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132 Summer Sweet Dr Lot 9 DAME COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 OPERATION PERMIT Account #: 989900241 fax PIN!IWH#: G9100A0009 Billed To: Craig Carter Builders, Inc. Subdivision Info:. ;Magnolia Acres Lot# Reference Name: ::Location/Address: 132 Summer Sweet Drive=27006 Proposed Facility: Residential Property!Size: .83 Acres },T* 8TE TheQissuance 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. 43 System Type.;_ S.T.Manufacturer�h r'� Tank Date Tank Size/j 00 Pump Tank Size, Bedrooms: System Installed By: 6&4,er Installer# 3 d Date: 3- GPS Coordinate: vV 34, oe Environmental Health Specialist 0Date: DCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 989900241Tax PINiEH#; G9100A0009 Billed To: Craig Carter Builders, Inc. Subdivision,lnfo::: Magnolia Acres Lot#9 Reference Name: :LocationiAddress: 132 Summer Sweet Drive-27006.::: Proposed Facility: Residential Property Size: .83 Acres ATC Number: 5979 `:Site Type: Kiew ❑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 _#BathroomsPeople_Basement Basement plumbing El Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size . ?3 CLL Type of Water Supply: 5,fCounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD) Tank Size_=GAL.Pump Tank GAL. Trench Width 3(fl' Max.Trench Depth && Rock Depths Linear Ft._3QO�0?5% Site Modifications/Conditions/Other: Qedu �>'I 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 M- 60. LILA'� Environmental Health Specialist ODate: DCHD 11/06(Revised) . APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT&ATC y(� Davie County Environmental Health P.O.Box 848/210 Hospital Street V Mocksville,NC 27028 1 a A�phcati (336)753-6780/Fax(336)753-1680 or. ❑Site Evaluation/Improvement Permit ❑Authorization To Construct(ATC) Y Both T _ 63tidn: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility f fff p m P � 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 Cc a: C*`l Cf $..��uS S.,e- Contact Person Billing Address t($9 yn d ..% o Kc a Q d Home Phone '5 3 V- 3�15�3 R5 4 City/StateMP AAaenec- PJC- 1 d7o0Co Business Phone 33(.-4146. a'341 Name on Permit/ATC ifDrfferent than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Comers Flagged NOTE: A survey plat or site plan must accompany this application. Included:)KSite Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with Complete plat) Owner's Name So.ntr al, r h o C Phone Number. Owner's Address_ - -n City/State/Zip 1 Property Address �&Mit'l'I 161- City. Lot Size .13 OrtcCJ Tax PIN# IIP0 OD O O Q t Subdivision Name(if applicable) Section/Lot# 1 1 9 Directions To Site: $'b ) 5...44, EW 4.. t. E on Qeoo l e S C eccV- QV j-50 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 Flo Does the site contain jurisdictional wetlands? ❑Yes Wo Are there any easements or right-of-ways on the site? ❑Yes 9wo Is the site subject to approval by another public agency? ❑YesgNo Will wastewater other than domestic sewage be generated? ❑Yes§Wo IF RESIDENCE FILL OUT THE BOX BELOW #People 3 #Bedrooms _7 #Bathrooms :7.S7* Garden Tub/Whirlpool Dyes)KVo Basement:❑Yes Aqo Basement Plumbing: ❑Yes,)&o 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 ltemative ❑Other A ell,4 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 >�No If yes,what type? This is to certify that the information provided on application is true and correct to the best of my knowledge. I understand that any permit(s)o C(s)iss here r bject to suspension or revocation if the site is altered,the intended use changes,or if rmati in application is falsified or changed I hereby grant right of entry to the Authorized �\ Represen e e nt to conduct necessary inspections to determine Compliance with applicable laws and tan sponsible for the proper identification and labeling of property lines and Comers and loc aggi or g ouse/facility location,proposed well location and the location of any other amenities. owner's or owner's leg representative signature Site Revisit Charge Date(s): Client Notification Date: Dte EHS: ���9aaz�r Sign given ❑Yes❑No Account# Revised 11/06 Invoice# P kioNOLN OR SlAiglEp ywEEi —SOR 4x cRE RD F.yi LOCAnON MAP I r M I i\ 1 � m m R,.7,43E cy, / / W 1 i � // R�SQ0� �u� / w E/ /� may, \ E S I g / Nh o i / S SEAL Q 7 I = ' 9A 0'.r L-2890 2; aR A\ v Z'92 Q: Q c Io F<O�t,ON "CHAFO\` 1 " 1 SITE PLAN ONLY 3o NATURAL BURR THIS WAS MAPPED FROM A DEED OR �r RECORD PLAT AND NOT FROM A SURVEY N 7gT � I BYYj ME.. .=9"W 207.91 0 I L. 30 0 30 60 90 �i N 77. 8.1 I GRAPHIC SCALE — FEET MAP PLO EJB"W 74.59 I PLES CREEK ROAD FOR CRAIG CARTER BUILDER SCALE TOWNSHIP COUNTY STATE DATE'S 1" = 30' SHADY GROVE DAME N.C. 9-18-12 LOT 9 MAGNOLIA ACRES PHASE 1 P.B. 8 PG. 63 REVISED 9-18-12 JOHN RICHARD HOWARD JOB NO. SURVEYING 12044 P.O. BOX 276 ADVANCE, N,C, (336) 998-5396 E &VREIf A'� R SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County,Health,Department' JUN - 16 Environmental Health Section ' �I P.D.-B6x,848/210 Hospital Street; Mocksville;NC 27028 �UHEALTH 0 Ij (33.6)751=8760/:.,Fax(336)751-8786' j. bow— Application For: ❑ Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) / ***IMP0RTAN7***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 (�/'Q� r �, Contact Person Billing Address !� Home Phone City/State/ZIP c. ,✓G Business Phone 3 3g — SYS .70 r7 Name on Permit/ATC if Different than Above SC� Mailing Address . �� City/State/Zip PROPERTY INFORMATION -NOTE: A survey plat or site plan must accompany this application. (Permit is valid for 60 months with site plan,no expiration with complete plat.) Street Address I City Tax PIN# 590'x' Subdivision Name a Section/Lot# Lot Size fc p�.i Directions To Site: ' 'd 7i ;l Date House/Facility Corners Iflagged r l 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? 0Ye9KN0 Does the site contain jurisdictional wetlands? ❑Yes�10 Are there any easements,or right-of-ways on the site? *Yes) No Is the site subject to approval by another public agency? ❑Yes>lo i Will wastewater other than domestic sewage be generated? ❑Ye�ATo IF RESIDENC FILL OUTI„THE BOX LOW oe r#�People #Bedrooms #Bathrooms Garden Tub/Whirlpoo es ❑No asement: Yes o Basement Plumbing: ❑Yes o l SII IF-NON-RESIDENCE FILLPUT THE BOX BELOW Type of Facility/Business �i 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: ktonventional ❑Accepted ❑Innovative ernative ❑Other Water Supply Typ unty/City Water ❑New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions lof the facility this system is intended to serve? ❑ Yes ' k4o h If yes,what type? 1� This is to certify that the informationp ded pplication is d correct to the best of my knowledge. I understand that F. any permit(s)or ATC(s)issue er s t e revocation if the site is altered,the intended use changes,or if the information submitte p ' atio fal ' or d. I understand that I am responsible for all charges incurred from this applicatio he tri fen to A orized Representative of the Davie County Health Department to conduct'necess msp det e c lia e th applicable laws and rules on the above described property located in Davie dol d o r, Site Revisit Charge ope e ' or owner's legal representative signature Date(s): ” FR Client Notification Date: Date f EHS: i iSigh gtven ❑Yes❑No ', Account# `�Revis4'2/06Invoice# + \,DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION l LOT Soil/Site Evaluation APPLICANT'S NAME (�� P� DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE ) D SUBDIVISION C' ROAD NAME ©d/ol'el_ Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit L'11/ Cut FACTORS 1 2 3 4 .5 6 7 Landscape position Sloe% HORIZON I DEPTH t Texture groupL Consistence Structure Mineralogy HORIZON II DEPTH y t Texture group Consistence / Structure S !/ Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE A41— CLASSIFICATION LONG-TERM ACCEPTANCE RATE �Q SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: �It'Ite GEND 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(01-90) N 80°03 O7"E 268-66' l 1 / A Al �ys�\ 'So�•f A �� �'� ���5-0pm / 'Pp 10 GARAGE �� �6�1/ l ,� NACE de UT1Ll1Y � 41 40 ICX4 dl. PROPOSED "OUSE tib'' co a / 30 0 30 60 90 CREarnEW DRIVE �y : / GRAPHIC SCALE - FEET MAP go FOR CRAIG CARTER BUILDER O nt Z SCALE TOWNSHIP COUNTY STATE DATES 2; Q TULIP MAGNOLIA DR F A i 3t 1" = 30' SHADY GROVE DAVIE N. C. 6-01-06. SITE PL A.1V ONLY ` LOT 9 MAGNOLIA ACRES PHASE 1 P.B. 8 PG. 63 5 �--� _ e c THIS WAS MAPPED FROM A DEED OR v . r RECORD PLAT AND NOT FROM A SURVEY Joe No. PEOPLES CREEK RD :���Z'� yrC'.5` ?�`. 'ii /CHAP% BY ME HOWARD SURVEYING LOCATION MAP �'i��rrh���u��„„��"•�• JOHN RICHARD HOWARD PLS 06070 P.O. BOX 276 ADVANCE, N.C. (336) 998-5396