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174 Longwood Drive Lot 22t DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002363 Billed To: L. Wayne Frye Reference Name: Facility: Residence ATC Number: 3274 Tax PIN/EH #: 5861-59-6196 Subdivision Info: Redland Lot # 22 Location/Address: Longwood Drive -27006 Size: see 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 WASTE WA CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: i Date: ! � I // 7_ CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion sha 1 idl has been installed in compliance with Article 11 of .S Disposal Systems," but shall in NO WAY be taken a a given period of time. �IA k t eos,.� 3f, Septic System Installed By: r----. Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Ne the system described on Improvement/Operation Permit h pter 130A, Section .1900 "Sewage Treatment and iar tee that the system will function satisfactorily for any Z 4 Z 2 J r I 2 DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section n� • ` P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002363 Tax PIN/EH #: 5861-59-6196 Billed To: L. Wayne Frye Subdivision Info: Redland Lot # 22 Reference Name: Location/Address: Longwood Drive -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3274 **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 �� #People #Bedrooms . 1,7 #Baths .2 , Dishwasher: Z Garbage Disposal: 0"'- Washing Machine: C?"-- Basement w/Plumbing: 0""- Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply (`2— Design Wastewater Flow (GPD) -5V,�O Site: New, Repair ❑ System Specifications: Tank Siz%j? GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width,, � Rock Depthl� Linear Ft.Ng�V� 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.t day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) w 1 APPLICATION FOR SITE EVALUATION/IhIPROVBIENT PERMIT & Davie County Health Department &IvironmentaiHealth Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 I rSE:P i 0 10 02 EMnannn�(r...._ ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS JYMMMY INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Mailing Address C) VIS 14 tuctS ^^ %%�l�� City/State/ZIP AJ :a 7(00(o 2. Name on Permit/ATC if Different than Above Mailing Address Contact Person Home Phone 99 2 -''`s `I Business Phone 4491w-4,!- YG City/State/Zip 3. Application For: WRIte Evaluation PoImprovement Permit/ATC fl Both 4. System to Service: &+ douse ❑ Mobile Home EI Business 0 Industry IJ Other 5. If Residence: # People _ # Bedrooms_ # Bathrooms Y --Dishwasher M Garbage Disposal Ir4 Washing Machine K 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: K County/City 0 Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? it Yes Vf No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUES'T'ED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Properly Dimensions: Tax Office PIN: # 60 tO1 ��% 019 (0 Property Address: Road Name -6604 City/Zip A)W71)CK l V If in a Subdivision provide information, as follows: � Y Name: yq� Section: Block: Lot:�� WRITE DIRECTIONS (from Moclsville) to PROPERTY: 15i? Date Property Flagged: / _It'tA&J2---j 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 fir all charges incurred front this application. 1, 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 sui bN 'ty. DATE, V— /d —1460-S-1-1 SIGNATURE JJ --A . THIS AREA MAY BE USE FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines y� d dimensions, str ores, setbacks, and septic locations). Site Revisit Charge I Datc(s): Client Notification Date: i EHS• Account No. Revised DCHD (07/99) Invoice No. El rT �1 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department ---__ Environmental Health Seadon P.O. Box 848/210 Hospital Street L 11 Mockaville, NC 27028 (336) 751-8760 [JUN t 4 26'i1 ***I1dFORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL TRELUIRED I2=FMATION I8 PROVIDED. Refer to the INrORMATION BULLETIN for i structs NMEN //OUNIY 1. Name to be Billed / 1 P note- .d Contact Parson W�!"/94 T�It�S c� Mailing Address S `� h� Rose Phone City/state/EIP ge, Business Phone 2. Name on Permit/ATC if Different than Above Nailing Address City/state/Zip 3. Application ror: Er Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. system to service: O�House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other W'�'• s. If Residence: # People 1 Bedrooms 1 Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Mashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/others Specify type # People / Sinks / Commodes I showers I Urinals + Mater Coolers IS IWDSERVICE: 11 Seats_� Estimated Hater Usage (gallons per day) 7. Type of water supply: 9d County/City ❑ well ❑ Community a. Do you anticipate additions or expansions of the facility this system Is Intended to serve? ❑ Yes ❑ No If yes, what type? **"IMPORTANT"** CLIENTS MUST COMPLETETIIE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with TIi1S APPLICATION. Property Dimensions: �o 1�P. r�'.5 -�- — Tax Office PIN: # 2y Property Address: Road Name Adc 15 Clty/zlp A11114yee, AJ_e ,,974,1 If in a Subdivision provide Information, as follows: Name: �R P ",( /.- „- <� Section: Block: Lot: a` WRITE DIRECTIONS (from Mocksville) to PROPERTY: /SFS •sas4 7-- D -7—/,9l 4- 1,3s,,91 Date Property Flagged: This Is to certify that the Information provided Is correct to the best of my knowledge. I understand that any permit(,) Issued hereafter are subject to suspension or revocation, If the site plans or intended we 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 suits ility. DATE _ G — y� lJ/SIGNATURE Y.4— THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Iuclud all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): I Client Notification Date: I EIIS: Revised DCIID (07/99) Account No. Invoice No. 4--, 1 Awl DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.22 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 22 Reference Name: Location/Address: USHighway 158-27028 Proposed Facility: Residence Property Size: se map Date Evaluated: w -7/w/0 1 Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % Zy HORIZON I DEPTH 3 Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence ; 5 Structure Sbk Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: F'%S LONG-TERM ACCEPTANCE RATE: (/ REMARKS: EVALUATION BY:� �'Q"4 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)