186 Longwood Drive Lot 26{ DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990000955
Billed To: Samnaz, Inc.
Reference Name:
Ph 5-12-oZ
Tax PIN/EH #: 5861-59-5239.26
Subdivision Info: Redland Lot # 26
Location/Address: Longwood Drive -27006
Proposed Facility: Residence Property Size: see map
ATC Number: 3198
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, S tion .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WASTEWAT TRUCTION IS VALID FOA PERIOD OF FIVE YEARS.
Environmental Health Specialist's Signature: �-Date:
CERTIFICATE OF COMPLETION
**NOTE** The issuance of this Certificate of Completion shall indica the syst scribed on Improvement/Operation Permit
has been installed in compliance with Article 11 of G.S. C1 apte 130 tion .1900 "Sewage Treatment and
Disposal Systems," but shall in NO WAY be taken as a guE rant th th system will function satisfactorily for any
given period of time.
4^' -
�r
Septic System Installed By:
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
• DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
. t P. O. Boz 848/210 Hospital Street
• Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990000955 Tax PIN/EH #: 5861-59-5239.26
Billed To: Samnaz, Inc. Subdivision Info: Redland Lot # 26
Reference Name: Location/Address: Longwood Drive -27006
Proposed Facility: Residence Property Size: see map
ATC Number: 3198
**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.
Residential Specification: Building Type A #People #Bedrooms _ #Bathso2 /2
Dishwasher Garbage Disposal Washing Machine; Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size Type Water Supply Design Wastewater Flow (GPD) j 0 Site: Ney?ET*' Repair ❑
System Specifications: Tank Size � GAL. Pump Tank /obGAL. Trench WidthT-O/ Rock Depth Linear Ft.Zey
Other:
Required Site Modifications/Conditions:
IMPROVE b1ENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW
FINISIiED GRADE. ****NOTICE: Contact a representative of a vie 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. o th y of installation. Telephone # is (336)751-8760.****
1
Q
Environmental Health Specialist's Signature: Date:
DCHD 05/99 (Revised)
�Cet r
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & A
Davie County Health Department
EnvironmentaiHealth Section >
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028 17
(336) 751-8760 ENIIIRONMENTA L_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 �S ck� at Z -rj C , Contact Person _ Q
r
Mailing Address � Home Phone
City/State/ZIP a Business Phone -7 7 %1 `=
2. Name on Permit/ATC if Different than Above k,.V.
Mailing Address
City/State/Zip
3. Application For: Alsite Evaluation improvement Permit/ATC ❑ Both
4. System to Service: p�House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
5. If Residence: # People_ # Bedrooms `4 # Bathrooms Zi t
P&Qishwasher barbage Disposal 0'F%,Fashing Machine
6. I£ Business/Industry/Other: Specify type
# Commodes
# Showers
9TBasement/Plumbing ❑ Basement/No Plumbing
# Urinals
# People # Sinks
# Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: W/County/City ❑ Well Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 11(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.
Property Dimensions: I V� y A-11 )( o I X
Tax Office PIN: # .5 � /— S % — ,52 3 I- 2,
Property Address: Road Name
City/Zip_r /
If in a Subdivision provide information, as follows:
Name: ce � I & M A wq-(/
Section: Block: Lot:
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
Date Property Flagged: 7— 5- oZ
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 suitabRi
DATE / / '*) / 4 Z__ SIGNATURE /Y //_/_[_ ir,— —
THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inclu e a of the following:—Existing and proposed
property lines and dimensions, structures, setbacks, and septic locations).
Site Revisit Charge
Date(s):
Client Notification Date:
EHS:
Account No. ! .5s
Revised DCHD (07/99) Invoice No. 33S3,
APPL1CA]ION FOR SITE [VALUATION/IMPROVEMENT PERMIT & ATC
Davie County Health Department
EnvIronmental Health SeWon
P.O. Box 848/210 Hospital Street
Mockaville, NC 27028
(336) 751-8760
***IIPORTANV** THIS APPLICATION CANNOT BB PROCESSED UNLESS ALL T
nWORMATION IS PROVIDED. Refer to the INTORMATION BULLETIN for i
1 /�
1. Name to be Billed /s� / t �V Contact parson k�
Nailing Address k� / // some Phone _L
' 16 4,
City/state/RIP " 'it1"V c C. Business Phone
2. Name on Permit/ATC if Different than Above
IL
JUN 4 2011 .
i
RE D
ru
tatfA6tk' WENTAI ►�.
LAqV1F(,OUN I Y
Z 7-
15?Wl --%1
Nailing Address City/state/Rip
3. Application For: Er Site Evaluation ❑ Improvement Permit/ATC ❑ Both
4. system to service: l"liouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other �� «
s. If Residence: 1 People
Bedrooms
1 Bathrooms
❑ Dishwasher ❑ Garbage Disposal ❑ washing Machine ❑ Basament/Plumbing ❑ Basement/No Plumbing
6. If Business/Industry/Others Specify type
1 Commodes
1 Showers
/ People 6 sinks
I urinals 1 Water Coolers
Ir rooDSERVICE: 11 seats Estimated Yater Usage (gallons per day)
7. Type of water supply: bounty/City ❑ Well ❑ Community
s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No
If yes, what type?
"AMPORTANTP" CLIENTS MUST COMPLETETIIE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with TIIIS APPLICATION.
Property Dimensions: 6 5 11e -7L
Tax Office PIN: # 57" 1-- -5X
Property Address% Road Namen� /ttr�lc S
City/Zip A),119x1ee, AJZ ,9/—Cw,
If In a Subdivision provide Information, as follows:
Name: P
Section: Block: Lot:
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
l S ray' p4 I v
1;,j - D-7-191 4- /3y, 0/
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 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 suitabilit'171y.
DATE e � — 11-2 �W 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
Date(s):
1 Client Notlficatlon Date:
I EIIS:
Account No.
/2(1—
Revised DCHD (07/99) Invoice No.
r '
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
' Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 989900136 Tax PIN/EH #: 5861-59-5239.26
Billed To: Westview Development Co. Subdivision Info: Redland Lot # 26
Reference Name: Location/Address: USHighway 158-27028
Proposed Facility: Residence Property Size: see map Date Evaluated: --sO
Water Supply: On -Site Well Community
Public 1___'
Evaluation By: Auger Boring Pit Cut
FACTORS 1 _24
3 4 5 6 7
Landscape position
Slope%
HORIZON I DEPTH _L1 0
Texture group
Consistence —
Structure
Mineralogyi
HORIZON II DEPTH
Texture group
Consistence r
Structure
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: SPS EVALUATION BY: < `'c'�`� `•`"p
LONG-TERM ACCEPTANCE RATE: � • OTHER(S) PRESENT:
REMARKS:yl ��i�-TZ Z 3ID,r
LEGEND
Landscaae 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)
_ - or plat bearings as noted
- - - 1.759 Ac.i m 31 J 4. Total Area 40.22Ac.
5. Total lots Phase I - 41 Lots
J;z
10' Public 45,789 sq. ft. Average lot size - 0.890Ac-
Utilities n 1.051 Ac.f 6. Zoned R-20
Easement w �7. Minimum building setbacks: 03 Front.... 30'/Side....15'/Back....30'/Side Street...
W -? 8. Public Streets, 20' wide ribbon. pavement
S86'44'41E 9. Public Water Systems & Private SeptY.c System 357.26' aD.C. MCCULLOH
r. 10. All utilities underground
a L , D.B. 188, PG. 541
'- N 86'44'41" W
i� 15' _ 274.96' � I 3�
N � �
Qi I I Typical Setbacks -� m 41,191 sq. ft. N NOTE
0 o Interior Lot N 0.946 Ac.t o
DIANE POTTS N N I (:4D Cp (a 0 0 This survey is subject to any facts that may be
eD disclosed by a full and accurate title search, NO
�1, PG. 724 i i 4 S 86'44'41 E o furnished me as of this date, and may be subjec
'-- 33, 874 s ft. I "'I '� �
30' �- 1 0.778 Ac.t N m
6 ^a' 381-08' easements, rights-of-way, restrictive covenants,
�f m assessmznts, if any, as the same may appear of
record in the Office of the Register of Deeds, Cle
15' c� ^ 2 9 1 of Court, Town or County Tax Office or which m
N 86'44'41" W °� 1 have been acquired by prescriptive use.
274.97'
d 9" 6 44,122 sq. ft. U
49'35" E —
108.
ft.
t
N
w
53
35,584 sq. ft.:*
0.817 Ac -t o0
N �j
00 PO
rnl r� Z
N �
-
O
2631 Reynolda Road
10' Public Utilities 1.013 Ac.t o
(336) 777-0078
Easement o
5
io
100
I
S 86'44'41 " E
37,552 sq. ft.
I
I
407.75"
0.862 Ac.t
,
FIELD WORK BY
CHECKED
BY. -
CJ
JEB
1°
45,294 sq. ft. o
N 86'44'41" W
r-
D -7
1.040 Ac.t
274.25'
121.01
I
CITY.,
COUNTY.•
o
N
433.42'(Total) S 86'44'41" E - -
51
I I Z
o)
U')I
274.57'
158.85'
36,112 sq. ft.
°? 03
�cl
I
0.829 Ac.t
�I�
Q, Im
27 ko /4J
RLB
�-
30,580 sq. ft. a
`a
0 702 A J- ^� N
0) C.
z o N 86'44'41" W
1- 272.93' 15 S 86'44'41" E
iv Typical Setbacksj 30I 238.42' = 25
Corner Lot
45,182 sq. ft.
1.037 Ac.t
M 36,244 sq. ft.
0.832 Ac.f I (:� ^ `r' CC) 26 &( o
C36 30' 10'x7 - 0' Sight o _N30,091 sq, ft.
Easement 00 I 0.691 Ac.t (o'
)--90.90' 25' _ 10'x70'
40'04" E — _C37�- �S8332 03"E�� Z Sight Easement /C7 `� N 6 26886
?hem, Drive94.24' S 83'32'03" E— C�
4'(Tota1) ® (50' Public )17.77 _
Rix') Tie Line Bethletie � �
--115.18'— —C35 _ C34� N 8332'03" W m 10' Public < 24
G� �'i Dive 1� Utilities
- 30.00' —98.17' � N 8332'03" 38,496 sq. ft.
W Easement
� 10'x70' Sight 113 84'-- � 0.884 Ac.f
3 , I — Easement 10'x70' Sight Geo
46,508 sq. ft. 4 i Easement
1.068 Ac -±'6 32,24 -sq. ft. 1-
0.740 Ac.t �
SEE SHEET 1 OF 2
rn
0\
0
w
W
N
D D.C. MCCULLOH
D.B. 160, PG. 64
Redland Way
Phase I
Owner:
Westview Development
Compa
2631 Reynolda Road
Winston-Salem, NC 27106
(336) 777-0078
SCALE:
100
I
0 so 100
I I I
FIELD WORK BY
CHECKED
BY. -
CJ
JEB
TAX MAP:-
PARCEL -
D -7
121.01
TOWNSHIP
CITY.,
COUNTY.•
Farmington
--------
Davie
STATE:
DATE:
PAGE NUMBI
NC
06-10-02
2 Q1
JOB NUMBER.-
DRAWN BY:
01205
RLB
REEHOR E116111EERIR6 IN
ENGINEERS SURVEYORS PLANNI
503 HIGH STREET
WINSTON-SALEM, WC 27101
TELEPHONE. 910-748-0071