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156 Mollie Road Lot 7Account #: 990002706 Billed To: Jeff Hayes Reference Name: rroposea racu¢y Kesiaence ATC Number: 4286 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Tax PIN/EH #: 5801-10-5600.07 Subdivision Info: Sheffield Acres Lot # 07 Location/Address: Sheffield Rd:27028 maize: i acre 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, Sectio 1 0 Sewag reatment and Disposal Systems). THIS AUTHORIZATION FOR WASM U TION VA OR A PERIOD OF FI YEARS. Environmental Health Specialist's Signator Date: 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 I g given period of time. 5* 11 q ST)l uKgL7� —rp,Jt�'DnT� I-22 Septic System Installed By: Environmental Health Specialist's Signature: DCHD 05/99 (Revised) 3 0 F In 511 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 ,�� 61 , (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account M 990002706 Tax PIN/EH M 5801-10-5600.07 Billed To: Jeff Hayes Subdivision Info: - Sheffield Acres Lot # 07 Reference Name: Location/Address: Sheffield Rd. -27028 Proposed Facility Residence Property Size: 1 acre ATC Number: 4286 **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 �D � #People #Bedrooms #Baths Dishwasher: Garbage Disposal: M Washing Machine: 21"� Basement w/Plumbing: 13 Basement/No Plumbing: Commercial Specification: Facility Type / , ,#P,eople #People/Shift #Seats Industrial Waste: 11Lot Size D � $N1 A� Type Water Supply `�-�N t1' Design Wastewater Flow (GPD) 3(00 Site: New L� Repair System Specifications: Tank Size I WD GAL. Pump Tank Other: Required Site Modifications/Conditions: GAL. Trench Width 5114' � Rock Depth WA Linear Ft. 300' 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.**** C-..., S14� Id Health Specialist's Signature: DCHD 05/99 (Revised) \ 0 �k FeEb L,O ES if -3 :�y v0s U14VSDar � 5t u --tNcM e WAV ON FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC r pn Davie County Health Department e V D Environmental Heath Section D.0, Box 848/210 Hospital Street DSC 2005 Mocksville, NC 27028 2't (336) 751-8760 b ORTANT** PLIC TION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED :2 FORt _` k IDE fer.to the INFORMATION BULLETIN for instructions. 1. NaAp.befDilled Mailing Address�i.. City/State/ZIPS/ 2. Name on Permit/ATC if Different than rJ Mailing Address /�Contact Person 3�-� /^1 Rome Phone .as Phone City/state/zip 3. Application For: ❑ Site Evaluation *mprovement Permit/ATC ❑ Both 4. system to service: AHouse ❑ Mobile Home ❑ Business ❑ Industry ❑ Other 5: Typo system requested: �J Conventional ❑ conventional modified ❑ innovative-r3aCCepted s. I1pif''7 Residence: # People # Bedrooms ' # Bathrooms _ ry yiuhwasher ❑garbage Disposal lashing Machina ❑basement/Plumbing Bement/No Plumbing 7. ( If Business/Industry /other: verify type # People # Sinks # Commodes # Showers # Urinals # Water Coolers IF FOODSERVICE: It Seats Estimated Water Usage (gallons per day) s. Type of water supply:/, County/City ❑ Well ❑ Community 9. Do you anticipate additions or expansions of the facility this system is intended to serve? ❑ Yes 06No If yes, what type? ***L11P0Rfz1NT'*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Properly Dimensions: , ��� WRITE DIRECTIONS (from Tax Office PIN: # 0 �' 6 e �S2 •� `� Property Address: Road Name IZS444 i e-14- City/Zip liC City/Zip If in a Subdivision provide information as follows: Name: Section: Block: Lot: to PROPERTY:' a n Date home corners flagged: d 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 subutitted in this application is falsified or changed. 1, also, understand that I mn responsible for all charges incurred from this application. I, hcreby,'give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie Comity and owned by to conduct all testing procedures as necessary to determine the site suitabi •t DATE I/ 2A / b� SIGNATURE T THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN (Incl all o nc following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Datc(s): Client Notification Date: Sign given Revised DCI1D (05103 \ EHS: Account No. a' Invoice No. 5/7D 1:011 SITE L•Vi1LUATION/Ih1PIlOV9AIL•NT 131111 11T & Xro " Davie County Health Department En vironmenta/ Hea/t/i Section O. Dox 848/210 Hospital Street - blockaville, NC 27028 (336)751-0760 • ***IDrPORTANT*** THIS APPLICATION CANNOT DL PROC.CSSZD UNLESS ALL TIIE REQUI121ill . ` INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. .' 1. Name to be Dilled//pL�ln/��(�( _ contact Person ^ - Mailing Addrans -341-70-1 Oa eeo Anee Dl- lloma Plionc city/state/ZIP �6rLy, Y)L /J✓S/ IV.G• L`%��•� DUainCas Phella C—� eJ S 2. Nano on Permit/ATC it Dittorant than Above S/amlP� Mailing Address city/stats/zip 1. Application Fore _-S�Site.Evaluation ❑ Improvement Permit/ATC - ❑ Doth 4. system to servicer LYHouse ❑ Moltile Home ❑ DusinesD ❑ Industry ❑ Other 5. Type system requested: M Conventional ❑ conventional modified - ❑ innovative G. If Residence: l) People - p Bedrooms - p Bathrooms L _ ❑Dishwasher ❑Garbage Disposal ❑Washing Machina ❑Dacomant/Plambing - ❑Dasomon L•/No nluinbing 7. If Duainoss/Iaduatry /other. verity type - a People: 0 sinks 4 Commodes A showers :tf Urinals-- Q 11ator COoloru IF FOODSERVICE: it S�edL•s Estimated Water Usage" (gallona par clay) - 8. Typo of water supply: IT County/city - ❑ Well ❑ Communi L•y' ---_—_ 3. bo you anticipate additions or expansions or the facility "tills Nysten, is intended to serve? ❑ Yes - ❑ Na If yes, what type? 140K) wAAPP LOT 7 ***1hLPOICTd1YT*** CLIENTS MUST CDAII)LL••TETHE IUEQU1JeHD PROPERTY INF01MIXI'IONItEQUESTED —I BEL01Y. Elthera PLAT orSITE PLAN AIUSTDESUDAr17TED by the client nitl, TIIIS AI 1 I ICA•1•lON Property Dimensions: _/�,(�/•3 T�-/--/ I/�0� )VIiITElluiLCI-IONS(anon'luel2sville)(al'RUI'lilt'I'1': rax.oirlce PiN:".. If s 8�/—/0 5 G Lt? Property Address: Road Name .'a 4 41j [� / iFcG� �4 Cityrzip If in a Subdivision provide infurnlation, as follows: Name• Section: I31oc12: Lot: - Date hon,c ca sera flagged: 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 it tie infurnnalion subnlitled in this application is Lllsif-zed or changed. 1, also, iulderstand Drat l mil reshoinsible for all charges ivaa'rrd fi•onr this (TvIleation. I, hereby, give consent to (l,c Authorized Representative ortllc vavic County Health Departmcul to enter upon above described 1)1*operty located in Davie County and owned by jtrn , Me to conduct all testing procedures as necessary to delerillille the site suitability. DATE SIGNATURE „ TRIS AREA MAYBE USED TOR DRAWING YOUR SITE PLAN (Includ all of the fullolvillg: Existing and proposed propertylines and dimensions, structures, setbacks, and septic locations). - i Sign given 10 -a -A hlwn ince..: Site Revisit Charge " Client Nolificalion D,itc: ERS: Account No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site'Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account .#: 990002086 Tax PIN/EH #: '5801-10-5600.09 Billed To: The Cana Group,LLC Subdivision Info: McCullough Property Lot # 09 Reference Name: Location/Address: Sheffield Rd: -27028 Proposed Facility:, Residence Property Size: , :see map. Data Evaluated: ^ 0 Water Supply' On -Site Well Community / Public, Evaluation By: Auger Boring ,Pit Cut FACTORS ; : • . 1 2 3 4 : .' 5 6 7: Landscape position Slope % .b 7z HORIZON I DEPTH _ l Texture group Consistence (j Structure Mineralogy HORIZON II DEPTH �3J Texture groupv . Consistence Vr. Structure Mineralogyu HORIZON III DEPTH - Texture group S` Sl (1i GOD Consistence S5 Structure L Mineralogy HORIZON IV DEPTH L10 -s Texture group(jF ' Consistence r Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: O J OTHER(S) PRESENT: REMARKS: ` LEGEND Landscape Position g ,. p P pe R -Ride S -Shoulder L. Linear slope FS -Foot sloe N ;,Nose slo CC - Concave slope CV - Convex slope T -Terrace FP - Flood plain - H - Head slope Texture S - Sand LS - Loamy Y. 'sand SL - Sand 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. VFR - Very friable -FR -, Friable' FI'- Firm . VFI - Very firm EFI - Extreme lyfirin Wet NS - Non sticky i 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) D OCTA 4 2004AIII ON 1:011 SITE LW1I.uartoN/WPIiOV0Ir•NT POINUT & M -C Davie County Health Department E/IY/!O/!/flenta/flea/t/7 SCCt/0!7 QNIRONMENTAI Box 848/210 Hoapital Street phVIEC my Mockbville, NC .27028 . Y (336) 751-0760';' ***IMPORTANT*** THIS APPLICATION CANNOT DL PROCESSED UNLESS ALL TILE REQUIRED INFORMATION IS PROVIDED. Refor to the INFORMATION BULLETIN for instructions i. Name to be Dilled 1L1'e'�/y/fL �O hp /G/7 V- Contac L' Person ZA14 j=� Mailing Address Home Phone �—�i!u� // 6/. City/State/ZIP L 0nurtn/✓S, lUL%�/.� Duuincsa Phone 'ELL � e3S .. - .Y _.._.. ....... 2. Name on Permit/ATC if Difforont than Above Sa)-, , " Mailing Address - City/State/Zip--___^• 1. Application For: ��B9 Site Evaluation _a ❑ Improvement• Permit/ATC ❑ not], 4. system to service: L�YHouse ❑ 13ollile Home 13 Business ❑ Industry ElOthal: . 'k S. Type system requested: a Conventional ❑ conventional modified ❑ innovativa - 6. If Residence: it People ¢ Bedrooms ¢ Batllroamu Z ❑Dishwasher , ❑Garbage Disposal ❑Washing Machine ❑Bazoment/Plwnbing - ❑Uasamont/Mo Plumbing 7. If Dusinoss/Industry /ether: verify type ¢ People ¢'sinla tl Commodes¢'Showers - - -¢ Urinals It Water Cooloir,_ IF FOODSERVICE:i},_,SSeats Estimated Water Usage (gallons pari day) _ 6. !7. Type of water .supply: County/City E3 well ❑ Conunuriil-y - S. be you anticipate additions or expansions; or tile facillty tIIIS SySIC111 is intended to serve? ❑ Yes ❑ No if ycs, what type? ***lAIPORTi1NTv'** CLILN'fS AlUST COAfl'LETE'fHl IiGQU!!(GU 1'KOP1sIL'1'1' lWtrO(LMA'1'[ON ItliQ ll l S (I:0 I l3ELO1V. Either a PLA9' or S1Tli PLAN r11USTfiLO• SUX1,r TIED by the client with •'1115 Al 1 1 ICATION Property Dimensions: IYRITE 01RECl'(ONS (rrum Alucksville) lu I'KUI 1 ICI'1': T:tx.OfrlccPIN. # S Fp /O <S 6b Property Address: Road Name /1 if f�-ri city/zip t 56•v7a� 117111 a Subdivision provide infuriation, as follows: Nalitc• Section: Block: Lot: d Date Hens corners Bagged: This is to certify that the information provided is correct to the best of Illy knowledge. I understand (ha(:u1y peruli t(s) issued hereafter. are subject to suspension or revocation, if the site plans or intended use change, a• if (he hirorma tion submitted in (his rpplicat(ot is falsilied ur changed. I, also, fuularstand dratI rrar res/rurrsiGlejur rr!( cluub'es iucrurrd,jrum thisappllcatierr. I, hereby, give consent to the Authorized Rcprescnta(ive,or(be Devic Cuuuty Ilcaltb llcJnu Uucu( to enter upon above described property located in Davie County and owned bj' , Mc L'v/,/, IO Conduct all testing procedures as necessary (0 dC(l'1-1111110 (Ile site Suitability. DATE- 9- 27 O SIGNATURE . z•: iL THIS AREA MAYBE USED FOR DRAWING YOUR SITE PLAN (Includ all of the following: Exjs(ing ; ild proposed property lines and dimensions, structures, setbael(s, and septic locations): Sign given Account No. - i' - r1 , DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SoiVSite Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account M 990002086 Tax PIN/EH M 58Q1-10-5600.07 ' Billed To: ,The Cana Group,LLC ` Subdivision Info: McCullough Property Lot # 07 Reference Name: Location/Address: Sheffield Rd. -27028 Proposed Facility: Residence Property Size:. see map Date Evaluated: Cv�lSll Water Supply: On -Site Well Community Public Evaluation By:. Auger Boring Pit ✓ :cut FACTORS 3 4 5 6 7 Landscape position Slope % HORIZON I DEPTH Texture group!i CG Consistence of / Structure 7— MinerAogy HORIZON II DEPTH Texture group Consistence r Structure Mineralogy HORIZON III DEPTH j I. yow" Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE /` CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVA LUATION BY:� LONG-TERM ACCEPTANCE RATE: O THER(S)PRESENT/:�- REMARKS:(� LEGEND Landscape Position R - Ridge S - Shoulder L - Linear slope FS - Foot sloe N - Nose slope CC - Concave slope CV Convex slope T -Terrace ; FP -Flood plain H - Head slope " Texture S - Sand ; ., LS - Loamy sand SL - Sandyloam 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 VFR - Very friable ': FR - Friable - FI -Firm VFI - Very firm EFI - Extremely,firm . We 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)