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121 Conifer Court Lot 13DAME COUNTY HEALTH DEPARTMENT • • Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002384 Billed To: J.M. Builders, Inc. Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-59-5239.13JM Subdivision Info: Redland Lot # 13 Location/Address: Conifer Court -27006 Property Size: see map **NOTE** ThrisTmprovement/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 1 #Baths 2 Dishwasher: 0"� Garbage Disposal: C?**' Washing Machine: 12"" Basement w/Plumbing: d Basement/No Plumbing: ❑ Commercial Specification: Facility Type (�e,#,People #People/Shift #Seats Industrial Waste: ❑ Lot Size ©7n �S Type Water Supply 0001- 'T Design Wastewater Flow (GPD) Site: New Repair ❑ System Specifications: Tank Size 10 VOGAL. Pump Tank GAL. Trench Width Rock Depth 12 Linear Ft. Other: �ISTZNGOT 1)70 Required Site Modifications/Conditions: > > I �� Y,�'�, a ��l ow L11-5 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.**** —004a �• o s � Coto jEL7ftk� LTil -D1GPn4 G gA jo,3 Pbr,,P FOO, P�J�t�C� Environmental Health Specialist's Signator . DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002384 Tax PIN/EH #: 5861-59-5239.13JM Billed To: J.M. Builders, Inc. Subdivision Info: Redland Lot # 13 Reference Name: Location/Address: Conifer Court -27006 ATC Number: 3223 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 WASTE TR-UgfflOI-9�MVALO'FOR A PERIOD OF FIVE )YEARS. Environmental Health Specialist's 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 bgAaken-as-xgnwmn4@ethhat the system will function satisfactorily for any given period of time. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) %Yo L `Tivr-j V- 0 sq• ft. _ 3 _ ;g Ac. -f 251v CO 1()=x70. m Sigh x 3p' EQse en t CIA x4C .50 R� o, � 3 t4�. OkG\ (60 C s ;d 0 . 109)c74)'Sight Eo ement ,9\0 , `U1p!Pub!tc jjtt�itiEaserneh es 0 0' • ��o►_ , Nfl _ 0' to '22 G 14 o 0 30.605 sN� � p� 703 Aq. ft. .4 cry V o v' 0 30, 7 N 0s� N, . ft. p q 705 Aa.f � . w - co 0 13 1 °' Lvndsca pe 31, 71 g s - Easem t r� p, 726 q• ft. en t v A C. i ndsoQpe 6 8 0lop L4 EoSemen t 2 o 10 x 7p c Sig ht EQseme n t o , 168 flify i/1) .:. ppb t . 4:84 � Rei/�� �a C-- .2 W GJ Jun 27 02 09:27a davie county envhealth 336 751 8786 p.1 APPUCATION FOR SITE EVALUATION/IMPROVEMENY PERAIIT & Davie County Health Department j Environmental Health Sectidln P.O. Box 049/210 Hospital. Street Mocksville, NC 27028 (336) 751-8760 JUL z z 2002l� :LczruK:LA-'e:r-- :L"15 A1?YLI(;ATZON .CANNOT BE PROCESSED UNLESS ALL THE P1 -OXAM INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed J, �(,i � I1 /t/J ,��.. Contact Person -Joho_ d le I— _ Mailing Address 2-1 1 CAove rr-A , Home Phone! 4� -qi 12 ,A '—f City/state/zIP t (�,(-, J56L�CVY1 "f G 2 1 103Business Phone --- ln —' ap % 6 2. Mama on Permit/ATC if Different than Above 'C -- Mailing Address _ / 3. Application or: f_Y Site Evaluation 4. System to service: U House ❑ Mobile Home 5. If Residence: WI Uishxasher City/State/Zip ❑ Improvement Permit/ATC n Both ❑ Business ❑ Industry FJ Other / tI People It Bedrooms I.(Garbage Disposal. U/Washing Machine 1P Basement/Plumbing G. If Business/Industry/Other: Specify type I Commodes # Shovers # Urinals I Bathrooms , 2 11 Basement/No Plumbing # People I Sinks # Water Coolers IF FOODSERVICE: ##' Seats Estimated Water Usage (gallons par day) 7. Type of water supply: i"J County/City 0 Well f1 Community ©. Do you anticipate additions or expansions of the facility this system is intended to serve? O 'Ycs M_Ko If yes, what type? **x1t•1110R7ANT*** CLIENTS 1NUSTCOhlPLL'TL•'T116 REQUIRED PROI'ERI'V INFORMATION REQUESTED 11ELONY. Either a PhAT or SITE. PLAN A1UST 131. SURM17TF.D by the client with THIS APPLICATION. 3 o-� 7P perty.nimensions: L g 32C). 292 9 ro'WRITE DIRECTIONS (from Moclmviltc) to !'KOI'Is!L'1'1': Tax Oft;cePIN: th��/- JS%/aiqq Property Address: Road Name C6f11-1f. r a. �A �e ,� LL,4`_�. City/Zip If in a Subdivision provideinformation, as follows: Name: _: �d kvA dl Section: I Block: Lot: 13 Date Property Flagged: This is 1u certify that the information provided is correct to the best of my knowledge. I understand that piny permits) issued hereaflcr are subject to suspension or revocation, if the site plans or intended use change, or if the i.afornin io;t submitted in this application is falsified or changed. I, also, understand Ilial I ani responsihlejoraHcharges incurrellfronr this application. 1, hereby, give consent to the Authorized Representative of the Davie County Health Dep:lrtment to enter upon Above described property Iocated in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. 1) ATE 7 � '�2 __ SIGNATURE OAI-o THIS ARTA MAY BE USED 1.OR 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 Uatc: Ells: l - Account No. Invoice NO.'�L ,f APPUCA11ON FOR SHE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department • Environmental Health SeWon j'} " P.O. Box 848/210 Hospital Street D Mockaville, NC 27028 (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCZSSVD UNLESS ALL TFOC RE INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for i stru 1. Hams to be Billed � i a .;t\! / Contact parson Mailing Address 1� // Home Phone City/State/EIP ull/ c., C', Business Phone 2. Name on Permit/ATC if Different than Above JUIN t 4 2o�o» lIR �,—tJlf EV![N��Ajqjk p�y 7_S �n1 Mailing Address City/State/Rip 3. Application ror: © Site Evaluation 0 Improvement Permit/ATC O Both *. eystan to servioas O'House 0 Mobile Home ❑ Business 0 Industry ❑ Other �� •�• 5. If Residence: ❑ Dishwasher # People 1 Bedrooms I Bathrooms ❑ Garbage Disposal ❑ Washing Machine ❑ Easamant/Plumbing ❑ Basamant/No Plumbing 6. If Business/Industry/Others specify typo t# People f Sinks # Commodes 1 Showers t# Urinals 1 Water Coolers IF FOODSERVICE: # Seats Estimated Hater Usage (gallons per day) 7. Type of Water supply: 9'6ounty/City ❑ well ❑ Community a. Do you anticipate additions or expansions of the facility this system Is intended to serve? 0 Yes 0 No If yes, what type? """IMPORTANT"11 CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUB41ITTED by the client with THIS APPLICATION. Property Dimensions:. Tax Office PIN: # 5739 •13 Property Address: Road Name _/&(I jS City/zlp _kplldvee. _e , If In a Subdivision provide information, as follows: Name: "�PP "J Section: Block: Lot: 3 WRITE DIRECTIONS (from Mocksville) to PROPERTY: :2- 7—/,91 4- i3�; of Date Property Flagged: This is to certify that the information provided to 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 sults plty. DATE SIGNATURE - THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inciud all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Datc(s): I Client Notification Date: EIIS: Revised DCHD (07/99) Account No. Invoice No. ( Z APPLICANT INFORMATION Account #: 989900136 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation PROPERTY INFORMATION Tax PIN/EH #: 5861-59-5239.13 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 13 Reference Name: Location/Address: US Highway 158-2000 Proposed Facility: Residence Property Size: see map Date Evaluated: � S C3 Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public FACTORS 1 2 3 4 5 6 7 Landscape position L_ Slope % TIV -2_7q HORIZON I DEPTH D' b , ZU Texture group Consistence Structure Mineralogy HORIZON II DEPTH - q 23 15W' Texture group + Consistence F' Structure Mineralogyt t t HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION ks LONG-TERM ACCEPTANCE RATE �J SITE CLASSIFICATION: Ps LONG-TERM ACCEPTANCE RATE: EVALUATION BY: j )t,J*_ f�ZA__aAA p ��L OTHER(S) PRESENT: `` REMARKS: F Y `� X �3� �I / rl W )-a �foGk- 4 2— 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 Fl - 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)