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158 Maple Valley Rd Lot 20 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street C� Mocksville,NC 27028 (336)753-6780/Fax#(336)753-1680 OPERATION PERMIT. Account #: 989900025 Tax PIN;EH#: G9090B0020 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#20 Reference Name: LocationiAddress: 158 Maplevalley Road-27006 Proposed Facility: Residence _ Property Size: 0.812 Ac. ATC Number: 5942 **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:_S.T.Manufacturer Tank Date Tank Size 6!© Pump Tank Size �� Bedrooms:—3 System Installed By:letU l CkJa Installer# Date: a�lZ GPS Coordinate: 1 � 1 1\5t 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 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 989900025 Tax PIN!EH#: G9090B0020 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#20 Reference Name: Location!Address: 158 Maplevalley Road-27006 Proposed Facility: Residence Property:Size: 0.812 Ac. ATC Number: 5942 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 #Bathroomsa #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Lot Size • Ll Type of Water Supply: Mounty/City ❑Well ❑Community Well System Specifications: Design Wastewater Flow(GPD)2&Tank SizeL600 GAL.Pump Tank ..,-' GAL. Trench Width.D&t I Max.Trench Depth Rock Depth Linear Ft. OV r Site Modifications/Conditions/Other: 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. 90 KZ Environmental Health Specialist Date: ilrurn i i inA(PpiAcPH) Davie County Environmental Health Qd• P.O.Box 848/210 Hospital Street Mocksville,NC 27028 ` (336)753-6780/Fax(336)753-1680. IMPROVEMENT PERMIT Account #: 989900025 Tax PIN/EH#: G9090B0020 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#20 Address: 225 Wing Haven Lane_ Location/Address: 158 Maplevalley Road-27006 City: Mocksville Property Size: 0.812 Ac. Reference Name: Proposed Fa Re idence NOICE 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: kNew ❑Repair ❑Expansion Permit Valid for: &Years ❑No Expiration Residential Specifications: #Bedrooms #Bathroom #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) Design Flow(GPD):_! Type of Watei Supply: icCounty/City ❑Well ❑Community Well Site Modifications/Permit Conditions: System Type_ LTAR Initial c Repair o Site Plan 9 �0 I J Environmental Health Specialist Date i.p.l 1-06 APPLICATION FOR SITE EVALUAnON/1WROWN ENT PBRNIIT&ATC ' Davie County Environmental Health P.O.Box 848/210 Hospital Street ' MockwMe,NC 27028 (336)753-WM1 Fax(331)753-2680 Application For. Site � mproveamt Permit it AuthorirrtimTo Construct(AT7 Both TyrofApplicatnBc ORepaic to ExMug System MigmnsionlModification ofExisting-System or faaifity •'-JWORTAN!***TMS APPLICATION GNNOTBE PROCFxSM UNLESS ALL OF TI&REQUnUM INFORMATION IS PROVIDED Refer to the INFORMATION BULLBfW for instructions. APPLICANT INFORMATION Name G ContactPersoab I L Address Horne Dhow Ci4dState,Z1P L -L Btsia=Plto Name on P==t/ATC ifDrfferem than Above Mailing Address City,'Statemp PROPERTY INFOPWATLON *Date HousdFacility Comers Flagged NOTE: A survey plat or site plan Haut accompany this application. Included:O Site Plan OPhtt(to scale) I (Permit is valid for 60 months withsite Plan;no P'l-) p 2 $o%mc's Name G r- a Phone Ntmtb[ J ot~r s Adder N City!s VQ Property Address Cityffelen/� Lot Size Tax PIN:€ 0 0q 0 60 o ZO Subdivision Name(if applicable) SectionlLot# Z d �yL DitectionsTo site` Z 6LD 40 b T'lL.S M,4#h FLAW If the aawta to troy of the following questions on must he attached: (/(IWe 01 Fi 1/414 f Arc these my existing Vammwater Systems on the sire? Yes_ / Does the site conn jt><isdictional wts�- _Yes I Are these rimy or right.of-v.%p on the site? Yes Is the simsobjea to itppit vg by another public agency? Yes Np,— Will wastewater other than domestic sewage be generated? Yes o - IF RESIDENCE FILL OUT THE BOX BELOW R People p Bedrooms #B�� 2-1 S- Garden Tub/V Whipool es CNo Basem:t l=Yes o Bas== OYes CfRo IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of FamilityMusineas Total Square Faotagc ofBnildmg 8 People €Sinks 0 Commodes #Showers 0 Urinals Estimated water Usage(gallons per day) (Attach documentation of similar facilitywater consumption) FOODSERVICEONLY.- #Seats Type my-tem rWuestrd: 7Convcriional 13A=cp1ed CLmavadve UAttrtnative- UOther Water supply Type:crE water a New well - 3Eros ft wen -Q Community Well Do you anticipate additioru or expansions of the facility this system is intended to serve?C Yes If yes,what type? This is to certify that the information provided on this application is true ad scants to the best of my knowledge. I understand that any pemtit(s)or ATC(s)issued hereafter are subjed to sospensum or revocation if the site is altered,the intended tae changes,or if the information submitted in this application is falsified or longed. I hereby grant right of entry to the Authorized Rtprcumtative of the Davie County Health Departam to conduct neeessmy ittsp2etiotm to determine compliance with applicahle laws I tmdcstand I responsible for the proper identification and tabefing of property Hues and comers and I flagg ty n location,proposed well location and the location of any other amenities. ' Property owner's or erar legal representative sigoanae Site Revisit(ltaree � Datds): i z Clie ntNotificationDate: pat IAS: Sign given CYes ONo Account€ Revised t t/OG Entree 3 6 ap �a��a n � w �v ADM N6 �29JO& a rcu co�Ua�vs ; -r�r _. _. uL\ir, rnuwr :5or1 --� �. +1aQ Q-Pa rGr•7 ''" ♦ APPLCA 130lY FOR SITE EYALVATION/MPROVUL if PERMIT X ATC Davie Coltnty Health Department i /�� En vlmnmental meal&sec on (i P.O. Box 1148/210 Hospital Street 1M.ock1vi33o, NC 2793$ . (3363751-0760 ••eXZVORSANS— THIS APPI.ICATI02I CA55M 8E FROCSSSED.Ma=S ALL 7= 8RQ=R3W nw03 tATI01T 13 YY.OVM=. Refer to the IWORNA710N BGLL=11 for instructio yn �s. ✓1. Wee. to be sill". /GC��l/D mod 64)S 7'-�y✓GLe nc.cc r.r.on i�t[C/L h`N,Ot�iC.8 dA) ✓jM1.11,g address es—dCrr��✓��.lJ �� (off.fb . q7;J--)5'79 ✓---CLtT/etet./za /Ylrx•;rrStl/tt.E• Alt'� i270J$ ✓oats.■-Pone q,?S-7.P,7q r. 1"—oo r.ceio/rrC 3r o rvrt than Above k.Llt.V eddrua city/scacs/alp ,—i. Application For: x3ite M—luation O IaProvement Dermit/ASC O Both ,rt. By■t—to Be.+Ls.,yvause O Mobile 4om6 13 Business Cl Iaduetry O outer -ri. Iyp.syeten requostmd, a Corr-ontlooal 0 eom•astional modified 0 ieno-atlw --s. IIf Xosideacer /r People r Bedroom B Bathroom --�' raDl,iweMr ma—U"*Movemal gveshLog keeWe ❑ia.are!/llueblmq. Osu.r.th4 Flumblmq !. It Buat.ese/Lduetry/Other: v.rLfV typo a People B stake I Cooeod.s a X.1 a ra a aYisala a Vater Cooler& IP TOODSERVICa: 9 Sesta lmtim9trd Nater 4pagv (eeilmoa par day) --I. Type of.retar supply, LYCotmty/CTLs O well El Cc=-,-,ty s. m you amttctpate eddLtlodm or expansions of the facility this system is intended to serve?C3 Yes crfio If y wh211 1MPOBTAtY7" LW>irCiblUS?f0 1GE78THBREQU/RED PROPERTY INFORMATION REQUESTED e EI[hcra P[AT er SITE PL rYT BESf/B6r/77£I7 b the slims x115 THIS APPLICAMN. LOYrOpCrly DimensfOns: .S�s 6?{?FJT rtrrEDIRrcrioNS it..Mocksvlik)to PROPERTY: ( a—Tax office PIN: p 158 iro &JI S • iv P,!FeyCas Ca,&�-� jPr9perl7 Ad4n,-p Road Name ,-h20P4-aS �C�/�E le-o City�P �lL� ,��Z70.$ finiSubdivlslon rovfdefnformatL3n,asfollows: Name. dJ4RC!/w4j24as• AWS0E 4 Section: Block TAr: '! &41ite home corners Tagged: !!e2ggtgZ le A• This is to certify that the iarortuatIon provided Is correct to the best army knowkdre. I Bnderstand tient say perni t(s) Lssued hereafter are subject to suspension or revocation,if the site plans or intended use change,or if the inrorntation submttttd to this applletfon is faltireed or dlaagnl 1,ilio.,r>,{p rrpnd rices J pnr resf,onsr�lsjoralrtl arra lncnrrrd jro n Osis applicadan. f,hereby,give cameos to the Authorized Representottve or the Davie County Hcith Dcpartrntnl (a enter Upon abore described propert_•looted in Davie County and owned by to conduct all testing proudures as sec awry to determiere the site st I DATE .2-a.3- o S 9CGNATUREf THIS AREA MAYBE USED FOR Dn,tWrNG YOUR STIR PLAN(Include all of the fallowing: Fxisting and proposed property lines and dbneosions,structures.setbadts, and septic locations). Site Rrvtsft Ciarge Date(s): Client Notification Date• i?dtS: c Sign give nAccount No. ftcviud DCHD(05!03 Invoice No. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPI,ICA)qMt(jRrQR 85 Tax PIN/EH#: 5isiW-L,-QQ3AjWORMATION Billed To:' Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot#23 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 I 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 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 foist 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 VI'-Very plastic Structure SC-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prisgiatic Mineralogy 1:1,2:1,Mixed Notes Horizon depth-In inches r 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 - Environmental Health Section SECTION-_ 7L LO Soil/Site Evaluation APPLICANT'S NAME z4n7 1 '7 "rO DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE SUBDIVISION ROAD NAME Water Supply: On-Site Well Community, / Public Evaluation By: Auger Boring Pit !/ Cut FACTORS M12 3 4 5 6 7 Landscape position Slope%HORIZON I DEPTHTexture rou ConsistenceStructureMineralo HORIZON II DEPTH Texture group Consistence Structure S Mineralogy HORIZON III DEPTH f t r Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION U LONG-TERM ACCEPTANCE RATE r SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: / REMARKS: �� %L i Y �.J� IZV e LEGEND �d a 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 VF1-Very firm EFI-Extremely firm Wet r 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) _