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152 Glenwood Rd Lot 13 i DAVIE COUNTY HEALTH DEPARTMENT ,, p Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 _ (336)751-8760p�. IMPROVEMENT/OPERATION PERMIT Account #: 990003228 Tax PIN/EH#: 5726-57-8401.13 BH Billed To: Bob's Home Place Subdivision Info: Meadowwood Lot# 13 Reference Name: Location/Address: 152 Glenwood Road-27028 Proposed Facility Residence Property Size: see map ATC Number: 3974 **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 #People #Bedrooms #Baths V _ Dishwasher: vr- Garbage Disposal: ❑ Washing Machine:0� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply t4 6 Design Wastewater Flow(GPD) Site: New M Repair❑ System Specifications: Tank Size%GAL. Pump Tank GAL. Trench Width,_�Rock Depth Linear Ft&O Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISERS)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.**** p10 � h /7/ L"A � � Environmental Health Specialist's Signature: Date: DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990003228 Tax PIN/EH#: 5726-57-8401.13 BH Billed To: Bob's Home Place Subdivision Info: Meadowwood Lot# 13 Reference Name: Location/Address: 152 Glenwood Road-27028 Proposed Facility Residence Property Size: see map ATC Number: 3974 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 CONST UCTIO IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: G 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 1 I 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. S�t',�u eo — Septic System Installed By: Environmental Health Specialist's Signature: Date: 1 DCHD 05/99(Revised) 7sr-3y/�' ` D EC E P W Lr, J CATION FOR SITE EVALUATION/IAiPROVEAIENT PERMIT&ATC I � U JAN 1 Q 2005 Davie County Health Department J _ C f i EnvironmentalHea/thSecGon V �t5 I P.O. Box 848/210 Hospital Street ENVIRONMENTAL HEALTH Mocksville, NC 27028 DAVIECOUNTY (336)751-8760 ***IMPORTANT*** THIS APPLICATION CAhWOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed _ OBS ,le 0,'"Z 104"01'.E Contact Person O.dl Mailing Address r_ Home Phone City/State/ZIPOG�l Dusinoss Phone 3-r 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip E�� T 3. Application For: Site Evaluation Improvement Permit/ATC ❑ Both 4. System to Service: ❑ House ❑ Mobile Home (((❑ Business ❑ Industry E Other 5. , Type system requested: L7 Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People ?� # Bedrooms _ # Bathrooms Z- ishwasher ❑Garbage Disposal Gbrashing Machine ❑Basement/Plumbing ❑Basement/No Plumbing 7. If Businenn/Industry /Other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolors IF FOODSERVICE: !! Seats Estimated Water Usage (gallons per day) S. Typo of water supply: C -County/City ❑ Well ❑ Community 9. Do you anticipato additions or expansions of the facility this systeIn is intended to serve?❑Yes 01Y0 If yes,lvllat type? ***L1IP0RTAN2-***CLIENTS hfUST C0hfPLETE TIIE REQUIRED PROPERTY INFORMATION REQUESTED • - BEL01V. Eithera PLAT or SITE PLANMUST6ESUBRITTE�DD by the client with THISAPPLICATION. Properly Dimensions: /40 Z 2 2— !C o X 2SW%1TE DIRECTIONS(from Aloclavillc)to PROPERTY: =OfriccPIN'- # `7v� — 7—S yo /3 all J ePZ Property Address: Road Name City/Zip 04'rd-2/ If in a Subdivision provide information,as follows: Name: _L'I�C Qnky Oa 1' 57 Z Section: � = Block: Lot: / Date home corners flagged: Z-7 This is to certify that the information provided is correct to tiie best of my knowicdge. I understand that any permits) 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 clianged. I,also,ruulcrstaud AralI aur responsible for all charges iucmred front this application. I,liereby,give consent to the Autliorized Representative of the Davie County IIealtll Department to enter upon above described property located in Davie County and owned by AJ}/Cjr6 ,4 "'z7 rr ;;zz to conduct all testing procedures as necessary to determine t11e-site suitab' 'ty. DATE SIGNATURE TRIS 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). J �G/Q d0i3 Site Revisit Charge Client Notification Date: ' EHS: Sign given Account No. Revised DCII (05/03 y' s Invoice No. �ps I i L I�lj111 I *4p (W t LOX 2 I I I LOT \ I AfEADOWOOD SUBDIVISION .� I PL-DA 7, PC. 136 AC. d S 88.31'50 E ZONED R-IC) ExiSnNG S 88'28'17' E RERAR 220.07 \ 3/4" ExiSriNG 129.49 LA IRON L2) s A AN== 0.945 AC. s AC. _ N n o' ' w 40. w� , ROBERT WHITAKER �— i riE'N . S 85'23'15' W SRO" p `N �L a D.B. 104, PG. 28 C2 % \ 222.19 cv N Raw AREA 0.956 AC. • �, —C7- C� i �� EXISTM,, DRIVE ui 2 r '1 0 m 2 69.2 o \ A >4 o . ��, W14 667 CD -- oNapN EAL J. p�. 0.809 AC.4',.,o �g5 a \ 1 i NOTES: I i 1. 7 TOT �\ 2. MINIML I 1 3. TOTAL I 4. AVERA. E g I 1 5. SUILDI 1d1�G. 6 6a I 1� Y 6 I6. SHALL 7.YG. I F ` 7. 50' Rt; r I 8. 50' RA 9. 35' n TION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Health Department ti0�2 Eiivironmenta/Health Section / P.O. Box 848/210 Hospital Street Mocksville, NC 27028 oNM (336)751-8760 ***IMP T*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED UW0f9MTION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Ir /L Contact Person . Mailing Address I Aa �.l("//C 1 G �{�VKfI �[� Home Phone 1-7 4 City/State/ZIPy [ C Z ,�:�usiness 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 obile Home ❑ Business ❑ Industry ❑ Other 5. IfResidence: # People # Bedrooms _sem # Bathrooms 1.I-Dishwasher I:I Garbage Disposal C ashing Machine LI Basement/Plumbing 11 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 a. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes V-PdS` If yes,what type? / ***IMPORTf1NT***CLIENTS MUSTCOMPLETE THE REQUIRED PROPER71-Y INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMI7TED by the client with THIS APPLICATION. Property Dimensions: Y2 .dx&g, WRITE DIRECTIONS(from Mocksville)to PROPERTY: Tax Office PIN: # � oZ�-- �=_�'T v A � e/ /c Properly Address: Road Name_S 1c�,�CC�/)p�C /L( — — ^-e ' City/Zip C . 0__ _ G J_ /1-74/ / l/i 2,76 L� ' If in a Subdivision provide information,as follows: O/ Name: jE.4-bOIc.J 0� `-� �>1c��! _� ZD"�Yf1C✓d C — �C ✓1`"'G`- f rG�:�� Section: 1,r 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 am responsible for all charges incurred from this application. I,hereby,give consent to the Authorized Representative of the Davie County:Hcalth Department to enter upon above described property located in Davie County and owned by to conduct all g proce ures as necessary to determine the site suitabili '37 DATE 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: Account No-77 /06 (-/ Revised DCHD(07/99) Invoice No. " DAVIE COUNTY HEALTH DEPARTMENT - `• �' Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001004 Tax PIN/EH#: 5726-57-8401.13 Billed To: Martin Lee Barber Subdivision Info: Meadowwood Two Lot# 13 Reference Name: Location/Address: Junction Road-27028 Proposed Facility: Residence Property Size: see map Date Evaluated: ( 9 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe% HORIZON I DEPTH r• Texturegroup �_ _r G Consistence Structure Mineralogy HORIZON II DEPTH ` Texture group Consistence Structure `/V Mineralogy , HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION ZEIN LONG-TERM ACCEPTANCE RATE p SITE CLASSIFICATION: EVALUATION BY:/Q �O. _ �1• LONG-TERM ACCEPTANCE RATE: i r" OTHER(S)PRESENT: REMARKS: `- 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) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■��-■�■iii■■■■��■■■■■■■■■■■■■■■■■■■■■■■■ MENNEN iiiiiiiiiiiiMGAMMMiiiMENNEN ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■