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133 Graywood Court Lot 21I DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002260 Billed To: Allen Wayne Builders,LLC. Reference Name: Proposed Facility: Residence ATC Number: 3675 Tax PIN/EH #: 5861-38-2199.21 aw Subdivision Info: Redland Place Lot # 21 Location/Address: Graywood Court -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 WASTE RU ON VALID FOR A PERIOD O FIVE YEARS. Environmental Health Specialist's Signature. Date: 2 L (� ��d nom 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 as a guarantee that the system will function satisfactorily for any given period of time. %5Z5 %, �, F .b cya /I 1 1 1;21 ,Z- � - } Septic System Installed By: • Environmental Health Specialist's Signature : V&al Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002260 Billed To: Allen Wayne Builders,LLC. Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-38-2199.21 aw Subdivision Info: Redland Place Lot # 21 Location/Address: Graywood Court -27006 Property Size: see map ATC Number: 3675 **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 l 1 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 �ou-sc #People #Bedrooms 3 #Baths Z Dishwasher: 12" Garbage Disposal: ❑ Washing Machine: e Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water SupplyC OI&" Design Wastewater Flow (GPD) % Site: New Repair ❑ System Specifications: Tank Size ,CC'.t7GAL. Pump Tank GAL. Trench Width-�UI Rock Depth 12/, Linear Ft.3S� Other: 1 -b1 ;?>TaAW T-10-3 &>�S Required Site Modifications/Conditions: 0.3 C�—I't�2 1�+ =� SI f HAS, t Z 1� c�G4: j0"L, 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.**** •4F�� u,�s C w t' \L e;�' KW QAkQ 1,31LL,- e� 41 �D 6'� Viola—, s P� i62 X Environmental Health Spalist's Signature: DCHD 05/99 (Revised) \ ,6-'-a V- d y sec s =s FaA \ qSq I tsSti1-7 ate: 3 3i IN Com► DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002260 Billed To: Allen Wayne Builders,LLC. Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-38-2199.21 aw Subdivision Info: Redland Place Lot # 21 Location/Address: Graywood Court -27006 Property Size: see map ATC Number: 3675 **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 I Y005�— #People #Bedrooms 3 #Baths 2 Dishwasher: Id Garbage Disposal: 0 Washing Machine: G!r Basement w/Plumbing: 0 Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift 22#,,S,,e��0 ats Industrial Waste: Lot Size �- Type Water Supply vDesign Wastewater Flow (GPD) �.�l�lJ Site: New 13;� Repair System Specifications: Tank Size 100OGAL. Pump Tank GAL. Trench Width 31olu Rock Depth 12-'1 Linear Ft. 3 � Other: Required Site Modifications/Conditions: �ST�u- O� Go'�1To.�Q��u ocr— EivJ&G,(! + l6 Z IMPROVEMENT/OPERATION PERMIT FINISHED GRADE. ****NOTICE: Cont, system between 8:30 aa.m. to 9:30 a.m. or 1:0 LA�rNres APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW aative of the Davie County alth Department for final inspection of this p.m. to 1:30 p. . on the day of installatn. Telephone # is (336)751-8760.**** Y� p qFP� FX Environmental Health Specialist's Signature: DCHD 05/99 (Revised) LOT 23 2 G Dq 'Jan 30 04 03:33p Allen Wayne Builders LLC 336 761-1502 ' Jan 30 04 02:513P davie County envhealth 336 751 8785 P•2 AI'NUCAMN IN SITE 1EVLLU4T101v/Lvl1IIUVC Myr I Lfwrr 5 ATC Davie County Health Department E/1171t)11IJ1fCW1f8711h Secbton P.O. Do: 44e/210 ltoapital Street )IOCkoville, DTC 271128 (336) 751 -8760 • a•I!(POR7AN7s ee Tias I1MICATIOK cAwor BB Pjtocrs= =Lusa ALL Til): 1tSourRED� -�— � INFORMATION IS PROVIDED. Refor to thoj XIUORHATIOP DDLLL'TIN for instruction:,. 3. K. to be 11111ad �'j�r/n �/(l�/r,6 /S:a; I'd,'(Y UC, Gpowtact tozsm � /�IQ�`��n(fn Nailiap Wdcwa _,�-f (�C/oY✓rC�A/� !r v1 . S�. %6 1:awo riwwa _� 1 � _`O�) / . city/statenip Wit——To- �G/rm{ (P. f . 222© n.:ai.... shown _ 7 7. Vamp oa landt/ATC If Dlrreraa: than Above ' naillay Addtasa �G1ity/Stoto/Yip _ 1. APpiicatioa For: Q Site Evaluation RC1 iaprovement Perxtiit/ATC Y l7 lluth �i j 4, syatm to Sorvicae YNouse ❑ Mobiie Hoag 0 Dtlsi4eda 0 Industry ❑ Othur $- 7rpa systen rtquaated: 1iQ Conventloaal ❑ conntiowal sodi(1ea ❑ Lunovativa a. It Residenco: fit People, a Deftootn: �3 A DatLroom::. _ I11o1mwasher ❑carbago aiapas.l A(-* . xachina 0811 .,wwurlu.bi.!j ❑,mce.cat/No rlvmbiwg 7. xE Dluolnaaa/rwduotry futhac+ -arl(y type a Poopla 1 :iiuka a eomii0deo a Wwori • ezina:a a nottc coaloaa IF FOODSERVICE: F Seats • EAtimated water V^.age toaalona per 4a71 _,_,,,_,W_ a. Typo of vatar aoyplr_Xr County/city ❑ well ❑ comity- a. 4 yew aattcipata oddttl— or Yes �NU Ilyrs/ b'Lat ly(m? a••IAIPOIZTAffi"*Cl1CNTSAtt/STCOAIPLM-T11E RtQU7KEDrN01•EItTI'4VFOltMA7'tONIIi:QI1G1rt:l1 _� BELOW. ElWeraPLAT arsrrZ ANA1VSTBESVBAfRTCDbythedit.1 with WISAPPLIC.010N. Property Dimensions: �y+ C WRITE UIIWC'1-KWS ttnau plucksvtik) Wt ItOt t;ltT 1'11 Tax office PIN: 3 8'— Proptrty Address: Ttoad NatucG c/ Citymp IfivaSubdiyWonprotideinfarmation as follows: Name:, Section: Illorli: Lot. 21 _ Date house corners >LCCed:12W /01-/ (� IL9 i .��F�q ?COQ Tliu is Io certify" We inforun6on proyMcd is correct to Elie ycst of fitly knosrtcdt,•e. I tutdera[and Mat any permits) issued hawfler are inbicct to suspeusiou or rcroeatiou, if the site plans or intended use dtaugr, "it Ike irlforn+a tion subaliucdin this applicatioa Israbificd or ch=gcd. L cica, widersrnndt1io1fain respensiblejurall N+argca incamd jra u rbisvpyliear/�tr, t,bcreby,�ivoeotu�,ttot-.eAu[/lorirl•dItepreseulativeoflbcUgricComd�IlulU+I)q+artineat to enter opou above described property located iu Darie County and owned by to cunduct at! testing procedures as neeessa.•y to dclertuine the sit7ze ; DATE I � SIGNURE AT /� TIM AREA MAYBEUSED FOR DRAW NG YOUR SME P tcI UofOlcfo ofmg: Existiugaudpi iiased property Lacs and dimension% structures, lethacks, and septic oeatioDs). SUCIUVisil Cllarec Dalr(s): CGeat 110LUIcutietl Date: Sipg1vtn ! V O Account No. Revised DCIID (85103 Invoice No. 37(e p.2 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 D :4 � V 3 2042 &V�jRONM `�tf r," t' HEAT Tu ***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°��1 re(U yv Mailing Address City/State/ZIP 2. Name on Permit/ATC if Different than Above Mailing Address Contact Person J Home Phone�rj Z22 to Business Phone 'j City/State/Zip 3. Application For: !"Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: Ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # DisBedrooms .� # Bathrooms hwasher G Garbage Disposal L]Washing Machine Basement/Plumbing ❑ 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: (aunty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? EHfts ❑ No If yes, what type? 'IMPORTANT*** CLIENTS MUST COMPLETETIIE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: / , �j A-cl- S 3 Tax Office PIN: #� Property Address: Road Name�ft/(�/ City/Zip If in a Subdivision provide informatioQ, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: L J- e�- �- Name: 55 ' J " Section: Block: Lot:Property Flagged:�— 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 byJ,�; p �n��� /►ICYtI 5 to conduct all testing procedures as necessary to determine the site suitapility. 111111111! KF' F 44PON' ,01 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. 6 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 #: 5861-38-2199.23 Subdivision Info: Louise Smith Adams Lot # 23 Location/Address: Redland Road -27006 see map Date Evaluated: Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit i Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH 0 - Texture groupi-- Consistence 5 Structure Mineralogyh HORIZON II DEPTH Texture group Consistence ; Structure L Mineralogyr 1 HORIZON III DEPTH !-{ Texture group —raa Consistence )4 PIT - Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE 0tJ aTeQ l CLASSIFICATION S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: D, 3!S - REMARKS: S REMARKS: EVALUATION BY: aA-A- 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) 56,239 Sq. Ft. 1.291 Acres l tT, W co CD M _ 1 -52,466 Sq. Ft. 41- 1.204 Acres± /�v (T -I 'z 99.51 .{Arc} `734 W 99. 06 7 3 72' 07 a 1b\iC R�W �3 \6 11.15' tic 1� ' A �• •. � 9 6 1 ' 3sp(0-h J r. 21 C) �2 _ DO �y ---I 31,766 Sq. Ft. U' 43,960 Sq. Ft.00 0.129 Acres t t = 1.009 Acres± . �\ i 1 ae, P, f^ 10 P� A. �B 17.15 r�64.15t' Ab8' 6 (2 3)} 3 ; ; (2 2) 'o