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156 Maple Valley Rd Lot 21 -,• DAVIE COUNTY ENVIRONMENTAL HEALTH • P.O.Box 848/210 Hospital Street Mocksville,NC 27028 . (336)751-8760 Fax#(336)751-8786 - OPERATION PERMIT Account #: 990002285 Tax PIN/EH#: 5789-97-0344.21 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#21 Reference Name: Location/Address: 156 Maplevalley Road-27006 Proposed Facility: Residence Property Size: see map ATC Number: 4588 **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. , System Type: Q`1 S.T.Manufacturer 5 hW—P Tank Date Tank Size 0 6 O Pump Tank Size /- System Installed By: $a-ckkcy_E.H. Specialist: Date: — d 1 C- 1 C- ( 7 Gh h �4 , I i C-L a c DCHD 11/06(Revised) •• DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Me ` Mocksville,NC 27028 5�Zq'1? (336)751-8760 Fax#(336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 990002285 Tax PIN/EH#: 5789-97-0344.21 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#21 Reference Name: Location/Address: 156 Maplevalley Road-27006 Proposed Facility: Residence Property Size: see map ATC Number: 4588 Site Type: ❑New ❑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 #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size Type of Water Supply: bounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD).3 Tank Size GAL.Pump Tank GAL. , Trench Width 3 Max.Trench Depth # Rock Depth Linear Ft. 3 Gd �ZF or Cltc.�✓�'t.— Site Modifications/Conditions/Other: `►`Si, Krcl��. . Contact the Davie County Environmental Health Section for final inspection of this system between 8:30—9:3 a.m.on the day of installation. Telephone#(336)751-8760. -7— 077 icy /^ '(p �-e Pay 00 `l5 l�gc(Lc(yw, Cti'orCz Ir- Oec. 1 Environmentalcia 'st Date: W. DCHD 11/06(Revised) eJ�U,7�Vl��J(-' ....---ul�.rti car;t:i�r;rOn --- •-- -. -- JJ0 -'J Z?0 rGle7 f�tt//� fes, L APPUMION FOR SITE EYAU ATION/t31PROVEMM PEILNIT&ATO :Davie C._ Health Department Environmental ma iffi Sedlon P.O. Box tl4tl/210 Hospital Stroat }focJcav:334. PC 27930 ' (336)751-8760 •••XMPpRTAyT••• TRIS APPLICATION CAR r BE PSOCSSSM 02U=S ALL = R=R8D ZNF01W&T CN ZS Yxov==. Refer to the ZNrO&P=QN EALLZTIN for instsuctio�nn. ✓l. u.se to be 3111.d �( �Nad5&d COVS7-LVA'(-eoau.cc e/jtallln9 Asar... WMjs-,jnl zy LA/ ✓city/at-te/za p-�4/IC al �?OJ$ �osia.a. rmo. �tQe�-7.27q r�x. ?&r ou a.ivLt/ATC!f O r rt than Above sr.11taq aedros city/Peace/alp �fl. application For: Ksito rVALIUAtion ixpravomeat C 0 Both --i. ay.t-to s.t-Le.. Fd Vose 13 Mobile naw. 0 ausinese CI Znauatry 0 other Type eyetew request6dli. ❑ Goa-entlooal (9 eoevestiosal-*dieted tsoovatiw mss. If/kkeesideaaes� I People I Bedrocaw a Bathms roo i' Val,iw.Mc li'a/.rDye Move-alWeeks")aaWe 01uewt/r2..bt q �eueretJtN pl.rbiwq . 7. It business/Industry/dthers verify type I people I SLAG a cmwod.s a roofers a urinal• a Water Crwlers Ir ro0DSERVZC3: 0 goat• =atimgtgd.Natg; Vgagq (q.11nna p.r dry) Typo of nater supply$ I'County/City - O well O Co®unity S. m you anticlpete addltIms or expansions or the facility this system is intended to serve?i]Yes O'4o If yes,trbatI LNIOR)•Am—CLtrtrr i 7r'm&3rt'D rixrE THt REQUIRED PROPERTY INFORMATION REQUESTED 6E EtthtraPLAT erSRCPL TBESf/BMl7TEDb tbed[mt tvlthTHIS APPLiGAT10N. L---Property Dimensions: S 2M pFJl"9FRITE DIRECTIONS ttroin mods-du)to PROPERTY: e-I•ax of[iee I'P.Y: a J763CAV -24 158 tTzi ffv s i'U tPropgrlyy3ddmn ReadNuse !fir-OPC-aS 0egEleel& cityrzip 4V VA,v C6 A/C Z27a.Zr f to a Subdlplttpn rovlde lnformattan,as follows: Name: /M /LCJ1 l[lpn!C i/45rp4.�.js. Seaton: BlockI er. 1 \ ate home eomrrs titggrd: j'l AGG2$� FQ� This is to Certify that the Infor=fJon provided Is correctbest army knowledge.I undersand that any perntit(s) issued hereafter arc subject to suspension or revocation,If the slit plans or intended use change,or if the information aubmtttMlofh)sappilotloaisfaisifiedore)tasgnL j.rtlao,rndersrpndtha�jp)prapanstlsjoralleGprretncnrredjrom Otis applicadon. I,hereby,give consent to the Authorized Representative of the D3viC County Health Dcpartmtnl to enter upon above described property located in Davie County and otvued by to conduct all testing procedures as acccasary to determine the site sul vDATE 'eR.75-O s -'SIGNATUREC�-g ait-1 1 THIS AREA MAY BE WED FOR DRAWING YOUR SSE PLAN(Include a8 of the Mowing: Existin:and proposed property lines and dimensions,structunr,setbacks,and septic locations). Site Revisit Crar:e Date(s): Client Notification Date- EHS: Sign givenAccount No. Revised DCHD(05103 Invoice No. 41le • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation AI'PI,JCAftTdY fM. 85 Tax PIN/EH#: ,#R§1"f,1A $1PW4ORMAT1ON t., Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#..2<a j Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: a —7 d Water Supply: On-Site Well Community I Public. r� Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% HORIZON I DEPTH Texture groupG 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 Ff,7,7,7ZIT LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: �CAo LONG-TERM ACCEPTANCE RATE: d OTHER(S)PRESENT:. Ar,1 •CdS a v 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-Prisrpatic 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(suitablc),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(suitablc),PS(provisionally suitable),U(unsuitable) LTAR-Long-term acceptance rate-gal/day/ft2 DAVIE COUNTY HEALTH DEPARTMENT' ` Environmental Health Section SECTION LoTe�ka j Soil/Site Evaluation APPLICANT'S NAME `Jl1fSf�yt DATE EVALUATED PROPOSED FACILITY _ v PROPERTY SIZE SUBDIVISION 1'/4f I ,12*d ROAD NAME Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position Slope% o HORIZON I DEPTH a2ir Texture group 1<C Consistence r- �7-- Structure Mineralogy HORIZON II DEPTH Texture group Consistence Structure 5 e Mineralogy HORIZON III DEPTH L f Qf Texture group Consistence - Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE , Ci , 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 oist 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) Dick Anderson 336 998 7279 p. 1 4".4,674 W006.y 9 . ,.g L s� �S e� •' j.