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184 West Knoll Brook Drive Lot 35Account #: 990003300 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital street Mocksville, NC 27028 (336)751-8760 , l 1 �f Billed To: Lifestyle Builders of Davie Reference Name: P Ai Tax PIN/EH #: 5749-33-2338.35 LB Subdivision Info: Meadow Ridge 2 Lot # 35 Location/Address: West Knoll Brooks Dr. -27028 Pro osed Facility Residence Property Size: see ma ATC Number: 4080 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: � � Date: -,Ij 1171J5 41 S'W rooms CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certifica f Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance Article I 1 of G. S. Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," buts in NO Y be to as a guarantee that the system will function satisfactorily for any given period ofd &,- I D /SD Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT _ Environmental Health Section P. O. Boz 848/210 Hospital Street J :i' Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990003300 Tax PIN/EH #: 5749-33-2338.35 LB Billed To: Lifestyle Builders of Davie Subdivision Info: Meadow Ridge 2 Lot # 35 Reference Name: Location/Address: West Knoll Brooke Dr. -27028 Proposed Facility Residence Property Size: see map ATC Number: 4080 **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 #People #Bedrooms .-!!� #Baths Dishwasher: ;!r Garbage Disposal Washing Machin Basement w/Plumbing Basement/No Plumbing: ❑ Commercial Specification: Facility Type /f #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply ( 6 Design Wastewater Flow (GPD) 1!�__) Site: New Repair El Z _ J/ System Specifications: Tank Size,.?, rAL. Pump Tank GAL. Trench Width �eiock Depth Izz Linear Ft. 4W Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOI FINISHED GRADE. ****NOTICE: Contact a reps system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to ROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW of the Davie County Health Department for final inspection of this on the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) rRI APPLICATION FOR SITE EVALUATION/IAIPIIOVEAIENT PER Davie County Health Department Environmental Health Section MAY I 0 2005 P.O. Box 848/210 Hospital Stree Mocksville, NC 27028 (336)751-8760 VAIRd-DIViE1JTa[ y i ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQ INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed L e S1k/ L rr�ll cIC�S (� ta1,�SQntact Person Z' l'((V`- e " Mailing Address (D� t l W 5���� ti Home Phone S L City/State/ZIP —il J UL, « c Q /L J ..2— % C�U�o Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation �mprovement Permit/ATC ❑ Both 4. System to Service: 21-1 use ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. Type system requested: 2 -Conventional ❑ conventional modified ❑ innovative 6. If Ofi idence: # People # Bedrooms # Bathrooms Di"h.asher 0-aarbage Disposal ashing Machine Casement/Plumbing ❑Dasemont/No Plumbing 7. If Business/Industry /other: verify type # People # Sinks _ # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 8. Type of water supply: ❑ County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No If yes, what type? ***L11P0RTAN7'*** CLIENTS MUST COAIPLETETHE REQUIRED PROPERTY INFORIWATION REQUESTED BEL01V. Either a PLAT or SITE PLAN MUST BESUBAMTED by the client witli THIS APPLICATION. Property Dimensions: 2 e 0r,6, 1VRITE DIRECTIONS (frons Mocksville) to PROPERTY: Tax Office PIN: #, 13-- 23 Q ti S 0- ' Property Address: Road Name k '-na City/Zip VIA 0 7U2J' ��n,��h� c� e..,, �. If in a Subdivision provide information, as follows: Name: �/� %z-, e - �-'J A , S C,52. Section:. Blocic .. Lot:_ Date home corners flagged: This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter arc subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or clianged. I, also, understand drat I am responsible for all charges incurred frown this application. I, licreby, give consent to the Autliorized Representative of the Davie County I-Icalth Department to enter upon above dcscribccl properly located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE i S ' J6 -, SIGNATURE GU TIIIS 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). Sign given Revised DCIID (05103 Site Revisit Charge Date(s): Client Notification Date: EHS: Account No.2,�—�a V/d 0 33 a 7 Invoice No. O 7 `/ ' APPLICATION FOR SITE EVALUATION/IMPROVEh9FM PERKT Davie County Health Department_ ,9 U l5 Environments/Hea/tfi Secrion P.O. Box 848/210 Hospital Street .Mocksville, NC 27028 MAY -''9 2001 (336) 751-8760 11 j ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN 1. Name to be Billed Ke ti t jcTH L , FoSTE Q. Contact Person W e m Fo5'i: �t Mailing Addsea s t& ojap L. Taec LAAac Home Phone 10 4 - �.a4fo -'17 8 $ City/state/ZIP Kausut(y- A(.yiazg Business Phone 33fo— i23-S8�0 2. Name on Permit/ATC if Different than Above _ ,- Mailing Address City/state/Zip 3. Application For: Site Evaluation ❑ Improvement Permit/ATC ❑ Both. 4. System to service: l( House ❑ Mobile Home ❑. Busi.ness ❑ Industry ❑ Othor S. If Residence: # People # Bedroo�ms 4 # Bathroo:,vi 4- k Dishwasher H Garbage Disposal C' / Washing Machine M Basement/Plumbing 13 Baaement/No Plumbing 6. If Buainess/Industry/other: Specify type # People # Sinks # Commodes # Showers # iTrinala # Water coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: lirCounty/City O Well ❑ t:�mL:unit; 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ ' Ves ❑ Pe r. If yes, what type? ***lAlPORTANT*** CLIENTS hfUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQ.TSTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 230 X250 K 310 J2fo0 5799 33 2338 Tax Office PIN: # Property Address: Road Name City/Zip If in a Subdivision provide information, as follows: WRITE DIRECTIONS (from Mocksville) to f'R'aPERTY: Us 15$ t�lbwrtA. Rkrt4T OQ j?nAo 21614-r AT EA/1R.4A/CC :ten R16t4T _Gu °To ErJO OF S_fyE' Name: MsADow RIDGE ( Ppcp,se0) + Section: TV40 Block: Lot: 36 Date Property Flagged: _inn'( • 9 . Z 0 Q / 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 infts•Mation submitted in this application is falsified or changed I, also, understand that I am responsible for all charges u-curred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Depars''lia it to enter upon above described property located in Davie County and owned by E,p-RT G_ • PicCl.grrI.Bor-y,_ to conduct all testing procedures as necessary to determine the site suitability. DATE rn#g Y '/, ?W1 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing said "nrogosed property lines and dimensions, structures, setbacks, and septic locations Site Revisit Ch;irgu Datc(s): Client Notification Date: EM: Account No. Revised DCHD (07/99) Invoice No. DAVIE COUNTY HEALTH DEPARTMENT i Environmental Health Section 'T Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900654 Billed To: Kenneth Foster Reference Name: Proposed Facility: Residence Water Supply: Evaluation By On -Site Well Auger Boring Property Size: Tax PIN/EH #: 5749-33-2338.35 Subdivision Info: Meadowridge SectionTwo Lot # 35 Location/Address: see map Date Evaluated: Community Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % 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 SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: 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 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 05/99 (Revised) DAYIE COUNTY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SECTION P. O. Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NC 27028 Phone #: (336)751-8760 May 25, 2001 Kenneth L.Foster 186 Maple Tree Lane Mocksville, NC 27028 Re: Site Evaluations/ Lot 3 & 4 US Hwy 158 Meadowridge Lots 31,32,33,34,35,and 36 Tax Office Pin: # 5749-33-2338 Dear Client(s): As requested, a representative from this office visited the aforementioned site on May 24, 2001. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, the site was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions, please feel free to contact this office. Sincerely, AeCS4.4&' �i/�lA . Robert B. Hall, Jr., R.S. Environmental Health Specialist • DAVIE COUNTY HEALTH DEPARTMENT • . Environmental Health Section SECTION_ LOT35r Soil/Site Evaluation APPLICANT'S NAME �"i PROPOSED FACILITY SUBDIVISION Water Supply: On -Site Well Community DATE EVALUATED 'S—/o�i� PROPERTY SIZE Ze 67�79,�7 ROAD NAME Public Evaluation By: Auger Boring Pit (/ Cut FACTORS 1 2 3 4 5 6 7 Landscape position .41 Sloe % HORIZON I DEPTH el v Texture groupS' Consistence Structure Mineralogy HORIZON II DEPTH / p f 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 SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RA REMARKS: -(-© r -Je)// /,I DCHD (01-90) EVALUATION BY: t YZ OTHER(S) PRESENT: MGEND 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 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 APPUCATION FOR SITE EVAUJATION/IMPROVEMENT PERMIT & � � � 0 W E ' Davie County Health Department Environmental Health 5bWon P.O. Box 848/210 Hospital Street ` MAT � 9 2001 Mocksville, NC 27028 (336)751—B760 ENVIRONMENTAL HEALTH ***nWORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL INFORMATIQN IS PROVIDED. Refer to the INFORMATION BULLETIN for instruction^. 1 . Name to be Billed Ke tit AE-rN L • Fo:,TEQ. Contact Person WE m Fvs=m- Mailingaddress v MapLrE'TQac LaAae � Cf� � � 1 Homo Phone -to 4 ' o "" to -t? ti 'il, - City/State/ZIP zgesu,lEtA�- S-10.22_ Business Phone 3'S(a—'723�SE!�o 2. Name on Permit/ATC if Different than Above Hailing Address City/State/Zip 3. Application For: Site Evaluation ❑ Improvement Permit/ATC ❑ Bothe 4. system to service: P(House ❑ Mobile Home D. Business ❑ Industry ❑ Other: s. If Residence: # People _ 4 Bedrooms 4 # Bathxcom:,r 4- N Dishwasher I'I Garbage Disposal ("Washing Machine NS 9asement/Plumbing 1.1 Basemor.t1Oz! .Plumbing 6. If Business/Industry/Other: Specify type # People # ei.ka _ # Commodes # Showers # Urinals # Water C•.o).erF IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day);,-, _ :i 7. Type of water supply: FRr County/City ❑ Well ❑ Community s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yea � N5 If yes, what type? ***11KPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION R1'QU: STED R� BELOW. Either a PLAT or SITE PLAN MUSTBE SUBMITTED by the client with THIS APPLICATION., Property Dimensions: 400 X 2(,oY 445XSa5 WRITE DIRECTIONS (from Mocksville) to Fl: i'Ckt7'i': 5749 .3.3 2338 Tax Office PIN: # Lis i 5 S rlbRrll . R LG iA T GQ Property Address: Road Name Rn R o , E3i G E+r aT i NrRAN CX'" ' >-'o City/Zip If in a Subdivision provide information, as follows: Name: fA Aool,u Rtoc e ( PRopo eb) R>,4,.L4T _Go ry Eiio OF SrRIE-ET Section: TWO Block: Lot: 3G Date Property Flagged: IMAM ' 9 . � •d irl This is to certify that the information provided is correct to the best of my knowledge. I understand that any pz rrJ#/ ) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the 'info tion, submitted in this application is falsified or changed. ],also, understand that I am responsible for all chargee incr, I -c! from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Depac rry .I, to euler upon above described property located in Davie County and owned by tRo ERr G. AIcCLAmp' to conduct all testing procedures as necessary to determine the site suitability. DATE m n y 7 A& SIGNATURE TRIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and O oposed property lines and dimensions, structures, setbacks, and septic locations). Devised DCHD (07/99) _ Site Revisit Charge Datc(s): f Client Notification Date:­.,­— FES: ate:.•_._,_. EES: Account No. Iuvoice No. DAVIE COUNTY HEALTH DEPARTMENT `14.Environmental Health Section SECTION o LOT :F115' Soil/Site Evaluation APPLICANT'S NAME 'oS ��� DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE SUBDIVISION i�Y lfcc% . _ / ROAD NAME Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH - p fl Texture group74 L 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 SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: r REMARKS: DCHD (01-90) r ale EVALUATION BY: !___Cly 7/ OTHER(S) PRESENT: gem 'q' V 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 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