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256 Longwood Drive Lot 33DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street ` Mocksville, NC 27028 e3 �! 7 - c> .3 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000955 Tax PIN/EH #: 5862-50-7220 Billed To: Samnaz, Inc. Subdivision Info: Redland Lot # 33 Reference Name: Location/Address: Longwood Drive -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3369 **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 & #People #Bedrooms _� #Baths Dishwasher: K► Garbage Disposal: ❑ Washing Machine: 0 Basement w/Plumbing Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply_ Design Wastewater Flow (GPD) Site: New Repair ❑ System Specifications: Tank Sizel AL. Pump Tank GAL. Trench Width{Rock Depth %� Linear Ft. ysC7 Other: Required Site Modifications/Conditions: 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.**** I Environmental Health Specialist's Signature: Date: /%i/%�y 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 #: 990000955 Tax PIN/EH #: 5862-50-7220 Billed To: Samnaz, Inc. Subdivision Info: Redland Lot # 33 Reference Name: Location/Address: Longwood Drive -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3369 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 CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: �4&-,4 // __ _ 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 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be taken as a gu tee that the system will function satisfactorily for any given period of time. 16 7 _l (,DAN P Septic System Installed By: / Environmental Health Specialist's Signature: �� Date:/Sf�3 DCHD 05/99 (Revised) SAMNAZIINC. 3367746700 02/11/03 06:40pm P. 001 Feb 10 03 04:00p davie county envhealth 336 751 8786 P.2 02/06/03 05:36pm P. 007 f'eb (I6 03 11:43a davie nuunty envhealth 336 751 07Hr, p•2 APPUCATIOA EOR SIZE fYA1IATIOV/IMPR1114"fAq PtRW16A1C Davie County Hewn Department Eer/1l amellLilHealth6e ton P.O. flow 841/210 Hospital Street Mocksville, HC 27O29 (3361751-8760 •ef lt�ORTAMW'" THIS APPLICI:TIOH CAMM AM PMMSSED UNUSS ALL TIM R$QUIRED II M014TION IS PROVIDED. Refer to then INFURMT20N KnJ.ST211 for jinnstr[uckioae. a,.. ♦o ►o ai)ltd __`?. .NA-1� � 1.. Contact r— .� �stC�Ic1 Itail►oo mm—, 1 ti ey/St•ta/LIP 4y�1.---.,.. f- .O Buaieo,sa PLerro Q Y7b a Iftee on Porait/ATC it Different than Above — `�fl•M.(.. __-- - •— 14"ILq Atldces• city/SLat./eap �). ApplicAtien For: A Sito Evaluation f) lsprovewent Perm!/A= n both sr -tae to Wuric.: O N use fl lfobile Hose 1.( liusinesa n InduattY 0 Othex Ja. If Assidaneo: a Peoplea Hedraon�s' _ a Hathroosa � ,fid D+e4rasMr, ;+ GaeDogc Dlepessi H//' Ka t my HeCAine 7 B 3e. t,*PluebAo" 11 aaaa�u/wp�P)UN02100 a. I[ lrsansa./Ieaa•tey/OeLore sP•e►fr t7" _- A PwePl• a Siatf I C—d" a 3b --r• 11 ur=o.tn • Hater eoole.s IF POOOgRYI[e t I Seats Estimated Water Usage !gallons Dar earl _ ,,,I: Type of 1ratel supply: Goanty/City D well 1? Coasanityy .,.t' Do yas asticitate oddiddes or eWastiaas of fbE facility Ibis syskm is ialraded to serve? 171 Ycs (ao If yes,1486 type? •••1MPOfTANT1 •' C IJE41S AWir-C4;A1YfE7F'THti 91Wt fAED PROPERTY 114FOOMATION REQUESTED W. Eiiber a rtAT ar.StTB rtAig MIbCT t!E SVNMITTE••D by for dices with TIIIS APPL1CA7101M TroptrtyDimen;(ons: �6�%� 3x1�x3-1 WRITE DIRECIrLONSl(tomMetlavilk)MPR`UPERl'Y: 1 TAK001te Jim: it Pr.pertF Addrvin: Rt1ad Maroc (.L*�� 0 vl 171% � � o IJ a1 �oa O/ t/1f is a Sobdivisiss provide ixtion), as fnffi•rw�s: ✓✓1 c p secom NKR:Let: 0 e 7 Dalt Properly !tamed: �O Tba is 1s certify tW the information prsviied is correct to the best of wy kw wkdge. l r1/etalaed flat nay permits) isseed beres4cr are sW!et to sespepiiab or revocation, if the site plans or intended use change, or if flit iafarsaation submitted is tkis appikalion is Gasified or dwaged. 1, also, undentand than 1 ala Pespoawble /w aff thwtes 1"co"ed fiota /AriP dVWjeasinnn 1, htre4r, give consent to tie Anthordmd Rcpnsentaitve ote Davie Ilcottb Department to carer upas above, described property bested in (Davie Ctntaty gad a ._ to cawdaca ell ' L Prwacdnru as —ees.ary b d0cr.aiac Me site SIG3AT(1RE ~-- -I—S+ 111 d 7I1ls AREA MAYBE USED FOR DRAWING YOUR SITE P (ladwe MINW. c4umum tad prof S prWay )/nes and dkacasiess. stractara scfbaeks, aid stake loranaaej ,:55—f0.5-6-���-�d APIIUCAI ION FOR 511E LVALUAIION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health SmWon P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336)751-8760 ***XHPORTANT*** THIS APPLICATION CANNOT BE PP.(=SBED UNLESS ALL T INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for i 1. Name to be Billed Hailing Address City/stag/EIV 2. Hams on Permit/ATC it Different than Above Contaot Person _ Homo Phone G4-1 Business Phone f JUN 4 2UJ1 .1 RE ED + tructfh9ii6,�MEN J _ Wailing Address City/state/Zip 3. Application For: Il"Site Evaluation ❑ Improvement Permit/ATC 0 Both 4. system to service: E"House ❑ Mobile Home O Business ❑ Industry ❑ Other W,..... 5. If Residence: # People 1 Bedrooms # Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Haahins ❑ Basamant/Plumbing ❑ Basament/Ho Plumbing S. If Business/Industry/Other: Speoify type # People # sinks # Commodes # showers I Urinals # Water Coolers IF FOODSERVICE: it Seats Estimated Water Usage (gallons per day) 7. Type of Water supply: g'County/City D hell ❑ Community e. Do you anticipate additions or expansions of the facility this system h Intended to serve? 0 Yes 0 No If yes, what type? *1*h1A1P0RTANP** CLIENTS IIIUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN 111 UST BE SUBA11TTED by the client with THIS APPLICATION. Property Dimensions: 4e tF15 4 - Tax Office PIN: # 57, ---5 Property Address: Road Nameu�c./ %S City/Zip C�1'iA ,'ee' If in a Subdivision provide Information, as follows: Name: n ,( /11 A- ''` Section: Block: Lot: i� WRITE DIRECTIONS (from Mocksvtlle) to PROPERTY: -194 - D - 7—A91 4- / 3�, of 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. 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 sulta ►lits. DATE G —(�� 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). i Revised DCRD (07/99) Site Revisit Charge Date(s): I Client Notification Date: EIIS: Account No. / Invoice No. o ` �- " DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ' Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size Water Supply: On -Site Well Tax PIN/EH #: 5861-59-5239.33 Subdivision Info: Redland Lot # 33 Location/Address: USHighway 158-2702 see map Date Evaluated: c %3 i Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L- L Slope % HORIZON I DEPTH /9-7 4. Texture group Consistence Structure IiA Mineralogy : I 1: I HORIZON II DEPTH Texture group Consistence ` Structure Mineralogy 1 - I r HORIZON III DEPTH 3 , c7 Texture group Consistence f' S Structure sek Mineralogy 14 ) HORIZON IV DEPTH --5-2- S2Texture Texturegroup Consistence S Structure MineralogyI SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 0 O SITE CLASSIFICATION: IOS LONG-TERM ACCEPTANCE RATE: 0 - REMARKS: LEGEND Landscape Position EVALUATION BY: R�L)C-04-0 lo 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)