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308 Longwood Drive Lot 35 ADAVIIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 3n loxg wood Pit, Account #: 989900283 Tax PIN/EH #: 5861-59-5239.35 A. BC Billed To: Bob Cope & Son Construction Subdivision Info: Redland Way Phase 2 Lot # 35 A Reference Name: Location/Address: Highway 158-27006 Proposed Facility Residence Property Size: see map ATC Number: 3895 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 T V L R A PERIOD OF FIVE YEARS. r' Environmental Health Specialist's Signature: Date: x Ac * It by (Dom 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 WAY be taken as a guarantee that the system will function satisfactorily for any given period of time. �3I : '�' /0 ? -kjs Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: 41 M U z G v r DAVIE COUNTY HEALTH DEPARTMENT %f • Environmental Health Section • ' „ P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900283 Tax PIN/EH #: 5861-59-5239.35 A. BC Billed To: Bob Cope & Son Construction Subdivision Info: Redland Way Phase 2 Lot # 35 A Reference Name: Location/Address: Highway 158-27006 Proposed Facility Residence Property Size: see map ATC Number: 3895 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 I 1 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 !t at7%�—,, #People #Bedrooms #Baths 2 + 2- Dishwasher: e Garbage Disposal: d Washing Machine: d Basement w/Plumbing: d Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 0 '1(C ACQ- Type Water Supply C.yOr'4 f Design Wastewater Flow (GPD) Site: New CZ( Repair ❑ System Specifications: Tank Size IW O GAL. Pump Tank GAL. Trench Width 3(,," Rock Depth AALinear Ft.4d Other: sVsr l - Required Site Modifications/Conditions: 0--3 C,0" TC,1Z, 3 15 , �-c. ly,rte �' 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.**** i—s' Environmental Health Specialist's DCHD 05/99 (Revised) K"J.ld bIjzslJt cLO Date: 'A VVI81IE EVALUA]IM/iMP110VEAIENT PERMIT Q ATC ti EC E 0 V E vio County Health Depurtmont vfronrriental Health Secdon Box 848/210 hospital Streat FEB 1 9 2003 Mockeville, NC 27028 (336)751-8760 * * * ORTANi' "' r'Ik1I$LICAT 011 CANNOT BE PROCCBSED UNLESS ALL I A r to the IMMMI ATI(M BULLETIN for 1. Name to be Billed �5� / ��1, e 1A w t I Contaot Person Mailing Address• r�,. j /� l� Hones Phone City/State/LID Business Phone 2. Names on Permit/ATC it Different than Above !Sailing Address City/State/zip ,JJ JUN 14 1 REWWD o N'17FNT41 t_i jj L'OfRJIY 3. Application For: to Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4, system to services 0"House ❑ Mobile Home ❑ Business ❑ Industry ❑ other «� « 5. If Residence: 1 People 1 Bedrooms 1 Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Washing /Sachin ❑ naaasant/Plumbing ❑ Basamant/No Plumbing 6. It Business/industry/Othart Specify type t) Peoples f Sinks 1 Commodes• I! Showers 1 Urinals 0 Water Coolers IF rMDSERVICE: # Seats Estimated Water Usage (gallons par day) 7. Typo of Water supply: td-County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility thLs system h Intended to serve? ❑ Yes ❑ No If yes, what type? h"IMPORTANTA" CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBARITED by the client with THIS APPLICATION. Property Dimensions: 6 � 1�. -e'— -�- Tax Office PIN: it '59'6 J -S q — 5��23`; ` 3 5 - Property Address: Road Name S y Ado % -n City/Zip }��11p/o'ee /V -e 9 If In a Subdivision provide Information, as follows: Name: :1�0 ,,( /,,- , :� Section: Block: Lot: 3 5 WRITE DIRECTIONS (from M(cksvllle) to PROPERTY-. -fA- D -7-49/ 4- 1-3;,'N 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 falsified or changed. I, also, understand that I am responsible for all charges Incurred from this appllcatlon. I, hereby, give consent to the Authorized Representative of the Davie County Health I)epartment to enter upon above described property located In Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. ` DATE �: — 41?` SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property !Ines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge j Date(s): Client Notification Date: EIIS: Revised DCHD (07/99) Account No. Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Proposed Facility: Residence Property Size: Water Supply Evaluation By: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5861-59-5239.35 A Subdivision Info: Redland Phase II Lot # 35 A Location/Address: Highway 158-27006 see map Date Evaluated: 3 Community Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group- L Consistence ; S Structure Mineralogy HORIZON II DEPTH '7— 5 /v ^Z Texture group Consistence F S Structure Mineralogy/ HORIZON III DEPTH Texture group Consistence , J Structure Mineralogy HORIZON IV DEPTH '5 Texture group Consistence Structure Mineralogy' 1 SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: P S LONG-TERM ACCEPTANCE RATE: REMARKS: Qi�kq_1 Z'6 � � P I EVALUATION BY:-� OTHER(S) PRESENT: toc u . (t1 -La,) W t '-� 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) �� 35-00 473.09'(Tot stat Revocable Trust 15 ,L.. tv ,+ 4 Cf" ICU .tI F.osement - 1 5-5.00' - --.. �2 -; l OVA! DRIYE O' Public RIW) 2 f Public Utility Easement fir, S C, Q ft • %tel 41 .,8 (1 V* n• , `t !" 40,400 ias N @CXiit CTf tt t rn �� 35-00 473.09'(Tot stat Revocable Trust APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & Davie County Health Department Environmental Health Section OCT - 7 2004 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 ENVIRONAIENTALHEALTH DAVIE COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. CReffer to the INFORMATION BULLETIN for instructions. f 1. Name to be Billed D ( e T kill wR . Contact Person 4/3,yicece Mailing Address G '/ e )166 Home Phone 7 r p er? City/State/ZIP (cede--'-Ille a Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: lel Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: 1� House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. Type system requested: ❑ Conventional 1R conventional modified ❑ innovative I 6. If Residence: # People # Bedrooms _ # Bathrooms Dishwasher ®Garbage Disposal IOWashing Machine ItBasement/Plumbing ❑Basement/No Plumbing 7. If Business/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 8. Type of water supply: 2SeCounty/City ❑ Well ❑ Community 9. 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: Tax Office PIN: # 57 -5:Z 3113 3 5 Property Address: Road Name 44f'W : City/Zip WRITE DIRECTIONS (from Mocksville) to PROPERTY: If in a Subdivision provide information, as follows: Name:,r� /4O �/ 41-9 Section: Block: Lot:_ Date home corners 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 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 suitability. DATE C7 .0 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 Sign given ti O Revised DCHD (05/03 Date(s): Client Notification Date: EHS: Account No. 9 r-7 7 as �g 3 Invoice No. T - - ��-