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221 High Meadows Trail Lot 27I I -rd ffiv DFA PA 01 VAIN I9475 WN r Environmental Health Section • P. O. Boz 848/210 Hospital Street f� Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT I 2;Z' -"I Account #: 989900283 Tax PIN/EH #: 5870-69-0403.27bc Billed To: Bob Cope & Son Construction Subdivision Info: Windemere Fams two Lot # 27 Reference Name: Location/Address: High MeadowsTrail-27006 Proposed Facility: Residence Property Size: see map **NOTE*NThis fmprovement/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 C�LNI: #People #Bedrooms 3 #Baths 2, � Dishwasher: 2" Garbage Disposal: u Washing Machine: 62" Basement w/Plumbing: Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Ot,,�WDesign Wastewater Flow (GPD) o Site: New Repair ❑ System Specifications: Tank SizeLOQD—IAL. Pump Tank GAL. Trench Width ' Rock Depth � Linear Ft.;2C Other: \ 'DjI51"Qtet?TI©n3 'i�yy Required Site Modifications/Conditions: jtaSw- W (' ip -ID 9 , ; ��� C }b1�„ "ti=4- ),S I � �t 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.**** 01 2 Environmental alth Specialist's Signature: I Cc ),f-", DCHD 0PP 5/9 (BPv;ce__ d___1/15" Mtea'TO 172Oi C� �Qe • DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900283 Tax PIN/EH #: 5870-69-0403.27bc Billed To: Bob Cope & Son Construction Reference Name: t-acwty: Kesiaence ATC Number: 2733 Subdivision Info: Windemere l=ams tvm Lot #27 Location/Address: High MeadowsTrail-27006 r'IUjA;1Ly JILG. acc IIICAF 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 00 Sewage T atment and Disposal Systems). THIS AUTHORIZATION FOR WASTE W O ON VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: A& //1 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. Clp t ' Y " xz-► �tS �P� p�V✓ r4or LpM PLTi Septic System Installed By: Environmental Health Specialist's Signature 7Date: ©� DCHD 05/99 (Revised) n C 1 t o 1.401 AC. 40 z/ E 1.187 AC r 45 N A7+36'45' Y 0.947 AC. 0.739 AC. '53 75 6j'2j,J3, nn 207. — \2gJ ry N 78.1 8,08' TOTAL- 234,57 N 46'41'25' E .28 S 34' 16' 04 Y 7 64. 26 6.30'57• V 67.011 ',6'.5 *� t N�1� W W Z 45 �i� W i 11�� 50 .• •G/•• 26 g. 41 s v "'1 n 0.892 AC, 1.124 AC. i� LP 1.282 AC. 689 AC.' r 0 t^ 0�// te4 21 o.1a � � • 96'30'37• y 07 - 340.70--- - - - - - - t $ 'v __ _ - _ - --'116.49 - TOTAL= 482.19 S 86'22'38' V 4{, 44 f22 HIGH' MEADOWS ROAD ).889 AC. 8 �`? 0.672 AC. G�y� TOTAL- 482,19 N 86'22'39'^ E�� 0.735 AC. -120-00- - 8 222 1 �'12Ar v C1 166.24- - - - - 120. DO - - e . 75.95 S5°t E , te3 Ells 37. e6 N •S•�8'17• Y C14 N `J9�Z1 $� 02 i ' PAVEp_� � 24 23 7 0:_ s 86' 37• E � 0.776 Ac 26— -- - - - — 120.00 c2 0.829 AC. 8 ,ror - [2 1 / . - 1-2 rryV � P k� a� 41 �� �O// /b YA P��� 2 8 v r 'Z 1.702 AC. 0 0.842 AC. V) s �Jy �,'t' a/ hh / 2 29 100.3 T7,3 4•A7 � = s r 2 F °r� r, 5 28 1.777 AC. AC P 8 -- _�� [1P AINA '1 _ r'Or• 4 C1 E .5fvf N•0. ' 00 260. 7 _� �� � / Gi.� / � � _ _ �.�.° t•:.., TOTAL- 876.79 N 87.03'09' Y :53.98 LAWRENCE L. 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R..:•r-TIT,• _ E • ,fir—"Kt__- 'rr r+�,e.c - '7 • Ar Uttht r are 1: .. v A II,,N% EEDAPTIEN• '^r t 1c :rn r, rnet tn,r D'>r ••'r•'r •. •r7 -7 'SAT( ',•�iE �OI!N'• .rc At rr. nt �,{!i tAlt MAV EC. C -A. FCR r•Dunr'n•^Y er inr SuDDvr o^ Pr7uD1 - NCcrsv.ue a Counr. Dna. • >DD •1 the l- oI r•<Drd.nQ r AL 8, TwE PLANMNG BOARD ce^'ro'• > Too -1 ^» It,—nae- •^e :EPnrirATE Or •PPPOVAI E_CA:'E._C_:^v-SAQNEPS plot. Lot - =or 0e•e•m.n. ..f - •.er/ re'..Crt IC •.. ..• _ .,• ECDr• rr�9nr Cno,rmon _. .. rh�r I•ne ':r0r D•W'r•O^'v ^Q Eoo'O nor ^r'rC• - ...S•ol.,f. r C'e .• NC"n r.1 r^e veva. lnunty Boord of 'n.n.r•.one•• n•.•n, ou• to In• recl .1 •cc, �C '^• rnr c.bd �r•o^ • cr, rr t^>t so0 Doo•D nor arnrn.ee 1^. c•D• .tn�n Ine :•ounDe'v d Lo' :N 7 n• �� A, /..3 /--_ - _ ,nr lu0 wrNOf. YE PE. �EC11�N 'Don 1„tn•r Irrl•ny Dy Do /'rY^7Y l ,^ •..r rr• _ _a,r •.1 _ __ _ - �•DIn pet,rrr.•enr Lr ISP t C^'JN" D,,fNWNG BOAD[. _ - _ .�A.Pu.N fu. r i t�,iNT• r � tCr �..> �p.nrl n•�'1'.. q^.API, ' ua c„ a, u< yr / 11 ,nn 119 APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Entirwmenta/Hea/tfi Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 {� U 9 FEB 2 120 I ENVIROMIIIENTAL HEALTH DAVIE COUNTY ***11V0RTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed � _ Contact Person 15to oe- L � Mailing AddressHome Phone City/State/ZIP �_�C/y V�r/ (� /CJI Business Phone ��U ��� 2. Name on Permit/ATC if Different than Above Mailing Address City/state/Zip 3. Application For: ❑ Site Evaluation 6"/Improvement Permit/ATC U Both 4. System to Service: louse ❑ Mobile Home ❑ Business ❑ Industry 6 -Other S. if Residence: �# People # Bedrooms # Bathrooms r#ebishwasher Irl'Garbage Disposal W`WWashing Machine V Basement/Plumbing 0 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: 2' County/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 COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: c �`'i" M—� WRITE DIRECTIONS (from M2ochsville) to PROPERTY: Tax Office PIN: # S�S%a - -� ��� • 2� ��� LT ��' % / h1D Property Address: Road Name _ }} 164 tACkb0"\S 1fA(t— ivy 0' C.! city/zip Ara1/Q&tC' Z- CCUOA)� If in a Subdivision provide information, as follows: Name: Section: Z Block: Lot: 'Z`% 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 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 procedures as necessary to determine the site suitability. DATE SIGNATURE�t'1/ 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). lU Revised DCHD (07/99) Site Revisit Charge Date(s): I Client Notification Date: EHS• '!"� ) IOU 8 3 Account No. Invoice No. 2 0 7 z 9 i yb b� 1 100 UTK.ITY ti a ` 7 ueu �/ 1 F2- m. �' —b— I - 4% ) / p J C b9tol WO 30 811 i �. _ ---- 021 8 ---891 691 v �a I 0\ 22 ryv �0 l s \ / + n ,6a,c %6 41"' tGN f 41 ` U �E — 11 etl g S21 `f i 9 2 t 612 oc oI 08 jTtA + 81 122 2 + €Ol L\ i2 , Cbl 861 66t 2i1 0 2 SLI 1 6L 96I I E► 2►. u6 S61 r►2 'Ili I ULA l0fl1 SL 912 5 t' V l\ + st2ti ►61 i �ftG S LSI QMI � 8S1 64[ C61 t+ I861 Y2 62 7 's6t r 88l L8I 98l 681 L2 IT, 6S2 8S2 p E[2� L ESI ►SI •� -r"1 U' ►L \ 02 � � 1 Oz � -, r� ►2 9p + a s2 ('� .• 7 201 02 ►2 C Et .C6� 6►2 jy 2[2 S[- ='�1 r, Ic S � 902 9S t fsz I 1 / 0. 292 t t[2 L'}^ 62 92 6P, �� 8t 60919 3 •CS.£2.£8 S ,. + 9[ 92 0 113, ONl103 NOdl 31ONpE 86Z + � 22'2 I 192 3 .80,£E.SB S 292 N0Or �E I `f i APPUCATION FOR SITE EVAUAITION/IMPROVEMENT PERMIT & ATC Davie County Health Department Envltonmenbal Health Section P.O. Box 848/210 Hospital Street Mockeville, NC 27028 (336)751-8760 AUG 2 5 1999 ***nV0RTANT*** THIS APPLICATION CUMM BE PROCE881W U1MZSS ALL THE REQUIRED IM MrMATION IS PROVIDED. Refer to the n=RMATION BULLETIN for instructions. 1. Nass to be allied WESIy1Ek1-DF'i(t, rJ4-T co-gPAW/ Contact Person - !A—ff GoyparY Wiling Address 2L31 9-EYN0441A RO. some Phone 336.116.7409 City/State/2:P NC 2'1i0b awinass Phone '136-11-1-0019 2. Now on Permit/&= it Different than Above 1ttiling address 3. Application ror: city/state/sip Geite Evaluation O Improvement Permit/ATC O Both -/ YLO%ga j 4. System to ser ioei E HouseS O Mobile Home O Business O Industry 0 Other S. It Residence: # People # Bedrooms # Bathrooms 0 Dishwasher O Garbage Disposal O lfaahing Ksohine 0 sasemsnt/Plumbing 0 sasessnt/No Plumbing 5. It ausiaess/Industry/Other: Specity two # People # sinks # Commodes # showers # 'Urinals # Water Coolers It 11=8ERVICE: # Seats Estimated Nater Usage tgallone per day) 7. Type of water supply: O County/City 0 Nell 0 Community e. no you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes ff No If yes, what type? ***IMPORTANT*** CLIENTS MAST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: Se e 1r7 Tax Office PIN: # J F/-10 Property Address: Road Name �� uG L61�4izjiv' City/Zip If in a Subdivision provide information, as follows: WRITE DIRECTIONS (from MockrAlle) to PROPERTY: mo&5 tuwtm To Wit cW RC4VO4MP, fZ '1'- fNOt trii o -'J LE fT. Name: 1A)l V1)CAW T: 0915 alma p' /J Section: ?/ Block: Lot: t2-;� Date Property Finned: 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 1, also, understand dkat I ant responsible for all charges incurred front this applicadom 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. DATE 8I KIg9 ---- SIGNATURE AO� THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the Fdlowfng: 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. /,7t�' Invoice No. /Z� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION_ LOT Soil/Site Evaluation APPLICANT'S NAME©!/ PROPOSED FACILITY SUBDIVISION Water Supply: Evaluation By On -Site Well Auger Boring Community Pit DATEEVALUATED PROPERTY SIZE ROAD NAME 6i�%GI�' Public v Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure .� Z 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: LONG-TERM ACCEPTANCE RATE: REMARKS: DCHD (01-90) Landscape Position EVALUATION BY: J� �'�/'�1 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