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169 Cornwallis Drive Lot 31DAVIE COUNTY ENVIRONMENTAL HEALTH P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Fax #(336)751-8786 Account #: 989900241 Billed To: Craig Carter Builders, Inc. Reference Name: Proposed Facility: Residence ATC Number: 4881 OPERATION PERMIT Tax PIN/EH #: 5831-97-8862 Subdivision Info: Pudding Ridge Lot # 31 Location/Address: 169 Cornwallis Drive -27028 Property Size: 200x230 **NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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. I System Type: l—* Of S.T. Manufacturer s IAAF Tank Date Tank Size Pump Tank SizeAffA:::: System Installed By-" d�• I AJ&,►+1 &&Jl . E.H. Specialist: Date: zoo' U1 r DCHD 11/06 (Revised) 430 0 Account #: 989900241 Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 IMPROVEMENT PERMIT Tax PIN/EH #: 5831-97-8862 Billed To: Craig Carter Builders, Inc. Subdivision Info: Pudding Ridge Lot # 31 Address: 157 Yadkin Valley Road Location/Address: 169 Cornwallis Drive -27028 City: Advance Property Size: 200x230 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: 91gew ❑Repair ❑Expansion Pemrit Valid for: 25 Years ❑No Expiration ./ Residential Specifications: # Bedrooms # Bathrooms_, � • 5 # People_�L Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats_ Square Footage(or Dimensions of Facility) Design Flow(GPD): 3(�O Type of Water Supply: 2IC6—u—nty/City []Well ❑Community Well As stated in 15A NCAC 1,8A.19G9{5) Site Modifications/Permit Conditions: cccepted Systems may also be usr-' i.p. 11-06 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 #: 989900241 Billed To: Craig Carter Builders, Inc. Reference Name: Proposed Facility: Residence ATC Number: 4881 Tax PIN/EH #: 5831-97-8862 Subdivision Info: Pudding Ridge Lot # 31 Location/Address: 169 Cornwallis Drive -27028 Property Size: 200x230 Site Type: ❑New ❑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 # Bathroomsa,5 # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats Square Footage(or Dimensions of Facility) Lot Size � 'Co Type of Water Supply: aunty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD&ATank Size�`'CAL. Pump Tank,�L. 2/t Trench Width Max. Trench Depth�4 <` Rock Depth Ft. c d in 15A NCAA 1W+ACL _ :{5) Site Modifications/Conditions/Other: Systams ,may also be use Contact the Davie County Environmental Health Section for final inspection of this system between 8:30 — 9:30a.m. on the dav of installation. Telephone # (336)751-8760. VA I Environmental Health Specialist Date: DCHD 11/06 (Revised) Z 32 I I ` PUDDING RIDGE RD I B1.00T------ 20.67 30.33' 0`0 Iz / c N GARAGE 2.33' W 3.67' / 15.00' _ _ _ — — PROPOSED c / I 81.00' N HOUSE / j I u O, 12.6700, rn .00 36.33' u V O / 1 I /r 0 Z D 0 0 1t toqD 1 o I I o I I 1 I ` IS 82 4 W 230.00 30 N �-1 SITE :v LOCATION MAP po 0 0 OD 00 C►K+M CA R. ......., O� S =0• pF�SS/O�� ;may — •QQ SEAL 9� •� �_ L-2890 iy2 SURA BCH ARQ\\' rl, SITE PLAN ONLY THIS WAS MAPPED FROM A DEED OR RECORD PLAT AND NOT FROM A SURVEY BY M E. 30 0 30 60 90 GRAPHIC SCALE — FEET FOR CRAIG CARTER BUILDER INC. SCALE =OWNSHIP COUNTY STATE DATE'S 1" = 30' 11 FARMINGTON DAVIE N.C. 4-23-08 LOT 31 PUDDING RIDGE SUBDIVISION P.B. 6 PG. 88 HOWARD SURVEYING JOHN RICHARD HOWARD PLS P.O. BOX 276 ADVANCE, N,C, (336) 998-5396 JOB NO. 08032 ` R SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/ Fax (336)751-8786 A licati �4�� uation/Improvement Permit ❑ Authorization To Construct(ATC) Aoth Typ of ApplicatiNew System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***17b11sORTANT*** 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 ere), , ;s Contact Person Billing Address J-5-7 Home Phone City/State/ZIP ,4ej >,a,,i t �lJ r�7 -7�' 6 Business Phone yS-.s�G� ' 7 Name on Permit/ATC if Different than Above Mailing Address City/State/Zip t'KUYBKIY INPUKMAI1UN . fiDate House/P acility Uorners stagged NOTE: A survey plat or site plan must accompany this applicatiori. Included.Wite Plan ❑Plat(to scale) (Permit isi valid for 60 months with site�lan, no xpiration with complete plat.) Owner's Name u ,7,Ve /j/js�`'0, `4ziq Allyf?/YI Phone Number Owner's Address City/State/Zip Property Addressi,5 �City Lot Size Tax PIN# – Z Subdivision Name(if applicable) �,� Section/Lot# / Directions To Site: Z-52 Y4t % . ! tlI c -17/11 . Lr Iv L, ca (:0/4;.tom.'1,4t _ Ga.L -;-/ Z I L'/— If the answer to any of the following questions is "yes", supporting documentatio must be attached. Are there any existing wastewater systems on the site? ❑ Yes To Does the site contain jurisdictional wetlands? ❑Ye;,-r_�o Are there any easements or right-of-ways on the site?1�es;&,;o es ❑No Is the site subject to approval by another public agency? Will wastewater other than domestic sewage be generated? ❑Yes�io TF RF41nFNC F. FTT.T. nTTT TNF. RC)X RRT.CIW # People Bedroomsv # Bathrooms Z_ Garden Tub/Whirlpooxyes ❑No Basement: ❑Yes Uo Basement Plumbing: ❑Yesfo IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building # People # Sinks # Commodes # Showers # Urinals Estimated Water Usage (gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: 15pConventional ❑Accepted ❑Innovative ❑Alternative ❑Other 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 XNo If yes, what type? This is to certify tha re information provided on this application is true and correct to the best of my knowledge. I understand that any permi s) )issued hereafter are subject to suspension or revocation if the site is altered, the intended use changes, or if the info io s ed in this application is falsified or changed. I hereby grant,right of entry to the Authorized Representative of the v o alth Department to conduct necessary inspections to determine compliance with applicable laws and rules. I unde t a a r sponsible for the proper identification and labeling of property lines and corners and locating and flagging or stak t 1 ou e/ c'1' location, proposed well location and the location of any other amenities. Property s r Site Revisit Charge -er's legal representative signature Date(s): k\\i�k Client Notification Date: UA Date UV EHS: Sign given ❑Yes ❑No Account # �S �;007g1 Revised 11/06 Invoice # __/, , -- DAVIE COUNTY HEALTH DEPARTMENT '`• a Environmental Health Section \I P. O. Bog 848/210 Hospital Street �( 0 Mocksville, NC 27028 �� C�� (336)751-8760 Z� IMPROVEMENT/OPERATION PERMIT Account M 990000981 Tax PIN/EH #: 5831-97-8862 Billed To: San Filippo Companies Subdivision Info: Pudding Ridge Lot # 31 Reference Name: Location/Address: Corwallis Drive -27028 Proposed Facility: Residence Property Size: 200'x 200' ATC Number: 2652 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AUTHORIZATION FOR WAS1tEWATER 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 TypeO�S6�- #People _ #Bedrooms #Baths Dishwasher: fid' Garbage Disposal: ❑ Washing Machine: ❑� Basement w/Plumbing: 21 Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size,' b6 X SOD � Type Water Supply OJ Design Wastewater Flow (GPD) Site: New ®Repair ❑ System Specifications: Tank Size IWO GAL. Pump Tank GAL. Trench Width Rock Depth 100 d Linear Ft. OCA Other: —ZA—' 4 c2/". Required Site Modifications/Conditions: o% ©,�SAZ—<.T/`c o s l.���� lrlgl�r 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 p.m. on the day of installation. Telephone # is (336)751-8760.**** Environmental Health DCHD 05/99 (Revised) i5 oAO erfi 1-44-t 's Signature: r* Date: /�?—$'—O c7 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990000981 Billed To: San Filippo Companies Reference Name: Proposed Facility: Residence ATC Number: 2652 Tax PIN/EH #: 5831-97-8862 Subdivision Info: Pudding Ridge Lot # 31 Location/Address: Cotwallis Drive -27028 Property Size: 200'x 200' 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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: CERTIFICATE OF COMPLETION Date: lo�?-5---,03 **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: Y� APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 i NOV 2 9 2000 ENVIR0'MENTAL HEALTH WME COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION'BULLETIN for instructions. 1. Name to be Billed i -+1-A,_ tact Person N-� Mailing Address. o - �( 2 Home Phone City/State/ZIP iq A ]�� µ /V 21760(, Business Phone �0 / 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For ❑ Site Evaluation S is ee- 4. System to Service: (House ❑ Mobile Home ❑ Business City/State/Zip improvement Permit/ATC 5. If Residence: VDishwasher # People ❑ Industry ❑ Other # Bedrooms # Bathrooms ❑ Garbage Disposal Washing Machine 6. If Business/Industry/Other: Specify type ❑ Both Z R Basement/Plumbing ` ❑ Basement/No Plumbing # Commodes # Showers # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ❑ County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes B'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,%- -7-00 }C Tax Office PIN: # CS3> 14 -/ 0 Z Property Address: Road Name C!0+"wV- 11 r C b, c; /zi Ss✓ n "I If in a Subdivision provide information, as follows: NamePt"'DI�J",C IJ �--L (s t Section: Block: Lot: - WRITE DIRECTIONS (from Mocksville) to PROPERTY: Date Property Flagged: 14 a'7 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 suits ility. IAVnDATE ( v t O SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN Wclude all of th oI! j g: xisting and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS: Revised DCHD (07/99) Account No. 7s7/ Invoice No. 6 O �v DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ADDRESS PROPOSED FACIILTY Water Supply: Evaluation By: On -Site Well Auger Boring DATE EVALUATED PROPERTY SIZE LOCATION OF SITE Community _ Pit FACTORS 1 2 3 4 Landscape position Slope % 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 > 3 Public Cut SITE CLASSIFICATION: EVALUATED BY:Gll6Z LONG-TERM ACCEPTANCE RA REMARKS: Sof r�lGeto DCHD (01-901 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 -Finn 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 3C -Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky SBK-Subangular blocky PL -Platy PR -Prismatic Mineralofty 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 ,• •. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME ADDRESS PROPOSED FACIILTY Water Supply: Evaluation By: On -Site Well Auger Boring DATE EVALUATED PROPERTY SIZE LOCATION OF SITE Community _ Pit FACTORS 1 2 3 4 Landscape position Slope % 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 > 3 Public Cut SITE CLASSIFICATION: EVALUATED BY:Gll6Z LONG-TERM ACCEPTANCE RA REMARKS: Sof r�lGeto DCHD (01-901 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 -Finn 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 3C -Single grain M -Massive CR -Crumb GR -Granular ABK-Angular blocky SBK-Subangular blocky PL -Platy PR -Prismatic Mineralofty 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