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130 Merry Lane Lot 13 • CONSTRUCTION For Office Use Only AUTHORIZATION "CDP File Number 200512- 1 = Davie County Health Dep County ID Number:5788165014-13 � 210 Hospital Street A�'�iLED Evaluated For: NEW •.,,.. P.O. Box 848 Dau: Township: Mocksville NC 27028 PERMIT VALID UNTIL: Phone: 336-753-6780 Fax:336-753-1680 0 6 / a 1 / a 0 a 1 F ant: Michael Chamberlain rAddress: er: Michael Chamberlain ss: 2224 Catherine's Way 2224 Catherine's Way Cay: Winston-Salem City: Winston-Salem State2ip: NC 27103 State/Zip: NC 27103 Phone#: (336)399-3703 Phone#: (336)399-3703 Property Location & Site Information r ss/Road#: Subdivision: MerryBrookAcres Phase: Lot: 13 ry Lane ance NC 27006 Directions Structure: SINGLE FAMILY Hwy 64 east, left onto Hwy 801 left on Merry Lane #of Bedrooms: 4 #of People: *Water Supply: PUBLIC System Specifications Minimum Trench Depth: a 4 rDesign ssification: Provisionally suitable Inches Minimum Soil Cover. 1 a System? QYes QNo Inches low: $ 0 Maximum Trench Depth: 3 6 Inches Soil Application Rate: 0 - 3 Maximum Soil Cover: 2 4 Inches *System Classification/Description: 'Distribution Type: GRAVITY-SERIAL TYPE 11 A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 0 _ Gallons *Proposed System: 25%REDUCTION 1-Piece: QYes QNo Pump Required: QYes QNo QMay Be Required Nitrification Field 1 6 0 0 Sq. ft. Pump Tank: Gallons No. Drain Lines 4 1-Piece: QYes QNo Total Trench Length: 4 0 0 GPM—vs— ft. TDH Trench Spacing: _ 9 Onches Feet O C.0 Dosing Volume: _ Gallons Trench Width: — 3 @Inches Feet Grease Trap: Gallons Aggregate Depth: inches Pre-Treatment: ONSF OTS-1 OTS-II Septic Tank Installer Grade Level Required: OI Oil OIII OIV Dann 1 of Q CDP File Number 200512 - 1 County ID Number: 578+3165014-13 ❑ Open Pump System Sheet Repair System Required:@Yes ONo ONO, but has Available Space rDesign System Trench Spacing: Inches O.C. ification: Provisionally Suitable — 9 E03 Feet O.C. Trench Width: Inches w: 4 8 0 _ 3 Feet Soil Application Rate: 0 - a 7 5 Aggregate Depth: inches *System Classification/Description: Minimum Trench Depth: a 4 Inches TYPE II A.CONY SYSTEM(SINGLE-FAMILY OR 480 GPD OR LESS; Minimum Soil Cover 1 a Inches "Proposed System: 25%REDUCTION Maximum Trench Depth: 3 6 Inches N itritcation Field 1 7 4 5 Sq.ft. Maximum Soil Cover: a 4 Inches No. Drain Lines 4 *Distribution Type: PUMP TO GRAVITY Total Trench Length: 4 3 6 �. Pump Required: OYes ONo OMay Be Required Pre Treatment: ONSF OTS-I OTS-II Site Modifications No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. a "Permit Conditions The issuance of this permit bythe Health Department in no wayguarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. ; This Authorization for Wastewater System Construction shall bevalid fora person equal to the period of validity of the Improvement Permit,not to exceed five years,and may be Issued at the sametime the Improvement Permit Issued(NCGS 130A-336(b)�If the installation has not been completed during the period of validity of the Construction Penni;the information submitted In the application for a permit or Construction Authorization Is found to have been Incorrect,falsified or changed,or the site is altered,the permit orConstruction Authorization shall become Invalid,and may be suspended or revoked(.1937(g)).The person owning or controlling the system shall be responsible forassuring compliance with the laws,rules,and permit conditions regarding system location,installation,operation,maintenance,monitoring,reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? OYeS ONO Applicant/Legal Reps. Signature: Date: *Issued By: 2140-Nations.Robert Date of Issue: . 0 6 a 1 / a 0 1 6 Authorized State Agent: Malfunction Log OYes @Hand Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTRUCTION AUTHORIZATION 200512 - 1 Davie County Health Department CDP File Number: 210 Hospital Street County File Number: 5788165014-13 P.O.Box 848 Mocksville NC 27028 Date: 0 6 / Z? 1 2 0 1 6 L� Olnch Drawini! Drawing Type: Construction Authorization Scale: OBlock ON/A � i � � � I __f_ � I ��__I:�I 1 I� I � I_1. .......... i l l � ! j � I Ali -F-T- E E- -1 � Imo! I I I ! i I 2 Cj- I I I l i d-._._ I � � ��.� ___-.-I- I -- I ._ I I�-�-_ I I �_.__�i 1__ I I �_ � I_ I _1_�_I_ 11 1 1 1 i ! I l i l y I I I s _ I I I _� l i ��_ .I `_______ �-Ig�__I_ � �' 3 I- - I__ _� ! I I ISI C) 1 i 1 1 LI T 77t77i7= ------- ------- ------- 9� ------------------------ ------------- ----------- ----------- ...............------------ ...... ------------- ---------- -----------------............ ............ =777- CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street CDP File Number: 200512 - 1 P.O.Box 848 5788165014-13 Mocksville NO 27028 County File Number: Date: _06 / ai / 2016 Click below to import an image from an external location: Drawing Type:Construction Authorization IMPROVEMENT PERMIT For Office Use Only 'CDP Fite Number 200512- 1 Davie County Health Department 5788165014-13 210 Hospital Street County ID Number. P.O. Box 848 Evaluated For. NEW Mocksville NC 27028 Township: Phone. 336-753-6780 Fax:336-753-1680 PERralr VALID UNTIL: 3/17/2021 "NOTE TO INSPECTIONS DIVISION: Building Permits cannot be Issued with this Improvement Permit. Applicant: Michael Chamberlain Property owner: Frank McNeill Address: 2224 Catherine's Way Address: 121 Fescue Lane CRY= Winston-Salem Cay: Advance State/Zip: NC 27103 State2ip: NC 27006 Phone#: (336) 399-3703Phone#: Property Location & Site Information Address/Road #: Subdivision: Merry Brook Acres Phase: Lot: 13 Merry Lane Advance NC 27006 Directions Structure: . SINGLE FAMILY_ Hwy 64 east, left onto Hwy 801 left on Merry Lane #of Bedrooms: 4 #of People: *Water Supply: PUBLIC System Specifications /,—Initial System Classification:*Site Provisionally Suitable Minimum Trench Depth: a 4 Inches Saprolite System? QYes eNo Maximum Trench Depth: 3 6 Inches Design Flow: 4 8 0 Septic Tank: 1 0 0 0 Gallons Soil Application Rate: 0 3 1-Piece: QYes QNo Pump Required: QYes QNo OMay Be Required "System Classification/Description: TYPE 11 A.CONV SYSTEM(SINGLE-FAMILY OR 480 GPD OR Pump Tank: Gallons LESS) "Proposed System: 25°!°REDUCTION 1-{'iece: QYes dNo Repair System Required:QYes ONO ONo, but has Available Space pair System �.S7fteClassification: Provisionally Suitable Minimum Trench Depth: a 4 Inches Soil Application Rate: 0 2 7 5 Maximum Trench Depth: 3 6 Inches "System Classification/Description: Pump Required: @Yes O No O Maybe Required TYPE 111 B.SYSTEM W/SINGLE EFFLUENT PUMP "Proposed System: 25%REDUCTION Pagel of 3 CDP File Number 200512 - 1 County ID Number: 5788165014-13 *Site Modifications ❑ open Fill Sheet No grading or construction activity is allowed in areas designated for system and repair without approval of Health Department. 'Permit Conditions The issuance ofthis permit bythe Health Department in no wayguarantees the issuance ofother permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. Site Plan The Improvement Permit shall be valid for 5 years from date of Issue with a site plan(means a drawing not necessarily drawn to O scale that shows the existing and proposed property lures with dimensions,the location of the facility and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters). Plat The Improvement Permit shall be valid without expiration with plat(means a property surveyed prepared by a registered land O surveyor,drawn to a scale of one inch equals no morethan 60 feet,that Includes:the specific location of the proposed facility and appurtenances,the site for the proposed Wastewater system,and the location of water supplies and surface waters. Plat also means,for subdivision lots approved by the local planning authority and recorded with the county register of deeds,a copy of the recorded subdivisions plat that Is accompanied by a site plan that is drawn to scale). The Department and Local Health Department may Impose conditions on the issuance and may revoke the permits for failure of the system to satisty the conditions,the rules,or this article.This permit is subject to revocation if the site plan,prat,or intended use changes(NCOS 130A-335(fl).The person owning or controlling the system shall be responsible for assuring compliance with the laws,rules,and permit conditions regarding system location,installation,operation,maintenance,monitoring, reporting,and repair(.1938(b)} Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature-, Date: "Issued By: 2140-Nations,Robert Date of Issue: 0 3 / 1 7 / .2 0 1 6 OValid without Expiration? Authorized state Ag O Create CA? 01-land Drawing Olmport Drawing **Site Plan/Drawing attached.** Page 2 of 3 IMPROVEMENT PERMIT 200512 - 1 Davie County Health Department CDP File Number: 210 Hospital Street County File Number: 5788165014.13 P.O.Box 848 Mocksville NC 27028 Date: Q Inch ock Drawing Drawing Type: Improvement Permit Scale: . A ON/ QN1 : ! it 4 i ! , I I i i x ----------- ' i _ ...__..._._. t � _.__; __�3- � i i 1 .......i ,...._ _.,,_ ..._ � i I �.... 1 1 f 1 l I I . a IMPROVEMENT PERMIT Davie County Health Department 210 Hospital Street CDP File Number: 200512 - 1 P.O.Box 848 5788165014-13 Mocksville NC 27028 County File Number: Date: 0 3 / 1 7 / 2 0 1 6 L -LClick below to import an image from an extemal location: Drawing Type: Improvement Permit A f X` lip tits q63� .�---120 D , J. Lt oa7 � T P PAID APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT&ATC Davie County Environmental Health RECEIVED Date: ZI2311 G- P.O.Box 848/210 Hospital Street Mocksville,NC 27028 Date: Received by: PO J M (336)753-6780/Fax(336)753-1680 2 Z3 LP a� Application For: �1 Site Evaluation/Improvement Permit />E Authorization To Construct(ATC) D Both Type of Application: ❑New System ❑Repair to Existing System :]Expansion/Modification of Existing System or Facility ***IMPORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFFBORMATION f �+ Name / �I r+la- 9, Contact Persor�/ C. Address Z2:7cetj w Home Phone City/State/ZIP Business Phone Email/YI .<«� �GP.[.[r��.� �r�, G-vim.-- 4ii--- Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included:U Site Plan LiPlat(to scale) (Permit is va' for 60 ronths with e p) no expiration with complete plat.) Owner's Name n Al /Jlf Phone N her Owner's Address / f.SLU City/State/Zip A` ,o Property Address Gl-t! City Lot Size 3 Tax PIN# Subdivision Name(if applicable) Section/Lot#�� Directions To Site: D) If the answer to any of the following questions is"Yes",supporting documentation must be attached: Are there any existing wastewater systems on the site? _Yes KNo Does the site contain jurisdictional wetlands? _Yes�`No Are there any easements or right-of-ways on the site? _Yes'5;?No Is the site subject to approval by another public agency? —Yes--No Will wastewater other than domestic sewage be generated? Yes'*o IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms #Bathrooms Garden Tub/Whirlpool I IYes o Basement: UYes.YNo Basement Plumbing: :]Yes-3No IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requestedV. Conventional ❑Accepted ❑Innovative DAlternative ❑Other Water Supply Type:YeCounty/City Water D New Well DExisting Well D Community Well Do you anticipate additions or expansions of the facility this system is intended to serve?E Yes No If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging or staki a house/fat ocation,proposed well location and the location of any other amenities. L/ !, Site Revisit Charge Property owner's or owne presentative signature Date(s): '7 -� .-1 Client Notification Date: Date EHS: Sign given I Yes DNo Account# �t/ 051-2,-, z v I Revised 11/06 Invoice# . .Jijn ^5 07 08: 30a davie countm envhealth 336 751 6786 P. 1 Davie County Environmental Health P.O.Box 8.181210 Hospital Street MocksvWe,NC Z7M (336)751-87611/Fax(336)75 i-8786 IMPROVEMENT PERMIT Account.#: 99DO043i 107 Jun a <iavie county enwhealti-1 33C ?Sl 87£1-8 P,2 V _ ,L>'I LI " Ti� FOR SITE EVALUATION IMPROVEMENT PERMIT&.ATC 1 -Davle Cmuty..&Vlroamnal Health P.O.,Box 8481210 Hospital Street 7►Mucksville,-0.270''.8 ��\E1o�FG (336)752-87601 Fax(3:46)7i;1+R7R6 ication For: L Site Evaluatiottl:sn•aovsment permit J-Authorivtion To-Construct(ATC) 718oth Tyvc ofApplication: GNew System !kepa:r:a F.xistinv Sye :n i lExpa:,sion/Modification oPExistine-Systein or Facility *�"IMPORTANTO"THIS APPLICIMON CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED MTOR1t.1ATION:S PROVIDED. P--f>_r to the IN-FG%''vW l'ON SULLE-M4 fo:ixstmctions. APPLIrCANT NFORMKrION I Name to be Bilied o P.w ly_�tl�.�._ Cu:ttact Fersttn ` I Billing AMmsa s� ,r lIvrae Phtt>ye _.a • ' O City/S�ttl:TP c 700(o Du liners Pho-ic I j Name on Pe.-mitI:TC if Ditrtru fan Abovc Mailing Address _ - City;State;/_ip PROPERTY TNF'ORMA"TTON *Date Rous::lI'acihty Corners 1-tagged --�� NOTE:"'A aarreyPUT or siteplzn nm:22eemrpanydiis application. •Inclt+ded:.,Site Plan ftl-lat(to sctrie) 1 M (P---=!E is valid for 60 nwail s with site plan,no expiration witI complete plat.) IOwncr'sNamec7 Ib:�+��+��< l� � �,,.:R.ft tg-g.i l.) .. Phone"humber33.(o- 999- _ i.it-/State/Zi _�(.fnt a��1 �� ; Owner's Address ��ir~v i�r,v-e- y r )C .�2 Pr t hddreas llclo�,. . t.ity �Neion ee )A _Ta;a PINS— _ jNatne(if applicable)farm � rE3 Sel:tiorlLoI Lit 12-+ 13 I Directions"T'a Site:�s-�(_,4Eza art !,FrA o� .OA l��} o�M a -,A Lame Lata o,� le; i —� If fha loswer to any of the followings•",qt is"yesupporting dccuncu:atiot- ust be Amched. I Are there any existing westcasster systems on rac site? OY1.:3 1I Does the€ire cotuain jarMtet ionalwctlands? t;rYes� oo i f Are there any easements or rij'1t-of-mays on fae site? i lYi.s�ti1So/ Is the sire subject to approval•)y another public agency? iYi s.tiigo Will wastexater othecthan do.nestic sewagtrbegenerated? Myt-s tu?Nb< —__- IF RESIDENCE_FILL OUT THE BOX BELOW _ #Pile 4 *BC&:0ms1'f 0 Bathrooms Garden Tttb/vJ!vrlpooi des ijNo j (I3tstsment: es El'�'o 13a.e, reni Plumbing UNo _ _ r�J �'40N-RESTDFNCF.FILL.01 IT THE BOX 13ELOW Type ofFaciiity/-Biisiness __ Total.StiureEootsge dD ildmg_ ?;Pru plc r_ *Sinks *Commodes Showers 4 Urinals I V-sanuared Water Usage(gallons per dav)^_..r. (Attach docnrnenntion of similar facility water WnsurT ptiot.) FOODSMVICE"ONLY: Seat: r-------_ --- Typcsys'xm-.cqu=ed: - 'oaveutiunO _Accepted 'Z(nnova:ivc ,Atrcraa:ivc "Doftr WMCt Supply.Typc:rd'CV,.wrY1Ci-.W-:trx :1.Nzw Well .GF-wciing Well C Community Well TT Du you at;icipate additiutn ut rApAns6'•us eif the facility airs sybtet»is iu.oncied;o nc.~i?u Yes o if yes.what,ypc? This is w eenify that the inforniation p:ovidcd on[iris appikatipn is true ant=rrect tr the test of r r,knowledge. 1 understand that any permit(!)or At"C(s)ifsucd hcre:%ft r ire subject to suspensioa or revocation if the site is aitered,the intended est,ctutnge.,,w it' dlc infnmutintiti sttb:rtittcd in thi:alll,tic"at_oe is.`.alsificd or chergrcl. 1 hcre�r:gra,u right of entry .c tiu At:;hcrizkd Representat;ve -orate Gavic Cot:nty"Health Dcparsts c*t to catdt:ct neves sry.inspectinns tr.dctcrrr ne compliance with 3Fplicaale laws and putts. r I ..J.1...f elan fn.rLn m.n... i.in.ri!in,/i nf•-+^I �•+1.+n ,f+.n+urn:t nnc ewrl.•n.nwr r.rF tnr•.r rine un.t tt�ru nl.. -, .....-..-...... .._..-.� ..• ...r.n .-,-.�-.rr.��n'-r- •n.r nuns I i - -.ur -iunr Irl n-I-r-I n^r-.�I I Incl I or mking the ltno:lity 71.opo!.ed well location=dtha lUtatioaofany other stnrnitret . site RevieitCi72rgc Property owncr'a or uwnef's legal np:-�enlati�'t sigcutwe i _ Tient Notitioation Date: Datr Elis: _,_•,,. tip given A«otttn0 #37,3 Rcviscd 111Q& Invoice k C'.4 I.1Hac1•AG1 )MG17 7T un f Gt7gAAF F,qs S 'f1N gmnH-I ")N 1 1H"1 i A I Talo n-))w Wf1N A 375 ► found Toto► 653 1 37' -2 0- 48 48 r� � th - t,0 i N 3x� t to�nd 1 1 - 6 3 89 AC 6 .703 D.C. �, —' ev c -730 ri IS ned a m - - 5�� o - Ln rt rr, Z O N S onsA y Z y S )i c ZZ 19 - 1 y 89 fS-44 "E oro ., _ - « 1 1.,uon•or, +MM 71 71 r Mr nKi :wnua `11.11 -IH-)1>4 1'gala n'1'11.1 I.InN-1 RichonS J. 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(32E # r 679 i } � 46073� 5 _ 5 PGG2 > ~ n 3 315 4158 ,63 " 3165 -t 3164.34A) ' ----' PcB2 . � ' 1235 PCC2 (62) z i 316 124 r ? 3176 (5.81 A) 7.O OA 1.43A (1.43A) � 6008 ES 8099 i (19.64 A) 1067 5014 4065 " 3193 N E i FcC2 1.43A 16 7 _ o PCB2 z 3205 4 -- ' N4 MERRY L N _ 3 39 356 3218 �g9A & 424 . n . 475 . _ . . 3225 • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT.IN ON i?� SR1�Y INFORMATION c o Tax PIN/EH#: 5788-,v- -r Billed To: Frank McNeill Subdivision Info: Merrybrook Acres Lot# 13 Reference Name: Location/Address: Merry Lane-27006&/ Proposed Facility: Residence Property Size: 6.389 - Date Evaluated: / v Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH o — Texture groupL Consistence Structure Mineralogy HORIZON 11 DEPTH _ L I -(ej - K4 Texture group G G Consistence r r Structure 461,- Mineralogy /Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE G ,' •1 SITE CLASSIFICATION: J ire ` EVALUATION BY: LONG-TERM ACCEPTANCE RATE: �` 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 Wel 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 05105(Revised) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■��■■��■■■■■■■■■■■■■■■e■■■■■■■■■�i■■■■■■■■■■■■■■■■■■■■■■EEE■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ NOON■■E■■■EEE■■EEE■E■■■■■■■E■■EE■■■■EE■EEE■■■■■■■■■■■■E■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■E■EE■■■EE■it■��1►�i■■■t■■i■tt■■t■■■■Ott■■t■■■■t■■t■■■■ ■■■■■■■■■■■■■NEE■■■■NE■■■nt�MRa■ ■■■■iE■t■EEE■EEt■■Et■■N■E■■■■■■■■ NOON■■■Ott■■OO■■■■O■■■■�■Ilii■■■■■tELir■■■■■O7t■tttttttt■■■■■■■■■■■■ ■■■■■■■■■■O■■■■■■■■O■O■■■■■E■■O■�■■fall■■■■■■■■■■■■■■■■■■■■■■■■■■■■ 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**NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans,plat or the intended use change. Permit Type: ew ❑Repair ❑Expansion Permit Valid for: 6Years ❑No Expiration Residential Specifications: #BedroomsY#Bathrooms q #People BasementE'gasement plumbingDe— Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply: R ounty/City ❑Well ❑CommunityWell fis stated in 15A NG,hC 18U.009(�+� Site Modifications/Permit Conditions: 688ed—Sj System Type LTAR Initial Q Repair _1 0 . Site Plan t4e3 4G e' Environmental Health Specialist Date i.p.11-06