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239 Essex Farm Road Lot 18Day. M6 [Oil All data Is pro`Aded as is withoutisamemy or guarantee of any Idnd dfhereapressed arImplied Including butnot limited to the Davie County, implied vramMles; 0 merchantability orflmrtessfor a pacular usG AD users 0 Davie County's Gls websne shall hold harmless the CowdyofDavie, NorthCarolina, Its agents, consultants, wntmetors oremployees nom any end aliddmsorwusesofactiondueto NC orarlsing out ofthe use or lnabnllyto asethe cls data provided by this webdte. I WARNING: THIS IS NOT A SURVEY Parcel Information_ Parcel Number: F8030A0018 Township: Shady Grove NCPIN Number: 5870641915 Municipality: Account Number: 8306970 Census Tract: 37059.803 Listed Owner 1: MCGOWAN KEVIN P Voting Precinct: EAST SHADY GROVE Mailing Address 1: 239 ESSEX FARM ROAD Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27006 Voluntary Ag. District: No Legal Description: LOT 18 ESSEX FARM PHASE 1 Fire Response District: ADVANCE Assessed Acreage: 0.69 Elementary School Zone: SHADY GROVE Deed Date: 10/2016 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 010310246 Soil Types: GnB2 Plat Book: 0009 Flood Zone: Plat Page: 290 Watershed Overlay: DAVIE COUNTY Building Value: Outbuilding & Extra Freatures Value: - Land Value: Total Market Value: Total Assessed Value: [Oil All data Is pro`Aded as is withoutisamemy or guarantee of any Idnd dfhereapressed arImplied Including butnot limited to the Davie County, implied vramMles; 0 merchantability orflmrtessfor a pacular usG AD users 0 Davie County's Gls websne shall hold harmless the CowdyofDavie, NorthCarolina, Its agents, consultants, wntmetors oremployees nom any end aliddmsorwusesofactiondueto NC orarlsing out ofthe use or lnabnllyto asethe cls data provided by this webdte. I Applicant: Reliant Homes Address: OPERATION PERMIT City: Davie County Health Department .� 210 Hospital Street' . - P.O. Box 848 - '°'" Mocksville NC 27028 a Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Reliant Homes Address: PO Box 968 City: King StatefZip: NC 27021 Phone M (336) 757-6068 Property Owner: Reliant Homes Address: PO Box 968 City: King State/Zip: NC 27021 Phone #: (336) 757-6068 Property Location & Site Information Address/Road #: Subdivision: Essex Farm Phase: Lot: 18 239 Essex Farm Road :Advance NC 27006 Directions "SINGLE FAMILY Hwy 64 E. left on Cornatzer Rd. about 6 miles Essex Structure Farm on left # of Bedrooms: 4 # of People: *Water Supply: PUBLIC *IP ISSUed by. -2140 -Nations, Robert *System Classification/Description: - -" - - - _ TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP *CA issued by: 2140 - Nations, Robert Saprolite System? O Yes ® No Design Flow: _ _ - 4 8 0 ... -- - *Distribution Type: PUMP TO GRAVITY Soil Application Rate: 0 . a Jr Pre -Treatment: Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: 1 9 a 0 Sq. ft. 7 488ft. 90Inches O.C. ® Feet O.C. 3 OInches ® Feet inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover: a 4 Inches Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: a 4 Inches Page 1 of 4 Pump Required? ® Yes (_) No *System Type: INFILTRATOR QUICK 4 STANDARD Installer: Frank Tasou Certification #: 2771 *EHS: 2140 - Nations, Robert - Date: 0 7/ a 0. l a 0.1 6 Approval Status N Approved ❑ Disapproved CDP File Number 200210 - 1 Manufacturer: shoaf STB: 760 42 Gallons: 1000 -- - Gallons:'' Date: 0 4/ 1 a/ a 0 1 6 'Filter Brand: POLYLOK PL -122 With Pipe Adapter ST Marker: ❑ Yes N No 2einforced Tank: ❑ Yes N No 1 Piece Tank: ❑ Yes ® No Manufacturer: shoaf F Countv ID Number: Lat. a mp Tank Installer: Frank Transou Certification #: 2771 'EHS: 2140 - Nations, Robert Date: 0 7/ a 0/ a 0 1 6 Approval Status' N�Approved❑ Disapproveds- ,3 ipply Line Installer: Frank Transou Certification #: 2771 . i 'EHS: 2140 - Nations, Robert Date: 0 7 / a0 / a0 1 6 Approval Status N'Approved ❑ Disapproved',` / Pump Type: Zoete PT: 42 Installer: FrankTransou -- - Gallons:'' 1250-,- Gal Certification #: 2771 = Dater 0_ a ,./- 1 0/ a 0 1 6 2140 - Nations, Robert - Riser Sealed N Yes ❑ No 0 7/ a 0/ a 0 1 6 Riser Height: N Yes ❑ No (Min. 6 in.) Reinforced Tank:_ N Yes ❑ No :1 Piece.Tank: N,.Yes Yes ❑ No. _ Approval Status PVC unions N Yes Pipe Size. No N Approved ❑ Disapproved Vent Hole N a inch diameter No Pipe Length: 1 3 6 feet ❑ *Schedule: 40 Pressure Rated N Yes ❑ No Approved fittings N Yes ❑ No F Countv ID Number: Lat. a mp Tank Installer: Frank Transou Certification #: 2771 'EHS: 2140 - Nations, Robert Date: 0 7/ a 0/ a 0 1 6 Approval Status' N�Approved❑ Disapproveds- ,3 ipply Line Installer: Frank Transou Certification #: 2771 . i 'EHS: 2140 - Nations, Robert Date: 0 7 / a0 / a0 1 6 Approval Status N'Approved ❑ Disapproved',` / Pump Type: Zoete Installer: FrankTransou Dosing Volume: - Gal Certification #: 2771 Draw Down: Inches 'EHS: 2140 - Nations, Robert - - 'Chain: STAINLESS - Date: 0 7/ a 0/ a 0 1 6 Valves Accessible N Yes ❑ No Flow Adjustment Valve N Yes ❑ No Check -valve N Yes ❑ No Approval Status PVC unions N Yes ❑ No N Approved ❑ Disapproved Vent Hole N Yes ❑ No \ Anti -siphon Hole ®-Yes ❑ No Page 2 of 4 CDP File Number 200210 - 1 z County ID Number: NEMA 4X Box or Equivalent ® Yes ❑ NO Installer: Frank Transou Box 12 inches Above Grade ® Yes ❑ No 2771 _ Certification #: Box Adj. To Pump Tank ® Yes ❑ No Conduit Sealed_ ® Yes - ❑ No 'EHS; 2140 -Nations, Pump Manually Operable ® Yes ❑ No / *Activation Method: PIGGYBACK Date: _ Alarm Audible -® Yes _ ❑ No Alarm Visible- ® Yes ❑ No 2140 - Nations, Robert - - - - _ . *Operation Permit completed by .Authorized State Agent — Date of Issue: 0 7 / a 1- ./ a 0 1- 6 _Owner/Applicant Signature: - This.system.has been installed. in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for = -Sewage Treatment and Disposal, -15A NCAC18A.1900 at. Seq., and allconditionsof the Improvement Permit and Construction.Authorization::This property is served by aTYPE ni B. sewage septic system. TYPE iii B. Rule :1961 requires that a Type septic system meet the following criteria: - - - - --- - - _-. Minimum System Review By The Local Health Department: 5 YRS. Management -Entity OWNER _ - Minimum System Inspection/Maintenance Frequency By Certified Operator: N/A - Reporting Frequency By Certified Operator: N/A Rule .1961 requires that a Type IV and V septic systems designed for a home/business owner must maintain a valid contract with a public management entity with a certified operator or a private certified operator for the life of the septic system. Rule .1961 requires that Type VI septic systems designed for a home/business owner must maintain a valid contract with a public management entity with a certified operator for the life of the septic system. Rule. 1961 (2) (e) requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the system owner and certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibilities of the owner and systems operator, provisions that the contract shall be in effect for as long as the system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. ® Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 3 of 4 Di OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 CIDP File Number: 200210 - 1 County File Number: Date: O Inch Page 4 of 4 P1 P2 P3 Page 4 of 4 P1 P2 P3 Drain Field: System Final Inspection Loa: Septic Tank: Pump Tank: Supply Line: Pump Requirements: Electrical Equipment: P1 P2 P3 "CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street .v4�. P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 For Office Use Only "CDP Fde Number 200210-1 County ID Number. EvaluatedFo_r.NEW Townshm: 02/24/2021 Applicant: Reliant Homes Property Owner. Reliant Homes Address: PO Box 968 Address: PO Box 968 City: King City: King State/Zip: NC 27021 State2ip: NC Phone #: (336) 757-6068 Phone #: (336) 757-6068 Address/Road #: 239 Essex Farm Road Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: "Water Supply: PUBLIC Subdivision: Essex Farm Phase: Classification: Provisionally Suitable Saprolite System? OYes ®No Design Flow: 4 8 0 Soil Application Rate: 0 2 5 "System Classification/Description: TYPE 111 B. SYSTEM W/SINGLE EFFLUENT PUMP `Proposed System: 25% REDUCTION Nitrification Feld 1 9 2 0 Sq. ft. No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: 27021 Lot: 18 Directions Hwy 64 E. left on Cornatzer Rd. about 6 miles Essex Farm on left Minimum Trench Depth: 2 4 Inches Minimum Soil Cover. 1 2 Inches Maximum Trench Depth: 3 6 Inches Maximum Soil Cover: 2 4 Inches `Distribution Type: PUMP TO GRAVITY Septic Tank: 1 0 0 0 _ Gallon 1 -Piece: OYes ®No Pump Required;®Yes ONo OMay Be Required Pump Tank: 1 0 0 0 Gallons 5 1-Piece:OY-es *No 4 8 0 ftGPM—vs— It. TDH — 9 Qinches O.C. Dosing Volume:4. Feet O.C. _ Gallons 3 SInches Feet Grease Trap: Gallons Aggregate Depth: inches Pre Treatment: ONSF OTS -1 O.TS-II Septic Tank Installer Grade Level Required:°OI Oil OIII .OIV CDP File Number 200210-1 *Site Classifx:atiom. Provisionally Suitable Design Flow: ' 4 8 0 Soil Application Rate: 0 a 5 *System Classification/Description: TYPE III B. SYSTEM WISINGLE EFFLUENT PUMP *Proposed System: 25% REDUCTION Nitrification Field 1 9 a 0 Sq. ft. No. Drain Lines 5 Total Trench Length: 4 $ 0 8 County IQ Number. ❑ Open Pump System Sheet )No ONO, but has Available Space Trench Spacing:9 _ O Inches O: t+ Feet O.C. Trench Width:Inches 3 . S Feet Aggregate Depth: inches Minimum Trench Depth: a 4 Inches Minimum Soil Cover. 1 a Inches Maximum Trench Depth: 3 6 _ Inches Maximum Soil Cover., a 4 Inches *DlstflbutionType: PUMPTOGRAVITY Pump Required: Oyes ONo. OMay Be Required PreTreatment: ONSF OTS -1 OTS -II *Site Modifications No grading or construction activity is allowed in areas designated for system and repairwithout approval of Health Department. *Permit Conditions The issuance of this permit bythe Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit not to exceed five years, and maybe issued atthe sametime the Improvement Permit issued (NCGS 130A-339(11)} If the installation has not been completed during the period of validity of the construction Permit, the Information submitted in the application for a permit or construction Authorization is found to have been incorrect falsified or changed, or the she is altered, the permit or construction Authorization shall become invalid, and may be suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, Installation, operation, maintenance; monitoring, reporting and repair Applicant(Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature: Date: *Issued By: 2140 -Nations, Robert Date of Issue:_ . 0 a / a 4 / a 0 1 6 Authorized State Pgek Malfunction Log OYes ; ®Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 - Mocksville NC 27028 Drawing Drawing Type: Construction Authorization CDP File Number: 200210 -1 County File Number. Date: 01/24/2016 Q Inch Scale:. . . pBlock = ft. CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital street CDP File Number: 200210 -1 P.o. Box ti48 Mocksville N�C-r– �702s County File Number: Date. ea/aa/a_eie -7 (e6 �/ a� K�– Jiro H Saw -7--Ac—(G Click below to Import an Image from an external location: Drawing Type: Construction Authorization f PAID( PPLICATI.ON_ FOR _ SITE EVALUATIONAMPROVEMENT PERMIT & ATC 6191 Davie County Environmental Health P.O. Box 848/210 Hospital Street e Mocksville, NC 27028 (336)753-6780/ Fax (336) 753-1680 Application For.Site valuation/Improvement Permit D Authorization To Construct(ATC) D Both Type of Application: ti ew System DRepairto Existing System DExpansion/Modification of Existing System or Facility *�*IMPORTAN7"•• TBIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. Name to be Billed Ptkj ,k "ores Contact Person f3tr�+w+kt•+` Billing Address P.o. ('10K 9L8 - Home Phone City/StaWZIP C,,.�NL 27e2.1 Business Phone 33t,-�57-t.o4C Name on Permit/ATC if Different than t plan must accompany this application. Included: S(Site Plan OPlat(to scale) 60 months with site plan, no expiration with complete plat.) Directions To must be attached Am there any existing wastewater systems on the site? Dyes Does the site contain jurisdictional wetlands? []Yes Are them any easements or right-of-ways on the site? []Yes Is the site subject to approval by another public agency? Dyes Will wastewater other than domestic sewage be generated? CYes IF RESIDENCE FILL OUT THE B # People S . - # Bedmoms 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) Type system requested: 9tonventional DAccepled ❑Innovative Water Supply Type: Aonly/City Water 0 New Well DExisting Well D Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? O Yes If yes, what type? This is to certify that the information provided on this application is We and correct to the best of my knowledge. 1 understand that any pennit(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 1 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 aresponsible for the proper identification and labeling of property lines and comers and eyuy lopWd digging or sl2zing th® facility location, proposed well location and the location of any other amenities. Sign given ❑Yes ONo - Account # 200 VO Revised 11/06 Invoice # A 43M Site Revisit Charge Date(s): ownei s or owner's legal representative signature Client Notification Date: Da EHS: Sign given ❑Yes ONo - Account # 200 VO Revised 11/06 Invoice # A 43M 17 UtnrtY ec"Mont — 'f 24.7 100.00 49.5 ESSEX FARM Rpgp 60' Public R/W) GRAPHIC SCALE 40 0 - 20 40 e0 160 ( IN FEET ) 1 inch = 40 ft. . - Rev i s i ons PLAT "Vliir &) NEUSS4 d(C6!0)rA r NOTGmI. Wal me drawl horn nerd Information and R NOT th. pool ammoved FOR and RE{IU I` HOME .. - rea t of on A010AL RED 6tRum. l .W.pa« M Nb plat b W enbw owml.�.a m Isle tenr 1he wad manklpdhy Record Referencest Lot 18 of ESSEX FARM, Phase I, page 2 of 2, PB. 9, Pg. 290 Non= - - - see DB. 988, Pg. 708 sot. 9,n.Ww Cu P.A. has mathwnatwedy Wand the paP...e.(radon an the property d Henn Olnwwian. Pin 5870641915 e'Inmibda . tbw ,°Chao racy ma e�mWhoctce .n1 W In a Scat le Date Townsh I Count State rortl hn mamontw - - DEVELOPMENT PLAN FOR:. Kevin -& Melissa 1 In. _ 40 ft. Feb. 09,'2016 Shady Grove " Davie NC PlanowaO and Reliant Homes - Job No.Drawn lo Plan # McGowan SLATE SURVEYING CO. P.A. AR -M237 s NOTE: Plan subject to approval by building P.O. Box 1082 Checked b inspection department prior to construction. 24_16_1 DPC Aing, N.C. 27021 3381983-9743 J.D.S. Alon Mock Trust ee 2000E/248 100.00 57.4 • I o i I 18 o I0 0I o 0 I s ' 117/ I 3e,0 10 pod a," $' Mew,1.0 o Y . N 30.4 - . 29.7 proposed 12.e dwellingI _ - eve Z0 11.7' *I&$ ' SETBACKS 0 20.1 11.0 Front _ 45 ft. Side 10 ft... . 29.7 I Rear 30 ft. � J 17 UtnrtY ec"Mont — 'f 24.7 100.00 49.5 ESSEX FARM Rpgp 60' Public R/W) GRAPHIC SCALE 40 0 - 20 40 e0 160 ( IN FEET ) 1 inch = 40 ft. . - Rev i s i ons PLAT "Vliir &) NEUSS4 d(C6!0)rA r NOTGmI. Wal me drawl horn nerd Information and R NOT th. pool ammoved FOR and RE{IU I` HOME .. - rea t of on A010AL RED 6tRum. l .W.pa« M Nb plat b W enbw owml.�.a m Isle tenr 1he wad manklpdhy Record Referencest Lot 18 of ESSEX FARM, Phase I, page 2 of 2, PB. 9, Pg. 290 Non= - - - see DB. 988, Pg. 708 sot. 9,n.Ww Cu P.A. has mathwnatwedy Wand the paP...e.(radon an the property d Henn Olnwwian. Pin 5870641915 e'Inmibda . tbw ,°Chao racy ma e�mWhoctce .n1 W In a Scat le Date Townsh I Count State rortl hn mamontw - - DEVELOPMENT PLAN FOR:. Kevin -& Melissa 1 In. _ 40 ft. Feb. 09,'2016 Shady Grove " Davie NC PlanowaO and Reliant Homes - Job No.Drawn lo Plan # McGowan SLATE SURVEYING CO. P.A. AR -M237 s NOTE: Plan subject to approval by building P.O. Box 1082 Checked b inspection department prior to construction. 24_16_1 DPC Aing, N.C. 27021 3381983-9743 J.D.S. FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health. P.O. Box 848/210 Hospital Street Mocksville, NC 27028 - (336)751-8760/Fax (336)751-8786 - - - don/Improvement Permit O Authorization To Construct(ATC) O Both ,stem DRepair to Existing System OExpansion/Modification of Existing System or Facility -PPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED ' INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 73 Name to be Billed ASC Ac'V64eon Billing Address ?•o•Qe,K 3fo \ City/State/ZIP �1ocrrwu..r r+C Name on Permit/ATC if Different than A' 2.`1j • Mailing Address - rc J Home Phone uiness Phone 7S/ - 7300 NOTE: A survey plat or site plan must accompany this application. Included: D Site Plan RPlat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat) Owner's Name�,SC Ac'VE(OP.Yc'Ni ceJt�r[G - - Phone Number 7S/-73� - Owner's Address Po By j4a - - City/State/Zip Noun.,i,« f�G 17oLe Properly Add, e - City - Lot Size - - Tax PIN# — /1y v Subdivision Name if applicable) ESSc]r_fi�cH Sectiop/Lot# 1 /I Are there any existing wastewater systems on the site? - I Oyes ONJa Does the site contain jurisdictional wetlands? - ❑Yes ONo Are there any easements or right-of-ways on the site? O'ies 0�10 Is the site subject to approval by another public agency? OYes 11NIG .. Will wastewater other than domestic sewage be generated? DY" o #People - #Bedrooms #Bathrooms Garden Tub/Whirlpool OYes 'ONo Basement OYes ONo Basement Plumbing: OYes ONo 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:�MConventional DAccepted DInnovative OAltemative OOther - Water Supply Type: [?'County/City Water 0 New Wel1 DExisting Well - O Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes O No If yes, what type? - This is to certify that the information provided on this application is We 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 an agging or staking the house/facili location, proposed well location and the location of any other amenities. Site Revisit Charge Prope r r s oro er's legal represents re - Date(s): Client Notification Date: Date. , / EHS: - - . Sign given OYes DNo - - Account # Revised 11/06 - - Invoice# " Water Supply: On -Site Well Evaluation By: 6,- Auger Boring DAVIE COUNTY HEALTH DEPARTMENT Public - Cuter_ FACTORS 22) 2 Q 2tp 4 5 6 7 Landscape position Environmental Health Section Slope % 7y 6,7b Soil/ Site Evaluation HORIZON I DEPTH APPLIOtANT INFORMATION PROPERTY INFORMATION Account #: 990004425 Tax PIN/EH #: 5870 $-2�65.1i Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot # 18 Reference Name:. Brad Coe Location/Address: Cornatzer Rd -27006 Proposed Facility: Residence Property Size: 0.691 Ac. Date Evaluated: U MineralogyS; " Water Supply: On -Site Well Evaluation By: 6,- Auger Boring Community 1 Public - Cuter_ FACTORS 22) 2 Q 2tp 4 5 6 7 Landscape position L_ Slope % 7y 6,7b HORIZON I DEPTH O— M O-21 Texture groupL Consistence (r Structure U MineralogyS; SSW HORIZON H DEPTH 21 Sp Texture group Consistence Structure. iia Mineralogy HORIZON III DEPTH' .. Texture group Consistence • -•Structure : -Mineralogy HORIZON IV DEPTH i Texture group Consistence : .;'..Structure - - - Mineralogy,- - - - SOIL WETNESS: ,'.. ..., dtr-: RESTRICTIVE HORIZON SAPROLITECLASSIFICATIONLONG-TERM ACCEPTANCE RATE0,7, .til SITE CLASSIFICATION: EVALUATION BY.,tx uG� LONG-TERM ACCEPTANCE RATE: ©a2 OTHER(S) PRESENT: ['REMARKS; Landscape Position Position LEGEND 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 5-SandLS - Loamy sand - SL Sandy loam L - Loam SI -Silt; SICL - Silty clay loam SIL: - Silty loam CI: - Clay loam SCL - Sandy clay loam - SC - Sandy clay SIC - Silty clay C - Clay CONSTSTF.NCF. mois 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 _ - I - SC - Single grain -M-Massive CR - Crumb GR - Granular "r ABK Angular blocky SBK - Subangular blocky PL - Platy , . PR - Prismatic Mineralogy 1:1, 2:1, Mixed ]Votes i , Horizon depth - In inches Depth of fill - In inches ' Restrictive horizon - Thickness an 'or ches 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 chroman or less Classification - S(suitable), PS(provisionallysuitable), U(unsuitable): LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/05 (Revisedl Davie County Environmental Health P.O. Box 848/210 Hospital Street Mock§ville, NC 27028 (336)751-8760/Fax (336)751-8786 Account #: 990004425 hMPROVEMENTPERfAJfIN/EH M 5870-64-2265.18 Billed To: PSC Development Corp.. Inc. Subdivision Info: Essex Farm Lot # 18 Address: PO Box 340 Location/Address:. Comatzer Rd -27006 City: Mocksville Property Size: 0.691 acre pa Reference Name: Brad Coe ?&q wire ��2m,�" Proposed Facility: Residence **NOTE**Thus 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: 04ew ORepair. OExpansion Permit Valid for: 05 Years-XNo Expiration Residential Specifications: #Bedrooms #Bathrooms_#People_BasamentOBasement plumbing❑ Non -Residential Specifications: "Facility Type # People_ # Seats_ ! 1 Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply: Xounty/City O Well DCommunity. Well Site Modifications/Permit Conditions: i Irvironmental Health L--96A5ZS \ . NQZ,2�, Applicant: Reliant Homes Address: OPERATION PERMIT eo Davie County Health Department - State/Zip: 210 Hospital Street . . P.O. Box 848 • Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Reliant Homes Address: PO Box 968 City: King - State/Zip: NC 27021 Phone #: (336) 757-6068 Property Owner: Reliant Homes Address: PO Box 968 City: King State/Zip: NC 27021 Phone #: (336) 757-6068 Property Location & Site Information Address/Road #: Subdivision: Essex Farm Phase: Lot: 18 239 Essex Farm Road Advance NC 27006 Directions y 64 E. left on Cornatzer Rd. about 6 miles Essex Fa Structure: SINGLE FAMILY Hw rm on left # of Bedrooms: 4 # of People: *Water Supply: PUBLIC *IP Issued by: tao~- Nations, Robert *System Classification/Description: TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP *CA issued by: 2140 - Nations, Robert , Saprolite System? O Yes (9 No Design Flow:PUMP TO GRAVITY p 4 8 0 PumRequired? Distribution Type: � O Yes V No Soil Application Rate: 0 . a 5 *Pre -Treatment: Nitrification Field. No. Drain Lines Total Trench Length Trench Spacing: Trench Width: Aggregate Depth: 1 9 a 0 Sq. ft. 7 488ft. 9 Q ®Feet Inches O.C. 0. C. 3 Q ® Inches Feet inches *System Type: INFILTRATOR QUICK 4 STANDARD Installer: Frank Tasou Certification #: 2771 *EHS: 2140 - Nations, Robert Date: 07/20/2016 Minimum Trench Depth; 3 6 Inches Minimum Soil Cover:a 4 Inches Approval Status Maximum Trench Depth: 3 6Inches ® Approved ElDisapproved Maximum Soil Cover: -a 4 Inches Page 1 of 4 R CDP File Number 200210 - 1 Seatic Tank County ID Number: Manufacturer: shoat STB: 760 Gallons: 1000 Dosing Volume: Date: 0 Date: 0 4/ 1 a l a 0 1 6 *Filter Brand: POLYLOK PLA 22 With Pipe Adapter ST Marker: ❑ Yes ® No einforced Tank: ❑ Yes ® No Piece Tank: ❑ Yes ® No Manufacturer: Shoaf. PT: 42 Gallons: 1250 Frank Transou Dosing Volume: Date: 0 a/ 1 0/.2 0 1 6 Riser Sealed ® Yes ❑ No Riser Height: ® Yes ❑ NO (Min. 6 in. nforced Tank: ® Yes ❑ No 1 Piece Tank: ® Yes ❑ No Pipe Size: a inch diameter Pipe Length: 1 3 6 feet *Schedule: 40 Pressure Rated ® Yes ❑ No Approved fittings ® Yes ❑ No Lat. Long: Installer: Frank Transou Certification #: 2771 *EHS: 2140 - Nations, Robert Date: 0 7/ a 0/ a 0 1 6 rump r ann Installer: Frank Transou Certification #: 2771 *EHS: 2140 - Nations, Robert Date: 0 7/ a 0/ a 0 1 6 �gpproval Status %� ®� Approved � � Disapproved` Supply Line Installer: Frank Transou Certification #: 2771 *EHS: 2140 - Nations, Robert Date: 07/20/2016 Pump Type: Zoete Installer: Frank Transou Dosing Volume: — Gal Certification #: 2771 Draw Down: Inches *EHS: 2140 - Nations, Robert *chain: STAINLESS Date: 0 7/ a 0/ a 0 1 6 Valves Accessible ® Yes ❑ No Flow Adjustment Valve ® Yes ❑ No Check -valve ® Yes ❑ NO Approval Status PVC unions ® Yes ❑ No L ® Approved ❑ Disapproved Vent Hole ® Yes ElNo Anti -siphon Hole ® Yes ❑ No Page 2 of 4 CDP File Number 200210-1 tl County ID Number: NEMA 4X Box or Equivalent ® Yes ❑ NO Installer: Frank Transou Box 12 inches Above Grade ® Yes ❑ No 2771 Certification #: Box Adj. To Pump Tank ® Yes ❑ NO Conduit Sealed ® Yes ❑ NO •EHS: 2140 - Nations, Robert Pump Manually Operable ® Yes ❑ No *Activation Method: PIGGYBACK Date: Alarm Audible ® Yes Alarm Visible ® Yes *Operation Permit completed by; Authorized State ❑ NO ,; ApprovafStatus ti ®.Approved ❑ Disapproved ❑ No 2110 - Nations, Robert Date of Issue: 0 3/ a 1/ a 0 1 6 Owner/Applicant Signature: This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for Sewage Treatment and Disposal, 15A NCAC 18A.1900 et. Seq., and all conditions of the Improvement Permit and Construction Authorization. This property is served by a TYPE iii B. sewage septic system. Rule .1961 requires that a Type TYPE iii B. septic system meet the following criteria: Minimum System Review By The Local Health Department: 5 YRS' Management Entity: OWNER Minimum System Inspection/Maintenance Frequency By Certified Operator: N/A Reporting Frequency By Certified Operator: N/A Rule .1961 requires that a Type IV and V septic systems designed . for a home/business owner must maintain a valid contract with a public management entity with a certified operator or a private certified operator for the life of the septic system. Rule .1961 requires that Type VI septic systems designed for a home/business owner must maintain a valid contract with a public management entity with a certified operator for the life of the septic system. Rule. 1961 (2) (e) requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit for a system required to be maintained by a public or private management entity, unless the system owner and certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibilities of the owner and systems operator, provisions that the contract shall be in effect for as long as the system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. ® Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 3 of 4 of 0 1. FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 \ (336)751-8760/Fax(336)751-8786 Gation/Improvement Permit ❑ Authorization To Construct(ATC) ❑ Both 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. Name to be Billed SSC ao'V6GopKoNT 9y{. / Contact Person 72'ARy J&fn t, - Billing Address � -6 . d - _X 3fo Home Phone City/State/ZIP _LJoer� r1►G Z lot 8 Business Phone 7S/ - 7300 Name on Permit/ATC if Different than Mailing Address OU5 rr1L)Ft 1 r tNrVKNVIAIIUN jjate House/racinty Uomers riaggea NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan lat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name �4.Sc lJo'y8coorlF't�i ct� ir1G Phone Number 7S/ - 7300 Owner Address City/State/Zip.,�ca.r /�G L7oL8 Property Addr ss City Lot Size je o" Tax PIN# 2� Subdivision Name(if applicable)Es = r7AZSectio ot# n Directions Tn Site: 14 4( 4 R'A/ _tiA1 2���(` A� -f'/CM If the answer to any of the following guestionsris "yes", supporting documentatio} must be attdched. Are there any existing wastewater systems on the site? Dyes EWMp Does the site contain jurisdictional wetlands? Dyes ❑1�Io Are there any easements or right-of-ways on the site? Cies ❑ o Is the site subject to approval by another public agency? Dyes [IN� Will wastewater other than domestic sewage be generated? Dyes 13'No IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms !;6 # Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: Dyes ❑No Basement Plumbing: Dyes ❑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: 66onventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: B-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 comers and locating an ging or staking the house/facility location, proposed well location and the location of any other amenities. Site Revisit Charge Prope r s or oer's legal representa re Date(s): 7 Client Notification Date: Date —7---7--/ Sign given Dyes ❑No Revised 11/06 Account # Invoice # -�� 73 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT IhIFORMATION PROP jRT. INFORMATION Account : Tax PIN/EH #: 58t0=6"=265: Billed To: PSC Development Corp. Inc. Subdivision Info: Essex Farm Lot # 22 Reference Name: Brad Coe Location/Address: Cornatzer Rd -27006 Proposed Facility: Residence Property Size: 1.006 acre Date Evaluated: D1 — IL <<- — 0-77 Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public VZ Cut FACTORS q % HLit Landsca e position L L_ Slope % ; HORIZON I DEPTH — p —7— 1 o— 1 6 —14 - -- c6 12 Texture group G Consistence12 Structure 5 0 L Mineralogy HORIZON II DEPTH 30 — I'S - 3&-' 1 - 30 12 - L1 .• Texture group C C C C Ci Consistence N Structure 5 A & Db IC 1e Mineralogy P 5 E yp HORIZON III DEPTH '3 0 — k Texture group Consistence v I r- f Structure S�' ,�, 5 6 kin Mineralogyb� HORIZON IV DEPTH Texture group Consistence �'• ` Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE a ,], SITE CLASSIFICATION: 05 EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: _ ubt5 � _���o �:�• im Qt ,u vt t a�() I LEGEND I,an scape 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 Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Y&I 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 sPCL (jLsdtil►� Mineral= 1:1, 2:1, Mixed NDIU 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 05/05 (Reviseril OPERATION PERMIT ' Davie County Health Department200210 - 1 CDP File Number: 210 Hospital Street P.O.Box 848 County File Number: Mocksville NC 27028 Date: 0 Inch Drawing Drawing Type: Operation Permi Scale: , O Block !. _ .. 0 N/A 1 . l .. 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