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127 Mollie Road Lot 12-- DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 989900204 Tax PIN/EH Billed To: J. D. Crews Homebuilder Subdivision In Reference Name: Jerry Crews ATC Number: 4324 AUTHORIZATION FOR WASTEWATER **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUI Health Section prior to issuance of any building permit(s). This Form/Aut the Davie County Building Inspections Office when applying for building G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatmen AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID Environmental Health Specialist's Signature: CERTIFICATE OF 5801-10-6512 Sheffield Acres Lot # 12 Mollie Road -27028 CONSTRUCTION D by the Davie County Environmental orization Number should be presented to ermit(s) (in compliance with Article 11 of and Disposal Systems). THIS 7OR A PERIOD OF FIVE YEARS. Date: **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit has been installed in compliance with Article I1 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. Septic System Installed By: Health Specialist's Signature: DCHD 05/99 (Revised) Date: Y DAVIE COUNTY HEALTH DEPARTIV x Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PER Account M 989900204 Tax PIN/EH Billed To: J. D. Crews Homebuilder Subdivision In Reference Name: Jerry Crews Location/Addre: Proposed Facility: Residence Property Siz( **NO I*"I1irs�mprovement/Operation Permit DOES NOT authorize the constructior system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTF Department prior to the construction/installation of a system or the issuance Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewa€ PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE I WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERM Residential Specification: Building Type #People h Dishwasher:Garbage Disposal: Washing Machinetw ,e Basement w/F Commercial Specification: Facility Type #People r #People/Shift _ Lot Size Type Water Supply 11,46 Design Wastewater Flow (GF System Specifications: Tank Size `vBIGAL. Pump Tank GAL. Trench Other: Required Site Modifications/Conditions: 5801-10-6512 Sheffield Acres Lot # 12 Mollie Road -27028 327x92x308xl if a septic tank system or any wastewater ACTION must be obtained from this r building permit (in compliance with Treatment and Disposal Systems). THIS (TENDED USE CHANGE. YOUR BEFORE INSTALLING SYSTEM. edrooms (,—? #Baths�� robing: ❑ Basement/No Plumbing: ❑ #Seats Industrial Waste: ❑ -,?JP Site: New Repair ❑ '�/ Rock Depth I -IC)Linear Ft. L9 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.**** r Environmental Health Specialist's Signature: DCHD 05/99 (Revised) r 11"'117, Date " PPUCATION FOR SITE EVALUATION/IMPROVEMFNf PERMIT & ATC pn D Davie County Health Departinent Q U Environmental Healdt Section P.O. Box 848/210 Hospital Street 2006 Mocksville, NC 27028 �cQ 1 3 (336)751-8760 ***IMP * THI3 APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED I VID/ED... Refer 'I,to-�the INFORMATION -BULLETIN for instructions -nnss ftJructtipons. 1. ,o be Billed D t�tZ C�(15 T'N/IV 6FBW(„DE'2 Contact Person ;9;2-RRg Mailing Address L401 ELM09U5- 2,4— Roine Phone -5422- 7Z&Iate City/State/ZIP _ rii0(,,KSfLIE t4C. ;l-7C%.a Busineie Phone sor . than 2. Name on Permit/ATC if Different an Above Mailing Address 3: Application For: ❑ Site Evaluation Wimprovemeitt Permit/ATC ❑ Both 4. system to service: LW House ❑ Mobile Home ❑ Business ❑ Industry ❑ Other S. __/I��ffResidence: / # People ''� // � # Bedrooms � p Bathrooms W Dishwasher W!9.bage Disposal &4.1hing Machine U Basammlent/Plumbing CJ Basement/No Plumbing 6. If Business/Industry/Other: Specify type # People # Sinks # Commodes # Showers # urinals - # water Coolers IF FOODSERVICE: # Seats 7. Type of water supply: Estimated Water 6/County/City e. no you anticipate additions or expansions of the facility this system is If yes, what type? ***1AfP0RTAN7*** CLIENTS MUST COMPLETETHE REQUIRED P BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the c Property Dimensions: 327 �X 9).. X 308 X 130 WRITE DI. Tax Office PIN: # 58 D 1 1 O 4E-1 Z RLLY In 1 Property Address: Road Name MotLiE, Ro)gD f0 Ri9 lags (gallons per day) Well ❑ Community d to serve? ❑ YesVo 'sRTY INFORMATION REQUESTED with THIS APPLICATION. 'IONS (from Mocksville) to PROPERTY: City/Zip tiro az8 ohl 4cIrT- If in a Subdivision provide information, as follows: _ Name: SHEFFi tZ L f�Cl2t S Section: Block: Lot: e2 Date This is to certify that the information provided is correct to the best of my know issued hereafter are subject to suspension or revocation, if the site plans or inter submitted in this application is falsified or changed 1, also, understand that f al this application. 1, hereby, give consent to the Authorized Representative of the to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitabi6)y-) DATE X - 13 - `D'ks SIGNATURE Flagged: 2 - /O- a �- .dge. I understand that any permit(s) led use change, or If the information responsible for all charges incurred from )avis County Health Department 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). 5elF ATrelf-1+ D pl-Wr MAV Site Revisit Charge Client Notification Date: EHS: Account No. gg Rooz Revised DCHD (07/99) 1Invoice No. W N AREA= ti d- <v / "0 2.193 AC.lo 14 LO 6 AREA- Q- � Fie qct '` � 10' UTILITY �J� b~ pq v vc DRAINAGE EASEMENT L6 L5 C6 20' ExiS-nNG LOT 7 — Li �R EA = 0.841 AC .UTILITY & - <v���� DRAINAGE EASEMENT J \ . ?f C� �� / s ZE 0 4 s 8 - E ARE .995 25' RADIUS (TYP.)�^ 40' RADIUS (TYP.) ' ' C``- ILh LOT 8 � ry gi.41; AREA= 0.799 AC. 1 FIRE307.99 ° FIRE M / P/ 10' DRAINAGE HYDRANT HY i� F�� LOT 11 O J ���� EASEMENT 10'X70' 31GHT� — AREA= 0.841 AC. Q! Q EASI? ENT- 4.09 co LOT 9 0 oil 6� ti `'��o AREA= 0.965 AC. ��+ X19. _� o• GJ LOT 10175,00 y �� AREA= 0.812 AC. _°' P.I.P. 116.2$ eQ/ 122.99 N 82.47'24' w C715.50 7074I) P.I.P. � 89.91 55.00 / J LARGE NAIL NAIL/& CAP / IN ROOT r /I Rnen Nek) KAP LD 1Z' OCT 1 4 TOO"' ON FOR S1TL evluuaTiON/IrolpildvDi IENr P Shur s nI C Davie County Health Department b7iironi»enta/Hes/f/r Section ENVIRONMENTAINFAIIH •0: Dox 848/210 Hospital Street 0AVIECDl1PIlY Mocknville�.NC 27028 (336)751-87GU., .***IDSPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLLSS ALL Tim REQUIRED I -\ INFORMATION IS PROVIDED.Refor .to the INFORMATION BULLETIN for inD L•ructiOLLJ y� � 1.,. Noma to be DSllod .LL12_LA/y*al2D lll7 !lC�.( _ ConL•act Pcrnon Mailing Address _ `/%Q — /O'a �g[1JI y��Qe� �/� !lane Pl,onc City/State/ZIP �,( i near Phuna " o,,, �,+.alvs, lV L �7� / � '' seri �_� _.._.. ..:.. . 2. Nano on Permit/ATC if DLZZaront than Above Sikh-Pi - - Mailing Address - City/state/Zip 1. Application For: �21iite Evaluation- .❑ Improvement.'Pelznit/ATC ❑ IluLh 4. Sint= to Service: t'yHouse ❑ Mol;ile Home ❑ Duninebs ❑ Industry ❑ 0thol 51. TYPO systole requested:, ff Convantional ❑ conventional moditiod ❑ innovu L•iva s. If Residence: 11 People p Bedrooms 3 11 BaLluooniu 2 ❑Dishwasher ❑Garbage Disposal ❑Washing Machina ❑nasanent/Plwnbing ❑nasoma,L•/llo Plumbing 7. IZ nuaSaaas/Industry /Othari verify typo - It People tl Cotwwdoa 11, showers D Urinals 11 Water Cooloru IF FOODSERVICE: Ek Seats Estimated Water Usage (gallons pax day): _ a Typo of water supply': E County/City ❑Well ❑ CoimnuiiiLy : S. Do you antieipato additiona or expansions urlllc facility this system IS iulcllded to serve? ❑ Yes ❑ No irycs,tvhattype? ***IAIPOItl!ltYY***CL1EN'fSA1USTCOAfPLLTVTIE EILL QUJ/tBDPROPIQUYIN1�ORA4AT1oNREQ[JESTI'D. —I *BELO\Y. Hitler a PLAT or SITE PLAN Al USTBESU1L111TT6D by ti client n)tb TII1S API)1 ICA'I'ION Property Dilncasions: �r;./e�� �i-%-/ /p- /7 O 1 RITL•• DIRECTION S (rrail, 6lud<svillc)�Iu�I1ItO/I tf lt'I'1': iaa.off)cePIN:Il s 8PI4/0 -5`/6 dt7 /ar'/ IL Properly Address-. Road Namc � � d �a � �y/ , , kr/ l ' city/zip esG ��e Il �7aS� Iris a Subdivision provide information, as follolvs: Name Section: BE Lot: Datc 1101110 corners flagged:' This Is to certify that the informaliou provided is correct to the best of Illy loiou•ledgc. I understand that any pen nitt(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if Elio inloriva lime submiucd in this application is L•tlsilicd or cinar,, ingcd. also, anders[rind that I run r'SIVIlsible jur all clatives htcurred from !/ris applicariau. I, hereby, give consent to ilm Authorized Representative of the Davie Cuwlty IIcallh Dc t:u•lweut to enter upon above described properly located in Davie County and owncd bysJtitea, MCL's/1,,,,;�/ to conduct all testing proced ores as necessary to delcru11110 (he site suitability. T DATE SIGNATURE . THIS AREA MAY BE USEDFORDRAWING YOUR SITE PLAN(Iuclud all of!110folloving: Lxislingandpropused propertylines and dimensions, structures, setbacks, and septic locations).: Sign given 10-1—A Tnntn AccountNo. )CH I I I J. BRYANT NCCLANROCH I T D.B. 186 PG. 484 / ZONED R -A Aa 122. I FAN 92'17'241 y 9� P.I.P. ��E ii 66 CNONO -C7 C715 TAU 136,35 Ory 700.00 90.68 90.61 45.40 89.91 - w 811'32' LOT 5 :. v W AREA= Nn 0) 0 2.193 AC. S. KEATON LOT 6 4 I o o h� AREA= PG. 12 R-20 " \\ 2.097 AC. I D.B. 189 PG. 307 \ \ y \ zp N 8512'46' W Q ZONED R-20 \ 10' UTLITY h . -.----.- DPAHACE E19 ENT f \\ L a 59'3737' \\ \II 20IYT E PAVEROA a D MOWE J LOT 7 u 015 - -,o• 50.00 AREA= 0.841 AC. ill.- � 4 25" RADUS (1YP LOT 8 AREA= 0.799 AC. 10' WANACE EASEMENT i � i _ >a E LOT 9 AREA= 0.965 AC PALLETONE OF NORTH CAROLINA D.B. 392 , PG. 810 ZONED I -2-S I m I LOT 12 ~ 4` AREA= 0.995 AC. g \ h> � N gli1,10, y \ �4 307.99 \ LOT 11 10'%70' \ AREA= 0.841 AC. 8 e Q `mow 11 R� co Dey eye . W q LOT 10 s4 z AREA= 0.812 P.I.P. CURVE 122. I FAN 92'17'241 y 9� P.I.P. RADIUS 8 �j CNONO TANGENT C715 TAU 136,35 T25'19' 700.00 90.68 90.61 45.40 89.91 3S / 811'32' 700.00 100.09 100.00 DOLMCE N ROOT ` 0) I / J. W. KEATON gi 4 I I JOHN W. KEATON D.B. 190 ZONED PG. 12 R-20 / v _ I D.B. 189 PG. 307 \ \ 10260 51.44 N 8512'46' W C7 ZONED R-20 \ 25.00 21.03 20.41 c W N 2823'05' E C8 59'3737' 50.00 52.03 I \\ S 2039'56' W C9 A 50.00 UNE BEARING DISTANCE 37.50 I \� L1 548'49'D4' W 45.00 64.35 50.00 L2 L3 5 3T52'49' W N 570712' W 53.87 80.1J 6715'22' - L4 N 5T07'lY W 19.58 N 11'15'48' W C12 L5 5 89'24'56' E 98.21 7-35 _ �.-. 1' ` L.6 L7S S 89.24.56' E 071723' W 9061 75.37 25.00 13.65 La L9 S OT1Y23' W S Or17'23• w 60.00 15.72 C14 6817'41' LID S OTI7'2T W 78.28 - S 4826'14' W LIT N 89'23'53" W 122.91 203.66 202.83 L12 N 52'0711' W 97.65 1034'40" 650.00 120.00 119.63 80.17 N 6533'29' W C17 2"52'23" 650.00 CURVE DELTA RADIUS ARC CNONO TANGENT CHORD NRG C3 T25'19' 700.00 90.68 90.61 45.40 N 60'54'55• W 04 811'32' 700.00 100.09 100.00 50.13 N 68'43'20' W C5 911'32' 700.00 100.09 100.00 50.13 N 7854'51' W C6 824'19' 700.00 102.69 10260 51.44 N 8512'46' W C7 4811'23' 25.00 21.03 20.41 1 L.18 N 2823'05' E C8 59'3737' 50.00 52.03 49.72 28.65 S 2039'56' W C9 73'423' 50.00 64.35 60.00 37.50 S 4801'02' E CIO 73'4'23' 50.00 64.35 50.00 37.50 N 8014'34' E Cit 6715'22' 50.00 50.45 56.84 34.54 N 11'15'48' W C12 1854'05' 25.00 7.37 7-35 3.71 S 37-26.57- E C13 31'17'18' 25.00 13.65 17.48 7.00 S 13'21'16' E C14 6817'41' 25.00 38.53 34A324.27 3470-102 COOK PLACE DR. S 4826'14' W C15 17-57'08' 650.00 203.66 202.83 102.67 N 79'49'23' W C16 1034'40" 650.00 120.00 119.63 80.17 N 6533'29' W C17 2"52'23" 650.00 32.59 32.59 16.30 N 5849'58' W APPROVED: � DIS ICT ENGINEER THIS THE U DAY OF A�-•�^��� 2005 NORTH CAROUNA - DANE COUNTY LEGEND •E.I.P. - EXISTING IRON PIN Q P.I.P. - PLACED IRON PIN + - UNMARKED POINT 0 N.I.P. - NEW IRON PIN 41) - WATER VALVE it - FIRE HYDRANT NOTES: 1. 14 TOTAL LOTS TOTAL AREA - 15.072 ACRES (ROADWAY NOT /2. INCLUDED); ZONED R -20/R -A 3. AVG LOT S12@ 1.077 AC. pl 4. MINIMUM SET -BACK LINES: 40' FRONT, 30' REAR 15' SIDE AND 25' STREET SIDE 5. ALL NEW UTIUTIES SHALL BE UNDERGROUND AND ARE LOCATED WITHIN THE 10' UTILITY EASEMENT. 6. STREET RIGHT-OF-WAY IS 50 FT. 7. DAVIE COUNTY WATER HAS A 6' WATER LINE IN PLACE ALONG SHEFFIELD RD. AND A NEW 6' WATER LINE ALONG MOLLIE RD. AS SHOWN 8. EACH LOT SHALL HAVE AN INDIVIDUAL SEPTIC SYSTEM TO BE APPROVED BY THE DAVIE COUNTY HEALTH DEPARTMENT 9. NO N.C.:;.S. MONUMENT WITHIN 2000' 10. IRON STAKES SHALL BE SET AT ALL LOT CORNERS. UNLESS OTHERWISE NOTED 11. THIS PROPERTY IS NOT LOCATED IN A FLOOD ZONE AS DETERMINED BY F.EMA 12. LOTS 1-5 SHALL HAVE A 20' WIDE BUFFER TO CONSIST OF EVERGREEN SHRUBS SPACED NO MORE THAN 5 FEET APART, AND ONE ROW OF DENSE SHRUBS THAT ARE 3 FEET OR MORE IN HEIGHT AT PLANTING. THIS STRIP IS RESERVED FOR THE PLANTING OF TREES AND SHRUBS BY THE OWNER: THE BUILDING OF STRUCTURES HEREON IS PROHIBITED. LOTS 1-5 SHALL ALSO HAVE UQUSTRON TREES h ULUAN CYPRUS TREES PLANTED AT 40' ON CENTER. PLAT MAP OF: SHEFFIELD ACRES OWNER ------------------ DEVELOPER THE CANA GROUP, LLC 3470-102 COOK PLACE DR. CLEMMONS, N.C. 27011 (336) 998-2095 '-. CLARKSVILLE TOWNSHIP DAVIE COUNTY, NORTH CAROLINA AUG -25-2005 TAX MAP REF.: F-1, PARCEL 112.09 SURVEYED BY: TUTTEROW SURVEYING COMPANY 107 NORTH SALISBURY STREET MOCKSVILLE; NC 27028 (336) 751-5616 SCALE: 1' = 100' 100 50 0 100 200 300 SCALE IN FEET FILE RIME: COORD NAME: DRAWING NUMBER: MCCUJER MCCULL-51 34500-3A REN6ED: a -36 -OS) T-IHl[RSECTgN t0 -18 -OS A -I BUILT PAVE. Y DAVIE COUNTY HEALTH DEPARTIV x Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PER Account M 989900204 Tax PIN/EH Billed To: J. D. Crews Homebuilder Subdivision In Reference Name: Jerry Crews Location/Addre: Proposed Facility: Residence Property Siz( **NO I*"I1irs�mprovement/Operation Permit DOES NOT authorize the constructior system. An AUTHORIZATION FOR WASTEWATER SYSTEM CONSTF Department prior to the construction/installation of a system or the issuance Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewa€ PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE I WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERM Residential Specification: Building Type #People h Dishwasher:Garbage Disposal: Washing Machinetw ,e Basement w/F Commercial Specification: Facility Type #People r #People/Shift _ Lot Size Type Water Supply 11,46 Design Wastewater Flow (GF System Specifications: Tank Size `vBIGAL. Pump Tank GAL. Trench Other: Required Site Modifications/Conditions: 5801-10-6512 Sheffield Acres Lot # 12 Mollie Road -27028 327x92x308xl if a septic tank system or any wastewater ACTION must be obtained from this r building permit (in compliance with Treatment and Disposal Systems). THIS (TENDED USE CHANGE. YOUR BEFORE INSTALLING SYSTEM. edrooms (,—? #Baths�� robing: ❑ Basement/No Plumbing: ❑ #Seats Industrial Waste: ❑ -,?JP Site: New Repair ❑ '�/ Rock Depth I -IC)Linear Ft. L9 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.**** r Environmental Health Specialist's Signature: DCHD 05/99 (Revised) r 11"'117, Date " DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account M 990002086 Tax PIN/EH M 5801-10-5600.12 Billed To: The Can_ a Group,LLC Subdivision Info: McCullough Property Lot # 12 'Reference Name: Location/Address: Sheffield. Rd. -27028 Proposed Facility: Residence Property Size: , . see map Date Evaluated: J�> 2 Z L i Water Supply: On -Site Well Community / Public Evaluation By ger Au , . ' � Boring Pit 1✓ ( � Cut ' FACTORS 1 2 3 4. 5 6 17 Landscape position L Slope % HORIZON I DEPTH </ •� Texture groupSg Consistence . Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure Mineralogy .. l 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 J SITE CLASSIFICATION: P^ 'EVALUATION BY: LONG-TERM ACCEPTANCE RATE: / OTHER(S) PRESENT: ` LEGEND Landscape 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 SandLS - 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 Mineraloev 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 DCHD 05/99 (Revised)