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112 Longwood Drive Lot 16• DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002746 Tax PIN/EH #: 5861-58-8459 Billed To: Marquis Building, Inc. Subdivision Info: Redland one Lot # 16 Reference Name: Location/Address: 112 Longwood Drive -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3464 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION f" **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 Trea ent and Disposal Systems). THIS AUTHORIZATION FOR WASTE ST S V ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatur : Date: 23 3 % PPlomi 4 3 9edeoor►,5 U — CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate has been installed in compliance Disposal Systems," but shall in 1 given period of time. Septic System Installed By: Environmental Health Specialist's Signature : DCHD 05/99 (Revised) described on Improvement/Operation Permit Section .1900 "Sewage Treatment and ie system will function satisfactorily for any �/& k4P t DAVIE COUNTY HEALTH DEPARTMENT - Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002746 Billed To: Marquis Building, Inc. Reference Name: Proposed Facility: Residence rd- 7-30 CKA Fla Tax PIN/EH #: 5861-58-8459 Subdivision Info: Redland one Lot # 16 Location/Address: 112 Longwood Drive -27006 Property Size: . see map ATC Number: 3464 **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 #People #Bedrooms ? #Baths Dishwasher: QGarbage Disposal: 13 Washing Machine: &/ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Facility Type �► ^ #People #People/Shift #Seats Industrial Waste: ❑ Lot Size D•�6QID AL -PA ype Water Supply l�tl014Y Design Wastewater Flow (GPD) �P(� Site: New 12/ Repair ❑ System Specifications: Tank Size 1000GAL. Pump Tank GAL. Trench Width 3(0 It Rock Depth 12ZLinear Ft. .�J „} Other: I 'Dlslb to.J &X WALL IT. f4 (� S Itc+C, Required Site Modifications/Conditions: V"VQ obi t'1� / •�' I C op� Pa. 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.**** Baa `calve ,,©° 96 i Ivo sj Environmental Health Specialist's Signature: aDa-Se• 23 �3 r V ; DCHD 05/99 (Revised) 05/12/2003 10:00 9406947 r ' GORDON WHITNEY PAGE 01 7,51 - 151%. APPUCATION FOR SM EVAWATM/iMPROVUMAT PERMIT & ATC Davie County Health Oeparbnent Etrtitevrt»enb/H"kh 56000J7 P.O. Box 848/210 Hospital atreet Itoekaville, NC 27028 (336)751-8760 ***Zia rANr*es THIS APPLICRTION CJNraW TIE PROGCSSZD UNLESS ALL TRE REQUIRIM INtORMTICN IS PROVIDL'D. Refer to the INMR4ATION BVLXJCTIN for instructions. i. Uams to be Killed {( � �/�..r`��� tl?I L.�IAils ..LuG Contact Parson (�nU� \ rifT � �'► thtiling Address 1 D. Rpm, z17Q pose Phone _. �[Qe—(o94i City/stato/zIP Ant/A-w LK 7- Business Phone 346- 3( C215 2. Uses on Perait/x= if Different then Above ImilUV Address city/state/zip a. Application tor: ❑ Site ivaluation )(Improvement Po=sit/ATC O Both a, system to servinst a House ❑ Mobile Homo ❑ Business O Industry O Other S. If Residence: a People a Bedroams -- a Bathrooms Z N Dishwasher U Garbage Disposal R WAsh-V N --h— F1 Basement/Plumbing 1.1 Sasem_tt/no Plumbing 6. If ftU*Lnsss/lnduatry/other: apecify type a People a sinks f Commodes / wwwars a Urinals a Mater coolers IP rooD3EAVICE: d seats Eatimated Water Usage (gallon, per day) 7. Type of water supply: R County/City O Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to urn? 0 Yes K No If yes, what type? •••1MP0RTAN7-e• ruimn bff/STCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PIAN MUST BESUBM/TT'SD by the client with THIS APPLICATION. Properly Dimensions, -A X 2d Z WRITE DIRECTIONS (from Mocksvilk) to PROPERTY: Tax Office PIN: M S4i% I.'l INS"I I'_� Enter, �J2tJ Lef--r Property Addrems: Itoed Nanta Le 112 .)6r.)m_DA- n1.AwA!1)fl ST_ Ccity/up,f nnOJAvrk ASL 7--2 4, Ilt2 614'1^'� If is a Subdivision provide information, as follows: Nacre. 2ED(-4,36 WR'4 SetKiw: �� Bbek Lot: 49_ _ Date Property Flagged: a z- Tbis is to certi>y that the iaformatim provided is soma to the best of my kxavviedge. l anderstsnd tint any permrit(s) Issued bereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted In this application is ldsifwd or changed. 1, also, understand rkat I am rapoms/ble jos art ciar=es lacamd from this applicalon. 1, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter open above described property bested is Davie County and owned by to conduct all testing procedures as necessary to determine the site suit Illy. DATE L SIGNATURE la92�L— THIS AREA MAX BE USED ICOR DRAWJ14G XOUR SITE PLAN (Include all of the following; ExisfiL and proposed property rima and dimensions, structures. setbacks, amid septic locatious). Site Revisit Charge rr-tta D Date(s): /} Client Notification Date: Account No. Revised DCHD (07/99) Invoice No. '.� 5 MOM 31AVO HMH 1V11 NNOTAM MAY 1 2 2003 RM00 31R HO 05/12/2003 10:00 9406947 GORDON WHITNEY l.c,T �� ep4hNo Way Ib5,2� 1. PAGE 02 l6(,. ql Al'I'UCAIION iOfi SIZE EVALUA110N/10110VEMENT PERMIT & ATC Davie County Health Department EnWronmental Health Se+adl*on VN P.O. Box 848/210 Hospital StreetMockaville, NC 27028(336)751-8760t * * * XNPORTANT* * * THIS APPLICATION CANNOT BE PIW=SBBD UNLESS ALL T RE D JJr INTORHATION IS PROVIDED. Refer to the INrORHATION BULLETIN for i etruatf tit EN VAVJEC011N1y 1. Name to be Billed 5� ) o .z`I1 Contact Person 61f,1,4-4 Nailing Address (G �� t 7004-, No=* Phone L City/State/LID t ui1/, c-. C, business Phone 2. Name on Perait/ATC if Different than Above Nailing Address / City/state/zip 3. Application For: Kr/Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to services O' -House ❑ Hobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People I Bedrooms I Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Baaemant/Ho Plumbing 6. If business/Industry/Others Specify type # People # Sinks # commodes # showers # Urinals # Water Coolers IF FOODSERVICE: # Seats/� Estimated Water Usage (gallons per day) 7. Type of water supply: 9-County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system Is Intended to serve? ❑ Yes ❑ No If yes, what type? *1"IMPORTANTPI" CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN IIIUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 6 5 J1, r&S 4 Ta:Office PIN: # 57" J -- 5ci - -5,2 r Property Address: Road Namesn /TUJL 155J City/Zip If In a Subdivision provide Information, as follows: Name: Section: Block: Lot:_ WRITE DIRECTIONS (from Mocksville) to PROPERTY: VILI :1'a -'l- D -7-A9/-- J-13 / Date Property Flagged: This V to certify that the Information provided 6 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 by to conduct all testing procedures as necessary to determine the site sulta tlity. DATE G — '1 �� 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). Site Revisit Charge J Date(s): I Client Notification Date: I EIIS: Revised DCHD (07/99) Account No. 13 Invoice No. 3' s -e S 1I G DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.16 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 16 Reference Name: Location/Address: US Highway 158-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: '% d (J/ Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public I--*— Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % 2 HORIZON I DEPTH 0-111 Texture group Consistence G� S Structure Mineralogy HORIZON II DEPTH 3 Texture group 4 Consistence Structure S3ic Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 1 LONG-TERM ACCEPTANCE RATE CA O SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE. REMARKS: EVALUATION BY:� OTHER(S) PRESENT: 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) Total) N64'50 28 E 0' pub tic R/W ) S 64'5028„ W ._--19,4.07' G'` 'v � b/`c U en t tili ties 30, 6 71 o /> °5 S 0,3 q 9• ft .,t S 64'50' 25,? 204.28 3 \/ 0 �0 S ° >Os S9 ft 10' C. �°sem °pe —S 64'52'45► 204.48 vE v CA N 645028 E �73t .40 -j 0>>2 sq. 8 q ft. N 6450'28„ 242.42 J51 76' 0 °1 s `�06 or) d S en t -\ J 5 64'52 45 156.97 70, vti/it; b�-c F°Se es gent. 1 E.