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177 Longwood Drive Lot 4r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002471 Tax PIN/EH #: 5861-59-5239.04TC Billed To: Touchstone Carolina LLC Subdivision Info: Redland Lot # 4 Reference Name: Location/Address: Highway 158-27006 Proposed Facility: Residence Property Size: see map ATC Number: 3295 **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 1F SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type j I f- C #People #Bedrooms 3 #Baths 2 Dishwasher: 12"'� Garbage Disposal: Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 0.1L1 ACRC--SType Water Supply Design Wastewater Flow (GPD) Site: New d Repair ❑ System Specifications: Tank SizeiUVOGAL. -Pump Tank GAL. Trench Width 3�0�Rock Depth �1,221 Linear Ft.35if�>' Other: 3 �� 1 ti-� T�"LW � i �� 14&TAU,JeJACS ! t0 •i% }tn )nJ. Required Site Modifications/Conditions: 5, nc� AOL�X.1 K" �V t ©� �P L W'17 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.**** 3D% G 3gQ 8 b— < 61 25' Environmental HealthgS�ialist's Signature: j L -G i 4 rA 1.xo j lit= DCHD 05/99 (Revised) 133' II k"xt2 , 12� /oho/oz v` 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 #: 5861-59-5239.04TC Billed To: Touchstone Carolina LLC Subdivision Info: Redland Lot # 4 Reference Name: Location/Address: Highway 158-27006 Proposed Facility: Residence Property Size: see map ATC Number: 3295 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 CON ION IS ALID FOR A PERIOD OF FIVE YEARS. iPi 2 Environmental Health Specialist's Signature: Date: - 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 r Septic System Installed y: Environmental Health Specialist's Signature :�'i u Date: DCHD 05/99 (Revised) OCT -10-02 00:59 QM T ... h.%... C.—le— LLC 336 943 2623 P_01 "N(l r"If'y ho f°r ££•LD/ • SFA-. s 10 Public Utilities too_- �, ,�r•� Easement y,' 40 SU Cie'" ��..`�'"•�', Otai S 87'4Q'04 E Bethlehem' Drive .4" W 309.14'(Total) OMAN 115.18' C35 30.00' SEE 10'x70' Sight . Easement �%W«..._ _.....,_,_,583'32 03"E 94-24 6�70Public C34_ N 8332 03'' W I%- 1 09x70' r 10'x70' Sight Easement CD 32,240 sq.. ft. 0.740 Ac. f 19'04" W 238.07' Z fe Line �5 or W I v V/ co n 0 ;✓ 1- 0 to 0 �- 0. 00 N � CD ft' 4-6,508 sq. ft. c LO 1.068 Ac. f 04 N co ah N SEE 10'x70' Sight . Easement �%W«..._ _.....,_,_,583'32 03"E 94-24 6�70Public C34_ N 8332 03'' W I%- 1 09x70' r 10'x70' Sight Easement CD 32,240 sq.. ft. 0.740 Ac. f 19'04" W 238.07' Z fe Line �5 or W It V/ - w rn Ito0 1- 0 to �- o z C32 .5 w 30,46 sq. ft. f 0.699 Ac.f 0 Ln APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department EnvironmentaiHealth Section' ., P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760��"'�`+"/CijT,t, I ***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 �GkiC�s7`o.VL' 6A,9OI/%JR L-. Z t_ Contact Person X � 1i/' Mailing Address Y' -'s L .�LU/SUl %IE 14AI'wa kd, Home Phone 9`/Jr'�Z76,Z 3 City/State/ZIP// .CLtI/SL// E 1;1l.. -2r%61.3 Business Phone %0,30 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation improvement Permit/ATC ❑ Both 4. System to Service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms 3 # Bathrooms 2. S L'i'Dish.asher A- �Garbage Disposal WWashing Machine O Basement/Plumbing fl Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # People # Sinks # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: W,<:Gunty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: e2--fj- Tax Office PIN: # �$�� /— 57 'S'Z3 F. 6 Property Address: Road Name City/Zip WRITE DIRECTIONS (from Mocksville) to PROPERTY: L leu S � �CJU O/�S If is a Subdivision rovide information, as follows: Name: It,Z Section: Block: Lot: 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 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 2 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). Site Revisit Charge Datc(s): Client Notification Date: EHS: Revised DCHD (07/99) Account No. - Invoice No.—?/ 7 J 1 Commodes 1 showers # Urinals 1 Nater Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of. Water supply: 0--County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system Is intended to serve? ❑ Yes ❑ No If yes, what type? ***1AIPORTANT*** CLIENTS bIUSTCOMPLETETUE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 65- 1�P. r,gS 4 Tax Office PIN: 0 5 ��'Z I -59 - 5,;23--/ -o � Property Address: Road Name AaL S City/Zip c11JIld'ye" , Ad -(f , �7'et If in a Subdivision provide Information, as follows: Name: �p ,-f �� n_ '- Section: Block: Lot: WRITE DIRECTIONS (from Mocksvllle) to PROPERTY: Date Property Flagged: This is to certify that the information provided Is correct to the best of my knowledge. I understand that any permits) 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 suitability. DATE G _U� SIGNATURE Jk,11y - - X- r//�' TRIS 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). Site Revisit Charge Date(s): I Client Notification Date: I EIIS: Revised DCHD (07/99) Account No. J Invoice No. - 2- _ t .. APPLICAIION FOR SITE EVALUATION/IMPROVEMENT PERMIT dt ATC Davie County Health Department Environmental Neale SectionI� Box 848/210 Hoa ital Street Mockaville, NC 27028 (336)751-8760 l�P.O. t 10, r�' ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCZSSED UNLESS ALL TREbIlIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for i struaEN 1. Name to be billedI {� 14-� e . S VkCOUNIY.- _.. Contact Person k� !" Mailing Address I } Hose Phone %G City/atata/ZIP < ulY, i. Al,C', business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/state/Zip 3. Application ror: I Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. Syntex to aervicet W -House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other �� .• 5. If Residence: # People i Bedrooms # Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If business/Industry/Others specify type i People # sinks 1 Commodes 1 showers # Urinals 1 Nater Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of. Water supply: 0--County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system Is intended to serve? ❑ Yes ❑ No If yes, what type? ***1AIPORTANT*** CLIENTS bIUSTCOMPLETETUE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 65- 1�P. r,gS 4 Tax Office PIN: 0 5 ��'Z I -59 - 5,;23--/ -o � Property Address: Road Name AaL S City/Zip c11JIld'ye" , Ad -(f , �7'et If in a Subdivision provide Information, as follows: Name: �p ,-f �� n_ '- Section: Block: Lot: WRITE DIRECTIONS (from Mocksvllle) to PROPERTY: Date Property Flagged: This is to certify that the information provided Is correct to the best of my knowledge. I understand that any permits) 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 suitability. DATE G _U� SIGNATURE Jk,11y - - X- r//�' TRIS 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). Site Revisit Charge Date(s): I Client Notification Date: I EIIS: Revised DCHD (07/99) Account No. J Invoice No. - 2- DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.04 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 4 Reference Name: Location/Address: LISHighway 158-270 Proposed Facility: residence Property Size: see map Date Evaluated: `7 1 ob/ / Water Supply: On -Site Well Community Public / Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position 14 Sloe % Wzy HORIZON I DEPTH -to group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy HORIZON III DEPTH - k 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: P5 LONG-TERM ACCEPTANCE RATE: 0's- `0' REMARKS: EVALUATION BY: _Jl r r tC � 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)