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164 March Ferry Rd Lot 47 DAVIE COUNTY HEALTH DEPARTMENT /P,, Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT 989900025 5789-76-5851.47 Dick Anderson Construction Marchwoods Lot#47 Dick Anderson Peoples Creek Road-27028 �:opo��.i Facility: Residence F:opett,, Size. 1 Acre .T'- lllu l or• 3122 **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 #People #B / edrooms � #Baths_-_?,_ Dishwasher:Z' Garbage Disposal: ❑ Washing Machine: Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seeats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow(GPD) <V b Site: New;30000' Repair❑ System Specifications: Tank Size/ DlD GAL. Pump Tank GAL. Trench Width&&/ Rock Depth Linear FtLSOd Other: Required Site Modifications/Conditions: IMPROVEMENT/OPERATION PERMIT LAYOUT- APPROVED EFFLUENT FILTER RISER(S)IF 6 11 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.**** r Environmental Health Specialist's Signature- Date: l'��%/ol- ✓ DCHD 05/99(Revised) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Bog 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900025 `fax PIN/EH#: 5789-76-5851.47 Billed To: Dick Anderson Construction Subdivision info: Marchwoods Lot#47 Reference Narne. Dick Anderson Lucaiiun!Address. Peoples Creek Road-27028 Proposed FaciKy: Residence Properiy Size: 1 Acre ATC Number: 3122 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 WASTEWATE ON TRUCTI IS VALID FO PERIOD OF FIVE YEARS. Environmental Health Specialist's Signature: yf/ .Date: 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 taken as a guarantee that the system will function satisfactorily for any given period of time. r-- (00' Lei t �c Tr o V,- -70'x 3u 1,Czy " 5 ` F T t4-Is Septic System Installed By: 1 N ti Environmental Health Specialist's Signature- ate: 2-30 3 DCHD 05/99(Revised) • APPUCATiON FOR SITE EVALUATION/IMPROVEMENT PEAMR do ATC Davie County Health Department D Envftonmental Nmfth Swdon P.O. Bos 848/210 Hospital Street DEC 71999 Mackaviile, HC 27028 (336)751-8760 ***nWCRZUM** THIS APPLICATIOH QIIQ W BE PROMfiZZ) UlI 388 ALL THE REQUIRED INTORMI1TION 18 Pj�ROVIDZD. Refer to the INTOItMUXON BUI.LIrTXH for instructions. 1. Name to be billed AC11 "606 2&60.6^_*J ST contacter pson l/•1/C/G AAfV"6QA) wiling Address a A S c idlA)0AAV&g Liv , Noes phone WA- 7 57 9 city/stat./asp 1 MMC e_&y1 t.t.e Al. C. ;7oAk ansinese phone 9Z�'• 7•Z 7 37 4" a. wase on permit/&= it Different.than above wiling address city/state/alp y. Applioation for: )<8ite Zvaluation 11 Improvement Permit/ATC O Both e. system to services *ouae O Mobile Home O Business O Industry 0 Other 5. If Residence: # People # Bedrooms fA 3 # Bathrooms Dishwasher )� rb oaage )(washing)p washing Machine o sas� Wn nt/plunbing 0 Iantma, plumbing 6. sf Business/sndustey/Otherr spenify `type` # people # sinks # commodes # showers # Oriasls # water coolers It TOODSEMCiR: # Seats latimated hater Usage (saucus par day) 7. Type of .rater supply: (County/city 0 Well 0 community e. Do you anticipate additions or expausions of the facility this system Is Intended to serve? 0 Yes �No If yes,what type? ***IMPORTANT***CLIENTS MUST COMPLMETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN ARW BESUBMITIBD by the sliest with THIS APPLICATION. Property Dimensions: AAn9w>A AI-AA 4WRITE DIRECTIONS(from Moelaville)to PROPERTY: Tax Office PIN: # S !7 I -7 6-S� �1 r�7) 0 70 TU S�O l Q'O ArwA� � Property Address: Road Name ( 'i E/C - LEFT• (2 /YIl 14 TP City/Zip /Y Atm)J W&yin 3 If in a Subdivision provide information,as follows: ln4►0 G9 Name: IMAR-04 U)obOS e•4�_,e Sections Btodu Lott Date Property Flagged: This Is to certify that the Information provided Is correct to the but of my knowledge. I understand that any permit(s) Issued hereafter are subject to suspension or revocation,If the site plans or intended use change,or if the information submitted in this application Is falsified or changed 1,also,uudeaw d that I an responsible for all charges Incurred from this appUcadom I,bereby,give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site sultswix. �Q f DATE I.2 -) " 9 9 SIGNATURE6eJ/.J .[.� THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): 1 Client Notification Date: t ERS: Account No. Revised DCHD(07/99) Invoice NO. o�oZr . � N � c_ 76 ka, 140' 7 ir� 1 ' ZD' 13o' i ab a ( 44 N 1 k43 1 zs 0 4,-7 r Io' 12p• ,J D t � 1 O J`b I Z D' X ,i %Do' J J � 8 � N v1 $ t4 II � 110 i2O' I�0 15D' X 05 1� I i DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account M 989900025 Tax PIN/EH#: 5789-76-5851.47 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#47 Reference Name: Dick Anderson Location/Address: Peoples Creek Road-27028 Proposed Facility: Residence Property Size: 1 Acre Date Evaluated: Z I (DO Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscapeposition L Slope% 7:2o HORIZON I DEPTH o --7 -7 Texture group L Consistence g Structure Mineralogy HORIZON II DEPTH —7-2a —7-14 Texture group Consistence Structure 6k lc Mineralogy HORIZON III DEPTH Zc>- 1 L4-2$ Texture group } Ck Consistence S P Structure Mineralogy HORIZON IV DEPTH - Z Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION S LONG-TERM ACCEPTANCE RATnE 0.Lj SITE CLASSIFICATION: i' S EVALUATION BY: `% LONG-TERM ACCEPTANCE RATE: OTHER(S)PRESENT: NT REMARKS: tV- t p,3 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 r 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 05/99(Revised)