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175 Redmeadow Drive Lot 28DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • " P. O. Boa 848/210 Hospital Street Z a Mocksville NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002436 Tax PIN/EH #: 5861-38-2199.28db Billed To: Darren Burke Constr. Subdivision Info: Redland Place Lot # 28 Reference Name: Proposed Facility: Residence Location/Address: Red Meadow -27006 Property Size: see map ATC Number: 3678 **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 1 l 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 H #Bedrooms Ll #Baths 2. ,57 Dishwasher: IJ Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: d Basement/No Plumbing: ❑ Commercial Specification: Facility Type„�� #People #People/Shift #Seats Industrial Waste: nn ❑ Lot Size t ^ �- Type Water Supply l.t kNVDesign Wastewater Flow (GPD) L+SO Site: New Ed Repair ❑ N System Specifications: Tank Size h AL: Pump Tank GAL. Trench Width � Rock Depth I2 { Linear Ft. Other:$Tel�t%Tl�-� 1, _ _� p Required Site Modifications/Conditions: l { r%UALL OTj C -c -sT©`�� K�"� ��C' t�c�t '�. �1 )o df� 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.****.*`,*** I � Is` � U ��� P F Environmental Health Specialists ature: DCHD 05/99 (Revised) ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002436 Tax PIN/EH #: 5861-38-2199.28db Billed To: Darren Burke Constr. Reference Name: Proposed Facility: Residence ATC Number: 3678 Subdivision Info: Redland Place Lot # 28 Location/Address: Red Meadow -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 Tre tment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONSTR 7 IS V LID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: 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. 14 Septic System Installed By: Environmental Health Specialist's DCHD 05/99 (Revised) 35,036 Sq- Ft. G a� 26 12�� Gizinski 0 804 Acres± S g•59' 42" E d;us - }o S 8 Rd , 197.43' 55 •�� Co rn Ln 7 c 7 0 2 w N ' r� 45,459 Sq- Ft* Z 30,190 1.044 Acres± N O 0.693 0 1 0 00 z CID CD -r,) 41 20B C3 ,ry - �� p`ti .O Cl)43,592 Sq. R. 1.008 Acres± e �-,t vj ��• o�`�- o� G. 7 4 •�g, G• J.P.S. .----; .► W SB4.A?- 56 -453 20. otcl\i .5861 31 2 B45,3 pou! McGraw 1 D. f3. 82, P9 2(-)4 . 1 tees of Church Feb 03 04 08:50a Darren Burke 336-778-0436 -,r Jun 10 03 11: 14a davie county envhealtn yso ra! 93/430 AFMCK11ON 10111 SITE EVALUMON/iM1`110 UM t'E1muT & ATC Davie County Health Department Ent4iwi/Ire/rtalKei►!labSescl7b/r P -O. BOX 848/210 Boapital Streat 14100mville, NO 27078 (336)7S1-8760 j +++TXPORL{Mee+ T= APtLZCSTION CANNOT BE PROCR.SSBD UNLESS dLL TUE REQUIRED _ BtFORHATTON IS PROVIDED. Refer to the nWOBNATIOH BULLETIN for i2Rtructionn. 1. Mane to be Billed �//'hM[�, �LC..�'il :� Contact Parson E'YL-�_,,_./.� Nailing Addresa i'��.Q L7II7-/`JW none Ptwes City/state/slP CJ �,��(w&,.c, AC- �L%wJJ� avaineea Yt.00. �►. S / 2. Morn on Permit/ASC It Ditteroot tlna Agora _iv(./i.�L' Maili.q w"-- sr� City/State/Ziv -,. -.- -_ 3. Application Ter: x S m ito ulvaluation 17 2mprovament Permit/ATC O Both 1. systeto 9.rvica: (�)4("o�use ❑ mobile Home O Dualneea 13 sadustry O Other S. Type Dyatta rtgaoa(te�de.6! Caewotimel ❑ eoaeentioaal moditiedd/ ❑ Imwvative S. IL Rosidenct: a People 0 Bedr�oo+m.4 �T�1�t� 0 Dathroonni Dteltvaeb.r Oo.rbaps Dispwai ..❑trasLieg ""W=a /O1Dasbxht'Cj12-1gia 08nsewent/Mu Pluwbin� 7. It ttv.1-11oduotry /otb.r+ varaLty type ! 0 People I Cos -odea a :b -ra a Urinal. a ".Lac C-1— _. T: POOnsMRVICSt 0 Seatu Ratimated Nater Usage toall-D ver dayl 3. Type oe -tar wDDay�Aceo-ty/City D viaii ❑ Co.wuaitY a. oa you anticipate additions or expansions of the (aclity this system is intended to serve' O Yes rano 1f yes, what type. `"•IMPORTANT"` C11EN71i MtlSrC041PLEM THE REQUIRED PROPLICry INFORMATION RIMUETML) DELOW. McraPLATerslrEPLAN MUSYDES�yUBA(r17 Dbrtheclirnl with ivisAPPLtCATION. Property Dimensions: :� 1 y- AYRrrE DIREC17Ons Gout 81ud. vi0e) t elft U49 Tax OIGce rim Propettr Address: Road Name/1, 1c,z;--a li�hI ChyrLip t�r,Y &te've— If in a Subdivision prori(aff mt,�f�n� follows. me. Na/(J (/!� , - Scctiaa Block: Lot: , Date honk writers fagged: o- e S � This is to certify that We infotwation provided is correct to the best or my bnorricdge. I onderssaad that any penitil(s) is3utd hernfter are snbjett to raspeathoa or revocation, if the site plans or tatnided aso dsaoge. or if the intonnatiee submitted in this application is fatsflMd or chaaCetl. f tetra, awdenranrllhel lam respvaWrjbr4d1chatrrsjncnrnWfr d+is opp/ieation. t. hereby, give co swat to the Authorized Representative of the Davie Counly health Depa nsrat to eatrr upon above described property located in Davie Conary, and owned by to conduct all testing procedures as necessary to determine the site suitability J DATE r -i(- 0�- SIGNATURE TINS AREA MAY BE IWD FOR DRAWING YOUR SITE PLAN (Include an or the following.- Eastiag astd propusad propeny Ilncs and dimensions, structure; strlbaclts, sad septic locations). Site 12evisil Cltatrc Sign given Revised DCHD (OSM3 Date($). Client Motiat2tiou Date: Account No. ��5 j" Invoice l'la-_"ssQl p.3 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT D Davie County Health Department Environmental Health Section QFC P.O. Box 848/210 Hospital Street 3 CD2 Mocksville, NC 27028 (336)751-8760 ENt/I D4 E14!H�1rR ***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 l e 1/ Contact Person6'rxa MailingAddressC2 � n�JfOL � � Home Phone City/State/ZIP br�S7,0 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: kYSite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service:Ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms ..i # Bathrooms 171L,Dishwasher CI Garbage Disposal L] Washing Machine Basement/Plumbing f.i Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # People # Sinks # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: runty/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? 8 -yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE TIIE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION. Property Dimensions: _ , f 19 -Cl- S Tax Officc PIN: # /3�' a / % �• 3 Property Address: Road Name L City/Zip WRITE DIRECTIONS/(from M/ ocksv`illlle) to PROPERTY: If in a Subdivision provide informatio , as follows: Name: it Section: Block: Lot: -?"'LDrZR Date Property Flagged: In? ^3--D �-- 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 byl(�;� p �„�✓�tA1T 5 to conduct all testing procedures as necessary to determine the site suitaility. DATE SIGNATU 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 Date(s): Client Notification Date: EHS: Account No. Revised DCHD (07/99) Invoice No. •r ` 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 #: 5861-38-2199.30 Subdivision Info: Louise Smith Adams Lot # 30 Location/Address: Redland Road -27006 see map Date Evaluated: 1 7_ -j2, --',j0 2 - Community Evaluation By: Auger Boring Pit + Public Cut FACTORS 3 4 5 6 7 Landscape position L Sloe % HORIZON I DEPTH Texture group'LL Consistence F S Structure Mineralogy %: ) " HORIZON II DEPTH Texture group Consistence = S Structure en Mineralogy HORIZON III DEPTH 2 •4V — Texture group Consistence Structure )c Mineralogy1� HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 3 D 35- •0• SITE CLASSIFICATION: V ) LONG-TERM ACCEPTANCE RATE: c):� EVALUATION By: OTHER(S) PRESENT: REMARKS: ff\AY QO(-V— la 30b LEGEND Landscaae Position 6:,)N-XA4& t,P 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)