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608 Bonkin Lake Rd DAVIE COUNTY HEALTH DEPARTMENT . * Environmental Health Section ' ' P.O.Boz 848/210 Hospital Street /�d- �—�-"'� � • . . � Mocksville,NC 27028 U (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900063 Tax PIN/EH#: 5823-89-66461m Billed To: Larry McDaniel Subdivision Info: Reference Name: Location/Address: Bonkin Lake Rd.-27028 Proposed Facility: Residence Property Size: see map ATC Nurpber: 2833 **NOTE** This ImprovemendOperation 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 � #People�_ #Bedrooms� #Baths\J� 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�/.l�/ Design Wastewater Flow(GPD)�f�4 Site: New�Repair❑ System Specifications: Tank Size�GAL. Pump Tank GAL. Trench Widtt�� Rock Depth�„� Linear Ft.��( Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S) IF G`�BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis 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(33G)751-8760.**** � �` � � \� \� . ,� � � � � ,� � . , - � � � Y Environmental Health Specialist's Signature: J Date: ,��`�� DCHD OS/99(Revised) . • ��� ' • • DAVIE COiJNTY HEALTH DEPARTMENT • . . � Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900063 Tax PIN/EH#: 5823-89-66461m Billed To: Larry McDaniel Subdivision Info: Reference Name: Location/Address: Bonkin Lake Rd-27028 Proposed Facility: Residence Property Size: see map ATC Number: 2833 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MLJST 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 NSTRUCTION IS VALID 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 de�c 'be on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S.Chapter 130A, S 'o .1 00"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken as a guarantee that the sy t 'll function satisfactorily for any given period of time. � / � � � c Septic System Installed By: � Environmental Health Specialist's Signature: Date: �����t� DCHD OS/99(Revised) , �u-ru�uuN ruu �IIE tVAWAl1UN/IMPROVEMENT PERMiY dt AT � � r Davle County Health Departrnent � �;� �; �� �� � � . . Envfrnnmenta/Health Serdon � ' � � P.O. Bcz 84B/210 Hospital Stseat ,� i L_ ,� �t�iie Nc z�oze , �`��:�Ol � � �336�751-8760 � �---;��='�•�' *♦*II�ORTAA1Tt** THIS APPLIC�TIdl� C1lNIPnT A� PR4C83� ONLE88 �I,L RE�It1►tl�'JT�',L N�LTH IIIE�OR�ITION IS PROVIDED. Refer to the INB'ORMATION BOLLSTIN for '%��U`m i. ��. co b. siiien 1�n i i'Y1�t�z.t�i�f�ui (c���s�-o�r�� n.r.«� �i l I ��: �sis� ��, �O�X. 5�rl • s� raoas �� 9 - I c�tiNar.ar.e�z:p YYl`c�c��iis l l� t�� �r JQ�g ans�. rno� ���(fl - '7S7- �d�.� s. Ilams od f�eal.t/l►i'C i! Di!larant than 71b�wa .J�� �c- Ca.�rr,� ,� �Y1� 11 e�, �is„Q �►ea�,. �5� �1 t3.�-iS I�J� cstY/aeate/zip ✓1�1 O ck S V��� , � �49�S �. Applicatioa i'or: U Site EvalnatioA Q/Improv+ement permit/ATC D Bok2� 4. syatam to enrvtoa: 6'Honse 0 Mobile Homn U Snsinaas 0 iadnstry 0 Other a. It Residenoe: f people '� ,� / 8adrooms ,�_ � Bathtoama !�j Q'Distwasher 0 Oatbaqe Disposal 0'11ast�le�q Nadiins 0 8as�t/Dimbiaq 0 8aaeaoeat/No pltimbinQ 6. i! Bnainess/Indastsy/Ott,er: 8peaity tiype - - - ,- - � people / SiN�s * Cca�odes f shoxers f nrinai� � Nater Coolers IP TOODSEAVICB: # Seats $stimated Aater Os ga (Qaliona psr aaY) . 7. Tpp� of watar snpply: O Conaty/City YJ i�ell 0 Cca�wnity s. Do yon anticipate additiow or e:pansiow of We fac,�llty Wis�riem 4 intendtd to urve! 0 Yea �No If yea,wbat type' '**IMI°bRTANT'•"CLIENTS�1lUST Cti11lPLETETHL REQUlRED PROPERTY INFORMATION REQUESTED 66LOW. Eltber a Pl.AT or S1TE PI.AN MUST BESUBMI7TED b t6e client �it6'fHIS APPI.[CATION. , ry �3.o�X 4S�f.&�S �C n�x� Property Dimension�. / X��•� WIt�TB D�tECfIONS(from Mal�sville)to PROPL+RTY: Ta:Otfice PIN: # J��� ��- �L(Q�lil . l Q�� � '�O �« � � -'�-C;�.✓��n..�--� Property Addrar. Road N�une�(1 �tn �`C� �D�.`�-�`- � �'c� �✓� �� `� . C1ty/Zip �O Ck6U��Lo , �� �S�-f G� i2 G� - �-e��-- _ QO � �-Q If ia a Subdivl��Oa provide informatton,�u t'ollowr. �o nk c.v� � P-� - lC�� � `�`��� e Name: � l�.Q �'� L�'-�t ' Sect�on: Block: I.ot: Date Rvperty Flagged: � -a�-�� This is to certify that tbe information prnvided ia corrtict to t6e best of my knor►ledga I anderstand that�ny permit(�) 1s�ued 6errxfte�arr au6ject to aaspension or rtiwoeation,If t6e site plan�or tatended nae cbange,or tf t6e informatlon submitted tn tbi�sppitcation i:�alaiAed or cbanged I,also,andersta�rd tljat I am re�pon�ble for a!1 dbargu Jnc�n�ed from tlifs appllcatio,r. I,6er+e6y,gfve rnnsent to t6e Aaf6oriud Repnaentative o�t6e Davie Caunty Heslt6 Departmeat to enter apon above described property locmted in Davie Connty snd owaed b?• to condnct all tating procedu�+a�s necautry to determine t6e dte aitabilit�•. DATE S �.�^a � SIGNATURE r � � THIS AREA MAY BE USED FOR DRAWING YOUR SITL PLAN(Wc all of t6e�oilowing: E��aad�rnpos..-d pro�Pty iina and aimen:ion�, strnctar�a, utbacks, and�eptic IouUona). ���- ���C��� _ 5 � ��{ ' Accoant Na � / . ✓ Rtvised DCHD(07/98) Invoice Na ��-� 3 � tw y � � Pbnted Ston� � S 97'00'00"E i84.88' � � . ' � Fnd � • ` ' . �(��� \� .. Y�D�O;d�01 �-b u3� �� L_ Parcel 1 Part of Tax Lot 20 g o ' $ o z000 ao�ee+/— � � �$ a n 1� �� � _ � , , . , . . � New Properly Lin� ' . � (Ses Nots�1) , \ ' ' IRS � � IRS 1RS Lr4 L—J �.�� (^� � IHS � `1 r IFS �\` L✓ � �r '�—� i I . ��� ����� �� r I , ' �'''' � � \`\ Bonkin Lake Road �� � ��i ' , ' P���M o�T�.��2o S.R. 1419 . ��� ��� , �-o � ����� � �� G , �� � . � ��� �.. - , . � ad � . . .� p � [� � � � � APPLICATION FOR SITE CVALUA7101!/IM1IPROV�h9EiifT Ij��7i1 i�lt3C �i'�. � �� Davie County Health Department �2 2 2u�1 ; ��j . ' / � , l� 1 2 Environmenta/Hea/t�i Section (,�,� �J fs� �S� P.O. Box 848/210 Hospital street ENVIRONI�1E ��Q ���' Mocksville, NC 27028 DAVIE NTAI HEALTH �G (336)751-8760 COUNTY � � � !� ***IMPORTANT*** THIS LICATION C1INNOT BE PROCESSED UNLESS THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFOR2�ITION BULLETIN for instructions. 1. Name to be Dilled � 1t.TTF+ 1 � � Contact Peraon Mailinq Address ���� �Y�,��� �• Home Phone RU3" G�r����C(�'( City/State/ZIP �0� ��� `]� .� 1��� Businesa Phona �i�jy��7S�— �����(� , �. 2. Name on Permit/ATC if Different than Above Mailing Addresa City/State/Zip 3. Application For: fl Site Evaluation ❑ Improvement Permi.t/ATC ❑ Both 4. Syatem to Service: �HOUS2 ❑ Mobile Home ❑ Business 0 Industry ❑ Other s. If Residence: � People �_ # Bedrooms _,,�_ # Bathrooms �.S Fd Dishxasher ❑ Garbaqe Diaposal tI"Washing Machine AYHasement/Plumbing U Dmaoment/210 Plumbing 6. Zf Buainess/Snduatry/Other: Specify typo # Paoplo II Sinka Y Commodes # Shoxers � Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallona por aay) �. Type of water supply: ❑ County/City �Well ❑ CommUnity e. Do you anticipate additions or eapansioas of the facility this system is intended to scrve? ❑Yes G�'1Go If ycs,what type? h1/�t ***IMPORTANT***CLIENTS MUST COMPLETETHE REQUIRED PROPGRTY 1NFOItMATION ItEQULS'I'GD BELOW. Either a PLAT or SITE PLAN MUST BESUI3MITTED by the client witl�TIIIS APPLICATION. Property Dimensions: WRITC DIRGCTIOiVS(from Mocksville)to I'ItOi'LIiTY: Tax Ofiice PIN: #� - �� - ' �rr�C,t. ���.� �r�n f t� �-�v �,.�:� �0 I, (uv',r� �3�{-OU060 0�0 Property Address: Road Name �� ;c �� on�v �-�u o , M � C;ty/Zip � �iirn I��r� E,S`'�iG I��. ro�loiJ �SS�C i If in a Subdivision providc information,as tollows: � t -�r rtp�ta . /?� ,,rp,�c'. �I.� n �ic l � Namc: b k.+n f' ��, -� �i n,t. I�.'�"'. Section: Block: Lot: Date Pr�perty rlagged: This is to certify that tt�e information provided is correct to the best of my kaowle.dge. I uvderstand that s+ny percnit(s) issued hereafter are subject to suspension or revocatioa,if the site plans or intended use ct�ange,or if tl�e infor►nation submitted in this application is falsified or changed. I,aJso,understand that I am responsible for aJl charges incurred from this application. I,hereby,give consent to the Authorizcd Representative of tl�e Duvie Cuunty Health Dcpartment to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determiue the site suitabili DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLA.N(Include all of the followin . �aisting and proposcd property lines and dimensions, structures, setbacks, nnd septic locations). �6�.Si�-, Sitc Rcvisit Ct�argc 1��l+�tSC. A�tr ¢. �+.�-'h I,r�i`�- �:�.�[krr� �c�Aw'�—�S�_ Datc(s): ' � ,I f• ���� j�� p�.. �"'� o� 1�S�G'N1+--' g�0� Clicnt Notification Datc: l �I�et..�. �a+�-(. EHS: � � l �I �� � Account No. �� Revised DCHD(07/99) � � Invoice,No. � � ` �, . � ��- �} � . »4�"'t�J � 'y5,ll:� � .' �ro�.u� h�,�..A,_Si�k-G.� �BI��ftv x 3'�{ ��-S �,,.k:� L��, Q� � � �� {-�,7 gu( � � A �QI 3 Z - � � ' " DAVIE COUNTY HEALTH DEPARTMENT � � Environmental Health Section • ,� �' . ,, . . Soi]/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001544 Tax PIN/EH#: 5823-89-6646 Billed To: Jeffrey Miller Subdivision Info: Reference Name: Location/Address: Bonkin Lake Rd.-27028 Proposed Facility: Residence Property Size: �acres Date Evaluated: �-ly '�� 7 Water Supply: On-Site Well b/ Community Public Evaluation By: Auger Boring �/ Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e osition .L L Slo e% G HORIZON I DEPTH �� �� Texture rou CL G�4 Consistence Structure Mineralo HORIZON II DEPTH �`" �6�` '� Texture rou C Consistence / Structure iJ fl� e/ J� 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: cP EVALUATION BY: �/1 ' LONG-TERM ACCEPTANCE RATE: � OTHER(S)PRESENT: REMARKS: ���.i ���' ��� a ,��'�° � 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 Mineralo�v 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 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O. Box 848/210 Hospital Street Courier #09-40-06 Mocksvilie, NC 27028 � Phone #: (336)75i-8760 April 18, 2001 Jeffrey A. Miller 1460 Farmstead Road Rock Hill, S.C. 29732 Re: Site Evaluation/Bonkin Lake Road Tax Offce PIN: #5823-89-6646 Dear Client(s): As requested, a representative from this office visited the aforementioned site on February 6, 2001. Based upon the information provided on the Application for Site �Evaluation and after an evaluation was completed on the site, the site was found to be provisionally suitable for the installatian of a modified, oversized on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions,please feel free to contact this office. Sincerely, �i�!�,t�.' : /��. Robert B. Hall, Jr., R.S. Environmental Health Specialist RH/di Enclosure(s)