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165 Graywood Court Lot 192.� DAVIE COUNTY HEALTH DEPARTMENT 7� Environmental Health Section US P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900635 Tax PIN/EH #: 5861-38-2199.19 WF Billed To: Wayne Frye Subdivision Info: Redland Place Lot # 19 Reference Name: Location/Address: Graywood Court -27006 Proposed Facility: Residence Property Size: 9.732 acres ATC Number: 3663 **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 �- #People #Bedrooms #Baths 2.5 Dishwasher: Garbage Disposal: ❑ Washing Machine: 211/ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People El#People/Shift #Seats Industrial Waste: Lot Size ©--7� 1 "`�rype Water Supply r Design Wastewater Flow (GPD)—'�500 Site: New m Repair ❑ System Specifications: Tank Size I GAL. Pump Tank GAL. Trench Width Rock Depth Other: 3' ST e - l 'v 100 8N6 /2'� Linear Ft. -S� Required Site Modifications/Conditions: 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 8:30a,m. to :30 a.m. or 1:00 p.m.to 1:30 n•m. on the day of installation. Telephone # is (336)751-8760.**** yo 17- Ito FX7ttft-SpeciaH3r`-StgnatdrL— DCHD 05/99 (Revised) r DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900635 Tax PIN/EH #: 5861-38-2199.19 WF Billed To: Wayne Frye Subdivision Info: Redland Place Lot # 19 Reference Name: Location/Address: Graywood Court -27006 Proposed Facility: Residence Property Size: .0732 acres ATC Number: 3663 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 CONSU. IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 2 TIFICATE OF COMPLETION **NOTE** The issuance of this Certificat of c has been installed in complian wi Disposal Systems," but shall in O given period of time. r� `�i�V- a 2-9 Septic System Installed By: Environmental Health Specialist's Signature : DCHD 05/99 (Revised) n' eti shall indicate the system described on Improvement/Operation Permit cle 1 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and AY t en as a guarantee that the system will function satisfactorily for any APPLICATION 1`011 SITE [-VALUATION/Ih1PROVBIENT Plai4111j ji);'1';t Davie County Health Department Environments/Hea/th Section P.O. Box 848/210 Hospital Street ' Mocksville, NC 27028 (336) 751-8760 JA N, 2 7_2Q04 z. ***IMPORTANT*** THIS APPLICATION CANNOT DR PROCESSED UNLESS ALL TIIE REQUIRED -- '----- INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed 2. 3. 4. 5. Mailing Address zl!'y City/State/ZIP Name on Permit/ATC if Different than Above Mailing Address Application For: ❑ Site Evaluation Contact Person�fT. % Home Phone 313-1 0c7/7 i7v 311/ Business Phone City/state/zip ty/State/`Lip L/ImprovemenL• Permit/ATC System to service: C'7 House ❑ Mobile Home ❑ Business Type system requested: M Conventional ❑ conventional modified 0 Both ❑ Industry ❑ Other _ ❑ innovative 6. If Residence: 1t People U Bedrooms Ud'Dishwasher ❑Garbage Disposal Mrashing Machine ❑Basement/Plumbing 7. If Business/Industry /Other: verify type U People _ # Commodes # Showers # Urinals 11 Bathrooluo � 0013�.'ement/No PluuSting - 11 Sinks — -- 11 Water Coolor:i IF FOODSERVICE: 1#�Seats Estimated Water Usage (gallons per day) _ 8. Type of water supply: M— County/City ❑ Well ❑ ComlttuniL•y 9. ,Do you anticipate additions or CXpallSi011S Of the facility this SyS1C111 is 1ll(C1ldC(1 l0 SCI -V0 ❑ YCS If yes, what type? ***IAfPORTANTk** CLIENTS MUST COAIPLETETHE REQUIRED PROPERTY 1NFORNIATION REQi1ESTE'D BELOW. Either a PLAT or SITE PLAN J11UST BE SUHiWITTED by the client with 'I'I 11S APPLICA'T'ION. Property Dimensions: 1VRITL DIRECTIONS (I'ronl Muck.wille) to PROPERTY: 1'ax Office PIN: #���/ �� / . l % �� Z�Y /r19 E &VO&L fl,45 l r �. Property Address: Road Name 65QAYy,'(DD0 U L.T �/✓ �EOL✓�.�0 �/�, l ST City/Zip If in a Subdivision provide information, as follows: ° 4� Nanlc: VlGi�.tJD t7Gr`�C� Section: Block: Lot: �� Date home corners nagged: '716 54/ This is to certify that the information provided is correct to the best of my knowledge. I understand that any pernlil(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 1 ani responsible for all charges iacuri-e l.roil this applicatioii. I, hereby, give consent to the Authorized Representative of [lie Davic County IIeallil Departutcui to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the Site suitability. DA'I'S _ %/��/Ul`� SIGNATURE TIIIS 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). Sign given Revised DCIID (05/03 Site Revisit Charge Datc(s): Client Notification Date: EIIS: Account No.K�goo�3 Invoice No. APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 obi 3 20p2 EIVViRONM OAV/fCOUNny�CTy ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIo INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed ! B Contact Person 1 Mailing Address c2b,31 ZFW'/W/�- LS Home Phone City/State/ZIP u) e --a) Phone 2. Name on Permit/ATC if Different thanAbove Mailing Address City/State/Zip 3.. Application For: P,1ite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: Ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. I£ Residence: # People # Bedrooms # Bathrooms 17A, 1.4 Dishwasher ❑ Garbage Disposal L] Washing MachineBasement/Plumbing 1.1 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: runty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? Comes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: �� '4n'a Tax Office PIN: #� Property Address: Road Name�(Z/l1/ City/zip If in a Subdivision provide informatiog, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: L � Name: QsaP Section: Block: Lot: --'51A3cW lWate Property Flagged: 1r -V —73--0 �- 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 responsiblefor 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 �{rr; n� � �✓1�tIff 5 to conduct all testing procedures as necessary to determine the site suita nlity. MITONVE/, 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. APPLICANT INFORMATION DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size Water Supply: Evaluation By PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.21 Subdivision Info: Louise Smith Adams Lot # 21 Location/Address: Redland Road -27006 see map Date Evaluated: 12-- 23 -2- On-Site On -Site Well Community Auger Boring Pit Public Cut FACTORS I 2 3 4 5 6 7 Landscape position Slope% ` p HORIZON I DEPTH Q - �} p TexturegroupL� t. Consistence Structure Mineralogy HORIZON II DEPTH Z Texture groupC- Consistence Structure MineralogyI+' HORIZON III DEPTH 3 'CfX Texture group-► } ��- Consistence r, Structure Mineralogy' HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE p. 5. O SITE CLASSIFICATION: F'S LONG-TERM ACCEPTANCE RATE: �' 3J - O.4 REMARKS: LEGEND Landscaue Position 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 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)