■■e■■ ■■■■■■■■■t!■■■■■■rlr/■■■/!�!�►'•!!��ii�iiaiiC� :��J11■■t■■■■■■■■■■■!■■t■ ■■■■■■■■■■■■■■■■■ai■■■■■■■■■■■e■■ ■■epi■■■■■■■■II■■■■■■■■■■■■■■■■■e■ ■■■■ltt■■■■■■■tt■i�■■■■■t■■■■■■■■I�i■■s�I■t■■t■■■I lt■■e■t■■■■■t■■t■■■■ ■■■■■■■■■■■■■■■er�■■■■le■■■■�I�tltt■!to■■!t■!■■■li■■■e■■!t■■e■■!■■■■■ ■■■■■■■t■■■■■■■ti■■■■■■■■■■t■lel■frill.■■et■■e■■11■■!el■l■!■■e■l■lle■ ■■■■■■■■■■■■■■■11■■■■■■e■■■■■■■■■■■■■��■■■■■■■■Ile■■■■■■■■■e■■■■■■e■ ■ells■■■■■■t■■■u■■�■■ttttttt■■■■t■■■■■t■t■■■!■li■t■■■■■tt!■■t■■t■e■ ■■■■■■■t■■tt■ttll■trl■■■■■■■tett■■■ �la■■■rl■■■l■etell■■■et■tttte■■tt■■e■ ■■!■■■■■■■■e■■■■■■Ir!■ee■■■!■■■■■■lsii■■iw■_■_■■_e■_ell■■■■■■■■!■■■■■■■■■■ ■e■■■■■■■!■■■■■.■■■Ill■■■■■t■■■e!'3ili�iL::�eet■E�fle■■'/ �■■■■■■■■■■e■■■■■!■■ ■■eeee■e■e■ee■/i■■■ills■■■■■■■■e■��a■■■ee■tl■■■■■Ilel■e■!■■■■ell■■■■■■ ■■■■e■tet■e■till■■■ri■■e■■e■■■e■e■■■■■■eee■t■■■■Ile■ee■e■■e■ee■■■eee■ ■■■■e■■■■e■■trot!■■'e■■■■eee■e■■■�e■■e■■ee■eeeli■■e■t■■■ee■■■■■ee■■ ■■eeeeelee■■tells■■■■e■■ee■■e■■e■■■■■■!■■tt■e■tlla��■tt■t■■■e■■■e■■e■ ■■■■■eeeeee■■ell■.e■■■eeeeeee■■e■■e�.>re■■ecce■■I11#.1■eee■e■e■e■tt■e■■ ■■■■el■■■■■t■■■■e_-��r�.e■■et�:��x�irr�, ■t■e■■■eeell■■■■■e■■■■■e■■e■e■■ ■■■■■■■■■■■■■■w.■■■Ise■■■■■■■■elel�■■■■■■■■■■■e■■11■■■■■■e■■■■t■■■e■■■ ■■et■■■■■■e■te�i■■■■i■■■ere■■ere■■■■■■■eeee■e■li■■■e■eee■te■■■■■l■■ ■ee■ee■■et■e■eelr■■■Ir■e■■nett■■el�■■■e■■e■■■eelle■e■■■■e■■■■■t■■■■■ ■■■■■■■■■e■■■■■Irl■■II■■■e■■■■■■■■■■e■■■■■■■■■e■I��■■■■eee■t■tt■e■■■■ Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990004322 Tax PIN/EH #: 5812-01-8121 Billed To: George Snyder Subdivision Info: Timber Trails Lot # 10 Address: 1201 Wagner Road Location/Address: Timber Trails Drive -27028 City: Mocksville Property Size: 4.86 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: .Xew ❑Repair ❑Expansion Permit Valid for:, <Years ❑No Expiration Residential Specifications: # Bedrooms 3 # Bathrooms3,s# People 2 Basement❑ Basement plumbing.B� Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): ata Type of Water Supply: Xounty/City ❑ Well ❑ CommunityWell Site Modifications/Permit Conditions: Site Plan , System Type LTAR Initial C'.G O• Repair lrW to5`1. yen � 240 p¢.,oP• �..t,�� Environmental Health Specialist Date. i.p. 11-06