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117 South High Field Road Lot 31DAVIE COUNTY HEALTH DEPARTMENT �`? "� ' Environmental Health Section /'7/'- • P. O. Boz 848/210 Hospital Street a Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900573 Tax PIN/EH #: 5870.69-0403.31 Billed To: Glenn Johnson Builders Subdivision Info: Windemere Farms Lot # 31 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: see map ATC Number: 2.6` **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 JYO il-f (f #People #Bedrooms #Baths, l2 Dishwasher: 711-- Garbage Disposal: 0-*" Washing Machine: 0"*"- Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply _ j_ Design Wastewater Flow (GPD) D_ Site: New Repair ❑ System Specifications: Tank Size/,,&L GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width�� ``' Rock Depth /��Linear Ft.,-)/ 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 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.**** o2PX3Xl� �r 0 r Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900573 Tax PIN/EH #: 5870-69-0403.31 Billed To: Glenn Johnson Builders Reference Name: Subdivision Info: Windemere Farms Lot # 31 Location/Address: Beauchamp Rd -27006 Proposed racihty: Residence Property Size: see ma ATC Number: 24, 1 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 NSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: 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. O F Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) ,)lJ Ir"ea0X3 X19 Date: IS—d 2 n&— GL - A. • APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMff0 `'/ R Davie County Health Department Entrironmental Health Section AW 3 0 2n P.O. Bos 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 ENVIRONrY1ENTAL HEALTH ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed _(7'Qr1N Jn f �,� scat & d ek5 FVLC Contact Person _C7��t•t Q_ �DGJ/9/S�G.��1 Mailing Address _ �3i(/j UndCie09S5 Home Phone City/state/ZIP r1gnC T �, C< < o� 100/7 Business Phone 336'fi'V `dS� 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation 0 --improvement Permit/ATC ❑ Both 4. system to service: Q-40'use ❑ Mobile Home ❑ Business ❑ Industry ❑ Other s. If Residence: # People # Bedrooms �_ # Bathrooms a ish-asher cbage Disposal P41ishing 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: a -do- my/City ❑ Well ❑ Community s. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No 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: Tax Office PIN: Property Address: Road Name�'�c City/Zip Tom`' If in a Subdivision provide information, as follows: Name: Al , r. c( 2 ee e--,, V-rA jer'�s WRITE DIRECTIONS (from Mocksville o PROPERTY: ni Section: Block: Lot: I Date Property Flagged: Yl Z�l ( o D r"ems. w rv---r 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 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 suits lity. -3o-aovO DATE � SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inclu all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): I Client Notification Date: I EHS: Revised DCHD (07/99) Account No. 7 2) Invoice No. 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 #: 5870-69-0403.31 Subdivision Info: Windemere Farms Sec.2 Lot # 31 Location/Address: Beauchamp Road -27006 See Map Date Evaluated: bcd IQl_ Community Evaluation By: Auger Boring Pit f Public / Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope % z HORIZON I DEPTH - - Texture group 0- L Consistence - S Structure Mineralogyt ' HORIZON II DEPTH _ Texture group1,9C Consistence Structure Mineralogy(� HORIZON III DEPTH Texture group W A C +5 Consistence Structure 5 Mineralogyi : I HORIZON IV DEPTH Texture group Consistence Structure 11— Mineralogy SOIL WETNESS m RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATEUu SITE CLASSIFICATION:V� 'l,�`i RO EVALUATION BY: LONG-TERM ACCEPTANCE RATE: 6a5& REMARKS: I'_10k"0 iVpao6m•y` 0r Landscape Position OTHER(S) PRESENT: /��fl %O )2j.,-0, LEGEND qPM-et,,✓,(, % 4* -r pG LoTA3Z. 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)