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131 Ridgehaven Place Lot 3DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ' P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001663 Billed To: Tim Pennington Builders Reference Name: Nelson Howard Proposed Facility: Residence 12 A.- Tax c. Tax PIN/EH #: 5749-43-5798.03 Subdivision Info: Meadowridge Lot # 3 Location/Address: Ridgehaven Place -27028 Property Size: see mpa ATC Number: 2763 (P"%5s6) **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 _ � V S6 #People --7— #Bedrooms — '5 #Baths Dishwasher: Id Garbage Disposal: [ Washing Machine: s2r/ Basement w/Plumbing: lzBasement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size �� ype Water Supply Design Wastewater Flow (GPD) 0 Site: New Repair ❑ System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width Rock Depth 122'Linear Ft.J� Other: ll-- i Required Site Modifications/Conditions: ��r� Ong ��Tn iQ00T D* _LxJAQSA 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.**** Kl = 3 c ,50 Environmental Health Specialist's DCHD 05/99 (Revised) `cb I <i,��li7Mini. M ��L��S ��Q� ►SSS 1 / V ��. 14 � . Date: M // DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section P. O. Boz 848/210 Hospital Street • Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001663 Tax PIN/EH #: 5749-43-5798.03 Billed To: Tim Pennington Builders Subdivision Info: Meadowridge Lot # 3 Reference -Name: Location/Address: Ridgehaven Place -27028 Proposed Facility: Residence Property Size: see mpa **NOT> * i iIss prove6i ent/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 Xr:Z,-C_ #People 2- #Bedrooms 3 #Baths 3 Dishwasher: Garbage Disposal: Rr Washing Machine: N!r Basement w/Plumbing: E( Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 7 Ap AeEs Type Water Supply ClwDesign Wastewater Flow (GPD) pSite: New R( Repair ❑ System Specifications: Tank SizelOODGAL. Pump TankIC003AL. Trench Width SIO Rock Depth Linear Ft. Other: �1STQIC�JT�O-� ►3f�SC3cs 1�1sTQ�L L.. 1 5 0% o •C,. IM t'j . Required Site Modifications/Conditions: �,.ISTo.I,� t*JTt9J2t{� 1p p(:f app- Li.` 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.**** FA DCHD 05/99 ,Specialist's Signature: Zai D qD �• .J )e Date: V DAME COUNTY HEALTH DEPARTMENT ' Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001663 .Tax PIN/EH #: 5749-43-5798.03 Billed To: Tim Pennington Builders Subdivision Info: Meadowridge Lot # 3 Reference Name: Location/Address: Ridgehaven Place -27028 Proposed Facility: Residence Property Size: see mpa ATC Number: 2763 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 Trea t and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CON U IS V ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature* ate: 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. P�r4iJ � a, 0 TO b, �L s Environmental '1\ - �' �O `,J1l L- , DCHD 05/99 (Revised) System Installed By: Specialist's Signature : f11 APPLICATION FOR a County Health EVALUATION/IMPROVEMENT RODepameE t PERMIT & ADaviIT Environmental HealthSecbonP.O. Box 848/210 Hospital Street27Mocsville, NC 27028 1 (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL T UXAE3^"' INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. I /vo�ttrtJr ��t7�Old 1. Name to be Billed /t/[i/'t[�//J/�JyrN/Aa �l��a /!/`t� Contact Person Mailing Address �✓ (/ Fa I/4 L� � Home Phone City/State/ZIP 'yZ&a' S i/ts / ��%FO Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: ❑ Site Evaluation 4. System to Service: V House ❑ Mobile Home 5. If Residence: # People Dishwasher l- Garbage Disposal City/State/Zip Improvement Permit/ATC ❑ Both Business ❑ Industry ❑ Other # Bedrooms _"31 AWashing Machine VS-Basement/Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # Urinals # Bathrooms 3_ ❑ Basement/No Plumbing # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes "0 If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION. Property Dimensions:/ 11(z $j(/IElpK3.�3 WRITE DIRECTIONS (from Mocksv/ille) to PROPER'T'Y: Tax Office PIN: # �� - 7 3 ^� 7 9 p ,�$ ger. -� �OL T`,e Property Address: Road Name City/Zip Ike- !S 1'" 51'/tee-t 60 le -,474 - If in a Subdivision provide information, as follows: Name: M`eakow ��Cl;� Section: Block: Lot:___, ao fio e,001 Date Property Flagged: _ '�47-j 1 0 t 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 s`ui�tabiillity. DATE SIGNATURE / c 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 DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. Invoice No. �� t r APPII(AIION FOR SIZE EVA111MION/IMPROVEMENT PERUI1 do A 0 W E „• ,�, Davie County Health Department Env/ronmenW Kea ft h Secdon P.O. Bos 948/210 Hospital Street JUL 1 1999 Mocksville, NC 27028 (336)751-8760 I ***DWCMTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED I INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. flame to be Billed KEW nl E T" - h 0 S � � R Contact Person KE N ae TH L • Fo,-i-e q- Nailing Address l �8(- nl a pLc T12�r, Ln -,j name phone 704 - 54<o--7 -7 cS 8 City/state/Zip 1"L� IOCK-,VIILC , .77oze Business phone 33Co--i 23-$850 2. flame on permit/ATC if Different than Above Nailing Address City/state/Zip 3. Application For: It Site Evaluation 0 Improvement Pe=Lt/ATC 0 Both 4. system to service: id House 0 Mobile Home O Business 0 Industry 0 other a. if Residence: # People � # Bedrooms '7' 4 # Bathrooms U,Dishxasher O garbage Disposal uwashino Machine O Basement/plumbing O Basement/Ito plumbing 6. If Business/Industry/other: Specify type # People # sinks i Commodes # Shovers # Urinals # Mater Coolers IF TOODSERVICE: # SeatsEstimated Nater Usage (gallons per day) 7. Type of water supply: LI/County/City 0 Well 0 Community s. Do you anticipate additions or expansions of the facility this system is intended to serve! 0 Yes 0 No If yes, what type' ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: X75 X µ65x290 x 387 Tax Office PIN: # 5-749 - 43- S`7 9 8 WRIT& DIRECTIONS (from MockrAlle) to PROPERTY: Property Address: Road Name 5 A « R A o To 10 Rea. %3 ( s R 1 (o 43) Tu R:.1 City/Zip'Mcu-c50'IIC alOze If In a Subdivision provide information, as follows: Name: McPiooWRt-DG6 CPrc�PuSED) R1C,VkT oP SA, -J - APP"-,,, 0.eaMILL Tc) S (TE n t-1 R\ L �A T Section: Block: Lot: _3 Date Property Flagged: & • 018 - 99 This is to certify that the information provided is correct to the best or 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 fi om this application. 1, hereby, give consent to the Authorized Representative of the Davie County Health Departmep-i to enter upon above described property located in Davie County and owned by 11'6�YN67W .- L. FOSTER, to conduct all testing procedures as necessary to determine the site suttabilih. DATE -(o -?-8 -195-w 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 DCHD (07/98) Account No. Invoice No. / a DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICAf4T'INFORMATI0N PROPERTY INFORMATION Account #: 989900654 Tax PIN/EH #: 5749-43-5798.03 Billed To: Kenneth Foster Subdivision Info: Meadowridge Lot # 3 Reference Name: Kenneth Foster Location/Address: Sain Road -27028 Property Size: 2.84 Acres Date Evaluated: Proposed Facility: Residence Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope % 4,2 HORIZON I DEPTH1-5?k - Z - Texture rou G Consistence ; Structure Mineralogy HORIZON II DEPTH -go Texture grou _ Consistence Structure Mineralogy I t HORIZON_ .III DEPTH a Texture group Consistence Structure -Soo Mineralogy; HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: ids LONG-TERM ACCEPTANCE RATE: 3� REMARKS: EVALUATION BY:-'W— 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 - Firm 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 SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineral= 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 DCHD (Revised 05/99) /�w) 3 m E 3 ZJ62 krw (dmd) S "Woe w C2� 3 Z31 w 4 2.913 Acres (dam 40.0' 8/L ' RtoGExAVEN PL / •' 2T PFOME KXM �S 04'03'4' w 212.9 40.0' R .�.. v� 1.562 &1 w (a s o4•oarog' w ♦. .../' 7' ♦ +. 1 / r 71 „11i 111 M]• ..• .'ESIR! ..1 SII► :,•. •„ .. ].i!► a� ..1 .111. �. .�1•' i�� 35i.AW 2199.94' Tatol 440.15' SARAH 'HOU-Mb NOM., WILL SK 4 PAGE 4Bo ,GENERAL PROW YARD SET BACK UNES ARE 44W rMM tA WN IT(1) SIDE YARD SET BACK LINES ARE 15'IYPICAL ( S?R£ET SIDE 6 223' ) S 3T50,12T w3 REAR YARD SET BACK LMS ARE 30'TYPM 4 ALL LOTS ARE A �1 OF 40.000 SOLME FEET K Soo' 1 w TME CURRENT ZONM OF PROPERTY IS 06R SU4* (6) 7HE LOTS ARE TO BE SERVED BY PLMM WATER AND PRIVATE (7) ALL urxniES ARE UNDERGROUND RftGNT OF V1GtY ! MIRSECMK (a) NO CRNVEMYS SHALL BE LOCATED WM41N 30 FEET OF A STREET ♦. .../' 7' ♦ +. 1 / r 71 „11i 111 M]• ..• .'ESIR! ..1 SII► :,•. •„ .. ].i!► a� ..1 .111. �. .�1•' i�� 35i.AW