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175 Sunchaser Trail Lot 6DAVIE COUNTY HEALTH DEPARTMENT %- �o0 0 Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT I �� Account #: 989900024 Tax PIN/EH #: 5735-38-0207.06 Billed To: Roger Spillman Subdivision Info: Sunburst Downs Lot # 6 Reference Name: Location/Address: Sunchaser Lane -27028 Proposed Facility: Residence Property Size: 5 + acres ATC Number: 2572 **NOTE** This 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 �O M 0134k� #People "t #Bedrooms .3 #Baths -2- Dishwasher: m Garbage Disposal: ❑ Washing Machine: 121"' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 6 D W -L-5 pe Water Supply*,E Design Wastewater Flow (GPD),23400 Site: New d, Repair ❑ #1 1 System Specifications: Tank SiA000 GAL. Pump Tank GAL. Trench Width Rock Depth1Z Linear Ft. Other:41!O.G X11.5, Required Site Modifications/Conditions: IGe ze loo Fao t, oo IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County F 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 installati -------------- #,A A I i - 1001, Environ ental Health Specialist's DCHD 0 /99 (Revised) uv�,j �'.t' -7 l pag _.,�, Flo' t Y ,TER RISER(S) IF 6 " BELOW h Department for final inspection of this Telephone # is (336)751-8760.**** 3Cm "e►Q Date: ILI' r Account #: 989900024 Billed To: Roger Spillman Reference Name: Proposed Facility: Residence ATC Number: 2572 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5735-38-0207.06 Subdivision Info: Sunburst Downs Lot # 6 Location/Address: Sunchaser Lane -27028 Property Size: 5 + acres 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 WASTEW�. N VA FOR A PERIOD OF FIVE ARS. Environmental Health Specialist's Signatu e. ate: -17//�-�� CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. 0Q 1 k3(, kIL'► 3 loo ' )00' \V Septic System Installed By: 00 Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 LK R 93 R SEP 1 1 2000 EfIVI D,VIE CO NTHIEALTH ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION Is PROVIDED. Refer to the INFOR ATION BULLETIN for instructions. 1. Name to be Billed p� C D•yo;' I m n -?J Contact person / �J Mailing Address 1 (� �d�C �-W �/� Rome Phone -St. af(� c / t7 �-1 / City/State/ZIP �/�� Z.?OLT Business Phone a--dq a.SS( 2. Names on Permit/ATC if Different than Above 3. Application For: l` Site Evaluation 4. system to Service: 0 House Mobile Home ❑ Business ❑ Industry 0 Other 5. If Residence: # People / 1-1 # Bedrooms 3 # Bathrooms o�-- ❑ Dishwasher 0 Garbage Disposal 4 Washing Machine 0 Basement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Nater Coolers IF FOODSERVICE: # Seats Estimated Mater Usage (gallons per day) 7. Type of water supply: 0 County/City well ❑ Community S. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes No if yes, what type? City/State/Zip -P Improvement Permit/ATC A'Both 'IMPORTANA' CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BEL )W. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. empew-jryrinensitons: .J 6201Q,n pax Office PIN: # 5 35'- Proptrty Address: Road Mame �.J ul,ln C -+g,-07 l 1� City/Zip MoC,Ksoi [e, WRITE DIRECTIONS (from Mocksville) to PROPERTY: If in a Subdivision provide information, follows: Name: 5 etias�.r Section: = BI Lot: 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 Davie County Health 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 sura ility. _ �� � • • � ,/� :mss �. ���IJ_1 y US ARE.& MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property; lines and dimensions, structures, setbacks, and septic locations). Revised DCH D (07/98) (0� 214 a CAO CUT)�s of�Fo �� Account No. /- Invoice Na `�' / � O .. r iv it t it M.R ,t _. If in a Subdivision provide information, follows: Name: 5 etias�.r Section: = BI Lot: 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 Davie County Health 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 sura ility. _ �� � • • � ,/� :mss �. ���IJ_1 y US ARE.& MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property; lines and dimensions, structures, setbacks, and septic locations). Revised DCH D (07/98) (0� 214 a CAO CUT)�s of�Fo �� Account No. /- Invoice Na `�' / � O kt Parcel 7 Parc Cl Bonk :ed O River r n �,- 5.004. _ See Sheet'.. .,, .. •.a v t_ n''`" IRS �.,.t.�..�y„may.� _ ice+-`•�c �,;. 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DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900024 Tax PIN/EH #: 5735-38-0207.06 Billed To: Roger Spillman Subdivision Info: Sunburst Downs Lot # 6 c� Mineralogy Reference Name: t ; Location/Address: Sunchaser Lane -2702 Proposed Facility: Residence Property Size: 5 + acres Date Evaluated: Water Supply: On -Site Well Community Public Consistence / Evaluation By: Auger Boring t/ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group C L.— Consistence 1 -S r Structure c� Mineralogy a : 1 t ; ; HORIZON II DEPTH cp - I Texture groupG Consistence Structure G Mineralogy HORIZON III DEPTH 1 - 4 Texture groupC C t Consistence Structure 531 S Mineralogy1 1:1 HORIZON IV DEPTH + fi Texture group Consistence f SS Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE L44 p SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: 014 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) J ■M■■■■■■■■■■■■■ ■■■■■■■■M■■■■■■ ■■■■■■■■■M■■M■■ ■M■■■■■■■■■■■■■ ■M■■■■■■■■■■■■■ ■■■■■■■■M■■■■■■ ■■■■w■■■■■■■MM■ ■■M■■■M■■■■■■■■ ■M■■M■■■■■■■■E■ ■■■■O■■■■■■■■■■ ■■■■■■■■■■■■■M■ ■ON■O■EMM■■E■E■ ■M■NO■M■MM■MEM■ ■■EMM■MME■■■M■■ ■O■MMOM■M■■■■O■ ■OMMOM■ON■E■OM■ ■OMMME■■M■E■■M■ ■■■E■■■■■■MEME■ ■OMOMMEMM■■■MO■ ■■ENNOMEM■M■NO■ ■O■MOMM■M■M■M■■ ■O■■■E■■OMM■■E■ ■M■E■■MEME■■■E■ ■■■■■■■■■■■■■■■ ■O■■■■■MM■M■■M■ ■MEMEMEMEMEMM■■ ■■ME■EMEMEMMEM■ ■■■■■■E■■■■■■■■ ■M■■NNE■NE■■■E■ ■EMEMEMEMEM■ME■ ■■■■■■ ■■■■■ ■■■■■■�■■■■■ ■ ■ ■■■MMM■■■■■■ME■ ■■■■E■■■■■■■■■■ ■■■■■■■■■■■■■■■ ■■■■■M■■■■■■■■■ ■■■■■■■■■■■■■■■ ■ ■■■■■■S■11■MMM■M■■■■■■M■■■■■■■■■ ■ ■■■■■■1.11■■■■■Iii■■■■■■�E�.7■■11■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■11■iii■■■■■ L'�■■■■■':■11■■■■■■■■/■■■■■■/■■■■■■■■ ■■■■■■■11■■■■■■■r/I■■■■■■■■■■IIS■■■■■■■■■■■■■■■■■■■■■■ UrrrrrllM■rrrrtilr rrrrrrrrrrrrMENNENrrrrrr I■■■r■■■■ 1■■■'I■■■■ 1■■II■■■■■ 1■►.M■■MM■ 1■■■■■■■■ ■ ■ i