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235 High Meadows Road Lot 28DAVIE COUNTY HEALTH DEPARTMENT. Pj p3o Environmental Health Section ' P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900573 Tax PIN/EH #: 5870-69-0403.28gj Billed To: Glenn Johnson Builders Subdivision Info: Windemere Farms Lot # 28 Reference Name: Location/Address: Beauchamp Rd -27006 Proposed Facility: Residence Property Size: see map ATC Number: 3037 **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 IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type hQ �t;l #People 2 #Bedrooms #Baths rZ Dishwasher: 13"�' Garbage Disposal: E5 Washing Machine: ET"' Basement w/Plumbing: ❑ Basement/No Plumbing: ❑� 11 Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size i ` o `'E Type Water Supply Design Wastewater Flow (GPD) Site: New Repair ❑ System Specifications: Tank Size W GAL. Pump Tank GAL. Trench Width-�, Rock Depth Linear Ft. &50 Other: � tiS'i"al,f� Ll�t,S � ©•C. ntitrS. Required Site Modifications/Conditions: �tJSjALL n �J C. i0�7Q I� Or -r- 00L)SL-p YZEP 1 S OPF W -off 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.**** Lo i p 3 gQ- r2asMr V Environmental Health Specialist's Signature: Date: / Di DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section Soil/Site Evaluation APPLICANT'S NAME PROPOSED FACILITY SUBDIVISION Water Supply: On -Site Well Community Evaluation By: Auger Boring Pit v—, -- SECTION_ LOT DATE EVALUATED 1„��� PROPERTY SIZE /44��G' / ROAD NAME GSx"�' r(� Public Cut FACTORS 1 2 3 4 5 6 7 Landscape position Sloe % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH �. Texture group Consistence Structure Mineralogyl� 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: LONG-TERM ACCEPTANCE RATE: REMARKS: 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 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 ,. T, 10CK a I ,. T, 10CK I CARL ` D. B. 1', 262 S 85' 33' 08' E 261 I 2.22 �+ Z96IRON 3kNGlE FOUND 0 + S 83-2 3'37• 25 E 76 48 9 49 26 29 616.09 �0� 1 _ O � + t 271 y 252 25 254 50 56 47 ti 2 5 N rJ5, 206 .7 155 1 272 250 50 -7g J 19O 249 �o• �• 24 20 102 �. 51 + 46 ✓ 2, 28 ^� + V 20 _ — 20 40 74 T, n �. 154 153 l 273 O 256 259' 27 �40 is 187 166 188 I fly' o R1A t 45 2, 24 193 1981 +1 189 157 158 t Ty.,0 1 9 44 194 15 + 1� v?- 0' T 244 216 9� '4 2 2 0 43 1 l95 196 79 ^ v -2 199 198 197 s 217 �1 10) NI',� 221 l8 �{ , , cY � _ 80 r) p �G 0 p 30 219 `1 + a 126 R 125 ? 12 88� � 81 70 2 ^ y 101 + AK 22 _ 123�ti � 9 1 o11by o b' n` 122 LAI, 'v J' 1 t / / 8 120 169 168-- 97 3'97 V - 31 '4 u0' D 54 5 S7 i i lie + /, + GE OAK R 101b9•'.o gtig4,1' � 1 58 J� " APP ON FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Health Department Environmental Health Section QG P.O. Box 848/210 Hospital Street ��1 Mocksville, NC 27028 (336) 751-8760 *WJ'TWF0RTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be Billed 6I`eHn �/t� n sc��+ JC.'[/ pa/t1Zs .lame, Contact Person G—lpijtiSby Mailing Address %�y6 (),'.d e�?4 5S /L. -J yy�� lj Home Phone6/ . City/State/ZIP lJgN P �/,L. %[�CJEj ��, Business Phone 9�� - CZJ % p� 2. Name on Permit/ATC if Different than Above ` ` c�e `/ 'S— 6033 O Mailing Address City/State/Zip 3. Application For: ❑ Site Evaluation B-f�provement Permit/ATC ❑ Both 4. System to Service: 2'House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5. If Residence:__ # People # Bedrooms -3 # Bathrooms a Dishwasher I Garbage Disposal 14 Washing Machine Ll Basement/Plumbing asement/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 e. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes L4 -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: Tax Office PIN: # DeCI Property Address: Road NameP City/Zip �-7 If in a Subdivision provide information, as follows: WRITE DIRECTIONS (from Mocksville) to PROPERTY: T�d ✓��--i�j o ti. Lc Name: ( A) Section: Block: Lot: �� 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 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 ATE °2 suit ill D �-aO^yl SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Inclu ll of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Revised DCHD (07/99) Site Revisit Charge Date(s): Client Notification Date: EHS: Account No. / 9 1' 6-7.3 Invoice No. z/ 34 �0"i 33 CT a = r� I— '— o C6 zo Q.. w w LO 352 o r > � s I .,:.rte.,, ` 1 u ; /�. / � • .--- �,,.;._- i 29 v, Q •/ °' 30 J 2 ' £376, 79 N 87'03'09' W 155 31,9 31 — -- LAWRENCE L. MOCK BY WILL REF:D-B. 69 Pg. 55 / / 'r S I ' -)fro 2— DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Account #: 989900573 Billed To: Glenn Johnson Builders Reference Name: ATC Number: 3037 P. P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 �023� Tax PIN/EH #: 5870-69-0403.28gi Subdivision Info: Windemere Farms Lot # 28 Location/Address: Beauchamp Rd -27006 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 WASTEWAT V ID FOR A PERI/OD OF FIVE YEARS. Environmental Health Specialist's Signatu ON N IS Date! 0� *3&d(Wn4 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. Cha ter 130A, Section .1900 "Sewage Treatment and Disposal Systems," but shall in NO WAY be t s a guarante t the system will function satisfactorily for any given period of time. F. r Septic System Installed By: NJ � Environmental Health Specialist's Signature: Date: DCHD 05/99 (Revised) APPUCAHION FOR SITE EVAUlATION/IMPROVEMENT PERMR a ATC Davie County Health Department Environmental Hwft Section P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 AUG 25 1999 +, ***nW(MV"** THIS APPLICATION CANNOT BE PR=SBED UNLESS ALL THE REQUIRED INTORHATION IS PROVIDED. Refer to the INfora TION BULLETIN for instructions. 1. Mame to be Milled yy E s sy1E•a D C\1F wr/�4 Com+ gwl c mteot person- ) �00F�try Nailing Address R4v1'JoknA YZO. Nome anon• 33L-W-uo8 city/state/aIa W%NST6A-SALtV\ tic, T1106 Business phone 336•"1��- da'1$ 2. Mame an P•rait/ATC it Different than Above Mailing Address / City/state/nip 3. Application for: Bite >Zvaluation ❑ Improvement Permit/ATC 0 Both stowlp 4. system to service: Cl�1 HouseS ❑ Mobile Some ❑ Business ❑ Industry O Other a. If Residence: i People # Bedrooms # Bathrooms O Dishwasher O Garbage Disposal O Washing Machine O Basement/plumbing O basement/no plumbing 6. Sf Musin•es/Industry/Other: specify type # People # sinks # Commodes # showers # Urinals # Rater Coolers I! TOODSERVICZ: #) Seats Estimated Nater Usage (gallons per day) 7. Type of water supply: ❑ County/City 0 Wall 0 Community 9. Do you anticipate additions or expansions of the facility this system b Intended to serve? O Yes 8 No U yes, what type? ***IMPORTANT*** CLIENTS MUST COMPLE/ETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PIAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property Dimensions: c e ei ' < a'tj WRITE DIRECTIONS (from Modmviile) to PROPERTY: Tax Office PIN: # �d �U /n-' V a3, ?f 110 &5 tnMIA To 21at1" ctrl 13EAVCRAM PA'I Property Address: Road Name �'Cl uc 1'� � o� Lerr. City/Zip If In a Subdivision provide information, as follows: Name: All NrXMf,/tF F42911 Section: Block: Lot: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 1, also, understand that I am responsible for all charges incarred frons this appUcadom 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 ry to determine the site suitability. DATE 8t gly SIGNATURE MdAQ-, THIS AREA MAY BE USED FO OUR STTE PLAN (Include all of the 1 ug: Existing and proposed property lines and dimensions, stc Zck-x_nd septic locations). Revised DCHD (07/99) \ Site Revisit Charge Client Notification Date: 1 EHS: Account No. IS6- Invoice No, atll-r