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120-121-150 Sherrill Ln . DAVIE COUNTY HEALTH DEPARTMENT �°� I��9`/ • '' —_.. Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 � (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990000717 Tax PIN/EH#: 5812-72-2925 Billed To: Shaun Sherrilt Subdivision Info: Reference Name: Shaun Sherrill Location/Address: Speer Road 27028 Proposed Facility: Residence Property Size: 12 Acres ATC Number: 2147 **NOTE**This Improvement/Operation Permit DOES NOT authorize the construction ofa septic tank system or any wastewater system. An ALTTHORIZATION 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 STTE PLANS OR T�iE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERNIIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type ,�'f�/D rn c° #People , #Bedrooms � #Baths z Dishwasher: � Garbage Disposal: ❑ Washing Machine: �Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #PeopleJShift #Seats Industrial Waste:0 Lot Size� ffl G Type Water Supply�_ Design Wastewater Flow(GPD) 3G D Site: New� Repair❑ System Specifications: Tank Size%00 GAL. Pump Tank GAL. Trench Width y��'�Rock Depth /g �Linear Ft. Cfl�d� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- AP O D EFFLUENT FILTER RISER(S)IF 6"BELOW FINISHED GRADE. ****N10TICE: Contact a representati e f e Davie County Health Department for final inspection ofthis system between 830 a.m.to 9:30 a.m.or 1:00 p.m.to 1:30 e day of installation. Telephone#is(336)751-87G0.**** ,\ti' ',U �� . r- � Environmental Health SpecialisYs Signature: Date: Y / ' / r' DCHD OS/99(Revised) « � DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section : P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990000717 Tax PIN/EH#: 5812-72-2925 Billed To: Shaun Sherrill Subdivision Info: Reference Name: Shaun Sherrill LocationlAddress: Speer Road-27028 Proposed Facility: Residence Property Size: 12 Acres ATC Number. 2147 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 1 of G.S.Chapter 130A,Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems). THI$ AUTHORIZATION FOR WASTEWATE NSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health SpecialisYs Signature: c� � Date: ��_ CERTIFICATE OF COMPLETION **NOTE**The issuance ofthis Certificate of Completion shall indicate the system described on ImprovementlOperation Permit has been installed in compliance with Article 1 I of G.S.Chapter 130A,Section.1900"Sewage Treatment and Disposal Systems,"but shall in NO WAY be taken as a rantee that the system will function satisfactorily for any given period of time. �f��C� � � r- Se tic S tem Installed B � `�-� P YS Y Environmental Health Specialist's Signature: G�`" Date: J�•��g� DCHD OS/99(Revised) , � - V�� APPI�CA�':'�R�FOR SIfE EVALUATION/IMPROVEMENT PERM T� �j � � Davie County Health Department Envlronmenta/Hea/th Se�tion P.O. Sox 84B/210 Hospital Straet A{�7 � ( �� . Mocksville, NC 27028 � � (336)751-8760 ENVIRONMENTAL HEALTH DAVIE COUNTY ***II�ORTANT*** THIS ABPLICATION CANNOT EE PROCEBSED UNL�38 ALL THE REQUIRED =N8'ORZ9ITION IS PR0�IIDED. Refer to the =NH'ORI�TION BULI+ETIN for instructions. �. Nam� to b� Hilld �S/�,�u., �/re.�►.!/ ��c.ati p.r.� �5'h�ti 5��,�/ � �s.�� ... !ao �5'��.�.•�/ L�z� 8�. �A. �'F� —1��7 �hr/st.c./z=r �`7ve�sv,/l�e. /L��C- a-?o o�� in... rt�on. �'tlo.�.•� 9�p��6'�7 _ /Z. Nam� on p�rmit/l1TC i! Di!l�rwt lhaa 71bow , l MailiaQ 71dds��• City/8tat�/Lip 9. �ppiicatioa For: � Site Evaluation ❑ Zmprovemeat Parmit/ATC �oth a. sY.t.m co s.�sa.: 0 Bouse �Mabila Home 0 Busiaess 0 Iadustry 0 Other s. it Residence: i Peopie � � Sedrooma / � Hathrooms _� � Di�hxasl�r U Garbaqa Disposal �Nuhiaq ltaahia� O Bas�nt/plvmbiaQ O Bu�nt/No plumble� 6. i! Hu�in��/Iadustsy/Oth�s: Sp�oily typ� � ?�opl� i Sinka # Commod�� Sho�ns� # Urinals � Nat�r Cooi�r• =F SOODSERVZCE: � Seata Estimatad �Pater Usaga (�ioa, p.r asy> 7. s�pa o! Kater supply: �Couaty/City � Well ❑ Community e. Do yoa andcipate add[Hona or ezpansions of the faciltty thts system Ls tatended to serve? 0 Yes �io If yes,what type? ***IMPORTAN7'"**CLIENfS MIIS'T C70MPLETE THE REQUIRED PROPERTY INFORMATION REQUESfED BELOW. Either a PLAT or SIT'E PI.AN MI/ST BE SUBMI?TED by t6e cllent with THIS APPLICATION. Property Dimension�: �� WRITE DIRECTIONS(from Mocksville)to PROPERTY: .�(Ta:oeice PIN: # �1�0 I o� - I o�-a�o(�J �j d� f�c�v�7�'�7, T�i�e7 �@ f� c�h � , Property Address: Road Name .f e � /ra a� �,i 6 e.�7�j� C'� /�v,�ol� %!Q-, f"s/7�'c,� � .s�v,.�.%/ l�t< �7 � City/Zip ��fv�'��e �7vi2� C'Lrh ,r�e �vsol, /��y L e�i'� dh If In a Sabdivision pravlde information,as follows: ,�/JQei' /Q�'a'1, %lr�e.� 6� i'ad-e. {-;��';�` Name: d 7 /1�91f7'L �'�Zr.�•+�/�L�z e � Section: Block: Lot: Date Property Flagged: This is to certify that the information prov[ded is correct to the best of my kaowledga I anderstaad that aay permtt(s) issaed hereatter are subject to saspeusion or revocation,if the site plans or intended ase change,or if the information aubmitted in this applicallon is faLsilied or changed. I,also,understand tha�I am responslble jor all charges incurred jroni thls appllcatlon. I,hereby,give consent to the Anthorized RepresentaHve of the Da e Coanty Health Department to enter npon above descrl6ed property locnted in Davie Coanty and owned by " l rr ' to condnct ali testing procednces as necessary to determine t6e site sdtabiUty. .�CA'""? � � DATE �*' I d' p� SIGNATURE _ �. THIS AREA MAY BE USED FOR DRAWII�IG YOUR STl'E PI.AN(Inclade all of the follawtng: EzisNng and propoaed prnperty lines and dimenstons, stractarea, setbacks, and sepHc locations). � ��6) Site Revisit Charge Q �o �" s`�si`T'� .k:c" Datc(s)' � � Sy 1,� �L�. � � � ��' •�,� Client NotiBcaHoa Date: i� �N o lP4 s� M � .�s��, �ARAI V � �• � � � `' ° /� z Acconnt Na l//.z�� ,��d Revised DCIiD(07/99) � Invoice Na � ►. L �' MnC2 �•18�� =��,=w?rfi:�" ,' \ ¢�'�;��k;c'� 4 ' .. M� 9.78A1 �� -�„�,h,,.�� °� . ` � I �k.4.� � � �ly�� 2324 Mn62 This map is for PERC TEST end BUILDING PERMIT purposes � only. The Davie County Tax Administrator's Office assumes no liability for any information contained on this map 719) 39g � 1.5A (9.�1A) � 5695 .� COUNTY-ID:D300000010 � O� � • � ` � � A � ( August 10,199910:08 AM r. Parcel Identification Number � 94.20 5812-72-2925 . f��. .�;,��` DAVIE COUNTY HEALTH DEPARTMENT Environmentai Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990000717 Tax PIN/EH#: 5812-72-2925 �illed To: Shaun Sherrill Subdivision Info: Reference Natne: Shaun Sherrill , Location/Address: Speer Road-27028 Proposed Facility: Residence Property Size: 12 Acres Date Evaluated: � Water Supply: On-Site Well � Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landsca osition .C. Slo % HORIZON I DEPTH Texture rou Consistence Structure Mineralo HORIZON II DEP'TH �' u Texture rou G Consistence i . Structure �C / Mineralo ,' HORIZON III DEPTH Texture rou Consistence Structure Mineralo � HORIZON IV DEPTH Texture ou Consistence Structure Mineralo SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION ' LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: U�� EVALUATION BY: (N.�� 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-Tenace FP-Flood plain H-Head slope Texture S-Sand . LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SICL-Silty day 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 EFT-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-gaUday/ft2 DCI�OS/99(Revised)