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1239 Rainbow Rd � DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 REPAIR OPERATION PERMIT Acct�u�t #: 990005842 T�x Pl�r'EH#; D70000006301 Biflcd 7a: Tommy Howard Sufadivi;ior� lnfo: . Re�fereE�ce PVa�i�: REPAIR PERMIT � LocationiAd�r�ss:�-1239 Rainbow Road-27006 Pro�c�s�;c9 F�ci€ity: Residential Repair � Aro��rfy�ize:�-�° 0:58 Acre � �� t�TC N�a�b�r: 5901 . ' **NOTE** The issuance ofthis Operation Permit shall indicate the system described on the ATC has been installed irr 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: � S.T.Manufacturer � ' Tank Date_� Tank Size� Pump Tank Size�/ Bedrooms�_ y�(l�r� System Installed By:� 11V1�Q ��,�_i�ar#: Date:��/�% b/Z r- GPS Coordinate: � f1 � �• � .. .M .� !�` '� • ' �1'. / � � KVV� �' ` �` �c��in 0 C� � . � P . , , �o�d ��'f �,�o� � � fb (�e N,3�x �, . � � . � �j�„rx �.• �� . . � p� . � �- - - � J � � - � � , � �� .� � � ��, , � � � � � , _ � . i � � f i � - �°� � � P�' Environmental Health Specialist: Date:��_�_�p� DCHD 11/06(Revised) , 4 ' ,�� - , DAVIE COUNTY ENVIRONMENTAL HEALTH ' " . P.O.Box 848/210 Hospital Street ' � Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRIJCTION � Accc�u�t #: 990005842 '�ax P1Nr'EH#: D70000006301 Bili��To: Tommy Howard : Su�idivi�iar� Info: R�fer�E�ce P�a�i��: REPAIR PERMIT LocaiioniAddr�ss: ..1239 Rainbow Road-27006 Prc�pos�i� F��i€ity: Residential Repair � Pco�er�y�ize: � 0.58 A re Site Type: ONew �epair ❑Expansion a,��*'N(1'��Thi5�Quthorization to Construct(ATC)MLJST 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 FNE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. Residential Specifications: #Bedrooms J #Bathrooms #People�Basement� Basement plumbing❑ Non-Residential Specifications: Facility Type # People #Seats • �' Square Footage(or Dimensions of Facility)� ' ' . � Lot Size _�� Type of Water Supply: C�4County/City ❑Well ❑Community Well System Speci�cations: Design Wastewater Flow(GPD) C'CQa Tank Size�ij,�Y�AL.Pump Tank � GAL. � Trench Width�� Maz. Trench Depth�� Rock Depth AJ�R Linear Ft.�as°/o Site Modifications/Conditions/Other: ' QPlQ�n Contact the Davie County Environmental Hefilth Section for final inspection of this system between 8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760. ��i'V' ��-C �"+ r� � ��r� `Jpvt ��ae�s.�p�� ,� -.� � �; � c ,'� � y _ � ', � , , � �� .� � -� 5� . �� I �S� ,�r�� . _ ` �� i � . . � . � � . _ .�� Environmental Health Specialist • Date: _ �2� (�� DCHD 11/06(Revised) 3/�lZ _ .�vUoi�e �D�7 GoMAPS - Davie County NC Public Access —r� :�!': l '�NATERSHED S�RUCTU %:::_;:..;% .� �r �41lATER_B�DtES � C�UNT1(_��UNG�IRY _,.,. . � STREETS i �v � . y� _��ti� R�ILROAD�CENTEF�L[h1E C ��y � � PARCELS �I o; G ITY_LIMIITS . ��`� , _ � 9ERLSlJDA RIiN ' R.air�oosl.��-" -'' _ _�� I � , _, � COOLEE�SEE �1 ao`N . - c � FarR�vAY�-� .,-_1C1T�R5�f:A�E�~ ~_. � DAVIE C011MTY t� � .'�-��,-'' _ �,�yS�P � - '`J_,:�tN� � 1�SOCKSVILLE Y ._MARTIN LN `'• �::v`'� u _ ~ ,� � nccountics ` 1 ��, . o� DA'VlE 0 c, n <all �other values> 7 O ,--� , !.� � Tuesday,Apri13 2012 o � fl _,�P��4_,., '� ; �. _-....-DAYE LM_-.-��_--�--=_� �, ***WARNING:THIS IS NOT A SURVEY!*** This map is prepared for the inventory of real properly found within this jurisdiction,and is compiled from recorded deeds,plats,and other public records and data.Users of this map are hereby notified that the aforementioned public primary information sources should be consulted for verification of the information contained on this map.The • County and mapping company assume no legal responsibility for the information contained on this map. . �` ' DAVIE COUNTY HEALTH DEPARTMENT , ' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION `Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. � t �. �Permit Number -- <r 1,.. Name / n,, �r.� �� /1t-;,��,iZ:u Date I�:: - � -- C, s` . �� ,�.,C<�.. Location ? �� -.t�,,.:,> i�.C! - .� S f ��- �t��.,,-:, ��:..c:_ - i��,•�i � ��=` ;� .��vc �r��. { t � l'i . i��'t f`..�5�r�t,r f `j O � . ,'� 1\,tt �•.C. ^j�C l'•C f';�.,� . Subdivision Name Lot No. _ Sec. or Block No. Lot Size �= �' k� �'�`�`� House `� Mobile Home _ Business Speculation No. Bedrooms 3 No. Baths s No. in Family �•- Garbage Disposal YES p NO p- Specifications for System: 1cc�,�� {y��\�_� ��^�- Auto Dish Washer YES p� NO p Auto Wash Machine YES p—NO �p '� �� ..�� X !1 ,��-t�� Type Water Supply ro�a ��T�, __ iLl.: .�ir,:c �� ri;,,..� ;3G"( /�� ,�-�1:,.7 ��,.;1° t `This permit Void if sewage system described below is not installed within 36 months from date of issue. - � -------.:-----� � � _� . ��;.�� , � � �\ � � —^—`__,. �,r---"'."", ��' 1y. � �.�l�.a \.'a.a��_. •—_........_. _ , .r_....-- Improvements permit by `�� 'i�`-- �'-=��'� a *Contact a representative of the Davie County Health Department for final inspection �of this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. " ,` /^ , �`� - ._, Final Installation Diagram: System Installed by `- ��f�'j'T�%%'�g"'�y�'-��•f'-'' � '�z� , _�,,� /7n o,�`�;'/J ' , `� ��/�.� a -��e X>>�i�,1 - y.J- � '� �� /I / �G, � � r �. ,c�,4`;�i/�� I �L�- J � �", -- Certificate of Completion ��=�� Date � �'��/�� 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. • DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name ` M ��1wAAU Date f d - 7- � 2 Address ��'�e � Lot Size ��d X Zoe � �c�vQr.ee r1C 27odZ FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position . � � S S PS PS PS PS U U U U 2) Soii Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) Q�� PS PS `-1� U U U 3) Soil Structure (12-36 in.) S S S S Clayey Soils � ,1F�9 PS PS � U U U 4) Soil Depth (inches) r� � S S pg PS PS PS U U U U 5) Soil Drainage: Internal S � S S PS PS � U U U Externai �j �� S S pg PS PS PS � U U U 6) Restrictive Horizons 7) Available Space �� S� S S pg S PS PS � U U U 8) Other (Specify) S S S S PS PS PS PS U U U U 9) Site Classification f �s U—UNSUITABLE S—SUITABLE PS—Provisionaliy Suitable Recommendations/Comments: �� e.� n� 310�� -�o�� a�As�:c. ��au► o� c�etoh ��a��.�. �_S�S�• r'�u3�' �p '�hs�a.��ac�. a't n �e�1. Y�� (!t[0.!n !� 3 I ��YW ��lSl°�.1 �.` �w.d��' • ��.PP ./Io�e., Described by�•�M� Title ��• �� `-�°`�� Date �D ' �- &2' SITE DIAGRAM � . S�l`. -�- i?.�.., � �'c w �a _ _ � .� _ _ _ _ — — � , � � A Z � � � t .J �► . � d 1 � N � � . l ` � R a r ¢ N � ��u►s� N � J ' � NwSc. �wk 1�M � �� y pt QL 5 � � R 1 � �Sa � —� R'f�► ,N 'I�srw '�� a '�1 DCHD(6-82) SFfF2fW {-�a�.ara'�2-D , APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT � � ` Davie County Health Department � . , � �' Environmental Health Section � 'i° ('� P. O. Box 665 \° �� • i Mocksville, N.C. 27028 � . � CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. ; Home Phone �J ` � 1. Permit Requ ted By Business Phone " � � 2. Address #-� 3. Property Owner if Dlfferent than Above � • Address ' 4. Permit To:a) Install Aiter Repair b) Privy Conventional,,c�Other Type � � Ground Absorption c) Sub-Division Sec Lot No. 5. System used to serve what type facllity: House�Mobile Home Business � � Industry Other b) Number of people � 6. a) If house or mobile home, state size of home and number of rooms. � House Dimensions �04 D ��. ��" Bed Rooms_ �gath Rooms�Den w/Closet b) If Bus(ness, Industry or Other, State: Number of persons served � What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes � urinals � arba e disposal lavatory 3 showers�� '��r�ashing$machine � dishwasher � sinks l n.,� [j � 8. a) Type water suppiy Public�Private Community D�'�1/�1� � �' ' ' '� �-i�� b) Has the water supply system bee approved?Yes No 9. a) P�operty Dimensions � b) Land area designated to building,slte �� l c) Sewage Disposal Contractor t..��G Tp'11��. 10. Do you anticipate any additions or expansions of the facility this sewage system is fntended to serve? What type? This is to certify that the information is correct to the best of my knowledge. .�'O— G - ��- i'Y Date wner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS � Allow 5 days for processing Directions to property: � /5'8 � ��!/,,D 2,0. �o ,�9riV,�cc� ,�D. ..�._ � .... f� �d�v�/ ,�� -o�tJ C�au�2 /��ffT' — ,�,��!/ �ious _____ �� ,� �,�'x� /'o f -. 6 u '�/ s�� s��a�,�s. � � � � DCHD(8-82)