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175 Westview Ave (2) � . . . . � Accou�t #: 989900024 "��x F�lNiEH�: M4130A0047 �iilcd To: Roger Spiliman SU�]�IVtSfO�l 1�3��: Refer�r�ce N���e: REPAIR PERMIT LocaiioniAddr�ss: 175 Westview Avenue-27028 F'ro�c���c9 F��;ility: Residential Repair �rnper#.y�iz�: 1.190 Acre �TC hfurnb�r: 5906 c V ! � � v ' • � Account #: 989900024 Tax PIN/EH#: M4130A0047 Billed To: Roger Spillman Subdivision Info: Address: P. O. Box 738 Location/Address: 175 Westview Avenue-27028 City: Cooleemee Property Size: 1.190 Acre Reference Name: REPAIR PERMIT Proposed Facility: Residential Repair ► ' , � �. , � � ' DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section P.O.Boa 848/210 Hospital Street . Mocksville,NC 27028 (33G)751-8760 Account #: 989900024 Tax PIN/EH#: 5735-65-9521 Billed To: Roger Spillman Subdivision Info: �''r�j VIIG�St'UfeW A�/� Reference Name: Location/Address: Westview Avenue-27014 Proposed Facility Residence Property Size: see map ATC Number: 4203 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST 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 CONS�UCTION IS VALID FOR A PERIOD OF FIVE YEARS. .,/�, G Environmental Health Specialist's Signature: �%`Z Date: � CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on ImprovemenUOperation Permit 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. � , 'G ' /D� '1 �n� ,- Q L Septic System Installed By: c`J ,C`�i' Environmental Health Specialist's Signature: ,ik�Y/�� Date: 1 D DCHD OS/99(Revised) �� , DAVIE COUNTY HEALTH DEPARTMENT " • � Environmental Health Section P.O.Boz 848/210 Hospital Street ..L � S Mocksville,NC 27028 Z L ' (33()751-87C►0 �� IMPROVEMENT/OPERATION PERMIT Account #: 989900024 Tax PIN/EH#: 5735-65-9521 Billed To: Roger Spillman Subdivision Info: Reference Name: Location/Address: Westview Avenue-27014 Proposed Facility Residence Property Size: see map ATC Number: 4203 **NOTE**This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHOWZATION 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 STTE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRA TOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. !L , Res�dential Specification: Build�ng Type #People � #Bedrooms ._ � #Baths� Dishwasher� Garbage Disposal: ❑ Washing Machine� Basement w/Plumbing: � Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply� Design Wastewater Flow(GPD)�:�� Site: New� Repair❑ C� System Specifications: Tank Size,,f00� GAL. Pump Tank GAL. Trench Width��Rock Depth�`� Linear F�SG'� Other: �► �tated in 15A NCAC 28A.19 y a so e u�� Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FiLTER RISER(S) IF G"BELOW FINISHED GRADE. ****N TICE: Contact a representativ ofthe Davie County Health Depa ent for final inspection ofthis system between 8:30 a.m.to 9 0 a.m. r 1:00 p.m.to 1:30 p.m on the day of installation. Telephon #is(33C)751-87G0.**** - o� S:�l� y ��i , �.�/ � � "����Gf� � r`��' � � �� '�� � � �';�, �� ,� � r �� e �f _ � Environmental Health Specialist's Signature: �,/�'�%�� Date: � DCHD OS/99(Revised) ;'2005 16:14 3362846188 SPILLMANS pq� g� ' � 1 AF'PL�CATION FOR SITE EVALUAT10NfiMP�tOVEMENT PERMIT dc A � ' Davie County Health Aepett�ent � / Envirotuu�eneei Haelth Sectioo � / C q � P.O.aox Sd8 �1 U Mocksville,NC 27028 (704)634-8760 •+++IMPpRTANT•�+• 'THISAPPLICATION CANNOT BE PR�CFSSED ESS �n r ALLTHE REQUIRED INFOItMATION 15 PROVID � c s - �' l � 1. Name to be Billed AL-'t Y' / /7�'���A n Concsct Pctson � S��'¢-� /1� Mailing Addxess �0 ��. ?� � Home Phone � 7 7 `! City/State/Zip l.�l)D�-e2^Q.Q, �r 2����- Business Phone S�� ` 2. Nemc on PcxmiUA1'C if Diffeceot than Above Mail'mg Address City/State/Zip 3. AppGcation For: O Siu Evaluation �Impsovcment Pernut&ATC O Both 4. Syatem to Serve: � Houu ❑ Mobile liome 0 Business 0 fndusery O Ocher 5. If Residence: M People ,� # Bedrooms � N Bathrooms (�___ p Di�hwasher 0 Garhage Disposal �Washinq Machine ❑ BasemenUPluenbing BnumendNo Plumbi�g 6. If Busi�ss/OctKr. Spccify type x People #t Staks ___._. N Commodes �► Showers � Uria�is Waccr Coolers If Foodservice: M Seats Estimatcd Water Usag�(gallons per day) 7. 7ype of waur supply: �County/City O Woll O Co�mmunity •--- 8. Do yon aetitipate additioni or expansion9 of tbe facility this system is intenEed to�er ? O Yes � No If yes,what type? PROPERTX INFORMATION REQUIRED: •�•IhIPORTANT'•'A PLAT OF 7'HE PR E�t'x'X MUST BE SUBMITTED Wl1'H APPLICATION. Properry Dimensions: ��I ( ' � WRiI'E DIRE ONS(from Tu Offict PIIV:It ���� -�� - �5,�--) 1 Maci�ari7le) PROPERTY: \ y� � Property Add�ess: Road Name W eSl �t Q A� �'�/�,.. i O S�� Q n� �J G�Y�P 4..A�C—�'3�1`�r_J"� Y/U 1 T j [IC. F ( Ql n �T7 If in Subdivision provide infotnwtion,as follows: � � � �v Name: � � e�-�- W Y scctioa: Lvc N: ' i � — 1'hi,r is a certify that thc information Pmvidcd is corrat to the best of my knowledge.I undersund[haz en permac(s)issued htnaRer ' I_ %`EP�� aze subjcct to auspcnsion or rc�ocsaon,if the site plans or intended use change,or iS the information subm ted!n this application is �� � S� falsified or changed I,also,andersund that 1 am rcsponsabk for all cpazges iocu�red from this appticaaon, ,fKreby,give consent to � 2� �p ' clae Authorized Repr "ve of the Davie County Heal�h bepaetment to enter upoa above described pro ety)ocaud in Davie County and owned by e-� ` y �'ta to c duct all testing procedures as nccessary to deteamine the site suiabiliry. r� � � c DATE �'/'La�d� SIGNA7URE Re�tised DCHD(06-96} T�� � dor �� . .�, . �.... . �� y � .. � . ... ,Vti . f m /F �7�fl � �.���� . � �99 �:: I / �39417�',.. .. �2y ^,. y' � (+}r�?���..�' 152�tAiA} . , , � , , �i3 5190 6996 : q:4g �. �ii �.4�. � � � o \ �� � � � � Y �6231 � m . i7 7tiA} , ts'r' �.. � .� .:l�.,,, �' 146 �,. 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F:-�.2' .. 1'.d� I i I v-�"� �`'. . - DAVIE COUNTY HEALTH DEPARTMENT ' ' � ' �` Environmental Health Section Soil/Site Evaluation � APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900024 Tax PIN/EH#: 5735-65-9521 Biiled To: Roger Spillman Subdivision Info: Reference Name: Location/Address: Westview Aven 014 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 -r� �i �/ Texture grou G �(" Consistence ' / ,� Structure Mineralo /� '/ - � HORIZON II DEPTH '� rr �� Texture rou � Consistence - �- Structure Mineralo HORIZON III DEPTH ..._— Texture rou Consistence Structure Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 1"— SITE CLASSIFICATION: �� EVALUATION BY: ✓ LONG-TERM ACCEPTANCE RATE: _ OTHER(S)PRESENT: REMARKS: LEGEND i,�ndsca�e 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 T�C�u'g 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 a'IQ1S� VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm '�' � 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 Mineralo�v � '� � � 1:1,2:1,Mixed `r �V � � ��. 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) ■���■��■�■■■■�■��■■■■■�■�■�����■■■��■■��■�����■■������■■�■�■��■�■■ ■���■�■■■��■���■■■■■�■�■�■��■■����■■■■■0■■�■��■■��■■■■■�■�������■ ■��■��■�■��■���■■■■■■■■■■■����■■ ■■■■■■■■■�����■�■■�■■■����■���■■ ■�����■■■■�■��■■■■���■■��■■■■�����■��■■�■■�■�■�■■��■■■■■�■�■■�■�■■ ■■��■■■■■■����■■■■�■■�■■���■��■�■■■■��■■■■■�■��■■■�■�■�■����■��■�■ ■■■■�■■�■■����■�■■�■�����■�■■■■��■■�■�■■��■��■��■■■��■■■■■�������■ ■■����■■■■����■�■■�■�■■■�■■■■■��■�■■■■■�■■�■■■���■■■��■���■������■ ■�■■��■��■■■������■�■■�■�■■�■O■�■■■��■■■■■��■■��■�■��■■■■�■���■��■ ■�■■■■�a■■■■��■�■■�■■■�■�■■■■o■�■��■�����■��■■■��■■�■■�■■■��■■�■�■ 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■■�■■����■■�����■��■������■■���■ ■■■■■�■����■�■■��■�■■■■■�■■■�■�■�■�■■�����■■■��■�■��■��■��■����■■■ ■■�■�■�■���■��■■■���■�■■■�■■■■��■■■■■■����■��■■■■��■�����■����■■�■ v ' • � Account #: 989900024 Tax PIN/EH#: M4130A0047 Billed To: Roger Spillman Subdivision Info: Address: P. O. Box 738 Location/Address: 175 Westview Avenue-27028 City: Cooleemee Property Size: 1.190 Acre Reference Name: REPAIR PERMIT Proposed Facility: Residential Repair