1927 Farmington RdDAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax # (336)753-1680
REPAIR OPERATION PERMIT
Accnunt #: 990002397 Tax PIN; EH #: 5842-68-6370
Billed To: Gene Johnson Subdivision Info:
Reference Blame: REPAIR PERMIT Location/Address: 1927 Farmington Rd -27028
Proposed Facility: Residential - Repair Property Size: 1 Acre
ATC Number: 5756
**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.
f System Type: S.T. Manufacturer_ Tank Date Tank Size_
Pump Tank Size 11
System Installed By: S6%W1)ah-A E.H. Specialist: Date: q-13-1(
GPS Coordinate:
;�I
DCHD 11/06 (Revised)
4; loth
2= $o, Zo tip
21' Li c l
y =13t* 3_
34 o' $SC
Via Gina. 14
LV ,
1
• DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 / Fax # (336)753-1680
REPAIR IMPROVEMENT PERMIT
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #:
990002397
Billed To:
Gene Johnson
Reference Blame:
REPAIR PERMIT
Proposed Facility:
Residential - Repair
Tax PIIS: EH #: 5842-68-6370
Subdivision Into:
LocationiAddress: 1927 Farmington Rd -27028
Property Size: 1 Acre
A�O�lihi 5IP56Authorization 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 IP/ AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat
of the intended use change. :,
Residential Specifications: # Bedrooms Z)L # Bathrooms # People Basement Basement plumbing
Non -Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Lot Size Type of Water Supply: O'County/City ❑ Well ❑Community Well
LAPf
�--�
System Specifications: Design Wastewater Flow (GPD) V Tank Size.„L_qIALAIump Tank GAL.
ie fe c
Trench Width 36— Max. Trench I)epth? b Rock Dept Linear Ft.— D
Site Modifications/Conditions/Other: Irk
s stated in l.5f, �XAC
1'I1"y ai:>V
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)753-6780.
E01
W1
Environmental Health
DCHD 11/06 (Revised)
41A,,%f(-/1I N
Date:
�1Nua�e�; lli6'
1.
Z
il �0 !Mo &Awm IN s �• �n�o ft z-
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION --CM
C,',p
J
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME dl 00 d �q _ S d� PHONE NUMBER V 757_Z-Kelele6
ADDRESS ( C/ �-7 FC4`� -� SUBDIVISION NAME
A / •P Y /I, ao� s� (111A LOT #
DIRECTIONS TO SITE /��� �;�... d '� w CL v —S
DATE SYSTEM INSTALLEQ S NAME SYSTEM INSTALLED UNDER
TYPE FACILITY 5t- NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY �� SPECIFY PROBLEM OCCURRING D4 C_ U-/1
DATE REQUESTED 3 INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge. and that 1 understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93
07,16) �
66Maps GIS
Page 1 of 6
http://maps.co.davie.nc.us/GoMaps/map/map.cfm?CFID=73662&CFTOKEN=10602933 3/21/2011
• DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION
GelkC2 tk Cato 3C'6560
��GowYgr�
1�
Ui.s �� 7 16,47i
Water Supply: On -Site Well Community
Evaluation By: Auger Boring Pit
PROPERTY INFORMATION
I -7 FafMttA560,�,Pj
M& -_k5(3 f I.e A/C_
a -7
Public
Cut
FACTORS
1 2 3 4 5 6 7
Landscape position
(�
Sloe %
HORIZON I DEPTH
-f
Texture groupG
Consistence
Structure
Mineralogyt
HORIZON II DEPTH
Texture group
Consistence
Structure
Mineralogy
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: 1) _5
LONG-TERM ACCEPTANCE RATE: 6).(-79 .(?9
EVALUATION BY: ` n
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
ul
VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm
3yd
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
1YoSes
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)