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182 Farmington RdAccount #: 990005921 Billed To: William Junker Reference Name: Proposed Facility: Business DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 /Fax # (336)753-1680 OPERATION PERMIT Ta, ` . iN/.EH #: F500000051 BPJ,PMPa 1t -C' Qe,: Subdiuisrsn)l.nla: �,:.;�Localoi ddress: 182 Farmington Rd-27028Prperty'-Size: 17.57 Acres AT * O� TheOis uance of this Operation Permit shall indicate the system described on the ATC has been installed in compliance with Article 11 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. System Type.: —i�t S.T. Manufacturer .$ 64 Tank DatTank Size /000 Pump Tank Size Bedrooms: System Installed By: -a/!i1m (/-46►/ Installer# Date: GPS Coordinate: DCHD 11106 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street ' Mocksville, NC 27028 (336)753-6780 /Fax # (336)753-1680 OPERATION PERMIT Account #; 990005921 Tau`PIN/EH #: F500000051 Billed To: William Junker � ��OP2f-�i�S' �,� C Subdivision;lnfo: Reference Name: 'Location;Address: 182 Farmington Rd -27028,: Proposed Facility: Business PEoperty Size: 17.57 Acres p,T*& Theis uance of this Operation Permit shall indicate the system described on the ATC has been installed in compliance with Article 11 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. System Type;. A�7_ _ S.T. Manufacturer .$ 64 Tank Date Tank Size /000 Pump Tank Size Bedrooms: System Installed By: D61,41Q Lg��►/ Installer# Date: GPS Coordinate: DCHD 11/06 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 / Fax # (336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005921 Billed To: William Junker Reference Fume:: Proposed Facility: Business ATC plumber: 5961 Tax PILI/EH #: F500000051 Subdivision lnfa: Location/Address: 182 Farmington Rd -27028.. Property:Size: 17.57 Acres Site Type: flew ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms # Bathrooms # People Basement❑ Basement plumbing❑ er�p Non -Residential Specifications: Facility Type L # i e e' # Seats Square Footage(o imensions of Facility) Lot Size 01 1 Q C Type of Water Supply: gCounty/City ❑ Well ❑ Community Well System Specifications: Design Wastewater Flow (GPD) IML_Tank Size_= GAL. Pump Tank / GAL. Trench Width Max. Trench Depth;-_ Rock DepthN/4 Linear Ft. Site Modifications/Conditions/Other: �edu�i`�t Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation. Telenhone # (336)751-8760. pw_16,4 1p� Environmental Health Specialist Date: n('ur) 1 1 mA (PPViCPrn Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT Account #: 990005921 Tax PIN/EH #: F500000051 Billed To: William Junker Subdivision Info: Address: 136 Triple J Lane Location/Address: 182 Farmington Rd -27028 City: Mocksville, Property Size: 17.57 Acres Reference Name: Proposed OTES This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: [j New ❑Repair ❑Expansion Permit Valid for: 05Years ❑No Expiration Residential Specifications: # Bedrooms # Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # eo�p # Seats Square Footage or imensions of Facility) Design Flow(GPD):IL-0 Type of Water Supply: [County/City ❑Well ❑CommunityWell Site Modifications/Permit Conditions: S stem Type LTAR Initial 12 Repair o Z w S Site Plan �OA(115 IJ I�tt�Ni� V�u�i}u 31� 8 Environmental Health Specialist i.p.l 1-06 Date O 1b , APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/ Fax (336)753-1680 Application For: ❑ Site Evaluation/Improvement Permit ❑ Authorization To Construct (ATC) Goth Type of Application: kNew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPIJCANT INFORMATION NameContact Person X4 �–� ° Address Home Phone J, City/State/ZIP` V� - Business Phone 7 s 1 9 Email !& d t.7N .✓.4- 1" a ;Ja nS -#E, sus -T Name on Permit/ATC if Different than Above Address rJX9J_V;J1%4W tQM9l:aur_�ai��►i 'Date House/,Facility Uorners NOTE:. A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name' ' Phone Number Owner's Address City/State/Zip Property Address , �� y�/, �„ City Xbdivision. f Size 17,5-7 Tax'PIN# 000W Name(if applicable)_ge6&��u� Section/Lot# Directions To Site: If the answer to any of the following questions is-"Yes",supporting documentation must be attached: Are there any existing wastewater systems on the site? No Does the site contain jurisdictional wetlands? _--Ye's — Are there any easements or right-of-ways on the site? _Yes — Yes ✓Io ��No Is the site subject to approval by another public agency? Yes Will wastewater other than domestic sewage be generated? Yes 2Vo TF RF,SIDF,NC'E FIT J, OT TT TNF, BOX RFLOW # People # Bedrooms # Bathrooms Garden Tub/Whirlpool ❑Yes ❑No Basement: ❑Yes ❑No Basement Plumbing: ❑Yes ❑No .IF NON -RESIDENCE FILL OUT THF BOX BF...LOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other. Water Supply Type: ❑ County/CityWater ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and comers and locating and flagging or staking the house/facility loc tion, proposed well location and the location of any other amenities. Site Revisit Charge Properly owner's or o?MeArlegai representative signature Date(s): Client Notification Date: Date EHS: Sign given ❑Yes ❑No Revised 11/06 Account # O/V Invoice # 91420 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990005921 Tax PIN/EH #: F500000051 Billed To: William Junker Subdivision Info: Reference Name: Location/Address: 182 Farmington -27y028 Proposed Facility: Business Property Size: 17.57 Acres Date Evaluated: 20 Z Water Supply: On -Site Well Community Evaluation By: Auger Boring V_ Pit Public X Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % C o HORIZON I DEPTH O-tf group' Consistence Structure Mineralogy HORIZON H DEPTH Texture group Consistence 1 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 • 2 SITE CLASSIFICATION: .25_. LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY:Wc.� �1 OTHER(S) PRESENT: c/ YJ 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 ONSIST N . . 10 rim VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm 3y -d 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 -� M(_ Mineralogy 1:1, 2:1, Mixed 1YQ.tes 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 05105 (Revised)