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346 Longwood Drive Lot 38J Account #: Billed To: Reference Name: Proposed Facility 0 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street f Mocksville, NC 27028 JL (336)751-8760 ,344 coy wood v. 5861-59-52398 DB Redland Way Lot # 38 Longwood Drive -27006 see map 990002436 Darren Burke Constr. Residence ATC Number: 3905 M , z -4:0� Tax PIN/EH M Subdivision Info: Location/Address: Property Size: 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 p it(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .19 -Sewage Trea me and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER C I N IS L A ERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ate: f� CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit `r has been installed in compliance ' ticle 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and q0Disposal Systems," buil NO WAY be as u�rantee that the system will function satisfactorily for any I�q given period of time. / IT ::� �5 QO f f 20'x., i 9 a 10 s � Septic System Installed By: i Environmental Health Specialist's Signature Date: 0 J DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section /Z-z'g -0 P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002436 Tax PIN/EH #: 5861-59-5239.38 DB Billed To: Darren Burke Constr. Subdivision Info: Redland Way Lot # 38 Reference Name: Location/Address: Longwood Drive -27006 Proposed Facility Residence Property Size: see map ATC Number: 3905 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 _ �i= #People #Bedrooms -7:)'— #Baths - Dishwasher: M/ Garbage Disposal: 1791r Washing Machine: Basement w/Plumbing: i/ Basement/No Plumbing: Commercial Specification: Facility Type �t�#People #People/Shift #Seats Industrial Waste: Lot Size 03'? `�jcType Water Supply Design Wastewater Flow (GPD)OW Site: New rzf/ Repair System Specifications: Tank Size'XOGAL. Pump Tank GAL. Trench Width 3(V Rock Depth 12– Linear Ft. � Other: `7 �)s 17J.44)1-1 aJ )ct_ Required Site Modifications/Conditions: c9-- EquVDATiol" 9, V�� 1©r of -F 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.**** o � 6 Environmental Health Specialist's ignature: DCHD 05/99 (Revised) \ 3�6C 6y,g --_. S 418.309 Tot . o 13 75 of 287.55- 46 (Q map' Mai co •fit �.,�'• ,�} ` �P eo) • ; �. ``� N �+i cit a .474.4 59 ,., 3 • �,n ''r+ �k�� -��.� rte' i��`fp.t `� a4 •' A, -• ' _ a.'' �',+�� ` ! r cam, , ! \.�6, _ 9 ��r) ) low Obt 20104 02:22p Darren Burke Construction 336-778-0436 p.2 Ju& 10 03 1104a davie County envhealth 336 751 8786 p.2 APPUCKHON fOtt SITE EVAt tlAT1ON/{NPROVEMENT I-EJtMR 6 ATC Davie CouW Health Deparbrmt ' fitv/+av>�arltaVNea/Q�Sectlon "x 8/8/210 Hospital Street Nockoville, HC 27029 (336)7S1-8760 ••MMIATZORI••• ?BIS iM. Refer o t116T BS JR0CRMATIOSED WLESSBULLETIN ALL ins RZQUIructiRSD }g7PORN1lS21717 ZS PHdYID6D,1. Relar to t:h0 IN1081�tATI�ON(�BULLSTiN fol instructioaa. U 1. Name to be Atli t\. _; xtut Parson .. .. .._. aatlias add<ua (� _ � � .hens �c�� _ //��� `0g�_ a City/3,,te/x1P IV( nustnua Thema _ }YI- t_.t 7-'i1 007 2. Not ea P. Lt/Are If Dtrres est than abov. _.. -- D M.tltay addrae. tits/tan./zip SSSS_ __ 007 z. Application Mors IC10fite Zvaluation 0 Imgro-ament Pariah/ATC O Both 2Qot,� A. siecaa cm sas.ice: k3, uae t1 Mobile Home ❑ ausiness 0 Imdustry O Other _, r � S. Type System requested; &tbmvamtienal E3 eouventio-4a waieied l7 ienovativo ��/ s. IL Residence;; 9 Peoplo - 3 9 Bedrooms _�, 4 Bathrooms _ c3 S i9se vaaber e<baq. njap Sal 1,�assina Kneh"o t2Csement/Plwbisg 139asawnt/No Tlw�t�ing 7. If aueiaeea/Iadwter /eschar: verity typo a People a Sinks a Coawodea a thevars a veinal. a Vatee eoolmra _ IT FWDSERVICE; 9 Santa Estimated Nater Usage t0allons par day; --• S. Type of water aspplyAUS.,ty/City, ❑ well E3 coemanit,,y P. bo you anticipate additioas oc ezpausions of the facility this system is intended to server 13 Yea 11a'ITu If yes. what type? "-WPORTAM'11e CL1P.1':."SA/LSSTCUMPLETETHIC REQUIRrD PROPERTY INFORMATION REQ11EYmn DELOW. Zithers PLAT or SIYR Pt.W IIIMI' DE SUBMITTED by the clicat with THIS APPLICATION Property Dimeations; 'c G� n �jWRITE DIRWrIONNS (from Mutlurillc) to rK(il, :tcry: Tat Office PIN: 9 O ltJ /' S 3 , • 3 D ^� Property Address: Road Name cicylZip t C2 0���� If in a Sandivision p We lotorttnZion. as follows: Name e.,- an d Wa Li / Section: ,r!2 Block: Lol: .7 Date Items comas flagged: MOID �1 This is to tertity that the inforsaation provided Is correct to the but of my knowiafgc. 19nde L. -I that Any Parsnil(s) issued beteafter aro sub*1 to saspensioo or revocation, if the site pians or intended use chauget or if the information submitted in this application 6 fabified or thangcd 1, elsol wrCersran.l rlror t sw resprasiWe jug aI1 eAmgu incnrrc f jinx; I14is applieatioiL f, hereby, give consent to the Authorized Representative of the Dartx(ttj� Health Unser�ytett / to enter upon above described property located in Davie County and owned by 1 /Ott/r? /C 2x4 k_ . (!o" J- 6o- to conduct all testing procedures as necessary to dderstine the It DATE t�i7� til m SIGNATURE` "?��, THIS AREA MAY ]MUSED FOR DRAWING YOUR SrIZ PLAN (Include all er the r9lowiar. Existing awd proposed proptttylines and dmfo*za. sirodures6 setbacks. hind 9tptte 10=130115). Site Revisit Charge Datr(s): Client Notil7ul)en DatC. Bits: 30 ghca Account No. Revised DCIID (OV03 Invoice Na m/ / / ✓ Oct 20 04 02:22p Darren Burke Construction 336-770-0436 P.3 m Zr iv t j j Cry i d rr 1mt 38 pmpmd o r s'E 24p.56' Proposed La"d For Lot 38 Redland Waif Phase 2 PBS Pg 108 I itch = 50 feet 1)AViE COUNTY HEALT11 DEPARTMENT Environrnenlal Heallh Section P. t). Bax 8481210 Aaspitai street {� l Mocl:sville, NC 27028 (336)'51-%760 Account #: 990002436 Tax PINIEH #: 5861-59.5239.38 DB Billed To: Darren Burke Constr. Subdivision Info: Redland Way Lot # 38 Reference Name: LocationlAddress: Longwood Drive -27006 Proposed Facility Residence Property Size: see map ATC Number: 3905 AUTHORIZATION 1:01Z WASTFIVATFR SYSTEM (=ONS'1'KU MON "NOTE" This Aulhoriradon for Wastewater System Construction MU'S'E BE ISSULD by the Davie County Ltivircmmental Health Section prior to issuance of any building permit(s). This FornVAuthorization Number should be presented to the Davie County Building Insptx;tiixns Office When applying fin building pesmit(s) (in compliance: with Article 11 of G.S. Chapter 130A, Wastoaater S)stems, Section .1900 Scia ge I`rc me and Disposal Systems). THIS AUTI IOWZATION FOR WASTEWATER CONSTRI.' -7 N 1S FOY—AYERIOD OF FIVE YEARS. -7 Environmental Health Specialist's Signature:-�Oate: �U -- (:FR7'1FK'A'TF. OF t OMPI-t-TION "N01 E The issuance of this Certificate of Completion shall indicate the system deseribed on Improveunent'Operaticm Permit has been installed in compliance % riicle 1 I of G.S. Chapter 130A, Secticm .1900 "Sewage Treatment and 10 Dispcxsal Syst,-ms," hut. NO WAY be as Airantee that the system will function salisfaetexily for any kkk given period oftime. nn/ tom• Septic System Installed By: — -_ _-`'`.'�_ . ls• c�-- / Environmental Health Specialist's Signature! - — ._ ��. Date: C J LZ `f MHD 05.99 (Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH SERVICE REQUEST Oa hnvelboe '^ ]APPLICATION IP/ATC OSWW REPAIR r ` Name �'N V v tq�� Telephone Number�o �j7 — 275T� Address a A% 0 AXIZ?0 Mailing Address (if different from above) Email Address: Subdivision Name Lot # Directions Date System InstalledQ dg� Name System Installed Under Type Facility 16 (, ilel Number Bedrooms_ Number People Served Type Water Supply & UM Specific Problem Occurring W&Ijk' �nw,461C4,6f ` 10,01L "t Date Requested 1 8 3 Info Taken By. THIS IS TO CERTIFY THAT THE INFORMATION PROVIDED IS CORRECT TO THE BEST OF MY KNOWLEDGE, AND THAT I UNDERSTAND THAT I AM RESPONSIBLE FOR ALL CHARGES INCURRED FROM THIS APPLICATION. Signature of owner or Authorized Agent Initial Fee Date REHS Revisit Charge Date Reason J Revised 2-2011 ` u (A6 T V `f L-1 ✓xj APPUCAIION FOR SITE EVALUATION/ IMPROVEAIENT PERMIT do ATC (� n e County Health Department .: ly E - U Irl E divnmental Health S&Von }R x 848/210 Hospital Street 4 ckoville, NC 27028 FEB 19 2003 (336) 751-s76o i7 * * * I ORTAN2*A*—TH-V" IN8'O TION 1. Name to be Billed Nailing Address / 63 City/Btata/zIP cATI N CANNOT BE PROCESSED UNLESS ALL T Refet to the INFORMATION BULLETIN for i 2. Nano on Permit/ATC if Different than Above Contact person _ Homs phone G4 Business Phone JUN t 4 2i)�il REhUIRED truatfl$tfghfME Nailing Address City/state/zip 3. Application ror: @'Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. Bystea to services O House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other W,�....; 5. If Residence: 1 People 1 Bedrooms # Bathrooma ❑ Dishwasher ❑ Garbage Disposal ❑ Mashing Machine ❑ Basement/Pluabing ❑ Basement/No Plumbing 6. If Business/Industry/Others specify type i People 0 Sinks 1 Commodes i Showers 1 Urinals 0 Mater Coolers IF rOODSERVICE: # Seats 7. Type of water supply: Estimated (later Usage (gallons par day) 9--County/City ❑ Well e. Do you anticipate additions or expansions of the facility this system Is Intended to serve? If yes, what type? ❑ Community ❑Yes 0 N 'A"IMPORTANT"" CLIENTS BIUST COMPLBTBTHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with TRIS APPLICATION. Property Dimensions: 6 5 4. ee'S 4 -- Tax Office PIN: # 5 1?Z I 5 � — .5,�23�i , 1; Property Address: Road Name- �1 �t�Jc S 91 Ciiy/zip �tcbill ee . JJ _e "9/—at If in a Subdivision provide Information, as follows: Name: e2o n Section!/ "S2 E7 Block: Lot: 3 Y WRITE DIRECTIONS (from Mocksvllle) to PROPERTY: 1,q- D-7-41 4- %3S;o1 Date Property Flagged: This is to certify that the Information provided Is correct to the beat 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 suits ility. DATE K 1/2" 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). i 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 #: 5861-59-5239.38 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 38 Reference Name: Location/Address: USHighway 158-27028 Proposed Facility: RESIDENCE Property Size: SEE MAP Date Evaluated: Z _ Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public / Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L Slope % HORIZON I DEPTH - 12 Texture group, Consistence Structure Mineralogy1 HORIZON II DEPTH Texture group Consistence P; , Structure Mineralogy HORIZON III DEPTH 427-579 -5 Z Texture group C- . Consistence SY '517 Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 3-O• SITE CLASSIFICATION: QS EVALUATION BY: 324 0 LONG-TERM ACCEPTANCE RATE: ' OTHER(S) PRESENT: REMARKS: QyiQ��Zf 1i Z- 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)