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128 Maple Valley Rd 24 � p DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section �O� P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990002285 Tax PIN/EH#: 5789-97-0344.24 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#24 Reference Name: Location/Address: Peoples Creek Rd.-27006 ATC Number: 4374 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 IS VALID FOR A PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: Date: CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate t 7tbed on Improvement/Operation Permit has been installed in compliance with Article 11 of G.S.Cha 130 o 00"Sewage Treatmdnt and Disposal Systems,"but shall in NO WAY be taken as a guar tem will function satisfactgrily for any given period of time. ED tl � ~a� � 1 to 4 - I Dam Septic System Installed By: Environmental Health Specialist's Signature: ate: 7 .2 Lo DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002285 Tax PIN/EH#: 5789-97-0344.24 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#24 Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: see map **NOTE*%Isgmproveme4i t/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 _ Dishwasher Garbage Disposal: 121"' Washing Machine: ET", Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow(GPD) Site: New❑ Repair❑ i System Specifications: Tank Sizer GAL. Pump Tank GAL. Trench Width-T6 Rock Depth /1//17'Linear Ftlal?-s Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISERS)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.**** L. �'! ( Environmental Health Specialist's Signature: Date: db DCHD 05/99(Revised) N GJ�V.7�V1 , •TQ11 ... ---unlit\-nnQWrsQ(I --- -- - - .7J4 .'717Q lGi..) • APPLICAI7U,Y FOR SITE EYAU ATIOv/LNPROVEMENIT PERMIT 4 ATC Davie County Health Department _ �/ p T--- Z4 En vlrvnmental Ma21W Sedzbn l P.O. Box a08/210 Hospital Strout 14ock0Ti114. NC 27994 ' (336)751-8760 •••ZffXM7AN7'— Tess AFPLXC%Tl:ON CANI+lvl'BE FX0CGSSF-D t)U=S ALL 7= R=RIW INlORISA2TQtr IS FROVIS:ID. Refer to thee IZrr MP=ON BULLZTI l for inetructionis ✓a. sraau to be lot)SI'-Zo .c�eo„tect 7-oo,s gD/U[�7`N�} iC-8dA) a/ftatlle9 Aedrss - (�/A/G-li4t/Ge..iJ /-A/ Vtfae tiwu. �1 g�-75'77 ✓csty/atate/Za /y]A(trs t//e�E A4( 27038 ✓au,sn.a.ph.. qq8—7.L7q ,,-2. ttaee oa Pecatt/ATC£r o •arent.than Above Melling aGdrse CLFy/Stat./Zty J ��L/�/,// /D �-1. Application lar: KSitG rNAltsation O Isprovasoeat Permit/ATC O Both .� ,tet. at.ts to S.e..lae, Boase ❑ Nabile U..* ❑ Dusinese ❑ Snduatry ❑ Other / �- ...--s. Type ers[o.reQust.ea. a eow.ntloaal B eoa.aataoaaa sodtetaa .—s. Iff Xesidence, S Poopla 1 Bedroosre _ tl Bathrooms / ! hv, 7. it buslosss/loduatty/other: ve8ty typo S people /Stoke I Coeaads a £Sovera a Uraaale a Nater Coolers Ir rooDsmvlm N�Soatte IIetimatac� Water Vraga (y.]ioea pr dry) -re.. Type at.rater suppiyr 17 County/City D Wall C] Co=%,-ity a. Do you aaticlpata additaads or expansions of the facility this system is intestd¢d to serve?0 Yes crf4a Ifyts,wbai t -- IAfroit M"'CLiewrd MUST CO)rp4BrE THe.IEQWRED PROPERTY INFORMATION REQUESTED D EltheraPLAT orSrrCPL rfrBESU86IilrFD by the d)eat.ritbTHIS APPtICAnom. t/l?►opCrtyDimensiodr iqj0&F2--WRITEDuacrtOWS(from M*Wvttk)toPROPERTY: vTax office PIN: a trU2 J-7 6 3 7 158 ro f o i S 7D P!�o P(.--S Clze-'.a� --PrapertyAddrew: RoadNuue !l�-:O/`4-eSjC2E��1& Cityrlip� All/�,tJ CE r j70.?K fin a Subill vWon rovide fuforout(-in,as follows: Name: o0 /LC,4/Unum e AWSC5 4 Section: � Block: Z.':. &-rate home cornets flagged: This is to certify that the inforcriUoa provided is correct to the best of tay knowledge.I understand that nay pernut(s) issued hereafter are subject to suspension or revocation,U the site plans or intended use change,or if the infornution submlticd In this application is falsified or e)ranctsL I,s/ao, incurrediron this application. T,hereby,give consent to the Authorized Representative of the Davie County Health Dtparimtal to cater upon above described property located in Davie County and owned by to canduct all teslint proccdures as rca:seary to deternsine the site sui / DATE '?-a.li-O S a-aZ"MATURE THIS AREA MAYBE USED FOR DRAWING YOUR STM PLAN(Include all of the following: Existing and proposed property lines and dimensions,struclurts.setback; and septic locations.) Site PeTWt Charge Date(s): Client NoUrie.Woa Date: EHS: Sign given _ Account No.� �tN Revised DCI(D(05/03 Invoice No. • X393 r DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLIC P&1V485 Tax PIN/EH.#: 5,PW-kRg4r4WFORMATION c. Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#27 Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: On-Site Well ! I Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 . 6 7 Landscape position Slope% HORIZON I DEPTH Texture group Consistence Structure 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 SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: LEGEND Lnndscnpe 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 VF1-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 VI'-Very plastic truct re 'SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prisipatic Mineraloev 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.wit chroma 2 or less Classification-S(suitable),PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate-gall& TO DAVIE COUNTY HEALTH'DEPARTMENT Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME DATE EVALUATED PROPOSED FACILITYC/SP PROPERTY SIZE n 7b5 SUBDIVISIONJost;?°4tyo ROAD NAME Water Supply: On-Site Well Community Public t/ Evaluation By: Auger Boring Pit Cut FACTORS 1 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH �` ` Texture groupc Consistence ` r Structure Mineralogy HORIZON H DEPTH Texture groupG Consistence e— 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: P5 EVALUATION BY: 'I- 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 F1-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 Mineraloay 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 ocrro(oi-9o)