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122 Hagen Road Lot 47DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section �� 7 /o P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 �-�- f IMPROVEMENT/OPERATION PERMIT Account #: 990001597 Tax PIN/EH #: 5870-59-3399 Billed To: Marquis Building Subdivision Info: Windemere Fams Sec.2 Lot # 47 Reference Name: Gordon Whitney Location/Address: Hagen Road -27006 Proposed Facility: Residence Property Size: see map **N* ffibFmproveeme OTESnt/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 j)OSE #People #Bedrooms L] #Baths ;7- Dishwasher: Dishwasher: Garbage Disposal: ❑ Washing Machine: u Basement w/Plumbing: ❑ Basement/No Plumbing: Commercial Specification: Facility Type n - #People #People/Shift El Industrial Waste: Lot Size X753 A—RESType Water Supply �y�'tY Design Wastewater Flow (GPD) ` tt� 0 Site: New d Repair 13 System Specifications: Tank Size I OCOGAL. Pump Tank 16co GAL. Trench Width Rock Depth 17- Linear Ft. *0 Other: 115 -&6M &JT1onl 73jK',2;S , AV9741,4. l f,A?,S Required Site Modifications/Conditions: I ��L.L 0'j G&-1 P(., 4/-4�00 10, 04C P40P I 1 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.**** AA92ox sett yo -_u - q7g00 DO A t Environmental Hea ecialist's Signature: Date: / a 0 DCHD 05/99 (Revised)1 +r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001597 Tax PIN/EH #: 5870-59-3399 Billed To: Marquis Building Subdivision Info: Windemere Fams Sec.2 Lot # 47 Reference Name: Location/Address: Hagen Road -27006 Proposed Facility: Residence Property Size: see map * *NOTEC * Phis �mprovement/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 Q #People #Bedrooms #Baths 2. �� Dishwasher: Gr"' Garbage Disposal: ❑ Washing Machine: M/ Basement w/Plumbing: ❑ Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift ##S�Sejeats Industrial Waste: Lot Size e-75SWiSType Water Supply��Design Wastewater Flow (GPD) '7©) Site: New Repair System Specifications: Tank Size ICO'OGAL. Pump Tank GAL. Trench Width-' Rock Depth Linear Ft. 007 Other: Required Site Modifications/Conditions: jt- STM -L 0,,3 `i-0DQ 1400SE; vj:-7ep lc Dom= 1,1•.lt 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 inst ilation. Telephone # is (336)751-8760.**** F L,:-�..S IBJ O(2 � 1 ,� H00� 1 !2- P. C -I til Environmental Health Specialist's Signature: DCHD 05/99 (Revised) too A114. • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001597 Tax PIN/EH #: 5870-59-3399 Billed To: Marquis Building Subdivision Info: Windemere Fams Sec.2 Lot # 47 Reference Name: Location/Address: Hagen Road -27006 Proposed Facility: Residence Property Size: see map ATC Number: 2885 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 I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTE C TION S VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa e: .c.1 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. qJ 5 . . o POO -Q- 14 r/o' Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & Davie County Health Department Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 E C E E JUN 18 ENVIRONMENTAL HE01 DAME COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. � - L / 1. Name to be Billed-MAE5 2 OI LI t i e -N Contact Person 6�'eopo Mailing Address C), 7,170 Home Phone 0140 (r7Q2 City/State/ZIP Af ),J ANGE li, C. Z7oa(o / Business Phone 5/-�mc 2. Name on Permit/ATC if Different than Above 1-W 0 0f+ -Toxo Mailing Address City/State/Zip 3. Application For: Site EvaluationImprovement Permit/ATC ❑ Both 4. System to service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms _ # Bathrooms 7- i/2- KDishwasher ❑ Garbage Disposal �I Washing Machine ❑ Basement/Plumbing �Q 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 8. 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. Eitber a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. .'753a4e Property Dimensions: Z0 X /'F4,'7L- ZoS A /oSYZ-17 WRITE DIRECTIONS (from Mocksville) to PROPERTY: Tax Office PIN: # 513 199 1339q ;;�� ^__ Property Address: Road Name 4A�,J eiC> I f VA n Q G ©.J fiUC P. City/zip 4m -o c- Z?Ootc, 10,1J66AEP-E S� �'� "1 F/* If in a Subdivision provide information, as follows: QowS Tiz K- 062 Name: ��rNn Ear F�t2n�S Lo-, -L,j 6.2L -SAK Section: Z Block: Lot: 7 Date Property Flagged: X, 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 _ to conduct all testing pT edures as necessary to determine the site sk'bility.DATE �p / SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: ExislIng and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Datc(s): Client Notification Date: EHS: Revised DCHD (07/99) Account No. 1 - I I Invoice No. c;�-2-� r L-6 ` 1 -i I U 11013 eJLev FA1241.5 d LAWRENCE L. MOCK BY WILL I r REF:D.B. 49 Pg. 8 I E TOTAL. 962.22 20 .2 83 23'57• 4 �e a � 200.1 4 4 ?' 0. i 48 N 1 ' �6 r 0.740 AC. •'� Ilse ` �I '�� Z 120 ��°� 49 ri ,/ �+ ' 2 1 1.401 AC. 4 N 47.36'45' M Cl - S c 0.739 AC. 53.75 94* 16'0 y TOTAL- 234.'57 N 46.41'25• E \? 28 167.57 S7 C � 64.26 67-00 Z W x 45 'mo o 4 50 ....... ri 8 n 0.692 AC. �a = ,��_ •�• j '•Z� cCD1.124 AC. 1 77 $ �, ` 116.4g• -- --- g .e72 Ac. rG1� 43 oHIG.1 0.735 AC. r Ii 222 , C1 - — 95 r 66.2 •3& 57,aE'r. •ti h 20'. PAVED-Pusuc •r — — 120. oo•'- . -� c2 - Q APPUCATION FOR SITE EVAUTATiON/IMPROVEMENT PERMIT & ATC Davie County Health Department EnOfvnmenbal Health Section P.O. Box 848/210 Hospital street Mocksville, NC 27028 (336)751-8760 { AUG 25 1999 1 * * * IMPORTANT* * * THIS APPLICATION CANNOT BS PR=SS)Z'D UMSS ALL THR RRQUIRZD INVOIMTION IS PROVIDZD. Refer to the IN>rOMWIOH BULLZTIN for instructions. 1. name to be aillod WESTytE%J DCVC .oPlKi+ T C0`gPJWW/ Contact person -&p�OO��TCY Nailing address 2L31 FGYA%OLflA IRO $vine phone 336.116. 008 city/statems, IA�\NSca,.t-Sa�+h ,Nc 2'110b easiness shone 336.11-1- 001a Z. Vanie on permit/arc it Different than above Mailing address a. Application lot: mite Zvaluation e. Systes to service: R/HouseS 0 Mobile Home a. If Residence: # people City/state/Zip O Improvement Po=st/ATC 0 Both 0 Business 0 Industry 0 Other # Bedrooms # Bathrooms 0 Dishwasher 0 Garbage Disposal 0 Washing Machin O sasenant/plusibing 0 aasament/No piumbing 6. Ze Dusiness/Industry/other: speoity type # people # sinks # Coaeodes # showers # Urinals # Water Coolers Il VOODSZRVICZ: p Seats Zetimated Water 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 5 -No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the cHest with TUN APPLICATION. Property Dimensions: See /77 Ct d Taz 081ce PIN: # �d �U ' �n� Property Address: Road Name city/zip /Gyvd�cc /1/�%UUP U In a Subdivision provide information, as follows: WRITE DIRECTIONS (from MockrAlle) to PROPERTY: f � a5 CNMU1 Ta R,Iaff a ti �3EA�c1tANP„/z t"AMTV CAJ LEFT. Name: W11JOCMW F4%c-tS Section: Block: �UaJ mAP p�f Lot: �a q7 Date Property Flagged: This 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 ase change, or if the Information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges 1ncunrd 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 aH testing procedures as necessary to determine the site suitability. DATR , 81014ATUM e&2�V V 01 THIS AREA MAY BE USED FOR DRAWING YOUR gFFE PLAN (Include all of the ulings Existing and proposed property Ulna and dimensions, structures, setbacksi\an septic locations). Site Revisit Charge Date(s)t I Client Notification Date: IRKS: Revised DCHD (07/99, 6'. Acconny No. /"� Invoice No. /1111)w/y I 0' 'b.ft01 WO 30 + aT1 LS s / O 11S tS ,0�7. n ,60•E L6, 691 691 by 1/ C' Y �yy��Atito 221 O ltd 66 /� v /E2t 22 + 6o7 _ a_ 1o1 to s OL � o� Be 612 of 0843 Eo p �L� + at 122 2 p 6,6(!/ + €OI ti\ / 12 C6IZ 86l 66I Z11 0 2 I 6L 961 S61 I E► 24 oat 9T2 1 5� � ji p 7, LSi + 41 i 1161 %rV 611 CML 8St St i 1 + 1661 C61 L2 Y2 ? dNc� 961�� L81 68I 881 L2 6S2 892 EL2 i� Est ►st (j 'L 6 02 82 ^ a 201 02 .n> 6►2 U 7��2L2 SC` � 11.91 102: ,C 902 'v 9S r6� K2 92 OS 2S2 tL2 + 92 62 , V � o� 81' I 60919 3 •LC.E2.Ea S S2 OCA + 9L � NOW NOLII 310NyE Fi6Z + Sv : 22 2 I 192 3 ,eo.EE.SB S 292 .e.a 2 Iwo I 8 '6. I NOOV' I ' 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: PROPERTY INFORMATION Tax PIN/EH #: 5870-69-0403.47 Subdivision Info: Windemere Farms Sec.2 Lot # 47 Location/Address: Beauchamp Road -27006 See Map Date Evaluated: Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit Public L/ —� Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Sloe % HORIZON I DEPTH Texture group L C Consistence WS' Structure Mineralogy I ' HORIZON II DEPTH 14, - — D Texture group G Consistence Structure lC Mineralogy• I HORIZON III DEPTHS - Texture group Consistence : S Structure Mineralogy; HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: 3 p' REMARKS: EVALUATION BY: )OlPF fjz�A�dOAP OTHER(S) PRESENT: 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 - FirmVFI - 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)