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151 Tulip Magnolia Drive Lot 17 ` A A ✓ DAVIE COUNTY HEALTH DEPARTMENT JW Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 U /� Account #: 989900241 Tax PIN/EH#: 5880-51-5022.17 CC Billed To: Craig Carter Builders, Inc. Subdivision Info: Magnolia Acres Lot# 17 Reference Name: Location/Address: Tulip Magnolia Drive-27006 Proposed Facility: Residence Property Size: 107 x 233 ATC Number: 3646 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: /�'/ Date: 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. PS- I Septic System Installed By: Environmental Health Specialist's Signature: Date:�n DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Z_ /,7- o y • Environmental Health Section 4 ` P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT ��1 Account #: 989900241 Tax PIN/EH#: 5880-51-5022.17 CC Billed To: Craig Carter Builders, Inc. Subdivision Info: Magnolia Acres Lot# 17 Reference Name: Location/Address: Tulip Magnolia Drive-27006 Proposed Facility: Residence Property Size: 107 x 233 ATC Number: 3646 **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 #People #Bedrooms_ #Baths /z 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 or-6 Design Wastewater Flow(GPD) Site: New/ Repair❑ P 1 � System Specifications: Tank Size`s GAL. Pump Tank GAL. Trench Width-a-� Rock Depth Linear Ft.wo Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the 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 th d4v of installation. Telephone#is(336)751-8760.**** /" / Environmental Health SP � Specialist's Signature: ` Date: - DCHD 05/99(Revised) O �p TION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Dy Davie County Health Department Environmenta/Health Section P.O. Box 848/210 Hospital Street DEC - 9 2003 Mocksville, NC 27028 (336)751-8760 *** WTV'THISA PLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED _ �- • Refer to the/INFORMATION BULLETIN for instructions. Name to be Billed t!• 'Ji ( ( /'/{/ � �j(� „L Contact Person Mailing Address �/� ,,� / gp� t•/ Home Phone Lif✓�- 1 City/State/ZIP e /v f1�0�!' Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation Improvement Permit/ATC ❑ Both 4. System to Service: House ❑ Mobile Home 0 Business ❑ Industry ❑ Other 5. Type system requested: ❑ Conventional ❑ conventional modified innovative 6. If Residence: # People # Bedrooms 4 It Bathrooms Dishwasher yJGarbage Disposal Washing Machine Basement Plumbin ❑Basement/No Pluuibing 7. If Business/Industry /Other: verify type It People It Sinks # Commodes # Showers # Urinals It 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 this system is intended to serve? ❑Yes /ErNo If ycs,what type? ***IIIIPORTANT'CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Eitllcra PLAT or SITE PLAN MUSTBESUBJUITTED by the client witli THIS APPLICATION. Property Dimensions: /d� 3�� WRITE DIRECTIONS(from Alockwille)toto PROPERTY: Tax Office PIN: # 7221 --s' `� /�to,/'/5 e,2ee " Property Address: Road Name ��, if City/zip AL'1"0"'c If in a Subdivision provide information,as follows: Name: ,a -ie'S Section: Block: Lot: Date home corners flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any per11lit(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 Iran responsible for all charges ineur•red from !tris application. I,hereby,give consent to t11e Authorized Representative of the Davie .01111(3.1 Ilh ).11•Inu•ni to enter upon above descr' ed property located in Davic County.lid on uc(1 to conduct all ICS g p cc ures as necessary to determine the site suitabil' DATE SIGNATURE TIIIS 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 locations). Site Revisit Charge Datc(s): Client Notification Date: EHS: Sign given Account No. '1` a l 2-Y Revised DCHD(05/03 Invoice No. V 1 ,- DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION--/—LOT., Soil/Site Evaluation APPLICANT'S NAME �� /��/ DATE EVALUATED •✓ �D a� PROPOSED FACILITY / PROPERTY SIZE ;Z&12 L' SUBDIVISION ROAD NAME c Water Supply: On-Site Well Community Public /ice Evaluation By: Auger Boring f Pit ^ Cut FACTORS 1 [2/' 3 4 5 6 7 Landscape position Sloe% HORIZON I DEPTHTexture rouConsistence Structure MineralogyHORIZON II DEPTHTexture rouConsistence StructureMineralo HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture ffoup Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE ^ 1 SITE CLASSIFICATION: EVALUATION BY: 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 yLet 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) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■�■■■■■■■■■■■■■■■■■■■■/■■ecce■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■a■■■■■■■■■■■■■■■■■■■■■c■■■■■■■■■■■■■■■c■■■■■■■■Oce■■ec■■N■■■/■ ■■■■■■■■■■■s■■■■■c■■■■■■c■■■■■■■■■■■■■■■■■■■■■■s■■■■■c■■■E■■■■Oce■ ■■■■■■■■■■■■■■■■■■■■■■■■■■/■c■■■e■■■■■■■■■■e■■■■■■■■Nee/■■cc■■■■■■ ■■E■■■■■■■■cc/e■■■■/■Nee■■■■■e■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■r,�■■■■■■■■■■■■Nee■■■■■■■■■■/cE■c■■■■■■■ ■■■■■■/■■■■■/■■■E■■■■■■■■■■■■/■■.��■■■■E/■■■■■■/■■■■■■/■■■cep■■■■■ ■/■■■■■■E/■■■E■e■E■■■■■■Ec■■■■/■ ■■��c■■■■■■■c■■ce■■n■■■■EES■■■■■ ■■■■■■e■■■■■■■■■■■■■■■:�!�■■■■e■■■■■■■■■■\\■■■■■■■■e■■■�1//lily■■■■■■■ ■■■■N■■/■N■■■O■■■e■■■■//%I■■■■■■■■e■■■■e■■■■\e■■e■■■■■Nee■■■e■■e■■■ ■■■E■■■c■■■■■■■■■E■■■■■■■■■■s■■■ ■■■■E■■■■■■�E■■■■■■■■■■ENE■■■■■■ ■■■■■■■■■/■■■■■■■■■■■■■■■■■■■■c■�i■■■■■■■■■■■e■■■■■■c■e■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■E■■e■■■■■■e■■\■■■■■■■■■■■■■NEON■■ MENNENMENNENMEMSEM '�iMENNENEMMONS IMMEEMiNo MEN ■■■■■■■■■■■■■c■■■c■■■c■■■■■■■c■■/■■■■■Nee■■N■■■■■■e■■■e■■■c■N■■■■e ■■■e■■■■■■■■■■■N■■■■■■e■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■ ■■■■■■■E■■■■■■■■■■ccs■■■e■e■■■■■ ■■//■■■■■■■■■■■■■■■■e■■■■■■ec■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■/■■■■■■■■■■■■■■■■s■■■■Nee■■■e■■■■■■■■■■■■■■E■■ ■■■■�■■■■■■■■■■c■■■■■■■■■■■■■■■■■/■■■■e■■■■Nc■ec■■s■■Nee■■■■c■■■E■ 02/09/2004 09:35 3369402620 CRAIG CARTER, BUILDER PAGE 01 A Craig Carter Builder, Inc. Hands On 119 Hwy. 801 S Builder Advance, North Carolina 27006 N.C. license Unlimited February 9, 2004 Mr. Buck Hall Environmental Health Section Davie County Health Department PO Box 848 Mocksville NC 27028 Dear Mr. Hall, We are currently constructing a house for sale at 151 Tulip Magnolia Dr., (Lot 17, Magnolia Acres) in Advance. I am requesting that the septic system utilize the Infiltrator system. Sincerely Mart a r (336)940-2341 Fax(336)940-2620