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940 Greenhill RdATC Number: 4774 **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. S.T. Manufacturer �� u System Type: � � Tank Date Tank Size L C n Pump Tank Size 1 lI I ( c') System Installed By: -t\ r �) (I r4 6 E.H. Specialist: A)11 Y: clbat, J, 3 1 —7 DCHD 11/06 (Revised) Z i " DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street f Mocksville, NC 27028 �z (336)751-8760 Fax # (336)751-8786 ( �) Ui � � OPERATION PERMIT 1 Account #: 990002517 Tax PIN/EH #: 5727-38-6006 f Billed To: Clayton Mobile Homes Subdivision Info: t G Reference Name: Jennifer Stiller and Linda Dean Location/Address: Greenhill Road -27028 Proposed Facility: Residence Property Size: 3.64 acres < <' ATC Number: 4774 **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. S.T. Manufacturer �� u System Type: � � Tank Date Tank Size L C n Pump Tank Size 1 lI I ( c') System Installed By: -t\ r �) (I r4 6 E.H. Specialist: A)11 Y: clbat, J, 3 1 —7 DCHD 11/06 (Revised) Z i " 4 Ui � � s 4 s L 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 #: 990002517 Tax PIN/EH #: 5727-38-6006 Billed To: Clayton Mobile Homes Reference Name: Jennifer Stiller and Linda Dean Proposed Facility: Residence ATC Number: 4774 Subdivision Info: Location/Address: Greenhill Road -27028 Property Size: 3.64 acres Site Type: M4ew ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Sectior�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 I # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size 1�, Le 4 ar,e,< `) Type of Water Supply: LK;ounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD)3 (cc Tank Size I,Occ.+ GAL. Pump Tank Coo GAL. It Trench Width 34 �� Max. Trench Depth 3L `� Rock Depth . i d Linear Ft. 5 3 3 As stated in 15A NCAC 18A.19re)(5) Site Modifications/Conditions/Other: ,ncce tR ed Systems may clsr.> ;`Fl 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. 16 q'5 fi i Ll 1 v L' ec'e-ti Environmental Health Specialist DCHD 11/06 (Revised) 063 ' \ y ./ / \ t �� G r*� � It Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990002517 Tax PIN/EH #: 5727-38-6006 Billed To: Clayton Mobile Homes Subdivision Info: Address: 1026 Northside Drive Location/Address: Greenhill Road -27028 City: Statesville Property Size: 3.64 acres Reference Name: Jennifer Stiller and Linda Dean 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: if1ew ❑Repair ❑Expansion Permit Valid for: C�Years ❑No Expiration Residential Specifications: # Bedrooms 3 # Bathrooms .1 # People 3 Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD): 3 Lo Type of Water Supply: County/City DWell ❑ Community Well As stated in 15A NCAC 18A.1969(5) Site Modifications/Permit Conditions: nceepted Systems rnav --j-f) 1 -V;1�" ....�''1 I�PL�ICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 pplicatik a uation/Improvement Permit Authorization To Construct(ATC) ❑ Both ype o cation: New 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 Chq4z,, 4AOrn, S it -1a Contact Person —Abp en a, AbPlL Billing Address hlo r -*-,S i de Z)r. . Home Phone L4Q,9 - a0 &moi' City/State/ZIP &j2fes, Me,, NG a R10 i. ->S Business Phoneme Name on Permit/ATC if Different than Above Mailing Address Q40 `1 retnhil l 13,o 070 PROPERTY INFORMATION *Date House/Facility Corners Flagged 10112-167 NOTE: A survey plat or site plan must accompany this application. Included: 2 Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name: nni r ir,cic2_�) P 0n Phone Number Owner's Address City/State/Zip IV�I-,c ks i kk e , IyL' �) '7 0 De Property Address ❑ Y-0 ocryti t 1 —Pd City M c- i<S v.11 c, Lot Size T. & Tax PIN# Subdivision Name(if applicable) Section/Lot# Directions To Site: _(r 4 In L or-, 1 r ec,, Kik ( —Rd. -Ek-6 940 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 ONo Does the site contain jurisdictional wetlands? ❑Yes MNo Are there any easements or right-of-ways on the site? AYes ❑No Is the site subject to approval by another public agency? []Yes 9 N Will wastewater other than domestic sewage be generated? ❑Yes KNo IF .RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms 13 # Bathrooms -Q— Garden Tub/Whirlpool ❑Yes XNo Basement: ❑Yes ANo Basement Plumbing: ❑Yes ,XNo IF NON -RESIDENCE 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:. ❑Conventional 'Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: 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 WNo 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 the hou�ciliV location, proposed well location and the location of any other amenities. a �U14 41 �-� VC/� Site Revisit Charge froperty owner's or owner's legal representative signature - , o�QU CliDate(s): A"), a Client Notification Date: Date EHS: Sign given []Yes ❑No Account # Revised 11/06 Invoice # R � � W http://maps.co.davic.nc.us/output/gomaps_DCGISWEB212429523 895.png 10/3/2007 GoMAPS - Davie County NC Public Access Davie County, NC - GIS/Mapping System Page 1 of 1 qP--Vt Click Here To Start Over Quick Search: (County ID c - Map p Use M Tips tris ' Active Layer. MIJA:0 ® PARCELS (Map Tips Available) �� Jap Layers ( Results i http://maps. co.davie.nc. usIGoMapslmap/Index.cfm?maimnapservice=gomaps&CFID=41... 10/16/2007 ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLIA NT INFORMATION unt #: 990002517 Tax PIN/EH #: 572T-38=PERTY INFORMATION Billed To: Clayton Mobile Homes Subdivision Info: Reference Name: Location/Address: Greenhill Road -27028 Proposed Facility: Residence Property Size: 3.64 acres Date Evaluated: Water Supply: On -Site Well V Evaluation By: Auger Boring Community Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L (� Slope % a 2 Z HORIZON I DEPTH - $ - -hG D -!.( 0_1% Texture group C_ C,�- G C_ C_ .- Consistence IVP Uf:rV P - .I/ TT I Structure e IsAkC 5-6 k S Mineralogy k {� _ 1< -f-Q! HORIZON II DEPTH t -- D - IA - -a-o Texture group Consistence e e Structure t- -b A0 4 Mineralogylc HORIZON III DEPTH D Texture group Consistence Structure Mineralogyu HORIZON IV DEPTH Texture group1/ Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE l CLASSIFICATION LIV6 LONG-TERM ACCEPTANCE RATE •3-15 0-1-15- A2 — SITE CLASSIFICATION: l�� c �o 10 LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND EVALUATION BY- OTHER(S) PRESENT: 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 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 Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineral= 1:1, 2:1, Mixed 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 lReviredl