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240 Sunburst Lane Lot 13r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900024 Tax PIN/EH #: 5735-38-0207.13 Billed To: Roger Spillman Subdivision Info: Sunburst Downs Lot # 13 Reference Name: Roger Spillman Location/Address: Sunburst Lane -27028 Proposed Facility: Residence Property Size: 6.247 Acres **NOTE* l hIss Nprove4m nt/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 `fit„ �nn►1 #People L1 #Bedrooms 3 #Baths -2— Dishwasher: Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: 1K' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size (P.'2 /\Qb-' Type Water Supply CCM4 4esign Wastewater Flow (GPD) Site: New e Repair ❑ System Specifications: Tank Size bW GAL. Pump Tank GAL. Trench Width 5Lo 1 Rock Depth 12," Linear Ft 300' Other: U -�eS Required Site Modifications/Conditions: 114 STpUt- b►1 Get4i"009- 1a' ' -s' e7rF 140')S'� IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie 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. on the day of installation. Telephone # is (336)751-8760.**** ��o x "ac�Zn —j�- D. wo. LrJ Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: /'00 • T DAVIE COUNTY HEALTH DEPARTMENT X Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900024 Billed To: Roger Spillman Reference Name: Roger Spillman Proposed Facility: Residence ATC Number: 2440 a? i Tax PIN/EH #: 5735-38-0207.13 Subdivision Info: Sunburst Downs Lot # 13 Location/Address: Sunburst Lane -27028 Property Size: 6.247 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 WASTEWAT IS rD FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ate: 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. Septic System Installed By: Environmental Health Specialist's DCHD 05/99 (Revised) � � 1%r k3fO��Xt ' L Date:10)00 ' APPLICATION FOR SITE EVA.�WANON/IMPROVEMENT PERMIT & ATC Davie County Health Department s Environmental Heafth Section D P.O. Box 848/210 Hospital Street 14AY 1 9 Mocksville, NC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE FJWCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer Ito the INFORMATION BULLETIN for instructions. 2. Name to be Billed i20q t r y y�Jr1� U ma VA Contact Person Nailing Address TU e)oy- " ! �Ts„ ` '-1 , 1 Bomoe Phone City/State/ZIP �o,QQ_ y\Q� 1vL a `01`i Business Phone 2. Name on Permit/ATC if Different than Above Nailing Address 3. 'application For: R Site Evaluation City/State/Zip 0 Improvement. Permit/ATC Both 4. system to service: ❑ House A Mobile Home 0 Business 0 Industry 0 Other S. If Residence: # People 4 # Bedrooms ,3 # Bathrooms 0 Dishwasher 0 Garbage Disposal i hashing Machine 0 Basement/Plumbing 0 Basement/No Plumbing 6. if Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # hater Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City a well 0 Comaaanity e. Do you anticipate additions or expansions of the facility this system is intended to serve! 0 Yes ■ No If yes, what type' ***IMPORTANT"** CLIENTS AIUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dirupmr-4inr iP • 2t/7 /-c-res f �' SCe MaP: `ais DrMECTIONS (from MockrMle) to PROPERTY: Tax Office PIN: # S 7,35 CQ 113 lJ 5o4 - LJ Property Address: Road Nam r 011a&One-IRA ' -k.Qwy On 00� Citv/Zip rnoty sz kk\ e 1ZtCi 1 am u If in a Subdivision provide information, as follows: Name: cSur0oy rsf Z7ou-�r\S Section: Block: Lot: 13 114-17 INV+ TOCIA U\ Le4 l r\ �roir" - . o � TOCw Date Property Flagged: Home 1 N P I Q°(, 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 by6V-Lk 0 r On to conduct all testing procedures as necessary to determine the site sMX4 (00• DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inclutr all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Account No. Revised DCHD (07/98) Invoice No. _4 1 r _ DAVIE COUNTY HEALTH DEPARTMENT 2 3 4 5 6 7 Landscape position Environmental Health Section i__ Slope % Soil/Site Evaluation HORIZON I DEPTH APPLICANT INFORMATION PROPERTY INFORMATION Account M 989900024 Tax PIN/EH #: 5735-38-0207.13 Billed To: Roger Spillman Subdivision Info: Sunburst Downs Lot # 13 Reference Name: Roger Spillman Location/Address: Sunburst Lane -27028^ — 2 Texture groupC bdc6D Proposed Facility: Residence Property Size: 6.247 Acres Date Evaluated: Structure 15 91?V- Mineralogy� Water Supply: On -Site Well Community V Public Evaluation By: Auger Boring f Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L— i__ Slope % TE HORIZON I DEPTH Texture groupGL Consistence grt S Structure GQ Mineralogy HORIZON II DEPTH — 2 Texture groupC G Consistence F: Structure 15 91?V- Mineralogy� ) HORIZON III DEPTH 0 32 - Texturerou -F `% S, Consistence E� S r s17 Structure Z?51e- Mineralogy 71 1 1 HORIZON IV DEPTH Texture groupS Consistence r Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE V -N SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: 0 - Lf REMARKS: LEGEND Landscape Position EVALUATION BY�--AGCT_ OTHER(S) PRESENT: 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) i ■ ■ i ■ ■MEMEMEM■M■■ ■EMM■■■■■E■■ ■■MMEM■MEME■ ■■MME■E■■MM■ ■■■E■■■■M■M■ ■M■■SSS■■■■■ ■■MEM■■■MM■■ ■MMM■■MMM■■E ■M■■■M■MMM■■ ■M■M■MM■■■■■ ■M■MM■■■■M■■ ■■■MM■■M■■M■ ■■M■M■M■MM■■ ■■■M■■■M■M■■ ■■M■■■■M■M■■ ■■MMM■■■■■■■ ■■M■■■■■M■M■ ■MM■■M■MMM■■ ■■M■■■■MMM■■ ■■■■M■■M■■M■ ■■■M■MM■■■■■ ■■M■M■M■■M■■ ■■MM■MM■■■■■ ■■■■■■M■■M■■ ■■M■■■■■M■■■ ■■■■■■MME■■■ ■M■MMM■MMEE■ ■■■■■■■M■■E■ ■M■ME■E■■■E■ m,nn ialval ■ ■■■■■■■E■■■■ ■■■■■■■E■■■■ ■■■■■■■■■■■■ ■M■■■■■■■■O■ ■■■■■■M■■■■■ ■EEE■■■■■E■■ ■■■■■■■■■■■■ ■■■■■■■■■■ ■■■■■■E■■■■■■■ ■■■■M■■■■■E■■■ ■E■■■■■■EE■■■■ ■■■■■■■■■■■E■■ ■■■■■■E■■■■E■■ ■■■ENE■■■■■■■■ ■■■■■■■E■■■■■■ ■■■■MEMO■■■■N■ ■E■■■■■■EEO■■■ ■■■■■■■■■MO■■■ ■■M■■M■■■■MME■ ■■■E■■■E■■■■■■■■ ■■■E■■■■MEMO■M■■ ■■■■■■■■■■■■■■■■ ■■■NEEM MEMO■■■ ■E■UM■ ■E■ no ■EMME■■ ■■■E■■■ ■■■ENE■ MEMO■■■ ■■■■■N■ ■■■■E■■ ■EMU■■ ■■■ on ■ENE■■■ ■E■■■■■ ■■■■■E■ ■E■■■■■ i ■ ■ ■■M■■E■ ■■NNEE■ ■■MEM■■ ■E■■MM■ ■■■■■■■ ■■■■ME■ ■E■■E■■ ■■■■■■■ ■■■OMM■ MNEME■■ ■E■■EM■ ■■■■M■■ ■MEMS■■ ■N■■■■■ i ■ NONE ■E■■ OMEN ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■OM■■■■■■E■■■■■■ ■■■■■■■■■■■■■■■■ ■■E■■■ME■■E■■■M■ ■■■■■E■■E■■■■■■■ ■■■■■■■■■■■■■■■■ ME no