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329 Longwood Drive Lot 43Account #: Billed To: Reference Name: -o DAVIE COUNTY HEALTH DEPARTMENT ,pd 2' 2 Environmental Health Section V P. O. Boz 848/210 Hospital Street �� ( / Mocksville, NC 27028 (336)751-8760 990002436 Tax PIN/EH #: 5861-59-5239.43 DB Darren Burke Constr. Subdivision Info: Redland Way Lot # 43 Location/Address: Longwood Drive -27006 Proposed Facility Residence Property Size: see map ATC Number: 3906 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 WASTEWATE TI IS V A PERIOD OF FIVE YEARS. 4 Environmental Health Specialist's Signature: Date: l� Z1i 7 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. i AV- b-rwV-x!� 11 'I-[ Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) tip pu-la--T r� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002436 Billed To: Darren Burke Constr. Reference Name: Proposed Facility Residence !,On f,I2_Zj-0L( Tax PIN/EH M 5861-59-5239.43 DB Subdivision Info: Redland Way Lot # 43 Location/Address: Longwood Drive -27006 Property Size: see map ATC Number: 3906 **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. � ��,, rr�.�� Residential Specification: Building Type CLrr #People 25 #Bedrooms C5 #Baths Dishwasher: Ef Garbage Disposal: 2"' Washing Machine: EY"' Basement w/Plumbing: Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ 1 Lot Size Type Water Supply DOS Design Wastewater Flow (GPD) Site: New Repair ❑ System Specifications: Tank SizeIOD©GAL. Pump Tank I©COGAL. Trench Width 5k; Rock Depth 12: , Linear Ft. Required Site Modifications/Conditions: I j{� Vin' N�)4c d- t� A 1& 0, 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.**** 600 43; _ Q 5 � 8 Environmental Health Specialist's Signature: DCHD 05/99 (Revised) -#�'0,�Qt�-r6c � zr\�jr �L� 4D (2�91&iQ tau "uez 9mve) L-"�'rt0j S,q-( c:�`--- ie�'N - M , t 0—� (a of BAC40AQD —)11 Ocut 20 04 02:23p Darren Burke Construction 336-778-0436 Jun 10 03 11:14a davie County envhealth 336 751 8785 p.2 J . AnM"JMN 1Uit Saf EVALtAYMN/IMPROVEMENT MUM Jr Al G Davie County Health Department L7P*Pzmwrtd///es7W SetWw P.o_ Box II6/210 Mospital Street Yocksville, WC 27028 (336)751-8760 e••IXPORI'ARr••• TttIS APr1.ICATI0N C LM&r W P"CESSED U=SS ALL THE REQUIRED WFONUTION 15 PROVIDED. Refer to the naoitmATIOH BuJJz= for instructions. 1. Nara to be Ail led Q it O �taet Psrsm /� '1 ''nn„ 1 �•+'� �l7llJ''C� nailing A4dcgs(IN t Yore Phone •C ( �� «ty/Aute/xIP t, �S (V D swaasr, smn. %- ( O. 2. We m #etch/Arc if i}lttecwtl�thhenn abew .r„– netlisa access. –_��y�r 7/O •`--- CSCYIIItata/iiP _.. ...._ __ 1. Application Dor. Site :avalvation C Zmproveeent Permit/ATC ❑ Sotlt 4. systa to IArviee. 0/1.04 Q Nobile Home ❑ Business O rndaatry D Other _ S. type Arisen re"Ortea. 1)YCmvmtion•l 0 ceoreotioaal so6itled ❑ lasavativo • �• f. IjW / People ,S, I Sedi�OO/mIi _3 A Bathrooms_ ✓ �l�Aesidewca:/ idbisbvasber, t — �sbeys aiaposal S7MiWaq dee ins tUbasasest/P1mbl.9 onasesent/No Plu..bing 7. It IuaiseWIMurtry /Other. verity type I People a sinks P Comudes I Sbowere I artna).e a water Coolers _ rr DOODSRRVICS. d Seats Ust3mated Nater Usage toallons per dayh T–. S. 'Type of wter MW9171 04ak'nt:y/City ❑ Mail ❑ COtmssnity s. no you anticipate a"I tions or expansions "the facility this system Is Intended to serve? ❑ Yes &IVo If yes, what type.. 11elAlp0RTAM"•• CLWr-SMUiTC0MpUT5THe REQUISW PROPEICPV HtP'ORMATtON REQUkSrLv I OELOW. Ener sMAT orsit'EPLANAILOTRESURAUMEDbythe diest with THISAPPLICATJOM Property Diatensio+ss. f IJP PU t P Ta: Office PIN: I -5-9 Property AddF Asad Kama -t7 3 LO/lAW(�'�fift _ r . if in a Subdivision provide lotamwion, as follows: Mine;�` �%�l ! 1 1 Q� Aja � Section: _ Dusk: i Lot* IJ 1vRrrE DPREC*nONS (firm APoe6sro pe) Pe PROVEht'f V; �J' • Y 2 - -� e 11) Date home corners (la=cd: i v p.4 Q oCr 2 0 Z404 vVV� D�� fCO� ✓�NW This isto ccritfy that theinformatioa arovidcd Is correct to the best of my knowietige. I auderstand that any persnil(s) issued bertaRer art subject to tospeudw or revocation, if the site pians or intended use snags, or if the Infennatiou submitted in this appiiatlon is (&Wrw.d or cb=gc& I, also, rrsdawand that ! ase rrspawsible for all charges inurrn-d from this appikarion. f, hereby, give to sent (o (be Autkarized Acpresen(ative of (hc Davic-,Cooanity 1Jea1Ut DcrGneai to eater upon shoes: described property located in Davie County and o%rrml by � hF3Y �� _ j�.11�__. __. . (6 to conduct an testing prose orres as necessary to determine the site suitabi)i DATE ID Lau &A SICNAT(TRE THIS AREA MAY BE USED FOR DItAVVD(G YOUR SITE PLAN (Include sit of the followiut: Existing and proposed property Uses and dlm--Jons, structures, setback:, and septic locations). Sign glum Revised DCUD (05103 Site Revisit Charge at Notification Date: is Account No. ` Invoice No. J L/ Ocx 20 04 02:23p Darren Burke Construction 336-778-0436 p.5 N 3'1539" E 145AQ / 1.ot 43 so I r 57 N fn fJ O V � p d N V G-290 rQCb m lair CA �ssr 4ze� 2D.fW 1 4 � r r 1 �r �r r 1 �•YEa SOMW ��,' R=12i5.Q0 Lmgw00d Ibive P mposed layout For Lot 43 RedWW Way Phase 2 PB 8 Pg 108 Seale i inch = 30 feet .! �• '`P. L. FEB 19 2003 E EVALUATION/IMPROMIENT PERMIT & ATC County Health Department ronmenfal flaalth Stadion e 848/210 Hospital Street ckaville, NC 27028 (336)751-8760 ***ZIdppRTANT*** ET UZPPLICATICANNOT BE PROCESSED UNLESS ALL INfORM)a7DN1-ff PROVIDED. Refer to 1the /JINrORMATION BULLETIN for 1. Name to be Billed?�T 11p11pJ Dote:a[] 1 Mailing Address 63 IQ City/state/EIp D/1/ A/C', 2. Name on Permit/ATC it Different than Above Mailing ]Address 3. Application For: @ Site Evaluation t. system to servieet O'—House ❑ Mobile Home s. If Residence: # People Contact Person Hess phone Business phone JUN 1 4 20;11 RzLuMED tructfA3t,wi-WEN vit OUNlY c" _ - rY- City/state/Zip ❑ Improvement Permit/ATC ❑ Both ❑ Business ❑ Industry ❑ Other # Bedrooms ❑ Dishwasher ❑ Garbage Disposal O Washing Machine 6. If Business/Industry/others specify type # Commodes # showers ❑ Basement/plumbing # people — # Urinals # Bathrooms ❑ Basemant/No plumbing # sinks # Water Coolers Ir rOODSERVICE: 11 Seats Estimated Water Usage (gallons per day) 7. Type of Water supply: 9"County/City ❑ well ❑ Community a. Do you anticipate additions or expansions of the facility this system is Intended to serve? 0 Yes 0 No If yes, what type? 111"IMPORTANT"* CLIENTS MUST C1OMPLETE TIIE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: _ 6 5 &. r&S -7 WRITE DIRECTIONS (from M/ocksviile) to PROPERTY: Tax Omce PIN: # Property Address: Road Name N'uJC S T rjjli 5 city/zlp- t�c�l�f9z�ee,-� , If In a Subdivision provide Information, as follows: rj`j'l — D — 7 " 4- Name: p 4C,( /.' A- � Section:Block: Lot: 3 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. 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 suits pity. DATE — `r �f SIGNATURE 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). a Site Revisit Charge Date(s): I Client Notitication Date: I EIIS: Account No. Revised DCHD (07/99) Invoice No. • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5861-59-5239.43 Billed To: Westview Development Co. Subdivision Info: Redland Lot # 43 Reference Name: Location/Address: USHighway 158-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: Evaluation By: On -Site Well Community, Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Co Texture groupC Consistence r �5 Structure C Mineralogys HORIZON II DEPTH Texture group — Consistence Structure MineralogyI 1 HORIZON III DEPTH 1 • y Texture group_ t Consistence ' Structure MineralogyI HORIZON IV DEPTH Texture groupL Consistence Structure T' Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE 0 •'?,, -O• . 3 SITE CLASSIFICATION: P5 LONG-TERM ACCEPTANCE RATE: EVALUATION BY: '� I OTHER(S) PRESENT: REMARKS: !� �Qa.�T nitl.D :1.itv1-i -� (3� �1��Q5�b�� A)MY lP—W Z4 -W 1�� Z FWi CrrL.3M 1,,)/ LoT '-4 2— %5, LEGEND 10 1>CA%'1 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)