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207 Longwood Drive Lot 50. v Account #: 989900259 Billed To: David Mallard Reference Name: Proposed Facility: Residence ' ATC Number: 3186 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 0�0 f Loki wood PP-- Tax 2- Tax PIN/EH #: 5861-59-5348.50 Subdivision Info: Redland Lot # 50 Location/Address: Highway 158-27028 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 Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CTIO IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa e: Date: /?//9- 716 2, 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�Y be ken a gt�tee that the system will function satisfactorily for any given period of time. r I Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) r - Date: �� V2 y ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900259 Billed To: David Mallard Reference Name: Proposed Facility: Residence IMPROVEMENT/OPERATION PERMIT Tax PIN/EH M 5861-59-5348.50 Subdivision Info: Redland Lot # 50 Location/Address: Highway 158-27028 Property Size: see map U ATC Number: 3186 **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 H WSE #People #Bedrooms 3 #Baths Dishwasher: G�' Garbage Disposal: Washing Machine: Basement w/Plumbing: 2!( Basement/No Plumbing: ❑ Commercial Specification: Facility Type /I#�,P13>eople #People/Shift #Seats Industrial Waste: Lot Size $�2 Type Water Supply W00 7 Design Wastewater Flow (GPD) &0 Site: New 21 Repair ❑ System Specifications: Tank Size I CWGAL. Pump Tank GAL. Trench Width 3r, Rock Depth I Z" Linear Ft.,�WO Other: 3�1ST218011o3I✓�, IN�TAU la^31S�tC7.0 • kAtt3, Required Site Modifications/Conditions: tt&%y,. Oj L0.%0j0,, 14 gir--p I S ICk, r IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) 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.**** I KV 13 R� Environmental Health Specialist's Signature: DCHD 05/99 (Revised) I3fFC-r- DU►Ja's I I Date: I 2. APPLICATION FOR SITE EVALUATION/IMPROVEMENT PFJ Davie County Health Department Environmenta/Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 E D V� do/v '90 foo �Rnn ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL�� {\/ INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instrf--- W ' s. Name to be Billed ��/, � _ ,//% /'Z��►'��•% Contact Person 7�� V cn 7.. � i�� < Mailing Address t% �S `7 ��a Home Phone 9 V S - -,x; %-7 City/State/ZIP (' Business Phone -5 / 9 Lr3 Normo on Permit/ATC if Different than Above 6, Mailing Address City/State/Zip 3. Application For: 11 Site Evaluation '/b� Improvement Permit/ATC ❑ Both 4. System to Service: CJ House ❑ Mobile Home ❑4Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms Dishwasher ➢4'Garbage Disposal A Washing Machine (A_pasement/Plumbing 1] Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 1WNo If Yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: "�- /Z--�- Tax Office PIN: # Property Address: Road Name L� - '- ✓ ��' City/Zip If in a Subdivision provide information, as follows: Name: d Section: Block: Lot: �a WRITE DIRECTIONS (from Mocksville) to PROPERTY: �� fy 2--l/ ST Date Property Flagged: C' —z O --a Z-, This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits) 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 nm 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 ownedb to conduct all testing procedures as necessary to determine the site suita�itity,% /J DATE, / 'Z- � ^� � \ SIGNATURE. ��..n/�•,� 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). Revised DCHD (07/99) -t-rit?7� 3c7 Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. O o Invoice No. O 5' 6 APPLICATION 17 Oil S11 [VALUATION/IMPROVEAIENT PERMIT & ATC Davie County Health Department Environmental Health SeWon ` P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCV88ZD UNLESS ALL INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for - , -1 - I . I /J_ 1. Name to be Billed Nailing Address k 4 �`� City/State/LIP < U/i/ �. 2. Name on Permit/ATC it Different than Above Nailing Address 3. Application For: B"Site Evaluation Contact Person 11�JUN 14 2iio1 REhUIRED / ruotfl9i`k��yEN - .VVIVIE C0JJiVJY / Boss Phone— Business Phone City/state/Rip ❑ Improvement Permit/ATC ❑ Both 4. system to services Er House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other W� 5. If Residence: # People i Bedrooms 1 Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Others specify type i People / Sinks i Commodes # Showers # Urinals t Yater Coolers IF FOODSERVICE: # Seats Estimated Hater Usage (gallons per day) 7. Type of water supply: w-bounty/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? h" "IMPORTANT*** CLIENTS MUST COMPLETE TIIE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with TRIS APPLICATION. Property Dimensions: 6 5 4e YE'S 4 Tax office PIN: # 571�'jv 1-- 51� -- -5 32 Property Address: Road Name _t -j / S City/Zip c11JAVee. AJ_e .9/ --at If in a Subdivision provide Information, as follows: Name: �Rp �,f �� ti •� Section: Block: Lot: 5 ° WRITE DIRECTIONS (from Mocksville) to PROPERTY: .54 P � LI 4�9 4- fj�JD-7-1,91 4- 1- Ol Date Property Flagged: This is to certify that the Information provided Is correct to the beat 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 suits flity. DATE (_D/' 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 J Date(s): Client Notification Date: I EIIS: Account No. Revised DCIID (07/99) Invoice No. APPLICANT INFORMATION DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size: Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5861-59-5239.50 Subdivision Info: Redland Lot # 50 Location/Address: USHighway 158-27006 see map Date Evaluated: Z / Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture groupL Consistence Structure G R Mineralogy HORIZON II DEPTH Texture group Consistence ` Structure Mineralogy HORIZON III DEPTH - ? Texture groupP Consistence Structure Mineralogyr HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: i' s LONG-TERM ACCEPTANCE RATE: S� . n)%A-rA / nl 'Z" .1 REMARKS: LEGEND Landscaae Position EVALUATIONBY-,- )1:11_ OTHER(S) PRESENT: 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) 33, 874 30' 0.778 53 584 sq. ft. 817 Ac_f C o . o o� I C36 A0) I riv e 15 N sq. ft. Ac.f RJR -A AA. PI 274. g-�T 37,552 sq. ft. 0.862 Ac. ± �,- N 86'44'41" 274.25 CE) 36,112 sq. ft. 0.829 Ac. f W N 86 `44'41 „ W 2 72.43' r1 5. [—Ty—D,c al SethaCkS -T ' tz L cr) rn C o r � Corner Lot 30' -- 52 36,244 sq. ft. _ 30' 0.832 Ac. f 10'x70" Sight Easement 7--25_ ~--� 583.32'03 00 ^c Go 4 (50, 94.2 4' ubl� P 5 � N �Ti --- - 34 2 3 0,3 10"x70' SrTMhf CGa -'— Line