165 Sunchaser Trail Lot 7O
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DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
• P. O. Boz 848/210 Hospital Street
' Mocksville, NC 27028
(336)751-8760
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IMPROVEMENT/OPERATION PERMIT
Account #: 989900024 Tax PIN/EH #: 5735-38-0207.07
Billed To: Roger Spillman Subdivision Info: Sunburst Downs Lot # 7
Reference Name: Location/Address: Sunchaser-27028
Proposed Facility: Residence Property Size: 5 acre tract
**NO i�14
*'lh�s tmprov7msent/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 -bk1 M H #People _ #Bedrooms -S #Baths �
Dishwasher: 19"" Garbage Disposal: ❑ Washing Machine: 13"'- Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type /�_ #People #People/Shift #Seats Industriall Waste: EI
Lot Size -5 -4611-4611-6CType Water Supply l0y�0Design Wastewater Flow (GPD) Site: New Repair ❑
or
System Specifications: Tank SizeLO-AAL. Pump Tank GAL. Trench Width3& Rock Depth /.?- Linear Ft,�3690
Other: '2 ►O 1604 �,Ot 14 P3E)Xty5 , 1,)stA l.le-)"5 C1 ` 0.e— K uj .
Required Site Modifications/Conditions:_ I V Ssw ,. t,A U4 -w t1 Q , VLE c!� D(ir illoos-
IMPROVEMENT/OPERA'T'ION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " 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)751-8760.****
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Enviro ental Health Specialist's Signature:
DCHD /99 (Re 'sed)
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 #: 5735-38-0207.07
Billed To: Roger Spillman Subdivision Info: Sunburst Dooms Lot # 7
Reference Name: Location/Address: Sunchaser-27028
Proposed Facility: Residence Property Size: 5 acre tract
ATC Number: 2706
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 .1 0 Sewage Tre ment and Disposal Systems). THIS
AUTHORIZATION FOR WAST EWA CT IS PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: Date: /—
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.
bo�l
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Septic
System Installed By:
Environmental Health Specialist's Signature
DCHD 05/99 (Revised)
Date: I
j APPUCAHON FOR SITE EVAWATION/IMPROVEMENT PERMIT &
Davie County Health Department D d
EnKivamenta/Health Sw ion
P.O. Box 848/210 Hospital street..
Mocksville, NC 27028
(336)751-8760
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALZ;"THE 'REQ
INFORMATION IS PROVIDED. Refer to
the INFORMATION BULLETIN for instructions.
1. Name to be Billed _(_���%L(J�I / l��V Contact person v Ee
Nailing Address 1133 gee Phone
City/state/ZIP
U Business Phon
2. llama on Permit/ASC if Different than Above
Mailing Address
City/State/Zip
3. Application For: 0 Site Evaluation ❑ Improvement Permit/ATC X Both
4. System to Service: 0 House d Mobile Home 0 Business ❑ Industry 0 Other
S. If Residence: # People # Bedrooms # Bathrooms
0 Dishwasher 0 Garbage Disposal 0 Washing Machine 0 Basement/plumbing 0 Basement/No Plumbing
6. If Business/Industry/Other: Specify type
# People # Sims
# Com®odes # Showers # Urinals # Water Coolers
IF FOODSERVICE: # seats Estimated Water Usage (gallons per day)
7. Type of Prater supply: County/City 0 well 0 Community
e . Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 'k No
If yes, what type'
***IMPDRTANT*** CLIENTS AIUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION.
Property Dimensions: 5 aC m T -Fu "
Tax Office PIN: # .5735 39 UQ -0 I
Property Address: Road Name cSUA LMASCP2
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
Ru)(l (Oo/ 1 oSoQTH- P'J�C 14T o> )
01AD51D r0- Lb.- 8105MI 0)\J
city/zip ry)XK6�11 L.F.n1 G 0 oU FV /Z D, - le -La Wr 00
(9,7oa8 n�
If in a Subdivision provide information, as follows: _ � .u�.iL-rrb l� 15r dhr T
Name: .S o AU25T T)OWres
RD . h rJ LeFT TQ P-90IU 7✓ OF
PUCCAEY--2 � c
Section: Block: Lot: Date Property Flagged: o q I ,
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits)
issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information
submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from
this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department
to enter upon above described property located in Davie Countyand own d bv = `t' kUC e- RUDOeSo
to conduct all testing procedures as necessary to determine the site sui i '
DATE d / SIGNATURE
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inctfide all of the following: Existing and proposed
propegy lines and dim ens. ous, structures, setbacks, and septic locations).
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Revised DCHD (07/98)
Account No.
Invoice No.
U a -`-E
DAVIE COUNTY HEALTH DEPARTMENT
- Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 989900024 Tax PIN/EH #: 5735-38-0207
Billed To: Roger Spillman Subdivision Info: Sunburst Heights 21 -at #7
Reference. Name: Location/Address: 1606 Junction Road -270 8
Proposed Facility: Residence Property Size: .713 acres Date Evaluated: 2
Water Supply: On -Site Well Community
Evaluation By: Auger Boring ./ Pit
Public
Cut
FACTORS
1
2 3 4 5 6 7
Landscape position
Slope %
t
HORIZON I DEPTH
;7,*
0 - /2-
ZTexture
Texturegroup
Consistence
Structure
Mineralogy1
_
1
HORIZON II DEPTH
Texture group
Consistence
a
Structure
GfL
Mineralogy
l
1
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
fl
SITE CLASSIFICATION: 0S
LONG-TERM ACCEPTANCE RATE:
REMARKS:
LEGEND
Landscape Position
EVALUATION BY: � VI:" 6m;q�
OTHER(S) PRESENT:
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)
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No
! .5.004 Acres f/
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J Contarlino Proposed
s/;242 81.
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117
'Ses Street 2-d 2
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308.60'.
874.BQ'
IRS Placed O River Bank
N 01055'28"E -983.20'. Tota!
2 I
Parcel 8
Parcel 6
,.
5.009 Aces.+/=
100 Year Flood Area
s
as Scaled from FEMA Map
IRS Placed ® River Bank
! .5.004 Acres f/
n
J Contarlino Proposed
60' Access -.Easement
117
'Ses Street 2-d 2
308.60'.
874.BQ'
IRS Placed O River Bank
N 01055'28"E -983.20'. Tota!
Parcel 6
Parcel 6
5.009 Aces.+/=
100 Year Flood Area
as Scaled from FEMA Map
Dated 12-17-93
munity-Panel No. 370308.0075 C
3/4" E7P
Found in Center of Old.RR
E1P
339.46'. S Q2°20'26'.'W
River Bank
3%4"
E7P Benf
-....__
340.59• S 05.33'13"W
37L72' ;:5:01°31'03"E
S 01'4726'E
17.50'
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Tax .Lot 30'
Tax':*MCI
q Center Llrre
cL - center Line
Tax 'Lot' 35
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n/f Herman SCOP± Rnhhil+
EP — Edge 0 Pavement
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IRS
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!RS 2.718,
o-- — - Area in Question
Tax Lot 30.0
Tax h;ap, M—