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196 Sawgrass Drive Lot 718Applicant: Address: City: State0p: Phone #: CONSTRUCTION AUTHORIZATION Davie County Health Department 17 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Isenhour Homes/Rhonda Cheyne 3411 Healy Dr Winston-Salem NC 27103 (336)659-8211 *CDP File Number 196278-1 County ID Number: 587?23388t Evaluated For: NEW "Township:y 0 3/ 0 5/ a 0 a 1 Owner: Isenhour Homes/Rhonda Cheyne Address: 3411 Healy Dr City: Winston-Salem State2ip: NC Phone #: (336)659-8211 27103 'Address/Road #: SubdWsion:. Saddlebrook Phase: Lot: 718 196 Sawgrass Drive --Advance NC 27006 Directions Structure: SINGLE FAMILY ' Hwy ,158 right on Baltimore, left on beauchamp on left # of Bedrooms: 4 # of People: *Water Supply: PUBLIC of pp Icatan Ra e. 0 - a 5 1 a Inches *System Class ifxatbnlDescription: *Distribution Type: PUMPTOGRAVITY TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) S 1tT k' *Proposed System: 25% REDUCTION Nitrification Field 1 9 a 0 Sq. ft. No. Drain Lines 3 Total Trench Length: Trench Spacing: Trench Width: ep c an . 1 0 0 0 Gallons 1 -Piece: OYes @No Pump Required: @Yes ONo OMay Be Required Pump Tank: 1 0 0 0 Gallons 1-Piece:OYes �►ONo 4 3 6 ft. GPM—vs— It. TDH g Qlnches D.C. Dosin Volume: _ Gallons . Feet O.C. g 3 gInches F et e Grease Trap: Gallons Aggregate Depth: inches Pre -Treatment: ONSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: 01 011 0111 OIV Minimum Trench Depth: a 4 S@e Classification: PrmisionallySuitable Inches Minimum Soil Cover. 1 a Saprolite System? OYes eNo Inches Design Flow: 4 $. 0 Maximum Trench Depth: a 4 Inches S l A f t Maximum Soil Cover. of pp Icatan Ra e. 0 - a 5 1 a Inches *System Class ifxatbnlDescription: *Distribution Type: PUMPTOGRAVITY TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) S 1tT k' *Proposed System: 25% REDUCTION Nitrification Field 1 9 a 0 Sq. ft. No. Drain Lines 3 Total Trench Length: Trench Spacing: Trench Width: ep c an . 1 0 0 0 Gallons 1 -Piece: OYes @No Pump Required: @Yes ONo OMay Be Required Pump Tank: 1 0 0 0 Gallons 1-Piece:OYes �►ONo 4 3 6 ft. GPM—vs— It. TDH g Qlnches D.C. Dosin Volume: _ Gallons . Feet O.C. g 3 gInches F et e Grease Trap: Gallons Aggregate Depth: inches Pre -Treatment: ONSF OTS -1 OTS -II Septic Tank Installer Grade Level Required: 01 011 0111 OIV CDP File Number 196278 - 1 County ID Number: 5871233881 ❑ Open Pump System Sheet No *Site Classification: Provisionally Suitable Design Flow: 4 8 0 Soil Application Rate: 0 - a 5 DNo, but has Available Space Trench Spacing: _ O 9 Inches O: O. Feet O.C. Trench Width: Inches 3 . �► Feet Aggregate Depth: inches Minimum Trench Depth: a 4 *System Classification/Description: TYPE II A.CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Cover' 1 a *Proposed System: 25% REDUCTION Nitrification Field No. Drain Lines 4 1 9 a 0 Total Trench Length:. 4 3 6 ft: Sq_ ft. Maximum Trench Depth: a 4 Maximum Soil Cover. 1 a Inches Inches Inches Inches *Distribution Type: PUMP TO GRAVITY Pump Required: Oyes Pre Treatment: ONSF ONo ®May Be Required OTS -1 OTS -11 _ *Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. i *Permit Conditions The issuance of this permit bythe 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. This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Pennh, not to exceed five years, and maybe Issued at the same time the Improvement Permit issued (NCGS 130A -338(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 she is altered, the permit orconstruction Authortzation shall become Invalid, and maybe suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding systen location, Installation, operation, maintenance, monitoring, reporting and repair (1939(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature Date: *Issued By: 2140 -Nations, Robert Date of Issue: 0 7/ 0 5/ 2 0 1 6 Authorized State Agent: _ Malfunction Log OYes ®Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davle County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Construction Authorization CDP File Number: 196278 - 1 County File Number: 5871233881 Date: 0 7/ 0 5/.1 0 1 6 W W Olnch Scale: .OBlock ON/A MMMMMMMEMMMMMM EMM MMMMMMMMMMM MMMMMMMM MMMM mom M MME EMMM MM M 9MM MMmom MMM MM MMMM MMM Mmom MM MMMMMMMMMMMM CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number. 196278 -1 P.O. Box 848 5871233881 Mocksvitle NC 27028 County File Number: Date: 07 / 05 /2016 Click below to Import an image from an external location: Drawing Type: Construction Authorization SEPTIG TANK \ /6• mY \ QiSITE FLAN LOT 'i18SCALE: 1'= 30'-0' N. M II' 06' W. 334.94' x{11/QJ � 0 m 248 9(L 1 1 v tL N � 01 OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 ` ^^' Mocksville INC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Isenhour Homes/Rhonda Property owner. Isenhour Homes/Rhonda Address: 3411 Healy Dr Address: 3411 Healy Dr CRY: Winston-Salem City: Winston-Salem Statefzip: NC 27103 State0p: NC 27103 Phone it: ' (336) 659-8211. Phone #: (336) 659.8211 Property Location & Site Information - Address/Road #: Subdivision: Saddlebrook Phase: Lot: 718 196 Sawgrass Drive Advance NC 27006 Directions Hwy_ 158 right on Baltimore, left on beauchamp on Structure: SINGLE FAMILY left # of Bedrooms: 4 # of People: 'Water Supply: PUBLIC 'IP Issued by 'System Classification/Description: TYPE 111 B. SYSTEM W/SINGLE EFFLUENT PUMP 'CA issued by: 2140 -Nations, Robert . gaproliteSystem? QYes QNo Design Flow: 4 8 0 , PUMPTOGRAVITY Pump Required? *Distribution ®Yes QNo Soil Application Rate: 0 - a 5 'Pre Treatment: Drain field a 0 4 0 Sq. ft. 'System Type: INFILTRATOROUICK4STANDARD rcationField rain Lines 7 Installer: FrankTransou Trench Length: 5 1 0 ft• Certification #: 2771 Trench Spacing:9 — Inches O.C. SFeetO.C, 'EHS: 2140 -Nations, Robert Trench Width: - 3 Inches (@. Feet 0 7/ 0 7/ 2 0 1 6 Date: Aggregate Depth: inches Minimum Trench Depth: 3 6 Inches Minimum Soil Cover. a 4 Inches Approval Status Maximum Trench Depth: 3 6 p Approved ❑ Dlsapp�oved ` Inches Maximum Soil Cover, 2 4 Inches CDP File Number 196278-1 Septic Tank County ID Number: 5871233881 r. , Manufacturer. Shoaf Let. STB: 763 Long: Gallons: 1000 Installer. Frank Transou Date: 0 5/ 0 a/ a 0 1 Certification #: 2771 6 'EHS: 2140- Nations, Robed 'Filter Brand: POLYLOK PL-122With PipeAdapter ST Marker. El Yes ® No Date: 0 7 / 0 7./ a 0 1 6 Reinforced Tank: [IYes [N No " Approval Status '`, ❑; Dlsapprovetl:;,,.' 1 Piece Tank: ❑Yes D No <Approved'O Pump Tank Manufacturer. Shoaf Installer. Frank Transou PT: 42 Certification #: 2771 Gallons: 1250 'EHS: 2140 - Nations, Robert Date: 0:a /- 1 7/ 1 0 1 6 Date: 0 7/ 0 7/ 2 0 1 6 RiserSealed ❑« Yes ❑ No i RiserHeght: ❑E Yes ❑ No (Mm.6m.) App'ro'val Status einforced Tank: ❑ Yes [E No ® '=Approved, Disapproved z ': 1 PieceTank: ❑D Yes ❑ No Supply Line Pipe Size: a inch diameter Installer. FranknTrensou Poe Length: 1 8 a feet Certification #: 2771 'EHS: 2140 - Nations, Robert 'Schedule: 40 Pressure Rated ❑ Yes 2 No Date: 0 7/ 0 7/ 2 0 1 6 Approved fittings ❑ Yes (] No Approval Status ® Approved 0 Dlsepproved :`; Pump Requirement Pump Type: Zoeler Installer: Frank Transou Dosing Volume: — Gal Certification #: 2771 Draw Down: Inches 'EHS: 2140 - Nations, Robert 'Chain: STAINLESS - Date: 0 7/ 0 7/ x 0 1 6 Valves Accessible ff] Yes ❑ No Flow Adjustment Valve ff] Yes ❑ No Check-valve ff] Yes ❑ No Approval US, PVC unions ® Yes ❑ No®Approved ❑ Disapproved Vent Hole ® Yes ❑ No Anti-siphon Hole R) Yes ❑ NO : CDP File Number 196278 -1 NEMA 4X Box or Equivalent p Yes Box 12 inches Above Grade ❑w Yes Box Adj. To Pump Tank © Yes Conduit Sealed ❑s Yes Pump Manually Operable R Yes *Activation Method: PIGGYBACK Electric ❑ No ❑ No ❑ No ❑ No ❑ No Alarm Audible p Yes ❑ No Alami Visible ❑1► Yes ❑ No 2140 • Nations, Robert *Operation Permit completed Authorized State County ID Number: 5871233881 Installer: Frank Transou Certification #: 2771 'EH S: 2140 • Nations, Robert Date: 0 7/ 0 7/ -a 0 1 6 Approval Status ®:Approve'd❑ Disapproved, Date of Issue: 0 7/ 0 7/ 2 0 1 6 . Owner/Applicant Signature: • --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 III B. sewage septic system. Rule.1961 requires that a Type TYPE III B. septic system meet the following criteria: Minimum System Review ByThe Local Health Department: 5YRS. _.... Management Entity: OWNER -: Minimum System Inspection/Maintenance Frequency By Certified Operator: NIA Reporting Frequency By Certified Operator. NIA 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 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 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 bya public or private management entity, unless the system ownerand certified operator are the same. The contract shall require specific requirements formaintenance 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 OlmportDrawing **Site Plan/Drawing attached.** Drawing OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 e.,oDeratlOR Permit S CDP File Number: 196278 -1 , County File Number: 5871233881 Date: W W ` Q Inch Scale:. . .OBlock ON/A CONSTRUCTION AUTHORIZATION " Davie County Health Department I ' 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Isenhour Homes/Rhonda Cheyne Pro Owner: Isenhour Homes/Rhonda Cheyne Address: .3411 Healy Dr Address: 3411 Healy Dr City: Winston-Salem City: Winston-Salem State/Zip: NC 27103 State/Zip: NC 27103 Phone #: (336) 659-8211 Phone #: (336) 659-8211 Address/Road #: -- Subdivision: Saddlebrook Phase: Lot: 718 196 Sawgrass Drive Advance NC 27006 Directions Structure: SINGLE FAMILY Hwy 158 right on Baltimore, left on beauchamp on left # of Bedrooms: 4 # of People: \Water Supply: PUBLIC System Specifications Minimum Trench Depth: a 4 Site Classification: ProvisionallySultable Inches Minimum Soil Cover: 1aSa rolite System? OYes ®No Inches Design Flow: 4 8 0 Maximum Trench Depth: a 4 Inches Soil Application Rate: 0 a rJ Maximum Soil Cover:.1 a Inches *System Classification/Description: *Distribution Type: PUMP To GRAVITY 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: ®Yes ONo. O May Be Required Nitrification Field 1 9 1 0 S ft. Pum Tank: 1 0 0 0 Sq. P Gallons No. Drain Lines 7 1 -Piece: OYes ®No Total Trench Length: 4 3 6 g• GPM --vs-- ft. TDH Trench Spacing:, 9 OInches O.C. _ ® Feet O.C. Dosing Volume: Gallons Trench Width: 3 O Inches ® Feet Grease Trap: Gallons A99regate Depth: inches Pre -Treatment: ONSF OTS -1 OTS -11 Septic Tank Installer Grade Level Required: O 1 O II 0111 01V Page 1 of 3 CDP File Number 196278 - 1 County ID Number: 5871233881 ❑ Open Pump System Sheet Repair system Required: ®Yes ONO ONO, but has Available Space *Site Classification: Provisionally Suitable Design Flow: 4 8 0 Soil Application Rate: 0 a 5 *System Classification/Description: TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) *Proposed System: 25% REDUCTION Nitrification Field 1 9,12 0 Sq. ft. No. Drain Lines 4 Total Trench Length: 4 3 6 g, Trench Spacing:_ g O Inches O. ® Feet O.C. . Trench Width: 3 O Inches ® Feet Aggregate Depth: .inches Minimum Trench Depth: a 4 Inches Minimum Soil Cover: i 1 a In Maximum Trench Depth: a 4 Inches Maximum Soil Cover. 1 a Inches -*Distribution Type: PUMP TO GRAVITY i ,,Pump Required: Oyes ONo ®May Be Required Pre -Treatment: O NSF OTS -I OTS -II *Site Modifications .No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. a:mv a 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. R, , 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 (1936(b)). .. ., . Applicant/Legal Reps. Signature Required? O Yes ONO Applicant/Legal Reps. Signature Date: *Issued By: 2140 -Nations, Hobert - Date of Issue: 0 7/ 0 5 .1, 0. 1 6 Authorized State Agent: _ Malfunction Log O Yes ® Hand Drawing O Import Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 . Mocksville NC 27028 Drawing Drawing Type: Construction Authorization CDP File Number: 196278 - 1 County File Number: 5871233881 Date: 07 /05/.1016 O Inch Scale:. O Block O N/A Page 3 of 3 P1 P2 CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital street CDP File Number: 196278 - 1 P.O. Box 848 5871233881 Mocksville NC . 27028 County File Number: Date: 07/ 0 5 /.2,0.1.6. Click below to import an image from an external location: Drawing Type: Construction Authorization i CQNSTRUCTION. AUTHORIZATION Davie County Health Department 210 Hospital Street 1 P.O. Box 848 4y�.0 l Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Isenhour Homes/Rhonda Cheyne Address: 3411 Healy Dr CRY: Winston-Salem StatefZip: NC 27103 Phone #: (336)659-821.1 iAddress/Road #: 196 Sawgrass Drive Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: `Water Supply: PUBLIC L r Office Use Only ber 196278-11 � ���I1 ber. 5871233881 NEW PERMIT VALID UNTIL: 0 9/ 0 9/ a 0 a 0 Owner. Isenhour Homes/Rhonda Cheyne Address: 3411 Healy Dr CRY: Winston-Salem StatefZip: NC 27103 Phone #: (1336) 659-8211 Subdivision: Saddlebrook ASiteClassification: Provisionally Suitable Saprolite System? OYes ®No Design Flow: 4 8 0 Phase: Lot: 718 Directions Hwy 158 right on Baltimore, left on beauchamp on left Minimum Trench Depth: a 8 Inches Minimum Soil Cover. 1 a Inches Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 2 7 5 Maximum Soil Cover: 1 8 Inches 'System Classification/Description: 'Distribution Type: LOW PRESSURE PIPE TYPE IVA.ANY SYSTEM WITH LPPDISTRIBUTION Septic Tank; 1 0 0. 0 Gallons 'Proposed System: 50%REDUCTION 1 -Piece: OY,es ®No Pump Required: '*Yes ONo OMay Be Required' Nitrification Field 1 7 4 5 Sq. ft. Pump Tank: 1 0 0 0 Gallons No. Drain Lines 4 1-Piece:.OYes ®No Total Trench Length: a 9 1 ft; GPM—vs— ft. TDH Trench Spacing: 8 Inches O.C. Gallons gFeet O.C. Dosing Volume: — Trench Width: a Inches — 0jsFeet Grease Trap: Gallons Aggregate Depth: inchestic Tanklnstalle�GradeLerve-Tre Pre-Treatment: ONSF OTS -1 OTS -11 Se tic q OI OII OIII OIV CDP File Number 196278-1 irSystem RequiredAYes 'Site Classification: PS LPP Design Flow: 4 8 H Soil Application Rate: 0 a 7 5 'System Classification/Description: TYPE IV A ANY SYSTEM WITH LPP DISTRIBUTION `Proposed System: 50%REDUCTION Nitrification Field No. Drain Lines 4 1 7 4 5 Sq. ft. County ID Number. 5871233881 ❑ Open Pump System Sheet No ONO, but has Available Trench Spacing: _ Olnches O. . 8 Feet O.C, Trench Width: Inches — a W Feet Aggregate Depth: inches Minimum Trench Depth: a 8 Inches Minimum Soil Cover. 1 a Inches Maximum Trench Depth: 3 6 _ Inches Maximum Soil Cover. 1 8 Inches "Distribution Type: LOW PRESSURE PIPE Total Trench Length: a 9 1 ftPump Required: ®Yes ONo 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. —i 'Permit Conditions The issuance ofthis permit bythe Health Department in no wayguarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. g 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 maybe Issued at the sametime the Improvement Permit Issued (NCGS 130A -839(b)} If the Installation has not been completed during the period of valldIty of the Construction Permit, the Information submitted In the application for a permit or Construction Authorization is found to havebew Incorrect, falsified or changed, orthe siteis altered, the pennitorConstruction Authorization shall become Invalid, and maybe suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, Installation, operatlon, maintenance; monitoring .reporting and repair (1939(b)). ApplicantlLegal Reps. Signature Required? OYes ONO ApplicanHLegal Reps. Signature- Date: 'Issued By: 2140 -Nations, Robert _ Date of Issue:. 0 . 9 / 0 9 a 0 1 5 Authorized St8le Agent, Malfunction Log OYeS '19LUand Drawing import Drawing **Site Plan/Drawing attached.**' Page 2 of 3 J CONSTRUCTION AUTHORIZATION 196278 -1 Davie County Health Department CDP File Number 210 Hospital Street 5871233981 P.O. Box Bas County File Number: Mocksville NO 27028 Date: 0 9 I 0 9/ a 0 1 5 W W ' CONSTRUCTION AUTHORIZATION N. .%, Davie County Health Department 210 Hospital street CDP File Number: 196278 -1 P.O. Box 848 5871233881 Mocksville NC 27028 County File Number. Click below to Import an Image from a (�A.Vw-"j Date: 09 / 09 /2015 location: Drawing Type: Construction Authorization ej lil S U uJ 7 --7-1(0 -7 c� Lcz 5 ��.pep Iv 1(> i 3 9a r�(0 5- Lr f �7s � ��.•.. .� ^- SPS. yeA 00 Cl 07R lz 12.1411 Cb 2t' y .� 31 -knloo' "" i s N4 RigPuMPIINt= l X62 Aa i �� ;acv;> ® t S d� +7 z p GO I €; YAID - .-_ Davie County Environmental Health P.O. Box 848/210 Hospital Street RECEI` Dat! �bv_�_�� - - Mocksville,, NC 27028 ------- _(M6)753.6780/Fax(M6)753-1680 v >.. Application For: D Site Evaluation/Improvement Permit ; {Authorization To Construct(ATC) Both Type of Application:Xew System ORepalr to Existing Systcm DExpansion/Modiflcation of Existing S stem or Facility ;IMPORTANT"' THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. rt. ra 11il•uNr vivo ..• 11 Name to be Billed=$ QhV\0%X-'�sys.QS ,`J1 ULC Contact Person 1ZV%O YN&a Uie�c Billing Address 3'-1 1 1 M= egk l sn V) Home Phone City/State/ZIP W:v S\ -a n Sol\yvv N 6\-A to 3Business Phone - Name on Pemnt/ATC if Different PROPERTY INFORMATION*Date House/Facility Comers Flagged S / I I i L 5 NOTE: A survey plat or site plan most accompany this application. Included: jXSite Plan OPlat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) 50i -q a1 Owner's Name S t o sn h0 v.Y` NG YY1� S t LL C Phone Number Owner's Address -6(4 It tH Jk Vr City/State/zip W.'^ S a-o,r� S a •n w Property Address101 LIW�Y'6�jS_Dr - City I�\1aV'�t Lot Size 1 • Oto a Ya.. ax PIN# C$' -j A,:k 3415 I Subdivision Name(ifapplicable )�Section/Lot#— �-� Directions To Site:8Q01tAC11Ati.nn 02n1 .Fn r:n >'sv� ClAUST.IV meadows , answer to any of the following questions is `yes", supporting documentation Are there any existing wastewater systems on the site? ❑Yes;NNo Does the site contain jurisdictional wetlands? OYes;sNo Are there any easements or right-of-ways on the site? OYes�Wo Is the site subject to approval by another public agency? OYes)�No #People #Bedrooms 4— #Bathrooms _ Garden Tub/WhirlpoolXYes DNo Basement: DYes o Basement Plumbing: DYes DNo IF 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 Y. C Q-1\103 i Type system requested- Conventional ❑Accepted Olmovative DAltemative Bother Water Supply Type: ounty/City Water 0 New Well DExisting Well O Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes Xo - 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 comers and '�o��a7�In�g�nd�fl�a�ggtp'n�g or staking th lit e/facili location, proposed well location and the location of any other amenities. tih t `"^f', Site Revisit Charge Property owner's or owner's legal representati a si ture Date(s): ig I 1 O 1 S Client Notification Date: Date EHS: Sign given DYes Mo Account# f Revised 11/06 Invoice # p I I z I I� I I I I I I I �S. 6?d 48'54'E. 6051' _ Fla—ILOT NUMBIE ,MYVI S E N R O U RINYVRNE wINSiaR-ELLEN, NL TIIW memr�-�'�" ASHLEY FRENCH COUN'C8Y COA:ml[miBUFFETR �.�..�MOYE] ,y___, VPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC cation For: D Site Evaluation/Improvement Permit .D Authoruation To Construct(ATC) „*oth of Application: New System ORepairto Existing System OExpansion/Modification of Existing System or Facility IMPORTANT'** THIS APPLICATION CANNOT BEPROCESSED UNLESS ALL OF THE REQUIRED M ]Plat(to scale) / Number Directions To Site: If the answer to any of the following questions is `ryes", supporting doc=entapon must be attached. Are there any existing wastewater systems on the site? DYes o - Does the site comainjurisdictional wetlands? Dyes Vo �U" ; n ' ' 'Are them arty easements or right-of-ways on the site? Dyes In _L J&Ch"�' "`)"J Is the site subject m approval by another public agency? DY es (too - WBI wastewater other than domestic sewage be generated? Dyes 1Vo IF RESIDENCE FILL OUT THE BOX LOW #People - #Bedrooms #Bathro�ims Garden Tub/Whirlpool es ONo Basement: Dyes 8Yo Basement Plumbing:. Dyes OiGo IF NON -RESIDENCE FILL OUT THE BOX BELOW A Type ofFacilityBusiness -Total Square Footag 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]Conventional DAccepted CIanovative DAltemative DOther Water Supply Type:(County/City Water DNew Well DExisting Well D Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? D.Yes l to 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 Chan ar if the infeonation submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Rep s mtive o the Davie Cozen Health Depam lent to conduct necessary inspections to determine compliance with applicable la Hiles. enders tha t responsible for the proper identification and labeling of property lines and comers and to m e a ng use/fa i by location, proposed well location and the location of any other amenities. Propr o er's or owner's legal represen tive signature Site Revisit Charge " Dme(sj. Client Notification Dare: Da EHS: _ -i -, Sign given Dyes;ONoAccount# 6710 Revised 11/06 . - Invoice 4 APPLICANT INFORMATION Name to be Billed -111—' u k1 ` �;jC . Contact Person Billing Address Home Phone City/State/ZIP usiness Phone 7 _ - Name on Pennit/ATC if Different than Above :�yll I �.- a\ Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facili Cor. NOTE: A survey plat or site plan must accompany this application Included: ite Pls vali for 60 months with site plan; no ryimtion v'th complete plat.) (Permit is-40 Owner's Name Pht . Owner's Address City/State/Zip_ . Property a .. . City .. Lot Size Tax P it - SubdivisionName(ifappli e) - J— OD Section/LoO_ M ]Plat(to scale) / Number Directions To Site: If the answer to any of the following questions is `ryes", supporting doc=entapon must be attached. Are there any existing wastewater systems on the site? DYes o - Does the site comainjurisdictional wetlands? Dyes Vo �U" ; n ' ' 'Are them arty easements or right-of-ways on the site? Dyes In _L J&Ch"�' "`)"J Is the site subject m approval by another public agency? DY es (too - WBI wastewater other than domestic sewage be generated? Dyes 1Vo IF RESIDENCE FILL OUT THE BOX LOW #People - #Bedrooms #Bathro�ims Garden Tub/Whirlpool es ONo Basement: Dyes 8Yo Basement Plumbing:. Dyes OiGo IF NON -RESIDENCE FILL OUT THE BOX BELOW A Type ofFacilityBusiness -Total Square Footag 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]Conventional DAccepted CIanovative DAltemative DOther Water Supply Type:(County/City Water DNew Well DExisting Well D Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? D.Yes l to 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 Chan ar if the infeonation submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Rep s mtive o the Davie Cozen Health Depam lent to conduct necessary inspections to determine compliance with applicable la Hiles. enders tha t responsible for the proper identification and labeling of property lines and comers and to m e a ng use/fa i by location, proposed well location and the location of any other amenities. Propr o er's or owner's legal represen tive signature Site Revisit Charge " Dme(sj. Client Notification Dare: Da EHS: _ -i -, Sign given Dyes;ONoAccount# 6710 Revised 11/06 . - Invoice 4 • • + • j/. Davie County Environmental Health ' P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780/Fax (336)753-1680 IMPROVEMENT PERMIT Account #: 990005710 T PiN/EH #: 5871-23-3881.Lot#718 -Billed To: D.R. Horton, Inc 8u6vision Info: Saddlebrook at Oak Valley Lot # 718 Address: 2000 Aerial Center Parkway, Suite ' Location/Address: 196 Sawgrass Drive -27006 City: Morrisville, / Property Sizer 46,306 Sq. ft. Reference Name: Proposed "Facility�.;Residential __ , **NOTE* *This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Co (,a wastewater system must be obtained fmll this nff d� 'or to they- construction/installation of a wastewater system or the issuanc--off `�mg petmirlX'm comps a ice Article 11 of G.S. Chapter 130A, Wastewater Syste s Improvement Permit is subject to . revocation"if site plans, plat or the imendea a change. r Permit Type: IVNew DRepair []Expansion rermu v auu IV.- - - -- - Residential Specifications: edrooms' � # Bathrooms_ #People_ Basement[] Basement plumbing[] Non -Residential Specifications: Facility Type # People_ # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD):(C(�o Type of Water Supply: pCounty/City [] Well ❑Community Well Site Modifications/Permit Conditions: System Type LTAR Initial ` 3 Repair Environmental Health Specialist Date_ i.p.11-06 -• ;e 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 #: 990005710 Tax PIN/EH #: 5871-23-3881 Lot#718 Billed To: D.R. Horton, Inc Subdivision Info::.Saddlebrook at Oak Valley Lot # 718 Reference Name: Location/Address: 196 Sawgrass Drive -27006. Proposed Facility: Residential - Property Size: 46,306 Sq. ft ATC Number: 5805 SiteTvoe:.ZNew ❑Repair ❑Expansion "NOTE" This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A 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_Basement0 Basement plumbing0 Non -Residential Specifications: Facility Type # People_ # Seats_ Square Footage(or Dimensions of Facility) Lot Size Type of Water Supply: ❑County/City ❑ Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) Tank Size= GAL. Pump Tank )Z GAL.11 APO Trench Width q Max. Trench Depth Rock Depth 1 POR5 Linear Ft.3`w' Site Modifications/Conditions/Other: �A OddOl4 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. unCcgn ifnel en Lkes 41j be- Environmental eEnvironmental Health Specialist �YQDate: Z DCHD 11/06 (Revised) I APPLICA'T'ION FOR SI"PE EVALUATIONJMPROVEMENT P.F."RAT & A;I'C Davie County'Environ,mentalHealth - - P:O. Box 848/210 Hospital Street Mucksville,NC 27028 - - (336)753-6780/ Fax(336)753-168Q - 'Application For: D Site EvaluationQmprovement Permit D Authorization To Construct (ATC) D Both Type of Application: DNew System DRcpair to Existing System OEzpdnsion/bfodification of Existing System or Facility rI. ••fMPORTAN?`•* THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE�REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. ' APPLICA ppNT INFORMATION Name pfl_Hp111Een 'Contact PersonW )) Address O Home Phone F�.L City/State/71P �attsav jlla.1 C 3..n fob 'Business Phon(436 �0-t'til Name on Permit/ATC ifDierenr than Above ` '7—"—'�" Mailing Address_City/State/Zip PrcUr.MC.IY INPUKMAIIUN - *Date House/Facility, Comers Flaaeed NOTE: A survey plat or site plan must accompany this application.-' Included: n Site Plan OPlat(m scale)' (Permit is valid for 60 months with site Plan; no expiration with complete plat.) - Owner's Name (� >' ��_ Phone Nttmbe .Owner's Address 2[ti12�4. Ise . Mae S�_ } t lO A _ s City/St to Zip Meo"%: Property Address - - ,City G. - _ Lot Size_-„�� - '-Tax PIN# - Z -� - - SubdivisionName(ifapplica le) Salk/ghnmk _SectiorL/Lotk�_ Directions To Site: - - - - If the answer to any of the following questions is "Yes"supporting documentation roust be attached: - Are there any existing. wastewater systems on the site? No _Yes Does the site containjurisdictional wetlands? Yes No - Are there any casements or right-of-ways on the site? Yes No Is the site subject to approval by another public agency? No _Yes Will wastewater other than domestic sewage begencrated? Yes' No IF RESIDENCE FILL OUT THE BO - W - #People-#Bedrooms4Bathrooms Garden Tub/Wh irhpool❑Yes ONo Basement: DYes GN -0 Basement_ DYes DNo IF 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 dncumentation of similar facility waterconsumption) FOODSERVICE ONLY, # Seats - Type system requested: eConventional OAccepted OInnovative DAltemalive; n6ther 11hlej' Water Supply Type: D County/City Water - D New Well OExisting Well D Community Well ., Do you anticipate additions orexpansions of the facility this system is intended to serye? D Yes ❑ No - IfYes, what type? - - 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 arc subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in Ibis application is falsified or changed I hemhy grant right of e6fr to Ihe'Authorized Representative of the Davie County Health Department to conduct necessairy.inspections to determine compliance with applicable`'' laws and odes. I understand that I am responsible for the proper identification and labeling of property lines and'comers and - - locati g and flagg nuse/fecRiry location, proposed well location and the location of any other amenities. V� Property owner's or.woe's legal eepresentative signature Site ReviStt Charge' Dnl /� Client Notification Date:' _ EAS: Sign given Dyes nNo Account8, Revised 11/06 - - ln'vnide"I! - - - - ?&M TRANSPORTATION PLANNING DEPARTMENT/REVIEW OFFICER SURVEYORS CERTIF YS FINAL SUBDIVISION PLAT APPROVAL I, John F. Beeson certify that t This is to certify that this plat masts the recording requirsnwnts my supervision from an actual 57a mad of the stibdiviston Aegutattma Ar Davis County. (PB ption corded in Deed Book llt7 iTRUCTlON .page f'K that the ratio of N is 1 : 10.000+, and that this pial seas pre; I Aevisw 47-30 as amended Witness my original sit offtosr of Davis County, oertth that the map or plat to uihtoh this and seal this day of . A.D., 20 LINTY are the owners of the rd within the subdivision iereby adopt this 1 establish minimum sets, alleys, walks, parks, private use as Noted. Partnership ' I �1M ontijfoatton is ab%imd masts alt statutory nrquimwisTdr for neording. Approved DO -9— of Aa OWIArvtsui Ofr— This the day of 20 S""'ey°r NORTH CAROLINA —DAVIE COUNTY NORTH CAROLINA —FORSYTH COUNTY Certificate of Approval of Private (on-site) Sewage Disposal System I hereby certify that the Davie County Health Department has evaluated the Subdivision formerly entitled SAWGRASS at Oak Valley with respect to criteria and conditions established by state law or promulgated thereunder and the same is found to comply with such criteria and conditions EXCEPT as found in such evaluation. For details of this evaluation and for limitations see the written report on file at the said Department. IMPORTANT NOTICE: THIS CERTIFICATE DOES NOT CONSTITUTE A PERMIT OR APPROVAL OF INDIVIDUAL LOTS IN SAID SUBDIVISION Now or Former) FOR INSTALLATION OF SEWAGE FACILITIES. Sue 0. Whitehead, Deed Book 195, Page Q Date County Health Official PIN:5871-33-357 (`• QG e S00°52'33'W 1121,16' 250,00' �J 50,00' 133.63' 132.51' 132,50' Date Lr) o cu cu 0 71 N 3 Ln w I w w I 35,486Sq.Ft. CU ;D 711 CU ZD 710 (U o 709 !, (U } CD o O LP I o� I� 0 30,080Sq.Ft. to 30,080Sq.Ft. 1. civ 30,078S Ft. N00 17 53 E m cU m to m CU q 244.13' } Z OD � °�° Has OD M 0 fig. —10' Public Utili tea, 34,956Sq.Ft. '3106,64' 576,9432,51'- —132.50' - N00°52'33'E C E 10' x 70' auc Sight Easement N N00°18'39'E w I S00°52'33'W — 576.45' N88°39'03'E 99.75' —101.50' -114,65'- 79,62' � 3 5' -- � w - •- (U 00 - mal r -,v Sir cog' cu wo m C` .] o, �'" ch F M Qr, 00 �so� Z 721 3 722 3 cn (tl 35,081Sa.Ft. n I _ I D a` �� 720 NM �'oo Z N00°00'15'E v I `D tONo 130,088Sq.Ft. m 0i 0• cU w 229.18' 0D OD 0 6,33,069Sq.Ft.7 30,050Sq.Ft. Z 3( Cl) / �o 0 c� 0� G AF,A r o ,� , t3,426Sq.Ft. qtiS13°54, 6041G244.43 11/ �✓ 124.20' 114,74' 127,61' 1 3 3 571,23' Lv\ .ape may t .� 33,897S Ft. l N 30,894Sq.Ft. °o i� ii ( Z 7BSq.Ft. - ado%o o S� Robert Johi and Tracy Ail S� G°' S� c'1'1Q' Deed Book 548, Y � / M � � PIN:5871- 23 718 10' x 20' Z Signage 46,306Sq.Ft. o Easement o }c o 89°48'54�E ? o 60.5j - Kinn-1 i ,nr;'\.i — — — — — — — APPLICATION FOR "ITE EVALUATIONAMP ROVEMENT PERMIT & ATC E C nn---� --- )Davie County Health Department IS U IS Environmental Health Section r P.O. Box 848/210 Hospital Street APR 6 2006 D Mocksvffle, NC 270:5 (336)751-87601 Fax (336)7: ;1-8786 Application For. O Site EvaluationMtprovemem Permit D Authorizat. on To Conswct(ATC) - fl Both ENVIRONMENTAL HEALTH DAVIE COUNTY a•"IMPORTANT''' THIS APPLICA•tTON CANNOTBE PROCESSED U]•ILESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Re'er to the INFORMATION BULLEI:N for instructions. I �r APPLICANT INFORMATION Name to be Billed 'AIC 11 Inc. �), COntact Person Billing Addrme Phone 1110 City/State/ZIP — L 0 Business Phone z^ DO Name on Permit/ATC if Different than Above M, or site plan must accompany t d for 60 months with site plan, Subdivision Name - Directions To Site: plat.) Date HousefFecility Comers blaggrn Irtri� If the aoewerto any of the following questions is 1 yes'•, supporting documen:ado must be attached. An them any existing wastcwttcr systems on the site? OY[a Does the site eontalnjullsdl011onal wetlands? ❑Yss 0 An there any easements or right-of-ways on the site? DYcs ONo Is the site subject m epproval'oy another public agency? DYcs ONo - Will wastewater other than domesticsewagebegenerated? OO Y:a No _ r , IF RESIDENCE FILL OUT THIi BOX BELOW (V b C/( Sti Ul f �h #People #BcMnoma #�a ms Garden TubfWhirlpool Dyes ONo Basement ❑Yes ONo Base:nent *BELOW ❑Ycs ON. IF NON -RESIDENCE FILL OL'T THE BOX BELOW Type of Facility/Business Total Square Foolage of Building_ #People # Sinks # Commodes # Showers —._ # Urinals Estimated Water Usage (gallons per day) (Attach doc.nnentation of similar facility water consumption) FOODSERVICE ONLY: # Seal Type systemrequested: tdConventional OAccepted Dlnnovative OAltereative r10ther _ Water Supply Type: r. County/City water D New Well OFz fisting Well • D Community Well Do you anticipate additions or expo ®.ons ofthe facility this system is intended to serve? D Yes tA'Id0 Ifyes,whattype? This is to certify that the information 13rovided on this application is nue an d correct to the best of my knowledge. 1 understand that any permit(s) or ATC(s) issued hemalte, 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. l undo Word Mat lam responsible forall charger incurred from this application. I hereby grain right of eetry to the Anthoriud PwVrtsentative of the Davie Conety Bealth Deparbneat to conduct necessary tions�°��lscf�mune 7co'te Eance with applicable lana and rules on the above described property located in Davie Calls, jj..avmedbY`a s"/11,�.pLI JJ lg (idle, [ori/u j^r•'l^ ,4 ,7 f ��f] ASjG�lrltill LI [ • P S�'p .M Mn.Vri Al Sim Revisit Charge H Sign given DYcs ONo Account # 00 31 `r Revised 2106 invoice # 1154L2!/ y 88' 13 53,133 S\NFt. 12 I 33,278 Sq. Ft.l 30,894 . } 4t> es ode Course Dive Ft. �P Qe �P.pe Fere llc 10 33,426 Sq. Ft. s epo \\\xz O 35,081 Sq. Ft. St. Andrews Golf Vill .Section 98, Phaee II, Section 2 Plat Book B, Page 21 ' q ® O 34,956 Sq. Ft. 35,486 Sq. Ft. 145' _ ,42'CTJ - - 243' �� 227 o 6 Q�m� 1151 a �C;i @ n Z 100' 33,897 Sq. Ft. I r O z2B' 30,¢88 Sq. Ft. f �M 30,080 Sq. Ft. �. AX)e .. �T / 0 270 227 � 4tte ol�I,j�11�'o/� N I 16 tp N A I F1N I �; 33,169 Sq. Ft. IY�� O .' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003765 Tax PIN/EH #: 5871-25-2458.13 Billed To: Oak Valley Associates Limited Partne Subdivision Info: Sawgrass Lot # 13 Reference Name: Bo Davis Location/Address: Beauchamp Rd -2 Proposed Facility: Residence Property Size: see map Date Evaluated: a7120l1 Water Supply: On -Site Well Community Public_ Evaluation By: Auger Boring k Pit Cut FACTORS 1 2 3 4• 5 6 7 Landscape position 77777 - Slope %..: ..... o 0 HORIZON I DEPTH i Texture group, C, Consistence Pop Structure �PY: 759r .Mneralogy HORIZON II DEPTH Texture group Consistence " Structure Mineralogy HORIZON III DEPTH Texture group Consistence .. .- _ ...... . Structure ...Mineralo -! HORIZON IV DEPTH , Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON' SAPROLITE CLASSIFICATION 5 -' LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION EVALUATION BY, IETW 'LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: , t .REMARKS: tandccane LEGEND Position .. .. _ - g pe pe '. CC Concave sloe CV - Convex sloe T - Terrace FP - Flood lain R Ridge , ,, S -Shoulder L - Lineaz slo FS -Foot slope. N -Nose slope P P p e lope Texture =H ads 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' -. - y VFR - Very friable i FR Friable F1'-, Firm .VFI - Very firm. ,_EFI - Extremely firm i. , - ` • NS - Non sticky, SS - Slightly sticky S Sticky VS = Very Siickq NP - Non plastic SP = Slightly plastic. P Plastic . VP - Very plastic, ' Structure' . • .. - - i ' - `SC = Single grain _ M - Massive .,CR - Crumb GR - Granular .... ABK - Angular blocky SBK-'Subarigularblocky PL -Platy PR Prismatic : S- Mineraloev t 1 1:1,2:1,'Mixed Horizon depth .In inches Depth of fill - In inches Restrictive horizon Thicloiess 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/M DCHD 05105 (Revised) 23_ 0'5_'03: 45p _ - 336-794-3105 p.2 .oe(? APPS; CATION fest SAE EVALUATION/11a91011BUINT Prn&trr S ATO - Davie County Health C )parDnent ' P, O. Boz OQD/210 NoaP Leal Sta:adt Box a/ne/Ifa7 llomr tta l S • Mack3trMa, NC 27020 - _ (3361751-671:0 •••11fPORTANT•.• 19115 APPLICATION CANNOT SIE PROC.?SSED It11LESS ALL THE REQUIn£D IRFDANATIDN 15 PROVIDED. 'Refer to the 7MRAT::ON But== for itobeiiatSann. 1. Nem /1(� )50 DCWS Do pilled 1i4kd((e�l HiSgaN�Y�1 ��,�. p4 ('Ae�ICWleact to peeow, . 0.1l1Dg Amei., �-16 �'��-"'�h U/. Nom shoo ...... " cur/Deaeyttp ;,,Jrnfi't--Sc-4vr, ItJ1:, •.�•710(,f amiaaeevmna i/3G� -7 3161 I . f. a. an f eodVATC 11 D11la1aat a'. lhove IdiS TD � dewL/)2N FF IWlinp Aedreea .iFs„{ my/ tate/L1P '� n , a. APptiratlon iorl Sita Elraxuatl. Ef Im:mevamant Polvit/ATC O Doth n rifle, e.. syaeea to scavlca, 6a'i[ouoe O NobixO Roma O nue i.aeaa ❑ mduuer] ❑ OI:IIas Sley (QI ViA Iat- f L' S. rya..r.t. a-anu.otad: 13 fto aattonaa 0 emveaLlonal :tea111cd O lnnwaelTa' 93accep Cud �1 f. xe��penleeaae: / PooP].n f acaroJJ•:aa � o DAWroolw 7 \ - FdUt, Maabet 4/Caibaa. Dlapual •IAR+ahlop 34eL1d. N:uaemnt/PluSLg 13b..unontio. pia -a T. Tf baolao../Tad.otcy /arD.t: vatlty type I paopl. k Slake f C000lev__ 0 sloven 'f Dela.lr /Hates Cd.ler - ,. IF. roQVSERVICS: D Santa, Entflaa Cad Wn for Vaage'goal.. pat day) e. Trp. o1 ..tae..Mly, f/Cavaty/City, ❑ No.11 13 eamlunity .. S. myw..ttelp•to aduue or eapewiol OrnIC faolilythis sy311'I0 i564eadtA to Sent? 13 yes, rCa - Ifyts,lvllat type? •••CUEN7:A/USTCOAfPLf)ETILE'REQDLSEn PROPGItT :tL1T10N RRQVRSCEtf •'I ` ONYO-ift el IIIi1.O1V. EiIHo-P1.ATar51TIt PPLANAIU.STRCSOrtdrll'lF.Obylhetlleel a1th TI IISAPPIJ CATION. TC IS - - • " Properly DimunsiolV:",C feel R00�1iwy IyurrE 31RECTIMS(frmn hloclaYillc) to PROPERTY: ' g71 - Tax O[Orc PIN: RG ✓11I PropertyAaaress: Road ttamc_ Ai. A�IZ' (flew. /1-A NS 1JL1 d(. - - -•' .If in A Subdivision provide Information' as follans: - " Section: Dlock: Lot: Dale 110 -3a terms Ragged: - This is[a teriffy that Clio iidunitilitinprovided Is coned to the but ofinyk olviedge. f undusimld lhalnny pennii(s) .. .. .. _ -Issuca bercaOcr Are subject to suspension or revocation, if Me site plans or 1. twided use change, or it the luforumtiin . .. ' subulm Miss this application is falcHavi a, duaged. 4 drop andenteudrAet:ant ruponsibleforoff divalwin:urredirrnm rbbepplicn/(on. I,Aereby,'give commit to Na Authdrtnd Repraclmtive oLbeD2ACCounry•1ica111 Departnunl� . to enter spun above ductibea properlylocafed in Davie Counlyand mm 'OA IA- ([i. ilf(7/ - .. .. ' Io lonUu[Iallfcsliugproecdura a`s uemSary to Jalemlble fhesi[esuilahiSlyS �rZj•'iis �/,:c _ ., ' - . DA•1•C' '_ SIGNATURE, w, 1,14 R•et.7 .. .. .. . 'yUISARRA MAYBE USED FOR DRk%7NG YOUR SIMPLAN(foduddcca0 arlbe'fo0mying: ]i:trOng dna prnpnsea _ ' . properly Dna and dlmulsloas, siructursa, sclbatk; and septic lonitalls). -" - •, - . . .. --SiteRevisit Charge . • . -. .. C7kntNoDOtAtlan Dole: - ... '. Sign givtn A—unt No. McNeil MID (05/03 ' Invai¢N0. : DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section. Soil/ Site Evaluation APPLICANT INFORMATION Account #: 990003765 Billed To: Oak Valley Associates Limited Partne Reference Name: Proposed Facility: Residence Water Supply: On -Site Well. Evaluation By: Auger Boring V-1 Property Size: PROPERTY INFORMATION Tax PIN/EH #: 5871-25-2458.25 Subdivision Info: OakValley Lot # 25 Location/Address: Oak Valley Boulevard -27028 see map Date Evaluated: Z Community Public ' FACTORS 1 1 2 3 4 5 6 7 Landscape position A L Slope % HORIZON I DEPTH -Pel Texture. group Consistence Structure . Mineralogy HORIZON H DEPTH t . Texture groupCy, Consistence AS Structure Mineralogy< HORIZON III DEPTH u 'Texture.kroup. 'Consistence . Structure Salt Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE t^,' C7TR rr.A.CCiArr'ATrr1N• I - n.,. r,........-.,.,. c�a.�Cr srr7P.r=/Q. �- TLV Al1V1\ L 1. LONG-TERM ACCEPTANCE RATE: S© 27 OTHER(S) PRESENT: f REMARKS: 4ay N�1� MICA l7 (.reg N&'PlAu3 1e syyo-' mJ cxi„�L 3,06,- Landscape Position LEGEND 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. Moic VFR - Very friable 'FR - Friable FI - Firm VFI - Very firm EFI -Extremely firm 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 - MassiveCR - Crumb OR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogy 1: 1, 2: 1, Mixed LY9SeS ' s Horizon depth - In inches Depth of fill - In inches Restrictive horizon Thickness and inches from land surface - Sepiolite -, 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 - Lone -term accentance rate - gal/dav/fO.. - n Ae,ne � _..:__., Davie.County Health ';Department - Environmental Health Section P.O. Box 848/216 Hospital Street Mocksville; NC, 27028 (336)751-8760/ Fax ,(336)751-8786 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: 1'i N j�EJJ)EY-C-G Wastewater Design Flow: System Type: 66onventional ❑Accepted ❑Innovative ❑Alternative ❑Other System Location: dQ E�,rrV�li�sk,� Valid: 83'Years ONo Expiration Site Modifications/Permit Conditions: ps-i.p.letter 2/06 DAVIE COUNTY HEALTH DEPARTMENT y' Environmental Health Section Soil/Site Evaluation -APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003765 Tax PIN/EH #: 5871-25-2458.25 Billed To: Oak Valley Associates Limited Partne Subdivision Info: OakValley. Lot # 25 Reference Name: Location/Address: Oak Valley Boulevard-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: aS7 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS. 1: 2 �3 4 5 6 7. Landscape position L -HORIZON I DEPTH _ 1 Texture group Consistence Structure Mineralogy HORIZON H DEPTH (J- Texture group 7C� Consistence f Structure Mineralo HORIZON HI DEPTH, '7Texture, rou 'Consistence Structure 501 Mineralogy .HORIZON IV DEPTH Texture group Consistence Structure , Mineralogy SOH. WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATTLE SITE CLASSIFICATION. I S EVALUATION LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT. REMARKS:V `; L2s,JR(/acti .c CA4n�IL` �t�tY� Ir Siati2s.: 'mJ,'w _ LEGEND .. i.andar ,ne Position. .. ., . R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope' CC Concave slope CV Convex slope T - Terrace FP - hood 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 ,. 1SIC - Silty clay C.- Clay CONSiSTF.NCF. Moist VFR - Very friable FR - Friable FI - Him ,. '. VFI - Very firm :..:.EFI _ Extremely firm .. ' 33'et 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 MassiveCR - Crumb GR Granular..:.ABK - Angular blocky ; SBK - Subangular blocky PL -Platy PR - Prismatic. Mineraloev .., :.r :•,, s a. 1:1,2:1;Mixed Mutes - Horizon depth - In inches - Depth of fill In inches Restrictive horizon = Thickness and inches from land surfac Saprolite - S(suitable), U(unsuitable) : - r Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chmina 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05105 (Revised) I'•aep tU-Ub UU:9bp Ujb--fag-j1Uo p.t APPY CATION AOR S1IE EVALt%7)ON/lntI RoMlWr PONIRS ATO Dave County Realth C 1parhnint _ P.O. Box 848/310 Roop teal Street - 'NocksirLue, NC 27020 (336)751-870 000yHPORTANT«rn =rs dppz,=l,7 DN CdMfOF Bs pRot.383HD MMWS AAL THE REQUIRED - SOPORMATION r5 PROVD)ED. Hofer CO the SNFDM2::OR DQUMM for lnatrueUond. no omen (.1In anry psso:yrl W -A. Y4rfA✓'ew,raec I.r ea bo U4vt1 /v Na111og Adele•.. J. -1161 Ham+ �/. Sero Vilest. s76-�y�3r�f rur/rtae.rsp Wt.v(iD�"Sctte, �1.ii. -iil(u((3 IIn-o__eloea.. p�roIne 1. Now vv p.talt/ATC It Dlffeteat than abwa �l'1 S )0 Cly /�(�4C^o nee; r " Holum Adds. .SF.yH { awl,"t.G/up •� • - n ! 1. Applittelon i".. dsitt RI•alu.U.a - O y ¢.vaagnt D.aeiC/ATC 17 Doth Ae e"��/(1 n fount C54�CLId rQlJ fh 1" d. sy.m. to aeM[u 9/R.uae 0 asvbiio Hoau D Ducineaa O IDt(uatsp O OGwr 6 s. *V" ort. a'..v.x.da i�cen.mtaw.a 13 <o.vonuolul :adttSN 17 snawauve CJncceprod 6. iE'?"Idaneo: I Pooplat DCdtacaa / DatDrootm . fdOlahwa.mraa.aae Dlapaa.t �N.etdvp Naeolae IO�m.ewne/11meLg []Caaet.tJlte p]wLlna .. 7. It nwtstaaa/Iadv.ay /OGwr: nurl[y typo I +.on)e �� I sink. t'0•ob. _ 0 EAwar.- E atlas. I Ndtr1 Cooler. t TE.FOODCRRVICR: 0 Seta RatiID.tod Meer R..go loarl.v par dor? E. typo of orator n lr, County/City Q No.] l - 13 Co»enicr I. pe>our.itulp.t.aa.tnwuerrapausi0usoftaaraaajthissysnm)s(utendmtom ??Yes 1A. (fya.IAlAityp.! __.--------...-.`_.{.._._....___.._...,......, Property D•uwnskiw. c `,)CL AI(,'1� WHITE)IItECfIfhVS(rrvwhlogsllk) to PROPIERTY:' Tu OlQcc PJN: dcJ g��- a� tS TSB II - _ ' ProperlpAditme: Road Name_ Ai, alld' stat,..., '[ wy j✓Ll Jv Glytip - Me a Subdivision pro.ide kfornatiny ss fenalvs: Section: Block: Lot: Date ho,ae comers nagged: - - TAB It to Wulf that [be )ufurtulQen pmrldd B correct to (be but of my k onledge. I undtMai,; that anypemdi(s) Wiled LerealtcraresatJcd to wspention of rwaeation, ((tbesi[o plass ort (ended use daagq orlrme (ufoluution suhndtld is lDB apptiatiwafatriruvl of CIMUCed ya4e, anderHeiufrAsr.'w, respw,ribkforalleLnCerLlmmdfrnw rbirapplirnfion. WiMby,girt mnsmlto the Autedrfeed RcpraantaGre or. toDmieCountyy1fa111 Departunall Io cuter Npun abets:dacdbEdprapertylonted in Davie Countyand mm toconduct an talliiingprocduraxotassary to detemdno thesite suilpLitity) // DATE "!•r 23-0 $(pVATtIRE� ,� .. iTjlnli.-1,144R'ea� TDISAMMAYDEWED FORD1(ARINGYGDRSMPLAN(IadudcnO of Me fonolrioy eLsaoufatNpmposed Property Dna and dhnmslosus structural senuclai, andsepOelowit M). Site Revisit Charge • t]kutNoDl)atlan Dalt Sign given ,AcriuntNe. RtviseADCIID (OSl03 Invoice Na