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823 Sheffield Rd r � � " ` O�PER�ATION PERMIT °r '�Q Se "`' Davie County Health Department •CDP Fite Number 120751 -1 . e"�R� . . , . . . �. � : - � 'a`.����, 210 Hospitai Street Goa0000z�o2 r•�- . ;;�� �: r�� P.O. Box 848 County ID Number_ ''�� Mocksville NC 27028 Evaluated For: NEW Phone:336-753-6780 Fax: 336-753-1680 Township: Applicant: Greg Gobble Property O�vner: Greg Gobble Aad�ess: 325 Georgia Road Address: 325 Georgia Road ��v- Mocksville ��Y� Mocksville State2ip: NC 27028 State2ip: NC 27Q28 p e�; 41� Phone�: (336)492-2411 Pro ert Location 8 Site Information AddresslRoad #: g�3 Subdivision: Phase: Lot: Sheffield Road � Mocksville 27028 Directions r �e: SINGLE FAMILY Hwy 64 West, Right on Sheffield Road to 847 _. Sheffield Road Site bbehind brick house on left aboui ::of Bedrooms: � 200Q ft. off of Sheffield - #of People: 2 'Water Suppty: PueuC "IP Issued by: 22aa-Day�:ai�.a�cire�:� 'System Classiticativn/Description: TYPE 11 A.COW SYSTEAt(SINGLE-FAh1�LY QR A80 GPO OR LESS) 'CA issued by: 22�34-Day�ralt,nr,drew SaproliteSystem? QYes QNo Design Flo��r: � 2 p 'DiStnbuti0flType: GRAVITY-SERIAL PumpRequired? QYes QDJo � Soil Applicatan Rate: 0 . 3 'Pre-TreatmenL Drain field N drification Field S4� n� ''SySt@�T1 TypB: �NFILTRATOR QUICK 4 STANDARD PJo. Dr�in Lines Instal�er: . sncrmandunn Tot�l Trench Length: 3 0 0 ft• Certification�: Trcnch S acin _ �Inches O.C. p �� Feet O.C. 'EHS: 22aa-oay�:au.Andre:v Trench Width: _ Inches . SFeet Date: 0 8 � 0 8 / 2 U 1 3 Aggregate Depth: inches trtinimum Trench Depth: 2 4 Inches F:tinimum Soil Caver. Inches Approval Status F.�aximum Trench Depth: 3 g incnes ❑ Approved❑ Disapproved F.laximum Soil Cover: Inches CDP�Fi�e��umber 120751 - 1 County ID Number: Go�a000zsoz . ' � � . Se tic Tank � t�tanufacturer. shoar Lat. . ;�� STB: Long: , Gallons: �ao0 Installer. Certification,~:: Date_ 0 5 � 2 2 / 2 0 1 3 - - - 'EH S: 2244-Daytiva!t,Andrew 'Filter Brand: ST trlarker: ❑ Yes ❑ No Date: 0 8 / 0 8 / 2 0 1 3 Reinforced Tank: ❑ Yes ❑ No Approvai Status 1 Piece Tank: ❑ YeS � No � Approved O Disapproved Pump Tank FAanufacturer. Instalier: PT: Certification": Gallons: "EHS: Date: / / Date: � � RiserSealed ❑ Yes ❑ No Riser Height: O Yes ❑ No (F�7in.6 in.) Approval Status Reintorced Tank: p Yes 0 No � Q Approved❑ Disapproved 1 Piece Tank: ❑ Ygs ❑ NO Supply Line Pipe Size: inch diameter Installer: Pipe Length: feet Certification#: . "Schedule: 'ENS: Pressure Rated ❑ Ye5 ❑ NO Date: � � Approved tittings p Yes ❑ NO Approval Status Cl Approved ❑ Disapproved u e u' e en Pump Ty�pe: Installer. • Dosing Volume: — Ga� Certification�: Drarr poti�vn: Inches 'EHS: 'Chain: � , � Date: Valves Accessible p Yes ❑ No Ftotiv Adjustment Valve p Yes ❑ NO Check-valve p Yes ❑ NO Approval Status pvc unions p Yes p No � Approved❑ Disapproved Vent Ho1e ❑ Yes ❑ No Anti•siphon Hole ❑ Y2S ❑ NO . CDP File Number, 120751 - 1 County ID Number: G0000�02G02 Electric E ui ment F�JEt�1A4X Box or Equivalent p Yes ❑ No instailer: Box 12 inches Above Grade ❑ Yes ❑ N0 Certification#: Box Adj.To Pump Tank ❑ Y8S ❑ NO Conduit Sealed ❑ YQS ❑ N 0 'EM S: Pump��9anuaily Operable p Yes ❑ NO / I *Activation t��ethod: Date: Approval Status Alarm Audible ❑ Yes ❑ No p Approved❑ Disapproved Alarm Visibte ❑ Yes ❑ No 2244-Oay.:al;.Andre�v 'Operation Permit completed by: Au4honzed State Agent:��'��:• �4����J Date of Issue: 0 8 � 1 5 � 2 0 1 3 � This system has been instaped in compliance�viih applicable PJC General SFatutes:ARicfe 11,Chapter 130A, Rules for Se;��age Treatment and Disposal, 15A NCAC 18A.1900 et. Seq„ and all conditions of the Improvement Permit and Construction Author¢ation.This property is served by a TYpE u�. SeWdge SeptlC Syst@t'ri. Rule .1961 requires that a Type NPE���• � septic system meet the follo��ring criteria: trtinimum System Revie�v ByThe Local Health Oepartment: N�A t��1anagement Entity: ��'�NER _ t��linimum System Inspection�l�laintenance FrequencyByCeRified Operator: ►�!n Reporting Frequency E3y Certified Operator. NrA Rule .1961 requires that a Type IV and V septic systems designed for a hometbusiness ovmer must maintain a vatid contract wiih a public management entitywith a certified operatoror a private ce�tified operator torthe life of the septic system. Rule .1961 requires that Type VI septic systems designed for a home'business o�mer must maintain a valid contract�rith a public management entity with a certified operator for the life of the septic system. Rule. 1�G1 (2)(e)requires a contract shall be executed bettiveen the system owner and a management entity prior to the issuance of an Operation Permit for a system required to be maintained by a public or private management entity, i�nless the system otivner and certified operator are the same. The contract shall require specitic requirements tor maintenance and operation, responsib�ities of the ovrner and systems operator,provisions that the contract shall be in effect tor as long as the system is in use, and other requirements for the continued proper performance of the system. ft shall also be a condition of the Operation Permit that subsequent otivners of the systems execute such a contract. C�Hand Drawing Olmport Drawing **Site PIanlDrawing attached.** Tota1 Time:(HH:Idl,1) ACtiVQy CodC: S•19 ZQ4-OP issued NE1'V Typc It Quick 4 • 0 � ttours 0 � t�tnutes � t � OPERATION PERMIT ' � � � , Davi�CountyHeaitnDepartment CDP File Number: �20751 - 1 210 Hospital Street P.o.BoXga$ County File Number: G0004002G02 hlocksviife NC 2�028 Date: � / , � Q fnch Dra«•ina Drawing � Scale: , ON�A k - .ft. Q __._._, _.._. _ .._ _ __ ; ' .. , i_ __ _ _ , ._;. ': . ' .::_ . . ..,. .._ _ . : , . '_ . . - - ' � _ _ � .___ _ _.; _.: ' _ __ _ _.._ . _. ,. _.__ , � ...-! . : . :;. . . ._ . , � ' QQD � : \ xivd . 3 : , ; �� + Y- � _ . . . _ .. Z, ._ _ . _ . _ _ _ ,.. � .. __. . ;__.. ,.,. _ - �- - - -- - . , _ : : __ ____ . . . _ .... _. _ .__ . _ _ - . _ __ .. _ ._. __ , �'� , ; � . : .. - _ _. _ _.. , . ._ ._ ,_ . _ _. � __ . _ , � , _ _ ; __ . . : � , � � � , . , -� .. . �_.�--. � _ _ . �- . . 2 . �S� . , , _._ _ .. . . , _ . _ _ ._ . _ _ _ _ _ _ , � � _ . _ _ ��� ' . -. . ; , . 0 , , . , _ . _ _ _ _. _. _ . _ , .___ __ . _ . . _ . , . :_ ._. � , , . : : ; , ; � _ . _� . . . . _ _:_ . __ ._ : __ _� _ _ _.. _ _ __. _ _ _ _ _ _ __ - __. , . , � , �� .. .�� , . _ . _ _ ____. . _ . _ ` _ _ _ , ._ . _ _ . _ , _ . _ _ . . _ . . � � , � , , , , ' � � � k ' . . . ,. . . , , � . .. , . . , . ' . . , . � . . . � . . �. �i � ' . .. . � .. � . . . : ' . - . . . . . . � . . � � , .. . �. �. . . ; . � � : - -��, � - �' ... .... : _. , ...,...... � _ ....... . ......... _ ........ ........ . � ' � � '� aCONSTRUCTION For ottice use on�v �� '' � ��� A�UTHORIZATION 'CDP File Number 120751 - 1 ,�°="�`� Davie County Health Department County ID Number. G0000002602 � 'r-� � 210 Hospitai Street Evaluated For: NEW �.��;;,. P.O. Box 848 Township: MOCkSVille NC 27028 PERl,�IT VAUD UNTI�: Phone:336-753-6780 Fax:336-753-1680 4 / 0 5 / a 0 1 8 Applicant: Greg Gobble Property Owner. Greg Gobble Address: 325 Georgia Road Address: 325 Georgia Road City: Mocksville C�ty: Mocksvilte State2ip: NC 27028 State2ip: NC 27028 Phone#: (336)492-2411 Phone#: (336)492-2411 Propertv Location 8 Site Information , Address/Road#: Subdivision: Phase: Lot: Sheffield Road Mocksville NC 27028 Directions Structure: SINGLE FAMILY Hwy 64 West, Right on Sheffield Road to 847 Sheffield Road Site bbehind brick house on left about 2000 ft.off of #oi Bedrooms: 1 She�eld #of People: 2 'Water Supply: PUBLIC Svstem Specifications Minimum Trench Depth: a 4 Inches Site CtassiTication: Saprolite System? QYes QNo Fdinimum Soit Cover. 0 Inches Design Flow: Maximum Trench Depth: 3 6 Inches Soil Application Rate: Maximum Soil Cover. , Inches 'System ClassificationlDescription: `Distribution Type: cw�vmr-SERIAL TYPE II A.CONV SYSTEM(SINGLE-FAt«ILY OR 480 GPD OR LESS) Septic Tank: 1 0 0 � GaUons 'Proposed System: 25%c�ouC7totv 1-Piece: QYes QNo Pump Required: �Yes QNo QP�Aay Be Required Ndrification Field Sq.ft. PumpTank: Gattons No. Drain Lines 1-Piece: QYes QNo TotalTrench Length: a g � � GPM—vs— ft. TDH Tr�enci� Spacing: _ 0 9 gFeet O C C Dosing Volume: _ Gallons Trench Width: 3 6 � Inches — _ . �Feet Grease Trap: . Gallons Aggregate Depth: _ inches Pre Treatment: ONSF �TS-I �TS-U Septic Tank Installer Grade Level Required: �I 01I 0 I I I �IV � Page 1 oi3 i . CDP�i;e Number �20751 - 1 County ID Number. G0000002602 .. • � , � � ❑ Open Pump System Sheet Repair System Required:OYeS O No 4No, but has Available Space epair Svstem Trench Spacing: Q Inches O. . 'Site Classificatan: — Q Feet O.C. Design Flow: Trench Width: _ . g Feetes Soil Aggregate Oepth: Application Rate: inches � Minimum Trench Depth: *System Classification/0escription: Inches Minimum Soil Cover. Inches Maximum Trench Depth: 'Proposed System: Inches Maximum Soil Cover: N�rification Field Inches Sq.ft. No. Drain Lines 'Distribution Type: TotalTrench Length: ft Pump Required: �Yes ONo �May Be Required Pre T�eatment: ONSF OTS-1 OTS-II "Site Modifications No grading or construcGon activity is allowed in areas designated for sysiem and repair without approva!of Health Depa�tment. 'Permit Conditions The issuance of this permit bythe Health Department in no way guarantees the issuance of other permits.The permit hotder is responsible for checking with appropriate goveming bodies in meeting their�equirements. This Authorization tor Wastewater Systen Constructlon shall ba valid for s person equa!to the pertod ai wlidity of the Improvenertt Perrnit nat to exceed fiv8 years.and mry be luued at the sametime the Improvement Permit Issued(NCGS 130A-336(b)}If the Installa�on has noR been completed dudng the perlod of validlry of the Constructlon Pertnit tha fMormatlo�wbmitied In ft�e appication for a permit or ConaVuctlon Autho�tzation is tound tio have becn t�ornec�falslfled or changed,orlhe site Is al�ered,the permlt or ConstrucUon Authoriznion shalt become invatid,and mry be suspended or revdced(.1937(g)).The person awning or oorrtrotling the systen shall be responsiWe Tor assuring oompliance with the taws,rutes,and permlt con�tlona regarding system IocaUon,Instatlatla�.operatlon.mafntenar��monitoring,reporting and repair (1938(bj�. Applicant/Legal Reps.Signature Required? OYes allo Applicant/Legal Reps.Signature- Date: � � 'Issued By: nad-oaywau, rew Date of Issue: _ � 4 � � 5 / a 0 3 Authorized State Agent: Malfunction Log DYeS OHand rawing Olmport Drawing TotatTime:(HH:����,�� **Site PIan/Drawing attached.** � Pege 2 of 3 � 1 Houts �inutes S-8-CA'S issued-new . � • CONSTRUCTION AUTHORIZATION w ; •. ., • , DavieCountyHealthDepartment CDP File Number: 120751 - 1 210 Hospital Street G0000002602 P.o.sox s�as County File Number: Mocksvilte NC 27028 Date: 0 4 / Q 5 / 0 � 0 3 Q inch DrawinQ Drawing Type: Construction Authorization Scale: . . , �Block = ,ft. � QN/A � P � I i .��- - ' - �-�__�.- ---� ' < < �_ -�.-!--�-�-�--; _.. ��-�-� i � � , . . , : � , �.._._�.�__.____�____.._i___..�..___._.._ �_.__. _._..__�..__�---...�..�.._..�... _,_ _i._ __ -- __ ___.�.__�.w_._ _.__ _ , .___ ,� _ _; i ( i i � i I � 1.:i_ �.__� � _� t I �` I �__ _I I _ f E r � ' � �:� � ' ��` , , � ! ! ; , i ' , i i ( � O� � �--.—+----�_�__._._..__v_! .._.�!_ I I � � � I { , � I i� _� � .__ _._ _._ __ :._____:_ ._�_._.,_^_.___ ____.__.._�_.___�.____._.__ ,�._.._ _ .�� _1_ I � I ' ► ! � ; _�_ ! I f I i ; ��� ► � , ,_ , � -- : . ---- �r— —'--- � E_._._I �— ___!_.__R____��—�_____�- �-!�-�--� GG ' _- _�-(b��- ��----�— - j ;� � � �' �Q ,' , � � ; f , i � I I � � �I ! �.� ( , . { 1___ ; ➢ ._____ .____._.___:_�._____._. __��_.__ ._�.___�._v.�+.___.____.._ �_. : � ` � I � I ;_ �, ._,._ l�� � I ! � 4 ( ��I j l _-! �=._..i__...._..�_��1+ - ...�� _.___.�__.._._. _...�. _.._. .____� 1 t S�, ' �-- - � � ( ; � I � I i � �� � �� i.� '� _____�� I � � ' �� l �n.�._.__+ ._._�_.. � � � _ ��__ .__ �.__ _ � , � __ ? � � ; : _ � .� �.�.�� 3_� ti i_____1 �� ( ..._._ I � � _ � �� ��� 1r _-� i —. � _ .. __ � � �' I �� i ____.�____._�.__..�_ I � _�_____._��. _�� .I - , ;— .; ----; -�- s�--- - ; � , . < < , , ,_ , �_ ' _---�__I_ ►_�_____... I. _ i__.�_,� � I_�_���!,��___� ._ � — _� ► - -�___ _._i � � �� � ��_��_,_..__� __ � �.._ _.� � _l____ � �_l.. � ` � .__. � .1..__. � �_ ! �? .__ � �.�.!._. ► � _._— � �J � � __ i ' - , r_�___ _,_ �.1_ _�_ , _ _;.M _ _ ,._�,�..,� _ _� �.. .. _�.__. __._ � � � � j , � , ► a � � I. � i ` ! _�.__? �__�_ _�___I__ �_ ►_�___1___�__ �-_�_-� � �_ , �- _+�_.r- .k i . s I � � ' � t � I I f , � � � j�__�_._.�.____i.�.�.?_ �- �- , �- - � ' : _. � __�_..____.., ! ' ! ; ' i I �� i��` �--� _!._ �_i�._�w �.__; �.. _ � __.� '� �._�._._ _ � ,—_I ;_____! i a� I � i � I _,_ I ' I E ! I � I �� I I � �--.-� -� ...-.-.A_�_ _ _ ;.._.__..1-...__.-�.__'_��.-•----� " _ _r. ' ...._ __._�...-�_.. _-... _ _.'._ � ^�^ _� ! '��� _i___ �� �l._-- � ----1_. � ___..�__ i �j_ __[..�� .._� .� `o_ ► --�1 ___._l i ;_ ;----_,.__.�. i -�--�� !.- - '- �--►- j _.�._ ;--j—j_.__-�__; -_k i � I�? I � 1 � I^ I--' I — —! �I I Y'— ; ' � � ; �--�—, � � � , � � _�_ �_ _.��. _____; { _____�_I____ � � � � � � _f� 1_ _ � � � � I � i _ � _�i� ! �__�'__ � ' i I _1 _1____� .._�� _'_ �_ �_�_ _� : _ �-- �� ._ � ..�.� � ,- -,-- - - - ,_ - - .____��� ;_ �_ �_ �� _..V!____..� :� \� ��___._ � � _.. .�_ . ___._ _ _. �. �-- -------�_..__��� � __._..�__._ _1�__I-__--._� _____..__.�( 1 ' � � ; . _�._.�. �a __ _ _ __.__.__. _ : _ __� s � i � � � � � _,. � E � 1 � 1 [ � I � � I —j— , � --+ - — ---� �_..�_ � ;�_1__ � ___��.� '� � � .. I _' . I__._ 1 � _ � I W..� __ � �. __.. � . �._ ! ._._ _.i _r�_._. _.�_.__ _� � ��. _�_ ( ��._ .�. ��_ .�._r.._ .�.�_ � — � _�_ .�. �— —� � �� � , � €! � i ( '; i � � I ! � � E � . I : � i i �._..___ _..._._(___....._.._____.Y__.__..� ..+_�__.� .�.____._,_;_...._....__ ..____..;M._._. _._._:...._�_...__.__._._____, ___.:�..__.�._.____�_...._...�._._....,...� !__ __�_ __�—i__►� � � ' .__ � _� 353` _—�—�_._.� � �_ I_ l i _ � _ i t ; � �1 � � �� E l � 1 4 _ � � _ � �--_i..__- ' _�__�-�� i���� I��I�I I E � !�1_�T C I _� .�.___._.�___ _._�___..__._ �.____________.___.___.____..__.___._____.,_.___._-------_F_.�___..___._�_�.______ _�_ ___.__._..�._.�.._���_ ,___�___._.____.._� PanR 3 af 3 i - t. � ' � � � �IMPR�VEMENT PERMIT ForOfficeUseOnlv *CDP File Number 120751 • 1 •:.5='"t• Davie County Health Department "� � County ID Number.Go400002602 � �i- � 210 Hospitai Street �, ., . � P.O.Box 848 Evaivated For. NEW ♦M�' . .. � . � . Mocksviile NC 27028 Township: Phone:336-753-6780 Fax:336-753-1680 pERR11T VALIO U��ITIL: �I/SIZO'IH "NOTE TO INSPEC710NS DIVISION: Building Permits cannot be issued with this Improvement Pertni� Appiicant: Greg Gobbie Property owner: Greg Gobble Address: 325 Georgia Road Address: 325 Georgia Road ��v� Mocksviile ��Y- Mocksvilie State2ip: NC 27028 State2ip: NC 27028 Phone�: (336)492-2411 Phone#: (336)492-2411 Pro ert Location � Site Information Address�Road#: Subdivisan: Phase: Lot: � Sheffield Road ' � Mocksville NC 27028 Olrections i � structure: SINGLE FAMILY Hwy 64 West, Right on Sheffield Road to 847 #of Bedrooms: � Sheffield Road Site bbehind brick house on left about� #of People: 2 2000 ft. off of Sheffield `Water Supply: PUBLIC S stem S ecifications nitial S stem *Site assi �ca an: Minimum Trench Depth: a 4 Inches Saprolite System? QYes Q No Maximum T�nch Depth: 3 6 Inches Design Fiow: a 4 0 Septic Tank: 1 0 0 0 Gailons Soi1 Applicatan Rate: 0 . 3 � 1-Piece: QYes QNo u Pump Required: QYes QNo Op,Aay Be Required 'System Classificatan/Description: TYPE 11 A.CONV SYSTEM(SINGLE•FAMILY OR 480 GPD OR Pum p Tank: G allons LESS) 'Proposed System: 25%REouCTlOtv 1-Pisce: QYes QNo Repair System Required:OYeS ONo ONo, but has Available Space Repair Svstem 'Site Classif�atan: � Minimum Trench Depth: a 4 Inches Soil Applicatan Rate: 0 . 3 Maximum Tr�ench Depth: 3 6 Inches .� "System Classification/Description: Pump Required: QYes Q No Q May be Required TYFE II A.CONV SYSTEM(S1NGLE-FAMILY OR 480 GPD OR LESS) 'Pfoposed System: 25°!o REDUCTION Page 1 of3 'CDP File Number 1�0751 - 1 County ID Number. Goo0oo02502 lSite Modiflcations ❑ Open Fiu Sheet No grading or constNction activity is allorved in areas designated for system and repair without approval of Health Depa�tment. *Permit Conditions The issuance ofthis permit bythe Hea�th Depa�tment in no tivayguarantees the issuance ofother permits.The permit holder is responsible for checking with appropriate goveming bodies in meeting their requirements. Site Plan The Mprovement Permlt�ar be valtd for 6 yeors from dste oi Issue wtth a slte plan(means a drawing not necessarfly dnwn to Osqte that shows�e exlsUng and proposed property Ilnes witl�dimensla�s.the loeanon otthetadllry and appurtmances,the �' site forthe proposed Wastewater system�and the locatio�oiwat�r wpptles and surtacewaters). Plat The�P�ent Pertnit shap be�slld without expl�tion wi�ptat(means a property surv�eyed prepared by a�eglstered land surveyor,drawn to a scale o!one Inch equafs no mor�than 60 teet,that Inctudes:the speciflc locatlon of the proposed fadtlty� ' 0 ar�appurtenancPs,the site tor the proposed Wastewater systen.and the Iocation at water suppltes and sunc�e watea. Plat ', also means,for subdivlslon lots approved by the locat plannl�g wthoriry and recor+ded with the county registerof deeds,a copy of the recorded subdivlsfons platUut Is accompaNed by a slte plan that Is drawn to acate). The Deputrnent and Lopl Heatth DepuOnent may Impose oonditlons on the Iswance and mry revoke the permlts f�tallure of the system to satisty the conditlans,th��es,or thls a�ticta This pertnit Is sub)ectto�ewcaslon it the slte qan,qat or Intenc�d use ctu�nges(NCGS 130A�35(q).The person owning or eontmtling tt�e system sha11 be responstbte tor assurtng complfance with the laws,ndes,and pertnit oonditions regardtng systen Ixation,Jnstallatlon,opera�on,maintenanc�moni�odng, repor�ng.and repair(.1938(b)} ApplicanULegal Reps.Signature Required? OYes �NO ApplicanULega1 Reps. Signature: Date: � � 'Issued By: 22a4-oaywa��and Date of Issue: e 4 � 0 5 � a 0 1 3 Authorized State Agent: , OValid without Expiration? O Create CA? OHand D ing Olmport Drawing **Site PIan/Drawing attached.** TotalTime:(HH:�.,�.,� 0 1 Nou�s_ t.�tnutes Page 2 of 3 � ActivRv Code: S-4•IP'S issued:new,valid tor 60 mos. - . , • IMPR01/EMENT PERMIT 120751 - 1 • . • , Davis County Healih Department CDP File Number: 210 Hospital Street G0000002602 P.o.eox sas County File Number: Mocksviue Nc 27o2s Date: / � � Q Inch Drawing Drawing Type: Improvement Permit Scale: . . . pBiock _ . .._.�-.- - T �—� QN/A - �ft, � + � � � 1� � � S ��_�—�—�^ � � ! � , . � ._.___ _....__,____._..�. ____. _ _ . __ __ ._ -_ _-- � f i �� � � � � ; �,, � 1 � � __�� _i-- r ---;- �;-,�1�_ . � , � � � � � ► � , i i � i . I I I I i _�. _ ! � y _ __ � __ � � _ __1__�:_�. _ ___��d�� _ + _ ► _l______�___�1___� _ � _��_._. ��1� _i_ _,_ _�_;��. _-_�_�i a�—_ � i �I� � ___� _�. ° - --.�____. _� � ._�_ I� �._ � � �.__ .____�___I___. ___..! __ ----�----�--�____l �__ i_____�__._ _.�__ _;_.__ __�_ j_ �_,�___.__ __.__;__ ��_�_.__.�. .► _ � _ _�__ 1 _ � � f - _ � � � �._I___. � � _ _.____�_ _ _�__ � E � � 1 ��._�._._��__ � ._.� ; :�� __._.�_ ! ;_---;_ �.,o f� � ! l _ . I i__ � _1__ _j_.-�__ �__�_f___t_I._ _ _!___ ' _ � �. i I � , �I : _ ' _�_._.�� - � -.�— --i� � � � ►� ' � ��� _~i __ ! ' I � � _�_ � _f:._ _,___ �_�, i ___ _ _�_ _.r� _,�_._...._.._.___�._._. r ��:�.i �_____i ��� __ � � 1�._�_ _�____ � �? __._,_ � __ �_ �;. �.____1_�.�____ --�. , ��� _ � . . ---.. � r. . 1 ► 1 I ! 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C I f i � � � i � �� — � i � —f-- -I �i—;--�� ._ _�_..�j_____._ _ �_ _;_ __.___`._._.�. _ ___� T.�.._!.______ ` _.� __---�--_�_.1_ � _.__ �__�__...►_.___�..__u___�_.__.�_ � � � � 1 ..�__.__._��_� � 1 _.�..+..�._.._,_ i.��,... 1 � I ! _ i i � I 1 � __. 1 �_ �-- —l_�l _—� 1____�—�—_ ����._^�� .__ �i _ ; � �_ I �-1 _ � � � _ i ____ E _.__ _ � _� � � 1 1._____:�__..._�_. � _..�- -_�____.�_ _ �___�_.��._ _ _�__ �.; _;_ _!�. _i_ � _____....__��. , �_� � j_ ._�� E y_i � _ � � � __� I �� � � I � ( I 1 I ; { ! i � E i ! � �_____ ._�._._.__.__.__.._.___._ ____, _ _. . __�_ ,_._.__.___��._._; _____. -- � --� , -- '���i � � 1���� ; � i � �_— _ ► � 1_ �_.__J_��--� 3_� �___► -.�_�.__�___ � �_ � I � � I �I 1 T � _ � �____�l__—�_____ rt __._.-_�_��L�__i_�f I L ��^� �'� -.� ��_I I I ! __ Page 3 of 3 .� _. , . • ► i • � APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC Davie County Environmental Health _ ��`� ��P P.O.Boz 848/210 Hospital Street � A C� � � � � ,�:, 4� "L �,�j`�� / Mocksville,NC 27028 `� � 6`"'� �(,� �' (33�753-6780/Fax(33�753-1680 �� � I�o'�_- Applicati�,i . .- rte Evaluation/Improvement Permit ❑Authorization To Construct(ATC) 0 Both Type of Application: ❑New System ❑Repair to Existin�System ❑Expansion/Modification of Existin�System or Facility ***IMPORTANT'R**THIS APPLICATION CANNOT BEPROCESSED UNLESS ALL OF TI�REQUIKED INFORMATION IS PROVIDED. Refer to the INFORMATION.BUL�.ETIN for instructions. --�- APPT,TCANT TNF(�RMATTnN Name D � Contact Person C�7A[��D�.. Address ? � Home Phone 3 - - 4 I 1 City/State/ZIP '► IV a d BusinessPhone 3310-3g�1-C�SDa CeJI� Email ' Name on PermidATC if D�erent than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Comers Flag�ed NOTE: A survey plat or site plan must accompany this application. Included: ❑ Site Plan OPlat(to scale) (Permit is id for 60 onths with 'te plan,no ira'on with complete plat.) ' Owner's Name ' r�__ Obb�� � �►inL��l t� Phone Number .33�- 3�-bSDa Owner's Address City/State/Zip�SU�1� .1y� a-10a� Property Address �'j{�.L����IG'r c� � City �(�kSVi I(P _ , Lot Size Tax PIN#��jUDUDb o��Da► ' Subdivision Name(if applicable) Section/Lot# 1� rr ' Directions To Site: ��-I- D� vC1CSU�I LJe }- S� '-�-�'ie��1. (xi 1 SY�t-t-IE 1{�qGC� ) i rl C �e If the answer to any of the following questions is"Yes",supporting doc entation must e attached: ' Are there any existing wastewater systems on the site? Yes,�No . i Does the site contain jurisdictional wetlands? Yes �[No Are there any easements or right-of-ways on the site? Yes �io Is the site subject to approval by another public agency? Yes �No I Will wastewater other than domestic sewage be generated? Yes�/No j TF RF,S�nF,NC.F,FTT,T,ni TT THF,RnX RF,T.nW ' #People �� #Bedrooms �_ #Bathrooms 1 � Garden Tub/Whirlpool DYes �o` Basement•. [9'Yes ❑No Basement Plum,bing: ❑Yes f�to � � �F�T�N-RF,STDF,NC:F..FIi.�:,niJT THF,BnX�F.I�nW Type of FacilityBusiness Total Square Footage of Building #People # Sinks #Commodes #Showers #Ur'►nals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: # Seats Typesystemrequested: OConventional �Accepted ❑Innovative ❑Altemative ❑Othei ' Cl�anrh.c�.r S Water Supply Type:�County/City Water ❑New Well OExisting Well . � Comznunity We�l Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes �o If yes,what type? .. This is to certify that the information provided on this application is true and correct to the best of my lrnowledge. I understand that any permit(s)or ATC(s)issued hereafter 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 comers and locating and flagging or,gtaking e/ cility Ioc�ti�prQp�ed well location and the location of any other amenities. " ��� bUlJ Site Revisit Chazge Pro owner's or o r's legal representative signature Date(s): �--� y— aU�3 : Client Notification Date: Date EHS: ���� I �o��l . Sign given ❑Ycs ❑No Account# � Revised 11/06 Invoice# � Cd ��� . , ; , 3 3�-I . �� ' S -��c T�NK � ' 1`��s� �riv� � �'8'x 5C9' dJ �': , q Q � lc� � � ' t.� �� ,. i ; � i , - -- ' 3s3 . g�J ' ' l,� tn�l,es �a Us ��w� [o�l i � � -l E� Q� � • ; . ` } _CiJj.t J— .�./J=�J � JZ•�.-7._L�%` ��'~ . " `�''� C1 g�1 ��r� i i . ti", fr �_� - ,t� f��__,__ �` �7� —�f� i �-�_� 881 � , - ____�----'-''""__._.-�.� �.'� l.i I /r' �,��a � r ��1 e�� � ..�,;, 12P, , ,:�� �k;�� ;' �=�-�����a // � `l � U ; -r-`� '.c,�`7�;� ; — ..- -��Y w� /� �s===-?��} 780 1`CF /' 1 i C�1'/.__r.Vo .__ . __.._ ._. ."' -......_.. ._._..� �� �i 1 ��` � \���"_`_l1 � '^'J� �� �}.�_7�� �� •`4 2�f�l . .. �'"y , 1 177 14J l�� 728 - - , � - . i27� l` _ .��--'`. ��-���r-,,�,� '�7,19 --- - � � ��,3 �00 s . ��,t � � C� pPe IF �Ail data is provided as is witAout wananly or guanntee oi any kind sither exp�esssd or implied including but not limited to the implied � ���� �C warranties ot merchanGbility or fitneea for a particular use.All uaen of Davie County's GIS websfte ahall hold hartnless the County of �(1 N� ' � Davie,North Carolina,Ms agenb,conauttants,contracton or employees hom any and all dalms or causea ot aetion due to or arising out of Printed:M a r 21 2013 � the use or inabiliry to use the G�S dafa provided by this websits. � ' • Appraisal Ca�d , , Page 1 of 1 DAVIE COUNTY NC 3 21 2013 9:41:43 AM OBBLE DARNELL GOBBLE LOREAN Retum/Appeal Notes: G2-000-00-026-02 , UNIQ ID 968388 SPLIT FROM ID 10112 - 9356000 ID N0:5810030178 � COUNTY TAl((100),FlRE TAX(100) CARD NO.1 of 1 j eval Year.2013 Tax Year.Z013 4.00 AC SHEFFIELD RD . 4.000 AC 4.000 AC SRC= .T� raised b 17 on 12 31/2012 03002 CALAHAN TW-01 C- EX• AT- LAST ACTION 20130109 � CONSTRUCTION DETA2L MARKET VALUE DEVRECIATION CORRELATION OFVALUE D OTAL POINT VALUE ER. BASE � Co BUILDING USE MOD Area UAL RATE RCN EYB AVB REDENGE TO � m AD7USTMENTS 97 00 %GOOD EVR.BUILDING VALUE-CARD p OTAL ADJUSTMENT EPR.OB/XF VALUE-GRD D ACTOR T'PE:Vawnt ARKETUNDVALUE-CARD 33,62 �Z OTAL QUAUTY INOEX STORIES: OTAL MARKET VALUE-GRD 33 62 � OTAL AVVRAISED VALUE-CARD 33,62 r OTAL AVVRAISED VALUE-PARCEL 33 62 OTAL PRESENT USE VALUE-PARCEL - OTAL VALUE DEFERRED-PARCEL � OTAL TAXABLE VALUE-VARCEL 33 62 � PRIOR UILDING VALUE , BXFVALUE � D VALUE . RESENT USE VALUE EFERRED VALUE OTALVALUE GERMIT CODE DATE NOTE NUMBER AMOUNT OUT:WTRSHD: SALES DATA FF. ECORD ATE DEED INDIGTE SALES . � OOK AGE TYPE / / PRICE 9 HEATED AREA NOTES = PLIT PER VLAT 2012 C� SUBAREA UNIT ORIG% SI2E ANN DEP % OB/XF DEPR �;' , GS RPL OD UA ESGRIPTIO T NIT VRICE COND LDG / FACT Y RATE V COND VALU � C TYVE AREA CS OTALOB XFVALUE � REPUCE � 0 UBAREA ' 0 OTALS ro 0 UILDING DIMENSIONS o ND INFORMATION �" IGMEST TMERADJUSTMENTS UND TOTAL � ND BEST USE LOCAL FRON DEPTH/ LND COND ND NOTES OA UNIT LAND UNT TOTAL AD]USTED LAND �AND SE CODE ZONING TAGE EPT SI2E MOD FACT RF AC LC TO OT TYPE CRICE UNITS TYP AD]5T UNIT PRICE VALUE NOTES URAI AC 0120 0 0 1.3750 4 0.9400 30+14+00-30+00 pyV 6,500.0 4.00 AC 1.29 8,404.5 3361 OTA�MARKET LAND DATA 4.0 33 62 OTAL VRESENT USE DATA http://maps.co.davie.nc.us/ITSNet/AppraisalCard.aspx?parce1=G20000002602 3/21/2013 . a - • � ' , , � . V) . Iron pipe found ��Orien , "CONTROL CORNER" S 87°53'20"E—• "CONTROL CORNER" . 590.40' . W , 3 ' . o M o , o M 4. 661 A cres f — � o 0 � � M o � o 2 , � , 1 1 •oC��� ,C�� N e . ���pp„ 6 _ _ go, F y� �� \o° — �_ — — --�_ _ \,� 590.08' � � 2� _" �_+------------_� N.-8�°pp'00"r{r � � ti�� N 86°00'.00'.'W 638.92't ----------+ �---'-- � � _�--�. ,� W � � ...`�.;.. Larry 1). Gobble N ��7�20 �� I�.B. 118, Pq. 356 1 . � � 1 � ` ' ' ' • ' • . DAVIE COiJNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation � APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990006038 Tax PIN/EH#: G0000002602 Billed To: Greg Gobble Subdivision Info: Reference Name: Location/Address: Sheffield Rd.-27028 Proposed Facility: Residence Property Size: 4.66 Ac Date Evaluated: 'y�_/�Of�_ Water Supply: On-Site Well Community Public �'�' Evaluation By: Auger Boring z. Pit Cut FACTORS 1 2 3 4 5 6 7 - Landsca e sition � L. Slo e% � HORIZON I DEPTH Texture rou L CC ' Consistence ./L � Structure �' r Mineralo ' : i HORIZON II DEPTH I- �' .�/Q' • Texture rou C � Consistence R /1 f Structure - Mineralo �� C : HORIZON III DEPTH Texture rou Consistence Structure - Mineralo HORIZON IV DEPTH Texture rou Consistence Structure Mineralo ' SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S P ' LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: �S EVALUATION BY: LONG-TERM ACCEPTANCE RATE: ' / OTHER(S)PRESENT: � REMARKS: ` LEGEND T, n s ape Position R-Ridge S -Shoulder L-Lineaz slope FS-Foot slope N-Nose slope ' CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope �ill� , 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 : � ,�'ON�ISTENCE a'IQ1St , _ - 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 ,�Ltl�tllT.g _ . SC-Single grain M-Massive CR-Crumb GR-Granulaz ABK-Angulaz blocky SBK-Subangulaz blocky PL-Platy PR-Prismatic Minerala�v 1:1,2:1,Mixed . 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