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111 Graywood Court Lot 22DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 //l Aa ywaoc& Account #: 990002260 Tax PIN/EH #: 5861-38-2199.22 aw Billed To: Allen Wayne Builders,LLC. Subdivision Info: Redland Place Lot # 22 Reference Name: Location/Address: eadow-27006 Proposed Facility: Residence ATC Number: 3680 Property Size: see map AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER U 8 v4LID FOR A PERIOD OF FIVE YEARS. 1,; Environmental Health Specialist's Signature: Date: —16—L (D (4 CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article I 1 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. A-2-5— Septic System Installed By: Environmental Health Specialist's Signature DCHD 05/99 (Revised) Date: 101/ • DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002260 Tax PIN/EH #: 5861-38-2199.22 aw Billed To: Allen Wayne Builders,LLC. Reference Name: Proposed Facility: Residence Subdivision Info: Redland Place Lot # 22 Location/Address: Red Meadow -27006 Property Size: see map ATC Number:'-3t. **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 �ok #People #Bedrooms 3 #Baths 2 Dishwasher: I2�' Garbage Disposal: ❑ Washing Machine: Commercial Specification: Facility Type #People Basement w/Plumbing: ❑ Basement/No PIumbing: ❑ #People/Shift #Seats Industrial Waste: ❑ Lot Size C)'141 �L�-Type Water Supply Design Wastewater Flow (GPD) �� Site: New 21"' Repair ❑ System 'Specifications: Tank Size1QC0 GAL. Pump Tank GAL. Trench Width --3t, Is Rock Depth 1Zr' Linear Ft. L106/ Other: LA ISTL&)1101-j -� Required Site Modifications/Conditions: D—�j cio,5Toc9e,S ( t ttc, v; r—P Ill Oar 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.**** ,N Ne I Environmental Health Specialist's Sig DCHD 05/99 (Revised) -See Sheet 2 of C f I 'I O r►r�} tit. ap- ,---- (21 C) �~ 'p o -� � G Easer^en�91 .� �.. ,- .45,E F LA 64.38' ��% N 19':-)5 _ - 151 '� 1_42 t I �s4 1 2 39, a `o 7::�Ln � m kt\)T 0,0CD 4 1,2002 0.946 AcrP,f m n ` 32,520 S Ft. a � -- q th Q N - t o�x TU' siqt t 32, 761 Sq, Ft. -� 0.747 Acresf E_OSAmen t 0.752 Acresf�- N �. ,�•� Fdse _. 10 X 70' Sight - � /; 1O' Public lJtilitY Eosementt- 1 Bg. iement'—� �- 10' Public Utility a 44.6g'"-�- ly �� 9 5. 47 S 935 '46 W _, � . f / Jan 30 04 03:33p IL nllen Wayne Builders LLC __336 7G1-1502 -7�, I- Sf s" Al'IUCMON 1DY SIIE UAU Ant]K{BiPftOYEiW POW &ATC Davie Cotuip Hewth Departnwnt 6trlizalm ©otalfle7lllt S�oii P.O. Naz 0481=0 tioapltal Street lrock4ville, 11C 27820 (336)751-0760 ••-xmpc;RT11ltT•s• mas ApoI.IG1 cu cauwT au PROCamw 1Amns ALL Tim mQuirxv,� f INPORl ATIOH IS PROWDED. Refer to t:ho IttlORl91TOH BULL== for inrtsncLions: \\\"'L' L u e to be nilled Ai%� tltt/nC 8u; j/Xf LC.i^• m.taet ler... � Q�l lhGn Wiling Aadtasa _..i / t (! C/DCCy/•,cfa Ae Ave . S�• ; $ o... pR..e atylute/21P fit%.1'+,�on JC /fnrN. f— 23tw.i..aa shorn 2. aaoa on p.wlt/A= tL eirfarest thvn ARove nalll.p Roti.." city./St.tcJr3p _ _ 1. Applicmtjon Por- Q sit@ svaluntioa XIspxvvstaent rcrait/A1c _.._ O UuL'b t. syecaw to sosvie.a )(9ouae D Hohile lone D ausinebs Q industry 0 Dumc, S. lyye si-ty revosatodt 11! mm coeat14"I 4 conveotlal aoditiaa i] losay.tivo s. It Residance: I / 1People. r Bedroos : _ r DatLrooeu _ o� �2 alaw.ahec l3oua . uspos.l ILtahtaq ilsrhino Oa..oss.Vrluelal..J rlw.ereat/ao Pl:rbta� 7. tt asada"t(Io3t.ery Joule.. �ritY gyps IF p Commodes a shawacs s ecine2. a notes Ooclors p.3 ZP tootls>; ace: il,fSeats ltatiaated Hater usage ta•ssesa per day) t. YYPo tat Maar ..pA'2Y� Jgt �J/qty U troll Q Comoni,ty 1. m You saeieip.ta oddLUMs or espanstossefibefaalytbissysteatisiulead- tosync'OYes No iryes, what type? •,•IAtPo8TQN1'�'•CLLCilli'SltUT7t�►PLStErltExkQ�neEnrworctcTTint•�DwNA71t3Mitspurs-rPal BELOW. EldkoraPLAT arSrrtAAN&fISTBESVNrirTF.Dbythe client %iihTttlSAPrucA*nON. 1'toperty Dias�sioas lYlt E DNtk;cn l(S wbo: rdudm isw w PRul'orn TaftotLarlAt: p� �� 9 i Property Address: Road Naloe I. �f�%Y.'t�a 0 r� r . Cl YMP if iu a Sttfldirlsiam pr/otnle informal as ran*= `C-�- SCcUen: Block: Lot z� Date beme solves llag6ed:1- .2 p ` O y Uk is to eerUry that flu iafedatatioupMided is cured is the but army kamedge- ! undatua d Iku any r— kx) rscaadkemalterare=NedtostopemimwnyocatlouiitthealnplansuriatcwWimCb2U ,or)fUteittWnudio+l sulmnWed in Ulus application is faisiLed or tbanged. A dm aaderstsad ikat rem rc*eaa2l fwcu rAair ar Qtesned fro.. this uppttatiwr I, benby, Lin consent to Lie Authosned Repm=talive of the Devic Cwwy IlcalA: Deparuncat to eater span above described pmVcny Wwted is Davie Conary and awned by _ to conduct all ltstioc pme4ma as accusa.-y to ddtrmine the site snihblT DATZ SIGIIATU1tE i• TiiISAtFAKAY ARUS= FOR DRAW IG YOM SnZtiortbc o : Esistingaadproposed ptppetiyiinesaaddre> *z% strpetum, setbacic% atalseptk tions). 0y We Revisit Cbargc Dale(.} . t:l[cuUVoti4rrtiou Datc: �. 8iLL5: sip cbtm / V O AtwmtHa BcrisatDCriD(OS/D3 IuwireNo.�^- .. APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department Environmenfa/Hea/fh Section P.O. Box 848/210 Hospital Street Movi k 11 NC 27028 D ECCE DtC 3 O (336) 751-8760FNM£ UAVI£ pal y£ tr'y ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUI INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed I p llyp/V _ _ Contact Person Mailing Address �1r l �/Aa"LLV��,� Home Phone may/ Cit /State/ZIP y � � � 7/� � Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: P191te Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: Ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms 171L, Dishwasher U Garbage Disposal Washing Machine Basement/Plumbing fl Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: 9--C—ounty/City ❑ Well ❑ Community s. Do you anticipate additions or expansions of the facility this system is intended to serve? FHes ❑ No ,. If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # Property Address: Road Name �, r City/zip WRITE DIRECTIONS (from Mocicsville) to PROPERTY: If in a Subdivision provide information, as follows: Name: m r Section: Block: Lot: LOT ZiZ Date Property Flagged: 1r;2 ^73'' C19 '�- This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. 1, 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 �I{�i o err f✓�� 5 to conduct all testing procedures as necessary to determine the site suits ility. DATE SIGNATURE 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 Datc(s): Client Notification Date: EHS: Account No. Invoice No. { DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPACANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.24 Subdivision Info: Louise Smith Adams Lot # 24 Location/Address: Redland Road -27006 see map Date Evaluated: Community, Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L PL Sloe % V 710?A HORIZON I DEPTH Texture group 01 L_ Consistence S. Structure _ MineralogyI ' HORIZON II DEPTH y, - Texture groupG)L Consistence ; Structure Mineralogyt HORIZON III DEPTH Texture groupL' [ Consistence Structure Mineralogy' HORIZON IV DEPTH 1.) Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: ` s EVALUATION BY: <:I� `J`-'Ia ►�� LONG-TERM ACCEPTANCE RATE: 0 ' �) tN acK OTHER(S) PRESENT: REMARKS: kcv- M1Xop 1.3 C' -6"'p e# I �00_'�F_ Lota110 Landscape Position ,YX,,74-TOP 011, eo6o' 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)