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150 Graywood Court Lot 10s I DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990000955 Tax PIN/EH #: 5861-38-2199.10S Billed To: Samnaz, Inc. Subdivision Info: Redland Place Lot # 10 Reference Name: Location/Address: Graywood Court -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3666 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 WASTEWAT ONS NIS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: D Ic P6p—m 4 �8Z 3 13Ea6 Ms 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. !�' Cb ? Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street / Mocksville, NC 27028 l C 0 y (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000955 Tax PIN/EH #: 5861-38-2199.10S Billed To: Samnaz, Inc. Subdivision Info: Redland Place Lot # 10 Reference Name: Location/Address: Graywood Court -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3666 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 H W �-'E #People L I #Bedrooms #Baths Dishwasher: 19"' Garbage Disposal: G?" Washing Machine: 10/ Basement w/Plumbing: [0 / Basement/No Plumbing: ❑ Commercial Specification: Facility Type y,��#People #People/Shift #Seats Industrial Waste: 13Lot Size I. Z9 okc-&- e Water Suppl4'' � � 1 Design Wastewater Flow (GPD) 4-�O - Site: New Ed Repair In System Specifications: Tank Siz4fQDOGAL. Pump Tank GAL. Trench Width 3(o Rock Depth 12- to Linear Ft. L%1 Other: Required Site Modifications/Conditions: ��/�� C(Z , �-�Gi' 10, oi�r 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 9:3.0-a.m-6r 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** H I y Environmental Health Specialist's Signature: J DCHD 05/99 (Revised) Date. ,, SAMNAZ,INC. SSG7748700 01127/04 OS:46pm r. ee4 • ---- •»••..�,q.�w 11uv[ lilt Yl PUL1111 4 -AW Davie County Neaith Department f,7Y11*0J7nJ07ta/Ned/tG Section 1-6( ( a P.O.. Dox 848/210 Hospital Street 2'I0ckuvillc, NC 27028 (3J6)751-0760 * * *IHPOR r NT* * * T}IIS A?PLICATION CWNOT BE PROCESSED UNLESS ALL TIM REQUIR!;b INFORMATION IS PROVIDE:). Refer to the INFORMATION BULLETIN Lor in L-rixt:tiona. I. Nama to be billed C41nth/a"L. _{� � Contact Person )failing Addresr, -TY Ileac Prone 7 -7 \f. Ci Ly/state/IIp �[C . .730 yusincsa I•hw,c `3—yY.__.41"� 2. Nang on permit/ATC if niffertat than IWovc C;, yl, Mailing Address --�� '--- c�tCity/StaL•c/yip _ _.- ]. Application For: 44ite Evaluation ❑ Improvement 11exavit/ATC Ll Lada 4. Syctem to Service: P(House 1lobile Rome D Businesz Cl Industry El OLlu:r 5. Type system requested: Kcon:entional ❑ conventioaull modified ❑ ii,nova Live 6. If Residence: a People _ I Bedrooms --77 ,../) / �iahwasher KJGarbage eiapoaal �ashing Machin ,cam aseucnt/Plumbing ❑DaLcu,Cn L/No 1.1u,utaing 7- 2f nuninesy/Industry /Other; verify typo ii`` 9 People a eoo,nndos I Showers ff urinals Y Water Ct,olcru IF FOODSERVICE; II Seats Enti)uated Water Unage (baliono pat' day) ___- a. Type or water supply;County/City D Well ❑ Com nlity 9. to you anticipate additions — expa)lsious atlbc facillty this sysie)n is }ulcllded to serve? ❑ yes ❑ No If ycs, 11•13a1 type' ***IAIPORTAJYT*** CULNTSMUST COMPLETE TnE NCQUIREV PROPLUTY INFORMATION 1tL'CiurS'17:u — - BELOw. i:itl,u-a Pl.A7orS1'rf: PLAlYdfUS76$SUIIAf177GD by the cllcut 1ri1b'!'111S AYPLIC.i1'riOlY. Yroperly Viulcns!ons: WRITE Oflll-Cl'IOiNS (from Alu.ts.•ilic) n. t lull I;x'r1: Tax Office PIN: 9 Property Address: Road Nmnc citylzipy+2�C� Ifin a Subdivision provide information, as follows. N2nlc: Section: Buck: Lot: _ _ �ja_ Date house corucrs nagged; This is to certify that the iufortnation pro,ided Is correct to the best oL1uy lu,o%vicdbe. 1 understand that any perulit(s) issued hereafter are subject to suspension or revocation, if the site plans or intcuded use thallbe, or if ibe )nlbrtltaliaa tubmillcd is this application is falsirsed or changed. 1, also, anders[and [liar L ani responsible for all drargta invurred ji-o- fills appliedriun. I, hereby, give cousent to .he Authorized Rcprescltlali►e of clic Davie County IIe;d1l1 Deparhavill 10 cuter upon above described properly lo':aied iu D2vic County and uwacd by I to cvuduct all testing procedures as accessary to etcruiue th DATE �Ye silC Sui it y. - - - - - <w v TIIIS AREA MAY U USED FOR DRAWING YOUR SITE F (In s uli; and prupusad property lines and dimensions, structures, selbacks, and septic locations). site Revisit charge Dalc(s): Clicut Notification Date: . EI -IS: Y ss �5 0o nL SAMNAZ,INC. 3367748700 01/27/04 0S:48pm P. 003 'FROM ':,PHILLIP i= Br LL CO FAX ND. : 3369455268 Jan. ?E. 2004 04:09PM P1 GRAYWOOD .COURT APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Q Davie County Health Department Envifonmenta/Heaith Section DEC P.O. Box 848/210 Hospital Street 3 Mocksville, NC 27028 (336) 751-8760 ENV1RONM D4 V, 0� yEACTy ***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 Mailing Address City/State/ZIP 2. Name on Permit/ATC if Different than Above Contact Person Home Phone Business Phone�L%%�3� Mailing Address City/State/Zip 3. Application For: kYSite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. I£ Residence: #People # Bedrooms .� #Bathrooms Dishwasher ❑ Garbage Disposal U Washing Machine Basement/Plumbing CI 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. Type of water supply: 9-15ounty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? 9 -yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE TIIE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION. Property Dimensions: Tax Of jcc PIN: # Property Address: Road Name �, r241 City/Zip WRITE DIRECTIONS/(from /Mocksv`ille) to PROPERTY: If in a Subdivision provide informatio , as follows: Name: Section: Block: Lot: - CT I Date Property Flagged: �,V This is to certify that the information provided is correct to the best of my knowledge. 1 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 incurredfrom 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 to conduct all testing procedures as necessary to determine the site suitapility. %,iJ oramwi1l,G1W 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: Account No. Revised DCHD (07/99) Invoice No. 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: PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.11 Subdivision Info: Louise Smith Adams Lot # 11 Location/Address: Redland Road -27006 see map Date Evaluated: 17-17-3O On -Site Well Community_ Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % 1,2 20 HORIZON I DEPTH Texture group Consistence Structure CQ Mineralogy ,` HORIZON II DEPTH 2 - 1 ' LP Texture group G Consistence F .• 5 Structure c Mineralogy1 I HORIZON III DEPTH 2,4 0 Texture group CA Consistence Structure Mineralogy; : 1 HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: j -S EVALUATION BY: LONG-TERM ACCEPTANCE RATE: 557 OTHER(S) PRESENT: REMARKS: SCJ It + %L w.l X 1'3 LEGEND 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 05/99 (Revised) Phone: (336) - 753 - 6780 Davie County Health Department Environmental Healdi Section P.O. Box 848 ci 210 Hospital Street Courier #: 09 -X10 -0G Mocksville, NC 27028 Pax: (336) - 753-1680 ON-SITE WASTEWATER CERTIFICATION (Check One) Replacement Remodeling Reconnection / Name: J �G 2 1�. Phone Number 37� , l �- r7LHome Mailing Address: 3l '`�el f (Work) Detailed Directions To Site: 6 /z, Z," 1.') Property Address: f J (o P 5% (.C/ U a [X*e- --z—/ Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: Type Of Facility: Date System Installed (Month/Date/Year):y U Number Of Bedrooms: 3 Number Of People: Is The Facility Currently Vacant? YesNo If Yes, For How Long? Any Known Problems? Yes eoIf Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: 2,+� c -WA P&'t- Pool Requested By: Approved Disapproved Q/ Comments: 94 V 5.f T Environmental Health Specialist Garage Size: Other: Requested: For Environmental Health Office Use Only of People. Date: a 5-1 G *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash Check Paid By:_ Account #: Money Order # Amount:$ ived By:_ Invoice #: /P F c (" (y, 4 7) °� 05 ! Davie County Health Department � 18 t� Environmental Health Section CFJMD P.O. Box 848 210 Hospital Street Courier # : 09-40-06 Mocksville, NC 27028 „ Phone: (336) - 753 - 6780 Fax: (336) 751 - 8786 ON-SITE WASTEWATER CERTIFICATION FOR DWELLING (Check One) Replacement Remodeling Reconnection Name: _ (/Ouy an -11 Phone Number 331i �� — 5'%S�% (Home) Mailing Address: %�Ji a �rrd Ls�ar��17�: f� ��liQ-y�y �'ry"5, (Work) ✓/r7 / 11.2' G /i�G 2711�c1 Email Detailed Directions To Site: )�/V ITS 7{� /��'1� ��l�� y�r� �7� - �r Ar f _ _ A _ _1 Please Fill In The Following Information About The EXISTING Facility: _* vi Name System Installed Under:Type Of F Date System Installed (Month/Date/Y � l v Is The Facility Currently Vacant? Yes No If Yes, For How Long? Any.Known Problems? YesDO If Yes, Explain: Number Of People: 3 Please Fill In The Following Information About The NEW Facility: V jA bQNus� 00M Type Of Facility: C� c (Number Of Bedrooms 'Number of People a Requested By: �i /a Date Requestecp (Si ature) For Environmental Health Office Use Only �Appro�vedDisapproved ,� Comments: if f� �0 v J - !� / ` 0'r %d yt d SC /� OY V SOld Wi /l A1692 40 0/ -6 q &rdIOd i12S /A Environmental Health Specialist �� Date: J7 LZ 3i *The signing of this form by the Environmental Health Staff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Cash /Check% Money Order # Paid By: [ 2Q Received By: Account #• Z7 3 6O - Invoice i Will AltA-i ( kC g- L. Date: sb 1