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1523 Hwy 801SDAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Account #: 990004406 Billed To: Buck Horn Construction Reference Name: Ronald Triplett Proposed Facility: Residence ATC Number: 4728 Tax PIN/EH #: 5870-96-9405 Subdivision Info: 157,3 Location/Address: NC Highway 801 S.-27006 Property Size: 6.66 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 for any given period of time. System Type: S.T. Manufacturer liGr Tank Date [ (& Tank Sizek e d Oa Pump Tank S v 3 System Installed By:J - A'44 L45,1.4 E.H. Specialist. Date. DCHD 11/06 (Revised) 9d,(S • . • 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 M 990004406 Billed To: Buck Horn Construction Reference Name: Ronald Triplett Proposed Facility: Residence ATC Number: 4728 Tax PIN/EH M 5870-96-9405 Subdivision Info: Location/Address: NC Highway 801 S.-27006 Property Size: 6.66 acres Site Type: Xew ❑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 PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. . Residential Specifications: # Bedrooms a # Bathrooms_). # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size i,�y Type of Water Supply:. Cy'C;ounty/City ❑Well ❑CommunityWell System Specifications: Design Wastewater Flow (GPD) �� Tank Size ft9©UAL. Pump Tank Trench Width ale Max. Trench Depth a Ll Rock Depth .1 'a Linear Ft. Site Modifications/Conditions/Other:Aic stated in 15A NC4C 18A.1969(5) Y_' no •�vi l41 c�K Systems may �>y ea p e ti 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. ? `m k5 7� ✓� Ivo sv> tau K ct'o F rlov� 100 �r„f' G't�+1 fin..✓ ell IN ,51 o `'�° ,4n.-- Environmental Health Specialist �� Date: 7 Q " DCHD 11/06 (Revised) 07l APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street 66 Mocksville, NC 27028 (336)751=8760/ Fax (336)751-8786 SIV ei� , Application For —wife Evaluation/Improvement Permit u orization To Construct(ATC) Aoth Type of Application: ❑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 d� l/t/��/� (_ x/1'151 �Clv` ContactPerson Does the site contain jurisdictional wetlands? Billing Address (,o �I Home Phone � (d 9 q Y 3 3 City/State/ZIP Lp v,/b✓,1/r IVC— -170-4-3 Business Phone 336, 6, J&.- OSY- ❑Yes ❑No Name on Permit/ATC if Different than Above /ZO A a l u J r We—(4 Mailing Address P-0 Poo x S 7 33 ✓ L City/State/� PROPERTY INFORMATION *Date House/Facility Corners NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 6 nths with site pla o expiration with complete plat.) Owner's Name i1Q (CI �' �e Phone Number YPY o���S' S-3,YS Owner's Address P.D. % j u:7 P /liC. City/State/ ip Property Address CityLUi¢N c2 Lot Size (o f U(P fl -L y e Tax PIN# 5 '7 on y 4as Subdivision Name(if applicable) Section/Lot# _/- Directions To Site: _ .,L - `tt7 1t,^T -f0 SSD 1 4.t •fi '�l�(..imd5 v,9rw OrosPr-N % D-457 M D c k -t, 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 ❑No Are there any easements or right-of-ways on the site? ❑Yes ❑No Is the site subject to approval by another public agency? ❑Yes ❑No Will wastewater other than domestic sewage be generated? ❑Yes ❑No IF RESIDENCE FILL OUT THE BOX BELOW # People / # Bedrooms # Bathrooms2 V2y - Garden Tub/Whirlpool Wes TgNo Basement: ❑Yes -I�No Basement Plumbing: ❑Yes Flo 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 X`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 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 staki the house/facili location, proposed well location and the location of any other amenities. G� _ Site Revisit Charge Prop1t owner's or owner's legal representative signature ,�- Date Sign given ❑Yes ❑No Revised 11/06 Date(s): Client Notification Date:. EHS: Account # VO (� Invoice # ishorn knew has been tion Reg lctiyu, rith the we welts in the Ihindles a ep h.tb Ip r6eg 1 is hn tDY noted ih.hoC Mel M ePpI-of Id lnetod and We ePPlevo( for the nd slwclarez mt Do led the final plot for sten. q sad THOWAS WIRONET ESSEX ALAN MOCK. TRUSTE I)A 126. PG. 012 D. FBOODOOO63 PIK. 58-/MSO992 REMAINDER AREA APPROX. 50 508 At distQnceS, 1,10flZoAtaf ground opplying Combined Grid Factor s. C.G.F. • 0.9 9 99181 2 2. •nns Monts. Agr.e wets. or 1the. dote of this plot• of the s�rvdy, tomos Moroney Estes Tryst - itea OTJ31/Oo (P,&. tl. Pg, 275.) rater.. N prl4.fe septic systems. Wgrdund three tial flood Horard Area DANE COUNTY. NORTH CAROLit1A Tied low registration of o'clock regittertd r, Plat Book- _ Page - al. wo StiCAf. REGISTER OF DEEDS BY ASST./OEPVTY _ LOT 1.0 AC 02/26/2007 10:50 FAX 336 7144401 PRUDENTIAL CAROLINAS U002/002 1 -"its ' APPLICATION FOR SITE EVALUATIONnWROVEMENT PERMIT & ATC �� Davie County Environmental health (� l� C9' P.O. Box 848/210 Hospital Street Mocksville, NC 27028 RA FEB2v(336)751-8760/ Fax (336)751-8786pplication For: ��ite Eva uation mprovement Permit ❑Authorization To Construct(ATC) D Both Tjype off pplicat �7 ew Systei DRepair to Existing System ❑Expansion/Modification of Existing System or Facility **IM *'TETE APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED FORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed tS t 64- Contact Person Billing Address _ 3 Home Phon . -- ,Ms City/State/ZIP , ( N(� a iF13 Business Phone Name on Permit/ATC if Different than Above Mailing Address PROPERTY INFORMATIO:y `Date House/FacilityCorners Flagged NOTE: A survey plat or site plan must accompany this application. Included: D Site Plan DPlat(to scale) (Pemnit is valid for 60 mo:aths with site plan, no expiration with complete plat.) Owner's Name A o rp /Yip t k/ Phone Numb�3341 & j L— % LO �_, Owner's Address City/State/Zip Property A dress pr City, Lot Size Tax PIN# 0 Subdivision Name(' pplicable) Section/Lot# Directions To Site: W-41. S_ iLk, n v m.e,��p 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? 0Yes JMNo Does the site contain }uri;idictional wetlands? Oyes Wo Are there any easements or right-of-ways on the site? Dyes tNo Is the site subject to apprcval by another public agency? Oyes CWo Will wastewater other than domestic sewage be generated? Dyes ]$No IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms _J5__ Garden Tub/Whirlpool R Yes ONo Basement: Dyes NNo Basement Plumbing: ❑Yes�No 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 _ 01nnovative ❑Alternative ❑Other Water Supply Type. D County/City Water D New Well DExisting Well D Community Well Do you anticipate additi ns or expansions of the f cilt this system i�ntennded to serve? �YsS • 0 If yes, what type? di".A 1-{ u n t) ^x t . This is to certify that the information provided on this application is true and correct to the best of my knowledge, I understand �.�vuoie� �7g f%�F �1� 03/01/2007 15:32 FAX 336 714 9901 PRUDENTIAL CAROLINAS Q002/002 APPLICATION 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 Application For: )QSite Evaluation/Improvement Permit D Authorization To Construct(ATC) D Both Type of Application: KNew System DRepair to Existing System DExpansion/Modification of Existing System or Facility ***1MPORTAN7"** THIS APPLICATION CAAWOTB£PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION 1S PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed ii S r, �' Q,} Contact Person Billing Address ,S 3 — Home Phon j�s, City/State/ZIP ' If, fit, a & &r 3 Business Phone Name on Permit/ATC if Different than Abi Mailing Address PROPERTY INFORMATION *Date House/Facility Corners Flagged 3 --0 7 NOTE: A survey plat or site plan must accompany this application. Included: D Site Plan DPlat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name A ((kyl f i'10 �i k, Phone NumbQ334} I LI(a O., Owner's Address City/State/Zip Property A dress At'AN Kx, City, Uf1 e & Lot Site r Tax PIN# 0S Subdivision Name(iapplicable' ; Section/L.ot# Directions To Site: A- & Q. w l ` x Is Akk ► rt a.. rVIALkIvL, f the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? Oyes Flo Does the site contain jurisdictional wetlands? Dyes W40 Are there any easements or right-of-ways on the site? Dyes Dko Is the site subject to appro-✓al by another public agency? Oyes ONO Will wastewater other than domestic sewage be generated? Oyes Wo IF RESIDENCF, FILL OUT THE BOX BELOW ,# People 1 # Btsdrooms # Bathrooms Garden Tub/Whirlpool,,Yes DNo Basement: Dyes Mo Basement Plumbing: DYesANo 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: # Sea•:s Type system requested: )!;Convent'.onal OAceepted DInnovative ❑Alternative OOther Water Supply Type: O County/City Water D New Well DExisting Well O Community Well Do you anticipate additi ns or expansions of the f cili this system is intended to serve? Dkyes •• a - If yes, what type? yo �Olhwlu. This is to certify that the information provided on this application is true and correct to best of my kno edge. I nderstand L ATf-/... .....,,.. •71,... ...v ., ... ..... ..... .. ........ ... ... . .. i .... :t .� .. ...... ... nl: ...s I, 1 distQnces. Horf=ontol grocer oPPIY'n9 Cambined Grid F s. C.G.F. - 0.999918122. •nns rnmis. A9reen,ant, or ie. d e. ole o! this plot, OI the sw.ey. iorhas edoron ry Esse] Trt,st It'd D./31/06 (P.S. n. P 2 9 rater. N pr Wore septic ss tem s. 'erground three 601 rlood Noyord 4rto lshorn hn eon ho] b— CIA tion Pequlolim]• .ith the CD nosed in Ne minu b] o/ p � ovvroma /Kraawnq hereby rated thot ]ueh N W instal and C) rdt approvol W the Q nd ]lrvclu.es I �t Dole +ed the Rnol plol la ion. q oad distQnces. Horf=ontol grocer oPPIY'n9 Cambined Grid F s. C.G.F. - 0.999918122. •nns rnmis. A9reen,ant, or ie. d e. ole o! this plot, OI the sw.ey. iorhas edoron ry Esse] Trt,st It'd D./31/06 (P.S. n. P 2 9 rater. N pr Wore septic ss tem s. 'erground three 601 rlood Noyord 4rto ft• et% uti lu; 1 ram � Y �I 1�1iL Cil F� pa �t f w i r' . — SITE EVALUATIONAWROVEMENT PERMIT & ATC Davie.County Health Department".' Environmental E'ealth .!lection P.O. Box 848/2101 l-lospitv1. Street Mocksville, NC 2701;8 (336)751-8760/ Fax (336)7!51-8786 on 3f? { Oyr. SiYeti vaFir�tion/1mpr�ivetnent Permit ❑ Authorize.:ion To Construct(ATC) U Both *1MPOR7AM'W—** THIS APPLICATION CANNOT BE PROCESSED U `7LESS ALL OF TH E REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLET IN for instructions. APPLICANT Name to be Billed Billing Address City/State/ZIP _, Name on Permit/ATC if Different t! an Mailing Address NOTE: A survey plat or site plan muut accompany this application. (Permit is' I'd f r 60 months ite 1 n, no expiration ,% Street Address /1/G City_ Subdivision Name M cetior DireFtiotis TA Site: Z I-" 6- Aj 01, Colt.tact Person A- r�lGe - _B ame Phone Bu-tiness Phone (p O r/Sl ate/Zip 1N# S$ -7 0175-0 q Z 2•� '7 ef Ac. Date House/Facility Corners Flagg -.d If the answer to any of the following questions is "yes", supporting documentatao must be attached. Are there any existing wastewater systems on the site? L']Y•:s Docs the site contain juriscliecional wetlands? ClY;:s Are there any easements or ril:ht-of-ways on the site? OYns Oo N Is the site subject to approval by another public agency? OY.:s o Will wastewater other than do mestic sewage be generated? OY•:s • o IF RESIDENCE FILL OUT THE BOX BELOW ' # People #Bedrooms # Bathrooms Darden Tub/Whirlpool OYes o Basement: OYes ClNo Basement Plumbing: OYes CINo %V IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business _ Total Square Poor:age of Building_ # People # Sinks # Commodes, # Showers # Urinals Estimated Water Usage (gallons p4:r day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: p1conventiontsl XA�`ccepted innovative 05� ltt rnative nOther Water Supply Type:,; d`6ounty/City Water O New Well nE:; fisting Well O Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? U Yes Flo If yes, what type? _ This is to certify that the informatinn •irovided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereatter are subject to suspension or revocation if the site is altsred, the intended use changes, or if the information submitted in this application is falsified or changed. I undr: t stand that I am responsible for all charges incurred from this application, i hereby grant right of entry to the Authorized Repre acritative of the Davie County Health Department to conduct necessary inspections to d • mine eomplii ce with applicable last .s and rules on the above described property located in Davie County and owned by "�}4!Y!/fS- �i 0%�/I/_ V Site Revisit Charge roperty owner's r • er's legal representative signature Dates):_ A. OlpClient Notification Date: Date _ LHS•! Sign given 0Ycs ONo Account # _ Revised 2/06 Invoice 4 4 • • APPLICANT INFORMATION Account #: 990003875 Billed To: Alan Mock Reference Name: Proposed Facility: Residence Water Supply:, Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5870-95-0992.01 Subdivision Info: Thomas Meroney Trust Lot # 1 Location/Address: NC Highway 801 N.-27006 Property Size: 3.65 acre Date Evaluated: On -Site Well Community Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position / cr Slope % :Z.15 HORIZON I DEPTH d- O •- l I - I_ 0 -- W Texture group l G Consistence . / (', Structure q , c( ` Y -54's-4—i- Mineralogy HORIZON II DEPTH ',K - ( /-1 -A- to= (� Texture group q t 1- 5�4t_. Consistence 40are"' rrG".',(J Structure T b'- S x GYy "K.'_ Mineralogy , t 1 1 1 1 HORIZON III DEPTH qe c, - Texture group... r r Consistence ti Structure Mineralogy HORIZON IV DEPTH a� Texture group Consistence Structure Mineralogy 0 SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 17 LONG-TERM ACCEPTANCE RATE 92 .11 SITE CLASSIFICATION: EVALUATION BY: �c� � Ink i1 LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: _ REMARKS 4...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 a'141St VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm. est 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 Mineraloev 1:1, 2:1, Mixed LYQteS 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) ■■■■■■■■e■■eeee■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■■■■e■■■ee■■■■■■ ■■■■■ee■■■■e■■ee■■■■■■■■■■■■e■■■■■e■■■e■■■ee■e■e■■t■■■■■e■■e■■t■ ■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■ee■■■e■■■■e■■■■■■■■ee■■■■■eee■■■■■■ ■eee■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■ ■e■■e■■e■tee■■■■sle■■■■■e■■■■e■e■■�:��•e■■■■e■■■■■e■■e■e■■■e■■e■■e■ ■■■■eee■■e■■■eee■i■■■■■■e■■e■■■■■■■■■■■e��•■■■■■■■e■■■e■■e■■e■■■■e■ ■■■■■e■■■e■■■■■e■■■■■eeeeee■■■■■■■■■ee■eet::�:•■ee■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■e■■e�■■■■■■eee■■■■■■■■I'i■e■■e■■eee■■■■ ■■■■■■■e■■■e■■■e■■eeee■■■■■■■ee■eeee■e■■■e■■■■e■■■r■eeee■■■e■■■■■■ ■■■■■■e■■■■■see■■gee■■e■■■■■■■■■■■■■■ee■ee■■■■■e■■■■■■■■■e■■■■ee■e■ ■■■■■■■e■■■■■■■■■■e■■■■■■■■■■■■■■■eeee■e■■■■■■eeeee■■e■■■■■■■■eee■ ■eee■■■■■■■■ee■■■e■■■■■■■■■■■e■■■t■■■■■■e■e■et■■■■ei■eee■■■■■■t■ee■ ■t■■■eeeee■e■■ee■■■■■■■ee■eee■■■I�Ie■■■e■e■■e■■:■■■■I■■ee■■■■■■■■■■■ ■■■■■■e■■■■■■■■e■e■■■■■■■■■■e■■■■■■■te■eee■■��■■el■e■■■■e■■■e■ee■ ■■e■■eeeee■eee■aee■eee■■■■■■■■■■■■ti■a■■■■■■■e�•t■e■■I■■■■eeeeee■■■e■ ■s■■■■■■e■■■■■■■■■■■■■■■e■■eee■■e■■�■■■e■■■ee■■■ee■,■■■■■■■■■■e■■■■ ■■■eee■■■■■■■■■■■�■■■■■■■■■���•■®e■■■I■■■■■1�C�1iB�1■■■■■I■■■e■eee■■ee■■■ ■■■■e■■■■■■■■■■■■I■■■■■■■■■1��■■►�e'�e■�■■■ee■■e■■e■■■u■■■■■■■eeeee■■ ■■■e■eee■■■■■■■■■.■ee■■e.a■1■��■■a■■i■e■e■■a■■■■■■■eeel■■■■■■■■■■■eee■ ■■■■■e■■■■■■■■■■■IC�eeC�s!'�I/I■��Aef�■■�e■■■■■■��■■■■■■■■■■■■e■■■e■■■■■■■ ■■■t■■eeee■■■■■■■I■■0r�=leetel■t!ti■i?■■■■i%��iii�si������:i■■e■■■OEM MON ONE ■■■■■■■■■■■■■■■■■I■■■■L�■■eel■■�►■i■■ ■■►',r■■■■■eee■■■■■■ ■■■t■■■■■■■■■■■ ■■■■■■■eee■■■■■e■le■■■■■■■■IIC�iC9■■t■I■■■■■■■■■■■■■■■■■eeee■■■■■■■■■ MEN ■■■■■■■■■■■■■■I■■■■■■■e■&1■l�a�■eee■-71■■eee■\■■■■eeee■■■■■■■eee■e■■■ iiiiitiviiieiiiiiiiieii■■■■iii::�i�■\r« ac■i�::::�■■■■eee■e■■■■■■■■ _..\■■■eee■■■■■■■■e■ ■■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■eel■■J■eee■■■r■■■■■■■■e■■ee■■■■■ �eeeeeee■■■■■■■■■■I■■■■■■t■■■■■■eeeeo�l■eeee■■■■t■■■tl■■■eee■■■■■■■■■ ',■t■■e■e■■■t■■ee■el■■■■■■s■■■see■■■ta�>.ee■■■■■e■■■■■eu■■■e■■■eeeeee■ ■eeeee■ee■eee■■e■I■■■■■e■eeee■■■■■�ed��■■■■■■■■■e■■ee�l■e■■■ee■■eeee■ RI:::::: :::::: C:::::: 1:::::: NOMINEE ::::::::::NIM MENNEN ■■■■■■■■■■■■■■■■■I■■■eeeee■■!�r,■ee►o■■■■■■e■■■e■■e■■■■►■e■■■■e■■■e■■■ ■■■■■■■■■■■■■■■■el■■e■e■eee■e■■■■■o.■■■e��e■■e■■■■e■■■■e■e■■■■■ee■■ ■ee■e■■e■■■■■■■■■1■■■■eeee■■■■■ee�■■■ecte■■■eeee■■e■■■�■e■■■e■■■■■■■ ■■■■■■■■■t■e■■■■■u■■e■■■■■■e■■ei�■tie■■e■■ee■e■ee■■■I�ee■■■■■■■a■■ OEM ■■■■■■e■■■■■■■u■■■■■■■■■■■P.P.ri■ ��■■■■e■■■■ee■■■■■■��■■■■■■■■■■■■ ■■■e■■■■■■■■■■■■■II■■■■■■■�i■■■■�■�■■■■■■■■■■■■■■e■■■■■■eeee■■■■eee■■ ■■■■■■■■■■■■■■t■■n■■■■e��■■■■■rr,■■■eeee■■■■■e■e■■e■■■r■a■■■■■■ee■■■ ■■eee■ee■eeee■■■■�leeee��■■eeer�Il■■■■■■■■eeee■■e■■e■�i■■■■■■■■■■■■■■ ■ee■■■■■■e■eeeeee■r■■■eye■■■■.■Irl■■■ee■■■■■e■■■■■ee��■■■eee■■■eee■■■ ■■■■■■■■■■■■■■■e■■�■■■■e■■�-�■■i�ee■■■■eee■■■■■■■�.■ee■■e■■■■■■■■■■■ ■■■■■■■■■■■■■t■■■■.ee■■■®•_■ee��■■ ■■eeeee■■■■■eee■■■■■e■■■■e■e■■■ ■■■■eeeee■■■■e■■■■le■■■■eee■■■■■■■■eee■■■eee��■■e■■■■■e■■eeee■■e■■■ ■eee■■■■e■■■■eee■■�:e�:_ee•_■■■■■■■■■■■e■■e.■■■■■e■■■■■e■■■■e■■■■e■ ■■■eeee■■■■■■■■■■■■■■■■■e■■■■■■ii:�iii�i.N■■e■■■■e■■■■eeee■■eee■■■ ■■ee■■■■■■■■eeee■eeeee■■■■■ee■■eee■■ee■■e■e■■■■e■t■ee■■■■■■tee■■■■ ■■■e■■■■■■■■■e■■■■ee■■■■■e■■■ee■■■■■■■e■eeet■eee■■■ee■■■■e■■■■t■ ■et■■■■ee■e■e■■■■e■■eeeee■■■■■■ee■■■■e■■e■e■■e■■■■■e■■■■e■■eee■■■■ ■■■■■■■■■■■■ee■e■■e■■■■■■■■■■■e■■eee■■eee■■e■■e■■e■■■■e■eee■e■■ee■ ■■■■eeee■ee■■■■ee■■■■eee■■eee■■■e■■■ee■■■■■■■e■■■■■■■■ee■■■■■■■e■■ ■■■■■■■■■t■■■■■■■t■■■■■■■■■■■■■■■■■■■tee■■■■■■■■■■■■■■■■■e■■■■t■e■ ■■■■■■et■■te■■■e■eeee■e■■ee■■■■■■e■■■■e■■■■■■eee■■■■■■■■■■e■■■■e■■ ■■■■■■■■et■■■■e■■■e■■e■■■■■■■e■■�,It■■ee■■ee■■e■■■■■e■■e■■■■tee■■■■ ■■■e■■■■■■■e■e■■eee■■■■ee■e■e■■■■■e■■■■■■■■e■e■ee■■■■■ee■e■■■ee■ ■■■e■■■■■■■■e■eee■■■■■e■■■■■■e■■■■■■■■■■■■eee■■es■■■■■ee■■■■■eee■■ ■■■■e■■■■■■■■eee■■■■■■■■■e■■■■■■■■■■■e■■■e■■■ee■ee■■■e■■■■■■eae■■■ ■■■■■■e■■■■tet■■■■■■e■■■■■■■■■e■■■■■■■ee■■eeeeee■■■■■■■■■■e■■e■■■■ ■■■■■■■■■eee■■■eeee■■■■■eeee■■e■■■■■■■e■■■e■■eee■■e■■e■■ee■■■■■■■■ ■■e■■■■■■e■■eeee■■■■■■■■■■■■■■■■e■■■ee■ee■■■■■■s■■■e■■e■■e■e■■e■■■ ■e■■■■■■eee■■■■■■e■■■■■■■■e■■■■■I�■■■■ee■■■e■■■■teeeee■■■se■e■■■■■ •624 W NT HILIUN MTLNJ >3'157W �' D. B. 1 511 G,2232 9'39"w ID 00000080 '?'1" 4W. L9 lu 5880066957 ; S88'28'24"E �-11 P CP-EIR 264.87' IP CONTROL CORNE CP N: 806875.5 E: 158 7 CP �`1 PIT#1 ERRS ' 5 0 At4'GRETE zk5 ��„ ccn < CULVERT o o PI #2 o J ® T 1 J� ol_ w � 3. 8 cres. m � OTAL AREA 1 698 Sq.f . INSIDE R/W o CP ® N = Z PIT#3 cc 0 30.57' 1 418.49' CP NI S89'14'23"W IR (ESSEX RUST o PIT#4 WILL FRU STEE EPK 3. 012 0083 F 50992 z ARE L: o )8 Ares. L 2 c Lp 3.001 res. c�5 PIT 5 w LA - "T o� 0 TOTAL AREA ® L4 ` 9833 Sq.ft. INSIDE R/W D r Z CP PIT#6 I W 24" RCP lJ EP -) �� CP 30.97' 343.96' EIR Z NIR S88'26' W --APP M W 0 O PIT#71> CID o o I LOT 3 \ o� U' ? 2.594 Acres. o: TOTAL AREA EIP 1096 Sq.ft. INSIDE R/W CONT L �- COR R ? 0605555 \ E: 1580089.38 EPK \ � x o w � cp Lo. P P o \ GRAVEL DRIVEWAY N87'16'45 \8 232.9 EIR COMBINED WITI- EP232.9 K � LOT 1. D: F800000084 T( �- L4 EIR-12" RCP ACCESS TO N.C. HV �'' SHED 0.238 Acres. :3 ERRS L2 EIR 222.98' JAMES FRANKLIN PATTON AND N87'33'54"W EIR WIFE, GLENNIE C. PATTON -- D.B. 134, PG. 139 36" RCP ID. F80000008601 �a��o PIN. 5870955676 s. •dQ JAMES H. HANES AN s. PATSY B. HANE D.B. 153, PG. 8( ID. F80000008E PIN. 588005364 \EIR P.I.N. Sul PIN. 5870950992D.J I' Review Officer of Davie County N 00 O Z9 l tl (Vtb9'L) O aM ptm gQ� a. . ZB�d co N O aM ptm gQ� a. . ZB�d m 247 G . , e Ub lU:•1 !43 aaev,ar a.uu••..a v•, v••roa..•• .+... •.+y .+.... ... t ITE EVALUATION/IMPROVEMENT PERMIT & ATC Q avie County Health Department:I NOY 5 2006 EnvironmentalIfealth ,!lection P.O. Box 848/210 Hospittil. Street Mocksville, NC 270 1:8 rnnnanNn 1FILHEALTH (336)751-8760/ Fax (336)751-8786 For• ly'�iti='tkvbh•sec•. t 'vement Permit Cl Authorize.Jon To Construct(A-1-C) U Both ***IMPORTANT"** THIS APPLICATION CANNOT BE PROCESSED U !?LESS ALL OF TBE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLS, IN for instructions. APPLICANT Name to be Billed IN Jen4 :1� Billing Address _ _ City/State/ZIP t t/ f-_ Name on Permit/ATC if Different than Mailing Address INF-ORMATION NOTE: A survey plat or site (Permit is lid f r 6 Street Address /1/� Subdivision Name /s Directions To Site: mw;t accompany this application. ahs yvitll pite plpn, no expiration o Contact Person /ICJG _H came Phone Bu-dness Phone (p /S-! [rte/Zip Tax PIN# slw -7 O 475 U 13 Z Date House/Facility Comers Flagg.ad -- If If the answer to any of the following questions is "yes", supporting documenlatiomust be attached. Are there any existing wastewater systems on the site? L)Yos Does the site contain jurisdictional wetlands? OY.:s o Are there any easements or right-of-ways on the site? Oy..sgo. Is the site subject to approval by another public agency? OY.:s Will wastewater other than do mestic sewage be generated? OY•:so IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms Garden Tub/Whirlpool (?Yeso Basement, ClYes CINo Alli Basement Plumbing: Oyes ONO /V/14 IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business _ Total Square Foo -age 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: PConventionttl AI'Aecepted ,011 novative e, iv rnative nOther„ Water Supply Type :101-6ounty/City Water Cl New Well rlE, isting Well O Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes I Vo If yes, what type? This is to certify that the information •5rovided on this application is true and correct to the best of my knowledge. I understand that any permits) or ATC(s) issued herearter are subject to suspension or revoc tttion if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed. I undo rstand that ram 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 do mine compli �j}ce with applicable lay. -.s and rules on the above described property located in Davie County and owned by d11n ll✓L��%- Site Revisit Charge �7,er's legal representative signature / Date(s):_ A. oto Client Notification Date: Date EHS Sign given OYcs ONo Account # V7 Revised 2/06 Invoice 4 APPLICANT INFORMATION Account #: 990003875 Billed To: Alan Mock Reference Name: Proposed Facility: Residence Water Supply: Evaluation By: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5870-95-0992.02 Subdivision Info: Thomas Meroney Trust Lot #& Location/Address: NC Highway 801 N-27006 Property Size: �O acres Date Evaluated: 3 —;2 5 �O `% On -Site Well Community Auger Boring Pit t� Public l/ Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % j -5 V HORIZON I DEPTH la Texture groupG G L Consistence P. TIC - Structure Mineralogy. HORIZON H DEPTH 14 36 -5 -- Texture group C Consistence (.,rj Structure Mineralogy 7"j i;' HORIZON III DEPTH -36-q<( Texture groupC Consistence r Structure / Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS ------0 '7/,! RESTRICTIVE HORIZON Rj SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE U . a 6 . SITE CLASSIFICATION-�� EVALUATION BY: le -t LONG-TERM ACCEPTANCE RATE: Q' a OTHER(S) PRESENT: °° ' L REMARKS • � 6 r -f ;2 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 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 Notes 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) :t1 2" W C�L� I NT I11L I UIV NI T tKJ E.1"W G D.B. 151 232 9~W ID. 80000008 '''41"w 9 588.28'24"E 5880066957 P CP EIR 264.87' IP CONTROL CORNE �� CP E:1858 875.5 7 CP ERRS j &KtRETE- 1 7- < < CULVERT o o P/1#2 T 1 3. 8 Cres. OTAL AREA 1 698 Sq.f . INSIDE R/W CP y PIT#3 o 'rn o 15 1 30.57' CP NI ESSEX RUST r 0 1 / /PIT#4 "RUSTEE EPK 3. 012 0083 ) 50992 iz� Z ARELp )8 A res. N O o J ` O � Z CP CO- N_ 24" RCP EP �� CP 30.97' NIR �i oO N \ CP � Z\ � I Q o �r EPK Z\ JAMES FRANKLIN PATTON AND / \`IIFE, GLENNIE C. PATTON D.B. 134, PG. 139 36" R ID. F80000008601 PIN. 5870955676 418.49' S89� 14'23 11 It PIT#1 LOT,2 3.001 cres. X45 /PIT#5 TOTAL AREA 9833 Sq.ft. INSIDE R/W �j PIT#6 3.96' Q PIT#7 o_ LOT 3 2.594 Acres. TOTAL AREA 1096 Sq.ft. INSIDE R/W EPK \WM �- L4 EIR--1 c� ERRS L2 EIR Lo N 87'16' 0.238 Acres. 222.98' N 87'33'54"W EIR IR ,r W � r- N 6 o Ln 0— � EIP CONT L COR R Z N: 06055.55 E:1580089.38 J � w rn � o >A - 0 S\ PP rno �N GRAVEL DRIVEWAY EIR COMBINED WITF LOT I. D: F800000084 TI ACCESS TO N.C. HV J EIR JAMES H. HANES AN PATSY B. HANE D.B. 153, PG. 8( ID. F80000008E PIN. 588005364 P.I.N. Sul PIN. 5870950992 Review Officer of Davie County D.J Z7 "/VI (vtb9'L) �J � 1,1 r 4r *30 �f%Y � � '� ;, •�, i* �� (.; � ;'A�, _moi.y;� � " • �,r n �,� (J.'J r / .. _ N. t�- .i 4 .W tti`.�_._ moo,,. yr'. F ,i 3 1 _ 3 - •y c. c M Y�Mt h* 2 . e (7.64A) , 4152 v a ♦ Ey�" n x}\ s.- , � ,.�`i a � ' ..- Lt!-..•... x..v - ��' ♦ .. ^i n-e fwe�/CSI .a•. er..>�s e. w G DA\4E COUNTY, NORTH CAROLINA E Filed for registration at w W in Plat Book W 'E M. BRENT SHOAF, REGISTER OF DEEDS 'E E BY E W C W W �C W L9 P CP EIR 1 � CP rel � =TE 1 ? 3.001 Cres. X45 VERT o o 9833 Sq.ft. INSIDE R/W o � � \j � CNir W 1 698 CIP l O cP .O 30.57' CP NI RUST 1 EE EPK � Z res. `� N 0 O� Z CP N L EP r� CP 24" RCP 30.97' Z NIR cor� 0 O N \ � \ CP - —� o o'clock S . and registered Page �i did l�� � $eiJ% ASST./DEPUTY 588'28'24"E 26—� �1J PIT#1 '® T 1 3. 8 Cres. OTAL AREA Sq.f . INSIDE R/W P® 4'23"W L 2 3.001 Cres. X45 PIT#5 TOTAL AREA 9833 Sq.ft. INSIDE R/W m6C1� \j PIT#6 • �z\ EPK S FRANKLIN PATTON AND C rl C:-nlnnC r DATTr)NI 343.96' S88'26' PIT#7 LOT 3 2.594 Acres. TOTAL AREA 1096 Sq.ft. INSIDE R/W N87'16'45" —12" RCP —SHED 0.238 Acres. R 222.98' N87'33'54"W ARY HILTON MYERS D. B. 151 232 ID.80000008 5880066957 NTROL C .R WILLI D. 11 P i cn I O � N w0 c., m O D r- m6C1� EIP L CONT L COR R J N: 06055.55 E: 1580089.38 J Lu OIc') PP0\o GRAVEL DRIVEWAY EIR COMBINED WITH LOT I. D: F800000084 TO 31-1 ACCESS TO N.C. HW' Davie County EnvironmentaMealth, P.O. Box848/210 Hospital Street . , Moeksyille ,NC 27028, (336)751-8760/•Fax (336)751=8786 Account #: 990004254 Billed To: Ronald Triplett Address: PO Box 5733 City: Asheville Reference Name: Proposed Facility: Residence IMPROVEMENT PERMIT Tax PIN/EH #: 587046-9405 Subdivision Info: Location/Address: NC Highway 801 S.-27006 Property Size: 6.66 Acres **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: f31 ew ❑Repair ❑Expansion Permit Valid for: 25 Years ❑No Expiration Residential Specifications: # Bedrooms # Bathrooms # People–L— Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): ZIV Type of Water Supply: 26`unty/City,- ❑Well ❑CommunityWell Site Modifications/Per mit Conditions: As stated in 15A NCAC 18A.19.69(5) Ossepted S�-s����7-z use Site Plan System Type LTAR Initial 61.,)L5— Repair :Re air O. _3QG \ N 41. Environmental Health Specialist i.p.l 1-06 Date 3- ? 9--07