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109 Redmeadow Drive Lot 36Account #: Billed To: Reference Name: Proposed Facility DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 990002436 Tax PIN/EH #: 5861-38-2199.36DB Darren Burke Constr. Subdivision Info: Redland Place Lot # 36 Location/Address: Redland Road -27006 Residence Property Size: see map ATC Number: 3825 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1909,5=Age Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER -CONS TIO IS VAUD-EOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's CERTIFICATE OF COMPLETION Date: **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 746, been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and 70 710 Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 16 0 ki V U✓ Date: /Z ZLO —a DAVIE COUNTY HEALTH DEPARTMENT Z Environmental Health Section P. O. Boz 848/210 Hospital Street y` v Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002436 Tax PIN/EH #: 5861-38-2199.36DB Billed To: Darren Burke Constr. Subdivision Info: Redland Place Lot # 36 Reference Name: Location/Address: Redland Road -27006 Proposed Facility Residence Property Size: see map ATC Number: 3825 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of a system or the issuance of a building permit (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type goof 'C- #People H #Bedrooms H #Baths Z.S Dishwasher: M" Garbage Disposal: ❑ Washing Machine: E( Basement w/Plumbing: e Basement/No Plumbing: ❑ Commercial Specification: Facility Type n #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 0.114 htlz-&� Type Water Supply ( Design Wastewater Flow (GPD) L -RD Site: New G?"' Repair ❑ System Specifications: Tank Size tOCOGAL. Pump Tank 1CCO GAL. Trench Width o Rock Depth 12:' Linear Ft. qe& Other: J5 �IS'I-�ttF��ftJ�cc-S Required Site Modifications/Conditions: kJST5 L.L- (>.j CO),YrOL�2, V -O& 16 0(r- P2ASP t_IA-,S, IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** N3 1 T �J LIJp b, ,coo V st+ uo EnvhZn ental Health St pecialist's Signature: Date: Z 0 DCHD 05/99 (Revised) ).J . . - 35'46" w U Rf'�) —77 N85.55 �32 „w o o O �-` S55 '- "E , � � 10' x 70 - �.. Sight Fsmt z 36 Z .35 0 4 CJI N rj 0 31,904 S rn N 31,543 Sq. Ft. to N 0.732 Ac9esf cn v' 0.724 Acres S Ft. • i q ...! } W Acres± _J 4- 7'(jotnl) ,%nf 105.071 11 7. B'7' 00 N�N 8,ant H. Godfrey Tax Map E--7 (D Lot 3304 N�.. DB- 194, R9-755 �'.. Nall Set - --. IC) tPr�E?��ticr 1 i Jul '�l 04 0:48a Darren Burke 336-778-0436 p.1 S`I-Jun 1003 1:14a davle county envhe,alth 336 751 0766 p.Z API'UCA'IION FOR SITE LVALUATM/IMPROVEMENT 1'L'1l llf J, ATC V Davie County Health Department Eayllw1 ei l71114W 5L- ibw J P.O. Dox 848/210 Hospital Street Mock3ville, NC 27028 (336)7S1-8760 I IMPORTANT-*- TRIS APVLiCATION CANNOT BE PROCESSED UNLESS ALL THE RCQUIRED IN --I FORHATION IS PROVIDED. Rofer to the IRPORMATZON BULLETIN for instructions. I+ 1. Name to be filled �&rrad T.I tLe'/Ceptact Person rd;-,/ Nailio0 dresa �4L5 (— 1_ '� � / ti,% • Llama Phone ^% !✓ lr• �- L�„�_ .ley/state/zIp �rtr :,'t.lalt�C 'lJ!' a7"er lata• Pbooe 927 <41 1. IIw en Pe—lt/ATC It olft■rn.t than Aboe• . liailLng Address City/Stat•/tiP ~— _.. ,•„_ _,_ a. nppiication Foe. ❑ Gitc :valo tion ❑ improvement Permit/ATC BOCK t. System to 9ecvlcs:�llOtn9e ❑ Mobile Home ❑ Dua1II.S3 ❑ industry ❑ Other _ S. TrPs aystem r•quasted Cbaventianal ❑ conventional modifier) ❑ lonovati.e t s. if Residence: P People. q 0 Bedrooms 0 Datilrooma Dl :? eheb vasb•t ❑oaage DUpnsal aaWq machine Weaeanent/Pir.mbinq On uu o Plbing 7. IL au■Iw•s/I�wtry /other% vailey type / / Peopla P Sinks _ x Cpmodes 0 ;h—t• 0 Urinals P Mice.' Coolers zr FOODSERVICEI B Seats Eatlmated Hater Usage loallons per dayl s. type of water ■upply�oult'y/City ❑ 11.11 ElCossnunity f. on, you anticipate a "ddstioons oe eapaltsious of the facility this syslent Is lulcudfd to servo: ❑ Yes )3zu If yes, w bat type •••IMPOR7*AM1 •• CI.IFN'S Vf"TCOb1PLETL• THE REQUIRED P1tOP1 ATV INFORMATION imotlFS rtm BELOW. EJlhera PLAT or SI rE PLAN J1USTRESUBMITTED by the client with THIS APPLICAT(ON. p Iti3 r' X 2�-� �'3TJ l3 SPropertyDiniensimis: \VRITEDIII(ECI'IQNS(frvw dl loviillc) lu)'Itgl'lGlrl' (,' Y Tax Otficc I•Qv: �` l` r'. t7i%c�'� ak, Property Address: Read Name_ cttymp _ It in a Subdivislou provide Informm-ion, as follows: Names i Section: Block: _ Lot: .—'> (1-1_ Date house corners fligged: I) f This is to certify that the information provided is correct to the best of my knon lcdgto I uudcrstand that any perutit(s) issued hereafter are subject to suspension or revocation, If tho site plans or in leaded use change, or if Ilse inlornlation subnsiited in this application is fabirwd or chanscd. I, also, uwJrrstand that I amt responsible for alt ehmres incurred franc this upplication. f, hereby, give consent to flit Authorized Reprtsculalive of the Davie County Uerlth DeLmrbncutL to cuter upon above described property located in Davie County and *wiled by 1;” to eondurt all testing procedures as necessary to determine the site suitability. DATE -7' 2- ( - SIGNATURE ti THIS AREA MAY BE USED FOR DRAWU4G YOUR SITE PLAN (Include all of flit followiuc: Exis(lug and propused property lines anddillxnuons, structures, setbacks, and septielocations)6 Site Revisit Charge Datc(s): Client Notification Date: EUS: Sten elvcn Q0 0 Revised DCHD (05103 Account No. ��. Invoice, No. APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 DEC 3 ?0o2 fN�tDAvl,c rot n%q ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUI I INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Mailing Address Contact Person Home Phone LIS�'X— City/State/ZIP 4g) -5. ��, 2Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: 91-5ite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms 171L, Dishwasher ❑Garbage Disposal U Washing Machine Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # People # Sinks # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: B--Gounty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? 8 -Ws ❑ No If yes, what type? 'IMPORTANT' CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: , 5� gi Tax Office PIN: # 59 — -;Z/ 9 7"" B Property Address: Road Name -,dLEI[(/ City/Zip If in a Subdivision provide information, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: 1-5y EA -4,/ LC �- ZZV,/ �-�/ A /) olz� Name: t�5;� � pew MAP Section: Block: Lot: _SOT 3(I Date Property Flagged: Ir;? 3— This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges ilicurrerl from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by �y�„����✓�t�tl 5 to conduct all testing procedures as necessary to determine the site suitapility. oMER/� iZ"NUMWE9VW.O®/�y THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size Water Supply: Evaluation By: On -Site Well Auger Boring PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.38 Subdivision Info: Louise Smith Adams Lot # 38 Location/Address: Redland Road -27006 see map Date Evaluated: 0 Community Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence —� Structure Mineralogy HORIZON II DEPTH Texture grou2 Consistence Structure a , Mineralogy HORIZON III DEPTH Texture group G4 Consistence Structure MineralogyI HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE " '10. SITE CLASSIFICATION: V3 EVALUATION BY:, LONG-TERM ACCEPTANCE RATE: D` �Jr� �' OTHER(S) PRESENT: REMARKS: �Afi ll� I✓� Z211 ►JO W4ir& tti C 1 T LEGEND Landscape Position R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope CC - Concave slope CV - Convex slope T - Terrace FP - Flood plain H - Head slope Texture S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/99 (Revised) N Q 0) L T7 W C 0 L L N A A0A7N r•AAOUNA Crr4XrVrAT or romalORJArrat1 MhIfI r7 VXrA/17NCM/AEYIA oJ71CRA SyAYR19M1t CRFEIJfCA7/0V 11 1[j5��,, Y.•Ara..,l LSI l..rn IAA.•• ,e:e t7UN Or lYf.IIIAYS rtlAV ILAr RFI•RDI•AI. 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