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303 Cardinal Hill Ln (2) �--'-`•�' DAVIE COUNTY ENVIRONMENTAL HEALTH � P.O.Box 848/210 Hospital Street Mocksville,NC 27028 � � (336)753-6780/Fax#(336)753-1680 . OPERATiO1�T PERMiT Account �: 990001729 . . '�ax PIf�E.%EH#: 1800000002 � BiEl�;�To: Cliff&Renae Tkach Suf��ivisio�i l�fo: • . Refer�r�ce P�am�: , <. LocationiAddr�ss: Livengood Road-2Z006 :, Propc�sed F��ilify: Residence _�; :. :-, , . .Pro�eriy�S�iz�: 11.011 Acres �- .� , . . ; ` , .:,_ , , . , rr: t,T�*����'�'Tne�iss�uance of this Operation Permit'shall uidicate the sysfem 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 S�_ Tank Date J/[/ Tank Size �va� � Pump Tank Size NIF� Bedrooms: 3 rT System Installed By: �C.Y�I� CI'�'I{S Installer# � Date:—��/�/' GPS Coordinate: �k���C A.Qi�- , D'��' sT , . �► � �� . � � � '�f �� 12� J T6<j �' t \� �°�. • (`I Environmental Health Specialist Date: � � . DCHD 11/06(Revised) , , , . . 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 Accau�t #: 990001729 . :: '��x.Pl�:'EH#: 1800000002 , �iflc�!To: Cliff&Renae Tkach _., :: � SuE��ivisioii lnf�: . , . , Referer�ee Nanie: . . .:�.LocationiAddress: Livengood Road-27006 : _ . , .. Pro�as�ci Faci€ity: Residence , . , . . ; , •P�op�rty�8ix�: 11.011 Acres ,. . . �TC N�mber: 5970 , �,,;: 7�� _ Site Type:.�iew ORepair OExpansion **NOTE**This Authorization to Construct(ATC)MLJST 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 FNE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. " � � � Residential Spec�cations: #Bedrooms �J #Bathrooms 2 #People �J Basement0 Basement plumbing❑ Non-Residential Specitications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) � Lot Size�_ Type of Water Supply: ❑County/City ❑Well ❑Community Well � • System Specifications: Design Wastewater Flow(GPD)�U Tank Size��v GAT,.Pump Tank / GAL. Trench Width�[cZ Max.Trench Depth �� Rock Depth�//� Linear Ft.�o�� Site Modifications/Conditions/Other: ���U�.T�00 . Contact the Davie County Environmental Health Section for fnal inspection of this system between 8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760. � . �s• � �t ��q�� � - �/� r `�� I � � ' � � �� I ' . � �� � � � �. . . � + r �'r � + .� + T .! \S' � . .:r... . . , . _ . . . . � � . � . . . � . .,.y:;:�� . . " . . � . � � . .�_.. '�.. . . � ��� � . � . . . .L� f' Environmental Health Specialist Da :_ � ���/� , r�rur� i i m�ruP�,;�P�� � , , ` ` Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT Account #: 990001729 Tax PIN/�H#: 1800000002 Billed To: Cliff& Renae Tkach Subdivision Info: Address 181 Livengood Road Location/Address: Livengood Road-27006 City: Advance Property Size: 11.011 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: �1ew ❑Repair ❑Expansion Permif Valid for: fd5 Years ❑No Expiration Residential Specifications: #Bedrooms�_#Bathrooms 2 #People 3 Basement� Basement plumbing❑ Non-Residential Spec�cations: Facility Type � #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):�C� Type of Water Supply: C�1County/City ❑Well ❑Community Well Site Modifications/Permit Conditions: " S stem T e LTAR Initial �, �o . 3 Re air o R � . Site Plan L/� loc.� '2 L �,-�:t��� 't '+ � ' r. � . I � � � �� I ( ' l. �. !�w`�'`'�� �,�,. . � Environmental Health Specialist • Date � Dl i.p.l 1-06 , , . . ��,�-��� -Gl��= h�:c����=1Jlce , , ,. . ' � � � b -�l��re: � � . �� - e- - APPLICATION FQR SITE EVALUATION/IMPROVEMENT PERMIT & ATC ' Davie County Environmental Health a v P.O.Box 848/210 Hospital Street � ' ''� Mocksville,NC 27028 . �I E C E 1 V (336)753-6780/Fax(336)753-1680 �I -tL'' � $(Z3 �I� Appl' or4�I�k: Ql�it���lu Improvement Permit AuthorizationTo Construct(ATC) ❑ Both - ,y Type A plication: ONew S m ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT***TH mA PLICATION CANNOTBEPROCESSED UNLESS ALL OF TH�REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION - Name �L f 't-f '� /��jy��t,G r�Q(� Contact Person �j�� T� �/, a-�-� Address I S� �--i V Home Phone 9 - ?7 � City/State/ZIP�d v�, _�, �J� ��o D � Business Phone ,S"/ - �g$� G Sj2 � SZ-i G l� Name on Permit/ATC if Different than Above ��� . Mailing Address City/State/Zip . �=,PROPERTY INFORMATION *Date House/Facilit Corners Fla ed 7"�-�Z- .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 expiratiori with complete plat.) � Owner's Name �C a� 5. � Q.� � Phone Number9�l�j�` /7 7 Owner's Address L_�v !2 City/State/Zip ,2 7v(�G 0� Property Address v��e, City � � \� Lot Size 30 X�{� O i Tax PIN# � b ' 0�2� �A� Subdivision Name(if ap licable Section/Lot# / Directions o Site: ���l9-S-� ON d /��iX �/ `��2/Yll�5 �90�� 0/J ��'h7 � P:�: . Ifthe answer to any of the following questions is•"Yes",supporting documentation must be attached: , Are there any existing wastewater systems on the site? Yes ✓No Does the site contain jurisdictional wetlands? Yes �/No Are there any easeinents or right-of-ways on the site? Yes ✓No Is the site subject to approval by another public agency? Yes: /y�No � Will wastewater other than domestic sewage be generated? � Yes ✓No • IF RESIDENCE FILL OUT THE BOX B �OW y�1.� `�'�Z����L �o'bil�-��7�° , #People #Bedrooms �� #B throoms Garden Tub/Whirlpool @-Y-cS�No Basement: es ❑No Basement Plu ing: q ' s ONo IF NON-RESIDENCE ILL O THE BOX BELOW Type of FacilityBusiness r Total Square Footage of Building I 2�0 #People O #Sinks �i #Comm #Showers_L_ #Urinals_�_ Estimated Water Usage(g ons pe ay) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY. #Seats T stem requested: onventional ❑Accepted ❑Innovative OAlternative- �Other Water Supply Type:2�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 loc ing and flagging or st 'ng the house/facility location,proposed well location and the location of any other amenities. � Site Revisit Charge Property owne s or owner's legal representative signature Date(s): . ���� � Client Notification Date: �� Date EHS: I Q Sign given �Yes ❑No Account# ��Z / Revised 11/06 Invoice# _� Cb� ���'��� P����� �2�i , , , . , , � ,�. , � DAVIE COUNTY HEALTH DEPARTMENT � � � • Environmental Health Section Soil/Site Evaluation � APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001729 Tax PIN/EH#: 1800000002-Barn Billed To: Cliff& Renae Tkach Subdivision Infa Reference Name: Location/Address: Livengood Road-27 Proposed Faciliry: Barn/Future Residence Property Size: 54.75 Acres Date Evaluated: �Z Water Supply: On-Site Well Community Public r Evaluation By: Auger Boring_ J� Pit Cut FACTORS 1 2 3 4 5 6 7 � Landsca e sition L Slo e% _ D°/O °a �a __ , HORIZON I DEPTH �— . � - Texture rou Consistence � (L ' Structure Mineralo �l : _ _ - HORIZON II DEPTH Texture rou Consistence Structure Mineralo :/ HORIZON III DEPTH Texture rou Consistence ; Structure Mineralo , HORIZON IV DEPTH ' • Texture rou � . Consistence Structure � Mineralo , SOIL WETNESS RESTRICTIVE HORIZON - SAPROLITE - CLASSIFICATION S S LONG-TERM ACCEPTANCE RATE , _ SITE CLASSIFICATION: �� EVALUATION BY: O� LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: 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 _. , Text�e 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 N�iSt , VFR-Very friable FR-Friable FT-Firm VFI-Very firm EFI-Extremely firm �'e.� � 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-Granulaz ABK-Angular blocky SBK-Subangular blocky PL-Platy ' PR-Prismatic Mineralo¢v 1:1,2:1,Mixed lYQtes _ � 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-gaUday/ft2 , DCHD OS/OS(Revised) ■�■���■����■��■��■������■�■■��■■■�■���■�■�e�■�■��■���s■■�■�■�■���■ ■�����■���■o�■■�■�.�■���■■���■���as■�■�■e■�■�■�������■■�■■■�����■ ■��■��■��■�■■�■sso■■■�■����■■�■■ ■■e■���■��■����■■��oo��o�������■ ■■�■■�������■�■�■es��■�■�������v�■�■��■�o��■�����■�■■■o�����o�■��■ ■�■��■�����■■�■■■�■■�■�■■��■■�■�■■�■�■■��a�o�■�����■■��������■�■■■ ■a■��■��■ss■�■■e��e■����■�■�o■v■■■��■�■���s�■■����■■■��■�■��■�■��■ 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' ond Is intended solely Jor the use ojCusrom Dam ProcessfnB.Inc.and the recipient(s)named a6ove.IfYou are not the recipient,or the employee oiagent responsible for dr�ivering this message to the tntended ieclpient,you ore . � . � � here6y naN/ied that ony review,disseminotian,distrf6uNon,prinlfng or<opying oJthls emall messog<ond/or any atrochments is strictly prahi6ited.If you have recetved thls tronsm/sslon(n erroq pleose notiJy the sender fmmedlotety - � . at800�888-6035andpermonenNydelerethisemnilondanyattachments � � . � ._.. .. ._.__.... _..___ _._ ._. __._._ ._._... ._..... . .__ ._. _... .._.___. .._. _____ .._.- _____ .____. .._ ...__.. ._...... .__.. _ .. _.. .. . From:Tracie Lakey[mailto:Tracie.Lakey@co.davie.nc.us] Sent:Tuesday,August 21,2012 12:41 PM To:Chris)ackson Ce:Bonnie Lanier � Subject:yoo hoo...iYs me again � How do you delete a property? Bonnie entered a property twice. So there is a duplicate entry. 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I . ! . ._...:;1 ' '" ,.... . , � . , � ,>'=oGJ❑ .,.�.� �� , __^... . _�_..__. _�._ ,_ � >�c['�❑ ��.:. _ � .. ;� r . ,� >> ._, . . . �.._ . ._. �� � � _. _ n . , . : � ... � 1.. ` _ � �,,� �-._.. �_ .._, �.� .,�� c_, __. � .. _ +, . ._ v .. . _ --� - - __ _..____ . ._ ,_ .. _ _ _ _ . _ _ ___ __ __ . -- .. . _ � Dane � � � , . r'�Trusted sites . � *�100 J • � � � S �'r.��'7"`'. J F?��`�. �'...fY= y`� 'w',� ._, *7; � ""� R►'� �' er , , "..��� ,9 fr-�.:x s: .(f ;:..,,+. � ,J. q �_.�IY�: � Tracie N.Lakey,REHS Environmental Health Supervisor Davie County Health Department P.O.Box 848 210 Hospital Street Mocksville,NC 27028 Phone:336-753-6780 Fax:336-753-1680 � . Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized S(ale offcial.Unaut�orizeC distlosure of juvenile,health,le9ally pmileged,or � otherwise con�dential inlormation,including confitlential information relating to an ongoing State procurement eNort,is prohiDited by law.If you have received this e-mail in error,please notify the sender immetliarely and tlelete all � records ot this e-malL � � . � � �w �- � . . . . . '$/2172012 GoMAPS - Davie County NC Public Access � l �\. � WATERSHED STRUCTURES I . � � t �, ' . ; WATER_BODIES � �r x�' � �, � COUN71(_BOUNDARY � .,� :^ ' ' STREETS �'� RAILROAD CENTERLINE .: . t;. ,. �.. ' .. ' . �'r � � '`�i -...�::-_...__._ h3-4�� — __�� ��_ �� � PARCELS . ��`,*-r._ CRUI•9P ITRL� �" -' I? CITY_LiMiTS � � `~ . � 5��:�„�,�3 1. ' �U1 g f-. � ��� I �, � BERtdUDA RUN � '� �; � C�OLEEMEE P PD r��• � 4 +� i_ �,' � DAYIECOUNTY Y .�::a 1 t�'' . � .MUCKSVILLE 1 ` r � . a����� • ,` nccountics _� ¢ � }`, /,+r� � � �� ' ,{ f . �. t �AYIE .. --C� '+�ver`+�t.��axYdi�py 3 � � � . . . . . .. . . 6 � j � H � � r `�. . <ail othe��alues> � � � � �. ��� � � � � + � � .ry � � I � � 1�► ' � fI � r '� �'�� �.,�„�„��;��.'f � � + :- � � �' �" . �a {� � � . i r �j � � ; ._ . �� ,` � � � . , . 6� `.'- -�.z�.:.:s,,. '.,- ... _�_ A . . .. . . j� � � j Monday,July 9 2012 � �ox� q-��a���«�b �l �� � ; , �_�y � --,__r-1YER5 rr,,�N�_ 0�'G3�it TR�- ***WARNING:TH1S IS NOT A SURVEY!*** This map is prepared for the inventory of real property found within this jurisdiction,and is compiled from recorded ' deeds,plats,and other public records and data.Users of this map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on this map.The County and mapping company assume no legal responsibility for the information contained on this map. . _ . , � . + '� / . . . . . ' . , . , • r ) 1" � a "� � - . ! , � � � ., .. . •/ !, � a'a� . . � �s° s � s w N"`'-� . �