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186 Summerlyn Drive Phase 1 Lot 5DAVIE COUNTY ENVIRONMENTAL HEALTH " P.O. Box 848/210 Hospital Street ' Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 OPERATION PERMIT Account #: 990005113 Tax l INIEH #: 5821-71-5260.05 Billed To: Alliance Development Subdivision info: Summerlyn Farm Lot # 5 Reference Fume: :.: Local;ioniAddress: Angel Road -27028 Proposed Facility: Residence Ptopi'rt.y Size: 0.774 Acre a,T68 �*r� ThSe isss ance 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. f System Type: S.T. Manufacturer�S Tank Dat Tank Tank Size . Pump Tank Size p System Installed By: Y'�QI'1 IV�e �ej( E.H. Specialist: W6�ate: GPS Coordinate: 0 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 AUTHORIZATION FOR WAS WATER SYSTEM CONSTRUCTION (00q� Account #: 990005113 C� Tax PIN'/EH #: 5821-71-6269.9 Billed To: Alliance Develop n it '{fir �� Subdivision lnfo: :Summerlyn Farm Lot # 5 Reference Name: LocationiAddress: Angel Road -27028 Proposed Facility: Residence Plop #y Sze: -pp--774 acre . - iteype: (IiNew ❑Repair DExpansion Fy010A006s a,TOA&EPOI'hiRMhorization to Construct (ATC) MUSTBE 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 # Bathrooms d., People_ Basement❑ Basement plumbingW_ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Lot Size 4 K Type of Water Supply: OCounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) Tank Size&0 GAL. Pump Tank)A GAL. Trench Width Max. Trench Depth (Q�` Rock Depth Linear Ft. -,5010 Site Modifications/Conditions/Other: Rd (�Oh Contact the Davie County Environmental Health Section for final inspection of this system between DAVIE COUNTY ENVIRONMENTAL HEALTH ' 1A P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005113 Tax PIN.%EH #: 5821-71-5260.05 Billed To: Alliance Development Subdivision Info: Summerlyn Farm Lot # 5 Reference Name: LocationiAddress: Angel Road -27028 Proposed Facility: Residence Property Size: 0.774 Acre ATC Number: 5768 Site Type: QNew ❑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 I 1 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 #Bathrooms _).y4 People_ plumbingP---- Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size '7T/! Type of Water Supply: County/City ❑Well ❑Community Well 140 Od &�G System Specifications: Design Wastewater Flow (GPD) Tank Size IO/ GAL. Pump Tank /� GAL. Trench Width '36-, ' Max. Trench Depth G�1 Rock Dept Linear Ft. Site Modifications/Conditions/Other: As stated 'in 15A NG Gk,UVPLUU Oystems may also be used 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. I a- Environmental Health Specialist DCHD 11/06 (Revised) I h � I11�` Foci _ I a- Environmental Health Specialist DCHD 11/06 (Revised) Visit www.DAGmarketplace.com for information on interior and exterior products for your homel FOUNDATION LEGEND IT ,field! TYPICAL PIPE THRU FLOOR COLUMN FOOTING DETAIL 00 COLUMN BASE 4 1 1 . -. CAP PLATE DETAIL x DETAIL AT THICKENED SLAB BASEMENT AND FLOOR FRAMING PLAN Visit www.DAGmarketplace.com for information on interior and exterior products for your home! � I I -- --------�--- = tea,.-. � I - - I I n I , O ;CC I i O � v I I I � I I - I I I ASFMENT M- 0 0 ----- �I !�l6�� ' ® i • I i 1 • I I FOUNDATION LEGEND IT ,field! TYPICAL PIPE THRU FLOOR COLUMN FOOTING DETAIL 00 COLUMN BASE 4 1 1 . -. CAP PLATE DETAIL x DETAIL AT THICKENED SLAB BASEMENT AND FLOOR FRAMING PLAN Visit www.DAGmarketplace.com for information on interior and exterior products for your home! 0 a 3 0 "Ir" ®fir®�rQlooe�-�9�®�WV�W� r m A A A F� AE r fit. ocsicn no. '+` Sp OFICAT10NS '+`m So MOr� re MII0Z9-1119-A MR DONALD A. GARDNM INC. °` BY s— or on A R C H I T E C T S P L A N N E R :s TSR 3 e 8 = — ' P.O. BOX 2817OREENVILLE &Q DONALD A. GARDNER B 20878 9"s 'o' c�ooix p�nri B 4 t s s 7 B B o ',FqE c D E S 1 O N S E R V I C E S, L L C rrr.0 oaporEnor.00m/BP STANDARD DES ` E APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health E C E tv E P.O. Box 848/210 Hospital Street Mocksville, NC 27028 APR 15 2011 (336)753-6780/ Fax (33 )753-1680 Ap i tion For: ❑ Site Evaluation/Improvement Permit uthorization To Construct (ATC) ❑ Both TypeV1 t: ew System DRepair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT'*** THIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name 1q / 1 czve e eo✓� �'✓`� C �r� g Contact Person L_S 01 a K y Address 13 Q Boma a Home Phone 3 34,- yob -QST -mss' City/State/ZIP W& (r-oy1,1e- AZ�( e__ a 7 3 Y Business Phone 336- 931-fd-,�-e Name on Permit/ATC if Different than Above m Mailing Address City/State/Zip M e -PS- � tle: , Nc 9_9 a m PROPERTY INFORMATION *Date House/Facility Corners Flagged* ba 0J NOTE: A survey plat or site plan must accompany this application. Included: VSite Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name A / e` (fan ,,A S Phone Number 326 - %21- 9 aag Owner's Address .9L62- !J e_ 1 o r_ (f+,, Cf City/State/Zip -2-)_7-)y Property Address r City Lot Size o, 7 Y �! C, Tax NN# 19.1 - / S2.6 0. 0-5- Subdivision .SSubdivision Name(if applicable) S c, m m er /y m Fe- r.n Section/L # Directions To Site: — I 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 J(No Does the site contain jurisdictional wetlands? _Yes _) No Are there any easements or right-of-ways on the site? _Yes _[No Is the site subject to approval by another public agency? _Yes Y I No �l0"' Will wastewater other than domestic sewage be generated? — jos ZC N�� CCS WA �� d e �a�{fi I IF RESIDEN # People � # Bedrooms # Bathrooms 9 Y,2 Garden Tub/Whirlpool Wes ONO Basement: $Yes ONO Basement Plumbing: ❑Yes 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: RrConventional ❑Accepted ❑innovative ❑Alternative ❑Other Water Supply Type: yCounty/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions_ or expansions of the facility this system is intended to serve? IK Yes ❑ No If yes, what type? 2 b�.� 1. e` 2 h a -se o4 e,^ -r - 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 stat yng the housc�*ility location proposed well location and the location of any other amenities. Property owner's oro er's 1 representative signature Site Revisit Charge Date(s): Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account # L Revised 11/06 Invoice # ,fid, y12' ► Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990005113 Tax PIN/EH #: 5821-71-5260.05 Billed To: Allliance Development Subdivision Info: Summerlyn Farm Lot # 05 Address: P.O.Box 957 Location/Address: Angel Road -27028 City: Welcome Property Size: 0.774 Ac. Reference Name: 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: ew ❑Repair OExpansion Permit ` Valid for: Years ONo Expiration Residential Specifications: # Bedrooms `7 # Bathrooms # People BasementO Basement plumbing0 Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of F��acci�ility) Design Flow(GPD): 420 Type of Water Supply: tt�;ounty/City DWell OCommunity Well As stated in 15A 1N(,AC 13A.11969(5 Site Modifications/Permit Conditions: rn.r-)y e!s.n USOIJ /t ' 501 I Site Plan -Dp-1 V c System Type LTAR Initial Repair 3+St Lnvironmental Health Specialist p 1 1-06 Date O N DAVIE COUNTY NORTH CAROLINA NOTICE OF REAL ESTATE ASSESSED VALUE 2/16/2010 ALLIANCE DEVELOPMENT OF THE CAROLINAS LLC 262 WELCOME CENTER COURT WELCOME, NC 27374 PARCEL IDENTIFICATION PROPERTY DESCRIPTION ASSESSED VALUE F401 OA0005 LOT 5 SUMMERLYN FARMS PHASE 1 MARKET:$50,000 FARM VALUE:$0 AS REQUIRED BY NORTH CAROLINA LAW, YOU ARE HEREBY NOTIFIED OF THE ASSESSED VALUE DUE TO THE FOLLOWING: PROPERTY REVIEWED, NO CHANGE IN VALUE THE ASSESSED VALUE REPRESENTS THE MARKET VALUE. SEE BELOW FOR STATUTE. IF YOU WISH TO APPEAL THE ASSESSED VALUE YOU MUST CONTACT OUR OFFICE TO REQUEST A FORM WITHIN THIRTY (30) DAYS OF THE DATE OF THIS NOTICE. PLEASE CONTACT: DAVIE COUNTY TAX ADMINISTRATOR 123 SOUTH MAIN STREET MOCKSVILLE, NORTH CAROLINA 27028-2437 (336)753-6140 ARTICLE 14. Time for Listing and Appraising Property for Taxation NORTH CAROLINA GENERAL STATUTE 105-286. TIME FOR GENERAL REAPPRAISAL OF REAL PROPERTY Octennial Plan ... Unless the date shall be advanced as provided in Subdivision (a) (2), below, each county of the state, as of January 1 of the year prescribed in the schedule set out in Subdivision (a) (1), below, and every eighth year thereafter, shall reappraise all real property in accordance with the provisions of G. S. 105-283 and 105-317. ARTICLE 13. Standards for Appraisal and Assessment NORTH CAROLINA GENERAL STATUTE 105-283. UNIFORM APPRAISAL STANDARDS. All property, real and personal, shall as far as practicable be appraised or valued as'its true value in money. When used in this Subchapter, the words "true value" shall be interpreted as meaning market value, that is, the price estimated in terms of money at which the property would change hands between a willing buyer and a willing seller, neither being under any compulsion to buy or sell and both having reasonable knowledge of all the uses to which the property is adapted and for which it is capable of being used. Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Account M 990005113 Billed To: Allliance Development Address: P.O.Box 957 City: Welcome Reference Name: Proposed Facility: Residence 111::60 IMPROVEMENT PERMIT Tax PIN/EH #: 5821-71-5260.05 Subdivision Info: Summerlyn Farm Lot # 05 Location/Address: Angel Road -27028 Property Size: 0.774 Ac. **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: flew DRepair ❑Expansion r Permit Valid for: 25 Years ❑No Expiration Residential Specifications: # Bedrooms 7 # Bathrooms # People Basement❑ Basement plumbing[] Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD): 4S 0 Type of Water Supply: County/City ❑ Well ❑ Community Well As stated in 15A NCAC 18A.1969(5� Site Modifications/Permit Conditions: accept -d �,St2•nS mag also be USM System Type LTAR Initial Repair . 2 Site Plan 3 S ss' J LA) i Qd t 7 Z < 0 C\ -L ,o J ti 3� Environmental Health Specialist Date - -.09 i.p.11-06 0 APPLICATION 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 Application For: Site EvaluatiorOmprovement Permit ❑ Authorization To Construct(ATC) ❑ Both Type of Application: ❑New 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 Biller, A"(AN66 -� 6 V6_t_o:TAt6"'TContact Person 1c9 i- 1 NI F: -C> Lx� Billing Address 7� - -adx 95-1 Home Phone City/State/ZIP (b t.0 o Mr_- t.Y _ 2'J A-7 a Business Phone 3 3e, --t 7 Z -- Z 1 q Name on Permit/ATC if Different than Mailing Address PROPERTY INFORMATION *Date House/Facility Comers Flagged 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 plan, no expiration with complete plat.) Owner's Name =f1 M GS S LAA MF_ rZ Phone Number 5'9 Owner's Address ; a I I Ne9EL.t, 2'Qef!h City/State/Zip AADr.k.-;, Vg t_t E ,. ot. 2'ro Property Address City MSC-�CSv/wee Lot Size Tax PIN# Subdivision Name(ifapplicable�t,_M Section/Lot# Directions To Site: /O• HtyV loot , P.tt�"-r 01-1 An1G6t t. 'FZ-0-1>� -PRo"-► 6F -r4- ori �1 C� LtT 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 )i3No Does the site contain jurisdictional wetlands? ❑YesANo Are there any easements or right-of-ways on the site? ❑Yes MNo Is the site subject to approval by another public agency? ❑Yes faiNo Will wastewater other than domestic sewage be generated? ❑Yes RNo IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms 4 # Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑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: XConventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type:;Bf 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? _kiJo 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 to nngand flagging or staki�ng the house/facility location, proposed well location and the location of any other amenities. (�_ ( _ e— ,"�' / !_-_b, Site Revisit Charge Property owner's or owner's legal representative signature Date(s): 6- AJ_ 2008 Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account # Revised 11/06 Invoice # DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLI ccoun1 IFgN6 aT' WN Billed To: Allliance Development Reference Name: Proposed Facility:. Residence Property Size: �'BP& &&%INFORMATION Tax PIN/EH #: 582 r-rr- Subdivision Info: Summerlyn Farm Lot # 05 Location/Address: Angel Road -27028 0.774 Ac. Date Evaluated: 1— I — aS" Water Supply: • On -Site Well Community Evaluation By: Auger Boring Pit Public FACTORS 1 23 4 5 6 7 Landscape position Slope % (� �, HORIZON I DEPTH — (� .ZZ p Texture groupSy Consistence `j„ S Structure Mineralogy _CZ S _ J HORIZON II DEPTH �d Texture group C Consistence Structure MineralogyCJ. HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS —� RESTRICTIVE HORIZON -- SAPROLITE --- CLASSIFICATION �. LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: PS— LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: `OTHER(S) PRESENT: t, TICA-t OAS pV 4igV 1 I I ILEGEND 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 Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Rhl 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 rJotes ' 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 (Revised) Davie County Health Department Environmental Health Section PO Box 848 (210 Hospital Street) Mocksville, NC 27028 (336)751-8760 Allliance Development P.O.Box 957 Welcome, NC 27374 Sry Date Service Code ID/ATC # Description Payment Due Now. Please Return a Copy of the Bill with Payment. Your Check is Your Receipt. Account No: 990005113 Invoice No: 6670 Billing Date: 9/19/2008 Sry Cost Quan. Extended Cost 7/1/2008 SITE EVAL-PS Summerlyn Farms - Lot Lots 5-14 - 27028 $150.00 10 $1,500.00 7/1/2008 SITE EVAL-PS Summerlyn Farms - Lot Lots 54-67 - 27028 $150.00 14 $2,100.00 7/1/2008 SITE EVAL-US Summerlyn Farms - Lot Lot 2,3,4 - 27028 $150.00 3 $450.00 Balance Due Now: $4,050.00 Evaluations are based on map dated June 6, 2008. K,,Ador�Aj Uif(aje- easialo,4,j Xssiq 6 Ax ookware & Gadgets -Griddles & ... Page 5 of 5