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253 Nolley Rd Lot 20 & 23 ' DAVIE COUNTY HEALTH DEPARTMENT � —3 Environmental Health Section P.O.Boa 848/210 Hospital Street L, I<-y4= Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900024 Tax PIN/EH#: 5735-59-0927 Billed To: Roger Spillman Subdivision Info: Wildwood Lot#20 &23 Reference Name: Location/Address2:561 ley Road-27028 Proposed Facility: Residence Property Size: see map ATC Number: 3602 **NOTE** This Improvement/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 CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type K&.1 #People L1 #Bedrooms 3 #Baths 2- Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Typenn,, #People #People/Shift #Seats Industrial Waste:❑ Lot Size N ACRE Type Water Suppl4-%W Design Wastewater Flow(GPD) D Site: New M" Repair❑ System Specifications: Tank Size 1000 GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft. Other: 1- yl SJR) A)l/oJ Zoxts r Required Site Modifications/Conditions: I�SrACL Qn� 7pJ21 Ki=j P J©'r /Vom / ,� /c9 ©{F f &ija INIPROVEAIENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISERS)IF 6 f°BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final 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(336)751-876 *(lr= I�t o _►�, t,,,t� - N `=► _Y �Q o¢o� 170 Environmental Health Specialist's Signature: Date:tto is DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900024 Tax PIN/EH#: 5735-59-0927 Billed To: Roger Spillman Subdivision Info: Wildwood Lot#20&23 Reference Name: Location/Address.Nolley Road-27028 Proposed Facility: Residence Property Size: see map ATC Number: 3602 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 WASTEWATE NS N IS V ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 7i CERTIFICATE OF COMPLETION **NOTE**The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in com fianceth-Article I 1 of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systi.11 1 " u shall m _ AY be taken as a guarantee that the system will function satisfactorily for any given period o time. 70� 10 t2 t$ .�s 8' WD �� ea Septic System Installed By: j Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) 10/20/2003 14:50 3362846188 SPILLMANS PAGE 02 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County HeaMh Depattrnent FirvJtotlrlteetaJHera/fh Saatitrn P.O. Bo: 848/210 Hospital Street Mockoville, MC 27028 (336)751-8760 ►aR ZXWVrr THIS AIPPLICNITIM C><AMT JN PR(Xl= iCt3 tf=63 ALL TW17M INFOA1a2lox IS pROVIDXD. Refer to.the yINFORM11T1011 BUUTZTIN for instr ctiopn4s,. 1. ase. to b.allies 0 l/���_ � t •iaM 1 Conl..ct r^.rwn (J IC.7 eo,ill,"Addcsss _ P6&K-7� sow Yharm Q�"I � City/elle/zrr—C� , o1�, tia►l�w.Phos O 5 2. same on r6adt/ATC it D11fare„t than sloe.. r-LU"Addres. city/null/ziy 3. Application For: O Site !valuation ❑ Improvement Peron/ATC0oth 4. aystoe to Sarno.: 0 House X"l ile Home 0 Business 0 Industry Othasl( S. S= Residence: i People 4f i Bedrooms _ I Be norm b DLahaa-h-r n aarbap-Dtapa-a1 p Ma-tilf g Nach"M Das+awnVrluebloy O ft..+ "q rluabinp i. rr resin-./Sndu try/othar, spooUr tyr. I Paoplw I A1nkA i Commons 1 aho.ors a ucinala •Vatez Coalar. a; IP YOODSERVICL: J Seats Eatimated Mater Osage (gallone per ) 7. Type of crater supply: �l.County/City ❑ well 0 Co.tsrartitr a. Do you anticipate sddito or tipsnsious of the facility this system Is intended to serve? I Yes O No Uya,what qw. ---IMPORTAM "CLIFMSJV= 0J1PLMTHE RBQIAUDlR0JV&WXINRORMAT70 REQUESTED BELOW. Efther a PLAT-SITE Pt.AM AFUSTBESUBAf/TTED by the clieat with THIS APPLICA ION. Property Dimeesioas: WRITE DIRECTIONS(Gam Moclu )to PROPEirm Tax Ofike emvALr k Mu 0000 oCXo q o Z ('0013 12 Property Address: Road Name 01 0-6,J} alyalp Modsyid fX �" bioI (� If in a Sabdirisltoa provide ti �informa{{�ofollow:ia,as follo : OYt r r\R, N-2T 4 cLs- � Name: Ll� (t W wU Sl1�V �S t dh l 1:5 Section: Block• Lot:tzAft Date Property Flagged: This Is to certify that the information provided Is correct best of knowledge.P my i I understand any ptrsslt(s) . Issued hereafter are subject to s(npessioo or revocation,U the site plies or intended we change,or if t information submitted is this oppiieatlpa is f dsilied orekaagea 1,also,andp7taal tA4r 1 am rapoatfble for all cba es tnearrcd from rAfs eppllcailon. 1,hereby,give consent to the Authorized Representative of the Dov" County l tartuicat to enter upon above described property located Is Davie County and o by aG to conduct all testing procedures as necessary to determine the site ani b 'ty. DATE_ LG-I9 _o3 SIGNATURE THIS AREA MAY BE USFOR DRAWINC YOUR SITE PLAN t aD o[The foiiawing: d and proposed MED Property line$sad di0tado1114 strictures,setbacks,and septic Site Revis I(barge Date{s): Client Notification Do e• C) Accouot No. L C> _ Revised DCHD(07/99) Lvoke No. m„L- DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900024 Tax PIN/EH#: 5735-59-0927 Billed To: Roger Spillman Subdivision Info: Wildwood Lot#20 &23 Reference Name: Location/Address: Nolley Road-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: 1 O 22- E) Water Supply: On-Site Well Community / Public Evaluation By: Auger Boring Pit r Cut FACTORS 1 2 3 4 5 6 7 Landscape position L G-- Slo % 41yo -. HORIZON I DEPTH - y Texture group Consistence S S Structure Mineralogy :1 = HORIZON II DEPTH Z1, j -3 - Texture group Consistence - Structure Mineralogy ` HORIZON III DEPTH 46 32, Texture group C' G C G f Consistence SS P G{ Structure Mineralogy ' HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS: . RESTRICTIVE HORIZON , SAPROLITE CLASSIFICATION - LONG-TERM ACCEPTANCE RATE f� SITE CLASSIFICATION: S EVALUATION BY: � � ►�J LONG-TERM ACCEPTANCE RATE: . OTHER(S)PRESENT: ,, REMARKS: 7~ -� s~E1-�d��-4 - �+'Kl; eoLK ��11L ) r-Acr� 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 CONSISTENCE Moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm Wet 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 ` `- Notes 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 05/99(Revised) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■e■■■■■■■■■e■■■■■■■■nal■ne■■■■■■■L�■■■■■■■■■■■■■■■■■■■■■■/■■■e■ee■ ■■ee■■■■■■■t■■►�■■■■■e■eLr■t■■eee■■e■i�■■e■tee■■■■■eeeee■s■e■e■■■■e■■ ■■■■■■■■■■■■■■eee■■■■et■►�■■e■■■■■■■■►o■e■■e■e■■■■■■e■■■■s■■ee■■■■■■ ■■/■■■■■■e■■■■■►r■/■■■■■■L�■■■etc■I�iie■ee■t■■■■■■t■■■e■■■■■e■■■■■■■■■ ■■■■■■■see■■■/■et■■■■■■■■e■■�■■■e■■■■►r■■■■■■■e■s■■■■■■■■■■■■■■■■■■ ■■e/■■■■eeetee■■►�e■■■e■e■►�e►�L■■et/eeeL�■te■■ee■■■e■■e■tse■■■ete■t■■ ■■ee■e■■■■■■■■ee■�t■■e■■■■��■se■■eee■■■■►�eee/e■■e■■ee■tee■s■es■e■■■ ■■■■■e■■e■■■■■■e■■ire■■■■■■■ee®s■�i■■e■e■e■■ees■e■■■■■■■■e■e■■■■e■■ ■■■■■■■■■e■■■■■■■■Lit■■■■■■e►�■■■■■■■■■t■■��■■■■■■■■■■■■■■■■/■■■■■■■■ ■■■■■■■■■■■■■■■■■■■et■■■■■■t►re■■■■■ee■■■em■■■■■ee■e■■t■e■■ee■■ee■■ ■Neeeteee■■et■■eee■■etee■e■■■��■set/■■■■■��st■ee■■eee■■e■■ee//e■e■e■■ LINEMEN iMENNENiiiiii ■■■tee■e■■■■■■■■e■e■■■■B■e■■M■■\'r1�le�IC:1/��iiw�■■■■■■■■■■■■■■■e■■■■■■ ■■/■■■■■■tt■■■■■t■■■■t■e►r■■■■■e■■■/■■lea■/■■la1\�7e■■e/■ee■■e■■■e/■t■■ ■■■■■■■■■■■■■■■■■■■■■■■■■►r■■■�r.�r�■■■e■ilia■■■■■►re■■■■■■e■■■■■■e■■e■■ ■■■e■/e■eee■■■■eee■ee■■e■r■/■lice■■■e■�:�■■■e■■��■ee■■■/■eee■■e■■■ee■ ■■■■■■■■■■■■■■■■■■■■■■■■■■Lie■t■meeeet�_i►girl■■■■■■,■■■■/■■■■■s■■■e■■■■■ ■■■■■■et■■■■■■■■■t■■t■■■■■■e■ nit■■■■■■��■■■e■■t1�■ee■te■t■■■e■■e■■■e ■■■■■■■■■■e■■■e■■■■■■■■■■■eLr■■ue�■■■■■■e■■■■■s�■■■■■eeee■ee■■e■■■■ fila■■■■■■■■■■■■■■t■■■■■■■■■■et■■■■■■■■■■e■■■■■■ee■■■■■e■■■■■■■■■■■■ ■■■■■■■■■■■■■t■■■■■■■■■et■e■►�■e■■■e■■e■t■■te■■■►�■eeeese■te■■■e■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■rel►►�■�I■e■■■■■■■■■■■■�e■■■■■e■■■■■■te■s ■■■■■■■t■■erect■■■t■■t■■■■■■!�i\1■ ■t■■■■■■■■■■■IFR1\■■■et■B■■■MOON■■ ■eee■e■t■■e■ee■eee■■■■eee■■■t►�►r■/e■e■e■eeet■■eeel�/■■e■et■■■■■e■■e ■■■■■ee■■■■e■■e■e■■■■■■■■■e■■■■��s■■■■■Mee■■■■■■oal1�■■■■Mee■■■■■■■■ ■■tttt■■■■■■t■■t■■tt■■■■■ttt■■e■■►�■■■■■■■e■■/■■■■■■n■■t■■■e■■■/■■■ ■■■■■t■OttOtt■■■■■BB■■t■■■■■■■t■■tie■■/■■t■■//■■/■/■i9■/■t■■■■■■■■■ ■■■■■■■■■■■e■■■■■■■■■■■■■■■■■■■■■■■1\■■■■■■t■■■t■eee■I1■■etc■■e■■■■■ ■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■e■►�■■■■■t■■Mee■■■Mee■■■■■■■■■■■■ ■/■■■■t■■■t■■t■t■■■t■■tte■■t■■t■■tee■■■■tt■■■t■t■■ettmri■tt■t■tt■■■ ro � WOM r/r iii � r Wom .. 7459 S4 3 2 O� 743G . 8257 S' 5e 1 135 c �O v 1009 n B N loo ,2093 -�- Ole 4900 9888 PCC2 ' ) 14 (1,14A) `` 248 .:60 26 79 1725 : CO 89 `* 291 c� Q nms/. t 710