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347 Longwood Drive Lot 41DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900259 Tax PIN/EH #: 5861-59-5239.41 DM Billed To: David Mallard Subdivision Info: Redland Way Phase 2 Lot # 41 Reference Name: Location/Address: Longwood Drive -27006 Proposed Facility Residence Property Size: see map ATC Nurpber: 3859 **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 #People #Bedrooms_ #Baths_ Basement w/Plumbin � Basement/No Plumbing: Dishwasher: � Garbage Disposal: � Washing Machine: g: Commercial Specification: Facility Type /� #People #People/Shift #Seats Industrial Waste: Lot Size '1—'/ °1 � Type Water Supply 1 � N7WDesign Wastewater Flow (GPD) '3(4 0 Site: New 7 Repair � System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width 3L," Rock Depth Linear Ft�j� Other:I�i �l�Tlca� Required Site Modifications/Conditions: IMPROVEME T/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW FINISHED GR DE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between :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.**** \a� UOc-'�3 1-3 n IA,J. lot Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 0 " Date: (d'' 1. n1 DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900259 Tax PIN/EH #: 5861-59-5239.41 DM Billed To: David Mallard Subdivision Info: Redland Way Phase 2 Lot # 41 Reference Name: Location/Address: Longwood Drive -27006 Proposed Facility Residence Property Size: see map ATC Number: 3859 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 a Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEW IO hs V D FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: /171/, 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 1 I of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WA tal�en a a guarantee that the system will function satisfactorily for any given period of time. I I M 14aK div-�-1 -i j Fe --r Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 1< ATION 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 INFOR14ATION IS PROVIDED./ Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed- f '/ Contact Person �j,00� Mailing Address J5('.' y /I��Oi'► Home Phone ��'S � 0— 79 City/State/ZIP Z {>.Yj (f..Business Phoneme 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: '"Site Evaluation Improvement Permit/ATC ❑ Both 4. System to Service: �K House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. Type system requested: ' Conventional ❑ conventional modified ❑ innovative 6. if Residence: # People # Bedrooms # Bathrooms_ PDishwasher 196arbage Disposal XWashing Machine ,Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 8. Type of water supply: ;( County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes /A!TNO If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # Property Address: Road Namen,f City/Zip 2- 7 (3 U C' r, If in a Subdivision provide information, as follows: c'5A L -- Name: xven Section: Block: Lot: _- Date home corners 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 ant 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 ow to conduct all testing procedures as necessary to determine the site abili ��/ DATE SIGNATU 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). Sign given O Revised DCHD (05/03 Site Revisit Charge Date(s): Client Notification Date: EHS• Account No. r7f 0 -3� Invoice No. 2 4--3 EVALIIA]ION/IMP(IOMIENT PERMIT & ATC le County Health Department vironmental Health Sectlon P ox 848/210 Hospital Street F 1 g 2003 4ockfiville, NC 27028 (336) 751-8760 PLICATI H CANNOT BZ PROCCSSED UNLESS ALL T INFOr*%TION-IS!`pit =v—Refek to the INFORMATION BULLETIN for i 1. Hama to be Billed _'� � 1 / 1 Contact Person 1 Nailing Addr/ Boase Phone City/Stag/LID C, Business Phone 2. Name on Perait/ATC it Different than Above 1[kJUN t 4 20;11 L�,,: RE D truatfA341t8ry�`'-� "1-�(OUN1Y S Nailing AddressCity/State/zip 3. Application For: U/ Site Evaluation 0 Improvement Permit/ATC ❑ Both 4. system to Servicat 9' -House ❑ Mobile Home 0 Business 0 Industry 0 Other u,a.,... 5. If Residence: ❑ Dishwasher # People # Bedrooms # Bathrooms ❑ Garbage Disposal ❑ Washing Machine ❑ Basamant/Plumbing ❑ Baaamont/No Plumbing 6. If Business/Industry/Othert epeoify type # Co—odes # Showers IF rOODSERVICE: 11 Seats # People # Sinks # Urinals # Yater Coolers Estimated linter Usage (gallons per day) 7. Type of Water supply: 0--C-ounty/City a. Do you anticipate additions or expansions of the facility this system Is intended to serve? If yes, what type? ❑ Community 0 Yes ❑ No *""IMPORTANT ** CLIENTS MUST COMPLETE T11E REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with TIIIS APPLICATION. Property Dimensions: 6 5-)Q rc'S 4 Tax office PIN: 0 5!�Z I --5cc - .5,;23�1 •`�) Property Address: Road Name %/'dL S City/zip Ahlll4vee, k/ -(f J/-1�Z If in a Subdivision provide Information, as follows: Name: "TP ';( /I. n- '14- Section: � Section: '` Block: Lot: WRITE DIRECTIONS (from Mockaville) to PROPERTY: 1 S ra 5'Sf n P)4 VAI / - D - 7-49 4- 13r:,91 Date Property Flagged: This 6 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 app/lcatlom 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 suit! Uity. DATE �, - 41d` SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include{ all of the following: Existing and proposed property linea and dimensions, structures, setbacks, and septic locations). 0 Site Revisit Charge Date(s): I 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 #: 5861-59-5239.41 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 41 Reference Name: Location/Address: US Highway 158-27070. Proposed Facility: Residence Property Size: see map Date Evaluated: V F> Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % Zi? 3 HORIZON I DEPTH '7o O Texture groupL Consistence S Structure Mineralogy' 1 HORIZON II DEPTH - 2 Texture group Consistence Structure Mineralogy HORIZON III DEPTH 1-4 1 Texture group Consistence f . Structure S Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: V � EVALUATION BY: LONG-TERM ACCEPTANCE RATE: C)' -35, OTHER(S) PRESENT: REMARKS: r�t Qca- r 'q I 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)