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275 Timber Trails Lane Lot 6AAlm Account M 990004017 Billed To: Michael Russell Reference Name: Proposed Facility: Residence ATC Number: 4454 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5812-01-5250 Subdivision Info: Timber Trails Lot # 6-A Location/Address: Timber Trails 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 WASTEWATER CONS S V ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatur : 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 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. --------------------- Cleky � .1 S c System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) ---r Date: 11 r - ' 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 #: 990004017 Billed To: Michael Russell Reference Name: Proposed Facility: Residence ATC Number: 4454 Tax PIN/EH M 5812-01-5250 Subdivision Info: Timber Trails Lot # 6-A Location/Address: Timber Trails Drive -27028 Property Size: See Map Site Type bNew ❑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 2. < # People 2-- Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats /n�PP fn Square Footage(or Dimensions of Facility) Lot Size 4 ' `1V�5 Type of Water Supply: �unty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow (GPD) Tank Size 1CCOGAL. Pump Tank GAL. Trench Width c=�+ Max. Trench Depth �2Z'' Rock Depth hl A Linear Ft. �c0 Site Modifications/Conditions/Other: YY-%� E1�)iJ ST% ., ' o -F motAe, ' LIJ%T, IleMPCIFF 1NAitk Contact the Davie County Environmental Health 9ection for final inspection of this system between L1 .3>✓ " 1M F;�'M t z _,4 'APPL3CATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health P.O. Box 848/210 Hospital Street l Mocksville, NC 27028 liu, (336)751-8760/ Fax (336)751-8786 � �/, vv VU Al) Application For: p Site Evaluation/Improvement Permit ❑ Authorization To Construct(ATC) Ooth {S`� Type of Application: ❑New System []Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***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 LjJ Qe �r` SSC, Contact Person i ICS 5Sc 1 Billing Address 13 (] i 2o-)` Home Phone 3c4 1 -? I lr, City/State/ZIP W 1,I S l - Sc, t?% A C✓ Z 2_0 Business Phone Name on Permit/ATC if Different than Above Address PKUPEK I' Y INYUKMA HUN "'Date House/Facility Corners NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan no expiration with complete plat.) Owner's Name ftp i c.IAck e I `� l cit? \ 1,?At Ste" 11 Phone Number Owner's Address P. V . 6 cK ZOS cj3 V��y1� �cirZ Z�d2— City/State/Zip W'S � A C, 2 -112- L7 Property AddressOA ) ,n be r' j City v: tl,e— Lot Size 5 Per— Q-0- Tax PIN# Subdivision Name(if applicable) Section/Lot# Directions To Site: 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? ❑Yes ENo Does the site contain jurisdictional wetlands? ❑Yes RRI'o Are there any easements or right-of-ways on the site? ❑Yes Cho Is the site subject to approval by another public agency? ❑Yes 9Ko� Will wastewater other than domestic sewage be generated? []Yes Cho TT 1l . [�TTTT AT/YT TTT T -l1TTT TTTT1 Tl T'T llTT7 lr ru,L UU 1 lnn DVA DDLIJ VV # People 7— # Bedrooms S # Bathrooms Z Z Garden Tub/Whirlpool FrYes ❑No Basement: ❑Yes Leo Basement Plumbing: ❑Yes NNo 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; S<�onventional ❑Accepted ❑Innovative ❑Alternative ❑Other Water Supply Type: C,<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 t -150 - 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 hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging or staking the house/facility location, proposed well location and the location of any other amenities. Site Revisit Charge roperty s l owner's or owner'egal representative signature 4 G —0 Date Date(s): Client Notification Date: EHS: Sign given. []Yes ❑No Account # , V/ 7 Revised 11/06 Invoice # 1,0 DAVIE COUNTY HEALTH DEPARTMENT ,... Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 \ ��D ` \\ IMPROVEMENT/OPERATION PERMIT Account #: 990004017 Tax PIN/EH M 5812-01-5250 Billed To: Michael Russell Subdivision Info: Timber Trails Lot # 6-A Reference Name: Location/Address: Timber Trails Drive -27028 Proposed Facility: Residence Property Size: See Map ATC Number: 4454 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 PUS I PO-Z� #People 2 #Bedrooms #Baths 2— Dishwasher: Dishwasher. ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: IV" Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 13Lot Size 41,62444Z Type Water Supply 6yDesign Wastewater Flow (GPD) /'78 Site: New 0--' Repair ❑ System Specifications: Tank Size I&V GAL. Pump Tank GAL. Trench Width 3i;i Rock Depth N/q Linear Ft. Iqo Other:�r I L��oi�CXIB%1J. �bs�%LiBlJttb.1 �2 Required Site Modifications/Conditions: � G�Jiri%� 4Ld /6 U 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 11:30 p.m. on the day of in$tallation. Telephone # is (336)751-8760.**** 412d2� I,,J oRR RZX A �1 ,,jf 15514T" <-�., Ilk 4111.1 � t 11 PO KP aNz- p�SLM�,-�T Pt�r►�lac� Environmental Health Specialist's DCHD 05/99 (Revised) 246 ?&/ 4 FROM : LORI L. CRR FAX NO. : 724-3386 Jun. 19 2886 08:24PM P2 davie countsv anvhCalth - 3313 751 0700 p.2 �14N FOJt SITE E-VALUATIONAUPROVEWN L PERMIT & ATC Davie County Health Department Environmental Realtb Section P.O. Bax 8481210 Hospr W Street VlocksYil % NC 2"7038 (336)751.8760/ Fax (336)75I-8786 Application For: 3 Slm Evaluat±on/lutprovernent Permit L3 Author.yatlon To Constmet(ATC) 1. e+"IVPOA?AN7*"- THIS APPLICATION WINOT NE PROCMEI; MEWALL OF 1 HE REQl,'1RED � INFORMATION 1S PROM 2b. geRr to the LNFOtiMA:ION BULL MN for iaumaidmr•. I T IQ* i\'arltle to >x billedt ei.._S �,. Cartact person �1- i dX ' ' _ . FillingAddress L'lt1 (*4 •, Home Phone _L3'34 S`- iLPSS' City/StatelZO* r - Q ,� ��-1 t Z.I ., ^,_E �isirtess Phone 3 Name on Perth ATC ifDfermi than Above Mlsltir7g A►ildret;r Citvi 3tatd2ip PROPERTY INFORMATION NOTE: A surfty'plat or site plan trl!st accompany this application. (Permit is valid Ibc 60 rttorwis with site plan, no expiration with t.'�j'� 'I�con 1 t) l StreetAddtess6i-_CitY,�;�3s ja.- Tax PINli sd' /,2- 6 j5 2so Subdiviiion Nnme �rrn h jC,-rM,/c Scctionr7,ou'�� f pm Lot Si.ce Directions To Site - Date KauftTamlhy Corners Fl;g";d 7-7-7-1=` If the answer to any at lila `ailowutg . uesclofiS is -yes" svpnortit+g domm titittoP.O= be atttxhed. t Ate thcec any exisfxg wastewater sysi-ms ort :he site? i !Yes 33.40 Dees tae aito contain jurfutcUonal weUands? lJ't es Are there any easetrmu cT i� ar of --ways an the site? O'/es I Is the site subject to apprt-w i by anotber public agency? Ui es 50 Will wne'ewatcr ot6. 911XI 40="114 sewage be 1%vacratod? i- -.res vl' o ; IF RESIDENCEFML OUT'CFIE BOX BELOW i # People p Aedreoms Bathroor x� CYuden TablUvhirlpeel H'Yes tJ' No . Basement: aves !Tin Dascmcnt?lu nbing-. eQes CNo ' IF NON-RESIDPNCE FILL WT THE BOX BELOW Type of Faeiliry.'Busiress 1'oCl Squarc Fo ,tage of Building _ , I V pcopk 4 Sinks _,_„ 0 CCtmrolc;, a'i Showers _ _ # Urinals Estimated Water Usage (getlons per &Y) (AnAch dc:uenentation of similar facility water consumption) FOODSERVIrI I n?�t- n Scads -- Type systent requested: dConventio•.al t?Accepted Utmovetive CAUernativa 00ther= Wates Supply Type:'vl(County/Cit-i Water New Well CE:is:ing Well r Community Well Do you anticipate additions or exp:tn.iotu: of the facility this systema is iota mea to serve? L Yes Y"No If ycs, what type' . _ �..,, ._...... 'chis is to certify that the information irovidcd on this app krion is true aod miTect to the best of very knowledge. 1 un4etstand that icy per:nias) or ATC(s) issutd'rrrezile:r are sul jecl to suspension or rvo,21--on if the site is wiles --d, the intended use ch2ages, or it the inL,rmatihn tubrttitted in du app ication is falsified or t heated. I um irttand that / am mr;►0ns1b1c fvr all chargos incareed rrnm Ihir 2nnlirminn r iv!rrhv oranr rind- n/►nrry ... tA� e.„bnmrA o.«.+ -+.........e ..r.c. »,...,. i-...».. v„aa n.-..�.»... 900/Z00f� Dd MUM XM Iliad 6L90 866 9H Idd WH KOX 900Z/6I/90 FROM LORI L. RUSSELL RMR, CRR FAX NO. : 724-3306 Davie Coun7 and owned by PTOPecty owner's owaer'$ ICW tr,reutt:ltive si&RAtUT? Date sip given Oyes 3No Revised 2106 Jun. -19-2M 08: ?SPM P3 Site Revisit Charge (Bert N aiftcaaon Date: Account Invoice b 5o0/£Q Dd WIND HIM 6t80 866 9££ IYd 911 NOW 900Z/61/90 Jun 14 06 10:16a 1f devie county envhealth 336 751 0766 p.2 APPLICATION FO.k SITE EVALUATION/IMPROVEMENI' PERMIT & ATC Davie County Health Department .Environmental Healt4 Section P.O. Box 8481210 Hosp tal Street Mocksvilie, NC 27028 (336)751-8760/ Fax (336)751-8786 Application For: :1 Site Evaluatioa/iinprovement Permit U Authorization To Construct(ATC) ❑ Both ***IMPORTANT*** THIS APPLI(`'ATION CANNOT BE PROCESSED UNLESS ALL OF THE REQi:IREI) INFORMATION IS PROVIDED. defer to the INFORMATION BULL " TIN for instructions. APPLICANT INFORMATIUI` Name to be Billed M i c-hAQ- I uya I Contact Person %q i a / ,5Se �, � I _ Billing Address Z'14.(�( utZT Home Phone City/State/ZIP _-,-:3c~`IgiA_CzZI t Z''"� F usiness Phone _ c Narno on PermitIATC if Different than Above _ Mailing Address City/ Mate/Zip PROPERTY INFORMATION NOTE: A survey plat or site plan trust accompany this application. (Permit is valid for 60 months with site plan, no expiration with c )mplete plat.) Street Address__ City TaxPIN#. Subdivision Nance im ;LC,c.! It, ___Sectiotv'Lot#, fo N Lot Si!.e Directions To Site: i Date House/Facility Corners Flagged g —/ If the the answer to any of the following �: uestions is "yes", supporting docum:ntatio ust be attached. Are there any existing wastewater systems on the site? F17cs o Does thr site contain jurhd: itional wetlands? U'(es Are there any easements or light -of -ways on the site? C Yes Is the site subject to approvs 1. by another public agency? C ,t es o Will wastewater other than r.wncstic sewage be generated? i"'"Ces plo IF RESIDENCE FILL OUT 'ITFIE BOX BELOW # People Z., # Bedrooms _ # Bathroorr.s Z, Garden Tub/Whirlpool EJ'Yes f=iNo Basement: 3 Tes iDNo Basc:rnent Plumbing: lames ONO ... ­ IF NON -RESIDENCE FILL OUT THE BOX BELOW Type of Facility'Business Total Square Footage of Building_ # People # Sinks _ # Conu ode # Showers It Urinals Estimated Water Usage (gallons per day) (Attach de cumentation of similar facility water consumption) � FOODSERVICT, ONLY: #r Scats Type system requested: tlConventio :al ❑Accepted Ufnnovative UAliernative 00ther� Water Supply Type: ;/County/City Water U New -Well ❑ E Fisting Well C Conununity Well Do you anticipate additions or expansions of the facility this system is into zded to serve? C Yes ✓No If yes, what type? This is to certify that the information irovided on this application is true and correct to the best of my knowledge. 1 understand that any pe=t(s) or ATC(s) issued hoes fter are subject to suspension or revo ration if the site is altered, the intended use changes, or if the information submitted in this app .ication is falsified or changed. I untl.-rstand that I am resI)onsible for all charges incurred from this application. I hereby grant right of entry to the Authorized Rept!sentative of the Davie County Health Department to conduct necessary- hmnearinnq to drte mine. cmmnlisrce with snnli^ahlr W eq and n,l-c m, t11r A},nvr Ar« rit,Pri nrnn✓rt,r ln�ifP l ;n >m ..... - •---� --••-r - • •---- -- .._...._...... ^-..j•..__.. ...... «rr..�_........ �.. �...................................�....v.. p.vl.�..� .vim.......... Davie County and owned by Sitc Rcvisit Chargc Property owner's r owner's legal re,:resentative signature Client Notification Date: Date EES: Sign given OYes 2No Revised 2/06 Account # Invoice 11 aA>�F • �•5 p �.� North Ca roma Clack on tho Map to'. O Zoomin O, Zoomout IS RacenterMap '0 Idonttfy PBrCeIS Zoom Factor. 12X O Radius Sealah (feet) K. Ak rr Find Adjoining Parcel • County 10: 020000002004 i ACddititt NuMbe4000028748000 • PIN:S812015250 • regal 1:41.263 AC TIMBER TRAILS • Owner Name: FOSTER KENNETH L • Owner/Address 1: FOSTER KENNETH L • Owner/Address 2: FOSTER GAIL F • OwnerlAddtass 3:186 MAPLE TREE LANE • City,State Zip: MOCKSVILLE ,NC 27028 - 5984 • Land Value: $179,080.00 . Building Value: $0.00 • Land Unit 1 Type: J AC • Deed Sook/Page. 00588 / 0837 • Deed Data: 2004/12/30 a Sans Pfta! $320,000.00 i Property Address: LN a County ton/ng: A -A • Census Code: • City Code: a Fire Distad WILLIAM R. DAVIE • Flood Zone: ZONE X • Flood Community: 370308 • Flood Panel: 0025 C • Flood Map Date: 12-17-1993 Map L. rawL Dmwsaktct ❑ CeasusTn Cigr Bound County Zor Multi Sy, Q E9ii Firs a Q Flood. Pine Q Flood Zona Q Parcels School Dist Mtiltl Syl • Q soles Town Zonli Q Townslaps Multi SyI Q Voting Pre( 'Infrastructu p oriveways QRaa Liras Q Strut Cont p ustNC Hlgi Multi Syl U N Aerial Phot Caleka and E911 Addrt Q Fire Depart Q schools MAUX Tins map M prep: inventory Of n:91 I within this lurlsdlt Compiled from re plats, and other F and data. Llyet6 < hereby notified th 90OMA Dd YK110 YO OEM U80 866-9H YYd fill KOW 900Z/61/90 1 J.*. BRACRBN D.B. 41, PC. 447 -------------- --- -------- — — — — r ! ! ! zeas w Tow W7.7W / Mon mfti TRAM 7 ter=-=- j yaz��• _ �--- -- _ — a . 555.89• t .. 235.3«0• Zt N IRACT 9 NO/S A dad VKI'IO2IVa BIWid 6190 666 9££ IVd 9MI NOW 900?/6I/90 0 M AMM c . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990004017 Tax PIN/EH #: 5812-01-5250 Billed To: Michael RussellSubdivision Info: Timber Trails Lot # 6-A Reference Name: Location/Address: Timber Trails Drive -2702 Proposed Facility: Residence Property Size: See Map Date Evaluated: TO( Water Supply: On -Site Well Evaluation By: Auger Boring Z/ Community �Public Pit `-� / / % oI07 Cut n. SITE CLASSIFICATION: Ps LONG-TERM ACCEPTANCE RATE.- ©' s: 7S' REMARKS: EVALUATION BY:� r 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 Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm 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) ;r LTAR - Long-term acceptance rate - gal/day/ft2 DCF:D 05105 (Revise Landscape position HORIZON I DEPTH Texture group Consistence Mineralogy HORIZON 11 DEPT�figG�Il L��T'i�:�f•�9Mli11FamomWaffm Texture ..Consistence it���S�C'i�`K]��v�� Mineralogy W_Twr�_46. HORIZON Ill DEPTH �1i�lii�- Texture groupIL�NY Consistence ff WHO swim Mineralogy "AA MILM. HORIZON IV DEPTH Texture group Consistence--��- -��--�- Mineralogy SOIL -----�- • • -,A V701SAPROLITE CLASSIFICATION SITE CLASSIFICATION: Ps LONG-TERM ACCEPTANCE RATE.- ©' s: 7S' REMARKS: EVALUATION BY:� r 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 Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm 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) ;r LTAR - Long-term acceptance rate - gal/day/ft2 DCF:D 05105 (Revise ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■e■■■■iii:::i■r■■.-���qv■c>t■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■e11■cilli■■■■■■■■■■■■■II■■■■■■■■■■■■■■■■■■■■■/■■■■■ ■■■■■■■■■■■■■/■■■■■■I1■■■■■■■■■■■■■■■■■Ile■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ell■■�/■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■�,■■■■■■■■e■■■■■e■■■Ile■■■■■■■■■■■■■■■■■■■■■■■■e■ ■■■■■■■■■■■■■■■■■n�,11■■■■■■■■■��■Iii■■■■■i■■e■e■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■r'1111■■■■■■■■■1e■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■e■■■lie■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ IMMUNE ■ENNEN NIMEMES"Emmommmum\umMENNENmummomMENNEN ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■ale■■■■■■■■■■■■■■■■■■■■■■■■■■slat■■■■■■■■■■■■e■■■■■■■ ■■■■■e■■■■■■■■■■■■■■■■■■tee■■■■■■s■■■■e■■sae■■■■■■e■■■■■e■e■■■■■■■■ ■■■e■■ee■■■■■■■■■■/■■■■eu:�ii�■■see■/■��■��a■■■■■/■■■■■■■■■■■e■e■■■■■ Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 Improvement Permit Michael Russell 2744 Bethel Court Winston-Salem, NC 27127 Re: Timber Trails Lot #6A Tax PIN# 5812015250 Dear Client(s): 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 or the intended use change. System To Serve: i` - iDGNC Wastewater Design Flow(GPD):4�O Valid: C�Years ❑No Expiration System Type: ❑Conventional Accepted ❑Innovative ❑Alternative ❑Other Site Modifications/Permit Conditions: i.p.letter 7/06