131 Sawgrass Drive Lot 293OPERATION PERMIT
Davie County Health Department
.T is 210 Hospital Street
$ P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336.753-1680
Applicant:
Isenhour Homes LLC
Address:
3411 Healy Drive
City:
Winston-Salem
StatefZip:
NC 27103
Phone #:
(336) 659-8211
ror umce use uni
'CDP File Number 81335-1
E900000293
County ID Number:
Evaluated For. NEW
Township:
Property Owner Oak Valley LTD Partnership
Address: PO BOX 10
CRY: Bethania
State2ip: NC 27010
i
hone#:
PropertV
Location & Site Information
Address/Road #: Subdivision: Sawgrass Phase 1
i
Phase: Lot: 293
T131-Sawgrass-Drive
Advance NC 27006
Directions
1-40 to Hwy 801
go South turn right on Mocks Ch Rd.
Structure: SINGLE FAMILY
to end right on
Beauchamp Rd. developement on
# of Bedrooms: 4
right
# of People:
'Water Supply: PUBLIC
'System Classification/Description:
'IP Issued by. 2244-Daywalt,Andrew
"CA issued by: 2244 • Daywall, Andrew
SaproliteSystem? OYes ®No
Design Flow: 4 8 0
'Distribution Type: Pump Required?
QYes QNo
Soil Application Rate
0 3
, Pre -Treatment:)
Drain field
NRrificationField
Sq. ft. 'System Type: INFILTRATOR OUICK 4 STANDARD
No. Drain Lines
Installer: limbeason
" Total Trench Length: 4 0 0
ft. Certification #:
Trench Spacing: _
Inches O.C,
9 OFeet O.C. EHS: 2244-Dayual4Andrew
Trench Width:, _ 3
6 Inches
sgFeetDate: 0 6/ 1 4/ 2 0 1 3
Aggregate Depth: inches
Minimum Trench Depth:
finches
Minimum Soil Cover.
Inches . Approval Stalus
Maximum Trench Depth:
®Approved O Disapproved
Inches
Maximum Soil Cover:
Inches "
CDP File Number81335 -1
County ID Number: ' E9D0000293
Se ti¢ Tank
Manufacturer shoal
Lat.
- Q
Long: '
STB:
Gallons: 1000
Installer.
Dater. 0 3/ '2 8/ 2 0
1
Certification #:
3
*EH S: 2244 - D"It Andrew,
*Filter Brand:
0 6 / 1 4 / 2 0 1 3
ST Marker. ❑ Yes El No
Date:
_
Reinforced Tank: E]Yes ❑ No
ApprovalStat us
Approved ❑ D'sapproved
1 Piece Tank: ❑Yes ❑ NO
Pump Tank .
Manufacturer.
Installer:
PT:
Certification #:
Gallons:
*EH S:
Date: / /
Date:
RiserSealed ❑ Yes ❑ NO
RiserHeght: ❑ Yes ❑ No (Min.6 in.)
Approval Status
einforcedTank: ❑ Yes ❑ No❑F
Approved❑ Disapproved
7 Piece Tank: ❑Yes ❑ NO
Supply Llne
Pipe Size: inch diameter'
Installer:.
Pipe Length: feet
Certification #:
*EH S:
*Schedule:'
Press u re Rated ❑ Yes ❑ No
Date:''
Approved fittings ❑ Yes ❑ No.
Approval Status ,
❑
Approved ❑ Disapproved ;.
• p YP
Pum T e:
nt
Installer
Dosing Volume: —
Gal Certification #:
Draw Down: Inches
*EHS:
*Cham:
Date:
Valves Accessible ❑ Yes ❑
NO
Flow Adjustment Valve ❑ Yes ❑
NO
Check -valve ❑ Yes ❑
NO
Approval Status
Pvti unions E] Yes ' ❑
No
❑Approved ❑ Disapproved
App
Vent Hole ❑ Yes ❑
No
Anti -siphon Hole ❑Yes' ❑
NO
CDP r=ile Number 81335 -1 County ID Number: E996000293
Electric Eauloment
NEMA 4X Box or Equivalent
❑ Yes
❑
No .
Installer.
Box 12 inches Above Grade
❑
Yes
❑
No
Certification #:
Box Adj. To Pump Tank
❑
Yes
❑
No
Conduit Sealed
❑
Yes
❑
No
'E HS:
Pump Manually Operable
❑
Yes
❑
No
'Activation Method:
Date:
Approval Status
Alarm Audible
❑
Yes
❑
No
❑Approved❑
Disapproved
Alarm Visible
E3
Yes
ElNo
2244 - Daywalt, Andrew
*Operation Permit completed by:
Authorized State
Date of Issue: 0 6. / 1 4/ 2 0 1 3
This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for
Sewage Treatment and Disposal, 15A NCAC 18A.1900 et. Seq.; and all conditions of the Improvement Permit and
Construction Authorization. This property is served by a sewage septic system.
Rule .1961 requires that a Type septic system meet the following criteria:
Minimum System Review ByThe Local Health Department:
Management Entity:
Minimum System Inspection/Maintenance Frequency ByCertifted Operator:
Reporting Frequency By Certified Operator.
Rule .1961 requires that a Type IV and V septic systems designed fore hometbusiness owner must maintain a valid contract
with a public management entity with a certified operator or a private certified operator for the life of the septic system. .
Rule .1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid contract with a
public management entity with a certified operator for the life of the septic system.
Rule. 1961 (2) (e) requires a contract shall be executed between the system owner and a management entity prior to the
issuance of an Operation Permit for a system required to be maintained by public or private management entity, unless the
system owner and certified operator are the same. The contract shall require specific requirements for maintenance and
operation, responsibilities of the owner and systems operator, provisions that the contract shall be in effect for as long as the
system is in use, and other requirements for the continued proper performance of the system. it shall also be a condition of
the Operation Permit that subsequent owners of the systems execute such a contract.
®Hand Drawing Oimport Drawing
**Site Plan/Drawing attached.**
Total Time:(H H:M M )
Activity Code: S -19204 -OP Issued NEW Type It Quick 4 0 1. Hours 0 0 Minutes
OPERATION PERMIT $1335: 1
Davie county Health Department CDP File Number: .
210 Hospital Street _ E900000293
P.O. Box 848 County File Number:
Mocksville '; NC 27028 Date:
W W
O Inch
Drawing Drawing Type: Operation Permit Scale: , ON ock ft.'
• '- CONSTRUCTION•
AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
Phone: 336-753-6780 Fax: 336-753-1680
Applicant: _ Isenhour Homes LLC Pro
For Office Use Onl
•CDP File Number 81335-1
County ID Number: E900000293
Evaluated For: NEW
Township:
PERMIT VALID UNTIL:
1' 1/ a 7,/ 1 0 1 7
Owner:' Oak Valley LTD Partnership
.Address: 3411 Healy Drive Address: PO Box 10
City: Winston-Salem City: Bethania
State/Zip: NC 27103 State/Zip7 NC 27010
Phone #: (336) 659-8211 Phone #:
\ -
Address/Road. #:. Subdivision: Sawgrass Phase 1 Phase: Lot: 293
131 Sawgrass Drive
Advance NC 27006 Directions
Structure: SINGLE FAMILY 1-40 to Hwy 801 go South tum right on Mocks Ch Rd. to
end right on Beauchamp Rd. developement on right
# of Bedrooms: 4 ,
# of People:
`Water Supply: PUBLIC
Site Classification: PS
Minimum Trench Depth: 3 '6 Inches
Saprolite System? OYes ®No
Minimum Soil Cover. Inches
Design Flow: 4 8 0
Maximum Trench Depth: 3 6 Inches
Soil Application Rate: 6 3
Maximum Soil Cover: Inches
'System Classification/Description:
'Distribution Type: GRAVITY - PARALLEL (eq.d•box)
- TYPE II B. CONY. SYSTEM WITH 750 LINEAR FEET OF Septic Tank:-
1 0 0 0
NITRIFICATION LINE OR LESS
Gallons
'Proposed System: 25% REDUCTION
1 -Piece: OYes @No
Pump Required: OYes a+ONo OMay Be Required
Nitrification Field --
Sq. ft. Pump Tank: 1 0 0 0 Gallons
No. Drain Lines
1-Pieoe: OYes (E)No
Total Trench Length: 4 0 0
GPM—vs— ft. TDH
ft,
Trench Spacing:Inches
9 _ 0 0
O.C.
@Feet O.C. Dosing Volume: _ Gallons
Trench Width:Inches
3 6
SFeet
_
Grease Trap: Gallons
Aggregate Depth* inches
Pre -Treatment: ONSF OTS -I OTS -II
Septic Tank Installer Grade Level Required: Ol Oil OIII OIV
vage.1 ors
CDP File Number 81335-1 ;, County ID Number: E900000293
❑ ,Open Pump System Sheet
Repair System Required: ®Yes ONO ONO, but has Available Space
epaif System Inches O.
Trench Spacing: 9 0 0 0
Site Classification: PS — �a Feet O.C.
Trench Width: 3 6 a Inches
Design Flow: 4 8 0 SFeet
Aggregate Depth: inches
Soil Application Rate: , 0 3
Minimum Trench Depth: 3 6 Inches
'System Classification/Description:
TYPE It B. CONV. SYSTEM WITH 750 LINEAR FEET OF Minimum Soil Cover. Inches
NITRIFICATION LINE OR LESS
Maximum Trench Depth: 3 6 Inches
"Proposed System: 25% REDUCTION
Maximum Soil Cover: Inches
Nitrification Field 0 Sq. ft,
'Distribution Type: GRAVITY - PARALLEL (ep.d-tax)
No. Drain Lines
Total Trench Length: 4 0 0 g, Pump Required: Oyes .ONO ®May Be Required
Pre -Treatment: ONSF OTS -1 OTS -II
'Site Modifications
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department.
-Permit Conditions
The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder
is responsible for checidng with appropriate governing bodies in meeting their requirements.
This Authorization for W astewater System Construction shall be valid for a person equal to the period of validhy of the Improvem end Permit not
to exceed five years, and may be Issued atthe same time the Improvement Permit Issued (NCGS 130A-M(b)). If the installation has not been
completed during the period of valldity of the Construction Permit the IMormatlon submitted In the application for a permit or Constructlon
Authorization is found to have been Incorrect, falsified or changed, or the site Is altered, the permit or Construction Authorization shall become
Invalid, and maybe suspended or revoked (.1937(8)). The person owning or controlling the system shall be responsible for assuring compliance
with the laws, rules, and permit conditions regarding system Water% Installation, operation, maintenance, monitoring, reporting and repair
Applicant/Legal Reps. Signature Required? OYeS OND
ApplicantlLegal Reps. Signature Date:.'
*Issued By:
2244-Daywalt.Andrew - - Date of Issue: a 7- l a 0 . 1 'a
Authorized State Agent: AviLp-DQ�1 a1 Malfunction Log Oyes
OHand Drawing ®Import DraWng TotalTime:(HH:MM)
**Site Plan/Drawing attached.** 1 Hours 3 0' Minutes
Page 2 of 3
S-8 - CAS issued - new
CONSTRUCTION AUTHORIZATION.
Davie County Health Department
210 Hospital Street CDP File Number:
P.O. Box 848 E900000293
Mocksville NC 27028 County File Number:
Date: i�1' / s/ a e 1 2.
Click below to Importari Image from an external location: Drawing Type: Construction Authorization
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IMPROVEMENT PERMIT
rim
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville - NC 27028
Use Only
335-1
D0000293
EW
Phone: 336-753-6780 Fax: 33133-753-1680 reRMrcvauo UNTIL 11/27/1017
"NOTE TO INSPECTIONS DIVISION: Building Permits cannot be Issued with this Improvement Permit.
Applicant:
Isenhour Homes LLC
Address:
3411 Healy Drive
City:
Winston-Salem
Statelzip:
NC 27103
Phone #:
` (336) 659-8211
Address/Road #:
131 Sawgrass Drive
Advance NC 27006
Structure: SINGLE FAMILY
# of Bedrooms: 4
# of People:
'Water Supply: , PUBLIC
SaproliteSystem? OYes ®No
Design Flow: 3 6 0
property owner: Oak Valley LTD Partnership
Address: PO BOX 10
City: Bethania
State/Zip: NC 27010
hone #:
Subdivision: Sawgrass Phase 1 Phase: - Lot: 293
Soil Application Rate: 0 3
'System Classification/Description:
. TYPE II B. CONY. SYSTEM WITH 750 LINEAR FEET OF
NITRIFICATION LINE OR LESS
'Proposed System: 25% REDUCTION
Directions
1-40 to Hwy 801 go South turn right on Mocks Ch Rd.
to end right on Beauchamp Rd. developement on
right
Minimum Trench Depth: 3 6 Inches
Maximum Trench Depth: 3 6 Inches
Septic Tank: 1 0 0 0
Gallons
1-Pie0e: OYes ONo
Pump Required: OYes (9 No OMay Be Required
Pump Tank: Gallons
1 -Piece: OYes ONo i
Repair System Required:OYes ONo ONO, but has Available Space
Repair Svstem
'Site Classification: PS Minimum Trench Depth: 3 6 Inches
Soil Application Rate: 0 3
'System Classification/Description:
TYPE 11 B. CONY. SYSTEM WITH 750 LINEAR FEET OF
NITRIFICATION LINE OR LESS
'Proposed System: 25% REDUCTION
Maximum Trench Depth: 3 6 Inches
Pump Required: OYes ONo Q Maybe Require(
Pagel of 3
CDP File Number 81335 -.1 County ID Number: E900000293
"Site Modifications ❑ Open Fill Sheet
No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department.
"Permit Conditions
The issuance of this permit by the Health Department in no way guarantees the issuance of other permits. The permit holder.
is responsible for checking with appropriate governing bodies in meeting their requirements.
Site Plan TheImprovementPermitshallbevalid for 6years from date ofIssueWith asite Plan (means adrawing not necessarlydrawnto' .
O scale that shows the existing and proposed property lines with dimensions, the location ofthefaci ity and appurtenances, the
v°
site forthoproposed Wastewater system, and the location of water supplies and surfacewaters).
Plat The Improvement Permit shall be valid without expiration with plat (means a property surveyed prepared by aregistered land
surveyor, drawn to a scale of one inch equals no more than 66 feet that Includes: the specific location of the proposed facility
O and appurtenances, the site for the proposed Wastewater system, and the location of water supplies and surface waters. Plat
also means, for subdivision lots approved by the local planning authority and recorded with the county register of deeds, a copy
of the recorded subdivisions platthat is accompanied by a site plan that Is drawn to scale). .
The Department and Local Health Department may Impose conditions on the Issuance and may revoke the permits for fallure of
the system to satisfy the conditions, the rules, or this article. This permit is subjectto revocation if the site plan, plat or intended
use changes (NCOS 13DA%%WM). The person owning or controlling the system shall be responsible for assuring compliance .,
with the laws, rules, and permit conditions regarding system location, Installation, operation, maintenance, monitoring,
reporting, and repair (4939(b)}
Applicant/Legal Reps. Signature Required?' OYeS ONo
Applican lei gal Reps. Signature: Date: rt
Issued By:
2244-Daywa4Andrew Date of Issue: 1 1 I a 7 1 0 1 2
, /1, OValid without Expiration?
`�
Authorized State Agent: rI r w�� /�/� O Create CA?
OHand Drawing ®Import Drawing
**Site Plan/Drawing attached.** TotalTime:(HH:MM)
1 Hours 3 0 "Minutes
Page 2 of 3
Activity Code: S4A -1P issued • relocation w/she plan -(valid 60 mos.
IMPROVEMENT PERMIT
Davie County Health Department
210 Hospital Street CDP File Number: 81335 -1
P.O. Box 848 E900000293
Mocksville NC 27028 County File Number:
Date: 1 1 2 7 1 0 i .1'
Click belowto Import an Image from an external location: Drawing Type: Improvement Permit
ApplicAbA For:ASite Evaluation/Improvement Permit Authorization To Construct(ATC) _; Both
Type of Application: _New System =Repair to Existing System _Expansion/Modification of Existing System or Facility
* * *IiVIPORTANT* * *THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
IICRVJCPUFAV ILei\I
Name to be Billed I�Ovw1 S LL Contact Person Z 110Y)0\01. CVe-4 Y\�_
Billing Address -3L� V, , ,A )D ( Home Phone
City/State/ZIP Business Phone , a \\
d�1\a
Name on Permit/ATC if Different than Above.
Mailing Address City/State/Zip
PROPERTY INFORMATION *Date House/Facility Corners Flanged
NOTE: A survey plat or site plan must accompany this application.
Included:( Site Plan iUPlat(to scale)
(Permit is valid for 60 months with site plan no expiration with
coinplete p at.) . -
Owner'sName 00\\1, \J<Oati LYCK c"dkw,(
Phone Number .
Owner's Address n p C?� OBJ 1 %
)City/State/Zip l'��k�o r 2 A (�
Property Address -1 l 5 0.w�o S Yo !
City 'ae\y rnv� C �1 n > p
Lot Size. .'1 (A ac r Q_ TaX PIN4 cc6'1 1 'A—\ 35
F-900000
SubdivisionName(ifapplicable) o ., -rmC (0e
v,ection/Lot# c)c\3 .3
Directions To Site: t 5� F ^ i aV k 0,\ G t, v. C Ug\n
a' \ F� ' n r Cu'tt-il & NIL' )
1
1 �'k Y " G�\'�k O Y\ Jv�f\YAWS O6 \ P �k ori
�� \ ktA 'f 'o C� � Q� (' O V% S Gl gni ri V -
If the answer to any of the following questions is "yes", supporting documentation must be Attached.
Are there any existing wastewater systems on the site?
LYes ff3No
Does the site contain jurisdictional wetlands?
OYes r No
Are there any easements or right -of, --ways on the site?
UYes fNo .
Is the site subject to approval by another public agency?
i]Yes-kNo
Will wastewater other than domestic sewage be generated?
CYes.kNo
IF RESIDENCE FILL OUT THE BOX BELOW
N People 4 Bedrooms - 9 9 Bathrooms 3 d'ar b/Whirlpool VYes —No
Basement LYes -)(No Basement Plumbing: CYcs =No
IF NON -RESIDENCE FILL OUT THE BOX BELOW
Type OfPacility/Business Total Square Footage of Building f People
# Sinks g Commodes 9 Showers 11 Urinals
Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY: N Seats
Typesyslemrequested:)(Conventional fiAccepted illnnovative .'Alternative COther
Water Supply Type:X County/City Water " New Well '.Existing Well Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? sC Yes kNo
If yes, what type?
This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand
that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation 'if the site is altered, the intended use .
changes, or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized
Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable
laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and
locating and Flagging or staking the house/facility location, proposed well location and. the location of any other amenities. -
�\_--C'� ,. Site Revisit Charge
Property owner's or owner's legal repro, cntstive signature -
Date(s):
Client Notification Date: h�
pppp �T�
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i SITE PLAN LO7 293
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
PO Box 848/210 Hospital Street
M6cksville, NC 27028
Phone: (336)751-8760/Fax: (336)751-8786
November 1, 2005
Oak Valley Associates, Limited Partnership
Attn: Bo Davis
3401 Healy Drive
Winston-Salem, NC 27103
Re: Proposed Carlius Keller Property Subdivision -
Site Evaluations -10 lots
19.21 Acre Tract plus a portion of 12.54 Acre Tract
Tax PIN#: 5871252458 and 5871242254
Dear Client:
As requested, a representative from this office visited the above site(s) October 27.
and 3l,'2005 to perform site evaluations. , Based on information provided on the
Application for Site Evaluation/Improvement Permit and results of the evaluations, the
following lots are classified provisionally suitable for the installation of on-site
wastewater systems(Lot numbers based on Preliminary Site Plan, Carlius Keller
Property map dated 3/14/05): lots # 25-34.. System design is limited to a three-bedroom
residence on the following lot(s): lot # 28.
House location and size, soil conditions and/or topography may necessitate the
use of pump stations, alternative or innovative systems, and/or surface water or
interceptor drains. System design will be determined at the time an Improvement
Permit/Authorization to Construct is applied for and issued.
Before a representative of this office will revisit the site to issue an Improvement
Permit/Authorization to Construct, the appropriate application must be completed and
submitted to this office. The location of the facility the system is to serve must be staked
off. Additionally, a copy of the recorded plat must be on file in this office.
If you have any questions, feel free to contact this office at 751-8/760.
Sincerely, /.Y
Jeff G. Beau&, R.S.
Environmental Health Section
Enc(s)
NORTH CAROLINA DEPARTMENT OF TRANSFORTATION PLANNINC DEPARTMENT/REVIEW OFFICER SURVEYORS CEMFICA TION Job° E. llj w n..v.n a,.•s.. L-lege °,.rA. r ,,,. FORgyTN CWNlY R6ClST6F OF DEEDS
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Lots 265-268 Lots 269-296
Zoned: R-12 Zoned: RA
St. Andrews Golf Villas 1I R-12 Lot Setbacks RA Lot Setbacks
� Oak Valley Section 9B 4I I Front Yard: 35' Front Yard: 40'
�A•�� Phase 3 Phase If. Sec 2Side Yard: 10' side Yard: 15'
O° / PB 7, Pg 110 PB 8, Pg 21 �1I
Rear Yard: 20' Rear Yard: 30'
cps C.C. Side Street: 25' Side Streak 25'
o v ,6.4*061h plat - 8 11131 Ylr _ytAy- 1a5s --t - + CENTERLINE CURVE DATA
110.00 - �115ST \
la9M- 10' Private Pi CURVE LENGTH RADIUS BEARING CHORD
Orokw9• Esmt \\1 d• 1 74.31 250.00 S79'51'03'E 74.03
>r v+ 170.43 500.00 SI3'04'32'E 169.61
R\$ Oak Valley Associates Limited Partnership RICHT OF WAY CURVE DATA
Future Development
Deed Book 652, Page 160 CURVE LENGTH RADIUS BEARING CHORD
Cl 66.88 225.00 N79'51'03'E 66.63
C2 3854 25.00 S47'2BTI'E 34.83
C3 6.99 35.00 S02'23'30'V 6.98
1294) 293 292 291 >i 290 C4 20.57 35.00 S24.56'40'V 20.27
i 19,626 Sq.Ft. C5 61.83 50.00 N06'21'04'E 57.97
33,396 Sq-Ft 41.147 Sq.FI. 25A.0117 �'R' C6 49.72 50.00 N57-33.43-W 47.70
33.295 Sq-R- 01 Ye, C7 47.81 50.00 S66'330290V 46.01
sw 9,ee 1o' PXbbe otil;Odo E°eomeM 32.0- g�,t Cit 76.43 50.00 SO4.37.40'E 6921
I of 2 / -.1 - -13aairC9 2055 35.00 N31'36'12'V 20.25
-loqu(--i-11aa0- Qj
IIe31�3r4, (yp' 2ahlle R/1f) \
a.15 (Lina) Sawgrass Dnve _031 �,
N79:S151 5925517E - 135416 WW .11500- 528 1`li A
u5a9'- u4�- Eaxmene e laY4nd
Cll 178.95 525.00 S13.04.32'E 178.09
C12 33.43 475.00 S20'49'28'E 33.42
- 11500 - - to. 1.W, ti 1,, Deed �a 4 MOO t)EP..................N-f Iron Pips C14 128AB0.00 475.00 42*31''34'E 128.89
11 07.P.S.............New 4ov Pipe C34 40.00 25.00 S42'3l'39'V 35.87
und) C15 M74 275.0 N79651'03T 81.44
PIN:SBry -2i-2615 pons .,..,,Point ono the gra-d C16 5002 525.00 S18'37'09'E 50.00
i OC.c..............Cootral Comer C17 73.60 815.00 SO0924021'E 7358
I2g3) 2g4 cis 18.05 525.00 S03'58'41VE 18.05
30,184 Sp.R. I �•�] Sq.R. C19 100.12 525.00 SIO'25'35'E 99.97
33±25 an IS, 61.610 sa.rt ✓8 C20 100.04 525.00 S2148.28'_ 99.89
30,32] Sq.R. fain,
COs Carl g SAWGRAss at Oak Valley
abed an4nie W alley GRAPHIC SCALE sat. n^--I
>e PIN:587T32J-P� 8231e'Y a-••' / a.«I•>.'
2171 3173Y 0725 m Oak VaUty Associates
ezT5 n6a9 - zN. _ _
11500' Limited Pnrtnership
11500 NOS31'461r - __ _ A«mN
I inch = 100 r- faae�T- o n�
Mary Erman B. Blackwelder
%N:5e71-IS-6NNe
State of North Caro:ina, County of Dzv;e
I. "W1V 0WL%A Review Off;:er of
Davie County, certify that the man or n'rv•
to which this certification is affixed m.1,
all
-/stt/taatttuuttorryy r{e5p'.u6i/rreemcats for recor�d7n;!
Notes:
nrro m+r R CR6ara R.
a•T CJ DII
1. All dbtonasa shorn on IN. plat aro hart-tol Distances.
2. 3/4• Iran Pipes at all c,m,n uniess otherwise noted.
�A/rop
wf / v -+s-+vas ani t1a t+e
3. Then an no N.C.G.S., U.S.C.& G.. or other Geodellc
Iver stn-�- �' les. YDo
Survey Monuments within 2.000 FM of MIs
-
4. Thls Phase has 32 Lola Total
lismpybn
aeW
5. Total Ana this phase: 48.21 Acr•,t
sr+Tt 0Af2
s@1T NIVdaR
6. Total Ano in Right-of-Woy thh phos,: 2.52 Acm3
NeMA Qnitwe Oa -06 -OT
7. Public Stoats (built b N.C.D.O.T. Standards),
AaAOIaR
2 of 2
8. 1.611. Wall- (within R/W and 10' Publi. LNnINn EasemeMs).
OaHO d./1-
9. Lots 267, 268, 269 and 290: Drlverays may not be wIthln 30 lest
of ,lint Int.r;-f.. right -of -.ay.
BEEBBO EOBIOEEOI08 IOC.
10. AR lots served by publla Mater.
R-INEER5 SVII-0R5 PLAI--
11. Lot, 289 - 293 carved by -H, IndMd.al wpttc systems.
aos Axa srutr
12. Remalnin9 lots semd by public serer.
xrs (ase) �.enoon
p�r„•„pnr,t,w.
13. width of Pavement: 29.0' Bock of Curb to Baek of Curb
«,,,
Davie County Environmental Health
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780/ Fax (336)753-1680•
IMPROVEMENT PERMTT
Account #: 990002855 Tax PIN/EH #: E900000293
Billed To: Isenhour Homes Subdivision Info: Sawgrass Phase 1 Lot # 293
Address: 3411 Healy Drive Location/Address: 131 Sawgrass Drive -27006
City: Winston-Salem Property Size: .76 Ac
Reference Name:
Propq ftj is mprovement Permit DOES NOT, authorize the construction of a wastewater system. An
Authorization To Construct a wastewater system must be obtained from this office prior to the
construciion/installation of a wastewater system or the issuance of a building permit(in compliance with
Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to
revocation if site plans, plat or the intended use change..
Permit Type: DNew ❑Repair ❑Expansion Permit Valid for: 05 Years ONo Expiration
Residential Specifications: # Bedrooms # Bathrooms —# People_ Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type # People_ # Seats
Square Footage(or Dimensions of Facility)
DesignFlow(GPD): Type of Water Supply: DCourity/City ❑Well OCommunityWell
Site Modificaflons/Permit Conditions:
System Type LTAR
Initial
Repair
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
.(336)753-6780 / Fax # (336)753-1680
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account # 990002855 Tux:PINI.EH E900000293 :.
Biped To: Isenhour Homes i. Subdivision Info--Sawgrass Phase 1 Lot # 293 ?:
Reference Name::: r Na, LocationiAddressi 131 Sawgrass
Proposed Facility: Residence r<. : s:n• Pf6perty. Size: .76 Ac
ATC Number. 5994
Site Type: ONew DRepair ❑Expansion
**NOTE** This Autliorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental
Health Section prior tp issuance of any building pennit(s),,(in compliance With Article 11 of G:S. Chapter 136A
Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO .
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat
or the intended use change.
Residential Specifications: # Bedrooms # Bathrooms_ # People_ BasementO Basement plumbing❑
Non -Residential Specifications: Facility Type # People # Seats_
Square Footage(or Dimensions of Facility)
Lot Size Type of Water Supply: DCounty/City OWell OCommunity Well
System Specifications: Design Wastewater Flow (GPD) Tank Size GAL. Pump Tank GAL.
Trench Width Max. Trench Depth Rock Depth Linear Ft.
Site Modifications/Conditions/Other:
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30 = 9:30a.m. on the day
of installation.
Telephone
#
(336)751-8760.1
Environmental Health S
rerun 11 /M (uP.,iQPah
DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780 /Fax # (336)753-1680
OPERATION PERMIT
Account #: 990002855
rani '.Taz".'PlN/EH'#: E900000293
Billed To: Isenhour Homes
r:C! ;w '! Subdivision lr1f _Sawgrass Phase 1 Lot #.293 i F;+
: ; 1
Reference Name: : "
41!:°Location/Address: 131 SawgrassDrive-27006 t.:
f ':
Proposed Facility: Residence
,» r ar;:it,r Pf per3y;Size: .76 Ac
ATC Number-: .5994 . ,
A ,: N'umt a:: 5994
.**NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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 ahy given period of
time.
System Type,_ S.T. Manufacturer Tank Date Tank Size
Pump Tank Size
Bedrooms:
System Installed By:
Installer# Dater
GPS Coordinate:
hep ea Uo UJ:4Op oo-ra va J p.
APDL: Gff10N COR SITE EVA10AMON/141munattrmr pruiltl S nm
Davie County ReaEll r )partntent - -'
- a v.VnvientalHwIl,ySCCUM
P.O. Boa 840/210 Hoa;Ltal Etrent
Nocksvillo,NC 27020
(336)731-871.0 -
•••LIPOATANT••a 2=!; bPPLICATIO)f CSlasfdr RA PROh.?SSED 3MLLSS ALL THE =Q=MR
SZIPOAtfhTION ;5 PAO�VIDLD.1 Aol/C!r to the SNtFOA/}NAT::ON DOLL$PIN for 3notructlona.
-"
. 1. Nem to U. nlllad Pe'T4 ,� C1i�rel N550:'k,Y4�f11✓�60 eaee r.ecen b.^ L)CV:f
Nallina Addr.af �lLr ()2"+�� �!. Awa Ptua it (I`
CL[Y/alae./elr �dtAdl—s,%Q� INy', �,71(%((s //nuOlnnQan Plmno i�G /r17 3/1%l
a. q.m. Oe lYralt/ATC lG DIUa[.nG tAu Nb.w Ides LO Cle (A rL eLIJ nc!Y{
J. Application IOre 1151fe _ EYaluatLnn ❑ Ia'•eowesant POrmle/ASC M notb
%le�'/1�Q(I�V7,�tOJ•'�
e. Srat.. to ae.vlw. M lfmff. 0 Mobilo Remo O Dun mean O ibduutt); ❑ OUtar
'jMy (YI VIJ Idf+ {L'tJ (r�f^1'Y
JJJJJJ
' s- ryf..r.te. awweam Cl/.l. . 13 co.v.aaml uadxflyd 13 lnnoratl+o l3accepred
{. I[ COLdOACni t poo 1. ,
P a s acdrJoJc xa � 0 natbroosm 7
L \•/•� _
��F J
l
' FlalaMavA.r ycaaaa. DlaO»ai laYaallmQY some Id:aaemne/P1uWlny Ona.e.mt/aro 91vm41no -
- - '
V. If Ou.mes/ZOtlu.[ry /OWerr +orlfy type a f.opla A slut.
t C..al.a � 1 aAovm a urta.l. t Ha[oe molar.
• IF rDOnaRRVICE: 0 Soata EGUMted W. to. O.aga toallen. v.c dart
1. T". of ..to...rr)y. dcoun Ly/afty ❑ Hot l - O Co zwalty, .
s. vo Yea eetielPate aaalttour or eap.wons orthe facluly ibis sph-m)s)dlevdnl to sense? 177.6 CA.
Ifycs, trhal lypr?
Properly Dilnwutmu:
Tax Office Pitt: e
Properly Addrexs: It,
Gtyrzip— i
ffin a Subdiislon prorWc loforandiw, as101, s:
Nati¢•
Section: Droek: Lot:
IYUME )IRECr1ONS ((rv.0 AIx1.4c) to 1'1101•t7tTl r
Date ho ae cooims flagged:
lois is to aertffythat lite iufumauon pmrldrrl is mvcct to the but of toy k auedge. I undr astd Mal any permil(s) -,
issued hereaan•art subject to suspension or revocation, if the site pari art. feuded use change, orLCNe lufarumtlon
suUndfled in this applialien it ahif¢da, ehaugedl,a4., andeRmudra.f.'mncp.nslble�rafldmgu6,wmdfram
fbirapplicnlion.I,hereb� gist consod fa tte Auth6rind Repraenaueeof•!seDasie Counq•Llrohl Departnunl - n
to euAx upun abore described penperlylomfed in Davie Cotmfyaeld olya 1✓
to eondu tall Ieslling procedurts as oaysary in, fhe sire suitshi)it)) L
D,I7a q,23"05- S1pV,ITURE COH�i c t R'BG7
TUISARFA MAY BE USED FORDZIRING YOUR SlTXPLAN(fadu a ofuie fotdnbrr: Exisuugandpmpos[d -
pmperfytocsanddlsnenslons, structure, setbacle; andrepfieloauuus). '
Site Revisit Charge
valets): .
ClICULNatflClllall Dale:
Elm
Sign given Account No.
Itev'ned DOW (05103 Lsroim No•
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #; 990003765 Tax PIN/EH #: 5871-25-2458.34
Billed To: Oak Valley Associates Limited Partne Subdivision Info: Oak Valley Lot # 34
Reference Name: Location/Address: Oak Valley Boulevard -27006
Proposed Facility: Residence Property Size: see map Date Evaluated: 11 D 27�
Water Supply: On -Site Well Community Public ✓
Evaluation By: Auger Boring Pit ✓ Cut
FACTORS 1 2 3 4- 5 6 7
Landscape position L L
.'
Slope %
HORIZON I DEPTH
Texture group
Consistence
Structure
MineralogyD
HORIZON H DEPTH - r3
Texture group.
Consistence
Structure J
Mineralogy04 (a
HORIZON III DEPTH -J
Texture group
Consistence
Structure k
Mineralogy
HORIZON IV DEPTH,
f
Texture group,
-' Consistence
Structure
Mineralogy
-SOIL WETNESS .. ,
RESTRICTIVE HORIZON..'
SAPROLITE
i.. CLASSIFICATION
LONG-TERM ACCEPTANCE RATE +
SITE CLASSIFICATION: " t" S EVALUATION BY.,
,.
LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT.
'REMARKS: _r —
LEGEND
Landscape Position
R -Ridge . Shoulder P P T -Terrace FP N =Nose slope
L -Linear sloe FS - Foot slope'
CC Concave slo CV - Convex sloe - 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
VFR - Very friable .' FR - Friable .,.: ' FI - Firm VFI -Very firm EFI ' Extremely firm ,
NS - Non sticky SS - Slightly sticky i- S - Sticky VS ` Very Sticky,
NP = Nonlastic
p SP -Slightly. plastic ; P - Plastic'- ' VP -, Veryplastic.:
SC -. Single grain M -Massive .. CR,Crumb . . GR -; Granular ABK Angular blocky
SBK -Subangular blocky ` PL- Plat PR - Prismatic -
MfirierstoU
1:1, 2:1, Mixed
Horizon depth - In inches
Depth of fill - In inches
Restrictive horizon - Thiclrness 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 chmnia 2 or less
Classification - S(suitable); PS(provisionally suitable), U(unsuitable)
LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05105 (Revised)
�5ep 23. UO Ub:9ap 000-,JY-JGa,J (..c
-
. � nprl: n)noN von SITE evuwnoN/Le(In(ovreLwr Pcnanr s sic
Dave County Health C:partment - -
EBPifon/nen4FiflW11.iSccfi0n - -
P.O. Boz 840/210 Aoeptral Shoot .
Mockayillo, NC 27020 - -
(3361751-870 - - -
o•alUl'OItTANTav� I= APPLICATION CANNOT BE PRI)CISSED DNLBSS ALL THE NEOIfI711U - -
1YPOANATIDN ZS PROVIDED. Roger to tho IlOOR)W::ON DOLrXM for j110tiVEti000.
1. N. to h. pilled l2�`1V )�) Ski"I aSige:IG�I (.yl. Pgjx"'taawet Paroen ho VOVyl
04LIi.2 A rasa 3�I0 1 1� ew!j 1) / . •' 1 Nom Ihme ".r L 1
CLtY/mato/:ip Wlnfib'�"Scien, 1Ni.� d\i (li((•s //EM�u��vlaeapas loan. /f 7� / a�7 3%dl
1. Now a. r.slt/ASE 1I Dl[Leant a. laova !e�r.c yp (yc. L(ewlo n2yj
F
1W11a91Mira" .i D.s..{ rl5ytvati./up �
J. A"lieaeioa FOL! dsuo Evaluation 13 ya,\.rovenont P.rnit/1120 O Dow
a. LY.ta. W Cervical sd lfouaa Nobila memo ❑ Dut Lneva O mQuatrl ❑ OC11oC
1- v aria. .1 ... %ad, a e..claoaz O co.va.tlowi uaalaan ❑ innwatly. GIaeCCpCcd
6. I�l� ytmldanee, 1 PooPl•,// 1 Dedroo/ess - p Dathe00laa 'J
-
n
plea i1fol
��jln(j L�1V )Il L• %�LJ (1%%`1 �"
- / ( L
1 i��i ljct""1,�
fdolaMaaaor ,lCarhaOe OLapaal TdnaahLg Xacalo. N:u.emnt/Plmaf„g Qvaee.N.J,r. Plu,d,S.O
t. Sf euosneav/Industry /Omar: verify typa p Paapl. a sinks
-
1 cavil.. - /Serovar. / ue3.4. / Natae Gaols.
• 27 POODSEAVICS: 0 Seats Datintated Itstar Ua.N toast. per day!
Se
o. Typo of vabr aappsy, ,S Csonty/City 13 Not 1 rJ Cwmutlity '
)/
P. a.yao n.4r.LVato.ddtao-a.c eapatWORS offhe faality fliisyltrm B A
fsleuded to Salle?I3 Ya C, -
Ifyes,Irhaltypc? -
-
1'ruperly Uiums(mLr. `QZ i-0' ^ r IYILITE JIEER1Ov5 (en,u Atxluvilley wl'ltOfElf1'Yr
Tax Office PlM: f: 1'^d, "1�D
Property Address: hoed Namc Gt(. ljA11i' ?lJ,
- Cityltip_ i
Irin n snhdiviston provide iuramiatiaN, as fouons:
Name: _
Seclidn: Block: Lot: Y Date ho at corners flagged: -
This is to eerlify that the inrurnraUm, provided is correct to the but of my k oDledge. l undastvtd that may trarndl(s)
issued hereafter art subject to suspension or revocations irDl.s(fn plass or 1. ferlded use rlauge, or If the h foruntiun
subndltad in this appiitafiun it rib irul os changed /. v4o, nnderr,msdrhnr: am rapanaibk(araf! dimltSGrtumdflanr -
O,isnppricn(ion.I,hcreby, ginemmerdtatl¢Autb6rircd Bepraathdre of.bcDmie Counlpllmlll Dtparfnuni _ n
to enter spun abossdacribed properlyloca(al in Davie Counlyand corn /✓
to conduct all lcullii�ng procedures ass acassary to deterndno lite site ru(Iwelt7h
DA'I'S
THISAREA AfIYEE USED FO1t DIG1RIN(; YOUR SIII:PLAti�(I�ncladdcall orOu fallottyng: Existing mid proposed -
property Una and dhnensioah sfractum, sabaelas and septic locations). - -
SitelttrisitCharge
Datcls):
- - QreatNOdilmdo'f Date:
Ens;-
Sign given Aca lNo.
Revived DCfID (OSTM IuvuimNa
I