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242 Stony Brook Trail Lot 41 • DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT `1 Account #: '990004432 Tax PIN/EH M. 5820-32-0877 Billed To: Ron Whitlock Subdivision Info: North Brook Lot#41 Reference Name: Location/Address: .Stony Brook Drive-27028 Proposed Facility: Residence Property Size: 5.008 ATC Number: 4868 **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 forr any given period of time. System Type: S.T.'Manufacturer. Tao Date f Tank Size Pump Tank Size 11 1 System Installed By: LO E.H.Spe alist: MAjwk Date: 22 6 le�ei 0 3S' >. c y� c►� nCT-M 11/0fi(RPvi-ed) 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 #: 990004432 Tax PIN/EH#: 5820-32-0877 Billed To: Ron Whitlock Subdivision Info: North Brook Lot#41 Reference Name: Location/Address: Stony Brook Drive-27028 Proposed Facility: Residence Property Size: 5.008 ATC Number: 4868 Site Type: ❑IGew ❑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 ;5#People Basementlsement plumbingR'--- Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size d D ' Cr tS Type of Water Supply: 2 ounty/City ❑Well ❑Community.Well System Specifications: Design Wastewater Flow(GPD)346 Tank Size_ 000 GAL.Pump Tank GAL. Trench Width 3 G Max.Trench Depth 3o Rock Depth /1 Linear Ft. A ,-.meted in 15A NCAC 18A.196%;Ja Site Modifications/Conditions/Other: C.r_►Mnted Systems may also be usccl 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)751-8760. ftd JL -z a � • 1 Environmental Health Specialist"• d Date: DCHD 11/06(Revised) :'}` • IIA EVALUATION/IMPROVEMENT PERMIT & ATC ie County Environmental Health JAN _ 3 200a .O.Box 848/210 Hospital Street C1 &ewA Mocksville;NC 27028 (3 6)751-8760/Fax(336)751-8786 °�jr ISN , ' �Pd1R0hV1EC r�au Applicati For: ❑.Sit ion/Improvement Permit ❑ Authorization To Construct(ATC), Both �I.�,�/U Type of A i ion: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing ystem 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 / i/f fe kmjville W. tkid/e 7029 Name to be Billed Contact Person Aa^ 'Zoc Billing Address //.4/ MAry.S AL Home Phone 2V 8- Q,23-7 City/State/ZIPBusiness Phone -2 S-)?- (D/4 8 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 -o'n Phone Number 94d'- (),;23-7 Owner's Address &'/ /yt47"K5 OL City/State/Zip U ,.Ke i?iC 2r 70 o(0 Property Address pT `J J :5+4 i3hodIL rry 4� s✓�//P Lot Size Tax PIN# Subdivision Name(if applicable) ,AJatf/t /3,&aoW Section/Lot# L / Directions To Site: 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 o Does the site contain jurisdictional wetlands? ❑Yes XNo Are there any easements or right-of-ways on the site? ❑YesNo Is the site subject to approval by another public agency? ❑Yes RNo Will wastewater other than domestic sewage be generated? ❑Yes 4No IF RESIDENCE FILL OUT THE BOX BELOW #People 3 #Bedrooms _ Bathrooms Garden Tub/Whirlpool ❑Yes MO Basement: es ❑No Basement Plumbing: VYes 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:. ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other 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 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 owner's or owner's legal representative signature Date(s): Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account# 37i Revised*11/06 Invoice# 0 STONY BROOK TRAIL a M -- N L2 Ll O ' �. OP P R l VAT E ROAD ` ---- 3`� 136 L T #4 , 8 AC.} A a LOT #40 N AC.) to ui (5.-519 '. Lo 00 -� Co �O J 502. 64 TOTAL p 30, 15 �s'6 a LOT #42 R (5.425 AC.) CL o z co Q4' 55 zQ� ��L ` �\ ;.} 0 60 UT UTY �5 0 ` L Lo ACCESS EASEMENT FOR THE PURPOSE OF INGRESS & EGRESS „fie _ -k ,aAPG� LOT #17 PPICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health E P.O.Box 848/210 Hospital Street Mocksville,NC 27028 _ (336)751-8760/Fax(336)751-8786 ii atibn For? Site Evalua ion/I provement Permit ❑ Authorization To Construct(ATC) moth ype f A 1• em ❑Repair to Existing System ❑Expansion/M�cation of Existing System or Facility . �(}(�?flEtdTA1 t: ***I LICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed -P.O, oy-ky-,k- Contact Person Billing Address /73 : Ar-V- j3-age- &A Home Phone 336 4/9.2-,2660 City/Stale/ZIP Mcsck3o,'I I e tJC 27-3-2 Q Business Phone 334 7S7- 6,1.o? Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged I? ZR 6'I NOTE: A survey plat or site plan must accompany this application. Included: XSite Plan ❑Plat(to scale) (Permit is valid for 60 months with site Ian,no expiration with complete plat.) Owner's Name Barbaro d- f)t' uej VPSJe-r'" Phone Number Owner's Address —J City/State/Zip kJaC,K-9AI(C NG Property Address --yt0Akl d61cr1^;J City 111 c-b u.llW Lot Size 57 vo 8 AG Tax PINgjn 3 JOA'7 j Subdivision Name(if applicable)�'t/o,c,L,( Q,ede K Section/Lot# elf Directions To Site: A-Ar" fnvck,)u;'lle &d (Poi W To =K�Me-q /u c.-/ C`a o (3 904A t N .E � Jr� d s4o4z Aeg,g ?' f /wr 4 I If the answer to any of the following questions is"yes",su orting documentation must be attached. Are there any existing wastewater systems on the site? ❑Yes Vo Does the site contain jurisdictional wetlands? ❑Yes XNo Are there any easements or right-of-ways on the site? ❑Yes ZNo Is the site subject to approval by another public agency? ❑Yes 6 No Will wastewater other than domestic sewage be generated? ❑Yes VNo IF RESIDENCE FILL OUT THE BOX BELOW #People 3 #Bedrooms .3 #Bathrooms o2 Garden Tub/Whirlpool)(Yes ❑No Basement: ❑Yes XNo Basement Plumbing: ❑Yes XNO IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks . #Commodes #Showers I #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:*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 W 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 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. Al=ei 6-1� Site Revisit Charge Proowner's or owner's legal representative signature Date(s): 17z "7 Client Notification Date: D e EHS: Sign given ❑Yes ❑No Account# Revised 11/06 Invoice# . � - . ..S7ONY_BROOK TRAIL r� Ll PRIVATE ROAD y ----- -- kc.) a ar�4 L T # - w a AC. LOT #40 �• (5.519 AC.) cu J 1� in i z 502. 64 TOTAL Q o OAC 30.15 W LOT #42 ass `� < �-- E (5.425 AC.) CL m �.55 2 v ,.) 0 60' UTlU7Y do . s U4) AGCESS EASEMENT Ll -1116t�. FOR THE PURPOSE- OF URPOSE nE INGRESS & EGRESS .ri _ of . qP LOT #17 GoMAPS -Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping System QP`s9s Click Here To Start Over Quick Search:{County ID c Active Layer. �J Use Mt p Trps GIS U td oP ® PARCELS (Map Tips Available) Map Layers Results . sV1HER Lt N7A G3000 07 + X5.00 AC OPf tIW Y 1 ra T �,° h F PcC2 Ir �, PaO ' M f k d . i)y�;i�' ' rxni�ui� � �I"P pii ffs +ai i�'; .� '^ r "�'.� ��� Y• .. � � �+ hi n rw'f�° i yam, ,,,,. .u.; r, C? ° WLc q s. ' MOCKSVILL, a irk p i 1 '. x'. http://maps.co.davie.nc.us/GoMaps/map/Index.cfin?mainmapservice=gomaps&CFID=4129... 9/5/2007 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPPEERMINFORMATION Account 2 Tax PIN/EH#: 5_?JZu_-J/__U0 11 Billed To: Ron Whitlock Subdivision Info: North Brook Lot#41 Reference Name: Location/Address: Stony Brook Drive-27028 Proposed Facility: Residence Property Size: 5.008 Date Evaluated: Z 67 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring �� Pit Cut FACTORS 1 23 4 5 6 7 Landscape position, 5 E7 Slope% 7.1 HORIZON I DEPTH -C, 0 -17- 0-M Texture grouptL t1— G i Consistence $ r $ F;S Structure S R. Mineralogy HORIZON H DEPTH # 1 ((i 12- 24•-L4 Texturerou C_ �e Consistence -1*V R 5 Structure 5 Mineralogyr. �v HORIZON III DEPTH Texture group C• Consistence Structure S - Mineralo yi HORIZON IV DEPTH Texture group �e Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON ILP Jq7- SAPROLITE -- •- .CLASSIFICATION S LONG-TERM ACCEPTANCE RATE •2 15- ": ' SITE CLASSIFICATION: EVALUATION BY: r--- LONG-TERM ACCEPTANCE RATE: '�', 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 ezture 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 IYIQist 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 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 DCHI)05105 (Revised) ■eetetetee■�e■■eelteeee■tee■■e■■■■■e■eet■eeeeee■■l■eeeleeeeelsaee■ set■■■■e■■t■■►■■e■■l■t■te■■■■■e■�■■eleeseetlteeeeelteeele■ttl■lt■ ■■■■eta■■■■■■■t■att■■e■■et■■■■■■ s■tle■teete■etletlett■t■e■ae■le■ ■etre■■t■■■■■ee■■eeetle■■ecce■ecce■■eeleeeeteeeeeeeet■eeeleeee■ee■ ■■■eeste■■■■■t■■eeeetet■■e■el■■teeeeee■■eeeelee■■■■eeetee■sete■ee■ ■sltla■tett■■e■■ttt■■■flee■■t■■els■■lteltt■ttte■■eletlltttttttttt■ 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■■letllttteei■■ettetltcr■■reeetee■ltelere■■e■ttee■■■te■■s■■ttr■■■t■ ■■tr■tlt■■■tt■ttet■ere■■r■■■■■■teles■■r■lrl■t■■■el■■lt■steelelle■e■ ' 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 990004432 Tax PIN/EH#: 5820-32-0877 Billed To: Ron Whitlock Subdivision Info: North Brook Lot#41 Address: 175 Jack Booe Road Location/Address: Stony Brook Drive-27028 City: Mocksville Property Size: 5.008 Reference Name: 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: Aew ❑Repair ❑Expansion Permit Valid for: 03"'Years ❑No Expiration Residential Specifications: #Bedrooms 3 #Bathrooms 2— #People 3 Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): 3(Oo Type of Water Supply:�nty/City ❑Well []Community Well Site Modifications/Permit Conditions: System TvDe LTAR Initial ._ 0, Repair Gc�►.S 677 Site Plan Environmental Health Specialis Date b� i.p.11-06