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252 Oakland Avenue Lot 44DAVIE COUNTY HEALTH DEPARTMENT e7e— ` Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account M 990003383 Tax PI /EH M 4798-86-8224 Billed To: Pinnacle Housing Group,Ltd Subdivision Info: Oakland Heights Lot # 44 Reference Name: Location/A dress: Oakland St -27028 Proposed Facility Residence Propert Size: see map ATC Number: 4063 AUTHORIZATION FOR WASTEWATER SYS' EM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE SSUED 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 WASTEWATER CON TRUCTION IS V LID FOR A PERIOD OF FIVE YEA S. Environmental. Health Specialist's Signature:WDate: ` 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. Septic System Installed By: � Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: s/? T/6S— Account #: 990003383 DAVIE COUNTY HEALTH DEPAR T'MENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 f IMPROVEMENT/OPERATION Billed To: Pinnacle Housing Group,Ltd Reference Name: Proposed Facility Residence a 5- ��✓ �, t�d7v1 Tax PIN/EH #: 4798-86-8224 Subdivision Info: Oakland Heights Lot # 44 cress: Oakland St -27028 Size: see map ATC Number: 4063 **NOTE** This Improvement/Operation Permit DOES NOT authorize the constction of aseptic 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 �ewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR *E INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People I #Bedrooms #Baths Dishwasher: Garbage Disposal: ❑ Washing Machine: P/ Baseme t w/Plumbing: ❑ Basement/No Plumbing: ❑ ' Commercial Specification: Facility Type #People #People/Shift # Seats Industrial Waste: 13 Lot Size Type Water Supply Design Wastewater Flow (GPD),_�'-fesSite: NewM' Repair 171 System Specifications: Tank Size 4OGAL. Pump Tank GAL. Trench Widthj�,_ Rock Depth 1,:�_ Linear Ft,20 Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFI FINISHED GRADE. ****NOTICE: Contact a representative of the Davie 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 Environmental Health Specialist's Signature: T FILTER RISER(S) IF 6 " BELOW Health Department Ifor final inspection of this tion. Telephone # is (336)751-8760.**** Date: DCHD 05/99 (Revised) i DAVIE COUNTY HEALTH DEPARTMENT • . Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 I IMPROVEMENT/OPERATION PERMIT Account #: 990003383 Tax PIN/EH #: 4798-86-8224 Billed To: Pinnacle Housing Group,Ltd Subdivision Info: Oakland Heights Lot # 44 Reference Name: Location/Address: Oakland St -27028 Proposed Facility Residence Property Size: see map ATC Number: 4063 **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 1 I 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 /n /a . #People �� I #Bedrooms ? #Baths_ Dishwasher: X Garbage Disposal: ❑ Washing Machine;X Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply JJ O.//Design Wastewater Flow (GPD) Site: New 0 Repair ❑ System Specifications: Tank Size LiD GAL. Pump Tank/a&0 GAL. Trench Width,, Rock Depth - Linear Ft.y ! / p Other: /�S/%//�S�C �S7� 1� 'BGCrI.� 9AIC4 06 /'�4) 41—,!>'— Xf ,'T Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISERS) 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 AS 6 415/ er nn 1 ar /fid Environmental Health Specialist's Signature: /�Date:(' DCHD 05/99 (Revised) 04/21/05 09:51 FAX 704 895 4612 PIN^.NACLE HOUSING la001 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC 1 Davie County Health DepanmeDt Environmenta/Health Section D P.O. Box 848/210 Hospital Street Mocksville, NC' 27028 4/ram nn (336) 751-8760 ***IMPORTANT*** THIS APPLICATION t:�NfNNOT nR PROCESSED UNLESS ALL•THE REQUIRED A bft INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN £or instructions. 2005 Name p 1. Na e to be Billed f -Antd4_ ApILS' �ttq Contact P son Div; 0 1 Mailing Address (tp315_F Nor�F.C.rnet. t1Ngie Ph -on.- _ iRQ�"JA9�N city/state/ZIP _{IiEAV%).rSu:{l.& r1C QW? susines Phone 70V-95S-q(a2 �E�IIN/y l 2. Name on Permit/ATC if Ditgeront than Above lI Hailing Address City/state/zip 1 3. Application For: 0 Site Evaluation ❑ Improvement Permit/AT f i1 -Both 4. system to service: 0 House "obile-Home 0 Business 0 Industry � 11 Other S. If Residence: I People _ i I Bedrooms 3 _ ® Bathrooms IYYDishMasher U Garbage Disposal Wiiashing Machina II Basement/Plumbing II Basement/No Plumbing 6. If Businass/Industry/Other: specify. type ►People 4 sink I Commodes i Showers I urinals I Water Coolers IF FOODSERVICE: Seats Estimated Water Usage (gallons Ir day) 7. Type of water supply: ❑ County/City a�ell- II Community 0. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes (1 T Igo Ifycs' what type? ***IMPORTANT*** CLIENTS M(dSTCOMPLETETIIE RRQU/RCD PROPERTY INFORMAT ON RLQUWI-ED BELOW. Either a PLAT or SITE PLAN MUSTRESUlfMl7TEDbythe client with III IS APPLICATION. Property Dimensions: 40gy1bn%2obx )d0 WRITS: DIRECTIONS (front Muucks'ville) to PROPERTY: ATaxOtrtcc PIN: # yt1 intoriay __7 Property Address: Road Name mr to r S rt + r.�J1 L i � Q int <— City/Zip HOLY. lrin a Subdivision provide information, as follows: Name: QylhlanA fat •chi-� Section: Block: Lot: �_ Date Property Flagged: y- 1/ 0� I This is to certify that the information provided is correct to the best of my knowkdge. I underslaad! that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information I submitted in this application Is fnlslfied or changed. /, also, anderstand that 1 ant responsible for all charges incarreel from �� /vl this application. 1, hereby, give consent to the Authorized Representative of the Davie County lie:dth Department 1 to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE 14-31-0,$ SIGNATURE Al" 4/-2,'7 -V THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN (include all of the followings Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). I Site fRcvi3if Charge Date(s): {l Client N if{ tion Date-. EHS: Account , 33 ?'3 Revised DCHD (07199) Invoice'No. I J 04/21/05 09:52 FAX 704 895 4612 PINNACLE HOUSING Davie Cbunty, North Carolina Spatial Data Explorer hturitt Carolina Click on the Map to: r Zoomin r Zoomout r' Recenter Map r Identify: Parce,S Zoom Factor: ZX r Radius Search (feet) i" -�W <`N NE £;tiv i'r Parcel.Data Find Adioinin� Parcels • Land Unit / Type: 111110B0014 J LT • Deed Book/Page; 00305/0802 • Deed Date: 1999/06/17 �:-E [a 002 Pagel _of 2 Map L. Drawl Draw select Boundary r Census Tra City Bound f County Zor MUlti Sy1 E911 Fire C j— Flood Pane jr Flood Zone Parcels r School Dis+ MU]ti Syl . r Soils r Town Zonit r Townships Multi Syl (— Voting Prey j- Driveways (r Rail Lines (' Street Cent r US/NC Higi Mufti Syr U N (— Acrial Phot Physical jr Creeks and r E911 Addrt • County ID: 1111050014 • Sales Price: $15,000.00 Fire Depart • Account Number:74911500 • Property Address: Schools • PIN: 4798868224 Dcav�i L • Legal 1:LOT 44 OAKLAND HEIGHTS • County Zoning: R -A • Owner Name: VALENTINE ALBERT 0 Census Code: MAP Cl • Owner/Address is VALENTINE ALBERT C • City Code: • Owner/Address 2: VALENTINE JOANNE C • Fire District. COUNTY LINE • Owner/Address 3:143 OAK TREE LANE • Flood Zone: This map Is prepi inventory of real I • City. State Zip: MOCKSVILLE .NC 27028 - 0000 • I Flood Community. 370308 within this jurisdic compiled from re, • Land Value: $18,000.00 • Flood Panel: 0075 C plats, and other p • Building Value: $0.00 • Flood Map Date 12-17-1993 and data. Users http://sdx.roktech-.net/servleVcom.esri.esrimap.Esrimap?name=Davie&Cmd=sParcel2&NCPI:.. 4/21/05 04/21/05 09:52 FAX 704 895 4612 Lbf PINNACLE HOUSING PINNACLE HOUSING PROPERTY LOCATOF HOMEOWNER -4(..0 PHONE # H: b - 0 lrEMP: W:-1oq-- a -79--2y88 HER W: HIS M: HER M: PROPERTY ADDRESS' STREET OTy STATE:_ �.1. �'J�r� ZIP ' 10,27 b SUBDIVISION NAME: oA&_ &ee_ LOW. yy MODEL#: Psei om]0 N: _FLOOR SIZE: X O COUNTY: _DAV jiF-r ,.._PERMIT#: _ # BEDROOMS: ELEVATIONS: 1 2 0 OFF FRAME MOD. /HUD/ CUSTOM ROOF PITCH: �(7/1 8/12 , ✓ 9/12 12/12 DRAW A MAP AND WRITE DIRECTIONS TO PROPERTY Ql 003 Z- -�� ed .7o4 ' g 8 ' Y DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME J!" �` r� % t DA E EVALUATED 7 /� �J I PROPOSED FACILITY %7 PROPERTY SIZE COIJ SUBDIVISION ROD NAME Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position { Sloe % j HORIZON I DEPTH Texture groupt Consistence J Structure Mineralogyl { HORIZON II DEPTH k« C '" Texture group{ Consistence % { Structure / { Mineralogy{ HORIZON III DEPTH f { Texture group! Consistence { Structure I Mineralogy{ HORIZON IV DEPTH { Texture group{ Consistence { Structure 1 Mineralogy3 SOIL WETNESS { RESTRICTIVE HORIZON i SAPROLITE 1 CLASSIFICATION { LONG-TERM ACCEPTANCE RATE { SITE CLASSIFICATION: EV LUATION BY: L� LONG-TERM ACCEPTANCE RATE: OT ER(S) PRESENT: REMARKS: 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 rm EFI - Extremely firm Wet NS - Non sticky SS - Slightly sticky S - Sticky VS - V ry Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - ery plastic Structure SC - Single grain M - Massive CR - Crumb GR -Gran lar 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 fro land surface to soil colors with chroma 2 or less Classification - S(suitable), PS (provisionally suitable), U(unsuitab e) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD (01-90) ■ ■■■■■■Mee■■■■■■■■■■■■■■■■�i■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■E■■Mee■■■■MM■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■E■E■EE■■Mee■■■■■■■■■■■■■Mee■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■E■EEE■E■■■■■■■■E■■N■■■■■■■Mee■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■Mee■■■■■■■■■■N■■■NN■■E■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■ ■■■■M■M■M■■■■■Mee■■■■■■■■■■■■■■■■■■ ■■■■■EE■■■■ESN■■E■■s■■E■E■■EE■■■■■■ ■■■■■■■■■■MMM■■■■■■MMMM■■■■■■■M■ME■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■EMM■■■■■■■■■�i■M■EE■■■ ■EEE■■■■■■■■■EEE■■■■■■■■■■■■Mee■■■■ ■E■E■■■■E■■■■■■M■■■■■■■■■■■■■eee■;��: ■■■■■■■■■■■■■Mee■■■■■■■■■�■■■■■I.\■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■eee■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■eMee■■■■■E■ ■■E■■Mee■■■■■■■■■■■■■■■■■■■■■■■■■M■ ■■■E■ ■E■E■ ■E■■■ ■ME■■ ■■M■■ ■■N■■ MOONS OMENS SOMME MOONS ■ENE■ MEN MEN mom ■O■ ■■MMME■■■■■ ■OM■■■■E■■■ ■■EMME■E■■■ ■■MOMMEM■■■ ■■■■EME■■E■ ■■■■MME■■■■ ■■■■EEE■■M■ ■■■■EE■■E■■ ■■E■■■M■■■■ ■MMMO■■■M■■ ■E■E■E■■E■■ ■E■■■E■■E■■ ■M■■■E■E■E■ ■■EMMEME■■■ ■■■■M■■E■E■ ■■MME■M■■E■ ■■MME■■■■E■ ■■■■E■E■■E■ ■■MM■■■■M■■ ■■■EMM■■E■■ ■EME■■■■E■■ ■E■■■E■■E■■ ■EM■■E■E■■■ ■E■■MM■■■M■ ■■M■E■ME■■■ ■■■■MMM■■E■ ■■MME■E■■■■ ■E■E■ ■E■E■ ■E■■■ MESON ■■M■■ ■EN■■ ■■■N■ ■■■■■ ■■N■ ■EE■ ■N■■ NONE ■■■11■■■■■■ ■■MIIME■■■■ ■EMIT■M■M■■ ■M■IIE■■■■■ ■ENIIN■■■E■ ■E■IIEN■■■■ ■wmmxOr■■■ ■■!JJ■■sI■■■ ■k:O■■■mI■■■ ■N■■■E■I■■■ ■u■EM■■I■E■ ■W■EM■■IMM■ ■■M■■ENI■■■ ■■M■■M■I■E■ ■■MME■■I■M■ ■E■■O■SIMM■ ■E■E■■KIM■■ ■■■MEM■■M■ ■■MMEM■■E■ ■■MEM■■■E■ ■EM■■■■■M■ ■E■■MME■■■ ■E■■■ME■■■ ■■■MEM■■■■ ■■MEMM■■■■ ■ME■■■■ME■ ■E■■■■■■■■ ■E■■■■EM■■ ■■M■E■■■M■ ■E■■MEM■■■ ■M■■EM■■■■ ■■ME■■■M■■ No ME ■e ■■