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157 Primrose Rd Lot 5 r . • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 990002285 Tax PIN/EH M 5789-97-0344.05 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#05 Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: see map ATC Number: 4522 i 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: - v - 6)4 CERTIFICATE OF COMPLETION 5 "f Tao / � oe; **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 taken as a guarantee that the system will function satisfactoril r y given period of time. yn Q r �rS� /i'n-� Li 46 0--e o"rt -e P� (�ou5•e 1 -t vAdS h-Pa✓' To- k•1 £+ Cq y < i V b-t , Septic System Installed By: is AA*C 4- G`� Environmental Health Specialist's Signature: Date: Z?/— —a 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#: 5789-97-0344.05 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#05 Reference Name: Location/Address: Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: see map ATC Number: 4522 **NOTE**This Improvement/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 77 #People #Bedrooms #Baths Dishwasher: d Garbage Disposal:0" Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Ce Design Wastewater Flow(GPD) v' d Site: New 0'` Repair❑ System Specifications: Tank Size A00 GAL. Pump Tank GAL. Trench Width S1, Rock Depth IV Linear Ft.3SU Other: As stated in 15A NCAC 18A.1989(5) Required Site Modifications/Conditions: Accepted Systems may also be used 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 3 a.m.to :30 a.m.or 1:00 p.m.to 1:30 p.m.on the day of installation. Telephone#is(336)751-8760.**** faO4 Lt� �e tC Floe j Environmental Health Specialist's Signature: ! Date: DCHD 05/99(Revised) lob 0�'aV I e:t✓ C-.0 ki sis : -To(- -----uiwn nlltilar ::iQ I acv .77a rcr� (�, 1 APPLICA(MV FOR SITE EYAt UATION/tMPROVEME1ff PEILHIT 14 ATC 'Davis County Health Department Envlranmenlal Health Sedrarr P.O. Box tt48/210 Hospital street Mog40-i314. NC 27020 (336)751-8760 rwwZWORTAU7 ww T=S APYLSCATION CAIN=BE kROCSSSED MV.XSS ALL TRS RMUIRIO INr0R2tAT2ON IS YRDV==. Refer to the XNFOMMTION BVIJZTSN for inetsuctions. r .. ✓1. Waste, to be allied / R'�2&a'Lin&Z)6,0-ST_Lt/[,`eoi,t.rt r.c.o,. ! 14fle dA) ✓krtltn9 Andress /-At .tfo,�e rGon. ��CZ"-257!� , a/cstT/at.te/za /Y16c4s✓/cLE- i{/(' ;t703g �6 s,.aibes.PAoo. 9Q�-7a.7q I,-2. ter N VoxedC/ArC Sr D .rent tAm Above M.111nq address C1 /Scats/i11{ rI. ApplIcation Yort Sita Ev luation Ixprovtmfeat 6Lm1 / C 0 aotb ,—i. 3ystwa to Har+low, House 0 Mobile Name (3 Business a Induatry 0 Other ---4. Type erste requested. a eotrentiooal M eoaweatiosal eodieted Sanovative --a. IIf Xvitidences 1 Poople 1 Hedrocum _ 1 Bathrooms -i' {dDl,lws6.r t5a.rbye Movooal oksolting Maeltiae ❑sao—t/►2uebis9 ❑weret/.N pioebiwq 1. It Ousioasa/Industry/other: "city typo t People 1 SLAka 1 Cor4od.s 1 r:loeers t url"Is a Mater Coolwrs IP FOODSERYICS: 0�Soatts lytimgeg� Maur; Vgag� t9�11oe�prr LI-Y)--t. Type of water mpply, Q'Coua"-y/City Cl 91411 0 C^---•••+qty 9. m you anticipate additions or expansians of the facility this system is intetdod to serve?0 Yes afic .r Ifyes,tvhatt_. ____ IMPORTANT"'CLIEIwTa MUSTCO lGL'fE THE REQUIRED PROPERTY INFORMATION REQUESTED 0E. Etthtra PLAT ar - PL TBESUBM)7TED b the ellmc with THIS APPLICATION. tfYroperiyDimensioas g ej%-'NRITEDIRECTIONS(fromModuvttle)toPROPERiY; ��roperlypddressp RoadNalae �jCf2�� City�p �Z� AJ e7 f in i Subdividan ravlde Informallm,ns fallosrs: Name: r7/456 4 Section: Block: Let: .5 C-Uite homcCOMM I12gged: rzAe�_L�t;�ezhbt ea This is to certify that the lnfortmtlon provided is correct to the best of my knowkdgc.I understand that any permN(s) issued hereafter aro subject to suspension or revocation.If the site plans or intended use change,or if the laternution snbmltted In this application is fahilied archangetL I,1/sr. incurred from r/tis application. I,hereby,give cement to the Authorized Representsidye of the Davie County Health Dcpartintat to enter upon above described propert;•located is Davie County and owned by to conduct all testing procedures as accessary to determine the site sui i DATE �G�.�i-O S -96NATURE THIS AREA MAYBE USED FOR DRAWING YOtM STIM PLAN(Include all of the following: Existing and proposed property lines and dimeesiotts,strudutcs,setb2" and septic locations). Site Revisit Crarge Date(s): Client Notification Date: EAS: Q 7` sign given_ Account No. V 0002 t Revised DCHD(05101 Invoice No. PEP 1� AI Voi<�e% 1 � t DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLIC"I IT iN RN4T1O�5 Tax PIN/EH#: 5789-97-0344.05 PRTYFORMATION Ir.Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#05 Reference Name: location/Address: Peoples Creek Rd.-27006 Proposed Facility: Residence Property Size: see map Date Evaluated: '— Water Supply: On-Site Well Community Public f Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position M SIORC% HORIZON I DEPTH Texture groupSLtr Consistence yr SS Structure Mineralogy HORIZON 11 DEPTH ^1l0 2 Texture group 0 Consistence Lf5 Structure L L Mineralogy `7 e. HORIZON III DEPTH Vp^3 2q ` Texture grou �-t �;C . Consistence G-SS P SSIP Structure Mineralogy HORIZON IV DEPTH �^ Texture group L Consistence ,JS Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATE 01715 �L SITE CLASSIFICATION: EVALUATION BY: � -�- �_"��-I'1'e LONG-TERM ACCEPTANCE RATE:— U• OTHER(S)PRESENT: REMARKS: At I QV4QrZ,- V ''q3 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 ex 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 Moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm 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 Mineraloev 1:1,2:1,Mixed 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