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173 Redmeadow Drive Lot 29DAVIE COUNTY HEALTH DEPARTMENT ti Environmental Health Section �� P. O. Boz 848/210 Hospital Street / ` Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000955 Tax PIN/EH #: 5861-38-2199.29S Billed To: Samnaz, Inc. Subdivision Info: Redland Place Lot # 29 Reference Name: Location/Address: Red Meadow -27006 Proposed Facility: Residence Property Size: see map ** NOTE *'ThIs�mprov emeent/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 d t= #People #Bedrooms 3 #Baths �•� Dishwasher: G3/ Garbage Disposal: Washing Machine: EP""' Basement w/Plumbing: ;3'� Basement/No Plumbing: ❑ Commercial Specification: Facility Type ,, #People #People/Shift #Seats Industrial Waste: . �01 ❑ Lot Size �e Water Supply C_ /1W ► Design Wastewater Flow (GPD) — � Site: New ValRepair ❑ System Specifications: Tank Size 1000GAL. Pump Tank GAL. Trench Width 3&•r Rock Depth �11 Linear Ft.30 Other: �l&Tzaj��f%�r�i%t�/�►%%V- /��J`'`i�15�0 QclT� Required Site Modifications/Conditions: [A&T .�U, , Ob.) C,fi P— Kay- 16'D* Hwy%, PeP ld ���Q IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) 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.**** �s A i G r+ �A��r��TIJt �— Oul civ Environmental Health Specialist's Signature: / i� Date: �� 3) Oy Civ is DCHD 05/99 (Revised) st DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksviille, NC 27028 (336)751-8760 IMPkOVEMENT/OPERATION PERMIT Account #: 990000955 Tax PIN/EH #: 5861-38-2199.29S Billed To: Samnaz, Inc. Subdivision Info: Redland Place Lot # 29 Reference Name: Location/Address: Red Meadow -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3668 **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 I 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 #People #Bedrooms -- #Baths Dishwasher: Moo'Garbage Disposal: G Washing Machine: 13"' Basement w/Plumbing: Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #�S-eaatts Industrial Waste: ❑ Lot Size Type Water Supply C�i:'1 Design Wastewater Flow (GPD) Site: New Repair ❑ r00� 3o'l f System Specifications: -Tank Size -GAL. Pump GAL. Trench Width Rock Depth 12 Linear Ft.� Other: Required Site Modifications/Conditions: IS' a Ha)SC' 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.**** Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 4- P SysT0---1 Date: v DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990000955 Tax PIN/EH #: 5861-38-2199.29S Billed To: Samnaz, Inc. Subdivision Info: Redland Place Lot # 29 Reference Name: Location/Address: Red Meadow -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3668 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION F lm **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 CO ION S VALID FOR A PERIOD OFF VE YEARS. Oq Environmental Health Specialist's Signature:__ Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall ind has been installed in compliance with Article 11 of Disposal Systems," but shall in NO WAY be t a given period of time. I Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) W �+O lyst described on Improvement/Operation Permit 13 ,� n .1900 "Sewage Treatment and t t stem will function satisfactorily for any UL- G • -2 5 32,404 Sq, Ft. 0.744 Acres± .t" V C) t3; 28 Radius 55.00 Sq. Ft. Acres± ,• -. �.J � N 0.752 Acres± -)r .± 31,939 Sq. Ft. -.-1U` '{ 0.733 —Acres ± rn AN 84.2 2.15'54 � 54 E �S�G� 82,15 10, Public Utit; 95.47 1 Redmeod( 80.Q6' , put). Jp- 31 J Z 30, 38 7 Sq. F l � 0.698 Acres N 32,576 Sq. Ft. 4'. o r 0.748 Acres± = 29 � T � 30,190 Sq. Ft. 0.693 Acres± S, 46.63 Gat 62.40 112.94 .2p' 44 W 1 �1•�0� 4g S Co o - J SAMI.IAZ,INC. 3367748700 01/27/04 OS:48pm P. 00b "L1411618 U tilt. Davie County Health Department f Z FWYilo,7meaW11 a/t1,Seclios7 P.O._ Box 848/210 Hospital Street Blocksville, NC 27028 (336)751-8760 ''•WPORTANT"" THIS AIPLICATION CANN07' DL RROCESS.CD UNLESS ALL TIIC REQUIRED INFORMATION IS PROVIDEa. Refer to the INFORMATION BULLETIN for inzLntetiouu. 1 1. Name to be Dilled V-\ LJ C., -7 t J(Z- _ ContaCt verson Hailing Address CP0 110140 Phone City/State/2IPi`�' �(J Dusincsa Nlw1:c� Z. Kamo on Permit/LTC if Differtat than Above Mailing Address -<' oi, City/State/zip J. Application For: Site Evaluation Q huprovelaant heratit/ATE: L -I berth A. System to Service: !SI/Xvuse 13 ISobile Rome D Duslacsa O Industry ❑ OLLcx 5. Type system requested: \ACon:entiooal ❑ conventional modified i -J innovative 6. It Residence: 9 People Bedrooms D l)atlnrouuc; G ishxaahera< rbage Disposal wastring Machine ka- Seven t/Plumbing l�Dasemrnt/No l•L,ua,i n� 7. If Duainess/Industry /Othor: verify typo___—_ 9 People --- 9 9 Cosisiodes 9 S:iowers 1t Urinale 0 Water Coolur:: IF FOODSERVICE: 0 Seats Estimated water U.:age (gallon par day) ^� S. Type of water supply: [County/City D Well ❑ Coau,unlity 9_ Do you anticipate additions or exhallsiotcy of 1110 facility this S)'SICIU is WClHtcd to scrtT' ❑ Yes Ll Nu If yes, what type? ••"WPORTANY' CLI EWS.iIUSTCUnlPIXZ8TI)E ACQ71WA D PROPERTY INI-'UttlIXI'lON Itl_(1111;S't 1;1) --^ BELOW Citliera PLAT or SITU PLAN AIUSTDE SlllldfM—ED by the dleal with'I'llIS A PPLICATION. 1'roprrl)' IJitncdsiotts: ���'p )CL(Z C� I- \l}Jii'!'l; llll(EC11OivS (rie131 p•tort:sviUt) l0 1'1t01•ti1( V : Tax Office I'M fl c �� cP 3 •oZ% S Properly Address: Road Mame tucL � O W _ City/'Lipi+^C�,� �y _ If ill a Subdivision provide information, fullolvs: Namc: t Qle�— • — Section: Block: Lot: Dale booic curuct-s nabbed: ,This is to certify that the iufortuatiou prop ided is correct to Elie best of my knott•iedgc. 1 ultdclxtand that any peralit(s) issued hereafter are subject to suspension or revocation, if thcsile plalsorinlcuticd use change, or if file inforulat[uu submitted in this application is falsified ur changed. 1, also, ru,ders(aad that 1 um responsible for «/1 charges iucnrred fruul this upplicoliaat. I, hereby, disc consent to :tic Authorized Rcpreseulalive of tic Davie Cuml�} Ic: 11 Departcucr$I to etilcr upon abort: described property luimlcd in Davie County and unucd by 10 conduct all testing procedures as iiecwaq to determine the site suitab' •2 � DATE TIiIS AREA I%IAY BI-; USIsD FOR bRAWiNC YOUR SITE PLAN (include actor the oilotvinb: Ln iug acid prupuacd property lines and dimensions, structures, setbacks, and septic loealions). 5ilc Rcvisil Ch:n•1;c �— .. Cliuit Notification Datc; SAMNAZ,INC. FRCtfi -�PHILLIP R BRLL CO 1 3367748700 FRri MD. : 3369453268 01/27/04 0Sz48pm P. 00S San. 27 2054 04 : c5PI9 P1 REDMEADOW DRIVE F' APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department Environmenta/Health Section DFC P.O. Box 848/210 Hospital Street 3 zo2 Mocksville, NC 27028 (336)751-8760 ENV�R�NNIENT �AVIf�p�1 y£q(Ty ***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 Mailing Address 6:5�(/1 -75 '&jAaZd/4L ��- City/State/ZIP Id -5. )�)d, �2 7 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: P1191te Evaluation Contact Person Home Phone Business Phone City/State/Zip ❑ Improvement Permit/ATC ❑ Both 4. System to Service: ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms Dishwasher U Garbage Disposal U Washing Machine Basement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/Other: Specifj type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: aunty/City ❑ Well ❑ Community s. Do you anticipate additions or expansions of the facility this system is intended to serve? Byes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: #o3g— Property Address: Road Name / City/Zip If in a Subdivision provide informatiog, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: /529--'r'A -4, / /r, 24-WZ1r1n101A2,:71, Name: DC1�t.�e.e �r f�`J ,/IYYii n �1JOIA 1% -,Ac Section: Block: Lot: LXTADate Property Flagged: Ir;? L7 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. 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 ,(m�; pr��✓�t�t15 to conduct all testing procedures as necessary to determine the site suita ility. DATE SIGNATU i — 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: L -J � Revised DCHD (07/99) V 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 #: 5861-38-2199.31 Subdivision Info: Louise Smith Adams Lot # 31 Location/Address: Redland Road -27006 see map Date Evaluated: 12 ZO �2 Community Evaluation By: Auger Boring Pit / Public _1_1� Cut FACTORS SITE CLASSIFICATION: 1 2 3 4 5 6 7 Landscape position Sloe % 41 bo HORIZON I DEPTH 0 —10 Texturerou GI - Consistence S Structure Mineralogy1 HORIZON II DEPTH Texture group Consistence ' S Structure S Mineralogy1: HORIZON III DEPTH - 3 Texture group C Consistence SS Structure IL Mineralogy HORIZON IV DEPTH 31 Texture group Vvcx Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE t-)— t�j' i LONG-TERM ACCEPTANCE RATE: ( REMARKS EVALUATION BY:�o OTHER(S) PRESENT: S 7`0 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)