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168 Redmeadow Drive Lot 24DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section , C- P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900573 Tax PIN/EH #: 5861-38-2199.24 GJ Billed To: Glenn Johnson Builders Subdivision Info: Redland Place Lot # 24 Reference Name: Proposed Facility: Residence Location/Address: Red Meadow -27006 Property Size: 3/4 Acre ATC Number: 3656 **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 VA(l J-�. #People #Bedrooms `I #Baths Dishwasher: 2( Garbage Disposal: ❑ Washing Machine: 135"' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type�� #People #People/Shift #Seats Industrial Waste: //'��❑ Lot Size Type Water Supply ` rw-may Design Wastewater Flow (GPD) %Q Site: New e Repair ❑ System Specifications: Tank Size(OMGAL. Pump Tank GAL. Trench Width�Z� Rock Depth �Linear Ft. 4� Other: '1-wn-kaAac-) Required Site Modifications/Conditions: 1,,N STAV- pri GOrJ't 00, 14 J IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative offlw-Davie County Health Department for final inspection of this systems gen 8:30_am-te-9:30 a7ff or 1-00 p.m. to 1:30 p.m. on the day of'nstallation. Telephone # is (336)751-8760.**** T� 30 v,- I \\\N IOate.: Environmen al eali�t Specialist�ture: t' DCHD 05/99 (Revised) DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street MockvAlle, NC 27028 (336)751-8760 Account #: 989900573 Billed To: Glenn Johnson Builders Reference Name: Proposed Facility: Residence ATC Number: 3656 Tax PIN/EH #: 5861-38-2199.24 GJ Subdivision Info: Redland Place Lot # 24 Location/Address: Red Meadow -27006 Property Size: 3/4 Acre 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 V ID FOR A PERIOD OF FI YEARS. Environmental Health Specialist's Signature: Date: CERTIFICATE OF COMPLETIO **NOTE** The issuance of this Certificate of Completion shall indicate the s tem has been installed in compliance with Article 11 of G.S. Chapter. 1 OA, Disposal Systems," but shall in NO WAY be taken as a guarantee at t given period of time. F,5 I 75 - Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) i-20 2�b ;d on Improvement/Operation Permit .1900 "Sewage Treatment and n will function satisfactorily for any - DTA LA O Q VI%bI 1 ' F011 SITE EVALUATION/IhIP110VUIL-VT PERMITS ATC C� U Davie County Health Department EeYirorl/nenia/Hea1t/1 Section Box 848/210 hospital Street JAN p� Mocksville, NC 27028 (336)751-8760 FLK . * VIPOE'.�1E PPLICATION CANNOT !JE PROCESSZD Ui7LLSS ALL THE REQUIREDINMAT PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed �;1e,7,7 , oA,5,-1 9 f /dei � �t-t� Contact Person 6/erJ�2_�c�J7rtfe.11 Mailing Address /!'/jli,I�gX�:l� /!:/etd /"" home Phonc City/State/'LIP %y-cy,1 -e , -272120k Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: ❑ Site Evaluation City/State/zip ld Improvement Permit/ATC ❑ Ifo Lli 4. System to Service:FtJ' louse ❑ Mobile Home ❑ Business ❑ InduStry ❑ OLlier - 5. Type system requested: I—Conventional ❑ conventional modified ❑ innovative 6. If Residence: it People it Bedrooms 11 BaLllroom:, 7. ❑Dishwasher ❑Garbage Disposal ❑Washing Machine ❑Basement/Plumbing ❑Basement/lio Plumbing If Business/Industry /other: verify type # Commodes it Showers It People It Sinks _ It Urinals II Water Coolcro IF FOODSERVICE: # Sea atts EBtimated Water Usagc (gallons per day) _. 8. Type of water supply:. -0i bounty/Cit:y ❑ Well ❑ CommuniLy 3. Do you anticipate additions or UpaliSloins of the facility this systelii is intelided to serve? ❑ Yes 'u If yes, w1lat type? ***IAIP01ZTAJYn** CLIENTSIIIUSTCOdIPLETETHE REQUIRED PROPLItTY IN1,701 4ATION IUEQ11JiST1-1'D IIELOIV. Eitlicr a PLAT or SITE PLAN /11USTBESUBKITTED by the client ivilll'1'1IIS APl'LICA'I'ION. Property Dimensions: ° /7`- `°��'� 1VIti'fE DlitEC'I'IONS (I•r(jui 111oclisville) to I'ItOl'Elt'I'1': CEJ // 11 / J Tax OfficePlN: 11 ��� /- 3� ^��9 zY %�� iz?c�aP�� �dU4i1�L, �C'4Cvv Le�(4�d Property Address: Road Name - 4 , % /��� �,� �e.�;�lr`'a�Iow 1�,oe City/Zip moo+ o n �i SGC{ If in a Subd' ' 'on provide information, as follows: Section: Bloch: Lot: Date Inonle corners flagged: 9 U This is to certify that the information provided is correct to the best oflny knowledge. I understand (hal any pernnil(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if (lie information submitted in this application is falsified or changed. 1, also, untlerstand that 1 a7n responsible fur all charges incurreel -oni this application. I, licreby, give consent to the Authorized Representative of the Davie Comity Ilealtll Dcpal•hrcui to enter upon above described properly located in Davie County and ovucd by to conduct all testing procedures as necessary to determine (lie site suitability. n / DATE I- 107 SIGNATURE, ��� ��✓!'Lt aGh THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Included of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Sign given lZevised DCIiD (05/03 Site ltevisit Cluu•hc Date(s): Client Notification Date: EIIS• Account No. !,,r / o 57173 Invoice No. I APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Q Davie County Health Department lS Environmental Health Section P.O. Box 848/210 Hospital Street 3 Mocksville, NC 27028 ?00 2 (336) 751-8760 EN�tR4N OqVZl- o�(y�ITH ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUI'015- INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed r l li Contact Person Mailing Address 1 iCO�(dL�� Home Phone City/State/ZIP %Q �? Business Phone 22 �2— 5- 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ["Site Evaluation 4. System to Service: ouse ❑ Mobile Home 5. If Residence: # People Dishwasher U Garbage Disposal 6. If Business/Industry/Other: # Commodes ❑ Improvement Permit/ATC ❑ Both ❑ Business ❑ Industry ❑ Other # Bedrooms / .i # Bathrooms U Washing Machine Basement/Plumbing CI Basement/No Plumbing Specify type # Showers # Urinals IF FOODSERVICE: # Seats 7. Type of water supply: # People # Sinks # Water Coolers Estimated Water Usage (gallons per day) Runty/City 8. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? ❑ Community B -yes ❑ No ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUB111ITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # Property Address: Road Name 2ZZ41tfi City/Zip If in a Subdivision provide information, as follows: WRITE DIRECTIONS/(from Mocksville) to PROPERTY: Name: D Section: Block: Lot: ,"Date Property Flagged: A7 -3-e9 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 mn 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 ,(m,�;p �„��j ✓�t�r15 to conduct all testing procedures as necessary to determine the site suitability. SIGNATURE 42 �ifArZrJAF%k MJMMIARNN�N-'��� 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 Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size: Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.26 Subdivision Info: Louise Smith Adams Lot # 26 Location/Address: Redland Road -27006 see map Date Evaluated: 12-120 10 - Community Evaluation By: Auger Boring Pit Public / Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % o HORIZON I DEPTH 1 Texture groupC lr Consistence J' Structure Mineralogy1� l HORIZON II DEPTH —2Q Texture groupG ►� Consistence : S Structure �t Mineralogy HORIZON III DEPTH Texture group 04 eL r Consistence 1 P Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE FXF&O Tel 1 �-- CLASSIFICATION QS LONG-TERM ACCEPTANCE RATE 0-S6 = 3� SITE CLASSIFICATION: Ps LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY— 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(unsuitab►-,) 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)