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111 Conifer Drive Lot 14DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section J P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002451 Billed To: Thames Home Builders,lnc Reference Name: Proposed Facility: Residence ATC Number: 3278 Tax PIN/EH #: 5861-58-5724 Subdivision Info: Redland Lot # 14 Location/Address: i ongwood nriyP-77006 Property Size: 0.703 Acres 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 CONT ION ISA PERIOD 0 AF F VE YE S. Environmental Health Specialist's Signature: 07 Date: 3 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. L)�21 C s 4 70� �, NK e- � V Al Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) -`- 2 -OD' -1-o- AL - s � fin^ � I �v� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT it: 30 Account #: 990002451 Tax PIN/EH #: 5861-586 ;44I Billed To: Thames Home Builders,lnc Subdivision Info: 'Redland Lot # 14 Reference Name: Location/Address: Longwood Drive -27006 Proposed Facility: Residence Property Size: 0.703 Acres ATC Number: 3278 **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 F100SE #People #Bedrooms 3 #Baths Z . J.. - Dishwasher: 12' Garbage Disposal: S2'*/ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type#,People #People/Shift #Seats Industrial Waste: 13Lot Size '-7 6 -Type Water SuppIALX 1 Design Wastewater Flow (GPD) Site: New 139'*�' Repair ❑ System Specifications: Tank Size IOW GAL. Pump Tank GAL. Trench Width 3l0 Rock Depth `� Linear Ft.-5SO Other: u -NS-f0-tb 1TWA hid, �n1�T4U.. L'►4LS 9 ID.G Ktk. Required Site Modifications/Conditions:y4STA LL 0 C'" TOR, V—et " .5;, ©,:-(: 1j-"jSt� 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.9:30 a.m. or 1:00 p.m. to 1:30 p—m. on he day 6T nsfatlation. hone # is (336)751-8760.**** rto 1 -k 1k-%nND,, Z Environmental Health Specialist's Signature: CefJ I R-- C -W 2T DCHD 05/99 (Revised) Sep 06 02 U2:UUp aavie counua e:.�YQa�–•• "" APPLICATION FOR SITE EwALUAi/ON/IMPROYMw PERMIT & ATC i Davie County Health Department ft � . Eltvimnme►IblKealtll �oII P.O. Bos 848/210 Hospital Street Mocksville, RC 27028 a _ a (336)751-876o -:A **s a** TBIS APP=CSTiCK CZMOS H8 PIdOQsSSW UKZ3S ALL TBE REQUIRED INFOIa9►TZOat IS BAOVm)tD. Refer to the I,<t\F0eBa1?Z�,� suxaBTIN for iastlzv ons. - 3. � to bo ai.11aa �itlA�inE i�ar�e ate,t t�C�� ��Atact QOCf00 V��r5,6* wailing Address Pp. 4 nX 6 -3 9 City/scaco/aur 2. xabta on tteaaitf= :Lf nUfareet tress above At / A Mailbag aditvws .5 A M G City/gra hup 3. AP1Plication Por: ❑ Som�ite EvalUatiom ❑ Iaps'ovement Pesmit/ATC t• Both .. 4. systato ssr►ice: V<f.se ❑ Mobil. Bove ❑ Business ❑ Industry U Other s. If Rasidemm: * People a Bedroobas 3_ a Bathroabas yrOishmmher WCkxbsao uLposai wV&.hiag --votIzumbuo 14 aasaes»tjwo Num6im 6. If Buslnass/Ipdustry/ot9bar: t:pacify types _►�/_/ t+__ __ a P�opis t Sinks I Commodes a Sbowrs I Mina" a water Coolasa IF Z?OCO$8&vICE: 4 Seats Estimated Water Usage [gallons par day) 7. Type of water supply: W County/City ❑ Well ❑ comaun ty s. Do you anticipate addilions or evasions of the facility this system b intended to stave? 11 Yes I.. KQ Ifyes, what type? •**1MP0RTAN7*** CLIENTS Mt5TC0AIPFXMTN8 REQUIRED PItOPER7Y INFORMATION REQUWEO tiELO%V. F.othersPLATerSrMPLA14NOTSESUBAtMiDb Aod pmt uMTl11SAPPLICA7iON. c Property Dimensio= /a`ti X IT J. O 7Xl ?b +Y 244'+21 WRrM DIi WnONS (from Meckmlle) to l ROPF3t'Ii': c Tax Office PIN: Property Address` Road Name 1005 W N d:/ P.Rv C cN re2alie 6 of= wee- G 2e 41 AW A Wft 5 L,,(d , Iris a Std!a�Gvi�s m provide information, as � O N -k C -0N Q1 t d 0 0 d Name iGP cj 1 pti !i W t Q6*rz dl J C Sectimw Black: ' LM-- Date Property riaggd: © 2— This is to certify that the information provided is correct to the best of my knowledge , I understand that any prrapft(s) Ism d hercaticr are stat ed to saspeasion or r+croeatios. if the site plans or intended snt dwntr. or if the lsforsui)oa submitted in this application. is fafsifud -changed I, aka, aadelstm d /kat l sat rcWowibk far all ckerZa tacamvl fast this appfiratma. t, hereby. give coascut to the Authorized itep entalive Davie County Health DtfaSimcul to eater upon above described property located in Davie County and 6/}1 er" �iW .f:7F �d ✓v to conduct aft testis pr bcdodes as ncrosary to determine the site b= � DATE �L' 1 51C I THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing sad proposed property Em and dsmeasiem structowey, scfbaekr, and septic loea6rmsj Revised DCHD (07/99) L i s] I ". j % I a% e- IV Site Revisit Charge Datc(s): COW Notitwwtsoa Date: FM& C Account No. Iovice No 3 a�, Ivo-orl�I�'n7 , O.OJ7 / W U APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department 4# Envhnnmental Health Setdlon j L 0 I' P.O. Box 848/210 Hospital Street U - _____�,( Mockaville, NC 27028 (336)751-8760 JUN t 4 IF rOODSERVICE: # Seats Estimated Hater Usage (gallons per day) 7. Type of water supply: 9--County/City 0 Well 0 Community a. Do you anticipate additions or expansions of the facility this system Is Intended to serve? ❑ Yea ❑ No If yes, what type? **'IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUB11111TED by the client with THIS APPLICATION. Property Dimensions: 6 5 )IP- rl�15 4 _ Tax Office PIN: # :5i?Z I - 5 gr •- S1-23`1 • H Property Address: Road Name A'dc 15 City/ZIp A6111/41 vee , AJ -(f If In a Subdivision provide Information, as follows: Name: P C,( Section: Block: Lot: WRITE DIRECTIONS (from Mocksvilte) to PROPERTY: Date Property Flagged: 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 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 by to conduct all testing procedures as necessary to determine the site suits Ility. DATE SIGNATURE - 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). 0 Revised DCHD (07/99) Site Revisit Charge Date(s): I Client Notification Date: I EIIS• Account No. Invoice No. 1 2 $ i6-7 ***IMPCRTANT*** I2Mr*MTION IS THIS APPLICATION CANNOT BE PROCESSED UNLESS ALT, TTRE ED PROVIDED. Refer to the INFORMATION BULLETIN for itruatfA9ti�8,1{IIEN •—'--- 41 i. Name to be Billed �I 1 E� / UAVIEC01INly Contact ?arson Y��% / S Mailing Addre-)a some Phone City/state/sIP c viv, c• C. Business phone 2. Name on Permit/ATC it Different than Above Mailing Addreas City/state/zip 3. Application For: @'Site Evaluation 0 Improvement Permit/ATC ❑ Both e. system to service, O House ❑ Mobile Home ❑ Business ❑ Industry 0 Other �� •�• 5. If Residence: # People / Bedrooms ! Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/plumbing ❑ Baaament/No plumbing 6. It Business/Industry/othert specify type I People # sinks I Commodes 1 showers # Urinals (# Water Coolers IF rOODSERVICE: # Seats Estimated Hater Usage (gallons per day) 7. Type of water supply: 9--County/City 0 Well 0 Community a. Do you anticipate additions or expansions of the facility this system Is Intended to serve? ❑ Yea ❑ No If yes, what type? **'IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUB11111TED by the client with THIS APPLICATION. Property Dimensions: 6 5 )IP- rl�15 4 _ Tax Office PIN: # :5i?Z I - 5 gr •- S1-23`1 • H Property Address: Road Name A'dc 15 City/ZIp A6111/41 vee , AJ -(f If In a Subdivision provide Information, as follows: Name: P C,( Section: Block: Lot: WRITE DIRECTIONS (from Mocksvilte) to PROPERTY: Date Property Flagged: 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 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 by to conduct all testing procedures as necessary to determine the site suits Ility. DATE SIGNATURE - 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). 0 Revised DCHD (07/99) Site Revisit Charge Date(s): I Client Notification Date: I EIIS• Account No. Invoice No. 1 2 $ i6-7 DAVIE COUNTY HEALTH DEPARTMENT �'. Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.14 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 14 Reference Name: Location/Address: USHighway 158-27006 Proposed Facility: Residence Property Size: SEE MAP Date Evaluated: -71S O Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L_ Slope % '? U!,Zv 2. HORIZON I DEPTH b- c� -f 0-1(0 Texture group C Consistence :'S : s Structure 5 S 3k Mineralogy1 I•` HORIZON II DEPTH q-2 1 a Texture group Consistence Structure S(C Mineralogy(�• HORIZON III DEPTH �- Texture group Consistence Structure 5 IC Mineralogyf HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE S CLASSIFICATION LONG-TERM ACCEPTANCE RATE O•aS • 3J SITE CLASSIFICATION; as EVALUATION BY: &A,0G4 LONG-TERM ACCEPTANCE RATE: r-) . r'�� OTHER(S) PRESENT: REMARKS:_G4'47Z- t'�_ 1 X .�o IQ NJ 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) :8 sq. ft. ►7 Ac.� 44 ;q. \c.+ 335•x; o'° �} 15'-171 33,33 -sq. 0,765 Ac. � Typical Setbacks \ Comer Lot 8 It . `30,59 sq. ft. 0a � 0-..702 Ac.f D. 25' >>�50_055�1 32.17_ 0.73 3^� 10'x70' Sight jk 33' • T, 00 19 0�` 6�i 0 1\9" -10' x 70' Sight Easement - 10' Public Utilities Easement �14 30,605 sq. ft. 0.703 Ac.t o ' ro a� 2 15 30,701 sq. ft. 0.705 Ac. f Easement cNo �•' fa W� tr 1.3 .. Oi © 3.1,718 sq. 10' Landscape Easement' � . " I G b A Y^1 10