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135 North High Field Road Lot 39-r DAVIE COUNTY HEALTH DEPARTMENTS Environmental Health Section 11 b P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900283 Tax PIN/EH #: 5870-69-0403.39 Billed To: Bob Cope & Son Construction Subdivision Info: Windemere Fams 2 Lot # 39 Reference Name: Larry Cope Location/Address: High Field Road -27006 Proposed Facility: Residence Property Size: see new map **NOTir" �%�i56 ib?nproVemecrt/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 ' AjpLm-,c #People #Bedrooms L_ #Baths 7.9 Dishwasher: Qf Garbage Disposal: 0 Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: Rr Commercial Specification: Facility Type ,#.,P)eople #People/Shift #Seats Industrial Waste: ❑ Lot Size 09q �%� t%S Type Water Suppl4LIX i Design Wastewater Flow (GPD)42Q Site: New M� Repair ❑ System Specifications: Tank SiJobo GAL. Pump Tank GAL. Trench Width3L' Rock Depth 12 Linear Ft.770 Other: 4 "-0509907104 Required Site Modifications/Conditions: �t�STAU- 0� (^ANTO) r � 16 O" Roe. L,.j' . K - t IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISERS) 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.**** ;;7 _11 11 1►J o�.R C,Lvsc-tS S To 1 F SeL-vo (� A�� OF ►���� i �L..ou2 LAP Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 3.�i Naafi �`�• �' FRz; N'=' � • it VO Date: —q/&/n-0 J �A— DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900283 Billed To: Bob Cope & Son Construction Reference Name: Larry Cope Proposed Facility: Residence ATC Number: 2556 Tax PIN/EH #: 5870-69-0403.39 Subdivision Info: Windemere Fams 2 Lot # 39 Location/Address: High Field Road -27006 Property Size: see new map 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 WASTEWATER CON IS VA D FOR A PERIOD �OF FIVE YEARS. Environmental Health Specialist's Signatu L----�D j te: f Al 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. % Stiff Dot,aa S Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) G N oo 6 ! F0 r SP5,-1 -- F-) Lj:Zt1 OcJ—XPS .10 %ST 2— Date: Date: I 4W I D ff2ff0MR0 0 APPUCATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC + Davie County Health Department AM 3 1 2000 Environmental Health Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 ENVIR00NPv1ENTAl HEALTH (336) 751-8760 L DAVIE COUNTY ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to theme[ INFORMATION BULLETIN for instructions. 1. Name to be Billed a q-5" 1eSE�nS�% ! �• Contact Person �1-14 ?failing Address 1� // %! �Q Home Phone City/state/ZIP C•.�J©1ee,—°7.—e Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: G -`Site Evaluation 7 mprovement Permit/ATC ❑ Both 4. system to service: R"HOuse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other i 5. If Residence: ,# People # Bedrooms # Bathrooms ��• NIfishwasher fr / Garbage Disposal Mliashing Machine ❑ Basement/Plumbing W"Hasement/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: P County/City ❑ Well ❑ Community e. 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. Either a PLAT or SITE PLAN MUST BESUBMI77ED by the client with THIS APPLICATION. Property Dimensions: �� ingf Tax Office PIN: # %O G y 63. Property Address: Road Name :? i A 9 City/Zip If in a Subdivision provide information, as follows: i Name: t,✓;R er+errf •ahs S Section: Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Date Property Flagged: 9 - �y r'o 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 sui ability. DATE 30 OD SIGNATURE 43�7 01 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). Site Revisit Charge Date(s): I Client Notification Date: I EHS: Revised DCHD (07/99) Account No. U -� Invoice No. `L crjemere_ fiaPm5 a --i , ♦\ .J ; 1, { '1 1V �_ raj JIA� �� .�,5 �I G � `r i � � •q. ;w I IKON PLACED y AT FENCE CORNER i. + " 1 409 N c� 47 THIS LOT MAY BE UNSUITABLE b9 AS PER DAVIE COUNTY HEALTIJ DEPARTMENT r o \ N I Y o 4 ! 40 46 D 37 I i 210 255 wm -1-10' UTILITY 3 W ! I ! EASEMENT g ir ! ! c, IU ►z 41 45 � - I ! RAW n M 16 36 a'° � o !3a ! W 210 a 42 43 4i 1' ! N ! ! N co u 35 f ! 127 ! I 20'. 1 . PgyED_pU LIC 192— ! I 34 ! �� 29 ! 30 !N ru 04 �! 50 33 17S Lo Sc N z8 31 32 z �` i 352 LARGE PINE STUMP 110 _i I I 26 876.79 N 87.03104' H APPLICATION FOR SITE EVAWATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Enviimnmenta/ Hea/th Sectfon P.O. Box 848/210 Hospital Street Mockaville, He 27028 (336)751-8760 AUG 2 5 1999 01'Jiv", ***nwcRTANT*** THIS "PlexcuXon CANNOT » PR=SMM UMBS UZ THE REQUXMM INVORIMION IS PROVIDED. Refer to the I3VOR1ATI0N BULLZTIN for instructions. 1. llama to be Billed WES JE1J J7FVCWPN►JW CO'n' W/ Contact Arson ! �oF�tCY Mailing address _ 2Q% REv:J04MA Ro. some ahons 3300.1.008 city/state/sXV Business B'hons '136 -11 -1 -00 -la 2. Rase or parait/ATC it Different than above Mailing address !. Application for: Veite ivaluation 5tampol' s. Retes to service: C3/HouseS 0 Mobile Home S. If Residence: f People City/state/sip 11 Improvement Permit/ATC 0 Both 0 Business 0 Industry 0 Other i Bedrooms s Bathrooms O Dishwasher 0 Garbage Disposal O Washing Machina O sasesent/plumbing 0 Basesent/no plumbing 6. if Business/industry/Others apeoify type ! Cossodes i People • sinks i showers f Urinals • Water Coolers It >1MBERVICE: d Seats Eatimated Nater Usage (gallons per may) 7. Type of Maur supply: 0 County/City 0 Well 0 Community 9. Do you anticipate additions or expansions of the facility this system Is intended to serve? 0 Yes Ef No If yes, what type? ***IMPORTANT*** CLIENTS MUST CUMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: 177 Tax Office PIN: # �D /U fin-' Property Address: Road Name ac 61/-k IF CityrLip H in a Subdivision provide Information, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: Mocks Cum To PAMt cW 814Vd MP fLZ4- POPMT)f aJi LEFt. Name: 1A)J gre4 ,/tf 7 AttMS � a m Section: �� Block: %t: �' Sa 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 ani responsible for all charges incurred from 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 conduct all testing procedures as necessary to determine the site suitabWty. THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the Mowing: Existing and proposed property Anes and dimensions, structures, setbacks, and septic locations). Revised DCHD (07199) Site Revisit Charge Date(s): I Client Notification Date: EAS: Account No. 1J Invoice No. /06'r LAWRENCE L. MOCK BY WILL REF:D.B. 49 P9. S ON PUCE,% 37 T FENCE CORNER 1 • , • ' + 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 PROPERTY INFORMATION Tax PIN/EH #: 5870-69-0403.39 Subdivision Info: Windemere Farms Sec.2 Lot # 39 Location/Address: Beauchamp Road -27006 See Map Date Evaluated: tg Community, Auger Boring Pit Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L_ Slope % 20 HORIZON I DEPTH Ll 0-'q t7- q Texture groupL Consistence fSSS --r Structure < Mineralogy IN III HORIZON 11 DEPTH Texture group Consistence Structure 6k 5 Mineralogy t: HORIZON III DEPTH 3 1 S - 14, Zg5,4- Texture groupC_t Consistence �- i S Structure k Mineralogy ' HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S U LONG-TERM ACCEPTANCE RATE I3 SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: EVALUATION BY: 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)