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183 High Meadows Road Lot 24DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section • P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001597 Tax PIN/EH #: 5870-69-0403.24mb Billed To: Marquis Building Subdivision Info: Windemere Farms two Lot # 24 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: see map ATC Number: 2732 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 Treatpent and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER ION IS YAID FOR A PERIOD OF// IVE YEARS. Environmental Health Specialist's Signa e: ✓ Date: l� 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. s IZ �< FQOe.1T Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section ��� d _ t C9 P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001597 Tax PIN/EH #: 5870-69-0403.24mb Billed To: Marquis Building Subdivision Info: Windemere Farms two Lot # 24 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: see map **NOTE*Niiibmprovement/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 110 O�SC #People #Bedrooms � #Baths Dishwasher: Iff"' Garbage Disposal: ❑ Commercial Specification: Facility Type Washing Machine: 0'-- Basement w/Plumbing: ❑ Basement/No Plumbing: #People #People/Shift #Seats Industrial Waste: ❑ Lot Size -1;W XZ D . Type Water Supply (tV,/V7VDesign Wastewater Flow (GPD) 3&0 Site: New 0"' Repair ❑ System Specifications: Tank SizeibOAAL. Pump Tank GAL. Trench Width3lp Rock Depth 12, Linear Ft. Other: 'I- P 1�JQ WTI ©I �DY V -S 1 rQ STAU..- L ► r J - Required Site Modifications/Conditions: I NSI AL - o'j (whooc YL, IS OAC NO0 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.**** �' �- 'TOT t s0' k 3co•'� 1 '. 1 � VE1 - ljt�G's P Z opc L -- `7 C iorAL, 1 -ND V-&"; c!' �' 1O' b N P2 P. u \ Environmental Health Specialist's Signa re:/ Date: DCHD 05/99 (Revised) 4 0 6 1.401 AC. 1.187 AC. ,e rr r • 4 N 47-36'45- y70 0.AC. 0.739 AC. 33.73 m� _ _ 27.55• 207, C N 78 t9OQ• I� _ _ y OT AI • 234.57 � 4 N 46.41'25' E 28 / /� 1" S 94.16'04 V 64.26 '30'57• y 167 67.70 CJQ Irl y I 7T W z 45 50 P' 26 g. 41 m - v 8 n 0.692 AC. 4 1.124 AC. cp7 i 1.282 AC. 689 AC. a X536 �. T- 2i' 7� b 340. T0 i6 30'57 y 2�9 l i _ -- - - - - 107 " Q - - -'116.491 rpTAl• {82 19 S 86'22'38' y 44 ;;,,,=.':,, .:: C22 HIGH, MEADOWS ROAD ). S9 AC. 8 43 W 0.872 AC. G��� TOTAL- 482.19 N 86.22'38' E M 0.735 AC. _ 120.00- - © 8 .222 , 159 Z�' J Gl - 75.95 166.24 - - - - - 120.00 - - _ z •LA' C'�i / 37.26 N 56.30'17• y Cl{ e�•��21 3T 'a--vE. ^ h 20' PAVED-PuSUC �Gr ` /' J ,.26 r 2 4 S 96• 57'E ' 0.829 AC. 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Or•e•m.^e �.'!' _ Boor, r..qn, fnpnmAn - rn.e I.mf to 4. pr•n4Cn1, ^q 80o•o nae n••er. ^r '^e :• .: S•]I„e. =x•e No••w •"]• or me ea.,• County Booro of 'om.e].o„•re r.••h, Ow tO tnf bcl e1 •<c. �n tnf r.bd-•e.o^ ry - .rnm Inf Ooa.00•v or Lot <•'r r. 1^:1 so.0 Doo•o not oc Mn•!] 1 e c'n' N Z r •n. �� 4(•r'.a I PE $E:71.:N 'uoon rum•' Int-,.q or Do•.. ve `''rP•"`�L// /i^ffifWii _ vhuo O• -.1, N! C-JN•• P0%9 LANNING SOAAr• ., •,rw . - -._ ... Au•N rl.. r (^ ANT, r _ __ - _ cOr]M 'O•rrl ^.•'7 I r' 8^..PI, r N • a. wl uc �'• / 17 nen � t9 » APPLICATION FOR SITE EVALUATION/IMPROVE 104Y PERMIT & A Davie County Health Department Environmental Hea/tfi section t FEB z 1 200 P.O. Box 848/210 Hospital Street 0 Mocksville, NC 27028 L_ _�__ (336) 751-8760 ENVIfiOi r,prrnL l;EALTH ***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 Contact Person Mailing Address (P-/2 AJL I�11 fd 7 "DD Home Phone ' 410—s 4 2 City/State/ZIP r/ � %<) (� ?oogo Business Phone /46 - 61C) 2. Name on Permit/ATC if Different than Above :54-M,75 n,„n Mailing Address City/state/Zip 3. Application For: fSite Evaluation XI Improvement Permit/ATC U Both 4. System to Service: )( House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence: # People # Bedrooms 3 # Bathrooms Z. 6. Dishwasher E7 Garbage Disposal Washing Machine If Business/Industry/Other: Specify type ❑ Basement/Plumbing # Commodes # Showers # Urinals # People Basement/No Plumbing # Sinks # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: X County/City ❑ Well ❑ Community e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 0 No If yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: 1 Zp Zq0 `i 126 ,XZ-v yo3•��a Tax Office PIN: Property Address: Road Name 24- 0(6-" &Aoo oK City/zip 4"A7 -'-CC tUC 2m")& If in a Subdivision provide information, as follows: N I) O -D-- FSS WRITE DIRECTIONS (from Mocksville) to PROPERTY: 1.5 ( ��FtL�E lgf� J &AoctmVp -1(f7b �s ame. E lu Lk:yVl Section: 2 Block: Lot: Date Property Flagged: Z- 17,2--10 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 ?wind by 14 to conduct all testing procedures as necessary to determine the site suitabi lity. 4 // AIJA DATE 2/ Z/ / of SIGNATURE /Y' zl%�6 `- T) 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. A -6- q I Invoice No. old 73 APPLICATION FOR SITE EVAWATION/IMPROVEMENT PERMR &ATC Davie County Health Department Envltontnenfa/Health Sectton P.O. Hos 868/210 Hospital Street AUG 2 5 1999 Mocksville, NC 27028 (336) 751-8760 ***IMPORTANT*** THIS APPLICATION CANNOT BZ PROCi8SZV UNLESS AM THE REQUIRED IMMTO ATION IS PRDMZD. Refer to the MffOii>r=XCffl BULLRT=N for instructions. 1. scams to be sillsd W ES is j JDcyc Lor-* C*-►PJWI`/ Contact ",son 66opa cy flailing adar.ss 2L3i 94yi-i LOA Ro. am* arson. 33L-10-1408 City/state/s=P W1'41rdA - SaLt"% ,1Jc '1110(a snsiness Pbon. 136-11-1- 0018 s. fame on Passit/A1TC it Different than Above Wailing Address 3. Application ror: GYSite evaluation s. system to services C3 Houses 0 Mobile Home a. If Residence: f People City/stats/sip ❑ Improvement Permit/ATC 0 Both ❑ Business ❑ Industry 0 Other I Bedrooms s Bathrooms O Dishwasher 0 Gasbags Disposal O Wasbing Machine 0 $asemant/Plusbing 0 sasemant/No Plumbing 5. it susinsss/2ndustr1/0thsrs specify type f People t sinks # Commodes # showers # Urinals # Water Coolers I! 1=8ZMCE: # Seats Estimated Water Usage (gallons per day) 7. Type of Maur supply: 0 County/City 0 Well 0 Communi itty s. Do you anticipate additions or expansions of the facility this system Is intended to serve? 0 Yes ff N"o, If yes, what type? ***1MPOR7ANT*** CWENTS MUST COMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SIMALITTED by the client with THIS APPLICATION. Property Dimensions:�epe °4 Tax Ofilce PIN: # �D �U ' �n-� �6 J7, Property Address: Road Name City/Zip fvva-ace- H in a Subdivision provide Information, as follows: Name: fir' #%9W 7At�5 Section: 3--- Block: Lot: WRITE DIRECTIONS (from Mocksville) to PROPERTY: AO&S CNur" To P -40d ' dW -JkgVChAtlPA,/, t'KPAeL-" a -'J LEff. Date Property Flagged: F"--25-41 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 1, also, understand that I ant responsible for all charges incurred from this appUcadom 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 awned by to conduct all testing procedures as necessary to determine the site suitability.DATE 81 Ddg7 SIGNATURE A& THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the f611owing: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge Date(s): I Client Notification Date: I EAS: Account A& /Z Invoice No. 106 K . r • 7J .�ef Ir 1 �F �7 I 39 2 G L7 ,,) F -LOCK CARL [ I D.B. 1 262 S 85'33'08' E 261 2.22 ; nc + 29B 3 k1JGLE IRON FOUND O 0 + 7� S 83.23'37 E 25 76 616.09 1 4849 26 29 + + 271 41 252 �i 254 25 50 (1, 56 475 2�5 206 250 56,155 14 � 1 75 272 c c J 190, 249 cp• .'�, 24 102 20 w 5%+ 0' 28 46 24 20 20 74 '1 " � 154 153 7J 14 273 0 2, 258 259 , 27 189 4 �'' �� 188 187 R}A t 186 189 1 'N F ` t 44 45 29 193 1981 +1 ` 157 i 158 l Tw �/ nn t 191 � 12' 216 �>t215 + 244 9 042 2 0 199 43 I 198 197 995 196 1 A 79 + v 2 221 Ali 10 + l8 1_ 28 so 30+ �1 219 � 126 `CE.f�ER -"77 'f 1 $• z6 p • 8l 12 - 70 29 101 +1 22 / .Q7 pyo / 9 101x'° v A �0 v tv 89 `0'ti^� v0."o l A 122 ^• / 1 yj A 169 168 1, >.97 ZlaO 3'09' V 31 p' 54 5 37 8 120_ 118 + GE OAK h 10169, DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION--,:;? LOT;21V Soil/Site Evaluation APPLICANT'S NAME DATE EVALUATED PROPOSED FACILITY 1(/ PROPERTY SIZE SUBDIVISION ROAD NAME �filiGLCr�i�rr�,o Water Supply: On -Site Well Community, Evaluation By: Auger Boring Pit t/ Public 4___� Cut FACTORS 1 2 3 4 5 6 7 Landscape position .4— Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH Texture group 6/ Consistence Structure 5 Mineralogy-/ HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: /' S LONG-TERM ACCEPTANCE RATE: r REMARKS: 62_'o _'o LEGEND DCHD (01-90) Landscape 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 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