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165 Elberon Ct Lot 8 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 990004119 Tax PIN/EH M 5758-03-2533 Billed To: M &M Construction Subdivision Info: Marbrook Lot#8 Reference Name: Location/Address: Elberon Court-27028 Proposed Facility: Residence Property Size: 1.1 acre ATC Number: 4739 **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 uarantee that the system will function satisfactorily for any given period of time. ca System Type: S.T.Manufacturer p ed Tank Date Tank Sizel�rZ'� Pump Tank Size % / - lco System Installed By: \�w'S C�rto�t3 x�,E.H.Specialist: ate: 3 � ct- � s! 21-0 fd at G t� i jj � , - DCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH l 1 • ` P.O.Box 848/210 Hospital Street Mocksville,NC 27028 q I (336)751-8760 Fax#(336)751-8786 I AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account M 990004119 Tax PIN/EH M 5758-03-2533 Billed To: M &M Construction Subdivision Info: Marbrook Lot#8 Reference Name: Location/Address: Elberon Court-27028 Proposed Facility: Residence Property Size: 1.1 acre ATC Number: 4739 Site Typeew ❑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 3 #Bathrooms 2*5#People BasementO Basement plumbing(] Non-;Residential Specifications: Facility Type '#People #Seats Square Footage(or Dimensions of Facility) Lot Size ,, I ACRES Type of Water SupplyA!rCounty/City ❑Well OCommunityWell System Specifications: Design Wastewater Flow(GPD) 5WTank Size ICMAL.Pump Tank IQQDrAL. Trench Width Max.Trench Depth Rock Depth JZ Linear Ft. 1-ILI D Site Modifications/Conditions/Other: "'� ,�/�%��i � O L Contact the Davie County Ovironmental Health.Section for final inspection of this system between 8:30—9:30 .m.on the d in llation. Tele hone#(336)751-8760. As tated In 15A acc pted Systems may also 9Qu `-- uce� h �1- i r �X Environmental Health Specialist ate: p —7 DCHD 11/06(Revised) 08/21/2007 21:33 88780 PAGE 02/04 . rtt Petx& O Authonzgdon To Causttuct(ATC) O Both .-I 57- �7 f op ❑Repan to EVStiog Sym OExpaoswn/ModiScaiion of Existing System orFaci oy ORTANI"_, ICA77ON CAWOT BE PROCESSED UNLESS ALL OF THE REQUIRED t IAIF�O RO FD. Refer to the INFORMATION BULLETIN for instructions. ��liPP1p1CANT TIO R�NM CAS NameibG�;�► nC , Contact Person M H - Bil ' s _ Home Pltotre rty/StatclL1P C o? Business PhoneN - 2 2- Name on Permit/ATC if Different than Above Mailing Address City/StatraZ PROPERTY INFORMATION Vate Muse/Facility Comers VqgLd NOTE: A s ney plat or Ate plttrt rause a000mpany lbws application. Inchrded: ❑Site Plan blWw scale) (PC it' valid for mw�ba with site plan, expiration with�oMem plat.) Owner's Name + a,tn l r t c. Phone Number� -9 Owner's Addtxss Citv6kate/Zi aZ Property Address aK. City 0 L'1 X ILTO-ze Lot Size Tax PIN#�, 7'SR-( Subdivision Name( Ii le 1'aol`-- Secti ILot# d s To n itt ✓�fp J0.0- 1�9yljLfrLC4' tS' If we answer to MW of the following quesdons is-Yes-,Pipporting documcutaU must be attaeleed. Are thea any existing wastewater systems on the side? nYes c Does the site ootuainimisdicxiond wetlands? Oyes Ilii 90 Are there any easeemeuis or right-of-ways on the site? OYes�4o Is the site subject to appivral by another public Wan? Dyes l K Will wastewster other than douweak sewage be generated? ❑Yes[llo IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms --I #Bathrooms Carden 1bWWhir1pool es ONo Basernent:.OYcs Wo .Basement Plumbing: OYca-o, W NON-RESIDENCE FILL OUT THE BOX-BELOW Type of Facility/Business Total Square Footage of Building, #People #Sinks #Commodes #Sbowers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY- #Seats Type system requested: id'Cora+emioml OAacepted Obmvadve- DAhentetive ❑Outer Wirer Supply Type:9/Couuty/City Water O New Well ❑EAstiag Well D Community Well Do you W*dpate additions or expansions of the facility this syst3ern is irmmttded to seme?❑Yes... II'No If yes,wbat type? Thus is tncettify that the infotmaIm providadon this application it tune and correct to the best of my kuowtledgc..I u d. that amy petmit(s)or ATC(s)issued beteslter are subject to suspemsion or revocation if the site, is altered,the iusmaded use changes,or if tho inforiox6on subwictwd in this application is falsif or changed..I b=by grata right of eWY to tb a AuthDliwd Reimsereative of the Davie Comity Health Depmbwa to conduct wcessary inspections to determine compliance with applicable laws and ndes.•i und=Aw d that I am tespow iw for the proper idoufficatiwn and labeling of property lines am camera aid locating and fbW;ing or staking the house/faaWy Wation,prop and well location and tie location of mW othw ameniti es. 08/21/2007 21:33 9966780 PAGE 04/04 1 JUN--13,2006 11:45 000-000-00000 . ,..�. page 1 SITE JOHN S880 14'15"� Amu2( 8.95' X S7. MCWT0 eftNc o 0 0 VS. NtfY. N � Q W O LoCAnOK M (NOT TO scut) I NOTES 1.TSIl6 IS A PA6lJ1liARl YAP ONLY.R tAAS MACE ONLY TO OBtNtt A ilUNbfG- PtLTr W THS MAP OOES MW k=ALL WW fwW rOW HUMAVI M AND EFMD NOT BE UBM nft AW Ift Of CMDVI C6 �A�o •s (A)I PREUMINARY PLAT Not For Recordation, LEGEND Comeya om Or SWes walla"L ME — — -- — .ewlnr►nrs �[--1—E—^ lov"T LIE[ IIIE 1111 RT Wl f if E E1p LltaTm IE°I Pips If w VMMO Eel EMM FWJM E PC"` 50 0 so _ Ux E•11 EAllxdr Ewrwa-w+Et_ . tat �► o aEelcwwf a m a a"' GRAPHIC SCAT-E — FEET OB/21/2007 21:33 9988780 PAGE 03/04 JUR 13,2006 11:45 000-000-00004 page 2 PREUM. (NARY PLAT. �L I?07'TS... Not For Recordation, 7.pq. �0-4D Convoyartc , Or Sales 538.19'19"E 40.00'(MM) N CV N 1 a Y M MARBROOK CT. HW56 LAYOUT FOR M & M CONSTRUCTION CO. ter a w"11AR6NOOK"SUBUM ON \ ! TAX YAP 70MMV COWM I SPATE eK�A DATE 150 YOCKM I E We N.C. 53 At .2O,2007 1 ` ` T K. RONALD IZE 01CMINE scut SURMUG TAX LOT No. aM„ r11 f1 "Mir OW Ne./IW sm L-a 071351 d , ICAT�911 F ITE EVALUATION/IMPROVEMENT PERMIT & ATC v Z a avie County Environmental Health P.O.Box 848/210 Hospital Street �MENTPLNFALj� Mocksville NC 27028 (336)751-8760/Fax(336)751-8786 Applic n 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. APPLICANT INFORMATION Name to be Billed Da t/e t 0 Contact Person Billing Address_ �$ �w X w / Ste„ h Home Phone City/State/ZIP 14&6.e4 ,4-cam' �(/� Z 7QQk 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 C �--�z ., Phone Number ?ALI.-SSC)3 Owner's Address Rol City/State/Zip_ /�c,r« /UC. Z 7Cv o Property Address .! (�v% Cfa 0eJ_ City /110(_ Lot Size c52P,in Tax PIN# Subdivision Name(if applicable) W k Section/Lot# Directions To Site: �'f S! (o y L '� Z'v�+.+ �� )er , S v fj ; O � `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 0-155 Does the site contain jurisdictional wetlands? ❑Yes ❑'ice Are there any easements or right-of-ways on the site? ❑Yes 0 Is the site subject to approval by another public agency? ea Y s ❑No Will wastewater other than domestic sewage be generated? ❑Yes 2N`6 — IF RESIDEN E FILL OUT THE BOX BELOW f #People #Bedrooms V #Bathroom;�, Garden Tub/Whirlpool Ores ❑No j Basement: ❑ es ❑No Basement Plumbing: ❑Yes ❑No 4 I+ IF NON-RESIDENCE FILL OUT THE BOX BELOW f 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: a-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 0-50— If yes,what type? We4 This is to certify tha a 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 legal representative signature Date(s): ��— ,2 Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# Revised 11/06 Invoice# y v 1 J00 h fE31 a � . (3 g7A) - F.f: + •.-.ice. . 7210 Q lr 4 �',f dY`F Qr r ai r rjxe 9!"`+`,'` �uYX{X41 ,,�'*f fF, "ri bi r t� ° , L„.AeR., r 37 !�+r T• ,•_ •rd� ,r: : ' •. r � R¢ 41 itdxn'` ' r �'� � s3 � ✓ aY .d+r :� fh��a8"�"` 'Ttn,a. ` s,•,a � y � •...�� �z„ a. ,� � �r 0.-,T.. .,p•£ e '!t..:•fi,1.v � a.r,it��S�� of + �` A`�s ` +�, «�f °r �_s`:� P di YJ51 .16 • - a• , M e ti• ctz (1& 1 A i-.?lt. p"vs'+`.4 r a - fit. i..- ,s,- •F, >� ��. .�4'.d 2'3 +�L �a�!aR (• �.i ���.�fP�f• � p`i,�1.. ` � �J .v•. 7 •�1 ��tr�,iT y �_ r #�•r. -t iR n* '=rf E ^t wy .*n�l •F ,�+ �. ''ot ate,#_ rx,a At 71 44 r r a k,.- .4 : �yl�, fI 16► � i' .�"�y dna � � "*� - m'�.: ( mt*x �'^ a 3!d'. �""� sem, .� ��•./c;s' .t a �` 'k"�$�;�',."wr� � a � ��' ,�j ` :� � },�". � •'�'- yrs - �g�.�`'"�• ;Is'°; +' i �# � �4 r �� �� ��.4� 6 '" __ uta�.�yr.�a•; .Yi' wr�1�' W'1 1'4.• JOHN CROTT 453 z� S R:D s�s 7648 cater pNNcMTT`-MK^ - o eo 5 .,c � �A o 711 A ,5%22 ,, PaD � � GnB s N (3.97 A) H 7110 Y ar;rrzn % o \ 6149 —� 9 81) — ( 4 ) ~O G CeB2 / �9141 108,' o � 5� - (1.81A �63 co \�I P / �� ' X64 cC2 CeB2 GaD (,5. co J „ 160 > W (,8.984) 1 6144 GnC2 1 N GnB2 K 61) Xa 17 fir;. so 0,0 J ti 9543 co d l 1 (t5p1 :-53i 1 y h �• (•© ' �� \�� 114, m , -'^u=..amu�. .. - '-,�• t VV -,D"� o 1 , let $D-tQQ N •v ,- 1 / 4 p5)Ln 23 0o DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004173 Tax PIN/EH#: 5748-83-9141.08 Billed To: Land First Development Subdivision Info: Marbrook Lot#08 Reference Name: Rodney Bailey Location/Address: John Crotts Road-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: 1 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L 5 C Sloe% 17--170 1917, HORIZON I DEPTH - O-14 Cb-- o- -7 Texture - Texture rou Consistence S SS Structure s6v_ Mineralogy Cvv 50 - HORIZON II DEPTH 2 Texture groupa 11 Consistence Structure Mineralogy HORIZON III DEPTH2--U Texture groupCL t, C t 1 Consistence VP S Structure Mineralogy �., HORIZON IV DEPTH y, Z - Texture group (300 CL SA 0 Gt_ Consistence Structure Mineralogy SOIL WETNESS — RESTRICTIVE HORIZON - 37 SAPROLITE - V CLASSIFICATION S LONG-TERM ACCEPTANCE RATE D.27S D•Z7S 27- \ SITE CLASSIFICATION: 1 S EVALUATION BY: C}NUC.II�^ LONG-TERM ACCEPTANCE RATE: D•Z7� OTHER(S)PRESENT: REMARKS: PV P KN Q !<�� �- +J UrA►Jt k 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 �Qist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm met NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic z 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 LYQt� 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 M 990004173 Tax PIN/EH M 5748-83-9141.08 Billed To: Land First Development Subdivision Info: Marbrook Lot#08 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. ' Permit Type: ;iew ❑Repair,❑Expansion Permit Valid for: 0 Years 2<0 Expiration Residential Specifications: #Bedrooms #BathroomsIL!---, People-Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) DesignFlow(GPD):� Type of Water Supply:;?Kounty/City ❑Well OCommunity Well Site Modifications/Permit Conditions: FL-We' 3t?cSTL7V`. System Type LTAR Initial Re airS Site Plan `` _ i. - i i .'N 00' 113'.N� 517.73' > z \ / x 1� A C. Z ip1 N1, NI Ts r Environmental Health Specialist Date ©7 i.p.11-06 10