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144 Graywood Court Lot 9DAVIE COUNTY HEALTH DEPARTMENT l Environmental Health Section P. O. Boz 848/210 Hospital Street f6l Mocksville, NC 27028 _ 7 OK (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900259 Tax PIN/EH #: 5861-38-2199.09dm Billed To: David Mallard Subdivision Info: Redland Place Lot # 09 Reference Name: Location/Address: Graywood Court -27006 Proposed Facility: Residence Property Size: 1.204 Acres ATC Number: 3662 **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 �I�li #People #Bedrooms r -2—S 5S Dishwasher: Lai Garbage Disposal: d Washing Machine: e Basement w/Plumbing: le Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �2 '1cvt'S Type Water Supply�001,31-y Design Wastewater Flow (GPD) Z&O Site: New M*" Repair ❑ x�D� System Specifications: Tank Size 1000 GAL. Pump Tank GAL. Trench Width � / Rock Depth /Z' Linear Ft. y Other: q DS11-vvl &)—FlC>j &)ees Required Site Modifications/Conditions: r. 14. �,W I -�'DW &� �, 0�� �P i ' . 1 , IMPROVENIENT/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 1:3 . . on the day of installation. Telephone # is (336)751-8760.**** �10'MI�J. 1 ,fi k Z V) `3 H Environmental Health Specialist's Signature: e: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900259 Tax PIN/EH #: 5861-38-2199.09dm Billed To: David Mallard Subdivision Info: Redland Place Lot # 09 Reference Name: Location/Address: Graywood Court -27006 Proposed Facility: Residence Property Size: 1.204 Acres ATC Number: 3662 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 WASTE WAT S IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: % Date: 2 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. 9,0' --1 �, t7 1 7 Septic System Installed By: !A"Ve Environmental Health Specialist's Signature :L!!t)6k 4Date: DCHD 05/99 (Revised) 99.24' This Lot) 212.70' I.P.S. S84. 8'05"E 1182_��'�Tn 137.72' ?p. �� Fos s�eo e�@'I e`er. (T ir. .. 9 X) v 52,466 Sq. Ft - 1.204 t .P 1.204 Acres± s yJ g s 89,178 Sq. Ft. op &N t` 2.047 Acres± 99.51 (Arc) N 8i'37=34„ W / 7 -99-06' N (Oh) 60• o�(4/ 7�3 \ s7 ;� / 3 CCb S51 S 6 { .9� 7 � sa- 9 Cc `06 704 CZE- z C� r , . " CATION 1:011 SITE EVALUATION/Ihit'IiOVU104T 1'L-1INII-I- S ATC < �, •Q4 Davie County Health Department Enyironmenia/Hea/t/, Section P.O. Box 848/210 hospital Street TptH��iH Mocksville, NC 27028 ENVIRpP�V1E C0�11�N (3 3 G) 7 51- 8 7 6 0 ***IPIPORTIINT*** TIIIS APPLICATION Cr1NNOT BE PROCESSED UNLESS ALL THE REQUIRED I INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. :��� 1. Name to be Billed !q 7 ConLacl• Person Mailing Address'`Z�' f/ j7�rj✓1 Ifoiuc Phone �%�% City/State/'LIP�LO� l ^ %/ e— AIL', 9 ml—DUJineJa Phone 2. Namo on Permit/ATC if Diff'ere'nt than Above Mailing Address City/State/Zip _- 3. Application For: ❑ Site Evaluation �, Improvement• Permit/ATC U DuLh <z 4. System to Service: A House ❑ IdObile Home ❑ Business ❑ Induut-ry ❑ Other S. Type system requested: A Conventional ❑ conventional modified ❑ innovaL-ive G. If Residence: Il People 1) Bedrooms )NDishwasher pGarbage Disposal Piashing Machine ;&Ba=ncnL/Plumbing ❑IlaacmcnL/No Plumbing 7. If Business/Industry /Other: verify type 0 People It Aimed _ It Commodes It Showers It Urinals 11 WaLcr Cooler:i IF FOODSERVICE: 11 Seats Estimated Water Usage (gallons per day) 8. Type of water supply: KCounty/City ❑ Well ❑ Conmiunity 9. Do you anticipate additions or CXpa11SiONS Of the facility (11is systelll is intended to SCrYC': ❑ yes I u If ycs, 11'11at type? ***IhI1'ORTiJNP** CLIENTS 41UST C0A11'LGTL- TIIE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. I3illicr a PLAT or SITE PLAN RUST RESUI1Af17"TE.D by the clicul ii'i(h TIIIS APYLICA'1'ION. Proper()' Dimensions: Tax Office IIIN: #.54 Property Address: Road Name -e ,g City/'Lip If ill a Subdivision provide information, as follows: Name: Section: Bloch: Lot: / 1V]Z!'1'h ll11iLC'1'lUNS (Il-uw 11•lucl• ''I ') hi I'1(UI'l;lt'1'1': ZEE 0ln- Ltd )ate (ionic corners flagged: L -_- o y This is to certify that the information provided is correct to the best of my knowledge. I understand (11.11 ;1113' perulit(s) issued hereafter arc subject to suspension or revocation, if the site plans or intended use cllaNbe, or if (lie infor111:10o11 submitted in this application is falsified or clianged. I, also, understand that I um responsible for all charges incurred from this application. I, hereby, gfve consent to the Authorized Representative of (lie DaN'ie County IIe:dlll I)cpar(uicut to enter upon above described property located in Davie County and owl.ied by _ to conduct all testing procedures as necessary to deterinine (lie site su' - I Ity DATE SIGNA'lUI, TIIIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of Clic following: Existing; and proposed properly lines and dimensions, structures, setbacks, and septic locations). Sign given 'Am,iscd DCIID (05/03 Site (revisit CIc11-ge Client Notification Date: EIIS: Account No. 7d7`0 c) Invoice No. d APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department EnvilonmentaiHealth Section DEC P.O. Box 848/210 Hospital Street 3 2r,;,92 Mocksville, NC 27028 (336) 751-8760 fN�tDANM TSI y �ECOy It ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUI INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed �Ne j�1 ,eta��Contact Person % Mailing Address rL�— Home Phone SSL �J City/State/ZIP ��{'` `27,129 Business Phone as Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: P ite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedroo# Bathrooms IDLI Dishwasher CI Garbage Disposal LI Washing Machine naasement/Plumbing fl Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Tripe of water supply: aunty/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? B -yes ❑ No If yes, what type? 'IMPORTANT' 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: �jCf 14ct S ,ll Tax Office PIN: #� Property Address: Road Name L / City/Zip If in a Subdivision provide informatiog, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: .�'A -34 L c �� 4WE'- L � Name: —� , W" Section: Block: Lot: "tr LOI- I Date Property Flagged: 42 ^3-' &9 �- 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 am responsible for all charges incurred front this application. 1, 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 to conduct all testing procedures as necessary to determine the site suitapility. _ �— 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). Revised DCHD (07/99) Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. Invoice No. a DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size: Water Supply: Evaluation By: On -Site Well _ Auger Boring_ PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.09 Subdivision Info: Lousie Smith Adams Lot # 09 Location/Address: Redland Road -27006 see map Date Evaluated: )2%Z,3/o2 Community Pit •I--- Public ✓ Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % 20 HORIZON I DEPTH 0 1 — L. - Texture group CL Consistence r SS S Structure Mineralogy1 HORIZON II DEPTH •` - 32 Texture group L Consistence Structure Ak MineralogyI� HORIZON III DEPTH 2 �' Texture group Consistence —f Structure k Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 3 �• SITE CLASSIFICATION: PS LONG-TERM ACCEPTANCE RATE: 0. S REMARKS: ILV Ck" P-I xa�o IJ P z Landscaae Position / WM Zq'T LEGEND EVALUATION BY: 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 kri o,) A44'f,— al '., 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)