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185 West Knoll Brooke Drive Lot 32DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section " P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990000981 Tax PIN/EH #: 5749-33-2338.32 SF Billed To: San Filippo Companies Subdivision Info: Meadow Ridge 2 Lot # 32 Reference Name: Location/Address: West Knoll Brooke Dr. - ATC Number: 4077 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 OF7,4 YEARS. Environmental Health Specialist's Signature: �Date: /P5, RTIFICATE OF COMPLETION **NOTE** The issuance of this Certica a of mpl tions 11 i irate the system described on Improvement/Operation Permit has been installed in oomph ce w' h icle 11 of G .Chapter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but sha l n N WA be t en,a a guarantee that the system will function satisfactorily for any given period of time. • 12.1 [mss Septic System Installed By: L� • L . '41� Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT P -" F-/6 - D 5 Account #: 990000981 Tax PIN/EH #: 5749-33-2338.32 SF Billed To: San Filippo Companies Subdivision Info: Meadow Ridge 2 Lot # 32 Reference Name: Location/Address: West Knoll Brooke Dr. - Proposed Facility Residence Property Size: see map ATC Number: 4077 **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: 01 Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ VMS Commercial Specification: Facility Type #People #People/Shift #Seeaaats Industrial Waste: ❑ Lot Size Type Water Supply— Design Wastewater Flow (GPD) /d Site: New Repair ❑ System Specifications: Tank Size,�� GAL. Pump Tank GAL. Trench WidthC?d Rock Depth �/ Linear Ft.3W Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAY.10 T APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a r pr se tative 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. o 1 3 m. on the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date: 15r DCHD 05/99 (Revised) 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes mlgo If yes, what type? ***1111P0RTAN7"*** CLIENTS MUST COMPLETL• I'llE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN h1UST BESUBh117-FED by the client witli THIS APPLICATION. Property Dimensions:'_i Tax office PIN: it 67 3 3- 2 3 -?X. 3 ;z 5 F Property Address: Road Name V,,5 4- 1,4. l( 8roo Kbn. City/Zip If in a Subdivision provide information, as follows: Name: I 0'..., )?-r-� Section:2' 11Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Date home corners flagged: �/ b This is to certify that the information provided is correct to the best of my knowledge. I understand that any perinit(s) issued licrcaftcr arc subject to suspension or revocation, if the site plans or intended use cliangc, or if the information submitted in this application is falsified or changed. 1, also, understand that 1 ant responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representati a of the Davie County IIcallh Department to enter upon above describcd.�property located in Davie County and okned by to conduct all tes 'ng p ocedures as necessary to deterniine the site su' i DATE. / SIGNATUIt1; TIIIS AREA MAY BE USED FOR DRAWING YOUR SITE PL (Inc de all the foil 1 ig: Existing and proposed property lines and dimensions, structures, setbacks, and septic to at' ns). Sign given Revised DC11D (05/03 Site licvisit Charge Date(s): Client Notification Date: EIIS: Account No. Invoice No. �9aad0 'W • APPLICATION FOR SITE EVALUATI ON/IMPROVE&I ENT PER& Davie County Health Department Environmental Health Section .� P.O. Box 848/210 Hospital Stre Mocksville, NC 27028 751-8760ht'�'l . (336) F 9� ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THEkyoyow INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for inatruce%Qns. 1. Name to be Billed PR _ _]4A)�f� 6,V4j�,1� %��% Contact Person A,14-", C j—�/2/2Q/2��,� Mailing Address . [ /v ✓ C)04 City/State/ZIP Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address C ty/State/Zip 3. Application For: 13 Site Evaluation improvement Permit/ATC ❑ Both 4. System to Service: House El Mobile Home Business ❑ Industry ❑ Other 5. Type system requested: conventional ❑ conventional modified ❑ innovative !� 6. If Residence: it People # Bedrooms # Bathrooms MDishwasher []Garbage Disposal Washing Machine ❑Basement/Plumbing ❑Basemont/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: O County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes mlgo If yes, what type? ***1111P0RTAN7"*** CLIENTS MUST COMPLETL• I'llE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN h1UST BESUBh117-FED by the client witli THIS APPLICATION. Property Dimensions:'_i Tax office PIN: it 67 3 3- 2 3 -?X. 3 ;z 5 F Property Address: Road Name V,,5 4- 1,4. l( 8roo Kbn. City/Zip If in a Subdivision provide information, as follows: Name: I 0'..., )?-r-� Section:2' 11Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Date home corners flagged: �/ b This is to certify that the information provided is correct to the best of my knowledge. I understand that any perinit(s) issued licrcaftcr arc subject to suspension or revocation, if the site plans or intended use cliangc, or if the information submitted in this application is falsified or changed. 1, also, understand that 1 ant responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representati a of the Davie County IIcallh Department to enter upon above describcd.�property located in Davie County and okned by to conduct all tes 'ng p ocedures as necessary to deterniine the site su' i DATE. / SIGNATUIt1; TIIIS AREA MAY BE USED FOR DRAWING YOUR SITE PL (Inc de all the foil 1 ig: Existing and proposed property lines and dimensions, structures, setbacks, and septic to at' ns). Sign given Revised DC11D (05/03 Site licvisit Charge Date(s): Client Notification Date: EIIS: Account No. Invoice No. �9aad0 'W r APPUCATION FOR SITE EVALUATION/IMPROVEMENT P> IMIT & ATC C E ' - Davie County Health Department D t5 l� Enlrironmenta/Hea/th S;e oa jf P.O. Box 848/210 Hospital Street f MAY Mocksville, NC 27028 ' 9 2001 (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE ID DAVJECOUMY TN INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instrnat:.a•.i_j . 1. Name to be Billed KE WI 1ETN L • ro:>Te . Contact Person W%e m FOS't ^- Mailing Address Ila(. mAP Lr. TaeE La, 4c Home Phone City/state/ZIP Ce%.,ii,r= A(- Z-102p'i Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/state/zip 3. Application For: VSite Evaluation ❑ Improvement Permit/ATC ❑ Both a. System to Service: (I House ❑ Mobile Home O.Business ❑ Industry ❑ Otht r s. If Residence: # People Bedrooms 4 I Bathrooms; 4- _ W Dishvasher 11 Garbage Disposal V'Washing Machine E7 Easement/Plumbing 13 Basement/Vo Plumbiuq 6. If Business/Industry/Other: Specify type People 1i I Commodes I Shovers t urinals I Water Cooluur. IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) _ 7. Type of Water supply: Pf County/City ❑ Well G Communis f e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Ye, ❑ Nc•, If yes, what type? ***1111P0RTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REOLU.SI''.%D BELOW. Either a PLAT or SITE PLAN MUSTBESUBM17TED by the client with THIS APPLICATION. - L... -.-Property Dimensions: 185 458 X 245 X 4.83 WRITE DIRECTIONS (from Mocksville) to Pit X'ERTY: 5749 33 2338 Tax Office PIN: # Us i58 rbpriA. R(C1+T 0&J ;.414 Property Address: Road Name r�aao, t3ia1;+-r PT tn/7XZRNCF 0-0 City/Zip N1r�0aw i2�nc,E n.`rli' DeLk2 E .• tom TURN If in a Subdivision provide information, as follows: R t (. t+ -GO -ro E N o OF 5'r rid `T Name: 1A Auow R►OGE ( PRoeo5eb) Section: Two Block: Lot: 32. Date Property Flagged: Ff%A �f This is to certify that the information provided is correct to the best of my knowledge. I understand that any Pt r,rit(s) issued hereafter are subject to suspension or revocation, If the site plans or intended use change, or if the inform-, ,ion submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incr r,•ed from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Departninit to cuter upon above described property located in Davie County and owned by F43be.R-r G. to conduct all testing procedures as necessary to determine the site suitability. DATE YY1 n Y 7, ZG4a/ SIGNATURE 7 - / 7 jyii THIS AREA MAY BE USED FOR DRAWING YOUR SffE PLAN (Include oil of the following: Existing a i d p mposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Chao'; r Datc(s): _ t Client Notification Date: + _ ERS: I Account No. 9 8' 7 ° Revised DCI3D (07/99) Invoice No. __ , DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900654 Billed To: Kenneth Foster Reference Name: Proposed Facility: Residence PROPERTY INFORMATION Tax PIN/EH #: 5749-33-2338.32 Subdivision Info: Meadowridge Section two Lot # 32 Location/Address: Property Size: sbe R41P Date Evaluated: Water Supply: On -Site Well Community, Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % 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: LEGEND Landscape Position EVALUATION BY: 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 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) DAVIE COUNTY HEALTH DEPARTMENT ` Environmental Health Section SECTION_ LOTf2 Soil/Site Evaluation APPLICANT'S NAME fy�SL�'� DATE EVALUATED�'eZT PROPOSED FACILITY PROPERTY SIZE SUBDIVISION % ROAD NAMElrf Water Supply: On -Site Well Community Public Evaluation By: Auger Boring PitCut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH /04 6 '� Texture groupSL'L f L Consistence Structure Mineralogy HORIZON II DEPTH -5�Q ' v Texture group Consistence r i 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 c SITE CLASSIFICATION: f/y LONG-TERM ACCEPTANCE RATE: /4— /s REMARKS: S 110"Ir � L 1w P' 01 EGEND Landscape Position EVALUATION BY: A Z� 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 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 (01-90)