631 Yadkin Valley Rd • i
j�� y • DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)753-6780/Fax#(336)753-1680
REPAIR OPERATION PERMIT
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�ccr�unt #: 990005926 ������� '�"�x Pi�€I�N#: C700000120
BiEI�� 7a: Harold Sheets �u��di�i�ion Ir3��:
f�efer�E�ce €��n�e:: REPAIR PERMIT Locai►onrAdr�r��s: 631 Yadkin Valley Rd-27006
F�ropc�sec9 F�aw•ility: Residential Repair � �ro��r�.y�iz�: 92.28 Acres
a�TC Nurnber: 5965 . .
**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. _
System Type:�_S.T.Manufacturer� Tank Date_� Tank Size�
Pump Tank Size _� Bedrooms �
� ��System Installed By: ti� � S'�h Installer#: Date: .����
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GPS Coordinate:
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Environmental Health Specialist: ' � L �� � , � Date:r'S L �G �
DCHD 11/06(Revised)
DAVIE COUNTY ENVIRONMENTAL HEALTH
� , P.O.Box 848/210 Hospital Street
�f ' Mocksville, NC 27028
' ' ' (336)753-6780/Fax# (336)753-1680 .
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AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRL1CT10N � �t.�l
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,Accou�t #: 990005926 �"�x F�1�[.�EH#: C700000120
Bifle;s� �'�: Harold Shee� Su��i�i:iarl ln�c7:
Re�fer�E�ce P�la��e:: REPAIR PERMIT Lacationi4d�lr�ss: 631 Y�in Valley Rd-27006
Prn�c�ssc9 ��a�:iiity: Residential Repair ��np����S�� 0�r�8 ��ir ❑Expansion
*t*^�Q TEh**Thi horization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental
p,THe�I��`�C�ion p�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 �3 #Bathrooms #People Basement0 Basement plumbingu
Non-Residential Specifications: Facility Type #People #Seats �
Square Footage(or Dimensions ofFacility) '
Lot Size �l�'�� Type of Water Supply: �County/City �Well OCommunity Well
System Specifications: Design Wastewater Flow(GPD)3f�� Tank Size�(S(i�A. GAL.Pump Tank GAL.
d
Trench Width��`` Max. Trench Depth3l�i`` Rock Depth�� Linear Ft.�o��""/Fs
Site Modifications/Conditions/Other: �Lt.(•��7�h
Contact the Davie County Environmental He�lth Section for final inspection of this system between
8:30—9:30a.m.on the da of installation. Tele hone# 336 751-8760.
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Environmental Health Specialist . �"i V� ' . • Date: � I'� '1C'�I�
DCHD 11/06 (Revised) .
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°✓�� �l� �'1 -�-��u �T�{3
•• ' " DAVIE COUNTY HEALTH DEPARTMENT
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Environmental Heaith Section
Soil/Site Evaluation �
�1PPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990005926 Tax PIN/EH#: C700000120
Billed Ta: Haroid Sheek Subdivision Info:
Reference Name: REPAIR PERMIT Location/Address: 631 Yadkin Valle Rd-27006
Proposed Facility: Residential Repair Property Size: 92.28 Acres Date Evaluated: ;�i��
Water Supply: On-Site Well _�C Community Public
Evaluation By: Auger Boring �C Pit Cut
FACTORS 1 2 3 4 5 6 7
Landsca e sition
Slo e % O/
HORIZON I DEPTH
Texture rou
Consistence '" '
Structure
Mineralo
HORIZON II DEPTH �
Texture rou
Consistence (
Structure E^ ,��
Mineralo ;�
HORIZON III DEPTH
Texture rou
Consistence
Structure
Mineralo
HORIZON IV DEPTH
Texture rou
Consistence
Structure
Mineralo
SOIL WETNESS
RESTRICTIVE HORIZON
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE
SITE CLASSIFICATION: f� EVALUATION BY: �'��'��,���� s��lC�
LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT:
REMARKS:
LEGEND
T,�ndscape Positi n
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
�C�ilCg
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
ON4IST .N .
�Q1S�
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
Sr> > .
SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky
SBK-Subangular blocky PL-Platy PR-Prismatic
Mineralo�v
1:1,2:1,Mixed
1YoY�S
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 suitab , nsuitable) ��
LTAR�Long-term acceptance rate-gaUday/ft2 �. DCHD OS/OS (Revised)