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117 Meadow Ridge Drive Lot 21 14, Account #: 990003524 Billed To: Greg Parrish Reference Name: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5749-43-5798.02 GP Subdivision Info: Meadow Ridge Lot # 02 Location/Address: Sain Road -27028 Proposed Facility Residence Property Size: 1.64 acres ATC Number: 4132 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 CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: r/`t" I 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. o ` c Septic System Installed By: Environmental Health Specialist's Signature: 6 �/ Date: 2 f z �S DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section el�.o� _' �► P. O. Boz 848/210 Hospital Street to Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003524 Tax PIN/EH #: 5749-43-5798.02 GP Billed To: Greg Parrish Subdivision Info: Meadow Ridge Lot # 02 Reference Name: Location/Address: Sain Road -27028 Proposed Facility Residence Property Size: 1.64 acres ATC Number: 4132 **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 14 #People #Bedrooms #Baths Dishwasher Garbage Disposal: e Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Z",07 Design Wastewater Flow (GPD) Site: NewO'Repair ❑ System Specifications: Tank Size /PO/GAL. Pump Tank GAL. Trench Width Rock Depth/j' Linear Ftc�S Other: A3 ctelod In 15A NCAC 18A.1969(5� pted Sf:SIenri iTTIIY C11SO 04: U4150 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.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** t s Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) 01) J E • APPLICATION FOR SITE EVALUATION/IAIPROVEAIENT PERAIIT & A?C nn�f Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 Ef\1T',0NME1;TA'_ I;FALTH (336) 751-8760 DAVIECOU10 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Contact Person C�✓� v �� �� Mailing Addrossc,, /�:�c.. �7� Z Home Phone ��t� City/State/ZIP !co -7 S �(.� �� -2/C2 CT Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: 0,-S to Evaluation ❑ Improvement Permit/ATC 0 -"Both 4. System to service:[,YHou ElMobile Home ❑ Business ❑ Industry E3 Other S. Type system requested: ' Conventional ❑ conventional modified ❑ innovative 6. If Residence: # People_ # Bedrooms # Bathrooms ishwasher Qdaibage Disposal 001-.hing Machine ❑Basement/Plumbing ❑Basemont/No Plumbing /✓/6V7. If Business/Industry /Other: verify typo # People # Sinks # Commodes # Showers # Urinals # Water Coolers /tr//,' IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) S. Type of water supply: Gl--County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑-No If yes, what type? ***IMPORTANT*** CLIENTS MUST COAfPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOIV. Either a PLAT or SITE PLAN A1UST B SUB.411TI'ED by the client with THIS APPLICATION. Property Dimensions: �, (,;7,Y � Tax Office PIN: Ila -5 / `7�%" `f 3— S`7-1nc�" Property Address: Road Name ;� �j City/Zip �SU✓�Z J(}5'd If in a Subdivision provide informatZ�a�l on, asfollows: Name: -C�J G,-." Section: Block: Lot: Z WRITE S(DIRECTIONS (from Mocksviillle) too -y PROPERTY: _ , :'l___ .Ccs/- 7 % (/Ze Date home corners flagged: ly , Z-' 0 �—!> This is to certify that the information provided is correct to the best of my knowledge. I understand that any per1nit(s) issued hereafter arc 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 tlic Authorized Representative of the Davie County IIcalth Department to enter upon above described property located in Davic County and owned by to conduct all testing procedures as necessary to determine the site suitability. _ DATE l� �- (/�J SIGNATURE Z� TIIIS 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 J Sign given Revised DC1ID (05103 Datc(s): Client Notification Date: EIIS: Account No.� Invoice No. APPLICAIiON FOR SIZE EVALUAIIUN/IMPROVEMENT PERMIT do AT 2 � E D W/ IE Davie County Health Department D L5 -� Environmental Heaft SmWon �.- P.O. Box 848/210 Hospital Street JUL 1 1999 Mockaville, NC 27028 (336)751-8760 rttZMPpgTANTrts THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. name to be Billed Ke N F4 E T N L. P O S i e . Contact Person K N ,-1'E T H L• FOSTER., Mailing Address l �hS6L G. YYI A PL -c T Ft L,4N, Some Phone 704 - 54-(o--7 -7 9 8 City/state/ZiP - I=IOCKS�t�u� , N.� -2702.- Business Phone 33C0 -1Z3-8850 1. name on Pewit/A1C if Different than Above Mailing Address City/state/Zip !. ipplication For: KSSite Evaluation 0 Improvement Permit/ATC 0 Both 4. system to Service: ErHouse ❑ Mobile Home 0 Business 0 Industry ❑ Other S. It Res # People T Bedrooms �J' G� i Bathrooms �- Dishwasher 0 Garbage Disposal aching Machine 0 Basement/Plnabing 0 Basement/No Plumbing 6. If Business/industry/other: specify type # Ca®odes # showers # People # sinks # Urinals # Nater Coolers IF FOODSERVICE: 11 Seats Eatimated crater Usage (gallons per day) 0/county/city7. Type of water supply: "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' ***IMPORTANT*** CLIENTS AIUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either it PLAT or SITE PLAN UU T RESUBMITTED by the client with THIS APPLICATION. Property Dimensions: SOX 23(6X351% 1-75x 384 -" �J WRffE DIRECTIONS (from MockrAlle) to PROPERTY: Tax Office PIN: # 43- S-7 9 8 l= AST o P V S � �wy� 1 S 8 Property Address: Road Name ROAtJ To Rano i s R I(o43) Tu P, 1-3 Cityinprcc-Kso 0 I 9107,8 If In a Subdivision provide information, as follows: Name: McAoouJkt-DGE CPtnPuSED� 9,%G4\T OP SA, --S -APP"-,(, O,eaft)(LG- To 5 ITIF n k-1 R\LLAT Section: Block: Lot: 2 Date Property Flagged: & • 018 " 94 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 responsiblefor all charges incurred fivm this application. I, hereby, give consent to the Authorized Representative of the Davie County Healtb DepartmeAI to enter upon above described property located in Davie County and owned by 11'&AWE7�4 _ L. Ft98TE R. to conduct all testing procedures as necessary to determine the site suitability. DATE G- ?-8 - 1991 SIGNATUM92��� "ZzzL THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimeusions, structures, setbacks, and septic locations). Account No. Revised DCHD (07/98) Invoice No. ' °2c DAVIE COUNTY HEALTH DEPARTMENT r Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900654 Tax PIN/EH #: 5749-43-5798.02 Billed To: Kenneth Foster Subdivision Info: Meadowridge Lot # 2 Location/Address: Sain Road -2702 Reference Name: Kenneth Foster 8 Proposed Facility: Residence Property Size: 1.Q4Acre Date Evaluated:P-1 Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L Slope % 4U 47, HORIZON I DEPTH D —T O Texture group C,GL Consistence Structure S MineralogyI HORIZON II DEPTH -ZZ Texture group Consistence Structure n 90 Mineralogy1: 1 HORIZON III DEPTH Texture group Consistence Structure 411C 5'0V__1 Mineralogy HORIZON IV DEPTH o - Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: ,> REMARKS: Q,�(��i 2 I p pp G on► �'TQq t LEGEND Landscape Position EVALUATION BY: &eAQW4jwfP OTHER(S) PRESENT: 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 Mineraloav 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 (Revised 05/99)