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157 Graywood Court Lot 20DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002811 Billed To: Stafford & Reader Enterprises Reference Name: Proposed Facility Residence Tax PIN/EH #: 5861-.38-0357.20 SR �� Subdivision Info: kej%� P,14e& Location/Address: Graywood Court -27006 Property Size: see map ATC Number: 3796 **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 4 #People #Bedrooms �,P #Baths _.S Dishwasher: e Garbage Disposal: Er' Washing Machine: 0' Basement w/Plumbing:0 Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seat',s\\ Industrial Waste: ❑ Lot Size Type Water Supply �� Design Wastewater Flow (GPD) yl lb Site: New;! Repair ❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width Rock Depth �� Linear Ft.�� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representat' a fthe 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 1:307iy�n the day of installation. Telephone # is (336)751-8760.**** r Environmental Health Specialist's Signature: Date: 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 #: 990002811 Tax PIN/EH #: 5861-38-0357.20 SR Billed To: Stafford & Reader Enterprises Subdivision Info: Redland Place Lot # 20 Reference Name: Location/Address: Graywood Court -27006 Proposed Facility Residence Property Size: see map ATC Number: 3796 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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Aw Date: 6, ? O CERTIFICATE OF COMPLETION Iear— 9GJ. u.3 **NOTE** The issuance of this Certalin of Comp ion shall indicate the system described on Improvement/Operation Permit has been installed in comith iOo4l of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but sbe taken as a guarantee that the system will function satisfactorily for any given period of time. �' -Tc>- - Tt�� �--� tic zs co Is 20 IL (00 i�L� q I� a r R4. Septic System Installed By: J Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) �.►� ` (�'� PPLICATION FOR SITE EVALUATION/IMI'ROVEAIENT PERh11T & ATC : Davie County Health Department Q EnvironmentaiHealth Section �uN �p9 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 itl (336) 751-8760 ONPAENjA� � *** ANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED NFORMATION IS PROVIDED. Refer to/ the INFORMATION BULLETIN for instructions. 1. Name to be Billed 614-/`f'orof a' J/�j�motet- Contact Person '5t-1011 Mailing Address _IPo• 13011 f % %l 3 /f//� /'� Home Phone 3.1 City/State/ZIP 61-e monS // C_ 2791 Business Phoi(;)( 33G 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ��,❑/J Site Evaluation �tmprovement Permit/ATC 11 Both 4. System to Service: L< House ❑ Mobile Home 13 Business ❑ Industry ❑ Other 5. Type system requeste/d_:Conventional 11conventional modified ❑ innovative 6. If Residence: # ecple # Bedrooms 't3 # Bathrooms JZ/Dishwasher &Garbage Disposal Washing Machine OBasement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) S. Type of water supply: X County/City ❑ Well ❑ Community 9. Do you anticipate additions )J or expansions of the facility this system is intended to serve? lllJ Yes If�cs,whattype? ))G'SSI,b/"� �O �rh.5� ❑ No ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: F N—) K, A 211 • Z �., 6 JyZI"y WRITE DIRECTIONS (fro►n Nlocksville) to PROPERTY: Tax Office PIN:, "035-7 211.1 n ?ow","WS � -e- / // Vay� Property Address: Road Name G�{i �YQ? 67. Lel! trh fi lo4d & City/zip ✓oloc < Id- - tel f' t`,ifo oe,'14kr h[zd If in a Subdivision provide information, as follows: Namc: ec9%tA!d ae-,L Oro tlno' sCcrH,ep,, eF�t �bvlC to� Section: Block: Lot: O Date home corners flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits) 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 ant responsihle for all charges incurred fi•onr this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to cuter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE '^I �i D 7 SIGNATURES TIIIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN (Include of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Sign given Revised DCHD (05/03 Site Revisit Charge Datc(s): Client Notification Date: EIIS: Account No. Invoice No. L7" LOT 20 gf-DZ00 -P1,4c-r- If 71-1- ro APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Q Davie County Health Department Environmental Health Section DEC P.O. Box 848/210 Hospital Street 3 20p Mocksville, NC 27028 2 riv (336) 751-8760 ViROI�!, DAVIF�pTt yEg1Ty ***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 i e Contact Person % Mailing Address":,a ����� Home Phone !22�� 5 City/State/ZIP �c��..S.—,�7���o Business Phone— lL% 2. Name on Permit/ATC if Different than Above Mailing Address__ City/State/Zip 3. Application For: I�Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service:Ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: # People # Bedrooms # Bathrooms I-ILI Dis�hwasher Ll Garbage Disposal ❑ Washing Machine Basement/Plumbing 11 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodas # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats 7. Type of water supply: Estimated Water Usage (gallons per day) (-County/City 8. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? ❑ Community lames ❑ No ***IMPORTANT*** CLIENTS MUSTCOMPLETETIIE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions:_/� G �Cf 14cl-L� S ti Tax Office PIN: Property Address: Road Name,I City/Zip If in a Subdivision provide informatioQ, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: EA -1 / L6C L � Name: Q{ twnAAP� Section: Block: Lot: '��LOT *1'Date Property Flagged: 1r;? ^�— �— 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 _,Lm�;„►��t�tT 5 to conduct all testing procedures as necessary to determine the site suita ility. DATE SIGNATURZ 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. 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 f� PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.22 Subdivision Info: Louise Smith Adams Lot 22 Location/Address: Redland Road -27006 see map Date Evaluated: 12- 23 ��- Community / Pit ✓ Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % mw u 70 HORIZON I DEPTH - 0-9 Texture rou Texture L Consistence S CC Structure C Mineralogy(� HORIZON II DEPTH 3 - Texture groupC Consistence —' $ Structure Mineralogy HORIZON III DEPTH Texture group I Consistence 1 - Structure 'S Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE - �•3�03� SITE CLASSIFICATION: K LONG-TERM ACCEPTANCE RATE: C - �� J REMARKS: t ,3 LEGEND Landscape Position EVALUATION BY: Ca� �L"►-1 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)