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150 Down Yonder Trail,�'�cc�u�t �: 990001211 Biiied i"o; Randy Grubb Refer�E�c� Nan�e: f�ropossd F�s�ifity: Residence �TC t�uEnb+�r. 4980 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT �"�x �€�i.%�N #: 5736-74-7837 �U�?i�IVISEUtl �f3�q: Lacationi.�cidr�:�ss: Down Yo �nder Trail-27028 Pro�erty Six.e: 6 Acres **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 fo � y given period of � q rime. � � � � d System Type: �� S.T. Manufacturer� �� Tank Date � Tank Size� � Pump Tank Size ,-a `�`.-�. � �� - z� - U � System Installed By: �,(.l,K,s�"" � E.H. Specialist: Date: 7 �� O V DCHD 11/06 (Revised) 0 0 ' , Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 '�-'��. (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT � Account #: 990001211 Billed To: Randy Grubb Address: 130 Kent Lane City: Mocksville Tax PIN/EH #: Subdivision Info: Location/Address: Property Size: �!. 5736-74-7837 Down Yo �nder Trail-27028 6 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 Pemut Valid for: Years ❑No Expiration Residential Specifications: # Bedroomsy� # Bathrooms �# People J Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Desigx Flow(GPD): ��D� Type of Water Supply: �County/City OWell ❑Community Well �s staied in 15A f�{;�C 1gA.1�°(5� Site Modifications/Pernut Conditions: __ _ __ _;�nr��thd Cy�GtnmS m��a��,� Initial Plan � �� E��ro�ntal Health Specialist —"'--I i.p. ] 1-06 � R'C� a� r � �c�a — l ��,,� . �s _ 5 `� 5!:r 5��, LTAR Q' � �ST�Ny �` � �w"� � / r �o ��tiJ I 1 1 �6u� �� , � `-� Go � a�� .,_ 1`'c� �/�� S �. /J � _ � , `� �.10 .,�"�. . Date � " 3Q "— � � � DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-878G AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION t'�cc��a�t #: 990001211 '��x F'i[�iEH #: 5736-74-7837 Billed i"ca: Randy Grubb �u��iivisEor� irifa: f�ef�er�r�c�; N�r3�e: Lac�tionir�ddr��ss: Down ;�pn�� Trail-27028 k�ropc�s�;ci Fac�lity: Residence i�ro�e�y Siz�: 6 Acres �i'C �lutnber: 4980 Site Type: ❑New ❑Repair ❑Expansion **NOTE** This Autharization to Construct (ATC) MCJST 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 l�.P T e of Water Su 1 oun /Ci OWell ❑Communi Well �.� � YP PP Y� tY tY tY System Specifications: Design Wastewater Flow (GPD) �_X.p�I'ank Size��CiAL. Pump Tank �ryT/� "AL. , G► Trench Width � Max. Trench Depth� � Rock Depth� Linear Ft. ��= ` �rs staied in 15A NC{`fC 18i�.1�6�(5) Site Modifications/Conditions/Other: �CCept��d 5ystcros rn�y alsc, bL t!s^r9 Contact the Davie County Environmental Health Section for fnal inspection of this system between 8:30 - 9:30a.m. on the dav of installation. Telephone #(336)751-8760. � � / i �� Environmental Health Specialist� DCHD 11/06 (Revised) �� r Q� � � �� / �� ( �� '�� d % � � �—�C7� C�-�� ry �� \� � O � �4 � S �CG� e � �\ � ��/ � Date: �- �� ti � � . ,.~ . _.. � � � �� . . �APP,IS`'i,(.;�T�O1�OR� E EVALUATION/IMPROVEMENT PERMIT & ATC ' `' � avie County Environmental Health ��, �y � 9 2009 `' P.O. Box 848/210 Hospital Street ' ' Mocksville, NC 27028 ✓�_-r,��E��``rHCA �;(336)751-8760/ Fax (336)751-8786 � ��'lr.•�� ''Ty r-- E�f�� '��'IE�GO/U, "� � Application For: it va1�E uation/Improvement Permit ❑ Authorization To Construct(ATC) QBoth Type of pplication: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTAN7*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for inshuctions. APPLICANT INFORMATION Name to be Billed r/� Contact Person O� Billing Address Home Phone --� - %� City/State/ZIP� � �� _ �Z Business Phone ?3� f�fo —%�`�/� Name on PermitlATC if Different than Above Mailing Address YKVYr,Kl Y llVt'VK1VlAl1V1V ^`liate riouse/racilitv (:orners NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Pernut is valid for 60 months}�'ith site lan, nP expiration with complete plat.) Owner's Name _�JS'c�-i ��.-c / r_ �i:.cT-� �- Phone Number Owner's Address /�CJ r,�J� �,i., �,/�,ve,�v %, City/State/Zip ` Property Address City Lot Size — Tax PIN# �'j3 (�i %�f7��`7 Subdivision Name(if applicable) Section/Lot# Directions To Site: If the answer to any of the following questions is "yes", supporting documentatio must be attached. Are there any existing wastewater systems on the site? ❑Yes C�o Does the site contain jurisdictional wetlands? ❑Yes dNo Are there any easements pr right-of-ways on the site? ❑Yes C� Is the site subject to approval by another public agency? ❑Yes dNo Will wastewater other than domestic sewage be generated? ❑Yes C'�o IF RESIDENC FILL OUT THE BOX BELOW # People # Bedrooms 3 # Bathrooms Basement: ❑Yes �vo Basement Plumbing: ❑Yes E�'l�To IF NON-RESIDENCE FILL OUT THE BOX BELOW Garden Tub/Whirlpool ❑Yes � Type of FacilityBusiness 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 systemrequested: C9'Conventional �Accepted ❑Innovative �Alternative OOther Water SupplyType: C�"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 Ci'No 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 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 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 st�' the house/facility 1 'on, praposed well location and the location of any other amenities. Site Revisit Charge Property owner's or owner's legal representative signature S - f �-a� Date � Sign given ❑Yes ❑No Revised 11/06 Date(s): Client Notification Date: EHS: Account # �� Invoice # (��% r -, r • C--��l s,�� /`� ., GoI�iAPS - Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping System P � t �`+' ..�="� � m-a�],, Q$'° '� Click Here Ta Start Ouer ,. , � � ��, Quick Se�r�cF�:(Caunt}r ID or Ot�aner M� '�`~° Active La}rer. ❑� Us� f*!ap Tps �� , �' � PARCELS (Map Tips Availablej �� tddre http://maps. co.davie.nc.us/GoMaps/map/Index.cfm?mainmapservice=gomaps&CFID=412... 5/ 19/2009 ' '� . • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil / Site Evaluation APPLICANT INFORMATION Account #: 990001211 Billed To: Randy Grubb Reference Name: Proposed Facility: Residence PROPERTY INFORMATION Tax PIN/EH #: 5736-74-7837 Subdivision Info: Location/Address: Down Younder Trail-27028 Property Size: 6 Acres Date Evaluated: '� `�/ � Water Supply: On-Site Well Community Evaluation By: Auger Boring_,�� Pit FACTORS 1 2 3 % I DEPTH f �'r — 2� I�— Consistence � � r{ ; � � .� -� Structure r'p,�—�� HORIZON II DEPTH I�1 �-�('� I"1 I� — Consistence Structure HORIZON III DEPTH Texture gmup Consistence Structure HORIZON IV DEPTH Texture group Consistence Structure SOIL WETNESS RESTRICTIVE HORIZON CLASSIFICATION LONG-TERM ACCEPTANCE RATE 4 Public � Cut 5 6 7 � � SITE CLASSIFICATION: �_- / EVALUATION BY: �/1 �%U/ /'] �.. LONG-TERM ACCEPTANCE RATE: v•� a 5 �'�- OTHER(S) PRESENT: ` REMARKS: �l a'�'c LEGEND T.andscane 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 TCXS�r� 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'ONSIST .N . . �'IQ1S� VFR - Very friable FR - Friable FI - Firm VFT - Very firm EFI - Extremely firm �'e1� 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 biocky PL - Platy PR - Prismatic Mineralo�v 1:1, 2:1, Mixed Notes Horizon depth - In inches ' Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprotite - 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) TTAR - T.nnv-tPrm acrPntanrP ratP _ aal/�ia��/ft� r�nTTn nc�nc in___:__�� ■��■��■■ ■■��■��■ ■■��■�■■■ ■��■��■��■■ ■��■■��l1�■■ ■�■��■�■�i�■■ ■■��■�■�i�■■ ■��i��■ ■��■��i��■ ■�■��■��i�■■ ■��■��■ ■�■��■��■ ■■��■■��■��;��■ ■■��■■ ■■��■��i��►�■ ■��■■�� ■��■��■��► ■�■��A�■��■ ■■ ■■ ■■ ■■ ■ w�■��■��■ ■ ■i�■��r:��:��,r�►� ■ �■��:�■��na�►v,■ ■��■��r,��u:��■ ■��■��=��■ ��'��:•�� ■�v■ ■�■■ ■■�■ ■��■ ■��■ ■��■ ■■�■ ■■�■ ■��■ ■��■ ■��■ ■■�■ ■�■■ ■��■ ■■■■ ■ ■�■■■ ■��■ ■�■�■ ----- �---- ■��■■ ■��■ ■ i ■��1\��■ �� ■��■c��■��■ ■��■ ■��■��■�■��a�i��■�■��■ ■��■��►��■��■ ■��■��■►�c��■�■ ■��■■��.�a��■ ■��■�■■��■c��■��■��■ ■��■��■■��■ a■��■■■��n��■ ��■�■■��■��■��■ ��u��►��■��■ ■��n•a�■��►��■ ■ ■��■��■ ■��■■ ■�■►��■■ ■��■ ■��►��■ ►��■��■ ■►��■ ■�►��■ ■�■��■ ■��■ ■��■_��■■ �■■��■ ■��■ e��■��■ ■��■��■ ■��■ ■�■��■ ■��■�■ ■��■��■ ■��■ ■��■ ■�■��■ � ■��■��■■ ■��■ ■��■�■��■�■ ■■��■■ ■�■��■��■ ■��■�■ ■��■��■ ■��■��■�■ ■��■��■ ■�■�■�■��■ ■■■�■��■ ■��■ ■��■ ■��■��■ ■��■��■ ■��■��■ ■■ ��■ ■ ■ ■ ■ ■