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115 Meadow Ridge Drive Lot 1Account #: Billed To: Reference Name: Proposed Facility DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 989900204 Tax PIN/EH #: 5749-55-4145.01 J. D. Crews Homebuilder Subdivision Info: Meadow Ridge Lot # 01 Location/Address: Meaow Ridge Drive -27028 Residence Property Size: see map ATC Number: 4281 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 .19 age Treatment and Disposal Systems). THIS AUTHORIZATION FOR WAS TRUCTI VA,7R A PERIOD OF FIVE YEARS. 72� Environmental Health Specialist's Sign re: 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. r f Ll� �, /) l /% t/lr�Ll( OLI '�l[ 6� ,s 4-( Septic System Installed By: Environmental Health Specialist's Signature: Date: UFt' DCHD 05/99 (Revised) CURVE RADIUS LENGTH CHORD I BEARING C-1 956.57' 155.77' 155.60' S 791VOT E C-2 956.57' 10.00' 10.00' S 744 1 B' 1 E SqIN RogU 1 REBAR FOUND M ( NO MONUMENTATION ) PROPERLY UNE o j°oo, C-2 — — UNE FROM DEED OR PLAT N/F NOW OR FORMERLY s 36 tr DEED BOOK PG ( rY W co DOUBLE MERIDAN DISTANCE 11,9 . <t co I 0 C7 rr 1 NIP ( NEW IRON SET ) 0 f RERAR FOUND 0 Meadow Ridge I PB 7 PG 129 ` O m o i N W 30,549. sq.1t. Ld 0 w 0.7013 Acres (dmd) o o Z ¢ M N0.7D62 30,765, Sq.% Acres (dmd) 44cli z Ib z 3 o� c WILIAM BOWLER NV DS 197 PG 746 co KENNETH L. FOSTER, PLS 2552 CERTIFY THAT THIS MAP WAS DRAWN UNDER MY SUPERWISION FROM AN ACTUAL FIELD SURVEY MADE UNDER MY SUPERV510AI ON MAY 7 20-2 —1 ; / FURTHER CERTIFY THAT ACCORDING TO SAID FIELD SURVEY, THE PROPERTY LINES AND LOCATION OF ALL STRUCTURES ARE ACCURATELY SHOWN HEREON". SET LEGEND ( NO MONUMENTATION ) PROPERLY UNE o j°oo, ao — — UNE FROM DEED OR PLAT N/F NOW OR FORMERLY z a DEED BOOK PG ( rY W co DOUBLE MERIDAN DISTANCE W <t co I �sS 44 8S 44, C7 a) NIP ( NEW IRON SET ) Lot 22 I Meadow Ridge I PB 7 PG 129 KENNETH L. FOSTER, PLS 2552 CERTIFY THAT THIS MAP WAS DRAWN UNDER MY SUPERWISION FROM AN ACTUAL FIELD SURVEY MADE UNDER MY SUPERV510AI ON MAY 7 20-2 —1 ; / FURTHER CERTIFY THAT ACCORDING TO SAID FIELD SURVEY, THE PROPERTY LINES AND LOCATION OF ALL STRUCTURES ARE ACCURATELY SHOWN HEREON". SET LEGEND ( NO MONUMENTATION ) PROPERLY UNE RIGHT OF WAY UNE — — — — — UNE FROM DEED OR PLAT N/F NOW OR FORMERLY OB DEED BOOK PG PAGE PB PIAT BOOK OMD DOUBLE MERIDAN DISTANCE CL CENTERLINE Q Ell' ( EXISTING IRON FOUND ) O NIP ( NEW IRON SET ) `S S OPOINT Q ( NO MONUMENTATION ) NCGS CONTROL MONUMENT EXISTING PK NAIL PK NAIL SET F/p 0 EXISTMG STONE MAP OR: 6 LAT NO.: PRECISION 1.•10,0001 C:\ADCA0D\CIVIL\P\1795\RAIN-L0T Thu May 24 11:07:09 2001 P.I.N. PROPERLY OF KENNETH L FOSTER AND MIFF GAIL F. PROFESSIONAL LAND SURVEYORS 2200 SILAS CREEK PARKWAY SUITE i—B WINSTON—SALEM, NORTH CAROLINA 27103 TELEPHONE: 336 / 723-8850 SEC. P.B. — PG. — 50' P: MOCKSVILLE MAP H-5 DAVIE COUNTY, N.C. JOB 1795-01A DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900204 Billed To: J. D. Crews Homebuilder Reference Name: Proposed Facility Residence Q�;oo�aov Tax PIN/EH M 5749-55-4145.01 Subdivision Info: Meadow Ridge Lot # 01 Location/Address: Meaow Ridge Drive -27028 Property Size: see map ATC Number: 4281 **NOTE** This Improvement/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 HDOE#People #Bedrooms `'l #Baths 3 Dishwasher: d Garbage Disposal: 171�- Washing Machine: 12'00' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial EI � ��WN l Waste: Lot Size (• -1S Type Water Supply � 1al Design Wastewater Flow (GPD) � Site: New Repair ❑ System Specifications: Tank Size' OCOGAL. Pump Tank GAL. Trench Width Rock Depth N A Linear Ft. Other: q b1%TQ.t 6 V i'I1Drt &%6 , A '�-Q�7�� Required Site Modifications/Conditions: L of -i -S'v.Zj-r IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT ILTER. RISERS) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County H alth 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 installati n. Telephone # is (336)75]-8760.**** I low r 1r / IPMAX `t aJOI W► 3&' 54 � a Environmental Health Specialist'sN1t:�W21tC)C� bQ DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIJ TEC E � V (� Davie County Health Department ly 15 U L� Environmenta/Heaith Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 FDE-C2 1 2005 (336)751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS PML THE RSOVIMpT INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed cJ� UZ EW 5 L=�(� j Z ��� Contact Person �JZ�j�(2 (^Rf)5 Mailing Address�O [�L rn o 2 a'Home Phone 44112-7619, City/State/ZIP Mi76KS1/1-1145 AIC, 2 7oze Business Phone 9 5/0 - ?,i Z -'t, -'Q- 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: ❑ Site Evaluation C.ity/State/zip ty d'Improvement Permit/ATC ❑ Both 4. System to Service: qy House ❑ Mobile Home ❑ Business ❑ Industry 11Other S. Iff/ Residence: # People // # Bedrooms 4 # Bathrooms 3 �y'Dishwasher &Garbage Disposal "ashing Machine O Basem—Pent/P—lumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # Urinals # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: C4/County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes V<0 If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 1.Z5 `X 311 X a36' X 303 WRITE DIRECTIONS (from Mocksville) to PROPERTY: R: ri k're'J Tax Office PIN: # 574gSS 4-// S/S" 14Uh4 (SS -a Sl, nl P,4_ f -V R'!i hi c rJ Property Address: Road Name Mk-ADmcJ R:i d c/ a- DR, M e-1KAc.) i lam„ �, D it_ j %r for 00 City/Zip M OG -Ks Vi l l e /l16 7 F Lel ( J -1D nJ © ti L.�T If in a Subdivision provide information, as follows: Name: 1i\ gKpoLb R- gk t5 Section: Block: Lot: I Date Property Flagged: l Z - Zo `oS 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 an: 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 -Iee-V CA 51J 5 to conduct all testing procedures as necessary to determine the site suitabil' DATE l Z- Z 1- 0!;- SIGNATURE 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 locations). -- PL -A -'►J Aq-M c m ,�D Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. TK' 5I Z ° I Invoice No. J / %�� �` • �'� ��Qnd span f I 10 '� EQserrt ...- 'i .� 924,28" o a 4, Q 31 4 �! Cn sur ori X 1. 179 Acres' w ' Heative o f M Access Easement ,... / c Rebar Vound 311.11 ' CONTROL CORNER RA�tiIS LENGT1� CK04� SEARING ' 25.0' 15831' 157.39' S 3Q4' 4 W • i+r rras r'7 4 f r_ .1 r+!'ys !AAl1 ♦4r t a APPU(AIION FOR SIZE EVAl11AMON/IMPROVEMENT PERMIT & Air @ ` Davie County Health Department D Envlionmenfal Keafth SOW= P.O. Box 848/210 Hospital Street JUL I r Mocksville, NC 27028 (336)751-8760 ***Zi P0itTANT*** THIS APPLICATION CANNOT BE PROCESSLD UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed KE N 11 E T N L.. t o S i E Q Contact Person KE N nl� 7l 1 L • FOS- CL )railing Address _l X�86L io MAPL.E Tkcc time Phone 704 -54(o -"7i i 8 City/State/ZIP IsIOCKS�t ��� , N •� .27U Business Phone 33Co --I Z3-£i8S0 Z. Name on Pewit/ATC It Different than Above Nailing Address City/State/Zip a. Application Tor: K Site Zvaluation ❑ uVroven ent Permit/ATC ❑ Both 4. system to service: Fd House ❑ Mobile Home ❑ Business ❑ Ind/ustry ❑ Other S. If Resilience: # People # Bedrooms ( # Bathrooms Dg ishwasher C) Garbage Disposal "iA hLnq Machine 0 Basement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/other: Specify type # People • sinks • Commodes # Showers *,Urinals • Mater Coolers Ir TOODSERVICE: If Seats// Estimated Nater Usage (gallons per day) 7. Type of water supply: (d'County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system U intended to serve? 0 Yes ❑ No If yes, what type' ***IMMRTAN7%** CLIENTS MUST Ct7MPLETE THE REQUIRED PRO ERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUS ESUBMITTED by the c1lint with THIS APPLICATION. Property Dimensions: 1'2,7 X 2 97 X 2 34 X 3 pe y WRI+TE'DIRECTIONS (from MockrAlle) to PROPERTY: Tax Omce PIN: # 5?49 - 43- 5-7 9 8 "'�l-=asT oN V S uw•w 1 S 8 Property Address: Road Name 15 A t.3 ROAr> Clly/ZiprAGC.u<S, , I Ic a-1 ozr3 If in a Subdivision provide information, as follows: Name: McAnowk(-DGE To S.Nio Raimo (sR 1(o43) rUPLIJ R%G"'T OP SA,•l - APPOL x O.eaMILG- -ru S.1 -r ne, R\LNT Section: Block: Lot: i Date Property Flagged: G • 018 - 99 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 ani responsible for all charges Incurro from this appUc adon. I, hereby, give consent to the Authorized Representative of the Davie County Health DepartmeAr to enter upon above described property located in Davie County and owned by %iENNE'_ i_• F��T E R to conduct all testing procedures as necessary to determine the site suitability. DATE (,-?-S — 199'► SIGNATU 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 locations). Revised DCIID (07/98) Account No. Invoice No. DAVIE COUN'T'Y HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLIC.s►NT 'INFORMATION PROPERTY INFORMATION Account M 989900654 Tax PIN/EH #: 5749-43-5798.01 Billed To: Kenneth Foster Subdivision Info: Meadowridge Lot # 1 Reference Name: Kenneth Foster Location/Address: Sain Road -27028 Proposed Facility: Residence Property Size: 1.19 Acre Date Evaluated: Water Supply: Evaluation By: On -Site Well Community Auger Boring Pit / Public 11_ Cut FACTORS 2 3 4 5 6 7 Landscape position l_ Slope % Zo HORIZON I DEPTH —% 15 Texture group CL G Consistence ; Structure k Mineralogy HORIZON II DEPTH 15 — Texture group G" G Consistence F711sy Structure Mineralogy; I 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 SITE CLASSIFICATION: RS LONG-TERM ACCEPTANCE RATE: 0-.6�_ REMARKS: LEGEND Landscape Position EVALUATION BY: ` C.� OTHER(S) PRESENT: 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 VFl - 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 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/112 I)CHD (Revised 05/99)