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473 Rainbow Rd + , ��,. • � DAVIE COUNTY HEALTH DEPARTMENT '. � Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990002874 Tax PIN/EH#: 5851-79-0491 B Billed To: Donald Jones Subdivision Info: Reference Name: Location/Address: Rainbow Road-27006 Proposed Facility Residence Property Size: 14.6 acres ATC Number: 3779 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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: �� Date: CERTIFICATE OF COMPLETION **NOTE** The issuance ofthis Cert' p indi te the system described on Improvement/Operation Permit has been installed in compliance with Article 11 of G. . apter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall i s . antee that the system will function satisfactorily for any given period of time. �� 3D lDd�Ac�- 'I��' � � �� i�� '' � �� o� � � ��� ,� � � Septic System Installed By: • � i G ✓ Environmental Health SpecialisYs Signature: Date: DCHD OS/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT � , • ' � Environmental Health Section ,3 � J � P.O.Boa 848/210 Hospital Street ��L � � �� = -�' Mceksville,NC 27028 (336)7S1-87G0 IMPROVEMENT/OPERATION PERMIT Account #: 990002874 Tax PIN/EH#: 5851-79-0491 B Biiled To: Donald Jones Subdivision Info: Reference Name: Location/Address: Rainbow Road-27006 Proposed Facility Residence Property Size: 14.6 acres ATC Number: 3779 **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 PERNIIT IS SUBJECT TO REVOCATION IF STTE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE INSTALLING SYSTEM. / Residential Specification: Building Type #People� #Bedrooms��� #Baths �-S Dishwasher:,� Garbage Disposal:-� Washing Machine:� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �ke Type Water Supply�� Design Wastewater Flow(GPD)S� Site: New� Repair❑ �� s. System Specifications: Tank Size�I�iAL. Pump Tank GAL. Trench Width� Rock Depth� Linear Ft.�C��r Other: Required Site Modifications/Conditions: Il�'IPROVEi�'IENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Departrnent 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(336)751-8760.**** �— , , V � � ������ � . �� . 1�`� �� � � � Environmental Health Specialist's Signature: Date:� � ,' DCHD OS/99(Revised) • � - ---.._,. _.._.._....... ...... .... .,�.,., p.c , . '• e . ' '` , .�(.. ` .� - _ . � . 'l� � V APPLICI�TION f�01I 51TL LVALUATIUN/Ih1PIiUVLA1GVT i'L•Itblfl'�ATG � �,� Davie County Health Department pJ Environmenta/Hea/th Section \J�/ P.O. Box 048/210 Sospital Street _ ���� btOCkaville, NC 27020 -�_ � �C\ (336)751-8760 �.� � • : t**IdlPORTANT*** TI{IS A]'PLIGITION CANNOT BE PROClSSLD UtVLLSS ALL T1IL 12LQUIRLll _ I I27FORMRTION TS PROVID�7i• ReEor to tho INFOItMATION IIULLI:TIN for in�I:7:LL(:L'1O11D. . � . �tamc to be Dilled���`�� �a��s Contact Peroon ��1��.....� �\ IV ���� �ON`� � � v Hailinq nddseas p�� t[omc Pl�onc��5+���V .. �fC\`I�S�� _` `w1 ` V \r . . � City/Statc/'LIP�I`��1�r,.1��` � LY�.�",�ulnea� Yhoue ��_�,�`�, � �---' ��-r Namo on PermiC/ATC il�DiCCer�ont than T.beve �b�+ _______... .. . . � � � �rHatlinq Addrass �'A�� City/ ato/i.ip � ,_ Q.�„ , , a. Application For: �Sil'e �valuation ❑ ImpL�riC Penuil'/ATC �� ❑ Dol-U c� �_.4. syaeem Co service:�Aoust: ❑ t•Sobile Home ❑ Dusinebs ❑ IndusL•ry ❑ Otlicx• _____ 5. Tyye aystom requc�ted: ❑ Coiiventiw�al �,conventional modilied ❑ iunovativa ✓ • � �s. if Ae3idoncc: 0 People. _� tl IIedroom: �_. A IIaLhrouinu ,p�,..,'� f�iahranher �arbagc Dis�:o�al �ashing Machino ❑Uasement/Piwnbing ❑uasemcue/du Ylu���bing � 7. IL nu�laans/Industcy /Othc::: verity type�r� & Pcoplc IF 91nkn ,,.__.._ N Commodea � �V 5howera � 9 Urinala p Waler Cooluro IF FOODSERVICE: $ Seat.e �V.A Estimated Water U�age (gsilona per day) __�_,__ --+�–•-'�— �a. iypu of .+ater eupply:�CounEy/City ❑ Well ❑ Couunuuil•y , `'Y.' ao you aneief.pare a�ateson� :�r espansious oC lhe Cacility lhis syslcm is iulcuded lu scrre'.'�]'cs Cl�o !f ycs,��I�al typc? ' _ � I �(� � ***IALC'OR37111�T"**CLIG�'1' TCOAIPLGTC'f}iL R1iQUlltGU 1'IL01'liYl'Y UVI�OItD�IA'170N 1tlsQUliS'i'lil) ' UE �V. rithcraPLA7'orSITCPLA USTBGSUIIMIT7'F_Abytheclicut rri(h'1'111SAI�PLIC.\'1'ION. _� (1� 3 �crly ll'imCusiotts: �y- �_ �1'1'G ll11tGC1'IONS(Ovm Niucl'st'ilic)lu 1'RO1'lilt'i'1': _� �.�.�tib�� `�'�otr«rtrr: �S� 5 �w.� �S �'a �� er�l "�' � �Property Address: Ruad Yamc � � �D-� �1,r;.a�� � c��yiz��� .�`•1�,1--p� 1���--T--- . � � • . I.�Ifu�a SuUdivisiou providc inform:itiou,as ful otivs: �Q �`��q,� e N•rutc: � . 17Y� 1 . ay / Section: Blocic: ___ Luh vDatc homc corncrs llaggc �-� '-� This is fo ccrtify that thc iiiformaGmi providcd Is corrcct to tl�c bcst of uiy i<no»•Icdgc. I uudcrslaud ll t auy pernti((s) /Q� a p / usucd 6crcaftcr are suUjcct to suspci�sion or rcvocatim�,l[tl�c sitc pia��s or iutcndcd usc chau�e,or if ltic infurm:iliuu � � � submittcd in this applicattou Is falsiC ud ur chaugccl. I,al.co,ru�dcrsrand lhnt!«in itspuasiGlafur«!1 cGrrrgcs lnrurrrd fi r�m Uris npplicatiurr. I,licrcbp,�icc couscat lo(l�c Authorizcd 12cpresculalivc oC llic U:ivic Cuwdy llc:dlh Ucparpucui lo culcr upon abu�•c dcscribcd prupc:ly Iuc:Ucd in D•rvic Cuwify•rnd o»•nc�b�. _ � ' lu wnJucl:d!Icsliiig pruccdw•cs�s r.:ccssary lo ilcicrutiitc Utc sifc suitab'' �i'L_�.,_y- b'�. y�srtn•ruiu; � TfIIS AREA MAY BE US�A FOR URA.tiYdNG YOUR SITE PLAN(L�dudc•rll uf t4e[ot[o��•iug: Lsislii�g and prupuscJ praperly lincs and dimcnsions, struc;ures, sclbacks, and scptic locations). � �/� Si(c Rcvisif Chargc (�L � � llalc(a): • Clicut Nolificaliou llatc: �115: a Sign givcn Account IVo. ��_� Revised DC1ID(OS/03 ' ' , Invoicc Nu. � ` � ��_ � ---`. � - + . `\ . ' �� '--....__. .._..- i � . _ _-- —'-- , ---_ __� ` " �� � �. � < <.� �'---;. ___ _ ___- - .- � . -�/-�ja � , _ _ ____ __.__.---------- - —__ _ • � . . - . � . . , . .. � • ' :�:,,,:� �� • , � � � � .�„_�t4'� "e'.:: :��'v� � • '�•����.. ��$+' �•� . . . , . .. . , , • � . - �r^➢y'teL FL Tt! • -. ' .. . 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Environmental Health Section � � � Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990002874 Tax PIN/EH#: 5851-79-0491A Billed To: Donaid Jones Subdivision Info: Reference Name: Location/Address: Rainbow Road-27006 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 `L � " Texture rou Consistence ✓ Swcture 6' Mineralo � HORIZON III DEPTH f ,, Texture rou Y Consistence Swcture � Mineralo HORIZON IV DEPTH Texture ou 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: �""�c] /G���,b//�-V/ �� � 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 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-Subangulaz 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 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',}�][� �:�^.f.../'� �'- *„ '. . 'rT ,: s , .s. .. e.di e �.; j�� r j,Ue�, nvix f w � � �I�u{ . . . � . . . ,... � � ��. , ,.,_'!�'AS��lv� �V�MSSA S 5����������'9�a18�' r,,:,, ,. ����. Z.":" . . . - . . , .. _ .> ,v,, ENVIRONMENTAL HEALTN SECTION P. 0. Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NC 27028 � � �...�-� �,s,.�, �,,. ��.,.. Phone # (336)751-8760 � W „ � ��,M..��.�...�...��� � � : ��� August 14,2003 Donald T. Jones 2950 Burlwood Drive Winston-Salem,NC 27103 Re: Site Evaluation/Rainbow Road,Lot 18 sites Dear Client(s): As requested, a representative from this office visited the aforementioned site on August 14,2003. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the sites,the sites were found to be provisionally suitable for the installation of modified, oversized on-site sewage systems. 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, �a�'�,t����. Robert B. Hall,Jr.,R.S. Environmental Health Specialist RH/df Enclosure(s) - � . - __. -.'�,.,,_,.. Pe�C I ol '- . ` O P as�E' . . � � - S�lalicJ Da[aL7C[�"`.'r�� ��� pU Nq Id�.n�i r:ai�ilina c�ick on tne rAap�o: Map Layers � Zoomin r ZoomOut �' Recenter Map r ldentify. PdfC��S - Draw Layers Zoom Facbr. �X � Radius Search(feel)� Dra�v s��l���h�d layr�rs: E3oundary r Census Trects ❑ �YJ � �I i � � , �'i^ � City BOundaries '" � �1�` / r County Zoning � � � � �_ I � �-- � � __ -,__: 1` I Mulfi Symbol - r J �."� �___L____ � � E911 Fire Districls ❑ ' T�_r�-- ��__1-----�'� I � ,- - � Flood Pancls � /i ��/ /f<f(1 I l 4I. r Flood Zones ❑ � / `� + I '_ � Parcels ❑ , + ( r School Districts �� { ����i,' �� I � I� ~ Multi Symbol - �_ ii �... �---_s— r sols ❑ ('J'/ �� _ 5b51790491 I� r Town Zoniny 0 �-'-- i — j (- Townships :� — � �� � � Multi Symbol - �'� �� f� � Voting Precincts ❑ � � '.,✓-� Infrastructure Ir � Driveways i' �_ / __ ` ; i li / f r Rail Lines — i -- --�____�_ �__ '�iti �' � � � � � � � Street Centerlines — � � +� � US/NC Highways � 4 � �-� --�'-1� � Mulfi Symbol - � ,�W �• `'l- USHighwaY— � Parcel Data Nc r,�9nwaY— Inlerslale— �'lll�� !�1��(1111111� ��ill'Cl'�S � Acrial Pho�ography ❑ Physical • Land Unif/Type:14.08 7 AC r Creeks and Rivers — • Counry IU:D600000078 • Deed Book/Page:00197 i 0930 E911 Addresses" r.l • Account Num6er.D600000016 • Deed Dafe:1997/10/14 � Fire Deparintents a • PIN:5851790491 • Sales Piice:50.00 � Schoals A .• Legal 7:14.68 AC RAIN80W ROAD • Property Address: • OwnerName:MANUALJEFFREY D RD Draw Layers • OwneUAAdress 7:MANUAL JEFFREY D • CounlyZoniny:R-20 • censuscode �,����� ��i�ii�i�� • Owned,4ddress 2:MANUAL DEBBIE R �y� • OwneUAdtlress 3: 1874 WEST OLD HIG�'JAY Gl • City Code: • Fire Dlsur�I: l his map is prepared lor R�e • City,Slafe Zip:LEXINGTON,NC 27295-0000 inventory of real property found • Land Value:$97,030.00 • Flood Zone. ZON[X within�hi5 jurisdiclion,and is • Flood Cornmunily: compiled Iroin recarded deeds, • Building Value:$0.00 pla�s,and olher public recorOs • Flood Panel:OOSU C anA tlala.Users of lhis ma are • Ou(Building/Exlra Fealures Value:$0.00 P • Flood Map Da(e: hereby noli�ed Ihat Ihe • A55es5ed ValUe:$97,030.00 aforemenlioned public primary • SoiC EnB information sources should be • Property Record Cartl consWted lor verilicalion o!the • Township:FARMINGTON informalion conlained on lhis • iown Zonin�: map.The Davie Counly, http://b6.208.132.254/scripts/esrimap.dlC?name=Davic_sdx&Cmd=sParcei2&NCPI1�-5�517')Ua91&mclick... �/22/U3