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166 Peace Court Lot 7• DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 Account #: 990001881 Billed To: America's Homeplace Reference Name: Proposed Facility: Residence ATC Number: 4554 OPERATION PERMIT �, / (P Tax PIN/EH #: 5777-33-1382.07 Subdivision Info: Still Waters Lot # 7 Location/Address: Peace Court -27006 Property Size: see map **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. System Type: A S.T. Manufacturer �� AbC Tank Date • 2 • tP Tank Size I COD Pump Tank Size \J System Installed By: D'+50 � 3 H. Specie f� /o DCHD 11/06 (Revised) ft`2 DAVIE COUNTY ENVIRONMENTAL HEALTH` P.O. Box 848/210 Hospital Street Mocksville, NC 27028 I (336)751-8760 Fax # (336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990001881 Billed To: America's Homeplace Reference Name: Proposed Facility: Residence ATC Number: 4554 Tax PIN/EH #: 5777-33-1382.07 Subdivision Info: Still Waters Lot # 7 Location/Address: Peace Court -27006 Property Size: see map **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 FIVE YEARS. This ATC is subject to revocation if site plans, plat or the 'untended use change. Residential Specification: Building Type #People #Bedrooms #Baths !L– Basement w/Plumbing: — Basement/No Plumbing Commercial Specification: Facility Type #People #People/Shift #Seats Lot Size _Type Water Supply Design Wastewater Flow (GPD) . QSite: NewLAte—pai` System Specifications: Tank Size kW GAL. Pump Tank — GAL. Trench Width Za Trench Depth 3 iv � w,t Ax Rock Depth a Linear Ft.�" Other: u 3 i Required Site Modifications/Conditions: I T41L J ( Q 515prF ka–:10 l C� ow Contact the Davie County Environmental Health Section for final in, pection of this system between p12 p0, L_i,ju 8:30 - 9:30a.m. on the day of installation. Telephone # (336)751-8760. Ir- Environmental Health DCHD 11/06 (Revised) L r� % �124� �✓ 01* Date: 12/4/2006 10:10 3 651655 AMERICAS HOME PLACE Ad -1lFG' t#w $ Awvip county envhealth 3311 781 8786 MLI FOR SITE EVALUATION/W110VEMENT PERMIT & ATC ` 1pavie County Environmental llealth P.O. Box 848/210 hospital Street K Q�� Mocksville, NC 27828 (336VS147601 Fox (336)751-11786 t� P 4 C � 6 • . U Site Evaluationlimproc:ment Permit 0 Authorization To Conitntet(ATC) K18oth V pplieski n *cw System l! Rcpnir m Existing System OFApansirnJModifiestion of Existing System or Fetidly •"IMP0RTA?M9* THIS APPLICATION CANNOTBE PROCa.YW UNLIiSS ALL OF THE R EQUMeD 1.14FORMATION IS PROVIDED. Rerbr ro the INFORMATION DUIJ-VM toy instructions. Name to 6e Billed A 9 a.. ;'ontact Person Billing Addreya _� 1 s.l ae _"'UX �tl j Hoare Phane City/State/ZIPt C�_�J1O_Busine;.sPhone.>if 4 / None on Pcrmit/ATC i f Dlfferent than Above. Mailing Address YKUYLK l Y 11Nk VKMAI'IV IN Date houtt:/F:.ellity tAIncm 1-1-42M NOTE: A survey plat or site plan mit acccimpany dais application. Included: 0 Site Plan OPlat(to scale) (Permit ii olid for 601wirills will site plan, no cxpushon with t eoplem pl,t ) Owner's Nnme e� R��. _ Phone Numlm Owner's Address Ciry,'Statj7..ip Lot SizeAl- _"ox Rection/Lot# # -1 — Directions To Site: anfwar nobly of the follewmg questions is •)es', strppotfing doeurnenutlen muni Are there tiny extating waetewatet nysterns on the site? Oyes lt'7o Does the site contain jurisdictionul wetlands? Oyes g to Are drere any easereenta or right-c:� waya on the site? OYes 04', to the site subject to spproval by atotber public agency? Oycs aVo Will wastewater other than domca:ic sewage be generated? Oyes TA -16 1F RESIDENCE FILL OUr THE: It OX BELOW #Poople#Bedrooms #8athroorrts_ Garden Tub/Whirlpool Yea �Nn Basement Oyes o BascntcntPltmbinS- OYca IQL. IF NON-PASIDFNCE FILL OLIT rHE BOX BELOW Type of FaeilityBusiness �Toul Square Footage of Buildin¢ # People # Sinks # Commode.` _ _ _ # Showers # Urinals __ Estimated Water Usage (gallons pec day) (,Attach documc-nation of similar futility wrier con.umption) FOODSERVICE ONLY: tl Seats Typcsystcmrequested: jf(Ctmverttional (.Accepted Otnnovative nAlknIA6.1e OOther WgterSupply Type: p('Cotinty/CIrywit" U New Well CHxlstint.,well O Community Wall Do you antiripme odditlosts tit exponsimot of the facility this system is intended M serve? O yes d.(Nn If yes, what type? _ .. p.2 Thls Is to terrify that the infonwtion pre vVed on this application is true and coneet to lbp hest of my Itnitwleflge. I Understand that any petmit(s) or ATC(t) issued hereafter ate subject to suspension or revocation if the site is altered, the intended use changes, of if the infomtation mtbmiMsd in this epplkatio i is falaifted at changed. I hereby grsnt right of entry to the Authorized Represenntave or the Davie Canty Health Departmcat to conduct occeaeary inspections to deto-mine cortpllanee with applicable laws and rules. I uncle d (nit 1 ram responsible for oho p*pti idatrifteetion and labelirte of prspt tty lines and camera and loehfing and r)ggin(1 ors nh _�itlty location, proposed well location and the location of nay other nuKnities. •' Site Revisit Charge f or owner's legal tepre.erttarive signature Dstc(a): Cl*%tRto6ClcetionDim; _ Date MIS: Sign given OYes ONv Reviled 1(/06 Account u l l lmolce M 0/ • 1n PAGE 01/04 12/-14/2006 10:10 3367651655 AMERICAS HOME PLACE PAGE 03/04 i i i i v •I AMERICAS HOME PLACE PAGE 03/04 i i i i •'rid � �!�� _� r', ; " 1+• i - ' is i t A '•� ' ............ 1 .....,,,,,.�,..,,,,,,. ll y' ............. t i' 7� �• y .1 1.2/14/2006 10:10 3367651655 AMERICAS HOME PLACE PAGE 04/04 F V., 1212B12006 19:52 3.36.72214144 PaSt-it' Fax Note 7671 0+w To A. co 1) /1 I/c ca. t Phone t 71)-14 `'"" — _ R 7? Fax: PRELIMINARY PLAT Whitt Land Surveying 839 WATSON AVENUE NANSTON-SA". NC 27103 (339S) 722-144 WHITT LAND SURVEYING ~1_ 20.14• PAGE 0.1 101 �\ ,o' UI1LliY EASEMENT PEACE COURT 60' PUBLIC R/W PROPOSED SITE PLAN OF LOT 7, -PHASE 1, _STILL. WATERS_ SUBDIVISION PULTON TOWNSHIP. DAME COUNTY, NORTH CAROUNA PLAT OF SURVEY FOR AMERICA'S HOME PLACE 12/29/06 PACE 12/29/2006 09:39 3367651655 13/27/2006 21;59 3387221444 Pcs1-n' FaxNota T871 "' !2 /� P :Ryna / Ta T, A . /i F� W �1• Cac.Pe i P.en.. Pham • , t 4 f 4 F... —745`S ra%1 FA AMERICAS HOME PLACE WHITT SAND 9URVEYM O 44.3' 0 PAGE 01 i � +o ururr W[tstrt 1 1 1 / ! 1 1 I PEACE COURT 80' PUBLIC R/W PRTDSED SITE PIAN OF PRELIMINARY PLAT LOT 7. PHASE 1, STILL WATERS SV8DIVISION _ FULTON TOWNSHIP. DAME COUNTY NORTH CAROLINA P_tAT OF SuRVET FOR AMERICAS HOME PLACE Whitt Land Surging 939 WATSON AVENUE wNSTON—SAbW NC 27103 — — -PATE SCXE.-- -- MAP RECORDED -0 (338) 722-1444 12/28/08 1 SO_'— _-- aoac -- >,cE PAGE ©2/©2 / i ! r 1 N I ! / ! / W E i AMERICAS HOME PLACE WHITT SAND 9URVEYM O 44.3' 0 PAGE 01 i � +o ururr W[tstrt 1 1 1 / ! 1 1 I PEACE COURT 80' PUBLIC R/W PRTDSED SITE PIAN OF PRELIMINARY PLAT LOT 7. PHASE 1, STILL WATERS SV8DIVISION _ FULTON TOWNSHIP. DAME COUNTY NORTH CAROLINA P_tAT OF SuRVET FOR AMERICAS HOME PLACE Whitt Land Surging 939 WATSON AVENUE wNSTON—SAbW NC 27103 — — -PATE SCXE.-- -- MAP RECORDED -0 (338) 722-1444 12/28/08 1 SO_'— _-- aoac -- >,cE PAGE ©2/©2 0 1 1 � 1 l / / / m 20,14' ,o• ununr EAS, PEACE CnURT 60' PUBLIC R' PROPOSM SITE PLAN OF FuLOT ' 'WATERS. SC -PRELIMINARY PLAT LTOW OMNP. b -AE STILL� ASUBDIVISION PLAT OF SURVEY FOR AMERICA'S HOME PLACE Whitt Lanai Surveying 839 WATSON AVENUE lirl%i$TGi1—SnLENf. iYC dElua pAT�:SCtt€: 1 mhr^ ci5{:G'RDED (335) 7$Z-19-44 i 12/29/0 i'-`JOr B49K PAGE E APPLICATION FOR SITE EVALUATION/IMPROVEhIEIYf PERMIT & ATC Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 APR 2 6 2001 ENVW0P1(';i , + 4LTH ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed (2AkJPbC11 ; 1 1 P� e ' ., S"C Contact Person 'R0t,;A0 \lig &A/ 1)6at , Mailing Address 606 . ).TI)on;: V 1 It Ayre -+. ^7 Home Phone 33c, - / 9,� - �7t- 2- City/State/ZIP 01A41-0111), SdI'h1 _ MC Z 712 / 8usinass Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: House ❑ Mobile Home ❑ Business ❑ Industry Other Sit . �V%SictJ 5. If Residence: # People # Bedrooms -3-q # Bathrooms - 'ZL ADishwasher Garbage Disposal Washing Machine ❑ Basement/Plumbing 0( Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Y No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUdP!'D PROPERTY INFOR IATiON REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: #, �5 -777- 3 3 -13�1� Property Address: Road Name City/Zip JAn,c-c . /l(RL606 If in a Subdivision provide information, as follows: WRITE DIRECTIONS (from Mocksville) to PROPER'T'Y: b y �ASf f� �wv q0 lr luv,1J ri opceeA '/�. nn. (e o Name: i tJ Section: I}St Block: Lot: Date Property Flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for aft charges incurred from this application. I, hereby, give consent to the Authorized Representative of the avie County I1calth/JDepartment to enter upon above described property located in Davie County and owned by 6A4A JJ'S �u41' I roT _�ie;�__,.__. to conduct all testing procedures as necessary to determine the site suita lity. 1 DATE �( �1 SIGNATURE L'vv/�( THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS: Revised DCHD (07/99) Account No. Invoice No. APPLICANT INFORMATION Account #: 990001720 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation Billed To: Campbell's Quality Properties, Inc. Reference Name: Proposed Facility: Residence Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5777-33-1382.18 Subdivision Info: Still Waters Lot # 18 Location/Address: Hwy 801-27006 Property Size: see map Date Evaluated: S 'ly dam_ Community Public Evaluation By: Auger Boring Pit L/ Cut 1v lage Lvn—z FACTORS 1 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTHTexture rouConsistence M.,�2 Structure MineraloHORIZON II DEPTH 'YD ` Texture groupC G Consistence E' Yry Structure ,L 5 Mineralogy HORIZON III DEPTH Texture groupk Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON —" SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE r -� SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: n , REMARKS: EVALUATION BY:i OTHER(S) PRESENT: /w /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 Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet 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 DCHD 05/99 (Revised) ir:-'k u9,,+ -t tr `4�(. x rASftClw� � ! �� � �♦f �� � '; ¢ i t <'; ��~ �'� Vim'_ 1 `� */_.� /�► i`:. r flt � �:� t �� •ti F � Y � 4 r► `, .*!F �,.Lt � � 1./ � Js 02. ACt � �f j { SIL � S �•Yy�7:~`)�y}.f�'., /y� �y/�) .. y 6 V I 4 7 j i SF L •'+ APPUCATION FOR SITE EVALUATION/IRIPROVEMEM' PERMIT & ATC Davie County Health Department En t/ironmenta/ Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 LOT D C TT —9 T N APR 2 6 2001 ENVIROP,�'r ;1LTH DAM, ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed �(unt9t[(S '( I PYC t' 1' !l Contact Person /2RVt';40 b. L2-T-7mp6et Mailing Address 9000 .�Anorv: �/ 1 �� z 1 Home Phone 33G — 795-- J ! 1 2— City/State/ZIP OlitAlom'-,AHI kk, Buninass Phone 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: K Site Evaluation City/State/Zip ❑ Improvement Permit/ATC ❑ Both 4. system to Service: X Housq' ❑ Mobile Home ❑ Business ❑ Industry Other 6,; •rvi'sic/J S. If Residence: # People # Bedrooms 3-H # Bathrooms Dishwasher Garbage Disposal ( Washing Machine ❑ Basement/Plumbing IX Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes VNo If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: #, U Property Address: Road Name city/zip l (-RP)06 If in a Subdivision provide information, as follows: Name: �`4'1 �� O pfhr5 Section: oat Block: Lot: WRITE DIRECTIONS (from Mocksville) troy PROPERTY: P. A I+ - {'� w v tt U (r t u v,,/ (1rureeA '/1- oAile 0 Date Property Flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by (.,1 -}tit U11'5 Qua�rUrnrY(iTi.Nr to conduct all testing procedures as necessary to determine the site suitab lily. DATE �/ t)f SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s) Client Notification Date: EHS: o Account No. /-1 Z Revised DCHD (07/99) Invoice No. ' APPLICANT INFORMATION DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Account #: 990001720 Tax PIN/EH #: 5777-33-1382.07 Billed To: Campbell's Quality Properties, Inc. Subdivision Info: Still Waters Phase 1 Lot # 7 Reference Name: Location/Address: Hwy 801-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: 5 Jl Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public / Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % CUO HORIZON I DEPTH Texture group ConsistenceCf�s 4f Structure Mineralogy HORIZON II DEPTH 9—IX 9-IX 72 Texture group Consistence _ Structure g 4:� L MineralogyI .— HORIZON III DEPTH Texture groupC Consistence CIS Structure 1� k Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE . SITE CLASSIFICATION: C ,l LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: 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 Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet 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 DCHD 05/99 (Revised)