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175 Graywood Court Lot 18DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001597 Tax PIN/EH #: 5861-28-7278 Billed To: Marquis Building Subdivision Info: Redland Place Lot # 18 Reference Name: Location/Address: 175 Graywood Court -27006 Proposed Facility Residence Property Size: see map **N011qTC NuMber: 3782 9* 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 tJ #People #Bedrooms #Baths Dishwasher: M" Garbage Disposal: ❑ Commercial Specification: Facility Type Washing Machine: ff� Basement w/Plumbing: ❑ Basement/No Plumbing: e #People #People/Shift #Seats Industrial Waste: ❑ Lot Size D' Ac&- 'ype Water Supply W`�� Design Wastewater Flow (GPD) '-SLOO Site: New Isr Repair ❑ System Specifications: Tank Size F 00Q3AL. Pump Tank GAL. Trench Width Rock Depth 12- Linear Ft. Other: 4 -LA &)T tQj B�►c - Reauired Site Modifications/Conditions: IrzMu, &) CDiyA7Q. �-� �� � Rd t-")�5, ��'S 109 wo-,A� 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.**** I `t J� Z o< 0 _ moo---- Environmental Health Specialist's Signature.. DCHD 05/99 (Revised) Date: :: • �_� DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001597 Tax PIN/EH M 5861-28-7278 Billed To: Marquis Building Subdivision Info: Redland Place Lot # 18 Reference Name: Location/Address: 175 Graywood Court -27006 ATC Number: 3782 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 I 1 of G.S. Chapter 130A, Wastewater Systems, Section .19AQ Sewage Treatm t and Disposal Systems). THIS AUTHORIZATION FOR WASTEW T ION IS VA D FO RIOD OF FIVE YEARS. Environmental Health Specialist's Signature. ate: ! 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 6DDisposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any A) given period of time. •� dip k! 2- 9 Septic System Inst lied By: ...� Environmental Health Specialist's Signature: Date: �7 2 Hj- %-, %..11 - DCHD 05/99 (Revised) ,.� C5 -�` rTI 10' Public Ut c4 -- ------ 173.19 . _. _ 125.00' v Radius S 18* 2.'?_9"w ,p - 50.00' r`�s°a Graywc>c>c] Court (50' Pt n ��oJo s N 78'52' " E c3 -4l.-73'-----, --13.8.83' --- - — ---14 7.2 3' �` -- 10 Public Utility Eosc ti - C8. --I 0 777 l Sq Ft '30,180 U' 1 80 S i�5 Acres f ' 0.693 Ac es j - f fe r n 81 ' 18 0. 72' (25 178<7 QI> s /in c Cor- X45 (46 This 147.2.4' ay 19 04 08:43a Gordon Whitney 336 940-6947 p.3 APPLICATION FOR SAE EVALUATION/IMPROVEMINT PERMIT & ATC Davie County Health Department 1 Env/ramnenta/Health S&Vott P.O. Box 848/210 Hospital Street Mocksville, NC 27028 / (336)751-8760 ***INP0RTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instLruCt)ions. 1. Name to be Billed 1 Contact Person Af,&M Mailing Address ZITO some Phone " City/State/ZIP /- f /)-,y.[- P- NC 1700 j±i Business Phone 3453-1(9V 2. Name on Pewit/ASC if Different than Above Hailing Address City/State/Zip 3. Application For: 0 Site Evaluation A linprovement Permit/ATC ❑ Both 4. system to Service: ,, House ❑ Mobile Home 0 Business ❑ Industry ❑ Other /17- 5. Residence: # People s Bedrooms , 11 Bathrooms Z VVVI'''f r. Dishwasher U Garbage Disposal r -Washing Machine {1 Basement/Pluibing ti. Basonent/No Pluabing r 6. I£ Business/industry/Other: Specify type 1 People i Sinks / Commodes f Showers / Urinals f Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: 0 County/City 0 well a, Do you anticipate additions or expansions of the facility this system is intended to serve? D Community ❑ Yes ❑ No 11 yes, what type? *"*JMPORTANT•**CLIENTS MI/STCOMPLETEIVE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESURM17TED by the client with THIS APPLICATION. Property Dimensions: " Sr,% t tt WRITE DIRECTIONS (from Mxlccville) to PROOPE17TY: Tax Office PIN: it S%w 1 'Ze6-7 7 `d },�`ts w •?-o p t >D l o - Property Address: RoadName J 7 s /•, p hyttt�y,���» 1 (T, L -D E-pcb �i�Nh City/Zip & A'6'-" 1� 2`lOD(i �/}i S� 1 't . �6 If in a Subdivision provide information, as follows: t Lgr-�- Name• hGVLA?JD LAC Section: Block: Lot: Date Property Flagged: This is to certify that the information provided is correct to the best of my knowledge. 1 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. J, also, understand that I am responsible for all charges incurred from this application. 1, 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 suitability. DATE SI��/DIi SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Listing and proposed property lines and dimensions, structures, setbacks, aad septic locations). Site Revisit Charge Date(s)- Client Notification Date: EHS: Account No. Revised DCHD (07/99) Invoice No.Z y a�� 9 Z004 DAV r COCA( HFACT ON H i B May 19 04 08:43a 4. Gordon Whitney 215 33G 940-G947 p.4 139 12a �O io A"?-qo %5 �L) I L.D I rvC� 2►a A APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT �C Q Davie County Health Department EnvitonmentaiHealth Section P.O. Box 848/210 Hospital Street 3 2oo� Mocksville, NC 27028 (336) 751-8760 ENViRpNM DAVIE l yFAITy ***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°-3�1 ,�(()j(J Contact Person Mailing Address '2fn �3) - Home Phone City/State/ZIP ��/ / �Q �p Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: 0,161te Evaluation ❑ Improvement Permit/ATC ❑ Both 4. system to Service: -Ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People #.Bedrooms # Bathrooms IDLI Dishwasher Ll Garbage Disposal ❑ Washing Machine Basement/Plumbing CI 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: (aunty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? El -Ws ❑ No If ycs, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # 02 7,y Property Address: Road Name -&Z / City/Zip If in a Subdivision provide informatiog, as follows: WRITE DIRECTIONS/(from Mocksville) to PROPERTY: 452�� �. Name: 1��.��,¢ E A � � J , �Sil rJe MAP Section: Block: Lot: 'LDT" �g Date Property Flagged: 1a�2 --3-' a2 �- 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 :5naQ��✓�jt1117 5 to conduct all testing procedures as necessary to determine the site suitapility. SIGNATURE 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 Date(s): Client Notification Date: EHS: Account No. 2 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 PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.20 Subdivision Info: Louise Smith Adams Lot # 20 Location/Address: Redland Road -27006 see map Date Evaluated: �Z Community Pit Public ✓ Cut FACTORS 1 2 3 4 5 6 7 Landscape a osition Slope % EE 2r HORIZON I DEPTH - - Texture group CL_ Consistence ` c Structure Mineralogy, HORIZON II DEPTH - Texture group C Consistence i r Structure Mineralogy HORIZON III DEPTH Texture groupf Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE — • , SITE CLASSIFICATION: 0 LONG-TERM ACCEPTANCE RATE: V REMARKS: LEGEND EVALUATION BY: sA -,T— t✓l JC -414,`o OTHER(S) PRESENT: 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 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)