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240 Longwood Drive Lot 32Account #: 990002471 DAVIE COUNTY HEALTH DEPARTMENT _ > Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5861-59- 239.32TC Billed To: Touchstone Carolina LLC Reference Name: Town & Country Builders Proposed Facility Residence ATC Number: 3292 Subdivision Info: Redland Lot # 32 Location/Address: Highway 158-27006 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 Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA ' N IS ALID FOR PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 65 1 Ile - 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 be taken as a guarantee that the system will function satisfactorily for any given period of time. Q OF Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: /, / 2 6 Z DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street l / Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002471 Tax PIN/EH #: 5861-59-5239.32TC Billed To: Touchstone Carolina LLC Subdivision Info: Redland Lot # 32 Reference Name: Town & Country Builders Location/Address: Highway 158-27006 Proposed Facility Residence Property Size: see map ATC Number: 3292 **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 : AL #People #Bedrooms L) #Baths 3 Dishwasher: d Garbage Disposal: Er' Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: d Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 0.91 Type Water Supply&'Ofy Design Wastewater Flow (GPD) qgD Site: New 121Repair ❑ 1 ,� 1 System Specifications: Tank Size i�C'AL. Pump Tank GAL. Trench Width 31 Rock Depth 1Z Linear Ft. Other: 5 �►ST/� �X�S Required Site Modifications/Conditions: it.1ST- rL O9 J 60,J 100lZ 004 T4SKS 15'aPP 10 -:,FF U -'s-> 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.**** �� IZ�T4WlJfo ,�.�tD I Environmental Health Specialist's Signature: DCHD 05/99 (Revised) — . Date: O iso) a DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002471 Billed To: Touchstone Carolina LLC Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-59-5239.32TC Subdivision Info: Redland Lot # 32 Location/Address: Highway 158-27006 Property Size: see map "co **N0419*%mbfmprovement/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 1 I 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 #People #Bedrooms —'2-'3 #Baths Dishwasher: M"'- Garbage Disposal: E� Washing Machine: 12 Basement w/Plumbing: ❑ Basement/No Plumbing: e Commercial Specification: Facility Type /n1 #People #People/Shift #Seats Industrial Waste: ❑ Lot Size ©Q7 M124s:�,S Type Water Supply lAt)tJ Design Wastewater Flow (GPD) --�io Site: New Repair ❑ �I �i System Specifications: Tank Size QVQ GAL. Pump Tank 1Vim/��ry�� GAL. Trench Width Rock Depth 2 Linear Ft. ''1%-y Other: 5 o-1�[� ON �., LL Loc, `�•C• N1lt�i Required Site Modifications/Conditions: or:i C W10l�� , Y {,Q QY Ulj 1%S 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.**** asp so�-�a F---sR.AsN ?mac, V Q T N e29 )I Z W/ LMT ,0 2s Environmental Health Specialist's Signature: Date: 10& D Z- DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002471 Billed To: Touchstone Carolina LLC Reference Name: ATC Number: 3292 Tax PIN/EH #: 5861-59-5239.32TC Subdivision Info: Redland Lot # 32 Location/Address: Highway 158-27006 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 WAST 3 TION VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signat re:: I Date: O//V O 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. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: v c40 i U 1 'N w_ i i m N O CJS -P 'ublic lities hent n CA cip 1 42,2847' , ft. 0.971 Ac.:i: APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department C� ,r B7Vir=Menta/Hea/th SOCN617 ocr �^ P.O. Box 848/210 Hospital Street 3 4W2 r Mocksville, NC 27028 (336)751-8760 ��MfNT�Iy FcoU fitly ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRE INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed —7�-C�/n 5 /CiVLt el4pe0l i./61 z / C Contact Person 3� /= (%� z Mailing Address /_ Fall/�S/,yjhr t//�1 FAIwii 9(.I , Home Phonejd City/State/ZIP £(UI�U!//� /12� _2 r,70,7.3 Business Phone 7}/�— %63—z 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation 'Improvement Permit/ATC H Both 4. System to Service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If RResidence:# People # Bedrooms # Bathrooms :�7, Dis lit hwasher W -Garbage Disposal WWashing Machine 1.1 Basement/Plumbing LLI a t/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals !) Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: W--Bounty/City ❑ Well 0 Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes CI No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQULSTED BELOW. Either a PLAT or SITE PLAN MUST BCSUBMITTED by the client witli THIS APPLICATION. Property Dimensions: �� ,.- --�,✓ ,r.L Tax Office PIN: Property Address: Road Names City/Zip If in a Subdivision provide information, as follows: Name: ';Ce_ 4-t a--� Section: Block: Lot: 2 WRITE DIREcTiONS (from Moclzville) to PROPE'101': 5- L-- �1 I 'p 2 Date Property Flagged: 4-- , 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 responsihIe for all charges incurred fran this application. 1, hereby, give consent to the Authorized Representative of the Davic County 1-Icalth 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 /O - 3 - D 2 SIGNATURE !�- v '� 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). a—;:7t/ -Lt L41 cu -o Site Revisit Char ge Date(s): ��l 0.,j Client Notification Date: 19 Account No. �;—y -7t Revised DCHD (07/99) Invoice No. 307 AI'PUCATION f011 SITE EVALUATION/ IMPROMIENT PEIINI1T & ATC Davie County Health Department Environmental Health Section VJUN P.O. Box 848/210 Hospital StreetMockaville, NC 27028 (336)751-87601 �., . 4 2001 ***IMPORTANT*** THIS APPLICATION CANNOT BE PRO=SSED UNLESS ALL T RE k—FOAI INTOMUaXON IS PROVIDED. Refer to the INrORMATION BULLETIN for i atructfklfJTAI-7irArrJ COUNTY 1. Name to be Billed 1 . '� ? o /j 14 1 / Contact Parson k' r'/� t`/ et/S Mailing Address 63 n1,12 / Boase Phone City/State/zIP v/1/, c r, G Business phone 2. Name on Posit/ATC if Different than Above Nailing Address 3. Application ror: @ Site Evaluation s. System to service: 0''House ❑ Mobile Home s. If Residence% 1 People City/State/Sip ❑ Improvement Permit/ATC ❑ Both ❑ Business ❑ Industry ❑ Other W. 1 Bedrooms 1 Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Mashing Machine ❑ Basameat/Plumbing ❑ Basamant/No Plumbing 6. If Business/Industry/Others Specify type 1 People 1 Sinks 1 Commodes # Showers 1 Urinals 1 water Coolers Ir rOODSERVICE: ii Seats Estimated Water Usage (gallons per day) 7. Type of water supply: g'County/City ❑ Wall ❑ Community 9. Do you anticipate additions or expansions of the facility this system is Intended to serve? ❑ Yes ❑ No If yes, what type? ',"IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 1l. f'fS 7L Tax Office PIN: # Property Address: Road Name q xdf S City/Zip A66il4yee , /V -(f "97'W' If in a Subdivision provide Information, as follows: Name: Section: Block: Lot: 3'2 - WRITE DIRECTIONS (from Mocksville) to PROPERTY: -r7O- D-7-L,9l 4- 3�,o/ 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 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 sults"Ity. DATE SIGNATURE , 41�AY4-11�1�51P 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 Date(s): I Client Notification Date: I EIIS: Revised DCHD (07/99) Account No. J 5 Invoice No. Z2, 12--, ` - DAVIE COUNTY HEALTH DEPARTMENT 1 Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.32 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 32 Reference Name: Location/Address: US Highway 158-27028 Proposed Facility: residence Property Size: see map Date Evaluated: —7U,90/ Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape osition'-. Slope % HORIZON I DEPTH V- ICT o • 1 Texture groupCi Consistence ' S Structure Mineralogy ` HORIZON II DEPTH Qi -4c S' Liu Texture group Consistence -,'196 rce,4-3' Structure k Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogyo HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION pJ LONG-TERM ACCEPTANCE RATE -D• SITE CLASSIFICATION: 23 EVALUATION BY: LONG-TERM ACCEPTANCE RATE: 01,3 OTHER(S) PRESENT: REMARKS: AAAX -T(Z 1?100, - be;P71i , 'So flu:- (2-OCK V t.)"'50 1 n'j 7 � LEGEND <2 7OLL Y /.-j 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)