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159 Longwood Drive Lot 6
' • DAVIE COUNTY HEALTH DEPARTMENT / Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 /5f g GU 0 0 d b/2, Account #: 990002471 Tax PIN/EH #: 5861-59-5239.06TC Billed To: Touchstone Carolina LLC Subdivision Info: Redland Lot # 6 Reference Name: Location/Address: Highway 158-27006 ATC Number: 3294 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 CONST U ISV LID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature Date:It-)110k2- 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 Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. 30 r I s. 7S Septic System Installed By: M'� e-- —j Environmental Health Specialist's Signature: e: /oh/0-3 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 i�q �wywoo � ��- Account #: 990002471 Tax PIN/EH #: 5861-59-5239.06TC Billed To: Touchstone Carolina LLC Subdivision Info: Redland Lot # 6 Reference Name: Location/Address: Highway 158-27006 Proposed Facility: Residence Property Size: see map **NOTE* Thnis �mprovement/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 #Baths 2 Dishwasher: Garbage Disposal: Washing Machine: 13 Basement w/Plumbing: ❑ Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size d •� QI S Type Water SupplhW Design Wastewater Flow (GPD) 0 . Site: New Repair ❑ System Specifications: Tank Size 10W GAL. Pump Tank GAL. Trench Width t1 Rock Depth 2►r Linear Ft.� 1 Other: 1 Q1 � fi� Oh'R �T t� 1 (d C lti/l.l�i �/� Required Site Modifications/Conditions: Wl:�>-%LL oA (` .61J-VOt� � f�li�/I� ID 1o Fp WP LOU, 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.**** iii �t7 MI+J , I Environmental Health Specialist's Signature,Date: /0 © 02 - �— DCHD 05/99 (Revised) f $1$I I t7 -1CI Mtt1• F I X12 1 zr 3 s� r `�t`t��=�U � . 9 F l�`� 1' Q o I-,1 t � ffYA r X 'A A`, ik N* "Te - *be -NIA - 201 iii �t7 MI+J , I Environmental Health Specialist's Signature,Date: /0 © 02 - �— DCHD 05/99 (Revised) rim O 3 46,508 sq. ft. 1.068 Ac, t S 86520' 13" W : 161.74' Totbl 96.06` 0 00 N 32,240 sq.. ft. 0.740 A c. f 17.19144„ 238.07' C5 30,466 aq. ft. 0.699 Ac.f 244.99' -rw-i 3" w 310.67'(Total) 6 35,349 sq. ft. 0.811 Ac.f S 84'5t .831 1 �,�� eJ 00 Z C32 it i i W 10' Public Utilities Easemen t Vx 10' � 3 Utili n i Easi CDCD 36,438 sq. ft. 0 0.837 Ac. ± �1 O CC1 .. z Vii• t� �4 V APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & O i� Davie County Health Department Environmental Health Section Oct P.O. Box 848/210 Hospital Street 3� i Mocksville, NC 27028 / (336) 751-8760RONMlly aa4fco�i�m H l IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: fA-County/City ❑ Well LI Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If ycs, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUES'T'ED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. 11'roperty Dimensions: ��-----�� Tax Office PIN: # 57� - /— S� ' �2 3 9• b fD Property Address: RoadName City/Zip WRITE DIRECTIONS (from Mocksville) to PROPERTY: If in a Subdivision provide information, as follows: Name: dg-fi— /� Section: Block: Lot: Date Property Flagged: c - 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 application is falsified or changed. I, also, uuderstmtd that I ant 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 ncccssa ctermine the site suitability. DATE /0 -,-3 - D Z SIGNATURE ,w 1%, ' THIS AREA MAY BE USED F R IS"ure:s,setl YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensi , st cacks, and septic locations). Site Revisit Charge Datc(s): V Client Notification Date: EHS: � Account No. `/7 q,) Revised DCHD (07/99) Invoice No. cl I ***IMPORTANT*** INFORMATION IS THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL PROVIDED. Refer to the/ IINFORMATION BULLETIN for THE REQUIRE instructsons. 1. Name to be Billed �±�57O,Y/C `f1tQ0///w��l+J L- L (✓ Contact Person 57-6 Of-/-,/16 LA Address �J•� h/cLL�l$(i///L'y//f�l -xwn kz Home Phone �y�'��✓� 3 City/State/ZIP I, 'CWI� Lrlllk 411 . .270,7- -3 Business Phone j - ?03-'T 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation `improvement Permit/ATC II Both 4. System to service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: People # Bedrooms .3 # Bathrooms S /#� LY Dishwasher 4-C.rbage Disposal WWashing Machine ❑ Basement/Plumbing 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: fA-County/City ❑ Well LI Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If ycs, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUES'T'ED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. 11'roperty Dimensions: ��-----�� Tax Office PIN: # 57� - /— S� ' �2 3 9• b fD Property Address: RoadName City/Zip WRITE DIRECTIONS (from Mocksville) to PROPERTY: If in a Subdivision provide information, as follows: Name: dg-fi— /� Section: Block: Lot: Date Property Flagged: c - 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 application is falsified or changed. I, also, uuderstmtd that I ant 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 ncccssa ctermine the site suitability. DATE /0 -,-3 - D Z SIGNATURE ,w 1%, ' THIS AREA MAY BE USED F R IS"ure:s,setl YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensi , st cacks, and septic locations). Site Revisit Charge Datc(s): V Client Notification Date: EHS: � Account No. `/7 q,) Revised DCHD (07/99) Invoice No. cl I 4df* APPLICATION FOR SIT E EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Meath SeWon P.O. Box 048/210 Hospital Street Mockaville, NC 27028 (336) 751-8760 -- T (� lJ JUN '4 ***IMPORTANT*** THIS APPLICATION CANNOT BIC PROCKSSED UNLESS ALL T RE D INFOR1ATION IS PROVIDED. Refer to the INFORMATION BULLETIN for i atructf/dti;W 1. 1 / G011N 1 Y Name to be Billed S� 'L� ) .a{/ Contact Person '% /9-r i"' S 6 Mailing Address ., ( -5 /'� ¢ Bose Phone ' %CJ 4/- City/state/RIP 1 L, c.. c Business Phone 2. Name on Permit/ATC if Different than Above )failing AddressCity/state/Rip 3. Application For: EY/Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to service: O�House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other W� •�• 5. If Residence: # People # Bedrooms # Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type i People # sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Hater Usage (gallons per day) 7. Type of Water supply: 0---County/City ❑(tell ❑ Community e. Do you anticipate additions or expansions of the facility this system is Intended to serve? ❑ Yes ❑ No If yes, what type? k"IMPORTANT*"* CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with TIIIS APPLICATION. Property Dimensions: 16 A- Y&5 IL Tax Oma PIN: # 5 T'v 1 -. S � — .5�?-Se 1° Property Address: Road Name Aujc S City/zlp Abilwee, Aj_(f If in a Subdivision provide Information, as follows: Name: P 6( A- Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: 14-54 P 114 5 5 7rA- D-7-/,91 4-1, of Date Property 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 application Is falsified or changed. I, also, understand that I am responsible for all charges Incurred from this appllcadon. 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 illty. DATE l —d` SIGNATURE 4—//')�47 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). k Revised DCHD (07/99) Site Revisit Charge Date(s): I Client Notification Date: I EIIS: Account No. Invoice No. J_"2 DAVIE COUN'T'Y HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation 'APPLICANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size: PROPERTY INFORMATION Tax PIN/EH #: 5861-59-5239.06 Subdivision Info: Redland Lot # 6 Location/Address: USHighway 158-27006 see map Date Evaluated: :::ZA 101 Water Supply: On -Site Well Community Public /1� Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position t— Slope % HORIZON I DEPTH - Cj Texture groupL' t- C - Consistence Structure % � Mineralogy► + 1 HORIZON II DEPTH - 13— 5<- , I (o Texture rou Texture c2 Consistence �� $ Structure 3 Mineralogy HORIZON III DEPTH ' ' `� Texture group—+ 50 Consistence S i Structure Mineralogy1 t ; HORIZON IV DEPTH 3 3 Texture grouptk Consistence Structure L Mineralogy" SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION Jos LONG-TERM ACCEPTANCE RATE ©► 3 •0 SITE CLASSIFICATION: V> kwiL f_,LT) LONG-TERM ACCEPTANCE RATE: 0` �6 ' 0' LT REMARKS: EVALUATION BY: 3,&� 1&c :Z LitAIA rip 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 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)