419 Sheffield Farms Trail Lot 7A THQi�I�TATION No 1 2 O DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section PROPERTY INFORMATION
Perm vttee's - yg . P.O: Box 848
Name. ' ' a7Ci/"W ' IEi/ /1l Mocksville, NC 27028 Subdivision Name: (/!
Plione #: 704-634-8760
Directions to property: J /l f (7 i'� �/Section i� Lot:
..
AUTHORIZATION FOR
. - WASTEWATER :
SYSTEM CONSTRUCTION Tax Office PIN:##-
Road Name,-�hA�- CL Zip:
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section
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)'
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS
ENVIRONMENTAL: HEALTH SPECIALIST -.
DATE ISSUED
y"' '• 1 1201 DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Permltte�+s--meg°^ ,,�,.
Name 4�t°1�tJS! /i6i Subdivision Name:
Directions to property: _: �r ('l r �'/ / f f Section: / Lot:_
IMPROVEMENT
PERMIT Tax Office PIN:#!ga - - &�
Road Name-,�F)A1("/J_ Zio: V/y
**NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater �y, tem. An .
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the
constructionPmstallation 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)
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SrrE
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED - SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE �_ # BEDROOMS ,? # BATHS �2 # OCCUPANTS GARBAGE DISPOS : Ye r No
COMMERCIAL SPECBmCATION: FACILITY TYPE # PEOPLE _ # PEOPLE/SHIFT # SEATS - INDUSTRIAL WASTE: Yes or No
LOT SIZE 3,a a TYPE WATER SUPPLY 41ll DESIGN WASTEWATER FLOW (GPD) 3T— Zd NEW SITE C1 REPAIR SITE
SYSTEM SPECIFICATIONS: TANK SIZE /D GAL. PUMP TANK GAL. TRENCH WIDTH 3G ROCK DEPTH �� ' LWEAR FT 0da i
" r1TFTRR /•rq'"
REQUIRED SITE
IMPROVEMENT PERMIT LAYOUT
**CONTACT A REPRESENTATIVE OF THE
BETWEEN 8:30 - 9:30 A.M. OR 1:00
OPERATION PERMIT
'H DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM
OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
F
J "�q
Q/
AUTHORIZATION NO. _ OPERATION PERMIT BY:� DATE:
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE 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.
DCHD 05N6 (Revised)
"
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED'UNEESS----- "- w ..Am
-t ALL THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billedyr�tAP�a Contact Person J °ry✓/ rn�` '�
VT
Mailing Address 754 Y M q; d St Home Phone 10113 V- 1 t 7 810
City/State/zip Nor- i2 nl.e. smgV Business Phone
2. Name on Permit/ATC if Different than Above n L I a in)
Mailing Address
3. Application For.
4. System to Serve:
5. If Residence:
O Dishwasher
V,
Site Evaluation d Improvement Permit & ATC ❑ Both
ErHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
# People 7 # Bedrooms _3 # Bathrooms .02-
0 -Garbage Disposal Er 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 Mr -Well ❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No
If yes, what type?
*** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: S ty-1•e % 1 WRITE DIRECTIONS (from
/ 1 Mocksville) TO PROPERTY:
Tax Office PIN: #
Property Address: Road Name 'z/ '
City/Zip
If in Subdivision provide information, as follows: 1 /
/ / 1 46v-
Name: S`i i 5i; e' Z 'tw-K S
uJtr�d�-
Section: Lot #: 7 1
This is to certify that the information provided is correct to the best of -my knowledge.( 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.. 1, 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 t, e, r y ll a- we a - Ile e Z /
u .t 4l
as necessary to determine the site suitability.
DATE. SIGNATURE
Revised DCHD (06-96)
!t to conduct all testing procedures
V f `
APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIF
Davie County Health Department
Environmental Health Section
E O. Box 848
Mocksville, NC 27028
im 16 19%
(704)634-8760eVnMMFNTe1
ucei
****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED'UNEESS----- "- w ..Am
-t ALL THE REQUIRED INFORMATION IS PROVIDED.
1. Name to be Billedyr�tAP�a Contact Person J °ry✓/ rn�` '�
VT
Mailing Address 754 Y M q; d St Home Phone 10113 V- 1 t 7 810
City/State/zip Nor- i2 nl.e. smgV Business Phone
2. Name on Permit/ATC if Different than Above n L I a in)
Mailing Address
3. Application For.
4. System to Serve:
5. If Residence:
O Dishwasher
V,
Site Evaluation d Improvement Permit & ATC ❑ Both
ErHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other
# People 7 # Bedrooms _3 # Bathrooms .02-
0 -Garbage Disposal Er 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 Mr -Well ❑ Community
8. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes ❑ No
If yes, what type?
*** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE
SUBMITTED WITH THIS APPLICATION.
Property Dimensions: S ty-1•e % 1 WRITE DIRECTIONS (from
/ 1 Mocksville) TO PROPERTY:
Tax Office PIN: #
Property Address: Road Name 'z/ '
City/Zip
If in Subdivision provide information, as follows: 1 /
/ / 1 46v-
Name: S`i i 5i; e' Z 'tw-K S
uJtr�d�-
Section: Lot #: 7 1
This is to certify that the information provided is correct to the best of -my knowledge.( 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.. 1, 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 t, e, r y ll a- we a - Ile e Z /
u .t 4l
as necessary to determine the site suitability.
DATE. SIGNATURE
Revised DCHD (06-96)
!t to conduct all testing procedures
Ac
s
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section SECTION -1 LOTS
Soil/Site Evaluation
APPLICANT'S NAME %%%r k)'l
PROPOSED FACILITY
SUBDIVISION
DATEEVALUATEDG Q_
PROPERTY SIZE
ROAD_ NAME
Water Supply:
On -Site Well
Community
Public
Evaluation By:
Auger Boring 1111�
Pit
Cut
Texture group
FACTORS
1 2' 3. 4 5 6 7.
Landscape position
4—
t_Slo
Slope
e %
HORIZON I DEPTH
Texture group
Consistence
Structure .
Mineralogy
HORIZON H DEPTH
r
Texture group
Consistence
Structure
Mineralogy
HORIZON In 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 CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE:
EVALUATION BY:
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 SII. - 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
O HD(01-90)
Davie County Health Department
and dome Health Agency
Environmenta(Health Section
P.O. a0% 8481 210 HOSPITAL STREET
COURIER #09.4.06
MOOKSVILLE, N.C. 27028
PHONE: (704) 634-8760
February 6, 1998
Jerry Martin
756 N. Main St.
Mocksville, NC 27028
Re: Site Evaluation/5 Acres
Sheffield Farms I/Lot 7
Tax FIN(s): 84891-92-0696
Dear Client(s):
As requested, a representative from this office visited the
aforementioned site on February 6, 1998. Based upon the information
provided on the application for site evaluation and after the evaluation
was completed, the site was found to be provisionally suitable installation of
an on-site sewage disposal system.
If you have any questions, please feel free to contact this office.
Sincerely,
Robert B. Hall, Jr., R.S.
Environmental Health Specialist
36'r CJ
Enclosure(s)