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249 Bethlehem Drive Lot 24DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ,)f - Account #: 990002384 Tax PIN/EH #: 5861-59-5239.24JM Billed To: J.M. Builders, Inc. Subdivision Info: Redland Lot # 24 Reference Name: Location/Address: Bethlehem Drive -27006 ATC Number: 3224 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 I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTE W IS V ID FOR A PERIOD OF FIVE ARS. Environmental Health Specialist's Signature: — Date: 2� CERTIFICATE OF COMPLETION **NOTE** The issuance of C Cate 6FC,,ompletion shall indicate the system described on Improvement/Operation Permit has been installin c plia with icle 11 of G. S. Chapter 130A, Section .1900 "Sewage Treatment and m Disposal Systes," ut sh in WA taken as a guarantee that the system will function satisfactorily for any given period of time. �7J V I q Tr-kO�-DAA Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002384 Billed To: J.M. Builders, Inc. Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5861-59-5239.24JM Subdivision Info: Redland Lot # 24 Location/Address: Bethlehem Drive -27006 Property Size: see map ATC Number: 3224 (12,46 ) **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 H OL)SL- #People #Bedrooms #Baths 2' ,- Dishwasher: Ea""� Garbage Disposal: Washing Machine: Er ", Basement w/Plumbing: �� Basement/No Plumbing: 13 Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: Lot Size V•98 e Water Supply &NY]Design Wastewater Flow (GPD) Site: New M//Repair '', System Specifications: Tank Size ]uGAL. Pump Tank GAL. Trench Width Rock Depth Linear Ft. Other: 3 aST21 &)Tion E-uj:,>S. JKiNL1. (.jAe5 Required Site Modifications/Conditions:I �SVkL-Lt� Ga�1�TO c ,Kim �J � �- t L�[.1' r 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.**** XlrIMI�• 4�-Foez L-1AeS W � E3Gc:TIoJ ' om& Fe \ r pLor, l i(v Is P -r --V 15* P r s✓Pep Pel Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) FL -TN DAVIE COUNTY HEALTH DEPARTMENT J • Environmental Health Section ✓ �/ `00 �- * P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002384 Tax PIN/EH #: 5861-59-5239.24JM Billed To: J.M. Builders, Inc. Subdivision Info: Redland Lot # 24 Reference Name: Proposed Facility: Residence Location/Address: Bethlehem Drive -27006 Property Size: see map **NOTE* nisbfmprovement/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 TRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type Hoose #People #Bedrooms '� #Baths • �� Dishwasher: Er"" Garbage Disposal: Washing Machine: El -,*- Basement w/Plumbing: 121""' Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift j##Seats Industrial Waste: ❑ Lot Size - 324 Type Water Supply Design Wastewater Flow (GPD) `'f Oo Site: New Repair ❑ System Specifications: Tank Size ICWGAL. Pump Tank GAL. Trench Width:�(D I Rock Depth 12- I Linear Ft. Other: 0 b1f>+PA t 1 it y� - & r )+MALL 1,1 4�1- `/� 0. C-- 4"0, Required Site Modifications/Conditions: I�PT 10%©y 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.**** GAtM tA�XT \ 41� Environmental Health Specialist's Signature: DCHD 05/99 (Revised) /314pe-6D VrAer, 10 C AN4 W>i) TO 5t --T EJi'LTIOrz Fow-P fZ 6*�L'( "T PL1L)rA1-11 Cl-� Date: 32'03,. 1 Q ,Y7o, -` 1 10 ''Qsem a Sigh nt O 3Q 22 s � Q.91 A ' ft• o Lp C• --s %r �,J► 4'.. N 8� •p 48m 4 259.01' E o 31� 2% N 4. 2p 39• 1 0' 712 q c ft. o W LAI N_ 2 Ng3 32 E " cn 299.9,3p 1 1 rn 0:) 32,129 s 6.738 q �• ft. OD c. '.U37Ac• rt. ... 1 Q' Public ,��;c ties Eoserriern t Zsa. 38-499 4 0. g84 Ac. eft.10010 ops os, 2' 423 892 1'031 s'9• ft, .W--- W 242.2' cUrr o v Co 0 Q, o cn -: co z m a Y/ S�7W '� AM rip a% ,�j 4.dg.;17 ��Q ljd7 10 �d-ol 27 02 09:27a dauie county envhealth 336 751 8786 APPLICATION FOR SITE EVALUATION/IMPROVEMENY PERAiIT & ATC Davie CountyHealth Department Eavironrnental Health Section P.O. Box 949/210 Hospital Street Mocksville, NC 27028 (336) 751.-8760 1 * * * IMP.ORTANT* * * .THIS APPLICATION CANNOT BE PROCESSED UNLESS AT.L THE REQ XPXD INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instruc ons. I., Home to be Billed �� rn (� l /LO(Y • Contact Person Jn h �} CAI I le r^ MailiFtg Address' -(I (� Lie �/��/�((�((. si home Phone 7� l�'t �Z City/State/ZIP h% (a&))),n 56L CVY\ _ �/G 2-71 usiness Phone 3 19 2. Name on Permit/ATC if Different than Above Mailing Address �� 3. Application I'or: tY Site Evaluation city/State/zip ❑ Improvement Permit/ATC ❑ Both 4. system to Service: [) House 0 Mobile Home ❑ Business 0 Industry FJ Other 5. If Residence: People Bedrooms Bathrooms 2 Z I VDishwasher I.VCarbage Disposal I t/F7ashing Machine I_j�asement/Plumbing I I Basement/No Plumbing G. It Business/Industry/other: Specify type # People # Sinks I Commodes # Shovers I Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons por day) 7. Typo of water supply: ❑ County/City D Well r] Community o. Do yon anticipate additions or expansions of the facility this system is intended to serve? O Yes VNo lfyes, What type? ** IA1POR7ANT*** CLIENTS NIUSTCOAIPLGTI:Tit E RI:'QUIRCD PROPERTY INFORMATION REQUE YI'ED III? LOW. Either a PLAT or SITE. PLAN AIUST RESUHUnT,ED by the client wild TRIS APPLICA'i7UN. 6 7 P 3 D-5, 6 2 Frer%, f- 3,', vs Property Dimensions: R �� a55. ,` WRITE DIRECTIONS (from Mocksvillc) to PRC?PI:Irff: i Tax Of lec PIN: # S5&(v / -59 a -q Property Address: Road Name I7 � �f 4v1 �` P4©Y) '1 L . �e d'a-/nj w City/zip )rl If in a Subdivision provide ••information, as follows: Name: Rch_�'d 'V Section: � I Black: Lot: Date Property Flagged: - This is io certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issue(] hereafter arc subject to suspension or revocation, if the site plans or intended use change, or if the information submittal in this application is falsified or changed. 1, also, understand that l am responsible jar aff charges incurred franc this application. 11 hereby, give consent to the Authorized Representative of the Davie County licalth Department to enter upon Above described properly located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. ])ATI? `7 - �B d 2 SIGNATURE 3 THIS AREA MAY BE USED TUR DRAWING YOUR SITZ; PLAN (I elude all of the follow g: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Rcvi.Sit Charge Dates) Client Notillcation Date: EMS: ,sed DCHD (07/99) Account No. Y Invoice No. c= C__®r� * * * IMP.ORTANT* * * .THIS APPLICATION CANNOT BE PROCESSED UNLESS AT.L THE REQ XPXD INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instruc ons. I., Home to be Billed �� rn (� l /LO(Y • Contact Person Jn h �} CAI I le r^ MailiFtg Address' -(I (� Lie �/��/�((�((. si home Phone 7� l�'t �Z City/State/ZIP h% (a&))),n 56L CVY\ _ �/G 2-71 usiness Phone 3 19 2. Name on Permit/ATC if Different than Above Mailing Address �� 3. Application I'or: tY Site Evaluation city/State/zip ❑ Improvement Permit/ATC ❑ Both 4. system to Service: [) House 0 Mobile Home ❑ Business 0 Industry FJ Other 5. If Residence: People Bedrooms Bathrooms 2 Z I VDishwasher I.VCarbage Disposal I t/F7ashing Machine I_j�asement/Plumbing I I Basement/No Plumbing G. It Business/Industry/other: Specify type # People # Sinks I Commodes # Shovers I Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons por day) 7. Typo of water supply: ❑ County/City D Well r] Community o. Do yon anticipate additions or expansions of the facility this system is intended to serve? O Yes VNo lfyes, What type? ** IA1POR7ANT*** CLIENTS NIUSTCOAIPLGTI:Tit E RI:'QUIRCD PROPERTY INFORMATION REQUE YI'ED III? LOW. Either a PLAT or SITE. PLAN AIUST RESUHUnT,ED by the client wild TRIS APPLICA'i7UN. 6 7 P 3 D-5, 6 2 Frer%, f- 3,', vs Property Dimensions: R �� a55. ,` WRITE DIRECTIONS (from Mocksvillc) to PRC?PI:Irff: i Tax Of lec PIN: # S5&(v / -59 a -q Property Address: Road Name I7 � �f 4v1 �` P4©Y) '1 L . �e d'a-/nj w City/zip )rl If in a Subdivision provide ••information, as follows: Name: Rch_�'d 'V Section: � I Black: Lot: Date Property Flagged: - This is io certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issue(] hereafter arc subject to suspension or revocation, if the site plans or intended use change, or if the information submittal in this application is falsified or changed. 1, also, understand that l am responsible jar aff charges incurred franc this application. 11 hereby, give consent to the Authorized Representative of the Davie County licalth Department to enter upon Above described properly located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. ])ATI? `7 - �B d 2 SIGNATURE 3 THIS AREA MAY BE USED TUR DRAWING YOUR SITZ; PLAN (I elude all of the follow g: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Rcvi.Sit Charge Dates) Client Notillcation Date: EMS: ,sed DCHD (07/99) Account No. Y Invoice No. c= A111111CA110N FOii SIZE EVALUAI I ON/IMPROVEAI ENT PERMIT do ATC •. Davie County Health Department _ Environmental Health Soon V(Fd P.O. Box 848/210 Hospital StreetMocknville, NC 27028 (336)751-8760 t r 4 ***II1P0RTANT*** THIS APPLICATION CANNOT BE PROCSSSND UNLESS ALL Tq RE D INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for i atructfki!- FN -, LVIVILC// OUMY 1. Name to be Billed E� ') �A Contaot Parson cl- Bailing Address (G � ' � n ? � �l P some Phone City/state/LIP ' /G C. Business Phone 2. Name on Perait/ATC it Different than Above Nailing Address City/State/Zip 3. Application For: B"Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to service: E3"House ❑ Mobile Home ❑ Business. ❑ Industry ❑ Other s. It Residence: + People 1 Bedrooms 1 Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing Machine ❑ Basement/Plumbing ❑ Basamant/No Plumbing 6. If Business/Industry/Others Specify type i People / Sinks 4 C / Showers / Urinals I Water Coolers IF rOODSERVICE: # Seats__ Estimated Water Usag* (gallons per day) 7. Type of Water supply: 11'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? "IMPORTANTP" CLIENTS MUST COMPLETETIIE REQUIRED PROPERTY INFORMATION REQUESTED I BELOW. Either a PLAT or SITE PLAN MUST BESUBA11TTED by the client with THIS APPLICATION. Property Dimensions: 5 . klfS -7 Tax Office PIN: # 5S — 5 -2 2� Property Address: Road Name ASL S City/Zip AcIP1144ed,IlJ_t° 9 If In a Subdivision provide Information, as follows: Name: /.- A- :1�- Section: Block: Lot:__ WRITE DIRECTIONS (from Mocksvllle) to PROPER'T'Y: 0 4 PILI ZIP 17-0- D-7-1,91 4-1,3F,,91 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 use change, or If the Information submitted In this application Is falsifled or changed. 1, 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 sults Ility. DATE � — 1/"L% 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): I Client Notification Date: I EHS: Account No. 3 � Revised DCHD (07/99) Invoice No.� -1_ ' : , • . DAVIE COUNTY HEALTH DEPARTMENT r r Environmental Health Section J Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-523924 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 24 Reference Name: Location/Address: USHighway 158-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: 0_ Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 2 00"1 3 4 5 6 7 Landscape position Slope % n HORIZON I DEPTH Texture group ConsistencePTS'SSF Structure 91 Mineralogy 1 ;1 HORIZON II DEPTH " 2 - .9-Z Texture group Consistence Structure Mineralogy HORIZON III DEPTH ;3 Texture groupCt Consistence Structure Mineralogy HORIZON IV DEPTH Texture group5 Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 5 S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: PS LONG-TERM ACCEPTANCE RATE: �' 'SSE o, `7 REMARKS: Qr Landscape Position EVALUATION BY: s� t/li��/k►h (' OTHER(S) PRESENT: tJ'�- Sttp Ptr 7- /114)( LNA!t!'1i -37-" 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)