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240 High Meadows Road Lot 43DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section d Z P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002162 Tax PIN/EH #: 5870-69-0403.43 BC Billed To: Bob Cope & Son Construction Subdivision Info: Windemere Fams 2 Lot # 43 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: 127'x 286' ATC Number: 3072 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction of 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 H it))t)5 #People #Bedrooms 3 #Baths .2 - Dishwasher: Dishwasher: 011, Garbage Disposal: 19"" Washing Machine: V Basement w/Plumbing: C� Basement/No Plumbing: ❑ Commercial Specification: Facility Type ` '#.,Pfeople #People/Shift #Seats Industrial Waste: ❑ Lot Size D. I3 AL` 6rype Water Supply (490 I Design Wastewater Flow (GPD) i� r Site: New Repair ❑ System Specifications: Tank Size1�DGAL. Pump Tank GAL. Trench Widthc.Jlo Rock Depth .IZ Linear Ft.r,� Other: 1- �I al �jt.�1 l�', B—,NU;S l.i r-3 es 0 • C• M 0. Required Site Modifications/Conditions: IQ 5UL4y,r Gp,J YD �Q Kph S� Dr -r- >ysc I F UEt.c-,4 6-4,s 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.**** SOS 1 3— 44WJ, Environmental Health Specialist's Signature: Date: g. 12-0102— DCHD tl 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990002162 Billed To: Bob Cope & Son Construction Reference Name: Tax PIN/EH #: 5870-69-0403.43 BC Subdivision Info: Windemere Fams 2 Lot # 43 Location/Address: Beauchamp Rd -27006 Pro osed Facility: Residence Properly Size: 121 x zoo ATC Number: 3072 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 WASTEW CO ON IS ALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signatu e: 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. 31k't, �ho _ p ,75 _ S 9,ew S ��S�It,`r�a►DQ ��Slt�e�t�flL PAA 0-zS CD2• � 1� Nor 'r- r,1-OtEll "T, I S PIy� t o Septic System Installed By: Environmental Health Specialist's DCHD 05/99 (Revised) C 0-E&Q- SYST-0 . APPLICATION FOR SiTE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Secfon P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 4 - AUG AUG 2 5 1999 ***IMP0RTANTk** THIS APPLICATION CANNOT BE PROC Z5MW UNLE88 ALL Tisa REQUXMM XRMFIrATION IS PROVIDED. Refer to the XIMMSTION BULLETIN for instructions. 1. Msme to be Billed W ES -1 V IC-) DCJF WfP KnrT 60i"1PAW1 Contact Parson &W Goga CY !tailing Address 2L3% 9EVh%GkflA RO• some Phone 336' 0.1.008 city/stats/s=P WINSTdAJ-Shit«% ,Nc 71I06 Business phone 136-111- 06'18 Z. Maas on Permit/ATC it Different than Above Bailing Address 2. Application ror: Veite Evaluation -/ fLowoo t. system to service: G HOuseS 0 Mobile Home 5. If Residence: # People City/stats/sip 0 Improvement Persit/DTC 0 Both 0 Business 0 Industry 0 Other # Bedrooms # Bathrooms 0 Dishwasher 0 Garbage Disposal 0 Nssbing itaobine 0 Bassment/Plumbing 0 Basement/No Plumbing 6. xf Business/industry/Other: specify type # Commodes # People # sinks # showers # 'Urinals # water Coolers Ir 2`OOD8ERVICE: # Seats Estimated Water Usage (gallons Per day) 7. Type Of Mater supply: O County/City O Well O community a. Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes ®No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLEIETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESVBARTTED by the client with THIS APPLICATION. Property Dimensions: <�eC/ml'p Tax Office PIN: # J D l'7U in G Z16'f, YJ Property Address: Road Name G 1141/h Citylzip His a Subdivision provide Information, as follows: WRITE DIRECTIONS (from Mocicsvilie) to PROPERTY: PK09mry Name: All tAXAW 7Fbtt9n1 L1�AW V4 p^ /J Section: ��/ Block: Lot: 141 Date Property Flagged: ,�S This is to certify that the information provided b 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 we change, or if the information submitted in this application is falsified or changed 1, also, understand that I aim responsible for all charges incurred from this application. 1, bereby, 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 sultabWty. THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the IblWng: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge I Date(s)s Client Notification Date: I EAS: Account No. Invoice No. 6a LAWRENCE L. MOCK BY WILL REF:D.B. 49 P9. 8 ON PLACEp663 37 T FENCE CbRNER '44 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: PROPERTY INFORMATION Tax PIN/EH #: 5870-69-0403.43 Subdivision Info: Windemere Farms Sec.2 Lot # 43 Location/Address: Beauchamp Road -27006 See Map Date Evaluated: p JK 47/� On -Site Well Community Auger Boring Pit Public 1__/ Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Slope% a HORIZON I DEPTH o - -7 - Texture group Consistence r Structure GQ Mineralogy t " I HORIZON II DEPTH - 1 7J Texture group Consistence Structure Mineralogy( ; HORIZON III DEPTH 1 f5 - 30 Texture group Consistence Structure 1 Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION -S LONG-TERM ACCEPTANCE RATE 0. SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: l 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 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) 39 47 0.940 AC. ,�' 0.753 AC. 11351 21' 122 INV ., Cl 1 7p�19'6. I/ 480 ,2h 0.740 AC. �� `��¢ F1-2-0Zb / 1011 a 1.4 0 tz N'" ^ 123 v t 28 40 46 N 47036145" W 53.75 o - f 0.947 AC. c 0.739 AC. �� N 46.41' 25' E '-� 234.57 \ 64.26 ��£ W TOTAL= 110.00 S 84-16'04' 167.57 Cry -'► \ CS N 86.30' 57' W 67.00 N� ~r��.. 10' UTILITY 115 N 110 O N 'moi N EASEMENT 10' UTILITY �• �. r i _ W 45 EASEMENT r� i 1.124 AC. 4cP° o 11a4 g �: 0.692 Ac. ci o \, 1 ' 0.689 AC. 6 � 2ti�107 210.00 4cr--- ] W N 86.30' 57' W \ �.fl 4 1 1 10'X70' SIGHT.) \ C22 / I 1 r 1 44 EASEMENT(TYr� a s 42 g 43 0.672 AC. o o 106 0.689 AC. 6 0.735 AC. 0 222 21 3� Z�� GL -75-95 41 I N I 52 cu cs 240 S h ' j �i� 1 60' 2 c R/W —' — —— — — — Z / 1 / 0' UTILITY 0.00 127.26— 5� Z� 3 EASEMENT 86. g TOTAL= 337.126 N 30'57' W C14 .r 20' PAVED—PUBLIC / TOTAL= 337.26/ S 86.30' S7' E 1 ---192.26---- —120.00-- ��—CZ 221 es - - APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department EnvirrvnmentaiIfealth Section P.O. Box 848/210 Hospital Street �L.! F�� Mocksville, NC 27028 /° /'8 fi (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 �p ��'(? �t /J �,( Contact Person Z, -,^,r Mailing Address yj q� // ('7Q Home Phone _ 316 - y 30 r% City/State/ZIP Cpp l cs� ret' ��, r� �0 /�� Business Phone 33�c - 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation Ci Improvement Permit/ATC ❑ Both 4. System to Service: "Ouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: c # People # Bedrooms # Bathrooms uY Dishwasher fT Garbage Disposal Lklaashing Machine L4-115asement/Plumbing ❑ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # People # Sinks # 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 ITNo If yes, what type? ***IMPORTANT*** CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax Office PIN: # Jr k '`le Ll- 0 3, Property Address: Road Name City/Zip If in a Subdivision provide information, as follows: Name: /=arm 5 WRITE DIRECTIONS (from Moccksville) to ,PROPERTY: r-,1OJr-S fih f`✓� [R� /(i i /amu. �l�L{ Section: Block: Lot: I'/ *l Date Property Flagged: �1- —/9—ea 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 ant 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 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): t� �a1 17 Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. l0 D -- Invoice Invoice No. oL -7 F-5 �-rltt-4,3 w"(de"ecc r-Af-,' 1-1,dto APPUCATION FOR SiTE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Eniofronmentd Mea tfi Seadon P.O. Box 848/210 Hospital Street Hocksville, NC 27028 (336)731-8760 __ -� µre, f�~�il •.,`,�,�:� �1. AUG 2 5 1999 ***nW0RTANT*** THIS APPLICATION CANNOT Ba PROCVSSXD UNLaSS ALL Tisa REQUIRaD INFORMATION IS PROVIDED. Refer to the INrORMIi►TION BULLETIN for instructions. 1. Naas to be billed WEs1ViE'J ��JEtoPJNCNT �6ri1PJW`/ Contact Person J? ) Gtyar-y Nailing address 2L31 REYN6LflA 1Z0- nom Phone 3300.1408 City/stats/ssP 21I0(o business Phone 336-111- 00-I$ Z. Name on Permit/M it Different than above Wiling address 3. Applioation ror: (9/ite =valuation 4. system to service: [3�Houses O Mobile Home a. If Residenos: i People city/stats/sip 0 improvement Permit/ASC 0 Both 0 Business 0 Industry 0 Other Bedrooms ! Bathrooms 0 Dishwasher 0 Gasbags Disposal 0 Vashing l=abia O asses nt/plumbing 0 saseaent/No PludAng 6. if 31usinsss/Zadustry/Othsr1 specify two # People f Sinks f Commodes i Showers i Urinals t water Coolers Ir FOODSERVICZ: # Seats Estimated Water Usage tgailons per day) 7. Type of water supply: O County/City O Well 0 Communitt/y e. Do you anticipate additions or expansions of the factity this systems Intended to serve? 0 Yes ITNo If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBARTTED by the client with TIM APPLICATION. Property Dimensions: Tax OMce PIN: # �7 d �U — in Property Address: Road Name City/Zip I'Veld11ce.'VC-;?2CV6 WRITE DIRECTIONS (from Mocksville) to PROPERTY: 110ck5 LN►4t 1-0 RaGHf' &J 1REAVC1tAMPAd APPMTV 0,4 H in a Subdivision provide Information, as follows: Name: 1A)1 fJr*MW F8gr 1S NEtJ MAP' /J Section: ?/ Blocks Lot: t tom? Date Property Flagged= (� p7 25- �`l 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 we change, or if the Information submitted in this application Is falsified or changed 1, also, understand that I ani 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 ail testing procedures as necessary to determine the site suitability. THIS AREA MAY BE USED FOR DRAWING YOUR STTE PLAN (Include all of the Ulowfug: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge I Date(s): Client Notification Date: I EAS: Account No. Invoice No. a 4 y- .SOCK _ I I q. 8 CARL I; I D. 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