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124 Redmeadow Drive Lot 5_ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section 2. 2 P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002162 Billed To: Bob Cope & Son Construction Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-38-2199.05BC Subdivision Info: Redland Place Lot # 5 Location/Address: Red Meadow -27006 Property Size: 41000 sq ft Z -d-0 3 -o V ATC Number: 3655 **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 1 zz- #People #Bedrooms #Baths 2+- 2 4 Dishwasher: IT"' Garbage Disposal: G3"*' Washing Machine: 13 Basement w/Plumbing: Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: Lot Size ` 81W1- �2 `! Type Water Supplyn; , Design Wastewater Flow (GPD) Site: New IR/ Repair System Specifications: Tank Size I OCOGAL. Pump Tank GAL. Trench Width36 " Rock Depth t--�A Linear Ft.:a7J / Other: 5% 2C-=P�=TIOZ 5 jS,Si Tb%- -AT &Ars �uu t�sro� 4-1 o xzs Required Site Modifications/Conditions: 1n/StgU, D'j C V9,041`2z 14� IS a SIa=- L.)z �:-PS 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.**** 4 32 ArOx Environmental Health Sped ist's Signature: 1 DCHD 05/99 (Revised) -11) Kor)' Z�D -') kl ? c i� �t_v,n•,�i t k� Zfl z� z� �t DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksviille, NC 27028 (336)751-8760 Account #: 990002162 Billed To: Bob Cope & Son Construction Reference Name: Proposed Facility: Residence ATC Number: 3655 Tax PIN/EH #: 5861-38-2199.05BC Subdivision Info: Redland Place Lot # 5 Location/Address: Red Meadow -27006 Property Size: 41000 sq ft 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 CONSTRU=QN IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Lit L—� Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit gp has been installed in compliance with Article 11 of G. S. Chapter 130A, Section .1900 "Sewage Treatment and 100 Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any (00 given period of time. tub r-1 rl --T4Ak T,)6,T` 1 PLc7 Septic System Installed By: Environmental Health Specialist's Signature :e: VJW DCHD 05/99 (Revised) APPLICATION f011 SITE EVALUATION/IhIP110MILNT PE11MIT Sr ' Davie County Health Department Environmenta/Hes/t/1 Section JAS P.O. Box 848/210 Hospital Street 2 2004 Mocksville, NC 27028 (336)751-8760 ENVIRONMENTAL HFJI(Ty DAVIECOU ***XMPORTANT*** TRIS APPLICATION CANNOT BE PROCESSED UNLESS ALL TIIE P,.EQUI1tLll INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed �,/1%� Y- / 44, to. IIA(i Contact Person Mailing Address XJ/(?� !tome Phone City/SL-ate/•LIP 60-9e.V- ��t X70/ Business Phuiie [ 2. Name on Permit/ATC if Different than Above---.._-__,- Mailing Address City/State/Zip 3. Application For: G?"Site Evaluation ❑ Improvement Permit/ATC ❑ ]loth 4. System to service: M111ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ other — - 5. Type system requested: ("Conventional ❑ conventional modified ❑ innovative 6. If Residence: (t People it Bedrooms 17' LaUirooim; 2Dishwasher L76arbage Disposal R;<ashing Machine (fasemenL-/Plumbing ❑Basement/No Pluwbing 7. If Business/Industry /other: verify Lype it People 11 sinks It Commodes It Showers it Urinals li WaLer Coolers IF FOODSERVICE: It Seats Estimated Water Usage (gallons per day) _ a. Type of water supply: Cl, County/City ❑ Well ❑ Colmnunity 9. Do you anticipate additions or exp:lllsiolls of the facility this system is ill(endetl to serve? ❑ Yes ❑ No If yes, what type? ***IMIPORTANn" CLIENTSAIUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION KEQOH'STED BELOIV. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client ii-ith'l'IIIS AI'1'LICA'1'ION. FT I'ropert}• Dimensions: � iDnD I:lx Office PIN: R �� L l ' 3� ��(`%�• o� �C Property Address: Road Nanle City/Zip If ill a Subdivision provide illforlllatioll, as follows: Nanlc: AJ lonJ 1VRITL DIRECTIONS (r -on, Mocl"%,ille) to PROPERTY: Let *�S Section: 1 Block: Lot: _ Date home corners flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any perulil(s) issued hereafter arc subject to suspension or revoca(iou, if the site plans or intended use cll:ulge, or if (lle iuforlualiou submitted in Misapplication is falsired or changed.&j also; understand that lain responsible fur all charges incurred f,•aul this application. I, hereby, give consent to the Authorized Representative of the Davie County IIealtll i)c11:u (ulcnt to enter upon above described property located in`Davic County and owned by to conduct all Iesting procedures as necessary to'deternline the site suitability. DA'1'L: l_ Z U� t j SIGNATURI; c TRIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of lllc following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Sign given Revised DC?ID (05/03 Site Revisit Charge Date(s): Client Notification Date: EI -IS: Account No. Z Invoice No. =�(� d LI21 vp ,96.6$! -22 -- > CIO) '14 --19 (7// APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Q Davie County Health Department Environmental Heath Section DEC P.O. Box 848/210 Hospital Street 3 ?0o2 Mocksville, NC 27028 (336) 751-8760 RCNMEIVT 11q�j£C p�( y£Alty ***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 !& B V Contact Person S.l dYd Mailing Address � 1 1 /� � Home Phone City/State/ZIP �P�7�Q �U Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: B-191te Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms Dishwasher ❑ Garbage Disposal LI Washing Machine Basement/Plumbing LI Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well ❑ Co=unity e. Do you anticipate additions or expansions of the facility this system is intended to serve? Byes ❑ No If yes, what type? "IMPORTANT' CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: G 7 f 14CI- � TaxOfficcPIN: Property Address: Road Name 241 City/Zip If in a Subdivision provide informatiog, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Name:S- fes MIA TI�W M Section: Block: Lot: Ors Date Property flagged: Ir;2 "3" e!9 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 to conduct all testing procedures as necessary to determine the site suitaoility. 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). Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. q�- I! o 0/ 3 to Revised DCHD (07/99) 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: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.05 Subdivision Info: Louise Smith Adams Lot # 05 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 Sloe % S HORIZON I DEPTH Texture groupGl — Consistence Structure Mineralogy 1 ' ' f HORIZON II DEPTH —7 - 2 0 Texture group Consistence , Structure Mineralogy1 HORIZON III DEPTH Texture group Consistence Structure k Mineralogy HORIZON IV DEPTH Texture group 1 �-j Consistence (117— 11Structure Structure Mineralogy SOIL WETNESS % RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: 05 LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: r�1 -+` & Uel" , OTHER(S) PRESENT: 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) t APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT O Davie County Health Department Environmental Health Section QFC P.O. Box 848/210 Hospital Street 3 Mocksville, NC 27028 o (336) 751-8760 ��RCNMENTAC �� CAVj£CON H£A(Ty ***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 r e Contact Person6'rxa Mailing Address'a3j �� Home Phone � City/State/ZIPU)- 2 %Q �? Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: P11ite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: B- 5ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # a Bedro23B:s—ement/Plumbing .� # Bathrooms Dishwasher ❑ Garbo Disposal g posal Ll Washing Machine f.l Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: aunty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? E f -Yes ❑ No If yes, what type? "IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 52 A-0-4 S Tax Office PIN: Property Address: Road Name City/zip WRITE DIRECTIONS (from /Mocksville) to PROPERTY: If in a Subdivision provide informatio , as follows: Name: .� Eve _ Section: Block: Lot: L 0T'�51)ate Property Flagged: 42 —:3—,0 �-- 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. 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 to conduct all testing procedures as necessary to determine the site suitaoility. AMIn/,A 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). Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. c d70 0 l3 Revised DCHD (07/99) 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: PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.06 Subdivision Info: Louise Smith Adams Lot # 06 Location/Address: Redland Road -27006 see map Date Evaluated: Z o Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slo e % HORIZON I DEPTH Texture group Consistence Structure G � Mineralogy; HORIZON II DEPTH Texture group Consistence . Structure MineralogyI� 1. HORIZON III DEPTH Texture group 14,10 D i� Consistence f Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS c V Chia G 56 t RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION $ LONG-TERM ACCEPTANCE RATE D . 3 SITE CLASSIFICATION: 05. LONG-TERM ACCEPTANCE RATE: REMARKS: P 2 P<XxY W e -r A Q -t Yl LEGEND Landscape Position EVALUATION BY: 6nyC_W4,`'+ OTHER(S) PRESENT: Lo T S►vi , K�Gt, ► f++ 2- R 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)