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127 Elberon Ct Lot 13 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 #: 989900050 Tax PIN/EH M 5748-83-9141.13 Billed To: Wayne James Construction Subdivision Info: Marbrook Lot#13 Reference Name: Location/Address: John Crotts Road-27028 Proposed Facility: Residence Property Size: see map ATC Number: 4677 Site Type:�ew.❑Repair ❑Expansion i **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 3 #Bathrooms 3 #People '7 Basement❑ Basement plumbinge" Non=Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot SizeZ Type of Water Supply:12rc"ounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD)�0Tank Size 10C�OGAL.Pump Tank GAL. Trench Width _Max.Trench Depth :F;D # Rock Depth tJA Linear Ft. 3� Site Modifications/Conditions/Other: ��c I`L I f� LIX, 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)75 4760. .17 —H%rt. Ips 1�)Vi jS h 'J C5' -1to' I 1-2 2 Environmental Health Specialist Date: 2� DCHD 11/06(Revised) i DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 . OPERATION PERMIT Account M 989900050 Tax PIN/EH M 5748-83-9141.13 Billed To: Wayne James Construction Subdivision Info: Marbrook Lot# 13 Reference Name: Location/Address: John Crotts Road-27028 Proposed Facility: Residence Property Size: see map ATC Number: 4677 **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 Tank Date Tank Size Pump Tank Size System Installed By: E.H.Specialist: Date: DCHD 11/06(Revised) OR SITE EVALUATION/IMPROVEMENT PERMIT & ATC °.f) Davie County Environmental Health 2001P.O.Box 848/210 Hospital Street `� Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 Applica iontFbf O mprovement Permit ❑ Authorization To Construct(ATC) ❑ Both pplication: ew 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 bf wt-'C' Contact Person Billing Address C?, Home Phone /- 2/5*v City/State/ZIP_f��r� /-s l F JV �7c,Z Business Phone tf/- '712cY Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged 5/ NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid fo 60 months with site plan,no expiration with complete plat.) /1 Owner's Name ,( '?Sfir�lODnle� Phone mber 7Q9 -3�1(J3 Owner's Address d -5• City/State/Zi jrasvi Property Address 0 S City { Lot Size 5&t- Tax PIN# —9 A/ . Subdivision Name(if applicable K ection/Lot# Directions To Site: Ig /aS , k 500 1/L/ If the answer to any of the following questions is"yes",supporting documentati9amust be attached. Are there any existing wastewater systems on the site? Dyes ❑No Does the site contain jurisdictional wetlands? [I Yes-ffNo Are there any easements or right-of-ways on the site? Dyes P1No Is the site subject to approval by another public agency? ❑Yes sNo Will wastewater ether than domestic sewage be generated? ❑Yes ETTo IF RESIDENCE FILL OUT THE BOX BELOW #People 4 #Bedrooms 3 #Bathrooms - Garden Tub/Whirlpool ives ❑No Basement: Dyes U No Basement Plumbing: DYes ❑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; onventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type:eCounty/City Water ❑New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes (2J If yes,what type? I 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. 1 Site Revisit Charge Property owner', or owner's legal representative signature Date(s): Client Notification Date: Date EHS: Sin given ❑Yes ❑No Account# q0 0 �o g g �7 Q Revised 11/06 Invoice# 04 i 05/14/2007 MON 10: 53 FAX 3369980879 ERA premier Realty 12002/002 �,f-k. A41' „ •-1' l •• ••r ' y L �� -60 Sw Nzo C Aft 49 'h.•it ,ra, , ,�14 , �•• • ♦� \ Y 4k J* . jo V& �� 5k ICAT OAI F ITE EVALUATION/IMPROVEMENT PERMIT & ATC Q \ $ � avie County Environmental Health �y0 P.O.Box 848/210 Hospital Street `MENSPLHFA`�t1 Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 Applic or: 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. i APPLICANT INFORMATION —y- �/� r Name to be Billed (_r,�v.�, 1- -��- h�Q gee 0 0 wwT Contact Person �C b�ne Billing Address_�L,�$ Ho X h Home Phone City/State/ZIP T ,�,� �/( Z7U01Business Phone el-O yo 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 -V.-1 �-.� ., Phone Number YJ Owner's Address Ro / Sc, t^ City/State/Zip�7d�c,��¢_ A- C. Z 2630(c, Property Address ' J G.r•� C.•a 4 ,� _ City Lot Size c5ee-Ina Tax PIN#_ 5 7V UUl /,/3 Subdivision Name(if applicable) Section/Lot# 3 Directions To Site: His�t (oLl L C.-v �cl. S ti �'v s ti- G e 10V— 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 ❑3'�o Does the site contain jurisdictional wetlands? ❑Yes B11ro Are there any easements or right-of-ways on the site? ❑Y5-s�o Is the site subject to approval by another public agency? ea Y s ❑No Will wastewater other than domestic sewage be generated? ❑Yes Q'1 0— IF RESIDEN E FILL OUT THE BOX BELOW JgijGee1P 3 raam3 #People - #Bedrooms -7 #Bathrooms ZJ 17, Garden Tub/Whirlpool D-Yes ❑No Basement: ❑Yes ❑No Basement Pluur bm—g: ❑Yes ❑No q i i 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: D o—nventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: D-C"ounty/City Water ❑ New Well ❑Existing Well ❑ Community Well j Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 3-1q0— If yes,what type? This is to certify thae 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 staking the house/facility location,proposed well location and the location of any other amenities. / Site Revisit Charge Property er' or owne s legal representative signature Date(s): �- �2 Client Notification Date: Date EHS: 4 Sign given ❑Yes ❑No Account# 4173 Revised 11/06 Invoice# 1 t 4763 TTS RD . �. pHlC.R O . � Paan $ �;., (,tea•' c+h,�„s'' �,: 3�..+j5 a - .. +•y - o k � "� *-It tll ^Cri . r '.� �`., ',r - ,�*.'r V�. x ••- ,,, 4a� y _ Q n M' a »"'-'nz• t +; "� L.:d rr ..Sr rta a" • " QD N a h 7110 L A6 9 a'81rY _ ii.: f $147,�y�Y'�„�x, 1'►'f +L' r tt., r • `rr .;y. 'td d ,�. •r'.s +' �(. ..�, } y' ?�� r. a y •w wa -��'� '�'. �!'.r .':E- ,s ' k ;KTa.}` •. ,�', x , ,a.;�w... 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T �' r -• �( t''{, alp � - 4a, _ 77 IL A ."u.. ,q. �X F:li`7 ,�jR'a �P'•tr1 aet`!r r 1" l'�. _ a ' �' A�•� •"�* ~��-+ � }ems' + �i.��,. �" s Jyt ♦rr F jj¢¢ r10a JAR � 2 '' .:Kifi.�a .-.�.�_ - �...:.- _ .. _.� .r.S".'• _ en%'.=_l.F;�f• ': ��� d , r r1Y _ a��at t -.itaF JOHN C R OTT S RD tzo, 4163 � 41 7648 ,s wro S �2161Y ,j]HNCfi�T - &p 1bPD 47 ® 6631 , �5432Pa D � � � °° o s Ao (��il GnB N \ (3 97 A) 7110 C �p 6 96r2A\ o�6149 a —' po 6P, 0181 9141 1 �o CeB2 ' a1' a (� ✓ (,.81A �63 00 I ° rl� D3 c@ 3Tl PcC22364 GaD CeB2 1S ER 1 cv 1 IT 160 W .P (16.9134) 1 6144 2222 2figA Al GnC2 l N co GnB2 r � c1pA �1 1L T4 !1570) (2''6C7A) 617 SC �24d 9546 � 1 � (150) (2n) 3.07A t r co N W i 1. \ N, \.co `� a LP Lo 1 � ;\ d N - V IS 4 0 T i IFT 5 X77' . rr w .....<..,... .....wr , ' ,4jL ;��'+.".���.,�"M�•w..`�uw_ `•1-• `. � �.�, _• ..y. ..n I � 'I� .1 v , •, DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account M 990004173 Tax PIN/EH#: 5748-83-9141.13 Billed To: Land First Development Subdivision Info: Marbrook Lot# 13 Reference Name: Rodney Bailey Location/Address: John Crotts Road-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: t t o7 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit '� Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L Slope% HORIZON I DEPTH Texture group !_ Consistence (._.r- Structure Mineralo _ i HORIZON H DEPTH - - Texture groupC C Consistence Sp Structure A3 Mineralogy HORIZON III DEPTH 1 - - Texture group 0 S C-V Consistence P ' Structure Mineralogy HORIZON IV DEPTH 4-3 Texture group Consistence Structure Mineralogy SOIL WETNESS -- -- RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE D-'L� ,Z •2�� SITE CLASSIFICATION: �S EVALUATION BY: �� jLlagyt,�Q LONG-TERM ACCEPTANCE RATE: ©' S OTHER(S)PRESENT: REMARKS: C-XSA IaAS V&QTZ Um LEGEND Landscape Position R-Ridge S -Shoulder L-Linear slope FS-Foot slope N-Nose slope I 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 MOW - VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm 3Ygt �� 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 rloJ 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) f N • Davie County Environmental Health P.O.Box 848/210 hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account M 990004173 Tax PIN/EH#: 5748-83-9141.13 Billed To: Land First Development Subdivision Info: Marbrook Lot# 13 Address: 228 NC Hwy 801 North Location/Address: John Crofts Road-27028 City: Advance Property Size: see map Reference Name: Rodney Bailey 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. PermitType: ew ❑Repair ❑Expansion Permit Valid for: ❑5 Yearso Expiration Residential Specifications: #Bedrooms ) #Bathrooms 2�#People Basement,2Basement plumbing Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):,3(,0Q Type of Water Supply: 215ounty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: System Type LTAR Initial ACC3 Repair Site Plan f ,'.'f 1 I01714NI ,, � T L^ oZ 1 Environmental Health Specialist A. )-Date 2s 0 i.p.11-06