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117 Redmeadow Drive Lot 35' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900573 Tax PIN/EH #: 5861-38-2199.35GJ Billed To: Glenn Johnson Builders Subdivision Info: Redland Place Lot # 35 Reference Name: Location/Address: Red Meadow -27006 ATC Number: 3716 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 WASTEWATF�ONKRUffi9N IVVALW_OR A PERIOD OF FIVE YEARS. Environmental Health Specialist's 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 11 of G.S. Chaptpr 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in O WAY be taken as a r ntee the tem will function satisfactorily for any given period of time. I -- p' `a Q0 ' i ctb4�c3c.'`kl2`• sctagD 7 T 4i� - s -r-) . Aix DAYe, /Z -2Lt Septic System Installed By: Environmental Health Specialist's Signature : DCHD 05/99 (Revised) t A` Date: J DAVIE COUNTY HEALTH DEPARTMENT ZAD M • Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 il- 3 - 3 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900573 Tax PIN/EH #: 5861-38-2199.35GJ Billed To: Glenn Johnson Builders Subdivision Info: Redland Place Lot # 35 Reference Name: Proposed Facility: Residence Location/Address: Red Meadow -27006 Property Size: see map **NOTE* This7mproveme6i t/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 O - #People #Bedrooms _ #Baths 2' -5 - Dishwasher: 21"' Garbage Disposal: ❑ Washing Machine: 2"" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size ().-13Ab�S Type Water Supply &ohiTY Design Wastewater Flow (GPD) qgQ Site: New 12/ Repair ❑ r � I System Specifications: Tank Size I�� GAL. Pump Tank �GAL. Trench Width3(;Rock Depth 12- Linear Ft. qw Other: Required Site Modifications/Conditions: 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.**** -fop M-1 1St], Jt!"D 3c" U0 �— 0 yon < , -- r" N, j;;(2-1vi-= Environmental Health Specialist's Signature: DCHD 05/99 (Revised) i� Date: {�Oq In 33 1U•Y, 70' Sight 4 Eosement - } bt%c 9 .9B, Sight Esn- N85.55'3` S85'55'32' (5n r� 7 , _ 2 2--- -- 95 .7 5' pp•1 pp, - 10' x 70' 1 1 • Sight Esmt N' cS7 3 Sq. Ft. Acres± , 117 •p� ;7 I J 7 "k 0� ) 61 Westview Development 340 31,543 Sq. Ft. 0.724 Acres± I.P.S Brant H. Godfrey lax Map E'--7 Lot 3304 DB -194, Pq -755 J 9 �ISEN�R on 11AR>>� ON 1:011 SIM IMILUATION/L41PI10Vi l IrNC 1101MIT & 117-G Davie County Health Department EnviTOa/»enia/Heap/1 Section P.O. Box 040/210 Hospital Street Mocksville, ITC 27020 (336)751-0760 ***II'SPORTANT*** TRIS APPLICATION CANNOT BE PROCESSED UNLESS ALL TIIL REQUIRED INFORMATION IS PROVIDED'.? Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Lena Vduscm I Contac L• Peron Nailing Address 194 f! of hbd ` /Col ` En �1 110111C Phone City/State/ZIP ��&C Q �� 7 -70OG Business Photic„., -_--- 2. Name on Permit/ATC if Different than Above 3. 4. Mailing Address City/StaLa/Zip Application For: ❑ Site Evaluation Improvement- Permit/ATC system to servicer House 11 Iiobile Home ❑ IIu.,inesn C1 Indus try ❑ OL-hcr ❑ Iu Lh S. Type system requested: I Conventional ❑ conventional modified ❑ innovaLive G. If Residence: 11 People 11 Bedrooms '^j U Bathrooms ?, Vshwasher ❑Garbage Disposal V—shing Machine ❑tlasement/Plwnbing ❑Basement/17o Plumbing 7. If Business/Industry /Other: verify type 0 People 11 mimes Commodes 11 Showers if Urinals 11 WaL-cr Cooloru IF FOODSERVICE: 11 Se s Estimated Water Usage (gallons per day) ____ 8. Typo of water supply: County/City ❑ Well ❑ Conununity 9. Do you anticipat0"N / additions or expallsiolls of the facility this system is intended to serve? ❑ Yes 0 N0 If yes, what type? ***IhI1'0RTdj''V7'*** CLIENTS MUST C0AI1LL•'TV TIIE ImQUIRLD PROPERTY INFORMATION REQUlsSTE*D BELOW. hither a PLAT or SITE PLAN rnIUSTBESUBMITTED by the client with'11IIS APPLICATION. Property Dimensions: See /"tta Tax Office PIN: 11 3 213S Property Address: Road Nalnc 1-”P"'E °t�j City/Zip If ill a Subdivision provide information, as follows: Nanlc: iZeA tel o 1'J (c'r'e Scctioll: BlocI:: Lot: � S WRITE DIRECTIONS (frons 11lucicsville) lu PROPI;ItTY: Date llonle corners !lagged: -il . -/ This is to certify that the information provided is correct to the best of illy knowledge. I understand that any pernlit(s) issued hereafter are subject to suspcilsion or revocation, if the site plans or intended use change, or if the inforluauol, submitted in this application is falsified or changed. I, also, understand that I cml responsible for all charges incurred i-om oris application. I, hereby, give conseut to the Authorized Representative of the Davie Comity Ilealth Depar(meul to enter upon above described property located in Davie County and onvned by to conduct all testing proccdurc5 as necessary to deteraline the site suitability. ,DATE _ ��J SIGNATURE ' tYL TRIS AREA MAY BE USED FOR DRANYING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Sign given Revised DCIID (05103 Site Revisit Charge Datc(s): Client Notification Date: E1 - IS: - Invoice No. 410 S y NORrN CAROLINA RF.PARrRFN, OF TRANSPORTATION I'LANNIW DIPARTNFNr/RFVIE/ OFFICA'R DIVISION OF NIO!lMAYS "`N A I, SUBDIVISION PLAT APPROYAll • Pfbmr�AAVR➢IYf3WN NOAD LV,NTyau.T'NN/ xir 1i1 �•�'��' h:3,i,.� N• xaANln cMINYIICATIaN l�e➢vFrr�uiw,ua[--.� eN... ,f ?ter /F:.e :v v r.rrn •�a'w�•w• I' •�M. M.r . . ir.._N DrY eL. T!1'rYi=�.._.... o-aff Tn1. Inr JS�avY •/-+2�='N�MMr.�_IIV,Y /fl'N CLIXJNA • DAVI6 [!1lIF RaaW CAABLNA -DAYfb LwINR Plat 3ook....'9...IPa9c ..G.°_... SURVL'TORS CERT/PICAT)ON /`y zuMMnLbn Avrn en aiii�il nrll Yeriv�au rinrmw d� !Fiat nJ.r (4n.lplwr masmM d D'iMF� e ! AveMG,�, mlvulwnn Poa—( lr nP➢Irpnil"uv rnl In aam•duvv nllean"T �'GO➢._,.,,r„l� IY �j{A0. Irl n..n1.. -.-YJ'/w- Y e *vSi+ mV rrl NO•'N,➢v. n M mu � LeJ/�f�� - �'�O i polo �ln xw•e.. �'O.NN cAACLINA -➢ vfE tDUNTY Sheet 2 or 2 I , 4 .uy lH I IUltiff+_.... /+^A•rY•^N Lr s,...y... x..,i... Ie]e_•.rfrN I. .n. LAVI6 COUNTY REOISTBR OF D1103 I el 1MZ.—I• u o`r.rw,u rfrlr rwn ,,,,• fiZ:'•aTw�l'Im4":..lwmn. pR.l. si-aa .wA eJ v aww PLAT NEwsTRAT10N /v ,dbn � • ys /'� J A• s•afn N I y prll.n �rN fy I b G �xrn w9u� N ^r•le �n rA,w,wr AN repWefrr pvmr�i V rnw. TAnI �Ifir IrNI vn aNflry pout n zrta. r! Ivy' TAb frw; SJwi• e! 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CMW". — Fominplen ----�- D.W JTITL ➢ATC PAC[ BUDDER AY ,T/I�IDJ IaH M1Ne.T0. pIPIIN ➢1` a I o1 Z Dalf3.a• RLa/rus , --�--3URV[Y0R3 PLANNd'RS 8OJ NFff .Ti'Af4 IINSNN- 9AlAL AC 1f1Of T 4EPitlN1 9q ->Id -WTI D V r APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Q Davie County Health Department EnvillvnmentaiHealth Section P.O. Box 848/210 Hospital Street 3 %Z Mocksville, NC 27028 (336) 751-8760 fNV�R�NM �AVIE 0fA yfgCTy ***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 e�1 ,�tlJ,-I /fi A Mailing Address City/State/ZIP fin% -�E 2. Name on Permit/ATC if Different than Above Mailing Address Contact Person Home Phone Ll�' Business Phone- City/State/Zip 3. Application For: P -site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: #People #Bedrooms .� #Bathrooms �l Dishwasher ❑ Garbage Disposal ❑ Washing Machine Basement/Plumbing CI 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: ®-C.ounty/City ❑ Well ❑ Community s. Do you anticipate additions or expansions of the facility this system is intended to serve? 9 -yes ❑ No If yes, what type? 'IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBM17TED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # 3�'' � / 9 7.3 Property Address: Road Name L��f Jt/(�Q/ City/Zip If in a Subdivision provide information, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: /�� � -4- / /,p C � Z2Z -'a/ A 4� 01�avol Name:_ ����, AIA a- -nA4P Section: Block: Lot: 13� 1.OF3S—Date Property Flagged: Ir;2 ~3-- e�9 -L— This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hercafter-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. 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 .lfl��;orr� fAtr 5 to conduct all testing procedures as necessary to determine the site suitapility. 1T . 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 SoiVSite Evaluation APPLICANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size: PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.37 Subdivision Info: Louise Smith Adams Lot # 37 Location/Address: Redland Road -27006 see map Date Evaluated: ��- Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % (p HORIZON I DEPTH Texture groupL Consistence S Structure Mineralogy , HORIZON II DEPTH )� ► 2 Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure `�1L Mineralogy; + HORIZON IV DEPTH Texture group %Jb'T 41 Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE �. SITE CLASSIFICATION: PS LONG-TERM ACCEPTANCE RATED. 3 'a REMARKS: LEGEND Landscaae Position EVALUATION BY: ,;z:t:� ` b2aC4A--,P OTHER(S) PRESENT: 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)