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168 Graywood Court Lot 12DAVIE COUNTY HEALTH DEPARTMENT f `' Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900317 Billed To: Glory Home Builders Reference Name: ATC Number: 3715 Tax PIN/EH #: 5861-38-2199.12 GB Subdivision Info: Redland Place Lot # 12 Location/Address: Redland Road -27006 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 CO S N IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature Date: 1 0 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. Ito a X 37' NV T `� N00 IG1L Lj � +ANw.� Septic System Installed By: L -- Environmental Environmental Health Specialist's Signature: DCHD 05/99 (Revised) N DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900317 Billed To: Glory Home Builders Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-38-2199.12 GB Subdivision Info: Redland Place Lot # 12 Location/Address: Redland Road -27006 Property Size: see map jF�co Y �- **NOff Q- r&W�JlNht/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 f�� 5 #People #Bedrooms�1 ' _ #Baths Z Dishwasher: 12' Garbage Disposal: 17" Washing Machine: E Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �� AC� Type Water Supply Design Wastewater Flow (GPD) L Site: New 12/ Repair ❑ System Specifications: Tank Size IC WGAL. Pump Tank GAL. Trench Width 3401 Rock Depth ^IA Linear Ft.3CDC>1 Other: Ll -DIMQtEOT-r- + Required Site Modifications/Conditions: L. sv-L� of -c Q- � C -Ir- 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.**** tt � : ►o' _ LAS a T ��o �. 46, VZ Hoch 16 A- t13 Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: 1 C c MAR — 9 2004 ENVI'tOt�.'BpRL NERLitI PLICATION 1`011 SITE [VALUATION/1h1P110VL-11IENT PL'IG1 IT & NI -C Davie County Health Department Environmeata/Hea/t/i Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ***IMPORTANT*** TIiIS APPLICATION CANNOT DD PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed 610 ru �i , r'�QJ' i Mailing Address <<f s ae',4'e -r ro q 4 -Vwcrc� Ky City/State/ZIP (.l�,ti,rrU i, < AIC ' 7-7o,7- 2. 7o,Z 2. Name on Permit/ATC if Different than Above ConLacL Person JAorAAC'-.-____-., Home Phone Business Phone4S-C�� Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation 1 Improvement- Pezznit/ATC 4. System to service: ErHouse ❑ 2lobile Home ❑ Business ❑ Industry ❑ Other ❑ 130th ti S. Type system requested: ❑ Conventional ❑ conventional modified ❑ innovative 6. If Residence: it People # Bedrooms `/t 11 Bathroom:; 2.-S QWashing Machine ❑Basement/Plumbing ❑Basement/No Plumbing l D ahwasher (Garbage Disposal 7. If Business/Industry /Other: verify type It People It Sinks # Commodes tt Showers It Urinals it Water Cooleru IF FOODSERVICE: )# Seats Estimated Water Usage (gallons per day) 8. Typo of water supply: County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to servdl ❑ Yes Em'u If yes, w11at type? '1111PORlAM' CLIENTS AIUST COUPLGTETHE REQUIRED PROPERTY INFORMATION RLQ01.S'1 ED 3ELONV. Either a PLAT or SITE PLAN t11UST13ESUBAHTTED by the client with THIS APPLICA'T'ION. Property Dimensions: 'fax Office PIN: Property Address: Road Name City/Zip If in a Subdivision provide infornlation, as follows: Nantc: 4j (. j Plc .Le- Section: Bloch: Lot: NViv1'E DIRECTIONS (final Mocksvillc) to I'ROPE'RTY: Date home corners flagged:(, -7/- 1. This is to certify that the infornlation provided is correct to the best of IIIy knowledge. I understand that any pernlit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in illis application is falsified or changed. 1, also, understand that 1 ant responsible fur till charges incurred frurn this application. I, hereby, give consent to the Authorized Representative of We Davie County Ilcallll Department to enter upon above described property located in Davie County and oivued by to conduct all testing procedures as necessary to determine the site suitability. DATE �� `ice SIGNATURE����t.�•��,�� 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). Com- `.J_A--' Sign given / Revised DCHD (05/03 Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. �l 0 O Invoice No. Td S 11 Q 4 O m CC)Ok 1rac0 9, 1'9- 2,38 9.._511' H or � 5561 1..3 ,3969 o tithe/ S. Cook. 41.01, D. B. 64, t'.9 -T c 1425.26 p Q 2) 4 1,354 Sq. Ft 0.949 Ac.res_t: U) �� _.> CA o�-� 01 411. w , r.� 48,177 rTt 1 106 Ar r P,.,3. I = (T1 56,2- 1.29 F�Serr�ent public t)tility ` 73-7 -12C�.00 125•U091� 1-73.19 ,, 9„W -�----49 Public R/W) S�78'S2 t (;raywppd Carr49 91 14 7 IS --'- -Utility mentEase 1331Public 1 r - 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 PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.12 Subdivision Info: Louise Smith Adams Lot # 12 Location/Address: Redland Road -27006 see map Date Evaluated: I 2 Z _.� /0 2— Community Public Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position 1. Slope % HORIZON I DEPTH 2 Texture groupGi- Consistence Structure Mineralogy HORIZON II DEPTH Texture group G Consistence Structure Mineralogy HORIZON III DEPTH 3 Texture group C-4, Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 3 LONG-TERM ACCEPTANCE RATE n SITE CLASSIFICATION: Z EVALUATION BY: C ]35r_- : L4 U L14 A LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: tJ Hw ) 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) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Q Davie County Health Department Environmenta/Health Section DEQ P.O. Box 848/210 Hospital Street 3 2Co2 Mocksville, NC 27028 (336)751-8760 �VIRONNjENT OAV/ECO[ yEA[Ty ***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 U Contact Person % Mailing Address C2 31 � Home Phone a 1e cj City/State/ZIP �� �2712 (p Business Phone 2 :�—as 7— 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: P1191te Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms Dishwasher Ll Garbage Disposal LI Washing Machine Basement/Plumbing 11 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: ®aunty/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? E3 -Ws ❑ No If ycs, 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: , 3Cf A-cfa S Tax Office PIN: # Property Address: Road Name 26�41yll/ City/Zip If in a Subdivision provide information, as follows: WRITE DIRECTIONS / /(from /Mocksv`illlle) to PROPERTY: 4�y r�14 - /,P � i ozlc, <24 ZZ� Name: t�-�X/,r.��� Fhs /{ Section: Block: Lot: =/�- F—�' 1pate Property Flagged: A2 --3- 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 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 to conduct all testing procedures as necessary to determine the site suilapility. t : /� Amir"'MOWN 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. J • - DAVIE COUNTY HEALTH DEPARTMENT A y Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.14 Subdivision Info: Louise Smith Adams Lot # 14 Location/Address: Redland Road -27006 see map Date Evaluated: Community, Evaluation By: Auger Boring . Pit �Q 1W?a9 JJ6 Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Sloe % 100 a HORIZON I DEPTH - to Texture group C -L - Consistence S Structure lC L MineralogyI 1 ` HORIZON II DEPTH - Z Texture group L' f Consistence Structure S k ask MineralogyI t I HORIZON III DEPTH Texture group 0— t Consistence Structure S Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: �15 'p EVALUATIONBY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: Nd� �t Rmw"�o 1W_ LEGEND Landscaae 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)