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130 Ridgehaven Place Lot 4DAVIE COUNTY HEALTH DEPARTMENT 3-1Z Environmental Health Section 4-j P. O. Bog 848/210 Hospital Street I •` ' Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001645 Tax PIN/EH #: 5749-43-5798.04sy Billed To: J. Shane Young Subdivision Info: Meadow Ridge Lot # 4 Reference Name: Location/Address: Ridge Haven Place -27028 Proposed Facility: Residence Property Size: 2.91 ACRES **NOTE*'� its 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 1 Ido ' #People _Z #Bedrooms _� #Baths 2— Dishwasher: El"'- Garbage Disposal: Washing Machine: r? ." Basement w/Plumbing: Er---Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 241 d Type Water Supply 0000yq Design Wastewater Flow (GPD) :&00 Site: New 0"' Repair ❑ System Specifications: Tank Size t1O GAL. Pump Tank GAL. Trench Width -ao Rock Depth 12- Linear Ft."5-4;D Other: S'rQ.� fav Ti oa �DX t I.,j �`Qt,� 1. r a�S ox— C, r�.1.� . Required Site Modifications/Conditions: WWI k4p 1 S • Or 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. 6s the day of installation. Telephone # is (336)751-8760.**** AfXby-lid \ O. r,�►1 C . �5 oto 07-11, 12p• ,� Environmental Health Specialist's Signature: Date: r/ 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 #: 990001645 Tax PIN/EH #: 5749-43-5798.04sy Billed To: J. Shane Young Subdivision Info: Meadow Ridge Lot # 4 Reference Name: Location/Address: Ridge Haven Place -27028 Proposed Facility: Residence Property Size: 2.91 ACRES ATC Number: 2756 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION �I **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 Treatme t and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CONS 7r��7,Date:C:L,7�;,7&1 PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: 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. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) -To Svo,t" k-b"]DAN NoT G�Jt�l;� A; tNSPs`�`°a `TgjV,4cM W61 OCT - Date: 12 149- 3 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Env/tt nmenfit/ Hea/ffi SSa= P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 p NT. 0 W R PM ! 9 M ENVIRONMENTAL HEALTH DAVIE COUNTY ***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 lAf7 Mailing Address lag Home Phone pe �A City/state/ZIP M OLtSSI% }I l f /e Business Phone 2. Name on Permit/ATC if Different than Above Mailing Addsess 3. Application For: ❑ Site Evaluation City/State/Zip [d Improvement Permit/ATC ❑ Both 4. system to service: i(House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: / # People Z 1 Bedrooms # Bathrooms 2- VDishrasher W Garbage Disposal L'/Wnhing Machine M Basement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: specify type # People # sinks # Commodes # showers # Urinals # Nater Coolers IF FOODSERVICE: # Seats �Estimated Water Usage (gallons per day) / 7. Type of Hater supply: n County/city ❑ well ❑ community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 191NO If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMI77ED by the client with THIS APPLICATION. Property Dimensions: %►. 91 oxWXg . WRITE DIRECTIONS (from Mocksvil)e) to PROPERTY: TaxOfiicePIN: # a 7�5- `7`3- S 7 �' �S --C> 456-(1 h . Property Address: Road Name -. 4 h o�e I�Well 4( Il Z M le, :L C3 City/Zip �k.A,-vd Ite. 270264 If in a Subdivision provide Information, as follows: Name: 64-4ty 'PN �4 Section: Block: Lot: : C. 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 responsible for all charges incurred front this application. I, hereby, give consent to the Authorized Representative of the DA,19 County e1,04, Dep rtment to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE SIGNATURE LIJ 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: I EHS• Revised DCHD (07/99) Account No. � & �5- Invoice No. 2,1q 1 1"' o at r Z —1' @,''y — ti Oo is:ud E 62.40' S•w — '-• '— — '` C c`' \ � tsot�' � �• e/� MAG'- - - - •- 27.72' ._ e 3 C �s IDGE DRIVE EADOW R �,• ht or Way Resor Ir JI �� �� �� �`-,; � �',�°Qe f �� s� mss• �. �.. NO ,'� ; ' -� �.S aC�' �' AJ. • �. �` 1.590 Acre es (dMd) 76i 23- fj i. '-, ;%'"� ` • E°• IV 323'�3' QY U40r ^ r r r N s � APPU('AHON FOR SIZE EVAIliAMON/IMPROVEMENT PERMIT d1 ATC L5 @ LE DW!5 Davie County Health Department D Envirvnmenta/KwIthSmWon JUL 1 1999 P.O. Box 848/210 Hospital Street itoakaville, NC 27028 (336)751-8760 ***IIHPORTANT*** THIS APPLICATION CANNOT BE PROCLSSi:D UNLESS ALL THE REQUIRED INFORHATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed KE N nl E T N L . t o sTF- R . Contact Person _ K N #a E T H L • Fb5-m g. Hailing Address � in maP�.E TRFE7 LA�1c Homs Phone 704 -54(0--77 v8 City/state/ZIP ��gLL I= OC. K5.!Int , N .�- . .77U-Z� Business Phone 3300 a. Name on Pealt/ASC It Different than Above Hailing Address City/state/Zip a. Application For: KSSite Evaluation ❑ Improvement Permit/ATC ❑ Both s. system to service: V House ❑ Mobile Home ❑ Business ❑ Industry ❑ other a. a- 1-3- I=shwasher # People # Bedroom �"� # Bathrooms 2 0 0 Garbage Disposal a -Na ping NMachine ❑ Basement/Plusbin 0 Bast No Plunbin g / g 6. If Business/Industry/other: Specify type # Commodes # Showers # Urinals # People # sinks # Rater Coolers IP FOODSERVICE: # Seats Estimated Hater Usage (gallons per day) 7. Type of water supply: id/County/City 0 well ❑ Co®wnity s. Do you anticipate additions or expansions or the facility this system Is intended to serve! 0 Yes 0 No If yes, what type' ***IMPORTANT*** CLIENTS AIUSTComPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PIAT or SITE PLAN AIUST BESUBAIITTED by the dient with THIS APPLICATION. Property Dimensions: 409 X 384 X iso X 3 31 Tai Office PIN: # 5 i 4-,"— 4 3— 5 9 WRITS DIRECTIONS (from Mocksville) to PROPERTY: I -AST ON V S 1w �l S R Property Address: Road Name 5 A l -J Po A o Tp RIA - o (-5P, i (o 43) Tu R h1 City/ZipTicc-Ks,J015 a1071€3 If In a Subdivision provide information, as follows: Name: (.P(aPoSED) Section: Block: Lot: 9,1G"T OP Sn.►a _ AtPP"�t. 0.e3M1LC- -ro S tTr n til iC \ L %4 T Date Property Flagged: & • a 8 - 99 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 any responsible for all charges incurred front $ his 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 t1',f�WeT?4 L. FQ¢STE. R. to conduct all testing procedures as necessary to determine the site suitability. 1111111 MWPW. THIS AREA MAY BE USED FOR DRAWENG 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. Invoice No. / °2� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900654 Tax PIN/EH #: 5749-43-5798.04 Billed To: Kenneth Foster Subdivision Info: Meadowridge Lot # 4 Reference Name: Kenneth Foster Location/Address: Sain Road -27028 Proposed Facility: Residence Property Size: 2.55 Acres Date Evaluated: ! Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH -(p - 12— 2Texture TexturegroupG !'i Consistence Structure L k Mineralogy1 ; j HORIZON II DEPTH 1P- Texture groupr Consistence Structure �c 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 SITE CLASSIFICATION: D LONG-TERM ACCEPTANCE RATE:- J REMARKS: LEGEND Landscane_Position EVALUATION BY: �G �tIG�Ii 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)