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4529 Hwy 64W (2) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account #: 990004233 Tax PIN/EH #: 4797-58-2998 Billed To: Jonathan &Michelle Coone Subdivision Info: Reference Name: Location/Address: 4529 US HWY 64 West-27028 Proposed Facility: Residence Property Size: 2 Acres ATC Number: 4599 **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 C Tank Date '� Tank Size �'vvv System Type: Pump Tank Size , ek- System Installed B . E.H. S at Y Y l� NN 3t DCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 ' o^ AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION . c Account #: 990004233 Tax PIN/EH#: 4797-58-2998 Billed To: Jonathan &Michelle Coone Subdivision Info: Reference Name: Location/Address: 4529 US HWY 64 West-27028 Proposed Facility: Residence Property Size: 2 Acres ATC Number: 4599 Site Type: ❑New ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST 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_ #People4- Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size 'D,GtC/'CS Type of Water Supply: ❑County/City X11 ❑Community Well System Specifications: Design Wastewater Flow(GPD)�%O Tank Size /_6Q6 GAL.Pump Tank GAL. Trench Width 3(nMax.Tren h De th Rock Depth l�- Linear Ft.� s stated in 5A 4'?'A.19f3(� Site Modifications/Conditions/Other: accepted System may also be use 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. �G /33 Y3' . 13}l•3 15 1 Me Environmental Health Specialist Date: DCHD 11/06(Revised) Davie County Environmental Health P.O.Box MUM Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account M 990004233 Tax PIN/EH#: 4797-58-2998 Billed To: Jonathan & Michelle Coone Subdivision Info: Address: PO Box 91 Location/Address: 4529 US HWY 64 West-27028 City: Stony Point Property Size: 2 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: N<ew ❑Repair ❑Expansion Permit Valid for: L�Years ❑No Expiration Residential Specifications: #Bedrooms _ #Bathrooms ' - #People 4 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 aWell ❑Community Well Site Modifications/Permit Conditions: System Type LTAR Initial C C- -t-c ca O-3 Repair y t G 3 Site Plan il a 40 a.� Environmental Health Specialist Date i.p.l l-06 r.. - Awn ON ITE EVALUATION/IMPROVEMENT PERMIT & ATC avie County Environmental Health / /0 J& � P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751=8760/Fax(336)751-8786 Applic tion L ith uation/Improvement Permit VAuthorization To Construct(ATC) Goth Type of pplicatio - New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPO TANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION /1 Name to be Billed Sona.-than e .;1A i('1'le 11( COt)n� Contact Person Billing Address C'/I ' Home Phone 704-53-5- q I�R City/State/ZIPf --g-Business Phone eel t -X04 9r7Z- 3170 Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged 2 - 5 - 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 expiration with complete plat.) Owner's Name ITa Me5 1Y)i ChZe 1 s I_ ft u Roof rs Phone Number 7D 4 54 L- 7 Z Owner's Address 4S2R US l 4WI4 k- V✓ City/State/Zip Mee ✓i I Fe 00 P70,97 Property Address--- City Lot Size ((,b[�tt-� (IC re 5 Tax PIN# L179. 75g-zy9 Subdivision Name(if applicable) Sect' n/Lot#. 1 Directions To Site: (-1{ V\( -in -T14()W -// r� '� OISr�YLn�S 4X Ick/;t �A -thin rhl nfL, V-7-- 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 Rigo Does the site contain jurisdictional wetlands? ❑Yes RNo Are there any easements or right-of-ways on the site? ❑Yes ©No Is the site subject to approval by another public agency? ❑Yes f9f4o Will wastewater other than domestic sewage be generated? ❑Yes BNo IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms L #Bathrooms Garden Tub/Whirlpool es ❑No Basement: ❑Yes Milo Basement Plumbing: ❑Yes W16 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 DAccepted ❑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?.❑ Yes (I10 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 comers and locating and flagging or staking the house/facility location,proposed well location and the location of any other amenities. �ffltCL d�Q Site Revisit Charge Property owner's or owner's legal representative signature Date(s): Client Notification Date: Date EHS: Sign given. ❑Yes ❑No Account# _ Revised 11/06 Invoice# Z7 G � r Y �. � q .•1 'iA4 F.. AT. -� !QST frT /��. :9' ❑ .1. �- � ry, . D'�` 35) r I � 22 S ❑ 219 �» 2236 e0 �;. _ • V it 998 TTT 2 - ` al WA 1 5t A S .a, � .Y .i?I'k }� Y �Y�k' 9 �• � I :elj h . qy ry (509 T - db6z '', {�o use F �arewks �= -- -- �- bU �( � '� � _� - - -- (5 . 05A) co 2998 2 9 �► CeB2 v (509) o 0 0 (53) N N 100 I 3cr ShG Q PaoPo5 5G ( o`xX-S" wA vel S1� - fa DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004233 Tax PIN/EH#: 4797-58-2998 Billed To: Jonathan &Michelle Coone Subdivision Info: Reference Name: Location/Address: 4529 US HWY 64 West-27028 Proposed Facility: Residence Property Size: 2 Acres Date Evaluated: - 10 77, V Water Supply: On-Site Well / Community Public Evaluation By: Auger Boring ✓ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position LL G L L�- Slope% - [ I - JC,(- HORIZON I DEPTH 6 _ _ Texture group 5 5 L Consistence Of Loo Structure Mineralogy In 1 t 1 1 '[ HORIZON H DEPTH - Texture group L . S' L `G Consistence Structure Mineralogy t [; HORIZON lII DEPTH 9-�( Texture group S;4L Consistence P ; Structure Mineralogy , HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 51, / LONG-TERM ACCEPTANCE RATE ©/•/3 O`. a, SITE CLASSIFICATION: �`� ✓(-� EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: A'C to 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 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 CONSISTENCE Moist VFR-Very friable FR-Friable' FI Firm VFI-Very firm EFI-Extremely firm .3'et 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 Mineralogy 1:1,2:1,Mixed 1!Iotes 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 05105(Revised) Parcel#: J100000012 Page 1 of 1 Davie County, NC - Basic Estate Search C,oU�1A. Davie County Web Site Basic Search Real Estate Search Tax Bill Search Sales Search View Prooertv Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel#:J100000012 Account#:62364000 Owner Information Tax Codes ROGERS JAMES MICHAEL&ROGERS BETTY GAIL ADVLTAX-COUNTY T 529 US HIGHWAY 64 WEST READVLTAX-FIRE TAX OCKSVILLE NC 27028 Property Information Townshl nd(Units/Type): 1.500 AC CALAHALN ddress:4529 W US HWY 64 Deed Information Local Zoning Pate: 03/1973 Book: 00089 Page: 0171 Plat Book: 0009 Page: 107 Legal Description PIN LOT 1 1.500AC ROGERS S D 4797582998 Property Values Building: 43,07 BXF: 901 Land: 24,1201 Market: 67,2801 Assessed: 67,2801 eferred: 01 Sales Information No. Book Page Month Year Instrument Qual/UnQual Improved Price 00089 0171 03 1973 WD Unqualified Improved 0 View Property Record for this Parcel View Mao for this Parcel View Tax Bill Information « Return to Basic Search All information on this site Is prepared for the inventory of real property found within Davie County. All data is compiled from recorded deeds, plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be consulted for verification of the information. All Information contained herein was created for the Davie County's Internal use. Davie County, its employees and agents make no warranty as to the correctness or accuracy of the information set forth on this site whether express or Implied, in fact or In law, Including without limitation the implied warranties of merchantability and fitness for a particular use. If you have any questions about the data displayed on this website please contact the Davie County Tax Office at(336) 753-6120. 1.5.9 http://maps.daviecountync.gov/itsnet/View.aspx?prid=1464561 7/6/2016