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132 Caudle Meadows Drive Lot 709DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780 / Fax # (336)753-1680 OPERATION PERMIT Account #: 990005710 T,,iX'.PiNiEH #:., 5871 -25 -2458 -Lot #709 Billed To: D.R. Horton, Inc Subdivision Into::;,Oak Valley' Lot # 709 Reference Name: r: Location/Address: Saddlebrook-27006 Proposed Facility: Residence : .Property, Size: 30,078 Sq.Ft: ATC Number 5791 .**NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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. System Type:_ S.T. Manufacturer Z5 Ue Tank' Date Tank Size Pump Tank Size System Installed By: —RJ6lrt A 0 E.H. Specialist:Wk'@bD&kDate: Zoe( GPS Coordinate: " 2 tidl 00 s DCHD 11/06 (Revised) �L f9l ►1 a� DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)753-6780 /Fax # (336)753-1680 --- AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990005710 Tax PIN/EH M 5871 -25 -2458 -Lot #709 Billed To: D.R. Horton, Inc G :'Subdivislon Info:. Oak Valley Lot # 709 Reference Name: N,,Location/Address: Saddlebrook-27006::­.,.r: Proposed Facility: Residence f7waliFv Property, Size: 30,078 Sq.Ft. Site Type: RNew DRepair 0Expansion ATC Number: 5791 **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 13j0A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat on the intended use change. Residential Specifications: # Bedrooms_�[_ # Bathrooms2.6 # People BasementO Basement plumbingO Non -Residential Specifications: Facility Type # People—# Seats SquareFootage(or Dimensions of Facility)___�__ Lot Size 3G,07?w' Type of Water Supply: OCounty/City OWell OCommunity Well System Specifications: Design Wastewater Flow (GPDYZQ___Tank SizeLW GAL. Pump . Tanker GAL. Trench WidtlabL Max. Trench Depth V' Rock DeptbA4 Linear Ft.q6v' M6 As stated in 15A NCAC SA Site Modifications/Conditions/Other: acceptedy Systems may .1pfc,o Contact the Davie County Eikvironmental Health Section for final inspection of this, system between 8:30 – 9:30a.m.on the day of installation. Telephone 9 (336)751-8760. `— — APPLICATION FOR SITE EVALUATION(IMPROVEMENT PERMIT & ATC r«a..n� S r j ��I 2� a riff°'sT �e' n•^rI �.+ r� s� i opiu.�r-�1 �,. x5 ¢ n �y Feai:mAj't � �'lxn�ry wrl lx��'r°?t ' f sf,yy va .s ,� vi y ;� .vt�avte Cooney EnvtromentalHealthay�`tvi!a <r,�.�,t •f?%. -'p y"5"ear+xy `�',r,'tifYi' .�r�t PO BoxB48/21Q.Hosprtal Street Y+x o`k" 4sr tJ<`'i,i�izAr.. SF ryia a i' X11 li)111 Ru , u iyt)rr n ?s 'r'. ��" ,a titi'll'!'ocksvrllet Cd,¢ Ogg is §T1 �rrt w e�r�at�l'u/IHiI i Il�rx�,P w/vap�9r},`. 'A -Otft az (336 7Si YG8l0��yw,t.5�« ` d:.5. ' 'u��cnm:'st ti. tiuInc�-ylT y�' f A m kNor: Evaluation/Improverrent Permit D Authorization To Construct(ATC) )$oth - New System ORepa r to Existing System OExpansion/Modification of Existing System or Facility - - ***LVPOR THIS APPLICATION CANNOT BEPROCESSED UNLESS ALL OF THE REQUIRED, ., DWOMMC-BON IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. - APPLICANT INFORMATION `N - Name to be Billed 4 �' 1JI71 ` Gl Contact Person Billing Address Home Phone , City/State2IP Q asiness Phone ^ �t Name onPennit)ATCifDi erenrthanAbove ALM. %,S !,1WU*�,'- - Mailing Address - City/State/Zip ' PROPERTY INFORMATION *DateHouse/Facili ty Corners Flagged NOTE: A survey plat or site plan must accomparry this application Included: ite Plan OPlat(to scale) (Permit is vali j for ti0 months with site plan, no g�P.mtion Ith complete plat.) Owner's Name I n ,. nc A /rn �� Phone Number Owner's Address City/State/zip Property Adekess P I City Lot Size Tax P # q Subdivision N e(if lic 1 �.1?.. Ob - Section/Lo Directi0 s To Site If the answe�m of the following questio is'y ' supporting documentapon tnustb attached. �OT tt j �ov, Are there arty :the wastewater systems on the site? Oyes o Does the site wntain jurisdictional wetlands? Oyes 00 _ '',, - t, . ,.'1 �V Are thele arty easements or rightof-ways on the site? ,,Yes p,t,N�oerl.lL� akd,* Is the site subject to approval by another public agency? OYes�*jjo - - Will wastewater other then domestic sewage be generated? Oyu pRVo . IF RESIDENCE FILL OUT THE BOXIBELOW POpie #Bedrooms #Bathro ms r Garden Tub/Whirlpool Basement: OYe�s Bo Basement Plumbing: []Yes OiG0IF NON -RESIDENCE FILL OUT THE BOX BELOW p Type ofFacilityBusiness - Total Square Footag of Building - WPeople - # Sinks # Coaunodes # Showers - # Urinals - - Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) - FOODSERVICE ONLY: # Seats - Type system requested)f Conventional OAccepted ,,Innovative OAlternative .00ther Water Supply Type: XCoumy/City Water ONewWell OExisting Well ❑Community Well - Do you anticipate additions or expansions of the facility this system is intended to serve? O.Yes Cho If yes, what type? - This is to certify that the information provided on this application is true and coned to the best of my knowledge. I understand _ that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Represen 'veof the Davie County Health Department to conduct necessary inspections to determine compliance with applicable In' an es. I un erstand t I a esponsible for the proper identification and labeling of property lines and comers and ; Iocat 'n of sml ' the se/facili location, proposed well location and the location of any other amenities. - in Prope owner' or owner's legal repre—sentalive signature _ Site Revisit Charge &1 Date(s): - - ..:. Client Notification Daze: Date ..v EHS: Sign given OYes ONo' Account# . Revised 11/06. _ - - Invoice# X30 .2 - pof, . n 4 m o�tiU :IY M F . � 4 . I ZOO o o N CLY'W) XIX M.L2,L0,68N m'z g. - - IZY99 mot z mF �ew=.Sg I � z OHO am N w —_ - - --N— - - - I W I Z O d w QX, N - I - I �kc Zvi to j �r1��1- K, oa Q } E` Ydj ¢ w I yia ¢ o H z Uo w? m - m _� N o� pU T o d oQ _ o Ig -I- I p (� =_ _ N a Zr Q � Z _ i Ni w E aQ o - "R - -^t ".iYZE ,_o .. o N $ ,QYE z r �o z- m 3 $ 3 • d Lb q� I � � F z -- CLvu .00'Liz - 3di, ugs z z �NZ ZN opoz Y 3<�F JU m UQ4'a O vm o Ni 61 N - - \,~� MtN� OJQv �itx w�SV 6 N W z 6 m �i O Z m 1- O w Z z Z w O W Q r K -- _ - Z�KOH mmo 3¢ o�0ox - - d O O m< N 0 a o Vl N d' -.. OZGNm�Zd O h O pip �ato " a?en en o ix Y w o 03 w zo o - p z; zI I z om ELVU.W/2Z MJ2.LO669N— JO zo - -mp o z . z }m ¢ FE — — — — — — — — — I - - j w o - F Lb WWW rc w od - - 8 W 00 w vo z N `.6 z - S u4i, I � Ft - ,GS $ - -,moo 0 D h O N ,� y, O I ti Q _ 4411 zwl E Lc a�-0-0 3 N m vi 2 W N a O ci A'YE �2YZE < .�. N $ Z In Z z v p 2 .O ih �_ - y !_, H m I I fJ O a S V � I � � am I N z — CLYI� ,0�'UZ 3.1Z L(k69$ d z _ gQ - Z U > \ G O M N 6d K Z_ _ - hW - K d NP O Z Y P N L5 ULA o a p j NCPW-'ZWt7j ZN W C a Q 1 SrZ+jS CJ 8 Z lIIII w _ - - ! 0\' 3OCG 1_ _ UQKOJv N O Z ¢ >i _� m! Z O W W F _ _ --3¢ 05002 0 j W - p 4 0 N R' - oz ONwmzd O d W p Davie.County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mo'cksville; NC 27028 (336)751-8760/ Fax (336)751-8786 May 1, 2006 Oak Valley Associates, Ltd. Partnership Attn: Bo Davis 3401 Healy Drive Winston-Salem, NC 27103 Re: SAWGRASS Proposed Subdivision/ Lot # Caudle Tract / Beauchamp Road Tax PIN# 5871252458 Dear Client(s): As requested, a representative from this office visited the above site April 11, 12, 18, 2006 to perform site evaluations. 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. This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans or the intended use change. Improvement Permit System To Serve: L4 gQ Wastewater Design Flow: 020 System Type: ❑Conventional R<ccepted ❑Innovative ❑Alternative ❑Other System Location: 1Z �A�a Valid: p3'1 -ears ❑No Expiration Site Modifications/Permit Conditions: ps-i.p.letter 2/06 —1 " riatq APPLICATION FOR SITE EVALUATION/IMP ROVEMENT PERMIT & ATC Davie County Health Department Environmental Health flection Y.O. Box 848/210 Hospital Street Mocksville, NC 27023 (336)751-8760/ Fax (336)7:1-8786 Application For. 0 Site Evaluation/lnlp'ovement Permir IS Name to be Billed On 14 R1(c 1 ou Billing Address eA City/State/ZIP Name on Femrit/ATC if Different tlan Above orshe Subdivision Name_ Directions To Site: .vilh site 0 Amhorinat on To Construct(ATO n Both )CESSED MILFSS ALL OF 1'Eff REQUQtED Ron. plat.) Date Iiouse/Facility Comers Flaggcd rylav4.4, -- ' If the answer to any of the following questions is "yes". supporting doenmeni;uio must be ananhed. - An there any existing wastcwrter systems on the site? DY[s Dow the site contamjurisdictional wetlands? DYrs o An there any easements or right -o£ --ways on the site? OY.s SIM Is the site subject to approval7y another public agency? Oyes ONO Will wastewater other than domestic sewage be generated? OY;e ONO - IF RESIDENCE FILL OUT TTili BOX BELOW (D Qb�U( U I Uh e pe.,nte- #Bedrooms rr BaUVOW Gardml out Whirlpool Dyes ONo IF NON -RESIDENCE FILL OC'T THE BOX BELOW Type of Facility/Business Total Square Footage of Building_ # People # Sinks # Commodes # Showers _,_ # Urinals Estimated Water Usage (gallons per day) (Attach doc.unentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type systemrequested: aConventionsl OAccepted Olunovative DAltemative nOther — Water Supply Type: pCounty/City NN c, O New Wag OFi: isting Well 0 Community Well Do you anticipate Do or mpnre.om of the facility this system is intended to serve? 0 Yes VIS no If yes, what type? This is io certify that the information l3rovided on this application is true and correct to the best of my knowledge. 1 understand that any permit(s) or ATC(s) issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the infommtionsubmitted in this applicationis falsified or changed, fund[ rstand that fam mspew(blefor all charger incurred from ibis application. I hereby gram right of entry to the AuthorizedReph sentetive of the Davie County Health Department to conduct recces inspections aJ�amine co Bac ce with applicable laps and rules "the abnve described property located in Davie Couvty and owreLdbyl1 / / 1p �ja7,Qre Grh�.u,�f.�=FkB,..�,.�,(rh'�_Ua�'�!u�tltr� �sj�',a+l�S, �I4• P�Slrrp n �n Sign given oyes OMDO Account # Dose 3� `� Revised?/06 - Invoice It —6itw APR 6 2006 D 4 Ob bO j iii v QI I � � cuur 3 Sq. Ft. St. Andrews Golf Villas Section 98, Phume 11, Section 2 Plot Book 8, Pape 21 Q e 30,894- Sq. Ft. 145' >103 150 (DO 33,126 Sq I b) 35,0W Sq. Ft. t. 35,486 Sq. f t. 148' 145' 142' 2 243- 2i' C_ � I v UD a. ;q, Ft. CIj 28' 30,J88 Sq -Ft. )0 30,080 Sq. Ft. 270 227' 0 Kassel n Kassel Sgo 1`159 327 0 33 69 Sq. Ft. 264 '01 i 27 in 30,078 Sq. Ft. '30450 9(j Ft. i ii 227 30, 60 Sq Ft. X)IQ 30,078 Sq. 11 t, 30,074 9-�I F t. 227' — I I I 251 all 40.0 10,137 Sd R. as 50'0 "1 d 762 ;a—�`C��� ,_.,f Ight Of 1 �) -a,,; I 1 DIVER 30,04.0 Sq. ft. 4o. 0 2,1 M 7 Sq. r t. 2>1, • • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990003765 Tax PIN/EH #: 5871-25-2458.04 Billed To: Oak Valley Associates Limited Partne Subdivision Info: Sawgrass Lot # 04 Reference Name: Bo Davis Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: see map Date Evaluated: I Z Dl/ f Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 I 6 7. Landscape position i...' .Sloe % ]A ^J HORIZON I DEPTH - 2 - 2 Texture groupC ConsistenceC'SPQ- _ Structure g Mineralogy- C HORIZON II DEPTH -SL4 21: S i Texturegroup.a G �Gk Consistence Structure 'Mineralogy HORIZON III DEPTH al I ^ YJ X72 72 Texture groupa : L Consistence r l n► Structure M. t� N\ 1.:..Mineralogy< S IHORIZON IV DEPTH- - Texture group Consistence Structure .Mineralogy i SOIL WETNESS- : .RESTRICTIVE HORIZON ... _ :.... , .. , SAPROLITE S CLASSIFICATION f7 S LONG-TERM ACCEPTANCE RATE - c SITE CLASSIFICATION:PS EVALUATION BY: C N LONG-TERM AccEPIANcE RATE: ©' OTHER(S) PRESENT: ' s REMARKS: i 1 :� LEGEND Landscape Positron L - Linear slope - R -Ridge S -Shoulder pe FS Foot slope .; . N -Nose slope;' : CC = Concave slope - CV Convex slope T -; Terrace FP =Flood plain : H = Head slope Texture... i 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 +, . CONSISTFNCE Ai VFR - Veryfriable, FR = Friable F1 Firm VFI =Very fain SFI -Extremely firm NS Non sticky SS -Slightly sticky " S Sticky ,: ° VS = Very Sticky NP on plastic SP -Slightly plastic P -Plastic VP -Very plastic ; r Structure -.... . f . .. -.. .� '-SC - Single grain M - Massive L CR Crumb .. GR.- Granular _ ABK Angular blocky- SBK -:Subangular blocky y an ulaz bloc PL -Plat PR -Prismatic - Mineralo¢v.. ! .. 1:1, 2:1, Mixed Horizon depth - In inches .. ; ...' Res ches Sa of to e S horizon Tluckness'and inches ' Depth of fill - In in _ - from land surface P 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 i Classification='S(siiitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05105 (Revised) ME ■■■M■■■M■■■ ■■■■■■■■■■O ■O■■■■■■■■■ ■■■MMOMOM■M ■MM■■■■■■■■ ■■■■■■MEMO■ ■MM■■■E■■■■■■■■■ ■■■■■MM■■■■■M■M■ ■■■■■■■M■■■■■■■■ ■M■■■■■■■■■■■■■■ i■ ■ no ■ ■ iii ■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ ._ .. _ _ _ _ K.a . .s — is __ �, a �