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115 Hagen Road Lot 45Account #: 989900259 Billed To: David Mallard Reference Name: Proposed Facility: Residence DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: 5870-59-4615 Subdivision Info: Windemere Farms Lot # 45 Location/Address: Property Size: see map **N 1 * iIslmo8 60 prvement/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 IACA)SL #People #Bedrooms �� #Baths .- Dishwasher: Er Garbage Disposal: 1?r Washing Machine: ff`� Basement w/Plumbing: 0 Basemer(/No Plumbing.n Commercial Specification: Facility Type #People #People/Shift #Seats Industrialante: Lot Size 2 Aft-STypeWater Supply Design Wastewater Flow (GPD) c t0� Site: New ER"" Repair 0 System Specifications: Tank Size /DCOGAL. Pump Tank GAL. Trench Widtb3tZ Rock Depth Linear Ft; -CJ Other: y �1�T� QL)T/CJ }C�—S 1n6-RqU, uy.�' Required Site Modifications/Conditions: �STQU. C*j on j1pua r o-Hf.1zG. �rw t f � IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER. RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of the Davie County Health Department for final inspection of this system between 8JQ 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.**** Environmental Health Specialist's DCHD 05/99 (Revised) v rn AV. Account #: 989900259 Billed To: David Mallard Reference Name: Proposed Facility: Residence ATC Number: 2860 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Pa -S -o l P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH M 5870-59-4615 Subdivision Info: Windemere Farms Lot # 45 Location/Address: Property Size: see map 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 WASTEWATE N ZIN ISV LID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: — Date:S54 &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 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. srP Q-, )rJ � i0� w.tick rl �QS.� r M \ ro I C -A "'k. 1 4 a) S 4 Septic System Installed By: Environmental Health Specialist's Signature : �� Date: DCHD 05/99 (Revised) ■--A--^— FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmenta/ Hea/tft Section O. Box 848/210 Hospital Street 11AY 7. 2001 Mocksville, NC 27028 (336)751-8760 I IN*IMPORTXyWte6NWHIS APPLIFATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED I lb FXVVIUEU.efer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed D -u . , T e9zog&=z Contact Person Mailing Address l / `�+� d/! Home Phone7 y� 79x,.y� 7.7 City/State/ZIP �(/: fJ:�a� •C. .C/ 72- 7�p Business Phone J% ' 7Z , 7 ` "' 2. Name on Permit/ATC if Different than Above Ti!1 C Mailing Address S�MQ_ City/state/Zip 1'� 3. Application For: Site Evaluation mprovement Permit/ATC ❑ Both 4. system to Service: ' ¢I House ❑ Mobile Home Business ❑ Industry ❑ other S. If Residence: # People # Bedrooms .3 # Bathr oms 3 Dishwasher YJ Garbage Disposal Washing Machine Basement/Plumbing ❑ 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: County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes gl No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITI'ED by the client with THIS APPLICATION. Property Dimensions: .S�•2i�l�¢sr� Tax Office PIN: Property Address: Road Name City/Zip If in a Subdivision provide information, as follows: Name: LI%: -x2lewPi'e /4PV.,,w-6 Section: Block: Lot: -Aliw— WRITE DIRECTIONS (from Mocksville) to PROPERTY: /5lS*'7 Tn &rr;&,pec XOaC T -Z Date Property Flagged: 5 / 7—O / 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 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 `✓1?,ray'e.1J iD 'fe ,, to conduct all testing procedures as necessary to determine the site suitab' ' DATE 5-177-01 SIGNATURE ��/`/�(�s%"►�'� 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). Site Revisit Charge Date(s): Client Notification Date: EHS• Revised DCHD (07/99) Account No. �%% °� �-S % Invoice No. 3 FACTORS DAVIE COUNTY HEALTH DEPARTMENT 2 3 4 5 6 7 Landscape position Environmental Health Section L_ • Soil/Site Evaluation HORIZON I DEPTH APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900136 Tax PIN/EH #: 5870-69-0403.45 Billed To: Westview Development Co. Subdivision Info: Windemere Farms Sec.2 Lot # 45 Reference Name: Brant Godfrey Location/Address: Beauchamp Road -27006 Proposed Facility: Residence Property Size: See Map Date Evaluated: 1 C1 le, bg TexturegroupG' Consistence Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut HORIZON III DEPTH Texture group FACTORS 1 2 3 4 5 6 7 Landscape position L_ Slope % HORIZON I DEPTH Texture groupG Consistence FNz- StructureMineralo HORIZON II DEPTH TexturegroupG' Consistence i Structure spit - 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: () S 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 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) V.a-ry 40- 0.753 At;. `- ► 135 122 � �� zr �, �6 .► 0.740 AG. N 29 _ Cl1 ��'19r6, Z 120 1(TAkE ~ c� Ism Lo U O N N in 123 v 128 4 0 � 46 N 47.36' 45' W/ -y -' 53.75 o E 0.947 AC. 0 0.739 AC. � � \ N W M 10.00 S 84` 16' 04 \ Cf Z 167.57 v 121 %o30' N 86. 57' W 67,00 •r +� (Lj :.moi J10' UTILITY 115 cu M EASEMENT N WZ 10' UTILITY 45 EASEMENT I E•' J Mc 0.692 AC. E O 118 41 M !n w� 0:689 AC. N I b = 210.00 107 111 M a W N 86.30' 57' W HI • ( 10'X70' SIGHT a \ ;4 O ifs � 44 EASEMENT(TYP.) j 4 co g 42 43 0.672 Ac. a o a 1 os 0.689 AC. cd g 0.735 AC. In 0 c+� N Z •t iso c F2_22 21 .2 in --' N c i g� cu 601252 240 c S �� 'i R/W 1-- -- __ ___ _ _ _ z �2°` i I g 210.00—` _ 127.26— __ _ 4 g93� EAS 101 :1 s TOTAL= 337, 26 N 86.30' S7' V C1 60 20' PAVED -PUBLIC / ;.AwRENCE L vOCK BY WILL REF 0 B 49 Pg 9 PARI 0 'ULLOCK „ t n er rct= 08 '91 PQ 535 38 3f' 47 48) 25 49 �7 0 461 / '! 18 37 50 26 45 `NICK, MEADOWS ROAD f' 3§' 6- �v \ , _J'L-!---- r -- —'----- j o: 99� •s.+� far �� O _43 44 "o" ,c"') ccsCo ,....., ... tom 'p, ;�' l!�• / =as . � � �� — —~ — — y.ar ser ! • 'e• •.m yl J ..�+r1 lDl uc n oao 17 ■ �°' • -fie -"+23 rw r.e - )• s•e °°.. 24 22 27 Jf 1 .« - / �� P ^f` ..r. d f. r...er +. 7r.a. b..+r .r•r D..r J/,j��,{/� j p9 I/ ;� +...... •. °..,,w �. ae�ot sa..wre. 7 `• r! / 4' l (v - ►F•y f er.t •W .C. ° �0' Vr rV 1 1• Rill U •.� 30 VV�"1E, — _ _ — ' g - 22". i •,� .�..•..° sr..... .� f rrN •y. w N ST' CIO � ��C A� — r ray..s Awr• s. Y r .iwrsw 33 \�� 0') - _ - r >~«,w r r . r fw• >. rani �7 1 28 �h,>�Z l �� t. ` •, '�``t�� „r ..!• .ter r r 1 > ;.AwRENCE L vOCK BY WILL REF 0 B 49 Pg 9 PARI 0 'ULLOCK „ t n er rct= 08 '91 PQ 535 38 3f' 47 48) 25 49 �7 0 461 / '! 18 37 50 26 45 `NICK, MEADOWS ROAD f' 3§' 6- �v \ , _J'L-!---- r -- —'----- j o: 99� •s.+� far �� O _43 44 "o" ,c"') ccsCo ,....., ... tom 'p, ;�' l!�• / =as . � � �� — —~ — — y.ar ser ! • 'e• •.m yl J ..�+r1 lDl uc n oao 17 ■ �°' • -fie -"+23 rw r.e - )• s•e °°.. 24 22 27 Jf 1 .« - / �� P ^f` ..r. d f. r...er +. 7r.a. b..+r .r•r D..r J/,j��,{/� j p9 I/ ;� +...... •. °..,,w �. ae�ot sa..wre. 7 `• r! / 4' l (v - ►F•y f er.t •W .C. ° �0' Vr rV 1 1• Rill U •.� 30 VV�"1E, — _ _ — ' g - 22". i •,� .�..•..° sr..... .� f rrN •y. w N ST' CIO � ��C A� — r ray..s Awr• s. Y r .iwrsw 33 \�� 0') - _ - r >~«,w r r . r fw• >. rani �7 1 28 �h,>�Z l �� t. ` •, '�``t�� „r ..!• .ter r APPLICATION FOR SITE EVAWATION/IMPROVEMENT PERMIT & ATC Davle County Health Department Env/tmmened Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27026 (336) 751-8760 AUG 2 5 1999 ***n1WORTAM** THIS APPLICATION CANNOT BX PRO=sszD UNLESS ALL TRE REQUIRED 1VFORKhTION IS PROVIDED. Refer to the INrOm=XOH BULLETIN for instructions. 1. Maine to be Killed WES VIE14 DCJCt4Pkkn C"PAWI Contact Person ) Gzwary Mailing Address 2L3% 9.00)atnA'Ro• Bose Phone 336.116.1x08 City/stats/sIP V1iN1TdA-S.Attr% ,NG 2110b Kwinese Phone 336.111- �1$ Z. Raine an Persist/ATC if Different than Above Mailing Address 3. Application rot: 19/ite !valuation s�jp�o1i a. systes to service: C3/Houses 0 Mobile Home a. If Residence: i People City/state/sip 0 Improvement Permit/ATC a Both 0 Business 0 Industry 0 Other I Bedrooms • Bathrooms 0 Dishwasher O Garbage Diaposal O Rasbing Machine O Baaement/Plumbing 0 basement/Ho Plumbing 6. ze Business/Industry/othesI specify type t People t sinks f Cosmodes i showers f Urinals • Nater Coolers it rOODSERVICE: # Seats Estimated Nater Usage (gallons per day) 7. Type of water supply: 0 County/City 0 Well 0 Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes ElNo If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MIST BES11B11BIM by the client with TIM APPLICATION. Property Dimensions: v` (f 1,77 !2 Tax 0111ce PIN: # �D �U — 6 fin" 6 V6 1, Property Address: Road Name /J�'C UC -2 Llhz' A'' Citylzip WRITE DIRECflON3 (from Mocksville) to PROPERTY: J�OcKS CNVRU1 To 210Nt' ctn�3EA�ck4}1pfZ'�l� i��ri► o� l-E>~f. If in a Subdivision provide Information, as follows: Name: _�IgHI J A/N� �ttr-y Section: Block: Lot: =5 Date Property Flagged: TMs is to certify that the Information provided is correct to the best of my knowledge. I understand that any permit(:) 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 fslstfied or changed. 1, also, understand that I am responsible for all charges Incurredfrom this application. 1, 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. THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the 161lowTng: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). I l N \ ►` L ti Revised DCHD (07199) Site Revisit Charge Date(:): I Client Notification Date: I EAS: Account No. X -FIC Invoice No. Al % o -- I ,10CK � 8 I CARL I D. B. 1 262 S 85'33'08' E 261 2.22 +5 3ANCLE IRON FOUND 29�' � 0 25 + �� S 83.2337• E 76 616.09 1 48 y 49 26 29 4 i, �- 271� 252 50 �- 254 25 56 O_ b ti l� 47 z 5 206 155 25� .56 1 -'75 272 -,F C 249 Cq 19�` �, 24 20 102 �. 51 + r 28 d 46 24 + 20 20 ,� ^� 74 154 153 p. 273 �0 s 258 259 IX' 27 188 187 �A`Jt -J 4186 E1�� G " 24 189 1 yl 45 29 193 1981 +I 158 -rw0 1 9 157 i 44 , 194 1-215 + \20I 1� o' i 12� 216 IS 244 a2 I 195 79 43 196 a' 2 2 0 199 198 197 1 21`1 �l.' 10) 2 221 18 - �i_ 28 80 �O + 30 219 a 126 125 70A 101 y 2 _ 123�ti.y. 89/ 22 . / 169 168 8 120 6.97 V LlrO S1 54 / 5 57 118 T09CE OAK + I o 16q / 1'' 58