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339 Longwood Drive Lot 42Account #: Billed To: Reference Name: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 990001597 Tax PIN/EH #: 5862-51-4394.42 MB Marquis Building Subdivision Info: Redland Way Lot # 42 Location/Address: Longwood Drive -27006 Proposed Facility Residence Property Size: 152 'x 220 ' ATC Number: 3929 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 WASTEW ER C ION !a -VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa e: Date: 1,211191 CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of s all indicate the system described on Improvement/Operation Permit has been installed in complianc ith Article 11 of G.S. Ch)7L->)7') , Section .1900 "Sewage Treatment and Disposal Systems," but shall i O WAY be taken as gu the system will function satisfactorily for any given period of time. 1 r ' Go G r ! F Septic System Installed By: Environmental Health Specialist's Signature : ate: 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 #: 990001597 Tax PIN/EH #: 5862-51-4394.42 MB Billed To: Marquis Building Subdivision Info: Redland Way Lot # 42 Reference Name: Location/Address: Longwood Drive -27006 Proposed Facility Residence Property Size: 152'x 220' ATC Number: 3929 **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 - QQ5C #People #Bedrooms #Baths Dishwasher: V Garbage Disposal: ❑ Washing Machine: 03"' Basement w/Plumbing: R Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size CA I k > Type Water Supply C6001`f Design Wastewater Flow (GPD)73 (zAC-,) Site: New Repair ❑ System Specifications: Tank Sizer GAL. Pump Tank GAL. Trench Width n�' Rock Depth —12-" Linear Ft3:ao Other: q 5a, X10. Required Site Modifications/Conditions: Ir48rgLL_ Q�.) 6&r'jjV0a , ICl'-l''1" I 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.**** r fE lcc-T,o-J P')4 C9Q a�*14 z o� Wj VA r � m )� ealth-gpeeialist's Signature-- — PDa: 9� DCHD 05/99 (Revised) 1 Nov 30 04 11:06a Gordon Whitney 336 940-6947 p.1 4 ZZA AAhce s P -h -Q&.. Lo -r- 4 Z PVPL.Af,v W A4 IC5Z( Zza Nov 22 04 08:55a Gordon Whitne 336 940-6947 P,2 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED iNFORHATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions 1. Kama to be Billed (I1'�rrJIS wit R ifJG . V*. — Contact Person ] Mailing Address `a 0. l,x Zt70 Rome Phone r $ City/State/tIP AOfA 3C� A -)C 2200t0 Business Phone 2. Name on Parmit/ASC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation 4. System to Service: kHouse ❑ Mobile Home S. If Residence: I People Improvement PermitlATC I ❑ Both ❑ Business ❑ Industry ❑ other 11 Bedr M Bathrooms �tl Dish. shet T1 Garbage Disposal A Washing Machine CI na .m e/Plumbinq 6. If Business/industry/other: Specify type f People Y commodes i Shovers # Vrinals Il Basement/No Plumbing f Sinks / Water coolers IF FOODSERVICE: Q Seats Estimated Water Usage (gallons per day) 7. Type of vater supply: County/City ❑ Well ❑ Comatunity g. Do yon anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes XNo If yes, what type? **`IMPORTANT"** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST RESURMI7TED by the client with THIS APPLICATION. t Property Dimensions: _ j_iL! .e 2Zo WRITE DIRECTIONS (from MoctmWlte) to PROPERTY: Tax Office PIN: 0 abZ 514 394 1-icr10 Property Address: Road Name �Qfgc-1J—rh City/Zip V If in a Subdivision provide information, as Follows— Name: Qr= Dt-A, r, ��vr Section: Block: Lot: Date Property Ragged: '1 Y 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 l am responsible for all charges incurredfrom this applications 1, hereby, give consent to the Authorized Representative orthe Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as accessary to determine the site suite ty. DATE !! I Z V�v4 SLGNATURE �'IIAL THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing nd proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Datc(s): �.�.i Client Notification Date: EHS• Account No.� Revised DCHD (07/99) Invoice No. NOV 2 2 2004 E1VVfI—'T VrT y Er °-- ' _ IyAtTH D 1. F�� ; � �oo3p. L EVAIUAIION/IMPROM- LENT PER& T & ATC County Health Department - vnmental Wealth Section In] c 848/210 Hospital Street ckeville, NC 27028(336)751-8760 ***I CANNOT BZ PROCESSED UNLESS ALL INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for Name to b. billed I 6" Genteel Person G Mailing Address )4 Boma Phone _ City/state/LIP 0/7/ , '1, C, / ,�Li business Phone _ Name on Permit/]ITC if Different than Above Msilinq Address 3., Application For: ® 'Site Evaluation City/state/zip true JUN 1 , ED NN►EN A -%I/I% O Improvement Permit/ATC ❑ Both 4. System to aervioes E3House O Mobile Home O Business O Industry ❑ Other W,�.,.r• 5. If Residence: 1 People 1 Bedrooms i Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basament/Plumbing ❑ Basement/No Plumbing 6. If business/Industry/Others speoify type i People 1 sinks 1 Commodes 1 showers M Urinals 1 Water Coolers IF FOODSERVICE: # Seats Estimated Hater Usage (gallons per day) 7. Type of water supply: 0--county/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system Is Intended to serve? ❑ Yes O No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETIIE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: . re,5 �- Tax Office PIN: # 1 —5�I — 539 4y Property Address: Road Name AdoS City/zlp Al iil9ved • AJ Z , �9!� ifIn a Subdivision provide Information, as follows: Name: "TA -� �� n- ti Section.1f kOr-y� -0:- Block: Lot: ',4-2-- WRITE ,4y WRITE DIRECTIONS (from Mocksville) to PROPERTY: /S S7 5iC P LI 1P T > i 1rq- D-7-191 4-1-L'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. 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 salts Ility. DATE — ` D/i 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). Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EIIS: Account No. 1 Invoice No. A 544 S' V-� 0 V�� 1 1L APPLICANT INFORMATION DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size: Water Supply: Evaluation By: On -Site Well Auger Boring PROPERTY INFORMATION Tax PIN/EH M 5861-59-5239.42 Subdivision Info: Redland Lot # 42 Location/Address: USHighway 158-270 see map Date Evaluated: 13/C Community Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Sloe % HORIZON I DEPTH C.) - 0 L) Texture group -L Consistence S Sf Structure Mineralogy1 HORIZON II DEPTH - In Texture groupF, Consistence ; Structure Mineralogy: 1 HORIZON III DEPTH 4S " 54P, Texture group SL Consistence EL f's Structure G2 Mineralogy HORIZON IV DEPTH Texture groupS Consistence Cr NDN Structure MineralogyI: SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 0.- D• SITE CLASSIFICATION: P LONG-TERM ACCEPTANCE RATE: 0, � 5� REMARKS: Q�%A� 1 Z 7D 'Nj " oil , 42 Landscape Position EVALUATION BY: —Z- e N �w,Q OTHER(S) PRESENT: T ws- N2-+413 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)