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120 Timber Trails Lane Lot 14. I r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001715 Tax PIN/EH #: 5811-09-2551 Billed To: Wishon & Carter Builders Reference Name: Proposed Facility Residence ATC Number: 4242 2' OD 1►- / S- -a t' Subdivision Info: Timber Trails Lot # 14 Location/Address: Timber Trails 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 WASTEWATER CONSTRU TION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature:A1.2 Date: `/j—e 2,-&S-' � accepted Systems may also be us CERTIFICATE OF COMPLETION 01 **NOTE** The issuance of this Certificate of Comp shall indite tl'i tem described on Improvement/Operation Permit has been installed in compliance with Art e 11 of G.S. C pter 1 A, Section .1900 "Sewa ea menta Disposal Systems," but shall in NO WAY tak as a gu ntee th t the system will function satisfactorily for y given period of time. �evd1 1� or 6-l3.�� 5f 23g N 44 41 /401 s �M� Septic System Installed By: SJVoU ' Environmental Health Specialist's Signature : DCHD 05/99 (Revised) Date: G -1.5"' 'a G DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Q ' P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 ` (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001715 Tax PIN/EH #: 5811-09-2551 Billed To: Wishon & Carter Builders Subdivision Info: Timber Trails Lot # 14 Reference Name: Location/Address: Timber Trails Lane -27028 Proposed Facility Residence Property Size: 5 acres ATC Number: 4242 **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 Iq#People #Bedrooms �� #Baths_ Dishwasher: Garbage Disposahe Washing Machine: 2Basement 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 Qt GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft. I�' P Other: As stated in 15A NCAC 113A.1969(5) eeepted-Sys,-..,. —ay e used Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - Al FINISHED GRADE. ****NOTICE: Contact a representati system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.r D EFFLUENT FILTER RISER(S) IF 6 " Davie County Health Department for final in day of installation. Telephyne-# is (336)751• 7 of this *** Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) I ' �Noy'12 04 09:50a V_ davie county envhealth 336 751 8766 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department EnVlronmeatal Health Section P.O. Bos 848/210 Hospital Street 14ocksv4lle, VC 27028 (336)751-8760 ***11'7PORTANT*** THIS APPLICATION' CANNOT BE PROCESSED DNLBSS ALL THE REQ1 SNFORMILTION IS PROVIDED. Refer to the nIFOR(KATION BULLETIN for instructions. P.1 1. name to be billed G/.: L /.,_ �F..�..'/c/-•_ Contact Person AJI, •.f mailing A-1 an /10 %7.-,- / 7 / 9 naw Pbone S 3 C - `�� `! - ? 7 '10 city/state/ZIP�� • -�! .' .� v.'r l.. A/c 7-/-e,-r— business Pbone 'r? (: - C-79' - Z n 3 I 1. Now on Penmit/ATC if Different than above mailing Address �� -^c �O✓G C-it/y/state/Lip 3. Application Fort M Tite Evaluation �� L, Improvement Permit/ATC Gf Soth 4. system, to service, G"e ❑ Mobile Soma ❑ Business O Industry ❑ Other S. Type system requested, W C mantional ❑ conventional nodifiad ❑ ianmmtive s. if Residence: # Peopla # Bedrooms 3 # Bathrooms D ECEOME OCT 19 2005 JENVIRONMENTAL HEALTH DAVIE COUNTY PS GeLahwashar Garbage Disp%aa1 LYxashing Machine dBasement/Plumbing ❑Sasement/mo Plumbing i✓d 7. If basiuss/radustry /Other- writY type i P*opla # sinks # commic"s a Shovers a Vrinals # nater Coolers IF FOODSERVICE: #_Seats Estimated water Usage (gallons per day) 9. Me of water supply, t9" Cou-tt'y/city ❑ well ❑ community, 9. Do you anticipate additions or expabslons of the facility this system Is intended to serve? ❑ Yes 0"14o if yes, what type? ***IMPORTANT''** CL1EM'S MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMI77ED by the client with THIS APPLICATION. Property Dimensions: ^ (-- ec X '/Cc WRITE DIRECTIONS (from Mockw[He) to PROPERTY: Tax Office PIN: # TS N 0 9 7- 5 r l r v/ 1,2- /- F t e - Property Address: Road Namei . ,! Tom... Yr 4-C C, < < r/,, C'L . City173p /�r— (-- r .. If In a Subdivision provide informal]on, as follows: Nana: �4,�.•� ��• •'/S Section: Block: Lot: _q St zo7- e< 77,-c! - - Date home corners Ragged: /cs - / F, - Cy -5- 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 suspem:ion or revocation, if the site pians or intended use changt; or If the information submitted In this application is falsified or changed l also, aaderstand Otaf l ant responsible for all charges incurred JMm this appUmflos. I, hereby, give tooter Ito the Authorized Representative of the Davie Cduuty Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as accessary to determine the site suitability. DATE /0- /7- y S SIGNATURE = ` THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property Rocs and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EKS: D jf xn Sign given � stN ' Account No. Revised DCHD (05/03 Invoice No. / �fN .. ' - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001715 Tax PIN/EH #: 5811-09-2551 Billed To: Wishon & Carter Builders Subdivision Info: Timber Trails Lot # 14 Reference Name: Location/Address: Timber Trails Lane -27,028 Proposed Facility: Residence Property Size: 5 acres Date Evaluated: Water Supply: On -Site Well Community Evaluation By: Auger Boring &---- Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH 1 Texture group Consistence r ,� Structure Mineralogy HORIZON II DEPTH �'- Texture groupG Consistence Structure y 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: v LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND EVALUATION BY. OTHER(S) PRESENT: 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 lu � VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Kit 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 Mineraloev 1:1, 2:1, Mixed LYQtea 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 05105 (Revised) ■■■■■■■■■■■■■■■■■■■/■■■■■■■■■e■■e■■■■■■■■■e■e■■■eee■■■e■■■■■■■ee■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■ee■eeee■c■e■ceee■eee■eeeeee■ I■e■■e■eee■■e■ee/■e■■e■■■■■■■■■■■ ■■■■■e■■e■■■ee■■■e■ecce■■■■■■■■/■I�■■■e■■■■■■■■e■■■■■■■■■■■■■■■■■■■ ■e■■■■■■■■■■■■ee■ee■ecce■■■■■■e■e■■■eeee■■ee■■e■e■e■■■■e■■e■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■eel-i►le�i■■e■/e■■■e■ecce■■e■ecce■ecce■e■■ ■■ecce■eee■■■■■■■■■■■■■■■e■■��ci�■■■■e■/■■■■/e■■■■ie■■■■■/■■■■■■■■■ ■■■■■■■■■■■■■■■■Ili!J■■■■■■■■■■e■�■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■�■■■■■■■■■■■■■■■■rm ■e■■■■■■c■■■c■■■■e■■■■■■� ■■■eee■c■■ee■eee■■■■■■■■■■■■i�%■i■■■■■■■■■■■■■■/■e■■■■■■■■■■■■■■■■■ ■■■■■■e■■■■■■ecce■■■■■■■■■Ile■■■■■c■■■11■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■/■■■■■■ee■eee■■■■■■■■ee■11■eeeee■■■el1■■■■■■e■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■GV■■■■■�■e■■■■■■■■■■■■eee■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■i■■■■e■■■■e■■■■■■■■■■■■■■■■■■■■eee■■■■■■■■■■■ ■■■■e■■■■■/■■■■■■■■■■■e■■■ee■eee/■■■■■■■■■■■ee■■eee■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■ee■eee■earl■%//eee■I�ee■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■e■■■■■■■■■■eee■eeeee■eee■/eee■ ■e■■■■■■■■/■■■e■■eee■■■■■■■■/■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■eee■■■e■■■eee■eee■ecce■■■■■■e■■■■■■ecce■e■■■■■■■■■■■■■■■■■■■■■■ ■■■■e■■■■■■e■■e■■e■■■eee■■e■■■■■eee■e■■■e■■eee■■e■■■■■■■■■■■■■■■■■ ■e■eee■■■■i■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■e■■■■■■■■■■■eee■■■ecce■■■■■■■■■�■■■■■■■■■■■■■■■■■■■■■e■■e■■■■ee■ ■eee■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■/■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■eee■■■■■■■■■■e■■■■e■■■■ecce■■ecce■■■■e■■ee■