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449 No Creek Rd � . . . '� . DAVIE COUNTY ENVIRONMENTAL HEALTH ��' , . P.O.Box 848/210 Hospital Street , • Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 �a /3 �Q� OPERATION PERMIT Account #: 990004354 Tax PIN/EH#: 5768-14-9067 Billed To: Cicuto Building & Remodeling Subdivision Info: •' Reference Name: Location/Address: No Creek Road-27028 ��� Nd C�����-�� Proposed Facility: Detached Garage/Apt. Property Size: 15 Acres ATC Number: 4709 **NOTE**The issuance of this Operation Pernut 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 ' e ��' Pump Tank Size =•J System Installed By: �� `��� E.H.Specialis • �!� � �ic� � ��r> C+�4w��. F�►T' ��yo ��� , �' 2N �� 1� , s �' 8 �� 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 #: 990004354 Tax PIN/EH#: 5768-14-9067 Billed To: Cicuto Building & Remodeling Subdivision Info: Reference Name: Location/Address: No Creek Road-27028 Proposed Facility: Detached Garage/Apt. Property Size: 15 Acres ATC Numbe�: 4709 Site Type�ew ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building pernrit(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 � #Bathrooms�#People � Basement❑ Basement plumbing0 Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size �5`��S Type of Water Supply:.�County/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD)�� Tank Size��L�'AL.Pump Tank GAL. 2 �� '1 j�� Trench Widthc�(,. Max.Trench Depth� Rock Depth� Linear Ft. Site Modifications/Conditions/Other: ���-�'J � � � ���i�c7� S� " � � . �� Contact the Davie County Environmental Health Section for final inspection of this system between . 8:30—9:30a.m.on the da of installatiau. Tele hone# 336 751-8760. � � N� C�dG � '�--,"F��11� . � �o � � �v :, s ��� . � � , �- i 3�r,. �t�pp��' � � �n c�2 � 7 8'I ���� Environmental Health Specialist Da : 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 #: 990004354 Tax PIN/EH #: 5768-14-9067 Billed To: Cicuto Building &Remodeling Subdivision Info: Reference Name: Location/Address: No Creek Road-27028 Proposed Facility: Detached Garage/Apt. Property Size: 15 Acres ATC Number: 4709 Site Type:�lew ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building pernut(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 � #Bathrooms � #People 2- Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type�A���'ti� #People #Seats Square Footage(or Dimensions of Facility) Lot Size ���� Type of Water Supply: �ounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD) !�' Tank Size ��'AL.Pump Tank�AL. Trench Width� Max.Trench Depth ��I Rock Depth i1l L� Linear Ft. �2.0� Site Modifications/Conditions/Other: �/�57�(.L C� `-�iJ?fJ7�� . ���� �J/o ��UJ��"� ���� •' Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760. � �� � . �X,���t.�C� � � 1-��� _^�� , � � , ��(�/r � ` `�O � t 1�� ,� PAae� •3�� � -r� ca�,� Environmental Health Specialist Date: � DCHD 11/06(Revised) May 09 01 12:44 � �a � ounty envhealth 336 751 8786 p. l �� � � � � D � � � �a,GL wl�en �eac�� • � ;APPLICA\T��I�R S TE E ALUATI()N/IM E'ROVEMENT PERMIT&ATC / n ''' � ��p� vie unty Environmental Health � ��1� 't'(7 1"IQ�n/�j �\� ��� P.O. x 848R10�iospita]Street � � \��GGUc� ( > ocksville,N( 2�:t8 ��RO���`, ��� 336 751-8760/Fax 336 751-8786 �N Qp�I�E Ap �cation For• �e Evaluation�lmprovement Permit 0 Authorizition To Consuuct(ATC) �S(,Both Type �eaGon:�Ncw System 7Repair to Existing System ❑Exp:nsion/Modification oCExisting 8'5�;•':S�r FaCiliry **•lMPORTAN'!'"•*THIS APPL(GITION CANNOT BE PROCESSEU LINLESS ALL QF TH��J1F.j�SJ INFORMATION 13 PR01!lDED. Refer to the INFORMATION BULLEI'IN for instntctions. APPLICANT TNFORMATION Name to be Billed C�G�� Qv��Iw� 1-��+o�-t�LL,� Cuntact Person ��-vi d.-n C� c-u�c+o Billing Address 0 UO � ����G�-. Fiome Phone City/State/ZIP :, � ,G• 2 1 2_ Business Phone �1(ci 5�3- `d 0�-/ '�'�� r -} Name on PermiUATC if Di,Jj"erent:han Above �,� ��'� L z2� Mailing Address City/State/Zip PROPERTY INFORMATION *Date Hou>e/Facility Corners Fla ed S .s G� ' NOTE: A survey plat or site plan m��st accompany this application. Inc:uded:U Site Plan fi�'lat(to scale) (Pemtit is valid Cor 60 montha with site lan,no exp'ration wi mpleteplat.) Owner's Name M.��r � Phane N�}m'ber — 4�- �{r Owner'sAddress . G✓ �.City/State/Zi (`'�OUK�v:I �L- 2�-D7� Property Addre s�L,(q � y City 0� 5 V� Lot Size r�l,�✓�'S ,�Tax PIN# �� Subdivision Namc(if a plicablc)_ S�:ction/I.,ot# _ Directions To Site:_�p�____F-'(�i�S��� = -Pc� , i�o C✓�../2 .,�_L e.�'—�'-, ►ti¢_, vh 4 0•r� � e. If the answer to any of the following t;uesrions is"yes",supporting documcntation must be attac ied. Are there any existing waste^�ater systems on the site? �J'es ONo Does the site contain jurisdi:tional wedands? Ol'es�Tlo Are then any easements or right-ot ways on du site? ❑5'es,�to Is the site subject to approval by another public agency? ❑'i es�jj�io Will wastewater other than domes6c sewage be generated? Cl'es�io IF RESIDENCE FILL OUT TEi�BOX BET,OW � ��� - . #People ;• 2 #Bedcooms 1 #B throoms Garden Tub/Whirlpool IlYes o Q� �- $asemen4:�OY,es o Basement Ptumbing: f7Yes o e � � � ���� . IF NON=RESIDENCE FILI,OUT THE BOX BELOW Type of Facilityi$usiness . _Total Square Faitage of Buildin� #PeOpJe ��� #Sinks #Commode.; #Showers #Urinals ' Estimated Water Usage(gallons��er day) {Attach documentation of similar facility water consumption) FOODSERVICB ONLY: #Seate Type system requested:.JQConventioual ❑Accepted Olnnovative ❑ALernative OOther . Water SupplyType:�County/Ciry`Nater ❑New WeU flExisting Well l I Communiry Welt Do you anticipate additions or expansions of the facility this system is inteuded to serve?o Yes �No ' If yes,what type? _, This is to certify that the informat�on provided on this application is true a�d cocrect to the best of my knowledge. 1 understand that any permit(s)ot ATC(s)issued here:�fter are subject to suspension or revo:ation if the site is altered,the intended use changes,or if the infotmation submitted in this ap�lication is falsified or changed. I hen:by grant tight of entry to tlic Autliorized RcpresenWtive of the Davie County Health Depa�trrent to conduct necessary inspections :o deterniine compliance with applicable laws and iules. 1 understand that I am responsible for the proper identi£ication and labelin;of property lines and corners and locating und tlagging . or swking ie house/facility loca'on.propoud well location and the Iucation of suy other amaiities. ' Site Revisit Charge Pr tty owne['s or owner's legal representarive signawre Dute(s):_ '� Client Ncitlficalion Datc: Date EHS: _ � �Sign givrn �Yes❑No Account�/ Revised I Il06 Invoice# �lL�// / �� ,��� `'9� � � . � , l a�\v � . s8� . �•V�O�!� ` �Q r , � . . i, �r;�n,ploced O rr�;'' _ �C� ` � _ tn M . =�'� po�nt � cv �� - � � . t � •� , •o `� � . � i ;, �'- ' � ►r�n � , � �� o N �� ' � foun� S 89°-02�- 50�� E�� ` ' � � � 572. 28� /(� = point _ � � � � �� � � N04°48-�15 E� � cv . . 3g.00 :.� omt �Y .� p � � - . . _ . �w . � �l � , �: � 3 45.41 , � O �.. - N8►'-30'W � � � t �� ��0 HC1�� cv c �ror. 9loci�=50�_. –�''�-� �,N.>�,�' ' � . _ a,�jO��� • YocP?'''� (�'l � - n. tl — S .87• 36 W� � .\�S, `W 1 �p�`L ,`L . . . lo�� '� � . E �t N6s� � �: . � �_N sa°-��'-3o"w. , � �.t�-_ p . _ 94 23•w�rQ: \.. \\ 34.16� ..� - `., .' �,_� � '�: � ,p °I ' / �tY. . � . . . � � r . � r . bY�✓ f � �I L��`�'�+ � � s, p�aC� +t. \ . o / . : _ �'`,.. . !: � �.� ,\_ �\ �,47 -54�W �-. 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Consistence � C � Structure L 5 Mineralo ' .� ' HORIZON II DEPTH ' � Q -� Zy -� (a ^,S t • Texture rou '•�'f G _ 5, S Consistence ` r� % ,' ' Structure � � Mineralo � HORIZON III DEPTH Q^GL ZZ— "��' Texture rou SGL-4 � Gonsistence SS ' ' , Structure Mineralo � • HORIZON IV DEP'TH ' i� — � Texture rou Consistence �,` �Structure ' Mineralo SOIL'WETNESS � � •— Z-- . RESTRICTIVE HORIZON 0 Z`Z �?1 SAPROLITE -- ` CLASSIFICAT'ION �' LONG-TERM ACCEPTANCE RATE . 7 �� SITE CLASSIFICATION: r � EVALUATION BY: �l"'R— U"��� - �.�' LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: � REMARKS: LEGEND Landscape Posi ion , 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-Ciay �ONSIS �.N . . a'IQ1S� VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm � NS -Non sticky SS -Slightly sticky S-Sticky VS -Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic � � , Skructure _ SC-Single grain M-Massive CR-Crumb GR-Granulaz ABK-Angular blocky T SBK-Subangular blocky PL-Platy PR-Prismatic • Mineraloev 1:1,2:1,Mixed lY��� 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 Classi�cation-S(suitable),PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate-gal/day/ft2 DCHD OS/OS(Revisedl � ■■■���■�■�■�■■■��■���������■■o■�■■■�����■■■�e���■■s��������■�����■ ■■■■��■��■���■■�■����■����■���■■�■�■�■��■����■����■■��■���■�����■ ■■■■����������■�■■■�������■����■ ■���■��������■■■■��������■�����■ ■■■■■����■��■■�■��■�■���s���■■■��■���■����■�����■���■■�����■■��■�■ ■■�■��■����������■�■■���■���■■���■�■��vii���■����■�■■��■����■■���■ ■�■���■�■■■■■����■■■�■�■������������■�I:��,����■�■����■■�����■�■�■■■ ■��■■■■��■��■����■■��■�■���■■■■�■■���■r►1A���\��■���■�����■�■�■�■■■ ■�■■������■�■��■��■■���■����■�■�■�����■\'�r7����■■����■�����■■■■�■�■ ■�■■��■��■■■������������■�■■■��■■■������r������■■■��■������■■■■■■■ ■��■■������■■�����■����■��■�■■■■�����■■�n■■���■■■������■���■��■��■ 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Davie County Environmental Health , � , P.O.Box 848/210 Hospital Street Mocksville;NC 27028 (336)751=8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990004354 Tax PIN/EH #: 5768-14-9067 Billed To: Cicuto Building & Remodeling Subdivision Info: Address: 4000 Juniper Ct. Location/Address: No Creek Road-27028 City: Raleigh Property Size: 15 Acres Reference Name: • Proposed Facility: Detached Garage/Apt. **NOTE**This Ixnprovement 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:. Years �No Expiration Residential Specifications: #Bedrooms I #Bathrooms � #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type �_..�—�� #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):_��v Type of Water Supply:�unty/City ❑Well ❑Community Well Site Modifications/Pernut Conditions: S stem T e LTAR Initial 1�? Re air � - Site Plan , , ���a;��j � �`'' ; �G-�����` � � �X�sT�� � � �� � � E�r ..�� � .�/ . a'. - :,`" . . . ' . \/ .• �� . 'c� ' . �� t �''� �" ;. .i� ��' p'��' � �� . 1� � ..��r G�� �: , Environmental Health Specialist � Date� / i.p.i 1-06 � � _ � � �, � ��� � „� � - .a � ' � � ° _ _ �, `� � j �a , ,� ��t ,. � r A� � ` � �:° � � � � � �,� �� � � „� � � � � ; ` �� � .� � �'_ �� �� � " �� ., , ' � < < - � � ,_ ; � �t � �a�" '� �% Ys � �� � n% , ; . . , : . -s - ,�.:� � �� _ e - *�� a . . f � � r �'�1 � ,.. � r . ., . _ °.: . ,,, � „ � - ,. : - �. .._ . , . ' , .,, � . . > s .. � . >� v '�-�, ��3, � _ � � . 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