145 Redmeadow Drive Lot 32t DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account #: 990002260
Billed To: Allen Wayne Builders,LLC.
Reference Name:
Proposed Facility: Residence
Tax PIN/EH #: 5861-38-2199.32 aw
Subdivision Info: Redland Place Lot # 32
Location/Address: Red Meadow -27006
Property Size: see map
ATC Number: 3679
**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 l 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 176J5':- #People #Bedrooms 3 . #Baths :Z
Dishwasher: Garbage Disposal: ❑ Washing Machine: 2 Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size 0•07-4C,112AType Water SupplyCCOAYTY Design Wastewater Flow (GPD) A00 Site: New Ga" -Repair ❑
•I 1
System Specifications: Tank Size LCOQiAL. Pump Tank GAL. Trench Width t Rock Depth j 2- Linear Ft.
Other: 5 VIST-12AJ5L)TIoZ
Required Site Modifications/Conditions: ItbSIN' L. Otz� C.(}J1 cg' Ka:P lo% VC;r Ptd tJJI,T� OF4=
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. Telephone # is (336)751-8760.****
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Environmental Health Specialist's Signature: Date: �J O L)
DCHD 05/99 (Revised)
I
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990002260 Tax PIN/EH #: 5861-38-2199.32 aw
Billed To: Allen Wayne Builders,LLC. Subdivision Info: Redland Place Lot # 32
Reference Name: Location/Address: Red Meadow -27006
Proposed Facility: Residence Property Size: see map
ATC Number: 3679
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 AslenoNisPERIODOF FIVEYEARS.
Environmental Health Specialist's Signatur ate: 2 `7
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.
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Septic System InstalleBy:par
Environmental Health Specialist's Signature:
DCHD 05/99 (Revised)
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mackwrUle, NC 27028
(336)751.0760
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INFUMATION IS pt:OVIDZD. Refer to the IHp08IA7!rON VUZZMV for inatructiono._-
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MAP
uia a subdivt�s,Eo-n�(prenid�t iarypS�(r/a}, a/: talloi*,f:
Na.C:.1��1. 1 LItJt, / 4C"
Section: Died— Lol:
lvitiTs Dutt=oas {train Mod:sviari to ritVt'LICTt':
Date home corners Ilagtd. 1- R — eq -/
Ibis is to ttrtity 16x1160 iafornlatim providrll lr eorxvct to flee best of nay Jtlwtrlcdtc I understand that nay peradt(s)
Issuod Mata ller are subject to mapection or f0vocatlon, if the sitepbns or Ialeatlod use change, or if the Information
salunWod w Uds app)icatioa)s fdAfied orchafted L &Lal, rrndasrawd�atlam rcgwatiblrjoraUtAatrrxaratrnrdjraa7
Akr s WiesAmL I, btreby, rive cement to tie Authoriacd Repmmotative of lbe Davit: County I&:dde Departutrni
to cater upon abosc dtstribed prvperty located is Davie County and w med by
to cundun aU IrstioC pteccdura as aecma.'y'lo ddn-Wffc the site stulabJ J ,
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DATE �SIGNA17IRli
1liISAREAMAYBEiiSEDFORDRAVANCYOURSMttof(ltc Is` aiarandpnpu=d
ptaptstylimsanddimea ions, stroetuM setbacks, sudseptie ).
Site Revisit Charge
Date(s):
MotHatiLCetioaDalc-
• f SHS:
SICU e m Account No.
BarisalDCHD(DS/U! Iavoice:No. 3q / 5
p.4
`1qN
\�`ryF9Uy
1 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Q �IF,
Davie County Health Department 19
Environmental Health Section DtC
P.O. Box 848/210 Hospital Street 3 %Z
Mocksville, NC 27028
(336) 751-8760 DNn16
DAVIE Nr t y�ICTy
***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUI
INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN Cor instructions.
1. Name to be Billed !t/e-sa'//rPI/) V Contact Person
Mailing Address 02/11�3 iC A/a ,fir LVZ'-/ Home Phone
City/State/ZIP p� �2710 (p Business Phone
2. Name on Permit/ATC if Different than Above
Mailing Address
3. Application For: I"Site Evaluation
4. System to Service:Ouse ❑ Mobile Home
5. If Residence: # People
Dishwasher ❑ Garbage Disposal
City/State/Zip
❑ Improvement Permit/ATC ❑ Both
❑ Business ❑ Industry ❑ Other
# Bedrooms # Bathrooms IDLI
�l
Washing Machine Basement/Plumbing ❑ Basement/No Plumbing
6. If Business/Industry/Other: Specify type # People # Sinks
# Commodes # Showers # Urinals # Water Coolers
IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day)
7. Type of water supply: B--County/City ❑ Well ❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? 8 -yes ❑ No
If yes, what type?
'IMPORTANT*** CLIENTS MUST COMPLETETIiE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION.
Property Dimensions: , 3Cf A--CI-6 S
Tax Office PIN: # 7� ,3�'– a� 7'3'
Property Address: Road Name �, /
City/zip
If in a Subdivision provide inf'ormatioq, as follows:
WRITE DIRECTIONS (from Mocksville) to PROPERTY:
rA -1. OAC -
Name: ���r�f�f� /1 --t
�L rJ01n1 rvl
Section: Block: Lot: -J LOT _52 Date Property Flagged: &7 �—
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 from
this application. I, 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 by :5;, 5
to conduct all testing procedures as necessary to determine the site su'I Plity.
i Or
10 W, WPM
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:
Revised DCHD (07/99)
Account No.
Invoice No.
3
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 #: 5861-38-2199.34
Subdivision Info: Louise Smith Adams Lot # 34
Location/Address: Redland Road -27006
see map Date Evaluated: DL
Community
Pit
Public
Cut
FACTORS 1
2 3 4 5 6 7
Landscape position
Sloe %
HORIZON I DEPTH
— 1
Texture group CILL
Consistence
Structure
Mineralogy
HORIZON II DEPTH 9
Texture group
Consistence .'
Structure c
Mineralogy1`
HORIZON III DEPTH 24 r
Texture groupZ
C-4
Consistence T
Structure
Mineralogy
HORIZON IV DEPTH
Texture groupVTC'
Consistence
to 1
Structure
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
v xW t
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
J
SITE CLASSIFICATION: O's
LONG-TERM ACCEPTANCE RATE:
REMARKS: P41 MlYL--n /"� �-S IDb
Landscaae Position
EVALUATION BY: S�;4
OTHER(S) PRESENT:
9XV ►yt" kap 1") lIEV, + Q� 2
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)