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583 Angell Rd , w� • DAVIE COUN'I'Y ENVIRONMENTAL HEALTH I�� • ' • � P.O.Box 848/210 Hospital Street 2d �� Mocksville,NC 27028 Z/� (336)'�51-8760 Fax#(336)751-8786 � OPERATION PERMIT Account #: 990004324 Tax PIN/EH#: 5840-18-3349 Billed To: Oakwood Homes Subdivision Info: Reference Name: Location/Address: Angell Rd.-27028 Proposed Facility: Residence Property Size: 2 acres ATC Number: 4671 **NOTE**The issuance of this Operation Pernut shall indicate the system described on the ATC has been installed in compliance with Article 11 of G.S.Chapter 130A., Section.1900"Sewage Treahnent 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�'��Tank Date 2—Z-� ' Size 1L� Pump Tank Size '` �System Installed By: l`��4 S �'�`�� �� E.H. S ialist: � ��� . UJ ✓ `�I F��'��'" �Q��� ��. � �-� ,� � ��x3i���klZ�� � lt�b' ��,,,,/'� � ��' s loo� ��,�, F 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 WASTE`VATER SYSTEM CONSTRUCTION Account #: 990004324 Tax PIN/EH#: 5840-18-3349 Billed To: Oakwood Homes Subdivision Info: Reference Name: Location/Address: Angell Rd.-27028 Proposed Facility: Residence Property Size: 2 acres ATC Number: 4671 Site Type�.�Tew ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building pernut(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 ��=�� Type of Water Supply: ❑County/City �ell ❑Community Well System Specifications: Design Wastewater Flow(GPD)��I'ank Size ��-�AL.Pump Tank GAL. .� �j�+ » ^ � Trench Width �' Max.Trench Depth �'/ Rock Depth �Z Linear Ft. � SiteModifications/Conditions/Other: L[.,[.,��� �}l��l�K. I�l.�,�i1� � �1 �� ��f' � �—f►sV' Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760. As stateti in 15A N�AC 1E�R.19S (5j ��1 acc�pteci Sy,�thms �;�ay �:iso b; u er] ,JL�- ��3� � . � �"���t io� � ..� � -� o � 8 � — � ��o0 -� � - � � � �� � � _ ���v� �o' 225' P¢�P. ����: �� . Environmental Health Specialis � Date: DCHD 11/06(Revised) � ... ... .._....�.». .... �y . r� v , � z � • , . � � , . , . . , t t2 Nr, y . b• r��S�.L` .: , -� N � � �,' �-rr1rrrr{{{p'��111 � V�Uta4)N^A � .� NN41Ny�NN � � . .. . ..Sr�U"N� � � ,\ . . . ... ' oNN�a�W� -�------- � 1. NZ7 � �`�'�rur�� > 2 z Qr I �t�Rfl�iPim['1n N O t°i� ('*1—' • �d N � �Q �A � e �7' ._ � �,�C�i� mN��Po�UZ �"� .}�0i � �` �m►m�Nwf� � H o � � � f„�,�1 w W L J � � � � � A � � � = p �� � �t�' � 3� � VJ ' p �'� �""� }� � �i v' �i n ` � v �,�r r ��� � '" � a ' _ �' "'° A ' : `'r � '.'c � �� �. � ��_.��y;� '% L----�----v-.�,_� � �— _ -� - �+f I r�� . . --- -�. _..a��� � — �.. ���.�_�-�.—� �� . � ry � �M��� �O� • NCSR 1408 19' PA1rT � � � B�►R SCALE , 300' 5D a 200 200 . 5URVEY FOR TERRY �McCLAMROCK ANGELL ROAD DRAWTNG DATA > DWG, No.� REVTSIaN SCA�E� i� - iao' 072538 bATEs �A�/N 8Yr TA �DATE� SURVEYED BY�.C, TA Oa/23/07 � � C[3UNTY� DA`JIE TAX ,ID� F500d0000701 Z 'd TltZ9'�NIP� M7CKS1/ILLE STATE���tl�6til9E� WdL'G�E LOOZ ' ll ' �eW �anApr•12• 2D�7: 4:05PM aa•,ie cou.,ty envhealtl'� 33e �si �•No•5619 P• � P,2 �-. • . _.__._. • ` � ����APPLTCA�TiO��'�F_�IT LL3ATION/1MPROVEMEN7'PERMIT&A7'C � ! e un �nvironmerdal Health D ty � � � . ox 848/210 Hospital Strcct ! , �. �,;�;� j � �Q� ! ucksvtlle,NC 2TU t8 : ) Sl-87Go/FQx E336j751-8'F�6 �lppiicatton F r.•�f-Sh hrat ment P it �Aucho�i:acion To Construct(ATC) �th yye of App1�"fion:r��'t�sa�Tf Repair to isting System pExpinsionlModification uf Existing Syscem or Facility uaa�tc;cu, n """lMPORTAMw••THIS APPLIC��7ION CANNOT BE AROC855.ED t RdLESS ALL OF T1iE REQUIItED � INFORMATIOTi IS PIt01/IDBD. F,cfcr to the iNFOAMATION HULLE'.fIN for insuuctioas. A.PPI�ICANT INFORMAT(ON Tlame to be Billed ('�lA i(� r�,_ e S C " K/ �ntact Ptrson���`�� G� � � Billin¢Address. Z HomePhone,�,�la'?4 '`7//d' �/ I I ' Ciry/StatelZLP Le��n/,��7a-`� B�.uincss Phonc 3�'�V�-70¢! Name on PermiVATC if D1Jjere�t.hen Above Mailing Address � !:ity/StatdZi _ PROPERTY INFORI�9ATI�N •]Date Ho�;e/Facility Corners Flagged '��e7�`� NOTE: A survey p��t o�site plap mt.st accomjra.ay this eppliution. lncluded:0 Site Plan CPlat(to scale) (Pernut is valid f�r 60 monihs wit3�sitq p18n,n0 exp�itltioR W��compJete plat.) Owner's Name �s►/✓,.✓ !Y)�/A�✓r/tOC./�_ ___ __ ,_Phone Number Owner'sAddress��y G.�nrr�ii��eM lo�rQ /� - City/State/Zip cd7,3(��________ Property Address G e-��B . � r„iry L t�'r 5 r�.l— Lot Size � /�C� Tax PIId1f O � � Subdivision Name(if applicablel Scation/LotN DirccdonsToSite_ .1. rn.l�,s, ra,.. Ca�n T� A�vyel �ed [�lns5 b r�4� 4'c, U F l.:11 L..o i s o,.� 1? tcc,r�ER AifaW�� If the an�wer to any o�the follo�winli q�iest�oas is'yes",supporiing docutneeu�tion must be attached. Are there any existiag wasrev:ater aysKms on the site? OYcs G3�Qo Aoes thc aite conpin f�risdic;ional wetlands? ❑Yes[�340 pre there aqy eaeanents or ri�,hGof-ways on lhe sitel OYcs 6ido • Is tlu site subjeet�a approval by�.00ther public agency? i.tYcs 8'�to , Wili wastcwata othci than dnmcstic acnvagc bc gc�ratcd? �Yrs @l�o IF RESIDENC�FILL OUT TFiE BOX BELOW #People #Bcdi��oms �_ t�Batturoomr Gatden'�'ub/Whirlpool es �JNo • Basemcnt:OYcs �io B:uc1xt�nt�lumbing� l7Yes D?Co _ IF NON-RESXllENCE FILL 01J'�T�IE B�X BELOW Type of Faciliry/Bosiness _ _ ____ Total Square Foo age oFBu;lding,�, h Peoplc _ #Sinks #Commodes #Showers „_ �l Urinals Fstimated Water Usage(galions p�:r day) (httaeh doeromentation ofs'rmi4at tac�lity water consumption) , FOODSERVICE ONLY: #Seats,.�a Iype system requesced:.pC�on�e��ional QAccepted Ulqnovative OAhrrnacive ftOther_ watu Svppfy7ype:1]Counry:Ciry V1'atet �ew Well �Exfsting Well ❑Communiry Well �• ` Ao you aaricipate a�tdition}oc expxm.�ns uCthc lacility tLis systen►is intnLied to serve".O Yes ty.i�o If yes,what t�%pe7 �_, _ � This is to eertify that the inforts+atiun provided on thin nppl;cation is true aMl conect to the best uf my koowledge_ [underst�nd that aay perrai�(s)oc ATC(s)iasued herul�er ere subject to�uspension oc revoauio»If the site is altered,the inteaded use d�anges,ot if thc informatian submitted in thi�spplir,allon is falsified or ehanged. I herel:y grant right of cntty to thc Authorized Rsp�e�entaci�e oi die Davit County Hcrlth Depernneat ro conduct neceas�ry inapections�a determine compiiance with applicabie laws a�id rula. I undustand that I aa+cesponsible fot�he proper identificadon and labeling of property llnes and cumers and loating a�d flaggiz�g or staking the hou�d�auliry locakiou,��roposeJ well�ocotioa azYd the}ocatica af trry ottter amenities. _�-1��— . Site Revisit Chacge �tOp�Jtiy owMtf'S(K OaTeT 6 aC$i)fe/f�E�on�tiv�Sj,gqatUR �8tt(S�: ,�'�� _ Cl'unt Notification Date: D,t� EHS:— Sign given QYes ONo Account k Jtevised t I/06 Itivoiee�{ Ror . l2� 20D7y 4�06PM�p� :. :� :�:>l�d :�arc� N�.5679 tp� 3� of t • : � •SFS�dUUUpVVYt'1 l�:)�. p t9CCLAMRUC y, CALVira q • � MC..CI.AMIi(�IC G.Ai:v2N F! 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Aor •12 � 2007a� 4:O1PM No.5679 p��1 1 uf 2 � , � � ' • � Davie Coanty Online GlS PKi�t Page � • . �: ,4 � •_� .. , -- , � .:�+•.��'•' 'd'� , � , �.r�r.l. • T ��:, • ��,;': '..:,:.,'::�:�ia11-.. , � . _, �, ':� .. v . ��� � _ .��...�----. -- , �o� Ff � ��..�,.,..,,. (,�u 1 t���� ���� I� ��D� 9 . .... ��-��� , ;i:..: . . . . . , _. . . � :;, � " ..,. . ... ♦ . Y� ..' • • � .. � .... e � .�t.� . y � .. � 'i�r:7�:trb�-r�m r�. .'.G�, ;y,e•� t$tr.'c t.�I:i� � �'i' � ' "'t"`wARNTNCi:7'HIS IS NOT n SURVfiY! Date:4/12/20�7 Rec i � i s�+* Parce� " umDer 50000000701 7t►is ma�is prepaxed lur the inventoty of rcai piN p,roperty found withi�t ihis jurtsdiction,a�td is Number 840183349 cvmpiled trom recordec!deed.,plats,and otlacs ccourn 000egaa35oo public records ancl data. Use..o)'this��ap are Number hercby nocilicd that thc aforemtntioned publ(c 'S�ed MCCIAMROCK CALVIN B primary infurnlatioa sourcex�hould be�onsulted ertt� for verif►cation ofthe infom�ation contained�» ��s�ea wne�tt2 dais map.The County as�ume�nc,Icga! Mailing 324 CUNNINGHqM LOOP ROAD responsibitity for ihe info�matio►t contained on this ddress� � Mailin t��� � ddress 2 it HOMASVII.IE Stdte NC 1 Code 7361 Lega� ODO AC ANG6LL RD DesUi fion crea e 89 • �eed Date �9950501 eed BOok 01800679 and Pa e lat Book Plat Ps e gu�tding 0 awe " utbuiiQin nd Extra Features alue and V01ue 83d0 t�ttp://maps.co.davie.nc.us/�vebsite/mapviewer/parce�print.ht�m 4t�2/2007 Rvr .12 . 2007 4�07PM No.5679 : P� 6 , � . c . . „ . ' i . ; S��e �.a;yout Form t . tl . ; � � � l ����fl w�e � f � �,e �f . ! ��J fi� �� �. � vjP ya j � I , � i d� � x �. 0 Nv� � � , . ; i S e ;�C ; � ' � . 1 � , i°' 21� � � �c� ' � a � ► (L���s �o�f f�N G� �� . �•U M�1eS rt"U �ta rs (�� PLE11�`���[.:;�1BEL�;4LL ITEM� � j� 1. 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APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004324 Tax PIN/EH#: 5840-18-3349 Billed To: Oakwood Homes Subdivision Info: Reference Name: Location/Address: Angell Rd.-27028 � Proposed Facility: Residence Property Size: 2 acres Date Evaluated: '� � � �i'► ;S j � , � Water Su ply: On-Site Well � Communit Public � Y Evaluation By: Auger Boring � Pit �r Cut ' , ' FACTORS 1 2 3 4 5 6 7 � Landsca e sition - � L L j,_, 1... Slope% � �� � �� HORIZON I DEPTH .- c� C.�^-- �+ .- Z �'� (Q � � 1'� r�- 1 Z -Z,; Texture grou ��. �'� C ,� < � c� � � c Consistence � �(?. � •� ` � �3p Structure � Q� st3t� 5'�,�� Mineralo _ „ f�?�t, S�c S�C. ' HORIZON II DEPTH 1 ' - e �O r- 12--�ld Z� ' � •,a� Texture rou � �C� �L t _(� - - t �..t., �-�C..-}� +Syo Consistence -_ , r_: r- �s� structure _ � S�S1< �3tc Mineralo �.. ►,n,1 �l V�.'��c4r1� -� �V� HORIZON III DEPTH � '3 � Texture rou ' S.��cu ~ �s� � Consisfence ,,� s� Structure � C. S Mineralo s��: HORIZON IV DEPTH - Texture rou � Consistence Structure • Mineralo � � � SOIL WETNESS ' - -- ��] RESTRICTIVE HORIZON � �xo -- �ry . SAPROLITE r- v U CLASSIFICATION 'l! J S �S LONG=TERM ACCEPTANCE RATE • a ,a-�- v.2'7� �'•� SITE CLASSIFICATION: � -/ EVALUATION BY: �C'�f'`�`1'a� LONG-TERM ACCEPTANCE RATE: D��� OTHER(S)PRESENT: REMARKS: � � LEGEND i.andscatie Position R-Ridge S=Shoulder L-Lineaz slope FS -Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope T�11Cg 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 " C.ONSISTF.NCE ' a'Ifl1S� VFR-Very friable FR-Friable FI-Firm VFI-Very�rm 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 &trus�urg SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic � ca MineraloQv - �� 1:1,2:1,Mixed �^' � � n / Q Horizon depth-In inches � � I � W Depth of fill-In inches � � Restrictive horizon-Thickness and inches from land surface � 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����������������������������������������������������������������������������������� ������������������������������������������������������������������������������������ ������������������������������������������������������������������������������������ ������������������������������������������������������������������������������������ ������������������������������������������������������������������������������������ ������������������������������������������������������������������������������������ ������������������������������������������������������������������������������������ ����������������������������������������� ����������������������������������������� ����������������������������������������������������������������������������������� ������������������������������������������������������������������������������������ ������������������������������������������������������������������������������������ ������������������������������������������������������������������������������������ ������������������������������������������������������������������������������������ ■��■■�����■�■■■■��■�■���■■��■�■�����■■���s�■�■■�■���■�■�■��■�������■■�■�■�■as�■�■■■■ ■■■���■���■■■���■���■��■��■��■��■�■���■■��■������■���■��■��■��■■��■��■���■����■■�■�■ ■�■��■�■■■��■�■����■■���■�■�■��■���■�■��■ ■�����■■■�����■�■�■���■■��■�����■�����■�■ ■��■�■������■�■�■��■�■�■�����■���■■■����■�■■■���■���■■�■�����■�■��■���■e■�t��■■��■■ . . � ' Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990004324 Tax PIN/EH #: 5840-18-3349 Billed To: Oakwood Homes Subdivision Info: Address: 828 Piedmont Drive Location/Address: Angell Rd.-27028 City: Lexington Property Size: 2 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. • �< Pernut Type: , ew ❑Repair ❑Expansion Pernut Valid for: ❑5 Years�o Expiration Residential Specifications: #Bedrooms-� #Bathrooms Z #People 3 Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): �D Type of Water Supply: �County/City�ell ❑Community Well Site Modifications/Pernut Conditions: S stem T e LTAR Initial ' / L . 2S Re air tij ,22. Si e Plan �J l 6.�7 P/� . Lr G � � � �-.CjJ ) r� � �� � � � � � � r � � � � . ��' ys�' � Environmental Health Specialist � u � Date ^ �c� �� i.p.l 1-06