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196 Longwood Drive Lot 27Account #: 990000955 Billed To: Samnaz, Inc. Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: 5861-59-5239.27S Subdivision Info: Redland Lot # 27 Location/Address: Redland Way -27006 Property Size: see map ATC Number: 3301 **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 �oo5e- #People q #Bedrooms LA #Baths ' Dishwasher: d Garbage Disposal: ® Washing Machine: l;K Basement w/Plumbing: e Basement/No Plumbing: Commercial Specification: Facility Type #�)P,eople #People/Shift #Seats Industrial Waste: Lot Size Q.-702 � ype Water Supply �nl l i' Design Wastewater Flow (GPD) 90 Site: New 133**" Repair 0 System Specifications: Tank Size I GLOGAL. Pump TankI QGAL. Trench Width Rock Depth Linear Ft. Other: '-� s�i'Q-1 P��TIc%.� �OXt�S IN-rfiA x t✓1,jc s D.C. koj . Required Site Modifications/Conditions: 1 �5��� �+� C.t��'fnt%Q, 10'CW PSP. ur,1G-.1 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.**** Environmental Health Specialist's Signature: DCHD 05/99 (Revised) ��� Date: O l V 0 Z" Account #: 990000955 Billed To: Samnaz, Inc. Reference Name: Proposed Facility: Residence ATC Number: 3301 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5861-59-5239.27S Subdivision Info: Redland Lot # 27 Location/Address: Redland Way -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 WASTEWATYR-CONS3;RUC110t1 LIS vALI&fQXA PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ate: 119Z 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 I 1 of G. S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY ngeante t the system will function satisfactorily for any given period of time. l �? p� ZS 1Do r— Septic System Installed By: 4d// Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: �/ /2'� F OM SAtTWZ, INC. FAY. NO._:.336 774 8701 Oct. 09 2002 10:28AM Pl 0 t d0 0Z tl2.54p idavle county envhealth 3�6 151 d/tlu t' APPLICATION FOR SITE LVALWUION/VArROWM(M PERA41T & ATG Davit County Health Department 67ri1VXVWG71 Health SOW" P.O. Box 868/210 Hospital Sheet Mockaville, NC 21028 . (336)751-8760 '—- p=— UrTaee THIS APPLICATION t`.AIDiOT 128 PA=SSXD MnXSS ALL TU RZQUIRHD LINTO MTiON iS 1MOVIDED. Refer to the INFO*RTION HVLLETIN for initroetions.A ( J L. a— , b. bill.d �/T� /i^2. ,-- `,,: f Cee►�et aeras. �� ��'�. �`1-)a A tui ino Addcaea $tel l�l{nw^►`/ ��_ Rows Phone q^� ci r/state/up �„ 21-4 aysine.s Phone 2. Baas : rez"VATC if Different than Abov. Holli f Address e— .�ciity/stat./sip 3. Apel! ation Pore U Site EoaluatiOn S. Improvement Permit/ATC D. Both e. ey.e. t. Se—i". KHouse C Mobile Homa I//0 Businass Q Industry 0 Other !. I11v ddenee: s PeOp1e s Bedrooms�_ o Bathrooms XDi��. ,..hes hn..b.ge Diepo.wl ♦Mashing Hschie. ��.mwnt/Plusbinq 11 aa.asert/imo pluwlaing c. If aw need/Industrr/othar: specify typo / popple I sinks I Car :des a Shows. a Urinal. a Nater Coolers IF R )DSaRVICCe M Seats Hetiteated Nata= Oea90 19-IIWW per aey) 7. Type S water supply: "!I'county/City o Nail Q Community a. Do yo anticipate additions or expansions of the faeBlty this system is Intended to serve? O Yes J;Mr. lfyes Nbottype? IMPORTAt-7 • CLIRNrS Aft/SrCVMF[LTETHE RE0rj[jCED PROPERTY /NFORMA7TON RtQUM'ED D' AW. Either ii PI AT erSrIS Fi AN MMTdESuffAmTED b the dieat with THIS APPLICATION. Proport; Dimensions: W'RIT11 DIRECTIONS (from Meeksvtnle) to PROPMEM Tax Offi ) PIN: a ^S — S Z 3 9. Z7 J Propenl Address Road Nama ``Q_t `A 1-1-3 g..� Ciy/lip V If in a St #division provide information, as follows: L L S A/ 0 Name: , 7t ed ],.,c �J Section: Bleck: Let: / Date Property Flaxecth This is to . rtify that the information provided is correct to the best of my knowledge, t understand that any permit(sf Icsuod her :Rar are subject to suspension or revocation, if the site plats or intended nae change; or if the Information submitted i this application is falsilied or ehaaged. 1, also, understand that I am responsible for all eluarges incurred jrom this applic Yon. 1, hereby, give consent to the Authorized Represent2tive of the Davie County Ha2lth Department to eater at a above deft. Mad property located In Davie County and owned by 11 to conduct D testing pteeedurct as necessary to determine the site suits \ q , DATE `O� 1. DSL SICNATI IRP. THIS ARI 1 MAY BE USED FOR DRAWING YOUR SITE PLAN (Include ado t-FottE g: Ex and proposed property 1 in and dhneasiois, strictures, setbsiek% and septic locations} Sife Revisit Charge Revised D H D (0719) )Vg s1� Netireelion Date:. Account No. Invoice No. w w 0,2 r -.�. S 86'44'41 " E 1 �- 357-26 U � — o Ico 30 a) `N 41,191 sq. ft. oq w 0.946 Ac. f r' 0 'Z-3 v S 86'44'4.1 ' E N o O 'V „a � � 381.08-1 O .- 10' Public Public 44,122 sq. ft. Utilities 1.013 Ac.f Easement w co co � r co 1 w — o Ico w w r' 0 N JCN 0 0 . S 86'441'41, 407-75 A 28 45,294 sq. ft. 1.040 Ac. f 433.422(To tal) F77.57' (iD 30,580 -sq. ft. 0.702 Ac.f ---•- S 86'4.4'41" E 238.42' r9__R__� S 86&44#41" E ft _O o ,o Q 25 45,182 1.037 F OM SRMNRZ, INC. FAX NO. 336 774 9701 Oct. 09 2002 10:26AM Pl (tit 08 02 02:54p 'davie countZj envhealth 336 Vbl Ultoo r APPLICATION FOR SITE EVALWTION/IMPROWEMI)a PERMIT & ATC Davie County Health Doparinseni Enriromarettbllfeelth sumn P.O. Dox 549/210 Hospital Street Moal(nvilLe. NC 21D28 (336)751-6760 � f..Y PDRSJIkiTaoa Tiff$ Apn ZHFO 11ATION IS BROVIDt9- 1. News . be a111ed +e7"0" 1✓ /'tc.� Ce.* v—s— sl ti I- i -a- I u "'^ Mai ina add—@f 4-�A c�,,t�, d� nose Phone . r Ug ci ./cuts/aTr Wr q� � � aosinass !'Acre a. Mass roz"VATC it Different then Abwn Vai.li 1 Address , e- City/lots/nip 3. Appli ation Sor- U Site SwluatiOn IxYaproveaent permit/ATC .. Both e, sy.f. fe C—Loo, KHouse Q Mobile Homs G Ousin.ars C Industry 0 Other s. If Re ddenee: a People :- _ a Bedrooms —AL_ a Bathrooms lrDss .ad..r }.12arbsgs M.p...1 st.i,.g lfachi..e -L s'C ,t/Plvxbiaq It 8aasw t/Mo ltaeStna G. If ac. Ap4aLtp typo 1 "to a sinks I Cor .dee a ft..ers a Cr;Kele s Neter Coolers IF IN )DSRRVirt: A Beata Estimated Wates beage /y.31ons Par rayl 7. Type f mater supply: ✓S County/city D well 0 Cespmu}S7,ty S. Do yo andelpste additions or expansions of the facility this system is intended to serva? D Yes R< Ifyes Nhattype? IMPOATAX "— CUMCM MIASMOMPLE'MTHE REQUIRED PROPERTY INFORMATION RtQDESTBo .OW. EitkeraPl.ATergrr6Pt.ANMUSTdSSUB.NIT lrythedicewilkTHISAPPLICATION. Propsrh DiNKatioaf• Tax OtTi 1 PIN: p Propern 4ddn= Road Nxnse `A u Cityrzip ``Qt 1\r1k .CA-- if id a Si idivision provide luformalion, as follows: Name: • ;?,.Ll J -'-L Section: Block Lot: - Sf UM DTRECnONS (frau Mecks.•nMJ to PROPERTY- -7---75 ROPERTY- 17S f� This is to - rtify that the information provided is correct to the hest of my knowledge„ I ondennand (bat any permit(sf Wood hot iftor are subject to suspension or revocatimy itthe site plans or intended use change, or if the Information submitted i this application Is falsified or chsaged. 1, also, andeisteird that t am respOtuiblajor all charges incurredjrom W; applic Ton. 1, hersby, give consent to the Authorized Representative of the Davie County Health Department to eater at a above dearrihed property located In Davie County and owned by in conduct dl testing procedures as necessary to determine the site saifn q r DATE_ `O' t_ O� VrNiT1tRVr I' THIS ARI k MAYBE USED FOR DRAWING YOUR SITE PLAN (Include alto a feI! g: Ex and proposed property t we and dim*edans, rtrocturet, satboeIL% sad septic locations). Site Revisit Charge Datt(s): Client Netirics6o. Date I XHS: Revitcd D HD (07199) Account No. �-5 Invoice No. APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department - — En vinvnmenta/ Health §eWon (- ) P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL TRE NF I IPaWION IS PROVIDED. lRefer to the INFORMATION BULLETIN for i ntru 1. Namo to be Billed �J�S�Uft�eLl %Ir�Lr X71°n�a{/ Kl Contact Person k��i /9 9 e Nailing Addressl 4 I'�� ¢ // Hose Phone City/atata/ZIP }��, �/ 5 U/i/ , .Ccy c . /v,r.,/G w Business Phone 2. Name on Permit/ATC it Different than Above �- Woj ��r /y= Nailing Address City/State/Rip 3. Application For: @/Site Evaluation 0 Improvement Permit/ATC ❑ Both 4. Sy■tea to Services 9' -House 0 Mobile Home 0 Business ❑ Industry 0 Other s. If Residence: i People Bedrooms 1 Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basanant/No Plumbing 6. If Business/industry/Others Specify type / Commodes f Showers I People i Sinks 1 Urinals E Water Coolers IF rOODSERVICE: 11 Seats Estimated Yater Usage tgallons per day) 7. Type of Water supply: 0--County/City ❑ Well 0 Community a. Do you anticipate additions or expansions of the facility this system Is Intended to serve? 0 Yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: Property Address: Road Name Auit S City/Zipt612 1191vee. Al -e ,1971t�a If In a Subdivision provide information, as follows: Name: �R p 6( /.,- A I'- Section: Block: Lot: --),1 WRITE DIRECTIONS (from Mocksville) to PROPERTY: / 'T \ fz!!Y— D-7-1,91 4_1,3EO/ 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 falsilled or changed. I, also, understand that I am responsible for all charges Incurred from this appUcatlon. 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 suit" Ility. ,ice---�- DATE l — 4D/ SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includes all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). 0 Revised DCHD (07/99) Site Revisit Charge Date(s): I Client Notification Date: EIIS: Account No. Invoice No. �" % • DAVIE COUNTY HEALTH DEPARTMENT 1 • ' Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size PROPERTY INFORMATION Tax PIN/EH #: 5861-59-5239.27 Subdivision Info: Redland Lot # 27 Location/Address: USHighway 158-27028 see map Date Evaluated: `% 7-3, D/ Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1A 2 3 4 5 6 7 Landscape position L Slope % 1170 HORIZON I DEPTH O Texture group Consistence 'S t° Structure Mineralogy1 ' HORIZON II DEPTH Texture group Consistence �S Structure Mineralogy= HORIZON III DEPTH Texture group G Consistence T Tr S P Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE ,� D, j•Cic SITE CLASSIFICATION: P5 LONG-TERM ACCEPTANCE RATE: 0. 3s-- REMARKS: s— REMARKS: EVALUATION BY: 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)