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101 North High Field Road Lot 35Account #: 989900283 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Billed To: Bob Cope & Son Construction Reference Name: Larry Cope Proposed Facility: Residence ATC Number: 2557 0 CIA - /6 / IA - X61 N,Ai Fold Tax PIN/EH #: 5870-69-0403.35 Subdivision Info: Windemere Fams 2 Lot # 35 Location/Address: High Field Road -27006 Property Size: 143'x210 new 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 WASTE ON IS V ID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: DDate: 4 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 I 1 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. 1 ��S h�j� Septic System Installed By: Environmental Health Specialist's Signature DCHD 05/99 (Revised) �S Date: &AA DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900283 T,x PjjVEH #: 5870-69-0403.35 Billed To: Bob Cope & Son Construction Subdivision Info: Windemere Fams 2 Lot # 35 Reference Name: Lary Cope Location/Address: High Field Road -27006 Proposed Facility. Residence Property Size: 143'x210 new ATC Number: 2557 **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 IA(>�- #People #Bedrooms _ 3 #Baths 2 •'K" Dishwasher: t►r Garbage Disposal: °e Washing Machine: 2?r' Basement w/Plumbing: ❑ Basement/No Plumbing: 0 Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: 13 Lot Size Q.to%KC2-c;�SType Water Supplx__w—tjTy Design Wastewater Flow (GPD) Site: New d Repair 110 h Rock Depth ZLinear Ft. , System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width ep 1—V Other: 2 Required Site Modifications/Conditions: 1ASTAL L- OA � 'COt �f.61; 1` xjt IZ0- cp 16 ea- IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 K 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.**** 00 Iqla � MeeJ . �Q.. � 1P �I Environmental Health Specialist's Signature: DCHD 05/99 (Revised) y.� Date: A b APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Envinvnmenta/ Health SL-ct/on P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ` (336) 751-8760 .�a D C�C�t�OM� Aid 3 12000 EN IRONMENUL ! ',, TH DAVIE COIF e ***IIPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed go!J 4P e-4- �v /15T'. Contact Person I JLP('S/ �/' e / / ( Mailing Address //'o o t d� /�(� o �/ Rome Phone f[� City/State/ZIP (, PeleeMe-e If -,Cf o'Z7'0/ / Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: 0 Site Evaluation City/state/Zip Improvement Permit/ATC ❑ Both 4. system to Service: ipf House ❑ Mobile Home 0 Business 0 Industry ❑ Other i s. if Residence: #People #Bedrooms #Bathrooms ,��- IV/Dishwasher WIG'arbage Disposal "ashing Machine ❑ Basement/Plumbing 0 Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # Urinals # hater Coolers IF FOODSERVICE: # Seats — Estimated Water Usage (gallons per day) / 7. Type of water supply: R County/City 0 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 BESUBMITTED by the client with THIS APPLICATION. / Property Dimensions: 1'/3 X �L, Tax Office PIN: N 8"7o -6 9 a 0 3• j5 Property Address: Road Name (7f_V7 City/Zip If in a Subdivision provide information, as follows: Name: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Section: Block: Lot: Date Property Flagged: 4'5'0—'00 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 1, also, understand that 1 ane 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 suit bility. DATE I —y'-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). Revised DCHD (07/99) A Site Revisit Charge Client Notification Date: EHS: Account No. Invoice No. 1 / q -� i u 5 l* 1 cp Z m � r WLLI a t..tuIn a; e > 0 e v N (STUMP I I I . I M �t cD 876, 79 N 8 LAWRENCE \L. MOCK BY WILCO REF:D.B. 69 pg, 55 / / / / / a 876, 79 N 8 LAWRENCE \L. MOCK BY WILCO REF:D.B. 69 pg, 55 / / / / / APPUCATION FOR SITE EVAUJATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Envi►rvnmental Heaft Section P.O. Box 868/210 Hospital Street Mocksville, NC 27028 (336)751-8760 .t I! AUG 2 5 1999 ***nV0RTANT*** THIS APPLICATION CANNOT BE FA=5SZV UNLESS ALL Tisa REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMTIOH BULLETIN for instructions. 1. mtaae to be Billed WfSi JNE DCJft,ofiAt (slIMPAW1 contact Person G 091r.Y Nailing Addresa 2LS% ?.Cy)Jatna'Ro. soee phone 336. 46.108 City/state/2=P W1N1TdA-SaLC«+ .Ne 1110b Business Mums 136-11-1- 601$ 2. Hans on Oeait/LTC It Different than above Wailing Address City/stab/alp a. Application For: GYSite svalustion 0 Improvement Permit/ATC 0 Both lam°"' s. Brat.. to services Houses O Mobile Home O Business O Industry O Other 5. If Residence: # People # Bedrooms # Batbrooms O Dishwasher O Garbage Disposal O Washing machine O Basest/plumbing O Basement/:to plumbing 6. If Business/Industry/others specify type # people f sinks # Comaodes f showers # urinals # Water Coolers It FMSERVIC3: # Seats Eatimated Nater Usage ig•llon• per dayl 7. Type of water supply: 0 County/City O well O Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes C -No Dyes, what type? ***IMPORTANT*** CLIENTS MIST COMPLETETHE REQUIRF.D PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: S�F e In �4- Tax Office PIN: # -�rd �U — 6 �n-� C) Z/6,7, J6 Property Address: Road Name �J�'C uc A City/Zip "-'%v6 If in a Subdivision provide information, as follows: WRITE DIREC11ONS (from Mocksville) to PROPERTY: 140a.5 LNKtX To RaM1 'VJ 6-Wd IPA,/ t'ItpA T)f a.Q Name: 1A1l VrXA—W Fps Section: % Blocks Lot: &Si Date Property 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 are subject to suspension or revocation, If the site plans or intended ase change, or if the information submitted in this application Is falsified or changed 1, also, understand ghat I ant responsible for all charges incurred from tbls applicadom 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 suitability. DATE 8� oo l 49 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the Jug: Existing and proposed property Uses and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge I Date(s): Client Notification Date: IEHS: Account No. Invoice No.©�� TON PLACE, 53 37 FENCE RNER LAWRENCE L. MOCK BY WILL REF:D.B. 49 Pg. 8 i4 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account #: 989900136 Billed To: Westview Development Co. Reference Name: Brant Godfrey Proposed Facility: Residence Property Size: Water Supply: On -Site Well PROPERTY INFORMATION Tax PIN/EH #: 5870-69-0403.35 Subdivision Info: Windemere Farms Sec.2 Lot # 35 Location/Address: Beauchamp Road -27006 See Map Date Evaluated: 10111bg Community. Evaluation By: Auger Boring Pit M Public I --- Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH o Texture groupe� C �— Consistence r S Structure 5 k S31�- Mineralogy 1 I f I HORIZON II DEPTH -7-2-2— Texture group Consistence Structure lL Mineralogy HORIZON III DEPTH ZZ - Texture groupC t C Consistence S FSS Structure k Mineralogy1 HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION f 5 LONG-TERM ACCEPTANCE RATE p. SITE CLASSIFICATION: �S LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: � &PA tb�p 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)