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184 Bethlehem Drive Lot 1`t DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Moclksville, NC 27028 (336)751-8760 Account #: 990002811 Billed To: Stafford & Reader Enterprises Reference Name: Proposed Facility: Residence ATC Number: 3492 Tax PIN/EH #: 5861-59-0117 Subdivision Info: Redland Lot # 01 Location/Address: Bethlehem Drive -27006 Size: i.z acres 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 W ER C N IS ALID FOR A PERIOD OF FI YEARS. Environmental Health Specialist's Signatur / 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. 1- 113 Fll .r.1T Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) !D DAVIE COUNTY HEALTH DEPARTMENT . Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002811 Billed To: Stafford & Reader Enterprises Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-59-0117 Subdivision Info: Redland Lot # 01 Location/Address: Bethlehem Drive -27006 Property Size: 1.2 acres irr,!:b ?-7-12.3 ATC Number: 3492 **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 �t)X6 #People 3 #Bedrooms 3 #Baths _ Dishwasher: rvr Garbage Disposal: 121" Washing Machine: Gy- Basement w/Plumbing: le Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift 2#,Se-attss Industrial Waste: ❑ Lot Size Type Water Supply u—w wDesign Wastewater Flow (GPD) ✓ Site: New Repair ❑ f System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft. � Other: ')l-na-l"t cJ �'� Y I gSrA.LL u �.1i S ') (). C . IA., ,J . Required Site Modifications/Conditions: p f -r 1005"', ��r;l'� l O P t_1..51:.5 7� ,r c.TIOJ IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW 0-0f- FINISIIED 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.**** Q� + SMV �C,�J7 woe — 7S oar >�� CON) $s• "� t5 4 - �tic�- -ra Vrf Environmental Health Specialist's Signature: Date: 4-W!5 9 % 2y DCHD 05/99 (Revised) �1" DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P. O.,Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002811 Billed To: Stafford & Reader Enterprises Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-59-0117 Subdivision Info: Redland Lot # 01 Location/Address: Bethlehem Drive -27006 Property Size: 1.2 acres ATC Number: 3492 **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 �1� l�c`c, #People .3 #Bedrooms #Baths `"r[ Dishwasher: 0"" Garbage Disposal: Washing Machine: Basement w/Plumbing: Basement/No Plumbing: ❑ Commercial Specification: Facility Type C69 Ace -6nn_ ,^#People #People/Shift #Seats Industrial Waste: ❑ Lot Size /' Type Water Supply ept NTYDesign Wastewater Flow (GPD) � Site: New R( Repair ❑ System Specifications: Tank Sized GAL. Pump Tank1ECO GAL. Trench Width :3a Rock Depth < Z Linear Ft. Other: �`I��Smt��' !'f[�.i 1 ` X+�` I •Jsrn1 l� u niG� �o.0 , K� r.� . Required Site Modifications/Conditions: C) gF f". (1 % IMPROVENIENT/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.**** Tw ) w �5 fpGF t�Rl�v � I , c" L10Environmental Health Specialist's Signature: DCHD 05/99 (Revised) ate: r JUN 1 8 2003 ENVIRONMENTAL HEALTH DAVIC COt1Nr_ CATION FOR SITE C•VALUATION/INIPROVEMENT PERMIT & ATC AT Davie County Health Department (;,ql.L Environlnenta/Hea/th Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 ***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 4;TQPr0V✓( �(�JeQ(�� N/�if%f s Contact Person Mailing Address O,� /(� %/ home Phone City/State/ZIP C../-e%1•'lmoyis 41C 2-70Lk Business Phouc 3 /6�e��_ 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip _ 3. Application For: ❑ Site Evaluation /improvement Permit/ATC CJ Both 4. System to Service: House ❑ 2dobile Home ❑ Business ❑ Industry ❑ Other 5. Type system requested: iconventio nal ❑ conventional modified ❑ innovative 6. If Residence: It People It Bedrooms 3 11 Bathrooms _ Dishwasher CZarbage Disposal Iy7Washing Machine tl9Basement/Plumbing ❑basement/No Plumbing 7. If Business/Industry /Other: verify type # Commodes # Showers IF FOODSERVICE: # Seats 8. Type of water supply: ltd County/City It People It Sinks It Urinals It Water Coolers Estimated Water Usage (gallons per day) ❑ Well ❑ Community 9. Do you anticipate additions or expallSiollS Of the facility this systelll is in(ellded to serve? ❑ Yes If yes, what type? o ***IMPORTANT*** CLIENTS MUST COMPLETE• THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBAfITTED by the client with'1'1IIS APPLICA'T'ION. Property DIII1cusions: �^1`� Ae � 1VRITL DIRECTIONS (I'rom Mocksvillc) to PROPERTY: Tax Office PIN: # J G U 1 ! If,5 F s r to Prha ayov 01Leler Property Address: Road Name i1..`�1�'ti--t' Q J od L e- FT 19S i /of 0`y! I �{%- City/Zip �V,�1 � ("itr7 If in a Subdivision provide information, as follows: Namt I4e: 4,d Wet Section: Block: Lot: Date llonle corners flagged: !' ►0'tl �a '� 3 -0-3 This is to certify that the information provided is correct to the best of my knowledge. I understand that any pernlii(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the infornu►(ion submitted in this application is falsified or changed. I, also, understand that I ail responsible for all charges incurred fi-oil Misapplication. I, hereby, give consent to the Authorized Representative of the Davie County Ileal Ili De )artnlciil to cuter upon above described property located in Davie County and owned by 'Yas"nt to conduct all testing procedures as necessary to determine the site suitability. DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN llclude all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). 'Ary Sign given. 1 Revised DCIID (05/03 Site Revisit Charge Date(s): _ Client Notification Date: EHS: Account No. Y / / Invoice No. 3G__ _l_5 APPLICATION 7011 SITE EVALUATION/ IMPROVEMENT PEIIMIT & RTC Davie County Health Department 1 - — Environmental Health SeWon P.O. Box 848/210 Hospital Street 9 Mocksville, NC 27028 (336)751-0760 JUN t 1. ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REibUJBED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN *ori atructtts�;;�,grtt , —� 1. Name to be Billed 1 F' '! a . �� % Contact Person Mailing Address �C3 r 'l� F¢ none Phone City/state/ZiP t �� DIi/,� c C. Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/state/Zip 3. application For: ®'Site Evaluation ❑ Improvement Permit/ATC ❑ Both *. System to servicat O'House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other W,�...�. s. If Residence: 1 People I Bedrooms 1 Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Hashing Machine ❑ Basament/Plumbing ❑ Basement/No Plumbing 6. If Business/industry/others specify type t# Commodes f People 1 sinks t# showers ! Urinal■ I water Coolers IF FOODSERVICE: # Seats Estimated Hater Usage (gallons per day) 7. Type of water supply: 9-/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? ***IhfPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with TINS APPLICATION. Property Dimensions: � 15> A0. re5 4 -- WRITE DIRECTIONS (from M/ociuvilie) to PROPERTY: Tax office PIN: # 51�'Z J —s S — 5�2 � LI ,p -� 7 Property Address: Road Name A'dC 15 �/ Clty/ZipCf lJf4"Ve ' /V -l_ q/ If in a Subdivision provide Information, as follows: Name: r( �� /l_ :,- -'I 11✓1' Section: Block: Lot: � Date Property Flmgged: 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 falsilled 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 t� — � SIGNATURE 1111S 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): I Client Notification Date: I EIIS: Revised DCHD (07/99) �5)a° 3 Account Na Invoice No. % r M• . a • DAVIE COUNTY HEALTH DEPAR'T'MENT • • Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.01 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 1 Reference Name: Location/Address: USHighway 158-27096 Proposed Facility: Residence Property Size: see map Date Evaluated: % In Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % o HORIZON I DEPTH 19-1(11 Texture groupL Consistence Frss Structure Mineralogy HORIZON II DEPTH - Z " Texture group Consistence i Structure Mineralogy' HORIZON III DEPTH Texture groupC OGt Consistence Structure - Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: os LONG-TERM ACCEPTANCE RATE: REMARKS: S riA LE - I p C, 11, yJ 1 f L �_19,X Ti%u LEGEND Landscape Position EVALUATION BY: - V_ f� ,S-.-- ' � a OTHER(S) PRESENT: f -Lf" 41 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) L4 -� ve N 02'28' 2fl"E 39.29' L3 1. BEAUCHAMP '1, PG. 655 w ZI 1 w Ln to d- 0 Z -ARD ,. 695 LO I� r-- Easement C31 -110.31 ' -r----.-108.02' ..1-90.90 ' -�- 309.23______._ Total S 87940'04" E -- Bethlehem ---- .Beth,lehem D --- N 87040'04" W 309.14'(Total) 188.96' 120.18' 10' Public Utilities 20' Public Easement Utilities Easement 1 53,871 sq. ft. 1.237 Ac. ± 184.01 I 1 I L1 N 86'16'43" W 213.98'(Total) a 2 75,770 sq. ft. Ci) 47,938 sq. f+ 1.101 Ac.± 6' L2 thieh,m Drive NO2*28'20*E ' Pcabiic RA 39.29 L3 D.L. & B.A. BEAUCHAMP D.B. 181, PG. 555 u� n tG� IM"RD D.B. 3x. PQ 60 1. It N a 0 �� V LO a ►o �o 8�•4� 309.23' Tatar a Bethle --- N 87"40'04" W 309.1.4'(T( ------ 163.9f' I. 10' Public Utilities Easement 46,52 sq. ft. z 1.068 Ac.f VJ 0 to co N 86'16'43" W 159.01 ' z M v 4 ¢ w ` � � 84,550. sq. ft. 1.941 Ac.± M V S 1 a LO , r N 46,52 sq. ft. z 1.068 Ac.f VJ 0 to co N 86'16'43" W 159.01 ' z M v 4 ¢ w ` � � 84,550. sq. ft. 1.941 Ac.± M V S 1 a