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111 Twisted Hill Dr Lot 21 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 n (336)751-8760 /�/ �GfJ�S�GZ� /ll� /✓�Z - Account #: 989900241 Tax PIN/EH#: 58860-51-47715.21�Jf Billed To: Craig Carter Builders, Inc. Subdivision Info: Magnolia Acres Lot#21 Reference Name: Location/Address: 27006 Proposed Facility Residence Property Size: see map ATC Number: 4182 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 C=IS VALID FOR A PERIOD OF FlUE YEARS. Environmental Health Specialist's Signature: Date: J CE IFIC E OF COMPLETION **NOTE** The issuance of this Certifi of pletio hall indicate the system described on Improvement/Operation Permit ioo has been installed in compli wi icl 1 I of G.S.Chapter 130A,Section.1900"Sewage Treatment and qy Disposal Systems,"but shall i O Y t en as a guarantee that the system will function satisfactorily for any given period of time. xr-11 q T �t1 . v Septic System Installed By: V— Environmental Health Specialist's Signature: Date: 2 DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT • ' Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900241 Tax PIN/EH M 5880-51-4715.21 Billed To: Craig Carter Builders, Inc. Subdivision Info: Magnolia Acres Lot#21 Reference Name: Location/Address: Tulip Magnolia Drive-27006 Proposed Facility Residence Property Size: see map **NOiN* 4ifpro#e§?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 #People _ #Bedrooms !!�e #Baths—? Dishwasher: Y510" Garbage Disposal: ❑ Washing Machine Basement w/Plumbing:e Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply � Design Wastewater Flow(GPD) �i�U Site: New Ooo' Repair❑r System Specifications: Tank Size/OJ(/GAL. Pump Tank GAL. Trench Width��" Rock Depth /-2 "Linear Ft. O Other: As accepted Systems may also be use5d Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAY T- P OVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a repre t ive fthe 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 1:3 p. .o the day of installation. Telephone#is(336)751-8760.**** Environmental Health Specialist's Signature: Date: b P ?� DCHD 05/99(Revised) w y APPLICATION FOR SITE EVALUATION/IbIPROVEAIENT PERMI Davie County Health Department EnvironmentalHeaitii Section ; P.O. Box 848/210 Hospital Street UG 2 2: 2005 Mocksville, NC 27028 (336)7S1-8760 ' �iY1R(!1�1r,ENTAL H ***ItIPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE U-. INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. / ff F 1. Name to be Billed / 1, �� Contact Person / C Mailing Address Home Phone � yCity/State/ZIPT� 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip X 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC Both / 4. System to service: House ❑ Mobile Home ❑ Business E3Industry El other 5. Type system requested; Conventional ❑ conventional modified ❑ innovative MacCepted 6. If Residence: # People � # Bedrooms # Bathrooms* JD1ishwasher Pkarbage Disposal Washing Machine ,L^J,Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) s. Type of water supply: ❑ County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility tliis system is intended to serve?❑Yes ❑No If yes,wliat type? ***IMPORTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Pro erl Dimensions: 7 fit' ✓, ��J WRITE DIRECTIONS(from Mocksville)to PROPERTY:' s 9b -�/,Y'71 s Tax Office PIN: # Property Address: Road Nam k,�t� - City/Zip If in a Subdivision provide information,as follows: Name: l� �`1 � Section:' Block: Lot: Date liome corners flagged:OZ;�' D S 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 in x ed from this a4t ' give consent to the Authorized Representative of the D v' Co y II r to enbed property located in Davie County and owned to codures as necessary to determine the site suitaDATSIGNATURE Tills AREA MAY BE USED FOR DRAWING YOUR SI'Z'E PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Client Notification Date: / EI-IS: Sign given Account No. le9 -�7 Revised DCIiD(05/03 � Invoice No. y - - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOTZ Soil/Site Evaluation APPLICANT'S NAME � �9 /�c� DATE EVALUATED PROPOSED FACILITY 9 PROPERTY SIZE SUBDIVISION s _a i �C ROAD NAME Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit ;/ Cut FACTORS 1 2 3 4 5 6 7 Landscape position 4- Slope Slo % /d a HORIZON I DEPTH "0 P Texture grou -5-104 Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure s Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: EGEND 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-Finn 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(01-90)