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971 Markland Rd Lot 7R Account #: 990005354 Billed To: Andrew Collins Reference dame: Proposed Facility: Residence ATC dumber: 4996 zj� 100.00 Lt I Paid b911-71v(-1e- DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Tax Pld: EH #: 5789-16-0725.07 Subdivision Info. Olde Farm Lot # 7 LocationfAddress: Markland Road -27006 Property Size: 1.28 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 9'en period of i time. d y — o System Type: 34-4 r -' S.T. Manufacture�� Tank Date •� Tank Size %�� Pump T nk Siz i X �.. I -/) / oPl �- - --::: > 7 b ffO/- DCHD 11/06 (Revised) 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 #: 990005354 Billed To: Andrew Collins Reference Name: Proposed Facility: Residence Tax PINI: H #: 5789-16-0725.07 Subdivision Info: Olde Farm Lot # 7 LocationiAddress: Markland Roaq-27006 IY Property Size:/ew 8 Acres ATC Number: 4996 Site Type: ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building pennit(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 Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size (� Q Gr'e5 Type of Water Supply: D unty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) SIJ Tank Size 0 0 GAL. Pump Tank.A$ GAL. 1 4, if Trench Width � Max. Trench Depth 3 G Rock Depth % I Linear Ft. j 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. fIDA CA -e V- I- � a1 Environmental Health Specialist `% �%% �:/%/ Date: DCHD 11/06 (Revised) �jko t.L-N - zE 0 &J%dr e6wt►- ctle ru(4 L6 wf n.pv �94,'� DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/Fax #(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005354 Tax PIN!EH #: 5789-16-0725.07 Billed To: Andrew Collins Subdivision Into: Olde Farm Lot # 7 Reference Name: LocationiAddress: Markland Road -27006 Proposed Facility: Residence property Size: 1.28 Acres ATC Number: 4996 Site Type: ❑New ❑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.. �y Residential Specifications: # Bedrooms # Bathrooms9� #People BasementCl'Basement plumbing Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size L7 G r C--" Type of Water Supply: ❑County/City ❑ Well ❑CommunityWell System Specifications: Design Wastewater Flow (GPD) Tank Size 1, a0%AL. Pump Tank GAL.r e fr it Trench Widthi! Max. Trench Depth_ Rock Depth Linear Ft..X ,,% As stated in 15A NCAC 18;%.196^'5 kews''^ Site Modifications/Conditions/Other: acr pts q� l,KyU us. Contact the Davie County Environmental Ilealth ection.for final inspection of this system between 8:30 — 9:30a.m. on the dav oftstaUation. Telephone # (33W51-8760. > M A_�Jo Environmental Health Specialist Date: DCHD 11/06 (Revised) •APPLLI R 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 ATelof `-on For: P ion/ vement Permit ❑ Authorization To Construct(ATC) ❑ Both T atl�' d em ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility p?�\� ** MP NT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED RMATI09IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPI.TC'ANT TNFnRMATTON Name to be Billed ��,��•(�—PL C__ (, �� Contact Person Y u�>!t" (I IL, Billing Address %fid Home Phone' (i'41 City/State/ZIP L, �„t r_� 4C l?Cz6 , Business Phone ; 7 Name on Permit/ATC if Different than Above Mailing Address 17 PROPERTY INFORMATION *Date House/Facility Corners Flaeaed 1I_9_0 NOTE: A survey plat or site plan must accompany this application. Included: Cite Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Named '— — ^Z ,-�1� , ? L'e, (� ,. Phone Number'45 Z/ 2— Owner's Address 6--111 tft..)y plyi 5Z 1 City/State/Zip c ft;;� c_- ?7l• >/-� Property Address v"'t_ lt� ...,1 1 r j, City a C� til_ �, Lot Size (,, Z_ Tax PIN# Subdivision Name(if applicable)_ U t&-*F6>,,1,&y%_ Section/Lot# Directions To Site: W V 4`,1.) Sit- ? .f L -,L G'lc� (c..�-:k l C 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 ErJ% Does the site contain jurisdictional wetlands? ❑Yes QNo Are there any easements or right-of-ways on the site? ❑Yes RNo Is the site subject to approval by another public agency? Dyes M1 Will wastewater other than domestic sewage be generated? Dyes BNo IF RESIDENCE FILL OUT THE BOX BELOW # People 5 # Bedrooms _4_ # Bathrooms ; %Z_ Garden Tub/Whirlpool Er es ❑No Basement: Dyes RiKo Basement Plumbing: ❑Yes DNo 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; ErConventional ❑Accepted ❑Innovative DAltemative ❑Other Water Supply Type: EKCounty/City Water ❑ New Well ❑Existing Well D Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes If yes, what type? 2'1Vo 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. J Site Revisit Charge Property owner's or owners egal representative signature e t Z `` Dat Date(s): Client Notification Date: EHS: Sign given Dyes DNo Account # V lS Revised 11/06 Invoice # Tl ✓/�/q PRELIMINARY PLAN NOT FOR CONSTRUCTION Y IF THIS STAMP IS NOT RED, THIS IS AN ILLEGAL COPY. THESE PLANS ARE THE SOLE PROPERTY OF XPRESS CAD SERVICES AND ARE NOT TO BE SOLD OR DISTRIBUTED BY ANY OTHER PARTY [ 4! Mwa Nn F rlw6. 1 4Mu W YrYy b Y F afmww jai YPIa Naa.iaa W NYF Rnl u.a F WT crtc avY is1. a. RFya4uu Io ar�aaul N iu Y iun+ W Wn� a 4ynpv F ��} Y NuaT N Md, W nJiT IN a•,M W�I+w WYwaywa !. aMw YY. MpR. F Y T -P rv...Ilr+Y wFa uW Yyy� M e1N Y1HJYf Ntlllwf. nwonns. uMu WNtl Yart1 aarRFw aw Y a.... N a Yaww M a1pYNa Ys p wYvl IY Yda d�aa V w... . l 6tiN W aY�wwni YJ1Y �, paeil.w, �a. MY Mnuaa M a/yln F ,Nq...w Fa n.aa• 11. Vnlr W w AYr N +R Iw,..a 1w� buNw 1/Y N waw K •.eow W a.v[ u. Nw Iy^1 F YYYF �w NueRI iNieal 111LiIY )4. !m Nw 1JN J !W ll.ro/ba . 1[Ca[ - IS M Lam nc OwH Cali rYu� MnM F wM/ W WaK a. W �fwYw M�mR�N 1iW„ iiN % R. /N`�FM Y I-1 IT Y YyN • Lw % T MPv-, FAyk.a�%T !qtl alar+ Maw/Is/ % R. Taal ala'+ ti aaa• ata % n. Mwl a.araY N w+�./W w . 1!m PRELIMINARY PLAN NOT FOR CON5TRUCTION 5QUARE FOOTAC� FIR5T FLOOR -1613 5ECOND FLOOR- 879 TOTAL- 2492 c"AQr- 620 FRONT PORCH- 333 5CRtMeD PORCH- 265 UNFIN. 5TOMt.- 622 PRELIMINARY PLAN NOT FOR CONSTRUCTION IF THIS STAMP IS NOT RED. THIS IS AN, ILLEGAL COPY. THESE PLANS ARE THE SOLE PROPERTY OF XPRESS CAD SERVICES AND ARE NOT TO BE SOLD OR DISTRIBUTED BY ANY OTHER PARTY ~a� a NM.avr Ir NOMI /..II ar Y a.pn M we�w. f �gr.ar M1 wYf W Mn4e arM srLp .M arq l W rqM N..Mw ue 4 N )qns x.+e.. Yxy+, .ro ..w Mmwf .nuo.w fv.«eve Min a Yryae .�. M1 .ap.l 1a. by .sel M pwW1. f. e+ne+r w iwn.M siWM rr_aa"91r+drw la. q.i rWMa) M+4Y•. M1 .rtM.n A � M1a4 V_M .M Mr .Md. ro wyf 1rw.Y N_ MW�w+ �1 .M reepr+m M Yr Ii r6r. W�^a N MYi.N rover. laraloaa 11 Mrr. 9NWa M A.b1.bM1 re.n. VlMWr1 it J41LYY ID4 Y alAv90a � 1a.YY Y. qYy N AW.tlar n_oe: reruNrl a � Ad li A_ moa M: Nagf �• repro. eFG.w ro ._Mf ave a .._w+r .W.w*• rr...e vM1M _.i...a n.... h. ro wu.o a) ..r a.•a ,w.. eve) aba.a PRELIMINARY PLAN NOT FOR CONSTRUCTION U C Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990005160 Tax PIN/EH #: 5789-16-0725.07 Billed To: Jerry & Charles Potts Subdivision Info: Olde Farm Lot # 07 Address: PO Box 37 Location/Address: Markland Road -27006 City: Advance Property Size: 1.28 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: rd<ew ❑Repair ❑Expansion Permit Valid for: BSYears ❑No Expiration Residential Specifications: # Bedrooms #Bathrooms Z # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD): 360 Type of Water Supply: P ounty/City ❑Well ❑Community Well As stated in 15A NCAC I8A.1969(5) Site Modifications/Permit Conditions: accepted Systems unay alno he used System Type LTAR Initial C © • 2? Repair -A 0. Site Plan , L Environmental Health Specialist ,,,>>_0r Z 7/ N Date 8 -'7 a9