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160 Meadow Ridge Drive Lot 20t� Account #: 989900259 Billed To: David Mallard Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT /d, e - ;?.-0 , d3 Tax PIN/EH #: 5749-44-8704 Subdivision Info: Meadow Ridge Lot # 20 Location/Address: Meadow Ridge -27028 Property Size: see map ATC Number: 2627 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 I 1 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�7� _ #People #Bedrooms #Baths 2• Dishwasher: E Garbage Disposal: u Washing Machine: 17/ Basement w/Plumbing: u Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size • y- ype Water Supply j Design Wastewater Flow (GPD) �R� Site: New T/ Repair ❑ System Specifications: Tank Size 1000 GAL. Pump Tank GAL. Trench Width :3L" Rock Depth 12Linear Ft. r Other: ►l+sr��r����5 �*�Sr�t.l-l►�t�S 1 �O.L' . 1.-.71.J . Required Site Modifications/Conditions: r os�- ©til �•�f�%e, -G is C�4-- HJSz, � j (:� . ta.Je IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT F LTER. RISERS) IF 6 "BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Heath 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.**** • - - uAt-'s 10 ignature: _ To 17P -c • Ll CHD 05/99 (Revised) AY 4 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900259 Tax PIN/EH #: 5749-44-8704 Billed To: David Mallard Subdivision Info: Meadow Ridge Lot # 20 Reference Name: Location/Address: Meadow Ridge -27028 Proposed Facility: Residence Property Size: see map ATC Number: 2627 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 Tre ent and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATE S TI IS AL R A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: ty 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. 0 U.3 cl� 1,) ckt>g� Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) %0 \cp t.* f )r _ X00 2 �r APPLICATION 1`011 SITE EVALUATION/IM0I10VLAIEN•T NLI Davie County Health Department Ell Yiro17nlenta/Hea/t/i Section P.O. Box 848/210 Hospital Stree Mocksville, NC 27028 (336) 751-8760 �-C -L 0 ----- A7 C JUL 3 1 1003 IRONMENTAL UE4LTH t1JJM ***IDIPORTANT*** TIIIS APPLICATION CANNOT BE PROCESSED UNLESS ALL ` 11L REQUIRLM INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instruct-ioni. , .�� r 1. Name to be Billed 6„�Gl1/, �� //1//� �a/' S ContacL Person 4 % Mailing Address f s`' t�<� .r77`i�1A�'f'r �� home Phone 1 '/ _ 7 r ( 7 City/S Late/ZIP W,5, � //_ •[ ` '/0 Business Phone 2. Name on Pcimit/ATC if Different than Above Mailing Address City/State/'Lip 3. Application For: ❑ Site Evaluation F 9"m rovement Permit/ATC ❑ Both A 4. System to Service: * House ❑ Mobile Home ❑ Business ElIndustry ❑ OL-ller _ 5. Type system requested: W Conventional ❑ conventional modified ❑ ilinovative 6. If Residence: It People It Bedrooms�.�-.-. I! BaL-hroont;j dishwasher X arbage Disposal Awashing Machine Basement/Plivabing ❑Basement/Iro Plumbing 7. If Business/Industry /Other: verify type It People II Iola N Commodes tt Showers tt Urinals It Water CJolclJ IF FOODSERVICE: t# Seats Estimated Water Usage (gallons per day) 8. Type of water supply: 'A County/City ❑ Well ❑ ConuuuniL-y 9. Do you anticipate additions or wipaIisi011s of the facility this systeiii is intended to serve? ❑ lies Y N0 : If.ycs, 11'liat type -- ***1AI1'0RTzhVT*** CLIENTS t11UST COdIPLETETIIE REQUIRED PROPERTY INFORAIATION KGQIJGST1-1'D BELONV. Either a PLAT or SITE PLAN hIUST BESUBIIIITTED by the client Willi TIIIS APPLICATION. Property Dimensions: o�H/--` Zl& ao?3L o990R Tax Office PIN: it - � Z Property Address: Road Nanic City/Zip If in a Subdivision provide information, as follows: Nalnc: Aacr,) Section: Block: Lot: 69 0 WRITE DIUCI'IONS (f -oni llloc �to PRO1,11:II ,Y: O Date !Ionic corners flagged: 3r` z 3 This is to certify that the information provided is correct to the best of niy knowledge. I understand that any pa•niii(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use chalige, or if llic inforniation submitted in this application is falsified or changed. I, also, understand that I ant responsible for all charges hicurred fruut this application. I, hereby, give consent to (lie Authorized Representative of the Davic Couuly health DepaN111Cn to enter upon above described property located in Davie County and owned by _______ to conduct all testing procedures as necessary to deterniine the site sui • 1 ity. DA'I'S % — ';V SIGNATURE, TIIIS AREA MAY BE USED FOR DRANVING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Client Notification Date. EI -IS: Sign given ! 1 Account No. Ye 7 70 Revised DCHD (05/03 r -2J LS L 4— Invoice No. ��v ' DAME COUNTY HEALTH DEPARTMENT Environmental Health Section 0 ( I P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001477 Tax PIN/EH #: 5749-43-5798.20 Billed To: Jeff Shouse Subdivision Info: Meadow Ridge Lot # 20 Reference Name: Susan Parker Location/Address: Meadow Ridge -27028 Proposed Facility: Residence Property Size: see map ***NOTE* Is rmprovBem nt/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 i�OIoSC #People #Bedrooms '�:) #Baths 3 Dishwasher: C3" Garbage Disposal: ❑ Washing Machine: Er' Basement w/Plumbing: 2 Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size AQ.QtType Water Supplk t, Y Design Wastewater Flow (GPD) Site: New 9!( Repair ❑ System Specifications: Tank Size'd00iAL. Pump Tank GAL. Trench Width._ Q_ Rock Depth Linear Ft:> Other: �� � �7V�L c , jtSTA-L. L) r') C � equired Site Modifications/Conditions: ` �S1I�1 l pal C O►-ATW2 , �'� 1 S � � G A A (J/17 _. c7...• IMPROVEMENT/OPERA ON PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) 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 :30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** AQPeoy . '7 C? Hem ac. Environmental Health Specialist's DCHD 05/99 (Revised) Date: AD A, /.1), -7 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001477 Tax PIN/EH #: 5749-43-5798.20 Billed To: Jeff Shouse Subdivision Info: Meadow Ridge Lot # 20 Reference Name: Susan Parker Location/Address: Meadow Ridge -27028 Proposed Facility: Residence Property Size: see map ATC Number: 2627 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 WAST C TIONI VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa re: Date: /v Ai 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) Date: Apo ......, i,vjrsiullfJ LW1 riJIM11 & AIC Davie County Health Department Environmental Health Secfon 3 P.O. Box 868/210 Hospital Street OC12000 Mocksville, HC 27028 (336) 751-8760 EWV(RONMEPdTAI HEATH •+►*ZZ�ORT711TI'#e• THIS APPLICATION CXNMW BE P1t=SSM U1q=8S ALL ZN14'ORMATIOH is PROVIDED. Refer -to the ININORBATION BULLETIN for instructions. Naas to be Billed2-1�t•f 7 �0 U.5, flailing Address,3 311 t R e rwn R City/state/ZIP W1r►t'bn AIe/ri /V C Z. Vase on Peach/AZC It Different than Above Contact Person 7U541t P4�f �Q'� \ / floes Phone_706% a k r`c. •% a Business Phone 7 S I — 9 (le a Nailing Address City/state/Lip S. Application lot: U Site 8valuation PImprovement Permit/ATC 0 Both 4. system to servioe: 0 House 0 Mobile Hares 0 Business 0 Industry 0 other a. It Residence: # People i Bedrooms ? # Bathrooms 7, (U5, 0 Dishwasher 0 oarbage Disposal D Mashing Maddae 0 Basement/Plmmbiag t/No Plumbing S. if Business/Industry/other: Specify type # Commodes # People # Sinks # Showers # Urinals # Nater Coolers IT i'OODSERVICB: i Seats Estimated Water Usage (gallons per day) 7. Type of Nater supply: County/City 0 Well 0 Cc®wnity a. Do you anticipate additions or espansious of the facility this system Is intended to serve! 0 Yes 0 No If yes, what type. ***IMPDRTANT*** CLIENTS MUSTCOMPLEIETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either s PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: V 5 / Z Z3 x .Z % l X Zj 0 WRFM DIRECTIONS (from Mocksvllle) to ROki Tax Office PIN: # Nth- Av, AllILI-�3-s��►� l 02 Property Address: Road Name �I�kluoP Citylzip I r I cies -M )P Q ado 0t5=i If in a Subdivision provide information, as follows: Name: IM ndow U2,e Section: Block: a Lot: 2-0 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 lnformation submitted in this application Is falsified or changed. 1, also, undergand that I am responsible for all charges Incurred from this applibatton. 1, hereby, give consent to the Authorized Representative or the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures a: necessary to determine the site sal ilitc. DATE I b A- 00 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Incla the following: Esist(ng and proposed property lines and dimensions, structu backs, and septic locations). I13� V r� � I p1) Account Na i Revised DCHD (07/98) ` - loo Invoice No. M e, cppjeS 4-rom - ___ _ MRO(,Koff FOUND 7 .. 7 PO 257 ; \ Of uNE / fcE120 , 1 REBAR FOUND (A /4QV%/ ,! tats m 1.40 16 ob se O / 02O:,g i 2'yCt` E/ �e2oeS tae- g° ;,2�dd,E z�� N05 J 15 ItkKBM SET c^ / " m S 7z38'AY E ! t-61 acres 17 - 1�/ REBAR FOL40 24 I v� s�95 2.74 aces 1.39 acres N t 22 u I ! 14 9`�� / 21 1.87 acres . S 26 3fl'0� I ! 203 acres ` 1.21 19 REBNt FOUND � 1.28 acres W 3 44, w REBAR FC 3 �a �t�0fCV 1 18 lPvl 1.37 W9" BOWLER I f I I p46 .1 / 13 -84 acres E ORNE CO)+ I / 2.40 ocrss �' /pKR1G0 215' _ / 2p1, �— - X48 N 2J19'1" ERM AR FOUND / \ 514' �p ���lf�• � _ , � 2O ( 4 Z 18 �\ .. i 1.822acres w ' NI IF 43 232- 8 1.85 5 ac4 3 \ 381 • U ! 1.74 acres o? ne ti 2.02 / C -g / 301 (/ 34rn N s��'' 0? acres /6• acres ' I / iU1• s�r�-� I - dQQP 2.88 ocre�t "T 0' f 14' 4 acres 3 1 q R ( I g18 C4 ,s.41 acres v / � 8 acres _ 1 W 551 ! v O 415' _ J S 109�4W I g TU �� 1.71 ocrw l RAL) 552 Ah � � •11 � � N SARAH HOLLAND \ 8K WILL � 4 PAGE 480 30 �. 2.72 acres �// v 2679. � 3.04 ares JA / 29 / 2,93 acres / / / o / \ 27 ! 3.24 acres m 2.38 acres 1 857 S iS00'OY W 1100.90' S 161004 W — — — — — — — — — — — — — i 3/4 W -H PPE Fr. `� \ � REBAR SET 34.4 ACRES 25 LOTS AREA WITHIN TOTAL SITE 0.306 LOTS Ff APPLICATION FOR SITE EVAtI ATION/IMPROVEMENT PERMIT do ATC [E @ EEa WIE Davie County Health Department D 1J LS Envifvnmenta/Krarlth Section ' + P.O. Box 848/210 Hospital Street Mockaville, NC 27028 -JUL .` (336)751-8760 ***ZHPORTANT*** THIS APPLICATION CAWWr RV PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed K,E N a S E T N L . re E 2 Contact Person KE P,-4 F_ r H L • Fc* - -e e - Nailing Addressl ��8L` (� rYla P� Thi Lnj t some phone 7 i 04 - 54(o-7 98 City/state/LID 1`IOCKSy���t , N •�- • .27oze Business phone 5_Z')(0 -_1"Z3-8850 2. Name on remit/ATC if Different than Above Nailing Address City/state/Lip 9. Application for: It Site Evaluation 11 Improvement Permit/ATC D Both 1. system to service: id House O Mobile Home 11 Business 0 Industry Cl Other a. If Residence: i People i Bedrooms .3_ y 11 Bathrooms Z B`6ishwasher O Garbage Disposal tushing Machine 0 Basement/plvobing 0 Basement/No Plusbing 6. If Business/Industry/other: Specify type i People i sinks i Caemodes i Showers i urinals i Water Coolers IS TOODSERVICE: # Seats Estimated Nater Usage (gallons per day) 7. Type of water supply: U/ County/City (] i011 O 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 IIIUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AIUST BESUBdIITTED by the client with THIS APPLICATION. Property Dimensions: 260)(5-12 X 145 X 576 WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: is 5-749- 4-5- S-7 9S Property Address: Road Name 15 (A1-4 Q P, o City/ZJpTicc-KS,r kIIE 91 OZ€S If In a Subdivision provide inrormation, as follows: Name: MEA60WR.I.DGAC_ �Propos�D) Section: Block: Lot: 26 L AST Oki 1,35 ti 1 w t_� S 8 TO CCS! r1 RoA.10 SR 1(o43) TuRnJ 90C," -f o0 SAa,a _ APP",,, 0.e5M1Lt: TU S (Tie nf-A K\y %A T Date Property Flagged: Lo • a 8 - /99 This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits) 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, o1se, understand that I an mVonsMle for all ehaiges Incurred frons this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Departmepsr to enter upon above described property located in Davie County and owned by J`iENN&'H ._ L. FfJST to conduct all testing procedures as necessary to determine the site suitability. DATE—(.- ?_8 — t 9 91 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. Invoice No. �� DAVIE COUNTY HEALTH DEPARTMENT FACTORS 2 3 4 5 6 7 Environmental Health Section L Slope % Soil/Site Evaluation ct .- 10 0-110 APPLICANT INFORMATION G PROPERTY INFORMATION Account #: 989900654 Tax PIN/EH #: 5749-43-5798.20 Billed To: Kenneth Foster Subdivision Info: Meadowridge Lot # 20 Reference Name: Kenneth Foster Location/Address: Sain Road -27028 Proposed Facility: Residence Property Size: 2.33 Acres Date Evaluated: Water Supply: On -Site Well Community Public >/ Consistence L _ Evaluation By: Auger Boring Pit Cut FACTORS 2 3 4 5 6 7 Landscape position L Slope % HORIZON I DEPTH ct .- 10 0-110 Texture group G Consistence —; Structure sG31L 5 Mineralogy` 1 1 HORIZON II DEPTH - % Texture group Consistence Structure Mineralogy HORIZON III DEPTH 17 Texture group Consistence Structure _ Mineralogy1 , HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: V LONG-TERM ACCEPTANCE RATE: o.4 REMARKS: EVALUATION BY: 1A �Z 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 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)