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140 Meadow Ridge Drive Lot 22DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax # (336)751-8786 OPERATION PERMIT Account #: 990004345 Tax PIN/EH #: 5749-54-0956 Billed To: David Launius Subdivision Info: Meadow Ridge Lot # 22 Reference Name: Location/Address: Meadow Ridge Drive -27028 Proposed Facility: Residence Property Size: 1.665 acre ATC Number: 4669 **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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. System Type:_ S.T. Manufacturer �' CJ eTank Date Tank Size kx,� Pump Tank Size System Installed By:.,1OC., &Z le� E.H. Specialist: 4. DCHD 11/06 (Revised) ATC Number: 4669 Site Type:,Xew ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms # Bathrooms3-!� -# People 7' Basement❑ Basement plumbioll Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Lot Size 1.0 A,(\ -Qt -,S Type of Water Supply: Zounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) " 18 Tank Size ICCO GAL. Pump Tank GAL. Trench Width . Max. Trench Depth �W' Rock Depth 2Linear Ft. c -� Site Modifications/Conditions/Other: ©A7 C.E1JT00.<- `� � ' 1044nio, oJr- ems' O[_t> A24e-;,, �2 Contact the Davie County Envirr nomental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation.Telephone # (336)751-8760. l As stated in 15A NCAC 18A.1969(5) accepted Systems may also be used zo 4a .Tf,Zt �>✓ Z'1qaD 145' p2eP U40 4t' PAZOP Lz-i ZSS, 1&.S VZ Environmental Health Specialist Date: 1511510 DCHD 11/06 (Revised) v ' DAVIE COUNTY ENVIRONMENTAL HEALTH / P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax #{336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account M 990004345 Tax PIN/EH #: 5749-54-0956 Billed To: David Launius Subdivision Info: Meadow Ridge Lot # 22 Reference Name: Location/Address: Meadow Ridge Drive -27028 Proposed Facility: Residence Property Size: 1.665 acre ATC Number: 4669 Site Type:,Xew ❑Repair ❑Expansion **NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat or the intended use change. Residential Specifications: # Bedrooms # Bathrooms3-!� -# People 7' Basement❑ Basement plumbioll Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Lot Size 1.0 A,(\ -Qt -,S Type of Water Supply: Zounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) " 18 Tank Size ICCO GAL. Pump Tank GAL. Trench Width . Max. Trench Depth �W' Rock Depth 2Linear Ft. c -� Site Modifications/Conditions/Other: ©A7 C.E1JT00.<- `� � ' 1044nio, oJr- ems' O[_t> A24e-;,, �2 Contact the Davie County Envirr nomental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the day of installation.Telephone # (336)751-8760. l As stated in 15A NCAC 18A.1969(5) accepted Systems may also be used zo 4a .Tf,Zt �>✓ Z'1qaD 145' p2eP U40 4t' PAZOP Lz-i ZSS, 1&.S VZ Environmental Health Specialist Date: 1511510 DCHD 11/06 (Revised) APE App lica 'on F Type of pplics ��CE EVALUATION/IMPROVEMENT PERMIT & ATC � 11 vie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 336)751-8760/ Fax (336)751-8786 ��LTFi t Wn/I nt Permit X Authorization To Construct(ATC) OBoth :ion: sem ❑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 INFORMATION Name to be Billed "-pa.0 I el C, L. 4 uv�,`u�5 Contact Person c6,�,O Billing Address 3,30 /K Home Phone S30 -a9S.3 yo V City/State/ZIP W , n f,e &1t3 A21z-i Business Phone 2_0.Z-.913-910( Name on Permit/ATC if Different than Above. Mailing Address Ci PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accompany this application. Included: X Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name c, "0 Phone Number J3r6 97,0 %�� Owner's Address _Q City/State/Zip AeAM �,,tC a�,n/� a tot& Property Address /y(2 MeaAbi—) A d.oQ r city. Lot Size A 6&S— qc TaxPIN ,S y q StV6151( Subdivision Name(if applicable) Mer,&, �� dna Section/Lot# Directions To Site: I_� s Jo Ga► n Aa Sia., n Rd &X.4�I R% •Q 4,k O Nk M -0"b) If the answer to any o 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 1XNo Are there any easements or right-of-ways on the site? ❑Yes IRNo Is the site subject to approval by another public agency? ❑Yes Mo Will wastewater other than domestic sewage be generated? ❑Yes Mo IF RESIDENCE FILL OUT THE BOX BELOW # People q # Bedrooms . J-/ # Bathrooms 3,S Garden Tub/Whirlpool XYes ❑No Basement: XYes ❑No Basement Plumbing: XYes ❑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:, XConventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: X County/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes X 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 staking the house/facility location roposed well location and the location of any other amenities. f dl tee 4 Site Revisit Charge Pro P or owner's 1 a representative signature Date(s): Client Notification Date: Date EHS: Sign given ❑Yes ❑No Account # S Revised 11/06 Invoice # W fr �� Q C 1a APPUCAIION FOR SITE EVAILAlION/IMPROVEMENT PERMIT do AT D (�\, Davie County Health Department Environmental Health SedUoti o P.O. Box 848/210 Hospital Street JUL I Mockaville, NC 27028 (336)751-8760 g D shwasher 0 Garbage Disposal "aching Wachina 0 Basement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/other: Specify type # People # Sinks # Commodes # showers # Urinals # hater Coolers IF FOODSERVICE: # Seats / Estimated Nater Usage (gallons per day) 7. Type of water supply: O'County/City O Nall 0 Conumnity s. Do you anticipate additions or cipansions of the facility this system h intended to serve? 0 Yes 0 No If yes, what type? """IMPORTANTw" CLIENTS AIUST COAIPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 149 K 284X 200 XA-0`7 Tax Office PIN: # - 4-6- 5 `l 9 S WRITE DIRECTIONS (from Mocksvllle) to PROPERTY: C=AST ON V S i-lcy.n jS €s Property Address: Road Name 5 A l-1 Roam To RDo,o ( s R 1(o 43) Tu P, 1-1 City/ZipTicc-1<S0'11E gIozo If in a Subdivision provide information, as follows: Name: iYIEAnowR(-DGE �Pr�poD� RtGV T OP SAt..1 _ ArPPRuy. 0,-'a MIL(: T(-) S (Tc nt-A R\ L %A T Section: Block: Lot: 2 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 ra ponsible for all charges recurred frosty this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Departmer-n to enter upon above described property located in.Davie County and owned by tSENNB7"M L. F!rE R to conduct all testing procedures as necessary to determine the site suitability. DATE /o . 7-8 - 199'►_ SIGNATU THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Ezisting and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/98) Account No. 6 Invoice No. 226- ***IMPORTANT*** THIS APPLICATION CU*Wr BE PROCESMW UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for// instructions. 1. llama to be Billed Kc' N r-1 E T N � • i"p STE R . Contact Parson Kt /J w1� T H L • FOSTEQ. Walling Addressl (o Yl A PL, -Tec- LANG some Phone 704 City/state/LIP ��8 1`LL IOCKSdiILC �J.0-. .?7U -2e Business Phone -J3Co-'IZ3-�8�0 Z. Name on Parslt/A= if Different than Above Nailing Address City/State/Lip a. Application For:Site Evaluation 0 Improvement Pesmit/ATC 0 Both S. system to service: td�House O Mobile Home O Business 0 Industry O other a. If Residence: # People �G _ # Bedrooms 3 _ r • Bathrooms Z - g D shwasher 0 Garbage Disposal "aching Wachina 0 Basement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/other: Specify type # People # Sinks # Commodes # showers # Urinals # hater Coolers IF FOODSERVICE: # Seats / Estimated Nater Usage (gallons per day) 7. Type of water supply: O'County/City O Nall 0 Conumnity s. Do you anticipate additions or cipansions of the facility this system h intended to serve? 0 Yes 0 No If yes, what type? """IMPORTANTw" CLIENTS AIUST COAIPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 149 K 284X 200 XA-0`7 Tax Office PIN: # - 4-6- 5 `l 9 S WRITE DIRECTIONS (from Mocksvllle) to PROPERTY: C=AST ON V S i-lcy.n jS €s Property Address: Road Name 5 A l-1 Roam To RDo,o ( s R 1(o 43) Tu P, 1-1 City/ZipTicc-1<S0'11E gIozo If in a Subdivision provide information, as follows: Name: iYIEAnowR(-DGE �Pr�poD� RtGV T OP SAt..1 _ ArPPRuy. 0,-'a MIL(: T(-) S (Tc nt-A R\ L %A T Section: Block: Lot: 2 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 ra ponsible for all charges recurred frosty this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Departmer-n to enter upon above described property located in.Davie County and owned by tSENNB7"M L. F!rE R to conduct all testing procedures as necessary to determine the site suitability. DATE /o . 7-8 - 199'►_ SIGNATU THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Ezisting and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/98) Account No. 6 Invoice No. 226- DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soi]/Site Evaluation APPLICANT INFORMATION Account #: 989900654 Billed To: Kenneth Foster Reference Name: Kenneth Foster Proposed Facility: Residence Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5749-43-5798.22 Subdivision Info: Meadowridge Lot # 22 Location/Address: Sain Road -27028 Property Size: 1.27 Acres Date Evaluated: Q 7 Community Evaluation By: Auger Boring Pit Public I_ --- Cut Cut FACTORS 1 2 3 V4 ., 5 6 7 Landscape position L L_ Slope % X0 370 HORIZON I DEPTH -'7 Texture group C, Consistence i 5 -- Structure 5 t - Mineralogy : 1 HORIZON II DEPTH - 2 1 Texture group Consistence Structure �f C Mineralogy1 ; ; HORIZON III DEPTH tD ,32- Z$ - 1 - — Texture group_1 S Consistence sIFSP Structure Mineralogy HORIZON IV DEPTH 32+ Texture group Consistence Structure Mineralogy` SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE S 5 CLASSIFICATION LONG-TERM ACCEPTANCE RATE 3 � SITE CLASSIFICATION: PS LONG-TERM ACCEPTANCE RATE: d �' REMARKS: LEGEND Landscaue Position EVALUATION BY: QASouA+�I 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 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)