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249 Longwood Drive Lots 47' • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002162 Billed To: Bob Cope & Son Construction Reference Name: Tax PIN/EH #: 5861-59-5239.48 Subdivision Info: Redland Lot # 47/48 Location/Address: Highway 158-27006 -IUjJUbUU f OUIRy. RCJ1UC11LU r1 UPUI Ly 014U. SCC ATC Number: 3203 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 .190 ge Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTE ER C 1 RU N IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature. Date:Z- 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 guaranteet t,� he system will function satisfactorily for any given period of time.AXr _ His I NSP 1 To / TbT4L- 2s oro ` Septic System Installed By:�-'� Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT r Environmental Health Section l P. O. Boz 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 N&mb r: 3203 **NOTE** This >emprovement/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 ill #People #Be&ooms L— #Baths Dishwasher: Y' Garbage Disposal: Led' Washing Machine: 111"' Basement w/Plumbing: 135" Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: II Lot Size �� 9 ASS Type Water Supply( � Design Wastewater Flow (GPD) Ll Site: New Repair 173 System Specifications: Tank Size I CCO GAL. Pump Tank GAL. Trench Width 3V Rock Depth 12-" Linear Ft. 4100 Other: VSTQ-i&)i1DrJ �� t3 SI -ALL, t—ItJ--S q IO.C. Mtni, Required Site Modifications/Conditions: l�S1Au, U, C.o� _� , ILi• P St OF -IF gcosEl ILS' I& c)FFF (gc�- "j ` 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. Telephone # is (336)751-8760.**** Rep Lid I )�, Tt }tS Rev �wu V, EnTnmental Health DCHDP5/99 (Revised) -S&9,7b6 fa4& Date: 11 CATION FOR SITE EVALUATION/IMPROVEMENT PERMIT &ATC D Davie County Health Department Environmental Health Section N�V P.O. Box 848/210 Hospital Street Mocksville, NC 27028 �:�ROPdhhENTAI�1 (336)751-8760 wily *** *** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billedr�?� �� lZ '-=CT a?�;�ontact Person Mailing Address ij/ Home Phone 115� 77 City/State/ZIP - eA"") %SU /A- �, b�` `Z10 Business Phone % Z- 2. 2. Name on Permit/ATC if Different than Above Mailing Address !Bus y/State/Zip 3. Application For: ❑ Site Evaluation Improvement Permit/ATC ❑ Both 4. System to Service: 'P House ❑ Mobile Home iness ❑ Industry ❑ Other S. Type system requested: 0 Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People # Bedrooms—E, Bathrooms---? ❑Dishwasher ❑Garbage Disposal ❑Washing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 8. Type of water supply: X County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes -SNo 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: Tax Office PIN: # �g (0 Property Address: Road Namen/n _ City/Zip If in a Subdivision provide information, as follows: Name: 2 ?'-1-- Z-1 ZC21 WRITE DIRECTIONS (from Mocksville) to PROPERTY: Section: Z- Block: Lot: Date home corners 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 an: 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 sites it ilit . DATE /'/ -/ _(� SIGNATU 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). 6 Sign given" Revised DCHD (05/03 C,k4' 77q or -t' P 1, A Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. Invoice No. _ L' DP�'iitlEllN FEB 1 9 2003 ENVIRONMENTAL HEALTH DAVIE COUP4TY ***IIpORTANT*** THIS AP SIN MPIaTION IS PROVIDED. 1. Name to be Billed U014oIlecJ % SHE EVALUAI ION/ IMPROMIENT PEII&IIT & ATC ulo County Noalth Dopartmont )vlrnnntental Haalth Sectlan ©ox 848/210 Hospital Street Mockaville, NC 27028 (336)751-8760 C=ON CANNOT BE PROCffiBSED UNLESS ALL T Refer to the INrORMATION BULLETIN for i %/"J lrf'A'01 Contact Person ("!', y , JJ JUN LLQ ! , RE D ' truotf�'Itlr'9NMEN —""' -- ?Sailing Address 11-tIn Y t none Phone %% '3 City/8tate/ZIP lt�,�l!S� a/L, (�yi., f44'1�, Business Phone 2. Name on Pewit/ATC if Different than Above Hailing Address City/State/Zip 3. Application ror: E'8ite ]Evaluation ❑ Improvement Permit/ATC ❑ Both 4. systan to Services fd'House ❑ Mobilo Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People I Bodrooms 1 Bathrooms ❑ Dishwasher a Garbage Disposal ❑ Washing Hachine ❑ Basement/Plumbing ❑ Basament/No Plumbing 6. If Business/Industry/others specify type 1 Co=►odes i Showers i People / sinks I Urinals t} Nater Coolers IS rOODSERVICE: # Seats Estimated Hater Usage (gallons par day) 7. Type of Nater supply: 9--County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is Intended to serve? ❑ Yea ❑ No If yes, what type? 4**IMPORTANT*** CLIENTS.41USTC03tPLETETIIE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Elther a PLAT or SITE PLAN MUST BE SUB6ATTED by the client with THIS APPLICATION. Property Dimensions: 1. rf'S- Tax Omce PIN: # Property Address: Road Name //Za S City/zip Ac&14'yed ' Ili ,9 If In a Subdivision provide Information, as follows: "-PName: r.) I"( Section: -�t�Y` Block: Lot: _ WRITE DIRECTIONS (from Mocksville) to PROPERTY: P 4 LI v 4- 1/0 — D — 7—/,91 4- -3 zo 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 suitability. DATE —/ 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. y DAVIE COUNTY HEALTH DEPAR'T'MENT • Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size: Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5861-59-5239.47B Subdivision Info: Redland Phase II Lot # 47 �► Location/Address: Highway 158-27006 see map Date Evaluated: LA303 Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 'Zf3 4 5 6 7 Landscape positionIV Slope % 97-6 HORIZON I DEPTH f ta' Texture groupG L Consistence S 5r S , Structure C_ Mineralogy• 1 HORIZON II DEPTH 7-t• Texture group Consistence —, 'w . 'S Structure 1< k Mineralogy1 • 1 HORIZON III DEPTH - l 1 - . _qflo Texture group Consistence ( S Structure Mineralogy; 1 I HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 0. q=0• SITE CLASSIFICATION: Q LONG-TERM ACCEPTANCE RATE: REMARKS: LEGEND Landscape Position EVALUATION BY:-NgI``� 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) ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900259 Tax PIN/EH #: 5861-59-5239.47 A.DM Billed To: David Mallard Subdivision Info: Redland Way Lot # 47 Reference Name: Location/Address: Longwood Drive -27006 ATC Number: 3913 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 WASTE W R C N I V FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: 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 1 I 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 ven iod of time. qz_c� s�-- Septic System Installed By: +^^ Environmental Health Specialist's Signature: Da DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street /- Mocksville, NC 27028 r fps O (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900259 Tax PIN/EH #: 5861-59-5239.47 A.DM Billed To: David Mallard Subdivision Info: Redland Way Lot # 47 Reference Name: Location/Address: Longwood Drive -27006 Proposed Facility Residence Property Size: see map ATC NuMber: 3913 **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 N�� #People #Bedrooms #Baths_ Dishwasher: 121"' Garbage Disposal: ❑ Washing Machine: 12'*� Basement w/Plumbing: Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �2-,'51 U6' Type Water Supply Design Wastewater Flow (GPD) SL'10 Site: New Repair ❑ System Specifications: Tank Size )CW GAL. Pump Tank GAL. Trench Width-` Rock Depth hV rLinear Other: ,I�- ►�i2.i �i l a•3 `ke Required Site Modifications/Conditions: 6�s-mL 8i�1 e�3.3 ith )Q , fil'L �c�irl�4i 1�^S� �l=ti�� t�tJ J tai IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 `° BELOW FINISHED GRADE. ****NOTIC • on ct representative of the Davie County Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. r •0 to 1:30 p.m. on the day of installation. Telepho le it is (336)751-8760.**** Sits �i � FILO,3 - Environmental Health Specialist's Signa e: Date: DCHD 05/99 (Revised) �r ) JIA \1 ': "X 154.230 363.o5* 513-25r(TOtcl Lot �4 2 31 acTe1 111.31 kA►c) S449' 18" E r� 1 11.1 §XCh) /4 EIP 1 1 N 86'44'41 ~ w - 50.oQ'(Tie Line) 3 4 EI p -260.37"- F; ,Jr., 1 55.L �46s sq, 0 7! rare '!_... 0' PV7fc 750. t Tota7l LONCA "�03' 1 5' 19 " '50.7 I '(cta 1 (50 326.2 1 fes. �o 0 C Q N 3 4 EI p -260.37"- F; ,Jr., 1 55.L �46s sq, 0 7! rare '!_... 0' PV7fc 750. t Tota7l LONCA "�03' 1 5' 19 " '50.7 I '(cta 1 (50 326.2 1 DAVIE COUNTY HEALTH DEPARTMENT r °a 1 Environmental Health Section 3 4 5 6 7 Landscape position IrL Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.47 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 47 Reference Name: Location/Address: USHighway 158-27000,6/,, Proposed Facility: Residence Property Size: see map Date Evaluated: -/ /L f%% Water Supply: On -Site Well Community Public ; HORIZON II DEPTH Evaluation By: Auger Boring Pit V/ Cut Ski n,_1 Consistence FACTORS 1 2 3 4 5 6 7 Landscape position IrL Sloe % (p HORIZON I DEPTH Texture groupt_ } Consistence C ' Structure Mineralogy1 ; HORIZON II DEPTH lfg4 -40 Texture group Consistence , wASPiK Structure IL Mineralogy1: HORIZON III DEPTH Texture group Consistence ' Structure Sky Mineralogy' HORIZON IV DEPTH + Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION I Ps 17 Ts LONG-TERM ACCEPTANCE RATE I d,-6,5 S1 0-3-o,351 SITE CLASSIFICATION: LONG-TERM ACCEPTANCE+ RATE: 0-55 OTHER(S) PRESENT: p �1 REMARKS: I CPO?/�ILI�T 3 nia i boJ P� D Lor `7 �1 -, ,_ M,&�e 1s -,'',G4- 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)