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162 Elberon Ct Lot 7 ...r DAVIE COUNTY ENVIRONMENTAL HEALTH Z P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account #: 990003908 Tax PIN/EH#: 5748-83-9141.07 Billed To: Mark Davis Subdivision Info: Marbrook Lot#07 Reference Name: Location/Address: Proposed Facility: Residence Property Size: See Map ATC Number: 4684 **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: y ; S.T.Manufacturer C?shi 4Date Tank SizeCOO Pump Tank Size System Installed By: C�P'�1^' E.H.Spece: 07 >I syb r `1 1 s c DCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH Qj P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990003908 Tax PIN/EH M 5748-83-9141.07 Billed To: Mark Davis Subdivision Info: Marbrook Lot#07 Reference Name: Location/Address: Proposed Facility: Residence Property Size: See Map ATC Number: 4684 SiteType:,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 A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. 2 Residential Specifications: #Bedrooms 3 #Bathrooms _#Peoplej Basement❑ Basement plumbin Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size - �2 Type of Water Supply:66ounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD) ZC4( >1 ank Size 10D GAL.Pump Tank GAL. .. Trench Width la Max.Trench Depth Rock Depth t-3 Linear Ft. /330 Site Modifi ions/CQnditions/Other: - t2 © -&r42 t � Contact the Davie County Environmental Health Katic4 ion r final inspection of this system between 8:30—9:30a.m.on the da of inst T le hone#(336)751-8760. �8 0 N mental Health nSpecialist "Je Date: 09 65�VQ 7 DC D 11/06(Revised) 221 !� 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 990003908 Tax PIN/EH M 5748-83-9141.07 Billed To: Mark Davis Subdivision Info: Marbrook Lot#07 Reference Name: Location/Address: Proposed Facility: Residence- Property Size: See Map ATC Number: 4684 � Site Type:,,ZCw* ❑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 #Bathroomsy #People Basement❑ Basement plumbin Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size 1�3� ' {2 Type of Water Supply:P ounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD)300 Tank Size.ICCOGAL.Pump Tank GAL. Trench Width Max.Trench epth Z� Rock Depth'JZ Linear Ft. Site Modifications/Conditions/Other: 1S`��L1 0 Contact the Davie County Environmental ealKaa ctiontephone final inspection of this system etween 8:30—9:30a.m.on the d of in ion. #(336)751-8760. stated in 15A NCAC 1EA. 969(5) d w,l h eco to�Stams may also 5 used tZ 175 6 ,,11 �e� `,`� ^� oO CGN� G1G✓ CC Q- , CA�r Ow —ly. "7 i ` i� r2 CAS GL.-dCE°tt �� S�51n.�c� Las ^ D cc_-,( far flG�trtd/ S �ak�cy of 'yd J� 0-to v-r 1©"1` / ZZ -e t e c h 7Lr'r, 1e CCOGc�®o�Y o r Environmental Health Specialist �e DCHD 11/06(Revised) - ,. 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 #: 990003908 Tax PIN/EH M 5748-83-9141.07 Billed To: Mark Davis Subdivision Info: Marbrook Lot#07 Reference Name: Location/Address: Proposed Facility: Residence_ Property Size: See Map ATC Number: 4684 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 A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms Z #Bathroomsy #People Basement❑ Basement plumbinu Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size 31,311 Type of Water Supply: ;?eounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD);3j00 Tank Size ICOJGAL.Pump Tank GAL. Trench Width Max.Tr7hepth Zg GP Rock Depth'1 Z Linear Ft. Site Modifications/Conditions/Other: �lScl�.la.� F� �lC�� 0 Contact the Davie County Environmental ealt ction or final inspection of this system between flD= 8:30—9:30a.m.on the d of in a a ion. le hone#(336)751-8760. J As stated in 15A NCAC 38A. 69(5 accepted Systams may also b use �D �a Y. jag Environmental Health Specialist ate: v2&&/ DCHD 11/06(Revised) y O R SITE EVALUATION/IMPROVEMENT PERMIT & ATC ' Davie County Environmental Health D P.O.Box 848/210 Hospital Street �ll�►� 15 �d�� Mocksville, (336)751-8760/Fax(336)751-8786 ppli val mprovement PermitAuthorization To Construct(ATC) ❑ Both e of A iceew 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 4Y2 0,4 V I Contact Person Billing Address �, 0 Home Phone 33 G, -KJ 7 7 City/State/ZIP O Business Phone �r 1 7 C, 7 7 j Name on Permit/ATC if Different than Above . Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged /S 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 S A/71155 S Phone Number Owner's Address City/State/Zip Property Address City Lot Size Tax PIN# Subdivision Name(if applicable) Sectign/Lot# Directions To Site:_ 6(4 F' Tp %<<�( If the answer to any of the following questions is"yes",supporting documentatioj ust be attached. Are there any existing wastewater systems on the site? ❑Yes Fdo Does the site contain jurisdictional wetlands? ❑Yes Are there any easements or right-of-ways on the site? ❑Yes Is the site subject to approval by another public agency? ❑Yes Will wastewater other than domestic sewage be generated? ❑Yes Ko IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms #bathrooms Garden Tub/Whirlpool a es ❑No Basement: es ❑No Basement Plumbing: ❑ es ❑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; VConventional ❑Accepted ❑Innovative ❑Alternative ❑Other u � �N Water Supply Type: ❑./ounty/City Water ❑New Well ❑Existing Well ❑ Community Well Y G 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 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 understanj that I am responsible for the proper identification and labeling of property lines and comers and locating and flagging or staking e h use oc 'on,proposed well location and the location of any other amenities. VJ '���` Site Revisit Charge Property er's or owner's legal representative signature Date(s): /45-/02 Client Notification Date: Dat EHS: F Sign given ❑Yes ONo ij Account# �7�b Revised 11/06 Invoice# 1'/ 70 A ICAT�gy F ITE EVALUATION/IMPROVEMENT PERMIT & ATC \ 2$ "� avie County Environmental Health p�HEA`�N P.O.Box 848/210 Hospital Street SME Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 Applic n or: r 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 to be Billed _c- Contact Person Billing Address �L,�$ Hoy Fd l 5,,,'Jh Home Phone City/State/ZIP 14&&. AJr 2 7-2 Q�Business Phone 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: ite Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name r=:.-5+ Ozv,-to Phone/N�umber �� •-3,?6)3 Owner's Address o/ S�, 4-L, City/State/Zip /mac,r« /AJC. Z 76,y Property Address J G.c•� C,.� 6�,�_ City /')I,> ks-,, ',I/V Lot Size &ee- _Tax PIN# 677a 0kirC7/t{/,67 Subdivision Name(if applicable) k Section/Lot# Directions To Site: HSV (A L '�- �'�1^►� Cry �tl. S� �� v�s�� � `e 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 03qo- Does the site contain jurisdictional wetlands? ❑Yes DNS Are there any easements or right-of-ways on the site? ❑Yes o Is the site subject to approval by another public agency? es ❑No Will wastewater other than domestic sewage be generated? ❑Yes DN-6— IF RESIDEN E FILL OUT THE BOX BELOW #People #Bedrooms -7 #BathroomsV 17-, Garden Tub/Whirlpool (mss ❑No Basement: 0 es ❑No 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: ErConventional ❑Accepted ❑Innovative ❑Altemative ❑Other Water Supply Type: 03 ounty/City Water ❑New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 3-1q If yes,what type? This is to certify that fhe information provided on this application is true and correct to the best of my knowledge. I understand that any pemmit(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 corers and locating and flagging or staking the house/facility location,proposed well location and the location of any other amenities. ,". alz Property er' or owne s legal representative signature Site Revisit Charge Date(s): Z- .2 Y=y(�, Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# Revised 11/06 Invoice# r c .< - ; 'e'•NuC � �, a '�: ,i,.. ,d_..tea_ ..q.�'" `�t t� -,iF }'� iLT - 4763oartrs R jo 1 .y1 r RIO I 't'2El,f„a�4. , OL,`"�,. •� d �„.+ [ F��.ax Ik4300 • � (Qf " �L �,`�"n"" `" .� y^• 'ria ��` '` ��' ! '�+:�' �:�� ' � J. +*s 'uF '" N �� � �}� d � 7�'�� " n Al 'a e ayb� 1110 6145 ia.',� A� ,���W�.'.� ..ti s��*;P� h��� ��• _ ('" ••.r � y;, r J ��,� '�''��� rt5�x� .<...., � i u °�`°,S1'° 3r`�,147 t�y�L-".,�• �r�y,.� � ..i x -• :� I'i � .: �... 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' ti I Cozrr LP 19'. .,' •!Y) t T ter' ,�f�, � � r % r i DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004173 Tax PIN/EH#: 5748-83-9141.07 Billed To: Land First Development Subdivision Info: Marbrook Lot#07 Reference Name: Rodney Bailey Location/Address: John Crotts Road-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: I1 0_7 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH p- ILI 0-S S Texture groupL Consistence S Structure Mineralogy HORIZON II DEPTH 2 S-2n_ 5" HT i Texture group C_ S,-CL Consistence Fi-S 5 Fr E Structure ( 551_ f Mineralogy S�._V 5exv HORIZON III DEPTH 47--so 7Z- 7- Texture groupS: Com►-fir_ S l_ � Consistence G-nJS (r ;3S AI) Structure &14l Mineralogy :::�-q to 7-3T, HORIZON IV DEPTH —4 Texture group L Consistence A15 Structure Mineralogy SOIL WETNESS -- RESTRICTIVE HORIZON q2, 2_ SAPROLITE S CLASSIFICATION P fS LONG-TERM ACCEPTANCE RATE C .LIS o.3 SITE CLASSIFICATION: �> EVALUATION BY- LONG-TERM ACCEPTANCE RATE: d'�' OTHER(S)PRESENT: REMARKS 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 I CONSISTENCE 1�l2ISt � VFR-Very friable FR-Friable FI-Finn VFI-Very firm EFI-Extremely firm 3yet 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 NQteS 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) Davie County Environmental Health P.O.Box 848/210 Hospital Street 'Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990004173 Tax PIN/EH#: 5748-83-9141.07 Billed To: Land First Development Subdivision Info: Marbrook Lot#07 Address: 228 NC Hwy 801 North Location/Address: John Crotts 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. Permit Type: ew ❑Repair ❑Expansion Permit Valid for: 0 Years o Expiration Residential Specifications: #Bedrooms-4 #Bathrooms5#People Basementasement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply: ;?6ounty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: rV p 'nwC)TL—V\' System Type LTAR is d• 77s- Initial Re air — a Site Plan tea. i •� � G Environmental Health Specialist / D e 2 412-6/ D? i.p.11-06