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116 Meadow Ridge Drive Lot 25Account #: 990003908 Billed To: Mark Davis Reference Name: ATC Number: 4339 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5749-55-4145.25 Subdivision Info: Meadow Ridge I Lot # 25 Location/Address: Meadowridge Drive -27028 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 I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Trea ent and Disposal Systems). THIS AUTHORIZATION FOR WASTE TS S V LID F PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa Date: to V /-*-) q 3ce /o0 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. S}oAF t< 000 4%T) °�\ Septic System Installed By: Environmental )Health Specialist's Signature: DCHD 05/99 (Revised) loco DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street ^Q Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003908 Tax PIN/EH #: 5749-55-4145.25 Billed To: Mark Davis Subdivision Info: Meadow Ridge I Lot # 25 Reference Name: Location/Address: Meadowridge Drive -27028 Proposed Facility: Residence Property Size: 1.50 acres **NOTE *Thris�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 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 2 Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size IJ I Type Water SupplyC�Design Wastewater Flow (GPD) 14100 Site: New 0" Repair ❑ System Specifications: Tank Size1" GAL. Pump Tank GAL. Trench Width 2V Rock Depth Linear Ft*� other: t713TRj(�vT"ifltl �C�`S , �C 'Et`�tE o�� � C�[0 S`i7S1� 1 Required Site Modifications/Conditions: ( N<-: /T �.L1_ CX4 Gor4z0LP, , KE -F-? S �,✓P=t- ®x-�= W IC) 'n � 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 inspe'on 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)751-876 .**** X ANCA'DFP17la 32- " -�, FE�t�E� "N FS I M ai-T� -FVv4 T \ 5 Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: 6(Q APPLICATION 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/ Fax (336)751-8786 Application For: ❑ Site Evaluation/Improvement Permit (%Authorization To Construct(ATC) ❑ Both ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed 2 DI&Vi S Contact Person Billing Address Home Phone •�J<G'� City/State/ZIP /1-a, , '"-� 66 ,Al/['__ :2 �j�ra�(zBusiness Phone Name on Permit/ATC if Different than Above Mailing Address PROPERTY INFORMATION S1 Me NOTE: A survey plat or site plan must accompany this application. / (Permit is valid for 60 months with site pla no exp' do with complete plat.) Street Address 'ee �'�tJ /-hCSax P1N# 7J/7 5 Subdivision Name - . , too ot# of Size Directions To Site: Date House/Facility Corners Flagged 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? ❑Yesx_ Does the site contain jurisdictional wetlands? Dyes Nlo ,Cej Are there any easements or right -of --ways on the site? ❑Y C Is the site subject to approval by another public agency? Dyes Vo Will wastewater other than domestic sewage be generated? Dyes Flo IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms # Bathrooms Garden Tub/Whirlpool es ❑No Basement: ❑Yes &o Basement Plumbing: ❑Yes ,)�No 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 requested: ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑Other -� % nml1C�} Water Supply Type: ounty/City Water ❑ New Well E1 Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes el�o 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 understand that I am responsible for all charges incurred from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to deezeco 1p linwith applicable laws and rules on the above described property located in Davie Countyan wfieed 1/J(/P 4 E MMZ =:�Site Revisit Charge Prbpe' 's o er's legal represbnt &e sig �anture Date(s): Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account.# Revised 2/06 Invoice # ; lrrI_i— r -- 1; APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT do ATC ;r Davie County Health Department Envfronmenfal Health SftWon P.O. Box 848/210 Hospital Street Moakaville, HC 27028 (336)751-8760 Lam• � � � �G' � � , D Ja ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Mame to be Billed f tE N nl E T N L.Q contact Parana KE N n1 r H L • FosTE r2 Mailing Address ($ is 1Y1 A Pc TRS L/aAlc Sam Phone 704 - 51%--7 ? E� 8 City/State/LIP I�IOCKS���I� , N •� - .7-1U7�' Business phone 3730 --TZ3-8850 Z. Mame on Pessit/ATC it Different than Above Mailing Address City/state/Lip a. Application For: It Site Evaluation 0 Improvement Permit/ATC 0 Both 4. system to service: t/ House 0 Mobile Home 0 Business 0 Industry 0 Other s. it Residence: # People # Bedrooms .3 - # Bathrooms Z— t�'Dlshxasher 0 Garbage Disposal 11 Nashing Machine 0 Basewmt/plmbing 0 Basement/go Plusbing 6. It Business/Industry/Other: specify type # Commodes # Showers # Urinals # People # sinks # Nater Coolers IP FOODSERVICE: # Seats �/ Estimated Hater Usage (gallons per day) 7. Type of water supply: 1d" County/City 0 Well 0 Community s. Do you anticipate additions or expansions of the facility this system Is intended to serve! 0 Yes 0 No If yes, what type! ***IMPbRTANP** CLIENTS AfUSTCOAIPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST RESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 19X381 Y, 15 o X 3 4'7 Tax Office PIN: # 5-14-9 — 43— S`I 96 Property Address: Road Name 15 A 10 Ro k o City/Zipricc-Ks0 Ole 91yZ€5 If in a Subdivision provide information, as follows: Name: MEAooWk(-DGE cpfapoSED) Section: Block: Lot: 2 5 WRITE DIRECTIONS (from MockrAlle) to PROPERTY: 1- AST O N V S %A L, -,,A 1 Ci R To 5,^-,6til RLND ( sR 1(o 43) TURt1 R%GvkT oP Sra,a _ APPR.� 0.e3M1LC TU S tTE n til 1t\L%AT Date Property Flagged: & • a 8 - 99 This Is to certify that the information provided is correct to the best or 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. 1, hereby, give consent to the Authorized Representative or the Davie County Health Departme►%r to enter upon above described property located in Davie County and owned by ^�ENAJe W - L. FVS-r E R to conduct all testing procedures as necessary to determine the site suitability. DATE G- Z8 — 1991 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). Revised DCHD (07/98) Account No. �5 Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900654 Tax PIN/EH #: 5749-43-5798.25 Billed To: Kenneth Foster Subdivision Info: Meadowridge Lot # 25 Reference Name: Kenneth Foster Location/Address: Sain Road -27028 Proposed Facility: Residence Property Size: 1.62 Acres Date Evaluated: Water Supply: On -Site Well Community, Evaluation By: Auger Boring Pit W Public Cut SITE CLASSIFICATION: K) LONG-TERM ACCEPTANCE RATE: • REMARKS: &C /V-.o?TL+ ^,; Z.2",,44. EVALUATION BY: ';� 1Opr__0 1�C 7 OTHER(S) PRESENT: 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 Mineraloev 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(provisional Iy suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/112 DCHD (Revised 05/99) Landscape position HORIZON I DEPTH Texture • , Consistence Mineralogy HORIZON II DEPTH - -Tex—ture group :WAX Consistence Mineralogy Texture group Consistence tiZiM-1iMEMOMineralogy EMS= 0191070 11WIMM Mineralogy FFW= HORIZON IV DEPTH Texture group Consistence SOIL WETNESS SAPROLITE gal waylg 12 114.11 SITE CLASSIFICATION: K) LONG-TERM ACCEPTANCE RATE: • REMARKS: &C /V-.o?TL+ ^,; Z.2",,44. EVALUATION BY: ';� 1Opr__0 1�C 7 OTHER(S) PRESENT: 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 Mineraloev 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(provisional Iy suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/112 DCHD (Revised 05/99) ME ME i le■ ■■■■■■■■■■■■■■■■■■■■■Ise■■■■e■■e■■■ee■e■■■ee■e■iee■■■e■■See■■■ ■■■■■■■■■■■■■■■■■■■■■ISE■■■■■■■■■■■■■■■■■■■■■■■i■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■e■■nee■�■■■e■■■e■■■■e■■■■■■■■i■e■e■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■ii1 ■■■ual■■■■■■e■■■■■■■■■■■n I�■■■■■■■■■■■■■■ ■■■■■■■■■■■■■e■■■■■■■glee■�■■■■■■■■e■■e■■e■■e■■i■■e■ee■■■■■e■■ ■■■■■■■■I��ii�\SSSS►4;y■elill■■i!�■■■■■■■■■■■■■■■■■■I■■■■■■■■■O■■M■ SSSS■■e/1 ■■eee■IIe■■■■■I■■■�i►�.■■■■■■■■■■■■■■■■■■■■■e■■ecce■■■■E■ ■■■■■■■■rye.�■r�■E■■EE■■E■��■1�1■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■rig■■■■■■■■■■r�■■■ii■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■�I■■■■■■■■■■■11■■■Illi■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■ 0 NORMAN ROEMER ENNOMMMonsonwommommammas ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■MM■ SOMME SOMME ■■E■■O■■O■■ ■■■■■■■■■■■ A2RARD F KTIGHI L FOSTER 1 I .. .. L7 . AMO RELt7tl[D 2RI133 A I. CFNRFY TNA T1E FtA.P' ERTI' iHR R A RNfFr RMT IHS RAT MEETS THE IECCIbiN AEA/lS1MCNR ff . ]UAORES MOT AS SHOwI ON- TNR PUT CRiAT©A SUBOMS]ON OF uNc" THE IM a MDCX94 ES =.riMtlM WA Alg16 N PUT 8001( ,PILE . WHICH THE FAWN OF YOCkM1E NAS .YM ORDINANCE aF l REYIDI OFTXEX OF DO£ COUDY. CEAFY 113 NIIDIDO FFDUU1�bN5 WNCN PEGVUTES THEE PARCELS OF NANO. WITNESS TNA 114. W OR RAT A wA[]I i CER5=130I R *I= MEM ALL SDNDM 0 MY KVQ THS_DAY OF .2000. IDOUREM )RS FOR VAMOR CIOL MORN SHORE . MWU OF OFEM APPR014D FLNC FTE I PAID PROFESSIONAL LAND SL.FHETOR OF rMN OFPIAXQ4WU DITX1A RED. / L.-2382 MR THE DAY OF . 20 Tn . . DAME COUNTY. NOR H CAROUNA DEPUTY - ASSISTANT CERTIFICATE OF APPROVAL OF PINATA -(ON-SITE) SEWA DISPOSAL X45 CERTIFl0.ATE OF APPROVAL OF MKM L F'S PLANNING D P RTTdENT 'I HEREBY CERTIFY lIW THE SUWMW14 RAT AS SHOWN I FIEWEBf CFA7IFY THAT THE DANE COUNTY HEALTH DEPARTMENT HAS 10.PEDH HAS BEEN FANO TO COMPLY WTTN THE EVALDATm THE SUS WON EN M' MEADOW ROM •'AFRI EXCEPTION OF SUCH WITH ED F SUCH �� "ANY. RESPECT TO CWIIIBA AND CONDITIONS ESTABLISHED RT STATE UW OR AS A I ANY, ARE NOTED N THE OF 7VE PROMULGATED TIVEREUNDFR NO THE SAYE R FOUND TO COMPLY WITH SUCH .R.MW& PLANNCES' O D RNNNO BOARD AND i1U7 R HAS Bml APPRC�ED FDR CdTMA ATA CONOOIONS EXCEPT AS FOUND N SJCH C04MATOK FOR RECORDING N THE OFFICE OF THE RErW OI OF DEEM. R R DETAA3 OF THIS FOR Mi ATMN AND L MONS $EE TK wNTTEN REPORT ON FILE AT THE 54D DEPARTMENT. HaegY NDTED THAT SUCH APPR"L FOR RCORAITION DOES NOT INCLUDE APPROVAL TO WALL AND VRL.GE SWAT( FACILITES NOR IMPORTANT THIS trxn .Tr ODES NOF DOES R INCLUDE APPROVAL FOR THE CONBTRUCTIDN OR OCCUPANCY _renrr- CONSiRL:_ A {'ERIWT CR APPROVAL OF NDMDI�+_ L:_ N SL FACARI _ OF BUILDINGS OR STRUCNRW S DATE DATE COUNTY HEALTI OFFICIAL DPECTOR MOCKSVILLE PLANNNO DEPARTMENT 'go MIX tee rocs � GEORGE WOMB- & MARY W. HOLDER D8 187 PG 39 M �RIDGGE MVS Cf_ X ROOD HCZWD AREA IT. IERWISF NOTED. L I l� Now OF FormerV I ANGELA M. MORK Rebar fowT� 2A9.SY LOCATION MAP NOT M SCALE NORTH CAROLINA DEPARTTAINT OF TRANSPORTATION KENNETH L FOSTER ONSION OF HIGHWAYS ? D8 211 PG 857 Rwa+e a�..G. tj r APPROVED1.39? Acral (&W) Wm DEgY.. Yp THIS TN DAD OF 30 \ Foli7y DAME COUNTY, NORTH CAROLINA \ W RAS' F 1De197 97 pG 1 1 Q X48 O � Q� 1 AN�n C� cm (dmd) @ I n / FINAL /b$ r . A / _ / Ham.! SECTION ONE SHEET 1 OF 3 Cl IG—EIHVICIAAI OWNER -DEVELOPER yj 1 KENNETH L. FOSTER A/W GAIL F. 186 MAPLE TREE LANE n MOCKSVILLE, N. C. SURVEYED MARCH 2000 ! ^ 1 BY KENNETH L. FOSTER P.L.S. 2552 TOTAL AREA = 93.573 ACRES ( DMD ) INCLUDING TWO ACREAGE TRACTS / TOTAL LOTS = 26 / AVERAGE LOT SIZE = 2.28 ACRES BEING PART OF TAX LOT 61 MAP H-5 DEED BK 211 PG 857 MOCKSVILLE TWSP., DAME COUNTY, N. C. KENNETH L. FOSTER & ASSOCIATES, P. A. PLANNERS -SURVEYORS 2200 SILAS CREEK PKWY. WINSTON-SALEM, N.C. 27103 PROJECT NO. TELEPHONE: 336-723-8850 1795-OOC