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1606 Junction Rd Lot 1 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street ' Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900024 Tax PIN/EH M 5735-38-0207, Billed To: Roger Spillman Subdivision Info: Sunburst Heights 2 Lot#1 Reference Name: Location/Address: 1606 Junction Road-27028 Proposed Facility: Residence Property Size: .713 acres NENhr per: 2619 **N ** is Improvement/Operation 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 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 Design Wastewater Flow(GPD) Site: New❑ Repair❑ System Specifications: Tank Size 10M GAL. Pump Tank GAL. Trench WidthZ c, f Rock Depth,42_ Linear ROAQb Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative of vie County Health Department for final inspection of this system between 8:30 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 p.m. y of installation. Telephone#is(336)751-8760.**** if Environmental Health Specialist's Signature: � Date: AO-�7AD DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900024 Tax PIN/EH#: 5735-38-0207 Billed To: Roger Spillman Subdivision Info: Sunburst Heights 2 Lot#1 Reference Name: Location/Address: 1606 Junction Road-27028 Proposed Facility: Residence Property Size: .713 acres ATC Number. 2619 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 Specialist's Signature: &Ze Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Complet'on shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Art' le 1 of G .Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WA bet en a guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) APPUCA710N F Count artme�PERMIT Davie � County Health De p D Environmenfa/Heafth Section P.O. Box 848/210 Hospital street OCT 2 3 2000 Mocksville, NC 27028 (336)751-8760 �n ***ndPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed -60', Uman Contact person - ( �p'l� �1 Mailing Address 3 O r� Home phone,�� , ^((�4- �7 Y 7_ City/State/ZIP —0pn)ePrnPP-1�I C� GY /y�� Business Phone 2. Name on Permit/ASC if Different than Above�2rr�°, Mailing Address City/state/zip 3. Application For: ❑ Site Evaluation irImprovement Permit/ATC Both 4. System to Service: 0 House Mobile Home ❑ Business ❑ Industry 0 Other s. If Residence: # People _k4 _ # Bedrooms 13 # Bathrooms PDishwasher 0 Garbage Disposal Washing Machine 0 Basement/Piunbing���� // 0 Basement/No Plunbing 6. If Business/Industry/other: Specify type LnJA # People S y a # sinks # Commodes Anda # showers C/\�A # Urinalsl�l��— ## Nater Coolers IF FOODSERVICE: # Seats 4` Estimated slater Usage (gaiions per day) 7. Type of water supply: ❑ County/City well ❑ Co=mmity e. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes 1 No If yes,what type' _ �L\4 **'IMPbRTANP** CLIENTS MUST COAfPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBAHI TED by the client with THIS APPLICATION. Pn ierrtty Dim sioTt- ns: a CIQ1$� q 3 y7.55 X7 WRITE DIRECTIONS(from Mocksville)to PROPERTY: � Tax OMce PIN: # 535-3 3-0DQ r7 �. (Oc) + 6t)c D. f L r-Z TAK tnnfm-1 1 (00(o D' Property Address: ad Name��1 w C;rT0Ii 12D. Or n _ g O )1 + f?d. city/zip rnpO KSOTU( , NG _ i n -+ on ,-JU n C�fi on PA. 14 If in a Subdivision provide information,as follows: r-� Rcaot on e Name: 6jo 0 (0010 U1kAJC1TMW R t�>, mo U Section: 2— Block: Lot:# 1 Date Property Flagged: 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 that I am responsible for all charges incurred from this application. I,hereby,give consent to the Authorized Representative of the D ie County He h Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site sui hl d � DATE t l o� DU SIGNATURE -r THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(inclu all of the follow g: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). ��ry� day Account No. 7 9 Revises 1)CHD(# / f) Invoice No. 10/a.7/0- -,S 2-8 0 P5 -'3 58 '66 0 PG 856 ;9 .-a 3 .62 qxcacl C-1 !-a W;n2ron of"W C -"I). Ic %, late—natio 0— CARO A k -3 co�tall-�j -le COF RL Ine _SS iS-b George P. Stone, PLS 4-1, A.— L-31 62 L-j Lot 23 Tax MOP M-4 ROB -/f Robert Boyd Ash'e.-, jic wife Win d', beat Ashley 08 20! 0 PG 848 Approx:r"Icte Locatiof-, cf 50' Gas Line Ec;se-nest , Contro, ti C!3'3,,"17-E 292 78 J `6 Corner Tax Lo* 24-.4- ox Map M C) n/f Perry Bruce 4ndersoro^ O �i N - D6 208 0 PG 709 DB 166 0 PG 806 NAD 83 LO 'j QD 0700,','J"E 2-0.87- , A e S 82'2 3 0 290.07, V--- 5 4Z S 10 331 / _ -. 249,,— 0 2' ElR note cco."ssee - Ote no JO..33,19, --6 249.43' CL, S 82'3 7-1 Tax Lot 24.G1 � 113.2- kc) I ox Map M-4 CZ z Shannon D. Spitimar )B 212 0 PG 533 0''44 'E 24792' Notes: - Zoning: P/A 2. Wotershea classification: WS-,V Protectea 3. At! Lots shall be served by public water. C- 4. All utilities shall be installed underground. z 1 - 5. A// Lots shalt be served by subsurface dispose systems ,ne :; co e � 6. Total Subdivision Area: 2.826 Acres +/- 7 ,-;t-"A 9 5 •. l !d` APP CATION FOR SITE EVAUTATION/IMPROVEMENT PERMIT& ! Davie County Health Department �6)a Eovlronmental Hea/lfi SftGion - 8 1999 D P.O. Box 84 1 s SEP J�v�S c 8�2 0 Hospital Street ` Nocksville, NC 27028 (336)751-8760 ENVIRONMENTAL HEALTH /V DAVIE COUNTY ***IHP0It2'ANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED I2FORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. llama to be Billed /Q-tt"e-q-/� 6�d�or n Contact person Bailing Address _ (/�__X 73��( Homoe phone 33(Q City/state/zIp 616)Qy�O,JW" ' T1 C ���l� Susi,,, Phone I ss-J 2. Name as Permit/ASC if Different than Above Bailing Address `� City/state/zip 3. Application For: IKIite Evaluation ❑ Improvement Permit/ATC 0 Both 4. system to service: 0 House "bile Home 0 Business ❑ Industry 0 other r� 5. If Residence: # People ! # Bedrooms 3 # Bathrooms 4 D Dishwasher 0 Garbage Disposal N'Washing Machine 0 Basement/Plumbing 11 Basement/No Plumbing 6. If Business/Industry/other: Specify type # People # sinks # Commodea # showers # urinals # Water Coolers IF FOrDSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: C County/City ❑ Well ❑ Community . s. Do you anticipate arddiaions or expauslors of the facility this system is intended to serve? 0 Yes ❑No If yes,what type' 'IMPORTANT"CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: ✓/Y r/ - WRITE DIRECTIONS(from Mrcksville)to PROPERTY: Tai Office PIN: # 52.3 s 3' O/ Property Address: Road Name Jv�G�JM �C2 City/tip 1 16Cz:�j VII. a' ?y� g112 If in a Subdivision provide information,as follows:/ Name: -S4"09 al'LTI &401-14 SeWoci _ '2 - Block: Lot: �� Date R.-operty Flagged: This is to certify that the information provided is correct to the best of my L..,-jowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation,if the site plans or iritended use change,or if the information submitted in this application is falsified or changed I,aLw,understand that I am responsiblefor all charges incurred from this application. I,hereby,give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by Qr i cc Ad,yCZ52 '`. to conduct all testing procedures as necessary to determine the site suitability. DATE ( '/��( / SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic fiocations). Account No. Revised DCHD(07/98) Invoice No. ��� 3751 PL am soy "CL 1151) -_- D 514 -—'.`�_ _ . 207 1'norl U—U M N U--�— - .m U U U U U U S4'f G'ol Q W lihdkml(14) %D b 771'UP (� crvw (� m e N O 500 i�ID�11(, Lr Q 16 Cdps 11 Pd UI 7 EdW 120 CdPL 2 �p 9.x7 Cul P! - 1. Pipes P' •--•� a Dr1+ti` .. - ':� ` r Pt F� 4 300 pt. 10 ' J!MM Cor. /Mn 26 d Prtsp p¢� 1. . -. �-- Pt 14&g P„p co n _ 0 412 Cat P L . \�j J 1�, Ce� Z 02"CL 114A1 tcros Porce! .1 om to a>w �. m are"C L as ,achy a mi Cal ftPrO OUdy CQnv+e>vd % N ODOD Rd (fW r4 WOVW Upa ileo �d Fid Ft o - - ,. )e1 lad °o-• 413.taol Pt _ \ ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section V Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900640 Tax PIN/EH#: 5735-38-0207.01 Billed To: Bruce Anderson Subdivision Info: Reference Name: Stacee Wyrick Location/Address: Junction Road-27027/. Proposed Facility: Residence Property Size: 3/4 Acre Date Evaluated: ///, Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit i Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope% HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure >/ Mineralogy .e / HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION tl LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: Yln /`t�i EVALUATION BY: J LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: 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 Mineralogy 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 05/99(Revised)