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173 Forest View Drive Lot 26DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section . P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001370 Tax PIN/EH #: 574943-5798.26 Billed To: Michael Iles Subdivision Info: Meadowridge Lot # 26 Reference Name: Location/Address: Sain Road -27028 Proposed Facility: Residence Property Size: 2.52 Acres **NOTE11 b i�iiss proveei ent/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 1 l 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 /T #People_ #Bedrooms #Baths Y, S Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: 8' Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply _ Design Wastewater Flow (GPD) ;�?a Site: New e Repair ❑ System Specifications: Tank Sizv�4 GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Widthc�O 'Rock Depth /9""' Linear Ft-.S—,O IMPROVEMENT/OPERATION 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 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature:2- Date: 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 #: 990001370 Tax PIN/EH #: 5749-43-5798.26 Billed To: Michael Iles Subdivision Info: Meadowridge Lot # 26 Reference Name: Kenneth Foster Location/Address: Sain Road -27028 Proposed Facility: Residence Property Size: 2.52 Acres ATC Number: 2543 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 WASTEWAT,4R CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date:QJ/%� 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 5 12Y/ Septic System Installed By: 41a Environmental Health Specialist's Signature : Date: DCHD 05/99 (Revised) APPLICATION FOR SttE EVAlUAT10N/IMPROVEMFM PERMIT & ATC Davie County Health Department Environmental Health section !� 1 8 2000 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ENVIRONh9ENTAL HEALTH H(336)751-8760 nnvic ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Nam to be Billed M I W EL I w✓ Contact Person !sailing Address 1 4 AA o M Amt CT Bam. Phon. 33( 9g8 -243? ` city/stat./$IP AP V"6r , !J6, 2Q 00 & Business shone 33 (0 78 9-- .g 0102 2. Nam on Permit/ATC if Different than Above Mailing Address City/state/Zip 3. Application For: ❑ Site Evaluation Improvement Permit/ATC ❑ Both s. system to Service: Y House ❑ Mobile Home ❑ Business 0 Industry 0 Other 1 s. If Residence: # People # Bedrooms 4 # Bathrooms 3,S Dishwasher Garbage Disposal washing Machine K Bass-ent/Plusbing O Basement/No Plumbiag 6. If Business/Industry/Other: Specify type # Commodes # showers # Urinals # People # sinks # water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City 0 Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes )(No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # Property Address: Road Name City/Zip If In a Subdivision provide information, as follows: Name:�"" 1 e, Section: Block: Lot: 7-40 WRITE DIRECTIONS (from Mocksville) to PROPERTY: 904 o n 4a L', 158 Rill on SAP) CLd; Rl j1'f 146 �a�QOW �crge Su.bRiv��Sioh � te-� a.`f le'61S QT r02J ' TLC P-Gta o'i' rod!; o"i iheleft ZLO 1.5 ire curve . -rs 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 1, also, understand that I am responsible for all charges incurred from this 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 to conduct all testing procedures as necessary to determine the site suitability. DATE �/ /8f2(w, SIGNATURE, 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). 12,9 -h 6ade�4- ares aha ¢o -Fe r ro f-ar� Lft e-, Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: I EHS: Account No. 1370 Invoice No. `'� - ,�► .•� f tit �,. 21 po. 037 14 ' ,v f4,,R tY r.r� , .. .. �T.. _. A+.'r .,. Y, ., /r/, - 1• r•��. /'� t'�•' ~� €i . IL000.ti +.+ ..sG t" � �: *.kyr, � ,�' �,•P (n�• � % , .,` � , . / .. .. OW .� ,, � �„♦...♦'�' —_�' � . `+ I '� � o, fry ''A i`' . + _ 1 i 'rh r E; ' , y1i111 v M 1 i� AA f D 8 211 pG ;. �• 34.4 qD t t.7t acxwi i RES AGR , tl Iry e RAL -i C F, ` �,,r• AAr UIA El vow j •��� a j 4j j . ' Y a : /� q / olVA&HI r/ AI/ 4 �Tl v 'ANG .Z 70 '` ,♦♦ `� y� atf47 30 oar" fJ EELS 6r YOO SED i iris / N STA46E10. pLd-A5P— 2743 D T S OE: r 1 3.24 are-, P'� posed ; 5e�}� i 28k o k 1 CxcrrnS . ?.fid ti 1 657 ► 363.17 , s war 1 w too S I t I'Volf w \ yt PPE F%ft '•..' "I �r otic \ S. \S40 ` F C MCCLA111OCK D8 63 pG DB age 504'\\,� �'• Dg '�8PG S EVALUATION/IMPROVEM ` V APPLICAl10N FOR Da is County Health Oeparttnent � PERMIT b ATC � Environmental Res/di SmWon P.O. Bos 868/210 Hospital Street JUL �f Mockaville, HC 27028 999 (336)751-8760 Ef W61shwasher 0 Garbage Disposal 8 -lashing Machine S. If Business/Industry/other: Specify type # Commodes t Showers 0 Basement/Plumbing 0 Basement/Ho Plumbing f urinals 11 People 11 Sinks # Nater Coolers IF FOODSERVICE: i( Seats// Estimated Nater Usage (gallons per day) 7. Type of water supply: 0"County/City 0 well 0 Community e. 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 AIUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Elther a PLAT or SITE PLAN AIUST BESUBAIITTED by the client wlth THIS APPLICATION. Property Dimensions: .5 4 4 X 4(. 1 X 3 6 5 Tax Office PIN: # S 7 4-9 - 4 3 - S `I 9 � WRITE DIRECTIONS (from Moclu;ville) to PROPERTY: 1 -AST ON U S 1w t_lS R Property Address: Road Name �5 A t -4 Ro A o To it ►J Rao• D ( s R l co 43) Tu R tl Ci1y1ZipTcC-�<sJklls 91OV3 POG"T 00 SA,,a _ APPOL y 0,e3 fn1LC- If in a Subdivision provide information, as follows: Name: McAoouJR(.DGE (?'oPoseD) Tb S (TIC n t�l R\Li-lT Section: Block: Lot:�— Date Property Flagged: (9 - a 8 - R 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 ibis application Is falsified or changed I, also, understand that I am raponsible for all charges lncuffmdfrom this application. I, hereby, give consent to the Authorized Representative of the Davie County Health DepartmeAf to cuter upon above described property located in Davie County and owned by /iEMNETff - L. PQST E R to conduct all testing procedures as necessary to determine the site suitability. DATE 4, - Z 8 - 1991 SIGNATU 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. ✓2� ***IIMPORTANr*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE' Q IRED INFORMATION IS PROVIDED. Reefer to the INFORMATION BULLETIN for instructions. 1. name to be allied hE N nl E T N L.. Fp S � E R . Contact person KE N rZF- T H L • Fos -TTI= 2 Nailing Address I SI i G l A PL -c TREE LAaI c some phone -7-704 - 54�- 8 City/state/LIP 14t0CKSy11LC- , .27028 Business Phone 33Co--1 3-8850 Z. (lame on Pewit/ATC if Different than Above Nailing Address City/state/Lip 3. Application For: It Site Evaluation 0 Improvement Permit/ATC 0 Both t. system to service: Fd" House O Mobile Home 0 Business 0 Industry 0 Other S. if Residence: 9 People if Bedrooms 3'f 11 Bathrooms Z W61shwasher 0 Garbage Disposal 8 -lashing Machine S. If Business/Industry/other: Specify type # Commodes t Showers 0 Basement/Plumbing 0 Basement/Ho Plumbing f urinals 11 People 11 Sinks # Nater Coolers IF FOODSERVICE: i( Seats// Estimated Nater Usage (gallons per day) 7. Type of water supply: 0"County/City 0 well 0 Community e. 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 AIUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Elther a PLAT or SITE PLAN AIUST BESUBAIITTED by the client wlth THIS APPLICATION. Property Dimensions: .5 4 4 X 4(. 1 X 3 6 5 Tax Office PIN: # S 7 4-9 - 4 3 - S `I 9 � WRITE DIRECTIONS (from Moclu;ville) to PROPERTY: 1 -AST ON U S 1w t_lS R Property Address: Road Name �5 A t -4 Ro A o To it ►J Rao• D ( s R l co 43) Tu R tl Ci1y1ZipTcC-�<sJklls 91OV3 POG"T 00 SA,,a _ APPOL y 0,e3 fn1LC- If in a Subdivision provide information, as follows: Name: McAoouJR(.DGE (?'oPoseD) Tb S (TIC n t�l R\Li-lT Section: Block: Lot:�— Date Property Flagged: (9 - a 8 - R 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 ibis application Is falsified or changed I, also, understand that I am raponsible for all charges lncuffmdfrom this application. I, hereby, give consent to the Authorized Representative of the Davie County Health DepartmeAf to cuter upon above described property located in Davie County and owned by /iEMNETff - L. PQST E R to conduct all testing procedures as necessary to determine the site suitability. DATE 4, - Z 8 - 1991 SIGNATU 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. ✓2� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account ##: 989900654 Tax PIN/EH #: 5749-43-5798.26 Billed To: Kenneth Foster Subdivision Info: Meadowridge Lot # 26 Reference Name: Kenneth Foster Location/Address: Sain Road -27028 Proposed Facility: Residence Property Size: 2.52 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 L Slope % $ZU I 20 HORIZON I DEPTH — - Texture group $C.L, GL— Sr—,L— Consistence Consistence r t= r 55SP Structure Mineralogy MI)c, W'3 ►x HORIZON II DEPTH Texture groupC, L' Consistence P' S Structure t Mineralogy tIq M4 HORIZON III DEPTH K4 2- Z Texture groupL� Consistence Structure PL_ S I< - Mineralogy HORIZON IV DEPTH 3Z4 - Texture group Consistence —rSe Structure c MineralogyM SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE 5 CLASSIFICATION 0.5 P -S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: P LONG-TERM ACCEPTANCE RATE: 0. 2 EVALUATION BY: ' � C'4,0 OTHER(S) PRESENT: REMARKS:L` 3 LST � � Q JL1 t2T 2 P�cJZ- G 1 ��1 �N 'JlbA, C9Al 1 JtS ©N LFJ" LEGEND Landscaae 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 Minera fty 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) . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 990001370 Billed To: Michael Iles Reference Name: Proposed Facility: Residence Property Size: PROPERTY INFORMATION Tax PIN/EH #: 5749-43-5798.26 Subdivision Info: Meadowridge Lot # 26 Location/Address: Sain Road -27028 see map 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 Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure 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: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S) PRESENT: REMARKS: 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)