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176 Primrose Rd Lot 13 DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 OPERATION PERMIT Account #: 989900025 Tax PIN/EH 5789-85-4888 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot# 13 Reference Name: Location/Address: 176 Primrose Road-27006 Proposed Facility: Residence Property Size: 0.747 ATC Number: 4981 **NOTE**The issuance of this Operation Pcrmit 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. QL42 ',u O P� 3 _ -1 — System Type: S.T.Manufacturer v Tank Date Tank Size ), 66v Pump Tank Size 1 L�eV G��ate: 69 S stem Installed B : E.H.S Y Yecialist: DP 3 c-41 fWILC6, btu` 10 DCHD 11/06(Revised) r DAVIE COUNTY ENVIRONMENTAL HEALTH P.O.Box 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760 Fax#(336)751-8786 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Account #: 989900025 Tax PIN/EH M 5789-85-4888 BilledTo: Dick Anderson Construction Subdivision Info: Marchwoods Lot#13 Reference Name: Location/Address: 176 Primrose Road-27006 Proposed Facility: Residence Property Size: 0.747 ATC Number: 4981 � Site Type: Z ew ❑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 #Bathrooms2-f— People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats /( Square Footage(or Dimensions of Facility) Lot Size V ' �Qu"� Type of Water Supply: County/City ❑Well ❑Community Well o� System Specifications: Design Wastewater Flow(GPD)3 46 Tank Size (�� GAL.Pump Tank A4AL. ` r Trench Width 34r Max.Trench Depth3 Rock Depth Linear Ft. 3A7 O As stated in 15A NCAC 18A.1969(5) VV Site Modifications/Conditions/Other: accepted SyRtems may also be used ��&J- LL e- Contact the Davie County Environmental Health Section for final inspection of this system between •30—9:30a.m.on the day of installation. Telephone#(336)751-8760. X39 0o L jib a 3a7 re v -eck Cl 7 Ion Environmental Health Specialist op Date: DCHD 11/06(Revised) Davie County Environmental Health P.O.Boz 848/210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 IMPROVEMENT PERMIT Account M 989900025 Tax PIN/EH#: 5789-85-4888 Billed To: Dick Anderson Construction Subdivision Info: Marchwoods Lot# 13 Address: 225 Wing Haven Lane Location/Address: 176 Primrose Road-27006 City: Mocksville Property Size: 0.747 Reference Name: Proposed Facility: Residence **NOTE**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: RKew ❑Repair ❑Expansion Permit Valid for: 5 Years ❑No Expiration Residential Specifications: #Bedrooms #Bathrooms ), #People Basement❑ Basement plumbing❑ Non-Residential Specifications: Facility Type #People #Seats Square Footage(or Dimensions of Facility) DesigR Flow(GPD): 3&0 Type of Water Suppplyy: ounty/City aW 11 ❑Community Well As stated in 15A NCAC 18A.M(5� Site Modifications/Permit Conditions: accepted systems may also be used System Type LTAR Initia C' �r O. T Re air. Gct r ? Site Plan Ar � u GS Environmental Health Specialist Date 7 i.p.1 l-06 APPLICATION FOR SITE EVALUATIONMaROVEMENT PERMIT&ATC Davie County Environmental Health P.O.Boz 848210 Hospital Street Mocksville,NC 27028 (336)751-8760/Fax(336)751-8786 Application For. Site Evaluation/Improvement Permit Authorization To Construct(ATC) Both Type of Application ew stem Repair to Existing System Expansion/Modification of Existing System or Facility IMPORTANT"'THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. APPLICANT INFORMATION Name to be Billed ,u,C.r— A,ctjr--A s o I4 Contact Person -bst-- 44jdxt4,-., Billing Address ZVK W i u Q RA Ue,Vy T— Home Phone 331 9919 7279 City/StatelZIP t3C—Ic�S D 1 Lt!—_ ASL 2,70 Zia Business Phone Name on Permit/ATC if D�erent than Above Mailing Address City/State/Zip PROPERTY INFORMATION *Date House/Facility Corners Flagged NOTE: A survey plat or site plan must accomparry this application. Included: Site Plan Plat(to scale) (Permit is valid for 60 months with site plan,no expiration with complete plat.) Owner's Name F O Phone Number !?S&9'94'?Z7 Owner's Address 2 1 6 LIW City/State/Zipi�tOC�(Cs d ; LL&- Pe— IT Property Address 1 o City 60 dduce C 212001. Lot Size D•7917 Tax PIN# Z4 Subdivision Name(if applicable) w o Section/Lot# l _ Directions To Site: If the answer to any of the following questions is`yes",supporting documentation must be attached. Are there any existing wastewater systems on the site? Yes Does the site contain jurisdictional wetlands? Yes 4M) Are then:any easements or right-of-ways on the site? Yes M> > Is the site subject to approval by another public agency? Yes 4 Will wastewater other than domestic sewage be generated? Yes 4 s� IF RESIDENCE FILL OUT THE BOX BELOW #People #Bedrooms -- #Bathrooms oZvd;' Garden Tub/Whirlpool Yes Basement: Yes Basement Plumbing: Yes IF NON-RESIDENCE FILL OUT THE BOX BELOW Type of Facility/Business Total Square Footage of Building_#People #Sinks #Commodes #Showers #Urinals Estimated Water Usage(gallons per day) (Attach documentation of similar facility water consumption) FOODSERVICE ONLY: #Seats Type system requested onventional Accepted Innovative Altemative Other Water Supply Type: County/City Water New Well Existing Well Community Well Do you anticipate additions or expansions of the facility this system is intended to serve? Yes <2D If yes,what type? This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand that any permit(s)or ATC(s)issued hereafter are subject to suspension or revocation if the site is altered,the intended use changes,or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am responsible for the proper identification and labeling of property lines and corners and loca_ �or stakin the house/facility location,proposed well location and the location of any other amenities. Site Revisit Charge Property owner's or owner's legal representative Aghaturc Date(s): Client Notification Date: Date EHS: Sign given Yes No Account# to I l 0002,6, Revised 11/06 Invoice# 73Q S2- is 93 a Sd 200' �Gr:,�vaS �e�d Lot +3 pUL�ee 1 0« 5 l Ad dAiocp, NC - -- ------ J(� ...... ult,:n t-tlllJr}'7Vf1 --- .-- -. -- Dig- APPLICAMNI FOR SITE EYAU ATIOMf IMPROVh:,MM PERMIT&ATC Davits Coynty Heelth Deparlmgnt 1 Env%ianme+ttal Health Sedian �'�`� P.O. Boz ata/zio Hospital Strraat: Moekavil14. NC 27P3t3 ' (336)751-8760 •••xmXMTAh-J - T>.MS APDiZGrION CA10M BE PXCUSSED t=XSZ ALL 71131 R=RFD - IN>! 1VQZ CH IS FROVIIIYD. Refer to the MTFOlt P=ON BV1J== for instructions. .-/}. Name to a.sill" / �'/��'t'/OG��yiJ��t1ST_L.v�uo„tect P.C.-_Z7/cle V/- L,is ddA - e/tlallleq A10sss � 13✓�•U �AJ ,_ f >aat.. q 79 ✓city/aute/zn 1YLu�. / t'- 27028 - assises.Paoo. q,?S-7-1-7q ,,-2 tees ou Petait/ArC i!n •.rent than Above Halling Address City/Stats/tip Fri. Application For: 9sito Maltsation 13 Iaprovement Permit/ATC ❑ Both ,rt. sy.%-to 3.vvie..XIIouse M Mobile noma ❑ Business Cl Induat:ry ❑ Other ...ri- Type syvtu rev"tnd. C COC VOntlonal 0 coay.etiosal.odittad ❑ }mwetiw 1s. If R/esidtace,_//r Foople r Bedrooa:e _ 0 Bathrooms 1 IdDlaawsk.r Ma-bq.Viso*.&! Posekles Uschise ❑asee.et/PlusM q ❑sasees•t/u.plusbs" 1. it susioes■/todustry/ether: verify type i People r Stska A Cmmodas s fsewra a u:risale s Mater Coal.rs IT TOODSERYICE: 0 seetts Notim-9t9d r44Pr IIpagM (yailoa.P-r ey) .—a. Type or Tatar su"IT, L(Coua:y/City ❑ well Cl C; s. Do you anticipate addI UM&or expansions of the facility this system is intended to serve?a Yes CTf7o [tyts,trhatt __ LtfJ'0A7tNJ-'•CLiCMd Ml/STCD 11 ETt?TH6 REQUIRED PROPERTY INFORMATION REQUESTED B ElrhvaPLATerSITCPL TBES(/NUMEDb the effect with THIS APPLICAMN. tOY►operty Dimensions: aS O It 6-�WTE DIRECTIONS(from Moduvine)to PROPERTY: e/ror office PIN: a trM 7�3 AV •/L 158 M &Jt S M PZ�6 666 CrZe-G-4-:: tPrapertyAddrrwp RaadNuse_! "�/ S�JGP�+L � l Citymp�QVA,0 CE /t/,f t270.?R f In a Subdirition rovide ICformat(3n las folloM: Beeston: Block Lat:=F_Y s+ffate horuceoraetsBaggal: �2AGCl�J' FtSaC " This is to certify that the inforluatfon provided is correct to the best of my knowledre.I onderst2nd that any pcm9l(s) issued hereafter arc subject to suspension or revmt(on.If the site plans or Intended use change,or if the information submitted In this 2ppl1otl04 is r2ls{ried or Chanrtsl.1,alae.andrrtfandTharJ par rapons{blgfor a114lprres inenrrrd fro m this applicarlan. I,hereby,give consent to the Authorized Reprzsentaltve or the Davie County Health Dcp2rhntnt to cater upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site sui i t✓DATE .2-a.�-o s -96NATURE THIS AREA MAY BE USED FOR DRAWING YOUR STTE PLAN(Include all or the reliowing: Existing and proposed property lines and dimensions,structums,setbacks, and septic locations). Site Revfsit Charge Date($): Client Notifiratioa Date: Sign given Account No. l2gviscd DC[!D(05103 - Invoice No. DAVIT✓COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation APPLICAWW"'N fflW85 Tax PIN/EH#: RWIA30410011MATION Billed o: Dick Anderson Construction Subdivision Info: Marchwoods Phase 4 Lot# 16 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 1 2 3 4 5 6 7 Landscape position Slope% fv HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH •7 r 161 Texture group Consistence Structure Mineralogy HORIZON III DEPTH r , Textureroup Consistence !tr Structure Mineralogy HORIZON IV DEPTH • Texture group Consistence PW Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE SITE CLASSIFICATION: EVALUATION BY: LONG-TERM ACCEPTANCE RATE: ID' 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 CONSISTENC): Moist VFR-Very friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firth . Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VI'-Very plastic S(ructurc 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 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/&v'`'12