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148 Longwood Drive Lot 19DAVIE COUNTY HEALTH DEPARTMENT .'1 Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 n j rd Pee5,6 IMPROVEMENT/OPERATION PERMIT Account M 990002363 Tax PIN/EH #: 5861-58-7857 Billed To: L. Wayne Frye Subdivision Info: Redland Lot # 19 Reference Name: Location/Address: Longwood Drive -27006 #jL k Proposed Facility: Residence Property Size: see map ATC Number: 3216 **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 #People #Bedrooms #Baths 2 • S Dishwasher: a Garbage Disposal: ❑-- Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size ©1k0S ' Type Water Supply &WOTY Design Wastewater Flow (GPD) ,�lolJ Site: New Repair ❑ System Specifications: Tank Size 1QC0 GAL. Pump Tank GAL. Trench Width Rock Depth t Linear Ft. 3M Other: ►)1ST� 1 �V �loe� p�Cr Required Site Modifications/Conditions: l 15 yw- (9^) �'��'�� "llni 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.**** • �15� �,5'mvJ. • o 11E—i'l0 75 75 1vE A 12eA • �rZeP. t_i►J� Environmental Health Specialist's Signature: Date: -7 V tv DCHD 05/99 (Revised) Account #: 990002363 Billed To: L. Wayne Frye Reference Name: Proposed Facilitv: Residence ATC Number: 3216 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5861-58-7857 Subdivision Info: Redland Lot # 19 Location/Address: Longwood Drive -27006 Property Size: see map 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 WASTE W IS ALID FOR A PERIOD qF FIVE YEARS. Environmental Health Specialist's Signatur Date: % n CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Com letion shall i dicate the system described on Improvement/Operation Permit has been installed in compliance with icle 1 of G S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NOW be t ken as a guarantee that the system will function satisfactorily for any given period of time. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) It 3' 13 ` APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department l5 O jj/i Environmental Health Section v P.O. Box 848/210 Hospital Street % 242 Mocksville, NC 27028 C % (336)751-8760 / ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for ins 1. Name to be Billed Contact Person Mailing Address 41 to U. s, 414/16T Home Phone h - 998- } City/State/ZIP � � �� /VC X0,96 Business Phone ✓�('� �'%�� 3fo�Jr 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation Improvement Permit/ATC ❑ Both 4. System to Service: V"House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. If Residence: pi # People # Bedrooms 3 # Bathrooms YZ- I Dishwasher 14��Garbage Disposal Washing Machine I] Basement/Plumbing II 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. Typo of water supply: YI County/City ❑ Well ❑ Community 0. Do you anticipate additions or expansions of the facility this system is intcndcd to serve? ❑ Yes it No If yes, what type? ***1h1P0R7ANT*** CLIENTS AIUSTCOAIPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED I31.L0\V. Either a PLAT or SITE PLAN AfUST 13F_ SUBMITTED by the client with THIS APPLICATION. Properly Dimensions: ,e 'n-� Tax Office PITY: 6 / --Sy- -7 e 5- j Property Address: Road Name� 0.j b le City/Zip If in a Subdivision provide information, as follows: Name: R L i -.t c-, %,— j Section: Block: Lot: / This is to certify that the informs do p issued hereafter arc subject to sus en iot or submitted in this application is fal 'fie o ch: this application. 1, hereby, give con en to he to enter upon above described prop rt loc tt to conduct all testing procedures as Ve ssa DATE THIS AREA MAY BE USED FOR property lines and dimensions, stri �L-> Revised DCHD (07/99) WRITE DIRECTIONS (from Mocksville) to PROPERTY: Date Property Flagged: is correct to the best of my knowledge. 1 understand that any permit(s) vocation, if the site plans or intended use change, or if the information ged. I, also, understand that I mn responsible for all charges incurred from uthorized Representative of the Davie County Health Department ,u' Davie County and o n d by a ctermine the site su tabi ity. 7 I SIGNATURE YOUR SITE PLAN (Include all of the following: Existing and proposed xacks, and septic locations). Site Revisit Charge Dates Client Notification Date: EI -IS: Account No. Invoice No. 76 :v c ' 1 Z9 -d T89L 966 922 3Jti21ANHJUa3NAMM WH ZZ:ZT Z99Z-ZT-'1nf APPLICAI ION 1=011 S11 E EVALUAI ION/IMPROVEh1ENT PERMIT & ATC Davie County Health Department EnvIronmenta/ Health Sectlon P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL I INH'ORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for J 1. trams to be Billed -ela / Contact person cl, Mailing Address '-?6v n 7 1 ¢ some phone City/state/EIp C.���1& Business phone 2. Name on perait/ATC if Different than Above JUN 4 0A RE D trua ilO ,VFN --___ ,71 Mailing Address/� City/state/lip 3. Application ror: I1 Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. system to service: E3House 0 Mobile Home 0 Business 0 Industry ❑ Other 5. If Residence: 1 People 1 Bedrooms 3 _ 1 Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Mashing Machine ❑ Basement/Plunbing ❑ Besamant/No plumbing 6. If Business/industry/Othart Specify type 1 Commodes 1 Showers 1 Urinals 1 people 1 Sinks 1 Mater coolers IF FOODSERVICE: # Seats � � Estimated Hater Usage (gallons per day) 7. Type of water supply: 9--County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system to intended to serve? 0 Yes 0 No If yes, what type? 11"IMPORTANT"* CLIENTS 1NUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: & 5 J , r&5 Tax Office PIN: t# 5T4 ) --5 � - -5 32 I Property Address: Road Name //Zdc /S City/zIp Altilldyed, A/Z ,, If in a Subdivision provide Information, as follows: Name: p al., "t, Section: Block: Lot: l WRITE DIRECTIONS (from 'M/ocksville) to PROPERTY: 5 i lel- D-7-/,91 4- i3Fof Date Property Flagged: This Into certify that the information provided is correct to the beat 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 to conduct all testing procedures as necessary to determine the site salts Ility. -. DATE _� _ `t`U�/SIGNATURE - - THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includ ail of the following: Existing and proposed property linea and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EIIS: Account No. 13(o Revised DCIID (07/99) Invoice No. ' DAVIE COUNTY HEALTH DEPARTMENT • % = Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.19 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Water Supply: On -Site Well Subdivision Info: Redland Lot# 19 Location/Address: USHighway 158-2702 Property Size: see map Date Evaluated: % l� d Community Evaluation By: Auger Boring Pit Public Cut V tt `1'3�chl SITE CLASSIFICATION: � S EVALUATION BY: � LONG-TERM ACCEPTANCE RATE: 0.3S -D • L 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) Landscapeposition �-��-0---- Consistence rs�����������■ HORIZON II DEPTH NUMMW Consistence Mineralogy HORIZON III DEPTH Consistence -��---- Mineralogy HORIZON IV DEPTH Texture group Consistence ------- SOIL WETNESS------- SAPROLITE WE V tt `1'3�chl SITE CLASSIFICATION: � S EVALUATION BY: � LONG-TERM ACCEPTANCE RATE: 0.3S -D • L 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) i n , w 10 Public o Utilities Easemen t n� 101 061) 176379 at Setbacks- Mer etbacksrner Lot 1.59 8Sq, ft , 3.702 Ac. , -t ' 3 10Public Utilities Easement N 83'5 ' 32" E --- 299.93' a' rn 20 ODo 32,1 29 sq. ft. �o cn ;01. / 0.738 Ac. f A001 C, i 40,�! '.©\) b' 10 6 ?"� 2'14 3 29„ 151 Typical Sefhrv'I'- tol Interior �9 , 33,333 s 0,,76 q. ft. A►c. ± S' • g•�6' 151, -'� Ln 1.8 32, 175 s �- q f fl 0.738 q `1 O•x70, c, f Sight Easement tJ• CP . ct� 17 31 282sft. %xK, d As