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348 Longwood Drive Lot 39Permittiee's-� '7 f DAVIE COUNTY HEALTH DEPARTMENT m ` Nae: Environmental Health Section PROPERTY INFORMATION P.O. Box 848 % R Directions to property: `J r'' Mocksville, NC 27028 Subdivision Name:.('��1!�1s!t �1 lt( t Phone #: 336-751-8760 U AUTHORIZATION NO: 003012 A AUTHORIZATION FOR Section. Lot. WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - - Road Name C;' '% l,uiCt�l <' Zip.: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Fonn/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) rr /� % n ,,- ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION ��.�1{✓i/L�?f� % IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH PECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE l>� # BEDROOMS 7 # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE t C TYPE WATER SUPPLY 6-bij 1(I DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE r) SYSTEM SPECIFICATIONS: TANK SIZE' GAL. PUMP TANK GAL. TRENCH WIDTH, ROCK DEPTH LINEAR FT. �?(0© REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYO , T �rFcA 0) /0 FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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. DCHD 02/02 (Revised) .Peisnift�e's I` DAVIE COUNTY HEALTH DEPARTMENT ame: r' Environmental Health Section PROPERTY INFORMATION ` M��.-,.; �.. (� 1 ;; r • t P.O. Box 848 a r.. Directions to -,property: Mocksville, NC 27028 Subdivision Name: . ! (�l t f, i"(( t' ,'{ tt 1 Phone #: 336-751-8760 • AUTHORIZATION FOR Section: Lot: WASTEWATER Tax Office PIN:# AUTHORIZATION NO: ®03017 A SYSTEM CONSTRUCTION Road Name ; .� f( Zip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) t ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTHffCIALIST ATISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE �`'� # BEDROOMS ', # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE + C TYPE WATER SUPPLY r" DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE i✓ SYSTEM SPECIFICATIONS: TANK SIZE' =GAL. ,PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR FT. �Cr%y r t - d REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYO T FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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. d -SND 02= (Revised) APPLICANT INFORMATION 3LJ& wood Pr S fovakQ_ /U c a700� Water Supply: On -Site Well DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation Community Evaluation By: Auger Boring _'-, Pit PROPERTY INFORMATION Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % o f HORIZON I DEPTH p - Texture group Consistence Structure S L Mineralogy HORIZON H DEPTH ' Texture group Consistence Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: PS LONG-TERM ACCEPTANCE RATE: LEGEND EVALUATION BY: �21 OTHER(S) PRESENT: 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 MOW VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wd 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 Nato 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 05105 (Revised) • jr- f'P(A]ION t III CVALUAIION/IMPROVEMENT PEIIMIT & ATC f ^ e ll lel IS a County Health Department _ tnnmental Health Section UJUN 3P. x 848/210 Hospital StreetQ,200 ckaville, NC 27028 (336)751-8760 14 2U�j ***.TIVORMNV**)h'tiffli°4liPPLICATI H CANNOT BE PROCISSSBD UNLESS ALL T RE D INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for i atruatfi19l1 F6 1 / VAVIECOUNI Y 1. Hamm to be Billed I � ) ,�{/ contaot Person Mailing Address �G 5 p )i Rome Phonej5— /G City/State/LIP < U/l/, I" C. Business Phone 2. Name on Permit/ATC if Different than Above Mailing AddressCity/State/Zip 3. Application For: "//Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. syntax to servioet Q' -House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other W�• .• 5. If Residence: 1 People # Bedrooms # Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ washing Machine ❑ Basement/Plumbing ❑ Basement/Ho Plumbing 6. If Business/Industry/othert Specify typo / People f Sinks 4 Commodes 1 Showers Urinals (}hater Coolers IF FOODSERVICE: # Seats Estimated water 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 ❑ No If yes, what type? "111AIPORTANTn" CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: e0 5 P. J-1�15 4 14 Tax Office PIN: # 15� — S •— 5 39 ,� Property Address: Road Name /&( AAS If in a Subdivision provide Information, as follows: Name: A 1,( /.- /l_ "4 - Section: ��' 7 Block: Lot: 73 1— WRITE DIRECTIONS (from M/ocksville) to PROPERTY: �M- D-7-4/ -J- 13r,,91 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 we 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 owned by to conduct all testing procedures as necessary to determine the site salla illty. DATE G — y (J/SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includ all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). 0 Site Revisit Charge Date(s): I Client Notification Date: I EIIS: Account No. Revised DCIlD (07/99) Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account M 989900136 Tax PIN/EH #: 5861-59-5239.39 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 39 Reference Name: Location/Address: USHighway 158-27028 Proposed Facility: Residence Property Size: see map Date Evaluated:�3 Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit / Cut FACTORS 1 2 3 4 5 6 7 Landscape position V Slope % (0 yo HORIZON I DEPTH Texture group+ G Consistence ; Structure Mineralogy *0 ' HORIZON II DEPTH r Texture group G tc k Consistence Structure Mineralogy' HORIZON III DEPTH Texture group24 Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: (� EVALUATION BY:-� Oe'4 w*Z LONG-TERM ACCEPTANCE RATE: 0. J5 OTHERS) PRESENT: D REMARKS: `�� �^�1%C IfJ S AP ` � LEGEND Landscaae 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) ns, •_ � TN tti �i Z o92 0`4VQ ON FOR SITE EVALUATION/IMPROVEMENT PERAIIT & ATC Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 I **PQRTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed _� rilkrxl/'i�- Contact Person Jf,50h fie,`llel- Mailing Address ( Home Phone (3 -74J W7 r grG7 City/State/ZIP C,�eihi�fC1�5 /J/ 7V/2 Business Phone �JG) 3/Sy7G-7 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: ❑ Site Evaluation City/ tate/Zip rovement Permit/ATC 4. System to Service:House ❑ Mobile Home ❑ Business S. Type system requested: ZrConventional ❑ conventional modified ❑ Industry J5:�Qther ❑ Both ❑ innovative l 6. If Residence: # People # Bedrooms M3 ishwasher Q�arbage Disposal 1p4ashing Machine lVB/asement/Plumbing 7. If Business/Industry /Other: verify type, # Commodes # Showers # Urinals I 6-s yle 1 # Bathrooms 12 ❑Basement/No Plumbing # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 8. Type of water supply: lid County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes /MNo If yes, what type? ***I/l1PORTAN7'*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMIT? D by the client with THIS APPLICATION. Property Dimensions: !--ttlr �C G1; J �5;oj{ �� WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # 9-46 EW V J f 0-71 Property Address: Road Name lGT 0 31/ lr, ` zit ed W iloinV City/Zip V- If in a Subdivision provide information, as follows: Name: II-edGtarl Section: Block: Lot: Date home corners flagged: l/— �/ d L% 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 alit .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 $7`q f{crC< P/1e,r/rte t, 7� to conduct all testing procedures as necessary to determine the site suitability. DATE 'Ol SIGNATURE, � 4 9 i ~' THIS AREA MAY BE USED FOR DRAWING YOUR SITE PL nclude all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Sign given ' V Revised DCHD (05/03 Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. �. a o CR, 1 qqXs� Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002811 Tax PIN/EH #: 5862-51-7693 Billed To: Stafford & Reader Enterprises Subdivision Info: Redland Way Lot # 39 Reference Name: Location/Address: Longwood Drive -27006 Proposed Facility Residence Property Size: see map ATC Number: 3914 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 Trea ent and Disposal Systems). THIS AUTHORIZATION FOR WASTEW CONS MCMV IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa e: ate: %t 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. 9 17 1oI Z2 ten, J -Z Septic System ns a e y:��c 's </ Environmental Health Specialist's Signature: ate: tl DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ` P. O. Boa 848/210 HosOital Street /Z Mocksville, NC 27028+ (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002811 taiIN/EH #;; 5862-51-7693 Billed To: Stafford & Reader Enterprises Subdivision Info: Redland Way Lot # 39 Reference Name: Location/Address: Longwood Drive -27006 Proposed Facility Residence Property Size: see map ATC Number: 3914 **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 Ar--V� #People `f #Bedrooms 3 #Baths Dishwasher: d Garbage Disposal: Washing Machine: Basement w/Plumbing: 0"""Basement/No Plumbing: 13 Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: El Lot Size RL Type Water Supply Design Wastewater Flow (GPD) 75C0 Site: New Repair 173 System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width ' Rock Depth 2 Linear Ft--3�0 Other: �C5j--)15TV-4 PVnaJ _-:P--, Required Site Modifications/Conditions: t' - C,`�3t y — I�S age V12:WW�� 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.**** C�1 �� 1 1 �► uoi& /lo' Environmental Health Specialist's Si ature: DCHD 05/99 (Revised) -1 tQ.•s•I A -Ada Jan 21 10 09:308 Phase: Q35l - 7N 67BO Information Services Cl:;a 3367531650 ounty Health Depar=- eanit OrnenW Health Section P-0. Box 948 �211 Yiaspit it Street Comier 4 : 0940.06 Mocks-ilic, NC 17028 ON-SITE W.ASTEW 4.TER CE N FOR DWELLING (Check One) Replacement _Reimodafino Reconnectlnon P x;u: 03M - 713.1690 (/ A � ?Vatter ,-0,eA gvq I Pbo:neNw ber (Home) ?Mailing AddMs: .3 y? % rMtiR00C+ Pre_ "iA ear (WorrkW) NDetaited Oireeuions To She: I S'T� X131 rd %� J� �e� Le en4D Lcm Dr, `tel klo0sP a I. P',C.J ez C'J-,:�e -Sa,. -- Please F)U In The fallowing Information About The MS7ING Facility /�•��ad�� �F��p�i se Neraa system Instalkd Unde!, 646L140ZJ4 'Type OfFa'L sty: 1`ldjliC Date Syst= Inmallod %=IvDate/Year): _< Number Of Scdrooms_,?__Nuwbcr Of People:.__ is The: Facility Catrerntly VACant? Ycs (9 If Yw, For Haw Long?, X Any Kmmn Pzvblems? ;'cs (9 ff Yes, Exp)ain: Please FJH In The FollowlagNfo:rrnatfon About The NEWFacititw:5 �i/,�rlfz Type OflFacilily: i i N ma �b/� 7 Numyor ofpaople 1Requestcd By: Ate Requested: j Z -h -- — Fos,environmental Health OfTice Use Only AppmVtd Disapproved Comments: Environinental Health Sp�=ialist Date - *The The signing of this form by The Environmental Heahb SMff is in no way untended, nor should be Taken as a guarantee I fextended or limited) that the on-site wastewater system will funv6on properly far any given period of time. Nynient: Casa Check MoneyDrder r Amount:SIVUrW Date: ?aid By: _Received By: Account V,, % — ••- Invoice 9:,, &I CR/10 39t/d snaSN di 89gg99L TT:50 0T9Z/ZZ/T8