125 Primrose Rd Lot 1 DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O.Box 848/210 Hospital Street
Mocksville,NC 27028
(336)751-8760 Fax#(336)751-8786
OPERATION PERMIT
Account #: 989900025 Tax PIN/EH#: 5789-86-2650
Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#1
Reference Name: Location/Address: primrose-27006
Proposed Facility: Residence Property Size: 1.8 acres
ATC Number: 4747
**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.
S
SystemType:X`' S.T.Manufacturer6wF Tank Date Tank Size
Pump Tank Size1V�/I
System Installed By: L.a V!!A 3Nk�ttt, E.H.Specialist: Date: 3-12-dy
l..xe it t �t� LII c)+a.ilc. 43 tubs "'rte)
4167. 106' (.T) Gam'' 44 tN' �rG�'� �� 3%V1k`
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DCHD 11/06(Revised)
-~ DAVIE COUNTY ENVIRONMENTAL HEALTH l��
P.O.Box 848/210 Hospital Street a 401
Mocksville,NC 27028 /
(336)751-8760 Fax#(336)751-8786
AUTHORIZATION(FOR WASTEWATER SYSTEM CONSTRUCTION
Account #: 989900025 Tax PIN/EH#: 5789-86-2650
Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#1
Reference Name: Location/Address: primrose-27006
Proposed Facility: Residence Property Size: 1.8 acres
l
ATC Number: 4747
Site Type: View ❑Repair OExpansion
**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 #People��BasementVBasement plumbing(a�
Non-;Residential Specifications: Facility Type #People #Seats
Square Footage(or Dimensions of Facility)
Lot Size Type of Water Supply: E ounty/City ❑Well ❑Community Well
System Specifications: Design Wastewater Flow(GPD)y O Tank Size /� od GAL.Pump Tank GAL.
Trench WidthG— Max.Trench Depth 3G Rock Depth 0 Linear Ft. y�7
Site Modifications/Conditions/Other: stnted in I SA NCA4 C I RA 1969(5)
accepted Systems may also be use
Contact the Davie County Environmental Health Section for final inspection of this system between
8:30—9:30a.m.on the day of installation. Telephone#(336)751-8760.
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Environmental Health Specialist . Date: / 4/_0
DCHD 11/06(Revised)
Dick Anderson 336 998 7279 p• 1
TE EVALUATIONIIMPROVEMENT PERMIT&ATC
avie County Environmental Health
P.O.Box g48 ID Hospital sheet
D 1 NO. 36)751-g7 ax(33ModmvMcjNC-6�,,3786
�11r��73 /
\App> anFan tl�itc r pexmit A.tkati t?orTaCmsnuet(AJ1L� ►3Bos+
ypeofAppti CRS oEd.stingsysmn ,oE:%;=ia&modirxasmtofExwjzgsystem orFacility
LIGl7If:N C.I1W1K)7 BE Pl-O p UNU=ALL OF nldE REQUnUD
fN DRMA PROVIDED.Refer to do INFORMATION BfA LEIaJ kr 6rmseaions.
LICA?iT INFORMATION _ q
Name to be Billed-s/i�-t•i AJCAsD&LOa1�'Corrtaa F*ewon ;Gk-
Billing Address it`�to i *a "04.0 (/trr/1HoaKPhonc 72-77
CitylStaterLlP��1 iKt_ -6�j1,. �?D�f$ Business Phare O
Namr onPem-WATCifDiJforntthan Above
Mailing Address Ci ,StaioPLp
PROPERTY 2*URMAT[ON *Date HouseJFaciii Comas F ed
NOTE: A sang p4r ex site plan mat acaoampsuaytbls dpp fodttded O Site Plan dPlatt(o scale}
tYamit ii vaLd for 6a ams itb aIle pLef,m e�cpiratiem with onatpkNphtj
Owner's Name .7)z4LI< V544 Phone Numhe r
OwncesAddtsss I- I Rte G4a _�9L�
PropeayAtldreass city,M&
iotsize, C. 'lacRIlN! O
SnbdivisionNaase(dappkabk. (WAOSStmt tf
DiaetionsToSite: '80I S
if thS>s�ra`tn attYo�f*Tie follQaotig gttectkns is'ges';suppos�rpl dseameofatieaemar be attached.
Are!Tate any eiacm+g aastervaeirrpstraa m the sitt? Dyes Pro
Does dmsho comma jmi4c ioai wetlands? t7Yes alto
Are there sag saxmmtc tsrigbt at=wys an the site? a]es 1
bThe site PAjeasoopprrwatbyacadaspv1hcagency? QYes
will wasam2ier cOcid m dm=t:c s be d?roUYes W'9
IF RESIDENCE FILL OUT THE BOX 13EIAW
g People #Beslroomf patiacyca �„ GardenTu>u4Pbirlpoot pYes
Basement Byes ONo BasrmMPimabingc Oes ❑N6
IF NON-RESMENCE FI¢EW 778 BOX BELOW. .
Type of Facilit 1Bi rW= _ Total Square Footage c f Building____ v People
X Sinks` #Coaamodes #Shntaets #hassle,
Estimated Usage{gallonsperda}j (Att-hdoamtauahonofsi:aailarfaer7itywaxercotnumptiou)
FOODSERVICb ONLY:g Sass
Typxtysmearequesked 96aventional D.'uetxpttd grnnovrlGv4 OAQaltUlve QQd=
water SupptyTypa D'CoaarylCity water a New wall Missing weu a Community will
Do you c+dedpaae addieeas to ecpanrions of the Lcility this system is i s1xndod a sant?o Yea
Itycs.what type? -
Ibis is to astify that See ink m danpmvieLd on this spplieation is wbe and comes to the bettaf tap ltam Wedge.I understand that
my p—*sj-A7gs)issued heeeaRc ars subje4 ro suspmgon or aeiroutie>a it the sin h apexed,ibe iaamded rue diaaga,eu if
the infvmtabrm mAnined m dhewtiugeyt k hkM#d m'changed I he-by put sight of cr&y to the Aachaiacd Itcpaeseniative
oftbe Davis CamiyMuffli Depsrtmms w*m&xt tsnxsswY intpnsioos to detrmipe uwidtappliowsai
6h lad rules.
I uoderttaad than am mpoosible lir d e purr:i6cnOcalion and labeling ofpxopaty fates and cumers aid locaft and&U4
or ataleiig, banal li ke>a ptopassd well loeason and the location of any other amenities.
p _ _!Fs3'a st seaoe¢'s- ive iegiaitae Site Revisit Charge
31= Miall Notifitataoa nater
Duk EHS:
Sign given Dyes M40 Aecowu R g
Revised 11106 Invoices
Dick Rnderson 336 998 7279 p. 2
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�.�51 KD�d u�t l I•ADZ G
Feb 23�05_01;49p __._Dick Anderson ___ __ _ 336 598 7279 P, 1
4 APPLICAI70.11 FOR SITE EVAU ATION/tUPROVEMEJf PERMIT&ATC
Davit;Cotynty Health Dcpattrpent
'Envlranmental Heallli Section
- P.O. Box 845/210 Hospital Street
' Mprlcapi334. NC 2793$ - -
(336)751-8760
eo�IttPORTAh"J�-* THIS APPIXCATION C== BE PRO USSED WUXSS ALL THB RI =RHD
2WOMATIOif IS YROv%=. Refer to the
�+3XFO7t V=0W BtnddTlN for instructions.
✓l. sue to Do sAli.d�[ /�i1/Db'��J tddJS?'-1N[.L.eanc.cc s.rwn !�/C1Lh`�tl.C.rt�_.80�
a/jtAili,g Audra" 4AI
✓cit?/huce/za QC:ir.4t/lct.E (' .'t?O J$ wetness n as
,,-2. naso on s t..ie/ArC if o .rent than Aoos•
tt.ilteq anew c1crIstate/zip
,,rs. Application For: Site Evaluation ❑Improvement Hermit/ATC D Both
,—s. syot.e to so..iso,)(IInuae ❑ wobils llomo ❑ Business Cl Eadu■try D Other
.rL. Typo*rtes.requ.eted. a CQrc ontlonal ® con.•atiosal.oditted i.awatlw
1s. II.fkasidenea, s people s Bedrotaae _ s Bathroom
-'� tdDi,br.eMr lSa.rDq.D/as•»u ukfae sr•eW �auawVP3...Ataq ❑sa••r•t/zr•rl—blwq
7. It aulsua/industry/attar: wrLfy type s s•opl• a Simko
I Cmmodae s£Bowra a DrIvAle a Vater Colors
Ir FU 0333 CN; IF (Torte Lti Sted natio; Apagg tyil.iaea per day)
.—s. Type of oats supply, �Coun:y/CLty ❑ well Cl coma%mity
s. 1w yen utscipats adaitlaas or expansions of the facility this system is intended to serve?a Yes Uric,
wroRrwa—c•r"ra mtarco tLCree Tlt6 REQuixw PROPERTY wFoRMATiON REQUFSTED
IIEE2!t,.CirbcraPIATerSITI-?EL �rBEStONH17TEDbyibeeittme with THIS APPLICATIOIC
C.f-Vroperty Drmeas+oru _�� S O ,Q('P W-SPRITE DIRECTIONS(from hioduvM)to rKoPERTY:
o-rax OtGce M. p 78 Y-76' 3(AV ,0/ 1S8 9TJ 0( S rp � GtEB
--?rgper1yAddress Read Name
CityOp --'07TQV,%y Ct~ 6 j70,Zr
f in a Subd(ristoa rovlde lnforntstiws as ralhewr.
Name. 121$leC14"04 C iqb?56
Section: Block tat: s rYate home earn=lhggod: !?_.9Gtrs5'1 fa4e�'«t"��
This is to tertify that the tafor=tton provided is correct to the bat of my lmowkdgt.I understand that any permit(s)
Issued hereafter arc subject to suspension or moeatton.If the site plans or Intended use change,or if the information
submitted In this application I$fatsiTtd Or changed.1,elan.rmlrrt!6n�ithat[pip[,erpdnst�tslorallFfiarpcslncarrNtjrom
this application• 1,hereby,hive consent to the Authorized Representative of the Davie County Health Dcpartsntnt
to enter upon above described property located in Davie County and owned by
to conduct aU testing proecdures as necessary to delermine the rite sui
1
-SIGNATURE v —�
THIS AREA MAYBE USED FOR DRAWTNC YOUR SITE PLAN(Include all of the following: Exigint and proposed
property Gnu and dlmeasionss structures,setback;and septic locations).
Site Rcdsif Char=s
Date(* -
Client Notification Date
�r9oo° 2,2Siju gHcn�_-�_,- Account No.
Itevscd 1DCAD(05101 Invoice No. q-76
DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
P%UUUU11L 1+: 5 Tax PIN/.EH#: 5789-97-0344.01
Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#01
Reference Name: Location/Address: Peoples Creek Rd.-27006
Proposed Facility: Residence Property Size: see map Date Evaluated: 77
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
FACTORS I 2 3 4 5 6 7
Landscape position
Slope%
HORIZON I DEPTH
Texture groupSCS
Consistence TNS FrNS
Structure
Mineralogy Nt,
HORIZON II DEPTH - 32 Ll Zl�
Texture groupG
Consistence
Structure 31�
Mineralogy
HORIZON III DEPTH 24-41
Texture groupG 51 C_t- C4 SoC
Consistence $ S SP
Structure
Mineralogy
HORIZON IV DEPTH 41^J
Texture group !.-
Consistence r*1S►
.Structure
Mineralogy
- SOIL WETNESS
'YRESTRICTIVE HORIZON
SAPROLITE S
'CLASSIFICATION S
LONG-TERM ACCEPTANCE RATE. - D•3T_
SITE CLASSIFICATION:' P� EV.ALUATION BY: '—
LONG-TERM ACCEPTANCE RATE: ' 3-� 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
Tcx ur
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
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-Pristpatic
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-gallday/ft2
r.