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141 Primrose Rd Lot 3 DAME COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990002285 Tax PIN/EH#: 5789-97-0344.03 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#03 Reference Name: Location/Address: Peoples Creek Rd.-27006 ATC Number: 4323 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 ON/ST UCTION IS VALID FOR A PERIOD OF FIVE ARS. Environmental Health Specialist's Signature: �< Date:MM M 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 inNOW Y n as a guarantee that the system will function satisfactorily for any given period of time. i 8 T '17' 1 V t4 GTD CAJAVbZZ Septic System Installed By: Environmental Health Specialist's Signature: %` Date: v DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street �I Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990002285 Tax PIN/EH#: 5789-97-0344.03 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#03 Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: see map **NOTEg* lmprovemen %Th st/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;,2r, Washing Machine Basement w/Plumbing: 0 Basement/No Plumbing: 13 Commercial Specification: Facility Type #People #People/Shift q#Seats Industrial Waste: Lot Size d Type Water Supply G Design Wastewater Flow(GPD) cS 0 Site: NewZRepair 11 System Specifications: Tank Size,`86DGAL. Pump Tank GAL. Trench Width`'Rock Depth-/—Ye Linear Ft, Other: As stated in 15A NCAC 18A.19690 - n d System ma. glen be us Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER. RISER(S) 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.**** V V AAC J !H Environmental Health Specialist's Signature: Date: P � DCHD 05/99(Revised) V Ct./ G.J�VJ�4L -r (•' ......_w r, rel iw-tr VfI ___ -- _. -_ JJ9 +7.70 fG (i7 (•+. J. .' APPLICa1110N FOR SITE EYAl1)ATIOU/IMPROkENE'Ji PEitNIT 4 ATC � O 'Dav(e Coynty Health Department /►� En v!/onmenbl Me 211 SeC60M n ALU P.O. Box 848/210 Hospital street Moghg-il14. 14C 2703$ ' (336)751-9760 e•�I2fF(=AN7•ev YSZZs APPLXCATIOM CXMMr BE PROCESSED UM=S ALL 77tH V==R= IN XKLT=N ZS VXDV D. Refer to the xNzvmP oN 7tOSdmix for instructions. ✓3. Vw ss be allied_ / .�i')`�t//Zt��j/�w/JS T-�'.�C.(�eooe.ee s.c.u,. L�/C/G�N��'-$d^� ./i+•Aaaay 4-IJ_! S--w.,nano C/g;r--25'7q '✓city/atatalsa /yJAf•�-s✓Id—e- i!/.(' ;L70 2.00 ✓aastaesa Pliant FITS 7P-79 a�a. Mer ee tog-lc/ArC J_f_=ftroat tam Above aetlt.g addreea c:1ty/atete/a1p �-7. Application For: Ksito Evaluation a uprov®ea}t 3?erm4t/7lTC O Botb ,—t. 9y.%—to 9.eetser)(Rouse ❑ Mobil. Rome ❑ nuttiness Q Industry ❑ Other —4- Type eyrtr.requested. M Coo•ontaonal D eon•.stioaal.edified t] smwstaw .—c. If 3tosidenee+�/r People r Hedrocum Y Bathrooms 2 1 idDLtu.eelwr LTwrby.G1sPeral e.1Ly MsaWo �luawt/tl.v�isg O.a.eerethh alu.bawq 7. if auetoes■/tdd.:stcr/Other: verify type a People a St+.ko . 1 Cdemddes a wooers a Orauls a Vater Cooler. IP F'000S1mncts: V Beate latim9ted Nater VpjL" 49%149L,!,Pyr dgy) -tea. Typ.of,rater supply, Q�`Couaty/City O hell J3 C—M4 ty s. m you anticipate addittoAa or expansions of the raclity,this system is intendod to strut?❑Ycr cro Ilycs,erhalt " —_-- LtfIORTitMe CLIYlrtiMUSTfO ILETETHEREQUIRED PROPERTY INFORMATION REQUESTED nE EtthvaPLIMMED by theelteat with THIS APPLICATION. L--yropertyDimerwons:_!1:3 . ceeQ;- it TEDIREcnorts(fromMocksvUk)toPROPERIY: e-�fax Office PN: s nq 158 M ,0l s 7D P,5-6 S C . rlyfldd"ya: JtoadNama t �P�s�tC /Zo Cityrzip 40 VP f in a Subdivision rovfde laformatfan,as follows: Sectton: Block: lot:�3— t-!late home carners Bagged: TiGis is to certify that the Info tmI102 provided is correct to the best army knowledge.I understand that any perotit(s) Issued hereafter are subject to suspension or revocation.If the site plans or intended use change,or if the latorntation submitted is this nppNotion is ralsifird or chsuetiL i.clap.tmdtrsrQnd that j Rn(r albnst�lsfor all cLnrpea inarrrcd jron Oris appmeadem I,hereby,give cement to the Authorized Representative or the Davie County Health Department to eater upon above described property located is Davie County and owned by to conduct all testing procedures as accessary to determine She site cul , t_--DATE e.?-eZ.'i- 0 5 "SIGNATURE x5/-9- THIS AREA MAY BE USED FOR DItAWMG YOUR SITE PLAT!(Include all of the folfowing: Eslstfrtg and proposed property Sties and dlmeaslons,sfructu:cs,setbacks, and septic locations). Site Revisit Charge Date(s): Client NoUficat(on Date:— sign given ate:signgivenAccount No. Revised DCHD("3 Invoice No. - DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFQRMATION PROPERTY INFORMATION U1 IL ff. ZZ85 Tax PIN/EH#: 5789-97-0344.03 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#03 Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape 2osition L C Sloe% 5 HORIZON I DEPTH Texture groupG G� Consistence P, SV FIA IsM Structure 8 Mineralogy HORIZON II DEPTH -25 Texture group Consistence - F, S Structure 5$ Mineralogy HORIZON III DEPTH 66 Texture group C • S4 Consistence rgS 5 Structure 594 Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE ,'3k5 I SITE CLASSIFICATION:_ EVALUATION BY: . l71Er- �A�P 2/ LONG-TERM ACCEPTANCE RATE: +0- 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 tructurc SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prisrpatic 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 with chroma 2 or less Classification-S(suitable),PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate-gal/day/ft2 I -- i • .n • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 �,rA (T!� (336)751-8760 Account #: 990002285 Tax PIN/EH#: 5789-97-0344.03 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#03 Reference Name: Location/Address: Peoples Creek Rd.-27006 j ATC Number: 4323 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 ON/S UCTION IS VALID FOR A PERIOD OF FIVE ARS. Environmental Health Specialist's Signature: `' Date:�L 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 tako as a guarantee that the system will function satisfactorily for any given period of time. i t �S X117' 14 STD C4hvbzZ _ 1 Septic System Installed By: Environmental Health Specialist's Signature: Date: *61M D� DCHD 05/99(Revised)