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227 Longwood Drive Lots 48DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002162 Billed To: Bob Cope & Son Construction Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-59-5239.48 Subdivision Info: Redland Lot # 47/48 Location/Address: Highway 158-27006 Property Size: see map ATC Number: 3203 **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 #Baths Dishwasher: C2"" Garbage Disposal: Er"'e Washing Machine: Basement w/Plumbing: Basement/No Plumbing: ❑ Commercial -7 Specification: Facility Type 171/1 #People #People/Shift #Seats Industrial Waste: Lot Size . I yA e Water Supply CVOtW Design Wastewater Flow (GPD) UO Site: New C?""Repair ❑ it it , System Specifications: Tank Size hCGAL. Pump Tank GAL. Trench Width Rock Depth 17- Linear Ft. Other: Required Site Modifications/Conditions: `r.SSVAU. Dr3 (D -j Y4 �S� fl( -r- dOLr--,c 101"[F 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 da oy f installation. Tel # is (336)751-8760.**** frCP, ta*- i MOXYL. 46 AF(4-y- z � � I F rs' cental Health Specialist's Signature: _ DCHDI05/99 (Revised) Date: Y7 10� API'UCAIION 17011 SITE EVALUATION/ IMPROVEMEM PERMIT & ATC ' Davie County Health Department Environmental Health SeWon P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336) 751-8760 * * * IHPORTANTk * * THIS APPLICATION CANNOT BE PROCZSBBD UNLESS ALL I INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for I 1. llama to be billed � � / � 4 61 / z Contact Person 1" Mailing )Address cG � n � RV Hone Phone le City/state/zIp C. = business Phone j JUN 4 201,)1 !'I �. RE ED tructfl�9 MMF.NT/ii lir'--- ��''—..U,AV1E CouNrr i"- 3d/ —Y,/,, 2. Name on Pornit/ATC if Different than Above Mailing Address/� City/state/aip 3. Application For: Pd'Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to services W -House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ basewnt/Plumbing ❑ basement/No Plumbing 6. If business/Industry/Othars specify type # People # sinks # Commodes # showers # Urinals # Water Coolers Ir 1!'OODSERVICE: # Seats Estimated Hater Usage (gallons per day) 7. Type of Water supply: 11-County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system Is Intended to serve? ❑ Yes ❑ No If yes, what type? "AMPORTANT*" CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 6 AO rc�S -7L Tax Office PIN: # 57 6 1-- 5� — 5 39' ` l Property Address: Road Name,n /Vedi S City/Zip 1114ve-2, AJZ , `� If in a Subdivision provide Information, as follows: Name: p 647 Section: Block: Lot: WRITE DIRECTIONS (from M%ocluvllle) to PROPERTY: r2- D -- 7-41 4- 1,3�'IV Date Property Flagged: This Is to certify that the Information provided Is correct to the beat of my knowledge. I understand that any permit(,) 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. 1, 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 suit! ility. DATE t1, — IVdW 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): I Client Notification Date: I EIIS: Account No. Revised DCHD (07/99) Invoice No. FARING 3"30'25"'E 3"30"02"W 5036"04"W t L 0 0 N °' 0 O N N N (49-) I IC)It N 0 r-0. q f \0. 42,2 0. is APPLICATION FOR SITE EVALUATION/INIPROVEh1ENT PERRIIT &,�7 Davie County Health Department Environmental Health Section — 22- P.O. Box 848/210 Hospital Street Mocksville, NC 27028 L�Ep�jN (336)751-8760IR M MtiNSP ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALLVMHE-REQUIRED INFORMATION IS P/RjOVIDDED.�f Refer to the INFORMATION BULLETIN for instruct/ions. /i 1. Name to be Billed i4 (:%e- ¢Sc,n Contact Person � dtrory -cez, '- Mailing Address / (/ �1 ���t� Home Phone 3,iQ v1 yy ' L/fCt %y City/State/ZIPCc'tOI��HI �� Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: ❑ Site Evaluation 4. System to Service: House ❑ Mobile Home ,. If Residence: I dishwasher it People _ I!f Garbage Disposal City/State/Zip 'Yc] Improvement Permit/ATC ❑ Business ❑ Industry ❑ Other # Bedrooms_ # Bathrooms 14"Washing Machine 131,15asement/Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # Urinals Il Both II Basement/No Plumbing # People # Sinks # Water Coolers IF FOODSERVICE: It Seats Estimated Water Usage (gallons per day) 7. Type of water supply: F_9'County/City Q Well 17 Community o. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes IA -Ko If ycs, what type? **1A1P0R7AN7'*** CLIENTS AIUSTCOMPLGTETHE REQUIRED PROPERTY INFORMATION REQUEST'E'D 13ELOW. Either a !'LAT or SITE. PLAN AIUST BESUBM17TF.D by the client with THIS APPLICATION. I1 Properly Dimcnsions..'s— WRITE DIRECTIONS (from Mocksville) to 1'ROI'F,It'I'1': Tax Office 1'IN: 11 Property Address: Road Name S0' City/Zip If in a Subdivision provide information, as follows. " GL Name: 1?410,11 we, Section: Block: Lot: 1Eyy Dale Property Flagged: This is to certify that the information provided is correct to the best of my knowledge. 1 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 fur all charges incurred front 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 suitability. DAT!, —0SIGNATURE f� THIS AREA MAY 13E USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed nronerty lines and dimensions, structures, setbacks, and septic locations). I ' Site Revisit Charge Dalc(s): Client Notification Datc: EI -IS: Account NO. Revised DCHD (07/99) Invoice No. T APPLICA)ION 1`011 SHE EVALUATION/IMPROVEMENT PEIIMiT & ATC Davie County Health Department Envrionmental Health Section P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336)751-8760 ***IHFORTANT*** THIS APPLICATION CANNOT BE PROCICSSBD UNLESS ALL INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for 1. Hama to be Billed Nailing Address city/stat./ZIP 2. Name on Permit/ATC it Different than Above Nailing Address Contact Person none Phone v� Business Phone City/State/Zip J JUN 1 4 2001 1 FitL"D I trust MEN --J VAVIL 'OUN1Y 3. Application For: 2 Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. Systan to Service: O"House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other W....,. 5. If Residence: 1 People 1 Bedrooms 1 Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Mashing Machine ❑ Basam►nt/Plumbing ❑ Basement/No Plumbing 6. It Business/Industry/Otharc Specify type 1 Commodes I Showers 1 Urinals i People 1 Sinks 1 Mater Coolers IF FOODSERVICE: # Seats Estimated Hater Usage (gallons par day) 1. Type of Mater supply: 9'6ounty/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? ***1A1P0RTANT*** CLIENTS MUST C031PL1:TETUE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AIUST BESUBMITTED by the client with TRIS APPLICATION. Property Dimensions:-�- Tax office PIN: Property Address: Road Name A".)c S i1 City/ztp Allilliyee. �J_e ,Olzzl If In a Subdivision provide information, as follows: Name: p a( Section: Block: Lot: `/ 9 WRITE DIRECTIONS (from Mocksville) to PROPERTY: pi-twP14 Pit/ ��- D -7-/,)1 g- %3�',ol 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 ase change, or if the Information submitted in this application Is falsified or changed. 1, also, understand that 1 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 suitability. DATE — y D/SIGNATUREIV IV THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN (Includ all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). 0 Site Revisit Charge Date(s): I Client Notification Date: I EIIS: Account No. Revised DCHD (07/99) Invoice No. DAVIE COUNTY HEALTH DEPARTMENT 4 Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.48 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 48 Reference Name: Location/Address: USHighway 158-270013 Proposed Facility: Residence Property Size: see map Date Evaluated: 77 0 Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit V Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % HORIZON I DEPTH 0 - Texture group Consistence : S Structure Mineralogy 1! ; HORIZON II DEPTH - -53 Texture group Consistence PC lc� Structure S Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 19'5 1 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: � 11) %�'�`' �"� t'`�/ EVALU TIN BY: / LONG-TERM ACCEPTANCE RATE: CVM6Z0D v' 3 >s OTHER(S) PRESENT: REMARKS: �Wo ? 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)