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147 Windemere Drive Lot 5DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900573 Billed To: Glenn Johnson Builders Reference Name: Glenn Johnson Proposed Facility: Residence Tax PIN/EH #: 5870-59-3399 Subdivision Info: Windemere Farms Sec.1 Lot # 5 Location/Address: Windemere Drive -27006 Property Size: 0.689 Acre * *NOTEC * ffibtmprov ment/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 #People #Bedrooms f. -P #Baths � Dishwasher: 12" Garbage Disposal: 121"' Washing Machine: 2"� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size e, Type Water Supply �� Design Wastewater Flow (GPD) Site: New B"Repair ❑ System Specifications: Tank Size/ Dep GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width "' Rock Depth 47 Linear Ft.307) 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. n t day of installation. Telephone # is (336)751-8760.**** Environmental Health Specialist's Signature: Date: f-2 —a—OV DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Account #: 989900573 Billed To: Glenn Johnson Builders Reference Name: Glenn Johnson Proposed Facility: Residence ATC Number: 2271 P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5870-59-3399 Subdivision Info: Windemere Farms Sec.1 Lot # 5 Location/Address: Windemere Drive -27006 Property Size: 0.689 Acre 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 CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: r 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. Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) �Ic TVA AS0 l') 3o APPLICATION FOR SITE EVALUATION/IMPROVEMEM PERMR & AT ✓ �VJ Davie County Health Department finvfionmenbal Health Section P.O. Box 848/210 Hospital Street DEC — 6 1999 Mockaville, NC 27028 (336) 761-8760 , ,,,,,�nnIRAFNTAI HEALTH ***tJPORTANT*** INFORMATION IS THIS APPLICATION CAM= BE PR=SMW UNLESS ALIT T QVbdk I PROVIDED.// Refer to the 11=0MATION BULLETIN for instructions. I. Mame to be Billed C�ZOA i JJ545.111 & l0legeSVersoncontact Verso/e'a�a T�,.rso•� Nailing Address /3Y6 1J O/+C'f gVa /161/ some a'hone 3�6 city/stab/sip fY"lza"74 1%' ' ,�%BOG suainess shone Z. Mane on peraiith►TC if Different than Above Nailing Address City/stab/sip 3. Application For: 0 Site Rvaluation U-Iiiiirovement Permit/ATC 0 Both 4. system to services onse O Mobile Home 0 Business 0 Industry O Other S. IfResidence: tarfa/# People • Bedrooms f Bathrooms ®'Dishwasher a bge Disposal 6xashinQ lfachine 0 D&SIment/pluobing 0 Sass ent/Mo pluolb n S. !f Business/2ndustry/Other: "City type h people # sinks Coomodes i showers Urinals i Rater Coolers IF FOODSERVICE: # Seats Estimated Nater Usage (gallons per day) 7. Type of water supply: 9--County/City 0 Ne11 0 Community s . Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes 914-0— If yes, what type? I***IMPORTANT*** CLIENTS MUST CIOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAIN MUST BE SUBMI>;I'ED by the client with THIS APPLICATION. Property Dimensions: r.Ip '{,eon 6 J .2 sof f,/f Tax Office PIN: 11 Property Address: Road Name Cityalp _ A)y� If in a Subdivision provide Information, as follows: Name: l✓,�dejrneeee Faein3 Section: _ Block: Lot: 5 a.lee 'e WRITE DIRECTIONS (from Mocksville) to PROPERTY: /5-J - f 4 ti/ ter %'6o zal yA );A er-ef f d°l fil OCA r). On - C-� c4c 4 Date Property Flagged: lJ ' % %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 ure subject to suspension or revocation, if the site pians 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 Incurred fronr 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 /.�- �' 9� SIGNATURE aza-� 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): Client Notification Date: EHS: Revised DCHD (07/99) Account No. Invoice No. %/ �/ C16 674458 C17 13'46'50' 200.00 . 4 48.10 47.99 24.17 N 23'59'00' W I------ LA 71.34.47' E N 130,90 47• - '-- - We, hereby certify that we are the owners of—�— /�~^- i X7.34 221'8 the property shown and described hereon and that we hereby adopt this plan of subdivision—�— with our free consent, establish minimum set— ' bock lines and dedicate all streets, alleys. walks• G�• parks and other sites and easements to public Futhermore, hereby •�9 W or private use as noted. we dedicate any and all sanitary sewer, storm sewer // // 5y ,Zk• �..� _—�� W In %D Coand water lines to Davie County('rf applicable). // �� — �O In Cu CO Rl(^•/M f /i ru rUni OWNER o Z /O (0.740 AC) Z (0.829 AC.) (0.94 OWNER / yh•� // h C'96 6.43 (1.090 AC.) �'8• / A � CS 10, U 69.0- --120.00"— ---, 'i (1.511 AC.)3 374.01 TOTAL N .� v coo 20' PAVED -PUBLIC //% • 9 S 86.31' 15• E 6e 470.18 S 63 6 \ /" _95.82_ —120.00- / N 87.03'09' W � C2 _ LARGE OAK // / Li 2 W LAWRENCE L. MOCK ru 7 s Y BY WILL N 1/t 6% Co REF:D.B. 69 Pg. 55 ti (0 789 AC.) tic (0.730 AC) (0 89 dC.) a ISn (O.f 1, Gracy L. Tutterow, certify that this plot was drawn 2 y c II Z tv e under my supervision from on actual survey made Z under my supervision (deed description recorded in Book 2DS ; Page 548 . etc.) (other);that the boundaries not surveyed ore clearly indicated as drawn from information found in Book _. Page _: that that the ratio of precision Is calculated as 1: 200001 that this plot was prepared in accordance with G.S. ANGLE IRON 147.83 47-30 as amended. Witness my original signature. FOUND 112.19 30.58 registration number and seal this day of (CONTROL CORNER) 1 N .27 Q120.00 2600.002 TOT OT/'- ' 12 A.D., 1999 , FnI Np 4386 Surveyor (��ONTROL CORNER WILLIAM C. MOCK � (Seal or Stamp) Registration Number � D.B. 131 Pg. 643 1 � ROGER THIS SURVEY CREATES A SUBDMSh)N OF LAND WITHIN 1 \ D.B. 1 NAN(EOF ATHAT REGULATESMUNICIPALITY AT HAS PARCELS OFAS LAND 1 D.B. 6 ANECRT _ + , / GRADY L. TUTTEROW. R.L.S. L-2527