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293 Longwood Drive Lot 46t r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990000955 Tax PIN/EH #: 5861-59-5239.46 Billed To: Samnaz, Inc. Subdivision Info: Redland Way Phase 2 Lot # 46 Reference Name: Location/Address: Long Wood Drive -27006 Proposed Facility Residence Property Size: see map ATC Number: 3845 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 N ISV OR A PERIOD OF FIVE YEARS. A13Environmental Health Specialist's Signature ate: 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. Mo f �t+40 a Sr 7,xvrL� s5.7,2 "q ' Septic System Installed By: fA I i Environmental Health Specialist's Signature : Date: 130 7 57 " DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT ~� Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000955 Tax PIN/EH #: 5861-59-5239.46 Billed To: Samnaz, Inc. Subdivision Info: Redland Way Phase 2 Lot # 46 Reference Name: Location/Address: Long Wood Drive -27006 Proposed Facility Residence Property Size: see map ATC Number: 3845 **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 L4 #Baths S Dishwasher: I' Garbage Disposal: f;' Washing Machine: 0'- Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �� l Type Water Supply CDO M Design Wastewater Flow (GPD) g Site: New 1K Repair ❑ System Specifications: Tank Size I OLICIGAL. Pump Tank 1000 GAL. Trench Width �o I Rock Depth 1 Z Linear Ft. LOD Other:�1®V I wN► r"� j Required Site Modifications/Conditions: [ N6TO' Y ew (fN ulo(<, Ka tf� 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.**** z G z� T- FIs' �Fw N ✓ Environmental Health Specia ate: -M� DCHD 05/99 (Revised) 10,01 50 I�i1W.J,Sc'1 LI? * * * T1FOR$'ANT* * * 1. Hama to be Billad ,'i ALUAIION/ IMPROVEMENT PERMIT & ATC l� a e unty Health Department Emental Health Seatlon P.O. 48/210 Hospital Street F E B 1 9 2003 1 aville, NC 27028 (336)751-8760 RI.ICATION lfANNOT BE PROCZSSED UNLESS ALL Refer o the INFORMATION BULLETIN for Contact Parson JUN 1 4 2uo1 . RE D ru tatf�4tJi8ZEN '_ OUN1Y 1 f t /l S -- -- Mailing Address -Y ,c_4 J4 Vd Boas Phone City/state/ZIP G/Y, �., �' Business Phone 2. Name on Parstit/ATC if Different than Above Nailing Address City/state/tip 3. Application For: R/Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. systan to services O"House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other s. If Residence: # People 1 Bedrooms 1 Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Mashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. 2f Business/Sndustry/Others specify type / People # sinks f Commodes # showers I Urinals # Mater Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: bounty/City ❑ Well ❑ Community e . Do you anticipate additions or expansions of the facility this system Is Intended to serve? ❑ Yes ❑ No If yes, what type? '"IMPORTANT"* CLIENTS MUST COMPLETETIfE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: �o 1�P- r1"5 -7L Tax office PIN: # 5,-2 Property Address: Road Name /&f- S Clty/zlpc111vee.Z ,19° If In a Subdivision provide Information, as follows: Name: 11'pp e(' Section:�'Y�"' Block: Lot: 14(l WRITE DIRECT//IONS (fromMocksville) to PROPERTY: /S 5Y P �+ltJ lP- � 1rq— D-7-/,9 / 4-1,X,,-) / 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 I am responsible for all charges incurred from this appUcatlon. 1, 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 suits ility. DATE Ci/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). 0 Site Revisit Charge Date(s): Client Notification Date: I EIIS: Account No. Revised DCHD (07/99) Invoice No. '. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.46 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 46 Reference Name: Location/Address: USHighway 158-270062 Proposed Facility: Residence Property Size: see map Date Evaluated: • / a �7 Water Supply: On -Site Well Community. Evaluation By: Auger Boring Pit Public FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % .- HORIZON I DEPTH Texture groupG— 1— Consistence Structure C Mineralogy HORIZON II DEPTH _qL0 •- 2Z Texture group Consistence Se Structure k Mineralogy HORIZON III DEPTH Texture group Consistence 5 Structure c Mineralogy" HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE O• J SITE CLASSIFICATION: (� LONG-TERM ACCEPTANCE RATE: O' REMARKS: LEGEND Landscape Position EVALUATION BY: C-� r�`t'�'t"' 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) V. 0 SAMNAZ,INC. 3367748700 _.0 08/06/04 01204pm P. 002 t cAdAs, V�j LGNGWGCD DR(V IP //S ORi4WNG /5 Nt FOR REC0RD4T70A T R CERT117EG C01 -OR /LLUSMriiGiv PURPOSE ONLY ;-4051 30 0 30 60 90 L GRAPHIC SCALE — FEET Td ldH2t':60 t --00Z 50 '6nu 89ZS;9P69£E TN Xd.� 02 lld8 8 dllllHd : W06j 0 i n p O� r- KO tip L� 4618• :�t •, X8.8• !S 1b 45.6' N 19 27 21 .b ZN v ul L6 si d d LGNGWGCD DR(V IP //S ORi4WNG /5 Nt FOR REC0RD4T70A T R CERT117EG C01 -OR /LLUSMriiGiv PURPOSE ONLY ;-4051 30 0 30 60 90 L GRAPHIC SCALE — FEET Td ldH2t':60 t --00Z 50 '6nu 89ZS;9P69£E TN Xd.� 02 lld8 8 dllllHd : W06j SAMNAZ,INC. 3367748700— P.O. Bax 848/210 Hospital Strcct tlocksville, NC 27020 (736)751-0760 08/06/04 01:04pm P. 001 j"•*IAIPOItTANT**^ THIS W)PLICATION CANNOT BE PROCESS,CD UNLESS ALL. T111.1 REQUIR INFORMATION IS PROVIDE,:). Refer to L•ho INFORMATION BULLETIN for in-"L•rucL•:io- 1. )tame to he Billed � !� ContaCL t•enuon r• Mailiny Adltrcaa�_ Uti� V �j )tome ptwnc ci City/State/Zip Duaineaa V)wue 2, Name Oil Permit/ATC if Di.Cfertnt than Above'a"'n Above77F1��boove Hailing Address R -1"1t. City/State/zip- 4 1. Application For: bite EvaluaLion XiDprovclnonL hermit/ATC 'i 4. System to Service: ?Q Hou3e ❑ liol�jle home ❑ Businc:):) ❑ Industry ❑ OLbu S. Type aystem requested: A-Con:ontional ❑ conventional modified (J iunovutive 6. If Rcaidence: a Peoplc _ � P Dedrooms _ a OaLltloum:: Dishwasher 4arbage Diapoaal KKaalling Machine ❑Laselm;ntJl'1wnUiny UBaCCwrtnC/Nu t'l:.m:,iuy 7. 11 Duaincos/Industry /other: verily type �. U People a Cmnodcw 6 Shoxcra' It Urinalo U Wacor Coolurs U hoLh IF FOODSERVICE: $ Seats Estimated Water Uzeage (Uallona her day) _ B. ryPe of water auppty: <county/City ❑ well 0 ConummiLy 9. Do you anticipate additions ur CXpastSious of [lie faculty this s3•SIC111 Is illiclulCd to Serre? ❑ 1'ta O<Nu Ilyrs, »•bat (J•pc? """ll11POItY�JNTxx" CL1LN'f5.1lUSTCOitI'LCTL'Cl1G 1tL(�UlJ ED P! OI -E-1 'rY IN ORNIATIOfV It[:f,)tJlia t t:u BEL01Y. 011tera PLAT or SITE PLAN AIIIST BESUA,111T TED by the chem witll'1111S AI'PlACATION._-_. t'roperly 1)IIticasions: 4 K � X��a 11'j(1'(•L Dlkl':C'1.1O�ti ((r,an plod,vvihc) W 1'I<t)t'Ijtfl'1': xaa Orrtt 1'1lV: ✓E �� (- S�•-- 2 3 % _ r _.- fS r' -� S _ Properly Addrrss: RoadName. L6(1 ' t:ts ), _ �I v D 4S City/Lip ____,r(� hC•� If in a Subdivisiojju pro sdc infut'mation, as fullolrs: A`anlc:1a Wa Section: -- --tGf� Block: _ Lot:Date house corners Daggett:_ Tbis is to certify that the information pio+--lded is correct to Use best of my lutoirledge. 1 understand that any permil(s) issued hereafter arc subject to suspension or revocation, if the site plans or intended use cl)anbe, or if Me infurmaliun submillcd its 11315 application is falSiticd ur chaugc& 1, also, ismierstaml that 1 ant responsible for all chargav invurs-1',l fi-om Jhi+ appliedtiasr. I, llereb)', dire couscut Iv ;he Aulltnrited Repreaeuta(ive of the llavic Cvttut)' ltt:ailh 1)cparinuwl lu soler upon above described prolicrly Iw:aicd in Davie Comity and mviled.by to conduct :dl testing pracedures is ncccss:u'y to dcttrmine (hc site suitobilil •, DATE Tins AREA mAY BE US,LD It OR DRAWiNC YOUR SITL PLAN (11tcludc aI! ( , and prupvsul property lines and dilueusions, structures, setbacks, and septic locations). Site lZcvisit Charge Dalc(s): -.— -- Clint Notification Date: _ _