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181 Bethlehem Drive Lot 55Account #: 989900259 Billed To: David Mallard Reference Name: Iroposed Facility: Residence ATC Number: a 3 c I DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 .t- I 1� I Tax PIN/EH #: 5861-49-9590 Subdivision Info: Redland Lot # 55 Location/Address: Bethlehem Drive -27006 Propertv Size: 108'x 330' 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 WASTEWATEUQONP7T7j1N IS 1ID FOR A PERIOD OF F17E YEARS. 7>d �--) A I - 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 WAYbe e as a guarantee that the system will function satisfactorily for any given period of time. WW Septic System Installed By: Nj�vmIzj T � Environmental Health Specialist's Signa*e : Date: 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 Account #: 989900259 Tax PIN/EH #: 5861-49-9590 Billed To: David Mallard Subdivision Info: Redland Lot # 55 Reference Name: Location/Address: Bethlehem Drive -27006 Proposed Facility: Residence Property Size: 108'x 330' Z� ATC Number: 3 3 6 9 **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. --7 Residential Specification: Building Type #People #Bedrooms 7�)— #Baths ' Dishwasher: 03"' Garbage Disposal: 92r' Washing Machine: �" Basement w/Plumbing: Basement/No Plumbing: EI Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: Lot Size D-062 Type Water Suppl&UNA—y Design Wastewater Flow (GPD) 5[00 Site: New Repair f t System Specifications: Tank Size 1QM GAL. Pump Tank GAL. Trench Width t� Rock Depth 12 Linear Ft. 4W Other: �)f 104 -FOALS, I N)--:"NT-NL.i, Required Site Modifications/Conditions: � tQu_ ( Q I,� Ems%'" owVic- Csd% IAC( ,�, fo 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.**** Illi `'/- � v ! I ! M� I * V Environmental Health Specialist's Sign ture: Date: $ 2- DCHD 05/99 (Revised) i APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & Davie County Health Department En vironmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 :oQ awn rnN?Rn','MFfITAL HEALTH ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed`%j/�C�������� Mailing Address ' City/State/ZIP .__2"—w su Ile -- 2. Name on Permit/ATC if Different than Above Mailing Address Contact Person Home Phone Business Phone City/State/Zip 3. Application Fore Site Evaluation Improvement Permit/ATC ❑ Both 4. System to Servicer—� House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. if Residence: #People #Bedrooms !; # Bathrooms C;� ---4+ Dishwasher "[7 Garbage Disposal ---4 Washing Machine- --f3 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: -- 'fl County/City ❑ Well El 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 MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. G� Property Dimensions: /QO ---33-o( 3of WRITE DIRECTIONS (from Mocksville) to P1101'ERTY: Tax Office PIN: Property Address: Road Name 11f �' `� '�`'` �6 Ti ir" City/Zip AD VA. JO e 270.7((% �L Z f d ZOE— 6►'l ¢� If in a Subdivision provide information, as follows: Name: Section: Block: Lot: Date Property Flagged: N/ 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 1 ant responsible for all charges incurred frau 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 to conduct all testing procedures as necessary to determine the site sui ility DATE / 3�— O 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). 1I— - /t -04,A 4-o,- Revised DCHD (07/99) Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. DS 7 Invoice No. a 2� LI/ • . APPLICATION 1`011 SIZE EVALUATION/IMPROVEMENT PERMIT & ATC ' Davie County Health Department " " R En vIronmenta/ Health SeWon • P.O. Box 848/210 Hospital Street Mockavills, NC 27028 I (336) 751-8760 ***IIdPORTANT*** THIS APPLICATION CANNOT BB PROCESSED UNLESS ALL T RE D J INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for i atruotfvl4t�g EN _ 1 LOUN1 Y 1. Name to be Billed / � ,z{! _ Contact Person Mailing Addrus �G3 Boas phone City/state/EIP UIT/ c C, / Businese Phone 2. flame on Psrait/ATC if Different than Above Mailing Address City/state/Zip 3. Application For% El Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. 9yste. to Services 13"House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other W.�.... 5. If Residence: f People I Bedrooms / Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Bassmsnt/Pluabing ❑ Basamant/No Plumbing 6. If Business/industry/Others specify type / Commodes # showers I People / sinks 1 Urinals # Water Coolers IF FOODSERVICE: # Seats _ Estimated Water Usage (gallons per day) 7. Type of Water supply: td'County/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system h Intended to serve? ❑ Yes ❑ No If yes, what type? *11,1IMPORTANP" CLIENTS AIUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: re15 -� Tax Office PIN: # Property Address: Road Name httdc S City/Zip C1l/l ,vee, lj-e "9 If In a Subdivision provide Information, as follows: Name: pp-,;( � n- Section: Block: Lot:s WRITE DIRECTIONS (from Mocksvllle) to PROPER•I'Y: rel- D-7-49 4- Date Property Flagged: This 6 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. 1, also, understand that 1 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/o/ SIGNATURE THIS 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). Site Revisit Charge Date(s): ICllent Notification Date: I EIIS: Revised DCHD (07/99) Account No. f� 3 Invoice No. Z •y DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.55 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 55 Reference Name: Location/Address: LISHighway 158-27096 Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: Evaluation By: On -Site Well Community Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L Slope % HORIZON I DEPTH • 2Z Texture group Consistence Structure k- Mineralogy HORIZON II DEPTH Z - 3 Texture group Consistence S Structure L Mineralogyr 1 HORIZON III DEPTH 3(0 •- 3 •� Texture group Consistence i Structure Mineralogyt HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE ©.3S SITE CLASSIFICATION: Ps EVALUATION BY: v8i:P LONG-TERM ACCEPTANCE RATE: d� OTHER(S) PRESENT: REMARKS: 1' T �`�C'tA" iii 211 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) 3� PG 75 9.H. PO TTS 1, PG. 724 L4 z1 NOT28'20"E ------ 39-29 .� L3 324.38'(Total) 108.28 a55 35,856 sq. ft. 0.823 Ac.t D.B. 191, PG, 724 S 88"49'35" 108.04* 1 (H54) 35, 677 sq. ft. 0.819 Ac.f E- 108.( --- 108.( 53 35,584 sc 0.817 A( w w to CK{{ �}d � W N t4) w o O? . CV M N M O p 10' Public Utilities Easement C3E -----108.02' _ _ —90.90 -- 309.23'(Total) S 87"40'04" E --- .Bethlehem Drive N 87'40'04" W 309.14'(Total) - —163.96 115.18' - 10' Public Utilities 30.00' Easement I � s .I • I I I I I I I I I I I I I I I I I I I I I I N � j I I I L-07-#5n 0,823 AG, OWMI-IN6 POKIGH