226 Herons LnDAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760 Fax # (336)751-8786
Account #: 990005358
Billed To: Ned & Lynda Sigmon
Reference Name:
Proposed Facility: Residence
ATC Number: 4997
f
OPERATION PERMIT
Tax PlN!EH #: 5853-80-2573
Subdivision info:
LocationlAddress: Herons Lane -27006
Property Size: 4.290 Acres
**NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC 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. f
System Type: 'r S.T. Manufacturer. Tank Date Tank Size
Pump Tank Size . ry/
System Installed By: )' f y 6pr,',Ak[e E.H. Specialist: ! ate:
DCHD 11/06 (Revised)
• DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028 ,"�\
(336)751-8760 Fax # (336)751-8786
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #: 990005358 Tax PINIEH #: 5853-80-2573
Billed To: Ned & Lynda Sigmon SubdMsion Info:
Reference Name: Location/Address: Herons Lane -27006
Proposed Facility: Residence Property Size: 4.290 Acres '+
ATC Number: 4997 Site Type: CKNew ❑Repair ❑Expansion
**NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental '
Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A
Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat
or the intended use change.
Residential Specifications: # Bedrooms # Bathrooms " J # People_ Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type - # People # Seats
Square Footage(or Dimensions of Facility)
Lot Size "! p Type of Water Supply: ❑County/City W ell ❑Community Well
System Specifications: Design Wastewater Flow (GPD)VV Tank Size/, Qc� GAL. Pump Tanq// GAL.
Trench Width Max. Trench Depth Rock Depth Linear Ft. 3� !
Site Modifications/Conditions/Other:O�Jr �0 el',_ 0� U �l d n.
Contact the Davie County Environmental Health Section for final inspection of this system between
Tele hone # 336 75118760.
1Xi'
1 • /.'
P
"-5 b
Environmenja alth Specialist,
DCHD 11� wised)
l
V`
T
'—Date: f ' �:V /
ti '1
'FOR SITE ElvrALC;ATION1'INIPROVEN EMIT PERMIT & ATC
Davie County Environmental Health
P.O. Box 8481210 Hospital Street
Mocksville, NC 27028
(336)753-6780,' Fax (336)751-8756
t C
1 � Applicatio tk Ev ati : provement Permit Authorization To Cc tmct(ATC) C Both
JNew vs 7Rcpairto ExLsting System - xpansioaI o taction o sting System or Facility
1 t
FjVV� P'*SMI
THIS APPLICATFON CR,�'itiOT BE PROCESSED UNLESS ALL OF THE REQL'1RED
ATION 11PROVIDED. Refer to the WFORMATION BULLETIN for instructions.
Name to be Billed Ned- + LVActa S t ft -ion Contact Person Ned Si Q on
Billing Address ZIA Wt3nAT eic L oo Home Phone r304 (rb -6Ql ti
Cit,v/State1zlP r NC zffif2 Business Phone '70t{ 4S(; i S89(a
Name on Permit/ATC if Different than
rKVYC1tiY MrVKMAIWN •VateliouseiFactLtvCorners Fla¢ ed
NOTE: A s:rvcy plat or site plan must accompany this application.
Included: C Site Plan �Ptat(to sea e
(Permit is valid for 60 months with site pian, no expiration with complete plat.)
Owner`s\ame Med .1 wmiq slt2mDel
Phone Number '70 -D i
0-mier's Address
Citys'Statu'lip t r MlboV; Itt A1C 2811 17
Property Address 2Z(a rrQgs LetnP
j
City _4dYanfe.fP % Mew }}b
Lot Size t4,290 per{L15693_TaxPIN# RS3 90Z5rL3
aszlred
Subdivision Name(if applicable)
S1ection!Lot#
Directions To Site: 4wV _SOi-FoWAr� S (�j In4Yot�
� FroM �`-ql> &b 3.2 wN,ks)
Turn Rtkh-F on rnns tease CQnRnrk:k
4e> ey)d b -.F road.
If the answer to aay of the following qu.-stions is "yes-, , supporting documentation
must be attached
Am' here any existing wastewater systems on the site?
Yes :]No
Does the site containjurisdictional we lands?
Dyes a3)
Are there any casements or right-of-ways on the site?
CYes
Is the site subject to approval by another public agency?
:1 -11V
Will wastewater other than domestic sewage be generated?
JYes
IF RESIDENCE FILL OUT THE BOX BELOW
r People # Bedrooms L4 k BatLrooms ' Garden Tub."A`hirlpool e 'm'4,
Basement: [Yes BasememPlumbina: 0YcsQ11l
IF NON -RESIDENCE FILL OUT THE BOX BELOW
Type of Facility/Business Total Square Footage of Building People
T Sinks # Commodes a Showers # Urinals
Estimated Water Usage (gallons perday) (Attach documentation ofsimilarfacility water consumption)
FOODSERVICE ONLY: # Scats
Type systemrcqucsted; 6nvention ]Accepted Dinnovative CAlternative GOther
Rater Supply Type: 7 CountyiCity NaterCExistiug Well D Community wcn
Ivtew 1Ve11
Do you anticipate additions or ccpansions of the facility this system is intended to serve? 7 Yes i No
If yes, what type, _
This is to certify that the information provided on this application is true and correct to the best of my knowledge_ I understand
that any permit(s) or ATC(s) issued hereafteran subject to suspension or revocation if the site is altered, the intended use
changes, or if the information submitted in this application is falsified of changed I hereby grant right of entry, to the Authorized
Representative ofthe Davie County health Department to conduct necessary inspections to determine compliance with applicable
laws and rules. I imderstand that I am responsible for the proper identification and labeling of property lines and comers and
locating and flag 'ng I stat ' g the house-If`acility location, proposed well location and the location of any other amenities. kI
)Property owner's or owner's leg reptesentttiti' signature Site Revisit Charge
��05_ Aled L��t�a�SY9
U Client Notification Date:
Date EHS:
Sign given CYes CNo Account# 1536Y
Revised 11106 Invoice 5 7�
1
aaa a u
"WN,
wA-bydAp-
r m4R 1(11•) •R•MF aeal TAY •uer.Yl•n OlenN1PAmN aro .[,.1b •M r.wwlM le P1Rr
(Nm
NOT=
1.U»t r6DrTTrr s S=Ecr» ANf AID AML =on(s)-or-vn No
OR fASDOR(3) »6O1 WY 011 WY MOT Y O! RECON A3 OF 11E
DOE Of 116 ARNEY.AID IIAT MlR 4 VmfIL 11Pp1 M C1101AD.
2. FOR INE INX DEED IR ERENCE FOR THIS FMPERTY SU DEED 9001E
749 ,PAGE 364 OtaA wWRI.O[LNGR6RYOA60®)
INO NODS CONTROL MONUMENTS FOUND NRUN 2000' OF THIS SITE
4, FOR Tf D® TINT COMBrIED YIXSgI w. SPARIfS, JR er16
W. KATIIv6Ne S SPARKS PROPERTY (TAE L015 n ! 723)
INTO ONE 0® wA5 RECORDED W Ol7D 8001( 752 AT PAGE
485 ON MARCH 31, 2000.
0. THE EICST91G GRAVEL DRIVENAY LOCATED ON TIME SKMON•S
PROPERTY N9CH LEADS TO THE EXISTING HOUSE IS TO BE
RELOCATED INSIDE THE NEW 30' ACCESS WHIM IS TO SOW
NEW LOT 2
0. THIS PROPERTY IS ZONED R-20
110 ANIIIp N ME 00111111 RN6aA q10.
R -Yr rr. r DwY or1Y r
•._/ M M�' Y�A� 4aaYrr YNrr rnr
Nib 1�)
LINDA HENDRIX FOLTZ
DEED BOOK 311, PAGE 730
CINDY L. ELLISHOF'F \ TAX MW C5 TAX LOT 60.01
ROBIN L. ELLIS WOODRUFF
DEED BOOK 207, PACE 423 \
TAX MAP C6 LOT 66
cm PORTO
3N' EI it AT 11E EID OF
AM�U�9fWGElLLEORYN pTEEEpDd E9�D[p�
N 09.4' 16"E -'r
M 0X 1W 311.69'
I r 5k)
/ M1d6• '•18.60• R \6'�'
t pS•"'.A j35 ` ' I -O
28.33 U7'R-V
ROY LEB 11 PAGE t I (aRXm)
1 DEED? MOR of 72A
6mw ,
flt. M •'• ° M � M67.36' R-J61.S7
N2N '567
_ N 30'2S']4'N
1
(CHORD) 123.13.50.64•
IZ a�Rr�°PDX N 18-IrWV
` (CNaD)
1�re.,s� v
17 ("E X755.44•
49).09
111 I COUNTY OF DAVIE
EED BOOK 98, PACE 93
1 TAX MAP C6 -LOT 73.01
4 1
RUBY MCKMGHT
1 DEED BOOK 42, PAGE 58B
TAR MNP OR TAX MAP 73
1
1
100 0 100 200 300
GRAPHIC SCALE — FEET
A .- j /- • - ,D'14,� ','4i RAX Lar 72.01)
WILSON W. SPPAM,JRJ
•% ✓+ \ DEED BOOK 7K 75NE 2 SPAM
EE44888
\�. TAX LOTS n AII1 72.03
(TAR LOT n)
1.65' R-173.00'
WILSON W. PARS, JR.
KATHERINE SPARES \,
DEED 2, PAGE 1015 n AND X488 �, \ J
lNuti N
�,rH NFy
FLOW
�,E�• (TAX LOT n)
EQ•r•`W� 10. Sn• [. FUE. T THE 9 M
ai IED A N%W# PROPER
(�K `1 Y6 3 a7
-�. FOR REOISIRAl10N AT Li • r oX2ALx fm
—
PLAY _. m of AND RECORDED N PUT
BOOK' i(• PAGE��9 - PLNC FEE ie'LL•ii�PAD
M. WENT SHOAF - DAVIE Co. REGISTER K DEEDS
fI66
DttID in%0°)
LAUREN GRAY TAYLOR
DEED BOOK 126, PAGE 707
DI TAX NAP CS TAX LOT 33
09°45'16"W
1 78.00' N 10105'05"E
NEW IAT 1
ARL! = 429 ACNES
Rd,
I
NEW IAT 2 '1n
AREA = 3.18 ACRES
Iw
x.
m
POND
r» 206.99•�4"�
CRE 04 7M r•a[ 7NM CmD 0-m a
N 11-46'18"E 658.53' DoDE,ROII Oat n=�4 1�
—r—
41�9r4' )~y f
P�: G
i O: -
M Am u arra Tem=ur R•w1s
N DEN 749 AT PAGE 3C AS TRACTS 1 ! 2
DIVISION OF THE PROPERTYDESCRIBEDOF
���.�.
FO• Road ti NoiL F.
Mr D W SVPFANsdI FROM AN ACTUAL SURVEY MUNE UNDER MY
DIRECT SI.FXJISDN (OHE DESCW IRCNDARI N WOK
I
I 1
N 11 .58-161-gy-- S 11°58'16'W
l 218.46'
10°37'4/7'4
t -E -t-
I
x..88, i
I 16770' I 1�57M 6"w
CHARLIE G. DOBY
D® BDaK 066. PAGE 240
TAX N4P ce TAX
MUN ANN MCKMGHT
I DEED BOOK 187, PAGE 485
I MENDY MCMII.I,L1N I
1
I
HILLEBRAND A. HIGHSMITH
I I
w ,10 CN1,
LOT 73.02
TAX EMP C6 TAX LAT 66.02
DEED BO01( 741, PAGE 42311,
(O1y TAX MAPa
Ia$
DB, 7p, PG. 437 B D8. 1 1 I, PG. 171
i
s
I n I N C4 � i
TOWNSHIP
COUNTY
TAX tarlu I
a7 1
MAP C6TAX swN
i
pi o
[ IP
OS
I
�oil
r7
3.7 •• 4O BU .�
q -4bau
a M awY n r r mne rAAo6 = rrla
a iw,'mi•71a i ciln1eiw .ii A M4 a �r
CB
FARMINGTON
DAME
N. C.
I
APRIL 01 2(
RN
n
1
0.9. 4T-30 u AMMEIDED.'911WIS AW TML SIGNATURE.
STERN
'•r�0 'I.,
[EEO.•
m='rY•
THIS IS A MINOR SUBOMSDN THAT YAv
.•```NCAgp %•A, i01LOW THE 'EXEMP1' SUBgNSON ""0CUS'
A DrVMON Or TBE PMPEBTE OT M B7
NED A. SIGMON ND MIX LYNDA R. SIGMON
---VRONALD LEE OIRMO[E, CERTIFY 1107 THIS PUT MS W001 UNDER
P�: G
i O: -
M Am u arra Tem=ur R•w1s
N DEN 749 AT PAGE 3C AS TRACTS 1 ! 2
DIVISION OF THE PROPERTYDESCRIBEDOF
rRaP[RTY t RK
ADAIMRD UES OMNI 6IRNEYED)
Mr D W SVPFANsdI FROM AN ACTUAL SURVEY MUNE UNDER MY
DIRECT SI.FXJISDN (OHE DESCW IRCNDARI N WOK
OF
2•yP •;!,
//
w• _
LOTS
TOTAL AREA OF THE a NEW LATS 1 ! Z 6 7.47 MALS
THE
t -E -t-
[•N1EfE [IRE -
344 i ETC,) (OTTER) i TNT M tXX9M1ES NOT
THE SURVEYED
�// SEAT ..[7
W°°'•Y
en6o ni'rlRr°,�iis Secy.
F RECD
i R Ir
NT UaU r IINi
ARE NONS
ARE ClEV0.Y INDICATED AS OIM1I[I!91011 91FORYOXN [DIM N 800K
//----- L•9O
O [. w rw 1• r aw . r Aaaaans AAu
TAX MAP
TOWNSHIP
COUNTY
STATE
SOON
OATS
[ IP
OS
RXIST
EilsT IM IRON pin
SEN swE Rdlo
FADE —; TNr!'t[610 OF PRECISON AS CMDIUATED
;T. 26i I THAT THIS PORT WAS PW%ED N WOOR0ANCE wm1
r7
3.7 •• 4O BU .�
q -4bau
a M awY n r r mne rAAo6 = rrla
a iw,'mi•71a i ciln1eiw .ii A M4 a �r
CB
FARMINGTON
DAME
N. C.
SS
APRIL 01 2(
RN
n
f..
MRN FOUND
r0=R r4E
0.9. 4T-30 u AMMEIDED.'911WIS AW TML SIGNATURE.
STERN
'•r�0 'I.,
[EEO.•
m='rY•
TAX BLOCK
RONALD LEE OXENDINE
SCALE
ra, RA
R•RLROAF
REOISIMiDIL4F,UHR AND ati1L THIS ' OF
ca...w ra.r�nAr�twwa.r==
» r .
SURVEYING
lm= 100'
RA'
[P
6C
RINITV-wAY
EON V r•KIER1
9ACR O CUM
<. < A&. O
�'�`'/�-
�w.�E .SG. C�JC �/y
1
.I�. i� 144"
--
rTAX LOT No.
e430 B'1'rm 1�Rr ROAD
CLOMONS. N.C. 27012
JOB No./EAP
X
COMPUTED PONT ONor
PROETSLONAL LAD S6Nc,OR (PLS) L-3063
sr lR ser. wsmruR 0—Y.sM
n.02
17Nm (336) 706-9979 L-9063
081106
01/14/2008 17:45 FAX 336 7144401
1iN��D�a� tics`
PRUDENTIAL CAROLINAS
CATION FOR SITE EVALUATIONIIMPROVEME"NT PERMIT & ATC;
Ds%lr Couii`ly Kns irnntncetml Health
11.0• Box $431210 Huvpihl Strom
N'IOG)ia17Ue, KG 371>21J ,A r(J a
p3�9s1-tt�6otrt.tr (nt ys1 v'
Site •o+✓ m c t PermAurJew- llom To CCpYvuet(A�c-,,,
Dom
n; leeu• S)'ixm Repair to siarinq Syatem p Syssm or Paclbn
•`TIAPPLtCAT1014aohwlro ilk OCCS.iEDUNLESSALL,OF'n EE RE
PaOvISIVFO. Refer nthe INFORMATIONBULLETINI'm in,traetiods.
Norte lobe Billed. {2_�m(5►-CMnn+41 Person
Billine Addicsa SM -b ASa.18.&.14 12td~L..�Q„ _ Nutnc Phr)0o
Cily/S1stt/ZfP _)�7tY�L' Snl�eYh, j�(p Busweaa Phvfse
Name oc PenniVATC if D;er:ai dtan Abowo,,,)}16� ( SDA S f�z=ti
p PeopleL y • • •,D 9 -Brooms _LL AN8atlmtorna 2 /� Oarden TWWhWpool Y WI
ftwilt : Yc� CNo) Bascincarplumbinn Yes rod
TypcOfEaCtlRytBtuinere• ToalS`narrFoengeoYs)ueldin6 %people
tl Sinke k Commodes i Shdivett IN uritnls
Estimated Waw t isage(gallons parday) (Almon d%utaentaliat arsimilar f iliry wetor o msuinpeanl
FOObsI?RVICF 0)4LV: r Scau
Type r, attar «quenled: Conventional Accepted �li,anvative Ahaoal,v Other`~ _ tt• » y .
waarsupoly Type CoumyrtJtty w•atcr. -4r New Wen ^ r ^ ,ttinj Well a urrity well ^ -
Oo ypa amicipatt additio+e ar rspamiopa of Qte teiuty this sysfero is intended to swe, vas
11yal,whal type,
This is to eeniA, On the imfornuuon provided on th(s.sppliration it srue and eoric4i w we bcriot my kmowlodtta I ondeinum d
nut airy• prima(g) or ATC(s) isswil hermItcr are sublecteosuspuaion as rortxetron it the site Is ahewd, the intended use
ct+aneet, or it rhe Inthraeeon subm+ in tbn apph rttuon es fabifico or etuupcd 1 kieby print rtrh+ pf entry to the AOthoaiced
Representative of the Davie Ca • H IIli Deparnmcet to eotduct r,ccessaq b+Epeeionr to de+ermtnc compliance with applicabk-
lawa and as. I a I am siNa for Ibc ptvpar idemifscnioa and libeling of properly hnes and earttn.s and
loco ' a
at or 1- tat airy p sed well location and the tocedw of airy othct anlCmhies.
:unity bur o' yg91 ysl attaove -- in
S,mRevrsnChar(te
Duds):
Clisnt traihestion Dmo:
Site 6; -ea Yet No Aocoyttt fi
3
Revisad 11/16 invnicc to "
03
1a002/003
+
e�
c
W
A sunm ptatur$11, ptaa tn.t accotipany :his iXItcatipn, Ltdaded haPla Plal(te "We)
(vomit Is valid 14T 60 month with sxe plan, no e�paauom veith anmDkre pial r
�110TV*
D"ar'sName ABR=IC.d-�i1#IJ �i, I�tk� l o�.t- Phone Number _.__..._
...
bwOCY'S Address 0 CitylSuielzip81;!daJ14, N -G-
! propem,Addre6a _ab(¢ Cif
Size 2.,4 Z nGA455 _Tax PINd�gS3 1S7
1L)irLot
Subdivkaeso(ifapplicab)e)
cvi=1'eSiw..jAy,tr Ota! 3•7, ww�
T•rz rail ua1�o�I,�j._:-c.oair��,►6 To TLtseLl cwt )ISt AT_ial.��,R':_.:.,....._...__._.,,,,�__
If the aoswor to any of the ioilowing qumtiors is "yea", wpporring timumeautdon muss bo attxhod
Artdtetetrriwrrtsoug+asrewamrFyrte+monthe she, N
Does sire site Contain)utisdietiottal wedands2 es
Are dtue any eutmetmt or right -at -ways on the silt, Yes
Is dsesitn subject to apycovO by tmotho public 4 -M -Y? Yes
Will Wastotvatcr other 1133P (loo/cstic WA-MRa tW genenttadl Yes o
p PeopleL y • • •,D 9 -Brooms _LL AN8atlmtorna 2 /� Oarden TWWhWpool Y WI
ftwilt : Yc� CNo) Bascincarplumbinn Yes rod
TypcOfEaCtlRytBtuinere• ToalS`narrFoengeoYs)ueldin6 %people
tl Sinke k Commodes i Shdivett IN uritnls
Estimated Waw t isage(gallons parday) (Almon d%utaentaliat arsimilar f iliry wetor o msuinpeanl
FOObsI?RVICF 0)4LV: r Scau
Type r, attar «quenled: Conventional Accepted �li,anvative Ahaoal,v Other`~ _ tt• » y .
waarsupoly Type CoumyrtJtty w•atcr. -4r New Wen ^ r ^ ,ttinj Well a urrity well ^ -
Oo ypa amicipatt additio+e ar rspamiopa of Qte teiuty this sysfero is intended to swe, vas
11yal,whal type,
This is to eeniA, On the imfornuuon provided on th(s.sppliration it srue and eoric4i w we bcriot my kmowlodtta I ondeinum d
nut airy• prima(g) or ATC(s) isswil hermItcr are sublecteosuspuaion as rortxetron it the site Is ahewd, the intended use
ct+aneet, or it rhe Inthraeeon subm+ in tbn apph rttuon es fabifico or etuupcd 1 kieby print rtrh+ pf entry to the AOthoaiced
Representative of the Davie Ca • H IIli Deparnmcet to eotduct r,ccessaq b+Epeeionr to de+ermtnc compliance with applicabk-
lawa and as. I a I am siNa for Ibc ptvpar idemifscnioa and libeling of properly hnes and earttn.s and
loco ' a
at or 1- tat airy p sed well location and the tocedw of airy othct anlCmhies.
:unity bur o' yg91 ysl attaove -- in
S,mRevrsnChar(te
Duds):
Clisnt traihestion Dmo:
Site 6; -ea Yet No Aocoyttt fi
3
Revisad 11/16 invnicc to "
03
1a002/003
+
e�
c
W
'�4 L"Ir�9 "1`�T(�}4 vow•.�,n
(" fid' ��t•Y.-/� �f 14AwJ.l�Y�9
4
N,,,r�, Vit;
�•
E00/E00 l SVNIIOHV0 IVIIN3GnHd
:pO.
JW
LOVO OLL 388 XV3 Sb'.LI 800Z/Ot/l0
.QoMAl'S - Davie County NC Public Access Page 1 of 1
w � '
Davie County, NC - GIS/Mapping System
O s"� Click Here To Start Over Quick Search:{County ID c
.` Active Layer. r Use Map Tips GIs
0 + PARCELS (Map Tips Available) �. �iap Layers I Results
http://maps.co.davie.nc.us/GoMaps/map/Index.cfm?maimnapservice=gomaps&CFID=412... 1/16/2008
i
•' APPLI;Ct�N�d1�tFQ�iA')<,Ai{'rI�1
Billed To: Michelle Sigmon
Reference Name:
Proposed Facility: Residence
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil jSite Evaluation
Tax PIN/EH #: 5899MPMTBY INFORMATION
Subdivision Info:
Location/Address: Herons Lane -27006 a
Property Size: 7.458 Date Evaluated:
Water Supply: On -Site Well Community Public
Evaluation By: Auger Boring t ! Pit
FACTORS
1
2 3
;
�,�—
7
Landscape position
Slope %
?
HORIZON I DEPTH
Texture group
c
6
�-
Consistence
P Qf,,,-
,,+
Structure
A 6 It
4115 K A
A 5'
c ' lr tlS X
'W,5pt
Mineralo
✓o /w
t i -f
.\!' .--
HORIZON II DEPTH
-
—
-. C
7 —
Texture group
Consistence
V V'- iV f Ufol'
Structure
L
��,,.,
(�•,�,�(.,�-
Mineralogy—
j
HORIZON III DEPTH
Texture group
Consistence
-�
Structure
v .
Mineralogyt
HORIZON IV DEPTH
rci
Texture group
C:
Consistence
`
Structure
►'
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
141 I
V
CLASSIFICATION
r 7
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION:
LONG-TERM ACCEPTANCE RATE: '
RFMARK4
EVALUATION BY: �6b Ne lYC
r •
OTHER(S) PRESENT: Adr lszS t`� r
Landscape Position LEGEND r -
R - Ridge S - Shoulder L - Linear slope FS -Foot slope N - Nose slope r
CC - Concave slope CV - Convex slope T - Terrace FP - Flood plain H - Head slope Ly
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
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
MineraloQv
1:1, 2:1, Mixed
Notes
Horizon depth - In inches
Depth of fill - In inches
I 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 05/05 (Revi�Prl)
Davie County Environmental Health
P.O. Box:8481210 Hospital Street
Mocksville, NC 27028
(336)751-8760/ Fax (336)751-8786
Account #: 990005003
Billed To: Michelle Sigmon
Address: 540 Ashbry Run Drive
City: Winston-Salem
Reference Name:
Proposed Facility:. Residence
IMPROVEMENT PERMIT
Tax PIN/EH #: 5853-80-2573
Subdivision Info:
Location/Address: Herons Lane -27006
Property Size: 7.458
**NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An
Authorization To Construct a wastewater system must be obtained from this office prior to the
construction/installation of a.wastewater system or the issuance of a building permit(in compliance with
Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement Permit is subject to
revocation if site plans, plat or the intended use change.
Permit Type: BNew ❑Repair ❑Expansion Permit Valid for: Q'SYears ❑No Expiration
Residential Specifications: # Bedrooms If # Batbrooma—'Y# People_;Z_ Basement❑ Basement plumbing❑
Non -Residential Specifications: Facility Type # People # Seats
Square Footage(or Dimensions of Facility)
Design Flow(GPD): Type of Water Suult. BCou /c well ❑Communi Well
pp3sn a�q Osieeu swal�'S P d&�&. t�'
SV
Site Modifications/Permit Conditions.:
)696T -VST 3d3N VGT u! polels
System Type LTAR
Initial -1 .
Repair C y ,-_ r D�
Site Plan
J
GJ -
1570
e
50
5-0
TO ® �t G 5,15 ''— f o . AT C. .
Environmental Health Specialist - Date X: S_--0
I*LO
- / --
C9M-1 M0A3AWS ONVI 1VNOIS5330Md '34Oi3X0 33'1 aIVNOM
(1) 10MUHL(�11oBv 03151 l
SNOISIAOMd 3HL AD NDIIVNIMM3130 V 3XIM 01 3l9vNn
SI MOAM WS 3HL 3levlIV" N0IIVMM0AI 311 ROMA 'C ❑
•A3AMnS 03M3GV0
1Mn00 V 00 Sl3DMVd ONIISIX3 AD NOILYNISM33H
3HL sv Hons 'Avoonvo M3H1ow dD SI A3AMnS 3H1 •4 ❑
'Sl3DMVd MD 13OMVd ONIISIX3 NV d0 SI A3AVM 3H1 '4 ❑
'V3MV a3LV11103WM 11V NI OWI i0 SI A3ANnS 3LL •Z ❑
•3DNVNIOW NOISIA1439nS V AS 03M3A03 V3MV W
NV NI OWI AD NO I S I A I OWS V 93MV0 AMUM 3111 •1 P
0NIM0110d 3HLAO 380M MO 3NO 01 A311M30 '4904-1 *ON
HOA3AHM aNVI 1VNOMS3.408d -AQGN O In 07MOM 'I
'SS3008d NOISIAlaens „ 1dW3X3,, 3H1 M01103
),VW 1VHl NOISWaenS 80NIW V SI SIHI
M 0C
2� •, � is � `�
£90£-1 (S -1d) MOA3AMnS oMdl-wNolss33oad
4Y -00Z ' o V
Ao AVo SIHI Iv3S aNv 838wnN NOLLVMISIO38
'38n1VNJIS IVN19180 AW SS3N11M '030N3AV SV 0£ -Lb 'S'9
HWM 30NVO8000V NI 38Vd38d SVM 1Vld SIHI 1VHl ' 000'81 :l SI
a3lVlnolVO SV NOIS138d AO OLL" 3H1 1VH1 30Vd
X008 NI ONn03 NOIIVWMOINI w0W NMv8a SV a31V310N1 A1MV313 3Mv
03A3AMnS lON S318VONn08 3H1 1VH1 ! WH10) ('013 ' f8£ 30Vd
6*L X008 Ni a308038 NOud121oS3a a330) NOISIAM3dnS I33MIa
AN 830Nn 3aVW Awns Tdnlov NV WOM3 NOISI/1M3dnS 13810 AW
63aNn NMV80 SVM lvld SIHI IVH.L )JLL830 '3NIaN3XO 331 CnVNOM 'I
AINO LNIod a31ndW00
X
8Mn0 j0 X0v8
08
1N3W3AVd j0 3003
d3
AVM-jo-IH91M
M/M
avouim
8/8
310d M3MOd
dd
aNnOA Mv83M
jeu
aNnOJ 3XVIS NOMI 9NLLSIX3
S13
3dld NOW 9NI1SIX3
d13
3dld NOW 13S A1M3N
dIN
3NIl 1N3W3SV3 3
3 3
(3A3AMnS lON) S3Nn 9NINIOMV — —
— — — —
3N I l AlUd08d
ON3033
133J - ]�VDS OIHdVaO
I I i m
I I g o I OX 00Z oo o 00
Xv IX C..I ICD
En , o 0
r I
a rn
x I 10)o
1
0,1 m
cn •� Q i I (96103("Z - I7M A8) I I I ao i �L dVW XVl 90 db'W XVl
x N oV 88 101 XVl 90 dVw Xdl 5£ l 301 Xvl 90 dvW XVl m I 88S 30Vd Z� X1008 4334 1
2Z* 30`dd ' 3 X1008 4330 vl ZO'S8 101 Xvl 90 db'W Xb'1 ZOTL 101 XVl 90 d" XVl �LHDINX�
I I L I 'Od III '8d 8 L£ti 'Jd ZIL '8( J1i AQN�i1i I � I'II Agnes
rn Ln H.LIWSHDIH 'V (INVZIIIMIH I N�I'I'IIHI� N S8-0 3odd 'L8l X1008 433( I o*Z 30Vd '99S X008 4330 I
CD - Cn 00 I i I .LHOINXDFJ NNS' NVIAIA Ago(, •f) qr ZIVHD 1
� I I
I 1 N
I (3Nn 3u) I I LO'£L 101�XV1 90 dVn XV1
M,19�.9SoZ l S
I 'I I C6 30Vd 86 N008 033
(3Nn 331) .OL'L9 l 19-'8 l z ,88*08 �IAdQ .�o A.LNnoo
x —x";� MIILV,L2oO L S 8119 l 18190 L L S— �,e B ,9 L -M l l N I o'
3DNVMO
Qj 'NOW 311d ----L
166'90ZQl
-_ � �3 lNN ��,� 316* L-0 --� � 3 p S (3NO1S Ol 33X8 IY021� Mol) ,�5.8S9 3.,81,9�o L L NL�— L&S •� CO
�� 3i3a� log M3NMo3 1003 (be£ 39vd '6b1 •80 (3Nn 3u)
°moo (3IXV of 3HIdS M/M rvoaj�+lol> ,60'L6b .9 ' lS v71
.its SCOL 3„L L,Stc �_ S83NM03
� �O 3319) A1M3dOMd S,NOW91S 'V 3N j0 '0 3XIds a/a
(NOd `� Gi O
MANOO '3'S 3H1 1V -Pj d13 ,b/£ •0' ^ �� (3Nn 331) 1s
cc
ONOd / O (ZL 101 XVI) �?� N,�e �Z i 3W3°•f� '�Z� M"6 o 3
odorN 3°`S60 p "'� , :ZS 5 Z
Aj GNOd
dIN / .C,4 \ / H3NV2re�ON�yS`0 �j
W a3O�a+ld / ti 6 0.0 \ , `\i J Q� �� 60 9 3 ,�011W 5� 33S �++ a
_ 3 00
N �_ MI100�i5oV� 1p�tel) CO-ZL ONV ZL SIO -1 XVl 61' \2 O 83NM00 U
M a �,M dIN (F . \ , — 8817 379Vd Z5L A008 0330 (aaoHo) L N 3wdS M/M ZI `Z,
M p ' NORM Z� \ �- sxH Y d►7 ' S �I�II2iHH,L�'x .S l'SZ l M.,OO.L 308
N-
- \ 1m �1) \ \� / / / 3318 aNv / b9'9S -
00 'Hr `SxHvdS •Al NOS'IIAt � � M.,ONOHO)o� N
� 5�80� S l ' E = d�'� 3 - � _ \ � (0aoH3) (oaoHo)) _ — — — � �
dIN z Z0ri AHN �� \ / �\ ONOd 1 .6£'89 M,.Lb.90.1£ N �' 6Z'L9 M.,O(,£o.SZ N _ —i�l .� 33s) 1
a r o \ \ .O0TL L=8 ,98'89=V / , AS' L9C=8 ,8£ L9=V— _l� g= vw ' cc 1
cc
O ow `n w sa3rs ��� (ZL 101 XVl)
E -a .�S tiesafJ M„6b.0£.
X o
7 cD � i - I I N £0'ZL ONV ZL SlOI XVl �/ / 90 ddY(1Q33Q 1
a 88ti 30b'd Z5L X1008 (33( �:�. 996$ ' (0aoH3> 3�dd ,� �00ja �0'Ii
00 / SxHVdS 'S HNI IaHJVX 9ti '� N l9'6S M„L0.££.SZ N SII `3
C'3 Y ate? ( \ dIN 2 o, ti° 'g� S 0V Z9TZ L =8 .OZ'09=v
z m •o� s I i 'Hr `SxHVdS ° M NOSZIAL 6�� ' `o�° e� �° 9� 8`925
a 6 I o O y L �,°' 3/ .6
o tido l £` ° �sti 'd'�
w 1� ,, a o \?� ro (£O'ZL 101 XVI) lb psy ti� 9 / /
o \ Sf, -0 C �y� s�1°,s—
\ ()/d f' in O .� `i 00 O O O� '�!
I 91 310N \ �� N� a�� CS% �• ( �sbti, .�,�,J S p dS °�
sauz)v 6z'� _ �3�' 33s - AVM3/Uaa %(� ;,� , e O '� �', °.�° $, ,� ti \ //j OZ -M 3NOZ SI Al83dO8d SIHI '9
I3AVMo 9Nl1Sl o (aMOH3) Lti, sd dO F,�°`�� J
I lo'I KHN �'� C` F13i N b9'06 3.,L t,Z*,OL N 0y JJd ,�d�d° �/ D Z 101 M3N
// Z lol M3N 3A83S Ol 1' is °� 8� ,00'L8t=M ,99't6=V °ti .>' S / / 3^8319 Ol SI HOIHM SS300v .05 M3N 3H1 301SNI a31v0013M
33N33 38IM 1N31Y3SV3 SS333V 3018 .09 M3N �/°Z 6L. far 3 ` �S, 0dJ / / / .,� �' I 38 Ol SI 3SnOH 9NLLSIX3 3H1 Ol SOv3l H01HM 1�LM3dOMd
1�J1� ?✓ (0330 `J !/,6£ £g� ' ' _ _ = 3 ,��' I S.NOWOIS 3H1 NO 31V0o1 AVM3AJN0 13AV80 ONLLSIX3 3H1 'S
S,NOw91S b 03N)b8£ 39vd ` Z•£�� _ tf 8002 l� H02NW NO 88b
'6bL '80 Ni a30M003M SI - _ _ X86 i �5�' _
1VH1 1N3W3SV3 SS300V 3018 _ _ '_ Cr pl �� 3 9� �ii� (3Nn 3t1) J� I 30Vd lv ZSL X008 334 NI 030800321 SVM 334 3N0 OlNI
,OG 3HL -40 1NIOd '938 VO _ _ - rM„Zl b�^ \ByebZ N _ / 9
y ° g N (£0'ZL ZL 19101 XVI) U83d08d SA8VdS 'S 3NI83H1VX GAZA
.85.009 (I/d MV3N 30N33 381M) L'ZZ 98'1919 .69' l l2 ONII 3LL) \ M"bl' gt. / _ PUD Mf 'smvdS 'M NOS11M 03NI8W00 IWU 0330 3Hl 803 '4
39MV1 V100 S 3K P 311�0t J0o0 L N j0� dl -3,.91. x.60 N X 'Cl. (moo y9�, MIS SIHI 30 .0002 NIH11M 0Nn03 S1N3W(1NOW 1081NOO SOON ONT
�8 ��•8L IZ 39Vd '881 mope 330 NIIOd ) <<'6g M ;0,�
3Hl NO TJ 3XIdS M a ` 9Z°� (0330 SMOVaS 'M VONAI 3A* V NOM91S V 03N)
8119 r5�o60 S 0330183304 3H1 NO TWO IW 3H1 \ Z��9:y N X008 33(l 33S Al0dOMd SIHI MOj 30N383338 0330 XOV8 3H1 803'Z
M3NMI0 IOMINOO -40 aN3 3H1 1V TJ d13 .b/£
'aNnO89 3H1 NOdn 3181SIA 38 lON AV” ONV'A3AMnS SIHl 30 31V0
£9 101 XVl 90 dVW XVl (330 NOW91S 3H1 j0 Z 13VM1 -40 M3N800 MS 99 101, 90 dVW )(Vi 3H1 j0 SV 080338 j0 38 ION AVM MO AV” H31HM (S)1N3W3SV3 80
LOL 30Vd `9Z L 11008 0330 9NISSIW 3Hl 30"3H 01) 3dr NOW M3N 9Z V 30Vd LOZ X1008 0330 aNV AVM-jAMO-4oTIV ONV A 01 133mnS SI MS3dOMd SIHl• L
HorlAv L XdHf) NaHfirl I AdflaQook Sala IHlsox SHION
10'99 101, XVI 90 dYn XVl \ dd11H SMH •'I AQNIO (SIN)02L 30` d L L2 X1008 0330
($ va a
aT.
a�d0a U10d XIHQNaH VGNI'I C” IsOI,Ld00'I
sae s I 1 i
1Nv1SISSV - kLnd30
A8
'S0330 30 831SID38 '00 31AVa - JVOHS 1N388 'W
OMd ; 333 ONnu ' 30Vd — X008
lvld NI 03080038 ONV OZ
)10010,0 1V NOLMISIO38 803 03113
3IV0
M33L UO M31A3M
*bu”-- -1 sl—Inb- A-Vnols No
epw pexWD 91 SMI.— 9343 ~ of Wo - dow -a Win AjW-
OP A-03 -00 Ja -3W A-�-M ' '1
31VOULL830 S,833WO M31A3M
31va
801.33810 9MNNVId
•a8V0A 0MNNVld A M3 31AVO 3HL A8 a3Hlnt)38 1VA08ddV ON
31VO 3WVN
NOW91S •v a3N )
•palou so asn a1DAud jo
ollgnd 01 sluawas0a PUD sa11s ja410 PUD 'sVod
's>11DM 'sAapD 'SlaWIS pD alDolpap PUD sang )JOD9las
6ulpllnq wnwluiw pagsilg0lsa 'luesuoo aail Aw 4118
uold UOISIAipgns si41 1dopo (gajaq (aM) 11D41 PUD
A1unoO ---3VW0— jo uoi}olpsunf uolslnlpgns a41
ui polDool sl 4o14M 'uoaja4 paquosap 4jadwd ay; ;o
(s).jauMo ay} (ajy aM) WD 1 1041 Appoo Agaja4 (aM) I