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123 Hagen Road Lot 46DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT qY~ Account #: 989900283 Tax PIN/EH #: 5870-69-0403.46bc Billed To: Bob Cope & Son Construction Subdivision Info: Windemere Fams 2 Lot # 46 Reference Name: Location/Address: Hagen Road -27006 Proposed Facility: Residence Property Size: see map ATC Number: 2963 (ODJlblf-P) **NOTE** This Improvement/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 ]I' SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type Nolte #People #Bedrooms 4 #Baths 2. s Dishwasher: d Garbage Disposal: ❑ Washing Machine: 12" Basement w/Plumbing: d Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size 0.-731 AW -' Type Water Supply C41A4W Design Wastewater Flow (GPD) Ll 80 Site: New 133" Repair ❑ System Specifications: Tank Size IQOoGAL. Pump Tank Other: Required Site Modifications/Conditions: �r - -F= QjElouj GAL. Trench Width � Rock Depth Linear Ft. �l IX-)Tn l .L 1 ,I PS "I 'f) C. n A 1 rJ . _ A. - IMPROVEMENT/OPERATION PERMIT LA - APPROVED EFFL ENT FILTER RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE• act a representative of the Davie Co my Health Department for final inspection of this system between 8:30 a.m. a.m. or 1:00 p.m. to 1:30 p.m. on the day of ins allation. Telephone # is (336)751-8760.**** 10Mint l tr rn— -,fir n n Ql'` i ( Pomp) 4 Environmental Health Specialist's Si DCHD 05/99 (Revised) APs -PA V- AA)7 LL PSV".,- ..�F�r1:-D Llr1tS ►� ��� u►�t- �C��IS _ Ll tel - O Y -5U" 7-24'1 Ur -1C-- 9� - \^7o' 4-3co' X13 , �P—Nt MOST tl.) oT c-P-Osf-> Lb241ra L,,1L's tate:T� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900283 Billed To: Bob Cope & Son Construction Reference Name: Proposed Facility: Residence Tax PIN/EH #: 5870-69-0403.46bc Subdivision Info: Windemere Fams 2 Lot # 46 Location/Address: Hagen Road -27006 Property Size: see map **NU'I'�* i�is inprovveement/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 ]I SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type VAQ OSS- #People #Bedrooms #Baths 2. 5 Dishwasher: Garbage Disposal: ❑ Washing Machine: d Basement w/Plumbing: 15"' Basement/No Plumbing: ❑ Commercial Specification: Facility Type//'' #People #People/Shift #SEleats Industrial Waste: Lot Size d34 :7 ACZ-S Type Water Supply �%41 Design Wastewater Flow (GPD) 1490 Site: New 0" Repair 173System Specifications: Tank Size I000GAL. Pump Tank 10 COGAL. Trench Width r ,' Rock Depth, 2 Linear Ft. 4' Other: 4 D M E I&M aJ �O �S . l t,�TL\LL.. L 1 N Cs 91o.c. !yU j Required Site Modifications/Conditions: )tJMALL, ©� [� T itL►�c-� `� 1 OFF �:}$ /In�� i �s'tF Zp' IMPROVEMENT/OPERATION PERMIT LAYO PROVED EFFL ENT FILTER. RISER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: C a representative of the Davie Co ty Health Department for final inspection of this system between 8:30 a.m. to 9�or 1:00 p.m. to 1:30 p.m. on the day of inst4llation. Telephone # is (336)751-8760.**** �sj �� ori; 1 tvL Qon APS. 0 41431 Sl— N, 1y2�� v T1 �t:>`r►�,J. Environmental Health Specialist's�miatu�i- „ ��_� Date: DCHD 05/99 (Revised) r.' 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 #: 5870-69-0403.46bc Billed To: Bob Cope & Son Construction Subdivision Info: Wndemere Fams 2 Lot* 46 Reference Name: Location/Address: Hagen Road -27006 A.........1.. C: Proposed Facility: Residence rropelLy %Aze. ow� I—?, ATC Number: 2963 La 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 Tre ent and Disposal Systems). TIES AUTHORIZATION FOR WASTEWA N IS ALID FOR A PERIOD,+ O 2FIVE YEARS. Environmental Health Specialist's Signature-; Date: / 3 CERTIFICATE OF COMPLETION '1 y **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 wi. function satisfactorily for any given period of time. rc, T O ` x3& "�zy QDw" " Arsl Septic System Installed By: Environmental Health Specialist's Signature: Date: log 0 Z. DCHD 05/99 (Revised) LAWRENCE L. MOCK j BY WILL ' REF:D.B. 49 Pg. 8 I .1 t 296.9!'5 S 83.23'57' rS 200.14 0.940 AC. 47 357° 0.753 AC. �N 48 cll 0.740 AC. 0 16 FIT 0-1 49 o � O ti „e 1.401 AC. cl rim 40 N 47'36'45' W S �) 0.947 AC. a .7 9 C. S3 o c� cz I T r, 1TOTAL• 23 .57 N 46.41'25' E V. 0: W tclD. S 84.1664.26 • V N 63 ,s 7.57 w 67.00 N c1 g W� N1 1 Q41 50 .... ..,n ■ 45 O 10 0. 0.892 AC. M ..►`� 1.12.4 AC. cp�i 0.689 AC. -- � ' - = ' 1* 60 Y1 A - 8 a 21 a 00 = W N tk 86.30' S7' V 2� d 107 ;zii V+ o V) r - __- ---_- --- 116.49- N ' �� .D 2 C22 Hl r 0.889 AC. 8 0.872 AC. - - � r N z '" 0.735 AC. ' v 2 g 222 ` 1. 2R. C1 - 75.95 60' � © 5 p _ _ o il TOT4L. 337.26 26— _ �N 86.90'57• .V C14 rL/ / ZO PAYED-Dila, ►� � m. .. U CATION FOR SITE EVALUATION/IMPROVBIENT PERMIT & ATC u Davie County Health Department Enviro/Imenta/Health Section Sv` , P.O. Box 848/210 Hospital Street `LSH Mocksville, NC 27028 ,,�N�ENS?;Nsy (336) 751-8760 %JAA-1RPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to 'be Billed .0 �- 64�PA C-0�1S ��, %/iC, Contact Person Mailing Address P".) '7& //(,o Home Phone 3a City/State/ZIP 6001,0e,onee- y� Business Phone f�i X 77 2. Name on Permit/ATC if Different than Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation C -Improvement Permit/ATC II Both 4. System to Service: "Ouse ❑ Mobile Home ❑ Business ❑ Industry CI Other 5. 'If�Residence: # People # Bedrooms IWDishwasher CI Garbage Disposal Dashing Machine leBasement/Plumbing 6. If Business/Industry/Other: Specify type # Commodes # Showers # Urinals Bathrooms .1L_ II Basement/No Plumbing # People # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: EYCounty/City ❑ Well 11 Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? I-1 Yes "o If yes, what type? ***Ib1PORTANT*** CLIENTS /MUST COMPLETE -THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMITTED by the client with THIS APPLICATION. Property Dimensions: ee � ! I / Tax Office PIN: # ST 70 _ �_a�o 3 • 7 3e Property Address: Road Name lT0i e Redi, City/Zip If in a Subdivision provide information, as follows: Name: lam/'. er►e.r� )(:;r -,n,5 Section: _� Block Lot: 1-16 WRITE DIRECTIONS (from Mocksville) to PROPERTY: Date Property Flagged: q —61? -69 l This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits) issued hereafter arc 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, understain! that I am responsible fur all charges incurred froul this application. 1, 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 conductalltesting procedures as necessary to determine the site suitability. DATE dct�Ct - B� 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). Revised DCHD (07/99) CO Site Revisit Charge Datc(s): Client Notification Date: EHS: Account No. 2 3 8 S,� Invoice No. -� 0 APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department EnWmnntenfal Health Seclfon P.O. Box 848/210 Hospital Street Moaksville, NC 27028 (336)751-8760 N111 V! AUG 25 1999 1 EIPdi►` i � �;� ***nWCRn1M** THIS APPLICATION CANNOT Bz BROmsst'D UNLESS Wz THE REQUIRED IMM MATION IS PR0VIDED. Refer to the XMMF 91TiOH BULLETIN for instructions. 1. Nsme to be Billed WESTVIC j Y��JCWPiA T CO'nP W`/ Contact Person ) ���ZfY Mailing Address 2 31 9-EyNGLnA RO• am* Phone 336.116.7.0o8 City/state/sXP ING Business Phone 336•111- 0018 2. Name on Permit/UTC it Different than Above Mailing Address 3. Application Tor: M/Site )evaluation _ / fWOW11100 e. sy.tes to service: [[3 Houses O Mobile Home s. If Residence: s People City/state/sip O Improvement Permit/ATC O Both O Business O Industry O Other f Bedrooms • Bathrooms O Dishwasher O Garbage Disposal O lashing Machine O Basement/Plumbing O aasement/No Plumbing 6. tf nusiness/Industry/other: specify type I People f sinks # Commodes # showers Urinals + Water Coolers IT TOODSERVICE: # Seats =atimated Water Usage (gallons per day) 7. Type of Mater supply: O County/City O Well O Communitty 0. Do you anticipate additions or expansions of the facility this system is intended to serve? O Yes E I No If yes, what type? ***IMPORTANT*** CLIENTS MAST COMPLETETHE REQUIREO PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: Tax OMce PIN: # Property Address: Road Name I City/Zip f /'d r/d/Jc e 41c- �6 If In a Subdivision provide information, as follows: WRITE DIRECTIONS (from Mochaville) to PROPERTY: fhOa5 61ft1 To PA04 cW W4Vd1A HP, fZ,/ PkopmTy o� Leff'. Name: IAS► ryrxw-Ar Fps Section: I --Block: Lot: _ 10� 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) boned 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 I am responsible for all charges Incurred frons this appUcmton. 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 awned by to conduct all testing procedures as necessary to determine the site suitability. THIS AREA MAY BE USED TOR DRAWING YOUR SITE PLAN (Ineluds all of the I&owfng: Exisdng and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge I Date(s): I Client Notification Date: I EAS: Account No. 1 -?a. Revised DCHD (07/99) Invoice No. lar I 8S � 1 � / 9 � XVO 30 811 d� Ls rS Q + is On Z n .60.E C6 021 891 AV ��ry A 221 IJ1 �bo\ �68 X01 / s Ly�;�E21 / 2 + 69 a� y to I+ re o�2 OL I 88 921 1 6l2 0 oA 08 89 -� 43 (.,L + X01 L\ Lt2 S 122 C6I 861 661 2 + U c 6L 561961 IZ11 EllrGl 2r �pnl Si 912 til 0 L LS1 + S12ti r6l 111Ci 641 Ick n NA 8S1 E61 1+ 186I 62 �� ? .�1 98[ _e1 d� L81 881 Ob'. 68l L2 6S2 892 ►2 p E12 ,a 1' est ►sl �1 7, rL \ g` 02 ' i oz Q. sp, - 61 82 ,. 201 02 r2 o> 6►2 U61 2L2 SL. 9S OS2 I 1 S61 ,01� S1 A 902 1 G 9S \ ►S2 92 � (` n 07 21.2 �l ' rig 2 f v} r + + 62 92 �+ o V f p O h 60'919 3 .Lt.C2.Ee S S2 C� + 91< ONl103 N08, 0 31ON �E 96Z + Sv 22'2 I 192 3 .80.EE.ge S 292 g t i I >10ol 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: Water Supply: Evaluation By On -Site Well Auger Boring PROPERTY INFORMATION Tax PIN/EH #: 5870-69-0403.46 Subdivision Info: Windemere Farms Sec.2 Lot # 46 Location/Address: Beauchamp Road -27006 See Map Date Evaluated: 1 Community Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group 0 - Consistence Consistence f' Structure Mineralogy+ HORIZON II DEPTH D Texture group Consistence i S Structure b MineralogyI ' HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION PS FS LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: PS LONG-TERM ACCEPTANCE RATE: D. J REMARKS: LEGEND Landscape Position EVALUATION BY: �1 `L�H[iGf I�1+ti1 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) No NONE ■M■■ OMEN SEEM ■■N■ SEEN ■■■■ OMEN ■■■■ ■■■■ ■■■■ SEEM Emma SEEN MEMO OMEN on ■ ■ ■E■■■ ■MME■ MEMOS ■■■E■ ■■■■■ ■■ ■ ■■■■M■■■■■M■M■■U ■■■■MEMO■MM■■M■ ■■■■M■■■■MM■■■M■■ ■MMMOMMMMMMMMM■M■ ■■■EM■■■■■M■N■■■■ ■MEMMME■■■M■■■■M■ ■NON■■■■■■M■■E■■■ ■EN■MO■■MEMS■■■■■ ■■■■■■■■■■M■■■MU ■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■ ■■ ■ ■M■ ■M■■■■■M■■■■MM■ ■M■M■MMM■■MMM■■ ■MM■■M■■■■■■■M■ ■MMMMMMMMNM■MM■ ■ME■E■■N■■■■■■■ ■■■M■M■■■MM■M■■ ■■■■■■■■■■■■M■■ ■■■M■■MM■■MMMM■ ■M■■■M■■■■■NOM■ ■MM■■M■■■■M■■■■ ■MMMMMNM■■MMOM■ ■■■■■■E■■■■■EM■ ■N■■■N■■■■■■M■■ ■MM■■M■MM■■■M■■ ■■■■■E■■■■M■M■■ ■M■■■■■M■■■■MS■ ■M■■■■■■■M■■M■■ ■MO■MEMMOMMMMM■ ■M■U■E■N■■U■■ ■M■ ■■ME■■ on ■M■■MM■■■M■■M■■ ■■■■■■■MM■■M■■■ ■■■M■■NM■■■■MM■ ■M■■■M■MMM■MMM■ ■MMM■MMM■■MEM■■ ■MMM■MMM■■MOO■■ ■MMM■O■M■N■■M■■ ■M■MEM■MM■MMMM■ ■MMM■MMM■MM■ME■ ■OM■■MMMEMMEMM■ ■MM■■M■■M■■■■N■ ■M■M■MEMMEMMOM■ ■■■M■■M■■M■■M■■ ■MEM■■■MM■■■MM■ ■M■■■■■M■■■■E■■ ■MMM■■M■■■M■M■■ ■M■M■■MM■M■■M■■ ■M■E■M■■M■■M■■■ ■M■MMMM■MM■MMM■ ■M■■■M■MM■■■M■■ ■■MMM■M■■M■■MM■ ■■■■■■■MME■■M■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■M■■■M■■■ ■■MMM■■M■■ ■■■MMM■■M■ ■M■■MMM■■■ ■N■M■MMMM■ ■■■E■ME■M■ ■E MEMS■■ ■■MONS ■EMNO■ ■EMM■■ ■■M■■■ ■ME■■■ ■E■EM■ SOME ■■M■ ■■N■