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431 Sheffield Farms Trail Lot 21**NOTE** This Authoriintion for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior 'to issuance of any Building Pemiits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with 21 cle 11 9f G.S. Chapter 130A, Wastewater Systems; Section .1900 Sewage Treatment and Disposal Systems) '! ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION :..IS VALIDFORA PERIOD OF FIVE YEARS. ENVIRO&MtN HEALTH tPWXAMT.,,.. DA ESUED - AJ z l 21 DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION 7Permit-'OJT tee"9 - -^'� L Me) � ' �^ ' � ZVame: = - af I' Ary Subdivision Name: - =�� 41 L L n �IOemY 5 'Direetionstoproperty: F�GI)�IBI�W _1�7 r��=L Yf Section: Lot: 7-1 IMPVEMENT PERMIT ,I. � Tax Office PIN:# ��1 - � I -trC a Road Name: .:4ti:il ILfrt°) t F;..i~ SZip: ?.%' 1� **NOTE** This Improvement Permit DOES NOT authorize the construction or installation 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 wmpliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) If I SEE THIS THE SYSTEM. YOUR WASTEWATER RESIDENTIAL SPECIFICATION: BUILDING TYPE MH # BEDROOMS f _ # BATHS 2— # OCCUPANTS 4 GARBAGE DISPOSAL: Yes or No COMMERCIAL L SPECIFICATION: FACILrrY TYPE # PEOPLE _ # PEOPLEISHIFr+�, _� # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE (� �,1I TYPE WATER SUPPLY WUL DESIGN WASTEWATER FLOW (GPD) � NEW SITE W- REPAH2 SITE ^11 rt 1 SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH 151,L ROCK DEPTH 12 LINEAR FI.� OTHER 1 DIST/LII l%ilonJ-L>FO}L- REQUIRED SITE MODIFICATIONS/CONDITIONS: 1 &iSTALL OrJ G00 10OR- IMPROVEMENT PERMIT LAYOUT A, FJWE /DrIGa� K12" 4v' s 90 — - — o.C, ---._- 90 `.-- ----� 0. c. FRooT- 1140 "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 (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED F AUTHORIZATION NO. OPERATION PERMIT BY:LL/V/ —DA TE: "THE ISSUANCE OF THIS OPERATION PERMrr 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 NOWAY BETAKEN ASA GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME, DCHD 05196 (Revised) APPLICATION FOR SITE EVALUATIONAMPROVEMENT PERMIT & Davie County Health Department Environmental Health Section Q P.O. Box 848 Mocksville, NC 27028 (704) 634-8760 EN ****IMPORTANT**** ' THIS APPLICATION CANNOT BE PROCESSED UNL THE REQUIRED INFORMATION IS PROVIDED. 1. Name to be Billed l Contact Person pov, Mailing Address 6 0 1^ Home Phone City/State/Zip evKw� o Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address `'X City/State/Zip 3. Application For: [ ] t erve: o Evaluation [ Improvement Permit & ATC [ ,] Both 4. System to S[V House [ ] Mobile Home [ ] Business [ ] Industry, [ ] Other MOO L 5. If R%idence: # People # Bedrooms # Bathrooms [vj Dishwasher [ ] Garbage Disposal [v] Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated W er Usage (gallons per day) 7. Type of water supply: [ ] County/City Well [ ] Community // 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [�'No Tf ves_ what tvne7 - -- _ EITHER A PLAT OR SITE PLAN PROPERTY INFORMATION REQUIRED: *** IMPORTANT **XVFM OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: ' 1 /i /tom% / '/ii_� WRI DHtECTI NS (from Moe v' le) TV RO Tax Office PIN: # y -11 - li5 o ^� Property Address: Road Flame QY h a L I LnA op Gi l City/Zip C If in Subdivision proyitile information, as follows: � , a Name: TTi Jl � RIne,—I, � C' ✓ C3 ` 1LO— clA Section: Lot 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 t Da ie County ealth De melt to enter upon above described property located in Davie County and owned QQ //� r by iJY i A in 0n [IN —F ihC '/I Elio conduct all testingyroeedWes as pecessary to dptermige the site suitability. sus Revised DCHD (06-96) TRIS AREA MAY IIE USED FOR L)RAWI�vG YOUR SITE PLAN: �ee / 1 1 tGL/(.eQ•/nl f N 56'55'05 W 197.760 N 37'3TlO' 85.47' >, Veit X15 � p^N sfaFq>� 3f,8p6g PC. - \ . p. 5.0 Ac:. a `W 4g8'"� a,9 g2 ,20;4.0O'-- EF-' V (k.et ) stmt Feen! N g8'51'0& E 1101.52 C .. 1(E 0 N 17.43"W 29 8 . 6 oaoouo ti _� � 1 m 49� i - E Aja �N 81'2T5O" E 87.22' n L n ..s..N.� •... Q�FiC N 56'55'05 W 197.760 N 37'3TlO' 85.47' >, Veit X15 � p^N sfaFq>� 3f,8p6g PC. - \ . p. 5.0 Ac:. a `W 4g8'"� a,9 g2 ,20;4.0O'-- EF-' APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC t Davie County Health Department r 7 Environmental Health Section D P.O. Box 848 Mocksville NC 27028 634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED U L THE REQUIRED INFORMATION IS PROVIDED. / /'y t 1. Name to be Billed 8 !9 F G A/ ct� ontact Person 544^ � Mailing Address 000 COILburrW Home Phone %6 - f)12�n g City/State/Zip C / Business Phone 766' 71?7S 2. Name on Permit/ATC if Different than Above Mailing Address City/State/Zip 3. Application For: [✓f Site Evaluation [ ] Improvement Permit & ATC [ ] Both 4.. System to Serve: [) House [�) Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People # Bedrooms_ # Bathrooms .3 [-f Dishwasher [-jGarbage Disposal [Washing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify # Showers # Urinals # Water Coolers # People,_Minks # Commodes If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [ ] County/City [rJ Vell [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [-TNo If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT *** A PLAT OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: g &ee, 5 WRITE DIRECTION/S (from Mocksville) TO Tax Office PIN: # A- — _ J G T - O i e Property Address: Road Name SA Wr'6za Fd3rm s / D fit 'T 5,4 ,, LX; .11 For)" e i City/zip ;lNeeKS��CAa NP, R70,2? I ' Yd a !/,l4 y�,.d/ es Z14W t If in Subdivision provide information, as follows: Name: SA;ff/ e -4W F4 .'h Section: Lot#: GSI This is to certify that the information provided is correct to the best of my knowledge. I understand that any permits) 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 Je rrt l /r�hle Lga(I�L& CXi to' duct all testing edu es as necess to determine the site suitability. DATE �d G O / l SIGNATURE-_ aw�i Revised DCRD (06-96) IV DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOTS Soil/Site Evaluation APPLICANT'S NAME tt 1 4"' kA, St—M,)aRT PRO POSED FACILITY M 1��r/�}YaIS Ct%f�D3rt0a�> SUBDMSION �5fr4-- �,Ao }=OBPA�S Water Supply: Evaluation By: . On -Site Well Community Auger Boring Pit DATE EVALUATED 1L i PROPERTY SIZE ROAD NAME IL Q, S, Public Cut FACTORS 1 1 2 3 4 5 6 7 Landscape position Slope % 27o 2'Z -o . HORIZON I DEPTH C> - ZZ O - - Texture groupG Ct_ Sct_ Consistence Structure k' e 2 Mineralogy 1; I 1: HORIZON II DEPTH 2Z -32 - Z 4-7-4 Texture group C -t' sap I' C C Consistence Ff — Structure Mineralogyf HORIZON III DEPTH �3 Texture group + Sa k Consistence Structure A9k AGk Mineralogy I.' 1 1: HORIZON IV DEPTH 364 3 Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION $ LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATIONBY: l� LONG-TERM ACCEPTANCE RATE: 3�� 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 - Veryfriable 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 tructure SC - Single grain M - Massive' CR - Crumb OR - 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 -tern acceptance rate - gal/day/ft2 DCHD (01-90) SEEN NONE MEMO Davie County rkafth Department and Home Health agency EnvironmentaC9leafth Section P.O. 00%848/ 210 HOSPITAL STREET COURIER #09.4.06 MOCKSVILLE. N.C. 27028 PHONE: (704),634-8760 November 17, 1997 Brian Leigh Poplin 8 Lisa Jean Stewart 6700 Cockleburr Trail Clemmons, NC 27012 Re: Site Evaluation Sheffield Farms/Lot 21 Tax PIN: 44891-72-7260 Dear Client(s): As requested, a representative Brom this office visited the aforementioned site on November 7, 1997. Based upon the information y provided on the application for site evaluation and after the evaluation was completed, the site was found to'be provisionally suitable for the installation of an on-site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, 1 Jeff G. Beau hamp, R.S. Environmental Health Specialist JB/wd Enclosure(s) i COUNTY HEALTH DE�htTlDAV__. . _ ENVIRONMENTAL HEALTH SECTION P. 0. Box 848/210 Hospital Street Courier #09-40-06 Mocksville, NC 27028 Phone #: (336)751-8760 October 27, 2000 Alan S. Hinkle 102 Steele Avenue Cleveland, N. C. 27013 Re: Site Evaluation/ Sheffield Road Tax Office PIN: # 4871-81-8453 Dear Client(s): As requested, a representative from this office visited the aforementioned site on October 26, 2000. Based upon the information provided on the Application for Site Evaluation and after an evaluation was completed on the site, the site was found to be provisionally suitable for the installation of an on-site sewage system. Before an Improvement Permit/Authorization to Construct can be issued the appropriate application must be filled out and the house/mobile home location staked off. If you have any questions, please feel free to contact this office. Sincerely, Robert B. Hall, Jr., R.S. Environmental Health Specialist RH/di Enclosure(s)