122 Longwood Drive Lot 17DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990002436
Billed To: Darren Burke Constr.
Reference Name:
Proposed Facility: Residence
ATC Number: 3342
P A
Tax PIN/EH #: 5861-58-8651
Subdivision Info: Redland Lot # 17
Location/Address: 12:1. Longwood Drive -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 Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWAT AJ'$TRIJQ--T4QN IS/VA A PERIOD OF FIVE, YEARS.
Environmental Health Specialist's Signature:
CERTIFICATE OF COMPLETION
Date:
**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 11 in NO WAY been as a guarantee that the system will function satisfactorily for any
given period of time.
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Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section
. �• P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002436
Billed To: Darren Burke Constr.
Reference Name:
Proposed Facility: Residence
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Tax PIN/EH #: 5861-58-8651
Subdivision Info: Redland Lot # 17
Location/Address: 122-1, Longwood Drive -27006
Property Size: see map
ATC Number: 3342
**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 V^� #People #Bedrooms #Baths �-
Dishwasher: Garbage Disposal: ❑ Washing Machine: 12"�- Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size (2,71 ? ��ype Water Supply Design Wastewater Flow (GPD) -2-i-AD Site: New 2" Repair[]
System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width �� � Rock Depth I I Linear Ft. 3
Other: � fLTI� F;Okas. /1N5j/-)lL LM1c.S 9 D.G. rrt/'a.
Required Site Modifications/Conditions: 4-i"p rr D 1 or -F rroP U ^y
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.****
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Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
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Site Plan
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APPLICATION FOR SIZE EVALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department U[JUN
Environmental Health SecdnnP.O. Box 848/210 Hospital StreetMockaville, NC 27028
(336)751-8760
t 4 2001
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL T RE D
INVORMATION IS PROVIDED. Refer to the INA'ORMATION BULLETIN for i atruoEN
LAqVIL // ouNI Y
1. Name to be Billed E? ?
DAVIE COUNTY HEALTH DEPARTMENT
j Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 989900136 Tax PIN/EH #: 5861-59-5239.17
Billed To: Westview Development Co. Subdivision Info: Redland Lot # 17
Reference Name: Location/Address: USHighway 158-27028
Proposed Facility: Residence Property Size: see map Date Evaluated: -711 D
Water Supply: On -Site Well Community
Public /
Evaluation By: Auger Boring Pit r Cut
FACTORS
1
2 3 4 5 6 7
Landscape position
L
Slope %
HORIZON I DEPTH
O ^
Texture groupG
Consistence
- : S
Structure
k
Mineralogy
ie-1
HORIZON II DEPTH
Texture rou
S
Consistence
Structure
M4k
Mineralo
HORIZON III DEPTH
41
Texture group
/
Consistence
Structure
Mineralogy
HORIZON IV DEPTH
Texture group
Consistence
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
S
LONG-TERM ACCEPTANCE RATE
Q
SITE CLASSIFICATION: V S EVALUATION BY:�`"�
LONG-TERM ACCEPTANCE RATE: d• r �� OTHER(S) PRESENT:
REMARKS: ��X 2-7''
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)