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108 Maple Valley Rd Lot 26 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 Account #: 989900025 OPERATION PER1Viiax bPIN/EH#: 5789-86-2259 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods IV Lot#26 Reference Name: Location/Address: Primrose Road-27006 Proposed Facility: Residence Property Size: 167x233x129x ATC Number: 4832 **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. \' ` 0 1 0 6) System Type: S.T.Manufacturers Tank Date Tank Size 110oo Pump Tank Size S stem Installed B : E.H.Specialist: !.-UJB NA110 J Date. Y Y P Q 7 � ------------- 15- - kr f �0 I �P- -(ITTT 1 1/AL /n �\ - DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street �I D Mocksville,NC 27028 (336)751-8760 Fax#(336)751--8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account M 989900025 Tax PIN/EH M 5789-86-2259• Billed To: Dick Anderson Construction Subdivision Info: Marchwoods IV Lot#26 Reference Name: Location/Address: Primrose Road-27006 Proposed Facility: Residence Property Size: 167x233x129x ATC Number: 4832 Site Type: Cfi1ew ❑Repair ❑Expansion **NOTE**This Authorization to Construct(ATC)MUST BE ISSUED by the Davie County Environmental Health Section prior 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#Bathrooms 3'4�#People Basement❑ Basement plumbing❑ Non=Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size Type of Water Supply: runty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD) l Tank SizeIAO�:GAL.Pump Tank GAL. 3�t► x`06 ' Trench Width� Max.Trench Depth Rock Depth Linear Ft. af �5I ��i�o�t Site Modifications/Conditions/Other: LL mA 6"j— W Contact the Davie County Environmental Health Section for final inspection of this syst m between 8:30—9:30a.m.on the day of installation. T e hone#(336)751-87 50. W to rnJr 101 7 JA' cam G� lio €� As stated In 15A NCAC 18A 1969(5) 11� accepted Systems may also )e use gay avironmental Health Specialist Da e:_ :3 Davie County Environmental Health P.O.Box'848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 Account #: 989900025 IMPROVEMENT PEWFIN/EH#: 5789-86-2259 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods IV Lot#26 Address: 225 Wing Haven Lane Location/Address: Primrose Road-27006 City: Mocksville Property Size: 167x233x129x Reference Name: Proposed Facility: Residence **NOTE**This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S.Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans,plat or the intended use change. Permit Type: Aew ❑Repair ❑Expansion Permit Valid for: 5 Years ❑No Expiration Residential Specifications: #Bedroomsq#Bathrooms-3-�rit People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People -#Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): G. 7 4(P Type of Water Supply: QAL`�ounty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: System Type LTAR ------Initial - Repair a Pr i rA roses -7 8 Site Plan 3f! ko O G \ i T 'T s J �b B. Environmental Health Specialist Date :-nes Dick Andersen 336 998 7279 P• 1 ' APPLICATION FOR 3ITE EVALUATION4WROVEMENT PERMIT&ATCERMAR Davie County Environmental Htalth EM Box 848810 Hospital citrcet Mocksvilic,NC 27023 (330751.8760/Fax(336)753.8786 2008ApplicarionFor-U Sim Evalua[Iodlmplovetnew Permit G Authorization Ta Construa(ATC) 0 Both Type of Application: ONew System C Repair to Existing:Syscat nEap=sionmodilication orExistiog System or Facili HE4LTH'IAlPORTAN***llilSAPPUCA"TIONCANNOTBEPItOCESSEDtll.`LESS ALLOPTILE"UIRMTY INFOPMAMONISPROVIDED. htdcrtothe MORMATIONBXt.ET.iforinstructions. APPLICANT INFORMATION G Name to be Bitted C .t)d�e 50 N t Contact Person Z i Ck- A'V d e-a sO Billing Address Z-1-5 U-51,02 V A..t2 a ai L 1#omePhme & 47i I&A- CitylStatclzlP Mrel��tI i L a(J� �_9aZ8 BminessPhone ,t3_S694157Z79F Nasse on romiWATC if Differs am Above Mas'IingAddtess Citylstatelzu) PROPERTY INFORMATION *Date HousesTacility,Comers FlaMd NOTE: A survey plat orsite plan n=accompany this application. Inelwled:0 Site Plan OPlat(to scale) (Perm v tid for 60 mondu with site plan,no expiration with cpm>iete plat) Owner's Name i tiv� phone Number da to 671 If 1`3 Ownces Address 2K. W-, 0 dEd) LM N L CitylStawzip myc-1 -5 L;.e-L f' AA=- Property VtProperty Address! S/K ArAv- rt t4 CityA_/ da�4e- At/Cr1 Lal Size .07NV .4r- _Tax PIN r o GAG a• Zu 66781-g`j 2259 Subdivision Narne(if appLicable) NMtr-44aL tilood q ---Section/l a1 !�e� Directions To site: wL'x re IdawLe A:AA� 't•o o eo/ nes rt-✓eLi Ifthe answer to any of the following quc:dons is W,supporting documentation rant be anacbed__ Are dicte any existing wasUvatcr systcau on the sire? 0 Yes,10�7o Docs the site contain jurisdiai:soal wetlands? 0 YL.-0<40 Are there any wsanetns or rW ofrways on the site? OYe.eta: Is the site subject to approval by another public ageayr nyc.ANo will wastewater olltatban dar-astie sewage be gcaerateV 0YG• o IF RESIDENCE FIIL OI7T TIM4 BOX BELOW 1 m #People 7 —flBahnartss #Bathroos GardrnTubMilirlpool QVC3XWo, Basemcnt:Dyes gNo Base wmPhmtbing OYes jWa IF NON-RESIDENCE FILL OC T THE BOX BELOW Type of Facilil)tMusiaest ToWSgtmm Fool2gevfBoilding Irpeople 4 Sinks #Comrnodcs_ #Showers #Urinals Estirnaaed Water Usage(gallows per day) (Attach doeuventation of similar facility water consumption) FOODSERVICEOMY: Mats Type syS=rcgtastrd:.*nvcm6onal DAarprcd Olnnovative rlAttacmtive DOthet Water Supply Type)<Couary1City Waver 0 New Well OExistiug Well 0 Community Well Do ym a ticipatc additions or expansio:e of die facility this system is inaended to serve?0 Yes K'No Ifya,What type? Ibis is to certify that the information powided on this application is true and•.orrect to the best of wry knowledge. I undersand ihat any pesmii(s)orATC(s)issued bctcatkr ere subjeet to suspension or revocat ors if the site is altered,the iatcnded use cbaagts,ors if, than infomrtion submitted in this ap;6cution is falsified or changed. t hereby grant right of entry to the Authorized Representative of the Davie County liethb Depanmeai to conduct necessary W;peuions to harmine convaiaaee with applicable laws and rules I understand that I ata ran spannbk for tke proper identification aid labeling a rpruperty lines and comms aad locating and tlaa ttg or the 5 1 callow proposed well location sad the location of any other amettnics. AA Sue Revisit Clmtgr Property'"er's or owaer's legs)rerrriemative scgnanac Date(s): Client Notification Doe: Dare EHS. Sign given 171Yes DNo Account ` - — Revised I I/" Invoice 9 /-.!(L/ Dick Anderson 336 998 7279 p. 1 t t � i f F 4 i �b e Plot . I j • i i 29 fl� / I 1 1 2.09. r��U GJ�U��Vi�T,7(' �_.._u14rS assent r50n --- -- _ -- JJO .y.7 t7 tGr,7 p, A APPLIGi17(XV E0111 SIX EVAILI ATION/WPROVEUNT PERMIT&ATG Davis County Health Department EnvlrvamentalHealth Section P.O. Box ane/zla Hospital street ptoekavi334, PC 279913 !3363751-8760 ew•ZMPORTAbr7*** THIS APPLICATZON CANNVr BE PROCSSSED Ma=3 ALL TQM $SQVIRBD INFORMATION Z3 YRO=233. Refer to the MWOMIPCION SULLETZH for iaatrvctiona. ✓3. N.sw to be 8111-A / .Y��t//,J'e/�J3od 64)S t1,U[,uw„teet rwt.on l��ele 414 i05 .8 d A)' /(s- e/fraillsq Afdresa �/AA1�✓e-V /— /. Vlfwe ru.— c/1;1-15791 '✓ity/st.ta/zir 616Ces y rdZ— Ale a7b34 ,-bnstoosa noon 9FIS-7.7.7q ,,-2. Her on Petvit/Ar'C to o •wrens tam Above M.Sltog x4drues city/st.te/alp w�.l. application For. XSLtG r7AlUAtion 0 Impravoment.Rarmit/ATC 0 Both rt. elyst—to ses+tee,)(!mune G Mobile IIcmo ❑ Business Cl Zaduetry 13 Othar ...ri. Type wyet—requ.atam 0 eowwAtlenal O eou.watiooal eoditled © le.wative r-c. ,I,f Xosideaee, I People I Bedrotxm _ 1 Bathrooms i• IdDlalweLer �b,yw Clspawel uktey ltsa►laa Onuawl/vluelisq Osue.ena/se plveSleq .. 7. It nusioeso/Iddastey/other: verify typo a people s Stake I comodas a r]ouern a OrinAle s Mater Caalors Ir rOoV=VZCBt tl�seattf Za tim9t9d Ka tis; IIeag" (OL-149L.5 plc dsy) --s. Typo Of ricer Supply, cr-coua:y/City 0 Well 0 Coimmuaity s. Do you aaeieipata adoitims oe expansions or the raeiiity this system is intruded to serve?0 Yes Oflo ifyts,tvhatt I _ lMP'OR7AN7 "t'LlClwti MUST e0 PLtTE THE REOUIRFD PROPERTY INFORMATION REQUESTED aE EltheraPLATerStTLTPL .r�STBESUBM17TEDb tbeetimt with THIS APPLICATION. L,�Iroperty Dimensions:—� . S G i 6!C�RITE DamcnONS(from Mocksvltk)to PROPERTY: a-,Tax office PIN: a 5729 J-7 d 3 . 9 f58 rO &ol S ' 77J P2510e---SCi2e---K ---Praperly}lddresr Read Name 6'.vPeze-S G(!A5e 2& CityrzipAQV&j C,E ,,- C.j7a,Zx stn a Subdiv(dop rovfde informatl3n,as follotvs: Name: Ima2c.ly A)nOn e R145,05 I-A Scctton: Btoek heat:-rZP17� a Wate borne carvers flagged: C?-o46&292 jla<1�9�/76t"JC9 This is to certify that the tntor=r1oa provided is correct to the bat army knowledge.I understand that any permft(s) issued hereafter are subject to suspension or revoeatfon,If the site plans or intended use change,or if the information subtot Ifcd in thts app,llotian is fabi6cd or chaaCeti.I,alae tm*w-and rheflaip rumens blsfor elf ehorivs inenrrrd f O- O+is applicadam. I,hereby,give cement to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all tenting procedures as accessary to determine the rite Sul {,DATE .0 -a. -r?s "SIGNATURE -t�fwt-f THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Inclode all or the rel(owing: Existing Bad proposed property lines and dimensions,structures,setbacks, and septic locations). Site Revisit Charge Datc(s): Client Notification Date. EHS Sign given Account No. Revised DCHD(MM3 Invoice No. Y DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPiACY92114i11,F(a1ENIMM85 Tax PIN/EH#: 5F&MM tFORMATION c,:,, Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#29 Reference Name: location/Address: Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: -a- Water -Water Supply: On-Site Well Community Public Evaluation By: Auger Boring c/ Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position V S102C% HORIZON I DEPTH Texture group Consistence 0 rift Structure Ct�rr•7v Mineralogy HORIZON II DEPTH Texture group Consistence Structure 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 n r SITE CLASSIFICATION: S EVALUATION BY: K�h ��(j //1 n S LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: LEGEND Landscape Position R-Ridge S-Shoulder L-Lincar slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H=Head slope Tcxtur 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 VFl-Very firm EFI-Extremely firm wct NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structures 'SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prisipatic Mineralogy 1:1,2:I,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 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME��1 /So/� DATE EVALUATED � �911JS PROPOSED FACILITY /76G11P_ PROPERTY SIZE SUBDIVISION �/!�/_ ROAD NAME Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS AV 3 4 5 6 7 Landscape position 4 Slope%v 61a HORIZON I DEPTH Texture groupSL'l Consistence i Structure Mineralogy HORIZON Il DEPTH y « Texture groupG Consistence T l Structure / 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: 4 "� EVALUATION BY: 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-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(01-90)