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111 North High Field Road Lot 36x DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900573 Tax PIN/EH #: 5870-69-0403.36gi Billed To: Glenn Johnson Builders Subdivision Info: Windemere Fams Lot # 36 Reference Name: Location/Address: Beauchamp Rd -27028 riupusuu raunny: mubiuence ATC Number: 2683 rlUFlClly JILL. 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: / —C:�qV-6/ 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 'm t pl T�b C I� Septic System Installed By: ,�,�� Environmental Health Specialist's Signature: �` '�C–`�=fit' Date: _ —O 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 #: 989900573 Billed To: Glenn Johnson Builders Reference Name: Proposed Facility: Residence PeY --> —7-0 / Tax PIN/EH #: 5870-69-0403.36gj Subdivision Info: Windemere Fams Lot # 36 Location/Address: Beauchamp Rd -27028 Property Size: see map ATC Number: 2683 **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. i Residential Specification: Building Type G`�U-S� #People #Bedrooms _ #Baths ro o Dishwasher: 0' Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial13�Waste: Lot Size OX Type Water Supply Design Wastewater Flow (GPD) tr Site: New �' Repair ❑ rf System Specifications: Tank Size GAL. Pump Tank GALL. Trench Width Rock Depth & Linear Ft CZ� Other: 4IX411i( )P4. 6ha rO 10ronvj-k,, ,n(F,J. • t4OcD Required Site Modifications/Conditions: 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.**** i��SI I�•�ovl 25" � / '�� �7l a I �r �O Environmental 4alth Specialist's Signature: /n /kms. Date: DCHD 05/99 (Revised) • APPLICATION FOR SITE EVALUATION/lAIPROVEMEW PEllii:li- & Ab M Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street JAN 2 5 2OW Mocksville, NC 27028 (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REU201MIJ INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed G/e.+n johnson go"Ide.es TAC. Mailing Address /13,44 V n je,fto4S5 KA City/State/ZIP ►IZ-� anCe !/•G. a %doh 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: ❑ Site Evaluation Contact Person Qe-01 : �p4nSdn Home Phone 33%- 9 tQ -S-6j--S- Business Phone 33 6 - 9yo-6-6s--1 MW City/State/Zip 3 9 -Improvement Permit/ATC ❑ Both 4. System to Service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People Bedrooms .- # Bathrooms ata, Dishxasher 11 Garbage Disposal 0,5isshing Machine 0 Basement/Plumbing EI 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: B'County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETIIE REQUIRED PROPERTY INFORMATION REQUES'T'ED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTEDby the client with THIS APPLICATION. Property Dimensions, a±--� Tax Office PIN: # �5-? 70 69-- 0�403 Property Address: Road Nam:a,','4" R� 1. City/Zip If in a Subdivision provide information, as follows: Name: Section: ��� Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: CJ - Date Property Flagged: l 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 front this application. I, hereby, give consent to the Authorized Representative of the Davi Coun II alth Depa true t to enter upon above described property located in Davie County and owned by . vn tl� to conduct all testing procedures as necessary to determine the site suitability. / DATE l- Q S" QyU I SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include property lines and dimensions, structures, setbacks, and septic locations). C. • �o � 2 1181 Revised DCHD (07/99) the following: Existing and proposed Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No.'? -Y'! b 6 X7-3 Invoice,No. — I / ! D fil"n P1,4CE0 LAWR E I REF:D S 85'33'08' E 982, 2c 205 • i Ul -O 38 39 6 „ z 47 THIS LOT MAY BE UNSUITABLE 65 ` AS PER DANE COUNTi HEALTH DEPARTMENT n I/ v (X:)% i _ fh 40 46 rn c 0' I 50 C ' � 1 CT) �y I 255 �3 / c ` > l U C) JTILITY L� ( a � � EaSEMENT •p \ W 4 CL 5 � � � 10' Ul'It ll'Y -\, r EASEMENT R/W r •, ,., ^ � Y Iv 210 � 21 ,P 3 Q Q 1..+ J I 5 /�4 I t ` I i� I I IOX70• o' O /, 4 LASEMEI,+ .�.�.. .rI t �3 `f W 10 ;�I a 42 T ro-_ / • °' :�� �. � _. — — — 210 -' _ 1 I � 27 a t3 � � — z YC co 20' PAVED -PUBLIC 210--- '� 120 25 f 3-1 i 4' ►o ;� 29 3 0 t' 1 fig, I r 3S 33 �� i 28 N 31 2' 32 f JL do ..ti r..., �"IX VWOW r O y i ' APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMR & ATC Davie County Department artment IL� P Environmental Healtit Section ( AUG 2 5 1999 P.O. Box 848/210 Hospital Street Mocicsville, NC 27028 y (336)751-8760 EI1'Jii.., • . ***nWCRTANT*** THIS APPLICATION CAM= BZ PROCBSSND UNLESS ALL THE REQUIRED INTORIMION 18 PROVIDED. Refer to the M=rMATION BULLETIN for instructions. 1. hams to be billed WEm1E.a 17F%IEw?7P S,.rT 6�ny `/ contact person ! Goot aiy Moiling Addres.boob 12 31 QEYl%GLtIA RO- s phone 33 b-146.1008 City/state/aIp VJ1NSTdA-SALfirI MNG '11106 business phone 336.171' Z. Mame on permit/ATC It Different than Above Moiling Address 3. Application Tor: W/ite evaluation Sun"ip0p' City/state/zip 0 Improvement Permit/ATC 0 Both e. system to services WHouseS 0 Mobile Home 0 Business 0 Industry 0 Other s. if Residence: # People # Bedrooms # Bathrooms 0 Dishwasher a Garbage Disposal O Xaahing Machine 0 basement/plumbing 0 basemant/no plumbing 6. Ze business/Industry/others specify type # people # Bioko # Commodes # showers # urinals # later Coolers IF 1=DSERVICE: # seats Estimated Nater Usage (gallons per day) 7. Type of water supply: 0 County/City 0 well 0 community a. Do you anticipate additions or expansions of the facIlty this system is intended to nerve? 0 Yes B No If yes, what type? ***IMPORTANT*** CLIENTS MUST CDMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Eltber a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APP WCATION. Property Dimensions: S Tax Office PIN: Property Address: Road Name City/Zip If in a Subdivision provide information, as follows: WRITE DIRECTIONS (from MockrAlle) to PROPERTY: PROM-" o --i LEf'f. Name: Wt Aww w —F4ir-S Section: Block: Lot: 3i!, 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 we change, or if the information submitted in this application is faisiffed or changed. 1, also, understand that I ane responsible for all charges incurred from this appUcadom 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 aU testing procedures as necessary to determine the site sultabWty. DATE 8'ml,79 SIGNATURE AV THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the I61lowing: Existing and proposed property Hues and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge Date(s): I Client Notification Date: I EAS: Account No. Invoice No. �w ON PUCEg63 37 T FENCE C% NER LAWRENCE L. MOCK BY WILL REF:D.B. 49 P9. 8 'A 4 • .~ 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: Evaluation By: On -Site Well Auger Boring PROPERTY INFORMATION Tax PIN/EH #: 5870-69-0403.36 Subdivision Info: Windemere Farms Sec.2 Lot # 36 Location/Address: Beauchamp Road -27006 See Map Date Evaluated: 0 I vqhi Community Pit -I-,- LEGEND / Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % 320 'lo HORIZON I DEPTH b `7 O — Texture group /'_L' Consistence Structure Mineralogy HORIZON II DEPTH '7 rl -20 Texture groupG Consistence Structure Mineralogy' HORIZON III DEPTH -2-1-3-2- -3 Texture group P'etkp k Consistence P Structure J Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION 5 LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: ps LONG-TERM ACCEPTANCE RATE: cam's REMARKS: LEGEND Landscaae Position EVALUATION BY: a___;Er ��A-t-.10 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 05/99 (Revised)