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172 March Ferry Rd Lot 46 DAVIE COUNTY HEALTH DEPARTMENT )0 A- ' Environmental Health Section O • - ti P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 989900025 Tax PIN/EH#: 5789-76-5851.46 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#46 Reference Name: Dick Anderson Location/Address: Peoples Creek Road-27028 Proposed Facility: Residence Property Size: 1 Acre ** *V ffbgr. 2886 N is mprovement/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 Jy #People #Bedrooms #Baths Dishwasher:o,ff-�Garbage Disposal: Washing Machine Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type #People #People/Shift #Seats Industrial Waste: ❑ Lot Size Type Water Supply Design Wastewater Flow(GPD)� Site: NewX Repair❑ System Specifications: Tank Size."GAL. Pump Tank GAL. Trench Width '/"' Rock Depth 1Z Linear Ft Other: 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.o f installation. Telephone#is(336)751-8760.**** Environmental.Health Specialist's Signature: Date: DCHD 05/99(Revised) • DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P.O.Boa 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Account #: 989900025 Tax PIN/EH#: 5789-76-5851.46 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#46 Reference Name: Dick Anderson Location/Address: Peoples Creek Road-27028 Proposed Facility: Residence Property Size: 1 Acre ATC Number: 2886 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: 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. 71-,24 �to evi:'-Juy 0J O �� TR�'Se 2 t_►�1cS . uo &124 FSA T Septic System Installed By: �!J 1 l; LAY-0-1 Environmental Health Specialist's Signatur Date: DCHD 05/99(Revised) APPLICATION FOR SPIE EVAWATION/IMPROVEMENT PERMIT do ATC O Davie County Health Department D _ Envitnnmental Hera/th Sectfon • P.O. Box 848/210 Hospital street DEC 71999 Mockavilie, NC 27028 (336)751-8760 ***I!lpO vm"** THIS APPLICATION C71IRM BN PRt7t2I MM UNLESS ALL TAB REQUIRED I1MRIMION IS PROVIDED. Refer to the M rORM1►TICH BULLETIN for :Instructions. 1. ltar to be clued �1C// A/dflZbtA'A1,CI�I�S�" contact "coca Moiling Address A A!5 W eA)e.A)A✓ESU L-N mme 419A— 7 57 9 city/state/sra �'1?ocresvi reeves. Al.. C. a 7o AS suse.aase :hone _ 999-- 7A7;e g. masse on Qerait/sac is Di!lerent.than above Mailing address City/stats/nip 3. Application ror: Site Eva cation 0 Improvement Permit/ATC 0 Both s. system to services t(House O Mobile Home 0 Business 0 Industry 0 Other S. If Residence: # People # Bedrooms M01- ! 3 s Bathrooms Dishrasber 1/Oasba" Disposal }Trashing Machina D Us em en t/pinmbiag 0 sasementAto Itlismbing 6. tt ausiness/iMuatcy/Otbac3 apecity tnel (f ftople 6 sinks I commodes f showers I Urinals i water Coolers It I=SERVICS: # Seats Estimated Nater Usage tsauons per dar) 7. Type of grater supply: (county/City 0 Ne11 0 community s. Do you anticipate additions or expansions of the facility this system Is intended to serve? O Yes �No If yes,what type? ***IMPORTANT***CMENTS MUTTCOMPIETETHE REQUIRED PROPERTY INFORMATION REQUESTED BELOW. Either a PLAT or SITE PLAN MUSTBESUBMIITED by the client with Tills APPWCATION. Property Dimensions: AA*—XQQ t A 1_A--X Q WRITE D`I : LREMONS(from Mock"le)to PROPERTY Tax Office PIN: 0 r�7 �2 —7 ".�� 1 l`� M 70 Ta 9-0170 Ar,,SA!4$ Property Address: Road Name ( '1Qeel-e el-1 M)Zas 4a City/Zip // YAt j was=3 If in a Subdivision provide Information,as follows: M410 G q Name: M11lL04 W O&Qs e--gaU L/ qg Sections Blocks Lots ��.f¢._ Date Property Finned: This Is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(:) Issued hereafter are subject to suspension or revocation,If the site plans or Intended use change,or if the information submitted In thin application Is falsified or changed 1,also,understand that I ane responsiblejor all charges lncumed from this applicatlos. I,hereby,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 toting procedures as necessary to determine the site sultab �Q DATE 19 9 SIGNATURE /J . THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN(Include sit of the followings Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Client Notification Date: ERS: Account No. Revised DCHD(07/99) Invoice No. ' N 1 140' o N 4Z� �. I `43 1 1 44 N 4 125• o� 4-7 /y7 120' 100' �fI�1� 12s' h'Oq/) ,o ' a 1zo, ?•Z 100' w 51JCDo /pyL 5D' Oo' i+ 0 v � N �j4 DAVIE COUNTY HEALTH DEPARTMENT '. .' Environmental Health Section Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 989900025 Tax PIN/EH#: 5789-76-5851.46 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot#46 Reference Name: Dick Anderson Location/Address: Peoples Creek Road- 7028 Proposed Facility: Residence Property Size: 1 Acre Date Evaluated: 2 I i Oc7 Water Supply: On-Site Well Community Public Evaluation By: Auger Boring Pit Cut FACTORS 1 2 3 4 5 6 7 Landscape position L Sloe% HORIZON I DEPTH _-7 - Texture group GL Consistence SP r55 Structure G2 CT Mineralogy I: ; HORIZON II DEPTH -7-20 - Texture groupC Consistence ; Structure Mineralogy HORIZON III DEPTH W•L41D I -32 Texturerou R Consistence 1 55 F1 Structure Mineralogy HORIZON IV DEPTH �- Texture group Consistence 1pr Nis W. Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE S CLASSIFICATION PS LONG-TERM ACCEPTANCE RATE 0.3 \ SITE CLASSIFICATION: 5 EVALUATION BY: �J -F r� LONG-TERM ACCEPTANCE RATE: U-� Q�� OTHER(S)PRESENT: ��bc , J 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 ois . 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 05/99(Revised)