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192 Graywood Court Lot 15DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street 11 Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002162 Tax PIN/EH #: 5861-38-2199.1513C Billed To: Bob Cope & Son Construction Subdivision Info: Redland Place Lot # 15 Reference Name: Location/Address: Graywood Court -27006 Proposed Facility: Residence Property Size: 1.827 Acres ATC Number: 3658 **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. 1 Residential Specification: Building Type #People #Bedrooms #Baths -2 + 2 Z57- Dishwasher: 111"" Garbage Disposal: 09" Washing Machine: Basement w/Plumbing: d Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size tx li4 Type Water Supply QpgI Design Wastewater Flow (GPD) '7Irsu Site: New M/Repair ❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width c Rock Depth 1 ZLinear Ft. G� Other: y �1 lliTl�r�Xl~ Required Site Modifications/Conditions: It\I��XL C)� C & To(a , Vl D� IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 0"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.m. on the day of installation. Telephone Wis (336)751-8760.**** Environmental Health Specialist's Si e: DCHD 05/99 (Revised) uNXS 1-j ep -P- DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002162 Billed To: Bob Cope & Son Construction Reference Name: Proposed Facility: Residence ATC Number: 3658 Tax PIN/EH #: 5861-38-2199.15BC Subdivision Info: Redland Place Lot # 15 Location/Address: Graywood Court -27006 Property Size: 1.827 Acres 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 WASTEWA N T ION I VALID FOR A PERIOD OF IVE YEARS. Environmental Health Specialist's Signature A. Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit ctp has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and I iL? Disposal Systems," but shall in NO WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. aCi iL` Septic System Install By: _ Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 0 ti zo o M N w d- 0 0 �5- 147.80' 5861 13 3969 Ethel S. Cook D. B 64, Pg. 186 S88'43' 04"E A•. Noj 6321 ®Q(Tei S LA 7 st 34,067 Sq. Ft. . l 4e* A0.782 Acresf LO to 79,583 Sq. Ft. 1.827 Acresf G5 Radius N S3 03 5' 418.90' ,r+ 60,595 Sq. Ft. .1 -7 n 7. If Business/Industry /Other: verify type H Commodes it Showers 11 People II (links ..__._-.-.._.. 11 Urinals 11 waLer Cooler: IF FOODSERVICE: It Seats Estimated Water Usage (gallons per day) 8. Type of water supply: County/City ❑ Well ❑ Conulluldty 9. Do you anticipate additions or expansions Of tic facility this sysiclll is illtellde(i to serve: ❑ Yes L-1 No If yes,11-llat type ***Idll'01ZTi1tYY*** CLIENTS nl1UST C0,41PLETE• THE ItLQUIRED PROPERTY INFORMATION RE-QuiiS'1'ED BELO1V. 1sitber a PLAT orSITE PLAN HUSTBESUIIbIITTED by the client willl'1111S APPLICATION. FT Propcfty Dimensions: L% i MV 15)RITL DIRL:C1'IONS (Pruni Mucksville) hl PROPE'RTN': Tax Office PIN: II 45a p' 39 ' --;z-/ s s /j C - Property Address: Road Nalne M"10rJ CC909+'�- �%�B,�,Y L✓d y x,07` �f City/Gip If in a Subdivision prnovide( information, as follows: Nanlc: / ►` [4�L,�Cy�+' �C-� Scclion: 1 Block: Lot: Date !ionic corners !lagged: This is to certify that the information provided is correct to the best ofnly knowledge. I understand that any pernlil(s) issued hereafter arc subject to suspension or rcvocatton, if tic site plans or intended use cliange, of if (lie lntol'111:1tioil submitted in this application is falsified or changed. d, also, understandthat lain responsible jot• all char— es inew-rrrLjraiN this application. I, hereby, give consent to the Authorized Representative of the Davie County IIcaltll Delco owill to enter upon above described property located hi Davie County and owned by to conduct all testing procedures as nccess:u'y to'deternliue the site suitability. llA'I'L: 'o20 —/1 t'! SiGNATUItLo�� _Q 4.1 TRIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing :u1d proposed property lines and dimensions, structures, setbacks, and septic locations). Sign given Revised DCVI) (05/03 Site Revisit Charge Datc(s): _ _---- Client Notification Date: EIIS: Account No. 2-1('0 2- Invoice No. 31- _57 APPLICATION FOIL SITE L•VALUAT10N/INIPIiOVi:IIInvr i,c-iiiii117' S Davie County Health Department 0 2004 nENVIRONMENTAL Enyironmenia/Hea/t/1 Section P.O. Dox 848/210 Hospital Street Nocknville, NC 27020 H�T.I(336)751-8760 OUNTy ***XbJPORTANT*** TRIS APPLICATION CANNOT DE PROCESSED UNLESS ALL HE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Dilled �1� ��/� �/�S: Co. 1. AV Contact Person , Nailing Address liome Phone /Lj'� �/���1 ^. _vZy7f!_-!,.•..- /�� ,r/ % City/SL-aL-c/'LIP Jl/ �1 70 L1 DUJln( JD Phouc C-O.�h�'1NN� 2. Name on Perznit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: E�Site Evaluation 11Improveluent PeriniL-/ATC ❑ 1SuL'll <t 4. System to Service: 1D]-11011se ❑ 2d0bile home ❑ Ilusine�s ❑ Industry❑ Otllcr _ S. Type system requested: (Conventional ❑ conventional modified ❑ innovative G. If Residence: 11 People It Bedrooms IdffDishwasher l:7Garbage Disposal Mtrashing Machine [RI asemenL/Plumbing 1113asement/110 plumbing 7. If Business/Industry /Other: verify type H Commodes it Showers 11 People II (links ..__._-.-.._.. 11 Urinals 11 waLer Cooler: IF FOODSERVICE: It Seats Estimated Water Usage (gallons per day) 8. Type of water supply: County/City ❑ Well ❑ Conulluldty 9. Do you anticipate additions or expansions Of tic facility this sysiclll is illtellde(i to serve: ❑ Yes L-1 No If yes,11-llat type ***Idll'01ZTi1tYY*** CLIENTS nl1UST C0,41PLETE• THE ItLQUIRED PROPERTY INFORMATION RE-QuiiS'1'ED BELO1V. 1sitber a PLAT orSITE PLAN HUSTBESUIIbIITTED by the client willl'1111S APPLICATION. FT Propcfty Dimensions: L% i MV 15)RITL DIRL:C1'IONS (Pruni Mucksville) hl PROPE'RTN': Tax Office PIN: II 45a p' 39 ' --;z-/ s s /j C - Property Address: Road Nalne M"10rJ CC909+'�- �%�B,�,Y L✓d y x,07` �f City/Gip If in a Subdivision prnovide( information, as follows: Nanlc: / ►` [4�L,�Cy�+' �C-� Scclion: 1 Block: Lot: Date !ionic corners !lagged: This is to certify that the information provided is correct to the best ofnly knowledge. I understand that any pernlil(s) issued hereafter arc subject to suspension or rcvocatton, if tic site plans or intended use cliange, of if (lie lntol'111:1tioil submitted in this application is falsified or changed. d, also, understandthat lain responsible jot• all char— es inew-rrrLjraiN this application. I, hereby, give consent to the Authorized Representative of the Davie County IIcaltll Delco owill to enter upon above described property located hi Davie County and owned by to conduct all testing procedures as nccess:u'y to'deternliue the site suitability. llA'I'L: 'o20 —/1 t'! SiGNATUItLo�� _Q 4.1 TRIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing :u1d proposed property lines and dimensions, structures, setbacks, and septic locations). Sign given Revised DCVI) (05/03 Site Revisit Charge Datc(s): _ _---- Client Notification Date: EIIS: Account No. 2-1('0 2- Invoice No. 31- _57 PN APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department Envifonmenta/Hea/tIr Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 .(336)751-8760 D DDc fN�IRpNM � �tFrnI— PFA/ ru ***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 !(/��lri/�P_!/) !/�YDt�iLa/ i/ Contact Person Mailing Address 6�2e 61 75 / zu"4/14y— /<�i / Home Phone City/State/ZIP ��{yC7, 2712 (6 Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address// City/State/Zip 3. Application For: I�Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms ID # Bathrooms 1:;L1 .l Dishwasher ❑ Garbage Disposal U 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: R-Iffounty/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? 8 -yes ❑ No If yes, what type? 'IMPORTANT' CLIENTS MUST COMPLETETIIE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # /3�' Property Address: Road Name L i S/ City/Zip If in a Subdivision provide informatiog, as follows: WRITE DIRECTIONS/(from Mocksville) to PROPERTY: ZZ -41 Name: JJeI' MA Section: Block: Lot: ' ?9 -Date Property Flagged: 1r;?�- 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. 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 {/�r�✓t$tlltl 5 to conduct all testing procedures as necessary to determine the site suitapility. _ _-----� M01VRMWJffAk�1 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 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: Water Supply: Evaluation By: On -Site Well _ Auger Boring_ PROPERTY INFORMATION Tax PIN/EH #: 5861-38-2199.17 Subdivision Info: Louise Smith Adams Lot # 17 Location/Address: Redland Road -27006 see map Date Evaluated: 23 OZ Community Pit I---- LEGEND / Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure K Mineralogy HORIZON II DEPTH - �Z Texture group Consistence r Structure Mineralogy1; HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 0 . L4 1 O SITE CLASSIFICATION: VS LONG-TERM ACCEPTANCE RATE: D ' 0 REMARKS: LEGEND Landscape Position EVALUATION BY: a:_W iwT 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)