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185 Graywood Court Lot 17DAVIE COUNTY HEALTH DEPARTMENT 2� t Environmental Health Section P. O. Boz 848/210 Hospital Street 1 / Mocksville, NC 27028 �d` a- �7 7 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900259 Tax PIN/EH #: 5861-38-2199.17dm Billed To: David Mallard Subdivision Info: Redland Place Lot # 17 Reference Name: Location/Address: Graywood Court -27006 Proposed Facility: Residence Property Size: 0.775 Acres ATC Number: 3661 **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 I f #People #Bedrooms 3 #Baths Z' Dishwasher: d Garbage Disposal: GR" Washing Machine: u Basement w/Plumbing: 171-1, Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 9)--7,5?WA Type Water Supply �W �IYDesign Wastewater Flow (GPD) -5toD Site: New 13 Repair ❑ System Specifications: Tank Size 1QW GAL. Pump Tank GAL. Trench Widthao Rock Depth Z Linear Ft. Other: I -DISV- I LuTL w f Required Site Modifications/Conditions: 1)s.nu' "') ts� jo ' ' & &rr 4!&5 k'�Cp I O owi� C�►�� 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}0 a.m. to 9:30 a.m. or 1:00 p.rq. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** I Environmental Health SKcialist's Signature: DCHD 05/99 (Revised) 'j( —V Date: e DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900259 Tax PIN/EH #: 5861-38-2199.17dm Billed To: David Mallard Subdivision Info: Redland Place Lot # 17 Reference Name: Location/Address: Graywood Court -27006 Proposed Facility: Residence Property Size: 0.775 Acres ATC Number: 3661 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 WASTEWATE 'TIO IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatur : Date: f7 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. F�a-,,+ Septic System Installed By: Environmental Health Specialist's DCHD 05/99 (Revised) —04 .,. T = SEAL L1828 Sl - 99.34 99.34 un 14 -� J 34,067 Sq. Ft. 0.782 Acres± o+ G5 " 6 0 iw (12 I-- 41,354 Sq ---- 0.949 Acre U7 (13 w 30,172 Sq. Ft. w 0.693 Acres± U�Qo Radius 50.00 .yo p -41.73 �j �CB"-- 4(Q •� �• 33,771 Sq. Ft. �^ ,^ 0.775 Acres± 10 1 p� Ol 12E 17 3.19, •52, 9» W S7 8 t wood Cour Gray N 7$•52, 0' public r- ( 18) 30,180 Sq. Ft. 0.693 Acres± S" Buffer 35 30"W, 25 .39---� G--, 13== \Q • � 4 ,B�• r > �- 11� 1J" CATION 1:013 SITE L•Vf1LUATtON/Ihlf'IIOVL•hiU11f 1'L•11M1T S JllC 1� Davie County Health Department k. Ewiro17menta/Hes/t/1 SeCM017 P.O. Dox 848/210 Hospital Street TFEHEALjN Nocksville, NC 27028 ENV1RpPV1EC0�S,� (33G) 751-8760 ***XbfPORTANT*** TIIIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE 10iQUIRED IlIFOR14ATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed :0(/ - Contact Person Mailing Address Az _,Ea_f 7 hyj nli Home Phone c y5-7�I Cit /State/'LIP ' , <' Y ! LOj,c1 _,� l�'��—, ^�' 7�? .S Dusiness Plwue --._ ..._.-. 2. Name on Permit/ATC if Different than Above Mailing Address City/Stal-c/Zip 3. Application For: ❑ Site Evaluation Improvement- herinit/ATC 17J I3oL11 t 4. Syatem to service: f1k Houae ❑ Mobile Home ❑ Business ❑ Induotry ❑ Other - ,` 5. Type system requested: A Conventional ❑ conventional modified ❑ innovative G. If Residence: 11 People It Bedrooms _s_ p21 11 l;atllrounlu �2 w Dishwasher RGarbage Disposal }lashing Machine ;9IIasemenL-/Plwnbing ❑UancmcnL•/Ido Plumbing 7. If Dusiness/Industry /Other: verify type It People It Sinks It Commodes It Showers tt Urinals 11 Water Cooleru IF FOODSERVICE: t1: Seats Estimated Water Usage (gallons per day) 8. Type of water supply: WCounty/City ❑ Well ❑ Conununity 9. Do you anticipate additions or CXI)11115i0lls of the facility this system is intended to selwe? ❑ yes �u If)'cs, what t}'I)c? - ***1A11,0RTzilVn** CLIEN'rSB1USTCOIfl'LETL- TML REQUIRED PROPER -1'Y INI�0104A"1'10N REQ I)E,'TED - BELOW. Eitlicr a PLAT orSITE PLAN HUSTBESURK177F.D by the client ivilh THIS APPLICATION. J Property Dimensions: Tax Office I'IN: Il�b'` / - 3-k - Property Address: Road Namc�-e,e /u- 4 City/Zip If in a Subdivision provide information, as follows: Name: Section: Bloch: Lot: J 7 WRIT E' lll1LIiC"!'IONS (!'roof 141oc1/` '1 •) lu 1'KOI'I:It'I'1': o )ate honk corners flagged: Ly 0 y This is to certify that the information provided is correct to the best of my knowledge. I understand that any pernlii(s) issued hereafter are subject to suspension or revocation, if tl(e site plans or intended use change, or if (lie inforulation subulit(ed in this application is falsilied or changed. Jr, also, understand Thal l ain responsiblefor till charges incurred fruul this application. I, hereby, bice consent to the Authorized Representative of the Dal'ie County IIealth Dell;u•lulent to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site su' ' 1 lty DA'J'E /�`` o SIGNATUI ✓� , TIIIS AREA MAY BE USED FOR DRA.INVING YOUR SITZ; PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Sign given I:evised DCIiD (05/03 Site Revisit Charge Date(s): Client Notification Date: E 11 Account No. Invoice No. 1� 1 " APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Q Davie County Health Department Envifonmenta/Health Section SEC P.O. Box 848/210 Hospital Street 3 Mocksville, NC 27028 (336) 751-8760 ENV1DA 14 T DAVIfCp�, yFACTy ***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 --W Contact Person % C Mailing Address'2f':5J 'F."&� — Home Phone City/State/ZIP )& 2 %Q Business Phone —^� 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: 0-1ite Evaluation 4. System to Service: ouse ❑ Mobile Home 5. If Residence: # People Dishwasher 0 Garbage Disposal 6. If Business/Industry/Other: # Commodes ❑ Improvement Permit/ATC ❑ Both ❑ Business ❑ Industry ❑ Other # Bedrooms # Bathrooms Ll Washing Machine Basement/Plumbing (J Basement/No Plumbing Specify type # Showers # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: B--Co—unty/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? Comes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETIiE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 9 A-11- A � � Tax Office PIN: # J 13�'' a2 9 7" 1 Property Address: Road Name ZI P,41 City/Zip If in a Subdivision provide information, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: RWIZAL,01 Al Name: tl �4SQ i Aw" � #` ��� Section: Block: Lot: l�h%atc Property Flagged: 42 —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 am responsible for all charges incurredfrom 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 �„r{�� � ✓�tlrm 5 to conduct all testing procedures as necessary to determine the site suitapility. ►i ce /� ;rVZAMA1��ii'� O 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. t.' DAVIE COUNTY HEALTH DEPARTMENT w ' , Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size: Water Supply: Evaluation By: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.19 Subdivision Info: Louise Smith Adams Lot # 19 Location/Address: Redland Road -27006 see map Date Evaluated: 12 Z F2DL Community Auger Boring ` Pit Public ✓ I Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % AcrIl HORIZON I DEPTH O Texture group Consistence i Structure Mineralogy`I HORIZON II DEPTH - Texture group Consistence S Structure Mineralogy1; HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION; a LONG-TERM ACCEPTANCE RATE: D •7 REMARKS: LEGEND Landscape Position EVALUATION BY: OTHER(S) PRESENT: 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)