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160 Graywood Court Lot 11Permittee's-- ;.:r.. Name:_ •, DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O. Box 848 1A 1Azl01 PROPERTY INFORMATION Directions to property: t - ` "' Mocksville, NC 27028 Subdivision Name: 1(:. ::'t` t ! �`i•., w_.,j".: / `E-';' r r .i is Phone #: 336-751-8760 i Section: Lot: ` r AUTHORIZATION FOR t l.1=i ✓elf it. l� ..a,j �j., ,,- .x.:E:'t( (, , WASTEWATER �-- SYSTEM CONSTRUCTION Tax Office PIN:# - - AUTHORIZATION NO: 002"0A Road Name: ( - Zlp. **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This FornVAuthorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I ],of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) r _ ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRQNMEKTAt'HjrXLTH SPtCIA� tS DATE I§SUED RESIDENTIAL SPECIFICATION: BUILDING TYPE WA --6# BEDROOMS " # BATHS 2 • # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE i • i��YPE WATER SUPPLY >� '� I t DESIGN WASTEWATER FLOW (GPD) _ t 1_ NEW SITE_ REPAIR SITE t/ SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ' ROCK DEPTH LINEAR FT. y L OTHER 2121-1 CL 1 6>01 I[) REQUIRED SITE MODIFICATIONS/CONDITIONS: `'^ 7f 7• (_j C- �T�^��� 11-l�' AC-r-��5 I' L , f rJSfi!�t (.. O'> C J Puck IMPROVEMENT PERMIT LAYOUT �, t- ' 'j;,1'i�r��.. l-.1�•St: 1�•� i`,t.+�� .i( f::.X1`�ltniL"1 LU�r;G.�,T t_twic (t ' Lt,�e d- t .{.-7 t-.q-.C�,1 n� - d- r jv �- -� _ r P.--n-I.':_0 `�6.�4-� lei`• -)i> t�'+V`�� ^ l_`'1... M**ti-t`x-- /� Ci..�,.�;5'i-l..�. f c :V' (...I tip& � { 11sJ�JC --(►_ �t�i CU JC. timet 1��t ' Ci�"-"C 'It%`t„vk �tU rr IrJta�t� CV h�i �G� ; CtJT Cv�JCi; tU� k r Ll�C t LJ —it, FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. DCHD 02J02 (Revised) /�(%L�f �Z ! �,/Ll • rt,- /L q / 'Permitf� x; - ; -DAVIE COUNTY HEALTH DEPARTMENT Name:1 Environmental Health Section PROPERTY INFORMATION P.O. Box 848 Directions to property: ; Mocksville NC 27028 Subdivision Name: 1 ` L.! i. -t`"`- ' F� f ; ''V w' } ?.f`_.!,% '. %w) Phone #: 336-751-8760 AUTHORIZATION FOR 6 i Rr'!`9'tp S. c, WASTEWATER SYSTEM CONSTRUCTION AUTHORIZATION NO: 0027 _4 9 A Section: Lot: Tax Office PIN:# - - ' i � 1 .':f ,Road Name: 1 `- Zip: c..r **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Pen -nits. This Fonn/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 1 ],.of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE AVY # BEDROOMS 41 # BATHS � # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATSINDUSTRIAL WASTE: Yes or No LOT SIZE + i i`� `��TYPE WATER SUPPLY,! ! l111 1 Y DESIGN WASTEWATER FLOW (GPD) '� NEW SITE__%�_ REPAIR SITE Y SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ` �'� ROCK DEPTH 1Z- LINEAR FT. HL, nT14F.R s 1 REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT PERMIT LAYOUT •.- 'v- h; + �;.'t �' + ,T '�!� 1-,lnl►`�. J�'..��-.�.!«:. f '�1'` 1+',.:1:"1 �-A+L`%t-`"t i; �i ; 1'..0 1(., i L.1`t, ./ ! r r.,,. 1, l�+.7 �.t• k.�. t:.::� � U c.�� r : i� �� t_. v _ L r) s. ��J A r r t fl; j , �.._...� _ .. _ .. .. � _. f ^t � yam`, i I C; y:'>�. S Ll E ( 11 -10, ._...-...�,,�r♦ ,':�s..'�"~, t•..��i nnv�T ;��. M.s.,-�. h c'.l.t�lr^fit,. • . (t1c::,.>t i► �-+'t C 1Ja.&. T' C!`yid ..1�,_lc�nik "11.)s;:i*Ji _%L) 1 L:—,C �y(�f1� r.w C.ITI Ca:.JCI�')4�'���L, 4- lA} iu 11 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. n OPERATION PERMIT AUTHORIZATION NO. OPERATION PERMIT BY: SYSTEM INSTALLED BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. DCHD 02J02 (Revised) //(-"el`rl %/Z✓/—�f�j%. f'�_ ,i�t� nJAN:16.MI, J:U/I'M W U1 VIRONMENjPI � 'vo 06 Mailing Address:` Dewed Directions T' � /� flisittlC Noperty davie county envhealth 336 75X rNU. 9b/ F. Z P. 1 ti DMIrE COUNTY HEALTH DI"PARTMENT Environmental Health rection PO Box 8WI0 Hospital :Street Mocksville, NC 27OV; Phone; (336)751-8760 WASTEWATER CERTIFICA,'11'ON FOR DWELLING REPLACEMENT 0 REMODELING o RECONNECTION o �r I f I� i V15 Phone Number: ' i fez 00 C� 'Jake . c 2-76b Please Fill In The Followin Information About The Existing Dwelling_ Name tern felled Under e.4S Sys los t Tf Type o Date System lwtalled(IYlonth/Day/Ye irr):_ � o L Number Ot' l3edrooms: .S is The Dwelling Currently Vacant? Yen Fj No 0 If Yes, For How Lorig7 Any Known Problems?!Yes 0 Nod If Yes, Explain: NO M OVeM s V/ 6 Pew re , AbGN r HA e�ue 1; r 3 Wee.,4' . Please Fill In The Following Information About 'Ilse New Dwelling. A - V , I gelling: umber Of ;TMs n Type Of Dwelling: AKe Number Of Bedroon,a: Number Of, ! 1a People: 7-- Requested By: Date Requested: (Signature) Fox Environmental Health Office Use Only Approved 0 Disapproved 0 Environmental Heolth Specialist *ne signing of this form by the Enviromitental Health Staff is in no way :intended, nor shouldi be taken as a guarantee(extended or limited) that the on-site wastewater system will fimcdon properly for any given period of time. Payment: Cash 0 Check 0 Money Or:ier 0 # Amount: s! ��%' �� � Date: Paid By: Received By._ Account #: Z! / _, invoice M- ' DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section �O�( P. O. Boz 848/210 Hospital Street • Mocksville, NC 27028 y� 1 3 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003128 Tax PIN/EH #: 5861-38-2199.11VB Billed To: Venable Builders,lnc. Subdivision Info: Redland Place Lot # 11 Reference Name: Location/Address: Redland Road -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3728 **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 Dishwasher: 12' Garbage Disposal: ❑ Washing Machine: d Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 1.1 AC AQAE�& Type Water Supply C-L-01�-7wDesign Wastewater Flow (GPD) Site: New E5/ Repair ❑ System Specifications: Tank Size �� GAL. Pump Tank GAL. Trench Width*,!jp Rock Depth 1 1 � th 2- LLinear Ft. Other:tCT2 �j1�T1 O�U?Ct�S Required Site Modifications/Conditions: k-IWL 0") cz-)ro Q. VZL-. 6tOts&I Id Orr ow. 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.**** aa L^.t?T� Environmental Health pecialist's Signature: DCHD 05/99 (Revised) LANE& l� �Em I DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990003128 Billed To: Venable Builders,lnc. Reference Name: ATC Number: 3728 Tax PIN/EH #: 5861-38-2199.11 VB Subdivision Info: Redland Place Lot # 11 Location/Address: Redland Road -27006 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION 19d— **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 CON ON IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature Aq,—)Date: 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. —TNta-Y-, iVN% 3 - Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 3-01 to Cas _.. � q v of S � ,f� , 26 , 1 11� � U � - /N 0) N p l �. v 41 3 54 Acres to U) C-- I t. i 105 /1rrps.f - 1 29 fTl co -J rri�— 10' Public Utility Easement 7 3.19' _� _ _�' - -- 1.25.00'--- - _ - 120.00'- 7 14 3.7 2' 578'52, 79"W _-- 491:91 ' Graywood Court (50' Pubic R/W) N 78'52' ., E -- -- 49 9l' --- 138.83' ____- - --- ---14 7.23' — -- - .�= ' - 141. , 5'1 p FENvIDAVIEWUNTY E R 2 6 2004 RONMEPITAL HEALDI J—�,,,,w„ CATION 1=011 SITE- CVALUATION/INIPIiOVU104T 11L'Itil•IIT S A'I'C Davie County Health Department EnYironnle11W1Hes/t/1 Section P.O. Box 848/210 Hospital Street Mocksville, NC 270213 (336) 751-E37G0 * * *Ib1PORTANT* * * TRIS APPLICATION CANNOT -BE PROCESSED UNLESS ALL THE REQUIRL'll TUFnRMATTnN IS PROVIDED. Refor to the INFORMATION BULLETIN for instructions. • 1. Name to be Dilled penile f U." -7k G Mailing Address /0 7 City/State/ZIP C/o lHf"0'" -7G1 L 2. Name on Permit/ATC if Different than Above Contact Person J—OJ2, t_ ]tome Phone nuuincuz Phone _�a__ �s J Mailing Address C ity/ /SState/Zip 3 A lication For: 13 Site Evaluation 19- Improvement Pe2auit/ATC pp � 4. System to Service: ❑ House ❑ Mobile Home ❑ Businctn ❑ Industry ❑ Otl,ei: _ S. Type system requested: + Conventional ❑ conventional modified ❑ iunovaLive G. If Residence: It People it Bedrooms _ II Bathroolm; 2 7. Dishwasher ❑Garbage Disposal dashing Machine f Business/Industry /Other: verify type 8 Commodes tt Showers ❑Basement/Plumbing ❑Baa:emenL/No Plumbing It People It Sinks # Urinals 11 WaLer Cooler!) _ IF FOODSERVICE: 11: Seats Estimated Water Usage (gallons par day) 8. Type of water supply: County/City ❑ Well ❑ Co,mnuniL-y 9. Do you anticipate additions or expal1Si011S of Elie facility this S)'slclll is iiiteilded to Serve? ❑ YCs 'No if ycs, what type? 'IMIPORTIVYP** CLIENTS,uuST COUPL1iTL• THE IWQUIRL•'D PROPEICIT INFORMATION RE'QlJ1.S• I -I'D BELONV. Either a PLAT or SITE PLAN r11USTIICSUX1117'TBD by the client �►ilh'i'IIIS r11'1'I,ICA'I'lON. Property Dlnicusioils: -C� Tax Office PIN: fl Property Address: Road Naine City/Zip If in a Subd ivisi on provide iaforniation, as follows: Name: - WeluAlk-ot Scctioli: Block: Lot: 1YKIT1; DIUCI'IONS (fano 11 cI%-ille) to PROPERTY: Date ]ionic corners flagged: 37-7q Date O This is to certify that Elie information provided is correct to the best of Iuy knowledge. I understand Mutt any peruiil(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the inforw ition submitted in this application is falsified or cliauged. I, also, understand that I aur responsible jar all charges incurred irom this application. I, licrcby, give couscut to the Authorized Representative of Elie D.n,ie Cowity IIealtli Depar(mcni to cuter upuu above described pruperty located in Davie County and uwncd by to conduct all testing procedures as necessal•y to deleriuiue the site suitability. DA'Z'E 3'�'Z — 0 y SIGNATURE; X V TRIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includall of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Sign given Revised DCHD (05/03 Site Revisit Charge Date(s): Client Notification Date: MIS: AccoulltNo. l 7 Invoice No. �� V APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Q Davie County Health Department Environmenta/Health Section DEC P.O. Box 848/210 Hospital Street 3 2(�2 Mocksville, NC 27028 (336) 751-8760 EIV�IRONMENT DgIf��U1 yFA1Ty ***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 e Contact Person % Mailing Address ,2rn3,1iC01(Home Phone eel r (-- City/State/ZIP �p�7/Q �p Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address /� City/State/Zip 3. Application For: P-1ite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: Ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms .i # Bathrooms � _l Dishwasher ❑ Garbage Disposal U Washing Machine - Basement/Plumbing fl 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: R-lffounty/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? 8 -'es ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETIiE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: _ �Cf �Q C/'G� '> Tax Office PIN: # % `13 Property Address: Road Name L r / City/zip If in a Subdivision provide information, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: /�� Ed 1- / zz—Z-Anyl A201 A /) 0&--, Name:- 1 GW MA Section: Block: Lot: T 11 Date Property Flagged: 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 ,4g4;-a..p to conduct all testing procedures as necessary to determine the site suitability. 11 WMI111ir grWgon III 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. Revised DCHD (07/99) Invoice No. DAVIE COUNTY HEALTH DEPAR'T'MENT 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 #: 5861-38-2199.13 Subdivision Info: Louise Smith Adams Lot # 13 Location/Address: Redland Road -27006 see map Date Evaluated: 12 Z Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit '� Cut FACTORS 1 2 3 4 5 6 7 Landscape position I- -Slope % U O76 HORIZON I DEPTH Texture group ir_- C Consistence Structure Mineralogy► ` HORIZON II DEPTH - 'y Texture group 2— Consistence ;SV Structure Mineralogy1 I HORIZON III DEPTH Texture groupC�. Consistence r Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 10.35-0.YD 't& SITE CLASSIFICATION: EVALUATION BY: A1 4 `"E LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: LEGEND Landscaae 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 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)