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320 Longwood Drive Lot 35 BATC Number: 3860 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 WASTEWATER CONS NIS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: L 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. ws,&e-TV l� Septic System Installed By: ""`Nv Environmental Health Specialist's Signature:L.� �"e: DCHD 05/99 (Revised) ` DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002811 Tax PIN/EH #: 5861-59-5348.35 B SR Billed To: Stafford & Reader Enterprises Subdivision Info: Redland Way Lot # 35 B Reference Name: Location/Address: 320 Longwood Drive -27006 Proposed Facility Residence Property Size: 144 x 303 ATC Number: 3860 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 WASTEWATER CONS NIS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: L 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. ws,&e-TV l� Septic System Installed By: ""`Nv Environmental Health Specialist's Signature:L.� �"e: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 , IMPROVEMENT/OPERATION PERMIT Account #: 990002811 Billed To: Stafford & Reader Enterprises Reference Name: Proposed Facility Residence fIL i--- O Y Tax PIN/EH #: 5861-59-5348.35 B SR Subdivision Info: Redland Way Lot # 35 B Location/Address: 320 Longwood Drive -27006 Property Size: 144 x 303 l/-'30 ATC Number: 3860 **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 Hoost . #People #Bedrooms -2)— #Baths 2+1 VZE`TH Dishwasher: ET'*' Garbage Disposal: 131/ Washing Machine: 171� Basement w/Plumbing: G!(' Basement/No Plumbing: ❑ Commercial Specification: Facility Type ,�#,P11eople #People/Shift #Seats Industrial Waste: Lot Size Oq 3 AILIkS Type Water Supply C,00"Pe, Design Wastewater Flow (GPD) Site: New 17", Repair ❑ r, System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width- Rock Depth 1 L Linear Ft. Other: j D— >-- °�J r�r•� Required Site Modifications/Conditions: I��Mw GO C C4-- Q t?Cal L4 FJ & 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.**** Z.. K to © 0 I FA �21JC nmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) ZS k "ILC.to s — t -09"K I I I q, --7770,011 �f0 Q? h�i � . (0' '9 cx� r. Lig a) SWO -be 99,6*W co c: CC> Go e'v �f0 Q? h�i � . (0' '9 ly- NEWS tai -be 00* "Ot '14 k4l 0 tDi CID (14 77 :uV).'w an j CO cx� Lig a) ly- NEWS tai -be 00* "Ot '14 k4l 0 tDi CID (14 77 :uV).'w an j CO —AUMCAII Oil SITE EVALUA11ON/IMPROVEMENT PEIIM(T & ATC le County Health Department - --- _ • — vlronmenta/ Health Scadlon(�' L r' Box 848/210 Hospital Street l Ii FEB 19 2003 Mockaville, NC 27028 (336)751-876 0 JUN 1 4 20�( , Is RMMMSEMPLICAT ON CANNOT BE PROCESSED UNLESS ALL T RE D I I ' r to the IMRMATIOH BULLETIN for i atruat�EN UAVIEC_ / OUNIY 1. Name to be Billed /� e ? ld �/ Contact "coon 01,14-t E MAddressrG3 ?10111� )i t Homs Phone /6 City/state/RIP 1411,1154wil, n,.� C. business Phone 7. Name on ?emit/ATC it Different than Above flailing AddressCity/state/Rip 3. Application For: @// Site Evaluation ❑ Improvement Permit/ATC ❑ Both 4. 6yston to services O'*'-Houas ❑ Mobile Home ❑ Business ❑ Industry ❑ Other �� •�• 5. If Residence: # People 1 Bedrooms 1 Bathrooms ❑ Dishwasher ❑ Garbage Disposal ❑ Hashing Machine ❑ Sasessant/plumbing ❑ Basamant/No Plumbing 6. If Business/Industry/Others Specify type i People f sinks 1 Commodes 1 Showers # Urinals ! Water Coolers II' IWDSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ta'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? *"*IMPORTANT*** CLIENTS MUST COMPLETE TIIE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: �o 1�2, re15 4 Tax Office PIN: 5 — 5 31 ' 3 Property Address: Road Name /6 cvr- S City/zip }�cIN9'Vee, JJZ ,( If in a Subdivision provide Information, as follows: Name: P�,f ��,_ /I_ � Section: Block: Lot: 3 S WRITE DIRECTIONS (from Mocksville) to PROPERTY: vy� —rA— D-7-1,91 4-13y,,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 falsified or changed. I, also, understand that I am responsible for all charges Incurred from this appllcadon. 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. a/ DATE �, — 4119/ 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). 0 Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EIIS: Account No. 13 Invoice No. 3 X'/ 7 • , DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.35 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 356 Reference Name: Location/Address: LISHighway 158-27028 Proposed Facility: Residenc Property Size: see map Date Evaluated: (23 Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit / Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % 2c HORIZON I DEPTH O —11 Texture group C L-- C Consistence 5S Structure Mineralogy! HORIZON II DEPTH 1 t 4_0 Texture group C t Consistence Ecswv Structure Mineralogy 1 I HORIZON III DEPTH ' Si Texture groupC Consistence Structure Mineralogyt HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 5 S LONG-TERM ACCEPTANCE RATE0--3S I SITE CLASSIFICATION: 1'S LONG-TERM ACCEPTANCE RATE: Q' REMARKS: LEGEND Landscape Position EVALUATION BY: Jct -t`- &-nJC j1k V' OTHER(S) PRESENT: 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) q,,3 3-t 2 q3.,o /I hTrl I 16 QS Z 30 76-L 00 puG 4 QrnROsI�"aU1 )N FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. the INFORMATION BULLETIN for Refer toy� instructions. 1. Name to be Billed 5'7�'�34F oy of �hte�"-' 0/ 4' e4 -eV ntact Person 'h s'{✓" I Mailing Address P0fJey Home Phone ^�41ae�D — r-�Ot?City/State/ZIP Clt-AikhQi9S r/c Z;7 Business Phone / 7X0� aq� / 2. Name on Permit/ATC if Different than Above, Mailing Address City/State/Zip 3. Application For: ❑fSite Evaluation ,Improvement Permit/ATC ❑ Both 4. System to Service: QI" House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. Type system requested: (conventional ❑ conventional modified ❑ innovative 6. If Residence: # People # Bedrooms _3 # Bathrooms ,, / //' �,/ for '/11�iT h MDishwasher & Garbage Disposal MWashing Machine IR ❑Basement/No PlumbingjH &Sem 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: County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes /XNo 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: 1 q Y 303 WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # 0�/S�J �Jf r& ��Oft�n°{ 14/e,yy'rt 4e1� Property Address: Road Name 3,20 1"'wl %fin, O .De 1, �a J h/���i U<✓e City/Zip ./70�dAr1L� �7a0G LOt �%OtYI r)l�% P^rt /7/Li 1%7 If in a Subdivision provide information, as follows: / Name: / l f° &Wyl t4/4 Section: Block: Lot: 3,'513 Date home corners flagged: f 2 y� 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 ani responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the DavieCounty Health Department to enter upon above described property located in Davie County and owned by '941011 -ed- A- Ae-ic%w to conduct all testing procedures as necessary to determine the site suitability. DATE (-2- q"Q 1/ SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). 71t-�d ]_ - 44- el� C��— Sign given �- �% 5-,0 7 Revised DCHD (05/03 rlo�&J 0%2.7 J -4 ,J Client Notification Date: EHS: Account No. Invoice No. f