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7306 NC Highway 801 South Lot 2DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street G Mocksville, NC 27028 �2�7j 107 (336)751-8760 Fax #(336)751-8786 OPERATION PERMIT Account #: 990004405 Tax PIN/EH #: 5745-39-5712 Billed To: Joel Wallace Subdivision Info: 1730 0 Reference Name: Location/Address: NC Highway 801 S-27028 Proposed Facility: Residence Property Size: 0.726 ATC Number: 4735 **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 fory given period of time. �) —G System Type: S.T. Manufacturer Tank Date Tank Size�� Pump Tank Siz System Installed By:L�l G<, _ (% E.H. Specialist:V66N0h0PJ Date: / DCHD 11/06 (Revised) i I DAVIE COUNTY ENVIRONMENTAL HEALTH pl3/o P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004405 Tax PIN/EH M 5745-39-5712 37go0alz Billed To: Joel Wallace Subdivision Info: Reference Name: Location/Address: NC Highway 801 S-27028 Proposed Facility: Residence Property Size: 0.726 ATC Number: 4735 Site Type: i�<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 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# Peopl Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats ,,cc�� Square Footage(or Dimensions of Facility) Lot Size V • Type of Water Supply: &<ounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) 3 & 6 Tank Size AL. Pump Tank a GAL. . - r= - 3�6` e Trench Width 3 6 Max. Trench Depth Rock Depth Linear FJ. lis stated in 15/1 NCA,C 18A.I.969(5 6f Site Modifications/Conditions/Other: reeepted SSystamg may al;ro be us I) -D. ��t�. 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. -1pia y L:-, f X�� i C) 0'r, t roc Environmental Health Specialist /(J/�J'G Date: 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 IMPROVEMENT PERMIT Account M 990004405 Billed To: Joel Wallace Address: 7300 NC HWY 801 S. City: Mocksville Reference Name: Proposed Facility: Residence Tax PIN/EH M 5745-39-5712 Subdivision Info: Location/Address: NC Highway 801 S-27028 Property Size: 0.726 **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: NNew ❑Repair ❑Expansion Permit Valid for: 8'5 Years ❑No Expiration Residential Specifications: # Bedrooms 3 # Bathrooms - # People Z Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD): 13 cea Type of Water Supply: E? ounty/City ❑Well ❑Community Well As stated in 15A NCAC 18A.1969(5) Site Modifications/PermitConditions: accepted Systems may also ht- used Site Plan S stem Type LTAR Initialn c 0 - � Repair C , r p .,I,; � 1 C a �vV 5.. M Environmental Health Specialist i.p.11-06 all Date — 7-11 APP ^ -11ON FO�,SIt'Tl] o: r L� ----" Da u ", EVALUATION/IMPROVEMENT PERMIT & ATC County Environmental Health . Box 848/210 Hospital Street Mocksville, NC 27028 1)751-8760/ Fax (336)751-8786 Applicati For: ti'altfa'ion/�pFov�'ment Permit ❑ Authorization To Construct(ATC) oth Type of A lication: 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 :5af Z m lQGll Contact Person c 5_ 5 p Billing Address Home Phone City/State/ZIP_ pr+ �li� jf��T�� 2-7q usiness Phone Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged / /Gy 1 Q / 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 Ian, no expiration with complete plat.) Owner's Name RZq ✓' Q e P Phone Number % Owner's Address :f 3/6 dwy �vl City/State/Zi %�� ,fes Property Address 0 City_' Ile Lot Size a -72,x' fax PIN T2_ Subdivision Name(if applicable)_ _ Section/Lot# Directions To Site: (Ol 4-0 p�ae�e %f_7 ✓'B� i � �zri�iV '�� 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 YZlo Does the site contain jurisdictional wetlands? ❑Yes �(No Are there any easements or right-of-ways on the site? ❑Yes DNo Is the site subject to approval by another public agency? ❑Yes JXNo Will wastewater other than domestic sewage be generated? ❑Yes rANo IF RESIDENCE FILL OUT THE BOX BELOW # People Z, # Bedrooms y # Bathrooms _ Garden Tub/Whirlpool ❑Yes ;KNo Basement: ❑Yes []No Basement Plumbing: []Yes KNo 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: # Ssmts Type system requested:. ventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: )e, 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 If yes, what type? ;(No 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 ouse/fa 'lity location, proposed well location and the location of any other amenities. ��' e Site Revisit Char -- g groertyy own is or owner's legal representative signature Date(s): Client Notification Date Date EHS: Sign given []Yes ❑No Account # V✓_ Revised 11/06 Invoice # _ r� r -- Registration Number NEA[ 1H QFFI FF •� C ;` N CAR .2204 S '!0�y t• /f ricer of Davie County, = SEAL hich this certificatic•n Iments for recording. L-2527 TO DATE Q- of the property shown in the Town of Mocksville v iivision withmy free consent, lines and dedicate all streets, end eosernent to public or hereby dedicate all sanitary Mocksville t'a,tF�;r rnvrlrP my Planning Department. 1 a 0� 3 ., AREA= 1.459 AC. - GoMaps GIS Page 1 of 6 http://maps. co.davie.nc.us/GoMaps/map/map. c frn?CFID=4129&CFTOKEN=616408 81 7/30/2007 Map Frame Davie County, NC - GIS/Mapping System Page 1 of 1 4�arF rte, Click Here To Start Over Quick Search:{County ID c r \ I 17 Active Layer. W U.. ,Vzip 77ps GIS oil c �' ® PARCELS (Map Tips Available) Map Layers I Results I http://maps.co.davie.nc.us/GoMaps/map/mapframe.cfm?CFID=4129&CFTOKEN=616408... 7/30/2007 APPLICANT INFORMATION Account #: 990004405 Billed To: Joel Wallace Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation Property Size: Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit FACTORS 1 2 PROPERTY INFORMATION Tax PIN/EH #: 5745-39-5712 Subdivision Info: Location/Address: NC Highway 801 S-27028 0.726 Date Evaluated: S 4 0 Public Cut 3 4 REM HORIZON I DEPTH r��t�� ♦ rANWIM Texture gro�. Consistence HORIZON II DEPTH Structure HORIZON III DEPTH Texture group Consistence Structure HORIZON IV DEPTH a % IJ Texture group Consistence .t Structure I Io 4 SOIL WETNESS / / RESTRICTIVE HORIZON G SAPROLITE / 1 CLASSIFICATION V% - LONG -TERM LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: �h.5 - EVALUATION BY: P6LA[_CX1/-c,,-? 5 LONG-TERM ACCEPTANCE RATE: G • �� S OTHER(S) PRESENT: REMARKS: ,n LEGEND I,andscane 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&A 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) LIAR - Long-term acceptance rate - gauday/ft2 DCHD 05/05 (Revked) g■ ■