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121 North High Field Road Lot 37DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ��, �, l0 3 P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001597 Tax PIN/EH M 5870-69-0403.37MB Billed To: Marquis Building Subdivision Info: Windemere Fams 2 Lot # 37 Reference Name: Proposed Facility: Residence Location/Address: Beauchamp Rd -27006 Property Size: see map ATC Number: 3366 **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 f L 0 Q�t'5— #People #Bedrooms 3_ #Baths `2 -- Dishwasher: Garbage Disposal: ❑ Washing Machine: 171"" Basement w/Plumbing: ❑ Basement/No Plumbing: Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 0,Q51 ! 'ype Water SupplyCLWI Design Wastewater Flow (GPD) 3(-'0 Site: New ff�' Repair ❑ 22__ '',,ll System Specifications: Tank Size � GAL. Pump Tank GAL. Trench Width S; Rock Depth Linear FtLlbc� Other: � 15Y�1 -C10� 39 -o 101:-�7TNLL- t✓).JES q' K -,,j . Required Site Modifications/Conditions: or) PM 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.**** oma=- is �T Environmental Health Specialist's ' Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001597 Tax PIN/EH #: 5870-69-0403.37MB Billed To: Marquis Building Subdivision Info: Windemere Fams 2 Lot # 37 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3366 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 WASTE W CO TIO IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signa e: Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completions11 ij has been installed in compliance with Article 11 f G Disposal Systems," but shall in NO WAY 6kak4 as given period of time. �1 ^ W 4 (If I A W �-- WL -L" Septic System Installed By: Environmental Health Specialist's SignatuK: DCHD 05/99 (Revised) ysem described on Improvement/Operation Permit 13 A, S ion .1900 "Sewage Treatment and th t the system will function satisfactorily for any f--C&-j T 15' - C11 �' �6 `� 0.740 AC. 'MS LOT IMT 8E L*CSL)(TABLE K j 9 16 • V Z t 20 ? wEALrH OEPAXTU04' c 00 S V 'I8' E " U 40 46 '2 N 47.3645• w c, �3 0.947 AC. .. c 0.739 AC. 53.75 +J� w►- `,�'W._ 7 N 46• 8 ^ `:. S 84.16'04'. V TOTAL= 234.5 6 3 ?' m .r 1 ;,,, ,V N '30' 00 57' y 67 157.57 0.691 AC. -•-. cf� `fit l� N c , L.Ljl F��. 8 W , 45% o01• E O_ �;-i ',"' , i 8-1 41 8 n L: 0.692 AC. o '�► �� 0.689 AC. 3 —jo °; 21 a 00 Z (,�' 9 �6 16. lk 36 W N 06'30-' y r t 07 r -i ,- 0.689 AC. a � f 7 <�s 4Z Li 44 S 96 .0 # E a o ' 06 0.888 AC. 8 �, 0.872 AC. W _ 210.0043 N z 0.735 AC. =•r•,h S — r J l; aAc" g 2 22 3 2� 60' ITZI `L 8 Q /w — — — _ _ S 5 ZAP 35 8 27.26 -- z = 0.689 AC. " ;-I TOTAL: 337.26 N •6.30'17' y C14 N `� ,Z� . r 20' PAVED-°UBUC _ _ TOTALS 337.2,6 S 86• '571 •31 E S 0 . 192.26 - 210.00 &A O • .. — 120.00 _ - W ar 22t tV O p. 2Q (JI � J r r s 1� 41 g 27 � W 34 ►r o 29 ^� 1.702 AC. 0.691 AC. Z 30 0.842 AC. • 0.980 AC. n C, 4 `6 Z ,f i S 88• SS' 4' E cQ �•, A ; S, �, APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT O Davie County Health Department Environmental Health Section FFB P.O. Box 848/210 Hospital Street %n �D�j� Mocksville, NC 27028 / (336) 751-8760 RON f D� yjF�N1'. H ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE RE INFORMATION IS PROVnnIDED. Refer to the INFORMATION BULLETIN for '' instruction 1. Name to be Billed�L Qi % (T ._1�1— Contact Person (�&(rp�porj �}f iTNGL/ Mailing Address I : nmz 0, 'E �D 17Home Phone -54c) G� City/State/ZIP AQg /C1 C Z'1 Db Business Phone (QU 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation )9, Improvement Permit/ATC ❑ Both 4. System to Service: House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms # Bathrooms Z Dishwasher El Garbage DisposalAWashing 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: ❑ County/City ❑ Well ❑ Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes XNo If yes, what type? k**IMPORTANT*** CLIEN'T'S MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBM17TED by the client with THIS APPLICATION. Property Dimensions: 14 L) tL 2 o3 jl- 14'-6 �L 2 Ip WRITE DIRECTIONS (from Mocksville) to 11PROPERTY: Tax Office PIN: # 6OD D g ZS ��s� YAP QED �� GA Property Address: Road Name 12-1 d16 -ti iF—r-z) City/Zip Aoy' UCc C 2 7 oil, r / � If in a Subdivision provide information, as follows: L F� Name:W I n) ��l'1� e G -i=1kS Section: Z Block: Lot: 7 Date Property Flagged: 2 Ia / /a3 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 ownc to conduct all testing roved res as necessary to determine the site suitabity DATE Io SIGNATURE 7 THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing an roposed nronerty lines and dimensions. structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. Invoice No.�'' 07 V7 m I k� = 'S o t APPUCATION FOR SITE EVAUTATION/IMPROVEMENT PERMR & ATC Davie County Health Department Envfronmentn/ Heal& Seclfan P.O. Bos 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 AUG z 5 1999 f ***ZJVOR=NT*** THIS APPLICATION CANNOT BN PWMSSND UNLESS ALL THE REQUIRED IMMFMATION IS PROVIDED. Refer to the XMMPMATiOH BULLETIN for instructions. 1. Nsm* to be billed WESJ[,E DCVC?:Il Ck4 C"PIWY Contact Parson &A q GwrcCy Meiling Address 2L -Si REvNaLJ)A Nome Phone 336• alb• 7.0o8 City/State/32P WINIUA-SALEV% Mf- 11106 businasa Loon 336'11"1' 0018 Z. Wasw on Permit/A= i! Different than Above Wiling address 3. Application ror: GYSite Evaluation e. system to sarvicat R Houses O Mobile Home S. If Residence: i People City/state/sip O Improvement Permit/ATC 0 Both 0 Business 0 Industry 0 Other Bedrooms s Bathrooms 0 Dishwasher O Garbage Disposal 0 lashing machin D basement/Plumbing 0 bassment/No, PludAnq 6. It business/Industry/Other: specify type i Commodes f People f sinks 0 showers + Urinals # later Coolers It >t'OO 82MCE: # Seats Estimated Water Usage tgallons per day: 7. Type Of Vater supply: 0 County/City 0 Well 0 Community a. Do you anticipate additions or expansion of the fecWty this system Is intended to serve? 0 Yes ET No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLMTHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: See _! Tax Office PIN: # �D �U fin-' 41D J, 3 Property Address: Road Name uc L4112-4'1e� J6 City/Zip f%ar/dncc /I/G,�%UUP WRITE DIRECTIONS (from Moclumille) to PROPERTY: 1' o&5 Cube, To 210N1' al -i &4V(hAMP'4'/' ipopEn-" a>J LE>r f . If in a Subdivision provide Information, as follows: Name: M A A It fa'%mS EW w� at Section: ?/ Block: Lot: =S 3'7 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 ase change, or if the information submitted in this application is falsified or changed 1, also, understand that I am responsible for all charges lneurred 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 a necessary to determine the site suitability. ,( , L DATE 81 db /,.1 SIGNATURE � J �JDV Z' THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the Mlowtng: Existing and proposed property Uses and dimensions, structures, setbacks, sod septic locations). Revised DCHD (07/99) Site Revisit Charge I Date(s): I Client Notification Date: IEHS: Account No. 13 6 Invoice No. hn� LAWRENCE L. MOCK BY WILL REF:D.B. 49 P9. 8 IRON PUCEQ63 37 T FENCE CORNER 34 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 #: 5870-69-0403.37 Subdivision Info: Windemere Farms Sec.2 Lot # 37 Location/Address: Beauchamp Road -27006 See Map Date Evaluated: t) I Iq f lqq Water Supply: On -Site Well Community_ Evaluation By: Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position I— L Sloe % 3170 HORIZON I DEPTH o-9 —� Texture group C—c- Gt" Consistence —rSSS — SS Structure G C--f/— Mineralogy 1 % HORIZON II DEPTH - 2 Texture group Consistence F Structure Mineralogyr HORIZON III DEPTH ' Texture group GF % Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION SVfs 1 LONG-TERM ACCEPTANCE RATE p .14 O SITE CLASSIFICATION: 1'2 LONG-TERM ACCEPTANCE RATE: 0 REMARKS: EVALUATION BY: BAL)CA�►�-� 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 - 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)