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134 Glenwood Rd Lot 15 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990003850 Tax PIN/EH#: 5726-57-8401.15 Billed To: Comfort Homes Properties Subdivision Info: Meadowwood Section II Lot# 15 Reference Name: Scott Corder Location/Address: Glenwood Road-27028 ATC Number: 4304 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 CONSTRUCTIOIN IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: / / Date: 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. 9 9' Septic System Installed By: Cy T Environmental Health Specialist's Signature: Zd _ Date: 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 #: 990003850 Tax PIN/EH#: 5726-57-8401.15 Billed To: Comfort Homes Properties Subdivision Info: Meadowwood Section II Lot# 15 Reference Name: Scott Corder Location/Address: Glenwood Road-27028 Proposed Facility: Residence Property Size: 1 acre **NO I sl mprovement/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 1 l 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 J/ #People #Bedrooms _ #Baths Dishwasher:lv� Garbage Disposal: ❑ Washing Machine, Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow(GPD) —J Site: NewE JRepair❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width ?!; Rock Depth Linear IS Other: Required Site Modifications/Conditions: 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...mm.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.**** .� �/�I � t. �►�'�1�� fir �`v��5�on ��� m r a �ra .P(OV oto Sy� Environmental Health Specialist's Signature: lV / Date: Wo P 1� DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ' P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 I�I� (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003850 Tax PIN/EH#: 5726-57-8401.15 Billed To: Comfort Homes Properties Subdivision Info: Meadowwood Section II Lot# 15 Reference Name: Scott Corder Location/Address: Glenwood Road-27028 Proposed Facility: Residence Property Size: 1 acre **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 011� #People,, #Bedrooms #Baths Dishwasher Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow(GPD) Site: New 0"' Repair❑ System Specifications: Tank Size/Q/-WAL. Pump Tank GAL. Trench Width—Z2. Rock Depth 1211 Ft.:�/,::�e)� Other: As stated in 15A NCAC 18A.1969(5) accepted Systems may also be use Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EF LUENT FILTER RISER(S) IF 6"BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davieounty 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 i stallation. Telephone#is(336)751-8760.**** Qd � `p! n i°✓ l� Environmental Health Specialist's Signature: I Z7Date: DCHD 05/99(Revised) 91/29/2006 11:46 7848720059 PAGE 81/02 +. -a Ua:Lop claws etsunty onuhealth 336 731 A786 p.2 APPUCaitON FOR SM EVAUATIWjj ilplloNEI ENT pM,I r yj ATC 0xvie toueriy ffaalttl t om bnent 67"WRA Y,t3//1dalm Secavy P.O. Bo: 868/210 Uxwpital Sty Wockavli.ls, vc '.7028 (336)751-87CO ♦feSbttaCSTA>oX'"►e =15 WVZaZCASZON CAMWT 28 P>20CE.?M URZM93 LTr:i Tug M QUU= X21"IU/AMN ZS PRDBIDBI?. Refar to the ZI/U'(I M7Pi0N SULL$rXlr £a: ineCxvetiono. I. aaae tm be allied Co Omtoct vertmu_ 11e111V Mer—S 0 escyletaealszr ��A?�S`✓.1�P f„!!'�X6e�'.� s,uiuses st,onn.�����!1;,�� v�•� a. aero m esrait/ASC At Aitrb'aat WW nb— XmUing a4k roar S. 3ppJ.1ia11au Ars 17 Site 2vA1LAt3om 11 moth 4. flat to serviae. D ifouma mobile ifoma r1 8tuiaesa 0 iaduotry D ether _ � JAN 2 0 2106 S. Typo ara.tm�requeetade XC.o.etieel/ n eomrentitaul modified it-1— t3accapt_ed s. ltiden .e s Poop-'a Bedrooms At INVIPONA'JannAfCQSher Examagaols?osal 9M� 1qtachina Clasepot/Xlumbtny Ouaauant/Ho pxw*Ang h� v�r��ef7 7. It 8arineeaJTndwtry/OGMre verity tyPe�.r_•„ 1 PoaFlo, 1 ai.Scs 1 cosmodaa 1 Showers 1 urinals 1 motor Coolers TF rOOPSSRVZCN; iiSZQ-ty/city Zatil ated ,later VAnge (aal2:oaa pot dare A. Typo al a %er,apply: Iii ❑ m4u D e a, Mity 9. ne yes—ticipat.e"itien. .s expamieas of the fitaky this sj^1tdd is Wended eo erre?l3 Yes *N- 1(yrs, )That t)'(rc? __ `•`IMPORTANT" CL 10 nUVSTCOMPLETLTIIF.Wtlle:C.0 PROPERTY INK*WIAT10N REQUESTED UXLOIY. rimer a PWT or3TM?LAM HMTaESD8DfM7Day mectlent yr10tT1U3atPPI.ICAM(M. Proputy lliuttesima: ���ASC Q��r7 IYRr'E DIRECTIONS(fron Moci:svllla)to PIiOPCRTY:' Tax 015ce YIN: Yrrpe:tynddses�:V�ae�����7�{71[Lp�t,rev� W �a�i,�¢����1`fie��,� ��rvm Jen►sea 1P.� ao ��,.tte�►ay Rd` If ie a Subdivision provide informilon,a WS �d /., les n nI j 7Lf/L/4 Nemo: section: _ Stud;—.— Lot: 1 K Datt honsc toracrs tla�rd: !a3 Q.� �l 116 is to t:tr(ify WA the inO malfiou provided is to..et to rite best of sly k"wled;e.1 unAntand that any perndl(s) issued hereafter ora snh fret to ausireuslou or revocation,if the site p1as.or inteuded use c1luge,or if the lnfonnstion subadtted in ibis application is fahiried or changed.I,tarso,amder wad that/oar all charzes uresmd from ifiit eppkcefiea. I,kemby,give ovist at to tie Aailioriod Representative of the Davie Cattail,Staph DqurswcW to enter opou alcove described property located in Davie County and an ned by � to conduct all lesOug proceedd�urm as t seessary to delornitlle the site sui //' DATE 1 % J O- SIGNATURE 1•=ARBA IMAY IIS USED FOR D"WINC YOUR SITS P (Iurlode AA of the follolr.:as: kt;rlsting alid tempo-d property Unci and dimeas'ioust structurest setbacks,and septic locaaoits). _ Site Itevlsit Charge Date(:): Clicut Noliticadou Data: EfLT:•� fit sign given__ Actmut No. L39V`y Revised DOW(05103 ` Iuvotce No. 01/20/2006 11:46 7048720059 PAGE 02/02 ._. ..,, 1:..v AAA vov ova um ruanK UMLIM MY �DOZ1D03 N t CardN shot••�t•1111•ra 1aPU zoom• O s•s�nae O faaordaraa.• O�e«n�w.Faroe�s', ; {D�aw 2oomFada<:���Q R>OIu•Se2+ah�� Oro.aa>mct A 8OUIldiry °canes To '6. Cfytt ' x286 83 a * F p grave tam Q, Ft18q? { sraaasr ? O re.e zany �-..�. IS mum aye jIC=33P7 t1 Orirawrgs �� ❑tuOLtr• N ParqW Data F-wd Ad14Efl=tends 13Iw, Pty ' • ianauuirT�UOtoMora>L:r [7c�••a • Deed Ooob/+eyer00397lO8'f) 0nit AMm • Dadf2LAUf?D4 • CamtplQ•L1QtDA0b15 • Snloa t�`q.•1d.00 13 Fire • Atmn►tr�'r7.38 • 1°!Cp•rlyAdtbesS �Sci�ool6 • Loyd UOT 15 MFADOWM • C"IY&A no'w" I • Qww/arae:BARBER"TW LPE ETAL • C•nwrt Cod•, 1 • !)+ r�4MMse•f AM"MA""cr:f f7Al � • CApfAXMr; • O~Atldt•ae 7.6APtWR 0".AMA • Pf4bkt S%1DLEL'MEE/iFE i ��a•Mvist+�w • oww%4*""3-t=JERXW CHtxtC"ROAD • Fbad Zone:ZONE X twenaay of no I • Clq MvtaZbr VOCKMLIE.NC77tas.4xr6 • Fowd 00mapmr.370309 +MCliia onntp9ee res+ •ed eeo.uw•c c • BLA*w Vow WOO- P Fbo0 Aft 0m,'t1 7T 1993 tardy r�edA TION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Vv Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street !� Mocksville, NC 27028 ODM ( (336)751-8760 v�R �cA ***.TMP T*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED V'HF0fQTION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. ' 1. Name to be Billed / i / ��� /�� /(✓ Contact Person /�j' 4'6jj/L,/{�Ll�• Mailing Address 7 tU o V `�//t 1 G (f '�e() _ Home Phone _T_36 — /-7S—/ z City/State/ZIP v ( L Z ,g,8usiness Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. System to Service: ❑ House t0—bile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms _ 3 # Bathrooms ? W- ishwasher LI Garbage Disposal 1 ashing Machine 1.1 Basement/Plumbing LI Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ounty/City ❑ Well ❑ Community o. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes Q-W If ycs,what type? ***IMPORTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with TIIIS APPLICATION. Property Dimensions: WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # 2,5, - /f�/J - c ��✓I t c, Property Address: Road Name_� ,�Cont �%( — _ ..h City/zip.� �QC.I�r�rV! t .�C __L / �'1•i/tom //til d..{, If in a Subdivision provide information,as follows: Name: ///6,4ZOBJ d ``� �I1aof ���cYDC✓r/ C ' �Jc9✓ - f tc � Section: 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 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 ant responsihle 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 testi g proce ures as necessary to determine the site suitabili DATE 3 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 Date(s): Client Notification Date: EHS: . gy o Account Noa t t O 1 Revised DCHD(07/99) Invoice No. ' •' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SQil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001004 Tax PIN/EH#: 5726-57-8401.15 Billed To: Martin Lee Barber Subdivision Info: Meadowwood Two Lot# 15 Reference Name: Location/Address: 7028 6 IBNwood b/'v Proposed Facility: Residence Property Size: see map Date Evaluated: 2- Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit-FCut FACTORS 12 3 4 5 6 7 Landscape position Sloe% /i HORIZON I DEPTH �- �� Texture groupC.L Consistence Structure Mineralogy HORIZON II DEPTH Ile Texture group Consistence / Structure Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 6Z 1 LONG-TERM ACCEPTANCE RATE �7 SITE CLASSIFICATION: r/✓� EVALUATION BY: /Ylrl/ LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: �Y � 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 Z SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky Q SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1,2:1,Mixed tIV 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) 05/23/2006 10:02 7048720059 PAGE 01/01 c.v.ow o+wi4V A-Auolnu�vu cca , Mocksville,N'C 27028 (3361751-8760 7$) Y7 JV MP1ZQV N1E T/0PERATI0N PERMIT Account #; 990003850 TaX PIN/GN#: 57:%6-57-0401,15 Billed To: Comfort Homes Properties Subdivision Info: Meadc wwood Section II Lot A 15 Reference Name; Scott Corder Location/Address: Gkonwood Road-77028 Proposed Facility: Residence Property Size: 1 acre GR' A,,lihLaptovve30ent/Operation Permit DOES NOT authorize the construction of a seatic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION gust be obtained from this ,Department prior to the construction/installatirn of a system or the issuance of a building permit(in compliance with Article I I of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatnnent and Disposal System's). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE TIDS PERMIT BEFORE INSTALLING SYSTEM. tesidentialSpecification: Building Type—e!� TPeople—� 9&drooms. 1Baths, Iishwasher:19� Garbage Disposal:0 washing Machine: Basement w/Plumbing:Cl Basement/No Plumbing: ,ommercial Specification: Facility Type __ #People_ #People/Shift #Srau Industrial Waste:0 at Size Type Water Supply _ Design Wastewater Flow(GPD)—����_ Site: New Z! Repair 0 yste,n Specifications: Tank Size_GAL. Pump Tank_GAL. Trench Widths Ro:k Depth Linear Ft,zO�_, Other; tequired Site Modifications/Conditions: 1NIPROVENIENTIOPERATION PERMIT LAYOUT_ APPROVED EFFLUENT FILTER. RISER(S)IF 6"BELOW .!Ni,5)iED GRADE. ~^VOTICE: Contact a-representative of the Davie County Health Department for final inspection of this system between 8:30 a.m.to 9:3 a.m.or 1:00 p.m.to 1:30 p-m.m the div of iastiallatio n. Tele=phone#iss((336)751-8760."""" �/,:Vs't'✓ ivy + Environmental Health Specialist's Signature: 1/rf J _ Date: )CFD 05r99(Revised) r t t��-000/, , &�q- 0a, 70Ll _ ? a , � �, 5�-