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955 Spillman Rd ti ,� . • . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (33G)751-8760 Account #: 990003681 Tax PIN/EH#: 5843-93-2576 Billed To: Paul& Pam Wilson Subdivision Info: Reference Name: Location/Address: Spillman Road-27028 ATC Number: 4376 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLTST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s)(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION I VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: � Date: G�'l 0 ��b CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article I 1 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. � t,,�o? -Ft�1S1���d ��J�aL�o, � q 7 T � Z' "$ i '� T�-t1� Jp� _ , �.��,� ��� 5 � ���� �.�., ,-� ► 2 ►��� '�a� `fi��9-19� G?v�c< y sY� c�•� r��- '���P4�2 �f� Septic System Installed By: ���' �4�� ,Y�t Environmental Health Specialist's Signature: Dat . 02 DCHD OS/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT ��t , , ..� Environmental Health Section I � ` P.O.Boz 848/210 Hospital Street � - Mocksville,NC 27028 I�� (`� ; (336)751-8760 � IMPROVEMENT/OPERATION PERMIT Account #: 990003681 Tax PIN/EH#: 5843-93-2576 Billed To: . Paul&Pam Wilson Subdivision Info: Reference Name: Location/Address: Spillman Road-27028 Proposed Facility: Residence Property Size: see map **NOTE�*1fi�islmprovement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALTTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems,Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRAC OR MUST SEE THIS PERMTT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People�_ #Bedrooms � #Baths� Dishwasher:�Garbage Disposal: ❑ Washing Machine� Basement w/Plumbing�asementlNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply���// Design Wastewater Flow(GPD) Site: New❑ Repair� � �� System Specifications: Tank Size�6 GAL. Pump Tank GAL. Trench Width�� Rock Depth �? Linear Ft�� Other: � �CCepted Systenz: rr�� �$A.1969(5) Required Site Modifications/Conditions: Y �tsu be used INIPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTiCE: Contact a representative of the Davie County Health Department for fuial inspection of this system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(33C►)751-87G0.**** � � //�-- /�_ R . . Environmental Health Specialist's Signature: Date:� /i�0 L� DCHD OS/99(Revised) , DAVIE COUNTY HEALTH DEPARTMENT -',, , Environmental Health Section ' �' � ^�/� P.O.Boz 848/210 Hospital Street /J�(���'=o� Mocksville,NC 27028 �I (336)751-87G0 IMPROVEMENT/OPERATION PERMIT Account #: 990003681 Tax PIN/EH#: 5843-93-2576 Billed To: Paul& Pam Wilson Subdivision Info: Reference Name: Location/Address: Spillman Road-27028 Proposed Facility: Residence Property Size: see map **NOTE�*Th�islmprovemesnt/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS „ PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTI2ACTOR MUST SEE THIS PERMTT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People�_ #Bedrooms 3 #Baths � Dishwasher: ,� Garbage Disposal: � Washing Machine� Basement w/Plumbing:,� BasementlNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply ��j) Design Wastewater Flow(GPD)��l Site: New� Repair� ,� System Specifications: Tank Size D �GAL. Pump Tank GAL. Trench Width���` Rock Depth /2 Linear Ft�Z� Other: Required Site Modifications/Conditions: INIPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie CountyHealth Department for final inspection ofthis system between 8:30 a.m.to 930 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Teleph ne ' (33()751-87G0.**** 1� .� n , �� �S v � Environmental Health Specialist's Signature: i"/ / Date: � �(� l��h DCHD OS/99(Revised) •o . �' S� • ' � ,' , - `�,/�yr�! D � � � � � / , p � APPUCA7lUN !"OR SITE CVALUA710N/!hl!'lIOVL•h1CNT PCR� TC �.�•!���� Davie County Health Department �u� 3 Environmenta/Health Sectian 1 ,�j�� P.O. Box 848/210 Hospital Street . MoCksville� NC 27028 , !�['�� � �� 4i �i,*iG1Y��F �-C�-e (��- (336)751-8760 ��jE���tP� �,.a�--- - ` ***I1�SPORTANT*** TIi2S APPLIC�iTION ANNOT BE PROC.�SSED UNLESS ALL THE RLQUIRED INFOIu-il�TION IS PROVIDL'D. Refer to thQ INFORbiATTON BULLETIN for inatructiona. �G���t �G�.w� W t�SDY) ��YI a✓ �Gu�i 1. Namo L•o be IIilled Contact Peraon Mailing Addroas ��� 1"��'a'r�'-� Iiomo Phone ��'������8�(� City/Stato/ZIP ��J����� � ���`S IIusino�o Phone �����% ����� 2. Namo on Permit/ATC if Different than Abova Mailing Addreas City/State/Zip 3. Application For: t�'Site �valuation � Improvement PermiL/ATC ❑ IIoth 4. syecem to sorvico: t�!'Fiouaa � t4obile 8omo O I3uainess ❑ Induutry ❑ Other 5. Typa oyntam requc+ntud: l!d" Conventional ❑ convantional modified ❑ innovativa �1acCepted G. rf Res�idence: 1� Paople � # nedroom� _� � Dathrooms � lldDinhwssshor ❑Garbage Dissposal L7Washing Machino L7Dasement/Plual�ing ❑Daaement/1to Plumbing 7. � If Duainess/Znduatry /Othor: verify type # Peoplo i� Sinka # Commo�ioa N Showora U Urinals 11 4�aL•or Coolora IF r00DSERVICE: �� Seatn Estimated Water Usaga (qaiions par day) s. xypu oE wator supply: ❑ County/City �WQll 0 Community 9. no you anticipato adclitions or expansions of thc facility tliis systcm is intcndcd to scrvc? C�Ycs ❑ lYo If��cs,�ti•lilt typc? � `-w"r� ***IJIIPORT�INT"�**CLILNTSAlUSTCOdiPLETETlI� I�L•QUIItL•D PROPGR'TY INI�OItD�iAT101V RI:QULST�D i3I;i.01V, i'sithcr:t PI.AT or SITG PLAN�1tU.ST BESU11AtITTLD by tl�c clicnt �vitli TI1IS APPLICATION. Property Dimcnsions: �O/ X Y'�// .Y lVR1T�DIRGCTIONS(froni lYIocicsvillc}to I'It01'I:R"I'1':' Tax O[Gcc 1'IN: �E_r�7 3 '� � 3'-���SB p�1(�.G���l/�s Cl.'�G�.VV�I • —,-- Property Addresr. Road Nacnc �✓ ,�XK.m� �'"I . ��• . ��.�; . r��..' r�..11�. . . �� � , . . . . . . ,.. ,',� . !MY '... . ...... � .. . N'b�G1r�V cllc N� - . , . , . c�cyiz;p � � � � q���" go l R u r SP�l��.,., _ �lr-•�s�- If ii�a Subdi��istoii providc infoi•matioii,as follotivs: � �-o -J-!.Q �2l— �4.L-�- —!s i�- �S o h Namc: ..� �- �-� /� s� D u.., -�. ��'C�- �e �� �oa.�s 3 l � c� Scction: Block: Lot: Datc`��omc corncrs Aaggcd: -�-�-��s �-,Q�. - ��gL s u-� y Tl�is is to certil'y tliat tl�e infoi•matioti provided is correct to tlie best of t�iy l.notivledge. I undersia�id tliat any permil(s) ��'���- issucd i�crcafter are subjeci to suspensioii or revocation,if tlie site plans or intended use cl�ange,or iC tLe iiiforivatiai �--�,e_S subnutted in this applicatinn is falsiGed or changed. I,also,urr�lersla�rrl tlrrrt I run respousiGle for n!!clurrges iuciu•red Jrum t/ris applicnlio�r. I,licreby�,gi��c consa�t to tlic Autliorizcd Rcpresentatiti�c of thc Davic County I�Icalll►llcpartutcnt � to ciitcr upou abovc dcscribcd pi•operty IOCB�C�IIl D1VIC COUIl�}'�Il(I Olti�t�cd by to conduct-all tcsticib proccdw•cs as ucccssary to dctcrininc thc ' c su ability. ' � DAT� �� SIGNAI`URL � � TIIIS AR�A A2A B�US�D TOR DRAWING YOUR SiTE PLAN(Includc�Il of tLc follo�vin�: Existin��ud proposcd property lines and dimensious, stractares, setbacks, and septic\locatioi�s). � ��� �� Silc Itcvisit Cl�argc �� �"`�� - . Datc(s): �z�� � �� � ��� Cliciit NotiGcatioii Datc: �I-IS: Sign givcn . ��- �� '. Accouut No. _�b U I . , �"�a Rcviscd DCIiD(05/03 � , �,S � �(�,�, � Lrvoicc No. � C�`'1 � ___ __ �_ __ _ _ ______ _ _ _ _ � 4ug 30 05 09:51a Mike Tester 610-263-U�t3 p.� I . f � � . , � . It�'G'pov� ! . . � . . � � . 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Gty Coo'e: � ■ Ov�sren'Aa'dress 3:239B FARMINGTON RO}�D • ����r+'�t:FARMINGTON � ■ Gity,Stat�e Z�o:MOCKSVILLE ,NC 27028-7857 • FJboa� Zorre:ZONE X � � Larro' Va1ue:$1.4�0.110.00 . F�boo' Co�e�e�rrrity:370308 t . 8ui7a�i�rg VaJlue:$344,050A0 . Aboo'Parrer:Oa50 C E . O�ut 8uis�orNrgl�xtra featerres Vak�e:$26.140.00 • ��boo'llAap�at�e:12-17-1993 t A�sessed U'akre:$894,594.00 ■ Sar�:En8 � • Propeitv Record Card ■ Towrrsfr�o:FARMINGTON ' . . To►wr Zorrrrrg: <_ . Votirrg Precirrot:FAR MI N G TO N � . Schoo�Dis#r�et:PINEBROOK � i i � •e '" � � ' DAVIE COUNTY HEALTH DEPARTMENT ..• � . � Environmental Health Section Soil/Site Evaluation � APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003681 Tax PIN/EH#: 5843-93-2576 Billed To: Paul&Pam Wilson Subdivision Info: Reference Name: Location/Address: Spillman Road-2702 • Proposed Facility: Residence Property Size: see map Date Evaluated: � Water Supply: On-Site Well � Community Public Evaluation By: Auger Boring ��_ Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e sition - Slope % . HORIZON I DEPTH �� ' � � � Texture rou Consistence y�`' Structure Mineralo � - HORIZON II DEPTH ' !� Texture rou Consistence Structure � Mineralo HORIZON III DEPTH � Texture rou Consistence � Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS • - RESTRICENE HORIZON SAPROLITE - CLASSIFICATION LONG-TERM ACCEPTANCE RATE , SITE CLASSIFICATION: EVALUATION BY: . ` / _ LONG-TERM ACCEPTANCE RATE: � ' OTHER(S)PRESENT: REMARKS: LEGEND i,andscape Position R-Ridge S-Shoulder L-Lineaz slope FS-Foot slope N-Nose slope . CC-Concave slope CV-Convex slope T-Tenace FP-Flood plain H-Head slope � Ts�t�rg � _ '� _ _ 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 , 11ZQ1St VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm . � � NS-Non siicky SS-Slightly sticky S-Sticky VS -Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic S r> >r SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy' PR-Prismatic _ Mineraloev ' 1:1,2:1,Mixed lY� � 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-gaUday/ft2 , DCHD OS/OS(Revised) ■■�■��■■��■�■�����■■■������■■■■■■�■�■�������������������■�������■■ ■�■Y�v�v�■■0����■�■■�■�■�����\■■ ■�■■■■■■�■��■�������■���■�■����■ ■�s�■■■■■■�■�■■e■■����■�■�■■���■ ■�■�■s■■■■���������������oo�■�■■ ■��■��■�■■�■��■�■�■���■■■�■�������■�■�■■■�■■��■���������������■■■■ ■��■��■■�■■■■�■�■�■�■■����■�����■�■�■�■�■■■�����■��■���■■■■�■■■��■ ■�ea�■s�■�s■��■���■�■���■�������■■■■■■�■■�■��■����■���■■�■����■■�■ ■�■■����■■�■��■�■���■�■■■■���■�■�����■�■��■��■���■�����■�■■s�■e��■ ■��■■■■��■�■■�■■■■■■�■■���■����■■■���■��■�■■�■■��■���■�■�■��■■���■ ■��■��■■■o�■o■��■■■���■o■�����■��■�■�■�■���������■��■�����■■�■�■■■ ■��■��■��■�■�■�■�■�■�����■�■�������s■�■�■■���s■�■■■■■����■������■ ■��■�■■�■■�■�■�■■■■■■��������■�■ s■�■�■■■■�����■■■�������■�■■���■ ■����■■�■■�■�■�■�■■���■��■�■�■■■■■��■■�■�■���■■�������■�����■��■�■ ■■■�■■■ss■s■■■�■�■e�■�■■��������■■�s■��■■■�■���■�■�■■■■■�■■�■■■��■ ■�������■�■��■���■�����■�■�■�■■����������■�����■�■��■�■��■■������■ ■�■■■■■■■■■��■�■�■�■���■���■�����■■���■�s■�■���■�■�■■■���■�����e■■ ■■o�■■■�■■■���o■�■�■�■�■������■�■■■■■��������■�■■■■������■■��■�■■■ ■■■�■��■��■�■■�■�■a■■��■�■s�■�■����■■�■�s��■��■���■■�■■�■■e�■���■■ ■�■■■■��■�■■�■�■�■�■e■�■■���■����■■■�■■■�■■��■���■����■■�■�����■■ ■�■■■■�■■■■■�■�■�■■�■■�■������■■ ■�■■■�■■■■������■■�■■■■�■■■o��■■ ■o■■e��■�■�■■■�■��■��■oe��v���■�■�■■o■��■�■o������■��■■■■■�■�e�■■■ ■���■■�■��■■�■■���■�■■��������■�■��■����■�■�■■�■■■■��■�����s�■�■�■ ■s■�■■�■■���������������■�■■■�■�■�������■�■����■�����■■■■■■■�■���■ ■■■o■■■��o��o��■��■o�■s■��■�����■����■����■��■���■■■■■■■■■■■■■�■�■ ■■■�����■�■���■�■�■s■�����■�■e�■�■�����■��■�e��■��■s■��■�����■�■�■ ■�■�������������������■■■■■�■■���■���■�■�■������■�■■�■�■■�■��■��■■ ■■■�■�■���■���■�■�■�■�■■■�■����■ ■��■�■����������■■�■��■�s�■���■■ ■■��e■���■■�■■■■■e■■■�■�■��■�■���■■�■��■���■■�■������a�■���■e���■ ■■���■�����■e����������n���■ar�■■■�������■�■���■��■����■�■�����■a■ ■��■�■■��■■■■��■����i��Il�■���■A���■���■�■�■��������■■�■������0���■ ■���■����o��eo������������::.:e�■�'u�o��■■■■■■�■����■■■���������■ss��■ ■��■�■�e�������■������►rw�■���►���n���■■■■■�������■■■�■���������■■■■ ■��■��se������������■■�n�,iu������r�ul�����■■■�■�����■■■�����■�����■�■■ ■�■��o�������■■■■�■■■■a��!����■v■i��n.��■�■���■��■■�■�■������■����■■■■ ■■■�����■��■����■�s■■�■����s��■■��■■■o�o�■�o■�����■�■■■�����o�■�■■ ■���■����������■������c�======='.� ■■■■�����■■�����■■■■�■�������ee■ ■■■�■��■����■�■�■�■�■�■����■�■il�■■�■�■���■��■������■■■�i��■��■�■�■ ■�■�■�o■��o■■■■�■�■�■��������■oi�■■���■��e�v■���■�■■■■���■����■s�■■ ■�■���■��■��■�■�■�■�■����■�■�■�i��■�■����e■■■���s■�■■��■�s�e�■�■�■■ ■■■�■��■��■�■�■�■■���������■�■�i���■���■�■�����■��■■■��■�������■��■ ■■�■�����■�������■�■����■■�■�■�i���■�■���■■��■�■��■���■■■■■������■■ ■��s��■■��s����������■�■■■■��■�i���■■■�����■■■�■�■�■��■�����■����■■ �iiiiii�iiiiii�iiiiii��=�===���iiiiii�iiiiiii�iiiiiii�iiiiii� ■■�■��■■�■■�■�■�■■■■■������5�■�Y�■■��■��■�■��■■■■��■��O■■�■■�■���■ ■����■�■���■�■■�■��■■■■i��■fi����■��■■■■�■�■����■■������■■■■�■■e��■ ■��■�����■���■��■■���■������'liii■■■�■�■��■�������■■�■����■■�■�■���■■ ■■�■■�■�■■���■�■���������■��IIJ■�■��5���■■■�■���■■�■�������■O�m■��■ ■��■��■��������■���■�■�■��■�r■e�■�������■■■����■■■■■������■�■��■�■ ■��■��■��■��■■■���■■�■������■�■��s�������■■����■��■■�����e�■■■�■�■ ■��■■■■����►����■�■■�o��■■���������■o��■���■�■����■���■��■■�e��■�■ ■��■�■�e�nr!t��e■�■�■■■��■�����■■ ■����■�■�■■��■o■■■��■o�■�����■�■ ■��■�o���r�����������■�■■■■■������■�■■■■�■■�■�■�■■��■■����■■......■■■ ■�■�■���������■��������������������o..��...���.��--_- - 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