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 -')
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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
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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)