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132 Arrendal Court Phase 1 Lot 21M OPERATION PERMIT Davie County Health Department t �¢ 210 Hospital Street P.O. Box 848 ...... .� `'°--•'' Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753-1680 Applicant: Alliance Contracting/Brian Lucas Address: PO Box 957 Cay: Welcome State/Zip: NC 27374 Phone #: (336) 995-6877 *CDP File Number 124316-1 F4 -010 -AO -021 County ID Number: Evaluated For: NEW Township: Property Owner: Alliance Contracting/Brian Lucas Address: PO Box 957 Cay: Welcome State2ip: NC 27374 Phone #: (336) 995-6877 Property Location & Site Information i Address/Road #: Subdivision: Summerlyn Farms Phase: Lot: 21 132 Arrendal Court Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: *Water Supply: PUBLIC *IP Issued by. *CA issued by: Design Flow: 4 8 0 Soil Application Rate: 0 3 N arification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: Directions Hwy 601 N. to Angell Rd on right. Then right on Summerlyn Drive. turn left on Arrendal Court *System Classification/Description: TYPE III B. SYSTEM W/SINGLE EFFLUENT PUMP SaproliteSystem? 0Yes QNo *Distribution Type: PUMP TO GRAVITY Pump Required? OYes ONo *Pre Treatment: Drain field 1 6 0 0 Sq. ft. 6 4 4 0 It. 9 ()Inches O.C. — Feet O.C. — 3 ()Inches Feet inches *System Type: INFILTRATOR QUICK 4 STANDARD Installer: Brian McDaniel Certification #: *EH S: 2140 - Nations, Robert Date: 0 5/ a a/.2 0 1 4 Minimum Trench Depth: 3 0 Inches Minimum Soil Cover. 1 8 Inches Approval Status Maximum Trench Depth: 3 6 Inches EEO] proved O Disapproved Maximum Soil Cover: a 4 Inches _ CDP File Number 124316 - 1 Manufacturer. Shoaf STB: 760 Gallons: 1000 Date: 0.1/ 1 4/ 0 5/ a 0 1 4 =Filter Brand: POLYLOK Dual PL -122 With Pipe Adapter ST Marker: ❑ Yes 1:1 NO nforced Tank: ❑ Yes ❑ NO 1 Piece Tank: ❑ Yes ❑ No Manufacturer. shoat PT: Gallons: 1000 County ID Number: F4 -010 -AO -021 Lat. Long: Installer: Brian McDaniel Certification #: REH S: 2140- Nations, Robert Date: 0 5/ a a/ a 0 1 4 Approval Status Approved ❑ Disapproved Pump Tank Date: 0 7/ 1 4/ 2 0 1 3 Riser Sealed 0 Yes ❑ No Riser Height: F1 Yes ❑ No (Min.6 in.) nforced Tank: ❑ Yes El NO 1 Piece Tank: ❑ I - Yes 0 No / Pipe Size: a inch diameter Pipe Length: 1 5 8 feet 'Schedule: 40 Pressure Rated El Yes ❑ No Approved fittings p Yes ❑ NO Pump Type: Zoeller Installer: Brian Mcdaniel Certification #: *EH S: 2140- Nations, Robert Date: 0 5/ a a / x 0 1 4 Approval Status 0 Approved ❑ Disapproved Supply Line Installer: Brian McDaniel Certification #: *EH S: 2140 - Nations, Robert Date: 0 5/ a a /.2 0 1 4 Approval Status D Approved ❑ Disapproved Installer: Brian McDaniel Dosing Volume: - Gal Certification #: Draw Down: Inches "Chain: ROPE Valves Accessible p Yes ❑ No Flow Adjustment Valve 0 Yes ❑ No Check -valve p Yes ❑ No PVC Unions ❑ Yes ❑ No Vent Hole ❑ Yes ❑ No Anti -siphon Hole p Yes ❑ No 'EH S: 2140- Nations, Robert Date: 0 5/ a a/ a 0 1 4 Approval Status 11 Approved ❑ Disapproved CDP File Number 124316 - 1 r-rrctr11c CUUMrnent County ID Number: F4-010-Ao-021 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 *EHS: Pump Manually Operable ❑ Yes ❑ NO *Activation Method: Date: / Alarm Audible El Yes ElNo Approval Status El Approved El Disapproved Alarm Visible ❑ Yes El NO 2140 - Nations, Robert *Operation Permit completed by_ Authorized State Agent: Date of Issue: 0 5/ 2 2 l a 0 1 4 This system has been installed in compliance with applicable NC General Statutes: Article 11, Chapter 130A, Rules for Sewage Treatment and Disposal, 15A NCAC 18A.1900 et. Seq., and all conditions of the Improvement Permit and Construction Authorization. This property is served by a TYPE 11113. sewage septic system. Rule .1961 requires that a Type TYPE III B. septic system meet the following criteria: Minimum System Review ByThe Local Health Department: sYRS. Management Entity: OWNER Minimum System Inspection/Maintenance Frequency By Certified Operator: N/A Reporting Frequency By Certified Operator: N/A 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 entitywith a certified operatoror a private certified operator forthe 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 operator for the life of the septic system. Rule. 1961 (2) (e) requires a contract shall be executed between the system ownerand a management entity priorto 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 formaintenance 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. R shall also be a condition of the Operation Permit that subsequent owners of the systems execute such a contract. OHand Drawing Olmport Drawing **Site Plan/Drawing attached.** • OPERATION PERMIT 124316-1 -bavie County Health Department CDP File Number: 210 Hospital Street County File Number: F4-010-AO-021 P.O. Box 848 Mocksville NC 27028 Date: Q Inch Scale: Drawing Drawing Type: Operation Permit . ON/A = ft. QN/ OPERATION PERMIT Davie County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC CDP File Number: 27028 County File Number: F4 -010 -AO -021 Date: Click below to import an Image from an external location: Drawing Type:Operation Permit IF CONSTRUCTION AUTHORIZATION Davie County Health Department 210 Hospital Street • �` P.O. Box 848 Mocksville NC 27028 Phone: 336-753-6780 Fax: 336-753.1680 Applicant: Alliance Contracting/Brian Lucas Address: PO Box 957 City: Welcome State/Zip: NC 27374 Phone #: (336) 995-6877 Address/Road #: Subdivision: 132 Arrendal Court Mocksville NC 27028 Structure: SINGLE FAMILY # of Bedrooms: 4 # of People: 'Water Supply: PUBLIC "Site Classification: PS Saprolite System? OYes ONo Design Flow: 4 8 0 S'IA I' t' Rt' For Office Use Only 'CDP File Number 124316-1 County ID Number: F4.010 -AO -021 Evaluated For: NEW Township: 1 1/ 2 5/ 2 0 1 8 Property Owner: Alliance Contracting/Brian Lucas Address: PO Box 957 City: Welcome State/Zip: NC 27374 Phone #: (336) 995-6877 Phase: Lot: 21 Directions Hwy 601 N. to Angell Rd on right. Then right on Summerlyn Drive. turn left on Arrendal Court System Specifications Minimum Trench Depth: 2 4 Inches r. Minimum Soil Cove Inches Maximum Trench Depth: 3 6 Inches V f pp Ica Ion a e. 0 - 3 Maximum Soil Cover: Inches "System Classification/Description: 'Distribution Type: PUMP TO GRAVITY TYPE II A. CONV SYSTEM (SINGLE-FAMILY OR 480 GPD OR LESS) S t' T k' 'Proposed System: 25% REDUCTION Nitrification Field No. Drain Lines Total Trench Length: Trench Spacing: Trench Width: Aggregate Depth: 4 3 6 ft_ ,up %, an . _ 1 0 0 0 _Gallons 1 -Piece: OYes ONo Pump Required: OYes ONo OMay Be Required Sq. ft. Pump Tank: 1 0 0 0 Gallons 1-Piece:OYes QNo GPM—vs— ft. TDH __8Inches O.C. Feet O.C. Dosing Volume: Gallons Q Inches Feet Grease Trap: Gallons inches Pre -Treatment: ONSF OTS -1 OTS 11 Septic Tank Installer Grade Level Required: 01 011 0111 OIV Page 1 of 3 CDP Filg Number 1243115-1 County ID Number: F4 -010 -AO -021 Kepair ❑ Open Pump System Sheet Kequireo:V T CS V IVO IJIVU, Wu1 11db MvdIIdUlU 0PdUV • •�v Mw• w7a+aar• Trench Spacing: Inches 0. *Site Classification: PS — 8Feet O.C. Trench Width: Inches Design Flow: 4 8 0 _0 Feet Soil Application Rate: 0 - 3 Aggregate Depth: inches *System Classification/Description: Minimum Trench Depth: 4 0 Inches TYPE IV A. ANY SYSTEM WITH LPP DISTRIBUTION Minimum Soil Cover. Inches *Proposed System: 50% REDUCTION Maximum Trench Depth: 4 0 Inches Maximum Soil Cover: Nitrification Field Inches Sq. 8. No. Drain Lines 'Distribution Type: PRESSURE MANIFOLD Total Trench Length: 2 6 6 ft Pump Required: QYes ONo 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 repair without approval of Health Department. `Permit Conditions The issuance of this permit bythe Health Department in no way guarantees 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 Permit, not to exceed five years, and maybe Issued at the same time the Improvement Permit Issued (NCGS 13OA- 336(b)] If the installation has not been completed during the period of validity of the Construction Permit the Information submitted 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 or Construction Authorization shall become invalid, and maybe suspended or revoked (.1937(g)). The person owning or controlling the system shall be responsible for assuring compliance with the laws, rules, and permit conditions regarding system location, Installation, operation, maintenance, monitoring, reporting and repair (1938(b)). Applicant/Legal Reps. Signature Required? Oyes ONO Applicant/Legal Reps. Signature* Date: 'Issued By: 2244 - Daywalt. Andrew Date of Issue: 1 1 / 2 5 / 2 0 1 3 Authorized State Agent: Malfunction Log OYes OHand Drawing Olmport Drawing Total Time:(HH:Id1.1) **Site Plan/Drawing attached.** 1 Hours . 0 0 Minutes Page 2 of 3 S-8 - CNS issued - new CONSTRUCTION AUTHORIZATION Dave County Health Department 210 Hospital Street P.O. Box 848 Mocksville NC 27028 Drawing Drawing Type: Construction Authorization 5�ak ROK or }SSC CDP Fife Number. 124316 - 1 F4 -010 -AO -021 County File Number. Date- 1 1 /25/2013 Olnch Scale: , , OBlock — ft ON'A 30 ""� C�'21� Paop 3 of .1 Pr APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & ATC op.P.O. County Environmental Health � .�j P.O.Box 848/210 Hospital Street Mocksville, NC 27028 V (336)753-6780/ Fax (336)753-1680 Application For: ❑ Site Evaluation/Improvement Permit 'Authorization To Construct (ATC) ❑ Both Type of Application: ;lew 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 rI LL -1 P((J a G Address a01t q57 vwpLC0,nn_q_ /`)C- Citv/State/ZIP V -.P L" rwe , j C )- 7 3 7 Email LP CARD L(N/} -- C o /M Name on Permit/ATC if Different than Above, Mailing Address Contact Person I Pf /S LUC s Home Phone 3 Y (O 8 7 Business Phone3 3 4 5— 6 g 7 Email:'Sr-If - t A-L,1,q Cj Cttf_oU/VA -CO City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flaaaed 11 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.) �2 Owner's Name A1.L1Atj&C Cotr-t'i (A/6ZA1,t/P,rCe DevetoP"-T-Phone Number -J `'0157 �oe-7 Owner's Address F0 o 5City/State/Zip}we . V,, Q LLoyge /,QC Property Address 0- fJ D A L G City MDG ICS V1 LLQ Lot Size o bct n c.N 5 Tax PIN# b 5 3 en- S$31 -n l ' S� by , �3 T .n Subdivision Name(if applicable) ') y rhe (L�`IN yW Z mS Section/Lot#y` N `t'U Directions To Site: (co ( Al -ro RNGeU_ f?- D, 7 -VR^/ M GH -r ®n/ S;V rnIhe/Z t -`/^i D1ZNeQ t V Z (-/ k FT O N A-IZ R-eNDa L CT 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 \ No Does the site contain jurisdictional wetlands? _Yes o �N Are there any easements or right-of-ways on the site? _Yes _ o Is the site subject to approval by another public agency? _Yes _\_No Will wastewater other than domestic sewaee be Qenerated? Yes \No IF RESIDENCE FILL OUT THE BOX BELO L t""" # People # Bedrooms # Bathrooms 3 1}- Garden Tub/Whirlpool*es ❑No Basement: ❑Yes �No Basement Plum mg: ❑Yes 5�lo 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 o'f similar facility water consumption) FOODSERVICE ONLY: # Seats Type system requested: ❑Conventional ❑Accepted ❑Innovative ❑Alternative ❑OtheraS7" IZEDvcrt©e'/ Water Supply Type: County/City Water ❑ New Well []Existing Well ❑ Community Well Doyou-anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes e'R(No 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 undq0tarid that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging orak' the house/facility lgcatjoa,�posed well lotion and the location of any other amenities. LZ Site Revisit Charge Pr owner's or owner's legal representative signature H/13 I/l Q- O Date(s): �3 Client Notification Date: Date EHS: Sign given ❑Yes ❑No Revised 11/06 Account # 12431(e Invoice # g-7 4 "�` • LA 276 79' 56 existing 0'drainage .�' •�' � 39.7 fence cc %P..'00 F .1 U, 23 /* V"\ -9 03.732 Ac.+/ Cb 'S �- ��,, day �'' W •,� f.. / l. � � . Jr. Oro ,,� .�• ' 22 N 0 0"ca0 `�` ..�•--•''•;00'1.20 Ac.+/— t� V.,- jr C9 �• r �+' O284.644 t -- of 69 33 point under 60.42 corn planter to set new r •''� ,�`NOJ Ar O c�0' o. 6 89 c toe %001 t ol 40 � P /O C) o � 15 F A At Davie County Environmental Health P.O. Box 843/210 Hospital Street Mocksville,'N'C 27028 (336)7.51-8760/ Fax (336)751-8786 Account #: 990005113 Billed To: Allliance Development Address: P.O.Box 957 City: Welcome Reference Name: Proposed Facility: Residence IMPROVIrI1IENT P>• R11'IIT Tax PIN/EH #: 5821-71-5260.21 Subdivision Info: Summerlyn Farm Lot # 21 Location/Address: Angel Road -27028 Property Size: See Map Improvement Permit DOES NOT authorize the construction of a wastewater system. An .•l uihorrZrudl,N TO Constnict a Wastewater systern must be obtained from this office prior to the ,;orlstrICI ioil lil"'t111lalion of a wastewater system or the issuance of a building permit(in compliance with Arline 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to reNocat}on if site plants, plat or the intended use change. I'en;llt i'�},r a� �' -'Repair ' 'Fxpansion�_.__.. hermit Valid for: ('_ Years ENo Expiration R(-siclential Specifications: .4 t3cdrooms— L— # Bathrooms—,___ #? People_____ Basement -D Basement plumbingi_: Noll- itcsiclef tial Specitications: Facility Type--_ _ # People__—_ # Seats Square Footage(or Dimensions of Facility)__ I3z;rgn l�io��.•((�if'U): �r�� _-- a�: �Ii�dilirttrurr�'1'crnut Conditions: F)pc of Water Supply: —)County/City L'Mrell IlConmunity Well ...__ _.. Initial � _ . .— �— Hair V � WA� H / / '^ p r \J IN i u -,L A �1`O, A,,, c w6c 4o,.<c .. l i Dale-- 2-.��1 �� � .-- -. . /1116-13/ APPLICATION FOR 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 Application For: Site Evaluation/Improvement Permit 0 Authorization To Construct(ATC) ❑ Both Type of Application: ❑New System ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IMPORTANT*** THIS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Bille,i A"(ANC'-E -� E V+: L o-PAtEtr7Contact Person Jc -H N1 F0 LYst Billing Addreq rte' . a "2)OX ClS 'Z Home Phone City/State/ZIP W&t c o MG AY'_ 'Z -?A-714 Business Phone 334� -t -7Z Z ro' 19 Name on Permit/ATC if Different than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Comers NOTE: A survey plat or site plan must accompany this application. Included: 0 Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site plan, no expiration with complete plat.) Owner's Name -T 9S L.AAMF-ie- Phone Number 33 c --9<:i -5c&S Owner's Address 18I IrJ96 t, �'-)AA,->r. City/State/Zip AK s Vrt_t Property Address " City /Lt�CKSv��e t Lot Size Tax PIN# Z Subdivision Name(if applicable ]Sli M M E g-t,te j rAg-AA Section/Lot# Directions To Site: N- HtyY Coal . P -ii t"I Ort ALkN 6LA, 'RoaD.,2Ro-PbR-T'rr Ont 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) dNo Does the site contain jurisdictional wetlands? ❑Yesk'No Are there any easements or right-of-ways on the site? ❑Yes %No Is the site subject to approval by another public agency? ❑Yes RNo Will wastewater other than domestic sewage be generated? ❑Yes UNo IF RESIDENCE FILL OUT THE BOX BELOW # People # Bedrooms 4 # Bathrooms Garden Tub/Whirlpool ❑Yes 0 N Basement: ❑Yes []No Basement Plumbing: ❑Yes ❑No 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: $Conventional ❑Accepted ❑Innovative OAlternative ❑Other Water Supply Type:;gf County/City Water 0 New Well ❑Existing Well ❑ Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes -) No 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 comers and I n andflaggiRng-or staking the house/facility location, proposed well location and the location of any other amenities. P-- r"h' ! ` �--a7 Site Revisit Charge Property owner's or owner's legal representative signature Date(s): 16- J- ZOOg Client Notification Date: Date EHS: Sign given ❑Yes ONo Account# Revised 11/06 Invoice # DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/ Site Evaluation APPLICANT INFORMATION IS' .8-J (Y VA Water Supply: Evaluation By: On -Site Well Auger Boring a.d'VL"-g Community Pit PROPERTY INFORMATION Lo + a t l -.-t - i i3--- o8 Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position (_ L t__ Slope % -2-- LHORIZON HORIZONI DEPTH 0—/ p Z Texture group C C Consistence ; Structure !!' Mineralogy i S X 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 -7 ? jJ SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: U• � REMARKS: LEGEND EVALUATION BY: gin'b OTHER(S) PRESENT: 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 !u � 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) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05105 (Revised) !' Davie County Environmental Health P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760/ Fax (336)751-8786 **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: Vew ❑Repair ❑Expansion Permit Valid for: W Years ❑No Expiration Residential Specifications: # Bedrooms__q__# Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats �1 d Square Footage(or Dimensions of Facility) Design Flow(GPD): �1 DU Type of Water Supply: ❑County/City []Well ❑Community Well Site Modifications/Permit Conditions: IMPROVEMENT PERMIT Account #: 990005113 Tax PIN/EH #: 5821-71-5260.21 Billed To: Allliance Development Subdivision Info: Summerlyn Farm Lot # 21 Address: P.O.Box 957 Location/Address: Angel Road -27028 City: Welcome Property Size: See Map 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: Vew ❑Repair ❑Expansion Permit Valid for: W Years ❑No Expiration Residential Specifications: # Bedrooms__q__# Bathrooms # People Basement❑ Basement plumbing❑ Non -Residential Specifications: Facility Type # People # Seats �1 d Square Footage(or Dimensions of Facility) Design Flow(GPD): �1 DU Type of Water Supply: ❑County/City []Well ❑Community Well Site Modifications/Permit Conditions: