153 Timber Trails Lane Lot 2t DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 Fax # (336)751-8786
Account #: 990001715
Billed To: Wishon & Carter Builders
Reference Name: Ted Baity
Proposed Facility: Residence
ATC Number: 4585
OPERATION PERMIT
Tax PIN/EH #: 5802-90-9082.02
Subdivision Info: Timber Trails Lot # 2
Location/Address: Timber Trails Drive -27028
Property Size: 5 acres
**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 for any given period of
time. C� r �i 0(, a lci, C (It, ( .°
ASystem Type: A � ` S.T. Manufacturer,._ Tank Date ( Tank Size t /6
Pump Tank Size
System Installed By: v%OZr^ E.H. Specialist: (--d ate: -7-1--7
4 pmlli� SEai2�rom--�
DCHD 11/06 (Revised) Cti---14
eA Rj
r } 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 #: 990001715 Tax PIN/EH #: 5802-90-9082.02
Billed To: Wishon & Carter Builders Subdivision Info: Timber Trails Lot # 2
Reference Name: Ted Baity Location/Address: Timber Trails Drive -27028
Proposed Facility: Residence Property Size: 5 acres
ATC Number: 4585
**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 1 I of G.S. Chapter 130A
Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD FIVE YEARS. This ATC is subject to revocation if site plans, plat or
the intended use change.
Residential Specification: Building TypQS a #People �- #Bedrooms 3 #Baths 'a
Basement w/Plumbing: _.__ Basement/No Plumbing +
Commercial Specification: Facility Type #People #People/Shift #Seats
Site:
Lot Size Type Water Supply Design Wastewater Flow (GPD) New Repair
System Specifications: Tank Size IjooIGAL. Pump Tank — GAL. Trench Width3t- Trench Depth 3
Rock Depth t 0. „ Linear Ft.4 SQ a `'
Other:
kS Jtatcd in
Required Site Modifications/Conditions: nnF
Contact the Davie County Environmental Health Section four
8:30 9:30a.m. on the day of installation. Telep
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Environmental Health
DCHD 11/06 (Revised)
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JAN -8-2007 08:48A FROM:WI5HON&CARTER 336-679-4436 TO:13367518786 P.2/5
T SITE EVALUATIONAWROVEMENT PERMIT & ATC
Davie County Environmental Health
1 P.O. Box 848!210 Hospital Street
J ra Mocksville,NiC .27028
(336)751-8760/ Fax (331)751-�87
' ff VT�
Appl tion F ion/Im vement Permit Au on-zation-oo Construct(ATC) O Both
Type �a i ORepair to Existing System UExpansion/Modification of Existing System or Facility
**' RTAN7*" TH9S APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. i�If
APPLICANT INFORMATION
Name to be Billed
W i ion
+� �.-fie.- /✓,r ��.
Contact Person 7e/
B-.'; e
Billing AddressBan,
Oyes ®No
/7%9
Home PhoneZ&)
-736
City/State/ZIP
r -%/e
N c. z 7oSs
Business Phone (o)
33dr - 6 79 - 2-03/
Name on Permit/ATC if Dfferent than Above
Mailing Address City/State/Zio
YKUPERIY 1NrURMATIUN 'Date
NOTE: A survey plat or site plan must accompany this application. Included: Iff Site Plan OPhtt(to scale)
(Permit is valid for 60 months with site plan, no expiration with complete plat.)
Owner's Name Phl4•- r, e,,%Ie �, Phone Number t�36��79-zc3/
Owner's Address Pd. &r /7/1 City/State/Zip X,/-, %1e: ,el C. 2 loss
Property Address ' City. /�.uF.r�i/• 'el c. .27ozB'
Lot Size S,gwe. f yfo' x Kra ' Tax PIN# rn�I�A _i � .8.4/7, P. --v/ x 5W2'g0g0Y2-
SubdivisionNante(ifapplicable) 77',76e•- 7;T,;.r Section/Lot# /-a 71 *�.7
Directions To Site: %io,-, /1eekSvril/e 6D/ 7-/-, drr LiSaH`y _G( /P/. .-77-'4, on ,9ed- L.�uF
ow
If the answer to any of the following questions is "yes", supporting documentation must W attached. '
Are there any existing wastewater systems on the site?
ayes ®No
Does the site contain jurisdictional wetlands?
OYes DNo
Are there any easements or right-of-ways on the site?
Oyes ®No
Is the site subject to approval by another public agency?
ClYes ®No
Will wastewater other than domestic sewage be generated?
OYes JONo
�P�
JAN -8-2007 Oe:48A FROM:WISHON&CARTER 336-679-4436 TO:13367518786 P.3/5
L JOUT TRE BOX BELOW
# People Z # Bedrooms 3 # Bathrooms 2. Garden Tub/Whirlpool OYes J@No
Basement: OYes ®No Basement Plumbing: OYes 6dNo
IF NON- tEMENCE FILL Ma IM 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: gConventional ❑Accepted OInnovative []Alternative 00ther
Water Supply Type. JO County/City Water 0 New Well ❑Existing Well 0 Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes Ja 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 arty other amenities.
Site Revisit Charge
Property owner's or owner's representative signature
Date(s):
X 7 Client Notification Date:
Date EHS•
Sign given OYes []No
Account # r 7
Revised 11/06 Invoice # A
JAN -8-2007 08�49A FROM;
.
336-679-4436 TO:13367518786 P'4/5
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATION
Account #: 990001715
Billed To: Wishon & Carter Builders
Reference Name: Ted Baity
Proposed Facility: Residence Property Size
PROPERTY INFORMATION
Tax PIN/EH #: 5802-90-9082.02
Subdivision Info: Timber Trails Lot # 2
Location/Address: Timber Trails Drive -27028
5 acres Date Evaluated:
Water Supply: On -Site Well - Community
Evaluation By: Auger Boring ` Pit
Public
Cut
FACTORS
1
2
3 4 5 6 7
Landscape position
L L_ h
L
t
Sloe %
3
3
HORIZON I DEPTH
, - 3
_
-
Texture groupC
L
C L
Consistence,
-
Structure
Mineralogy•
1
t ;
= 1
HORIZON II DEPTH
-
6I -
Texture group�.
Consistence
�r
Structure
^,Ah
Sj+I<,
Mineralogy
1 1
• ,�
"
HORIZON III DEPTH
-1441
Texture group
Consistence
Structure'
Mineralogy
P 'N
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
1J,
LONG-TERM ACCEPTANCE RATE
1
0 .2ZZ L
I c-. 7V'
SITE CLASSIFICATION: `�C�t c1. !j L, jrPh),C
LONG-TERM ACCEPTANCE RATE: 6 11 �^
REMARKS:
EVALUATION BY: l: I i7t I c n �Z—
OTHER(S) PRESENT:
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
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
CONSISTENCE
m1St
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
LYQtes
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 05105 (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 #: 990001715 Tax PIN/EH #: 5802-90-9082.02
Billed To: Wishon & Carter Builders Subdivision Info: Timber Trails Lot # 2
Address: P.O. Box 1719 Location/Address: Timber Trails Drive -27028
City: Yadkinville Property Size: 5 acres
Reference Name: Ted Baity
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: VNew ❑Repair ❑Expansion Permit Valid for: 95 Years ❑No Expiration
Residential Specifications: # Bedrooms .3 # Bathrooms '�, # People Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Design Flow(GPD): Type of Water Supply: KCounty/City ❑Well ❑CommunityWell
Site Modifications/Permit Conditions:
Site Plan
System Type LTAR
Initial c << -} 1-d 0 .
Repair ji cc_ -e 'fc cl 0.3 -5 --
Site
•a5 --
Environmental Health Specialist
i.p. 11-06
Date 2-6 — 6r 7