The URL can be used to link to this page

138 Maple Valley Rd Lot 23 _.. , u...-...•,,.,t:;ice_ DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 OPERATION PERMIT Account #: 989900025 Tax PINiEH#; 5789-85-0899 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#23 Reference Name: LocationfAddress: 138 Maple Valley Road'-27006 Proposed Facility: Residence Property Size: 0.690 Acre ATC Number: 5023 **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. poo System Type: S.T.Manufacturer Tank Date Tank Size Pump Tank Si System Installed By:].=h, e V640C E.H.Specialist: Z4W4ate: /3 v �N -n i( o Q., C-4 �s U �p 1� DCHD 11/06(Revised) DAVIE COUNTY ENVIRONMENTAL HEALTH O P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 989900025 Tax PINIEH#: 5789-85-0899 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#23 Reference Name: LocationiAddress: 138 Maple Valley Road'-27006 Proposed Facility: Residence Properly Size: 0.690 Acre ATC Number:. 5023 Site Type: 211e`w ❑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 3 #Bathrooms 3 #People 2 Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions'_ofFacility) Lot Size b .�s C Type of Water Supply: a unty/City ❑Well ❑Community Well 4UIfDoa System Specifications: Design Wastewater Flow(GPD)3 Tank Size GAL.Pump Tank GAL. L u , //3 6 r Trench Width 5(."Max.Trench Depth� Rock Depth ( l Linear Ft. �.`J —mss stated in 15A NCTC-T$A.1969;5). p/ Side Modificatiorls/Conditions/Other: accepted Systems may also b:; usedd T Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:30a.m.on the day of installation. Telephone#(336)751-8760. �s . a. y J � J j Environmental Health Specialist Date: DCHD 11/06(Revised) Davie County Environmental Health P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)753-6780/Fax(336)753-1680 IMPROVEMENT PERMIT Account #: 989900025 Tax PIN/EH#: 5789-85-0899 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#23 Address: 225 Wing Haven Lane Location/Address: 138 Maple Valley Road'-27006 City: Mocksville Property Size: 0.690 Acre Reference Name: Proposed Facility: Residence "NOTE"This Improvement Permit DOES NOT authorize the construction of a wastewater system. An Authorization To Construct a wastewater system must be obtained from this office prior to the construction/installation of a wastewater system or the issuance of a building permit(in compliance with Article 11 of G.S. Chapter 130A,Wastewater Systems). This Improvement Permit is subject to revocation if site plans,plat or the intended use change. – Permit Type: w ❑Repair ❑Expansion Permit Valid for: 8'S Years ❑No Expiration Residential Specifications: #Bedrooms #Bathrooms 3 #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD): Type of Water Supply: ounty/City ❑Well ❑Community Well .As stated in 15A NCAC 18A.1969(5) Site Modifications/Permit Conditions: accepted Systems may also be used S stem Type LTAR Initial cc 7!5— Repair Re air d,7 Site Pla G t ti Environmental Health Specialist ate 9 i.p.11-06 t APPLIC FOR SITE EVALUATION/IMPROVEMENT PE MT&ATC U `iO�Oj Davie County Environmental Health OAC 1 P.O.Momma Hospital27028 (336)751-876W Fez(336)751-$M '?S3 } EvWMti meZ Authoaritdion To Coraunet(ATC) Binh err lteparr o System D�arlModirk ioa ofFxisting System orFaeility "•1.400RTAM•'•TIBS APPLICATION CANNOTBEPROCESSED UNLESS ALL OF TlM RDQUMED INFORMATION 13 PROVIDED Refer to the INFORMATION BULLETIN for instructions, APPLICANT INFORMATION 1 NametobeBillod-biQ.k kode-AA013 tadPtnson A�C�� k-acU f'Sam BillingAddr= ..s OB "L Home PhoneR3(i CiWSta1dZIP le-A.11113 L, Me— -y-na $ BuriaessPhone—g31. 4 8 22.7 Nome on Permit/ATC ifDifjerentthan Above %Wing Address cilyistaidZip PROPERTY INFORMATION *Date Hoase/Fac9i Corners Flagged NOTE A survey plat orsibe plan mast accompany this applies iom included: Sile Plan Plat(to scale) (Permit- valid for 60 upwa pith site P N no expiration witb complete Plea.) Owner's Name 111 k o Phu s Number k%l V OwncesAddress Z I,%3cb C, Slxmaf p 6 ✓%AAL. property Address tl►lle City A& u L041. Lot Sine O. 6 OTax PIN#Q g4f3 O 142's Subdvision Name(if applicable) NO&M 5 seaiwwtoGt23 _ Dktcdm To SitC irthe am vftr to any of the folkmtiog questions is'•es,supporting documentation must be attached Are there any existing w=tewater systems on the site? Yes Does the site contain Jurisdictional wetlands? Yes Ass there any easements or ti&of-w ys on the site? Yes Is the site subject to appsaval by another public agency? Yes Will wastevraterotherthan domestic sewa be aerated? Yes IF RESIDENCE FILL OUT TFC BOX BELOW #People 9. #Bedrooms_, #Bathrooms Gudm T.WWhiripool No Basavent: Yes 60 Basement Plumbing Yes M> , ff TION-RESIDENCE FILL OUT THE BOX BELOW Type ofFaclityMminem Total Square Footage of&ulding !PWPie p Sinks #Commodes 9 Showers i+Urinals Estimated Water Usage(gallons per day) (Attach dowmeatatiort of sinnflar facility water oonsuv43doo) FOODSERVICE ONLY: *Seats Type system rested: Accepted innovator Alternative Other Weser Supply Type: 412REW Ne:vr W ell Fiisting Well Community W ell Do you anticipate addition or otpansiuns of the fhality this sysxm is intended to serve? Yes If ye;what type7 This is io certify that the information provided on this application is tette mad Cana to the best of my 1mowledga I understand than tory permit(s)orATC(s)issued berwfter an subject to suspension or revocation if the site is altered,the intended use changes,or if the mfomadw submitted in this application is falsified or dmiged I hereby grant rigba of entry to the Authorized Repmsentative of the Dana Couray Health Depso meat to conduct necessary inspe Woos/o dat=Mc compliance vnth applicable laws and rnkt I tudeasta d that I am responsible for the proper ideotifieation and labeling of property lines and eoraers and logatirtR and 1,00ing is ghe housetfaeility loatim proposed well location and the location of any other smesities. 1 Site Revisit Charge Property ownds or pl repts vestotsn signattue Datc(sx L- (-9-9 Client Notification Date: Date ERS: Sign given Yes No Account= 19990002,6r Revised 1 V06 Invoice it ofv �,d 6LZL8669E£ ONI ISNOO N091:13aNV Nota dg£:W 60 LO Ona N 6- co co ca , M lop Z H z , O z 1V lo, O CO w z VSov " ' ugt Z 3 o PC-. Z790 (� -Pik W { r3r . N � s . o .. --- •-- _. _ o,ao ono tc /� MAP N, a AOPW A,!b)o5- APPILICAII&V FOR SITE EVAUATION/INPROVEIINT PEPWAT&ATC Davie County Health Department Z iZ Env/rvnmentlllealtYr Section �J P.O. sox a4a/210 Hospital street Mogkavi314. NC 27924 (3363751-8760 rerIMPORTAdTfee TIMS APPLICI1TIOx CANNOT BR FROC&S380 OSR=3 ALL TRS ==RRD INBORMRTION Z3 PROV3:1=. Refer to the naVR X=0K BMJMZN for inotructiona. ✓1. wase to be allied /6tAd1V-1�!:5&J Cp.tJS -LNG(tee ncaet tenon Del ae fN.0 �iC 8 dA) s/Ilalaiag A14seaa 2Ayn14A✓Ce_.lf 411/ ✓cic7/at.telLa /i7A(�Stl/CtE Jl4r a7DJ$ ✓a"mesa Phaoe `V-7.7.79 +�I. IU. on M1e[u1C/Ar'C it o erere t6m Above Melling adds"! clCy/SC.Ga/Liy Application Por: xsits rValuation ❑7sprovamegt Permit/STC O Both vi. Dy.%—to 9.eelee. "ouae ❑ srobile IIome ❑ suninese Cl Iaduatry ❑ Other .`s. Type.yetem requested. a Cowentional (9 Coa•"tiosal modifted 13 1"ovative .If Rtesideace. s People I Hodrocaw a Bathrooms 2� —r ®'cl.in..ah.r Li'a.rbye Dlssw»el "kip tYe►iee ❑sueret/aluebly Oa..ereehte Pleeblee 1. It auslaess/Industry/Other: verity type a People a stake I Canaod.s a fsevera a art"1s a water coolers IF.tOODSERYICB; 0Sootta Ltim9tg� Nater IIpayg {y�llaea pr dPy) —mss. Type of.star supply, G 6-unty/city 0 wall 0 commuaity, S. Do you anticipate addttlona or erpamsions of the facility this system is intetded to serve?13 Yes Erflo Ifycs.trhait imroRrAmr 'curxri MUSICO IGETE THE REQUIRED PROPERTY INFORMATION REQUESTED DE22M ElthtraPLATerSIM rRESIZZIMMEDbyttseellent with THIS APPLICATION. L.Fyroperty Dimensions: A7j,1'pFJS�97RiTE DtitECTtotts(from 1Nockrrllk)to lROPERTY: e—'Yaroffice PIN: p :5-799 J763q V •;L ` pe �G fees S 7V P254 USSCl2�=F Properly Addrew Rgad Name A�l��P�S C/�1& al,mpV,0,ZC6 A16 j7aAr f(n a Subdtrislon rovide inforenatiin,aas lollotrs: Name. dj4AZ14 ajne) f c RMS5 tz Seaton: Dloclr Lot: &+!late horac coruers llaggcil: C2A6C—f2 2 -1 L This is to certify that the information provided is correct to the hest ormy knowledge.I understand that any perr ut(s) issued hereafter are subject to suspension or tfvotatloo,If the site plats or intended use change,or if the infornrdtion submitted In this npplimtlon is rafsificd or e3xingnl 1,clap,tmlGrslpnd reps!nnr retponslblrjar all sfierges incurred jroon this application. I,hereby,give cement to the Authorized Representatire of the Davie County Health Department to enter upon above described prvpert.located in Davie County and owned by to conduct all testing proadures as atccasary-to determine the site sui i L--DATEa DATE ?- .5-O S ''SIGNATURE THIS AREA MAYBE USED FOR DRAWING YOUR SrM PLATT(Include all of the reliowing: Existing and proposed property Goes and dlmeoslons,strudurcs,se(backs, and sfptieloeations.) Site Revisit Ciarge Dale(s): Client Notification Date: EHS: Sign given� Account No. "� S Revised DCHD(OVO Invoice No. AW DAVIE COUNTY HEALTH DEPAIUMLNT Environmental Health Section Soil/Site Evaluation APPi,1CA�*4h"MWPf@?g85 Tax PIN/EH#: 9'iIOMMM4119FORMATION Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#26 1.;,r Reference Name: Location/Address: . Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: On-Site Well ' ty i Public Evaluation By! Auger Boring P, ,iommuni t Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH tfQ Texture groupG Consistence Structure V_ 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: P� EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: REMARKS: LEGEND Lindscage 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 Structtire 'SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prisrpatic Nlineraloev 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 DAVIE COUNTY HEALTH DEPARTMENT 6 ' Environmental Health Section SECTION-LOT Soil/Site Evaluation APPLICANT'S NAMEDATE EVALUATED PROPOSED FACILITY 7� PROPERTY SIZE SUBDIVISION �`I2lUO�°�' �I�� ROAD NAME Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit_tel Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slo % b HORIZON I DEPTH Texture groups Consistence Structure MineralogyG' HORIZON II DEPTH Texture group Consistence 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: 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 ois 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 truc ure 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(0I-90)