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234 Sheffield Farms Trail Lot 12,14,15!**NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS V?.Lm FORA: PERIOD OF FIVE YEARS �EN,YIRr— O� NMENTAL HEALT 'dPECIALIST. DATE ISSUED A AP ON FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC --j, [ A D Davie County Health Department Environmental Health Section P.O. Box 848 NEW PHONE NUMBER: Q r Mocksville, NC 27028 EFFECTIVE MARCH 22, 1998 336 751-8760 THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE �REQUIRED I INFORMATION IS PROVIDED. 1. Name to be Billed . D lJ/ • V.J 0. l l Contact Person Mailing Address\olI ,I •A�I) i (� D W C ADAk--. L ti Home Phone n City/Statemp Y e-6 U i t l e-1 A C A-7 0! Z Business Phone 2. Name on PermittATC if Different than Above Mailing Address City/StateMp 3. Application For: [,]-Site Evaluation I nprovement Permit & ATC MSoth 4. System to Serve: k4jlfouse Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People_ # Bedrooms_ # Bathroomsy [ 7lltshwasher [ ] Garbage Disposal [Washing Machine [ ] Basement/Plumbing [ ] Basement(No Plumbing 6. If Business/Other. Specify type # People #Sinks # Commodes — # Showers # Urinals # Water Coolers If Foodservice: # Seats,_Estimated Water Usage (gallons per day) 7. Type of water supply: [ ] County/City [L]'fell [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes H,o If yes, what type? .�v ! EITHER A PLAT'OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT **00Mt OF THE PROPERTY MUST BE 'p, SUBMITTED WITH THIS APPLICATION. Property Dimensions: �' ���'t" A, WRITE DIRECTIONS (from Mocksvme) TO PROPERTY: Tax Office PIN: #�- O �� 601' l\J'p �i `tom 1 Z�avxeS Property Address: Road l f ame - ��?-/ City/Zip MUGk'dl�`]1Q.. Zig ; Tlt..).w•L I`��..�.,i— `i -u SAe-!�.•aallt�- If in Subdivision provide information, as follows: Name: 1` '-�-� ._P/R ILA 'tk 0-101 l d' 1$ &A- Section: Lot#: !�ft t�4 , e 3 16 This is to certify'that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. 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 F by to conduct all testinurocedures as necessary to determine the site suitability. DATE Lam' Z —9 Revised DCHD (06-96) THIS A �1MAY $E USED FOR DRAWING YOUR TE PLAN: ti � /4( -� tr045Q ` h OPr�.�� +. a w oc ` t2� 4q� ' 0 + �6 e��� `j � d�F �� ti '+�, ,( it �, �� �� '�•�' � � ,,S . '940 2 In tT A 10 h h \q\ 1. Q°robq,90 H B °Js N € h?��sIY �"��"9 So• r" V �` / N7oy WI I{f{ijN,9=x,6sw 142,60occ ' ,0a.c, 60.69 ' {`-✓ �s m/ J� ,f N 29•,3,onw 75,9'2" �. s �,• 'SL+. �„� �� 1 h 32'S2'00"N 62.96' 667' S 8,Q • ) / \ H 30• V B' 40"W 07.56• i oe'as„w e,s. i JO 694 040, 16, G) r � � , 1n' �4 y % �J�S N 4d `30 .,51v 02.20, �-----� 00 w 60.36' 6 76' "'----�—� l' k 0,.49 nC ' .^N � 45.1Y S3.AJf f v N ,z�.z• c, ti 0.0 Ac.L4 I 15”L4 se6• cY 0 Ac i .yo 'ty�� A ` ` ^ -, - 4A DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section .::: SECTION ' " LOT Soil/Site. Evaluation,', APPLICANT'S NAME !/+� �� DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE SUBDIVISION ROAD NAME . WV/,i,' Water Supply:. On -Site Well ` Community Public Evaluation By: Auger g Boring_y,_� Pita Cut FACTORS' 1 2: 3 4 5 6 7: Landscape position .C. Slope % HORIZON I DEPTH . Texture group _. Consistence Structure . Mineralogy HORIZON II DEPTH T4d Texture group Consistence Structure /G 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 c �. SITE CLASSIFICATION: EVALUATION BY: 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 CONSISTENCE Moi 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 Mineralogy 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 nceo(01-9o) e■ ■0N■■ ■EN■■ Account #: 990001227 Billed To: Tim Wall Reference Name: Tim Wall mupuseu racmry: oam ATC Number: 2466 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 4871-81-8453.14Barn Subdivision Info: Sheffield Farms Lot# 14 Location/Address: Sheffield Farms Trail -28634 bite: bu A 7uu 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 I I of G.S. Chapter 130A, Wastewater Systems, Section.1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWATER CON CTIO IS VA FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: & O 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. J /fir Septic System Installed By: Health Specialist's Signature: 7 _T//V� Date: —,2 Z-10 DCHD 05/99 (Revised) DAME COUNTY HEALTH DEPARTMENT (---A-_e- —a o Environmental Health Section P. O. Boz 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001227 Tax PIN/EH #: 4871-81-8453.14Barn Billed To: Tim Wall Subdivision Info: Sheffield Farms Lot # 14 Reference Name: Tim Wall Location/Address: Sheffield Farms Trail -28634 Proposed Facility: Bam Property Size: 50 X 100 OE*hos**N66 prvemendOperation 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 I1 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 #People #Bedrooms #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type �Q #People —L #People/Shift #Seats Industrial Waste: ❑ Lot Size Z i 4CA S Type Water Supply 0ELl-- Design Wastewater Flow (GPD)45-0 Site: New 2( Repair ❑ System Specifications: Tank SizejQ GAL. Pump Tank GAL. Trench Width34 0 Rock Depth IZ '� Linear Ft p Other: 1-D%2TP&f)0-Vtoa 'ejD1G Required Site Modifications/Conditions: ' 0CL Pal)IlD a(� 71 GdYT��T 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.**** Environmental Health Specialist's Signature: DCHD 05/99 (Revised) S so'X3t 'xli' T LL Date: eo APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIF & r. Davie County Health Department EnWivnmenfa/Health Section P.O. Boa 848/210 Hospital Street Mockoville, NC 27028 (336)751-8760 *moi I -2 2000 ***IMPCRTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1. Name to be H111ed * �L/ / Perom k M /' {l�/�4'"iLG�. Nailing Address J •contact 7,e /, • Home Phone 'V/ 9d- !p ` y' %d `.� y 6 City/state/ZIP a --I-5r6 Business Phone 2. Name on Permit/ATC T. if Different than Above ,' I / W (�.1/ Meiling address 64- 11—e City/state/zip 3. Application For: 94ite Evaluation ❑ Improvement Permit/ATC ❑ Both 4. sy■ten to service: ❑ House ❑ Mobile Home ❑ Business ❑ Industry p,CffierI S. If Residence: # People # Bedrooms// i Bathrooms 11 Dishwasher 11 Garbage Disposal D Washing Machine G-ffg.— nt/Plumbing❑ Basement/No Plumbing 6. If Business/Industry/other: Specify type # People - # Sinks # Commodes # showers # Urinals # Water Coolers IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of Water Supply: ❑ County/City f 0 Community e. Do you anticipate additions or expansions of the facility this system is intended to serve?_ . ❑ Yes B-Pi&� - If yes, what type? ***IMPORTANT***CLIENTS MUSTCOMPLETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION. Property Dimensions: WRITE DIRECTIONS (from Mocksville) to PROPERTY: TaxOfficePIN: # r; �/ eine (r( Property Address: Road Name Q 3L{ Skt'f'fi e I h ( .y. City)Zip �I G+ vvi (o stn 3 Q o If in a Subdivision provide information, as follows: Name 4-0 Section: Block: Lot:Date Property Flagged: i�� n This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am iesponsible for all charges incurred from this application. 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 to conduct all testing procedures as necessary to determine the site suitability. DATE �D SIGNATURE 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). Revised P vtif Site, Revisit Charge Date(s)- Client Notification Date: EHS: ' GG-l��iawihy ��y G ��i`�Tithed �� Account No.* o %22 Invoice No. DAME COUNTY HEALTH DEPARTMENT Environmental Health Section 1, Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001227 Tax PIN/EH #: 4871-81-8453.14Barn Billed To:. Tim Wall Subdivision Info: Sheffield Farms Lot # 14 Reference Name: ,Tim Wall Location/Address: Sheffield Farms Trail -28 4 Proposed Facility:. Bam Property Size:' 'SQ X 100 Date Evaluated: G 8 d7 Water Supply: Evaluation By: On -Site Well Auger Boring Community Pit 'Public Cut FACTORS .: .: 1 2 .. . 3 4 5 6 7 Landscape position :. Slope HORIZON I DEPTH o IO Texture groupv G Consistence SS F r Structure . ,..., . , G2 Mineralogyt., ; HORIZON II DEPTH V - l -3 Texture group: C + Consistence Structure .. .. - r - ca Mineralogy HORIZON III DEPTH - Texture group - .. C Mineralogy 1. I HORIZON IV DEPTH.. 1 Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION iS . LONG-TERM ACCEPTANCE RATE LEO. SITE CLASSIFICATION: II EVALUATION BY: LONG-TERM ACCEPTANCE RATE:"(_ OTHER(S) PRESENT REMARKS: LEGEND Landsca e Position osition . 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 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 OR - 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 -tern acceptance rate - gal/day/ft2 DCHD 05/99 (Revised) ■■ No AP_ P�,�,I ON FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC '®�" D Davie County Health Department Environmental Health Section P.O. Box 848 NEW PHONE NUMBER: Volt Mocksville, NC 27028 EFFECTIVE 64ARCH 22, 1998 !�°' ... N •(ae4) 6344769-7 336 751-8760 THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED II INFORMATION IS PROVIDED. 1. Name to be Billed tX ` l Contact Person SA'M e Mailing Address`a li ,I .1 cxC� 6�L.. 1„ t�t Home Phone City/StawZp Y. v� Q,6 U i Le_ [ 4 C— A-7 0 .� E Business Phone 2. Name on Permit/ATC if Different than Above -` Mailing Address City/State0p i 3. Application For: [ Site Evaluation A nprovement Permit & ATC [tooth J. 4. System to Serve: PCTTI=e I Mobile Home [ ] Business [ I Industry [ ] Other 5. If Residence: # People -_3_# Bedrooms__3_ Bathrooms—@L—[ T15ishwasher [ ] Garbage Disposal [✓J'Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [ I County/City [RVell [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes "Io If yes, what type? EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: +*# IMPORTANT►;��A pL�l1'i OF THE PROPERTY MUST BE �oo SUBMITTED WITH THIS APPLICATION. Property Dimensions: �' 11,461.1 04RITE DIRECTIONS (from MocksvUle) TO PROPERTY: TaxOfficePIN: #A2i Z� I - �'io 1 _ (,O 1 N�a ! ' j 'j 3avHe5 Property Address: Road Name CktucL . I . Q . City/Lip IrWGF6VIre- z40Z-er i ILU"4' V)' k.i- t�J3 5Ise If in Subdivision provide information, as follows: Name: PaMlIJ 1 �p o 'tQc 1311 �t 15 Section: Lot#: l� . T�PKOtt1FLA(Y[d �i> This is to certify that the information provided is correct to the best of my knowledge. I understand that any perrmt(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. 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 to conduct all testing rocedures as necessary to determine the site suitability. DATE Z '-9 t SIGNATURES .t i� a (, JL Lp Revised DCHD (06-96) 16ar-, THIS AREA MAIJ BE IISED FOR DRAWING JOUR S TE PLAN: vS W C.-C"', &hJ/"v' AU:ItfiLi' I" ATION NO: 15 ( %A DAVIE COUNTY HEALTH DEPARTMENT lod 10-V ell Environmental Health Section PROPERTY INFORMATION Permit tee's . , P.O. Box 848 � — Name:/. Mocksville, NC 27028 Subdivision Name:.�9� / / Phone # 336-751-8760 Directions to property: �� %' y� i� AUTHORIZATION FOR Section: % Lot: WASTEWATER SYSTEM CONSTRUCTION Tax Office PIN:# Road Name:_-�P� **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building -Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section 1900 Sewage Treatment and Disposal Systems) 15 L HEALT SPECIALIST DATE ISSUE IS VALID FOR A PERIOD OF FIVE YEARS. RESIDENTIAL SPECIFICATION: BUIIAING TYPE # BEDROOMS �# BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION FACILITY TYPE # PEOPLE _ # PEOPLE/SHIFT # SEATS _ INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY - ��// DESIGN WASTEWATER FLOW (GPD) ��G/NEW SITE tf:� REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE ZOO(—) GAL PUMP TANK GAL. TRENCH WIDTH `1T / ROCK DEPTH —,Z=2 LINEAR Fr. REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT *APPROVED EFFLUENT FILTER* *RISERtS) IF 611 BELOW FINISHED SRADE* "CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN 8:30 - 9:30 A.M. OR 1:00 -1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE '# IS (78t9iRWOMOX X 336)751-8760 OPERATION PERMIT OPERATION PERMIT BY: SYSTEM INSTALLED DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I I 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. DCHD 05s96 (Revised) I. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION I:OT Soil/Site Evaluation LICANT'S NAME !�� `/ DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE SUBDIVISION ROAD NAME Water Supply: Evaluation By: On -Site Well Auger Boring_ Community Pit Public Cut Consistence HORIZON III DEPTH s-�®oar • ��®saw-� .... to SITE CLASSIFICATION: X - EVALUATION BY: LONG-TERM ACCEPTANCE RATE:T 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 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