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127 Summer Sweet Dr Lot 11 DAME COUNTY HEALTH DEPARTMENT Environmental Health Section { A 5j(g10 a5Q P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 C)W ng.(; (;��(�n t�0-aswa(4-k (336)751-8760 6�6 — 15;z- Account #:#: 989900241 Tax PIN/EH#: 5880-51-4715.11 CC Ia7 � Billed To: Craig Carter Builders, Inc. Subdivision Info: Magnolia Acres Lot# 11 Reference Name: Location/Address: Summer Sweet Drive-27006 Proposed Facility Resident Property Size: see map ATC Number: 4134 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 WASTEWATER CONS UCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: 2011 Date: —// 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. 1 Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900241 Tax PIN/EH M 5880-51-4715.11 CC Billed To: Craig Carter Builders, Inc. Subdivision Info: Magnolia Acres Lot# 11 Reference Name: Location/Address: Summer Sweet Drive-27006 Proposed Facility Resident Property Size: see map ATC Number: 4134 **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. I Residential Specification: Building Type #People #Bedrooms #Baths Dishwasher/ Garbage Disposal Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial)Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply 40 Design Wastewater Flow(GPD) Site: Nem Repair❑ System Specifications: Tank Size,&gGAL. Pump Tank GAL. Trench Widt��Ifock DepthILinear F Other: A3 cLftted n 15A NGAG �. 01-51 =Captod Systems may also be 7slid Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISERS)IF 6 11 BELOW FINISHED GRADE. ****NOTICE: Contact a4k entative 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 m.to T. on the day of installation. Telephone#is(336)751-8760.**** Environmental Health Specialist's Signature: dlAaj/ Date: . Z DCHD 05/99(Revised) APPLICATION FOR SITE EVALUATION/IhiPROVEh1ENT PERM C Davie County Health Department Ju Environmental Healtly Section • 5 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760ROlt�j uahFzac y� ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUI INFORMATION IS PROOVJIDED. Refer tothe lINFORMATION BULLETIN for instructions. 1. Name to be Billed C�1 , e' rf{� ,�/JLe, /f7Cs ( Contact Person / 2 Mailing Address U S nome Phone � oll City/State/ZIP /0 /A1fy(e / a7��& Business Phone S-7 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip �� 3. Application For: ❑ Site Evaluation ❑ Improvement Permit/ATC �1Q Both 4. System to Service: douse ❑ Mobile Home ❑ Business ❑ Industry - ❑ Other 5. Type system requested:,Conventional ❑ conventional modified ❑ innovative t3accepted 6. If Residence: # People � # Bedrooms # Bathrooms iahwasher Garbage Disposal)6ashing Machine ❑Basement/Plumbing ❑basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: #I 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 A6 No If yes,what type? ***101PORTAN7"CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE P//LAN MUST RESUBMITTED by the client with THIS APPLICATION. Properly Dimensions: WRITE DIRECTIONS(from ModaviUc)to PROPERTY:' o — Tax Office PIN: it �b 1 71S Property Address: Road Name /;2 7 City/Zip /14 If in a Subdivision rovidc I for76'-es I,as follows: Name: G /!�Ild Section: _� Block: Lot: Date home corners flagged: a/zz D s 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 1 aun responsible for all charges i erred rom this application. I,hereby,give consent to the Authorized Representative of the Davie County H a to enter upon aboveescribe property located in Davie County and owned by to conduct all teslil proce res as a essary to determine the site suitability. DATE 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). Site Revisit Charge ` Datc(s): Client Notification Date: EHS: Sign given Account No. Revised DCHD(05/03 Invoice No. oZ�, 12 1 I N I S 77045'38"E 317.58' Z lod i$ 1 W � 5.00' 36.00• / Wvi Z \ g '*i g 2.070' HOUSEI D: n \� \ PROPOSED 8 14.33• I w 11 r s n CT CA o I GARAGE a DECK 1� SOW p _--- o --- 62 _ .90 --_ 1 6 Fes/ S 23.33' 23.33• / .8 '----_ 177.41•____--___ I �4w1 / _ _ _ -� G _ Ro�/� N S a I' I 50' NATURAL BUFFER co � 15'_ � � W .221.01, I E I i I N 8202613311W 74.98' S JAY MINTZ �N C 4 q0�,��i, I I N2� FEssio .•�, sQ° tib' = I 30 0 30 60 90 SEAL CREEKVIEW DRIVE L-2990 It.i. = I GRAPHIC SCALE — FEET +� 'L suer..•''� �: MAP FOR CRAIG CARTER BUILDER INC. SCALE TOWNSHIP COUNTY I STATE DATE.s TUUP MAGNOLIA DR WQ SITE PLAN ONLY �� 111 = 30' SHADY GROVE DAME N. C. 7-5-05 zo SRE LOT 11 MAGNOLIA ACRES PHASE 1 P.B. 8 PG. 63 Oix THIS WAS MAPPED FROM A DEED OR RECORD PLAT AND NOT FROM A SURVEY i 5, o. r 5,.'<<J- PEOPLES CREEK RD BY ME. HOWARD SURVEYING JOB NO. LOCATION MAP / JOHN RICHARD HOWARD PLS 05095 ✓ P.O. BOX 276 ADVANCE. N.C. (336) 998-5396. ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION / LOT ,/ Soil/Site Evaluation APPLICANT'S NAME DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE_ c5—ea /Y2,112 SUBDIVISION ROAD NAME Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope% HORIZON I DEPTH ;'l Texture group Zf Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence / Structure /l 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 i SITE CLASSIFICATION: EVALUATION BY: �< LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: LEGElb 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(01-90) % - -- -. a/. _ -_ _ � a�! 1�` i •.�.. i / r 17, Ilk �/ < r� � S r•f� 4 43 La-Z It 5wo- 50- q'15aT ..• •,r •jfd /y, r �, � j,o� /r