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145 Longwood Drive Lot 8DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002451 Tax PIN/EH M 5861-58-5561 Billed To: Thames Home Builders,lnc Subdivision Info: Redland Lot # 8 Reference Name: Location/Address: Longwood Drive -27006' r -acuity: Kesiaence ATC Number: 3277 t'roperty 51ze: U. /U1 Acres 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 Trea ment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONS TI0)4 IS YALID FOR A PERIOD OF FI YEARS. Environmental Health Specialist's Signature: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indi has been installed in compliance with Article 11 of G.S. Disposal Systems," but shall in NO WAY be taken as given period of time. �o 7 � fiC )o -I n Septic System Installed By: �A6 Environmental Health Specialist's Signature: DCHD 05/99 (Revised) stem described on Improvement/Operation Permit 1 ASection. 1900 "Sewage Treatment and tha the system will function satisfactorily for any <00 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street • Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT 6/< ("y Account #: 990002451 Tax PIN/EH #: 5861-58-5561 Billed To: Thames Home Builders,lnc Subdivision Info: Redland Lot # 8 Reference Name: Location/Address: Longwood Drive -27006' Proposed Facility: Residence Property Size: 0.702 Acres ATC Number: 3277 **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 1'10l)SCe, #People #Bedrooms 3 #Baths �Z •� Dishwasher: GT"" Garbage Disposal: ff" Washing Machine: M"" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification:13UtinCFacility Type � __ #People #People/Shift #Seats Industrial Waste: Lot Size b - ES//�� Type Water Supply �-� rY Design Wastewater Flow (GPD) 340 Site: New M*' Repair ❑ System Specifications: Tank Size I CCQ'AL. Pump Tank GAL. Trench Width 30Rock Depth 12- Linear Ft. Other: �i 171�T21 �7t�1"IGI� S. � s�4u. UAcs I �o.0 M Ij• Required Site Modifications/Conditions: I jSTAl„ t, 0),3 P 5 cf-Ct IMPROVE MENT/OPERATION4 €•RMT LAYOUT - APPROVED EFFLUET FILTER RISER(S) IF 6 " BELOW FINISHED FF�DE. ****NOTICE: Contact a representative of the Davie Coun Health Department for final inspection of this system betwen 8:30 a.m. to 9:30 a.m. or 1:00 p.m. top.m. on the day of installation. Telephone # is (336)751-8760.**** _o lt� 3 3C_ 3. c' Environmental 11ea-1th Specialist's Signature: IV/) 1, OA) 6L. CO Q0 ✓c DCHD 05/99 (Revised) Sep 06 Ue UGeUUp MWAS •-- --- i' APPUGiiiBN t�1R sm ofYALWW710N/atPRO1Itmm pomr & Aic . Davie County Health DeparUnetnt �� . ' ,t�wdr1JlfavlMr�vi JCY I P.O. Baa[ 818/210 Rospital Street Moc7wille, = 27028 (336)751-8760 �:+rit•*y8I3'APFI.iC11TYt� t�tOT BB f�rRSs ABL Z88 f1 ling; . sme. to the mna mm=m Bujam i'o= instructs ons . y j r '► I. sae. too be aulea 0 S Rom ata, lltes� Tt&,., w..iGgo j`50 :THAM �s wnbw addm.. P O. Q dt. 35 $ atoe. x,,.336 3 19 - 7?/?� 7 t:ity/steos/sss W l ti x*VG tJ -S A leen a0 C 2703.9 a now 33 C. " 3 9 ? .- 7 S/ 7 2. mom on r.>:itlA= it nwoome tb= M.MR _ _ �*4 / A :<a-ainq mase... S P M c cowstawsLP ,. Applicata*& Yhr: Q me Evalnatioa t] Inaprovmwmt Pe=At/AW oth 4. sprat.. W Sor►soe: 9r10asa Q Mobile, Howe 0 susiaess f] n.Juxtsy U 0thor s. sf Residence: a People a f3edr00os ,& a Bathrooms w,,w4 nasb.r wcubepa Vive"A wssni.q umbs— u cress. --- f to saosaent/uo pl.ebim 6. if ausintb n -ft st-wothar: Stealer tn. _ N/I AL a Veopis a Sinks a tom ods s Showa a uxiftalm a water Coale= 28 ROCD8$BVM.- # Seats Estimated Water Usage taallans per dw 1. Typo of .rater *gpply: Or,"ft/tiny 4 wen n ceeemmity I. D0 you taatidP"c adtl I me or cVmm&= of the faa'Gty "system rainfaded toaervO O Ya twQ_ I[yesr what "a? `**IUPOJITANT&" CLJ MS A(WTCOAMZ TBT RWMW paomay MomA-nom tiEQUfiS m f ELOW. rAdwr.r[arerSrrt=rr MMMrSES=trr=hytbetVAm vA&TMArPUCATtOrr. L f rgwrtyDiitneasi0=/6o x i �. 3? x.wz�,�a w&CfBnrREC�}�oNst[..mMoeh wranri 7Y: ` Tau office PIN: a f?vopetSy AddatsC Rmd Naaae CtrK4r w e+s d Duro e Fft T'd2AIJC 6 0 It in a Snb&vW= provide infosaaafiaa. as a 0.6 O N -k W Ord d MUM. 1R%cI lag 4 W A{4 p6rem l 4)�t,r e &cCOMI: f3bck: flat cote lropat7,Fi d - This h to aatHy tme tfYc iefortmtio. pesvided & onnreet to the best of say hgartedge I amdashad t1n! w iw+•duo famed taascafter ase ssUUycet tosasptasiam at<s�eraeatlars, if the sits phos ar iateaukd use aMe� or if ttac istovaaaatiw submitted is this appfipation 6 6fs71od oa� I. alias rxderstarNtlatt I we, rgpaa�tfble, firafl cAravars iaauzrdJmar Ah 1. tetany. fm cmmt do de Authorized Rgwesmbdre awle Cossey Ham Dczartmeat to cater upas above des ugmad png" [ocakd in Dade CaeaQr amt mac". •��+ .e7E'lZp,�i✓c/ to caudad afl . procedum s uooemmy to dadarmi■c the** , DATE i SICNA THIS AREA MAYBE USED Ir0R DRAVMW YOUR SITE P4AN (tncbaie a8 oidia idtmhV ExhOut sand propmtcd FMP"Y UM Md , A meta M sdl acjas„ sad sepffe beatiotas). Revimd DCHO (07194) mS 1,17 V %I'V e N Site Revisit Charge Date(s),- Mad NotMewCam Date: 1n&; Account No. tmwm ice. e9 � z GE N l;0 oma. -JN z 3 lY7ZJ Qct � \ M cJ APS u K APPLICl11ON FOIL SITE EVALUAIION/IMPROVEMENT PERMIT & ATC �..� Davie County Health Department r - Envlronmenta/ Health Saadon 'I ' P.O. Box 848/210 hospital Street PU[JUN Mockaville, NC 27028 (336)751-8760t 4 2� li * * * II.IPORTANV * * INFORMATION IS THIS APPLICATION PROVIDED. Refer CANNOT BE PROCESSED UNLESS ALL T RE� ED to the INFORMATION BULLETIN for i atruatfkit£FN 1. Naaso to be GilledI � • 1 ��. / COUNTY l Contact prison W I'19 -c e' Mailing Address / 6' � /4 Bona Rhona jCi �r City/State/LIPU/T/, c C. > Business phone 2. Name on Peraait/ATC if Different than ]Above Hailing Address City/State/Zip 3. Application For: U Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. Systam to Services i'House ❑ Mobile Home ❑ Business ❑ Industry O Other W.,...«, 5. If Residence: 1 People / Bedrooms 1 Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ washing Machine ❑ Basement/Plumbing ❑ Basamant/No Plumbing 6. If Business/Industry/Others Specify type # Commodes # Showers f Urinals I People 1 Sinks # Yater Coolers IS FOODSERVICE: # Seats Estimated Nater Usage (gallons par day: 7. Type of water supply: td'County/City D Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is Intended to serve? ❑ Yea O No If yes, what type? 111"IMPORTANT"" CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 6 5 240, rIf'S -ZL Tax Office PIN: # 15i�Z 1 — 5 — 5.v311' I � g Property Address: Road Name Azr/c S City/Zip Abllwee' "-e , 9i� If in a Subdivision provide Information, as follows: Name: ,;( /. ,, .� Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: sq P 4 PILI v-� -rzO - 7 -/,9 I 4- 1,3�, 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 falsified or changed. I, also, understand that I am responsible for all charges Incurred from this applicallon. 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 suits ility. DATE — Y li� SIGNATURE -- TIIIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includ all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). 0 Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: I EMS: Account No. 13 Invoice No. 777 DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section • Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.08 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 8 Reference Name: Location/Address: USHighway 158-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: On -Site Well Community. Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L�__ L Sloe % 3 HORIZON I DEPTH o-0 Texture group!i L_ Consistence Structure S Mineralogy HORIZON II DEPTH Texture group�r Consistence Structure MineralogyI ` HORIZON III DEPTH Texture group Consistence Structure Mineralogy . HORIZON IV DEPTH Z Texture group Consistence G $ Structure 5 Mineralogy. SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE O SITE CLASSIFICATION: P's � �7 LONG-TERM ACCEPTANCE RATE: ©' Ll 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) 1 - • %q. ft. ...� 21 0.699 Ae.± 31,020 sq. ft �w 244.994.712- Ac. ± ' N 83053) 3' n 2 99.9 w 10' Public ft. (20 349 sq. Utilities . 32129 s ).811 Ac. f Easement ,q • c� 0.738 Ac 0.51 17 10' Public $ 3 Utilities s.g3' 31 �� 1N Easement 3d cfl 7 0 6,438 sq. ft. - 33,33: 0.837 Ac. f o cs,0 76 2 (I oto 1� � 15 , � 335•.,.' `.�y C-) o a, o 30 N Typical Setbacks , �• c., Corner Lot N CP \30,559 sq. ft. •.� n 0��\ 0.702 Ac.f3 10'x70' Sigl- 9 ' oUc,_. Easement 70 sq. ft. 25 2) s 09 Ac. f / *05bLtic 9 60 Olt 5 \ g 0'x70' (Check Name: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street " r Mocksville, NC 27028 Phone: (336)751-8760 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING REMODELING ❑ RECONNECTION ❑ Number:�i 6"`� - S �`� (Home) Mailing Address: / "T_ Z_0 14r_ 6'j oo O (D. .326 -ZI06 - C`Ci g / (Work) Aa v,6,J c'c rJ C.. 7-'7 o 0•.6 Detailed Directions To Site: a''S `t -SP T-('-) Lot4G W��O (. r_� 7 r�iZ� HOuS� o,J C_ i'V5 � Property Address: �`�` C- �� r a c J ''L 7 C' Ee-' '^•I `� -~i " Please Fill In The Following Information About The Existing Dwelling: Name System Installed Under: L 411Q Type Of Dwelling: /-l00S C Date System Installed(Month/Day/Year): NumberOf Bedrooms: Number ?f People: Is The Dwelling Currently Vacant? Yes ❑ Nox If Yes, For How Long? Any Known Problems? Yes ❑ NoX If Yes, Explain. Please Fill In The Following Information About The New Dwelling: Type Of Requested By: L Of Bedrooms: Number Of People: Date Requested: 0 For Environmental Health Office Use Only Approved ❑-'Disapproved ❑ `" F Comments: Environmental Health Specialist ,r -,..� / e'' (/r._- . �+ Date '"The signing of this form by the Environmental Health Staff'is in no way intended, nor should be taken as a guarantee(extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash ❑ Check`©" Money Order ❑ Amount: $ Date: Paid By: 1 r ,, ,, l g l , I: ! Received By: Account #:_t Inv ,..s #: P,iy L C/ vuivitlrO - LQY1C %-Ounl37 INU YUb11C Access f Page 1 of 1 ~' 22ft http://maps.co.davie.nc-us/GoMans/man/nrint.cfm?C'FTT)=] 903 1 ;77AA I n /i A I---