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272 Longwood Drive Lot 34 ADAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 01/ Account #: 990000955 Tax PIN/EH #: 5861-59-5239.34A S Billed To: Samnaz, Inc. Subdivision Info: Redland Way Section 2 Lot # 34 A Reference Name: Location/Address: Q9nongwood Drive -27006 Proposed Facility Residence Property Size: see map ATC Number: 3889 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 CONS I SV ID FOR A PERIOD OF FIVE ARS. Environmental Health Specialist's Signature: Date: q c CERTIFICATE OF COMPLETION L TOTE** The issuance of this Certificate of Completion shall ind to the system described on Improvement/Operation Permit le UUs has been installed in compliance with Article 1 of S. ha ter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be tak as gu antee that the system will function satisfactorily for any given period of time. 0 ale vp �K I►�SP�c�T16� r 3 O �� ����� �� T -t C Septic System Installed By: %_ I Environmental Health Specialist's Signature : DCHD 05/99 (Revised) Date: 1 t l pS v 111.37 *(Arc) aY9' 1 a" 1 Ch) /4" EIP O 3) 3r I 11,30,473 Z 31 acres --215.6,3' E 86.44.41' W 5! T0.00►e Exist. Stour (Found- 235.419. ip 1 S 01059"59" E sts cac•h_,_1♦ 59.86! "403' ; �' i 9. --V. , I . -*-.- 59-8 61 _.- ..176.24 • Ift o o m o 3) 3r I 11,30,473 Z 31 acres --215.6,3' E 86.44.41' W 5! T0.00►e Exist. Stour (Found- 235.419. ip 1 S 01059"59" E sts cac•h_,_1♦ 59.86! "403' ; �' i 9. --V. , I . -*-.- 59-8 61 _.- ..176.24 • Ift SAMNAZ,INC, 93677413700 09124104 11129am P. 001 Davie County Health Department Envi�o�lneata///ea/t/ SIX6917 P.O. Box 848/210 Hospital Street 7�1 -t Uocksville, HC 27020 f (336)751-0760 **Ails AIIPLICA:ION CANNOT Bl PROCESSED U21LESS ALL 2717.1 REQUI12L ll S�IS OVID P, Refe•r� to the INFORMATION 'BULLETIN for ill-- Lrut'Liona- ry�_ :3•^ 1�A`� C— Contact 1 -craw) V l..Atr>ti Y\ N, �omo Phont Ci �Latc/22S' _ V-'=–c.�---� iil� Ilu:,inddcas phuuc -7 Nam- on Permit/ATC if Differcpitnthan Al)ova�l�L Mailing Address i`�`w«' CitylStaleJ:.ip �,^__ ��tJ�l�._•.___. 1. Application For: XSite [valuation 0 Itttprove)nouL- heelLiC/ATC L1 Slut!, 4. System to service. ZCHoUse Cl Mobile Home O Dusineaa O llldu: try ❑ 011ier 5. Type system requested: ❑ Con:vntiona2 a-;Qnventio+lal modified ❑ innovative 6. If Residence: A People _ p t HCdroonis �+ ft Italilrooaa:: `/� Kiahwasher OCarbage Dispoaal i4ashin2 Machina %a5Cmen L/l'l U;nbing L7tla::tYnen[/Nu r•I uu.l,i nU 7. It Duainess/ladustry /other: Vorify type C People tl 3inl:c A eopupdo- 8 showers- h Urinalu p Mater L,WIera IF FOODSERVICE: 0 Seats Rutiu)ated 'Plater Uzage tJallouo poo day) 8. Type of water supply;IY Cosncy/City L7 well XColutnuniL'y 9. Do you anticipate add[LLi\`ono ar C\l)altSiO1L3 of [tic facility this sysICal LY illicu(ietl loserve? 13 VC.N D<i\U If )'C$, N'112t (yh CY "*WPORTANT`** CLIENTS:1IUSTCONIPLETETIIE ACQUIRED PROPERTY INFORMATION lttiQur Srtil) BELOW Is)tlaeraPLATorSITE PLAN flit clivait with 'I'll15All PLIC.1' JON. f �ALUSfTIICSU/1d117T,COby 1'ropert) tiinmasivns: 35 %� �� �'i rix 3 117ltrtli UlutiC)'tolVS (frena ({lortaril3t) lu rut/rI:)['r� : 1•az Office1'IN: it ` i> 'q3 PropertyAddress: RoadNilllcGNC d �� ��� L•1 ._A� .�__3�—,,,� City/Zip va h c -u— _ It in a Subdivision provide il[lor (ion, as folio►vs: Name: I+ �Lj c-,, L ) ,, Section: ^ Block. _ Lot: Date Norte corners!lagged: 1� 2- 7-0%P This is to certify 1bat the information pro,-ided is correct to tllc best of illy knolciedgc. 1 understand that any licentil(s) issued Itereafter arc subject to suspension or revocation, if the site plans or imlcmicil use change, or if the infurmwtion submitted in fills application is lalsifcd or changed. I, also, "ndelstand ilia/ / ana responsibl furall chalsra hic" -red fi-on+ rkisappl caliun. 1, Itereby, gile consent to the Authorized Representative of file Dario County 11cal0l I1cparilut•111 to crier upon abore described properly located in Davie County and uuerctL by. to cuaduc( all testing procedures as necessary to detct7uioe the site suitabilil . DATIs THIS AltEA AIAY llI; USED FOR DRAWING YOUR SITE PLAN (Incl etc all of the fu! Iving: Existing :rid propuscd property lines and dimctislons, structures, setbacics, and septic locations). Site Ite•isit Chargi: Datc(s): Clicmt Notilicatiun Date: • L1LS• CM DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 16— (336)751-8760 6—(336)751-8760 f � IMPROVEMENT/OPERATION PERMIT Account M 990000955 Tax PIN/EH #: 5861-59-5239.34A S Billed To: Samnaz, Inc. Subdivision Info: Redland Way Section 2 Lot # 34 A Reference Name: Location/Address: 293 Longwood Drive -27006 Proposed Facility Residence Property Size: see map ATC Number: 3889 **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. r Residential Specification: Building Type I #People �_ #Bedrooms_ #Baths ' Dishwasher: 21"" Garbage Disposal: C3'*' Washing Machine: E Basement w/Plumbing: Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 2 % !WZ& Type Water Supply (�Design Wastewater Flow (GPD) 3 Site: New M/ Repair ❑ I= „ I System Specifications: Tank Sizer GAL. Pump Tanki-GAL. Trench Width �a1 Rock Depth Linear Ft. Other:�`{1i1np�.3 Required Site Modifications/Conditions: kyjm u, Or-) 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.**** Ise Environmental Health Specialist's Signature: DCHD 05/99 (Revised) l , IF - Ll� Date: A Id ftl � T � 1 1 N v N G N � ftl � T � 1 1 N v yj !_ONGlialGOD DRIVE MAW `6 AN -PI) k--7 m 50 b 50 _ -1 GO .\ GRk.PNIC SCALE - FEET NO A CC•PTiNEO COP'S \ FOP ILLUSFPA WN PURPOS•F_ OIVL Y �\ bili DRAWING /S NOT f -UP RFCORoARON `. LS --4092 v. v v � cn ,y c. 1 MAW `6 AN -PI) k--7 m 50 b 50 _ -1 GO .\ GRk.PNIC SCALE - FEET NO A CC•PTiNEO COP'S \ FOP ILLUSFPA WN PURPOS•F_ OIVL Y �\ bili DRAWING /S NOT f -UP RFCORoARON `. LS --4092 ..�.../EPPIJCAT Ll i IIL EVALUA1I014/I&1I'110VLUlENT PLIMIT & ATC !y ie County NQalth Dopartlnont tllrmnmental h'salth gcWon ox 840/210 Hospital Stroot k4ockavillo, NC 27028 (336) 751-8760 ***•IMPORT"-T**'V-ut PLICA I H CANNOT BE PROCESSED UNLESS ALL :INHORMATrIQN—I'rVI BSD, --,R er to the IMMRMATION BULLETIN for 1. Name to be Billed �• r i (�c / a [" 4• ���� �! Contact Porson 1, Ll JUNt RE Q _-� truaI tit�ifTO'Alru5! : - Mailing Address /,V,"�I 1 Sona Phone City/State/LIP < %/t, u/1/,� i , �� . - Business Phone 2. Name on Pers:it/ATC if Different than Above Mailing Address City/State/Lip 3. Application For: Q" Site /Evaluation ❑ Improve -ant Pormit/ATC ❑ Both 4. system to Service: B'�House ❑ Mobilo Home ❑ Businens ❑ Industry ❑ Other WA'•', 5. If Residence: # People I Bedrooms t Bat iroomta ❑ Dishwasher ❑ Garbage Disposal ❑ washing Machine ❑ nasement/Plumbing ❑ Basement/:lo Plumbing I 6. If Business/Industry/Other: Specify type # Co—odes # shovers # People 11 sinks # Urinals I Water Coolmra IF rOODSERVICE: # Seats Estimated Water Unage (gallons par day) — 7. Type of water supply: ta'County/City ❑ wall ❑ Community a. Do you anticipate additions or expansions of the facility this system Is Intended to serve? ❑ Yez ❑ No If yes, What type? I***IMPORTANT*** CLIENTS MUST COi11PLLTETHE REQUIRED PROPERTY INFORUTATION REQUESTED I BELOW. Either a PLAT or SITE PLAN BI UST BE SUBAH7TED by the client with THIS APPLICATION. Property Dimensions: 4 --- Tax Office PIN: # Property Address: Road Name AJc S city/zip A61i If in a Subdivision provide information, as follows: Name: l �_ �ySection: �� Block: Lot: WRITE DIRECTIONS (frown MucksAlle) to PROPEIVYY: /M— D-7-1,91 Date Property Flagged: This Is to certify that the information provided b correct to the best of my knowledge. I understand that any perinh(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 I ant responsible for 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 aIle sultabllity. i DATE f SIGNATUREell 10 r UIIS 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). Revised DCIID (07/99) Site Revisit Charge Date(s): Client Notification Date: EIIS: Account No. Invoice No. S 9 DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size: PROPERTY INFORMATION Tax PIN/EH #: 5861-59-5239.34 A Subdivision Info: Redland phase ii Lot # 34 A Location/Address: Highway 158-27006 see map Date Evaluated: .� Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public v Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence ; , ` S Structure Mineralogy�- HORIZON II DEPTH 2L} -. 3 •2 Texture group C-tSe Consistence F s Structure Mineralogyi HORIZON III DEPTH - D Texture group Consistence E4rw Structure Mineralogy1". HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION vs LONG-TERM ACCEPTANCE RATE p • p . 3 SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RA REMARKS: Landscape Position , SAP LEGEND EVALUATION BY: 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)