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176 Meadow Ridge Drive Lot 19DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 " (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001309 Billed To: San Filippo Companies Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5749-44-7560 Subdivision Info: Meadowridge Sect Lot # 19 Location/Address: Meadowridge Drive -27028 Property Size: see map **NOTE* Ihisimproveernlent/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 #People #Bedrooms !/' #Baths Dishwasher:,.Moo� Garbage Disposal Washing Machine: Basement w/Plumbing<ET Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial 171�Waste: Lot Size Type Water Supply Design Wastewater Flow (GPD) fM— Site: New;3 Repair ❑ System Specifications: Tank Siz� GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench WidthjL x Rock Depth L,Zf Linear Ft.-�&� 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 pD.-Aa ayof installation. Telephone # is (336)751-8760.**** N t - Environmental Health Specialist's Signature:—doDate: 51-`' `dl DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Account #: 990001309 Billed To: San Filippo Companies Reference Name: Proposed Facility: Residence ATC Number: 2941 P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5749-44-7560 Subdivision Info: Meadowridge Sect Lot # 19 Location/Address: Meadowridge Drive -27028 Property Size: see map 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 WASTEW CONSTRUCTION IS VALID F R PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature. Date: OIC -1 — 7—u 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 guar system will function satisfactorily for any given period of time. ya Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) /,A Date: / ���-`� AUG, 2 2rol APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Ellvifw7mentaiHealth Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 ***1WPORTANT?*LROVIDED. APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED ENVIl MMIUMUi I5 Refer to the INFORMATION BULLETIN for instructions. Person 1. Name to be Billed �- � zo y� Mailing Address L � `� �C P hone �qe P 1 City/State/ZIP ( d llGw4� C 2`76 Business Phone C% y o` g K 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation 011l rovement Permit/ATC ❑ Both 4. System to Service: V'House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People % # Bedrooms # Bathrooms '2_ kieelshwasher I<Garbage Disposal R Washinq Machine Lrf Basement/Plumbing L] Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats _� Estimated Water Usage (gallons per day) 7. Type of water supply: M County/City ❑ Well ❑ Community 8. 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 MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: ":;e� ,) WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # r'f 7 � (�y /< Property Address: Road Name t -4" city/z;p�i` ;/l/ 3✓�- If in a Subdivision provide information, as follows: Name: L UIA0 re-, Section: Block: Lot: _ Date Property Flagged: or 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 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 sui bility. DATE D/I')— SIGNATURE f THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN ( ude all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. 3 U % Invoice No.� APPUCATION FOR SITE EVAUlAIRON/IMPROVEMENT PERMIT do AT Davie County Health Department [ [ [] Env1immenfal Meal/fh S&Won D ` P.O. Box 848/210 Hospital Street Mockaville, NC 27028 JUL 13361751-6760 * * * ZMPORTADIT* * * THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL INFORMATION I3 PROVIDED. Refer to the INFORMATION BULLETIN for instructions. Nam 1. to be Billed f�E N 4. n1 E T N . F� S i.E R contact Person x 3 +Jg TH L • Fos., -u Q. Nailing Address l ��8LL (o i'YI a PL.E TP'Er LANs a me phone 704 -54(o- -7 -7 9 8 City/state/Lip Is10CK5V ���� , N •�- • .?7oze Business phone 33Co--I Z3-f38S0 Z. Name on wait/ATC It Different than Above Nailing Address City/state/Lip a. Application For: 1( Site Evaluation 0 Improvement Permit/ATC 0 Both 4. system to service: Er"'House ❑ Mobile Home 0 Business 0 Industry 0 other s. If Residence: # People # Bedroom -.3 ms # Bathroom Z-- g1Dishvasher 0 Garbage Disposal B'Nashing Machine 0 Baseeent/plumbing 0 Basement/No Plusbing 6. If Business/Industry/other: specify type # People # sinks # Commodes # shovers # urinals # Nater Coolers Ip IWDSERVICE: 11 Seats// Estimated Water Usage (gallons per day) id 7. 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? ***IMP0RTAN7*** CLIENTS AIUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AIUST BESUBAIITTED by the client with THIS APPLICATION. Property Dimensions: 183 X 40.7 X 2 55 X 4 4 Tai Office PIN: g S-7 - 43- S-19 8 WRITE DIRECTIONS (from MockrAlle) to PROPERTY: 1 -AST ON U S i -1w i C' �S Property Address: Road Name 15 A',1 RoAo To SCS. Ruao (s P. 1(o43) Tu Pp.1 City/ZipT1-c-Ks.j,11E 9101,8 If in a Subdivision provide information, as follows: Name: MEAoowRl-oGE (-Ptapom&D) Section: Block: Lot: 19 91GV%T 0P SAia _ APP",& 0,e,,MILC-7 -Tb S :TE n k-1 R\ L kA T Date Property Flagged: & • 018 - 99 This is to certify that the information provided is correct to the best of my knowledge. 1 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 responsible for all charges Incurred from this application. 1, hereby, give consent to the Authorized Representative of the Davie County Health Departmef-c to enter upon above described property located in Davie County and owned by ^iCAWaTI{ _ L. Pit E R. to conduct all testing procedures as necessary to determine the site suitability. DATE is - ?-8 - 0c) -i SIGNATUMqj��� 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. e��r Invoice No. DAVIE COUN'T'Y HEALTH DEPARTMENT • Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900654 Tax PIN/EH #: 5749-43-5798.19 Billed To: Kenneth Foster Subdivision Info: Meadowridge Lot # 19 Reference Name: Kenneth Foster Location/Address: Sain Road -27028 Proposed Facility: Residence Property Size: 2.20 Acres Date Evaluated: - Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut • •©©0©00 HORIZON ,r • ConsistenceMineralogy HORIZON II DEPTH NORM FZNFZ� Texture - Consistencer•rar������■ HORIZON III DEPTH Texture group Consistence M.M. •------- Texture •------- -----�- ConsistenceMineralogy ------- ------- SOIL WETNESSRESTRICTIVE HORIZON M. • • ����----- CLASSIFICATION WSAM M 11,41M IM -14 -IN mrawl� SITE CLASSIFICATION: PS LONG-TERM ACCEPTANCE RATE: 0.1 EVALUATION BY: ttl:I1-ia-IrA►n OTHER(S) PRESENT: REMARKS: k1aL- d- &-ke -m 1�& 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)