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125 Lost Farm Dr Lot 1 CONSTRUCTION For Office Use Only AUTHORIZATION *CDP File Number 232292-1 ' Davie County Health Department County ID Number 5880519904 210_Hospital Street Evaluated For. NEW P.O.Box 848Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone:336-753-6780 Fax:336-753-1680 0 1 / 1 0 a 0 a a Applicant: Jason Reader Property Owner. Darren and Amanda Cranfill Address: PO Box 828 Address: 246 Bermuda Run Drive City: Clemmons CRY: Bermuda Run StatetZip: NC 27012 State/Zip: NC 27006 Phone#: (336)M-0767 Phone#: Property Location & Site Information Address/Road#: - Subdivision: Magnolia Acres Phase: Lot: 1 125 Lost Farm Rd .Advance NC 27006 Directions Structure:_ -;SINGLE FAMILY Hwy 64 East left, go into Advance 2nd People Creek Rd right to Magnolia Acres #of Bedrooms: 4 #of People: 4 *Water Supply: PUBLIC System Specifications Minimum Trench Depth: a 4 Site Classification: PrWsionallysuitabte Inches Minimum Soil Cover. Saprolite System? QYes eNo Inches Design Flow: 4 8 0 Maximum Trench Depth: a 4 Inches Soil Application Rate: 0 . a 7 5 Maximum Soil Cover: 3 6 Inches *System Classification/Description: 'Distribution Type: GRAVITY-SERIAL TYPE III G.OTHER NON-CONN.TRENCH SYSTEMS Septic Tank: 1 0 0 0 _ Gallons *Proposed System: 25%REDUCTION 1-Piece: QYes @No Pump Required: QYes ®No OMay Be Required Nitrification Field 1 7 4 5 Sq. ft. Pump Tank: Gallons No. Drain Lines 5 1-Piece: QYes ONo Total Trench Length: 4 3 6 ft GPM—vs— ft. TDH Trench Spacing: 9 @Feet OCCInches O . _ _ Dosing Volume: _ Gallons Trench Width: 3 @ Inches — Feet Grease Trap; Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS-1 OTS-II Septic Tank InstallerGrade Level Required; OI QII O Ill OIV Donn 9 ^f'l CDP File Number 232292 - 1 County ID Number.5880519904 ❑ Open Pump System Sheet Repair System Required:@Yes ONo ONO, but has Available Space rDesign System Spacing: 7- Trench 0. . ification: Provisionally Suitable ..�, — Feet O.C. Trench Width: QInches w: 4 8 — _ V Feet Soil Application Rate: Aggregate Depth: � a a 5 inches Minimum Trench Depth: a 4 *System Class ification/Description: Inches ._TYPE III G.-OTHER NON-CONY.TRENCH SYSTEMS Minimum Soil Cover 3 6 Inches - = Maximum Trench Depth: a 4 *Proposed System. 25%REDUCTION - - Inches - Maximum Soil Cover: 3 6 Nitrification Field - -a 1 3 3SqInches .ft. *Distribution Type: GRAVITY-SERIAL No. Drain Lines` '- 55 Total-rench Length = � - Pump Required: ()Yes GNo ()May Be Required 5 '3 3 ft Pre Treatment: O N SF. OTS-I OTS-II *Site Modiflcations No grading or construction activity is allowed in areas'designated'for system and repair without approval of Health Department. - *Permit Conditions The.issuance of this permit bythe-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. This Authorization forWastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit,not to exceed five years,and maybe Issued atthe sametime the Improvement Permit Issued(NCGS 130A-336(b)).If the Installation has not been completed during the period of validity of the Construction Penn It,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 orconstruction Authorization shall become Invalid,and maybe 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 4eNo Applicant/Legal Reps. Signature- Date:- * 2140-Nations,Robe 0 1 1 0 2 0 1 7 Issued By: Date of Issue: . Authorized State Agent 00 Malfunction Log OYes @Hand Drawing Oimport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION 232292 - 1 Davie County Health Department CDP File Number: 210 Hospital Street 5880519904 P.O.Box 848 County File Number: Mocksville NC 27028 Date: 01 / 1 0 / 0 1 Olnch Drawing Drawing Type: Construction Authorization Scale: Oslock N/A I I � 1 �l I Ll I I I i I I I i Of ru � r C(L el- i 176_ _ .I ....I d .... -LH-1 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital street CDP File Number: 232292;, 1 P.O.Box 848 5880519904 Mocks.Ville NC 27028 County File Number: 0 1 / 1 0 / 2 0 1 7 Date: - - - - - - Click below to import an Image from an external location: Drawing Type:Construction Authorization IMPROVEMENT PERMIT For office useonly *CDP File Number 232292-1 Davie County Health Department County ID Number.5880519904 210 Hospital Street P.O.Box 848 Evaluated For: NEW Mocksville NC 27028 Township: - Phone:336-753-6780 Fax:336-753-1680 PERMIT VALID UNTIL 1/9/2022 *NOTE TO INSPECTIONS DIVISION: Building Permits cannot be Issued with this Improvement Permit. Applicant: .Jason Reader r,Address: perty Owner: Darren and Amanda Cranfill Address: PO Box 828 246 Bermuda Run Drive City: Clemmons. y: Bermuda Run _.StatefZip: NC 27012 ,State2ip: NC 27006 _Phone#: (336)345-0767 Phone#: Prol2erty Location & Site Information - AddresslRoad#: Subdivision: Magnolia Acres Phase: Lot: 1 125 Lost Farm Rd _Advance NC 27006 Directions ;:,Structure: _SINGLE-FAMILY = = Hwy64 East left, go into Advance 2nd People Creek #of Bedroons.-,--- Rd right to Magnolia Acres #of People: 4 `Water Supply: PUBLIC r _ System Specifications nitia�l S_ystem *Sne Classification:� —ProvlsionallySu;tablo Minimum Trench Depth: 3 6 Inches SaproliteSystem? QYes QNo - Maximum Trench Depth: 3 6 Inches Design Flow: 4 8 0 Septic Tank: 1 0 0 0 - Gallons Soil Application Rate: 0 2 7. 5 1-Piece: QYes @No *System Class ificationJDescription: Pump Required: QYes QNo OMay Be Required TYPE III G.OTHER NON-CONN.TRENCH SYSTEMS Pump Tank: Gallons *Proposed System: 25%REDUCTION 1-Piece: QYes ONo � j Repair System Required:@Yes ONO ONO, but has Available Space r epair System Classification: Provisionally Suitable Minimum Trench Depth: 3 6 Inches Application Rate: 0 - 2 2 5 Maximum Trench Depth: 3 6 Inches u *System Classification/Description: Pump Required: QYes O No Q Maybe Required TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25%REDUCTION Pagel of 3 CDP File Number 232292 - 1 County ID Number: 5880519904 *Site Modifications ❑ 'Open s=ill Sheet No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. _ *Permit Conditions The,issuance ofthis�pemtit by the Health Department-in noway guarantees the issuance of other permits.The permit holder is:responsible for..checking-wrth appropriate governing bodies in meeting their requirements. The Improvement Permit shall be valid for 6 years from date of Issue with a site plan(means a drawing not necessarily drawn to Sit Plah: scalethat shows the existing and proposed property lines with dim ensions,the location ofthe facility and appurtenances;the . " .;. ;_site fortheproposed Wastewater system,and the location ofwater supplies and surlacewaters). Plat-.--. - The improvement Permit shall be valid without expiration with plat(means a properly surveyed prepared by a registered land -surveyor,drawn to a scale of one Inch equals no morethan 60 feet*that Includes;the specific location of the proposed fertility O and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters. Plat _ - -also means,for subdivision lots approved by the local planning authority and recorded with the county registerof deeds,a copy. - - = - of the recorded subdivisions plat that is accompanied by a site plan that Is drawn to scale). The Department and Local Health Department may Impose conditions on the Issuance and may revoke the permits for failure of - the system to satisfy the conditions,the rules,or this article.This permit Is subjectto revocation if the site plan,prat,or Intended use changes(NCG5130A-335(f)).The person owning or controlling the system shall be responsible forassuring compliance with the laws,rules,and permit conditions regarding system location,Installation,operation,maintenance;monitoring, reporting,and repair(.1938(1b)). Applicant[Legal Reps.Signature Required? Oyes ONO ApplicanVLegal Reps.Signature; Date: *Issued By: 2140-Nations,Robert Date of Issue: 0 1 0 9 f a 0 1 7 tz Authorized State Agent: OValid without Expiration? 0Create CA. G)Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT 232292- 1 1 Davie County Health Department CDP File Number: 210 Hospital Street 5880519904 P.O.Box 848 County File Number: Mocksville NC 27028 Date: 1 / Olnch Drawing Drawing Type:-Improvement Permit Scale: . 0131ock ON/A ft. s. I l ,mss s`♦ _ 5z"' _T1 1 I A_ I _ 1, 11 ; M...A .i O1 IMPROVEMENT PERMIT Davie County Health Department 210 Hospital street CDP File Number:'232292 - 1 P.O.Box 848 - 5880519904 _ - Mocksville _. ._. NC 2702$ County File Number: - - Date: .01 / 09 12017 Click below to import an image from an external location:Drawing Type: Improvement Permit t.. Wa445 IQL APPLICATION FOR SITB EVALUATION/IMPROVEMENT PERMIT & ATC /0 Davie County Env ri onmental.Health P:0 Box;8'912 0 Hospital Street Mci&A ille,NC 27028 (336)753,6780/-Fax(337531680 Application For: ❑ Site Evaluation/Improvement rovement Permit ❑Authorization To Construct(ATC) ❑ Both PP P ) 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 )4 SC171 Contact Person Ae,,,1,1 Address .a 2� Home Phone '33L'— 3y5-a767 City/State/ZIP (/-, Maas IC)_70/2 Business Phone Email 7if6a&1 (f- ,iyeydr,i caHsGcyi Email: 5'4_4r,4e_ Name on Permit/ATC if Different than Above 6e445frwt,ey1 Mailing Address n d• 16 o x $Zb' City/State/Zip G _1AC Z-7 c I L PROPERTY INFORMATION *Date House/Faci lity Corners Flag ed 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 0A✓.e,r&, o-Awply 1rvay-21 Phone Number Owner's Address �L y` 9,,,nfd.r {'fir,., ofl. City/State/Zip 1701,94 Property Address W5 Last Parra o(✓ City/4Q�✓a:,icy Lot Size 1,61 oai,_5 'Tax PIN# 5%,30 51ggbN Subdivision Name(if applicable) Mag�ol�e;' &✓p 5 �,,Section/Lot# -�- Directions%To Site:, 0/ 5 ri on Jer es C e ten SrOherl, „�.; T oh tvli /1?A role Lf' oh 1k,; "/(, 13T 'oH osfi'F�rr 10* t 'e4d_1o, asb10/7� If the answer to any of the fo lowing'questions;is"Yes",-supporting documentation'mustbe ttached: Are there any existing wastewater systems on the site? Yes. VNO Does the site contain jurisdictional wetlands?_ Yes VNo Are there any easements'or right-of-ways on the site? _VYes No Is the site subject to approval by another public agency? Yes ✓No . • ' Will wastewater.other than domestic sewage be generated?. Yes ✓No IF RESIDENCEFILL OUT THE BOX BELOW Feople `#Bedrooms __ #Bathrooms 3,ri Garden'Tub/Whirlpool M"Yes ON sement: ❑Yes ;9 4o Basement Plumbing:,. ❑Yes.4110 IF NON=RESIDENCE'FILL OUT THE BOX BELOW;- Type-of Facility/Business -Total Square Footage`of Building . #People # Sinks :#'Commodes I# Showers #Urinals Estimated:Water.Usage(gallons per day) ' (Attach documentation 'of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requ ted: ❑ ecepted 0 ovative' OAlternative ❑Other Gv1,1 r1cn11iov rt Pv5h,b1� o2517a dee/vci%p"` 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 EK No yes,what type? This is tocerti that the'informat fy ion' provided on this`applicatiori is true and correct to the best of my knowledge. I understand that pernlllks)itis)or%_nks)1SSUCCI"11CICa1trF QIP SUUJC%A.U)JUSFCMIULI U1 lowti2lUUll IL Ulu J1ta 1J auCtCu,Utc U1tc11UCU Uao t.lanugw,yr a---- the information submitted in this,application is falsified.or changed.Permits issued will expire 5 years from the date of issuance. 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 staking the house/facility location,proposed well location and the location of any,other amenities. Site.Revisit Charge Date(s): A ant's Signature Client Notification Date: EHS: . g . . sig Bae Propertyowner,s or owner's legal representative sl nature Account# I. CZ Revised 11/16 Invoice# C� ~, DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME 11Ot44�ZDATEEVALUATED 7--29'191 PROPOSED FACILITY PROPERTY SIZE 3D 61.a t SUBDIVISION a l'Q R� ROAD NAME 2aoD�/d Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit 4-.,/ Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture group .S-C Consistence Structure Mineralogy HORIZON II DEPTH •yG F" r" Texture group Consistence r Structure Mineralogy - HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: P EVALUATION BY: F✓ia LONG-TERM ACCEPTANCE RATE: / OTHER(S)PRESENT: REMARKS: Yee 0 r -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 oist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm W 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/day1ft2 DCHD(01-90) ._.. _ � � — -�- -.� � _ � _ � — — 30 MAGNOLIA ACRES P.B. 8 PG. 75 � � _� �_ �_ � � �_ _� ,.,�. _._ �_ � LOST FARM DRIVE _ _ — _._. � � o � � � ,�_ o �_ � � �. __I_-------------- � N � � � � �_' � �� + I � — -�--- —� �� S ��`��auuiu►u�ri�� .�`�� '(N .. C A RO '''�. � �P'pFESs/p''•��: � �:�Q� �• � � SEAL 9 -.;�� f� _ �- ' f L 89 ��T � _ . i '9 Ufiv�y�� .-'O�� `f!`r'lC�A�Rpt`'�\\\\\\` PRELIMINARY �IVORK SHEET � � � .� •� ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ . MAP FOR J. READER CONSTRUCTION SCALE TOWNSHIP COUNTY STATE DATE'S 1" = 3Q' SHADY GROVE DAVIE N.C. 11-1-16 LOT t KNOX FARM P.B. 8 PG. 185 REVISED 11-17-16 JOHN RICHARD HOWARD JOB N0. SURVEYING � sQ� P.O. BOX 276 ADVANCE, N,C, (336) 998-5396