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1888 Sheffield Rd • � DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account #: 990004398 Tax PIN/EH#: 5801-10-2181 Billed To: Linda Vaughn Subdivision Info: Reference Name: Location/Address: Sheffield Rd.-27208 Proposed Facility: Residence Property Size: 2.039 ATC Number: 4724 **NOTE**The issuance of this Operation Permit shall indicate the system described on the ATC 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. System Type:11Z$"`y� S.T.Manufacturer S�+�F Tank Date S u•o� Tank Size�(� roP(ry.G Pump Tank Size�/� � � �i � SystemInstalledBy: �l�v4ta►1 l�u�u�J E.H.Specialist: Date: g'�S^"�7 Q • pwP�,� �, ��o � �'�'� ob� Na"``' m . c�°"''"" woz►^a ��wad;ll•� a,�- �,�' . � -� � A a�` �� �o�r �y W�u �Yju�'l t�t'�'Q t:�"" . e �n C'� S� �� l o e' � �'"' . � . ZsG�r,� r ' 100� � �`� p/, �p`�. �� 4 a1� �'� �' �.cva �'`� o '�, N .VI - a - s� ' � r . � � '7�Si �°�+^� � � i . H � J � C DCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 p�� O/� (336)751-8760 Fax#(336)751-8786 �Y 3` �, AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990004398 Tax PIN/EH#: 5801-10-2181 Billed To: Linda Vaughn Subdivision Info: Reference Name: Location/Address: Sheffield Rd:27208 Proposed Facility: Residence Property Size: 2.039 ATC Number: 4724 Site Type:�'New �Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MIJST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s),(in compliance with Article 11 of G.S.Chapter 130A Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans,plat or the intended use change. • Residential Specifications: #Bedrooms J #Bathrooms 2- #People�Basement0 Basement plumbing0 Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size 2-�E'�,Q�S Type of Water Supply: �ounty/City ❑Well ❑Community Well - System Specifications: Design Wastewater Flow(GPD}31Of7 Tank Size�DO�AL.Pump Tank GAL. �� n � Trench Width3�o Max.Trench Depth '-�2 Rock Depth�J A Linear Ft.� Site Modificati s/ onditions/Other: HV a� N 6� � L � Contact the Davie County Environmental Healt Section for final inspection of this system between . 8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760. ��`� �', I ��� � . � � f � � ` � ( � �� � � . � � � �� � � �S�� � �� / N 1 f1y� � � =. �'�� D� ' � . . ��'`' �,5, `� � •ti� , � , ' . c - �'1 Environmental Health Speci ' ' � ate: � 2 DCHD 11/06(Revised) , • . � . , . . Davie County Environmental Health P.O.Boz 848/210 Hospital Street Mocksvilie,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account #: 990004398 Tax PIN/EH#: 5801-10-2181 Billed To: Linda Vaughn Subdivision Info: Address: 111 Rocksprings Road Location/Address: Sheffield Rd:27208 City: Harmony Property Size: 2.039 Reference Name: Proposed Facility: Residence � **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans,plat or the intended use change. Pemut Type: ew ❑Repair ❑Expansion Pemut Valid for: ❑5 Years ❑No Expiration Residential Specifications: #Bedrooms�#Bathrooms 2 #People J Basement0 Basement plumbing0 Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply:�unty/City ❑Well ❑Community Well Site Modif cations/Pernut Co ditions: \� � S stem T e LTAR tial 0.3 e air L ' �`j. Site Plan ,/� `"�-�/,,'� � f��2..�—��.. i�,l�..�c_. . _ .. ^� ri�/};�� '� � ry�� � . _ .__ , - - ;Y.��,� .s;— �, , � . � � _ _�� �� E vironmental Health S ep cialist Da � '.p.l 1-06 � � � APP I�' ITE EVALUATION/IMPROVEMENT PERMIT & ATC ' � � avie County Environmental Health � $ 2001 P.O.Box 848/210 Hospital Street � Mocksville,NC 27028 : J��- � 4 _ (33�751-8760/Fax(33�751-8786 . ���H Applic tion ��t�l"s��i��io ovement Permit C►�h rization To Construct(ATC) oth Type o pplicati n:., ystem ❑Repair to Existing System ❑Expansion/Modification of Existing System or Facility ***IM ORTANT***THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. � APPLICANT INFORMATION Name to be Billed Contact Person�.�.9 � .� ,�'� u Billing Address Home Phone ��j c��s� �'�G ��'7 ' City/State/ZIP , � - " � Business Phone Name on Permit/ATC ifDifferent than Above . Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged + -20 -v7 NOTE: A survey plat or site plan must accompany this application. Included: 0 Site Plan ❑Plat(to scale) (Permit is valid for 60 months with site pla no expuati n 'th mpl te lat.) . Owner's Name `� u .� '� � Phone Number Owner's Address �t/ �o� l�5 ly1� le City/State/Zip Property Address �� City Lot Size�,o3y Tax PIN# � Subdivision Name(if applicable) Secti n/Lot# ' ections To ite• U . - �/�J o C��u ' D �Yi If the answer to any of the follo ' g questions is"yes",supporting documentation must be attached. Are there any existing wastewater systems on the site? OYes C�To Does the site contain jurisdictional wetlands? ❑Yes C�3�o Are there any easements or right-of-ways on the site? ❑Yes C�10 z� Is the site subject to approval by another public agency? ❑Yes � Will wastewater other than domestic sewage be generated? ❑Yes l�o IF RESIDENCE FILL OUT THE BOX BELOW #People 3 #Bedrooms � #Bathrooms � Garden Tub/Whirlpool ❑Yes ❑No - Basement: ❑Yes C�'No Basement Plumbing: ❑Yes ❑No. . IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of FacilityBusiness Total Square Footage of Building #People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Typesystemrequested; �Conventional OAccepted ❑Innovative �Alternative ❑Other Water Supply Type:�County/City Water ❑New Well ❑Existing Well � Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? � Yes C�'No If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my laiowledge. I understand that any pernut(s)or ATC(s)issued hereaRer are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and locating and flagging , or staking the house/facility location,proposed well location and the location of any other amenities. �� Site Revisit Charge Property owner's or wner's egal r`presentative signature Date(s): �� Client Notification Date: Date+ EHS: � — Sign given ❑Yes ❑No Account# ��� Revised 11/06 Invoice# __�'�� � . .. . .... . .�_. . 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(i � 7� "�� : r� .. ✓' � 'f ' s t 5'��a �` . � �' � � � e � d s � ° ���� �J ¢ � '�', ` i�.��^+�'' �� �`•� *A"'�_ -.;,+� .:4 ; ���.9'�:c � .A`> _ _�":`aYl�-.< y. _.a.� . _ ..`� . �. _� _ .�!. a _ . .... _. , r.... http:i/maps.co.davie.naus/GoMaps/map/mapframe.efm?CFID=4129&CFTOKEN=616408... 7/20/2007 � • < • DAVIE COUNTY HEALTH DEPARTMENT ' Environmental Health Section Soil/Site Evaluation � APPLI�N,�T�1VF���'�N Tax PIN/EH#: 5801 �v�P�ItTY INFORMATION Billed To: Linda Vaughn � Subdivision Info: Reference Name: Location/Address: Sheffield Rd.-2720 � Proposed Facility: Residence Property Size: 2.039 Date Evaluated: Water Supply: On-Site Well Community Public � Evaluation By: Auger Boring , � Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca e sition � j,. � Slope% HORIZON I DEPTH 8- � _ �� �j Texture grou Consistence - Structure Mineralo HORIZON II DEPTH � Texture rou L Consistence � Structure Mineralo ' � - HORIZON III DEP'TH � Texture rou -- - Consistence ` , Structure - Mineralo HORIZON IV DEPTH � Texture rou _ 1, �,� . Consistence - , Structure ��;� =•.x Mineralo � ��� , SOIL WETNESS -� °'- RESTRICTIVE HORIZON .— ,-- •� � ��. , : ..�,�;� �, SAPROLITE .— — ,.-• : CLASSIFICATION ,� LONG-TERM ACCEPTANCE RATE , p . Q ; Y \ SITE CLASSIFICATION: �EVALUATION B� LONG-TERM ACCEPTANCE RATE: '�' �OTHER(S)PRESENT: � � REMARKS: � %-j v' I ' . - , _ . .•, F LEGEND.... :,_ . Landscape Position • , : ' . . R-Ridge S-Shoulder L-Linear slope - FS -Foot slope N-Nos�slope ' ' CC-Concave slope CV-Convex slope ' T-Terrace FP-Flood plain " H-'Head slope Texture . � . S-Sand IS-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 NIQ1St : � , `. VFR-Very friable FR-Friable -, FI Firm VFI-Very firm EFI-Extremely firm , � ' � NS-Non sticky SS-Slightly sticky S-Sticky VS.-.Very Sticky . NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic , StrLctLre _ - ., , �,; SC-Single grain M-Massive CR-Crumb �-�� GR-Granular ABK Angular blocky � SBK-Subangular blocky PL-Platy PR-Prismatic�: - � - � ; lYJi eralogv ' '` __�:1,2:1,Mixed , ' _ LYsi�� _ Horizon depth-In inches � , Depth of fi11=In inches '' .-� ` Restrictive horizon=Thiclaiess and inches from land surface . _. - Saprolite-S(suitable),U(unsuitable) - � Soil wemess-Inches from land surface to free water or inches from land surface to soil colors with chroma 2 ar less � Classification=S(suitable),PS(provisionally suitable),U(unsultable) . �-� ; LTAR-Long-term acceptance rate-gaUday/ft2 ` � DCHD OS/OS(Revisedl ■■■■■�����■■��■��������■�■�■���s�■■■���������������������■■■■����■ ■���■��■��■��■�e■�■■�■�■��■��■�■���■■�■e■�■�■�■■�■■�■■���o�■���■■ ■�■■�■o����■�o■a�■���■����a�■■�■ s■e��■�■��a■�■�■�■�■��o���■�■s�■ ■�s■����■�����■■�t��■■�e�����■■�eo■e��o�■�■�����■��■■�■��■�����■�■ 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■■e���■■��o���■nr����������■��■■���■■�■��s��■��:o■�����■■�►��o���■��■ ■��o�����■o�■��r��������■■■■����■��■■���■��������■■■���■�����������■ ■�■�o■■■■■■�������■�■■■���■�����■■�������■�■■■s�■■�������a�������■ ■������■■����■r���■■�■�:�■���__■_��o�e_�a�����o�����������������■��o�■ ■�■■■����■���������■�■��■o�■�����������������������:��ee��������■ ■�■s��■�■������■�■�■��:��■���■�■ ■���■�■■■���■_:��������e������■�■ ■����■��■■■0���.�!�■�-��'��;!:;e�!7►.��I�r]'I1�■e!�.�•.s■���■��■■��������■ ■�e�■�������������■�■-�=='�:��:r�rc-s:•r���r::��..:::■oo���o■�■��■��o�■���■ � ' ` � � � � JUL.31.2007 9:q3PM ENEF�GYUNITED N0.551 P.2i2 ������ . ^ � � . , , , Po QOX 1b33 iTATE�NLIF,NOR'1N C�RqUlu 2e6sY 70A-p33241 Pbo�u Taa-a7i-0]Gl f�s ' Jufy 31,2007 , Dear Sir: You had inquired about an easement that EnergyUnited has on a piece vf property. As a matter of policy EnergyUnited does not allow encroachmer�ts on its right of ways for septic tanks or associated - lines. We are v�n'11i�g to ailow you to encroach on our easement with your septic tank lines, with the ' following unde�standing: � 1. You w�li only encroach o�our right of way with your septic tank line as a(ast reso�t. If suitable . • land is available outside of our right of way,this should bs�tlized fully before entering our right . of way with the septic line. � 2. tn the event EnergyUnited has ta enter its right of way with tntcks or other heavy equipment, EnergylJnited wili not ba hold responsible far any damage to tY�ese lines inside our right of �y. . Please sign this IEtter as a�indicatio�of your understanding af these stipulations and retum a copy . to�nergyUnited. �1f you have any ques�ons regarding these stiputations,piease do not hesitate to contact me at 704- 924-2145. � Sincer�ly, • ,.���� ���" " � Steven J.McCachem , ' Director ofi Engineering Services . . ,�'.�n�/�.• �,�%/���J ,������1��--- � . / Property Owner Signature ,�1 �Y� ` � ' ,p �A/ 1/.J .✓ -� � /r.� %�.e �G/' � 4" ° � � �� �� - ��,�� f —z- Address or Qescript�on of Property J •