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120 Conifer Court Lot 9' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)75% 1 -R760 Account #: 990002471 Billed To: Touchstone Carolina LLC Reference Name: Proposed Facility: Residence ATC Number: 3293 /20 C®nW-tea r CPU Tax PIN/EH #: 5861-59-5239.09TC Subdivision Info: Redland Lot # 9 Location/Address: Highway 158-27006 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 Treatm t and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA S SVA D FORA PERIOD/ OF FIVE YEARS. Environmental Health Specialist's Signature: Date: / D� CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion has been installed in compliance with A cle I Disposal Systems," but shall in NO WA t given period of time. 'T&O V -):Vi� Z-27 Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) call indicate the system described on Improvement/Operation Permit of G.S. Chapter 130A, Section .1900 "Sewage Treatment and \asarantee that the system will function satti torgbfor any ��o S hT Ijfjj�-S V < �� o 27 l o� Date: �D • DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section ' P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT /:?o Account #: 990002471 Tax PIN/EH #: 5861-59-5239.09TC Billed To: Touchstone Carolina LLC Subdivision Info: Redland Lot # 9 Reference Name: Location/Address: Highway 158-27006 Proposed Facility: Residence Property Size: see map **NO�� * ►Isb�mprovement/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. i Residential Specification: Building Type �� #People #Bedrooms #Baths 2- J Dishwasher: 01", Garbage Disposal: d Washing Machine: El Basement w/Plumbing: ❑ Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift 2# 0 ,Seats Industrial Waste: Lot Size ©�d�i �° n 6Type Water Supply (.dtJ1Y Design Wastewater Flow (GPD) --�t0o Site: New Repair System Specifications: Tank Size IND GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft..SSD/ Other: --,�� �� 7tic LO��f��� . s 1 � • C• M-10.7 . Required Site Modifications/Conditions: k aS VAVL Oa .�^� � � -� 'fit = r p � �t U Ne IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the -ie Coii t�ty 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 . on the day of installahi Telephone # is (336)751-8760.**** / uA14 btu l� f EnvironrrientaHealth DCHD 05/99 (Revised) 0 �o MS ,�: 's Signature: H APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & GGG {/� D Davie County Health Department �J Envirwmwta/Health Section OCr ► � P.O. Box 848/210 Hospital Street 3 //• Mocksville, NC 27028 (336) 751-8760 0ll, H ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRE INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed %c?�s%.vG' e'ggO///w1�/q /- / C Contact Person '5%�(%L y / f Mailing Address J j.� 1,-afjsyi'/Ic 14,ywiiy Z2, Home Phone 9y.5',zl,,z 3 City/state/ZIP CuhSt����h� AC • ,7'%023 Business Phone 35 5- '70 3-,' 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation `%-Improvement Permit/ATC ❑ Both 4. system to Service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: # People # Bedrooms .3 # Bathrooms ly Dishwasher W -C-.- bage Disposal WWashing Machine 1.1 Basement/Plumbing 1.1 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: W--1C:!6unty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 4Q- - ✓ Tax Office PIN: # 5gt� /- S� 'S��-3 9•� Property Address: Road Name�'�'% S City/Zip If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS (from Mockcsville) to PROPERTY: Date Property Flagged: tick / O0' O This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter arc 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 ant 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 _ to conduct all testing procedures as necessary to determine the site suitability. DATE /O - 3 - 4 2 SIGNATURE �L/"' ' :�& THIS AREA MAY BE USED FOR property lines and dimensi , s n 1C1 Revised DCHD (07/99) 7 PLAN (Include all of the following: Existing and proposed tic locations). y 2 Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. Invoice No. 3/ ( / APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & Davie County Health Department Ellvifwmenta/Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 'DecC E0b� Oc:3 If / HCH ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRE-I'�� INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed +.�5 �c,VC e'gg0ll/do Contact Person ssT,[!i� C,/J J� /cF f`t_ Mailing Address �$.S /,fajSL+n��/� I//ENWM / %((�_. Home Phone x''15-26,2 3 City/State/ZIP �(1ln�L�i//� !r -22%473 Business Phone j— -7030 2. Name on Permit/ATC if Different than Above Mailing Address City/State/zip 3. Application For: ❑ Site Evaluation improvement Permit/ATC 11 Both 4. System to service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: �# People # Bedrooms # Bathrooms 2. S Wbishxasher LWGarbage Disposal WWashing Machine ❑ Basement/Plumbing 1.1 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: W,-<��ounty/City ❑ Well CI Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes CI No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: ,gyp �•-� --,z� Tax Office PIN: # �4u 4� /- S� ' �23 9• Property Address: Road Names City/Zip WRITE DIRECTIONS (from Mocksville) to PROPERTY: If in a Subdivision provide information, as follows: Name: c9 4,a-- /L Ok Section: Block: Lot: / 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 arc 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 fur all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County I-lealth 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 suitability. 1421 DATE /O - 3 - O Z SIGNATURE t� 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). Revised DCHD (07/99) Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. Invoice No. API'LICA11ON FO11 SITE EVALUAIION/IMl'ROVEh1ENf PEI1M(f & ATC Davie County Health Department EnWronmental Health Seddon P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336) 751-8760 k FJUN �1l ht 4 ***IIdPORTANT*** THIS APPLICATION CANNOT BE PROClCSSBD UNLESS ALL Tto RE ED INFORMATION IS PROVIDED. Refer to the INrORMATIOH BULLETIN for irt3trUotN"WF1VTAf. WMEC0111VIY 1. Name to be Billed I 54 ) ? Contact Parson Nailing Address /4 some Phone %G City/state/LIP ui>/, i., C', Business Phone 2. Name on Persist/ATC if Different than Above Nailing Address _� City/state/Zip 3. Application For: ©'Site Evaluation D Improvement Permit/ATC ❑ Both 4. system to Servicat ErHouse D Mobile Home D Business ❑ Industry ❑ Other �� « 5. If Residence: # People 1 Bedrooms 1 Bathrooms ❑ Dishwasher ❑ garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/industry/Others Specify typo 1 Commodes 1 Showers 1 Urinals i People i sinks f Water Coolers IF FOODSERVICE: # Seats Estimated Hater Usage (gallons par day) 7. Type of water supply: 0--County/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system Is Intended to serve? D Yea ❑ No If yes, what type? 11"IMPORTANT"*" CLIENTS MUST CDMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN IIIUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 65- . r&5 4 -- Tax Office PIN: a -57�23y Property Address: Road Name llea / /S If In a Subdivision provide Information, as follows: Name: P �,� fl A- "A - Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: i;41— D— 7—/.�2 / 4- A of Date Property Flagged: This is to certify that the information provided is correct to the beat 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 falsifled or changed. I, also, understand that I am responsible for all charges Incurred from this appRcatlon. 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 snits Illty. 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). Site Revisit Charge Date(s): I Client Notification Date: I EIIS: Revised DCHD (07/99) Account No. /36 Invoice No. `f 1 2— I i i 1OHEALTH :_, ru r .r r ' - Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.09 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 9 Reference Name: Location/Address: USHighway 158-2700 Proposed Facility: Residence Property Size: see map Date Evaluated: S Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slo e % 47y L4 7, HORIZON I DEPTH 0-S Texture group (,] L Consistencer—rWsp Structure S C MineralogyI 1 1 HORIZON II DEPTH ?13 Cl Texture group 0— Consistence Consistence ' S Structure k Mineralogy HORIZON III DEPTH -3 Texture group -I Consistence s �' Structure Mineralogy: I HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION , LONG-TERM ACCEPTANCE RATE al,O• SITE CLASSIFICATION: EVALUATION BY: r LONG-TERM ACCEPTANCE RATE: f'� • �� OTHER(S) PRESENT: 11 REMARKS: 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) ■E■ ■E■ ■E■ ■E■ ■E■ No ME No No ■■ ■■■■■ ■■■■■ ■■■■■■ Emmons ■■■■■■ ■■■■■■ ■■■■■■ Emmons ■■NNEN NONE NOON i ■ ■ ■ ■ monsoon ■E■E■E■ ■MEE■■I ■ENNE■ MONSOON MONSOON MONSOON ■NEEM■■ ■M■■ME■ ■O■■■N■ ■MMEMMI ■E■EM■ ■E■M■MMEMMMOMMEM■ ■M■M■MME■EME■EME■ ■E■EME■■M■NME■■M■ ■ ■ ■ ■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■nee■■e■nee■ecce■■■■■■ ■■■■■■M■■■■■■■■ ■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■E■M■■M■ ■■■■■ ■■■■nee■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■ ■■■■■ ■■■■M■■■■■M■■■■ SEEMS ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■mom■■■■■ ■ ■ monsoon MONSOON MONSOON ■■EMME■ ■E■■ME■ ■ ■■■ ■■■■■ ■E■■■ ■E■■■ SEEMS ■■■■■ ■o■■■ SENSE ■■■■■ ■Em■■ SOMME ■EE■ ■OE■ ■■M■ NEON MEMO MEMO NONE NOME ■■N■ MEMO NONE SEEN MEMO NONE ■■■■ �iOEM ■ i ■ ■ ■ ■ tall x:3"/ 31€367x(Totc#} 86 - r _' 10' Public F 35s349 s ft. wr q 9= Utilities 0.811 Ac.f Easement f4 v �� a$� .51 S _ 31.8_.$3 1 36,438 sq* ft. CO --� 0.837 Ac: ± 15 S 7� 2 � TYP icol Setbocks � Corner Lot c -- -- N 03.03'0 �,, 8 40.Q1`• \30*59 sq. ft. 06.fi3 o 0,302 Ac.± a 30,870 sq. ft. o. 25 / ��. 0.709 Ac. f 30 TIN / r 42,071 sq. ft. ('6 0 , 0.966 Ac.f 1�'� bpi 0� G o 5 � 19� Sight Ea 10' Public �y � Utilities v '�� Easement �� 10 Public Utili� �' Easement A4 30, 60`