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201 Bethlehem Drive Lot 53DAVIE COUNTY HEALTH DEPARTMENT • ' Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002436 Billed To: Darren Burke Constr. Reference Name: Proposed Facility: Residence 1I= b Tax PIN/EH #: 5861-59-2521 Subdivision Info: Redland 1 Lot # 53 Location/Address: Bethlehem Drive -27006 Property Size: see map ATC Number: 3378 **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 �AW—%C #People 3 #Bedrooms 3 #Baths �1- Dishwasher: El`- Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 0�S17 AGS Type Water Supply CDONDesign Wastewater Flow (GPD) 3UC1 Site: New Ell Repair ❑ System Specifications: Tank Sizel�GAL. Pump Tank GAL. Trench Width +Rock Depth Z Linear Ft.3SC Other: tJ17- (�:o Tto •.> > 3��:�SS I ��?sC,L'► _ L tJ �l� C f'3 Required Site Modifications/Conditions: J�� �'� C 1Tc?J�, I�zT �t C 1-� to IL,4FF 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 Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: 0 DAVIE COUNTY HEALTH DEPARTMENT . Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002436 Billed To: Darren Burke Constr. Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-59-2521 Subdivision Info: Redland 1 Lot # 53 Location/Address: Bethlehem Drive -27006 Property Size: see map ATC Number: 3378 **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 sr- #People #Bedrooms 3 #Baths Z Dishwasher: CRO""- Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Q!C 47 �SType Water Supply 0"JWDesign Wastewater Flow (GPD) Site: New 92( Repair ❑ rr ,� r System Specifications: Tank Size ICDMAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft. 3� Other: �5��1E; "lc�� �>�� � ��� tr�� l-1 nit� � r o . C . Required Site Modifications/Conditions: i tJ�`A�L ( C -t3 `Twp, 4 �� HousM-ap�` 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.**** �7 3� +rte I Coo` L 1� / Environmental Health Specialist's Signature Date: 7 DCHD 05/99 (Revised) Account #: 990002436 DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Billed To: Darren Burke Constr. Reference Name: Proposed Facility: Residence ATC Number: 3378 Tax PIN/EH #: 5861-59-2521 Subdivision Info: Redland 1 Lot # 53 Location/Address: Bethlehem Drive -27006 Property Size: see map 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 MALID Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONS N IA PERIOD O FIVE 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. J LA LIX� O � Q `1 y t i3 v., 17- Septic ZSeptic System Installed By: Environmental Health Specialist's Signature: te: 2% DCHD 05/99 (Revised) 00 P0 NE-. POTTS N N r� 15' 1, PG. 724 N 0 Ln co 88'49' 35" E --- 1.04' I 108.06 N CO 0 CD ies ent C36 02' _ _ 90.90'— --- S 87040'04" E thlehem Drive 309.14'( Total) 120.18'-- C35__ 49 33,874 sq. ft. 0.778 Ac. f N 86'44'41 W 274.97' (K) 37,552 sq. ft. 0.862 Ac.f N 86'44' 41 " W 274.25' (::5i) 36,112 sq. ft. 0.829 Ac.f N 86'44'41 " VII 272.93 ' (:5D 36,244 sq. ft. 0.832 Ac. f `C37 --583. 23 03„EC 94.24' 4 (50Y Public R W ) ---C34 -- N CO w � 4 % 53 sq. ft. 35,584 sq. ft. Ac. f w 0.817 Ac.± o 0 �C0 N 0� M. N O M O z o N CO 0 CD ies ent C36 02' _ _ 90.90'— --- S 87040'04" E thlehem Drive 309.14'( Total) 120.18'-- C35__ 49 33,874 sq. ft. 0.778 Ac. f N 86'44'41 W 274.97' (K) 37,552 sq. ft. 0.862 Ac.f N 86'44' 41 " W 274.25' (::5i) 36,112 sq. ft. 0.829 Ac.f N 86'44'41 " VII 272.93 ' (:5D 36,244 sq. ft. 0.832 Ac. f `C37 --583. 23 03„EC 94.24' 4 (50Y Public R W ) ---C34 -- RPR 20 2001 10:15PM HP LASERJET 3200 Y' Feb 20 03 08:3Sa davie county envhealth 336 751 8786 APPlICAI M FOR SITE EVALUAIMM 111FROVDADIF PERMIT A ATC Davie County Health Departmeslt P.O. Box 618/210 Hospital Street Kocksville, KC 27028 (336)751-0760 P.1 P.I 4 �ed�Gia�P { i1*XlV RTANT+s• THIS APPLICATION CZJMOT BC PROCESSED URMSS AIL TU REODIRM II 11 ORl9LTStAi IS MCVM U). Refer to the INVORe-laTION SU%MM73I for instructions. aese to >» aialw nP'�eontece PsraoaJIi�Y. 6,0 Le7tl @11 N.Llino xddceu fl5(n RE&AM a acne a.. 71010- 90 god City/State/LSP C./e,ud1W,rAL= a�ol� a.ain.ss'none 34R'-- �SYI , 2. Maas ea aeraLt/ATC if DirSezwt titan Abava �iC[y1..•e.. ssuseq Asdrra 54 w'eL _ eiwstate/sip SG �. Application For: /Site Evaluatiaa R Iaprovement Pea[t/ATC ❑ Both t.i.- ayeteo to teaviae: yM'�Bonse O lsobile Bone ❑ Business ❑ Industry O Other a droos_ iaewahar I) rarnoo. Di.poaal �t v ahinq M,ohi,,. a n we—r./so ola niaW 6. rr aeeiga.a/Industry/Otter: sp—ier tree a roople a siaka a Coretlea a she"" a Utinela a Vater Ceol.r. IF TOOOsaRYlt:i: 1 Seats Estimated Water Usage 49.=.— per day) ,'t' Type of untag supply: si, ¢bcommunity ounty/City 0 well ❑ Conity ,mar: Do you anlitipak additives or expsosions of the fadI4 this systme is intended to serge' 0 Yes 1,@' o It yes, what tyle4 •"IMPORTANT"& cLtzrm utSrcompiElETHE RegLitRttiD minium mFORMATION ICQUPSIED I t W FRbersrLATwSITLPLAN MU3rHESUBMZYTND 6.1 the eileat vAMM iSAPPUCAMOM x 3ta33 preptAy Di.ensioes �1 D 9 X 3 33 • ( 108 �(a WRn-E DI IONS (fres toMocl aville PROPERTY: �srOffia PIN: Jp 5 9G IS ! 95 �TYXu Ptop" Address: Read Name 4, CillaipLdyw�t/ r ,ifiesSubdivision provide latarnaGsn.asfollows: LPF P>-e4kki�1C(r(,t Dr Nam: mJa 1.of-- 53 ova 1P,+ Settles: , $bckt Lot: 53 Dale Property Flagged:° a • 03 �---- 7hls it to certify that the Infunwatiou provided is torrect to the ben of my knowledge. I eadarst end tint any ptrnslt(s) Wood hereafter are subject to suspension or revocation, if the site plans or intended use Change, or If she information submitted is this spplleaUom is falillied or efa0ged 1. also, snde rim,d (hw I am r sponslbk for all charges /scumd from Ails dpplketloa. I, hereby, give consent to the Aatheriud Representative of the k County Hemilk Department to enter open above described property Mcsttd In Davie County and owned by LA2wren 1 CO Cn� i�/G to conduct all testing procedus s as necessary to determine the site arita t _ —VATb � --)LO ' 0 3 SIGNATURE THIS ARLA MAY BE D FOR DRAWING Y SITE PLAN (Inc a all of the foilowiBg Existing sad proposed prop" lion aad suns, strtaOK*4 tstbaeks, ie lotaltaas} Slee Revisit Charge Date(s): D Client Notification Dale p1rIIS: I� �`f ►y c� Account No. Revised DCHD (07/79) [moire No. y� 5 '-Go APPLICATION FUR SITE EVALUATION/IMPROVEMENT PERMIT lit ATC Davie County Health Department '} Environmental Health Seratlon P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336)751-8760 * * * IMPORTANT* * * THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for 1. Nasrs to be Billed }tailing Address 6 3 City/State/ZIP 1<1tV5 Contact person some Phos. Business Phone 2. Name on Pertait/ATC it Different than Above Bailing Address City/state/Zip 3. Application ror: la'Site Evaluation I lor JUN t 4 20;i1 , jtru D atfA9t1;8FN JAVIEC0111py- ❑ Improvement Permit/ATC ❑ Both 4. Systan to Servioet 13"House ❑ Mobile Home ❑ Business 0 Industry ❑Other WA,." 5. If Residence: I People / Bedrooms f Bathrooms ❑ Dishwasher ❑ Garbage Disposal O Washing Machine ❑ Basement/Pluabing ❑ Buemant/No Plumbing 6. If Business/Industry/Othert 1 Commodes specify type i Showers + Urinals / People / Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of Water supply: 0--County/City D Well 0 Community e. Do you anticipate additions or expansions of the facility this system Is intended to serve? 0 Yea 0 No If yes, what type? """IMPORTANT"11 CLIENTS AIUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 0!� 5 )Ie re -5 4 — Tax Office PIN: It 57" / •.5i - 5,-23�1 Property Address: Road Name /Cf'uJL S City/Zip 114'V 'C , )V_(f "9 If In a Subdivision provide Information, as follows: Name: P d /.- A .� Section: Block: Lot: � 3 WRITE DIRECTIONS (from Mocksville) to PROPERTY: 7A- — D - 7-4 / -J- /3�, I1 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 falsitled 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 salts ility. DATE — y lJ�SIGNATURE Y4 lot �' 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). 0 Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EIIS: Account No. G (3 1° Invoice No. APPLICANT INFORMATION DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation Account M 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size: Water Supply: Evaluation By On -Site Well Auger Boring PROPERTY INFORMATION Tax PIN/EH #: 5861-59-5239.53 Subdivision Info: Redland Lot # 53 Location/Address: USHighway 158-27006 see map Date Evaluated: % 12 10 1 Community Pit Public I ---- Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % HORIZON I DEPTH O - cri Texture group rL- Consistence 3S Structure S Mineralogy`. HORIZON II DEPTH Texture group Consistence Structure 5 k Mineralogy1'. HORIZON III DEPTH 48 Texture group 4 - Consistence Structure !� Mineralogy HORIZON IV DEPTH S - Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE O. SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: D' 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)