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2152 Davie Academy RdAccount #: 990003949 Billed To: Michael Moran Reference Name: 'roposed Facilitv: Residence ATC Number: 4415 DAVIE COUNTY HEALTH DEPARTMENT f.oV „_Q � O' Environmental Health Section h�r P. O. Boa 848/Z10 Hospital Street � Mceksville, NC 27028 (33G)751-87G0 Tax PIN/EH #: 5780-33-7935 Subdivision Info: Location/Address: Davie Academy Road-27028 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** T'his Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to , the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: �`'i�t�} // Date: �1�.� i'� CERTIFICATE OF COMPLETION � � **NOTE* e issuance of this Certificate of Completion shall indicate the system described on ImprovemendOperation Permit 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. �;�.k,,� ���,,1 ��Y�B �� Q v�e�� s�-� �-�'� C.��> Septic System Insta ed By: _ Environmental Health Specialist's Signature : DCHD OS/99 (Revised) r � ! 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 #: 990003949 Billed To: Michael Moran Reference Name: Proposed Facility: Residence ATC Number: 4415 Tax PIN/EH #: 5780-33-7935 Subdivision Info: Location/Address: Davie Academy Road-27028 Property Size: 35 acres Site Type: �Tew ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MiJST 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 Z# People 2 Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size ��E Type of Water Supply: ❑County/City �11 ❑Community Well System Specifications: Design Wastewater Flow (GPD) ��Tank Size /�AL. Pump Tank GAL. Trench Width -J''io� � Max. Trench Depth ��� Rock Depth� Linear Ft. �3�� � Site Modifications/Conditions/Other: ��� �/:+_ ����=°3'���� . �!�����- C)-� C._sa: �`% Contact the Davie County Envifonmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the da of installation. Tele hone # 336 75 760. 7���� �� �- �-- `�' ����','� �� . � Ma�S� � 0 Environmental Health Specialist DCHD 11/06 (Revised) � ic �1Vlv ._s�,.. ��.�tY Date: �-�I�I I �� 02/14/2007 17:A7 FA� 3362t342675 � � r� r 7�9-.y��Y�"�t�,#'�A�'�'c "1 i �y � � � � 4: �' !�. i...i.vrrEl �!� �� -r._ 1+ .q� m�r o.m� � M�rhn�l Mnran Rc� .� . � JOCRSY BILLING OFFIcE MORA1V/SMOOT f+s �. 7AR't . . ' - � Si� .. . " .'� . . . 't�� �F _ , -' .. , , . • a� � -I� �: . - � . .. . . , .:� .: .... .... .. . .. _ - - . .... . . : ....... ........ . . . :. . �. .. .- . . . . . .:: �; :�.,�.:::� . .. . . ... : �...��+� - ... . . ..,�. . . ....:.. . _. . . . . � : � Nti;Q�. � �. ��;�� °:::.�=..;�:,�.�: � . . .. . . - : �.:_. � .. :�d��� �:: �� �� ... - � � � .. . . . . . .,.::: r,`� ., ..� .; �...`.� ::r�` .. . . . 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" - � �. } �' ' � ' . ..�.. . ,�r�Q ��rr�xv�ar��,9 p:�►��=�y .r:s.�-fa�°,l�r :�:a�a : :�fi�:,:w,�..;:`r�e��.:� . ... �. . . � ... . :: . .. . :.�..: ..: . �. � ,.... ... . . � �: i,;re; : c�o� t J : .�.:��o�,abl�y�:.°<g�� : .�:';: °� c;c.e:`:��;� -}-a . .. rJ�R �� �a;l �i����s;:.. . .. :.. .. . : . . . . Linda M. Pegram Appraisals r�Aoz�oo2 ; 3� z/ ���-�� ,1�, � � _..v � �. / , �-;, . �, �� � � _i '�� �. ��5 _.__---� / . _ , , ._ � , _ _ �.f , ._- ' � � � � l , , ` � J ______� �� • .,--�`" � `. / .._. � , - �. �,. , _ r--.r_-.__._ - � ,;�-� / . � ��1,t •,� �\ �_ _ � i r� ` .\ �------.�j ' �_�% l.� �•,` ,� �--f` /�.,.,-- � _,,,..r-_'-._ __ � �`\ �'•\ /_ , `\ '"� - '` yl f, /�.. �� � /1 ` \�, , `\�� � ���` \ `\ /„�/ \�i \�\ `.!��..�J `�/V .\�� ' ``�� ✓ t !� � �` ...-•�-��.,1 '�.. /`f.���` , '��� /`. � '�t ��� ,_ ` _�- �h' 1 , � � \ _ ` ' -, . J�/i�"`� /�� - "-- ____ %�J� �'...-� �'/�� � ' -.���.,��.�......._�_"_.�-„ _._' , _.__ �� �?) r � , `� � � �� 1 ' ; � r � �j� .�. /�-""�� ,���' 2��'v = � s _ J �� DAVIE COUNTY HEALTH DEPARTMENT '' Environmental Health Section .� ,; P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (33G)75]-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003949 Billed To: Michael Moran Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5780-33-7935 Subdivision Info: Location/Address: Property Size: �e V � �p-S Davie Academy Road-27028 35 acres **NOTE�* This Impro4emeiit/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SIT'E PLANS OR THE INTENDED USE CHANGE. YOUR ��W� WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLIN�G� S��� Residential Specification: Building Type � #People �_ #Bedrooms "#Baths _� — ���� Dishwasher: � Garbage Disposal: ❑ Washing MachineX� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification Lot Size �� Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Type Water Supply � Design Wastewater Flow (GPD) �L,% Site: New ❑ Repair ❑ r System Specifications: Tank Size� GAL. Pump Tank GAL. Trench Width� Rock Depth���Linear F Other: /�� accep;eu 5ysterns �nay aiso be uso Required Site Modifications/Conditions: 11�9PROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6" BELOW FINISHED CRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (33()751-87G0.**** Environmental Health Specialist's Signature: ` Date: �/ DCHD OS/99 (Revised) � l���d 1� k�. a� �� ����e � o,�FOR SITE EVALUATION/IMPROVEMENT PERMIT & AT O Davie County Health Department / � Environmental Health Section �" U S� 1 Q w y U y 1 P.O. Box 848/210 Hospital Street I ��1 ��e- -�Uc U, Mocksville, NC 27028 ,� ` � (336)751-8760/ Fax (3 )751-8786 �� � Z2'o� ` :ion/Improvement Pernut Authorization To Construct(ATC) ❑ Both , fJ'l ZZ �� **�iVIPORTAN7*** 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 � j� Q�� �, �(`q /� Contact Person %�'i � c�Ue � �i� ��J � r� Billing Address 1$ y' � kr + i� Home Phone 3 3 6.. � y� -- � �s6 .� City/State/ZIP �cKS v� II � NC c�7 E� c��; Business Phone � 3G- a8 �/' c3�Sy�/ A�ay l�.'at�K� �cr5 "L:c'c+—/, Name on PertnitlATC if Different than Above Mailing Address City/State/Zip _ __ PROPERTY INFORMATION NOTE: A survey plat or site plan must accompany this application. (Pernut is valid for 60 mont�}s with site plan, no expiration with om lete plat.) Street Address_ ��. ; � � �I.o � � City :. , . Q � ;� ( Tax P1N# Jr7a �- � ,-S' - %� � �' Subdivision Name Ij 'L� ;��� '�,�l�,�t#�,� �;��t rc� Lot Size Directions To Site: �i��nf -F / t�.►; /v � �n n »A�G� _- 65 / ) i r.1_��1 !�n i� �: c ��, ��,. /%.1 ie�� �i - Date House/Facility Camers �'lagged ��-02/-0 (D 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 �No Does the site contain jurisdictional wetlands? �Yes C�7No Are there any easements or right-of-ways on the site? ❑Yes C�'No Is the site subject to approval by another public agency? ❑Yes a2�to Will wastewater other than domestic sewage be generated? ❑Yes Q.pdo IF RESIDENCE FILL OUT THE BOX BELOW �/'d!o �/ `� # People o1 # Bedrooms # Bathrooms _ Basement: ❑Yes �To Basement Plumbing: ❑Yes ❑No IF NON-RESIDENCE FILL OUT THE BOX BELOW Garden Tub/Whirlpool ❑Yes �No 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:�Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: 0 County/City Water �II New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? Tlus is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any pernut(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 understand that 1 am responsible for all charges incurred from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to dete �ne com,�liance with applicable laws and rules on the above described property located in Davie County and owned by .J�„n.� ,S �', �yi V1 C,*--� -l-%22g'/ �i"�d�" � __�_ - Property owner's or owner's legal representative signature �/� 0/�� Date � Sign given ,�Yes ❑No Revised 2/06 � �Il.�`ll-� .-�/��4 ��e �Zev�sif Site Revisit Charge Date(s): Client Notification Date: EHS: .,� Account # C��1��_ � � Invoice # ��4"Ll � � ���. ��m APPLICANT INFORMATION Account #: 990003949 Billed To: Michael Moran Reference Name: Proposed Facility: Residence Water Supply: Evaluation Rv� HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group ^---'-•---- DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil / Site Evaluation RO R IN RM I Tax PIN/EH #: 5780-33-7935 Subdivision Info: Location/Address: Davie Academy Road-270 Property Size: 35 acres Date Evaluated: ���� � On-Site Well � Community Aueer BorinQ_ _ _ _ Pit ...,.,�,a..,sy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE Public SITE CLASSIFICATION: � EVALUATION BY: t(/ ��/ LONG-TERM ACCEPTANCE RATE: , OTHER(S) PRESENT: REMARKS: LEGEND T,�ndscaFe Position R- Ridge S- Shoulder L- Lineaz slope FS - Foot slope N- Nose slope CC - Concave slope CV - Convex slope T- Tenace 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 .ONSIST �.N . �'I41S� VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFT - Extremely firm � 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 - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogv 1:1, 2:1, Mixed lY9Sr� Horizon depth - In inches Depth of fill - In inches Restrictive horizon - T'hickness 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 OS/OS (Revised) ■�■������1�■���■��■■■■�■■■■�■■���■��■����������■■���■�■■■■■■■�■■�■■■ ■�■�■■����1�■■�■■■��■�■����■���■■ ■■�■■■■■■�■■■������■■�■■■�■�■■■■ ■��■��■�■�1��■■■��■��������■����■��■��■�■■�I���■�■■�■■�■■�������■�■ ■����■■■■il�■�■■■������■���■��■��■■■■■�w■■��11�■■■■����■��■����■�■�■ ■■����■�■����■�������■�■���■■�■■■■�■■�■■�s■■�������■�������■�■�����■ ■■�■����■����■�■�■�����■���■�■���■■■�s�■�■■����■■�■■��■�■■������■��■ 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Box 848/210 Hospital Street Mocksville, NC 27028 ' ' (336) 751-8760/ Fax (336) 751-8786 May 16, 2006 Mr. Michael Moran 184 Kennen Krest Road Mocksville, NC 27028 Re: Davie Academy Road Tax Pin #: 5708-33-7935 Dear Mr. Moran, As requested, a representative from this office visited the above site May 15, 2006, to perform a site evaluation. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. 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 or the intended use change. Improvement Permit System To Serve:---�'� t''� Wastewater Design Flow:�� �� System Type: ❑Conventional ccepted ❑Innovative ❑Alternative ❑Other ._..._ .._.._.. System Location: ������' ,/�C�C�c.." Valid: q,�Years ONo Expiration Site Modifications/Permit Conditions: rivironme tal Health Specialist ps-i.p.letter 2/06 s� Date --.� .. . -. . I �' �f ���� %/ �� U �b,� �I �� Q�7i2 ( . �'% p}� �,� .?�- �--i _ _ _ . 1 � �� � r ., n� / , , --�'' �`�,�--- ��� � �` �'l_-- , - --.. ._. _ _ _.. --..----�-_.. _�_ / _.__.. ____ . _ __. _._ _. _. __.__----_ - --.��/- � � . = „-�" --'�_-- � J ��,_ � i . �c� — ; �� . � ) i � /�\ � ,� �,f� C� � � � _._. a� � . . - ��/��-C�i _r z � � ������c��n � m