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510 Calahaln Rd DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account #: 990003705 Tax PIN/EH#: 5709-59-0573 Billed To: David Anderson Subdivision Info: Reference Name: Location/Address: 510 Calahaln Road-27028 Proposed Facility: Strawberry Farm Property Size: 7.91 Acres ATC Number: 4943 **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. V`y� 22 © J System Type: S.T.Manufacturer Tank Date Gl�J Tank S' e Pump Tank Size - 9 System Installed By: E.H.Specialist: Dater w 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 a AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990003705 Tax PIN/EH#: 5709-59-0573 Billed To: David Anderson Subdivision Info: Reference Name: Location/Address: 510 Calahaln Road-27028 Proposed Facility: Strawberry Farm Property Size: 7.91 Acres ATC Number: 4943 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. Residential Specifications: #Bedrooms #Bathrooms #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type "11 #People #Seats Square Footage(or Dimensions of Facility) f(u S Lot Size —7. a.c A-•-5 Type of Water Supply: 26ounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD)_JLJ� Tank Size 1,600'AL.Pump Tank GAL. Trench Width 3[vr Max.Trench Depth 3 b C. Rock Depth Linear Ft. . Site Modifications/ConAs stated In 15A "CAC 18A.1969(5) ditions/Other: =C4Pt9d � _ 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. �l tbky 00 Environmental Health Specialist Date: DCHD 11/06(Revised) . 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 M 990003705 Tax PIN/EH M 5709-59-0573 Billed To: David Anderson Subdivision Info: Address: 510 Calahaln Road Location/Address: 510 Calahaln Road-27028 City: Mocksville Property Size: 7.91 Acres Reference Name: Proposed Facility: Strawberry Farm **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: 4NeW ❑Repair ❑Expansion Permit Valid for: 5 Years ❑No Expiration Residential Specifications: #Bedrooms #Bathrooms #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type 4d r` #People #Seats Square Footage(or Dimensions of Facility) L ( (p Design Flow(GPD): (a v Type of Water Supply: (County/City ❑Well ❑Community Well. Site ModiAs stated In 15A NCAC 18A.1908(5) v` fications/Permit Conditions: Asa raDtad SW fam-tray-"l;ti, System Type LTAR 1t Initial Repair .3 Site Plan Environmental Health Specialist i.p.l l-06 L� i��I�v�h GUd uld like 70 �E IC�AA�HI SITE EVALUATION/IMPROVEMENT PERMIT & ATC QDavie County Environmental Health 2009 P.O.Box 848/210 Hospital Street �pN 2 Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 1RONbhEN1 Fl Ilk A lication My:�ISSf • ion/Improvement Permit ❑ Authorization To Construct(ATC) L7 Both T e of ion: [(}iVew System ❑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 r U'��/ �f?i�!'��'�`si'h Contact Person f 1,4 y Billing Address S%C+ (�_/�-�r/h i�tZ Home Phone. C _- City/State/ZIP 1` ��/t/ ,,. tiiL L 7 c Z Business Phone ��l(/ - 7- ///,o Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged 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 plan,no expiration with complete plat.) Owner's Name9- Phone Number Owner's Address City/State/Zip Property Address l C &I Irl J)t! l7 city Lot Size_ 17 I I f1& Tax PIN# 57()q- 674i- Q! 73 Subdivision Name(if applicable) Section/Lot# Directions To Site: �lo C-4. f If the answer to any of the following questions is"yes",supporting docume tation must be attached. Are there any existing wastewater systems on the site? G7 es ❑N Does the site contain jurisdictional wetlands? ❑Yes CYN00 Are there any easements or right-of-ways on the site? ❑Yes li1No Is the site subject to approval by another public agency? ❑Yes ❑No Will wastewater other than domestic sewage be generated? ❑Yes ❑No IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms #Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes ❑No Basement Plumbing: ❑Yes []No IF NON-RESIDENCE FILL OUT T1-JE BOX BELOW Type of FacilitylBusine it,` -' ; OMTotal Square Footage of Building /rG #People #Sinks #Commodes Of"t#Showers #Urinals Estimated Water Usage(gallons per day) ,�'y (Attach documentation of similar facility water"consumption) FOODSERVICE ONLY: Seats Type system requested a'C:onventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: Q'County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 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 aking the house/facility location,proposed well location and the location of any other amenities. 7r Site Revisit Charge roperty owne 's or owner's legal representative signature Date(s): Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# Revised 11/06 Invoice# _f GoMAPS -Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping System Click Here To Start Over quick Search:(County ID or Owner Ni Out Active Layer. Use r�fa,Q Tres® ❑ PARCELS(Map Tips Available) sw': M. Addre BECK DAVID PAUL "A -VICTORY-LN- --- 510 � I 1 I I I I I 0156f ✓ I http://maps.co.davie.nc.us/GoMaps/map)qndex.cfm?maimnapservice=gomaps&CFID=412... 1/21/2009 GoMAPS -Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping System gym, Click Here To Start Over Quick Search:(County ID or Owner Ni Oltz _ r Active Layer. ❑UseRfap 7-lps Eq 10 PARCELS(Map Tips Available) w Addre I LANIER KENNETH A " G200000009 (391) (196)- - 46.62 AC CALAHA FD 3 cv w a at a .d La Ln v ! 351,-jy'\ 1 � / Qa (48I} I I � d w w 1 IM � ti r 472.x--- -^'— 486,E Or SO4 543 \ + \ ro' �y 510' r J � I ✓lgb �y� 0 15611 http://maps.co.davie.nc.us/GoMaps/map/Index.cfm?maimnapservice=gomaps&CFID=412... 1/21/2009 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003705 Tax PIN/EH#: 5709-59-0573 Billed To: David Anderson Subdivision Info: Reference Name: Location/Address: 510 Calahaln Road-27028 G Proposed Facility: Strawberry Farm Property Size: 7.91 Acres Date Evaluated: Water Supply: On-Site Well Community Public / Evaluation By: Auger Boring �� Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Q 'O Texture group Consistence �y Structure �C Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy 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 O SITE CLASSIFICATION: �� EVALUATION BY: LAA d.'t-�_ LONG-TERM ACCEPTANCE RATE: �' 3 OTHERS)PRESENT:,V 1 Q t-)�a A%AJfCV—_ .4W_ ue 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 NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic S>tructurg 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 05/05 (Revised)