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176 Redmeadow Drive Lot 26, • J . DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002436 Billed To: Darren Burke Constr. Reference Name: Proposed Facility: Residence ATC Number: 3677 Tax PIN/EH #: 5861-38-2199.26 DB Subdivision Info: Redland Place Lot # 26 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 Treat t and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATERSTAI-06-15 VA ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: CERTIFICATE OF CO **NOTE** The issuance of this Certificate of Completion shall indicate t sys d has been installed in compliance with Article 11 of G.S. Ch ter 1 OA, Disposal Systems," but shall in NO WAY be taken as a gu ant that given period of time. ` O too Ito Ito 149c tcTt Z- �z Septic System Installed By: Environmental Health Specialist's Signature DCHD 05/99 (Revised) ;don Improvement/Operation Permit .1900 "Sewage Treatment and n will function satisfactorily for any DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002436 Billed To: Darren Burke Constr. Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-38-2199.26 DB Subdivision Info: Redland Place Lot # 26 Location/Address: Red Meadow -27006 Property Size: see map ATC Number: 3677 **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 0 #People #Bedrooms ��" _ #Baths Dishwasher: 21Garbage Disposal: ❑ Washing Machine: 13 Basement w/Plumbing: e Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift /� ,#SSElAeats Industrial Waste: Lot Size ��Ct-iA��ype Water SupplyoJn PTY Design Wastewater Flow (GPD) `-MVV Site: New Repair ❑ i►I System Specifications: Tank Size 1CCQSAL. Pump Tank GAL. Trench Width EG Rock Depth 12 Linear Ft. " Other: 't (L1 Required Site Modifications/Conditions: 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.**** Fi-z- b l,l 1►J okD ,,AP rot .� -<--r — 'Tlo., Ql' \ ► A- - JSr )CdX3t ',cia'- C, \ 1�` '�f 4 Environmental Health Specialist's Signature: ►CHD 05/99 (Revised) • Date: (s P12404 To G' 11-0-1, Q 4 81 154.6 -_1 31,9 s 2 �- - 0.7 mss• 32,404 Sq. Ft. `�S ��� 0.744 Acres± 120 d'- wers F` )owers 2 6 . 92 )ael E. Gizinski 35,036 Sq. Ft. 1986 0.804 Acres± ,,p Meridian) 3 0 S 88.59' 42" E 0 197.43' rn L (D c � 8.26 2•�5 S� O q Rdd��s 55.00 GSC 1 S. i G' 11-0-1, Q 4 81 154.6 -_1 31,9 s 2 �- - 0.7 mss• 32,404 Sq. Ft. `�S ��� 0.744 Acres± 120 d'- wers F` )owers 2 6 . 92 )ael E. Gizinski 35,036 Sq. Ft. 1986 0.804 Acres± ,,p Meridian) 3 0 S 88.59' 42" E 0 197.43' rn L (D c � 8.26 2•�5 S� O q Rdd��s 55.00 GSC 1 Feb 03 04 08:50a Darren Burke 336-778-0436 Jura 10 03 11:14a davie county envhealt,h 336 7S1 8786 p.2 i• APPUMION FOR WE OfALUAT1ON/MPROYEAIEAtf 1.01611[ ,lt API: Davie County Health Department ' Fiyvirw�mtvtb/Hea/GbStIeY/an p_O. Bele 848/210 Hospital Street Mockeville, NC 27026 (336)7S1-8760 SMPORT NTaep THIS APPLICATION CANNOT BE PROCUSED UNLESS ALL THE REQUIRED IItFORMATION IS PROVIDED• Refer to the INFORMATION BULLEM for instructions. I *** 1. Wage to ac Billed j( ".C -C t'rl :�c Contact parvo mail!" Andean `7'g�s 1. cit?/State/iZP L'.��hr Cy' ���•�L�1+2 DwIna" Phone 2. Nme on penult/aTC it Ditterantt than Above W-414.g.ddr.s. City/State/zip _.. ...._ _- 1_ Appiiesdoe For, �Sito �raluntion fJ improvement permit/ATC O Both 4. Sig can to s.vice: (�il—ttt"oV1Tye E) Mobile 11c no El Business 0 Industry E) Othcr S. Type aystes request`ed:Xl CmwoLional ❑ conventional soditied •❑ Innovative G. It Residence: t People o Bedrooms a Dathrooms 7 s Dl.hraabar ❑ Lactage Disp Ma "ac:hing/elwsemehtlpl Sege ❑Pa-empt/Wo rl—bin 7. It nueiees./l.dwtry, /ether: verity type ! — tl People Sinko I conned— 0 :horets TI uclualg a Mater ck—lerD IT ROODSBRVICSt tt Seats 8atimated Water Usage feel loon per doy) e. Type of rater supplyr<Cou-�tY/City 13 titch O conamaitr s. DO you aoticip.te addltlow or expansions orthe raeitity this system is inleuded to serve: O Yes �Cn Irycr, what type? I6—IMPORTAIM" CLIMS Aft" COMPLETETHE XEQUtRED P1tOPEtft•Y tNl ORMATION liL'QIIL%-rtiD I BELOW. EltheraPLAT orSIrEPLAN A1L5TbESUBMIT7EDbythe ctient Wilk THIS APPLICATION. o :'iG �1\ Property Dimensions: � 7 x i `f7 ?-�� ;'j fix17E D1kliC1'1014S (bout Alec" viUc) t Pitt jE r\' 0 Tax Ofricc PM. n S 6 /i— 3 7 Properly Address: Road Name '` e /, tf in a Subdivisii011 PZZ JOEVIMY210, as follows: N21131 xa_,1�2L Section: iitoek: Lot: Dale home corners rlacged: �_- p.I Ibis is to certify that the iatorrsiafioe provWed is correct to the brit of illy kuowicdba I understand MA any peretit(s) issued hereafter are subject to saspendon or rcvomtion, if the site piens or intended use change, or if the iuforstwion submitted In this apptiotion is Eddfird or cbanged. 1, also, ugdowaotJthat l ams respunnYdefor oNebarrer incternWfhoa, Misapplication. 1, herrby, give consent to the Authorized Representative of the Davie County Health Deparliw:nt to enter upon sbokr destribW property totaled in Devic County and owned by to Conduct all testing procedures as necessary to determine the site suitability DATE rt - SIGNATURE THIS AREA MAY BE USED FOR DPAWING YOUR SITE PLAN (include all of the following_ Eidsling mid propusal property Ants and ithwastous, structure, setbacks, and sepfic locations). Site Hevisil CILirge Datc(s): Client Ctotiticatiou Date: FHS: 51gn siren Account No. Revised DOW (65/03 Invoice No. _ V / APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department Environmentaiffealth Section DEC P.O. Box 848/210 Hospital Street 3 ?oo Mocksville, NC 27028 (336) 751-8760 ENVl,)R? bAV/ fCOI�(y�CTy ***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 City/State/ZIP 2. Name on Permit/ATC if Different than Above Mailing Address Contact Person Home Phone Business Phone 22�j�—%!� City/State/Zip 3. Application For: I"Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to service: Ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms 1721 Dishwasher ❑ Garbage Disposal U Washing MachineBasement/Plumbing CI 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: e --t unty/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the. facility this system is intended to serve? H --yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: �Cf /� C/'G� WRITE DIRECTIONS(fromModis-v`illlle) to PROPERTY: Tax Office PIN: # �'3�� a f+ y �. 2- Property Property Address: Road Name City/Zip e� If in a Subdivision provide informatiog, as follows: Name:5 �6 h0" Ma Section: Block: Lot: 7 Z(p Date Property Flagged: 42 ^--3-- e!9 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. 1, also, understand that 1 am 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 .�11J(�io�✓1bt�� 5 to conduct all testing procedures as necessary to determine the site suitapility. 4,0r=12200 TI -IIS 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: Revised DCHD (07/99) Account No. Inv 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 #: 5861-38-2199.28 Subdivision Info: Louise Smith Adams Lot # 28 Location/Address: Redland Road -27006 see map Date Evaluated: 1 2 i) 2— Community Community Public / Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Sloe % HORIZON I DEPTH Texture group Consistence r Structure CIL CjZ Mineralogy; j I• i HORIZON II DEPTH _ 2 Texture group Consistence ; Structure Mineralogy; HORIZON III DEPTH 2 Texture group WArzdL Consistence J i T-pr5sr Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE `'� 017i —IV LVDS &R.' i�� t T t aa.)-' G;CC}1v ql t v SITE CLASSIFICATION: VS / EVALUATION BY: �`= LONG-TERM ACCEPTANCE RATE: C. . 0' 77J OTHER(S) PRESENT: REMARKS: 112',Ilk b 1 cic'� r•1`t�$ 'rid 'bG QL�DZb LOT LI�t' W11 L-OT'Zi 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 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)