233 Pratt Farm LnDAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section j J
P. O. Boa 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
IMPROVEMENT/OPERATION PERMIT
Account M 990001443 Tax PIN/EH M 5813-79-4399
Billed To: Tim Brittain Subdivision Info:
Reference Name: Tim Brittain Location/Address: Pratt Farm Road -27028
Proposed Facility: Residence Property Size: 5 acres
ATC Number: 2612
**NOTE** This Improvement/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 lwa)>A #People *2) #Bedrooms --5 #Baths �2-
Dishwasher: Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑
Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑
Lot Size e Water Supply Design Wastewater Flow (GPD) 3600 Site: New Repair ❑
System Specifications: Tank Size MW GAL. Y Pump Tank
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Other: 'P-�L. 5
Required Site Modifications/Conditions:
GAL. Trench Width ' Rock Depth % Z Linear Ft.
41
N�;154Lt, &,146s 9 06 A414 -
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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.****
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Environmental Health Specialist's mature: Date: � Z, cX7
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DCHD 05/99 (Revised) -�iI P,
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
P. O. Boz 848/210 Hospital Street
Mocksville, NC 27028
(336)751-8760
Account #: 990001443 Tax PIN/EH #: 5813-79-4399
Billed To: Tim Brittain Subdivision Info:
Reference Name: Tim Brittain Location/Address: Pratt Farm Road -27028
Proposed Facility: Residence Property Size: 5 acres
ATC Number: 2612
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 11 of
G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS
AUTHORIZATION FOR WAST ER CON IS VAL ORA PERIOD OF FIVE YEARS.
Environmental Health Specialist's Sign tures Date: 10 0" Q
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.
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Septic System Installed By:
Environmental Health Specialist's Signature: Date: 12 L
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DCHD 05/99 (Revised)
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. Davie County Health Department t- y
• Environmenfa/Health SMUGH
P.O. Box 968/210 Hospital Street 0u l
Mocksville, HC 27028 �+
(336) 781-8760
•+►•i!lnOliTItH1'*}• THIS APPLICATION C3awT ffi VAOMSS3•D UNLESS ALL THE REQUIRED
INFORMATION IS PROVIDED. Refer -to the INFORMATION BULLETIN for instructions.
name to be Billed �I � (Y�i I` ,)C T�'� 1 n Contact Person t ��
Nailing Address J33 V C�'i i nr-c �, .�-. Bcoe Phone 3 3 Io- ln� 7-5::;6G 1p
Business amne _7c c 13 -til 1
Mame an Persdt/AZ'C If Different than Above
Mailing Address
3. Application For: ,N Site.Svaluation
6. system to service: 0 House Alftbile Homs
s. If Residence:
JDishwasher
# People
City/state/Zip
0 Improvement Permit/ATC 0 Both
0 Business ❑ Industry 0 Other
# Bedrooms i Bathrooms C
0 0, age Disposal 0 Washing Machine 0 Basement/Plumbing O Basement/no Plumbing
6. if Business/industry/other: specify type
# commodes
# People # sinks
# showers # Urinals # Water Coolers
10 IF FOODSERVICE: # Seats Estimated Nater usage (gallons per day)
7. Type of water supply: ❑ County/City _"RAell 0 Community
s. Do you anticipate additions or expansions of the facility this system is intended to serve! 0 Yes 0 No
U yet, what type'
***IMPORTANT"** CLIENTS ritUSTC10MPLElETHE REQUIRED PROPERTY INFORMATION REQUESTED
BELOW. Either a PIAT or SITE PLAN MUST BESUBMITTED by the client with THIS APPLICATION.
Property Dimensions: 5 Ar
Tai Office PIN: # 5 ) �51 aq I I
Property Address: Road Name ?(A,'E�,S•rV`
CityiZip 0
If in a Subdivision provide information, as follows:
Name:
Section: Block: Lot:
WRITii DIRECTIONS (from Mocknille) to PROPERTY:
Date Property Flagged:
This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(:)
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 mpoasible for all cha ges i cun-ed from
this gppHcadon. 1, hereby, give consent to the Authorized Representative of the Dav mCounty fleallp Department
to enter upon above described property located in Davie County and owned by ) i 73 r t 4-. t �
to conduct all testing procedures as necessary to determine the site suitability.
DATE_ I4 a Z6 b 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 DCHD (07198) v
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DAVIE COUNTY HEALTH DEPARTMENT
' A Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION
Account #:
990001443
Billed To:
Tim Brittain
Reference Name:
Tim Brittain
Proposed Facility:
Residence
L&
Water Supply:
Evaluation By:
On -Site Well
Auger Boring
PROPERTY INFORMATION
Tax PIN/EH #: 5813-79-4399
Subdivision Info:
Location/Address: Pratt Farm Road -2707,8
Property Size: 5 acres Date Evaluated:
Community
Pit
Public
Cut
FACTORS
1
2
3 4 5 6 7
Landscape position
L
1_
Slope%
G
HORIZON I DEPTH
-
- -
Texture group5:
C_ L
GL LL
Consistence
r 5 N�
�f SS ti
n1 -,-
Structure
Ga'LCR
C-R
Mineralogy1:
I
; ;
HORIZON II DEPTH
2 -
- 2
-
Texture group
G
C
Consistence
C:
Structure
k
Mineralogy
HORIZON III DEPTH
-
. y
Texture groupS
Consistence
r
Structure
MineralogyI
:
;
HORIZON IV DEPTH
3Z -F
Texture group
Consistence
Structure i
Mineralogy
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION x
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: vs
LONG-TERM ACCEPTANCE RATE:
REMARKS:
I
EVALUATION BYE �4—�--
OTHER(S) PRESEN't-,
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
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
DCHD 05/99 (Revised)
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'EIP
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EIP 26.35'
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Davie County Wealth Department
Environmental Wealth Section
PO Box 848 / 210 Hospital Street
Mocksville, NC 27028
Phone: (336)751-8760
October 16, 2000
Mr. Tim Brittain
533 Virginia Drive
Yadkinville, NC 27055
Re: Site Evaluation -
5.03 Acre Tract/Pratt Farm Road
Tax PIN #: 5813-79-4399
Dear Mr. Brittain:
As requested, a representative from this office visited the above site on October
13, 2000. Based on the information 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.
Based on the evaluation, a three-bedroom residence would require approximately
400 linear feet of septic drain line. This is subject to change and actual dimensions of the
septic drain field will be determined at the time an improvement permit is issued.
Before a representative of this office will revisit the site to issue an Improvement
Permit/Authorization to Construct the appropriate application must be completed in full
and submitted to this office. The location of the facility the system is to serve must be
staked off.
If you have any questions, feel free to contact this office at (336)751-8760.
Sincerely
Jeff G. Beauchamp, R.S.
Environmental Health Section
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