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230 Wagner Rd (2) , DAVIE COUNTY ENVIRONMENTAL HEALTH • ' , P.O.Box 848/210 Hospital Street � ' Mocksville,NC 27028 � � ` i (336)753-6780/Fax#(336)753-1680 � �`�� OPERATION PERMIT 51 �ccnu�t #: 990005636 Tax PI�liEH#: 5820-02-9638 Site#1 � �iIl�:s� To: Michael and Stephanie Burton Su�adivi�iorz Ir3��: ' ��E�� Iar�i�:: Loc�iianiAdu�r�ss: Wagner Road-27028 f�ropt�s�;c� F��;i€ity: Residential : , ��o�,�r�y��iz�: 46 Acres _ . ; , . �,T�*��E��'The74 aance of this Operation Permit shall iridicate 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. � i I,�� Tank Size DCJO � System Type:�S.T.Manufacturer Tank Date Pump Tank Size � � - System Installed By: Q 1" E.H.Specialist: 1[� ate: J�1-d 2n�� GPS Coordinate: - �-Dl�9rt.e�!' e�� 3'X��' e�� '►� cc.. . � ia' �� s —! � . lo,�� `�� . / _ � � e�s �� , c�' �d . l'�� DCHD 11/06(2evised) . � � DAVIE COUNTY ENVIRONMENTAL HEALTH � , P.O.Box 848/210 Hospital Street (��( �� ' � Mocksville,NC 27028 r ,/�.k' (336)753-6780/Fax#(336)753-1680 �1` b AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION ' A�cr�ue�t �: 990005636 "��x PI�.�EH#: 5820-02-9638 Site#1 Billci� TQ: Michael and Stephanie Burton Su��iivi�ior� lri�c�: Refer�E�ce N�n�e: LocationiAdr�r�ss: Wagner Road-27028 Propc�sec9 F��:iEity: Residential ��t��ert.y �iz�: 46 Acres Site Type: }�1New ❑Repair ❑Expansion ��TC E�umber: 5740 **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Envirorimental 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: #Bedroom�_#Rathrooms� /2#People�Basement❑ Basement plumbing❑ - Non-Residential Specifications`. Facility Type ; i#People #Seats � , Square Footage(ar Dimensions uf Facility) Lot Size � � Type of Water Supply: ❑County/City �Vell ❑Community Well System Specifieations: Design Wastewater Flow(GPD) Tank Size GAL.Pump Tank GAL. Trench Width� q�� Max.Trench Depth�JQ`^_ Rock Depth� Linear Ft.��'�,(� ! �t�:i� � I:1 x�r� �';`��l. :� 4 �y. Site Modifications/Conditions/Other: w ;_.^'�:1 �'}':t rr�� ,' �':;�� ' � • ��► Contact the.Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the da of installation. Tcle hone#(336 751-8760. y� Q�C�s �- �w e��r�u�l' bQ _ G�YtG(7� /�r�o�' � � SeP�c L�t�'t� i nsfaG�F� 4 a�� !� . � - ,�'' � • Q,�,S�S � ( f � Environmental Health Specialist Date:�� DCHD 11/06(Revised) _ ' � � , � Davie County Environmental Health � ' ' P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 � IMPROVEMENT PERMIT Account #: 990005636 Tax PIN/EH#: 5820-02-9638 Site#1 Billed To: Michael and Stephanie Burton Subdivision Info: Address: 133 N. Claybon Drive� Location/Address: Wagner Road-27028 City: Advance, Property Size: 46 Acres Reference Name: Proposed Facility: Residential **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Azrthorization 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: �New ORepair ❑Expansion Permit Valid for: �5 Years ❑No Expiration Residential Specifications: #Bedrooms � #Bathrooms��2#People � Basement8 Basement plumbing� Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):�� Type of Water Supply: ❑County/City �Well ❑Community Well Site Modifications/Permit Conditions: S stem T e LTAR Initial � Re air .S'� .3 Site Plan ��O��h �a�t �4 1��G � �� ` �. �°°� a��s � f� a-��, � � �� Environmental Health Specialist Date � 2� r i.p.l l-06 . , - ' ��C� /l1�c�cru� a� � �` � ' � 117Q�� i�� R SITE EVALUATION/IMPROVEMENT PERMIT & ATC �� Davie Coun Environmental Health � F kk� 21 't(�1� � � P.O.Box 848/210 Hospital Street � � ., • Mocksville,NC 27028 ��' _. (336)751-8760/Fax(336)751-8786 Application For: ite Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both Type of Applicat'ion: �Iew 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 n/� �c, � `��G� Name to be Billed I " l I�{'�Q�� S�"(�1�1(,l,(L1� �V�YI Contact Person rn�C��G�1 F�j(,(.✓-I��YI f Billing Address� � cl C� 6Yl � Home Phone 5�$-GI Z5�-/ City/State/ZIP V�'ai'1('� � �1 C 2�1(�U� Business Phone Name on PermidATC if Different than Above Mailing Address City/State/Zip �,1-�/�/I PROPERTY INFORMATION *Date House/Facility �ners Flagged ��OGlSP� �`1��- 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�v s L�R�w� �s-��-�� Phone Number �(o-7'S( �76�� Owner's Addres-� (L City/State/Zip M o��s��`lG �UG 27ai�_ Property Address �� _��,�,�� ,�� City`��,i ��(e� 4`�� , Lot Size_ �� iA,�R,GS, Tax PIN# 5�Z13'(�qL+3� � CI�e�/ Subdivision Name(if applicable) Section/Lot# J Directions To Site: (o p( �7�a�,,- �, - �v ,r�os� � �� Gv�t�2,�r Pl1-�� o� R.�r �a 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 ❑No�.J�c ��2 G Does the site contain jurisdictional wetlands? ❑Yes f�o Are there any easements or right-of-ways on the site? ❑Yes C�1Qo Is the site subject to approval by another public agency? ❑Yes C�10 Will wastewater other than domestic sewage be generated? ❑Yes C�3Qo IF RESIDENCE FILL OUT THE BOX BELOW #People � #Bedrooms �_ #Bathrooms�. � Garden Tub/Whirlpool es ❑No Basement: es ❑No Basement Plumbing: ❑Yes C9�� IF NON-RESIDENCE FILL OUT THE BOX BELOW .�' Type of FacilityBusiness 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 systemrequested:. E3'Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: ❑ County/City Water C+�New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes C�'— 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 pemut(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 Departme onduct necessary inspections to detemune compliance with applicable laws and rules. I understand that I am responsible r the pro'er i tificati n and labeling of property lines and corners and locating and flagging or staking the ouse/facility loca on,propos ell locati and the location of any other amenities. � Site Revisit Charge Property owner's or owner's legal representative signature - Date(s): p�, Client Notification Date: Date EHS: �e � ' Signgiven ❑Yes ❑No �� 5� Account# ��>�c�� Revised 11/06 � Invoice# -�� ,e�rnr� ��s5 t . • , ' • ' DAVIE COUNTY HEALTH DEPARTMENT � � Environmental Health Section Soil/Site Evaluation arrLicaiv'r tivFortMa'rtorr PROPERTY INFORMATION Account #: 990005636 Tax PIN/EH #: 5820-02-9638 Site#1 Bilied To: Michael and Stephanie Burton Subdivision Info: Reference Name: Location/Address: Wagner Road-27028 Proposed Facility: Residential Property Size: 46 Acres Date Evaluated: 3— I_"_�—�_— Water Supply: On-Site Well / Community Public Evaluation By: Auger Boring / Pi[ Cut FACTORS 1 2 3 4 5 6 7 Landscape position V Slope % HORIZON I DEPTH D� y �'�' Texture grou C Consistence _ ,� - (�- Structure S�IL Mineralo HORIZON II DEPTH � Texture mu Consistence Structure Mineralo HORIZON III DEPTH Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE O• 3 SITE CLASSIFICATION: � S EVALUATION BY: � LONG-TERM ACCEPTANCE RATE'v ' � � OTHER(S)PRESENT: ��I� REMARKS: � Cc G F'c� � �fi��'� ,e LEGEND 2 /�/ i,�ndscap.�Position . Ulv�/( �� R-Ridge S -Shoulder L-Linear slope FS-Foot slope N-Nose slope � CC-Concave slope CV-Convex slope T-Te�race FP-Flood plain H-Head slope T�xtut� � 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 CONSIST .N _ . DZQiS� VFR�Very friable FR-Friable FI-Firm VFI-Very fitm EFT-Extremely firm 'Y� NS -Non sticky SS -Slighdy sticky S -Sticky VS -Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic S r� �r SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogv ' 1:1,2:1,Mixed • tes 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[o free wa[er or inches from land surface to soil colors with chroma 2 or less Classification-S(suitable),PS(provisionally suitable),U(unsuitable) TTAR -i:nnv_tPrm a�rPnfanrr ratP_ oal/rlav/ft7 nnTTr�ncinc m__.___�� ' , � � , ;:Gol,Vlaps GIS Page 1 of 6 _ � 1 ---J 1.;�-f� i �::' .:� � ( 1 rr � Gt '��y��C�Qa' �(-�1q ' , �� ' � � � �f � `� �—�— _..�� — _ �� — .,� ., .�� , 'S �+".. `.�� s� Q� --a `. I 'ry � J�� , �� ' I o:i�,�` . � '•��, _—� �. `` rTp,�� __ �-_"`��. � I '��5,� r,, I ^`' ��l}1},..�� t��'- � �f%� j I ��(V� 5k�5'�� ..._s.�.g�..��..� ' ' i l �—�Q�` .+� _.j.'`{'.� �-F{".��-�``�r�n -_~ '"--_ ti�� l T�- i�1�S~rH � ��I V�... -�-- T�I � , c:��c�, �zr,_ �.�=-_ � � I I I i I ~ ��'�_�'-=y"=�-�-i� I �� ,.�L____+ _ _ I �� II � � r��, �__=1_��-`�`_-- ��_ — � I I~ - J �JI L7 � r � � - � � i � �f={�r�=-r r I ' � ,� _ - �- T—�~�ti � i ; i ; f'" �� , _ � � � i � _ y �4--�-,�_�_I - I _ i ,'`'''�� II '� ,7 yy '''�y --T � !��2��i rt '�, tit ��ti '1� '., �'', i—�_. , http://maps.co.davie.nc.us/GoMaps/map/map.cfm?CFID=4129&CFTOKEN=61640881 2/21/2011 REVIEW OFFICER'S CERTIFICATE J CgAFFIN la�that th. map or Review plat to whichr We cwUfkx tDavis County. slrE DONALD PG. 324 i. meets all statutory requina eats for recording. D.B. 165, D.B. 193, PG. 373 1 06 1BERTHA L. BLACKWELDER D.B. 1969 PG* —, REVW.W OFFICER DATE D.B. 56, PG. 564 I 9 .7 NEW I SHEILA D. BR WN 4 SEs ao. ——— EXISTING IRON I D.B. 425, PG. 245 a. S e z ILs 1039 7QI D(ISfING N @7.06.33' V 1R0N o / NO SCALE VICINITY MAP I hereby certify that I am the owner of the property shown ' and described hereon, which located in the County of Davis that I hereby adopt this plan of subdivision with my free consent, established minimum building setback lino and dedicate all streets. l alloys. walks, parks and other sits and easement to public or private use as noted. Furthermore. I =dedicate ate all sanitary / sewer and water lines to the County of Davis Fled for registration at o'clock M. DATE �+ t3 2011 and recorded in GRADY McCLAMROCK r ADMINISTRATOR OF AMOS S. BROWN, Heirs C�j Pkrt Book Page '• M Fliq tis = paid W WdW MW — DAVE Co. Register of Deeds DEPUM-ASSISpWf NO APPROVAL REQUIRED BY THE w DAVIE COUNTY PLANNING DEPT. W ' DAVIE COUNTY PLANNING DIRECTOR q * N " I AREA= 46.000 AC. s � _ / INCLUDES S.R. 1310 R/W "OS S. BROWN, Heirs -------------°` W.B. 2005—E-243 4' DEED RE.F. D-06. 6, PG. 382 DWELLING RUTH C. GAITHER 0 —'°—1 � r � D.B. 1939 PG. 527 _ auj, r =p R :o int t EXISTING p :. &X IRON U—N u w 71I � G f r I PLAT MAP: NEW I, Grady L Tutterow. certify that this plot was drawn AMOS S BROWN, Heirs I ��6A1 V l under my supervision from an actual survey made I �01ap�'4 ' under my supervision (deed descri on recorded in �►''' i OWNER ------------------ DEVELOPER Book . Page , etc.) ( hether);that the I �'c' 46.000 AC. TRACT WAGNER ROAD boundaries not surveyed are clearly indicated as drown I from information found in PL Book _. Page ; that the ratio of precision is calculated as 1: +2o.00D ; I AMOS S. BROWN, Heirs that this plat was prepared In accordance with G.S. I NEW C/O GRADY McCLAMROCK 47-30 as amended. Witness my original signature. ( <*f 1R0N 161 SOUTH MAIN ST. registration number and seal this day of / 9 MOCKSVILLE, N.C. 27028 A.D., 2011 Surveyors�,� �� o� CALAHALN TOWNSHIP (Seal or Stamp) Registration Number DAVIE COUNTY, NORTH CAROLINA Finn Licence Number F-0372 Is AN EXErwT St1�NISION ,r d NEW LW BEARING DWAKE DATE: FEB-14-2011 TNIs �'¢� �f'I 4;�, MN Lie N 52'°3'43• w 61.73 TAX MAP REF.: G-3, PARCEL 4 ,�w.wr cation for Subdi,A.ion — Davi. Cauniv. oft CoroW>lo • A sly L30 5619'12' w 94.06 NOTES: Number L-2527 ` 0 Y �' L40 N 50'23'57• w 94.23 L Grady L Tutterow. Registered Land Surveyor. !O O . wrtly to one a mon d th" foNoedrp as indicated by an X , `� Al N 4r05 44 W 134.62 SURVEYED BY: .AS� '� IN c%i or�. N `�,rf„ .42 N 4T21'180 W 173.60 �a That this is a plat of a survey that creat" a subdivision of C O,� ,� �'`� A3 N 4415'22' W 251.05 1. TOTAL TRACTS= 1 TUTTEROW SURVEYING COMPANY • '' ,4 S 1431'40' E 205.77 107 NORTH SALISBURY STREET fond erltNn Dire Dna of a canter or municipality that hos an .�f .� v� ordinance that regulats" parade at Nand: �V?j'�,� �'`��tA� 5 S 04C18'45' 3'23 o' E 81.38 2. TOTAL AC.= 46.000 AC. MOCKSVILL.E, NC 27028 b. That this plot is of a survey that W located in such a oportion r ,ce regulaa county bs� W4 L48 unregulated a, to on 48 S 0,V31'29*0E 20..8 3. X= UNMARKED POINT OF PROPERTY IN C/L OF ROAD AND C/L OF CREEK (336) 751-5616 a That this plot is of a survey of an srdstirp parcel or 119 S 1730'25' E 22.48 paw of bred; tM S 58'54'43' E 91.04 d. Thot this plat is of a survey of another category, such as the 111 S 30'58'55' E 21.73 4. NO NCGS GRID MONUMENT LOCATED WITHIN 2000 Ff. 150 75 0 150 300 450 r�bkwtlon of to the survey, or t:2 S 0746'48' E 28.44 exception 1,53 N 7703'54' E 57.66 e. That ution available to this surve�ror is such Tip :y4 S 4T2T2r E 38.76 that I am unable to mains a dsfanrdnatNnb to the bed of my " L55 N 34 2350' E 37.83 prof"aionol ab0br as to prevwons norrIA In a. through 116 abaw. 116 S 10'5W0e' E 21.56 SCALE IN FEET . ,• L17 S Tai 1 1Y E 45.75 Signature ASB—PLAT BLACKRDI—50 Surveyor Regishnation Number 1211-3