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248 Bonkin Lake Rd • DAVIE COUNTY HEALTH DEPARTMENT ,` , � , Environmental Health Section P.O.Box 848/210 Hospital Street Mocksville,NC 27028 � �+ � (336)751-87C►0 f� � /" //— � ✓ IMPROVEMENT/OPERATION PERMIT Account #: 990002596 Tax PIN/EH#: 5833-05-5959.JW Billed To: James Williams Subdivision Info: Reference Name: Location/Address: Bonkin Lake Rd.-27028 Proposed Facility: Residence Property Size: see map ATC Number: 3440 **NOTE** T'his 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 SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. ,. Residential Specification: Building Type #People�_ #Bedrooms #Baths � Dishwasher:� Garbage Disposal:� Washing Machine: ❑ Basement w/Plumbing� Basement/No Plumbing: 0 Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: � Lot Size�S ��C Type Water Supply-�'�� Design Wastewater Flow(GPD)--���� Site: New�Repair❑ System Specifications: Tank Size%GAL. Pump Tank GAL. Trench Width � ��Rock Depth��Linear Ft.�U ��i/ Other: Required Site Modifications/Conditions: I1�IPROVEI�1ENT/OPERATION PER1�11T LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) IF G ��BELOW FINISI�ED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis system between 8:30 a.m.to 930 a.m.or 1:00 p.r4-ta- . .m. i ay of installa ' . ele hone#is(33C►)751-87C0.**** � /t tti�a'��(��w�1 j-t '� � ,1 �y �i4�o��� ,�fJS!>11 s4 7`�V �� ✓ ���� .�� ���.J��� �.��Iq �a� �� (I � R^ ��7� Ll `_`,')(1 � 1\fV V � L Environmental Health Specialist's Signature: Date: DCHD OS/99(Revised) "r ' � ` DAVIE COUNTY HEALTH DEPARTMENT ��-'J Environmental Health Section P.O.Boa 848/210 Hospital Street Mceksville,NC 27028 (33G)751-8760 Account #: 990002596 Tax PIN/EH#: 5833-05-5959.JW Billed To: James WiAiams Subdivision Info: Reference Name: Location/Address: Bonkin Lake Rd.-27028 Proposed Facility: Residence Property Size: see map ATC Number: 3440 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). T'his 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. Environmental Health Specialist's Signature: Date: � CERTIFICATE OF COMPLETION **NOTE** 'The issuance ofthis Certificate of C s a m ica i��described on Improvement/Operation Permit has been installed in compl' e with Article Chapter 130A, ion.1900"Sewage Treatment and Disposal Systems" s all in Y be taken as a guaran at the ystem will function satisfactorily for any given period of time. ��j �d' �'�� 1�� ! � Septic System Installed By: � / � Environmental Health Specialist's Signature: i�- ` Date: �`/ ` i f DCHD OS/99(Revised) � ' R � / ` . C� �,a-L.O'�— � , � • , --_ � � � � � a � ({ M � lY...r""� , . D 'v u � TION FOR SITE EVALUATION/IMPROVEMENT PE(iMIT&ATC Davie County Health Department �0 5 �- ] 2003 Environmenta/Hea/th Section A�R P.O. Box 848/210 Hospital Street � ��'� � � g „ 3 Z�' Mocksville, NC 27028 FNViRONMENT�-HfA�'TH (336)751-8760 �-e bt�t � Y y_ 6 G ���, ppV1EC0UNTY ORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS AI,L TFIE REQUIRED INFORI�,TION IS PROVIDED. Refer to the INFORN�,TION BULLETIN for instructions. � 1. Nama to be Billed�}�,✓JCS [/v 1(.L�lQ6Q/� Contact Person �"-j�/yJ�-S �if//ui�4l3�1s Mailing Address Z b Z� ��/�Nl��Y �oI Home Phone�,3(vl T(i�- �W S-� City/State/ZIP rQ �J/1!�/�l� NC. o�.7a�— Business Phone �33�5� �-�o(p— Q(p(p`7 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. A.pplication For: �Evaluation �mprovement Permit/ATC ❑ Both 4. system to service: �House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People Z # Bedrooms � # Bathrooms 3 dYDishxasher G1�Garbage Disposal �Flashinq Machine ��Sasement/Plumbing fi Basement/No Plumbing � 6. If Business/Industry/Other: Specify type # People # Sinks 1f Commodes # Showers # Urinals N Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. R�ipe of water supply: ❑ County/City 9�T+Tell ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to scrve? ❑ Yes B�PPo If yes,what type? ***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMI7TED by the client with THIS APPLICATION. . L Property Dimensions: �/�/�ie�k• �'�S� 1'C �S-a0' �VRITE DIRECI'IONS(from Mocksvilie)to PI20PLR"i'Y: Tax Office PIIY: # .5833 -- as- - s�s 9_ .i w -r,�v�/ ,y�,� �o i ,� �o ��✓,. roi PropertyAddress: RoadName �Q��� �f-� �t� ![i�PN .Pi-rL� aiv �O/ 9t foo /�Aa20sC City/Zip/J/�D�S✓i��� NC. �3 /hiGES 7�0 ��N�/N ���' �e►� If in a Subdivision provide information,as follows: %l.e1l! Lf oiv /.3oN�iN �.� ����o,��� Name: (�UICL /�� ON �� � �ur✓7��5 L,4rvD SSNS, Section: Btock: Lot: Datc Property Flagged: �7"! S? �0.3 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 t/tat I ant responsible for a!!chnrges incurred from tlris application. I, hereby,give consent to the Authorized Representative of the Davic County Hcalth Departmcnt to enter upon above described property located in Davie County and owned by /�/�, ��4MS �NSNre;c� �niv,v,,��j to conduct all testing procedures as necessary to determinc thc site suitability. � f' DATE �7��J 3 SIGNATURE ��8n1� O. �f/�..�•-�-.-> THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAIY(Include all of the following: Existing and proposed property lines and dimensions, st tures, setbacks, and septic locations). �S �,C�� �o � Site Revisit Chargc V_ 5►�r f}cE eS I¢2E �O �G � P P � Datc(s): y� ��� S-fMu�S Na cv �'u`� ou� �9t►v'^�.� U` �f'hc�a ,s Lanc� ,���� �'��- SA�� FFc�!`S Clicnt Notification Date: o�v �"h c ai<� kj�.�wc� �'z�s�1�NL i�i�pc✓-�`f S�e(� o�l3an�i� Li n�Q-. Dv-}�F te( Liive_ I S � La ke 5�'�ia--/ �5 EHS: �{-1.� �r'6 p o�s e�1 ��'��.F f-y � _ �f�/z���/� /���-� a�" �'1�s , �,,.� .�� -F-4�� s�s� �uvs. ., - - _ _ _ _ �S �'�OP��y. Account No. � � �►��,Es,f� S 3 �r Revised DCHD(07/99) 2 � Invoice No. � .a —�-a � '� `'� � �� �� ` Cc"�n... S' � L-arr � � * � � • � � . � • J � . � g z.oaoA 366 N 6744 0 � N I �������43$.������i/ $2� � � 56 � __ , - - � ..i a (12.99A) � (17.16A) 2211 � 3 2 6 8252 � ���������������y N � � � 55$ �4�� 360 (8�) (327) (277} 574 � 231 234 ,� 2 3 r--- � cs.sz,a> 7552 �---- � � � �----- �O V 205` "�s7o"---� 377 �---- ' 243 '�- ^ ^ � ,___ �. � � .----- 186 �,.""' 1 -'• 275 (25.71A) - ' - 5959 1 s""' � h"'-- 29�.83 (244) (gZ) w � w ..�i 91��A> -• 5474 � �2 3 �� � � . 49 ' , , (�.�4A� $ ,� (17.18A) `�'s 912Q` ' (15.66A) '� 6097 2048 .� . `6�� � Ag9 / ,�' ,18 el � (1.03A� �62� i ,, • � � • . '- • DAVIE COUNTY HEALT'H DEPARTMENT , Environmental Health Section . Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002596 Tax PIN/EH#: 5833-05-5959 Billed To: James Williams Subdivision Info: Reference Name: Location/Address: Bonkin Lake Rd.-27028 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 osition Slo e% HORIZON I DEPTH Texture rou Consistence 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 RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Lineaz 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 Mineraloav 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 OS/99(Revised) .� . .•'� , . ,.� • � APPLlCATION FOR SITE EVALUATION/IMPRUVEMENT PCRh11T& �-'' =--�� ' � Davie County Health Department � � � ' Environmenta/Hea/thSectron � ��T 2 3 �.�.:': ? P.O. Box 848/210 Hospital Street a Mocksville, NC 27028 ---- -�-�-�""'=""'� EraviF;o,,��,�;iT,;�_!�°,_���� (336)751-8760 pq,_IF i�;)�4wi� _ ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFOFtMATION BULLETIN for instructions. ! 1. Name to be Billed �� N�r/`� /-�-f`� � Contact Person ��OS�� Mailinq Address ��//t-`� �/Z- Home Phone � �y� 3�`7 ] � � City/State/ZIP ��'�y�,t/ f��/� . /�' �-- Business Phone �G( 9� 0� f y / '` 2. Name on Permit/ATC if Different than Above �✓��e J�l�+� Mailing Address 6�� �/��" city/state/zip �.rn!`„i �'�/F 3. Application For:�'rte Evaluation ❑ Improvement Permi.t/ATC Il Both a. system to service: f�House ❑ Mobile Home ❑ Business ❑ Industry Cl O�her s. IP Residence: # People �_ # Bedrooms 3 # Bathrooms Z--- I�shwasher ❑ Garbage Disposal !`1 Washing Machine LI Basement/Plumbing II IIasement/No Plumbing 6. If Business/Industry/Other: Specify typo # Peopla # Sinks �I Commodes �i Showers # Urinals 8 Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. 7.�pe of water supply: ❑ County/City �11 LI Community a. Do you anticipate additions or expansions of the facility this system is intcnded to scrve? ❑ Yes [$-A�}o Itycs,what typc? �; r ***IMPORTANT***CLI�NTS MUSTCOd1PLETETHE REQlIIRED PROPLR'fY INFOIiMA'I'IOtV I2GQU[:S'I'GD l3EI.OW. Eithcr a PLAT or SITE PLAN�L1UST BESUI3MIT/'ED by tl�c clicnt �vith TIiIS'�11'I'LICATION. � Property Dimcnsions: � � - � �d � �`'U WR17'G UIRGC'I'lONS(fro�i�Mocicsvilic) lo PliOI'l�;lt'1'l': Tux Officc P1N: # �533�os S?S� -6 a�l !'✓ /�� ��� �.--� p /� Property Address: Road Name���,C..in� �a��( � l= � �l �/: � /,�''t/� �a�� /Cc� Clty/ZI� /'�J`7�S �/�` �`r- � �D� � !N� �OA-,�S-� �y� �d ' T If in a Subdivision providc information,as follows: �^"/�'��, ��. N��'f�t� 5�.,�c� d�%�� Namc: / " "/f/� a s� e .C�F-.t/�e _ �� �� � � Scction: Block: Lot: � Datc Property rlaggcd: This is to certify that the information provided is corrcet to the best of my knowledgc. I undcrstand tle,�t any permit(s) issucd hcreaftcr are subjcct to suspension or revocation, if the sitc plans or iutendcd use change,or iF tlie inforu�ation submitted in this application is falsificd or changed. 1, also,�urrlerstaud Ilrat 1 a»r responsiGle for rr/!c/nuges iucrrrred f'r��nt a,;s a�ni;�ar�o,t. I, hcreby,give conscnt to the Autl�oriud Represcutativc of thc Davic County ticaltl� Dcpartment to cntcr upon abovc describcd property locatcd in Davic County and owned by to conduct all testing prcecdures as ncccssary to dctcrminc thc sitc suitabilily. DATE Z.3 �Z�6� SIGNATUI2� i�� —__. THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Includc all of thc following: �xisting and proposcd property lines and dimensions, structures, setbacks, and septic locations). Sitc Rcvisit Chargc Datc(s): ��j- � 3- �' � �� / Cticnt Notification llatc: G� C�C 2�7 S �Hs: � G���� 1 � n P' Account No. �_ � ��.o � Revised DCHD(07/99) � Invoicc No. � ., "- (283a4) 8�63 � 7948 . • �srn 951 ' 1661A) ' .'_ - 1583 _ c � ' '.... r. O Z � _ Z . � '°° m Y . (12.99A) ;U �� � (77.76A) . O 2211 O y _ 8252 � ._......_ _ r a (5.30A) � �on ,,,. . aeo i.ai res.� 1��1 Iznl Sl� , (17.99A) � � L"/ �— 9598 ` �5.5u) � �' �—.�� ��� • � " � 7552 ,� . "..---"'_— � . C�__ a !:J -._� � � �,z.«,, .-- . _ . �a „n �., ,.._,-•,-., - _..9370 ' �65 �A�i N].!� �J �� � j `x ; "" ' � (807A) . 1 (ZS.�IA� ""'"' _ _, • PS �oy ' 8071 � , r..�- t � $9� � '"'" � i. ( � i : q � � �znn� � M 861$ _ ry a.l { . '' 2601 . � ......_ mo ' (121JA) n�u .'.... � 4551 : «�� I�zl �t.. ... ...._ (��� Y 8376 } � 'u� � (5.59A) ,�£ � SQ4 (3.02A) t i.,� nr,� 1225 " � m.� ,�+g � / i � ��91� � (15.66A) (17.18A) (15.57A) °h, � 2048 6067 °".. ',� ' �� . � `„� &� ��.esn� � �'°' °.. ' 1764 ~"h, � • (��) �''�� 7627 � � � ,_..... �� i �. . ......._......_. � `q,� 'b7 '°h .� a.... � 4516 y �•.. � �°' (20.67A) r � . �.� 3177 (10J� � ��'.. _ � �sn� 4w4 c 'a !� � -'� (2781A) y�� � F � 5015 .�_.-.. r,. � d � s 4 � , 1�ae9y _ . 77a0 1 ? � `�� g � •�� DAVIE COUNTY HEALTH DEPARTMENT � Environmental Health Section - ', ' ` SoilJSite Evaluation APPLICANT 1NFORMATION PROPERTY INFORMATION Account #: 990002020 Tax PIN/EH#: 5833-05-5959.A Billed To: Hunters Land Co. Subdivision Info: Reference Name: LocatioNAddress: Bonkin Lake Rd.-270 8 Proposed Facility: Residence Property Size: see rrtap Date Evaluated: �� �O� Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit � Cut FACTORS 1 3 4 5 6 7 Landsca e osition L L- Slo e% �l HORIZON I DEPTH a—t o O— Texture rou S� �1� L Consistence F'r , gSP SS Structure G!Z Mineralo HORIZON II DEPTH �� 1 Co 1 O�3 Texture rou G�- - Consistence ��sd V Structure A3 �1L a- Mineralo 2� 2 � ; 1 HORIZON III DEPTH 1 —Z'7 3 2— Texture rou -} � •�c �G Consistence Structure SQ�� Mineralo � HORIZON IV DEPTH Texture rou � Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 5 S � LONG-TERM ACCEPTANCE RATE �j. SITE CLASSIFICATION: � ��.i1�-�J� EVALUATION BY: � 'T"" LONG-TERM ACCEPTANCE RATE: �� OTHER(S)PRESENT: REMARKS: �`w� �,� �VL� ���� S+ � 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 day 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 Mineraloav 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-gaUday/ft2 DCHD OS/99(Revised) ■■��■������■■���������■������������■���■■��■����■����■�����■��■ ■� ■�������■��������■�■■��������■�■■�����■��■������.■��■�■��������/�i ■������■������������■■�■�■�■�����■■■���������■����������������■�■ ■������■■��■�■��■��■■����■�■���■ ■�■�■�■■��■■�■�■■����■■������■�■ ■�����������e�.�v�wsv��������������■���������������e�������������■ ■��■��■�����■������������■■����■���������■����■��■■���■�■�������■■ ■�■■���������■��■��■����■���s■����■■■���■�����e��.���■v�o��������■ ■■���■■■e�s■■��■�■��■����■■■�■�■�■■���■�■��■����■�����■������■�■�■ ■■����■■o���o��o�■■o■���■■����■��■■■■���■■���■���■�����■���������■ ■�����■■��■�����■����■���■�■��■��e������■������������■■■������■�■■ ■����������o�������������������■ ■�������������������■����������■ 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'� .. . ./ �r ' , - j " . /. . . � Z�avie Gounty,�fealth Z7epart`merrt Errvtronmental,�fealth Sectlorr PO Box 848/210 Hospital Street Mocksville,NC 27028 Phone: (336)751-8760 October 31, 2001 Billy Joe Sams Hunters Land Co. PO Box 712 Yadkinville, NC 27055 Re: Site Evaluations 2-S+Acre TractsBonkin Lake Road Tax PIN#: 5833-OS-5959 Dear Mr. Sams: As requested, a representative from this office visited the above site(s) on October 26 &29, 2001. Based on the information provided on the Application for Site Evaluation and after the evaluation(s) were completed, the site(s) were found to be provisionally suitable for the installation of an oversized, modified on-site sewage disposal system. Due to shallow soil depths to rock,topography and poor soil characteristics on the sites, we will require that the septic system be sized at approximately 2001inear feet per bedroom, or 6001inear feet for a three-bedroom residence. Additionally, a pump station may be required. This is subject to change as actual desi�n and dimensions of the septic system will be determined at the time a permit is issued. Before a representative of this office will revisit the site(s) to issue an Improvement Permit/Authorization to Construct, the appropriate application must be completed in full and submitted to this offce. The location of the facility the system is to serve must be staked off. The property must be surveyed prior to makin�this request. If you have any questions, feel free to contact this office. ^ Sincerely, .�� -, JeffG. Beauc p, R.S. Environmental Health Section Enc(s) -