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110 Hagen Road Lot 50DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001261 Tax PIN/EH #: 5870-69-0403.50 Billed To: Stone Hinge LLC Subdivision Info: Windemere Farms sect 2 Lot # 50 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: see map ATC Number: 2636 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 Treatm t and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CON T U IS V D 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. ga '9o, 510 0 g� 0 Gip' ,�,3ci ,v 2 •' %0` - I� CAZa-J T Septic System Installed By: L,) Environmental Health Specialist's Signator ate: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001261 Tax PIN/EH M 5870-69-0403.50 Billed To: Stone Hinge LLC Subdivision Info: Windemere Farms sect 2 Lot # 50 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: see map ATC Number: 2636 **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 st #People #Bedrooms SD #Baths 2 - Dishwasher: 0 Garbage Disposal: ©Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #..Seea^ats Industrial Waste: '- ❑ Lot Size 2 �4!;L��'ype Water Supply vrJ Design Wastewater Flow (GPD) HCl Site: New � Repair ❑ '� n System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width � Rock Depth 2 Linear Ft. 3ZZb Other: �1�l�t�ci�a,�'"`SE.-� IISSi�LI,LI�i (�•C. 1.1. Required Site Modifications/Conditions: 1asTe�.t, o� C.&C- V-• 1L.D-2P �` Off 00P7 ,ICS' la IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 i° 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.**** 1-1 ts,C—E,J V-0 AD 0 t ?t>96 -4 - 100' C1 01C' Health Specialist's Signature: ate:Ajqjn0 MW, 5' F2o►JT 14C' _ IAOOSFI - X - o -pe-v., -4 (0111 � DCHD 05/99 (Revised) `• APPUCATION FOR SITE EVALUATION/IMPROVEMENT PER411T & ATC Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 OGT 2 6 21u0 c EfffilL MENTAL HETH 1 A ***I,MPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed Gt L� Contact Person j00 e(Q V 011 -If C -L, Mailing Address 'U / Nk-",► Home Phone — s� 7/– (-- City/State/ZIP .22--g C K s / i /& Business Phone / Z) `L—J �� 2. Name on Permit/ATC if Different than Above i�- Mailing Address City/State/Zip 3. Application For: ❑ SiteEvaluationL2' rovement Permit/ATC ❑ Both 4. system to service: B -house ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People a Bedrooms_ # Bathrooms 2" 'WiE ishwasher IJ-Cii�bage Disposal q1 -Washing Machine fl Basement/Plumbing CI Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: IU/County/City ❑ Well ❑ Community a. Do you anticipate additions or expansions of the facility this system is intended to serve? U Yes U No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MAST BESIlBMITTED by the client with THIS APPLICATION. Property Dimensions: ���e WRITE DIRECTIONS (from Mockivllle) to PROPERTY: Tai OMce PIN: #_ .� �U j mo&S CN to To I?Aait GW RLAOOL4r1P^ Property Address: Road Name City/Zip U in a Subdivision provide information, as follows: Name: 1A)( lJocA nC i 4q-m—s .N� , �.� Al Section: -2-'Block: Lot: �� Date Property Flagged: 1 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 plana or Intended on change, or If the information submitted in this application Is falsified or changed. 1, also, understand that 1 ant responsible for all charges Incurred frons this 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- / �`' ' ` SIGNATURE ve THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the "jug: Existing and proposed property Uses and dimensiow, atroctara, setbacks, and optic locations). Revised DCHD (07/99) Site Revisit Charge Date(s): 1 Client Nodfleadon Date: `EHS: Account No. / Invoice No. - �� APPLICATION FOR SITE EVAI IJATiON/IMPROVEMENT PERMIT & ATC Davie County Health Department Envitonmental Health SeWon P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 AUG 25 1999 Et4'JiKina �• �•� ***1JVCRT=V** THIS APPLICATION CRMW BN PR=SfiZD UNLESS ILL THE REQUIRED =N)t'ORMAT=OH IS PROVIDED. Rater to the XMM MAT=Ott BULLETIN for instructions. 1. Name to be Billed WESTVIC-3 D4[VC oP;N9W C "'1PAW1 Contact Person —&W) CTOOFACY Mailing Address SL -61 9LEVN6t-np. RO, eons non 336' 116.1008 city/state/22P ui1NSTdrl-Sa►fi+h .Nc Business Phone 336-1'11- do"I$ 2. Rama on V*=Lt/ATC it Different than Above Wailing Address 3. Application Tor: 0 Site avaluation e. systan to semdoes (3 Houses 0 Mobile Home City/state/sip 0 improvement Perait/ATC 0 Both O Business 0 Industry 0 Other s. If Residence: f People t Bedrooms • Bathrooms 0 Dishwasher D Gasbags Disposal a Washing Maobine O Basement/Plumbing a Basement/no Plumbing 6. zf Business/zndustry/others specify type f Commodes I People i sinks i showers ! urinals • Water Coolers IF IMSERVICE: # Seats Estimated Hater Usage (gallons per day) 7. Type of water supply: 0 County/City O Well 0 Communitty e. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes EiNo If yes, what type? ***IMPORTANT*** CLIENTS MIST COMPLETETHE REQi/1RED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN ULIST BE SUBM 77ED by the client with THIS APPLICATION. Property Dimensions: (Se Tai OMce PIN: # �6 �U fin-' �d 1 • �� Property Address: Road Name City/ZIp WRITE DIRECTIONS (from ModuMlle) to PROPERTY: JJ0ck5 CNW(yt TQ 1? -4&# GW WAVCRAMP kf 4 If in a Subdivision provide Information, as follows: Name: A)l AIIXAW -FM - Section: Block: Lot- �-) 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 use change, or if the Information submitted in this application Is falsified or changed. 1, also, understand that I am responsible for all charges incumd 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 awned by to conduct all testing procedures as necessary to determine the site suitability. DATE - / (1 - Z t" - SIGNATURE , TEN AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the "JuSt Existing and proposed property lines and dimensions, structure, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge I Date(s): Client Notification Date: I EHS: Account No. Invoice No. s 1, AOCK I CARL I D. B. 1� 262 S 85'33'OB' E 261 2.22 2+ z98 3kNCLE IRON FOUND + 83.23'37• E 76 48 $ 49 26 + 9 616.09 �' ), c 1 271 Gb, 252 , 254 25 50 47 2 5 9 56 ti 55 206 7 250 56 155 1 1` ,75 272 'L 249 19 (D' 2420 102 51+ r 28 46 0 20 20 74 •jn W' 0� 154 153 1= � 273 � 258 259 � 27 i 189 188 187 {�}l1:*= 166 Ifl" 1'lIF' o 44 1981 +1 45 29 24 l93 157 158 119 TwN0 Qlal 11 A2I 194 ��'S 216, 11213 + "t5 1i o I 2,4 9� IIrO' '42 2 0 43 1 197 195 196 A 79 v 2 199 198 \1' 10 + 221 l8 ILS y o Q 80 1_ 28 30+ 219 .1 0 126 125 �IUD cEll� 77 ZGp. BI 12 _ ^ 70 2y 101 + � 2 o / 9 400 10 as° V V 89 22 Ati`O�v \OJ . p �uQ 169 8 120 168 ---- 6.97 3'09' V 21x0 31 54 3 37 l + CE OAK i 01.69,;a � G / I' 58 . w • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION Account M 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 #: 5870-69-0403.51 Subdivision Info: Windemere Farms Sec.2 Lot # 51 Location/Address: Beauchamp Road -27006 See Map Date Evaluated:BI� Community Evaluation By: Auger Boring Pit Public «---*— Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % ?v HORIZON I DEPTH rg _ZS (2-7-k Texture group 01r G Consistence F P Structure Wi4_ k Mineralogyp ' HORIZON II DEPTH -L(0 21 � V Texture group 451,0:Ti - Consistence f i Prls'v' Structure -sIL k Mineralogy HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S S LONG-TERM ACCEPTANCE RATE , LI SITE CLASSIFICATION: 1 EVALUATION BY: �dl�C.tl kn P LONG-TERM ACCEPTANCE RATE: 0.4 OTHER(S) PRESENT: REMARKS: &Ole) L_ot) 1 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 tructure 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) LAWRENCE L. MOCK I BY WILL ' REF:D.B. 49 Pg. 8 CARL D. T LD.B. 191 ' E iO7A1.■ 9Q2.22 ----+■,'. pry r cif„ 203.20 w .� 296 95 S 83'23'37•.E 200 14 -* .., r. W.. 47 S 0.793 AC. ' 48 w f H 1 76 ` ' 0.740 AC. 916• V = t20 t�oZ491 �^ 1e 1.401 AC. z f + 25 1.187 AC. 46 F27 Cl N 47'36' 45' Y �"O S 0.739 AC. 53.75 m W — — �7 J3• . 207.4j , 0 TOc' • TOTAL" 234.57 w+ N 46.41'23# E \ •,� 2Q ''h7 •16'04 y 64.26 0 167.37 45 50 26 0.892 AC. �a _MEm 1.124 AC. cp// i� tp 1.282 AC. s Cl tiT• / Q a . �, / / 184 ,07 • ` 340.70 -- 116.4Y NOTAL■ 482.19 S 86'22'38' Y _;:�.,�, C22 HIGH' MEADOWS ROAD 3 W 44 �-� N 86.22.381 E 0.872 AC. G� TOTALS 482.19 AC. n � "• � 120-00- 107 20.00 — — - — —120-00- 5 -- R'i o 222 1 �' 2�. Cl _ .._ 73.93 -. _- 166.24• — ._ a 5$ - � 26— — -- , �c���1 •�,/ �,y C1 1• a_ /E' n N �2 Isuc ' ~ 24 23 0.829 AC. 0.776 AC — - o* — 221 ? P o , ,, �, m aVv 27 r`� z 8 1.702 AC.'I 121, 43 n 28 1.777 AC. % , �"Isk J ' S Q �/ ' a 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 #: 5870-69-0403.50 Subdivision Info: Windemere Farms Sec.2 Lot # 50 Location/Address: Beauchamp Road -27006 See Map Date Evaluated: I D M Community Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position 'L Slo % HORIZON I DEPTH 6--23 Texture group c Consistence Structure Mineralogy` HORIZON II DEPTH 23 114 Texture group Consistence Structure L Mineralogy HORIZON III DEPTH 3 - 4 L Texture group Consistence rrr S Structure G2 Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: Ps EVALUATION BY: du14: 1 � V11P LONG-TERM ACCEPTANCE RATE: ©' OTHER(S) PRESENT: REMARKS: 64 01 D L -C) 0 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 fess Classification - S(suitable), PS (provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/99 (Revised)