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1964 Sheffield Road Lot 20DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section f P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001459 Tax PIN/EH #: 4871-81-8453.20 Billed To: Alan Hinkle Subdivision Info: Sheffield Farms Lot#20 Reference Name: Location/Address: Sheffield Road -27028 Proposed Facility: Residence Property Size: 5.7 acres **N07EispoeeMmnt/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 Dishwasher: Garbage Disposal: ❑ #People #Bedrooms 7 #Baths 2_ Washing Machine:;511� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type - #People_ #People/Shift #Seeaats Industrial Waste: ❑ Lot Size Type Water Supply /(%l/I Design Wastewater Flow (GPD) G p Site: New ❑ Repair ❑ ', /J System Specifications: Tank Size GAL. Pump Tank _GAL. Trench Widtl>�� Rock Depth Jam° Linear Ft. -� d Other: Required Site Modifications/Conditions: 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.**** D •/d S6 D� Environmental Health Specialist's Signature: Date: /a —31-00 DCHD 05/99 (Revised) » . DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bog 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001459 Tax PIN/EH #: 4871-81-8453.20 Billed To: Alan Hinkle Subdivision Info: Sheffield Farms Lot # 20 Reference Name: Location/Address: Sheffield Road -27028 racu¢y: mesioence ATC Number: 2624 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION 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 WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ital Health Specialist's Signature: &W/ Date: 1 f20'(9-� 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. 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: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) Date: APPLIcanON FOR Davie County salsa Department PFJiMR & ATC D [ Q .� _ Envliwtmonla/Hes/thSee:�►an rm-r 0 ?.O. Box 840/210 Hospital street 41v1 9 20�� UVJ Mookavilla, NO 27028 (336) 781-0760 ENVIRONMENTAL HEALTH DAVI•*eIl�tNtTANT►* - SBIB AVKJWLCASION t ARMT HD PROC8B8)!D VNL1Z88 ALL SRm REQUIRED 1-1 INIORNATION i8 P"IsDRD, Reler to the Ittl01tt018ION BULLETIN for laatruations. 1. tier te t,. siuea L .� s j! X"17 amt..... G Centeet Dereen 5 t-P "e � p jV -G . v1-7013 eon t+hoo. '�/G cat3r/tate/azD G -el))ew SuaLneso Mw" 0. 2. Nese an Permit/ATC It Di!lerSoti than Above - Cit!/tate/fig a. t:pplication ror: B Bite Evaluatioa=� /o'3o-a� p. �,.,,.,� O6:/i� —ae.r�rovOm"t r.rmit/ASC 11 Both e:` hr`.co.a seaTln�, O, douse . iWNobile Roma " O Buoiness O Indus e. I! ttesidence: try 0 Other / People _� I Bedrooms / 1 Bathrooms O� ..hx..Ms O O.sb.a. Di.pe..l ":Ss ins k1chine O au.n.nt/Dlumbina D aa.�nlpto Dliobina - 6: I! toelneee/zaer �etry/Oth, ar+oily type - :I Coemoye - ., People - I flake .. ;. _ I Showers - Csiaele - - Water Cooler. - I>r,gOODBERVICE: / seats Estimated hater Una4e toulow per a+71 7. Type of water supply: - U County/City O'Neil ❑ Community s. Do you anticipate additions or expansions of the facility this sydem is in to serves O Ya P] ilio If yes, what type! 7."a-IMPORTAN7#ee CLIENTS AIpLSTpOSfptETE INE REQUIRED PROPERTY INFORMATION REQUESTED BELOW, Ellher t PLAT ter 81TE p1.AN MUST BESUEIWT M by the client with 711tS APPLICATION. Property Dimensions: WRrM O RKTIONS (Rees. MOC13011e) to PROPERTY: Tax Office Plum..N aC,/Srl / R1 Property.Addrela:' Road NameL o�`� () I✓�� e�n�t f✓1d o31c� 1 �_�n �\ \ �� Clty/ZIp Aor43y;�Lo }rl,'GQSN �GToj LO �- HIn a Subdivision provide Information, a follows;-�^u(�CC �?5 J Names 2 T7'1 10 �ctY MS on b y key �c /55-4n3 Sections BlocksLots Lb_ `•--.�ZartV 1b1t Date Property Fianedt This is to certify that the Information provided is correct to the best of my knowledge I ondetstand that any permll(s) Issued hereafter are sobject to ImPenslon or revocation, it the site plane or intended use ehangst or if the any peinformmiK submitted to this appllcatiotion a is falsified or changed. I, also, understand that I am rMontible for all charges Incurred front tab ter upon a 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 SeP rV and Sova o to conduct aU testing procedures u necessary to determine the dee suitability, , C3 ��bvs� DATE /U DO SIGNATURE --�- - .1 ': IIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (include all of the foli property line and dimensions, structures, setbacks, and septic locations). awlags Existing and proposed ---- - ----- //� Site Revlsit Charge Please complete the highlighted area(s) and ` Dais($)% 14 return. T .-v,•e Cfy rt+dX oFFici �a e Pru • Client Notiftcatios Datei ENS: Aecoaat No. .. I Revised DCHD (07/99) y / ' Invoice No.—�-�� DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION ` PROPERTY INFORMATION Account #: 990001459 Tax PIN/EH #: 4871=81-8453.20 Billed To: Alan Hinkle Subdivision Info: Sheffield Farms Lot # 20 ' Reference Name: i Location/Address: Sheffield Road -27028 p y P . es Date Evaluated: Pro posed Facility: ResidencePro erty Size: 5.7 acres , WaterSup P Y On -Site Well By Community Public P Auger Boring ✓ Pit Cut FACTORS 1. 2 36 4 .. ., 5, 6 .. 7. Landscape position Slope%. HORIZON I DEPTH .... _ Texture group Consistence -Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure - - �� . /L Mineralogy' 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 CLASSIFICATI EVALUATION B LONG-TERM ACCEPTANCE RATE OTHER(S) PRESENT:; REMARKS: 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 - 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 CONS ISTENCE :.. Moist 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 Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK'- Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Miheraloev 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) ..� fdto. w 00 Q � 5,7 Ae � ao, 00. 10.0 R/W as Claimed by the �1'� i v I�'a pP �'/ N.C. Highway 05" 1d Fy'� 9 y Commlasi0n M .�15' Esheffield. Rd. „A,r_ _ jo s. S �Jb �dt+N aT7a%?,?d'9 a�?t�'e,�4r1y.+"J. r• n 1^CA m lit, SCALE 1 „ = 200' SURVEYED: CRC MAPPED: CRC Prelirtfir Sheffic Parcels 12.06 and Portal 1, TOWNSHIP COUM ClarksvillC Davie C. Ray C 119 Dgpot Mocksville, NC Phone ( 704 Fax. ( 704