152 Caudle Meadows Drive Lot 711Applicant:
`-OPtRATION PERMIT
+�
`r Q
Davie County Health Department
210 Hospital Street
P.O. Box 848
�^
Mocksville NC 27028
Stategip:
Phone: 336-753-6780 Fax: 336-753-1680
Applicant:
The Veritas Group, Inc/Michael
Address:
PO Box 582
City:
Kemersville
Stategip:
NC 27285
Phone #:
(336) 404-1522
+CDP File Number 139829-1
County ID Number:
Evaluated For: NEW
township:
,/Property Owner: The Veritas Group, Inc/Michael
Address: PO Box 582
City: Kemersville
State/Zip: NC 27285
hone #: (336) 404-1522
Property
Location & Site Information
Address/Road #:
Subdivision:
Saddlebrook Phase: Lot: 711
152 Caudle Meadows Dr
Advance NC
27006
Directions
Structure: SINGLE FAMILY
140 east exit Hwy 801 go right South, right on Mocks
Ch Rd, Right on Beauchamp rd, right into Back side
# of Bedrooms: 4
of Oak Valley
# of People:
y: PueLlc
*IP:
*System Classification/Description:
TYPE 11 A CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS)
*CA: 2140 -Nations, Robert .,
rDesignFlow:
SaproliteSystem? OYes QNo
4
8 0
+ GRAVITY -SERIAL Pump Required?
Distribution Type: OYes ®No
on Rate: 0
a 7
5
*Pre -Treatment:
Drain field
Nitrification Field
1
7 8 a
Sq. It. *System Type:
No. Drain Lines
Installer:
Total Trench Length:
ft•
Certification #:
Trench Spacing:
—
Inches O.C.
Feet O.C. +EHS:
Trench Width:
—
()Feet
Inches
Date:
Aggregate Depth:
inches
Minimum Trench Depth:
Inches
Minimum Soil Cover.
Inches
Approval Status
Maximum Trend, Depth:
❑ Approved ❑ Disapproved '
Inches
Maximum Soil Cover:
Inches
CDP File Number 139829 -1 County ID Number:
Manufacturer. Shoaf
STB:
760
Pump Tank
Gallons:
1000
Date:
0 6/
1 8/
2 0 1 4
`Filter Brand:
POLYLOK Dual PL -122 With Pipe Adapter
ST Marker:
❑ Yes
❑*'
No
nforced Tank:
❑ Yes
El
No
1 Piece Tank:
❑ Yes
El
No
❑ No
Lat. Q
Long:
Installer: Frank Transou
Certification #:
'EH S: 2140 - Nations, Robert
Date: 1 a/ 0 1/ a 0 1 4
Approval Status
El Approved ❑ Disapproved
Pump Tank
Manufacturer.
Installer:
PT:
Certification #:
Gallons:
'EHS:
Date: /
/
Date:
RiserSealed ❑ Yes
❑ No
Riser -Height: ❑ Yes
❑ No
(Min.6in.)
Approval Status
einforced Tank: ❑ Yes
❑ No
❑Approved
❑ Disapproved
1 Piece Tank: ❑ Yes
❑ NO
Supply Line
Pipe Size: inch diameter
Installer:
Pipe Length:
feet
Certification #:
'EHS:
'Schedule:
Pressure Rated ❑ Yes
❑ No
Date:
Approved fittings ❑ Yes
❑ No
Approval Status
❑ 'Approved
❑ Disapproved
Puma u e e
Pump Type:
Installer:
Dosing Volume:
-
Gal Certification#:
Draw Down:
Inches
'EHS:
*Chain:
Date:
Valves Accessible ❑ Yes
❑
No
Flow Adjustment Valve ❑ Yes
❑
No
Check -valve ❑ Yes
❑
No
Approval Status
PVC unions ❑ Yes
❑
No
❑' Approved ❑ Disapproved
Vent Hole ❑ Yes
❑
No
Anti -siphon Hole ❑Yes
❑
NO
CDP File Number .13982,9 -1
NEMA4X Box or Equivalent ❑ Yes
Box 12 inches Above Grade ❑ Yes
Box Adj. To Pump Tank ❑ Yes
Conduit Sealed ❑ Yes
Pump Man uallyOperable ❑ Yes
*Activation Method:
Alarm Audible ❑ Yes
'Alarm Visible ❑ Yes
County ID Number:
erecmc
❑ No Installer:
❑ No Certification#:
❑ No
❑ No 'EHS:
❑ No
Date:
❑ No IApproval Status
❑ ApprovedEl Disapproved
ElNo
2140 - Nations, Robert
'Operation Permit completed by:
Authorized State Agent:- Date of Issue: 1 2/ 0 1/ 2 0 1 4
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 TYPE II A. sewage septic system.
Rule .1961 requires that a Type TYPE II a septic system meet the following criteria:
Minimum System Review By The Local Health Department: N/A
Management Entity: OWNER
Minimum System Inspection/Maintenance Frequency By Certified Operator:
N/A
Reporting Frequency By Certified Operator: N/A
Rule .1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract
with a public management entitywith a certified operator or a private certified operator forthe life of the septic system.
Rule .1961 requires that Type VI septic systems designed fora homebusiness owner must maintain a valid contract with a
public management entitywith 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 a 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 Olmport Drawing
**Site Plan/Drawing attached:**
OPERATION PERMIT
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC
Drawing Drawing Type: Operation Permit
CDP File Number: 139829 =1
County File Number:
27028 Date:
O Inch
Scale:. . .Oelock = .ft.
O N/A 1
■
No
.N.
o
...
..
0
..
.MIMME..
.ME.....
. .
........�.
.............
.
..........::�
........
..
..I
...
ME
..�.
.
0
.No
..
.�.�n
.............
............■..
.........
........
No
No
■
MMMIMMIMMMIMME
MEN
NNE
....................NONE
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:
Address:
City:
State/Zip:
The Veritas Group, Inc/Michael
PO Box 582
Kernersville
NC
Phone #: (336) 404-1522
Address/Road #:
152 Caudle Meadows Dr
Advance NC 27006
Structure: SINGLE FAMILY
# of Bedrooms: 4
# of People:
*Water Supply: PUBLIC
27285
0 3/ 1 7/ a 0 1 9
Property Owner. The Veritas Group, Inc/Michael
Ensore
Address: PO Box 582
City:
State/Zip:
Phone #:
Subdivision: Saddlebrook
Kemersville
NC 27285
(336) 404-1522
Phase: Lot: 711
Directions
1-40 east exit Hwy 801 go right South, right on Mocks Ch
Rd, Right on Beauchamp rd, right into Back side of Oak
Valley
Page 1 of 3
Classification:
Provisionally Suitable
Minimum Trench Depth:
a 4 Inches
\Site
Minimum Soil Cover:
1 a
Sa rolite S stem?
P y
Oyes 9No
Inches
Design Flow:
4 $
Maximum Trench Depth:
3 6 Inches
Soil Application Rate:
0a 7
5
Maximum Soil Cover:
a 4 Inches
*System Classification/Description:
*Distribution Type:
GRAVITY -SERIAL
TYPE II A. CONV SYSTEM (SINGLE-FAMILY
OR 480 GPD OR LESS) Septic Tank:
1 0 0 0
Gallons
*Proposed System: 25% REDUCTION
1 -Piece:
OYes ®No
Pump Required: OYes
®No O May Be Required
Nitrification Field
1 3
8 a
Sq. ft.
Pump Tank:
Gallons
No. Drain Lines
4
1 -Piece:
OYes ONo
Total Trench Length:
4 0 0
GPM—vs--
ft. TDH
ft
Trench Spacing:Q
—
Inches O.C.
9 ® Feet O.C.
Dosing Volume:
�J
_ Gallons
Trench Width:
3 O Inches
—
®Feet
Grease Trap:
Gallons
Aggregate Depth:
Inches Pre -Treatment: ONSF OTS -1 OTS -11 /
Septic Tank Installer Grade Level Required: 01011 O III ON
Page 1 of 3
CDP File Number 139829 -1
*Site Classification: Provisionally suitable
Design Flow: 4 8 0
Soil Application Rate: 0 - 2 3 5
County ID Number:
®Yes O No O No. but has Available
*System Classification/Description:
TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR
LESS)
*Proposed System: 25% REDUCTION
Nitrification Field
No. Drain Lines
Total Trench Length:
1 7 8 a Sq. ft.
4
400 ft.
Trench Spacing:
Trench Width:
Aggregate Depth:
❑ Open Pump System Sheet
9 O Inches O.
® Feet O.C.
3 OInches
® Feet
inches
Minimum Trench Depth:
a
4
Inches
Minimum Soil Cover:
1
Oyes
Inches
Maximum Trench Depth:
3
6
Inches
Maximum Soil Cover:
2
4
Inches
*Distribution Type: GRAVITY -SERIAL
Pump Required: OYes ®No OMay 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.
750
*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. �m;;;
2000
This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Permit, not
to exceed five years, and may be Issued at the same time the Improvement Permit Issued (NCGS 130A -336(b)). If the installation has not been
completed during the period of validity of the Construction Permit, the Information submitted In the application for a permit or Construction
Authorization Is found to have been Incorrect, falsified or changed, or the site Is altered, the permit or Construction Authorization shall become
Invalid, and may be 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 location, Installation, operation, maintenance, monitoring, reporting and repair
(1938(b)).
Applicant/Legal Reps. Signature Required? Oyes ONO
Applicant/Legal Reps. Signature, Date: /
*Issued By: 2140 -Nations, Robert
Date of Issue: 0 7 / 1
7 /.1 0
1 4
Authorized State Agent:Ni!
'_ Malfunction Log
Oyes
® Hand Drawing Olmport Drawing
**Site Plan/Drawing attached.**
Page 2 of 3
APPLTA FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
C�' Davie County Environmental Health
P.O. Box 848/210 Hospital. Street
I>•W �' Mocksville, NC 27028
(336)753-6780/Fax(336)753-1680
Application For: O Site Evaluation/Improvement Permit fa'Authorization To Construct (ATC) ❑ Both
Type of,Application: ONew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility
***IMPORTANT*** THIS APPLICATION CANNOTBE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
AYYLIL.AIN 1 1N P UKMA HUN
Name 7�c Vet;{ -;k arao -n c Contact Person cA�t { x✓.f[
Address .d. $ou 5'12 Home Phone
City/State/ZIP Kernrrayslk,nK an*,S- Business Phone
Email IMiKt @t?dns „c�iar%VPr. �. S • us.• -t
Name on Pennit/ATC if Different than Above
Mailing Address City/State/Zip
PROPERTY INFORMATION *Date House/Facility Comers Flagged 7—
NOTE: A survey plat or site plan must accompany this application. Included: O Site Plan OPlat(to scale)
(Permit is valid for 60 mpnths with site plan, no expiration with complete plat.)
Owner's Name_ & Veri o G oo� ., =.e Phonq Number 33C •SSW-/5�:3.
Owner's Address I r0. 1 s S$.T City/State/Zip_K z1^n-i2-V1/c,AAC ,P7,7J-$-
Property Address /$a Ile / rw City !�c%va..e�
Lot Size Tax IN# /
Subdivision Name(ifapplicable) >✓ �sl�e�. Sect �0IW4'4,&bk !��
Directions To Site:
Specify Problem Occurring:
IF RESIDENCE FILL OUT THE BOX BELOW
# People# Bedrooms Al # Bathrooms P.6' Garden Tub/Whirlpool es ONo
Basement: OYes No Basement Plumbing: OYes 00
1F NON -RESIDENCE FILL OUT THE BOX BELOW
Type of Facility/Business Total Square Footage of Building # People
# Sinks # Commodes # Showers # Urinals
Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption)
FOODSERVICE ONLY: # Seats
Type system requested:
nal ❑Accepted ❑Innovative OAltemative ❑Other
Water Supply Type: {County/City Water O New Well ❑Existing Well O Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes
If yes, what type?
LIM
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
Is s an rules. I unde Mand tha�.am responsible for the proper identification and labeling of property lines and corners and
loc n and fl gging r t n the house/facility location, proposed well location and the location of any other amenities.
Property owner's or owner's legal representative signature Site Revisit Charge
Date(s):
-Client Notification Date:
Date EHS:
Sign given ❑Yes ONo Account #
Revised 11/06 Invoice #
CONSTRUCTION AUTHORIZATION
Davie County Health Department
210 Hospital Street
P.O. Box 848
Mocksville NC 27028
)rawinu flrnwinn lima• Cnnstnirfinn Authnri7afinn
CDP File Number: 139829 - 1
County File Number:
Date: .07/ 17 1 x 0 1 4
O Inch
Scale: ` , O Block ft.
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-
Page 3 of 3 P1 P2
i
MINIMUM $6TBACK REQUIREMENTS (RA)
FRONT YARD SETBACK 40'
REAR YARD SETBACK 30'
SIDE YARD SETBACK 15'
-
SIDE STREET SETBACK 25'
- _ V 1b.
q�w
. - s sAxcT.ss ¢wD
. s{E¢
owv awD
'RELATYE TO
VICINITY MAP -
PB 10 PO 3�9
SCALE NTS
n K�70 GRT
SAWGROS DRIVE
50' PUBLIC RIGHT-OF-WAY
S89'41'21"E 20226'.
------
10" PUBLIC, UTUTY EASEMENT
4 ---------------------------- -------
---
SDE STEET SMACK'
___
.I
<I
I I
I
C) 8 6
711 j�1 3 0
aI
u .'� ��
P810 PG 349 I r gyp,
30,080 SF
In �I
'I gi
la
of L. i 7v MI YM0'SEIBACIC------.—� -
1
-
N89ror27 W 227.00'
�
710
PB 10 PG 349
- ¢TSEAL� =
•
L_ 1 -
LEGEND
Q IRON PIPE FOUND/SET -
- •.b y
E•
��
%� •. URVPS
PLAT BOOK
/hy,R . \ ``
DS DEED BOOK
PG PAGE
,.LINE LEGEND
BOUNDARY UNE
_ �r �T�
GRAPHIC SCi,AIZ
ADJOINING PROPERTY LINE— '—
'. b Q I
SETBACK LINE ------.----
_ `--�—�-�
-m
EASEMENT LINE-----------------
TIE LINE --- -------.--
SITE 'PLAN I IN F=T)
BUILDING UNE.
� 1 INCH m.40 FT.
PROPERTY OF VERITAS CONSTRUCTION
ADDRESS 152 CAUDLE MEADOW DRIVE
"
TOWNSHIP FARMINGTON 1COUNTY DAME
STATE NO , -
ZONED 'RA
SUBDIMSION-SADDLEBROOK AT OAK VALLEY
LOT NO. 711
SECTION 14
PLAT BOOK 10 PAGE 349
PUT REF. DATE JUNE 11. 2011
SCALE 1'=4D'LICENSE NO: C-1362
Regional Surveyors,
Land me.
8642 WEST MARKET STREET, SUITE 100
--
GREENSBORO. NORTH CAROLINA 27409
IELEPHONE,(336) 665-8155
NO. DATEREMS0N DESCRIPTION
BY JOBS 2014-3 1 DRAWN BY. KRL I DATE 7-9-2014
i
I
I
I
i
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i
APPLIGATION'FOR "ITE EVALUATION/IMP ROVEMENT PERMIT & ATC D� 0 —nn
Davie County Health Department U D
Environmental Heath "Teetion
P.O. Box 848/210 Hospital Street APR 6 2006
Mocksvllle, NC 27028
'(336)751-8760/ Fax (336)7:1-8786
Application For. D Site EvaluationMtp-mvemem Pennit D Authorirat on To Constmct(ATc) nBoth - ENVIRONMENTAL HFALTH
DAVIE COUNTY
a.YMPORTANT'sa TWS APPLICA'ITON CANNOTBEPROCESSED UT ILESS ALL OF TOE REQUIRED
INFORMATION IS PROVIDED. Ra", to the INFORMATION BULLETIN for instructions.
t
APPLICANT INFORMATION_
�rVV
rt/3
NametobeBilled 06111 11l4 0'+ 6Cortampetson 8Nf
Billing Address ¢ir Hume Phone — 6
City/State/ZIP - D Business Photic 2^ 00
Name on Permit/ATC if Different dust Above
Mailing Address City/SttitrJZip .
PROPERTY INFORMATION _ �f
NOTE: A army plat Orsite plan must accompany Ods application 15817 Ir -241
(Permit is valid for 60 months :vide site plan, no mpintion withwrrpl Tex PIN#
Sheet Address `Au .vaCity
{
Subdivision Name uM Section/L.o# // Let Sizes Pp—
Directions ToSite: /
Date House/Facility Comets Flagged YYlg f4J-
If the =war to my of the following questions is "yes", supporting documentadoy mast be atlaehed
An them any existing vrastmater systems on the site? Dy -
Does the site certain jurisdictional wetlands?
OYas o
An there any earenents or right-of-ways on the site?
DWS ONO
"
Is the site subject to approval'ry another public agency?
nY<s ONo
-1-11 "" M venerated?
OYw DNo
/ r
SA o Pk)
Garden Tub/Whirlpool OYes ONo
lF NON -RESIDENCE FILI.OL'T THE BOX BELOW
Type of Facility/BusinessTotal Square Footage of Building_ #People
N Sinks # Commodes # Showers _, _ # Urinals
Bstimated Water Usage (gallons par day) (Attach docmentation of similar facility water consumption)
FOODSERVICE ONLY: # Seats
Typo systemrequasted::�WCDnventiomd DAeeepted Dlo ovative DAlternative nOther — -
Water Supply Type: fdCounty/City'i'ew D New Well 13F. 1.1d.9 Well ❑ Community Wall
i
Do you anticipate additions or expansions of the facility this system is intended to serve? D Yes - o
If yes, wbat type?
This is to certify that the inforaation Provided on this application is live and correct to the best of my knowledge. 1 understand that
any permit(s) or ATC(s) issued bereafer are subject to Suspension or revue ation if the site is altered, the intended use changes, or if
the iefomtation submitted in ihie application is falsified or changed f undi rstand that [am respons/blefor all charger incurred
from this application. I hereby grant right of entry to the AWhorixedRepn senmtive of the Davie County Health Department to
conduct necessary ons r}p¢mdae cont Bence with applicable taus and odes on the above described property located n
Davie Coudy and orcaned b 'p q
YJ" COI' ..^(/ f7mp;"k. p s41
f
hV�'
r7onr l�
Site Revisit Charge
Date
Account#
Sign given UYes OND Invoice It _ri /aei
Revised 2106 -t
3 Sq. Ft.
r s e
st Ed d
e
30,894 Sq. Ft.
>I�
33,426 Sq.
Ft.
;q, Ft.
28'
0
Kassel
n Kassel
)go Wq
.377
Q
35,081 Sq. Ft.
St. Andrews Golf Villas
Section 98, Phuse 11, Section 2
Plot Book 8, Poge 21
4.
C8) 1 07
'54.9')G Sq, It. 35,486 Sq, Ft.
14 5' 142'
24.3'
—22)7
Q)
Lo
N
30+98 Sq'. Ft. X) 1 30,080 Sq. Ft.
ICS' I�
727
33,(p69 Sq. Ft.
264'
ul
30450 Sq.
Ft.
I 18
30,060 Sq. Ft
30,074 Sc Ft
25
(� O'b
30,,1,37 Sd Ft
-- -0p
?10
50' -j
62 6 /C
wi - ,Cd
Ide NCS'-
7
-- I?
1917t Of Qy)
'A—; F \
-I- — -6 , '9', 1 , , , ,/,
11
J)
30,078 Sq. Ft.
227'
30,078 Sq. ft.
30,040 Sq. It.
�,/
4o.o. 2,1
51,107 Sq. Ft.
2i1-
- MI
SII
Sq.
I i.
J)
30,078 Sq. Ft.
227'
30,078 Sq. ft.
30,040 Sq. It.
�,/
4o.o. 2,1
51,107 Sq. Ft.
2i1-
- MI
� y �
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/ Site Evaluation
APPLICANT INFORMATIOPJ PROPERTY INFORMATION
Account #: 990003765 Tax PIN/EH #: 5871-25-2458.06
Billed To: Oak Valley Associates Limited Partne Subdivision Info: Sawgrass Lot # 06
Reference Name: Bo Davis Location/Address: Beauchamp Rd -270 6
Proposed Facility: Residence Property Size: see map Date Evaluated: 2 1 O
Water Supply: On -Site Well Community Public ✓
Evaluation By: Auger Boring Pit ✓ Cut
FACTORS 1, 2 3 4: 5, 6 7
Landscape position .
Slo % . $ 7o
HORIZON I DEPTH
^
Texture grou
Consistence
Structure
Mineralogy,
HORIZON II DEPTH
Texture group I
Consistence- S �r
Structure S61c ' S
t.Mineralogy
HORIZON HI DEPTH 4'1-
Texture group
Consistence $�Ij �N .
Structure M M
...Mineralogy.
HORIZON IV DEPTH
Texture group
Consistence
Structure
SOIL -WETNESS
RESTRICTIVE HORIZON
SAPROLITE S .
CLASSIFICATION S'
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: EVALUATION BY: �EF� DtiA w. P
LONG-TERM ACCEPTANCE RATE: lJ OTHER(S) PRESENT: -
,
_..',..
,
REMARKS:
T.'
'LEGEND
'
Landscape Position
R -Ridge ' S -Shoulder L - Linearslope FS -Foot slope N =Nose slope'
CC : Concave slope CV'- Convex slope T - Terrace FP - Flood plain H Head slope'
S =Sand LS -Loamy sand' ' .,SL -Sandy loam L - Loam i ` SI -Silt
SICL - Silty clay loam ` SIL - Silty loam CL - Clay loam SCL - Sandy clay loam
SC'- Sandy claySIC - Silty clay ',C; -.Clay
CONSISTENCE —
'-
VFR - Very friable ' ; FR Friable FI .- Firm VFI - Very firm EFI - Extremely firm ,
}3eI.
NS -Non sticky SS ,Slightly sticky S -Sticky VS -Very Sticky
'NP - Non plastic SP - Slightly plastic P - Plastic VP - Veryplastic
Structuie
SC - Single grain M - Massive _, CR Crumb GR -;Granular ' ABK - Angular blocky
SBK - Subangular blocky PL - Platy. - PR -Prismatic
1:1.2:1, Mixed .
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).'
May 1, 2006
Oak Valley Associates, Ltd. Partnership
Attn: Bo Davis
3401 Healy Drive
Winston-Salem, NC 27103
Re: SAWGRASS Proposed Subdivision / Lot #
Caudle Tract / Beauchamp Road
Tax PIN# 5871252458
Dear Client(s):
As requested, a representative from this office visited the above site April 11, 12, 18,
2006 to perform site evaluations. Based on the information provided on the Application for Site
Evaluation and after the evaluation was completed, the site was found to be provisionally
suitable for the installation of an on-site sewage disposal system.
This Improvement 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 construction/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 or the intended use change.
Improvement Permit
System To Serve: ' �J�� GL= Wastewater Design Flow: 188
System Type: ❑Conventional �ccepted ❑Innovative ❑Alternative ❑Other
System Location:`. 1 /}moi/ Valid: 135 Years ❑No Expiration
Site Modifications/Permit Conditions:
TRANSPORTATION
SURVEYORS CERTIF]
PLANNING DEPARTMENT/REVIEW OFFICER
YS
I
t)
r r, 1.? RP_PQS ce�tijtl that ti
my supervision from an actual Ttify that
FINAL SUBDIVISION PLAT APPROVAL I•
This is to certi}y that this plat *nests the tscoyding "quirsmffnts i
/ lir;• uFw.nu:.y .
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County'Envirortmental Health -
P.O. Box 848/210 Hospital Street
Mocksville,NC 27028
(336)753-6780/ Fax(336)753-1680- _
Application For:. 0 Site Evaluation/Improvement Permit . . 0 Authorization To Construct (ATC) 0 Both -
Type of Application: ONew System ORepair to Existing System OExpausion/Modification of Existing System or Facility
r "'IMPORTANT.'" THIS APPLICATION CAANOT BE PROCESSED UNLESS ALL OF THE UQUIRFI)
Arr W GADI 1' IM URMFl U V N
Name. OR 130 A&A - - -Contact Per son A�
Address Ill b A Home Phone 17�u}eanTF•'• 1./ Il
City/State/71Pi1�er:.vjlla. i��/1360 Business Phan 112 .9 t'S eA.4q� ,
Name on Permit/ATC if Different than Above _
Mailing Address _ city/state/zip- -
PROPERTY INFORMATION - - *Date House/Facility, Comers Flagged_
.NOTE: A survey plat or site plan must accompany this application.
-is
Included: O Site Plan'.OPIat(to scale)
(Permit valid for 60 months with site plain uo expiration with
Owner's Name p0. H,,.�,�y
complete plat.)' : I
� Phone
Ntunbe j q
Owner's Address_ 2cw p—xe1 QN r Rk•y/ 3 } 1 lO A'
City/St t zip A'Ie -
Praperty Address - _ / -
Lot Size --30-,( # SR
Tax PINS/ -23
SRS/ -23-38A106
City /ry n� M
V
Subdivision Name(if applicable) ,57dJJehr»nk .-Section/Loto
Directions To Sitc: -
-
If the answer to any of the following questions is"Yes"supposing documentation roust be attached:
Are there any existingwastewater systems on the site? _Yes
No
Does the site containjurisdictional wetlands?
No -
_Yes
Are any casements or right-of-ways on the site?
No
_Yes
a site
Is Ute site subject to approval by mother public agency?
v r
_Yes
Will wastewater otherthan domestic sewage be'generated? Yes
_No
-No' -
# People
# Bathrooms Garden Tub/Whirlpool Oyes- ONo
'es ONO
IF NON -RESIDENCE _FILL OUT THE BOX BELOW
Type of Facility/Business - Total Square Footage of Building_ - It People -
IF Sinks # Commodes - N Showers - # Urinals
Estimated Water Usage (gallons per day)
FOODSERVICE ONLY: # Seats _- - (Attach documentation of similar facility water consumption)
-
Type system requested: 8'Conventtonal' DAccepted Mnnovstive OAltemative- a&er rtA'll/6h4A)—'
Water Supply Type: 0 County/City Water - 0 New Well ❑Existing Well 0 Community Well
Do you anticipate additions or expansions of the facility this system is intended to serve? O.Yes 0 No -
If )¢s, what lypeT
This is to certify that the information provided oh,tbis application is We 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 u'. '-
changes, ur if the information submitted in this application is falsified or changed I hereby grant right of entry to the Autsehorized
Representative of the Davie County Health Department to conduct necessary.iespecdons to determine compliance with applicable': -
.laws and rules. I understand that I= responsible for the proper identification and labeling of property lines and comers and
Iota rg and fla gin m ousdfac0ity location, proposed welt location and the location of rany other amenities. -
Property Owner's or owner's legal representative signature '. Site Revisit Charge
Dat !�— Client Notification Date: -
EIIS:
Sign given Oyes ON'o - Apcounl#, -
Revised 11/06- - 1ccaunt"R - - -
ll