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114 Idlewild Rd Lot 2 CONSTRUCTION For office use only AUTHORIZATION "CDP File Number 139275-1 ° Davie County Health Department CounID Number - - - - - - - --- ------—---- - - 210 Hospital Street Evaluated For. NEW �`•v �,. P.O. Box 848 Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax: 336-753-1680 0 8 / 0 6 / .2 0 1 9 Applicant: Arena Builders Property Owner: Arena Builders Address: 3445 Wyo Road Address: 3445 Wyo Road City: Yadkinville Cay: Yadkinville State2ip: NC 27055 State/Zip: NC 27055 Phone#: (336)388-2586 Phone#: (336)388-2586 Property Location 8 Site Information Address/Road #: Subdivision: Idlewild Phase: Lot: 2 114 Idlewild Road Advance NC 27006 Directions Structure: SINGLE FAMILY hwy 158 east to Redland Rd. turn left, cross 1-40 Idlewild on right. #of Bedrooms: 4 #of People: z* 1 ter Supply: PUBLIC -- I j System Specifications Minimum Trench Depth: a 4 rSitessification: Provisionally suitable Inches S stem? Yes Minimum Soil Cover.Y O ( No 1 aInchesglow: 4 8 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 3 Maximum Soil Cover: a 4 Inches "System Classification/Description: "Distribution Type: GRAVITY-SERIAL TYPE II A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 Gallons "Proposed System: 25%REDUCTION 1-Piece: OYes Q N o Pump Required: OYes QNo OMay Be Required Nitrification Field 1 6 0 0 1 Sq ft Pump Tank: Gallons No. Drain Lines 4 1-Piece: OYes QNo Total Trench Length: 1 0 0 ft. GPM—vs— ft. TDH Trench Spacing: _ 9 2Inches O.C. Dosing Volume: _ Gallons Feet O.C. g Trench Width: 3 @Inches _ - Feet Grease Trap: Gallons Aggregate Depth: inches Pre-Treatment: ONSF OTS-1 OTS-II Septic Tank Installer Grade Level Required.- 01 Oil 0111 OIV CDP-File Number 139275 - 1 County ID Number: ❑ Open Pump System Sheet .__----._.._–_..--.._-__.Repair_System Required:OYes .ONO___ON0,_bUt_has Available.Space_______.____-_..____...___ epair System Trench Spacing: Q Inches O.C. `Site Classification: Provisionally Suitable — 9 Feet O.C. Trench Width: Inches Design Flow: 4 8 0 _ 3 Feet Soil Application Rate: -_0—•-3Aggregate Depth:------------------- - -- - inches .— Minimum Trench Depth: a 4 Inches "System Classification/Description: TYPE 11 A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover. 1 a Inches Maximum Trench Depth: 3 6 Inches "Proposed System: 25%REDUCTION Nitrification Field 1 6 0 0 Sq. ft. Maximum Soil Cover: a 4 Inches No. Drain Lines 4 `Distribution Type: GRAVITY-SERIAL ' Total Trench Length: 4 0 0 ft Pump Required: OYes (@)No OMay Be Required Pre-Treatment: ONSF OTS-1 OTS-11 "Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. 7,1 'Permit Conditions The issuance of this permit by the Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements.. r^ 2( This Authorization for Wastewater System Construction shall be valid for a person equal to the period o1`validity of the improvement Permit,not to exceed five years,and may be Issued at the sametime the Improvement Permit Issued(NCGS 130A-336(b)�If the installation has not been completed during the period of validity ofthe Construction Permit,the information submitted in the application for a permit or Construction Authorization is found to have been Incorrect,falsified or changed,or the site is altered,the permit or Construction Authorization shall become Invalid,and may be suspended or revoked(.1937(8)).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,Installation,operation,maintenance,monitoring,reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes. ONO Applicant/Legal Reps. Signature Date: / "Issued By- 2140-Nations,Robert Date of Issue: 0 8 / 0 6 / .2 0 1 4 Authorized State Agent: Malfunction Log Oyes @Hand Drawing Olmport Drawing **Site Pian/Drawing attached.** D-') -f2 • CONSTRUCTION AUTHORIZATION 139275 - 1 Davie County Health Department CDP File Number: 210 Hospital Street ------- _--._.-------------------------_ P.o Box 848 —__-----------___-`.__-__-__------County_File_Number:__ .._..-------__-- Mocksville NC 27028 Date: 0 8 / 0 6 / 2 0 1 4 Q Inch Drawing Drawing Type: Construction Authorization Scale: QBlock eft. aN/A 10 c, ,L6 ✓ h � I API'LICA.. FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health '.� (�-� P.O.Box 848/210 Hospital Street PAID Mocksville,NC 27028 Date: 73;/y (336)753-6780/Fax(336)753-1680 Recelvedbv: JJgIy1 Application For: ❑ Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both 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 ULNA &YAMC- Contact Person 0C o A(4a�z Address R Home Phone City/State/ZIPy/1 p/Li.J U I«<f C 27 d (' Business Phone Email (t'A Q. A(le-WA GO i LO tjkC i CoM Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged 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 Phone Number Owner's Address City/State/Zip Property Address i I LI 161LC kJk8 P2 City S t►cC Lot Size Z. Tax PIN# Subdivision Name(if applicableQCE l471 L10Section/Lot# Directions To Site: ew, AJ Specify Problem Occurring: IF RESIDENCE FILL OUT THE BO E #People #Bedrooms #Bathrooms 2 Z Garden Tub/Whirlpool es ❑No Basement: ❑Yes o Basement P g: ❑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 ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: �(Clounty/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes L Xo 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 Da e County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. n r and that I am responsible for the proper identification and labeling of property lines and corners and locating and fl gi staking the house/facility location,proposed well location and the location of any other amenities. Site Revisit Charge Property ne 's or owner's legal representative signature Date(s): Client Z l ,Client Notification Date: Date EIIS: Sign given []Yeses ❑No Account# ��; Revised 11/06 Invoice 4 4-;129 CJJ o _ S W t11 �- ,- _. - Fn 00 118 )41 3 7 . c -- co 114 M . __..-.-_-_--- r------------------ -.... r j 110 tilt ---- ------ ----- _=105 1 �vpi r r 324 305 CORDON CORDON DR DRGORDON DR (207) 200 103} (185} 1©7 All data Is provided as is without warranty or guarantee of any kind either expressed or Implied Including but not limited to the implied � t�ti 1~ warranties of merchantability or fitness for a particular use.All users of Davie County's GIS website shall hold harmless the County of Davie,North Carolina,its agents,consultants,contractors or employees from any and all claims or causes of action due to or arising out printed:J u n 17, 2014 5 of the use or Inability to use the GIS data provided by this website. J 94.80' — "— — N 02"30'56"E Lot 2 Lot 3 w Lot 1 o CD o N T C3 C) N O N n lA CII c') En M 'o C N Z Proposed House 18.8' Garage 18.9' I I to I6 I 3 I 33 94.74' 3 10'Utility and Drainage Easement _ _ — N 04°31'00"E Idlewild Road 50'Public Right-of-Way Proposed Layout For ARENA Builders Associates, LLC Prepared By: Lot 2 Idlewild Subdivision Autry-Abernathy,P.A. C-2341 6601 Skylark Road Davie County,NC Pfafftown,N.C.27040 Plat Book 8 Page 192 336-922-4335 336-922-4624 Fax Scale 1 inch=40 feet j nn•co 04, 1e143a eevie eeunar envneeitn 376 7S{ 67116 t I • f . aYlUGKM WnN Oounq MS1RR✓t ML I.o,sac su/s;0 9olpitsl scat ii ' Jettlri2lt,xc J102I ._ 4 tuglst•tuI . ...U{pC,tt•a►st¢,inr.:cuimt Cuomo'Dl„ a,u,J acc say � •. yQD,ld7lOr Im ILOVlbCD. Ufa to tie mltwfm 10a=lee lYbLiWP1eY•.. as oa Iilt.t Wattt will�b l6_„k6�' .• . ,a,,,y„Ipw d11�G jodtt�f t� Ant w nwa «tysnalsa tiVitkr. 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I t0'd £[£tTZt9££ w + + A9N NN 9C:t0 MO-►t-d:�S DAVIE COUNTY HEALTH DEPARTMENT . _ Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003354 Tax PIN/EH#: 5862-34-9883.02 Billed To: H&V Construction Subdivision Info: Idlewild Lot#02 Reference Name: Location/Address: Gordon Drive-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: 1 2 O Water Supply: On-Site Well Community Public Evaluation By: Auger Boring ` Pit ✓ Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Sloe% 775 HORIZON I DEPTH b^IT- Texture group Consistence f Structure r_ Mineralogy HORIZON II DEPTH 111 -24 Texture group S'CL 4 Consistence Frmv Structure Mineralo HORIZON III DEPTH 2_4 34 Texture group .05' C Consistence Structure ss)( Mineralogy HORIZON IV DEPTH .q Texture group 5'CL Consistence is Structure Mineralogyr✓ SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION Ft LONG-TERM ACCEPTANCE RATE 0.!55-,0.&/ SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: 0,5-5 OTHER(S)PRESENT: REMARKS: ©UX17-bk el)3 e 2V 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 Wet 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 05/99(Revised)