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123 Timber Trails Lane Lot 1Account #: Billed To: Reference Name: Proposed Facility DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Xj 990001715 Tax PIN/H #: 5812-01-5250.01 WC Wishon & Carter Builders Subdivisio , nfo: Timber Trails Lot # 01 Location/A ess: Timber Creek Drive -27028 Residence Progert ize: 5 acres ATC Number: 3966 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 .190 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEW ON_ R IS VALID FOR PERIOD OF FIVE YEARS. i Environmental Health Specialist's Signatu e: Date: QJ CERTIFICATE OF **NOTE** The issuance of this Certificate of Completion shall indi MR has been installed in compliance with Article 11 of G.S. h, Disposal Systems," but shall in NO WAY be taken as a j um given period of time. I I LI t►U Septic System Installed By: Environmental Health Specialist's DCHD 05/99 (Revised) ,r,�os ON i described on Improvement/Operation Permit , Section .1900 "Sewage Treatment and the system will function satisfactorily for any Date: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street r Mocksville, NC 27028 4P (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001715 Tax PIN/EH #: 5812-01-5250.01 WC Billed To: Wishon & Carter Builders Subdivision Info: Timber Trails Lot # 01 Reference Name: Location/Address: Timber Creek Drive -27028 Proposed Facility Residence Property Size: 5 acres ATC Number: 3966 **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 _, t. #People #Bedrooms 3 #Baths 2 - Z Dishwasher: Iff"' Garbage Disposal: ❑ Washing Machine: Q" Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type„nn #People #People/Shift #Seats Industrial Waste: El Lot Size 5 Type Water Supply __ 6WA)r6esign Wastewater Flow (GPD) 5Ln Site: New 0 Repair ❑ System Specifications: Tank Size /OOOGAL. Pump Tank GAL. Trench Width 34 p Rock Depth 14” Linear Ft. Z Other:�1`jTQaf�t)TIv.J Required Site Modifications/Conditions: �ST^t,i.._ ().3 C 0,-,3- 0,(2 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 Te ephone # is (3 6)751-8760.**** tt-1o�- 1 ILi' on Environmental Health Specialist's DCHD 05/99 (Revised) Fkrj T � � J R e tYtsv 3-2 >t34 t)$:SOe davie county envhealth 336 751 8786 APPUCATION FOR SREAYALUA ION/IAWWWD{1fhIT:PEt3U f a ATC Davie County Health Department Fit tritOrrmenla!lHea/I!i Setfiorr P.O. Box Ro/= iNosyital.8:coat Moaksville, NC 27028 -(336)751-836o aa•SMPORTAAT••• TItIt: I1P]>LZGSZOtf GAIJItiDT 8E PROC86SED 1)NLESS ALL 1itC R64ffZAED tN7DSxn•wcnar ZS -=ARM== Refer to the Mc1P RMATSOH BULL== for instructions. `l. -1r4mle to be a113adJ( %:.�h,;A14VA�, 9-i; j12 � S contact Parson A] !tit e,-CaLl mulirq Address F. t7 , &, ie 1-y 19 nava Poona -3 q r__eq LZ Ft e2 elwatate/slr 4L cl IL; sn .i; t t P suainam rhoaa Tj'�,�- r". '>' 4 - 7-0 M-► Z. Kane os ramait/ATC es Different than Above .c..icylJ8tat1' 3p J. ApFli-aatian •For: `SiteL+traZUdtiOa p amprov 11 Permit/ t7 Both i. Syaten to Service, !VXouse 0 Nubile Nme O Business 13 Zadustry 0 Other S. Type A" tan r*"atods 0 N.veattoaal 13 conventional nodtfiod � 1a>bwtLw S. If Residencar s FoeFle, Y Xedttacros 3 t-siatlrivoma _�L LAY (;-gcl �L4,.-'r I 1 I1, ECS Lip j#E ENOC V 2 2 2004 —Z ENViRONAlENTAL HEgirn COUNTY LY rirYsn�gopar :�aasbeKe •Dkapml-E3aaasctssg -x.enYaa 'QaasdeoottPl,mbinr DsaeuuantlKo Pl+�tng Ale 8�.y��,...wa•�1'- ,T-. 3e:PuaSaaaafrada+taY /obbar,-.aritr-type _ o raorla s sinks –.-i-Csw.ndr i 9noesri / 'Urinals f plater coal—s ZF FOOOSERVZCE: # Seats Estimated. Kates IIeega-tyalloas-Per ter? S. Tyra of vscar.auWy+ -zr CDu, ty/city 13 well 13 Community e. anticipate aaatucas or e[pansiaas of the facility this system Is Intended to serve? Q Ycs L$N4 If yu.4hat type? •—WPQRTAV7`a•`CUENI S hff/ST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. T• axeraPLAT orWEPIAN -MILS]'-MUMAOTTED-by-thetilent-with THIS APPUCATION. =Prsperty-Dimcssionr "—�4:- 4,30-' 7r "f30 * i�� WRITEDiREGT10N5(tromMocksvuM)toPROPERTY. Ta:OlficoPIN: N3 ' 2.0� _ 5 zs+ s l6<71 .tlor.f1. L -eF #- 4".% I'iaperl� O.dstrers Rsad Nsane e � b rr f r r r. -.i o_ Citymp tgjitffVIC — -Z 017 y ..r C- IIInaSuhdivisionpeavidc-InfarrDatiaD,as folium: ,;��[,_'h � v. "fry 'i`. w 6.er 3 -Name- _j'i..,.�-cy� 7�r-g ,'/� `rr-lit.t i .s -i�-1--�.Y' -t1:.2 �Y.�'� :�ii/l �:�n:. •r-.£ :!!t-/�+.✓ �jr-t •t! Scetlow lttaak: —.— Lab , Date >tratac oornerY Its jgeJ: Za ll l Tkislsfo.sertltyttlat3brsaform�tiesr(rrowtkrtirrnrreet'ta'tt�et,cstotatyknowtedge. funderstandthat any pernrit(s) Issued hereafter are subject to snspcm-ion er K1ht iulVTMetion submittedln this application is (diiGcd or changed. I, also, understand dint! amt respousfNefor all charges lacarred frtun Ah4pplicatlsit I, Lerrby. give esertta#}re AutltorizrAReprerenutive of the Davie County Health Department to enter upon above dtatrlbtdpropeny footed laDavtc CouettyAnd:owmd-by Yom.%�-+fj to conduct 26 testing procedures as Dccescary to detcrmhe the site sutiablRty. DATE___j�77j �r SSC1HATti[tj . �- r IMSARFa1MAYBE WED FOR DIvii}7TttrIVMSrM]FLAX ( edudeallofthefollowing: Ertstimgandpreposed property flues and dimtndons, structures, setbacks, andsepticlacatiolas}. Z•dl 96�b6G9sEE UO NOHSII9 e4S•OI b0 zz noH $i(L-RZ•'i'A3ii i'trargC �310ES}: Client Notification Date- EHS: Sign given Rented DCHDO50 Invoice No. Z•dl 96�b6G9sEE UO NOHSII9 e4S•OI b0 zz noH m a m m v m N (D (D m m rm M v4 m DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ` Soil/Site Evaluation APPLICANT INFORMATION Account #: 990001715 Billed To: Wishon & Carter Builders Reference Name: Proposed Facility: Residence Property Size: Water Supply: Evaluation By On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5812-01-5250.01 WC Subdivision Info: Timber Trails Lot # 01 Location/Address: Timber Creek Drive -27028 5 acres Date Evaluated: Community Auger Boring ✓ Pit Public Cut ,FACTORS 1 2 3 4 5 6 7 Landscape position Ct/ _ Sloe % HORIZON I DEPTH— �`C%- 2 Texture group" � ; CL-.. 5 ; C.L-- Consistence V Structure Mineralogy< s1C HORIZON II DEPTH ` — 3 , Texture group g' Consistence Structure Mineralogyt HORIZON III DEPTH Texture group SIC <1,0510 C'1 ) STCk Consistence Structure c MineralogyS'�C Sri HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: yJ LONG-TERM ACCEPTANCE RATE:' REMARKS: aL L P—t" LEGEND Landscape Position EVALUATION BY: C /t'-- v OTHER(S) PRESENT: 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) l 1 ON ■ ■ iii NNE ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■OMM■M■M■■■■■O■■ ■MEE■■■■ENOMMEN ■■■■■ ■E■E■ ■E■E■ ■■NE■ ■E■E■ ■ENE■ SOMME ■■NE■ ■EN■■ ■■■■■ ■■E■■ ■■■■■ ■■E■■ MOONS ■■NM■ ■■■■■ ■■■■■ ■■M■ MEMO SEEN NOME NONE NOON NONE NONE MEMO ■■■■ ■ ■ ■ ■E■N■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ SSSS■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■M■■■■■11■■Mt■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■ti■■■■■■■■■■■■■■■■MMn■OMtM■■■■■ MENMEM mollmomMENNENEMENE �MENNEN ■■■■■■■■■Mutt■■■sem■r■■■■■■■■■■■■■■■■■■■■■■■ ■�_-_-----�;....0�:....M71.\SSSS■11■■■■■■■■■■ r■iii■■■■■n■■■■t■■■■Mr�■:�f11■■■■11■■■■■■■M■■ ■ire!■■■■■r�■■■■■■■■■■■■■■■■■■11■■■■■■■■■■ a■■■a■■■■■iia■■■■■■■■■■■■■■■■■■■■■■■■■■■s SSSS■■■■■■■■■■■■■■■��■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■l!a■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■!■■■■■■■■■■■■Orr■■■■■■■■■■ ■■■■■■■■■■■■■■Sri■■■■■■■■■■■■11■■■■■■■■■■ ■■■■■ ■■■■■■■■■■■■■■■■■■■■■11■■■■■■■■■■ ■■■■■■■■N■■■I■■■■■MSM■■■■■■■■■■■■■■t■■N■ ■■■■■■■■■'1►:�uul■■■■■■■■■■■■■■■NOON ■■■■■■■ ■■e■■■rel■■■■■■■■■■■ ■■i■■■■■■■■■■■■■■■■■■■err■■■■■■■■■■ ■■11■■11■■■t■■■■■■■■■■■I■Ott■■■■■■■■■■■■■■■11■■■tS■■■■■ ■■■M■�ISSSS■■OS■■M■■■■I■■■SM■■■■■■■■■■■Ott■■■■■■■■■■■ ��■■■�■■�■■■■■■■■■■■■I■Ott■■■■■■■■■■■■■Ott■■■■■■■■■■ DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PO Box 848/210 Hospital Street Mocksville, NC 27028 Phone: (336)751-8760 /Fax: (336)751-8786 December 2, 2004 Wishon & Carter Builders Attn: Neil Townsend PO Box 1719 Yadkinville, NC 27055 Re: Site Evaluation - Timber Trails -Lot #1 Bear Creek Church Road Tax PIN#: 5812015250 Dear Client(s): As requested, a representative from this office visited the above site November 30, 2004 to perform a site evaluation. Based on the information provided on the Application for Site Evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of an on-site sewage disposal system. Before a representative of this office will revisit the site to issue an Improvement Permit/Authorization to Construct, the appropriate application must be completed and submitted to this office. The location of the facility the system is to serve must be staked off. If you have any questions, feel free to contact this office at 751-8760. Sincerely, Jeff G. Beauchamp, R.S. Environmental Health Section Enc(s) Jun 28 05 03:24p WISHON CARTER 3366794436 p.2 WiShonand Carter Builders, IAC. 1412 West Main St Yadkirnille, NC 27055 June 28, 2005 Mr. Jeff Burcham Dear Sir. I do hereby verify the use of tire chips in the septic field at 123 Timber Trails lane, Mocksville, NC. If you have any questions you may contact me at the office 336-679-2031 or my mobile 336,469--2290. Sincerely, Neil Townsend Project Manager