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127 Redmeadow Drive Lot 34Account #: 990000955 Billed To: Samnaz, Inc. Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT 1")'c --// -� /0 I Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: 5861-38-2199.34S Subdivision Info: Redland Place Lot # 34 Location/Address: Red Meadow -27006 Property Size: see map ATC Number: 3667 **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 THISPERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type Hoosc #People H L) #Bedrooms #Baths 3 Dishwasher: Er Garbage Disposal: 133"' Washing Machine: T Basement w/Plumbing: ❑ Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift LAD Industrial Waste: Lot Size O • 641%1Ta % k-" Type Water Supply &4w Design Wastewater Flow (GPD) ff Site: New lt' Repair System Specifications: Tank Size I000 GAL. Pump Tank GAL. Trench Width' I Rock Depth Zr Linear Ft. � Other: A, TQA(,,- 1 l m �r Required Site Modifications/Conditions: It.)S`�AiL L VI-) �i�Os �L�iw" �t �N` i���% �Ia& it; A-yf 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.**** ' ►o`�.Irt. 'k S, --T PwrA(so 7-r 01(DH -To AVOID :SI j& -- I 'R)lrv\ i STafio,\) t3o� Environmental Health Specialist's Signature: DCHD 05/99 (Revised) F ly ur, it j oak -:y (Zt--PA12 vJ lu g% PoKo H L% Date: Z S O Account #: 990000955 Billed To: Samnaz, Inc. Reference Name: Proposed Facility: Residence ATC Number: 3667 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5861-38-2199.34S Subdivision Info: Redland Place Lot # 34 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 WASTEWA N T IS VALID FOR A PERIOD OF FI YEARS. Environmental Health Specialist's Signature: LDate: 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. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken Is a guarantee that the system will function satisfactorily for any given period of time. X50' 4 op _$ A v�:: F&01�y r 4"3 s r --'Z� ? r Z- Z-3 Septic System Installed By:1� Environmental Health Specialist's Signatur Date: 2 DCHD 05/99 (Revised) o � 41,2.00 Sq. Ft. CL �Z 0.946 Acres± o _I I� Ft. � O J /. 10 X__MSigi-It t lj Easement --.& 8j Easem Sight - Q �; 1Q, public Utility----�` I_ 189 9 8 _ 6 V c� (90 00 00 JAI 46" E 1��-001 f C L Z 0,35 34N 0 31,904 Sq. Ft. 3 N 0.732 Acres± L 30,386 Sq. Ft. .J CA O P1 0.698 Acres± U, N 30,373 Sq. Ft. o -0.697 Acres± Cres± U' Q .141 117.00 1.006' w 1 7.00 619. a7��j��ol) ' SAMNAZrINC. 3367748700 01/27/04 OS:48pm P. 012 ......n.�.mruuvcnlCfY1 t'LlUlff a, AIC –� r Davie County Health Department • • b7J6Alr n70%alHeJ1b'1 SeCM017 P.O.. Box 848/210 Hospital Street k Mocksville, NC 27028 (336)751-8760 =**II`SPORTAMT*** TRIS A?PLICATION CANNOT 13E PROCESSED UNLESS ALL TUM r.&QUIRM) INFORMATION IS PROVIDED. Refer to tho INFORMATION BULLETIN for iaZ LruCtioua. 1. Name to be Billed__n + Contact 7'oroon Hailing Address 7A r� c,IJ.�Itome A110ne 0 City/o^tato/:2P Jj 1�� l� Z/� ( t O'4 lluoinesa 1'ilonc T. Nano on Permit/ATC if aiffertat than Above.. -4\*_ ,�,_�,�..._.......... Mailing Address City/SW Ge/::iP _ _,•._�._ 1. Application For: Site Lvaluation 0 IMpt:oveiacnt 1•CX=!L/ATC u ntiLlt 6. Sictem to Service: �'Hailse ❑ N Dile Rome 17 Buainerta ❑ induGLry ❑ OLLct: S_ Type Cyst= requested: KSon:cntional Q 'conventioaal modiiled G iunovative 6, If Residence: 4 People B Bedrooms _ A ISaL'htouue: 3 _. Aiahwasher /L`IFarbage Dispoaal i1�Nashing Machine ODasement/Plwabing ❑base—'L/No 1•luuui.+.} 7. if Duaioess/Industry /Other: vezify type 9 People 11 ... 11 comcpodas A 3hoo+crs 9 urinals tl Watar Gaolers _ `• IF FOODSERVICE: 9 Seats L'8timated Water Usage gallons per day) 8. Type of water supply: KCounty/City ❑ Well D Couum,niLy 9. Do you anticipate addiLiono or expaasious of clic facility this system is iIII ell dell to serve? ❑ Yes 0 No If ycS, What t)'pC? "•*IAIPORTAgYl "* * CLICNTs if UST COAlPLCTE TI[E Ii�QUI![GD PuoYE1C11' LYI Y3Itp?r1T101`i IttiQt tt 11'I:u 820/V. L•'itneraPLAY orSITE Pl-%NA1USr6GSUl/dl/T'T'l:'DbyIII ecllenI. irith'I'l(1SA11PUCATION. Property Viu:citsions. -� �1 i' ==ter 1 11 RJR UIRECHO NS (frust Qlurtavillr) to 1'It[71't:atTY: Tax Office 111N: #_ _ &I "3� ' �b 1q3 }/S Property Address: Road Name City/Zip ac— If in a Subdivision �provide infferni4 ioon, as follows: Section. Block: Lot: Date hone comet's fagged. This is to certify that tt{e information pro' idcd is correct to the best of my knowlel1rc. I undcatand that any perntit(s) issued hereafter are subject to suspension or revoratiou, if the site plans or iu[cudcd use cfiange, or if (fie iofurunal iii it submitted in this application is falsified or changeil. I, also, understand Mot I urn respunsihle for all chrn;ves ineurrrd frau, dos applicadva. I, hereby give consent to 7hc Authorized Itcpreseatalivc of the Da1'ic CounlylleAlh Dup.irlim•111 to enter upon shore described properly IUCa(nl 711 I)av/C ['U11711y afld UIrIICd b)• _�. �_ • _ ' (o cuaduc( all testing procedures as 1lecessnry to delel•liline (Ile site sultab it)-. DATI: Cpl ....:.,�...,...: TRIS AREA AJAYBE USED FOR DRANV NC YOUR SrfE PLAN rnpusud property lines and dimensions) structures, setbacks, and septic locations). Site Revisit Cital-ge Client Notification Date: 0 Elis: a 0 0 0 SAMNAZ,INC. 3367746700 01/27/04 05:46pm P. 011 FROM PHILLIP R BALL CO FW. NO. : 3369455268 Jan. 26 2004 06:42PM P1 •c RLDMEADOW DRIVE APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Q Davie County Health Department EnvifonmentaiHeaith Section Dte P.O. Box 848/210 Hospital Street 3 Zoo Mocksville, NC 27028 (336) 751-8760 �VIRCNMENT CAVIE CO� 1 y�CTy ***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 t e V Contact Person J l' Mailing Address fjl ') E dl acL Home Phone City/State/ZIP _4d-5. &�!, V Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: 9-19ite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: -use ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms D, , Dishwasher 0 Garbage Disposal Cl Washing Machine Basement/Plumbing Cl 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: B--County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? EHWs ❑ No If yes, what type? 'IMPORTANT' CLIENTS AIUST COMPLETETIiE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMI7-FED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: v Property Address: Road NameL / City/Zip WRITE DIRECTIONS (from Mocksv`illlle) to PROPERTY: /��EA-3-/ L�i aWK– If in a Subdivision provide informatio , as follows: Name: C A/ t� t+-4 Section: Block: Lot: LDrc.�ate Property Flagged: 1r;? ^3" �— 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�,04 1 1 Sd cAr�215 to conduct all testing procedures as necessary to determine the site suita ility. DATE �� – D� SIGNATUREi NT 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 APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-38-2199.36 Billed To: Westview Development Co. Subdivision Info: Louise Smith Adams Lot # 36 Reference Name: Location/Address: Redland Road -27006 Proposed Facility: Residence Property Size: see map Date Evaluated:�10 Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit / Public i Cut FACTORS 1 2 3 4 5 6 7 Landscape position l— L Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH C4 — 2— 2 Texture group Consistence , Structure 1� Mineralogy HORIZON III DEPTH 32 Texture group Consistence Structure Mineralogy` HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: PC LONG-TERM ACCEPTANCE RATE: I REMARKS: EVALUATION BY: g-- 1 )1AL -fl'�''�` 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)