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246 Bethlehem Drive Lot 23DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900573 Billed To: Glenn Johnson Builders Reference Name: Proposed Facility: Residence -z.•L-k) Tax PIN/EH #: 5861-59-5239.23GJ Subdivision Info: Redland Lot # 23 Location/Address: Redland Road -27006 Property Size: see map ATC Number: 3272 **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 SPIE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type _H a • c. #People #Bedrooms 4 #Baths 2' Dishwasher: Garbage Disposal: M"" Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #v Seats Industrial Waste: Lot Size I 03 AO -QC- S Type Water Supply Design Wastewater Flow (GPD) 'o0 Site: New � Repair ❑ System Specifications: Tank Size I ©W GAL. Pump Tank GAL. Trench Width 3V Rock Depth 1.9 " Linear Ft._!]k?;� Other: Required Site Modifications/Conditions: its mid, 1,/A/ e, 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: 1' ,[, / CIf f DCHD 05/99 (Revised) \ I. i L) rSeS Date: DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900573 Tax PIN/EH #: 5861-59-5239.23GJ Billed To: Glenn Johnson Builders Subdivision Info: Redland Lot # 23 Reference Name: Location/Address: Redland Road -27006 P �- Proposed Facility: Residence Nroperty Size: see map ATC Number: 3272 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 buildin permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treat enit and Disposal Systems). THIS AUTHORIZATION FOR WASTE IS V I PERIODOFI IVE ARS. Environmental Health Specialist's Signatur : Da • 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) x --)PA^J SoJ • APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT kAUG j5 � �"�"IDavie County Health Department'�..... 1'/IEnVM017Menta/ Health SectionP.O. Box 848/210 Hospital Street 2 9 2. _ Mocksville, NC 27028(336)751-8760 ,�A....__ - ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQU INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed 61nv1124s,4 Contact Person Mailing Address �3f/�G �,/j le s 277 Home Phone City/State/ZIP �o//P�lGL. ��� o7/ODS Business Phone Selo -SiS-57 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: ❑ Site Evaluation City/State/Zip ��mprovement Permit/ATC 11 Both 4. System to Service: C ouse ❑ Mobile Home Cl Business ❑ Industry IJ Other aK 5. If Residence: #People #Bedrooms #Bathrooms Z I�shwasher I:VG'arbage Disposal W leashing Machine LI Basement/Plumbing H 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 FJ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Rl<o (ryes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUES'T'ED BE..LOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: Property Address: Road Name City/Zip If in a Subdivision provide information, as follows: Name: Re Section: Block: Lot: WRITE DIRECTIONS (from Mocksvillc) to PROPERTY: Date Property Flagged: 41 -112 - 'This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter arc 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 I lealth Department to enter upon above described property located in Davie County and owned by�l/�fr.� to conduct all testing procedures as necessary to determine the site suitabili!y. /f ��— DATE, 8-1) I -Q Q SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all properly lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) El 1 IV 1'\./ e -1V rel following: Existing and proposed Site Revisit Charge Date(s): Client Notification Date: EHS: 73 Account No. Invoice No. I _ , tbx eils'xa`� ') xs�' nx�•09'w 1 � µ' x{(sexdl � II IY .0 r9.uR:• nn AlKM I et • r. et/to•..i/ •s �. �� l . i I ea m. .d.' / '•.a ee. ro/n I I / I I I Oev�Kfti__ -__-- �• S03'42'•7•W 730..6•�.ala) S07U9'3-'* _I :929 \ I ` / 96" .y, �--502'.2'!6"w 7]2.0'. '2' sol'sb'ss-» S*3,0. ••y ]oi.2r Tela) A--- -29.- \` i I [.NINA DIr1 Rood ]]I' 'a• �— xx f! ......-. so, xRys� b I _ , tbx eils'xa`� ') xs�' nx�•09'w 1 � µ' x{(sexdl � II Ac.— I / 0I .4 I / I I I I _ , tbx eils'xa`� Redland Wn21 I I / I Redland Wn21 API'LICAIION 1`011 SIZE EVALUAIION/IMPROVEMENT PERMIT & ATC Davie County Health Department Envilronmenfal Health SeWon P.O. Box 848/210 Hospital Street Mockaville, NC 27028 } f (336) 751-8760 JUN i 4 2i�il,� * * * XHPORTANV * * THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL T REbUMD Li) INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for i structf TAI 11plIfl -,J� / OUNIY 1. Name to be billed � . 51 1 1 -d Contact Parson b o4 -t e ?sailing Address ¢/ Roma Phon. City/stats/21P v/Y c C. business Phone 2. Name on Perait/ATC if Different than Above Nailing Address City/state/Zip 3. Application For: R Site Evaluation ❑ Improvement Permit/ATC 0 Both 4. System to services 8'Houae 0 Mobile Home ❑ Business ❑ Industry 0 Other W,.,... 5. If Residence: 1 People I ! Bedrooms # Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ washing Machine ❑ basement/Plumbing ❑ basemant/No Plumbing 6. If business/Industry/other: specify type / People / Sinks # Commodes / Showers 1 Urinals # water Coolers IF FOODSERVICE: .# Seats Estimated Hater Usage (gallons par day) 7. Type of water supply: 0-County/City D well 0 Community a. Do you anticipate additions or expansions of the facility this system Is intended to serve? 0 Yes 0 No If yes, what type? **"IMPORTANTI'I" CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with TMS APPLICATION. Property Dimensions: �o 1. r11-5 �- — Tax Office PIN: # 57 Properly Address: Road Name Az)u 15 9, Clty/zlp IP114'yed' ILS -(f , 91—ttt If in a Subdivision provide Information, as follows: Name: �RP "'( /1, "�- Section: Block: Lot: �3 WRITE DIRECTIONS (from Mocksville) to PROPERTY: -r7O- D - 7--A9 l 4-W, of Date Property Flagged: 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. 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 neccssary to determine the site suitability. DATE. Y �� SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property Imes and dimensions, structures, setbacks, and septic locations). k Revised DCHD (07/99) - Site Revisit Charge Date(s): I Client Notification Date: I EIIS: Account No. L Invoice No. P -'V / -,)- APPLICANT INFORMATION DAME COUNTY HEALTH DEPARTMENT Environmental Health Section SoiySite Evaluation PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.23 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 23 Reference Name: Location/Address: USHighway 158-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: 7/10 Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % :5/0 HORIZON I DEPTH O- & Texture group 0— Consistence Structure Mineralogy1 HORIZON II DEPTH - Texture group�- Consistence Structure -sL- Mineralogy HORIZON III DEPTH S Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE . F>S .0-t4055-0. SITE CLASSIFICATION: EVALUATION BY: __�Or�c LONG-TERM ACCEPTANCE RATE:S" �' W OTHER(S) PRESENT: REMARKS: 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) r� '7� igh t ►�o L2) Q sq. ft. �_' c3' �_ 91 A c. f •`rte_ 0 o. FkAow'48'" E 259.01 a2l ,020 sq. ft. 1.712- Ac. ± 299. 9 3' ..(..20 32,1:29 sq. ft. 0.738 Ac. ± Easement sq. tt. 0.884 Ac, f 441,892 5 ft. _ 1.031 Ac.± 15' / O y Typical Setbacks !nt$rior� i_ot 9 �..- 30' J.K. & L.M. MCCULLOH D. B. 54, PG. 432 1. 77 W .. ci7 cs J.K. & L.M. MCCULLOH D. B. 54, PG. 432 1. 77