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110 June WayOPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 ant: Neal Foster ss: F 800 Redland Road y Advance State2ip: NC 27006 Phone #: (336) 998-7200 PropertV Loca Address/Road #: Subdivision: June Lane Advance NC 27006 Structure: SINGLE FAMILY # of Bedrooms: 3 # of People: 4 *Water Supply: PUBLIC C P Issued by.A issued by: 2140- Nations, Robert Design Flow: 3 6 0 Soil Application Rate: 0 . 1 3 5 Nitrification Field No. Drain tines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: /"Property Owner. Neal Foster Address: 800 Redland Road City: Advance State/Zip: NC 27006 `Phone #: (336) 998.7200 Phase: Lot: Directions Us Hwy 158 East left on Redland Rd. left on Hilton Road to June Lane, right onto drive beside of field house to rear of old shed *System Classification/Description: TYPE II A CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Saprolite System? OYes ONO *Distribution Type: GRAVITY- PARALLEL (eq. d.box) Pump Required? QYes (E)No *Pre Treatment: Drain field a 1 6 0 Sq. ft. 5 5 4 0 ft. 9 &Fe t O.C.O C. 3 &Fe lnchtes inches *System Type: INFILTRATOR QUICK 4 STANDARD Installer: Sherman Dunn Certification #: 2702 *EH S: 2140- Nations, Robert Date: 0 6/ 1 3% 2 0 1 6 CDP Fite Number 197062-1 County ID Number: — Draw Down: Septic Tank Manufacturer. Shoaf Lat. ❑ Yes ❑ STB: 760 ❑ Yes ❑ No Long: ❑ Yes ❑ Gallons: 7000 ❑ Yes ❑ Installer. Sherman Gunn ❑ Yes Date: 0 5/_ 1 1 / x 0 1 6 Certification #: 2702 EHS: 2140 - Mations, Robert `Filter Brand: POLYLOK PL -122 With Pipe Adapter ST Marker El Yes 2 Na Date: 0 6/ 1 3 / 2 0 1 6 Reinforced Tank: ❑ Yes ® Na Appraval.Status 1 Piece Tank: ❑Yes lD No77 ®Approveyd ❑ Disapproved Pump Tank Manufacturer. Installer: PT: Certification #: Gallons: THS: Date: / / Date. RisserSealed ❑ Yes ❑ No RiserHeight: ❑ Yes ❑ No (Min.6 in.) Approval Status noed Tank: �IfPrieOD ❑Yes ❑ No IQ Approved ❑ Disapproved Tank: ❑ Yes ❑ No Supply Line POe Size: inch diameter Installer. Pipe Length: feet Certification #: "Schedule: THS: Pressure Rated ❑ Yes ❑ No Date: Approved fittings ❑ Y@S ❑ NO 7 777) Aoarov6 Status .. f Pump Type: / Dosing Volume: — Draw Down: Inches "Chain: Valves Accessible ❑ Yes ❑ No Flow Adjustment Valve ❑ Yes ❑ No Check -valve ❑ Yes ❑ No PVC unions ❑ Yes ❑ No Vent Hole ❑ Yes ❑ No Anti -siphon Hole ❑ Yes 0 No Installer. Gal Certification #: THS, Date: Approval,Status ❑Approved ❑ Disapproved CDP File Number 197062 - 1 County ID Number: Electric Eauioment NEMA 4X Box or Equivalent ❑ Yes ❑ No Installer: Box 12 inches Above Grade ❑ Yes ❑ No Certification #: Box Adj. To Pump Tank ❑ Yes ❑ No Conduit Sealed ❑ Yes ❑ No *EH S: Pump Manually Operable ❑ Yes ❑ No *Activation Method: Date: Alarm Audible El Yes ❑ No _ Approval Status (].Appraved�=Disapproved Alarm Visible_ ❑ Yes ❑ No 2140 - Nations, Robert *Operation Permit completed by: _Authorized State Agent: Date of Issue: 0 6/ 1 3/ 2 0 1 6 Owner/Applicant Signature: This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for Sewage- Treatment and Disposal, 15A NCAC98A .1900 et. Seq., and all conditions of the Improvement Permit and Construction Authorization. This property is served by a TYPE 11 A, sewage septic system. - Rule .1961 requires that a Type I TYPE 11 A. septic system meet the following criteria: - Minimum System Review ByThe Local Health Department: WA _Management Entity: OWNER Minimum System Inspection/Maintenance Frequency By Certified Operator: WA Reporting Frequency By Certified Operator. NSA Rule .1961 requires that a Type IV and V septic systems designed fora home/business owner must maintain a valid contract with a public management entity with a certified operator or a private certified operator for the life of the septic system. Rule .1961 requires that Type VI septic systems designed fora home/business owner must maintain a valid contract with a public management entity with a certified operatorforthe life of the septic system. Rule. 1961 (2) (e) requires a contract shall be executed between the system owner and a management entity prior to the issuance of an Operation Permit fora system required to be maintained by a public or private management entity, unless the system owner and certified operator are the same. The contract shall require specific requirements for maintenance and operation, responsibilities of the owner and systems operator, provisions that the contract shall be in effect for as long as the system is in use, and other requirements for the continued proper performance of the system. It shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. @Hand Drawing 41mportDrawing **Site Plan/Drawing attached.** OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC Drawing Drawing Type: Operation Permit CDP File Number: 197062 -1 . County File Number: 27028 Date: Q Inch Scale: QBlock ON/A Ly 31, CONSTiWC-1I0N AUTHORIZATION r Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 For Office Use Only *CDP File Number 197062-1 County ID Number. Evaluated For: NEW Township: MCQ\AIT\/AI Irl I MTII - Phone: 336-753.6780 Fax: 336-753-1680 0 9/ 3 0/ a 0 a 0 Applicant: Neal FosterProperty0wner Neal Foster Address: 800 Redland Road Address- 800 Redland Road City: Advance GAY: Advance State2ip: NC 27006 State2ip: NC 27006 Phone #: (336) 998-7200 336 998-7200 Phone # t � Property Location & Site Information Address/Road #: June Lane Advance Structure: # of Bedrooms: # of People: 'Water Supply: NC 27006 SINGLE FAMILY 3 4 PUBLIC Subdivision: Phase: Lot: Directions Us Hwy 158 East left on Redland Rd. left on Hilton Road to June Lane, right onto drive beside of field house to rear of old shed Fol Site Classification: PS Shallow Placement Minimum Trench Depth: a 8 \ Inches Saprollte System? y QYes QNo Minimum Soil Cover. 1 6 Inches Design Flow: 3 6 0 Maximum Trench Depth: 3 4 Inches Soil Application Rate: 0 - 1 6 5 Maximum Soil Cover: a a Inches *System Classification/Description: *Distribution Type: GRAVITY - PARALLEL (eq. d -box) TYPE II A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Septic Tank: 1 '0 0 0 Gallons 'Proposed System: 25% REDUCTION 1 -Piece: (QYes QQ No Pump Required: QYes @No OMay Be Required Nitrification Field a 1 6 0 Sq. ft. Pump Tank: Gallons No. Drain Lines 5 1 -Piece: QYes ON Total Trench Length: 5 4 0 ft- GPM—vs— ft. TDH Trench Spacing:._Feet 9 Onches O.C.Dosing Volume: O.C. Gallons Trench Width:2 3 Inches Feet — - Grease Trap: Gallons Aggregate Depth: inches - Pre Treatment: ONSF OTS -1 OTS -11 Septic Tank Installer Grade Level Required: CJI Oil 0111 O1V Conn 4 ^f'A _ r CDP File Number 197062-1 County ID Number. ❑ Open Pump System Sheet Repair System Required:@Yes ONo ONO, but has Available Space rrDesign System Trench Spacing: 9 OInches 0. . ification: PS Shallow Placement Feet O.G. Trench Width: 2(�) Inches w: 3 6 0 — 3 Feet Soil Application Rate: 0 - 1 6 5 Aggregate Depth:. inches Minimum Trench Depth: a 8 "System Classification/Description: Inches TYPE 11 A. CONY SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) Minimum Soil Covera 1 6 Inches Maximum Trench Depth: 3 4 Inches "`Proposed System: 25% REDUCTION . Maximum Soil Covera a a Nitrification Field a 1 8 a Sq. It. Inches No. Drain Lines 5 "Distribution Type: GRAVITY - PARALLEL (eq. d -box) Total Trench Length: 5 4 0 ft. Pump Required: Oyes @No OMay Be Required Pre Treatment: ONSF OTS -1 OTS -II "Site Modifications No grading or construction activity is allowed in areas designated for system and repairwithout approval of Health_ Department. "Permit Conditions The issuance of this permit bythe Health Department in no wayguarantees the issuance of other permits. The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements. ; This Authorization for Wastewater System Construction shall be valid for a person equal to the period of validity of the Improvement Perml% not to exceed five years, and maybe issued atthe sametime the Improvement Permit issued (NCGS 130A -336(b)} If the Installation has not been completed during the period of validity of the Construction Permit, the informationsubmitted In the application for a permit or Construction Authorization Is found to have been Incorrect, falsified or changed, or the site is altered, the permit orConstruction Authorization shall become Invalid, and maybe suspended or revoked (.1937(8)). The person owning or controlling the system shall be responsible forassuring compliance with the laws, rules, and permit conditions regarding system Iocatlon Installation, operation, maintenance, monhorin% reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONo Applicant/Legal Reps. Signature: Date: — / "Issued By: 2140 - Nations, Robert Date of Issue: 0 9 / 3 0 / a 0 1 5 Authorized Slate Ag Malfunction Log Oyes #=`: wmana urawing vimpon urawing **Site Plan/Drawing attached.** Page 2 of 3 CONSTF.UCTION AUTHORIZATION Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 DraWinQ Drawing Type: Construction Authorization CDP File Number: 197062 -1 County File Number: Date: 09/30/2015 Olnch Scale: OBlock no t CONSTRUCTION AUTHORIZATION ' Davie County Health Department 210 Hospital Street CDP File Number: 197062 -1 P.O. Box 848 L Mocksville NC 27028 County File Number: a Date:. 0 / 3 0/2015 -�-o o0 Click below to import an lmt6 from an external location: Drawing Type: Construction Authorization ,1ti ItoG Q 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 #: 990004092 Billed To: Neal Foster Reference Name: Proposed Facility: Residence ATC Number: 4768 Tax PIN/EH #: 5862-16-6236 Subdivision Info: Location/Address: Hilton Lane -27006 Property Size: 15 Acres Site Type..,Aw ❑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 3 # Bathrooms 3l # People 4 Basement❑ Basement plumbingO Non -;Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size J�Ix J Type of Water Supply:Xounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) Tank Size 100 D GAL. Pump Tank --� GAL. Trench Width 31 TrenchDepthm-3q Rock Depth LZ LinearFt._t_ Site Modifications/Conditions/Other:--- W . '' L�1� Ll J S f Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 = 9:30a:m. on the Aay of installation. Telephone # (336)751-8760. As stated in 15A NCAC 18A.1969(5) accepted Systems may also be used ' ')C3(0xt2, 120• aD 1. 70 JrJr,- 'J Environmentalt p ialist te: �� Z,Qj �ait.- DCHD 11/06 (Rev' e Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Account #: 990004092 Tax PIN/EH #: 5862-16-6236 Billed To: Neal Foster Subdivision Info: Address: 800 Redland Road Location/Address: Hilton Lane -27006 City: Advance Property Size: 15 Acres Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to revocation if site plans, plat or the intended use change. Permit Type: 2New ❑Repair ❑Expansion Permit Valid for .�5 Years ❑No Expiration Residential Specifications: # Bedrooms � # Bathrooms 3, S# People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply�unty/City ❑ Well ❑ CommunityWell Site Modifications/Permit Conditions: Site Plan 1� iall-06 •.� �, if T) 11 1 n /_X_ ^-..��x1 ty15T. SHq> vt:_� 9o�y� Date OCT -17-2007 16:02 FROM:FOSTER AND ASSOCIATE 336 659 1111 70:7518786 tr MArb - t)avte t;ounry. M Mix Access ' GoMAPS.- .Davie.CountV. KC -Public Acce! P.1 rage i of i N A Wednesday, October 17 2007 --T' 1rw fit. •�vs w prCts . J. --F— �� _(C IV� http a/maps.co.davic.nc.us/GoMaps/map/print.cfm?CFID=3144&CFTOKIEN=32328054 10/17/07 1� AUG 3 0 2006 Et\VIRO*\MENIAL sitz •' DAVIE COON -ten V,4/Q07 (9-4�616 -J i/QLQ�3 .ITE EVALUATION/IMPROVEt vie County Health Department environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 For: 0 Site Evaluation/Improvement Permit PE IT & AT�.,pi ,to ❑ Authorization To Construct(ATC) �/oth ***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 Contact Person Billing Address Home Phone - 7,60 City/State/ZIP t/Q.NCe �/L �2 Business Phone Jv5q-/y00 ��� Cell RZ�-D3`Z Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION &//V0 4114- 41 bm,Eho� NOTE: A survey -plat or site plan must accompany this application. (Permit is valid for 60 mouths with site plan, no expiration with oinplete plat.) Street Address- {rJ�y>' , 144A19City Tax PIN# 5%7170&2-A0 Subdivision Name Secti n/Lot# L t Size _`j/� Directions To Site: /LS U!U 15? KIR-r -Z /o�A� ,0 4.ti Lot /PJ i V IA) 1k7j! � i;, r Date House/Facility Corners:Flagged �J�o If the answer to any of the following questions is "yes", supporting documentation must be attached. Are there any existing wastewater systems on the site? Dyes ENo Does the site contain jurisdictional wetlands? Dyes Cho Are there any easements or right-of-ways on the site? Dyes Irgo Is the site subject to approval by another public agency? Dyes no a Will wastewater other than domestic sewage be generated? Dyes CN' -' o J 111 IF RESIDEN E FILL OUT THE BOX BELOW # People # Bedrooms __ # Bathroo s Garden Tub/Whirlpool ❑Yes Basement: ❑Yes o Basement Plumbing: ❑Yes ❑1 "'1 IF NON -RESIDENCE FILL,OUT THE BO(rBELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes V;Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested:onventional ❑Accepted ❑Innovative ❑Alternative, 0Other . Water Supply Type:ounty/City Water ❑ New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 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 understand that I am responsible for all charges incurred from this application. I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to 4ejerrmine com liance with ap licable laws and rules on the above described property located in Davie County and owned by (,� tarr" Property ///owner's or owner's legal representative signature t 1\J 1 No Date Sign given Dyes C3fIo ni U ` Revised 2/06 Site Revisit Charge Date(s): Client Notification Date: EHS: Account # Invoice # ' •' • .r DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004092 Tax PIN/EH #: 5862-16-6236 Billed To: Neal Foster Subdivision Info: Reference Name: Location/Address: Hilton Lane -27006 Proposed Facility: Residence Property Size: 15 Acres Date Evaluated: Water Supply:, On -Site Well Community Public Evaluation By: Auger Boring Pit ✓ G` Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L Slope % $ 4 HORIZON I DEPTH ©_ j F — jo+. a -2i Texture group r— +5n OA A /? Q Consistence Consistence iviinermo HORIZON IV DEPTH 14 Structure ■1 mmerajogy SOIL WETNESS i RESTRICTIVE HORIZON . -.0 Z-Ar SAPROLITE V 5 CLASSIFICATION LI LONG-TERM ACCEPTANCE RATE tiJCa1�.r� SITE CLASSIFICATION: Qr7 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 CONSISTF.N . , �'I41SI _ VFR - Very friable FR - Friable FI Firm VFI - Very firm EFI - Extremely fret 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 05105 (Revised) ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■s■■■■■■e■■■■■■■■■■■■■■■■etas■■■e■■e■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■e■■■■■■■■■■area■■■■■at1,■■■■■■a■■■■■■■■■■■■■■■■■■■■■■■■■s■■■_�■■■■■ ■■■■■■ :■■■■■■■■■■■■■■■■■■■■■eeu■■■■■1�■■,�■■■■■■■■■■■■ee■■■u■■ lWoRr.■ ■■■■■■ ■■■■■■ ■■■■■a"R==mmLm --cmismWE MEMO hip. 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(i U P.O. Box 840/210 Hospital Street Mocksville, NC 27020 (336) 751-8760 * * *X1JPORTIINT * * * TIIIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORDIATION BULLETIN for instructions. 1. Name Lo be Dilled ' V ° A Fvz�'v Mailing Addrons azz 1� LcL.J Ci Ly/SLato/ZIP r`.' L Z..706a 2. Name on Permit/ATC if Different than Above 13ailiSIU Address Ci i Contact Person cl_ ( 15�5-zl� Itomo Phone //1 '�a ,72cc Business Phono dell V15 3. Application For: ❑ SiL-e Evaluation ty/.,tate/Z p ❑ Improvement Permit/ATC &--11 _'S Dotll 9. System to servicer Je 1-10=se ❑ Mobile Homo ❑ Business ❑ Industry ❑ Other S. Typo syntem requested: E Convontional ❑ conventional modified ❑ innovative Maccepted 6. If Residence: it People �7 Bedrooms - _ it Dathrooms _ Dishwashar ❑Garbago Disposal ZIM'hing Machina X—a..mont/Plumbing ❑Dasemont/fro Plumbing 7. If Dusinass/Industry /Other: verify type iI People tI Sinks I Commodes tI Showers tI Urinals it WaLor Coolers IF FOODSERVICE:itSeats EoLimat;ad Water Usage (gallons par day) it. Typo of water supply: aeaCounty/City ❑ Well ❑ Community 9. Do you anticipate additions or UlMllsiotls of tic facility this systelll is hileude(1 to serve? ❑ Yes o If )-cs, wut type? ***1j1r1'0R7,1Nn** CLILN1'S �11UST cOAIPLETL•"I IIIc REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Eithera PLAT or SITE PLAN AIU.STBESURMITTF,D by the client with TINS APPLICATION. Propet•ty Dimmislons: 1s k- 4 -/— •rax ofrrec 1>iN: n Se 4r.,2l GG 234 Property Address: Road Nanlc City/Zip If in a Subdivision provide lufornlation, as follows: Milne: Section: Block: Lot: WRITE DIRECTION'S (fi•um Mucl(sville) to PROPER'11% LA -5 A, 1-55 t, a, Date honk corners !lagged: --15- .067 '!'his is to certify that the iufornl:ltiou provided is correct to the best of illy 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 ill (Ills applicitioll is falsificd or changed. 1, also, rurderstand drat 1 ain responsible fi r• all clunges incurred from this application. I, hereby, give consent to the Authdrized Representative of the DUv'e Corlty IIIc. Wi Department to enter upon above described pl•operty located in Devic County and olvned by `- l �- K w� B>4c,- to conduct all testing procedures as ucecssary to deternliuc the site suita�bilit Qy. DAT!; SIGNATURE I " " `—' TIIIS ARIs'A MAY 13E USIM FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Sign given Site Site Revisit Chal•ge Datc(s): Client Notification Date: EIIS: .Accomlt No. Itevised MID (05103 Invoice No. Page I of I file:HC:\WINDOWS\TEMP\B5TDJALO.htm 6/7/06 Davie County GIS Online Legend Selected Features jji City Limit Lines BMMUDARJN COOLEMEE MOCKSVLLE: Streets INTERSTATE RAM PRIVATE /11/ PUBLIC REST AREA .................... Property Dimensions Z; Property Lines Flood Zones ............ ZONEA ElZONEAE ZCN E AE rL ZCINEX EM ZONEX45 Streams Water Bodies (415) V, Todwakem br.] CqqTq. Im aaos i.................... file:HC:\WINDOWS\TEMP\B5TDJALO.htm 6/7/06 Page 1 of 1 file://C:\WINDOW S\TEMP\L2YGH 1 FD. htm 6/7/06 Davie Coun GIS Online v Vbww�y Legend rAlog lt: ff Selected Features City Limit Lines SEAMU:3A4JV s �ipA. ,�"` • � CGDeiENLt age Kr i E l t 1'o^+ It l l MW S w �f Streets g /tif 14TERSTATC'? . All Mill pRNATE PUBLIC �p 7 +r.' m v �►�{ � i ry.r RE' vT AREA Property Dimer.: p „+ Propetty Lines Aerial Photos k ` Flood Zones rf ,,,, � -EAEi'_ rK � � � ...u► 6*0 El204E X Psi w ,e qr Z04EXs5 ,. s lM1'aier Bodies 4rsYr file://C:\WINDOW S\TEMP\L2YGH 1 FD. htm 6/7/06 v Vbww�y rAlog lt: ff P f age Kr i E l t 1'o^+ It l l S w baa Mill file://C:\WINDOW S\TEMP\L2YGH 1 FD. htm 6/7/06 KA