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345 Sheffield Farms Trail Lot 5Account #: 990001122 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Tax PIN/EH #: 4891-81-4277 Billed To: Louis & Bobbie Marroquin Subdivision Info: Sheffield Farms Lot # 5 Reference Name: Louis Marroquin Location/Address: Sheffield Farm Rd. -28634 Proposed Facility: Residence Property Size: 5.4 Acres 94 **NOTE* ��ilib iipro2v3emment/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 #People �� #Bedrooms � #Baths '2— Dishwasher: Z� Garbage Disposal: ❑ Washing Machine: 17� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ - Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ h ?: ;,. Lot Size Type Water Supply Jf// Design Wastewater Flow (GPD)(%Site: New Repair System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width Rock Depth ,1�2 Linear Ft,6� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 K 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.**** 0 Environmental Health Specialist's Signature:!�JL�� O'� d Date: / �2 Pd DCHD 05/99 (Revised) 1 94 **NOTE* ��ilib iipro2v3emment/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 #People �� #Bedrooms � #Baths '2— Dishwasher: Z� Garbage Disposal: ❑ Washing Machine: 17� Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ - Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ h ?: ;,. Lot Size Type Water Supply Jf// Design Wastewater Flow (GPD)(%Site: New Repair System Specifications: Tank Size GAL. Pump Tank GAL. Trench Width Rock Depth ,1�2 Linear Ft,6� Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED EFFLUENT FILTER RISER(S) IF 6 K 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.**** 0 Environmental Health Specialist's Signature:!�JL�� O'� d Date: / �2 Pd DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Bos 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001122 Billed To: Louis & Bobbie Marroquin Reference Name: Louis Marroquin Proposed Facility: Residence ATC Number: 2394 Tax PIN/EH #: 4891-81-4277 Subdivision Info: Sheffield Farms Lot # 5 Location/Address: Sheffield Farm Rd. -28634 Property Size: 5.4 Acres 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 WASTEWATER-CONSTRUCTION,ISS VVALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: ��1' •C�; � Date: V� -7;'&� 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 s—'sEgctori y gor�fiy given period of time. 2� 4Z�Rf Lei Jree1t / O /2 /.2 ? Y Septic System Installed By: Environmental Health Specialist's Signature: Date: DCHD 05199 (Revised) APPl1CAT10N FOR SM EVALUATION/IMPROVEMENT PERMIT a - Davie County Health Department D [� [ 9 W [ Env/tnrtmental Nee/th SecEfon P.O. Bos 848/230 Hospital Street Mocksvills, VC 27028 'APR 18 2000 (336)751-8760 +++IiBtlRTARTe+• THIS APPf,ICATI0s1 t7lNNOT 82f ENVIRONMENTAL HEALTH IHl0RD01TION I8 PROVIDED. Hafer to the raMICH VNLS88 ;7 [ / ��/ IHI'OR101TIDtt BDL 212 for instructions. 1. Mum to be Baled �S / �1� /!�/�WI?h g2 f�1/Lfr�l t cmtwt a•reoo u �SWtE�O(u i acct.. come none -7,9'(- 5'/6 -a S Is ost7/stat./c:srv�ynoNt/ /1/C' riZ863� swiaew awtoaa 7oY- 3 ®S - i o 5/ s. Memm mm a•ralt/aZ'C it Ditt•rnt that above wailing Address . City/atata/sip. s• Application tors site =valuation D Improvement Petah/ATO t�8oth o•. Mtmm to sestioe, X House D Mobile Hunts 0 s- i e. I! Residenoe: kDiahreeher s Hess 13 Industry 0 Other People e Bedrooms 3 I Bathrooms 62 O alba" Dispeeal t. tt swine.•/todostsr/otb•rt 1 Commodes kwaebion, meehine apeoitr typo e showers it E0013113f ICB: t) seats 7. Type of Water supply: D aaseseet/rltsbi'o e urinals El Weeant/Mo ale•hinq e water coolers lestimated Water Usage l9allow per der) 17 county/City k Vall e. Do you anticipate additions or expansions of the fecHily this system b Intended to serve? D Community Dy" b(No If yes, what type? ...CLIENTS "W C0 ftE7g•HE Property Dimensions: Tax Office PIN: p Property Address: Rad Name Chynip A2ovy .c. a�s�ay It In a Subdivision provide Inforaratia, a follows: Names _S(1�%Tf iw-l—i42MS Section: Block ]Cuts PROPERTY VWoRMATION REQUESTED WRITE DyET�ONS Mom MaYeville) to PROPERA�a n,v Date Property Flaggedl _ /' A6 ° n2ao© This Is to certify that the Information provided Is correct to the bat of my knowledge. I understood that any permlt(s) faced hereafter are subject to snspenslon or revocation, e, or if the Information If site plain or Intended use ehanQsubmitted in this bflOtd or changed.I, acro, understand h► submitted at I an raponstble jot aU ctiarget IacurredJMns thh apppcad&L 1, hereby, Stye consent to the Authorized Representative of the We to enter upon above described property located In Davie County and owned by C -� He�ith Department to conduct all testing tis t Y s Procednra ns necessary to determine the site sultabWty DATE � /?- 02000 SIGNATURE ,J TMS AREA MAY BE USED FOR DRAVANG YOUR S1TEnclQsta] ny sod --proposed Property Iina and dimensions, stmetures, setbaclm, and sePIptic"(del)ade all of the foH s E Sita —ReI Ch r`e Date(:): Ghent Notification Date: Account No. - —� Hauled DCHD (07/99) /y /� Invoice Na e ri 1, 3 200' 330' 330' rn �J Ac„ 5.3 Ac. `° 5 Ac. J ��.5 Ac. 10 S0. access sdnms 280' ' 124'--' 280• �- 315' I `— ___292' _ 292 ` 3 CIO J � N 5. Ac. 5.7 Ac 5.5 Ac. m d 160. 284' ?8S, 119' '7.5 Ac. � 6.4 � 13 C14) cl WOM3ed 50' access edsemsnt 352' -- 35`2 ' 2_ u 5.7 Ac . N 7 Ac. 255' ! 219' 33t DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soi]/Site Evaluation - 'APPLICANT'INFORMATION . PROPERTY INFORMATION Account # , ' • � • � x PIN/EH #: • 4891-81-4277 Billed To: Louis 0& Bobbie Ma rroquin Subdivision'lnfo: Sheffield Farrna Lot #5 'Reference Name:' Louis Marroquin P Location/Address:: Sheffield Farm Rd: 28634 y . ProposedFacilit ,Residence Property Size: 5.4 Acres" Date Evaluated' Water Supply; On -Site Well •. t% : ;Community Public Evaluation ByAu er Borin i� Pit Cut g g FACTORS .. l 2 3 4 5 6' '7 Landscape position L Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON H DEPTH ' Texture group Consistence- Structure lL Mineralogy HORIZON III DEPTH 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: �� EVALUATION BY: LONG-TERM ACCEPTANCE RAT E:r OTHER(S) PRESENT: REMARKS:' -i,,LEGEND Landscape Position RRid , g S Shoulder " L - Linear slope FS -Toot slope N - Nose slope CC Concave slope CV - Convex slope T - TerraceFP -'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) ■ ■■■■■■■■■s■■■■■ ■■Me■■■e■ee■■o■ ■MUMEMEeee■eee■ ■■■M■Uoo■M■■U ■■■t■ ■EMMEM ■■ot■■■■o■■E■E■ ■■■UMMEME■■MME■ ■■■■MM■M■MEMMUM ■■■■oe■e■MEMEME ■OMMEMEe■Ees■■■ ■■■■■ ■■■■■