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200 Sunburst Lane Lot 14DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900024 Tax PIN/EH #: 5735-38-0207.14 Billed To: Roger Spillman Subdivision Info: Sunburst Downs Lot # 14 Reference Name: Location/Address: Sunburst Lane -27028 Proposed Facility: Residence Property Size: 5.039 acres **NOTE* i�iis �1m rov8ement/ eration Permit DOES NOT authorize the construction of a septic tank P OP ep 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 U W #People #Bedrooms #Baths 2 Dishwasher: Garbage Disposal: ❑ Commercial Specification: Facility Type Washing Machine: C>3' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ #People #People/Shift #Seats Industrial Waste: ❑ Lot Size/ -t Type Water Supply WEL Design Wastewater Flow (GPD) /� Site: New Repair ❑ System Specifications: Tank Size GAL. Pump Tank T GAL. Trench Width Rock Depth Linear Ft.� Other: 2 lA STQ l gl, r/ OJ 125'22kGS 149ra G zN &s, ! ©.C► A 1 ^1 , � 1 � Required Site Modifications/Conditions: I of STA U. _ UA C&-4002, IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) 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 1:3Q p.m. on the day of installation. Telephone # is (336)751-8760.**** 120 51 mw'-�q Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Dater1 /101 DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900024 Tax PIN/EH #: 5735-38-0207.14 Billed To: Roger Spillman Subdivision Info: Sunburst Downs Lot # 14 Reference Name: Location/Address: Sunburst Lane -27028 Mrs Proposed Facility: Residence Property Size: 5.039 acres ATC Number: 2818 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 WASTE CO IS V FOR A 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 DisposalAR' 11 in N AX a t that the system will function satisfactorily for any given p . f Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date:g��" ©� y©� - nON FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC FR U V Davie County Health Department Environmental Hea/Gh Section P.O. Box 848/210 Hospital Street PR 1 7 2001 Mocksville, NC 27028 (336) 751-8760 ***IFS R�ffYTHI3 KATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED I ION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed (,(- --� 111MCL 0 Contact Person -Vf17 -> Mailing Address Homoe Phone 7,1 / Q City/state/ZIPCQ6LN (— (v� Business Phone �42 V 2. Name on Permit/ASC if Different than Above Mailing Address City/State/Zip 3. Application For: L1 Site Evaluation ❑ Improvement Permit/ATC Both 4. system to service: ❑ House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People Bedrooms _ # # Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ hashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sims # Commodes # showers # Urinals # hater Coolers IF FOODSERVICE: # Seats Estimated hater Usage (gallons per day) 7. Type of water supply: ❑ County/City Lei i ell ❑ Co==nity e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes UNo If yes, what type? ***IMPORTANT*** CLIENTS AIUST COKPLETETIIE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AIUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: ` ,, o,3 1 ekCre S Tax Office PIN: # 513 5- 3L d 0 rl Property Address: Road Name oJ,t.GP horst &A -e- City/Zip If in a Subdivision provide information, as follows: Name. 4� CPU Section: Block: Lot: Iq WRITE DIRECTIONS (from Mocksville) to PROPERTY: bltdK W ( 5 & 6h GladgIVh� jM Zi u,1C,i Oh RA 15-1 Date Property Flagged: q- 117-0 1 This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) 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 reaponsiblefor aR 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 County and owned by J•kCe e, s. Lti cl ri CK to conduct all testing procedures as necessary to determine the site suitabilityp , DATE q- 1 r7 -0 I SIGNATURE `/� AIM w THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, -and -septic locations). Revised DCHD (07/98) Account No. 2° Invoice No. Z� 1 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900024 Tax PIN/EH #: 5735-38-0207.14 Billed To: Roger Spillman Subdivision Info: Sunburst Downs Lot # 14 Reference Name: Location/Address: Sunburst Lane -2702 Proposed Facility: Residence Property Size: 5.039 acres Date Evaluated: Water Supply: Evaluation By: On -Site Well Y Community Auger Boring f Pit f Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH C -/ Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence h Structure Mineralogy 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 SITE CLASSIFICATION: I LONG-TERM ACCEPTANCE RATE: 0, ` REMARKS: 601 OJ re -o- -T U` LEG EVALUATION BY: t—)mob- ,1:�a Q_t4li, OTHER(S) PRESENT: 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 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) ■ MENS■ MESON ■■E■■ MESON MEMOS ■ ■■■■■■■■■■■■■ ■■■N■■M■■■■■■ ■M■■■■■■■■■■■ ■■■■■ME■■■■■■ ■■■■■■■■E■■■■ ■■■■■■E■■■■■■ ■■■■■■■■■■■■■ ■■■■■■■■■■■■■ ■N■■■■■M■■■■E ■■■■■■■■■■■■■ ■M■■■■■■■■■■■ ■■■■■■■■■■■■■ ■■■■■u■■■■■■ ■E■■■ ■■■■■■ ■■■■■■■■■■■■■ ■■■■■■■■O■■■■ ■■E■■■■■■■■■■ ■■■■■■■■■■■■■ ■■■■■■■■■■■■■ ■■■■■■■■■■■■■ ■■■■■■■■E■■■■ ■■■■■■■■■■■■■ ■■■■E■■■■■■■■ ■■■■■■■■■■■■■ ■■■■■■E■■■■E■ ■EEE■■■■■EEE■ ■E■■■■■■■■■E■ ■■■■■E■M■■N■■ ■■E■■■E■■EEE■ NEEM■■E■EMEME ■■■■■■■■■M■■■ ■■■■E■E■■■■■■ MEMO■■E■■■■■■ ■MMM■■■■■■■ ■■MME■■■E■■ ■■■M■■■■M■■ ■M■■NO■EME■ ■EMM■■■■■E■ ■■■tett■■■■ ■■■MMEM■■N■ ■■E■■E■■EE■ iii mom MEN ■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■e■■■■■ecce\e■■e■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■M■■■■■■■■■■■eee■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ::���■Mee■■■■e■■■■■■■eee■■ecce■■ ■■■■eee■■■■M::�■■■Mee■■■■■■■e■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■Mee■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■eee■e■■■■Mee■■■■■■eMee■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■E■■■■■e■■■te■■■ecce■■■■■■■N■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■Mee■■■■■■■ ONEEMEIMMEMEN MEMNONMENNENMEMNONiiiiii ■■■■■■■■i■■■E■eee■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■wee■■■■�■■■wll■■■■■■■■■■■■■■■■■■■■■■■■■■■ a