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134 Longwood Drive Lot 18DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002471 Tax PIN/EH #: 5861-59-5239.18TC Billed To: Touchstone Carolina LLC Subdivision Info: Redland Lot # 18 Reference Name: Location/Address: Highway 158-27006 Proposed Facility: Residence Property Size: see map ATC Number: 3296 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 Ar-::, C- #People #Bedrooms 3 #Baths z ' Dishwasher: 133' Garbage Disposal: 13""' Washing Machine: u Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type �1 #People #People/Shift 2#'Seaats Industrial Waste: ❑ Lot Size 013 � SType Water Supply l.,� Design Wastewater Flow (GPD) SW Site: New 125 Repair ❑ System Specifications: Tank Sizej=GAL. Pump Tank GAL.. Trench Width 34P" Rock Depth IZ" Linear Ft.-S50a Other: L4 -Dim I&iiT0^; 'rj!�:%LL L-Oo1 q 0,C.1%, ,'J, Required Site Modifications/Conditions: ©A Col'ooQ. t50 S,OPF ad051?-. 0% 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.**** Z. G T ,A. I ,7 it's cpw�� �' � _ to �.� r3 • __ � ._-- C�� _ -30 — Environmental Health Specialist's Signa re: - Date: /0 D 2 DCHD 05/99 (Revised) i DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002471 Tax PIN/EH #: 5861-59-5239.18TC Billed To: Touchstone Carolina LLC Subdivision Info: Redland Lot # 18 Reference Name: Location/Address: Highway 158-27006 Proposed Facility: Residence Property Size: see map ATC Number: 3296 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 CONS CT -I VALI FOR A PERIOD OF FIVE ARS. Environmental Health Specialist's Signatu ate: 1© �Z 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 I 1 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and ys Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any &5- given period of time. $5' Septic System Installed By: Environmental Health Specialist's DCHD 05/99 (Revised) NC0gF- r ,JT Date: �SZi .� APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & Davie County Health Department EnV1110= ata/Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 D �. Oct , �n 32 ! / CO�NH�H J ***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 c�,1, 57G�wC C�J4Q0�%1ik, Z C Contact Person _/+/%` Mailing Address �jr.� ��CLrJSUJI�E t4wwt,7 201- 1 Home Phone c1y5-..26�2 3 City/State/ZIP /JAL . f2 r70 3 Business Phone %0 7✓ 2. Name on Permit/ATC if Different than Above Mailing Address city/State/Zip 3. Application For: 0 Site Evaluation 'improvement Permit/ATC Il Both 4. System to Service: eHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: People # Bedrooms ,3 # Bathrooms _ �# L'i'Dishwasher I -Garbage Disposal W -Washing Machine I:I Basement/Plumbing II 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: 4-�ounty/City ❑ Well I.1 Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 17 No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETCTHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client witl► THIS APPLICATION. Property Dimensions: ,,&QL:f=— --v— --„•- Tax Office PIN: # Property Address: Road Name City/Zip If in a Subdivision provide information, as follows: Name: Section: Block: Lot: ) p WRITE DIRECTIONS (from IVlocksville) to PItOPE'RTY: Date Property Flagged: 4--1) r ,-t-c- lOP) z.r 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 ani responsible fur all charges incurred f -oul 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 suitability. %, DATE /D - 3 - D Z SIGNATURE :::�w v ' �� THIS AREA MAY BE USED FOR DRAiP(G property lines and dimensions, structure, setb Revised DCI1D (07/99) I 916 and E PLAN (Include all of the following: Existing and proposed Site Revisit Charge Datc(s): Client Notification Date: EHS: '7Account No. . Invoice No. 317 APPUCAIION 1`011 SHE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department �. Environmental Health Section P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL T INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for i 1. Name to be Billed JAS UI[>c[) / 0tP, VylOd KJ Contaot Parson W r'. Mailing Address City/state/LIP l,(/,415'f0/11 2. Name on Permit/ATC if Different than Above Bose Phone Business Phone Jrf JUN t 4 2%� 1 ),I • RE ffiD tructfA9 rttBrL-' J Mailing Address City/state/sip 3. Application For: Q"Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. system to Services f -House ❑ Mobile Home 0 Business 0 Industry 0 Other W,�.,•r. s. If Residence: # People Bedrooms 1 Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/other: specify type / Commodes showers 1 Urinals People / sinks f Water Coolers Ir FOODSERVICE: # Seats Estimated Water Usage (gallon■ per day) 7. Type of Water supply: 14'County/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 0 No If yes, what type? 1111*01PORTANT*** CLIENTS AIUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 6 5 AOL r�5 -7L -- Tax Office PIN: it "59Z 1 •.59 - 3y Property Address: Road Name A-Z)L S City/Zip AIP141ye ', ly_e .9/� If In a Subdivision provide Information, as follows: Name: P Section: Block: Lot: g WRITE DIRECTIONS (fromMlocksville) to PROPERTY: 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 falsified or changed. 1, also, understand that 1 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 Ility. DATE — Y "L�� SIGNATURE — THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includ6 all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). a Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: IEHS: Account No. Invoice No. ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.18 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 18 Reference Name: Location/Address: USHighway 158-2702 Proposed Facility: Residence Property Size: see map Date Evaluated: r%10 dl Water Supply: Evaluation By: On -Site Well Auger Boring Community Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position I— Slope % HORIZON I DEPTH 6 Texture group Consistence Structure Mineralogy ' HORIZON II DEPTH Texture group Consistence S Structure 3 g Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE 0 , 3 �> SITE CLASSIFICATION: S LONG-TERM ACCEPTANCE RATE: D. REMARKS: 2-4 -,41 LEGEND Landscane Position EVALUATION BY: C')63—: )504L)C A'iP OTHER(S) PRESENT: 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)