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317 Longwood Drive Lot 44DAVIE COUNTY HEALTH DEPARTMENT v Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001597 Tax PIN/EH #: 5862-51-4394.44 MB Billed To: Marquis Building Subdivision Info: Redland Way 2 Lot # 44 Reference Name: Location/Address: Longwood Drive -27006 Proposed Facility Residence Property Size: 153 x 203 ATC Number: 3935 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 WASTEW CON ION IS VALID FOR PERIOD OF FIVEY ARS. Environmental Health Specialist's Signatur : Date: tW9 CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvem t/Operation Permit has been installed in compliance with Article 11 of G.S. Chapter 130A, Section .1900 "Sewage Treatment and Disp sal Systems," but shall in NO WAY be taken as a guarantee that the system will fu�cipp satisfactorily for any giv 1 period of time. I L A �.� 4101 r,.t l � Z, 1 lz.a C- o► �.... s /60 l I F-, Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 1`'t -V Date: S,Z ?_ D DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street 3 _ Mocksville, NC 27028 S (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001597 Tax PIN/EH #: 5862-51-4394.44 MB Billed To: Marquis Building Subdivision Info: Redland Way 2 Lot # 44 Reference Name: Location/Address: Longwood Drive -27006 Proposed Facility Residence Property Size: 153 x 203 ATC Number: 3935 **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 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 _ #People #Bedrooms_ #Baths Dishwasher: 93" Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: 171 - Commercial Specification: Facility Type nn '' #People #People/Shift #SSCeats Industrial Ell Waste: Lot Size 0 77 �S Type Water Supply 1.Z4�J Design Wastewater Flow (GPD) ''f b a Site: New Ll'alRepair ❑ 22 System Specifications: Tank Size JCM GAL. Pump Tank 1t,00GAL. Trench Width c�o� Rock Depth LZri Linear Ft.SLO Other:�l�l Required Site Modifications/Conditions: V'11,. �^�T@�� 4-1%+�t' td Ung 1C&15� 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.**** o • DCHD 05/99 (Revised) J 7 M"I.'d n anno n n S 03'30'2540: E' 59.17 N 0Er26'5 1" 113.59ts 724 Pq 57 41 2(Total) _ 5.=� 45- _ , ' 1+4 y _ f 5-0. 64a : acres CD A• • � rte• . s 8, 3S'! Dec 07 04 09:11a Gordan Whitney 996 640-6647 p.l 75 /- -9 78`G APPUICATION FOR SITE EVALUAT(ONJIMPROV'EMENT PERMIT & ATC Davie County Health Department Eneirvrrrrrental Hic-alth section P.O. Box 848/210 Hospital Strut Mocksville, NC 27028 (336)751-8760 ***YAL"ORTANT*** THIS APPLIC'TION CANNOT BE PROC-ESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed If I rrr-cyv1 -51 I L f -is contact Person Mailing Address � j/1�b�,5-k � 1-7Q r� / Home Phone city/State/zi y/� Pt—j AJ4 )-700(5 8usinass Phone 2. Name on Permit/ATC if Different than Above mailing Address City/State/zip 9. Application For: C Site Evaluation y- Improvement P2r...i.t/ATC 0 Both a. system to service: [� House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. I£ P.esidence: #-People # Bedrooms # Bathrooms 7- DishlcSi:titr U t;.:. -bags 1'isrosal �Naehin^,� Y=.^^i^.s 1.1 Pa�.�^.tJPlii {93a� CJNo Plua3ing b. If' snsineas)Sndantry/bthar: specify type` i People / Y Sinks # commodes # Showers I Urinals I Water Coolers IF FOODSERVICE: # Seats: Estimated Water Usage (gajtjens pow Aay) 7. TYPO of Vatsr Scpply: Q County/City 0 Well 0 Cornwsnity e. DS you 5nlicipilt idu'iliOEB OP tltparulvns of the faclUty this system Is Intended t0 serve? 0 Yes ❑ No If yes, what type? ***f31PORTAAP**CLIENTS 111USTCCGfP'LETETpfE isE'QUIREDPROPERTY INFORMATION REQUESTED BELOW: Either a PLAT or SITE PLAN MUST 89-TUBMJ77WD by The client with THIS APPLICATION. Property Dimensions: L6 3 -F 2.0 '1 WRITE DIRECTIONS (from Mociaville) to PROPERTY: Tax Office PIN: # ,<2 2-514-324 ��11 Property Address: Road Name 331-1 Lat,tLT:i¢A (JR, City/Zip AO J A "C�'- "e -, %7Jr,6 If in a Subdivision provide information, as follows: Name: t hN t) F,t-ctinn• Block: Lot: Date Property Flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits) sashed heFrenneP Sit ;iihjeet to suspension or revocation, If the site plans or intended use change, or if the information submitted in this application is falsified or changed. /, also, understand that f 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 to conduct all testing pyoeedures as necessary to determine the site suZbi /j t 7t7 DATE_ /7/ V 6 SIGNATURE 3 W THIS AREA MAY E USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Extstu g and proposed property tines and dimensions, structures, setbacks, and septic ]cation). Site Revisit Charge Dale(s): Client Notification Date: -'e— CHS: (J - Account No. / r 7 Revised DCHD (07/99) invoice No. a 200¢ r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.44 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 44 Reference Name: Location/Address: LISHighway 158-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: 43 Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit �_ Cut FACTORS 1 2 3 4 5 6 7 Landscape position t- L- Slo e % HORIZON I DEPTH Texture groupL Consistence r SS Structure Mineralogy1 1 HORIZON II DEPTH ce Texture groupL Consistence - Structure Mineralogy HORIZON III DEPTH j - Texture group t x "o Consistence Structure S5 i; Mineralogy' HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: l =7 EVALUATION BY: LONG-TERM ACCEPTANCE RATE: D• OTHER(S) PRESENT: REMARKS: (_V42 TZ_ _ V''-341' 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) 155' x 46B (�i)\0 30,980 s. \f t. o x 46 A\ 'N\ 155 -� 45B x 45 309978 sq. ft. x 45A 15 0 o x 44. �' 30,664 PERK H OLE NO i -- �- • 155' .----. � 44A --` -- '' --155' --� .-�x --153' -- —. \Lo4awood Drive -- \ s0' R/Ir 334' -- --- �' Public U t i l i t ie� �_Ugm e 135' \ 35B/C ~ 35B/B 71,244 sq. ft. \ n I x 35A/B U, 35A CI 4118 71 sq. ft. 0 C-351 Co 40,400 V rA'��1 IVJ In\ FEB 1 9 2003 * * * I�WORTANT* tf7AVIPIH ,W APP INFORMATION IS PROVIDED. . 1 _1 1. Naar to be Billed Nailing Address _ Q_�,3, city/state/RIp SITE EVALUATION/IMPROVEMENT PERMIT & ATC vie County Health Department ivir vnment al Health Secdron Box 848/210 Hospital Street Mockaville, NC 27028 (336) 751-8760 CATION CANNOT BE PROCESSED UNLESS ALL Refer to the INFORMATION BULLETIN for 2. Nams on permit/ATC if Different than Above Contact person Borne Phone 705 Business phone JUN 420`)1 RED ructfl�t� % N q� f OUNIY It,� v l"� AS Nailing AddressCity/State/Rip 3. Application For: Er/�"Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: 9' -House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other W�••. 5. If Residence: # People # Bedrooms # Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Mashing Machine ❑ Basement/Plumbing ❑ Basaasnt/No Plumbing 6. If Business/Industry/Others Specify type # People # Sinks # Commodes # showers # Urinals # Rater Coolers Ir FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Typo of water supply: 9Y-County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system Is Intended to serve? ❑ Yes ❑ No If yes, what type? I*"IMPORTANTPI" CLIENTS hfUST COMPLETETIIE REQUIRED PROPERTY INFORMATION REQUESTED I BELOW. Either a PLAT or SITE PLAN MUST BE SVBMITTED by the client with THIS APPLICATION. Property Dimensions:-�- Tax office PIN: #_ Property Address: Road Name/&L S City/Zip 461111d'y e , AJ -(f "9x If In a Subdivision provide Information, as follows: -**-pName: P 4;( �� A - Section: /" �L-J�Bloek: Lot: `f WRITE DIRECTIONS (from Mocksville) to PROPERTY: . , �2- 7-/,91 -4- /X'01 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 appRcatlon. 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 ility. 4�� DATE � — y Li` SIGNATURE 44 - 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): I Client Notiflcatlon Date: I EIIS: Account No. Revised DCHD (07/99) Invoice No. t' C• W' Cy so= 99 *0 tit J 4), w # . C -:LC /0 - -� cru #bs 9W%7 , � G i'v 091� /�-00h� 4 t. E M �- WAIT - la" -be (8, "Xx> i Z Yyt ,0'St, I i 14-):',i.*s,*i N. w 1 z' = �Z ��: t"rt.r -" ;0. ''J cc, 2.11 t!k � �f i D v L �3 WAIT - la" -be (8, "Xx> i Z Yyt ,0'St, I i 14-):',i.*s,*i N. w 1 z' = �Z ��: t"rt.r -" ;0. ''J cc, 2.11 t!k � �f i D v