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172 Redmeadow Drive Lot 25DAVIE COUNTY HEALTH DEPARTMENT n Environmental Health Section /' o P. O. Boz 848/210 Hospital Street 7 Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900635 Tax PIN/EH #: 5861-38-2199.25 WF Billed To: Wayne Frye Subdivision Info: Redland Place Lot # 25 Reference Name: Location/Address: Red Meadow -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3664 **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 WE #People #Bedrooms_ #Baths <' Dishwasher: R( Garbage Disposal: ❑ Washing Machine: 133"' Basement w/Plumbing: ❑ Basement/No Plumbing: Commercial Specification: c Facility Type #People #People/Shift -20 /-.\ Industrial Waste: ❑ Lot Size 0,�qq !#- 'Ype Water Supply YDesign Wastewater Flow (GPD) ---(,OU Site: New 12 Repair ❑ r1 11 System Specifications: Tank Size 00GAL-. Pump ,Tank GAL. Trench Width 15& Rock Depth /Z Linear Ft. Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUE T FILTER. RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a r resentative of the Davie Coun Health Department for final inspection of this system between 8:30 a.m. to 9:30 a.m. orr11:OQpWto 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** �O Dwv e Health Specialist's Signature: DCHD 05/99 (Revised) ;p7 Oq ate: DAME COUNTY HEALTH DEPARTMENT joq.,t— Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900635 Tax PIN/EH #: 5861-38-2199.25 WF Billed To: Wayne Frye Subdivision Info: Redland Place Lot # 25 Reference Name: Location/Address: Red Meadow -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3664 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 Trea ent and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONST IO S V ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature Date: 2/3/,0q TIFICATE OF COMPLETION **NOTE** The issuance of this Certifica of mpletion shall indicate the system described on Improvement/Operation Permit 1`IU has been installed in compliance lit icle 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO A taken as a guarantee that {he system will function satisfactorily for any given period of time. 1 Ute' 4o7- Ar- ov -CrIC4 r �� 12 IAF H 1 -TN,x�� Septic System Installed By:t Environmental Health Specialist's Signature : _ _ Date: DCHD 05/99 (Revised) --S 06 COC TsaaoQJ` O d tt0' rn 6P o. o ,00'99 v snipoa 461 Q, g o ---._ 8 S 79,C3�•ZL,S o-+ .9Z VJ �saaay �,0g'0 u )J - bS /}1su986,121� � �eL ' J W1 (:p '0 j� bs Pot" 0 Z spa o; °e6 ,ZL*091 ' •d 4:.9 L N APPLICATION 17011 SITE EVALUATION/INIPROVEMENT 110 Davie County Health Department • Environinenta/Hea/tll Section P.O. Box 848/210 Hospital Street biocksville, NC 27028 (336) 751-8760 JAN 2 7 2004 ENVIRONMENTAL EAH nnim-. ...._ ***IbiPORTANT*** TRIS APPLICATION CANNOT BE PROCESSED UNLESS ALL TIIE R' INFORMATION IS PROVIDED. Refer to -the INFORMATION BULLETIN for instructions. 1. Name to be Billed /-///I) ! Mailing Address T /I 'City/State/'LIP !/� , �• �7�6 2. Name on Permit/ATC if Different than Above Contact Person liomc Phone Business Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation 0 Improvement Permit/ATC ❑ hoth 4. System to service: M_'House ❑ Mobile Home ❑ Business ❑ Indust-ry ❑ Other 5. Type system requested: Conventional ❑ conventional modified ❑ innovaLive 6. If Residence: 11 People # Bedrooms _ 11 Bathrooim; LLJDishwasher ❑Garbage Disposal 129ashing Machine ❑Basement/Plumbing 07 .ncnL/No Plumbing 7. If Business/Industry /Other: verify # Commodes # Showers 11 People 11 Sinks It Urinals It WaLer Coolerij IF FOODSERVICE: #1Seats Estimated Water Usage (gallons per day) ea� 8. Type of water supply: Ma County/City ❑ Well ❑ Community 9. Do you anticipate additions or CXpallSi011s or the facility this Systun is illlelldca to serve? ❑ Yes Nu If yes, lvllat type? ***IAIPURTANT'k** CLIENTS A1UST COAIPLBTL• TILE REQUIRED PROPERTY INFORMATION RE'QOE'ST .D 13ELOW. Either a PLAT or SITE PLAN AIUST BESUBAIITTED by the client }villiTHIS APPLICATION. Property Dinicasions: WRITE DIRECTIONS (Pruni Nlucksville) W PROPI:I('I'1': �Q� cZ/ ZSw Tax once 1'1N: f!✓U - 3 �' /1 �/ _ e" &12" f Property Address: Road Name 46--I-A) A/J(, ,1,2 4,, City/ZipL ) uL/✓T� />gfy,/>1"�l If in a Subdivision provide information, as follows: LroT Nanlc: fel eVl,.�,) &C e__ Section: Block: Lot: Date llonle earners flagged:' % b 1 This is to certify that the information provided is correct to the best of lily knowledge. I understand that any pernlil(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use cliange, or if the infoi•nladon submitted in this application is falsified or changed. 1, also, understand that l um responsiblefor all charges incrcu•red.Ji-om this application. I, hereby, give consent to the Authorized Representative of the Davie County IIeallli Dep:u•lnlun( 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. �l DAT& _ � / SIGNATUl E � 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). Site Revisit Charge Datc(s): Client Notification Datc: EIIS: Sign given `' Account No. _ Cc, 3,5 Revised DCHD (05/03 Invoice No. 0 APPLICATION FOR SITE EVALUATION IMPROVEMENT PERMIT Davie County Health Department 0 �� EnVftflMenta/Health Section DEC P.O. Box 848/210 Hospital Street 3 2oo2 Mocksville, NC 27028 (336) 751-8760 fNViR�n`MFNT DAVIF�pUj ljr-. ***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 le -3 1 J Mailing Address City/State/ZIP 412-5./ 2. Name on Permit/ATC if Different than Mailing Address Contact Person Home Phone %J/ ' K -- Business Phone 2��2— %�23 City/State/Zip 3. Application For: P1Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service:ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: #People #BedroDis21f ..i #Bathrooms IDLI FJ hwasher Garbage Disposal L1Washing Machine sent/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: runty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? F�-Yes ❑ No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE -1711E REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: � Cf /Q-C/'a ' > Tax Office PIN: # 5941— "39- 9 72-7 Property Address: Road Name&Z-41V41 P41 _ City/Zip If in a Subdivision provide inf'ormatiori, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: /5VEA-1/ /,p c�I (Ut— L A2 -19:7/- I- 2-19:7/- I-t°g� Name: b -Q Sl (�`J AWE =: Section: Block: Lot: �LZT Z57Date Property Flagged: Ir;2�- 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 ,(�1>[/;p an���✓�1tI 5 to conduct all testing procedures as necessary to determine the site suitapility. 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 PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.27 Subdivision Info: Louise Smith Adams Lot # 27 Location/Address: Redland Road -27006 see map Date Evaluated: 17- 1 2a' 1--9.— Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public f Cut FACTORS 1 2 0,7612- 4 5 6 7 Landscape position V l_ Slo e % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group e_ - Consistence Structure C Mineralogy1 1 1 1 HORIZON III DEPTH .. o - Z 2 Texture group FF Consistence SS Structure J k 5 k 5 MineralogyFL HORIZON IV DEPTH 3� Texture group Consistence Ira 1 T la 1 i Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION PS LONG-TERM ACCEPTANCE RATE ©?r10,35-0.4 q SITE CLASSIFICATION: S EVALUATION BY: VCr-1-i4-te LONG-TERM ACCEPTANCE RATE: t)' 1:;� OTHER(S) PRESENT: REMARKS: 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)