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466 Rainbow Rd . � � , ; " J • DAVIE COUNTY HEALTH DEPARTMENT Environmental Heaith Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990001776 Tax PIN/EH#: 5851-89-6160 Billed To: Waters&McGuire Building Co. Subdivision Info: Reference Name: Alex McGuir�e Construction Location/Address: 466 Rainbow Road-27006 Proposed Facility: Residence Property Size: 292X115 ATC Number: 2869 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSLTED 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 WASTEWATE ONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: � Date: fo -- ('' D� CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis Certificate ofCompletion shall indicate the system described on ImprovemendOperation Permit has been installed in compliance with Arti le 11 of G. Ch pter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO AY aken as ant that the system will function satisfactorily for any given period of time. !— S tic S tem Installed B : G%l� � - �P Y� Y ��,,� L Environmental Health Specialist's Signature: f�i��'�"6� Date: g"`-'� DCHD OS/99(Revised) DAVIE COiJNTY HEALTH DEPARTMENT ��G ��-+—/ � o / • . Environmental Health Section � � . P.O.Boa 848/210 Hospital Street � �,Z�a Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001776 Tax PIN/EH#: 5851-89-6160 Billed To: Waters&McGuire 8uilding Co. Subdivision Info: Reference Name: Alex McGuire Construction Location/Address: 466 Rainbow Road-27006 Proposed Facility: Residence Property Size: 292X115 **NOTE'N�iib�mprove�me nt/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AiTTHORIZATION 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 PERNIIT IS SUBJECT TO REVOCATION IF STTE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERNII'I'BEFORE INSTALLING SYSTEM. Residential Specification: Building Type �7 #People�,_ #Bedrooms C� #Baths�� Dishwasher:.� Garbage Disposal: � Washing Machine:� Basement w/Plumbing: ❑ BasementJNo Plumbing: � Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste:0 G Lot Size �t� Type Water Supply��_ Design Wastewater Flow(GPD)� Site: New��Repair❑ System Specifications: Tank Size/fr�(� GAL. Pump Tank GAL. Trench Width c.'1���.Rock Depth/��� Linear Ft.� � Other: �.e%�t.0 �Gv� /l�s�� �/ iCl /�'� Required Site Modifications/Conditions: IMPROVEMENT/OPERATiON PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6`�BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie Counry Health Department for final inspection ofthis system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to :3 .m.on t e y f installation. Telephone#is(336)751-8760.**** � Environmental Health S ialist's Si ature: "� .� Date: �v ���� P� &i DCHD OS/99(Revised) � � . . .r _�, • � - APPLICATION FOR SiTE EVALUATION/IMPROVfMEM'PERMIT&ATC D � � � � a � . Davie County Health Department � d 2001 Envirvnme,nta/Hea/th Se+dfon " P.O. Box 848/210 Hoapitnl. .8�raet . .' Mocksville, NC 27028 ENVIRONMENTAL HEALTH (336)751-8760 DAVIE COUNTY *t*Il�ORTA�NT�** THI3 APPLICATION QINNOT B�E PROC�33a'D UNLE33 ALI, TH8 REQOIRLD , INFORMATION I3 PROVIDED. Refer to the INFORMATION BULLETIN fot iast=tiCtiOns. Naa� !o b� Biii�d 'v S` v: �-O Coastawt IIrs,an ,��Q�T^=�a_�1�1 �'e.- xailinq 71dds... - , 80�. rhons �,�t?- R�Ig'� City/Stat.�/LS? 1 ^ � Hwia�ss p!►oa� ! 1�"," O�OO� Nam� oa p�zmit/7►TC i! Di!l�r�nt lhaa 11bow � L ���5 C ltailiaQ 7�ddr�s� S,�("� City/Stat.�/Lip �o G.M�-sL Appiication gor: O Site Evaltu►tioa 0 Improvament Pasmit/ATC �th sy.t.m eo s.��.: �e 0 Mobile Home O Bnaiaeas 0 Iaduatrp � Other I! Rosidessce: f Peopla � . t Badrooma � • Hathrooma °�- r3�nsahra.h.r n carbay. ci,posai ��ashiaq rtact�sa. a sas.a�nt/ri�sibiaq o s.,wat/xo rlvabiaQ 2! 8usino�s/=ndustsy/Oth�rs Sp�aity typ� f II�opl� � Siak� + Coaodas � Shor�rs � Uriaal� � lfal.�r Cool�r� IS P'OOD8ERVICE: � Seats $stimated Natsr Osaq� tQauoau p.r as�r) Typs o! Mater suppiy: 18'Cotmty/City ❑ Nall 0 Community Do yon anNcipate addltioas or ezpanslons of the faclllty t6is ayatem ta lntended to aerve? 0 Yes �-t�� If yes,w6at type? "**IMPORTANT***CLIENTSMIISTC�DMPLETETHE REQUIRED PROPERTY INFORMATION REQUESI'ED BELOW. Either s PLAT or S1TE PLAN Mf/STBESUBMITTED by the cllent w�itL THIS APPLICATION. Property Dtmensions: X WRITE DIREGTIONS(trom MoebvWe)to PROPERTY: ' Tai Office PIN: #_'�J'� ����CCo�(c(�? _�1 J� � -�- I.�Cx i n h����'� - �.�If (]/l /���l n� ,) , /� �f PrnpertyAddress: Road Name `�(9�0 -I�G�I A�,nc��• City/Zlp �Q��O r V ia s Snbdivisioa provide taformation,as follows: Name: Sectioa: Biock: Lat: Date Property'FtaSged: �9�1"n t�t�to cerNfy that the tnformaHon provlded i�correct to the best of my knowledge. I andecatand that any permit(a) ned hereatter are aobject to aaspension or revocaHou,lf the a[te plans or intended ose c6snge,or i!the information bmitted in this appltcaHoa Ls falsifted or c6enged. I,also,anderstand that I ant nsponslble jor all cha►gts Incurrtd jront is appllcatton. I,hereby;give consent to the Aathorized Representative of the Da Coant alth Departmeat enter upon above described property located in DuWe Connty sad mvned by � r.c� condnct atl tesHng ptocednres as neceaasry to detetmine We s[te anita ATE 10���ZI � SIGNATURE �' I3 AItEA MAY BE USED FOR DRAWING YOUR STTE PLAN(Inclade all of the folla�wing: Eiiatin`and propt�sed � perty itnes sad dlmensions, atrnctares, aetbacics, end aeptic iocaHons). 3ite Revbit Charge Dstc(a): Ctient NoHtication Date: EHS: Accoont Na ��DD�1?'1 G �_ . 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':�N NG . . �'r y j ., .. , .. .. .. . . .'�. ; _ °-��i!w�W1! , • �-; DAVIE COUNTY HEALTH DEPARTMENT � � ' Environmental Health Section ' ' Soil/Site Evaluation APPLICANT INFORMATION PROPERTY IlVFORMATION Account #: 990001776 Tax PIN/EH#: 5851-89-6160 Billed To: Waters&McGuire Building Co. Subdivision Info: Reference Name: Alex McGuire Construction Location/Address: 466 Rainbow Road-27006 Proposed Facility: Residence Property Size: 292X115 Date Evaluated: ��f Water Supply: On-Site Well Community Public [� Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca osition Slo % HORIZON I DEPTH �. � Texture ou Consistence Structure Mineralo � HORIZON II DEPTH `' �� i� Texture rou Consistence � SWcture � /c Mineralo HORIZON III DEPT'H Texture rou Consistence SWcture Mineralo � HORIZON IV DEPTH Texture rou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON . SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE . SITE CLASSIFICATION:�� EVALUATION BY: 11'i LONG-TERM ACCEPTANCE RATE: .� � OTHER(S)PRESENT: REMARKS: �J���Z�� ���'/ �t��i'� 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 Mineraloev 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 DC�ID OS/99(Revised)