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245 Timber Trails Lane Lot 5Account #: 990003407 Billed To: Teresa Dix Reference Name: Greg Parrish Proposed Facility Resident ATC Number: 4013 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksviille, NC 27028 (336)751-8760 0 gq< Tax PIN/EH #: 5812-01-5250 Subdivision Info: Timber Trails Lot # 5 Location/Address: Timber Trails Drive -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 CONS RUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: y q 8edr106XS '�A CERTIFICATE OF C?.N **NOTE** The issuance of this Certificate of Completion shall indicate the has been installed in compliance with Article 11 of G.S. Chapter l Disposal Systems," but shall in NO WAY be taken as a guarantee given period of time. $p Septic System Installed By: I on Improvement/Operation Permit 1900 "Sewage Treatment and will function satisfactorily for Environmental Health Specialist's Signature: - .. I � Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003407 Tax PIN/EH #: 5812-01-5250 Billed To: Teresa Dix Subdivision Info: Timber Trails Lot # 5 Reference Name: Greg Parrish Location/Address: Timber Trails Drive -27028 Proposed Facility Resident Property Size: 5 acres ATC Number: 4013 **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 7 #Bedrooms #Baths Dishwasher: LK Garbage Disposal: 71" Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow (GPD) "/V Site: New e Repair ❑ System Specifications: Tank SizekM GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width cSt r' Rock Depth A9 Linear Ft IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED h FINISHED GRADE. ****NOTICE: Contact a representative of the Da,, system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day FILTER RISER(S) IF 6 " BELOW aIth Department for final inspection of this . Telephone # is (336)751-8760.**** 1 Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) t APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ® ly Davie County Health Department ! Environmental Health Section AIA P.O. Box 848/210 Hospital Street - 7 2005 Mocksville, NC 27028 (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQtr%-At%i_' INFORMATION IS PROVIDED. Reser to the INFORMATION BULLETIN for instructions. 1. Name to be Billed /5 Mailing Address City/State/ZIP / ,' s 2. Name on Permit/ATC if Different than Above we Contact Person Home Phone Busin ss Phone 'r��4l-,CU -5- IF FOODSERVICE: #�Seaats Estimated Water Usage (gallons per day) s. Type of water supply: l�County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what 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. Property Dimensions: c5 a CGZ Tax Office PIN: # S E/.2 / — �Z5 Property Address: Road Name/ City/Zip If in a Subdivision provide formation, as follows: Name: M ✓��/ l�� S Section: Block: Lot: S WRITE DIRECTIONS (from Mocksville) to PROPERTY: Date home corners 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 aa: 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 b�% to conduct all testing procedur s as necessary to determine the site suitabilit DATE ---t !L� 5 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inclui property lines and dimensions, structures, setbacks, and septic locations). v Sign given Revised DCH (05/03 all of the following: Existing and proposed Site Revisit Charge Date(s): Client Notification Date: EHS: �YAccount No. 5p. Invoice No. 47& 0 Mailing Address City/State/Zip 3. Application For: Evaluation Improvement Permit/ATC 13 Both 4. ��CdSite System to service: GK" House El Mobile Home Business ❑ Industry ❑ Other 5. Type system requested: alconventional ❑ conventional modified ❑ innovative 6. If Residence: # People # Bedrooms # Bathrooms 00ishwasher Odarbage 00ashing ❑Basement/Plumbing Mt -a Disposal Machine ement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: #�Seaats Estimated Water Usage (gallons per day) s. Type of water supply: l�County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what 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. Property Dimensions: c5 a CGZ Tax Office PIN: # S E/.2 / — �Z5 Property Address: Road Name/ City/Zip If in a Subdivision provide formation, as follows: Name: M ✓��/ l�� S Section: Block: Lot: S WRITE DIRECTIONS (from Mocksville) to PROPERTY: Date home corners 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 aa: 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 b�% to conduct all testing procedur s as necessary to determine the site suitabilit DATE ---t !L� 5 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inclui property lines and dimensions, structures, setbacks, and septic locations). v Sign given Revised DCH (05/03 all of the following: Existing and proposed Site Revisit Charge Date(s): Client Notification Date: EHS: �YAccount No. 5p. Invoice No. 47& 0 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMI l� Q / Davie County Health Department +V Environmental Health Section P.O._ Box 848/210 Hospital. Street NOV onr Mocksville, NC 27028 '�04 (336)751-8760 EN,,.. Eur ikrg— ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL TH QUIk'tti INFORMATION IS PROTVID4E/yD�. Refer to the INFORMATION BULLETIN for instructions. `) ✓ln 1. Name to be Billed 1 t//Y l'ij_� /� Contact Person�� Mailing Address �5ntP (.AJ r -YQ�e( �� `�-/�� Home Phone 1 qi D —, -1� C'J City/State/ZIP _ Ad UctM1C •V L 1:R / n Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: M Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: M H,.,ousse [3 Mobile Home ❑ Business ❑ Industry E3 Other 0 S. Type system requested: - conventional ❑ conventional modified ❑ innovative 6. If Residence: #People 57_ # Bedrooms #,.,_Bathrooms 19Ifshwasher QGarbage Disposal in ❑ M Shg Machine Basement/Plumbing asement/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) Eea 8. 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 9-Tq10— If yes, what 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. Property Dimensions: 45 WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # 591C205 -25L b 1 N I I— lam' () Property Address: Road Name Ly� S I 1 mk rU I �S �V C11L City/Zip _ Yl l `l[5 ,,0 If in a Subdivision provide information, as follows: 11 OM lam' / Name: I I'M beA- YO) I .1 iA '=5 0 in 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 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 frons this application. I, hereby, give consent to the Authorized Representative of the Davie County IIealth Department to enter upon above described property located in Davie County and owned b to conduct all testing procedures as necessary to determine the site suitability. DATE / / ^ iS � (� SIGNATURE O� /L�-51 zS _ 1 _•(G THIS 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). Sign given Revised D HD (05/03 Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. c,)- o Invoice No. / DAVIE COUNTY HEALTH DEPARTMENT r ' . Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003407 Tax PIN/EH #: 5812-01-5250 Billed To: Teresa Dix Subdivision Info: Timber Trails Lot # 5 Reference Name: Location/Address: Timber Trails Drive7028 �t Proposed Facility: Resident Property Size: 5 acres Date Evaluated: 11-_22 U V Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut b" -- FACTORS 2 3 4 5 6 7 Landscape position Sloe % l HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence �- Structure l MineralogyJ !• 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: A LONG-TERM ACCEPTANCE RATE: � REMARKS: END Landscape Position EVALUATION BY: Aekl l 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 V 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) ■■ on ME on ON No NN NN NN ■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■e■c■■■■■■■■■■■■■■■gra-�■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■c■■■■■■■■■■■■eee■■�i■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■e■■■■■e■■■eee■■■■■c■■■��:.■�.•,i�■■c■■■■■c■■■■e■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■c■■■■■■eee■■■■■�.=:e■■■■■■�a■■■■■■■■■■■■■■■■■■■■■ ■■eee■■■■■■■■■■■■■■■■■■■■e��■■■c■ec■■■■■■■■■■■�■■cc■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ce■■■■■■■■■■■■■c■■■■■■■■■■■eee■■■■■■■■■■■■■■■■■■ccc■c■ ■■■■■■c■■■■tees■■■■■■■■■■■■■■■■■■■■■■■■■■■■c■■■■■■■■■■■ ■■■■■■c■■■■■■■c■■eee■■■■■c■■■■■■e■■■■■■■■■■■■■■■■■■■■■■ ■■eee■■■■■■■■■■■■■■■■■■■■■■■e■■■■■■■■■■■■■■■■■e■■■■■■■■ ■■c■c■■■■■■■e■■e■eee■■�■e■e■■■c■■c■■■■■■■■■■■■■■■■■■■■ ■ce■■■■■■■■■■■c■■■■■■■ ■■■■■■■■■■■■■■■■■■■ce■■■■ecce■■ ■■■■Nee■■■■■■■■■■■■■■■■■■■■■■■■eee■e■■■■■■■■■■■■■ecce■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■eee■■■■■■■■■■■■■■■c■■eee■■c■■■■■■■■■■■c■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■c�■■■o■■■■■■■■■■■■■eee■■■■■■c■■■■ ■■■c■■■■ace■■■■■■■■■■■ ■■■■■ce■c■■■■■c■■■■■■■■■e■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■.■■■■■ear•_===_ ■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ Sr G n (JI ow 15c&`% ►2�ac(. L�� S r 5 , C h h c j, u a n a • , u� � ' �� .. ` � � x s"�r. Jnr. c 1 5:t�lt., �� ;.. ` � •� `� �� ____. �'� t t`�\�\�,.�\��\;\��..� f ,ir!l fl,JlJfii � c �,� '`� >>,/,'. j ; j; ;';' +1�� ^t, ,, .�� •� __� — \� \"\�,"�\. ':c` \ �•� //j//i1l 1:. N.i�, ',5,21 �•��" r' !a�!1 L CAPL LUST O. .al''Ij�' 1i;r' l�ll I� B. 3f8. pr, 8 '�!1 1� ,� � �;�`• 4;Y i� t !�� r , �; ;. �,� -� A J JJ�� yo �y_•.j ir. .1: , \ �, ;ir �\ t' �• i Yds �� ♦•s`I '. } � �,� "� :! s/ Yti•s 'S•,t�. i � moi• �i J 11 4 '1.75• .r>- '��'.�� .. . � �( � � 1� ` '.1nfZ�s7.�.. {{I�.�grql�. � � � ! i /^--' •` - .WKIlTB��. n •� I n / /v �� .s;♦ �� .,• 1 �: �.t. �� .�. , . _111)1 _ :-,� e'0 �\\�, `�� -...�1\�`-_.. , n � ,' 1'' �:• ,, •'t\•'. .,`..r -'1•��•'i ice.... `1 ' / � -' w_- - - • _ _ _. ��... / 1.75 •TWA T17 Baur saw, si 1 17u7^ ra 'i I - sirirx • aso.va s OoucUS X. yo MARY C. YP - D.B. 1921. 1'c. !' c — 1 --'--'-------.— 4----- j —r — --------------------------------- ------------ t— ------------------ PRELIM/NARY SIT£ PG4N LiRxY s. BOLES TOTAL AREA=-9f"Si sl AC:` - EVELYN r. BoLPS 386 RacuJacs sR %Jt',E;t_ PW • w.sm . -�l x y n a • , u� � ' �� .. ` � � x s"�r. Jnr. c 1 5:t�lt., �� ;.. ` � •� `� �� ____. �'� t t`�\�\�,.�\��\;\��..� f ,ir!l fl,JlJfii � c �,� '`� >>,/,'. j ; j; ;';' +1�� ^t, ,, .�� •� __� — \� \"\�,"�\. ':c` \ �•� //j//i1l 1:. N.i�, ',5,21 �•��" r' !a�!1 L CAPL LUST O. .al''Ij�' 1i;r' l�ll I� B. 3f8. pr, 8 '�!1 1� ,� � �;�`• 4;Y i� t !�� r , �; ;. �,� -� A J JJ�� yo �y_•.j ir. .1: , \ �, ;ir �\ t' �• i Yds �� ♦•s`I '. } � �,� "� :! s/ Yti•s 'S•,t�. i � moi• �i J 11 4 '1.75• .r>- '��'.�� .. . � �( � � 1� ` '.1nfZ�s7.�.. {{I�.�grql�. � � � ! i /^--' •` - .WKIlTB��. n •� I n / /v �� .s;♦ �� .,• 1 �: �.t. �� .�. , . _111)1 _ :-,� e'0 �\\�, `�� -...�1\�`-_.. , n � ,' 1'' �:• ,, •'t\•'. .,`..r -'1•��•'i ice.... `1 ' / � -' w_- - - • _ _ _. ��... / 1.75 •TWA T17 Baur saw, si 1 17u7^ ra 'i I - sirirx • aso.va s OoucUS X. yo MARY C. YP - D.B. 1921. 1'c. !' c — 1 --'--'-------.— 4----- j —r — --------------------------------- ------------ t— ------------------ PRELIM/NARY SIT£ PG4N LiRxY s. BOLES TOTAL AREA=-9f"Si sl AC:` - EVELYN r. BoLPS 386 RacuJacs sR %Jt',E;t_ PW • w.sm . Environmental Health Section P. 0. Box 848/210 Hospital Street Courier 09-40-06 November 23, 2004 Teresa Dix 156 Lonetree Drive Advance, NC 27006 Re: Site Evaluation/ Timber Trails Drive Tax Office PIN: #5812-01-5250 Dear Client(s): As requested, a representative from this office visited the aforementioned site on, November 22, 2004. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, the site was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions, please feel free to contact this office. Sincerely, Aec.414 & 6.�IWA. Robert B. Hall, Jr., R.S. Environmental Health Specialist :-0.3"M] ri Enclosure(s)