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153 Longwood Drive Lot 7• DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002363 Billed To: L. Wayne Frye Reference Name: Proposed Facility: Residence 'PA Yllal 0 --2- Tax PIN/EH #: 5861-58-3897 Subdivision Info: Redland Lot # 7 Location/Address: Longwood Drive -27006 Property Size: see map ATC Number: 3215 **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��%Jl'1 #People #Bedrooms 3 #Baths 2 ' Dishwasher: Ell" Garbage Disposal: u Washing Machine: Basement w/Plumbing: Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift Lot Size lb -SS -7 L,&pe Water Supply 600"-WDesign Wastewater Flow (GPD) I „I GAL. Trench Width '3(0 Rock Depth 2 Linear Ft 3 SO 10S r&L'L L -1012 s I �.C`. if�t.lo . System Specifications: Tank Size 1000 GAL. Pump Tank Other: `► #Seats Industrial Waste: ❑ loC7 Site: New Repair ❑ nn I- -- _ , Required Site Modifications/Conditions: j1�is� - n� �.r�v1�t7�, YEW 5 t� ""`"�'. V. to P a. Ur1b 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.**** LOT /0\ ('` fr — '7Radlr G In'MuJ. Environmental Health Specialist's Signature: I—OT DCHD 05/99 (Revised) Date: & oz— nd � - DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002363 Tax PIN/EH #: 5861-58-3897 Billed To: L. Wayne Frye Subdivision Info: Redland Lot # 7 Reference Name: Location/Address: Longwood Drive -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3215 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 WASTEWA I VAL FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatu ate: 2 14e llo 2— 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 be taken as a guarantee that the system will function satisfactorily for any Given period of time. �'�T con,Pt.crE =N 47- /AdP CT,,J u Septic System Installed By: Environmental Health Specialist's DCHD 05/99 (Revised) Ems. sTo,sti �J L-A%w I D 114 l„,;, • t , APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & A f. Davie County Health Department /" Environmental Health Section P.O. Box 848/210 Hospital Street u j1 Mocksville, NC 27028 �,+' (336) 751-8760 `x _� UL r ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS PL THExRIQU( INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN fo i.nstructlis-: 1. Name to be Billed Contact Person (�/. S,. /lt�i/ /67Y �7 �l�) / Home Phone �)� q93-18- r/ Mailing Address 4I10 City/State/ZIP AJ_1,Q-,V1-c � /vC � / V(/(? Business Phone 2. Name Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: f1 Site Evaluation Improvement Permit/ATC Il moth 4. System to Service: P"*House ❑ Mobile Home ❑ Business 0 Industry 1:1 Other 5. If Residence: # People # Bedrooms 3 N Bathrooms p,I Y 11// Z YI Dishwasher WGarbage Disposal Washing Machine Iy fu'...ent/Plumbing II Basement/No Plumbing G. If Business/Industry/Other: Specify type # People # Sinks N Commodes # Showers # Urinals # Water Coolers IF. FOODSERVICE : It Seats Estimated Water Usage (gallons per day) 7. Typo of water supply: Vr County/City 11 Well I1 Community o. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes -f-rNo If yes, what type? **IA1P0R7AN7'*** CLIENTS MUSTCOAWLETBTHE REQUIRED PI201'ERTY INFORMATION REQUESTED IE,LOW. Either a PLAT or SITE PLAN MUST BESUBAIITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # (p - .1$ 19-2 % Properly Address: Road Name o.Q. City/Zip If in a Subdivision provide information, as follows: Name: 0-'t ' 'k- '.- f WRITE DIRECTIONS (from Nlocksville) to I'R01'E1ffY: r o P" Section: Block: Lot: I Date Properly 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 are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this applica ' ' falsified or changed. I, also, understand that I aur respousihle for all chargee incurred from this application. 1, here )y, consent to the Authorized Representative of the Davie County Ilealtli Department to enter upon above descrktW poperty located in Davie County and o n d by _ to conduct all testing pro ures as nccessary to determine the site su tabi ily. I I DATE, i . `- SIGNATURE THIS AREA NI*Y 13E U I SITE PLAN (Include all of the following: Existing and proposed properly lints incnsions structures, setbacks, and septic locations). 1� 53 Site Revisit Charge Dalc(s): Client Notification Date: EI -IS: Account No. j1JD07199) Invoice No.� F IW JUL-12-2002 12:21 AM WAYNEDAPHNFRYE .,j T 10, rl 336 998 7081 P.01 AF -r' If ;11JXI/�y/v ���. p N7 4.101A. -UP �q/ AI'I'UCAIION FOR SHE EVALUAIION/llHPROMIENT PERMIT Fi ATC Davie County Health Department 't Enyfronmental Naalth Swdon P.O. Box 848/210 Hospital Street Mockoville, NC 27028 (336)751-8760 JUN 14 2001 ***IIPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL T RE D j INFORMATION IS PROVIDED. Refer to the INrORMATION BULLETIN for i atructfii3t47'aN _,_J / 1. Name to be billed /� )1,4.'0dContact persn k� l -A-:-`/ f �=/� Mailing Address n n Rome Phone City/state/LIP 1111, t, `. / >/U business Phone 2. Name on Permit/ATC if Different than Above Mailing AddressCity/state/sip 3. Application ror: © /� Site Evaluation ❑ Improvement Permit/ATC ❑ Both e. ayatea to service: O House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other �� « 5. If Residence: 1 People / Bedrooms 3 1 Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Hashing Machine ❑ basement/Plumbing ❑ basement/No Plumbing 6. If business/Industry/others specify type 1 Commodes # showers Ir MDSERVICE: # Seats E People 0 sinks 1 Urinals 1 Yater Coolers Estimated hater Usage (gallons per day) 7. Type of water supply: 0-County/City e. Do you anticipate additions or expansions of the facility this system Is Intended to serve? If yes, what type? ❑ Community ❑ Yea ❑ No ***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: Ae. r&.5 -7L Tax Office PIN: ft '51?Z 1--.5 S — 5��23-- e1 Property Address: Road Name .�lgev S 91 city/zip AbIlyee, AJZ "91 - If in a Subdivision provide Information, as follows: Name: P /� n- ".- Section: Block: WRITE DIRECTIONS (from Mocksville) to PROPERTY: P".'41/ . V'3- 4 f,!1- D-•7-1,91 -J- i3y;/-,/ Date Property Flagged: This Is to certify that the information provided b correct to the beat of my knowledge. I understand that any permits) 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 Salta llity. j - DATE —(%f 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). 0 Site Revisit Charge Date(s): Client Notification Date: EIIS: Account No. Revised DCHD (07/99) Invoice No. DAVIE COUNTY HEALTH DEPAR'T'MENT - Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.07 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 7 Reference Name: Location/Address: USHighway 158-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: % t?/ If I Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit 'If f ____ Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % -"/o :�± �b HORIZON I DEPTH - / 0 -17 - Texture group C_ L, Consistence C-.-5,590 Structure a4 s6k_ Mineralogy ) "' ) HORIZON II DEPTH 1' Z 2 • Z S Texture group Consistence : 5 Structure IC Sgk Mineralogy HORIZON III DEPTH z 2 Texture group+ Consistence Structure S Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE . 0. SITE CLASSIFICATION: V_S LONG-TERM ACCEPTANCE RATE: ©` REMARKS: LEGEND Landscaue Position EVALUATION BY-� 10(f 144 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) 96.06' A 0 y 0 i 6 35.349 sq. ft. 0.811 Ac.f 7 36,438 sq. ft. 0.837 Ac_t n W 10' Public o Utilities Easemen t n 10' Put \k-Utilities Easem( 2' C -Oka\). t 15' 1 It Typical Setbacks s 5� •$5 Corner Lot kN 03.03'(}2" E 40.01 9 30,870 sq. ft. 0.709 Ac. f 8 LI P 30, 59 sq. ft. o 0.702 Ac. ± 25 --N 30 �:;0011 IR/I %-I%. 05 oN 1L4jo