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125 Cattle Way (2)DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753: 6780 / Fax # (336)753-1680 OPERATION PERMIT Account #: 990005845 T�x �'ii�I.%EN #: 5757-64-0405 Bifle� To: William & Cylyndia Smith Su�itii�i�ian ir���: .. ,, Re:�er�E�ce N�ni�: � LacatianrAd����ss: Cattle Way-27028 f�ro�c�sQi� F��:iEity: Residential �, ��o��riy�S�ix.�:: 4.016 Acres a�TC Number: 5938 **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. i ,� / ? �� System Type: ''� ` S.T. Manufacturer ��'� Tank Date ✓ r� Tank Size F Q� d Pump Tank Size Bedrooms: � c56 Lt—S System Installed By: � ,(..tr� Installer# Date: �"" i�— ��— GPS Coordinate: �� � ._ X ��h Environmental Health Specialist DCHD 11/06 (Revised) Date: U � � � �•� w � � �-��-�----1� ., • J 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 Accr�ur�t #: 990005845 . "i�x F�I�€fEH #: 5757-64-0405 BiElc� TQ: William & Cylyndia Smith .'�� Su��i�i: iort Ir���: . R�fer�r�ce N��ie: :� LacalianiAd+�E��s�: Cattle Way-27028 Propc�ssc9 F;�c:iiity: Residential � Pfc��er#y �iz�: 4.016 Acres a'�i'C N�ar�tbe�: 5938 , Site Type: C�ew ❑Repair ❑Expansion **NOTE** This Authorization to Consh-uct (ATC) MiJST 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 plumbing0 Non-Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Lot Size y� f Type of Water Supply: ❑County/City ,�Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) ��Tank Size IbDO GAL. Pump Tank � GAL. �i /r . Trench Width �_ Max. Trench Depth�(� Rock Depth� Linear Ft. �{�c��/� 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. \���,,�1� � ' � s� Q? ���/ r- � � � ��`C� �` � � � ��� � � ���; � Environmental Health Specialist ' � Date: Tlruri 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 Account #: 990005845 Billed To: William & Cylyndia Smith Address: 420 Frank Short Road City: Mocksville IMPROVEMENT PERMIT Tax PIN/EH #: Subdivision Info: Location/Address: Property Size: 5757-64-0405 Cattle Way-27028 4.016 Acres Reference Name: Propq��,��i�t,,ycj.,hR T�mpeovement 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: 6�,New ❑Repair ❑Expansion Permit Valid for: �45 Years ❑No Expiration 1` Residential Specifications: # Bedrooms � # Bathrooms Z/'Z: # People Basement� Basement plumbing� Non-Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):�� Type of Water Supply: ❑ County/City �Well `❑ Community Well Site Modifications/Permit Conditions: Environmental Health Specialist i.p.l 1-06 w.. _ i I � • ' � . APPLICATIO OR SITE EVALUATION/IMPROVEMEI�IT PERMIT & ATC � � � � � � Davie County Environmental Health P.O. Box 848/210 Hospital Street APR 0 4 2012 Mocksville, Nc Z�o2s (336)753-6780/ Fax (336)753-1680 BY: - Application For: ❑ Site Evaluation/Improvement Permit ❑ Authorization To Construct (ATC) ❑ Both y Type of Application: � System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Naine �U i( � 1Cwv� 3 C ` d,' S,-E Contact Person �; l\�aw. 5 w«-�k Address Z� rck�� 1�c,,r� 1�, Home Phone �3'3(0� qq& -iSZ (p City/State/ZIP /hoc..ks'.,; \�e /�f �, 2�02$ Business Phone C33(o� `t8Z ,, 3(09 S' Name on PermidATC if Different than Above. Mailing Address YKUY�KI Y 1NrUK1V1Al1UN �llate House/N'acilrty Corners N'la ed NOTE: A survey plat or site plan must accoinpany this application. Included: ite Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan; no expiratiori with complete plat.) Owner's Name wi \�c.�v�n � ; � Phone Number Owner's Address L�Zd �rcwtl�. �11��l� �2 �, City/State/Zip_(1/�aL\CS v� ll e/v.�. Property Address .(1��.�1 e t,� ,o��, City (�,��Sv ��� e Lot Size y, b 14 �t Tax PIN# 5 � 5� C� UDUD 5" Subdivision Name(if applicable) Section/Lot#< Directions To Site: 1'7��,,,,16� H2�. �e-�� o� ..,4"►.�� SL���- 12.�t�+ o K cafl,-l�e �� 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 �e� �,poes the site contain jurisdictional wetlands? �Yes ,.�e— Are there�any easements or right-of-ways on the site? Ycs �' Isthe site subje�t to approval by another public ager.cy? Yes .�o Will wastewater other than domestic sewage be generated? Yes t,Akf' IF RESIDENCE FILL OUT THE BOX BE�OW # People �( # Bedrooms � � # Bathrooms ZYz Garden Tub/Whirlpool �❑No Basement•.—C `es �No Basement Plumbing: � �No l�,;�e,�. l S:„��- IF NON-R�SIDENCE 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: onventional �Accepted ❑Innovative ❑Alternative- ❑Other Water Supply Type: ❑ County/City Water ew Well ❑Existing Well ❑ Community Well _ _ _.. _ Do you anticipate additions or expansions of the facility this system is intended to serve? � ❑ No If yes, what type? � p${a. � ca� :��o�.� �-�cs, �Q� � S� vt1� ( 5�4-e� 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 rul s. I understand that I a respo ' or the proper identification and labeling of property lines and corners and locat� ' g Qr stakin se/f 'lity tion, proposed well location and the location of any other amenities. Property owner's or own r's legal re s tive sig e Site Revisit Charge Date(s): /Z Client Notification Date: Da e EHS: Sign given ❑Yes ❑No Revised 11/06 Account # � 1� 7� Invoice # � 4i� ����I2 �d- �fi�� GoMAPS - Davie County NC Public Access � ***WARNING: THIS IS NOT A SURVEY!*** This map is prepared for the inventory of reaI 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. � WATERSHED STRUCTURES WATER_BODIES � C�UNTY_BOUNDARY STFtEETS �' RAtLROAD_CENTERLINE � PARCELS CfTY_LIMITS � BER6!UDA RUN � COOLEEhSEE � DAVIE COUNTY ah40CK5VILLE • nccountics DAVIE � <all other values> Monday, Apri�2012 � � •".� _.,�°��- i ��,1 , ..�:.,.� � ' L. JONES 97, PG 143 5757649313 ntw IRON IRON � C3 WILLIAM K. SMITH D. B. 212 PG. 588 PIN # 5757640405 - c; � . .�.—� tTIE� CATfLE WAY �.,...�..... -... �...�..�.R �� AREA= 4.016 AC. TO BE RECOMBINED W.tTH �405 � � - � � ,, ' '� � Y� � � wEw 67.69 ��N N 83'p8�46' F--- EI�ITFa r..- �.-- �'� �� l� CONTROL CORNER EXISTING IRON � � � j � v .� � 1 • � � ti�°�;"° KEITH L. JONES ^�' S��°� D.B. 197 PG. 143 PIN #.5757649313 NE}y IRON . CONTROL • CORNER HVI Fled for registi Plat Book Filing fee � paid KEITH L. JONES D. B. 384, PC 104 PIN # 5757646592 CATTLE WAY •EXISTING 30' EA$EMENT SEE D.B. 384, pG. 104 � NOTES: 1. TOTAL TRAC 2. TOTAL AG.= 3. NO NCGS C 4.TOBEAR t � . , • . .. -�. . , � .,_> DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section , ,,� Soil / Site Evaluation 'APPLICANT INFORMATION � PROPERTY INFORMATION Account #: 990005845 Billed To: William & Cylyndia Smith Reference Name: Proposed Facility: Residential a Property Size Tax PIN/EH #: 5757-64-0405 � Subdivision Info: Location/Address: Cattle Way-2702 / ,��/ 4.016 Acres Date Evaluated: � ! �.�°�` �` Water Supply: On-Site Well '�v'� Community Evaluation By: Auger Boring ' i.� Pit � FACTORS 1 2 3 ` Slope % �HORIZON I DEPTH Texture group Consistence $itUCiUIC Mineralogy � HORIZON II DEPTH 2 4 ,� Public Cut 5 6 7 ��`°�'t� �"�' y.� � � k,�. "e',��,.;' °,7s{ �`�- `:r;:' rzf';� , , �.,. : �. }'` :r 7.fti � � � . .� � �f'^ �',�. �. ,. ,..��� rF � �:` ��1;.. } . . �� ��,.:�5 rf ��, W 6 -� �i,�'� �'4.'�Ru. �� � _.^y • �,�„�.a Consislein�e v"1 H�`� �'r �;.�=a a{ p f j, , d Structure t.i^.i«<r�I �,.> �"i° -� .* r, a;~; f`� r z tr+�"�.i7r..' :���`� - Mineralo � ► . � ' ` � - " ` � HORIZON III DEPTH - Texture rou � Consistence Structure Mineralo HORIZON IV DEPTH i Texture rou Consistence � Structure - , "�,- " Mineralo SOIL WETNESS RESTRICTIVE HORIZON � SAPROLITE CLASSIFICATION •,''.S� S �' :Y � LONG-TERM ACCEPTANCE RATE f . 5 . 2 . SITE CLASSIFICATION: � EVALUATION BY: ��'."!�'a"�•��c�',{� ���-,/'� LONG-TERM ACCEPTANCE RATE: •� OTHER(S) PRESENT: � REMARKS: LEGEND �.�ndsca,pe 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 T�xturg 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 ONSIST ,N . �415� 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 Structurg SC - Single grain M- Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic MineraloQv 1:1, 2:1, Mixed IYQ�e& 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) ■■��■�■��■■���■■■■�■■■■■■�■■■■■■��■■�■■■■■■��■��■■�■■��■■■■�■�■■■■ ■■����■������■■��■■■�■�■■��■�■�■��■�■■■■■■■����■■■�������■■■�■■�■ 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