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125 Conifer Court Lot 12DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002746 Tax PIN/EH #: 5861-58-3341 Billed To: Marquis Building, Inc. Subdivision Info: Redland One Lot # 12 Reference Name: Location/Address: 125 Conifer Court -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3564 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 WASTEW T IS VALID FORA PERIOD OF FIVE YEARS. 49/1 - Environmental Health Specialist's Signa e: ate: 0 3 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. 2-A to to Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 1 ro' _ 0 Date: U DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002746 Billed To: Marquis Building, Inc. Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-58-3341 Subdivision Info: Redland One Lot # 12 Location/Address: 125 Conifer Court -27006 Property Size: . see map ATC Number: 3564 **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 Type 140ost - #People #Bedrooms —2.) #Baths - ' J Dishwasher: Garbage Disposal: ❑ Washing Machine: d Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size+��"T Act,pe Water Supply(1V1',W Design Wastewater Flow (GPD) Site: New Repair ❑ System Specifications: Tank Size IDCOGAL. Pump Tank GAL. Trench Width �� � Rock Depth IZ_. Linear Ft. l Other: g�_ jhS:MtL UNl.� �• C. ll,, J. Required Site Modifications/Conditions: �'' l LL - 1��. l flt .7 , �1' �e L t-too!:,2,Y—emp 14: � ocrQ J �� 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.**** Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 42;071 fib -'Ac.:j: 2 .. ok, 1 Of Public;'. Utilities_ � 1 Easement ��,� �''Si( .; A- w 10 Publi: 7-, 8' Easemen 2�.� �` ' : e ;a • 40.595 s Q.934 ��� f t. Ac. cn t3''13 t: -.g _12 .- 3.1, 718 s �� 35 89 M 0.728 Q. B : sq. f t. 24 Ac. f 1�b' Ldn dsca to Evsenitn t 'FS SW17H r ` 1(7' Public ' J94, pC 200 Utilities 10��, EaSeme t S 1 4 ".Q5/12/2003 10:00 9406947 GORDON WHITNEY PAGE 03 1 ( AP'M"aft r1W SLVAR"n O"ENT PC MIT • ATC Department �ZeCV P.O. Box 846/230H04Pita t Mo�aville, WC 27028 (336)751-8760 000 *e THIS APPlIGTI ZMtORtB1TZOR ZS PROVIDED�l, Rater CANNoT Bl: PRO(gggrb Ul:LESS ALZ� T!M MtMxI0K BULLETIN for iaatruotatis l• eros to be swilled ionoras. caatant P.raan� f Mailing adawaa . O� 170 cher/st.ta/zzp ktaeiaee. aeon. Z. ttae °° serutlasc it aitrrnt taws seovw M,iliop a04ras. C&Ntttats/fip 3. lippliont:ion Por: 0 $ite Evaluatioq �-j �.IaproJamaat Peimit/ATC (] nOgf 1• ors— to service: V House 0 Mobile Homs p 13uoiaaaa O Industry 0 Oth, S. It Residonoe: s People 1 Aedrooms _ _ 1 eatttroaea fi /L V Dishwasher U Catbase triaposal )kWas" K&OhAaa V naseewrt/sluabiaq 0 Desea.ot/ao rlvaWnq 4. It auainves/Ind-stry/other: specify typo 1 Cawode9 1 showers 1 7tinaia I People / sinks 1 Mater Coolers ZIP IOODSERYICE: ; Seata Eatimated hater Usage (gallaoe par dark 7. Type of water reapply: 0 County/City 0 Fall p C:oemm.i.ty 6. Do you anticipate additives or expansions of the facility this system is intended to serve? O Yes r No If yes, what type? 1f1/MP0XTANP**CIJF.NnMUSTCOMPLETETHE FWIMEDPROPERTYINFORMATIONREQUESTED BELOW. FWwr a PIAT or SITE PLAN MUST BE SUBMITTED b the client with THIS APPidCATION, Property Dimensions: -42;t 165),212 p Ii:e .t1 i'3 WRITE DIREcnoNS (from MocluviBe) to PROPERTY: Tax Office PIN: 8 /2 �� � �f ��g F 'Fie -0 Lker �tl :Q Property Address: Read Name 12S LaeN.r61r 'w 6r,� if in a Subdivision provide irnfotmstioa, as fdbws: i ?- y� Name: &L-6,.0 Section: �_ Block Lot: Date Property Wlaggcd'- This is to cvrdlY that the iaformstbm provided b correct to the best of my knowledge. 1 Mudentaud that nay ptrmit(s) issued hereafter aro subject to suspension or revoeatba, if the site pians or intended one Champ, ar if the intormnt'es sabmitite in this application is falaitkd or champ& 1 also, understand thatr am resposslble for sit rharru lscarrrdfrost t&& appGra.'2ss. t, hereby, give consent to the Axtborized Represeatetive of the Davie County Health Deparimeut to enter "show described property located is Davie County and owned by to conduct all testing procedures as necessary to determine the site sMiI DATE _ S� f_U� SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (include di of the following: I land proposed property lines sad dinceskus, structures, setbacks, sad septic locatives} ` Site Revisit Charge got -P - �(j, i_f, [Cr}c.� (,Jr ly Dam,); �'r t'eEfl Cheat Notification Date' <J Account N..��� Invoke No. Revised DCHD (07199) _ _rte[--� Tom Toa IMV3H 1VtN VINUM Jk4AY 1 2 2003 RA R3R Ho 05/12/2003 10:00 9406947 GORDON WHITNEY PAGE 04 �c 'JI - 4�Il.CjINd t" o f7, APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health SmWon P.O. Box 848/210 Hospital Street Mockeville, NC 27028 (336)751-8760 ***SMBORTAN"** THIS APPLICATION CANNOT BE PROCESBVD UNLESS ALL INTORI✓ATION IS PROVIDED. Refer to the INFORMATION BULLETIN for 1. Name to be Billed *tailing ]Address City/state/Z29 Contact Person P� JUN 4 2001 Rose Phone Business Phone 2. Name on Perait/DTC it Different than Above Mailing Address City/state/sip 3. Application ror: ®"Site Evaluation O Improvement Permit/ATC ❑ Both 4. •aystan to servical t -House ❑ Mobile Home 0 Business 0 Industry 0 Other VOL,. 5. If Residence: # People I Bedrooms i Bathrooms O Dishwasher 0 Garbage Disposal 0 Washing Machine 0 Basement/Plumbing 0 easemant/No Plumbing 6. If Business/Industry/Othert "city type i People / sinks 1 Commodes i Showers # Urinals i Water Coolers IF rOODSERVICE: # Seats __ Estimated Water Usage (gallons per day) 7. Type of Water supply: 11-6ounty/City O Well ❑ Community e. Do you anticipate additions or expansions of the facility this system Is Intended to serve? O Yes O No If yes, what type? *,"IMPORTANTPI" CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: Ae re.S 4 Tax Office PIN: # J5" 1-159 — , 1239 . i v Property Address: Road Name nn /& S City/Zip Ahp' I ee , If In a Subdivision provide Information, as follows: Name: P 4J /.,- ,-d' Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: ISFI 54 ,0 p,- S yz!�l- D-7-191 4-13Eel Date Property Flagged: 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 ase change, or if the Information submitted In this application Is falsified or changed. I, also, understand that I am responsible jar 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 to Davie County and owned by to conduct all testing procedures as necessary to determine the site sulta§111ty. , THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includi all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). 0 Revised DCHD (07/99) Site Revisit Charge Date(s): I Client Notification Date: I EIIS: Account No. Invoice No. '1�L J I %' - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.12 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 12 Reference Name: Location/Address: USHighway 158-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: -7` 0 Water Supply: Evaluation By On -Site Well Auger Boring Community Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % 220 HORIZON I DEPTH Texture groupG Consistence Structure Mineralogy1, 1: HORIZON II DEPTH 0. 7-Lp1 - Texture group C+q"'oC Consistence C Structure 31 Mineralogy1 �' HORIZON III DEPTH 2 2U -4 - Texture group Consistence G<'SSSP Structure Ir Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: '3 EVALUATION BY: JOT 8eAQC10 ,tel OTHER(S) PRESENT: REMARKS: La 'CAat1AD 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)