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112 Redmeadow Drive Lot 4// bo DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Z if ' P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002436 Tax PIN/EH #: 5861-38-2199.04 DB Billed To: Darren Burke Constr. Subdivision Info: Redland Place Lot # 04 Reference Name: Location/Address: Red Meadow -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3672 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a 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 'A oose #People Lf #Bedrooms _ #Baths .�•� Dishwasher: d Garbage Disposal: ❑ Commercial Specification: Facility Type Washing Machine: d Basement w/Plumbing: El"' Basement/No Plumbing: ❑ #People #People/Shift #Seats Lot Size 'IRS QC S Type Water Supply l.�L>-'TYDesign Wastewater Flow (GPD) 4'0 Industrial Waste: ❑ Site: New u Repair ❑ ?, n � System Specifications: Tank Sizer GAL. Pump Tank I OCO GAL. Trench Width -moo Rock Depth 1.2 Linear Ft. Other: cJ l��iQ 1�JTip.J�� Required ite Modification /Conditions: 0-3 C.0--TTCXs2 ' 1� e4 -f-. Uri S 04 ka"Cbm-o ) IMPRO MENT/OPE ATION PERMIT LAYOUT- APPROV D EFFLUENT FILTER RISER(S) IF 6 "BELOW FINISHE GRADE. **: *NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system be een�0/a m. o 9:30 a. . or 1:00 p.m. to 1:30 p.m. on the y of installation. Telephone # is (336)751-8760.**** +� X I: I I 3 O �N 4 ep P—C- �D 44 A i y 115' I ( z0 � 20 �D1�SN Environmental Health Spec a st's Signature: DCHD 05/99 (Revised) Ca /9'7' • P�rwP -r0 1k ki DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002436 Billed To: Darren Burke Constr. Reference Name: Proposed Facility: Residence ATC Number: 3672 Tax PIN/EH #: 5861-38-2199.04 DB Subdivision Info: Redland Place Lot # 04 Location/Address: Red Meadow -27006 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 WASTE S N IS ALI R A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatur : Date: 2 D� CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit Ke has been installed in compliance with Article I 1 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and �V Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any ' S given period of time. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) t ►� klar4 Feb 03 04 08:50a Darren Burke 33G-778-0436 p,2 Jun 10 03 11:14a davie county envhealth 336 751 8786 p.2 R APPUCJIJION FOR SITE EVALUATION/IMPROWAIfNT PE1UUli.VIVID Davie CountyHealth Department Envi/WA167�talflealtASe+clian P.O. Box 848/210 Hospital Street HOckaville, VC; 27029 (336)751-8760 •••IMPORTANT•*• THIS APPLICATION cumr Be PROCESSED vNw,;sS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the 2NFORMATION SULLRTIlf for instructiona. 2. Name to be Billed P. 4 contact Porson r "rl .._.i _ /Dar jI _rJ � aailiaB addr4RS T t7 S � i- roc iG'] Bane Phone - `�C• ;I- rt�(5A",e' Nle- ZZG j2 Busiaesa R (6, city/starazis, Wtt d5 Pbone eJ.:IT� 2. Wow an P"twit/ATC if Dttlamat than above 52 Lh c, 34LIL" A4draae '>c.,.--- city/seato/24P _ .. ...._ ..- 2. application For: ❑ Site valuation O Improvement Permit/ATC XBotb 4, syets to 3erri.c0:t1if-aouse ❑ 1lobile wane ❑ business ❑ industry ❑ Other S. Type system requeeted.1 Cf_ vocational ❑ conventional aoditled ❑ lnnovativo I People q 0 Bedrooms L1_ B Datlltoom:, C -L-5 t. If Residence: _- �iiahw her 00arbege Disposal �ashlnn Haebine -I Dar• sen%Pilag OBascmenuNo rlw.uing I``t Busitaoa/Iadvetry /other: varity typo 7. a People 0 Sinks _ o Coe.odea B Sbavere a VCLaa1a B Nater Coolers IT ROODSERYICR. it Soatlt Rotitaated Water Usage Iaallewn par )my) a. Type of water avPPLyt),teowity/City 13 hell ❑ community s. Do you anticipate additiosa or expansions of the facility this system B intended to serve'! 0 Yes elizvo If yes, 4sbat type? ••"IMPORTAM'a•aCLIE",,,SMWCdA/PLETETHE RCQOIX6U PttorElCrytNFoItMATIoN ttLQt) SrGu BE40W. EltheraPLAT arSIrEPLAN MUST I�OESV��RK/n7EDbythe client wit4THISAPPLICATION. J Proprrly Dimensions: / X °L// A Z� V'C �tDT �j 'WitrrE DIRE 'IONS (From hlocl:sri0r am PR01 Ii1rfl: Tax Office PIN: A lQ /„ F - ` ( / i 0 Property Address: Road Name �� 16'r41— gC {' cliym, z , r •E a%(F If is a Subdivisic rmidc,(n{tmma:ion, as follasys: Name: (JJ(/ Section: Bock: Lot• Date hoateeorttersilaeged: !T Tuffs it to certify that the information prodded is correct to Ilse best of my kneirlcdge. l uadersland that any peyatil(s) issued hereafter aro subject to suspension or revocntio n, if the site plans or intended use dtange, or if the information submit ted in this application is falsifird or ehaated. 1, also, aaderrrand that L sat irspousibte%ar all ebmbes incurred jnun (kis eppticariaa. I, kereby, give consent to theAutharaed Representative of the Da ie county health Del) mtcn/t � to otter upon above described property located in Davie County and owned by 1, e� j /�J/ &I w• to conduct all testing procedurees� /as mteessary to detertmine the site suite t t DATE a SIGNATURE U/ r THIS AREA MAYBE USED FORD RAWINGYOUR SITE PLAN (Include all of the fotlaniop: Fz1S1ing and proposed property Kaes and dune sioas, strnelures, setbacks, and septic locations). Site lievisi i Charge Dalc(s): Client Notiruatiou Date: EUS: Sign gives Account No. l� Revised DCHD (05103 Invoice No. APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Q Davie County Health Department Environmental Health Section DEC P.O. Box 848/210 Hospital Street 3 zo2 Mocksville, NC 27028 (336) 751-8760 OA �utDFN1118 CO ***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 Mailing Address City/State/ZIP 2. Name on Permit/ATC if Different than Above Mailing Address Contact Person Home Phone Gly' Business Phone — a s, 5 City/State/Zip 3. Application For: EYSite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: R- 5ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other --y 5. If Residence: # People # Bedrooms # Bathrooms IDLI Dishwasher ❑ Garbage Disposal U Washing Machine Basement/Plumbing ❑ 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--County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? B -yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE TIIE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # J- 0 a 9 �. Property Address: Road Name, ZZ,14jj r ;2/- City/Zip If in a Subdivision provide informatio , as follows: Name: v =>— Section: Block: Lot: WRITE DIRECTIONS/(from Mocksv`illlle) to PROPERTY: Xy- cGi circ, L AT a-ry Date Property Flagged:�- 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 frons 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 _ Via; :57",4 to conduct all testing procedures as necessary to determine the site suitapility. �� /� ► � _ ��ai� v��/%1�'d1�/®ice 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. q 0 6 / 3 Invoice No. s 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: PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.04 Subdivision Info: Louise Smith Adams Lot # 04 Location/Address: Redland Road -27006 see map Date Evaluated: i /9102_ Water Supply: On -Site Well Community / Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position I L Slo e % a HORIZON I DEPTH Texture groupL Consistence Structure Mineralogy HORIZON II DEPTH - Texture groupC- �— Consistence Structure Mineralogy•' �' HORIZON III DEPTH A- 'Z$ Texture group Consistence S Structure MineralogyI I I HORIZON IV DEPTH 3c6 -5O Texture group Consistence S Structure C2 Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S J LONG-TERM ACCEPTANCE RATE 0. SITE CLASSIFICATION: ` J LONG-TERM ACCEPTANCE RATE: 0. 3J REMARKS: M-4, rj EVALUATION BY: N LI 9 4�'1-IfiCA1_p OTHER(S) PRESENT: AgQV'r �v' R01 rp"4 - '>p L'07 - LEGEND _'50Mer "/rte ,r�) F-4) Landscape Position MAY PiL'7e6� "'jC) 3)I � � A � �� R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope A24D 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) E 258' 35 193.76 59 p _ - __.e2 A ________. 95.75' 10' X 70' - Sight Esmt z DI) _ CnN 0 31,904 Sq. Ft. 9) 0.732 Acres± W Z 36 O N N 31,543 Sq. Ft. Cn 0.724 Acres± W o n co NI NI I* W � 4 34,196 Sq. Ft. N 0.785 Acres± 10' X 70' Sight Esrnt • o b ° � b v a a. a 95.86' n1 N85'55'32tow co 't� cd �. o 0 rn� 585.55 32 „E LO 59 p _ - __.e2 A ________. 95.75' 10' X 70' - Sight Esmt z DI) _ CnN 0 31,904 Sq. Ft. 9) 0.732 Acres± W Z 36 O N N 31,543 Sq. Ft. Cn 0.724 Acres± W o n co NI NI I* W King A r. L a, • o b ° � b v a a. a 0 t--- n1 co 't� cd �. rn� King A r. L a,