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118 North High Field Road Lot 41DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 989900136 Tax PIN/EH #: 5870-69-0403.41 Billed To: Westview Development Co. Subdivision Info: Windemere Farms Sec.2 Lot # 41 Reference Name: Brant Godfrey Location/Address: Beauchamp Road -27006 Proposed Facility: Residence Property Size: See Map **NOT) * iIss proveme nt/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_ #People #Bedrooms '� _ #Baths Dishwasher: Z Garbage Disposal:;2r Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow (GPD) �/&. Site: New.4!5' Repair ❑ System Specifications: Tank Size aj! GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width Oe"Rock Depth—Linear Ft._ko 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 n.m. m the day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date: ?—,/V DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900136 Billed To: Westview Development Co. Reference Name: Brant Godfrey t-aciuty: Kesiaence ATC Number: 2569 Tax PIN/EH #: 5870-69-0403.41 Subdivision Info: Windemere Farms Sec.2 Lot # 41 Location/Address: Beauchamp Road -27006 r1upuity VILG. Vcc IVIGIFJ 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: f� 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. u r Septic System Installed By: Environmental Health Specialist's Signature: 2iAl Date: DCHD 05/99 (Revised) APPLICATION FOR SITE EVAU1AT10N/IMPROVEMENT PERMIT & Davie County Health Department SEP Enu twnmental Health Suction 7 e �� C(!!. ` P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 ***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 ale'M Ja !'KS e,01 Xe ; lle f-5 T KC Contact Person _e5le"lr/ JC7/�K-SD's Mailing Address &"4g & Rome Phone q0 5f6' City/State/ZIP vt � L Business Phone (�9 % y1 -5-6,5-7 2. Name on Permit/ATC if Different than Above Mailing Address City/S��tate/Zip 3. Application For: ❑ �ouse luation V -improvement Permit/ATC ❑ Both a. system to Service: ❑ MobileHome ❑ Business ❑ Industry ❑ Other S. If Residence: # People # Bedrooms # Bathrooms IG a /a l�aisnrasher A-�bag. Disposal :cashing Machine O Basement/Plumbing O 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: County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes 9 -No If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTBD by the client with THIS APPLICATION. Property Dimensions: 6-1— ^— Tax Office PIN: #$ �a 6 9- 3.4 I Property Address: Road Name'Be&-.-C- � City/Zip da.nc -- a7oQr If in a Subdivision provide information, as follows: Name: WRITE DIRECTIONS (from Mocksville) to PROPERTY: O C es Ck"N '�-L. 4 . ry /tet- G IJ L-4-+- . Section: 'Z- 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 I, also, understand that 1 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 to conduct all testing procedures as necessary to determine the site suitabil DATE I —7 z;24f)00 SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Includoll of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations Revised DCHD (07/99) Site Revisit Charge Date(s): I Client Notification Date: I EHS: Account No. Invoice No. �r APPUCATION FOR SITE EVAUlATION/IMPROVEMENT PERMIT a ATC, Davie County Health Department h Envimmental Health Sectfon `! �' AUG 2 5 1999 P.O. Hos 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 ***nWCRTANT*** THIS APPLICATION CANNOT BX PW=SSICD UMLESS ALL THE REQUIRED INFORMATION 18 PROVIDED. Refer to the INrOTMMIOH BULLETIN for instructions. 1. Mame to be billed WEMJC%4 LC�IELofJH Co",PAW/ Contact Varson —SW) GoOPULY Mailing Address 2(,31 REYNGt-nA 'RO. come Phone 33L-10-1.008 City/state/EIV Vh J1TdA-SALtV% mc. 1110b business Phone 336.111- dal$ Z. Same on Permit/UTC it Different than above Mailing Address City/state/sip 3. Application ror: Witte =valuation O Improvement Permit/ATC 0 Both s. states to services f3 HouseS 0 Mobile Home 11 Business 13 Industry O Other s. If Residence: # People # Bedrooms # Bathrooms O Dishwasher 0 Garbage Disposal O lashing Macbine 0 basement/Plumbing 0 basemant/Ho Vivabing s. If business/Iadastry/others specify type # People # sinks # Commodes # abowers # Urinals # Nater Coolers Ir T*MSZRVICZ: # Seats Zstimated Rater Usage (gallons per day) 7. Type of Nater supply: 0 County/City 0 Well 0 Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? O Yes Ef No If yes, what type? ***1MPOR7ANT*** CLIENTS MUST COMPIETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN Mt1ST BE S11BIM77ED by the client with THIS APPLICATION. Property Dimensions: -ee "-,)/ a" Tax 08ice PIN: # �0'U in- fly,y- S/4 Property Address: Road Name uC if�/n City/Zip Vc-29%c If In a Subdivision provide information, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Upas (u►i1 To PA&ff dri REAWRAMPAd, PKPPmT,j o.,i Le . Name: fA)J W (X8W 7 Atr1S Section: ?/ Block: Lot: �� 141 Date Property Flagged: 4 This 1s 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 ani 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 all testing procedures as necessary to determine the site suitability. THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the f6llowfug: Existing and proposed property Una and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge 1 Date(s): Client Notification Date: I EHS: Account No.r /,? C Invoice No. /,Q Co 38 s. 39 0.902 AC. ? }� 0.940 AC. Y eE WSUITAeLE LAWRENCE L. MOCK BY WILL REF:D.B. 49 Pg. 8 47 ' 0.753 AC. 48 l51 0.740 AC. ,6• V s ml lc •acyl .+ayc �.ev• , WT VA 4 po DVAE [pUfn IC y�C'rl •• uEO •rCALM 0EPARTM SAn" u u O N C 40 r F /Lf . 4 N 17'x•u• Y c1 s cUEp .. •�. Ear Df '�i[:^.y i J 0.947 AC.0.739 is AC. �37e �..•_I a aKK•w+w • Count. O e. ' • !.Dope•!. �� QQJ ",• D••• � r. •- .: PM�ar C [ _/a" a14r "•YEP[ 1.57 N 46'11.25•�.51.16.04.1170TAL� 27 • 37167.57 61.26 •Z. : Z} m m - 0.591 AC. N V N Z 67.00 r� C iQ N ' y _ W. 'Z• 4 O 45 g iS S6- 1 3oc 1' E ?_ 4 1 1W Pal it J: 0.59.2 AC. m 1. 0.689 AC. t 1576 2i 6A 8 36 210.00 8 0 •3057• M \a. 2 $F N _ V v - Y 0.689 AC. -74 P r 6 S s. j o= 44 .coE'y�r D. C22 S 86. E i a A e 42 0.689 AC. B 43 0.672 A.C. X15 210. 0.735 AC. _ - TOTAL- 357 K N N•30•37• V - - __ - Cl4 H Sd2d'7, .'`-rE�•• 0.689 AC. _ n S 20' PAVED-PUSUC - - TOTAL. 337.eS W S 71• _ DO >; � - - - - 172.x_ - - ._ - — 120.00. C2 - ® s = 27 34 z a o = 29 i. 1.702 AC. - 0.691 AC. - � z �° 30 0.842 AC. 0.960 AC. © y to 33 W O 20 0.750 AC. :6 Q 11 s 1.777 AC. 31 z 32 t�. b�\ ._ \ g �• 0.706 AC. c� s5 0.606 AC. •\ E r l 'i�Ov 35227 ---- __•�[ UstuEy_� �(lF'a TOTAL. 576.77 N 97.03•". W LAWRENCE L. MOCK BY WILL REF:D.B. 69 P9. 55 lc •acyl .+ayc �.ev• , .. a .� y. -YE D. f•. a. •.. y�C'rl •• !•f ::v fi a.i•-:;'_ - •. .[ fPPPevu e. ••a Pl7yA1+W eoaPO .. r •. .. .. ."+q eoD•f "e• ron .. •�. Ear Df '�i[:^.y i •. :1 rr..l nt< . <..BCfr-c•pf, Py aced .1. lc •acyl .+ayc �.ev• , .. a .� y. -YE D. f•. a. •.. y�C'rl •• •. :1 rr..l nt< . <..BCfr-c•pf, Py aced .1. �..•_I vtP '�• aKK•w+w • Count. O e. ' • !.Dope•!. �� M aoPd ",• D••• � r. •- .: PM�ar C [ _/a" a14r "•YEP[ 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 #: 5870-69-0403.41 Subdivision Info: Windemere Farms Sec.2 Lot # 41 Location/Address: Beauchamp Road -27006 See Map Date Evaluated: I o Iq o L79i Community Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L_ Slope % L42 HORIZON I DEPTH O ' Texture group d'L Consistence C Structure Mineralogy HORIZON II DEPTH - Z +-70 Texture group I L' Consistence Structure 56k Mineralogy HORIZON III DEPTH ' 5V 7,0 - Texture grou r7rX Consistence Is r Structure Mineralogy` HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE JEME SITE CLASSIFICATION: ©s LONG-TERM ACCEPTANCE RATE: 3� REMARKS: LEGEND Landscaae 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 Mois 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)