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222 Rocking Chair Ln DAVIE COUNTY HEALTH DEPARTMENT ' ' Environmental Health Section • ' r.o.Bog sa8nio xo�P;t��st��t Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001222 Tax PIN/EH#: 4891-83-9814 Billed To: James Coggins Subdivision Info: Reference Name: James Coggins Location/Address: Sheffieid Farm Trail-27028 Proposed Facility: Residence Property Size: 9.650 Acres **N07'E*��iibgmprovemBendOperation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALJTHORIZATION FOR WAST'EWAT'ER 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 PERNIIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People� #Bedrooms� #Baths�_ Dishwasher: � Garbage Disposal: 0 Washing Machine:��Basement w/Plumbing: ❑. BasementJNo Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste:❑ Lot Size -2.� Type Water Supply��'�'� Design Wastewater Flow(GPD �oa Site: New� Repair� System Specifications: Tank Size�Cba GAL. Pump Tank GAL. Trench Width� Rock Depth /a7��Linear Ft9�� Other: =�V /T. ��l-toA�(�. �O��-f-"i�r`--!�l l _ � �f�� / �" / Required Site Modifications/Conditions: f7 C� I o� (�i INIPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S)IF 6`°BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis 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.****i , � 1�I� � �� r �� a� �ao�f ��, z�,�r�. / �o, �- o, ..o� �,�. � � ��- �o�/�-o � . ��'�r��o�� °I�� ►�1� ( � �Dof� �� 7g7`; �� C'i?�"c_r� ,. � Environmental Health Specialist's Signature: �� ` �� Date: CP �6 �� DCHD OS/99(Revised) ��'� ��,� s �� . � . , . �',� ' � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section . P.O.Boa 848/210 Hospital Street . Mocksville,NC 27028 (336)751-8760 . Account #: 9900012?2 Tax PIN/EH#: 4891-83-9814 Billed To: James Coggins Subdivision Info: Reference Name: James Coggins Location/Address: 5heffield Farm Traii-27028 Proposed Facility: Residence Property Size: 9.650 Acres ATC Number. 2468 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 WASTEWA CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: /�cGc�_ Date: (o a�--� CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on ImprovemenbOperation Permit has been installed in compliance with Article 11 of G.S.Chapter 130A,Section.1900"Sewage Treahnent and Disposal Systems,"but shall in N uarantee that the system will function satisfactorily for any given per�o�i of tu 1�J, � �� — � ' �' ,� .�, , � �� -�'f. l � � ��L � � Septic System Installed By: �� ✓"T�� Environmental Health Specialist's Signature: �` ~ "- �'� Date: �l�7 "'�� DCHD OS/99(Revised) _ DAVIE COUNTY HEALTH DEPARTMENT �'� ' ��`– ` . Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001222 Tax PIN/EH#: 4891-83-9814 Billed To: James Coggins Subdivision Info: Reference Name: James Coggins Location/Address: Sheffield Farm Trail-27028 Proposed Facility: ResidenCe Property Size: 9.650 Acres **NOT�*�'�iibgmpro 4emsentl0peration Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An AiTfHORIZATION 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 PERNIIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CIiANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type � #People�_ #Bedrooms�� #Baths� Dishwasher: �Garbage Disposal: ❑ Washing Machine:�asement w/Plumbing: ❑ BasementlNo Plumbing: �- Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply�� Design Wastewater Flow(GPD)�� Site: New� Repair❑ System Specifications: Tank Size��GAL. Pump Tank GAL. Trench Widt�� Rock Depth��Linear Ft. ocher: T Coh o , � r`D�' � , �— �—[� i Required Site Modifications/Conditions: -4 4n.t�� IhiPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****NOTTCE: Contact a representative ofthe Davie County Health Deparhnent for final inspection ofthis 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(33G)751- 760.**** � 5D� o / / �!l�i�7Fl �pr� /�G/1rE 90��, . / . L o��r- .�. � /�n/C ,,a/s � � lS � � / �'� - ��tE 5°t K'o'`1 �- c�� v � Environmental Health Specialist's Signature: �'/`'�o°-'1- �S Date: 1„��—��✓ DCHD OS/99(Revised) �r.�•�`'� c�/`� , a 4_�S' . DAVIE COUNTY HEALTH DEPARTMENT ��`� �/'J�v ' ` ` ' ' ' Environmental Health Section � , P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001222 Tax PIN/EH#: 4891-83-9814 Bilied To: James Coggins Subdivision Info: Reference Name: James Coggins Location/Address: Sheffield Farm Traii-2702$ Proposed Facility: Residence Property Size: 9.65p Acres **NOTE�* Thms�mprove�m$nt/Operation Permit DOES NOT authorize the construction of a septic tank system or any wastewater system. An ALJTHORIZATION FOR WASTEWAT'ER 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 PERNIIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type � #People_Q� #Bedrooms�� #Baths� Dishwasher: �1�arbage Disposal: ❑ Washing Machine: 0�asement w/Plumbing: ❑ Basement/No Plumbing: �� Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: � � Lot Size �..2� Type Water Supply� Design Wastewater Flow(GPD)�� Site: New��Repair❑ I / System Specifications: Tank Size�GAL. Pump Tank GAL. Trench Width� Rock Depth�� Linear Ft�� o�h�: S�-� �J'�/. �� S //� Required Site Modifications/Conditions: _(�S� /��/�� IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 G°BELOW FINISHED GRADE. ****NOTICE: Contact a representative ofthe Davie County Health Department for final inspection ofthis 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 installati 751-8760.**** �'`� � .� I � � �s¢.�- esfi� ��'� c I�� ,a� - � � � � � /��5� � ' " o' � �o� o � � �� Environmental Health Specialist's Signature: � Date: � 0"-7 Z�� DCHD OS/99(Revised) �olc �,��-.G�-G/- ,o�y ,Q�� G� • , �� ' APPUGATION FOR S EVALUATION/IMPROVEMENT PERMIT&AT 1� � � � u " � G-� . Davie County Health D�partment Qo o Environmenta/Hea/LfiSe�ion a�N - 6 2000 �.�..�%w� a_�_z--� - p.o. Ho� 848/210 Hospital Street tY��J' ��w�., �S/-/ bs� Mocksvilie, NC 27028 ' (336)751-8760 �� DAVIE CO NTNYEALTH ***I1�ORTANT*** THIS APPLICATION CANNOT EE PROCESSED UNLESS ALL THE REQUIRED INFORL�TION IS PROVIDED. Refer to the INE'ORt�TION BULLETIN for instructions. 1. xame to va sillea TG�. M P S � l.,Eaq q /\/1l S conr.act rerson L/ a.M t?5 C�d r�"9%/f! S Mailinq Add=eas C! 8ome Phone �3�j� /s�� ijij� a� City/State/22P � � Susineaa Phone ��_�� j�Q Q 2. Nama on Yarmit/ATC if Dilforont than Abova Mailinq ]lddrasa City/State/Zip 3. Application For: 0'Site Enaluation ❑ Improvement Permit/ATC L�Both a. system to soz,��e: CtYHouse O Mobile Home ❑ Business ❑ Industry 0 Other 5. if Residence: i PQople � t Bedrooms �_ t Bathrooms � l�l Diahraeher ❑ Garbage D3aposal L�1'iiashing Machine fJ Basement/Pl�binq f�Hsaement/No Plumbing 6. If Husinoaa/Znduatry/Othor: Speoily type # People � Sinka � Commodea � 8hoxera � Urinals � Water Coolera IF E'OODSF�2VICE: # Sests Estimsted Wster Usaqe (gallonn per day) 7. �pe of water supply: ❑ County/City B'Well ❑ Co�unity e. Do you anticipate additions or eipansions of t6e facility this system is intended to serve? ❑Yes C9'No If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATI�ON REQUESTED BELOW. Eit6er a PLAT or SITE PLAN MUST BE SUBMITTED by t6e client with THIS APPLICATION. Property Dimensions: �`% -f- n!'r n�-- WRITE DIREC'fIONS(from Mce ville)to PROPERTY: Taz 0i1'ice PIN: # ��q� - �� — �� - PropertyAddress: Road Name $h �.1,'�i i e.Id �F�M rj— � � City/Zip � s�.-n��+Ll�,�-_�'. If in a Subdivision provide information,as follows: , S �� Name: Section: Block: Lot: Date Property Ftagged: J�3/'-�d This is to certify that t6e information provided is correct to the best of my knowledge. I understand that any permit(s) issaed hereafter are su6ject to suspension or revocation,if t6e site plans or intended ase change,or if t6e information submitted in th�s application is falsified or changed. I,also,understand that I am responsible jor all charges incurred jrom thls appl�catlon. I,6ereby,give consent to the Authorized Representative of the D vie County Health Department to enter upon above described property located in Davie County and owned by M S d� h a_ �nQ%II(,5 to conduct all testing procedures as necessary to determine the site suitability. � DATE �,j;f �,— (�C� SIGNATURE � THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN clude all of the following: Eristing and proposed property:ines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client NoHfication Date: EHS• ��l � �j Account No. �z2„'Z V�� Revised DCAD(07/99) Invoice No. � � � �}y�J�S��1k;y,�'v\p `1/'Y • y, . S . 5 ��TY .. � � , '�� / ( � ( . Mir'f.��yj'iR f�. i . '�" T l 1�-'' ! ' ' Q� f��., {1 � �.. F�.`� '. . . . , . • �• y°'v+a'!4�71�1 � * 1� . ,• . . _ � � '�11!!S � It f1��CT?D�`A1fY tAa1[MTii i AMtfpLpT! ,ql , � M tn �� Af�,w►t► �Eoo�►,;Nt1E�,To t1R DAi��F TN1s ►uj. � ' .,. � t�r� ��.k:kp� i 'r�..j. �'j ��"+`�ryilq' ` M :�'- T �. .?�r i.o f .. .. .. . , W �N I "��,�s,��;,r s=,��;`- X, �-� ��r •�. � Y', *. . � `o�n P CEL '"' ".d. f�� yd'i' t '�, i „ `i; + , N OD ��+`s�i��isT��To w+r�i�er��iw►t.�w►r u�iiaa�o rr�nu _ I �' 1O`� �AVIb � aMo+.ta�t�la�oP rq,r�K=aF r+�s orns. . w m m I D.B, 134 ns. �S",M-sa"�34�1 v' y ti.R,��.ta � (JT f:� , . . . Z �r��tq"�-�r"` '# �4� 5��...'` a'4 -�. � ° �.� ri� ii.°+ . . . - , . . i . �� , 13 . '+X'c�4t"�d��r�� +�^^�y,"i- r b�. . �; f��i � 1� � , _ ' I �7 B � � 0�.41 q, 'a• �, ,`� � i.: ,�_ .+ .� �, � . � H ��' .� �t � ,�t !x MAP , *�`'SF" �. ' x�' '�� , � ' �.;" ,' ,� ` 66,IREDELL 7AX I L ,��.�,,r��';±x ''�� ; N« � `�, q,Aj�,gp,L1�lON.�R• �� ,' �` + �L.TAX MAF' 17 9 I . 807-106 �Y• ��,,,,� �' 28. IREDEIl TAX i�IAP:'1��B ;; P��. 66.IREDE D•B I �, � :�PAEtCEI-KNIt� ' , / `�� p,,J, SALMON.JR. :;'gF�BV ` �.g,g�7 105 I � : �� V� ° . ! K..�� ♦ 1Y l7 S, ! � ,� t stone found —�� c } � � ,; Ea� �,�f r.: . . �. . � . �' ? � N 03°58'10"W N ��'37'15��F ��4,� '� t: , �;: 139.77� S� � , . 484.45' �Y�¢;��t} ; 03°46'10"W .ton.touna h+t.nc.11M EIP � � .' NIP ln stone ile. N 375.27' �i�y '; � • ____ :.._.-- ,y , t �„�,.,,..�,�.. -- �� . ,�` y,�✓;A�lt"� '� t• f♦ }.� �`'''{y Vv,`3!t �� "`' `.; ,;c f �- �4 � .: j- . - � , ; �� 'f� +�. t` f 1 r , '*r � `J �{`3 :� ` '�' � �°• �� c �� ),: � : � .,ky . . �'i '��; .7` � �' ! s::: � t�, }..- . . � �� . t��f i.'�3 . . . t ^ Z �• �� '��' s . ' � � �1 �<�-,, �'' - 0� a } . : �"� Oo �� W 1 �� ; , . -+ w `� �`�� ` ` . .:� .m•�• ) � � ��, �� *, 1,.:, .� : ;� � 650 ACRES ( by m ,,�� :��f .� . , ; ;� � 9 atir �. d:. , • Cr f i ` •': � N� ;.; � _\ , E ,� �, � � �M,•;�.PJIRCEI:.1 TAX I�IAF o � �' ;� ��F, BOBB'Y�KN{GHT; ` . . �<�o.B..�,�--�o r �� :. _ �0 �,-� � �` -� �� • I 1 1�. f 9 ;�a. � �� 1/'��, \\ V+ � 1�, i} � t�.� �. •,�A J. /•: f . . ' � `� 1 I rY� ��j 4 S , y, . '� ,�,.�' . t�� ! ��4 k �S t . . . � � I. +�a d .' a� , • .: - � ..a. �«,✓ �m��r„��y� r''��"'Mr�~ '` �.r.X" '�f '�'"�..�. r° ��_�_s.s,�.,, R€' ..7Y,-,rt—'�!�,`r.' ..i! "".R . , �;�:." , h pr � {A {?�E� C. q+,`4 w-µ'; r �'�' *... ::.k w*N` �'jY(, • � . � . t�..i•' r * ' ., � . �' " . ��' - stone found ' '` 983.57' ' r ,,, . . �.—S 04°25'1 �E :�� •� . I �r� ' � �� - stone in rock pile \ �i -- .' � a � :: c��. �° � I nr. `" � ' �'' ' DAVIE COUNTY HEALTH DEPARTMENT , . ` ' ' � Environmental Health Section Soi]/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001222 Tax PIN/EH#: 4891-83-9814 Billed To: James Coggins • Subdivision Info: Reference Name: James Coggins Location/Address: Sheffield Farm Trail-27028 Proposed Facility: Residence Property Size: 9.650 Acres Date Evaluated: ��,v Water Supply: n-Site Community Public Evaluation By: uger Borin Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca osition Slo % HORIZON I DEPTH Texture ou Consistence SS Structure Mineralo ' ;! HORIZON II DEPTH Texture rou Consistence Structure Mineralo ' ' HORIZON III DEP'TH Texture rou Consistence Structure Mineralo � • HORIZON IV DEP'TH Texture rou Consistence Structure � Mineralo SOIL WETNESS RESTRICTIVE HORIZON . SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE , SITE CLASSIFICATION: �� EVALUATION BY: i.+ � � LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: ' �i . � ` �Bs►�� — �� LEGEND Lan cape 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 day 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 tructure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangulaz blocky PL-Platy PR-Prismatic Mineralo�v 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-gaUday/ft2 DCHD OS/99(Revised)