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196 Forest View Drive Lot 28-29' DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 / (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000981 Tax PIN/EH #: 5749-52-7327 Billed To: San Filippo Companies Subdivision Info: Meadow Ridge Lot # 29 Reference Name: Location/Address: Forest View -27028 Proposed Facility: Residence Property Size: see map ATC Ng,.bfr: 2694 **NOTE** This mprovement/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 o Osz #People #Bedrooms #Baths _' 5 Dishwasher: 121 Garbage Disposal: Er Washing Machine:[?"' Basement w/Plumbing: 2"'- Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift ##Seats Industrial Waste: �%� 4&D- ❑ Lot Size �� Q`���Type Water SupplyUoDesign Wastewater Flow (GPD)Site: New 13 Repair ❑ 't ZI System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width Rock Depth �Z Linear Ft. -r6P0 Other: ,r3 �iISTQ tjt�TlO.s cS , 15'fd�-L- Required Site Modifications/Conditions: ���T�t-L- Ora Gid.-JTCh �f?oGG QP.oQt�n1 %�`n j'S'�' IMPROVEMENT/OPERATION PERMIT LAY9,Ufi- , FINISHED GRADE. ****NOTICE: Contact represent system between 8:30 a.m. to 9:30 ap. o :00 p.m. to 1:30 �Y% 7 ZN Environmental Health Signature: P-13 TO ts. DCHD 05/99 (Revised) P�• UrJ D EFFLUENT FILTER RISER(S) IF 6 " BELOW Davie County Health Department for final inspection of this day of installation. Telephone # is (336)751-8760.**** Date: -2- Q'I DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Account #: 990000981 Billed To: San Filippo Companies Reference Name: Proposed Facility: Residence ATC Number: 2694 P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH M 5749-52-7327 Subdivision Info: Meadow Ridge Lot # 29 Location/Address: Forest View -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 Sewa a Treatm t and Disposal Systems). THIS AUTHORIZATION FOR WASTEW l I V DRIOD OF FIVE YEARS. Environmental Health Specialist's Signatu Date: 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 I 1 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: L APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT Davie County Health Department Eni ronmenta/Hea/tfi Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 r• -1-4 7i ***XAPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS Air -rte RF j1Y INFORMATION IS PROVIDED1. Refer to the INFORMATION BULLETIN for instructions 1. Name to be Billed \l �„ o, �(,©v S-� y ( E H7 Contact Person"�� T� Mailing Address�-0—'\-So e 22� Home Phone City/State/ZIP 4A V a v -y -U 6_ 2--200 Business Phonea —f` Ll 2. Name on Permit/ATC if Different than Above , —I Z Mailing Address City/state/Zip 3. Application For:Site Evaluation ❑ Improvement Permit/ATC ❑ Both a. System to Service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms 171 # Bathrooms! Z— ,Ld ishwasher p'Garbage Disposal .F( Washing Machine 0--Basement/Plumbing ❑ 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: Mi County/City ❑ Well ❑ Community 11 e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes &N-0 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: Tax Office PIN: # 2-7 Property Address: Road Name t"pr� V � elu) City/Zip l lf)c-I V-Ael If in a Subdivision provide information, as follows: Name: d L Section: r Block: Lot: 2� WRITE DIRECTIONS (from Mocksville) to PROPERTY: 1k 1� • 1 5:;5g -F�s4-- o� ® �v.�_. l.�o� o� fD1PSfiViec✓ ScabX✓i�c� �^ Date Property Flagged: Z/-7 AD / 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 vie C. uu °ty Health Department to enter upon above described property located in Davie County and owned by4�.- to conduct all testi n procedures as necessary to determine the site suitability. \ l DATE 1/SIGNATURE A ' I(/'/ - 61 /,"/6/i THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN Wclude all of the fo wing: 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. C7 F J Invoice No. rri.�•�••rsr�— �Ti—.._. C I '�y`w 'fir; • �, � KNOLL BROOK QR& 5r A&k F4W Cf • Aara'�t 4 30 pp Qd A -W tow 26 / 29 PACE x � 27 28 ap o w,r .64 64 -, APPU(AIION FOR SIZE EVALUAVON/IMPROVEMENT PERMIT do ATC Davie County Health Department • Envltvamental Health 5wffon P.O. Box 848/210 Hospital Street Mockaville, NC 27028 (336)751-8760 ***ZWORTANr*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Hams to be Billed KE N A E T N L . rc> STE 2 . Contact Person KE /J as T H 1. • FOS i� 2 Mailing AddressI ,8L in MAPLE T E2 L14,o ame Phone ?04 - 54(o--7 -7 9 8 City/State/LIP 0C K5J k L-�t_ , ".�- _ -270?'a Business phone 3 6CO --['Z-3 1A--8850 2. flame on Permit/ATC It Different than Above Hailing Address City/State/Lip 2. Application For: it Site Evaluation 0 Improvement Permit/ATC 0 Both 1. system to service: IJHouse O Mobile Home O Business 0 Industry 0 Other s. It Residenos: # People _ # Bedrooms - # Bathrooms Z '(Dishwasher 13 Garbage Disposal 01ashing Machine 0 Basement/Plumbing 0 Basement/No Plumbing G. If Business/Industry/other: specify type # People # sinks # Commodes # Showers # Urinals # Nater Coolers IP FOODSERVICE: II Seats Estimated Nater Usage (gallons per day) 7. Type of Nater supply: 01County/City 0 Well 0 Conannity 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 A1USTCVMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN AIUST BESUBAIITTED by the client with THIS APPLICATION. Property Dimensions: 419 X (0 39 X 590 Tax Office PIN: # 5749 – 43– 5`I 9 8 Property Address: Road Name �S A 10 Q A r -,i- City/ZipriaC.Ks,J 0 1 9-107 ,0 If in a Subdivision provide information, as follows: Name: iYIEA�oWR� DGE Pr�poD� Section: Block: Lot: 2 9 WRITE DIRECTIONS (from MockrAlle) to PROPERTY: TO 0 R00-IDisR 1(04-3) TuR►J R1G41T oP SAi s - APPRcq. O.5 MILlz TU S tTE n,-1 1k\L%JT Date Property Flagged: (a • 018 - 94 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 this application is falsified or changed. I, also, understand tbaf I am reVonsrble for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Departmer-r to enter upon above described property located in Davie County and owned by tl'E5A a7-14 _ L. F¢'�T E R to conduct all testing procedures as necessary to determine the site suitability. DATE G • 2 8 – 1991 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 1 ' `+ ons). 100 142- L4 7– Revised DCHD (07/98) 10 v Account No. L� Invoice No. ''2c DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900654 Tax PIN/EH #: 5749-343-5798.29 Billed To: Kenneth Foster Subdivision Info: Meadowridge Lot # 29 Reference Name: Kenneth Foster Location/Address: Sain Road -27028 Proposed Facility: Residence Property Size: 2.91 Acres Date Evaluated: aq Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position I_ L Slope % HORIZON I DEPTH— Texture groupG G Consistence' Structure !'v Mineralogy HORIZON II DEPTH Texture group Consistence - Structure 5 Ic MineralogyI HORIZON III DEPTH 7 n-ar Si4 94 Texture group Consistence r r S 47 Structure 5 !; Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE .3 SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: 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 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(provisiosally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 I)CHD (Revised 05/99)