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305 Longwood Drive Lot 45Account #: 989900259 Billed To: David Mallard Reference Name: ATC Number: 3847 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5861-59-5239.45 DM Subdivision Info: Redland Way Phase 2 Lot # 45 Location/Address: Longwood Drive -27006 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 . 900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEW CO T TI IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatur : Date: i b 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. < <o /0 r 3� 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 #: 989900259 Tax PIN/EH #: 5861-59-5239.45 DM Billed To: David Mallard Subdivision Info: Redland Way Phase 2 Lot # 45 Reference Name: Location/Address: Longwood Drive -27006 Proposed Facility Residence Property Size: see map ATC NuMber: 3847 **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 4D #People #Bedrooms 3 #Baths_ Dishwasher: K Garbage Disposal: d Washing Machine: Basement w/Plumbing: IRr Basement/No Plumbing: ❑ Commercial Specification: Facility Type 13(� ,� #People #People/Shift #Seats Industrial Waste: '36 Lot Size n' ©Cc �42_ Type Water Supply(0LWTY Design Wastewater Flow (GPD) Site: New Repair El to� � System Specifications: Tank Size IM GAL. Pump Tank 1000 GAL. Trench Width I Rock Depth Z Linear Ft. Other: Required Site Modifications/Conditions: ` w aLL 4 (Anilme'. 4-d l �c � / tri 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. to1_30 p.m. on thg day of installation. Telephone # is (336)751-8760.**** lie 1 IN, K v� ag- Environmental DCHD 05/99 (Revised) j Ag TION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC ., Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 9451 piCCGtI y t(N (336) 751-8760 ORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFOR14ATION IS PROVIDED./ Refer to the IN70RR�MATION BULLETIN for instructions. 1. Name to be Billed._Zd.J.�I /���`' `�s�J Contact Person 45/'�%%/` Q Mailing Address 1,120 � n/t /+ Home Phone .5 nz,l��) City/State/ZIP>.��J.. �C' // ,` Business Phoneme jL�� ��- � t 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: J `Site Evaluation Improvement Permit/ATC ❑ Both 4. System to Service: House ❑ Mobile Home C3 Business ❑ Industry ❑ Other 5. Type system requested: -'y' Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People # Bedrooms _s # Bathrooms_ Dishwasher WGarbage Disposal JIWashing Machine ,Basement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type, # Commodes # Showers IF FOODSERVICE: # Seats 8. Type of water supply: X County/City # People # Sinks # Urinals # Water Coolers Estimated Water Usage (gallons per day) ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes I&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. Propert}, Dimensions: -P Irl- ••-tom' Tax Office PIN: # i J % rJe� 3 9 Property Address: Road Name /-Dn,(' r -J City/Zip �- 7 o If in a Subdivision provide information, as follows: Name: Xpenl Section: �2- Block: Lot: _rJ WRITE DIRECTIONS (from Mocksville) to PROPERTY: G - Date home corners flagged: SZ/A/-- -)<w 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, miderstand 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 owae to conduct all testing procedures as necessary to determine the site abili j t DATEr/J SIGNATU 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). --A CO—,t--4L V Sign given D Revised DCIID (05103 Site Revisit Charge Datc(s): Client Notification Date: EHS: Account Nod �7 p V ," S Invoice No. Y-9 Lam, APPI�IL'Jll i T� C E � U E F E 8 1 9 2003 SIIE EVALUAIION/ IMPROVEAIENT PEWIT & ATC vie County Health Department 7vilimnmenta/HealthSerd on Box 848/210 Hospital Street Mockaville, NC 27028 (336) 751-8760 CANNOT BE PROCESSED UNLESS ALL to the INFORMATION BULLETIN for JUN 1 4 2i )1 RE D rut WENTAI 1f,,,,A-J /� i (1l IM Y i. Name to be Billed I / E ' Contact Parson k I"/9 -C e S �1 Hailing Address 19 Hoare Phone0/ /G City/State/ZIP 014JAIIIIALII a Business Phone 2. Name on Perait/ATC it Different than Above Mailing Address City/state/Zip 3. Application For: l Sita Evaluation ❑ Improvement Permit/ATC ❑ Both 4. system to Services O"'House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other W,�.,..• 5. If Residence: # People # Bedrooms # Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑►lashing Machine ❑ Basement/Plumbing ❑ Basement/No Plumbing S. If Business/Industry/Others specify type # People # Sinks # Commodes # Showers # Urinals # water Coolers IS rOODSERVICE: # 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 Is Intended to serve? ❑ Yes ❑ No If yes, what type? ''**111IP0RTANT*** 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: 6 5 Jo r�'S -7L S Tax Office PIN: # 57" 1 •-5?l � a ��9 •� Property Address: Road Name Ar -dc S City/Zip Chill ee Jk/_L° 91 If in it Subdivision provide Information, as follows: Name: "TP 6 � A- Section: Block: Lot: _ WRITE DIRECTIONS (from Mocksville) to PROPERTY: I S S' E,4Sq Pry!')"4 T,L/ :/- "�' -� 7A-- 7-191 4 - Al o/ 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 for all charges Incurred from this application. 1, 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 SIGNATURE - - THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Iuclud all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). n Site Revisit Charge Date(s): I Client Notification Date: I EIIS: Account No. Revised DCHD (07/99) Invoice No. DAVIE COUNTY HEALTH DEPARTMENT '1 Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.45 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 45 Reference Name: Location/Address: USHighway 158-270006 7 n Proposed Facility: Residence Property Size: see map Date Evaluated: �7 , Water Supply: On -Site Well Community_ Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position l_ Slope % HORIZON I DEPTH D " Texture group L Consistence r Structure Mineralogy` MIC HORIZON II DEPTHTexture rou Consistence Structure l� Mineralogy( l ; HORIZON III DEPTH ZiS S Texture groupG' C fit Consistence Structure AGk Mineralogy 1� 1 HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE 0. C2 SITE CLASSIFICATION: ell - LONG -TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: OTHER(S) PRESENT: 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)