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167 Longwood Drvie Lot 5DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT(OPERATION PERMIT ,2:�06 Account M 989900259 Tax PIN/EH #: 5861-59-5348.05 Billed To: David Mallard Subdivision Info: Redland Lot # 5 Reference Name: Location/Address: Highway 158-27028 Proposed Facility: Residence Property Size: see map ATC Number: 3184004 > **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 4o1 -)se #People #Bedrooms 3 #Baths 3 Dishwasher: 133"� Garbage Disposal: d Washing Machine: 12""'Basement w/Plumbing: 13Basement/No Plumbing: ❑ Commercial Specification: Facility Typenn-- __ '' #People #People/Shift #Seats Industrial Waste: 13Lot Size . IAI NCS Type Water Supply l�% Vt Design Wastewater Flow (GPD) 3t00 Site: New Repair ❑ System Specifications: Tank Size LCUD GAL. Pump Tank GAL. Trench Width RockDepth17-� � Linear Ft.3SD Other: , S} +l��t%TIO CS,' G�T1�Ll L-1 ^!S Required Site Modifications/Conditions: ItASru%— ptj 1 p V -t ) s+oFF 101 of 414 I. -ie 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.**** PeoP. tt ,&jA1N. I Qn�,�([ p a v� �tyL Peto lav IV6 Environmental Health Specialist's Signature: Date: 2 DCHD 05/99 (Revised) 160C RM Account #: 989900259 Billed To: David Mallard Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: 5861-59-5348 Subdivision Info: Redland Lot # 5 Location/Address: Highway 158-27028 Property Size: see map ATC Number: 3184 **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 TypeODL)SE #People #Bedrooms #Baths 3 Dishwasher: 0" Garbage Disposal: G!r' Washing Machine: I?"- Basement w/Plumbing: Er ", Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size . (Aq AUE✓ Type Water Supply C00N Design Wastewater Flow (GPD) 3W Site: New 21, Repair ❑ System Specifications: Tank Size 1000GAL. Pump Tank GAL. Trench Width 3Co Rock Depth 12 - Linear Ft. 3:54-D Other: Ll -loys-rogoT-1oz ~%xr<S, if rsy- L 11'ao— Required Site Modifications/Conditions: k4STAu- 04 C2.17a0— 15` VX- jkSc �4 10GX W -t. A-9 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.**** pP ul,)c 01 "' _ 'k -op I-1,sC Environmental Health Specialist's Signature: DCHD 05/99 (Revised) t,10}E 1A) owl Date: Account #: 989900259 Billed To: David Mallard Reference Name: Proposed Facility: Residence ATC Number: 3184 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5861-59-5348 Subdivision Info: Redland Lot # 5 Location/Address: Highway 158-27028 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 WASTEWAT ALI FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ate: :::;4Z3 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 N WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. FQ0'--N T- e� X2V r 30 T -Ant k DATc !c> -it Septic System Installed By: Environmental Health Specialist's Signature: Date: Z DCHD 05/99 (Revised) r APPLICATION FOR SITE EVALUATION/IMPROVEMENT Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Stre Mocksville, NC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED INFORMATION IS PROVIDED. Refer to the INFORMATION B1 1. Name to be Billed /�9 % % Contact Person/ Mailing Address Home Phone LV 5 - 72 77 City/State/ZIP r Business Phone 12 2— 7,-7- ? 2 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: ❑ House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other # Bedrooms _ # Bathrooms 5. I£ Residence: # People Dishwasher ➢4 Garbage Disposal ,Aq,Washing Machine 6. If Business/Industry/Other: Specify type # Commodes # Showers -Basement/Plumbing ❑ Basement/No Plumbing # People # Sinks # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: j County/City ❑ Well ❑ Community B. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes KNO If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: �' O Tax Office PIN: # Property Address: Road Name So City/Zip If in a Subdivision provide information, as follows: Name: . P ,Ie�,,17 127 Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Z;f% T7770 5/ Z --5-1,15 7— 7;i�5ze/C ,,-"*o7-- / o , -r/ S C vl 04 5;1�7- C - Date Property Flagged: C, —z 0 '-az' 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. 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 ownedb to conduct all testing procedures as necessary to determine the site suita�rli15, /J DATE ^� 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). / Site Revisit Charge // Date(s): Client Notification Date: t EHS: Account No. Revised DCHD (07/99) Invoice No. AI'I'UCAiION FOR SITE EVALUAIION/ IMPROVEMENT PERMIT & ATC • Davie County Health Department Environmental Health SeWon P.O. Box 848/210 Hospital Street Mockaville, HC 27028 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCZSSrD UNLESS ALL T INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for i .1 -1 - / . 1 17_ i] 1. Name to be Billed Mailing Address �•. 4 p City/state/ZIP e. 2. Name on Perait/ATC if Different than Above Mailing Address 3. Application For: fed Site Evaluation 4. 6ystan to Services I"House ❑ Mobile Home Contact Person _ none Phone %Ci business Phone � � r JUNit tREbUJUD _J tru(3t:04 EN ouN1Y I S - — _. I City/stat*/Rip ❑ Improvement Permit/ATC ❑ Both ❑ Business ❑ Industry ❑ Other W�•� 5. If Residence: 1 People / Bedrooms ! Bathrooms ❑ Dishwasher O Garbage Disposal ❑ Mashing Machine ❑ basement/Plumbing ❑ Basement/No Plumbing G. If Business/Industry/Others specify type # People / sinks / Commodes i showers 4 Urinals I Mater Coolers Ir rOODSERVICE: # Seats Estimated Yater Usage (gallons per day) 7. Type of Mater supply: 9--County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? I***IMPORTANT*** CLIENTS MUST COMPLETE TIIE REQUIRED PROPERTY INFORMATION REQUESTED I BELOW. Either a PLAT or SITE PLAN MVST BE SUBA117TED by the client with TIIIS APPLICATION. Property Dimensions: 6 5 Ap jjg5 -� Tax Office PIN: # 57" 1--51i— Property Address: Road Name AL)S City/ZipC�ljf9��, If in a Subdivision provide Information, as follows: Name: P ,;( A- r� Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: i /7`yl - D-7-19-1 4- /3�, ,,V 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 we 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 appl/catlon. I, hereby, give consent to the Authorized Representative of the Davie County Ilealth 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 sults4illty. Zj�2 DATE — y /i/ SIGNATURE -4 4L THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includ all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EIIS: Account No. / 3 (- Revised DCHD (07/99) Invoice No. APPLICANT INFORMATION DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation 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 #: 5861-59-5239.05 Subdivision Info: Redland Lot # 5 Location/Address: US Highway 158-2700 see map Date Evaluated: "7 %l,010) Community Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Sloe % (c>Lf HORIZON I DEPTH Texture group Consistence `S Structure S Mineralogy HORIZON II DEPTH 1 ' Texture group n Consistence S Structure <Ak 561<, Mineralogy; HORIZON III DEPTH — 1 Texture group Consistence S Structure Mineralogy: I HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 0.3' SITE CLASSIFICATION: P S LONG-TERM ACCEPTANCE RATE: O REMARKS: LEGEND Landscape Position EVALUATION BY: dmAll' 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) g' C35 D,3 8 sq. ft. 8 Ac.f 20)13" o/ -q �\N f -j CD 0 C� Cc) to I. ca 0 i! Ln Cr) m --ft.. N 8332 C3 47— _ 3 W.,. 10'x70' Sight w Easement 4 Cr) 32,240 sq. ft. rn 0.740 Ac. :t _ r� 00 N 87.19'04" 238.07' z w C32 CD It a 30,466 sq. fj.. I "- 0.699 Ac. f 86`2013 244.99' W 310.07'(Tot01) 35,349 sq. ft. 0.811 Ac. ± 31683 36,438 sq. ft. 0 83? Ac ± CA 10' Public Utilities 4LOsemen t Lane 0 0 U 33.2 ��.� •��--,-�.,' Typical Setbacks f E'r~ rn A r 1 r^, f 0 �C