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173 Redland Road Lot 3Account #: 990000955 Billed To: Samnaz, Inc. Reference Name: Proposed Facility: Residence ATC Number: 3669 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5861-38-2199.03S Subdivision Info: Redland Place Lot # 03 Location/Address: Redland Road -27006 Property Size: see map AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION i11111- - **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 WASTE S U IS V I D, F PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ate: k 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. I a `--Aad U -t -10.- t - P► gcz, PJ-)qa y - Septic System Installed By: Environmental Health Specialist's Signature : DCHD 05/99 (Revised) rv�j oJ,S5t Date: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section r P. O. Boz 848%210 Hospital Street �� Mocksville, NC 27028 / Z (336)751-8760 IMPROVEMENT/OPERATION PERMIT /173 &dtP& ed Account #: 990000955 Tax PIN/EH #: 5861-38-2199.03S Billed To: Samnaz, Inc. Subdivision Info: Redland Place Lot # 03 Reference Name: Location/Address: Redland Road -27006 Proposed Facility: Residence Property Size: see map **N OTE*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. '5DisResidential Specification: Building Type 0N) C -1G #People 4 #Bedrooms - #Baths 2–.5— Dishwasher: hwasher: 11� Garbage Disposal: I!( Washing Machine: Er Basement w/Plumbing: d Basement/No Plumbing: ❑ Commercial Specification: Facility Typenn #People #People/Shift #Seats Industrial Waste: ❑ Lot Size (' 4P 444 Type Water Supply �;A?L,W1Y Design Wastewater Flow (GPD) Site: New 12( Repair ❑ System Specifications: Tank Size GAL. Pump Tank Other: Required Site of I GAL. Trench Width 3(o Rock Depth � Linear Ft. 340 �S . 252 aQ-XCT1©,--) r I 4=7& IS 04T In er=F IMPROVEMENT�OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW FINISHED GRAD . ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8:30 .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.**** SST �1%cTl©�� .4 C' (Si raor-47 1 bRa`k� Environmental Health Specialist's Signature: bate: DCHD 05/99 (Revised) SItiolw!CV-� I— DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000955 Tax PIN/EH #: 5861-38-2199.03S Billed To: Samnaz, Inc. Subdivision Info: Redland Place Lot # 03 Reference Name: Location/Address: Redland Road -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3669 **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 Typep �' � #Peo le #Bedrooms 3 #Baths �• S Dishwasher: Er Garbage Disposal: M" Washing Machine: if Basement w/Plumbing: d Basement/No Plumbing: ❑ Commercial Specification:/Facility Type Ca&Design #People #People/Shift #Seats Industrial Waste: ❑Lot Size -� v `-�W Type Water SupplyWastewater Flow (GPD) t0� Site: New u Repair ❑ " System Specifications: Tank Size )�AL. Pump Tank GAL. Trench Width � Rock Depth )-7—" Linear Ft. Other: Ll —01 STQ1% T j,Q--,) aha Required Site ModiAcations/Conditions: TL,11 1�-0 0 Az IMPROVEMENT/�PERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISrR(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 ((3336,)751-8760.**** STA Y 7- io oO k.3to ,Y -t2' FQoaT Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) ILOEJ9 SA 5- ' SAMNAZ, INC. 3367748700 01/27/04 0S148pm r. r,e� 1,011111 Ar/1l1; Davie County Health Department ( 3 ee P.O.. BOX 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 **•nW0RTllNT*** TRIS A?PLICATION CaMloT BE PROCESSED UNLESS ALL 2II1 REQUIRED INFOILVATION IS PROVIDLJ. Refer to the INFORMATION BULLETIN for in ,L'ruct-ior,a . 1. Name to be Dilled — rA VWX/1f t1 CDntatt Portion [ �. Mailing Address C-0u� ✓ �1b (L !{orae Pironc city/state/z=r �T.t� l.r-�, � �j� — �� •� - 2. Nam* on Permit/ATC if Differcat than Above �w.�:•' __ Hailing Address �V^—'e-- City/StAtd/ziP 1_ Application For:Site Evaluation 0 Ilnprovemaut i1cx1nit•/ATC LI Uutlr 4. system to Service: House 0 Mobile Rome 0 bush cam ❑ InrJUSLry U 0Ll:cr: 5. Type system requested: "-.Ioadl EJ conventional modified [) imbovative G. It Residence; Peoplc F}— @ Bedrooms_ 0 Iiathrouru:: Z �(� 14,ziuhxasher 161Garbagc Disposal— , washing Machina KDasencat/1•lumbing ❑uzza. ot./m. 9. It su*lneas/Industry /ichor: verify Lyper 11•Coplc I �i+Jcn _ i Comodos I showers lF Urinala I Water cool L'r. IF FOODS$RVICE: tf Seats Estimated Watar UmaUe halzoun per day) _ _ 8. Type of water supply; county/City ❑ We11 ❑ Couuuunity S. Do you anticipate addition; or exp JWa1t,Y or talc facility this S)'SIC171 is itl(CUIICil(V SerrC: ❑YCS K-, If yes, what type? •*"IMPORTAM""* CLI EMMifUSTCOAJpLLTL TILE RLQUIItLDPROMICIT IN Oltt1•1AT10N KG•'QIttiat't:1) BELOW. tsiflier aPLATorSITE PLAN ARISTBEW1/dll7TCDbythe clinu w(lo I•IUS.tPPLICATION.__ 1'roperipUinlctrstons �� �� '��( Y Z�'I )VAITL UUMC110INS (tions Nloc svilk) to 1•1e(11'1,*1( 1 : Tax Office 111N: # -5-8(I 1 1 7.6 3 •S ___..- - Properly Address: Road Name 0. citylzip It in a Subdivision provide information, as fullolys: )\ante•-- Scclion: Block: _ Lot: Date honk corners I)abecd: This is to certify that the illfornration pro,.-idcd Is correct to the best of my knowledge. 1 understand that any perntil(s) issued hereafter are subject to suspension or revocation, if the site ptarls or )ntcrldul use change, or if the information submitted in this application is falsified or changed. I, also, understand that I run respunsible jar all charges introit real Roof this upplieativtt, I. hereby, give consenl to the Authorized Represenlative Df the Daric Cuauty Ile:dllr tleparlutcul to enlcr upon atlor'e dcscribed properly lo,:alet in Davie Cuutlly and unwed by to cuaduct all testing procedures is accessary to determine the site suitab' -' t— DATE 'l� �_... / TRIS AREA MAYBE USED FOR DRAWING YQUR SI• E PLAN (In udc a le-ftrHotsitt�: 3:r1 �r propuacd property lines and dimensions, structures, setbacks, and septic locations). Site Revisil ChargC Date(s): Clivus Notlficatiuti Date: ERS: 6L C/7 p 0 0 C) g c� g�5 SAMNAZ,INC. FRCM FHILLIP P BALL CO t NOT A C£RT/F/£D COPY FOR ILLUSMATION n 3367746700 FAX NO. 336945526e 01!27/04 05:48pm P. 007 Jan. 26 2004 03:36PM P3 TNIS DRAWING /5 NOT FOR RECORDATION REDLAND ROAD SR 1449 40 40 80 GRRPM SCALE - FEET - �— APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Q Davie County Health Department EnviionmentaiHeaith Section DFC P.O. Box 848/210 Hospital Street 3 �D�Z Mocksville, NC 27028 (336) 751-8760 �utRBNMENTg1 D4 TAI HEq(T coy 8 ***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 Contact Person Home Phone Ljfl'i� City/State/ZIP ��Q �p Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: PYSite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: Ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms .� # Bathrooms Dishwasher 11 Garbage Disposal U Washing Machine Basement/Plumbing ❑Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers IF FOODSERVICE: # Seats # People # Sinks # Urinals # water Coolers Estimated Water Usage (gallons per day) 7. Type of water supply: 8—County/City s. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? ❑ Community 8 Yes ❑ No ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with TIIIS APPLICATION. Property Dimensions: Tax Office PIN: # Property Address: Road Name 2aIZ414i 241 City/Zip If in a Subdivision provide information, as follows: Name: Section: Block: Lot: WRITE DIRECTIONS//(from Mocksville) to PROPERTY: Date Property Flagged: 42 ^ - 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 aii charges inncurrerl 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 ;,r!►�'tlt� 5 to conduct all testing procedures as necessary to determine the site suita¢ility. 0 WIN a W& A#���'iv. 1Nd�i 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: Revised DCHD (07/99) Account No. Invoice No. t 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: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.03 Subdivision Info: Louise Smith Adams Lot # 03 Location/Address: Redland Road -27006 see map Date Evaluated: �2 t`'i 0Z Community Evaluation By: Auger Boring Pit Public —I-" FACTORS 1 2 3 4 5 6 7 Landscape position L C0— Slo e % Slope 5Z % ZZo HORIZON I DEPTH 0-11 O Texture group Consistence 1 - Structure Mineralogy / HORIZON II DEPTH0749 Texture group Consistence I _ Structure Mineralogy' HORIZON III DEPTH Texture group 1 -14 --so+ Consistence Imo; Structure IC MineralogyI HORIZON IV DEPTH Texture group Consistence 197117 Structure Mineralogy SOIL WETNESS 2 RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION s LONG-TERM ACCEPTANCE RATE O. 0.3 SITE CLASSIFICATION: �S / EVALUATION BY:��a`"`� u �S LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: 1 `iF' iZLi'IL yv1tw`'� 10 i 2�-I- 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 Ii1, 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) I.P.S N O � r^ �I �. o 0 V I 0 0 . .i OD coo rn i I I.P.S N O � r^ �I �. o 0 V I 0 0 Q OD coo rn i I