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128 Graywood Court Lot 7DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section _2 P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900259 Tax PIN/EH #: 5861-38-2199.07dm Billed To: David Mallard Subdivision Info: Redland Place Lot # 07 Reference Name: Location/Address: Graywood Court -27006 Proposed Facility: Residence Property Size: 1.442 Acres ATF Number: 3659 **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 #People #Bedrooms 3 #Baths z •� Dishwasher: lr Garbage Disposal: Cl' Washing Machine: 121'.' Basement w/Plumbing: ET Basement/No Plumbing: ❑ Commercial'', Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size I A ACAS Type Water Supply 1�7ot4-N Design Wastewater Flow (GPD) '-2440tr Site: New L'� Repair ❑ System Specifications: Tank Size 1C00GAL. Pump Tank 1 WOGAL. Trench WidthRock Depth 12 If Linear Ft. q0r Other: LA '�)1JQIbOIIOr i Bo'kL� Required Site Modifications/Conditions: 1 r4SVa �S 1c; L9j:,P Ft2oP u •� 15, c,�r-e IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 K 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.**** / ELI Lt-.kS t►J t--Q�Al �1 1p�4 ot Environmental Health Specialist's Signature:/ J /� Date: 1 I I , :2 DCHD 05/99 (Revised) Account #: 989900259 Billed To: David Mallard Reference Name: Proposed Facility: Residence ATC Number: 3659 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5861-38-2199.07dm Subdivision Info: Redland Place Lot # 07 Location/Address: Graywood Court -27006 Property Size: 1.442 Acres 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 Tr atment and Disposal Systems). THIS AUTHORIZATION FOR WASTE W UCTI N IS ALID R A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 2-1310 RTIF-f�TE OF COMPLETION **NOTE** The issuance of this ert' ca of Completion shall indicate the system described on Improvement/Operation Permit has been installed in m li ce with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," bu h in O WAY be taken as a guarantee that the system will function satisfactorily for any rgiven period of time. A3 1.3L' f Sn' 13a � Na Ca �, �-1 - 8 , A�:fc IQ� Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) ?5"E --- 137.72' I D.B. 166, Pg. 766 I.P.S. 1182.01' Tota (463.64' This Lot; V� 78 Sq. Ft. o��tK 47 Acres± �,,9� S r C,� 213.57' O; `v 0 n r/� .6 62,827 q. Ft. `O 1.442 Acres± W \ w W r� WR 0 0 N T ol to 101, -a. 4.0 3�° ,� z 00 Lo o 2 � N 0. ��37,938 Sq. Ft - 0. 0. 0.871 Acres± ,� o r- cp 9 CATION FOII SITE L•VALUATION IMPHOV011INT PLIiMIT A`I-C r .Q4 Davie County Health Department Environmenta/Hea/i/1 Section P.O. Dox 848/210 Hospital Street tA`I{�1iN Nocksville, NC 27028 ENVIRpP�V1EC0U(Ily (336) 751-87G0 ***IDIPORTIINT*** TRIS APPLICATION CANNOT BE PROCESSED UNLESS ALL HE RLQUIRLD INFORMATION IS PROVIDED. Refor to the INFORMATION BULLETIN for instrucLiona. 1. Name to be Billed Contact Contact 1 cr•'on _ Mailing Address/9") � h�s-i T [�y _ ltanc Phone c yy_7�I Ci Ly/SLatc/ZIP,za,�J_ ,T 12', �[� � �'• Busine::s Phone � �/_ , / 2. Namo on Pcrmit/ATC if Different than Above __-_�__.._•_••., Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation Improvement Permit/ATC ❑ ]SoLh ii 4. System to Service: A House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. Type system requested: A Conventional ❑ conventional modified ❑ il,novaLivc G. If Residence: It People It BedroolnS _ II Lathi:ocniu; p % _- /RDishwasher RGarbage Disposal }lashing Machine WasemenL/Plumbing ❑Basement/190 Plumbing 7. If Dusiness/Industry /other: verify Lype It People 11 Sinks It Commodes It Showers 0 Urinals It NaLcr Coolcru IF FOODSERVICE: 1I: Seats Estimated Water Usage (gallons per day) S. Type of water supply: KCounty/City ❑ Well ❑ Conuuunity 9- Do you anticipate additions or C\I)ansiolls of the facility this systelll is illlelldecl to selwe? ❑ Yeti PON() If yes, 11•llat typC? ***11111'011TANl'°** CL1EN'I'SAIUSTC0A1PLETL•'TI1L REQUIRED PROPLlt'1'Y 1NF0101ATION REQUESTl l) BELOW. Isither a PLAT orSITE PLAN MUSTBESUBJ11ITTED by the client 11•ith 'I'IIIS AI'PIACATION. Property Dinlcusions: Tax Off icc PIN: #fib''(, / - .3-k - Property Address: Road Nalilc�-eel City/Zip If in a Subdivision provide information, as follows: NaIllC: Section: Bloch: Lot: I Wilms DIRLC1'IONS (I•ruul 51uc1 ) lo o hate honk corners flagged: L -� 0 `-X This is to certify that the information provided is correct to the best of illy Iami-ledge. I understand that aly I)ermit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if (lie infornla(ion submitted in this application is falsilied or ch:ulged. 1, also, understand that l ain responsible fur rill chat-ges intim-red. ruin this application. I, hereby, give consent to the Authorized Representative of the Davie Couuth' Health Del):u•(nicn( (o enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site su'2., llA'I'L SIGNATUI Y ' THIS AREA MAY BE USED ICOR DRA1•VING YOUR SITZ; PLAN (Include all of rile following: Existing :old proposed property lines and dimensions, structures, setbacks, and septic locations). R Sign given Revised DC1ID (05/03 Site Revisit Charge Datc(s): Client Notification Date: MIS: Account No. 8l ,7 0�S`% Invoice No. - L� f APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department Environmenta/Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 T Q DEC 3 zD2 ENV/ROAl �DAVIEENTA[ yfAlru ***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 W: Mailing Address c ri1-3i City/State/ZIPp� 2. Name on Permit/ATC if Different than Above Mailing Address Contact Person Home Phone 7/D GAO Business Phone Z� ?—as' City/State/Zip 3. Application For: f"Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: Ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms 1721 Dishwasher ❑ Garbage Disposal U Washing Machine Basement/Plumbing CI 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: 9-1County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ff-Yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQYI EST 6D BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: / / 3Cf A-cf- S o� Tax Office PIN: # :/3�� /' 9 Property Address: Road Name L . / City/Zip If in a Subdivision provide information, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Z-5-49" x'A -1- / - /,0 �� 0 -it - Name: e291d21-6 -N&E "70 ry\A Section: Block: Lot: LOT % Date Property Flagged: 1n2 ^� �- 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 al/ charges incurred from this application. 1, hereby, give consent to the Authorized Representative of the Davie County Health=:5 ent to enter upon above described property located in Davie County and owned by �i :5:" 1 to conduct all testing procedures as necessary to determine the site suitapility. _ !� 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. 6t- T f d v 1s" 'r Revised DCHD (07/99) Invoice No. • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-38-2199.07 Billed To: Westview Development Co. Subdivision Info: Louise Smith Adams Lot # 07 Reference Name: Location/Address: Redland Road -27006 Proposed Facility: Residence Property Size: see map Date Evaluated: 1 2123JD Z Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position 1_ Sloe % (070 HORIZON I DEPTH O - 10 —12 Texture group GL_ C4— Consistence Structure Mineralogy HORIZON II DEPTH 1p - - Q Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy' SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION I VS J LONG-TERM ACCEPTANCE RATE I SITE CLASSIFICATION: pS LONG-TERM ACCEPTANCE RATE: EVALUATION BY: _�05CF lal��-ILS t"vi" OTHER(S) PRESENT: REMARKS: LOT _ VALL OeLL `FO 'I>, OW -7- Q8CY- 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)