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245 Bethlehem Drive Lot 25DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002436 Billed To: Darren Burke Constr. Reference Name: Proposed Facility: Residence ATC Number: 3267 Tax PIN/EH #: 5861-59-5239.25DB Subdivision Info: Redland Way Lot # 25 Location/Address: Bethlehem 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 T atment and Disposal Systems). THIS AUTHORIZATION FOR WAS RU ION VALID FOR A PERIOD F FIVE YEARS. Environmental Health Specialist's Signatu e: Date: -/ 06W 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 A be taken as a guarantee that the system will function satisfactorily for any given period of time. : TA4yiA-ic -7Zz) Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 012l Y r Date: • DAN .COUNTY HEALTH DEPARTMENT Ivironmental Health Section •�� P. O. Boa 848/210 Hospital Street t� Mocksville, NC 27028 /cl (336)751-8760 IMPRO` :-MENT(OPERATION PERMIT h Account #: 990002436 Billed To: Darren Burke Constr. Reference Name: Proposed Facility: Residence M, Tax PIN/EH #: 5861-59-5239.25DB Subdivision Info: Redland Way Lot # 25 Location/Address: Bethlehem Drive -27006 Property Size: see map ATC Number: 3267 **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 Nome #People #Bedrooms _ #Baths 2 Dishwasher: 21"' Garbage Disposal: Washing Machine: ©'-- Basement w/Plumbing: 0�- Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size I •'03-1 AUC,S Type Water SupplyWl)rn1TV Design Wastewater Flow (GPD) Site: New Ly Repair ❑ �� GAL. Pum Tank GAL. Trench Width ��1Rock Depth Z,Linear Ft. 3eA7' System Specifications: Tank Size p ep Other: Required Site Modifications/Conditions: 1---Y MALL- dc -A CC-N'1120Z c � ��� �� &LAS n•...c . LI2a 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.**** 1 --y t� VE o� •�'—� ori' Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: a � 21- 407.75' 28 -A. 45,294 sq. ft. o 1.040 Ac.± 1 433.42'(Tota1) 274.57' 27 30,580 sq. ft. 0.702 Ac.f 8§L4-4'41 " 238.42' E 26 30,091 sq. ft. 10'x70' 0.691 Ac.± Sight Easement S 83.3203,' E-- 117.77 Bethlehem Drive S 86'44'41 " E ---- ME .o Q 158.85' E25 45,182 sq. ft. 1.037 Ac.f inx 10' Public --Utilities 0 2011 Q4� 38 44F; .Rn. ft. .r C .00T'29 2000 3:30AM HP LASERJET 3200 4*A- p.l 1-,,,c, vi i car wt v v u LJ I I I Z--� 50 1 "O I I OCT 25 2000 4:Q5RM HP LRSERJET 3200 P.1 Rug 30 02 08,388 davie counta.irwhealth 336 751 8768 P•1 % UIUQTION FOR SITE- eVALU4TI0WINPR0VUJtENT IIUUIR A ATC 0avle county Health 0epantnent Aiwasacan P.O. no: B4y/p Noopitalt r �. Mocksville, NC 27028 4336)752-8760 ••e rNMIR AM3't`•• MIS APPLICATION az;; BE FROW M ==,; ALL Tim RESIOIRCD INSWO TION I8 PR09I21EO. If.. to the ZWOPMTIout BOLtBTnT for ieatxuotiooe ). wase e. be Milled D x w) C t®seee burr.. — +Kr 7s�) r te_ w.i)teo Adan.. !�-=-� lYfkY✓ t� deo. adeno 7Caro -;?C) 1A e.eTr.e..a/snl'lo.-rlino�e me ����a ...�,...,1..,,. ->ue. /39q-GSYI i. Iden an aetale/ATO it ciffoe"t then lailina Ad:...r 3. Application Por: O Sita EvalaAti.on D Lsprevement Penait/ATC th .- aTrar. w r.rvlae. K.— it mobilo How C) Bu.iaa.. Q mduatry 11 other S. If R..id.eeal 1 P&OPIe Y Bedrauae Batarooata //////��� _ 1 / �Di.M.rtrr 1. Caa.epe DL -M-1 w*.M" Beam" �Cera�4Plu.aYaq 11 A mb-ti . Ply V e. Ir eoA.a.VES-luoUrlother. W..i f typ a Teeple __ I Slat• 1 tea,oaa. a meMro a Vxia.le 1 a.te Ctlleer IP FOODSERVICE: d Seat. Estimated ISILL" Daege IY.II.ns pec dry) 7. To. of eater .apply: `y CIIERt'y/City O Reil O Cousueeaty .. Do you aotkipaleAdditives orexpamalma0thebcaiib this lyRemISMttadedtaaene? nYes lr)es, what type? •• M7,1tTAA)re•• QJK-tTSA1t49rCWPIATSTRE XEVMECP)U)PEMTIW0RMATION UQUESIVI) BELOW. F,Nherr PLAT or PILAN MUlTdd$UgWfTEO Il! l llkb TSSI$API ATION. Property INOGASIaAS. 501F as �bY.ffdltTw7e M pP��lt01'P.)t 1 efts 1,/RgGt77 fa Tax 011lceMN: S �Sh .et�� iV Properly Addroam Read Namar RemlAa -/ICI. 4dm[A2 Ady2or-n a? wo a subdivides provide tarevo11lalie/14 as�,rom w: /�7 S t/L C f de 54i Nage: (1�1L1/itippld�l N/iiU tial: 6leck. �- W. „ DakP,.p yMe.,.& -MIS is to certify that She laPotmamilm provided to eeenret so tka hero ofmy knowhldw. 1 understand that any petatil(s) bs.ed bcrnrter an s.bjtet So ampeeSion w rcvaetttoi% irw site plane or lete.ded use cLonp, or it 1W Iarorm.ltoo .v6ndllcd i. tbir appHcntiou If hWDal or eluorcd. � r!!4 pedrtirind lbel / w rerp..ailrfw r/l derftx hrenrmJ/ruwr Iter yT(icNrri I. krrby.ghe wscat to 4e ANaurixrd Heptaea6llIn of tht Devoe County ]!wl Depnn.wm p enter upon abort Ack'ribed Property [walal In David Ge1.ty Sed owned by _... le a adun a (ati.e pnKti)ores a acccaury N deterntbw the site SaitabiliII. DATE VGMATVRE TRL4 AREA MAY 39 VSED FOR DRAWING YOUR SITE PLAN (laeh.is di ar01e &WmimV ExisO.y and prepand pr.peaiy Han and SseentonSw SSrneptes, Aetkarks, and septic tocatbat). Sik RrvWI ChaSCr Date(s); � .o CSQ Clienl NottHrAtlaa Dattt � RJ1SC /'� / Aero.d Na. dt". R4dwdDCHD(07fM / n S "'r j Cxi✓CN Invaiet Na 9-4. - - 10 � a yQ-jc-r- ON APPLICATION FOR SITE EVALUATION/IMPROVEMENT PEIIMIT & ATC Davie County Health Department sEnvironmental Health Section J, v w P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336) 751-8760 ***IkJPORTANT*** THIS APPLICATION CANNOT BE PROCWSSBD UNLESS ALL INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for 1. Name to .be Billed Mailing Address 6 City/state/LID Contact Person I D L; (-il I JUN t 4 261;11 l RE ED J tructfJl�lIBNMFN I r t 'OUNiY !' / -- l4 Bone Phone /%�y� w C. Business Phone 2. Name on Perait/ATC if Different than Above Hailing Address City/state/sip 3. Application For: Q"Site ]Evaluation ❑ Improvement Permit/ATC ❑ Both 4. system to service: 13"House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other W.....«. s. If Residence: i People 1 Bedrooms f Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/industry/Othart specify type # People 1 Sinks 1 Commodes 1 Showers 1 Urinals 1 Water Coolers IS FOODSERVICE: # Seats Estimated Nater Usage (gallons per day) 7. Type of water supply: 9--County/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system Is Intended to serve? ❑ Yes ❑ No If yes, what type? *"*IMPORTANT"* 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: 5 res 4 Tax Office PIN: # J S S - .539 S Property Address: Road Name /lr ' S City/Zip child'yee, V -(f , �97'et If in a Subdivision provide Information, as follows: Name: �;( /-_ Section: Block: Lot: ,- S WRITE DIRECTIONS (from Mocksville) to PR OPERTY-. •v'3- 7,!l- D-7-/;91 4-i3Eof 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 herealler are subject to suspension or revocation, If the site plans or intended use change, or if the information submitted in this application h 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 suits fifty. i 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: I EIIS• Revised DCHD (07/99) Account No. Invoice No. I DAVIE COUNTY HEALTH DEPARTMENT - Environmental Health Section y Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account * 989900136 Tax PIN/EH #: 5861-59-5239.25 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 25 Reference Name: Location/Address: USHighway 158-27028 Proposed Facility: residence Property Size: see map Date Evaluated: r7 )ADI Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % 1- HORIZON I DEPTH -5 Texture group CL_ Consistence Cr5550 Structure l� Mineralogy HORIZON II DEPTH Texture group e ---t Consistence .-' S ' Structure k Mineralogy I. 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 O 3; O SITE CLASSIFICATION: rte/ EVALUATION BY: '_�inT— ���JL1dA LONG-TERM ACCEPTANCE RATE: �' OTHER(S) PRESENT: REMARKS: P41 t4aM _35"-31 J 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)